bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine learning algorithm for predicting longer postoperative length of stay among older cancer patients.
Authors: Shahrokni Armin , Rokni Seyed Ali , Ghasemzadeh Hassan
Published: September 2018

e21536

Background: To predict longer postoperative length of stay (LLOS) among older cancer patients, we have used a novel method to assess factors associated with this outcome. Methods: Our study was based on 47-item electronic Rapid Fitness Assessment (eRFA) data presented last year (Shahrokni, et al. (J Clin Oncol 34, 2016 (suppl; abstr 10011). LLOS was defined as LOS ≥8days.We used machine learning model to explore the relationship between > 70 pre, intra, and postoperative variables with LLOS. A filter-based variable selection algorithm was utilized to only identify the most important variables as defined by information gain. We computed the mutual information between each variable and the LOS, and ranked them from high to low gain. To create an interpretable machine learning model, we used decision tree classifier. The tree started with the most informative variable as the root and branches based on a threshold value such that the entropy decreases by most. Results: In a cohort of 492 postoperative older cancer patients (median age 80), the variable selection algorithm showed that only 5 variables are sufficient for predicting LLOS with an accuracy of 77.2%, sensitivity 81.6% and specificity 61.31% in all patients. The algorithm started with operation time (OT) of < or > 4 hrs. For example, patients with OT > 4 hours and social activity limitation (SAL) > 7 were 78% likely to have LLOS. Patients with SAL ≤ 7 and OT > 5 hours were 75% likely to have LLOS. Patients were 71% likely not to have LLOS if OT < 4 hours and SAL ≤ 7. To avoid the effect of potential data collection errors and increase the accuracy of the model, we used the Bootstrap Aggregating (bagging) method which ensembles the decision of a set small trees. Particularly, we generated 3 datasets from randomly sampling patients from current dataset with replacement and built 3 different trees. As a result of combining 3 short trees we reach the accuracy of 83.2% with sensitivity 83.9% and specificity 82.4%. Conclusions: Machine learning model could be helpful for predicting LLOS among older cancer patients. Prospective studies are needed to validate this method in different academic and community settings.
Using health-related quality of life and treatment measures to predict 10-year mortality in older survivors of early stage breast cancer.
Authors: DuMontier Clark , Clough-Gorr Kerri , Silliman Rebecca A , Stuck Andreas , Moser André
Published: September 2018

e21548

Background: Older women make up the growing majority of breast cancer (BC) survivors. Guideline BC treatments are known contributors to long-term survival, and health-related quality of life (HRQOL) is emerging as not only an important outcome in survivorship care but also as a factor thought to influence mortality. However, prognostic models that include HRQOL alongside BC treatment measures are lacking. We aimed to develop a 10-year mortality risk score based on a priori chosen treatment and HRQOL variables. Methods: We studied 660 women ≥65-years old diagnosed with stage I-IIIA primary breast cancer in years 1997-1999. Data from medical and psychosocial domains were collected over 10 years from interviews, medical records, and death indexes. BC treatment variables included receipt of definitive locoregional surgery +/- radiation, chemotherapy, and tamoxifen. HRQOL variables included physical function [10-item Physical Function Index (PFI-10) from the Medical Outcomes Study Short Form-36 (MOS SF-36)]; mental health [5-item Mental Health Index (MHI-5) from the MOS SF-36]; and social support [8-item modified MOS Social Support Scale (mMOS-SSS)]. We used penalized logistic regression models to develop a 10-year mortality risk score, and investigated its discrimination (c-statistic) and calibration (observed versus predicted mortality using the Hosmer-Lemeshow (HL) test). Results: Mortality though 10-years of follow-up was 34.8% (230 of 660 women). The c-statistic of a risk score using only age, number of comorbidities, stage of BC, and BC treatment was 0.71. The c-statistic increased to 0.74 with the addition of HRQOL measures and showed good calibration (p = 0.72 from HL test). Physical function and mental health had strong independent associations with mortality (women with high PFI-10: OR 0.63, 95% CI 0.43, 0.92; women with high MHI-5: OR 0.57, 95% CI 0.39, 0.85). Conclusions: In older early stage breast cancer survivors, our risk score combining HRQOL with treatment measures showed good discrimination and calibration. HRQOL is independently associated with 10-year mortality and adds predictive ability to age, comorbidity, stage of BC, and BC treatment.
Efficacy and safety of isolated limb perfusion for melanoma in elderly patients.
Authors: Madu Max Fullah , Deken Marion M. , Van Der Hage Jos A. , Józwiak Katarzyna , Wouters Michel W.J.M. , Van Akkooi Alexander Christopher Jonathan
Published: September 2018

