bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics, treatment and clinical outcomes of leiomyosarcoma: A retrospective study from single center.
Authors: Liu Yang , Wang Xiao-Wen , Ji Hong-Chen , Yang Jing-Yue , Chen Yan , Wang Zhen , Zhang Hong-Mei
Published: June 2022

e23536

Background: Leiomyosarcomas are genetically heterogeneous tumors with highly variable survival. The clinical efficacy of different treatments has not been determined. This retrospective study analyzed the clinical pathological features, treatments and outcomes of leiomyosarcoma patients. Methods: A retrospective review was performed of leiomyosarcoma patients between 2000 to 2021. 214 patients were initially investigated, 102 patients were excluded owing to a lack of follow-up or loss of data., and 112 patients were finally analyzed. Treatment outcomes were measured using overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS). Optimal responses of first-line chemotherapies were also investigated under RECIST criteria. Results: Mean age of patients was 52.63 years, and male to female ratio was 1/2.2. Tumors mainly located in head and neck (2.68%), trunk and extremities (35.71%), abdomen and thoracic organs (16.07%), retroperitoneum (17.86%) and pelvis (27.68%). Patients with ⅠA, ⅠB, II, IIIA, IIIB and IV stage was 15.18%, 23.21%, 9.82%, 12.50%, 7.14% and 9.82% respectively. 2 patients received only chemotherapy after diagnosis, and 109 patients underwent surgery, among them 33.04% (37 cases) of patients had further radiation or chemotherapy. The median OS (mOS) of all patients was 42.65 months (95% CI 33.77-50.43). Adjuvant therapy had no significant influence on median DFS (mDFS) (28.63 months vs 30.33 months, P= 0.888). Significantly, R0 resection prolonged mDFS (33.30 months vs 7.37 months, P = 0.019) and mOS (102.5 months vs 35.83 months, P= 0.001). 32 patients occurred recurrence and all had surgery. 28 patients occurred metastases and 6 of them received surgery alone, 11 patients had systemic treatment, 6 patients received both treatments, 5 of them were untreated. In patients with metastases, the median PFS of systemic treatment (15.33 months) was shorter than median DFS of local treatment (48.83 months), while systemic treatment achieved similar survival time as surgery (78.03 months vs 79.27 months, P= 0.651). The disease control rate (DCR) of anthracycline-based regimens, ifosfamide (IFO), gemcitabine-based regimens and targeted therapy was 52.94%, 33.33%, 33.33%, 50% respectively. Conclusions: Surgery with R0 margin improved survival significantly of leiomyosarcoma patients. For survival time of patients with metastases, systemic treatment was not inferior to surgery, and anthracycline-based regimens had a higher disease control rate.
Desmoplastic small round cell tumor: Analysis of surveillance, epidemiology, and end results (SEER) database 1975 to 2018.
Authors: Waqar Syed Hamza Bin , Ali Hassam , Sheikh Taha , Hamouda Danae M.
Published: June 2022

e23540

Background: Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive soft tissue sarcoma with a poor prognosis. The incidence and prognosis of patients with DSRCT have been inadequately understood. Survival analysis for DSRCT has been sparsely investigated in a population-based study. Methods: We conducted a retrospective cohort study using the SEER 9 Registry (1975-2018). Site recode International Classification of Diseases for Oncology (ICD-O-3) 8806/3 was used via SEER*Stat software to select DSRCT cases. SEER*Stat software estimated annual percent changes, and Poisson regression estimated risk ratios. Cox regression models were constructed to estimate the hazard ratio for survival at five years. The period-specific rates were portrayed as rate per 1,000,000. Results: The male and female age adjusted DSRCT incidence rates were 0.22 and 0.05, respectively (p < 0.05). Incidence rate of DSRCT has been rising in the last two decades from 1975–2000 to 2001-2018 (0.013 vs. 0.31,p < 0.05). Males have a higher age adjusted DSRCT incidence rate (0.22 vs. 0.05,p < 0.05), and non-metropolitan counties had a higher incidence rate than metro counties (1.14 vs. 0.14,p < 0.05). The observed survival at 12, 36, and 60 months was 81%, 39.9%, and 23.4%, respectively. There was no significant difference in survival between females and males. Ages greater than 70 years had poor survival compared to ages less than 60 years (p < 0.001). Compared to surgery with chemotherapy, surgery combined with radiotherapy and chemotherapy was associated with a 62% lower risk of mortality (p< 0.001). Conclusions: This study reveals that DSRCT incidence has been increasing since 2000, is more common in white males. Gender may not affect survival in DSRCT, and surgery combined with chemoradiotherapy is associated with improved survival outcomes compared to surgical management with chemotherapy alone. Further comparative data would be beneficial to confirm reported findings.[Table: see text]
Radiotherapy, volume reduction, and short-term surgical outcomes in the treatment of large myxoid liposarcomas.
Authors: Lee Linus , Tepper Sarah , Owen Grant , Wang Dian , Lopez-Hisijos Nicolas , Colman Matthew W. , Gitelis Steven , Blank Alan T.
Published: June 2022

