bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and management of bevacizumab associated hypertension in outpatient oncology clinic
Authors: Jee C. , Brockstein B. , Hui W. , Lawton J. , Harper A. , Carro G.
Published: August 2020

e20677

Background: Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor is utilized to treat a wide range of cancers. However, clinical trials of bevacizumab reported the incidence of hypertension (HTN) up to 36%. A national guideline has not been established to manage bevacizumab-induced HTN. The incidence and management of bevacizumab associated HTN were evaluated in an outpatient oncology clinic. Methods: A randomized, retrospective chart review of 100 patients who received at least one dose of bevacizumab from 1/1/07 to 12/31/07 was conducted. The overall incidence and management of hypertension were evaluated. Other bevacizumab associated toxicities were compared in patients with or without hypertension. Results: The overall incidence of bevacizumab-induced HTN was 31% (95%CI: 22%-40%) with CTC (v 3.0) grade 3 HTN rate of 10%. The number of patients with a history of HTN or uncontrolled BP prior to bevacizumab therapy was significantly different across the four HTN grade groups (p= 0.0019). Out of 31 patients who had grade 1–3 HTN, 8 patients (26%) were managed by the oncologists, 8 patients (26%) by the primary care physicians, and 15 patients (48%) had no management. Bevacizumab was held in 3 patients due to high blood pressure (BP) resulting in one patient discontinuing bevacizumab therapy. The odds of other bevacizumab associated adverse events in patients with grades 1–3 HTN was 2.776 times than that of patients with grade 0 HTN (p=0.0201). Conclusions: Bevacizumab was associated with HTN in 31% of patients. Patients with history of HTN or uncontrolled BP prior to initiating bevacizumab were at an increased risk to develop a higher grade of HTN. Management of bevacizumab-induced HTN could be improved since BP of 63% of patients with grades 2 and 3 HTN was not adequately controlled.

No significant financial relationships to disclose.
Optimizing medication management: The pharmacists’ role and the cancer patients’ view
Authors: Meier K. , Wagner W. , Thor-Wiedemann S. , Wiedemann G. J.
Published: August 2020

e20684

Background: The safety of cancer patients given antineoplastic drugs as an outpatient treatment strictly depends on patients’ compliance to the information given by physicians and other health care professionals. On that note, pharmacists play an important part because they supply the cancer patients with the prescribed drugs and influence the actual intake of the medication. It has been shown in several large-scale studies that at least one third of all cancer patients do not take their vital medication. Is this missing compliance partially caused by insufficient or lacking information by the pharmacists? The patients‘ view. Methods: 312 (out of 514 invited) cancer patients from all parts of Germany undergoing cancer treatment filled in a questionnaire (Picker Institute, Germany) asking about the use of pharmacist services in 47 pharmacies and their satisfaction with the information received. Results: In pharmacies with an oncological focus 50% of the cancer patients received specific counselling. Other pharmacies provided oncology-specific information to 6%. 18% of the surveyed patients would have liked counselling but did not receive any. 17% were not interested in further information. Patients were disappointed about the lack of information regarding medication (25% of the patients), nutrition (43%), supportive therapy (35%), complementary medicine (51%). Complete satisfication with the information given was achieved in counselling regarding medication (30%), nutrition (22%), supportive therapy (28%), and complementary medicine (10%). Conclusions: The majority of the surveyed cancer patients were not satisfied with the information regarding medication, supportive therapy, nutrition, and complementary treatments provided by pharmacists. Our data have implications for pharmacist education and may help to improve patient support and compliance by ameliorating consulting skills.

No significant financial relationships to disclose.
Psychosocial impact of prostate cancer surgery on sexual intimacy
Authors: Krupski T. L. , Mouraviev V. , Mayes J. , Polascik T.
Published: August 2020

e20685

Background: Prostate cancer survivors live with the day-to-day consequences of the disease and its treatment. Prostate cancer, has been labeled a “relationship disease” because it impacts both partners. Traditional research does not include psychosocial aspects of sexual well-being. We designed a retrospective survey asking patients’ and their partners’ about the physiologic and psychosocial changes experienced after prostate cancer treatment. Methods: The study design is a cross sectional retrospective mailing sent to men treated surgically for prostate cancer. Questions related to physiologic changes centered around foreplay, libido, erection, orgasm and ejaculation while emotional status, relationship/partnership quality, self image, and social support comprised the psychological questions. Of the total 47 items, 18 items assessed the above concepts in binary fashion while the remaining 29 used a Likert scale. Results: After obtaining IRB approval, we mailed consents to 368 men. Only 65 men acknowledged receiving the information and 51 consented to participate. The participants were a median age of 59.6, predominantly Caucasian (80%), and treated by prostatectomy or cryotherapy. In terms of emotional status, 20% were diagnosed with depression and 10% with anxiety since their prostate cancer diagnosis and of those 32% felt it affected their sexual status. One third of the men rated their overall sexual relationship with their partner as “poor.” Of those men, 44% also perceived their partner was supportive. Over 80% felt their partnership quality was “stable,” “strong,” and “happy.” Almost half (43%) of the men experienced a decrease in self-esteem while 16% were unhappy with their physical appearance. While few men (4%) availed themselves of support groups, 18% found the advice of other patients helpful in coping with their sexuality. The side effects were unexpected in nearly half (43%) of the men. Conclusions: These preliminary findings suggest that prostate cancer treatment may be associated with psychosocial problems related to depression, anxiety, and self- esteem that impact sexual relationships. Although prospective validated questionnaires are needed to confirm these findings, better counseling through the disease trajectory may help combat these emotional issues.