e21549

Background: Data on isolated limb perfusion (ILP) in elderly melanoma patients is scarce. We aimed to evaluate the efficacy and safety of ILP in our institutional cohort of melanoma patients. Methods: Retrospective analysis of AJCC stage IIIB/C melanoma patients who underwent ILP for locally advanced (unresectable) melanoma in-transit metastases of the limb between 2000 and 2016. Normothermic ILP (37-38 °C) was performed with either Melphalan or Melphalan and Tumor Necrosis Factor (TNF). Baseline characteristics, local toxicity (Wieberdink) and systemic toxicity, locoregional progression-free survival (PFS) and melanoma-specific survival (MSS) were assessed and prognostic factors for response to ILP, melanoma recurrence and survival were analyzed using univariable and multivariable analysis. Results: 88 patients were included. The overall response rate to ILP was 81%, with a complete response (CR) rate of 47%. Median overall locoregional PFS was 6 months, while patients with a CR had a median PFS of 16 months. Median overall MSS was 38 months. Two patients (2.3%) suffered Wieberdink IV toxicity (compartment syndrome), while no patients required amputation because of severe toxicity. Based on the median age of 70, we split patients into younger and elderly groups. Toxicity rates, response rates and locoregional PFS did not differ significantly between younger and elderly patients. CR was prognostic for improved locoregional PFS and MSS. Moreover, patients > 70 and patients with stage IIIC disease had a higher risk of melanoma-specific death. Conclusions: ILP has good and potential durable responses, but also less frequent and less severe toxicity than recently developed targeted or immune therapies, which can be reserved for progression to stage IV. This study showed that ILP is an effective and safe procedure for elderly patients ( > 70) with locally advanced melanoma of the limb.
Body image, self-esteem and quality of life during oncology treatment in breast cancer, cervical cancer, and prostate cancer in comparison to the healthy population.
Authors: Kieszkowska-Grudny Anna , Rucinska Monika , Ciesak Robert , Wisniewska Marta
Published: September 2018

e21550

Background:Cancers are the second most common cause of death. Treatment of cancers is complex and might be aggressive, takes a long time and is usually difficult to accept for patients. As a result of disease and treatment a body image(BI) is impaired and can reduce quality of life(QoL),which has become a very important factor. The objective of the study was to investigate BI and QoL during oncological treatment of breast cancer(BCa), cervical cancer(CeCa) and prostate cancer(PCa) patients and to compare with healthy groups of men(HM) and women(HW). Methods:The analysis included 280 participants: 31 BCa-pts just after oncological surgery (age26-86 years,M = 63,23,Me = 65), 44 BCa-pts during adjuvant radiotherapy (age37-69years, M = 57,23,Me = 60), 21 CeCa-pts during therapy (age30-68years,M = 54,43,Me = 60), 52 PCa-pts with clinical stage T1-T2N0M0 (age57-86;M = 70,65;Me = 70) after standard three-dimensional conformal radiation treatment (3DCRT), 32 PCa-pts (age59-84;M = 74;Me = 75) after stereotactic hypofractionated radiotherapy (HRT), than without any type of cancer 50HM (age47-92years;M = 62,28;Me = 60) and 50HW (age30-84 years,M = 51,46,Me = 50). The subjects filled out the questionnaire EORTC QLQ-C30 (ver3.0.) and a specially designed questionnaire for a body image assessment. Results:All factors associated with BI between groups differed significantly (p < 0,05): general appearance, self-esteem, physical and sexual attractiveness. The highest assessment in all categories were done by HRT-pts and the lowest by BCa-pts during radiotherapy, than BCa-pts after surgery. HM and HW perceived BI on a similar level, however lower than HRT-pts. Overall QoL was significantly lowest in BCa-pts after surgery (p < 0,05), but physical, role, emotional, and general functioning were the worst in BCa-pts during radiotherapy (p < 0,05). The lowest social QoL was assessed by CeCa-pts (p < 0,05). Conclusions:It seems that oncological treatment influences significantly BI of cancer patients and worsens QoL especially in breast cancer women just after surgery and adjuvant radiotherapy. HTR-pts assesses BI and general QoL even better than healthy groups.
Implementing and analyzing a distress screening tool (DST) in a community oncology setting: Breaking down barriers to comprehensive medical and psychosocial (PS) care—The Kaiser Permanente Lone Tree, CO (KP-LT) experience.
Authors: Kono Scott Arthur , Reichel Jammie , Menter Alex R. , Mayer Stephen Armond , Klancar Lillian , Sturtz Keren , Narayanan Vignesh , Crank Rebecca , Elliot Brenda , Grimes William G , Barden Jeromie , Virdi Kylee
Published: September 2018

e21553

Background: PS distress (D) in cancer patients is an underestimated barrier to optimal care. The NCCN recommends D screening and intervention for D scores (DS) ≥4. KP is an ideal environment for large-scale screening. We sought to identify barriers in DST compliance, find a successful standardized workflow (SWF), and understand sources of D to elevate the standard of PS care. Methods: The DST was administered by the physician at completion of initial encounter to all new patients. Compliance recorded before and after implementing a SWF in 2/2016. Our DST utilizes 4 Major Categories of Distress (MCD) [Practical (P), Social (S), Health (H), Emotional (E)] to identify specific areas of D, and stratify DS by diagnosis [Benign (BH)-, Malignant- (MH) Hematology, Solid Tumor (ST)]. Clinic outreached any patient with a 4+ DS. DST was modified (mDST) 9/2016 to provide a DS for each MCD rather than 1 overall DS to improve practicality. Results: 936 DSTs completed from 6/2015-1/2017 (304/632 were mDST). DST compliance increased from 51% to 78% after the SWF. 289/632 (46%) scored 4+ (avg. DS 6.15). 153/304 (54%) mDSTs scored 4+ in ³ 1category. The avg. DS was 3.9 (n=936). Avg. DS for: BH= 3.67 (50% scored 4+, avg. 6.0), MH=3.79 (49% score 4+, avg. 6.14), and ST=4.02 (54% score 4+, avg. 6.18). The 3 most common concerns in each MCD are reported in Table 1. Most frequent outreach requests: Dietitian (n=88, 9%), LCSW (n=70, 7%), and Financial Counselor (n=50, 5%). Conclusions: Sources of D are a patient reported metric, not provider-assumed. DST use is feasible and essential to comprehensive cancer care. A SWF is crucial for success and led to a 27% increase in compliance. 4+ DS is frequent and was higher than expected in BH. Identifying specific stressors allows early intervention and improved resource utilization. [Table: see text]
Postponement of death weighed against duration of treatment and toxicity as key components in shared decision making about last line oncologic treatment.
Authors: Jensen Lars Henrik , Trabjerg Natacha D , Hansen Torben , Jakobsen Anders Kristian Moeller , Steffensen Karina Dahl
Published: September 2018