e23546

Background: While tumor volume reduction following radiation has been documented in myxoid liposarcomas, it is unclear whether large tumors experience similar volume reduction to smaller tumors. Methods: MRI studies performed before and after completion of pre-operative radiation therapy (RT) were examined. Tumor sizes were noted and categorized as large vs. small based on size > 10 cm. Tumor volumes were calculated, and operative duration and major wound complications were recorded. Results: The median largest tumor dimension was 12.4 cm before RT and 8.7 cm after RT. The median tumor volume was 298.9 cm3 before RT and 106.9 cm3 after RT. There was no significant difference in the mean percent tumor volume reduction between large tumors and small tumors (p = 0.11, 56.3% vs. 64.5%). Operative duration most strongly correlated to post-RT MRI volume (R2= 0.674, p < 0.001). Despite volume reduction, tumors that were large on presentation were more likely to experience major wound complications post-operatively. Conclusions: Radiation appears to be as effective at reducing myxoid liposarcoma tumor volume in large and small tumors. However, large tumors on presentation appear more likely to experience wound complications despite tumor volume reduction. Future studies should investigate disease-related outcomes as a factor of volume reduction in myxoid liposarcoma.[Table: see text]
A nomogram to predict the prognosis of advanced soft tissue sarcoma patients treated with anlotinib: A real-world population-based study.
Authors: Wang Bin , Liu Jie , Zhang Ren shu , Jiang Yu
Published: June 2022

e23550

Background: The ALTER0203 randomized controlled trial proved the antitumor activity of anlotinib, a multitargeted tyrosine kinase inhibitor, in 8 subtypes of advanced refractory soft tissue sarcoma (STS). Our previous studies have shown that anlotinib showed antitumor activity in more than 30 STS pathological subtypes in the real world. This study further constructed a nomogram to predict the prognosis of advanced STS patients treated with anlotinib based on real-world data. Methods: We retrospectively analyzed the data of patients with unresectable locally advanced or metastatic STS who received at least one dose of anlotinib from June 2018 to March 2021. A nomogram was developed to predict the survival probability based on the multivariate analysis. The performance of the nomogram was evaluated by concordance index, bootstrap resampling calibration curve and time-dependent ROC curve. Results: A total of 209 patients were included in this study. The median age was 48 years (range 11-85 years), and the median follow-up time was 18.7 months. Based on five independent prognostic factors including ECOG performance status, FNCLCC grade G2-3, poor nutrition, increased neutrophil count, and treatment patterns according to the multivariate analysis, we constructed a nomogram to predict the prognosis of advanced STS patients treated with anlotinib. The concordance index was 0.780. For the prediction of 1-year and 2-year overall survival probability according to the nomogram, the area under the receiver operating characteristic curve was 0.833 and 0.829, respectively. Conclusions: The nomogram based on ECOG performance status, FNCLCC grade, nutritional status, neutrophil count, and treatment patterns can accurately predict the 1-year and 2-year OS probability for advanced STS patients treated with anlotinib.
In vitro evidence that combination treatment with anti-PD-1 and anti-CD47 immunotherapy may not be efficient in human soft tissue sarcoma.
Authors: Strizova Zuzana , Ozaniak Andrej , Smetanova Jitka , Capkova Linda , Bartolini Robin , Lischke Robert , Bartunkova Jirina
Published: June 2022

e23560

Background: Soft tissue sarcomas (STSs) are rare mesenchymal tumors. With more than 70 histological subtypes of STSs, studies defining robust biomarkers of therapeutic value are lacking. Even with the improvements in local control rates, metastases and death occur in 50% of patients that are diagnosed with high-risk STSs. Across nearly all sarcoma types, macrophages dominate the immune landscape of STSs. While immune checkpoint inhibitors (ICIs) represent the major immunotherapeutic approach in malignancies with a high load of T cells, the anti-CD47 anti-cancer therapy mostly promotes macrophage-mediated phagocytosis. The efficacy of both therapies is critically dependent on the composition of the tumor microenvironment. Methods: In our study, we evaluated the potential additive effects of combining the anti-PD-1 immunotherapy and anti-CD47 immunotherapy ex vivo. The proportions of tumor cells and tumor-infiltrating lymphocytes were characterized ex vivo from resected tumors of 73 patients who underwent surgery for STS. The expression of CD47 on tumor cells was analyzed by immunohistochemistry. Cell suspensions were obtained from freshly resected tumors and the proportions of CD45+, CD45-, CD3+, CD4+, and CD8+ cells were measured by flow cytometry. The effect of the anti-PD-1 blockade, anti-CD47 blockade, and the combinatorial application of anti-PD-1 and anti-CD47 therapies on the immune cell activation in vitro was investigated by culturing of cell suspensions at a concentration 0.3x106/ul in the presence/absence of therapeutic monoclonal antibody (Nivolumab 2 ug/ml; anti-CD47 clone MIAP410 20ug/ml) and evaluated by a cytokine Luminex assay (Milliplex® MAP Human Cytokine Bead Panel (Sigma Aldrich) for TNFα, IFNγ, and IL-2 cytokines analysis). Results: The addition of anti-PD1 to CD3/CD28 stimulation drastically increased the production of all cytokines analyzed. This increase in pro-inflammatory cytokine secretion was even more pronounced after adding an anti-CD47 monoclonal antibody to the cell culture. However, a combinatorial application of anti-PD-1 and anti-CD47 agents in vitro was found to limit rather than potentiate the immune activation in the TME of human STS. On an individual level, the most profound response to anti-PD-1 was observed in high-grade leiomyosarcoma and the most profound response to anti-CD47 therapy was observed in an undifferentiated pleiomorphic sarcoma. Conclusions: Our data suggest that combinatorial strategies based on ICIs and anti-CD47 blockade may not provide the desired outcome in STSs. Both therapies, anti-PD-1, and anti-CD47 alone, could however bear a therapeutic potential in selected tumors after close evaluation of the CD47 and PD-1 expression status, as well as the extent of T cell/macrophage infiltration.
Symptoms and psychosocial distress associated with malignant wounds: Secondary analysis of a prospective cohort study.
Authors: Takamizawa Shigemasa , Ishiki Hiroto , Oyamada Shunsuke , Kiuchi Daisuke , Amano Koji , Satomi Eriko
Published: June 2022