No significant financial relationships to disclose.
Distress as a quality indicator of cancer care
Authors: Buso M. M. , Decat C. S. , Nonino A. , Araujo T. C. , Matos Neto J. N. , Schorn P. W.
Published: August 2020

e20686

Background: Distress is present in every phase of cancer. This high prevalence of distress showed the necessity of acting strategies that may favor the reduction or elimination of possible psychological and psychiatric disturbances. Facing this reality, the National Comprehensive Cancer Network suggested Distress Management in 1997. Today the oncological units need not only acting strategies, but also methods of evaluation of assistance quality. Methods: This study main goal was to evaluate the assistance offered in a private cancer treatment center in Brazil, using the distress prevalence during all the phases of the treatment as a quality indicator. Patients (N = 169) of both genders (37.9% male and 62.1% female), with age between 17 and 86 years (median = 53), with 18 types of cancer, took a part in this investigation. The research was authorized by an ethics committee. The procedure of gathering data included the consent of patients and the application of the Distress Thermometer (DT). The evaluation was made in three distinct stages of chemotherapy: beginning, middle and end of treatment. The data were analyzed according to the criteria defined in literature and with the software SPSS 15.0. Results: In the first stage of the evaluation, the major part of the patients showed a significative level of distress (69.8%), which is similar to literature data - In this phase the patients live with pain, losses and incertitude in relation to the prognoses. During the treatment, there was a progressive reduction in the second (32.4%) and in the last phase of evaluation (14.3%). Such fall was due to: 1) the routine of monitoring distress, the identification of the nature of distress and the intervention; 2) integration of the health team in a interdisciplinary work. Conclusions: The significative reduction of distress during the treatment points out to a good quality of cancer care. During the research it was possible to identify improvements and to reconsider some attitudes and conducts. There was a non automatization in the assistance, making it more human, individual and specific for each necessity. This result suggests the importance of DT as a quality indicator of cancer care.

No significant financial relationships to disclose.
Pattern of palliative care, pain management, and referral trends in developing countries: Still far from optimum
Authors: Sharma K. , Mohanti B. K. , Sharma D. N. , Rath G. K. , Julka P. K. , Muzumder S.
Published: August 2020

e20694

Background: Although palliative care and pain management are essential components of oncology practice, studies show that these areas are often inadequately addressed, more so in the developing countries where palliative care and pain management units are still inadequate. Methods: We randomly selected 252 patients receiving palliative RT (radiotherapy) at our tertiary care centre for oncology, from October 2006 to august 2008. Patients with bone pain were excluded as it could add a bias. Patient's records were studied retrospectively. Results: A median follow-up of 21 weeks was available for 197 males and 55 females with a median age of 55 years. Maximum (60%) patients were of head and neck cancers followed by oesophagus (14%), lung (10%) and others. All cases belonged to stage III (27%) or IV (73%). Dysphagia (35%), growth/ulcer (34%), respiratory symptoms (12.5%) and pain (7%) were the chief indications for palliative treatment. Overall, pain was present in 154 (61%) cases, out of which 92 (60%) were referred to pain clinic. All except two consulted pain clinic with a median pain score of 8 (0–10 point scale). Eighty six (96%) patients received opioid based treatment with adequate pain relief in 33% cases and loss of follow-up in 40% cases. Only eight (3%) cases were referred to a hospice. Thirty six (14%) cases were considered for radical treatment following very good response to palliative RT. Conclusions: In this selective sample, the standard of analgesic treatment is satisfactory. However, there is a lot of scope for improvement regarding referral to pain clinic and later to the hospice. Patients’ follow-up needs to be improved along with further studies evaluating patients who are considered for further RT till radical dose. Programs to change the patients’ attitude towards palliative care, physicians’ (residents) training to improve communication skills, and institutional policies may be the promising strategies.

No significant financial relationships to disclose.
Evaluation of the effect of selenium on radiation-induced toxicities in head neck cancer patients
Authors: Buentzel J. , Micke O. , Glatzel M. , Bruns F. , Kisters K. , Muecke R.
Published: August 2020

e20698

Background: The substitution of selenium effects in activation of the selenium dependent enzyme glutathione peroxidase which is important for scavenging free radicals. Until today only limited data are available about the clinical impact of selenium regarding the toxicities due to free radical producing therapies, e.g. irradiation or chemotherapy. Methods: 39 patients (8 female, 31 male) with advanced head neck cancer were included to a randomized phase II study. All patients had shown a reduced concentration of selenium in the blood and serum (main inclusion criterium). The mean age was 63.52 ± 9.31 years. Tumour localizations: oral cancer 15 patients, oropharynx 19 patients, hypopharynx 5 patients, CUP 1 patient. Group A (n=22) received 500 μg sodium selenite at the days of radiotherapy and 300 μg sodium selenite at holidays or weekend. Group B (17) was irradiated without any selenium substitution. Both groups were well balanced according age, gender, localization and stage of the tumour. We evaluated the RTOG grade of radiation-associated toxicities once per week. Following statistical methods were used: Mantel-Haenssel-χ2-test, Fisher's exact Test. SPSS. Results: We observed the following serious toxicities (group A versus group B): dysphagia 22.7% vs. 35.3%, loss of taste 22.7% vs. 47.1%, dry mouth 22.7% vs. 23.5%, and stomatitis 36.4% vs. 23.5%. A statistical trend (Fisher's exact test) is only seen in the area of loss of taste (p=0.172). The analysis per week had only shown a significant reduction of dysphagia in the selenium group at the last week of irradiation (p=0.04). Conclusions: The small randomized trial has shown limited effects of selenium in the prevention of ageusia (loss of taste) and dysphagia due to radiotherapy because of head and neck cancer. A clinical relevant radioprotection was not observed.