e21555

Background: Decisions about last-line treatment are challenging in oncology practice. The hope of prolonging life and reducing symptoms should be weighed against the time spend on treatment, side effects and cost. Standard oncology measures of effect such as median survival time and number needed to treat are not easily explained to patients. Postponement of symptoms or death has been shown to be superior to e.g. number needed to treat in communicating the benefit of treatment to patients. The aim of the present study was to develop a tool for shared decision making in last line treatment of patients with colorectal cancer. Methods: A literature review identified pivotal phase III trials about specific antineoplastic agents for metastatic colorectal cancer after standard treatments. Principles for determining the mean survival followed restricted mean survival time analysis. High-resolution survival curves were digitalized. Areas under the curves (AUC) were calculated for the experimental group and the control group. Results: Two drugs are approved for colorectal cancer after exposure to standard treatments; regorafenib and TAS102. AUC at one year for regorafenib was 30.1 weeks compared to 26.6 weeks for placebo resulting in a difference of 3.5 weeks. AUC at one year for TAS102 was 31.4 weeks compared to 25.7 weeks for placebo resulting in a difference of 5.7 weeks. Average time on treatment was 12 weeks for regorafenib and 14 weeks for TAS102. Risk of severe, medical significant or life-threatening (grade 3-4) adverse events increased from 14% to 54% (regorafenib) and from 52% to 69% (TAS102). Conclusions: Data was developed for shared decision making using restricted mean survival time. A patient with colorectal cancer after standard treatment can be advised: »This is a deadly disease irrespective of treatment. On average, taking medicine for about 12 weeks will postpone death for 4 to 6 weeks. Taking the medicine will cause 17 to 40 extra patients out of 100 experiencing severe or life-threatening side effects«. The concept of postponement will be further explored as a key component in patient empowerment for value based care.
An explorative study of the psychological profile of women who access an oncofertility unit.
Authors: Di Mattei Valentina E. , Carnelli Letizia , Mangili Giorgia , Rancoita Paola M.V. , Bernardi Martina , Mazzetti Martina , Taranto Paola , Bergamini Alice , Papaleo Enrico , Candiani Massimo
Published: September 2018

e21557

Background: Advances in cancer treatment have resulted in an increase in survival rates. Thus, quality of life after disease is being addressed more often; loss of fertility is a crucial aspect, especially in young women. This study aims to investigate the psychological profile of women who access the Oncofertility Unit at the San Raffaele Hospital before gonadotoxic treatment. Psychological consultation is undertaken prior to the medical evaluation as an integrative part of fertility preservation counselling. Our hypothesis is that women who access the Unit present psychologically adaptive characteristics, which facilitate a better adjustment to diagnosis and disease; this involves the decision to cryopreserve their oocytes to avoid possible future infertility. Methods: Seventy-six women were counselled between January 2014-2017; 96% of these (N = 73) decided to undergo cryopreservation. Only these women returned the administered questionnaires and took part in the study. A self-report measure and three validated questionnaires were used: the Beck Depression Inventory (BDI-II), the State Trait Anxiety Inventory Form-Y (STAI-Y), and the Temperament and Character Inventory – Revised (TCI-R). Results: The age range of the sample was 19-42 years (mean = 30.49; SD = 5.42); 21% (N = 15) of patients were older than 35 years. Seventeen women (23%) were single and 12% (N = 9) had children prior to the cancer diagnosis. Regarding the BDI, 89% (N = 65) of patients obtained minimal depression scores [0-13]. On the STAI-Y trait subscale, 70% (N = 51) of patients’ scores fell within the low anxiety range [20-40]; state anxiety scores were higher, but only 18% (N = 13) of women reported high levels [60-80]. The TCI-R highlighted that 95% (N = 69) of patients had medium or high levels of Persistence (perseverance despite fatigue Conclusions: Women who access the Unit report low levels of psychological distress (depression and anxiety) and show adaptive personality traits. This supports our hypothesis. The main study limitation of the study is the lack of data regarding women who decided not to undergo cryopreservation.
Use and usefulness of the “know yourself” tool in outpatient cancer care.
Authors: Berger Zackary , Yesantharao Pooja , Zhou Alice , Blackford Amanda , Smith Thomas J. , Snyder Claire Frances
Published: September 2018