e24008

Background: Symptoms associated with malignant wounds (MWs) worsen a patient's quality of life. However, MWs’ impact on psychosocial health and end-of-life status is unknown. Methods: This is a secondary analysis of the results of a large prospective cohort study conducted in 23 palliative care units in Japan. Consecutive patients were enrolled and followed up until their death or for six months. Patient demographics, symptom burden, medication use, and MW status were documented on admission. Healthcare professionals rated the symptoms using the Integrated Palliative care Outcome Scale (IPOS), a 5-point Likert scale. Quality of death (QOD) was evaluated at death using the Good Death Scale (GDS). The primary outcome was the prevalence of severe psychological symptom burden, evaluated as an IPOS-feeling score of 2–4. Factors that affected psychological symptoms and their relationship with GDS were also investigated. Results: Among the 1896 enrolled patients, 156 (8.2%) had MWs. MWs predominantly affected females and younger patients, and the most common primary sites were the breast (28.2%) and head and neck (19.2%). Among the patients with MWs, 75 (50.3%), 59 (39.6%), and 42 (28.2%) had exudate, pain, and bleeding, respectively. Among the 32 patients with MWs requiring dressing change at least twice a day and 117 patients with MWs requiring dressing change less than once a day, 20 (62.5%) and 44 (37.6%) had an IPOS-feeling score of 2–4, respectively (p = .015). Patients with MWs required antidepressants and opioids more frequently and received higher doses of opioids. Between the patients with and without MW, there were significant differences in IPOS-feeling and pain scores but not in breathlessness, fatigue, anorexia, somnolence, or dry mouth scores. IPOS-feeling and pain scores were worse in patients with MWs. Patients without MWs did not have better GDS scores (p = .48). Conclusions: Patients with MWs frequently required antidepressants and opioids, suggesting an increased prevalence of depression and severe pain. Psychological distress was influenced by the frequency of dressing changes. The presence of MWs did not affect the QOD.[Table: see text]
Analyzing immunotherapy adverse events in elderly cancer patients.
Authors: Puskoor Sujith , Calderon Jonathan , Surapaneni Rakesh , Raiyani Chandni
Published: June 2022

e24009

Background: Immunotherapy (IT) has cemented itself as a mainstay in cancer treatment, especially in those with late stage malignancies. Generally, these agents are well tolerated, but there is a known association with immune-related adverse events (iRAE). Due to an underrepresentation of elderly patients in clinical trial data, it is valuable to understand the tolerance of these agents. The primary objective of our study was to evaluate for an association between older age, defined as age 75 and above, and increased risk for iRAE in a real-world population. Methods: We performed a retrospective study utilizing data from elderly patients (pts) who had first received IT (specifically Pembrolizumab, Nivolumab, Atezolizumab, Avelumab, and Durvalumab) from 01/01/2015 through 12/31/2019. This subset of pts were followed until 12/31/2021. Descriptive analyses were performed to identify iRAE patterns. A chi-square test or a Fisher’s exact test was used to test for associations in bivariate comparisons while a two-sample t-test was used to test for differences in continuous variables between age groups > 75 to 79 years (Group 1) and > 80 years (Group 2). Statistical significance was determined by p < 0.05 unless otherwise noted. Results: 103 pts qualified for assessment over the study period. Group 1 had a total of 48 pts with a median age of 77. Group 2 had a total of 55 pts with a median age of 84. The study had 57 males and 46 females. 96 pts were Stage IV and 7 pts were Stage III. The most prevalent malignancies in the study were lung, skin, and renal cancer. Treatment intent was palliative for 96 pts, adjuvant for 6 pts, and neo-adjuvant for 1 pt. Overall, there were 72 pts with reported iRAE and 31 pts without reported iRAE. Of the pts with iRAE: 7 pts required outpatient observation without intervention, 38 pts required outpatient intervention(s), 19 pts were hospitalized, and 8 pts required ICU level of care. There was one death due to complications from encephalitis associated with hypophysitis and hyperthyroidism. Regarding discontinuation of IT for pts: 42 pts transitioned to hospice, 35 pts had progression of disease, 8 pts finished their treatment regimen, 5 pts developed an alternative diagnosis, and 9 pts discontinued due to iRAE. Nine pts in the study required corticosteroids for their iRAE. There was no statistically significant difference in incidence of any iRAE (regardless of type) between the two age groups 75-79 and over 80 years (p-value = 0.3703). Similarly, there was no difference for sub-categories including stage of cancer, type of cancer, treatment intent, and severity of iRAE. Conclusions: Elderly pts over age 75 that received the aforementioned IT were shown to have relatively tolerable safety profiles regardless of their age group and the majority continued with IT despite iRAE. This study reinforces the notion that IT could be used in geriatric pts without fear of exposing this vulnerable age group to substantial rates of negative outcomes.
Correlates of common concerns in older cancer survivors of leukemia and lymphoma: Results from the WHI-LILAC study.
Authors: Loh Kah Poh , McLaughlin Eric , Krok-Schoen Jessica L. , Johnson Lisa , Odejide Oreofe Olukemi , El-Jawahri Areej , Qi Lihong , Shadyab Aladdin H. , Paskett Electra D.
Published: June 2022