[Table: see text]
Analysis of the MyLifeLine.org Cancer Foundation user database: Does a cancer patient website for internet communication between cancer patients and their wellwisher community assist in cancer patient support?
Authors: Fisher R. E. , Donziger M. , Lahr L.
Published: August 2020

e20700

Background: The MyLifeLine.org Cancer Foundation established a website (MyLifeLine.org) in 2007 to provide a dedicated home base for communication between a cancer patient and his/her support circle. The premise of this program is the assumption that internet messaging fosters support and communication between patients and wellwishers in a more convenient format than use of standard communication, such as telephone use. Methods: In October, 2008, an email survey was conducted among the 250 individuals that made use of this home base for communication. Survey respondents were informed that the information tallied would be used anonymously for analysis of pattern use, and for publication. All data was collected anonymously. Results: Thirty-three percent of users submitted survey answers. Users were in all phases of cancer treatment. By age and gender, 64% of users were female, and 80% of users were between the ages of 30 and 70. Forty-one percent of respondents used this communication tool at least once a week. Seventy-one percent of users reported an improved sense of communication through use of this web-based tool. Forty-four percent of users felt this tool limited the number of phone calls they received. Sixty-six percent of users felt that their supporting community were better informed of their health status by mutual use of this home base internet site. Conclusions: This survey demonstrates that internet communication through a dedicated cancer patient home page for two-way messaging provides a number of benefits for support and communication. This tool limited the number of phone calls that would burden a patient receiving cancer care, and improved the sense of connectedness between a cancer patient and his/her support community . Demographics of this web tool user base demonstrate that the majority of users are female, and that its users span the ages of 30–70, which shows the acceptance of internet use by younger and older populations. The survey confirms the premise that initiated the website's inception. Use of this web based tool can be a valuable form of communication for cancer patients and their supporting community.

[Table: see text]
Evaluation of nausea and vomiting in melanoma patients treated with consecutive days of cisplatin
Authors: Sato T. , Laudadio M. , Pequignot E. , Chervoneva I. , Chan K. R. , Mastrangelo M. J.
Published: August 2020

e20702

Background: Chemotherapy-related nausea and vomiting (N/V) continue to be significant problems for cancer patients. In order to properly design a study leading to control of N/V in patients receiving consecutive days of cisplatin, stage IV melanoma patients who received three consecutive days of a cisplatin-containing chemotherapy were assessed. Methods: Patients were treated with cisplatin (25mg/m2, days 1–3), DTIC (220mg/m2, days 1–3), BCNU (150mg/m2, day 1) and tamoxifen (20mg twice a day, consecutively). The second cycle was given in 4 weeks without BCNU. Appropriate antiemetics were given during chemotherapy and then as needed for symptom control. N/V were assessed with the Functional Living Index-Emesis (FLIE) questionnaire for seven days (days 1–7). The median intensity of N/V during the early phase (days 1–3) and the late phase (days 4–7) was analyzed using the linear mixed effects model, adjusting for the subject random effects. The rates of intractable N/V (total FLIE score equal or less than 108) were analyzed in the random-effects logistic regression model. Results: A total of 14 patients answered the FLIE questionnaire. For nausea in cycle 1, the means of the median FLIE scores were similar in the early (52.7, 95%CI: 44.5, 60.8) and late (50.2, 95%CI: 42.0, 58.3) phases. In cycle 2, lower scores were observed in the late phase (45.2, 95%CI: 36.4, 54.0) than in the early phase (54.1, 95%CI: 45.6, 62.7) with a significant difference of 8.9 points (95%CI: 0.1, 17.7, p=0.049). For vomiting, the means of the median FLIE scores were similar in the early and late phases of either cycle. For the rates of intractable N/V, the differences between cycles and late vs. early phases were borderline significant. Higher odds of intractable N/V were estimated for cycle 2 vs. cycle 1 [OR=2.44 (95%CI: 0.945, 6.29; p=0.065)] and for late vs. early phases [odds ratio OR=2.39 (95%CI: 0.970, 5.870; p=0.058)]. Conclusions: The FLIE questionnaire is useful for objective assessment of N/V in patients who receive consecutive days of emetogenic chemotherapy. The data obtained from this study will form the basis for a future interventional study in which anti-emetics that are effective for late-phase N/V will be tested.