e21558

Background: Patient-physician communication is important to cancer care. The National Coalition for Cancer Survivorship developed the Know Yourself Tool, a 2-page form, to improve patients’ understanding of goals of care and clinicians’ understanding of patients’ priorities/expectations. We assessed the Tool’s use and usefulness. Methods: This mixed-methods study at an academic cancer center recruited 1 medical, 1 radiation, and 1 surgical oncologist for each of 5 cancer types: breast, lung, gastrointestinal, genitourinary, head & neck. For each clinician (n = 15), we recruited 2 control patients to observe usual care (n = 30) and then 4 intervention patients who were provided the Tool (n = 60); eligible patients were at a decision point in their care. Data were collected for the decision making visit via patient and physician post-visit surveys analyzed descriptively and visit recordings/transcripts to analyze: 1) option presentation 2) patient preference assessment 3) shared decision making elements 4) patient question asking opportunities. Results: Of 90 patients, 39 (43%) were female and 75 (83%) were white. Of the 60 intervention patients, 42 (70%) completed a post-visit survey: 15 (36% of respondents) reported using the Tool and 13 (31%) discussing the Tool. Nearly half (49%) reported the Tool helped them prepare for follow-up visits and know the importance of their perspective in decision making. Patients reported the Tool was easy to use (76%) and would recommend the Tool to others (52%). Clinicians reported on Tool use for 24 visits, finding it most helpful in identifying areas of concern (74%). Based on visit transcripts, physicians were more likely to describe certain options as more appropriate than others with intervention vs control patients. However, physicians were less likely to assess patient preference, engage in shared decision making behaviors, and provide opportunities for patients to ask questions with intervention vs control patients. Conclusions: Use and usefulness of the Know Yourself Tool was limited. Further work should identify barriers to Tool use, determine if there are specific subgroups for whom the Tool would be more useful, and further elucidate how the Tool affects patient-clinician interactions.
Relation of depressive and anxious symptoms to overall distress and mortality in patients undergoing radiation therapy.
Authors: Brett Christopher , Strong Gerald , Hintenlang Lauren L. , Whitaker Dale Alan , Jagadesh Niveditha , Miller Robert Clell
Published: September 2018

e21567

Background: For patients diagnosed with cancer, depression and anxiety represent a common and significant burden, which has been proposed to not only affect quality of life but to potentially shorten duration of life as well. This study examines the influence of patient reported symptoms of anxiety and depression on overall distress and mortality in patients undergoing radiation therapy. Methods: As part of their intake paperwork, patients undergoing radiation therapy completed distress screening that included 29 questions regarding their level of concern with various factors related to their care as well as their overall distress level. This information and other parameters including demographics, site of primary disease, use of chemotherapy, presence of metastasis, and last known status were recorded for analysis. Answers regarding degree of concern for “feeling down or depressed”, “loss of interest in my usual activities”, and “feeling nervous or anxious” were examined for influence on study endpoints. Results: Results for final analysis were available from 519 patients undergoing therapy from April 2010 to May 2016. The cohort’s average age was 66yrs, 71% were treated curatively, and 29% were treated palliatively. The most common treatment sites were breast (27%), thorax (16%), H&N (12%), GU (12%), GI (10%), and CNS (7%). Significant correlation was found between level of concern with symptoms of anxiety and depression and level of overall distress (P < 0.001, Kruskal-Wallis Rank Sum Test). Significance remained on separate analysis of curative and palliative subgroups. No significant correlation was found for 1 or 2 year survival on either single or multivariate analysis of curative or palliative patients. Conclusions: Depression and anxiety are common conditions among cancer patients, and can contribute significantly to their overall distress. Although no effects on mortality were demonstrated on initial follow-up of this cohort, it remains evident that attention to emotional well-being is critical in the care of such patients. Additional investigations can be pursued regarding ideal interventions for patients identified by such screening.
Family quality of life (FQOL) of patients with cancer and caregivers.
Authors: Goldman Jamie , Dietrich Mary S. , Wells Nancy L. , Murphy Barbara A.
Published: September 2018

e21568

Background: There are no validated tools assessing FQOL in the cancer population. We developed a 32-item cancer specific tool (CFQOL) comprised of general and cancer specific subscales directed towards the patient and caregiver. Domains included family interactions, roles, communication, and emotional support. Methods: 150 patient-caregiver dyads in a general oncology population completed the CFQOL, SF36, FACT, BC-FQOL, and FACE IV tools. Exploratory factor analysis was used to identify the underlying structure. We compared the CFQOL with validated measures using Spearman's Rho. Results: Characteristics: Patients - median age 59, 57% male, 96% Caucasian, and 65% in treatment. Caregivers - median age 56, 67% spouses/partners and 86% primary caregiver. The analysis revealed a single underlying structure for both the general and cancer-specific domains (Cronbach's α 0.96 and 0.94 respectively). Median scores for patients on both measures were 4.5 out of 5 (IQR: 4-5); caretaker scores were lower (median: 4.2, IQR: 3.5-4.2, p < .05). As expected, convergent validity was supported with those tools focusing on similar themes to those in the CFQOL, and items involving physical aspects demonstrated divergent validity but were not statistically significant (table 1). Conclusions: The CFQOL is a brief, valid tool for assessing multiple constructs relevant to FQOL in the cancer patient population. Patterns of correlations were similar for general and cancer subscales questioning the need for both sub-scales. Further validation and exploration of sensitivity to change is indicated. [Table: see text]
Long-term cancer survivors: Satisfaction with medical care and information received during the diagnosis and treatment of cancer.
Authors: Gallego Alejandro , Martinez Beatriz , Espinosa Enrique , Ghanem Ismael , Ruiz-Gimenez Leticia , Garcia Tania , Gonzalez Teresa , Castelo Beatriz , Zamora Pilar , Redondo Andres , Feliu Jaime
Published: September 2018