e24031

Background: Older survivors of leukemia and lymphoma often experience long-term and late effects of chemotherapy, worsened by aging-related conditions such as functional and cognitive impairment, which may be inadequately addressed. In this study, we described common concerns in older survivors of leukemia and lymphoma, and assessed demographic and clinical factors associated with these concerns. Methods: We utilized data from the WHI LILAC study that recruited post-menopausal women aged 50 and 79 years. Participants who were diagnosed with leukemia and lymphoma after enrollment in WHI and answered at least half of the questions on current concerns in LILAC were included (n = 420). Participants were asked about 14 areas of current concerns common in cancer survivorship and to rate each from 0 (no concern) to 2 (major concern), with total score ranging 0-28. Linear regression was used to assess demographic and clinical factors associated with the concern score, and logistic regression for factors associated with the three most common concerns, with backward variable selection methods. Results: Mean age at assessment was 81 years (range 69-99) and 73% had non-Hodgkin lymphomas. Median time since diagnosis was 8.8 years (range 2.5-20.8 years). Seventy-two percent reported any concern; median concern score among these survivors was 3.5 (Q1-Q3, 2-5) (Table). Factors significantly correlated with the concern score were sadness, pain, loneliness, worse quality of life (QoL), lower physical functioning, more comorbidities, and greater prior symptom count (all p < 0.05). Significant factors correlated with common concerns were: 1) Fatigue/sleep: leukemia diagnosis, greater prior symptom count, feeling sad or depressed, reported distress, lower physical functioning; 2) Physical functioning/activity: public health insurance, older age, greater prior symptom count, reported pain, worse QoL, higher BMI; 3) Memory/concentration: prior chemotherapy or radiation, loneliness, worse QoL, greater prior symptom count (all p < 0.05). Conclusions: Almost three-quarter of survivors of leukemia and lymphoma reported at least one concern, with common concerns being fatigue/sleep, physical functioning/activity, and memory/concentration. A multicomponent intervention is needed to address these common concerns in older cancer survivors.[Table: see text]
Let our patients shine: Survivorship and health interventions in nutrition and exercise program for breast cancer survivors.
Authors: Teplinsky Eleonora , Cording Jessica , Horowitz Elizabeth , Fishman Elena I , Podolski Amanda , Christoudias Moira Katherine , Tomaszewski Donald , Angner Robert , Klein Laura
Published: June 2022

e24032

Background: Nutrition and lifestyle interventions are instrumental in modifying cancer risk. These changes are often challenging for patients to make due to residual side effects from active treatment and/or ongoing toxicities from current treatment. The SHINE (Survivorship and Health Interventions in Nutrition and Exercise) Program is a wellness program for patients with breast cancer focusing on three pillars of nutrition, exercise and community in order to improve overall health outcomes and decrease the risk of cancer recurrence. Methods: Participants in SHINE have either been diagnosed with ductal carcinoma in situ (DCIS) and/or stage I-IV breast cancer. They are referred to the program at the three-month breast surgery post-operative follow-up appointment or any time after that. All patients are referred to meet with a registered dietitian (RD) and integrative health coach, who provides counseling and education on how to reduce risk through diet and lifestyle, using evidence-based recommendations. Patients are provided with support and accountability. A collaborative program, the Physician Referred Exercise Program (PREP), was established with our health system’s medical fitness center, Valley Health LifeStyles. Patients undergo a fitness assessment that focuses on aerobic fitness, muscle strength and endurance, flexibility, & functional activity. Each patient then receives an exercise prescription developed by a degreed exercise specialist, taking into account both the physician’s & patient’s recommendations & goals. Results: Each component of the SHINE Program has been developed in various stages due to the COVID-19 pandemic. 336 patients with either DCIS or stage I-IV breast cancer have been seen by the RD from December 2020 through January 2022. Mean number of visits/patient: 1.89 (range 1-8). N = 48 were participants in a 12-week study on the feasibility of nutrition counseling and impact on quality of life (QOL) which is still in progress. 76 patient referrals have been placed to the PREP program from August 2021-February 2022. Multiple community programs (Table) have been created for patients to help them develop shared experiences & camaraderie with each other so that they can better integrate new ideas and lifestyle modifications. Conclusions: The SHINE Program addresses care for the whole person, empowering individuals to live their healthiest lifestyle. Future work will focus on clinical trials to evaluate the benefits of these individual and collective interventions on overall QOL, QOL subscales (physical, psychological, social & spiritual well-being), & survivorship symptoms.[Table: see text]
Cardiotoxicity in patients on anthracyclines and traztuzumab: Identifying risk factors and echocardiographic parameters.
Authors: Parmar Kanak , Jones Andrew , Appiah Duke , Jones Catherine , Quirch Miguel , Pawar Dushyant , Del Rio Pertuz Gaspar , Nguyen Tung , Morataya Cristina , Sethi Pooja
Published: June 2022