No significant financial relationships to disclose.
Survivorship care planning needs in diffuse large B-cell lymphoma (DLBCL)
Authors: Friedman D. R. , Dupont A. H. , Coan A. D. , Herndon J. E. , Rowe K. L. , Abernethy A. P.
Published: August 2020

e20703

Background: Cancer survivorship care plans inform and direct care in the survivorship setting. These care plans should be tailored to individual medical information, needs, and circumstances, as providing excess information can be overwhelming. According to survivors of DLBCL, what are important components of care plans? Methods: We developed a 22-question survey to define and rate important survivorship health and psychosocial concerns; items were developed based upon literature review and experience in survivorship clinics. Through the tumor registry, 178 patients were identified who had been treated with curative intent (including stem cell transplant) without evidence of recurrence since 1/2006 and who continue to receive care at Duke University Medical Center. Results: Sixty-five survivors consented and returned a completed IRB approved survey (response rate 37%). Responders: 58% female, 88% white, and 75% from North Carolina, with mean age at diagnosis of 59.7 years; 42% had stage four disease at diagnosis and 12% had had a transplant. The majority of survey participants (62%) indicated that they preferred their oncologist and primary care provider to jointly manage their survivorship care. On a 1–10 scale, the top scoring issue (mean 9.67) was “A plan to screen for possible return of your cancer.” Other top scoring issues (mean 8.81 - 9.48) related to cancer history (treatment, complications, stage or late effects) and non-cancer health monitoring. The lowest scoring needs related to social support, sexuality, financial/legal issues, alternative medicine, and mental health services (mean 5.45 - 7.12). There was greater agreement among responders on the importance ratings of the higher scoring issues than the lower scoring ones (standard deviation 1.01 - 2.34 vs. 3.18 - 3.56). Conclusions: DLBCL survivors prefer care plans focused on medical issues, and health care coordinated jointly by oncologists and primary care physicians. The lower importance of psychosocial issues and alternative medicine in this population differs from survivors of other cancers, underscoring the importance of tailoring care plans by cancer subgroup.

No significant financial relationships to disclose.
The prevalance of chronic autoimmune urtiker and angioedema among lung and breast carcinoma cases
Authors: Yalcin D. , Kargi A. , Savas B. , Bisgin A. , Ozdogan M. , Coskun S. , Terzioglu E.
Published: August 2020

e20707

Background: Although the risk of allergy and atopy in cancer patients has been studied in various prospective studies previously, no significant association was found between leukemia, breast, colorectal, lung cancers and allergic disorders or atopy. Our purpose in this study was to investigate the prevalance of chronic urticeria and angioedema in breast and lung carcinoma of adults in Mediterrianean Coast of Turkey, Antalya. Methods: 86 breast and 62 lung carcinoma patients that had diagnosed and underwent chemotherapy in Akdeniz University Oncology Clinic were studied. Blood eosinophil, total IgE, ANA, C3, C4, hepatitis markers and autologous skin test were examined in the cases with probable chronic autoimmune urticeria, angioedema. The data were statistically assessed with SPSS version 13.00. Results: Overall 148 patients were included. Median age was 62.4±14.6 years, 60.1% of the patients were women (47.2% of which is not working). 55.6% of the patients are living in apartments. In general, 5.4% (8 case) of the investigated population were diagnosed as autoimmun urticeria; Seven of the 8 of these were breast carcinoma cases (7 out of 86 breast Ca). In contrast, only one of them was lung carcinoma (1 out of 62 lung Ca). Total IgE level was 122 ± 21.4. None of the cases with positive autologous skin test has ANA positivity. Similarly, these cases were also HBV and HCV seronegative. Accompanying angioedema was present 3 cases (with no drug or food history). One case has a hashimato tiroiditis who underwent LT4 replacement. Another patient with autoimmun urticeria has allergical asthma together with 5 cases of allergical rhinitis and conjunctivitis. Conclusions: In this study the frequency of autoimmune urticeria is much higher in breast carcinoma cases compared to patients with lung carcinoma. Further researchs are needed to verify these results and to determine why such association exist.

No significant financial relationships to disclose.
Adjuvant systemic therapy in elderly patients with breast cancer: A Brazilian single center experience
Authors: Ismael G. , Coradazzi A. L. , Beato C. A. , Milhomem P. , Oliveira J. , Manzoni C. , Segalla G.
Published: August 2020

e20711

Background: Breast cancer is the leading cause of cancer in women in Brazil and in the western world. Despite the high incidence of breast cancer in elderly women, there is no solid information regarding the real impact of the adjuvant systemic therapy in this population, considering the underrepresentation of patients with 65 years of age or older in cancer-treatment trials. Moreover, elderly patients may face some difficulties to receive adequate adjuvant systemic treatment in the routine clinical practice. Methods: Two hundred fifty eight patients with 65 years of age or older at the time of diagnosis of operable breast cancer and treated in our Institution from February 2000 to December 2005 were retrospectively studied. Clinical and pathological data were recorded as well as the type of adjuvant systemic therapy: hormonal therapy (HT), chemotherapy (CT) or both. We evaluated the disease free survival and overall survival and compared the results between the group of patients treated with HT only and the group of patients treated with both HT and CT. Results: Ninety five (37.5%) patients were stage I, 150 (58.1%) were stage II and 6 (2.3%) were stage III, while 5 (1.9%) patients were diagnosed with DCIS. Ductal carcinoma was the most frequent histological type (81%) and grade II were reported in the majority of patients (47.3%). Mostly of patients were hormonal sensible (74.4% were ER+ and 64% were PR+) and HER 2 negative (81.8%). One hundred seventy eight (69%) patients received any kind of adjuvant HT while 91 (35.3%) received any kind of adjuvant CT. There was no statistical difference between patients treated with HT when compared with the group of patients treat with HT and CT, regarding disease free survival and overall survival. However, a higher rate of high risk patients were observed in the group treated with both HT and CT. Conclusions: Despite the age, a considerable part of this elderly breast cancer patient's population has received adjuvant systemic treatment. Benefits from HT and/or CT may be considered in this group of patients.