e21573

Background: Long-term survival rates for many types of cancer have substantially improved in past decades. A specific medical office was started up two years ago at our institution for the follow-up and comprehensive care of this population. Long-term cancer survivors were surveyed to know how they perceive medical care and information received during the diagnosis and treatment of cancer. Methods: A 54-item questionnaire was developed based on QLACS (Quality of Life in Adult Cancer Survivors). 286 patients completed the questionnaire from January 2015 to December 2016. All of them were disease-free and without any antitumour therapy for at least two years. The information was collected in a database and processed with SPSS 18. Results: Median age at the time of diagnosis was 56 years. Colorectal and breast carcinomas accounted for 54% of all cases and 61% of patients had been diagnosed in early stages of disease. Median time from cancer diagnosis to questionnaire completion was 104 months (range 29-444 months). Sixty-seven per cent of patients were satisfied with the information received by their oncologist about their cancer, although information provided about other health issues was less satisfactory. Twenty-eight per cent reported that the oncologist never made recommendations about healthy lifestyle. In fact, only 8 patients (2.8%) made dietary modifications, all regular alcohol drinkers (31.1%) maintained their daily intake and 73 patients (25.5%) gained 5 kg over their recommended weight. Anxiety/depression symptoms were reported by 30% of the best informed patients about cancer treatment and 52% of the worst informed. Only 12.4% of long-term cancer survivors of our study consulted their family doctor during the last year, while 75.4% visited their oncologist. Finally, the medical care of the oncologist was satisfactory for 235 patients (83.2%), receiving an overall score of 8.7 on a 0 to 10 scale. Conclusions: Most long-term cancer survivors feel satisfied with the medical care received, but the information provided about other health aspects should be improved. Furthermore, although they rely on their family doctors, most prefer being followed-up by their oncologist.
Long-term impact of head and neck cancer (HNC) and treatment on financial distress and employment of HNC survivors.
Authors: Wulff-Burchfield Elizabeth Marie , Schlundt David G , Bonnet Kemberlee , Castellanos Emily , Dietrich Mary S. , Murphy Barbara A.
Published: September 2018

e21575

Background: Increasing HNC survival highlights the importance of understanding late biopsychosocial outcomes. Financial and occupational impacts of HNC remain unexplored, thus we undertook a qualitative analysis to identify themes and explore the impact of HNC/treatment on survivors’ financial health. Methods: Eligibility: Locally-advanced HNC who participated in an R0-1, NED, and > 1 year post treatment. Ten of 12 eligible patients were interviewed. Topics queried: financial issues related to HNC/treatment, financial/insurance matters affecting treatment, impact of treatment on fiscal responsibilities, financial counseling, and late impact of HNC/treatment on work. Frequency distributions were used to summarize patient characteristics. Interviews were transcribed verbatim, double-coded, and organized into themes and subthemes. Results: 50% male, 100% Caucasian, 60% married, median age 64 years, and median time since treatment of 64 months. Most denied ongoing financial strain from HNC/treatment, citing mitigating factors of preparedness (e.g. preexisting savings), health/disability insurance, and marital status. Those with financial distress noted an income limited by savings or disability. None reported financially-related delays in care. However, 2 patients used free healthcare. Most denied impact of HNC/treatment on financial obligations, but a minority reported subsequent delays in dental care, paying credit card bills, and travel. Financial counseling was used by 4 patients; benefits included decreased stress, access to financial programs, and education. Healthcare providers were considered an important source of financial counseling. Not all patients returned to work; late effects (fatigue, cognitive changes) impaired work capacity for those who did. Limitations: Population may have been skewed by loss to follow-up of patients with financial toxicity that precluded ongoing medical follow-up. Conclusions: Long-term financial distress was limited in this cohort of HNC survivors. Preparedness, adequate insurance, marital status, and financial counseling attenuated financial impacts of HNC. For those returning to work, late effects may affect capacity.
Evaluation of cardiovascular health in sarcoma survivors.
Authors: Baker Laurence H. , Murthy Venkatesh Locharla , Weinberg Richard Lawrence , Jalife Jose , Herron Todd
Published: September 2018

e21579

Background: Heart disease is the most common and serious chronic illness observed in sarcoma survivors treated with doxorubicin. Now the commonest heart disease in theses survivors is coronary artery disease (CAD). We established a Sarcoma Survivorship Program to include patients at high risk of chronic illness including exposure to doxorubicin who are at least 2 years free of disease post treatment. Methods: Every 6 months patients electronically complete NIH’s PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaires (on Anxiety, Depression, Mobility, Pain Interference, Sleep Disturbance, and Physical Function). Detailed family history is documented. Chemotherapy doses are abstracted from original medical records. Data collected includes: blood pressure, lipid profile, high-sensitivity C-reactive protein (hs-CRP), basic metabolic panel, chemistries, renal and pulmonary function, expert echocardiography. All patients signed an IRB approved informed consent. Results: All patients had normal left ventricular ejection fractions (median = 60%) yet 8 (N = 24) patients had an elevated hs-CRP suggesting increased risk of early CAD. 10 patients had untreated hypertension. More than half of our patients have a BMI > 25 and self-declare that they do not exercise. Our high rate of family history of heart disease (58%) raises the issue of genetic predisposition both to heart disease and sarcoma. We compared standardized cardiac risk assessments with mediastinal calcification and epicardial fat on serial chest CT scans. A 39 y.o. man had a coronary calcium score > 400 Agatston units and scattered calcifications were found in 4 additional patients under the age of 40. Conclusions: This survivorship phase of oncologic care represents a unique opportunity to improve the health and quality of life for sarcoma survivors as well as a new focus for translational research to understand mechanisms driving premature aging and chronic heart disease. We assess cardiomyocyte function (cell viability, organization, fibrosis, electrical coupling and contractility) for survivors and matched sibling controls with cells from skin biopsy using 3D bioengineering techniques to culture and mature the phenotype from human stem cells.
Sexual health and quality of life in testicular cancer survivors (TCS) in a third level hospital of a middle-income country.
Authors: De La Mora Hector , Hinojosa Juan , Velazquez Hugo Eduardo , Castillejos-Molina Ricardo Alonso , Monjaras Victor , Bourlon Maria Teresa
Published: September 2018