e24052

Background: Anthracyclines and human epidermal growth factor receptor 2(HER-2) directed therapy are widely used as chemotherapy in various cancers. Up to 10% of patients treated with anthracyclines will develop reduction in left ventricle ejection fraction (LVEF), and cardiotoxicity by HER-2 directed therapy can be as high as 35%. The drop in EF is often late and changes may not be reversed at that point. Strain imaging using global longitudinal strain (GLS) has potential for detecting cardiotoxicity earlier however guidelines remain to be standardized. The objective of this study is to study variations in GLS over time as well as evaluate the relation of patient characteristics with various echocardiographic parameters. Methods: Linear mixed effects models with random intercepts were used to evaluate trends in EF and GLS over time and model the association of cancer therapy and patient characteristics with repeated measures of GLS and EF. Patients were enrolled in the study from 2018-2021 who received anthracycline, or HER-2 targeted treatment for any cancer and had serial echocardiography. Results: In the overall cohort there were more females (61%) than males (20%) in the study. Most patients had breast cancer (67%), followed by leukemia (14%) and lymphoma (13%).35% patients were in the younger age group (< 65 years) and 46% patients were in the older age (≥65 years). There was a significant change in GLS in older patients at 7-9 months (-15 SE 0.6) and 10-12 months (-14 SE 1) (P 0.006; P 0.001). Only 13 patients out of 81 patients developed cardiotoxicity as defined by the current consensus guidelines based on LVEF. Further analysis was then performed between these two groups at various time intervals. LV end diastolic volume (LVEDV) at baseline was significantly higher in the cardiotoxic group (P 0.016). GLS at baseline in both groups had no statistical difference. However, GLS began to show significant differences in the initial 1-3 months in the cardiotoxic group (-14; SE 0.9) as compared to the non-cardiotoxic group (-17.03; SE 0.3) (P 0.003). This difference persisted over various time points from 4 months till 1 year (P < 0.0001 at all points). Conclusions: Our data suggests that GLS may be used as a measure to identify patients who will develop cardiotoxicity by obtaining it at baseline and early during treatment. Higher baseline LVEDV was associated with development of cardiotoxicity. Older patients tend to have more drop in GLS and frequent measures will help to detect cardiotoxicity in this group.
Identifying common concerns and predicting vulnerable populations among breast cancer survivors.
Authors: Roy Pooja , Kovalenko Iuliia , Chan Gomez Janet , Rudge Beth , Wert Yijin , Torp Lisa , Wert Yijin
Published: June 2022

e24064

Background: Long-term survival is common after breast cancer treatment with 5-year survival reaching almost 90%. Breast cancer survivors (BCS) face varying degrees of quality of life (QOL) issues depending on their age of diagnosis, disease severity, and treatment. We present a retrospective analysis aimed to describe demographics of BCS, recognize common concerns and identify the vulnerable patients. Methods: This is a retrospective analysis of BCS seen at our Breast Cancer Survivorship Program from October 2016 to May 2021. Patients were given a survey to assess self-reported symptoms following treatment. The descriptive analysis of patient characteristics included age, cancer stage, and treatment type. The bivariate analysis included the relationship between the patient characteristics and their outcomes. Chi-square test was used to analyze group differences. Fisher exact test was employed when any of the expected frequencies was five or less. Logistic regression models were developed to identify significant predictors for outcomes. Results: 902 patients (age 26-94; median 64) were seen. Patient's characteristics studied included cancer stage, age group, and treatment modality. Most common self-reported concerns affecting BCS were fatigue (34%), insomnia (33%), hot flashes (26%), night sweats (23%), pain (22%), trouble concentrating (19%) and neuropathy (21%). Majority of patients (91%) reported having a happy outlook and felt a sense of purpose (89%), but 13% of BCS felt isolated at least 50% of the time. Young survivors (age ≤45) (p = 0.028), higher stage BCS (Stage 2-3) (p = 0.0061) and those who had chemotherapy either alone or as part of their multi-modality treatment (p < 0.0001) were significantly less likely to return back to at least 50% of their pre-treatment baseline (Table). Conclusions: Our study showed that younger BCS, patients with higher cancer stage, and those who underwent chemotherapy are the most vulnerable groups in terms of severity of QOL issues. Identifying vulnerable populations and evaluating common concerns after treatments are important in delivering quality care. Optimizing interventions under standardized approach would help to increase QOL in BCS.[Table: see text]
Identifying patient characteristics associated with chemotherapy-induced peripheral neuropathy (CIPN) severity in a phase II clinical trial: A retrospective analysis.
Authors: Zhi Wanqing Iris , Dreyfus Nechama , Dooley Andee , Piulson Lauren , Li Qing Susan , Bao Ting
Published: June 2022