No significant financial relationships to disclose.
Anemia evaluation in oncologic patients in the emergency room
Authors: Tobeña M. , Serrano S. , Ferrer A. , Vidal M. , Pajares I. , Lopez D. , Millastre E. , Ruiz-Echarri M. , Lambea J. , Tres A.
Published: August 2020

e20714

Background: Anemia is a very common diagnosis in oncologic patients and it can be produced by different causes. The aim of this study is to describe the prevalence and causes of anemia in oncologic patients who consults in the emergency room. Methods: From October 2007 to October 2008, all oncologic patiens who consulted in the emergency room were collected. We analyze the prevalence of anemia and its causes. Tumor location is described too. Results: Of the 560 patients collected, 223 (39.82%) were diagnosed of anemia. 64 of them (28.7%) had lung cancer, 33 (14.8%) breast cancer, 32 (14.3%) colon cancer, 15 (6.7%) bladder cancer, 15 (6.7%) prostate cancer, 13 (5.8%) head and neck cancer, and 51 (22.5%) other malignancies. Median haemoglobin level was 10 (range 4.2–11.9). As etiology was identified chemotherapy toxicity in 113 patients (50.7%), anemia of chronic disease in 65 (29.1%), tumoral bleeding in 41 (18.4%), and non-tumoral upper gastrointestinal bleeding in 4 (1.8%). Conclusions: Anemia is a very common diagnosis in oncologic patients, mainly in lung and breast cancer. The most frequent causes of anemia are chemotherapy toxicity and chronic disease.

No significant financial relationships to disclose.
Frequency of co-morbid illnesses in cancer patients in Turkey
Authors: Abali H. , Ata A. , Turhal S. , Ozdogan M. , Seyrek E. , Erman M. , Celik I.
Published: August 2020

e20717

Background: Co-morbidities in cancer patients can adversely affect the management of their primary illnesses at multiple levels from diagnosis to therapy. We saught to examine co-morbid conditions in cancer patients treated at 3 university hospitals in Turkey representing three different geographic locations. Methods: A total of 622 consecutive cancer patients presenting to outpatient clinics were recruited to the study from November 2007 to May 2008. Each patient answered a questionnaire consisting of questions on co-morbidities and drugs taken. Based on the questionnaire, Charlson Comorbidity Index (CCI) was calculated. Results: Their median age was 55 years (minimum-maximum: 21–87) and 376 (62%) were female. Breast cancer (39%), colon and rectum (19%) and lung cancer (14%) were the 3 most frequent cancers. Of the patients, 60% had at least 1 co-morbid disease and 49% were using at least one medication daily. The most frequent comorbid diseases were hypertension (25%), other cardiovascular disorders (15%) and diabetes mellitus (13%). Incidence of comorbid diseases were increasing by age; 65% in patients between 60–69 years and 76% in patients older than 70 (r=0.25, p<0.001). Similarly, of those over 70 years, 65% was on at least 1 medication (r=0.29, p<0,001). CCI scores were calculated as 0 in (71%), 1 (23%) and 2 (5%) and it also worsened by increasing age (r=0.15, p<0.001). Conclusions: It is crucial to remember that co-morbid illnesses are not infrequent and many patients take medications for conditions unrelated to their cancer, which potentially may affect multiple stages of clinical management.

No significant financial relationships to disclose.
A phase II study of early up-front red blood cell transfusion followed by maintenance epoetin-alpha subcutaneously support during chemotherapy
Authors: Nortier J. W. , Ogilvie A.
Published: August 2020

e20719

Background: To determine in patients with cancer related anaemia (Hb<11,3 g/d) starting with their chemotherapy the efficacy and safety of up-front red blood cell transfusion and subsequently maintenance epoetin-alpha (Epo) administration. The study target was the range of low-normal Hb levels of 11,3 to 12,9 g/dL aiming at improving tumor oxygenation. Methods: A multicenter, open label, single-arm phase II study. All eligible patients with metastatic solid cancers received around their first or second chemotherapy cycle a transfusion of 1–3 units of erythrocytes depending on their Hb level. This was followed by Epo subcutaneously weekly at an initial dose of 40,000 IU during the chemotherapy period. Epo was only administered when the Hb level was below the lower margin of the target Hb range. All patients started with pre-emptive oral iron suppletion. Primary objectives were: correction of anemia to the Hb level target range and safety. Secondary objectives were: Quality of Life, Length of Treatment Duration and Time to Treatment Failure. Safety included: blood pressure, thrombo-embolic events, adverse events and serious adverse event. Results: 18 Patients enrolled in this study from March 30, 2006 to November 11, 2008. An intention-to-treatment analysis was performed for the primary objectives in 16 patients (8 with breast-, 4 with colorectal-, 1 with ovarian- and 1 with pancreatic cancer) and reported here. Patients were during a median of 12 weeks (range 1 to 32 weeks) on study. Median Hb increased from 10,2 g/dL to 11,2 g/dL after transfusion and stayed at that level during the first 19 weeks of Epo administration; Hb levels were between 10,0 and 11,5 g/dL. In the following period until the final 32nd studyweek, Hb levels increased slightly, ranging from 10,3 to 11,8 g/dL. Two patients remained during the study in the Hb level target range. The safety of Epo was good. Grade 3/4 adverse events and serious adverse events that occurred were found to be all chemotherapy or progressive disease related. Conclusions: Although this up-front treatment increased Hb to stable levels during chemotherapy, the target Hb levels were not reached in most patients. This was presumably related to the lesser than projected yield of the red blood cell transfusion.