e21589

Background: TCS have long life expectancy, but struggle with numerous potential long-term sequelae, including sexual dysfunction (SD). They can suffer organic SD as a treatment side effect, and non-organic SD as a result of psychosexual changes related to the disease. The aim of this study is to determine the prevalence of SD in a cohort of TCS in a middle-income country, and to examine possible influences on health-related quality of life (HRQoL). Methods: An observational, cross-sectional, descriptive and analytic study was conducted. TCS in our cohort underwent IIEF-5 questionnaire, and sexual hormones measurement. HRQoL was examined using SF-36 questionnaire. Beck Depression Scale was used to assess psychological symptoms. Logistic regression analysis was used to evaluate the association among SD and disease characteristics and HRQoL. A Pearson correlation test was performed between SD and disease free survival interval. Results:The study population comprised 35 men whose and mean age was 32±8.3 years (21-54) and the median follow-up time since the end of treatment was 24 months, . Twelve TCS (34%) reported any level of impairment of erectile function (ED), 21 (60%) had loss of sexual desire, and 15 (42%) reported orgasmic dysfunction (OD). The presence of ED, loss of desire, or OD were not associated with worse scores in all SF36 domains, including both composite scores and the total SF-36 score. Treatment with adjuvant chemotherapy (CT) or CT plus retroperitoneal lymph node dissection were not associated with ED (p = 0.8). Fatigue (SF-36 vitality) was statistically significant higher among our cohort of TCS compared to an age-adjusted normative Mexican male population, independently of SD or depression level (0.001). Fatigue was independently associated with higher levels of gonadotropins and lower of testosterone (p = 0.05). Conclusions: The incidence of SD in Mexican TCS is similar (34%) to the rate reported in other populations. HRQoL is decreased particularly in the vitality section, when compared to age-adjusted normative controls. Nevertheless, we did not demonstrate a correlation between SD and worse HRQoL or depression level. Fatigue was associated with low level of tesosterone.
Illness understanding of oncology patients in a community-based cancer institute.
Authors: Sivendran Shanthi , Jenkins Sarah , Svetec Sarah , Horst Michael , Newport Kristina Braine , Yost Kathleen J. , Yang Manshu
Published: September 2018

e21605

Background: Several studies have demonstrated patients have a poor understanding of prognosis, survival and effectiveness of chemotherapy, particularly in the setting of advanced cancer. This study examines oncology patients’ understanding of their illness based on accurate reporting of stage at diagnosis as well as knowledge of remission status. Methods: 208 cancer patients previously treated at our large community based cancer institute participated in The Consumer-Based Cancer Care Value Index (CCCVI) Field Survey. Electronic medical record (EMR) documentation of stage at diagnosis and remission status were compared to patients’ self-reported responses. Concordance of responses and variables influencing discordance were evaluated. Results: 51.0% of patients’ self-reported cancer stage matched the abstracted stage with the highest concordance in the advanced cancer patients (72%) versus stage I-III patients (36.4%-61.5%). Unexpectedly, discordance was lower among advanced cancer patients as compared to stage I-III patients (p = 0.0528) Those who were concordant for cancer stage at diagnosis were significantly more likely to be female (p = 0.001), under the age of 65 (p = 0.01), have an income greater than $60,000 (p = 0.03), and have more education (p = 0.02). 64.4% of patients’ self-reported remission status matched the abstracted status. Nearly 30% of patients were not sure about their status even when they were in remission. Conclusions: Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding, as well as highlights that an even greater number of patients with early stage I-III cancers have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.
Quality of life and cognitive functioning impairment associated with cisplatin-based chemotherapy in testicular cancer survivors.
Authors: Chovanec Michal , Vasilkova Lucia , Setteyova Lucia , Rejlekova Katarina , Obertova Jana , Sycova-Mila Zuzana , Palacka Patrik , Kalavska Katarina , Svetlovska Daniela , Mladosievicova Beata , Mardiak Jozef , Mego Michal
Published: September 2018