e24067

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of chemotherapy agents such as platinum, taxanes, vinca alkaloids, and bortezomib. Currently, as no effective prevention strategy is available, chemotherapy delay, reduction, and discontinuation are often necessary due to worsening CIPN. Our retrospective study aimed to identify patient characteristics associated with CIPN during neoadjuvant or adjuvant weekly paclitaxel chemotherapy in patients with early-stage breast cancer. Methods: We retrospectively collected baseline data from the screening phase in a phase IIA trial of weekly acupuncture intervention in women with early-stage breast cancer (ClinicalTrial.gov NCT02364726); the primary outcome was reported previously. Baseline data including age; body mass index (BMI); gender; race; CIPN severity; hemoglobin; hemoglobin A1c; TSH; vitamins B6, B12, and D levels; and anxiety and depression were retrospectively extracted from the electronic medical record (EMR) on the first day of treatment or up to four months prior to chemotherapy initiation. CIPN severity was measured by the Common Terminology Criteria for Adverse Events v4.0. Chemotherapy relative dose density (RDI) was calculated by total chemotherapy dose received divided by the total chemotherapy dose planned; disease recurrence and mortality rate were collected at the time of analysis. Logistic regression was used for statistical analysis. Results: A total of 105 patients’ baseline characteristics were extracted from the EMR. Baseline BMI was associated with CIPN severity (odds ratio [OR] 1.08; 95% confidence interval [CI] 1.01-1.16, p= 0.04). No significant correlations were observed in other covariates. At the median follow-up of 61 months, there were 12 (11.4%) breast cancer recurrences and 8 (7.6%) breast cancer-related deaths. Chemotherapy RDI was associated with disease-free survival (DFS, OR 1.026; 95% CI 1.00-1.05; p= 0.028). Conclusions: In this retrospective analysis, increased BMI was associated with worsening CIPN severity. Chemotherapy RDI was associated with improved DFS. Our findings suggest that baseline BMI may be a risk factor for CIPN. Additionally, suboptimal chemotherapy delivery due to CIPN maybe negatively impact DFS in patients with breast cancer. Further study is warranted to identify risks for CIPN.
Pain management in oncology-dedicated and general emergency departments.
Authors: Turgeman Ilit , Campisi-Pinto Salvatore , Habiballah Maher , Bar-Sela Gil
Published: June 2022

e24076

Background: Cancer-related pain constitutes a dominant reason for admission to emergency services, and a significant patient and healthcare challenge. Evidence points to the rising prevalence of opioid misuse in this patient group. We sought to compare drug delivery in an oncology-dedicated emergency department (OED) and a general emergency department (GED) within the same hospital. Methods: Electronic files of patients with cancer seeking emergency services in a three-month period were obtained from the hospital registry. Data on patient demographics and drug-related characteristics were determined. Drug administration was compared between groups and thereafter according to admission types, using Fisher’s exact test, chi-square test and Mann-Whitney test. Results: In total, 584 patients had 922 visits to emergency services (OED n = 479; GED n = 443), and were administered 1815 drugs (OED n = 825; GED n = 990). Patient demographics and admission types were balanced between groups. Pain was the most common chief complaint (17% OED; 21% GED). In the OED, 12.5% of drugs were direct analgesics, compared with 19% in the GED. Opioids were prescribed more often in the GED than the OED (p = 0.008), significant for both pain related and non-pain related admissions, notably gastrointestinal and infectious conditions. Treatment in the GED was associated with delivery of three times as many intravenous opioids (p < 0.001), a narrower spectrum in selection of oral and intravenous opioids (p = 0.003) and non-opioid analgesics, lower usage of pain adjuvants and rapid-acting opioids (p = 0.003), and finally, the administration of agents not recommended for cancer pain treatment, such as meperidine and benzodiazepines (p = 0.003). Similar utilization of resuscitative fluids, gastrointestinal agents and antiemetics was observed between groups, with larger variation in drug choice in the OED (p = 0.001). The OED showed greater usage of bisphosphonates and growth factors; conversely, antibiotics, blood products, clotting agents, antihypertensive and diabetic drugs, predominated in the GED. Conclusions: Compared to the GED, management of cancer-related pain in the OED is characterized by fewer opioids, enhanced diversity in drug type, route and method of delivery. Emergency services should be incorporated in cancer programs to promote safe and effective urgent care.
Disparities in palliative care utilization in cholangiocarcinoma patients: A National Cancer Database (NCDB) study.
Authors: Chun Bennet , Lee Chang , Eaton Vincent , Silberstein Peter T.
Published: June 2022

e24077

Background: Cholangiocarcinoma is an adenocarcinoma of the intra- and extrahepatic bile duct epithelial cells. Although cases of cholangiocarcinoma in the US are rare, there is a low 5-year survival rate for these patients. The preferred treatment option for all subtypes is surgical resection. Alternative options include palliative care (PC) treatments such as chemotherapy, radiotherapy and locoregional treatments. There are many obstacles in accurately diagnosing cholangiocarcinoma, including obtaining adequate tumor samples for histology and determining what is malignant vs. benign in patients with primary sclerosing cholangitis (an important risk factor of cholangiocarcinoma). Such delays in diagnosis can lead to delays in treatment, which in turn results in a poor prognosis and worse outcome for patients. To the authors’ knowledge, there is no current study assessing PC disparities in patients with cholangiocarcinoma. Methods: A total of 46,751 patients who had a diagnosis with cholangiocarcinoma were identified utilizing the National Cancer Database (NCDB) ICD-O-3 histology code 8160. The 5-year survival of PC use was analyzed via a Kaplan-Meier curve. Demographic factors (race, biological sex, income, facility type, insurance, geographic location, and Charlson-Deyo co-morbidity score) were studied in relation to the receipt of PC. Results: Approximately 15.16% of our cohort received PC (7,089/46,751). There was a statistically significant difference in the staging of those patients that received palliative care, with 52% of our cohort being stage IV (p < 0.001). The sex of patients who received PC was equally distributed between men and women (51.0% to 49.0%). The majority of PC recipients were white (83.6%) individuals making under $63,000 (69.6%) with a reported Charlson-Deyo score of 0 (64.9%). Many patients who received PC had Medicare (57.6%) and were treated at either an academic/research program (45.4%) or at a comprehensive community cancer program (33.6%). Facility locations were predominantly located in the Mid-South Atlantic and East North Central regions, compared to the Pacific regions (56.3% vs 8.4%), and patients who received PC lived mainly in urban areas (98.2%). The median survival for PC patients was shorter compared to patients that did not receive PC (5.32 months vs 9.23 months). Conclusions: This is one of the most comprehensive studies that identifies the demographic disparities of patients who received PC for cholangiocarcinoma. The typical PC patient is a white individual with Medicare, living in an urban area in the Mid-South Atlantic and East North Central region making under $63,000. By highlighting the disparities that exist, our study can aid clinicians in addressing PC under-utilization in specific demographics to help provide more comprehensive care.
Attribution of symptoms to adjuvant endocrine therapy and association with adherence among older women with breast cancer: A qualitative study.
Authors: Lee Amy Yoonjin , Lyons Anna , Kamaraju Sailaja , Stolley Melinda , Neuner Joan Marie , Flynn Kathryn E.
Published: June 2022