[Table: see text]
Chemotherapy-associated steroid use and its effect on blood glucose, nephro-, and other toxicity of chemotherapy for non-diabetic oncological patients
Authors: Yan X. , Wong P. , DelPriore G. , Bottino J.
Published: August 2020

e20721

Background: Gynecologic cancer chemotherapy regimen include prechemotherapy, intrachemotherapy, and postchemotherapy administration of glucocorticoid steroids, which introduce the risk of hyperglycemia. Some studies have suggested that hyperglycemia is associated with increased chemotherapy toxicity. We evaluated the effects of dexamethasone as part of ovarian cancer and cervical cancer chemotherapy on blood glucose and its subsequent effect on nephrotoxicity in non-diabetic patients. Methods: We conducted a retrospective chart review of patients diagnosed with ovarian cancer and cervical cancer and received steroids as part of their chemotherapy during 2006–2008. Subjects who had elevated glucose detected at any time during treatment were compared with controls who had normal glucose levels. Pre- and post treatment serum BUN, creatinine, and blood glucose level were obtained. Results: 17 non-diabetic patients who received cisplatin or paclitaxel or both were studied (median age 50 years; range 42–60); All of the patients received 10 -20 mg of DEX intravenously before cisplatin/taxol. Glucose was only mildly elevated in 4 patients (110–200 mg/dl). None of the four cases with elevated glucose levels had any toxicity. One of the eight controls (12.5%) had elevation of creatinine. In all of the 17 patients, only one had evidence of mild nephrotoxicity, however her median blood glucose was not elevated while on therapy. Conclusions: This preliminary study did not show that current steroid regimens prescribed with chemotherapy have a significant overall effect on glucose elevation and subsequent increased nephrotoxicity of chemotherapy. Additional patients will be presented.

No significant financial relationships to disclose.
Species distribution and antimicrobial susceptibility profile of gram-negative bacteria in hospitalized cancer patients
Authors: Ashour H. M. , El-Sharif A.
Published: August 2020

e20730

Background: Nosocomial infections pose significant threats to hospitalized patients, especially the immunocompromised ones, such as cancer patients. Methods: This study examined the microbial spectrum of gram-negative bacteria in various infection sites in patients with leukemia and solid tumors. The antimicrobial resistance patterns of the isolated bacteria were studied. Results: The most frequently isolated gram-negative bacteria were Klebsiella pneumonia (31.2%) followed by Escherichia coli (22.2%). We report the first-time isolation and identification of a number of less-frequent gram negative bacteria (Chromobacterium violacum, Burkholderia cepacia, Kluyvera ascorbata, Stenotrophomonas maltophilia, Yersinia pseudotuberculosis, and Salmonella arizona). Most of the gram-negative isolates from RTI, GITI, UTI, and BSI were obtained from leukemic patients. All gram-negative isolates from SI were obtained from solid-tumor patients. In both leukemic and solid-tumor patients, gram-negative bacteria causing UTI were mainly Escherichia coli and Klebsiella pneumoniae, while gram-negative bacteria causing RTI were mainly Klebsiella pneumoniae. Escherichia coli was the main gram-negative pathogen causing BSI in solid-tumor patients and GITI in leukemic patients. Isolates of Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, and Acinetobacter species were resistant to most antibiotics tested. There was significant imipenem-resistance in Acinetobacter (40.9%), Pseudomonas (40%), and Enterobacter (22.2%) species, and noticeable imipinem-resistance in Klebsiella (13.9%) and Escherichia coli (8%). Conclusions: This is the first study to report the evolution of imipenem-resistant gram-negative strains in Egypt. Mortality rates were higher in cancer patients with nosocomial Pseudomonas infections than any other bacterial infections. Policies restricting antibiotic consumption should be implemented to avoid the evolution of newer generations of antibiotic resistant-pathogens.

No significant financial relationships to disclose.
Trastuzumab-mediated cardiac dysfunction (CDx) outside of clinical trials: Single Asian center experience
Authors: Park J. , Han S. , Oh D. , Kim J. , Lee H. , Kim Y. , Im S. , Kim T. , Bang Y.
Published: August 2020