e21607

Background: Testicular cancer (GCT) survivors are at risk for different types of late treatment sequelae. This study aimed to evaluate long-term quality of life (QOL), sexual (SexF) and cognitive functioning (CogF) issues resulting from cisplatin-based chemotherapy. Methods: QoL, SexF and CogF data were prospectively collected in 83 GCT survivors with median 9 year follow-up (range 5-32). The chemotherapy group (CTG) consisted of 53 and 18 patients receiving a cisplatin cumulative dose of ≤ 400mg/m2 (LCD) and > 400mg/m2 (HCD), respectively. The control group (CG) included 12 patients treated with orchiectomy (6 pts) and adjuvant radiotherapy (6 pts). Data were collected using EORTC QLQ-C30, QLQ-TC26, FACT-Cog and sexual functioning questionnaires and analyzed according to the scoring guidelines. Results:The CTG survivors had significantly (all p < 0.05) more limitations while working or doing daily activities (37% vs 8%), needed to rest more often (61% vs 33%) and feared the disease relapse more often (73% vs 50%) compared to the CG. A subscale for family problems within QLQ-TC26 have shown higher impairment in the CTG vs. CG (mean score ± SEM: 54.2 ± 26.7 vs. 38.8. ± 7.3, P < 0.05). Cognitive abilities were perceived better in CG vs. CTG (mean score 24.5 ± 1.8 vs. 20.5 ± 0.7, P < 0.05). The CG surivors had higher education level and fathered more children compared to the CTG. The CTG felt more unsettled than the CG (all P < 0.05), however the impact of perceived cognitive impairment on their lives did not significantly differ ( P = 0.4). Patients who received HCD have suffered from dyspnea more often than patients treated with LCD (mean dyspnea subscale score ± SEM: 22.2 ± 4.4 vs 8.9 ± 2.6, P < 0.05). The HCD group also reported more difficulties to concentrate while watching television/reading newspaper and struggled to name things during conversation compared with the LCD group ( P < 0.05 for both). No impairment in sexual functioning was reported. Conclusions: Our study shows thatGCT survivors cured with cisplatin-based chemotherapy suffered from QoL issues and their perception of cognitive abilities was altered. The HCD of cisplatin further impaired several QoL and cognitive aspects.
A web-based tool to predict chemotherapy-associated cognitive impairment during survivorship.
Authors: Dorajoo Sreemanee Raaj , NG Terence , Chae Jung-Woo , Yeo Hui Ling Angie , Shwe Maung , Gan Yan Xiang , Foo Koon Mian , Loh Wei-Jen Kiley , Koo Si-Lin , Chay Wen Yee , Tan Tira Jing Ying , Beh Sok Yuen , Lim Elaine H. , Lee Guek Eng , Dent Rebecca Alexandra , Yap Yoon Sim , Ng Raymond C.H. , Chan Alexandre
Published: September 2018

e21609

Background: Chemotherapy-associated cognitive impairment (CACI) experienced during survivorship can dramatically impair quality of life, particularly among patients receiving treatment with curative intent. We construct a web-based tool to predict the risk of self-perceived CACI at 15 months post-chemotherapy initiation among early stage breast cancer patients, to facilitate screening and early intervention. Methods: We recruited patients receiving chemotherapy for early-stage breast cancer between 2011 and 2014. Subjective cognitive function was assessed using FACT-Cog before, during and at 15 months after initiating chemotherapy. Based on a previously established minimal clinically important difference, an 11-point reduction in FACT-Cog score relative to that at baseline was considered as clinically significant CACI. Factors evaluated as potential predictors of CACI included clinical, laboratory and demographic factors, behavioural symptom and quality of life assessments (EORTC-QLQ-C30). Logistic regression was used to construct a model predicting CACI. Validation was performed on an external cohort recruited between 2015 and 2016. Model discrimination and calibration were evaluated using the receiver operating curve (ROC) and Hosmer-Lemeshow goodness-of-fit, respectively. The model was implemented as a web-based tool. Results: A total of 131 patients were recruited for model development. The model consisted of baseline EORTC-QLQ-C30 fatigue subscale percentage [effect size (95% confidence interval), 5.0% (2.0% to 7.0%), p < 0.001] and the change in FACT-Cog score after 2 cycles of chemotherapy, relative to baseline [-4.0% (-7.0% to -1.0%), p = 0.007]. The model was validated on an external cohort of 33 patients, with an ROC of 0.60, Hosmer-Lemeshow goodness-of-fit statistic of 5.86 (p = 0.44), sensitivity of 57.1% and specificity of 76.9%. The web application is accessible at http://bit.ly/CognitiveRisk Conclusions: A web application to predict CACI risk has been developed and externally validated. The tool facilitates early screening for patients at high risk for CACI and allows timely interventions to prevent or minimize the impact of CACI during survivorship.
Fear of progression in patients with low-risk malignant melanoma.
Authors: Kaehler Katharina C. , Wagner Tobias , Blome Christine , Forschner Andrea , Garbe Claus , Gutzmer Ralf , Hauschild Axel , Heinzerling Lucie , Livingstone Elisabeth , Lang Berenice M. , Loquai Carmen , Schadendorf Dirk , Terheyden Patrick , Augustin Matthias
Published: September 2018