e24086

Background: Oral adjuvant endocrine therapy (AET) is an effective treatment for hormone receptor positive breast cancer to decrease recurrence and mortality. However, adherence to AET is poor, with 1/3 of patients not completing the recommended 5-year treatment course. Studies have shown that symptoms of the medication, such as joint pain, hot flashes, and fatigue, are associated with AET discontinuation. While previous studies have focused on symptoms post-AET initiation, preliminary evidence suggests that pre-AET symptoms may be an important predictor of early AET discontinuation. We used qualitative interviews to explore adherence to AET and patients’ attribution of symptoms to AET to provide context for a larger quantitative study on the role of patient-reported distress pre-AET as a predictor of AET discontinuation. Methods: Participants were recruited from the Froedtert/MCW Cancer Center registry, stratified by high (≥4) and low pre-AET Distress Thermometer scores and adherence to/discontinuation of AET. Semi-structured phone interviews followed an interview guide focused on constructs previously identified in the literature as having strong associations with AET adherence. Interviews were recorded and transcribed. A multidisciplinary team developed a codebook based on the conceptual framework describing AET discontinuation by AlOmeir et al. as well as other themes that emerged from the data. Results: Interviews were conducted with 31 participants; ages ranged from 57-86 years. Participants were diverse with respect to race/ethnicity (55% white, 26% Black, 13% Latina, and 6% other racial/ethnic groups). Participants who reported symptoms described hot flashes, joint pain, low appetite, memory loss, depression, and fatigue. We saw support for previous findings by AlOmeir et al in which ability to deal with symptoms affected the decision to continue AET. We uncovered additional nuance related to attribution of symptoms, in that some participants attributed their symptoms to a side effect of AET, while others attributed symptoms to other factors including older age, recent completion of other cancer treatments, and psychological burden associated with a cancer diagnosis and treatment. Those who did not attribute symptoms to AET focused on AET as necessary treatment to increase survival, while those who attributed symptoms to AET reported a more negative AET experience in general, with AET described as an additional burden after cancer. Conclusions: Symptom attribution rather than experience of specific symptoms may be a key factor leading to discontinuation of AET. Patient-reported symptoms and associated distress pre-AET may be a viable way to identify patients at high-risk for AET nonadherence, allowing for timely intervention. This will be quantitatively tested in a large sample.
Cisplatin-induced tinnitus (CIS-TINN) and patient-reported outcomes in adult-onset cancer survivors.
Authors: Shuey Megan , Sanchez Victoria , Dinh Paul C. , Monahan Patrick O. , Sesso Howard D. , Dolan Mary Eileen , Fossa Sophie D. , Einhorn Lawrence H. , Vaughn David J. , Martin Neil E. , Fung Chunkit , Frisina Robert D. , Travis Lois B.
Published: June 2022

e24089

Background: Cisplatin is one of the most used cytotoxic drugs worldwide, but few studies have comprehensively evaluated CIS-TINN in adult-onset cancer survivors. It is critical to identify survivors with high degrees of handicap and related risk factors, as tinnitus (TINN) is strongly related to adverse health outcomes (AHO) including reduced quality of life, and poorer physical and mental health. Methods: Eligible cisplatin-treated testicular cancer survivors (TCS) (aged < 60 y at diagnosis) completed comprehensive, validated health surveys, including the 20-item Tinnitus Primary Function Questionnaire (TPFQ). TPFQ assesses the 4 main TINN-impaired domains (see Table), each with a response metric of 0% (no interference) to 100% interference by TINN, with final impairment groupings of 0-16% (none/minimal), 17-42% (mild/moderate), and 43-100% (significant). TPFQ measures were compared by 2-sided signed-rank tests. Multinomial logistic regression models (adjusted for age, income, education, yrs since therapy, cisplatin dose, BMI, smoking, hypertension, and hearing loss (HL)) tested for associations with TINN severity. Results are shown as OR [95% CI], p-value. Results: Among 213 TCS [median age 46 y (IQR: 38-52 y); median time since therapy: 10.6 y (IQR: 6.8-16.6 y)], the most common AHOs were CIS-TINN (60%), and HL (60%). For TCS with CIS-TINN, the mean degree of reported interference across all TPFQ domains was 21% (median: 15, IQR: 3-33). TCS with CIS-TINN reported significantly greater interference with emotion (median: 22, range 5-40) than with concentration (median 13, IQR: 1.0-37, p = .004), hearing (median: 10, IQR: 0-30, p < .001), and sleep (median: 2.4, IQR: 0-21, p < .001). Conclusions: Following cisplatin chemotherapy, CIS-TINN is a leading AHO and often reported with HL and reduced quality of life. Severe CIS-TINN was associated with greater handicap on the TPFQ as well as with depression, cognitive dysfunction, and hearing aid use. Overall, however, TCS with CIS-TINN and HL reported underutilization of hearing aids.[Table: see text]
Diagnosis of malnutrition according to glim criteria predicts complications and six-month survival in cancer outpatients.
Authors: Marti Pi Maria , Gascon Ruiz Marta , Casas-Deza Diego , Torres Ramon Irene , Zapata-Garcia Maria , Sesma Andrea , Lambea- Sorrosal Julio Jose , Alvarez Maria , Quilez Elisa , Zurera Berjaga Maria , Moratiel Pellitero Alba , Ruiz Moreno Ines , Goas Gomez Ana , Isla Dolores , Arbonés-Mainar José Miguel
Published: June 2022