e20732

Background: Trastuzumab is an effective drug for the treatment of HER2 positive breast cancer (BC) and CDx has been reported as a major toxicity. The purpose of our study was to investigate the trastuzumab mediated CDx in practice setting and the treatment outcome at single Asian center. Methods: We retrospectively analyzed 181 HER2-overexpressing BC patients (pts) who were treated with trastuzumab containing regimen between January 2005 and December 2007 at Seoul National University Hospital. We investigated the incidence of CDx and the degree of reversibility using echocardiography (EchoCG) and identify the risk factors to predict CDx. Results: Among 181 patients (pts), 112 were treated for palliative purpose and 139 had previously received anthracycline-based chemotherapy. Baseline EchoCG results were available in 129 pts (median age 47; range 25–79) and median left ventricular ejection fraction (LVEF) was 59% (range 45–70). Median follow-up duration was 21 months. LVEF decreased more than 5% points in 37 out of 129 (28.6%). According to the national cancer institute common terminology criteria for adverse events, grade (G) 2 and G 3/4 CDx developed in 4 (3.1%) and 8 (6.2%) pts respectively. Seven pts experienced symptomatic heart failure (HF). 3 among 5 pts who experienced discontinuation of trastuzumab could resume trastuzumab after median 146 (range 94–163) days of discontinuation. Median LVEF was 54% (range 45–63) at baseline in pts who experienced G2–4 CDx and deceased to 45% (range 30–49) after median 175 (range 65–415) days of trastuzumab treatment. HF treatment was initiated in 9 pts. 4 pts received angiotensin converting enzyme inhibitors (ACEI), 3 pts angiotensin receptor blockers (ARB) and 2 pts ACEI or ARB with diuretics. Occurrence of CDx (G2–4) was associated with higher anthracycline cumulative doses (p=0.039) and lower baseline LVEF (p=0.003). The incidence of symptomatic HF was related with past medical history such as hypertension (p=0.019) and lower baseline LVEF (p=0.005). Among the pts who had G2–4 CDx, LVEF was restored to 54% (range 40–59) which was similar to baseline at median 187 (range 56–477) days after the diagnosis of CDx. Conclusions: The majority pts with trastuzumab-mediated CDx were asymptomatic and LVEF could be reversible.

No significant financial relationships to disclose.
Analysis of resilience scores in a cohort of solid tumors ambulatory cancer patients in chemotherapy treatment
Authors: Ferreira Filho A. F. , Wunder A. P. , da Silva D. L. , Slomka L. , Machado M. W. , dos Santos M. P. , Graeff S. , Freitas D. , Friedrich A.
Published: August 2020

e20736

Background: Resillience is the ability to successfully cope with change or misfortune, allowing a person or a group to regain balance and keep going despite adversity and also to find meaning amidst confusion and tumult. It is a positive personality characteristic that enhances individual and group adaptation. Very scanty data exists regarding its quantification and distribution in cancer patients. The objective of this study is to evaluate and describe resilience scores in a population of ambulatory solid tumors cancer patients receiving chemotherapy treatment. Methods: Individual Resillience scores were measured by the Wagnild and Young Scale, validated for portuguese language from Brazil. It is composed by 25-item questions, scored on a 7-point scale from 1 = disagree, to 7 = agree, with all items worded positively. Possible scores range from 25 to 175 with higher scores reflecting higher resilience. During the year 2008, this scale was applied to 48 ambulatory solid tumor cancer patients in chemotherapy treatment at Oncosinos / Hospital Regina in Novo Hamburgo, Brazil. The study was approved by the Ethics comitte and all patiens signed the informed consent form. Results: The mean age of patients was 52 years (19–76) and 34 (70%) were women. The most common cancer types were: breast (48%), colo-rectal (21%) and prostate (8%). Most patients (47%) had stage IV disease and were in palliative chemotherapy treatment. Stage III cancer was present in 40% and stages I and II in 13% of patients. The mean score of resilience was 141+ 12 (101–174). The scores demosntrated a normal statistical distribution. No statistical differences in the mean resillience scores were detected between groups of patients as defined by: sex (P=0.11), age > or < 50 years (P=0.9), cancer type (P= 0.78), disease staging (P= 0.9), or the chemotherapy treatment intention, if palliative or curative (P=0.91). Conclusions: The resilience scores in this cohort of patients display a statistically normal distribution. Our results suggest that the total resillience score is an intrinsic individual characteristic that is independent of cancer stage, cancer type, age and sex of the patients. Further research is necessary to clarify the implications of these findings.

No significant financial relationships to disclose.
Voriconazole-induced QT-corrected (QTc) interval prolongation, bradycardia, hypothermia, mydriasis in an immunosuppressed patient with Ewing
Authors: Alkhallaf S. , Cornille H. , Markowska B. , Lankri Z. , Delepine N.
Published: August 2020

e20738

Background: Invasive aspergillosis is an important cause of increased mortality and morbidity in immunocompromised patients. Early treatment of probable aspergillosis by voriconazole is recommended by many authors. Nevertheless direct possible lethal complications must be taken into account. Methods: we describe a case of voriconazole adverse events in a 18 y old patient treated for aplasia by antibiotics and caspofungin. He remained febrile: Voriconazole initiated for digestive mycosis, caugh, endemic aspergillosis. Second injection was badly tolerated ( fever 40 °, dyspnea, chills, myalgias, hypotension) leading to stop Voriconazole. Few hours later, bradycardia (36 bpm/mn), QT c interval prolongation (QTc 482ms), bilateral mydriasis, hypothermia appeared. Others risks for cardiac events were studied: prior cardiotoxic chemotherapy; lightly low calcemia and magnesemia, negative T ondes, traducing major potassium deficit in cardiac cells, in spite of initially normal kaliemia (4.6 mmol/l) mild hypokalemia (3.3 meq/l). Systemic infection was eliminated, cerebral MRI normal, blood dosage of voriconazole at 80 h and 96 h after last dose negative. We discontinued potentially arrhythmogenic drugs. Specific treatment consisted of electrolyte disturbances correction, IV atropine, scopolamine patch. 24 h holter ECG revealed neither torsades de pointes nor ventricular tachycardia. QT c interval remained longer for 3 days. Onde T was normalised at day 6, with disappearance of bradycardia and hypothermia,without any cardiac event. Results: Azole family antifungal agents were pointed out as arrhythmogenic (QTc prolongation, torsades de pointes) in combination or alone. Few data reported bradycardia and QT c prolongation with voriconazole, although the drug package insert warns about such reactions. Furthermore, none case of mydriasis was reported but noted in Pfizer American data file(< 2% of case). Conclusions: Careful monitoring of QTc prolongation and bradycardia in patients receiving voriconazole is mandatory, particularly those with electrolyte disturbances, concomitant QT prolonging drugs, and /or receiving toxic cardiac chemotherapy.