e21615

Fear of progression in patients with low-risk malignant melanoma Fear of cancer progression (FoP) is one of the problems most commonly reported by cancer patients and is among the most prevalent cancer-related worries in cancer survivors. FCR is highly variable in different cancer entities. Background: This study aimed to elicit the prevalence and significance of FCR in melanoma patients with low risk tumors and further to assess psychosocial and demographic factors predicting severity of FoP as well as to determine the impact of FoP on quality of life (QoL). Methods: In total, 133 patients with low-risk melanoma (pT1a) completed the short version of the Fear of Progression Questionnaire (FoP-Q-SF), the Hospital Anxiety and Depression Scale (HADS), and the EQ-5D questionnaire, as well as self-constructed questions on the socio-demographic background. Results: MeanFoP-Q-SF sum score was 30.1 points (± 8.4 points SD) and the median 29 points. Two thirds of patients deviated not more than 1 SD from the mean. Risk factors for elevated FoP were female gender (p < 0.01), young age (p = 0.04) and working (p = 0.02) patients and patients with severe comorbidities (p = 0.03). Cancer in closely related persons predicted higher FoP (p < 0.01). HADS anxiety scale (r = 0.49, p < 0.01) and depression scale (r = 0.26, p < 0.01) correlated with FoP. A negative correlation with the EQ-5D index was found (r = -0.34, p < 0.01). Conclusions: As in many other malignancies,FoP is prevalent in low-risk melanoma patients and is associated with reduced QoL. Severe comorbidities, cancer in related persons, gender and income could be identified as predictors of FoP. Considerable high levels of FoP even in patients with low-risk malignancies underline the need of psychosocial support and intervention for special subgroups of melanoma patients to enable the patient to manage FoP more successfully.
Comparison of palliative care for lung cancer patients (pts) at two Veteran Affairs Medical Centers.
Authors: Kothadia Sejal , Wang Zhen , Lee Sarah , Chang Victor Tsu-Shih , Park Yeun-Hee Anna , Olson Ellen , Klein David , Leaf Andrea Nadine , Hwa Stephanie , Zhong Fengming
Published: September 2018

e21621

Background: Palliative and end of life care is essential for lung cancer pts. We examined palliative care delivery for lung cancer pts at 2 VA medical centers. Methods: In an IRB approved protocol, we reviewed medical records of matched pts diagnosed with liver or lung cancer between 2006 and 2012 who were seen by palliative care at 2 VA medical centers (S1, S2). Veterans were compared by 1) demographics, 2) palliative interventions, and 3) outcomes: ED visit within 1 month (mo) of death, ED visit within 6 mo of death, and ICU within 30 days of death. Analyses were performed with SAS Studio Version 3.5. Results: We analyzed 69 male pts (29 at S1and 40 at S2), with a mean age of 63 and 66 years respectively. Thirty (43%) pts were Caucasian and 39 (56.5%) African American. Cancer stages were I (1%), Stage II (3%), Stage III0 (29%), Stage IV (58%), and unknown (8%). Median Karnofsky performance status was 60%. By site, differences were seen in DNR/DNI (S1, S2) [ 21 (72%), 12 (30%) p = 0.0007). For palliative care interventions, significant differences were seen in treatments for pain (S1, S2) [17 (59%), 37 (93%) p = 0.0011], constipation (S1, S2) [10 (34%), 35 (88%) p < 0.0001], and dyspnea (S1, S2) [8 (28%), 29 (73%) p = 0.0003], but not for holding goals of care discussions. We observed differences between sites in evaluations by palliative social work (S1, S2) [15 (51%), 39 (98%) p < 0.0001], mental health (S1, S2) [21 (88%), 10 (25%) p < 0.0001], and chaplain visits (S1, S2) [ 19 (66%), 36 (90%) p = 0.0167]. Finally with outcome, there was a difference between consultations by other medical specialties (S1, S2) [ 19 (66%), 39 (98), p = 0.0005] but not for ED visits, admissions, procedures or ICU stays at the end of life . Conclusions: There are site specific differences between VA medical centers and may reflect local practice patterns, Additional sites should be studied.
Reno-vascular toxicities associated with carfilzomib: Systematic review and meta-analysis.
Authors: Shah Chintan , Bejjanki Harini , Bishnoi Rohit , Jain Ankur , Samal Subhankar , Moreb Jan
Published: September 2018

e21622

Background: Carfilzomib (Carf) is a novel proteasome inhibitor that is approved for patients with relapsed multiple myeloma (RMM) who have failed ≥ 1 prior lines of therapy. The incidence and seriousness of Carf associated reno-vascular toxicities (RVT) is not well known. We performed systematic review of Carf literature with meta-analysis to determine its incidence and overall risk. Methods: Initial search of literature led to a total of 175 Carf related articles. However, we used a total of 29 publications; phase I/II, phase II and phase III clinical trials (n = 3) which used Carf as monotherapy or in combination. We excluded phase I studies. Incidence rates and odds ratios (OR) were calculated with either fixed effect or random effect model based on the heterogeneity of included studies. Toxicity such as hypertension (HTN), renal failure (RF) and venous thromboembolism (VTE) were reported according to CTCAE v4.0. Results: A total of 4560 patients with various hematological and solid malignancies were included. Incidences of toxicities were: 15.9% and 4.7 % for HTN, 11.2% and 3.44% for RF, 6.47% and 2.22% for VTE, respectively for all grades and high grades in each category. When compared to control group taken from phase III clinical trials, the risk of HTN and RF due to Carf was significantly higher [OR = 2.91 and 3.32 in HTN (P < 0.001)], [OR = 1.71 and 1.79 (P < 0.05) for RF], respectively for all grade and high grade in each category. Moreover, incidence of HTN with higher than standard dose of carf (27 mg/m2 twice weekly) was significantly higher (P < 0.001). RF and VTE did not have the dose effect. Concomitant use of immunomodulator (IMiD) significantly increased, as expected, the incidence of VTE (P < 0.001). There was no variation in the incidence of RVT among newly diagnosed versus RMM (P = 0.4). Conclusions: Overall incidence and risk of hypertension and renal toxicities seems to be high when using Carf. Higher doses of Carf seem to lead to higher incidence of HTN, while the risk of VTE is higher with concomitant IMiD use. The pathophysiology for these complications is poorly understood, however it could be secondary to endothelial effect of carf. Physician should be vigilant about these effects as it can lead to poor overall outcomes.