e24093

Background: Malnutrition is a condition with great impact in oncology patients. Poor nutritional status is often associated with increased morbidity and mortality, increased toxicity and reduced tolerance to chemotherapy, among other complications. The recent GLIM criteria for malnutrition aim to homogenize its diagnosis, considering the baseline disease status. Due to the few studies that assess the predictive capacity of these new criteria, we aimed to evaluate their performance for the prediction of complications and mortality in patients with cancer. Methods: Prospective, single-centre study. All outpatients under active treatment for head and neck, upper gastrointestinal and colorectal tumors between February and October 2020 were recruited. These patients were followed up for 6 months, assessing the occurrence of complications and survival, based on GLIM diagnosis of malnutrition. Results: We enrolled 165 outpatients 46.66% malnutrition. During 6-month follow-up, patients with malnutrition (46.7%, according to GLIM criteria) had an ̃3-fold increased risk of hospital admission (p < 0.001) and the occurrence of severe infections (considered as such those requiring hospitalization, intravenous antibiotics and/or drainage by interventional procedure) during follow-up (p = 0.002). Similarly, malnourished patients had a 3.5-fold increased risk of poor pain control and a 4.4-fold increased need for a higher dose of opioids (both p < 0.001). They also had a 2.6-fold increased risk of toxicity (p = 0.044) and a 2.5-fold increased likelihood of needing a dose decrease or discontinuation of cancer treatment (p = 0.011). 6-month survival of malnourished patients was significantly lower (p = 0.023) than non-malnourished patients. Conclusions: Diagnosis of malnutrition according to GLIM criteria in oncology patients on active treatment predicts increased complications and worse survival at 6-month follow-up, making them a useful tool to assess the nutritional status of oncology patients.[Table: see text]
Cancer cachexia impact on chemotherapy dose reduction, treatment discontinuation, and survival: A qualitative systematic review.
Authors: Bonomi Philip D. , Walsh Declan , Currow David C. , Ballinari Gianluca , Skipworth Richard J. E.
Published: June 2022

e24103

Background: Cachexia is a syndrome of muscle wasting, weight loss, and anorexia, that frequently affects patients with advanced cancer across all major areas of oncology (surgical, medical, radiation, and chemotherapy), contributing to poorer treatment outcomes, including survival. In this qualitative systematic literature review, we reviewed the recent literature to assess the impact of cancer cachexia on chemotherapy dose reduction, treatment discontinuation, and survival. Methods: A systematic search was conducted on PubMed and Embase on November 26th, 2021, using the following search terms, among others: “cancer”, “cachexia”, “sarcopenia”, “muscle loss”, “body weight loss”, “chemotherapy”, “drug dose reduction”, “survival”, “treatment withdrawal”, and “treatment interruption”. 1,559 entries published between 2018 and 2021 were identified, of which 175 were duplicates. Publications were screened for eligibility and only original research in peer-reviewed journals were considered eligible. Inclusion criteria included: chemotherapy-specific studies; studies reporting on cachexia, body weight, or body composition changes; and studies reporting data on survival, chemotherapy dose reduction or treatment discontinuation, or occurrence of toxicities which may lead to chemotherapy dose reduction or treatment discontinuation in these patients. All studies that did not analyze the impact of cachexia on these outcomes were excluded. Results: A total of 63 studies, comprising a total of 15,832 patients, were considered eligible and selected for further analysis. The majority of analyzed studies, comprising 14,493 patients, reported associations between cancer cachexia (or its characteristics, such as weight loss or muscle wasting) and chemotherapy dose reductions in 7% of the studies, treatment discontinuation in 20% of the studies, and increased toxicity in 25% of the reports. Cachexia parameters were associated with inferior survival in 90% of the studies. The types of cancer most commonly associated with this effect were pancreatic (31% of studies), foregut (gastric, esophageal, and others, 17%), and lung cancer (14%). Conclusions: More than 70% of studies identified in the literature were retrospective assessments of patient records, while the remaining were prospective observational and interventional studies. In this review, cancer cachexia parameters were associated with reduced treatment delivery and inferior survival in multiple types of advanced cancer. These observations could have important implications for clinical practice, as early detection and successful treatment of cachexia might provide better outcomes for cancer patients undergoing chemotherapy. Disclosure: This study was funded by Helsinn Healthcare SA. Contact: Gianluca.Ballinari@helsinn.com .