No significant financial relationships to disclose.
Toward the elimination of medical oncology admissions
Authors: Mintzer D. M. , Zheng S. , Sprandio J.
Published: August 2020

e20740

Background: While medical oncology is growing in volume, it is increasingly becoming an outpatient enterprise. Issues leading to hospital admissions in the past are commonly either prevented or managed on an outpatient basis. We sought out trends within our practice on the frequency and reasons for hospital admissions. Methods: Computerized office visit and hospital admissions data were obtained on admissions by physician and year, for Pa. Oncology-Hematology Associates from 2000–2007. A retrospective chart review was also done for one physician from 6/08–12/08 to determine the reasons for admission. Results: While the total number of patients seen per year increased by 40% over the review period from 2000–2007, the relative number of admissions has steadily declined. Adjusting the number of admissions per patients in the practice (since the overall increase in volume partially masks the decline in admission frequency), the reduction in admissions is further evident. The frequency of admissions for the 4 senior oncologists showed a 50% reduction in admissions per patient over the past 8 years. Of 56 admissions reviewed from 6/08–12/08, 20 were related to infections (although only a minority were neutropenic), 13 for symptom management of disease progression, 6 for anemia/bleeding, 3 for bowel obstruction, 3 for non-infectious complications of treatment, and only 1 for chemotherapy administration. Conclusions: Trends in our practice indicate a continued decline in the frequency of admissions per patient. Elective admissions for diagnosis, work-up, and chemotherapy are rare. Improved medications for symptoms related to cancer, its complications and treatment-related toxicities and improvements in palliative care (psychosocial support, communication about prognosis and treatment goals, and end-of-life care) have contributed to decreased admissions. Increasingly, even patients with incurable disease are managed from diagnosis to death entirely as outpatients. Optimizing outpatient management and avoiding admissions in medical oncology has major implications for practice quality, patient quality of life, cost and allocation of health care resources.

No significant financial relationships to disclose.
Feasibility and economic viability of home-based supportive care
Authors: Cerny C. A. , Mutti A. , Ferreira D. M. , Jardini D. P. , Cecyn K. Z. , Suzuki E. , Ceschim P. C.
Published: August 2020

e20741

Background: Oncological treatment is becoming more complex and more costly. When their symptoms worsen, many patients seek an Emergency Room and arrive without a good performance-status. This causes insecurity to the attending physician, and it also represents a huge chance that this patient would receive an avoidable admission. With the appropriate home-support it is possible to attend the majority of patient's demands, offering a good quality clinical support.Home administration of some drugs is more comfortable and helps to eliminate some taxes that are commonly charged by private clinics. Methods: We performed an analysis of a private healthcare company's database.To avoid seasonality and high impact on costs of terminally ill patients occurring at an analyzed month, we selected a six months interval, from January to June 2008. Results: About 500 patients are active each month at the home-care program. They received from simple monitoring to 24 hour home nursing support. Hematological malignancies, as expected, require more resources.Home based supportive care could prevent the majority of avoidable hospital admissions. Conclusions: Home based supportive care can meet the basic needs of clinical support during chemotherapy and the demands of comfort at the end of life, in order to reduce avoidable hospital admissions. This contributes to reducing the cost of treatment.

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Reproductive health importance in oncology care
Authors: Zaren H. A. , Patel A. , Radeke E. K. , Uy A. B.
Published: August 2020

e20744

Background: Based on a case series of patients, we recognized a disparity between patients’ reproductive health goals and conveyed health information by providers on reproductive health issues. The objective of this study was to assess the reproductive health interest amongst cancer care providers. Methods: This observational study was performed using a 13 item questionnaire that was administered to 15 healthcare professionals in oncology and allied health fields. The items in the questionnaire related to information regarding the importance of cancer care, sexuality, fertility preservation and contraception. Results: Of the providers surveyed, 11 were medical doctors, 3 were nurses, and 1 was indicated as other. On a scale of 0 to 10, 86.6% (n=13) rated cancer care as extremely important (10), 33% (n=5) felt the same for fertility preservation, and 46.6% (n=7) for sexuality. In a rank of importance, cancer care was first, followed by sexuality, fertility, and contraception. Only 33% (n=5) of providers always asked patients about interest in fertility preservation and with regards to contraception, only 33% (n=5) offer contraception to reproductive age patients. Conclusions: Although most providers felt that sexuality and fertility are important to women diagnosed with cancer, their practice and information provision does not reflect these findings. This highlights the significance of bringing closer together the goals of the health care providers with their actual practice to improve patient care.

No significant financial relationships to disclose.