bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of time intervals in cancer screenings and older participants’ characteristics, in a U.S. nationally representative sample.
Authors: Razavi Marianne , Bergerot Cristiane Decat , Philip Errol James , Dale William
Published: June 2022

e24020

Background: Various guidelines regarding cancer screening intervals for older adults exist. They often differ based on age cut-offs. There is limited national data about factors impacting adherence to these guideline-based intervals. Using a national-representative dataset, self-reported screening rates between men and women for breast (Mammogram) or prostate (PSA) cancer were explored. The demographic and lifestyle characteristics associated with screening time intervals were also investigated. Methods: Data from the nationally representative National Social Life Health and Aging Project Wave 3 (NSHAP-W3, 2015) was used. Individuals with no history of cancer were asked: How long has it been since you last had a screening (Mammogram or PSA). Responses ranged from 1 = within the past year, 2 = between one and five years ago , 3 = more than five but less than ten years ago, 4 = ten or more years ago, 5 = never. Age groups consisted of 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, ≥80. Ordinal Logistic regression was used to study the association between screening time intervals (Mammogram or PSA) and participants’ characteristics (demographic, emotional, self-reported physical health, and physical activity). Results: Community-dwelling older adults (n = 2,320) were included (52% women, 48% men, with mean age of 66.9 years). There was a curvilinear response by age. The middle-age groups (60 thru 79) were significantly more likely to report shorter screening intervals, compared to the youngest group (50-54) and oldest group (≥80): ORs ranging from 0.30 to 0.61. No significant differences were observed between the oldest and youngest groups. Higher household income was associated with shorter time intervals (Mammogram: OR = 0.77; PSA: OR = 0.78, p < 0.001). African Americans were more likely to report shorter intervals between Mammograms (OR = 0.43, p < 0.001), compared to white women. More physically active men were likely to report shorter intervals (OR = 0.92, p = 0.021). Conclusions: Participants who are in their 60s or 70s, are more likely to have shorter time intervals between cancer screenings. African American women, and men performing frequent exercise are also more likely to have shorter intervals. These results emphasize the importance of sociodemographic and lifestyle factors, when seeking to impact cancer screening timing.
The association of cancer diagnosis with frailty status in high need, high risk veterans.
Authors: Resendes Natasha M , Oomrigar Shivan M , Tannous Toufic , Ruiz Jorge G , Hammel Iriana M
Published: June 2022

e24024

Background: Frailty, a common geriatric condition, is characterized by a vulnerability to stressors caused by multisystem dysfunction associated with poor clinical outcomes. Patients with frailty are often High-Need High-Risk (HNHR), a group with higher levels of healthcare utilization. Cancer diagnosis could increase the incidence of frailty in this group by several mechanisms: immunosenescence, chronic inflammation, potentially harmful effects of therapies and associated comorbidities. The study aim was to determine the cross-sectional association of cancer with frailty status in High Need, High Risk veterans. Methods: This was a cross-sectional study of HNHR Veterans in the Veterans Integrated Service Network 8 identified through quarterly reports run by VA predictive analytic models. We compared Veterans with and without cancer in terms of frailty status, sociodemographic characteristics, substance or alcohol abuse and number of medications. Frailty was defined using a 30-item VA Frailty Index (VA-FI, excluding cancer) generated as a proportion based on the number of items present. We compared non-frail (robust = 0–0.1, and pre-frail = 0.11–0.20), and frail (mild = 0.21–0.30, moderate = 0.31–0.40, and severe = > 0.4). After adjusting for gender, age, alcohol abuse, tobacco abuse and number of medications, we performed a multinomial logistic regression using odds ratios (OR) with 95% confidence intervals (CI) with cancer as the independent variable and frailty status as the dependent variable. Results: A total of 10916 Veterans were included in the analysis, mean age 68.5 (SD = 11.8) years, 93.4% male, 74.7% Caucasian, 18.0% Black, 7.4% Hispanic, 8710 (79.8%) frail and 3641 (36.1%) had Cancer. Of those with cancer, frail = 3358 (85.2%) vs. non-frail = 583 (14.8%) (p < .0001). After multivariate multinomial logistic regression, the presence of cancer was associated with being severely frail as compared to robust, adjusted OR:2.3(95%C.I.:1.8-2.9), p < 0.0001. Conclusions: In this HNHR veteran population, cancer had a positive, cross-sectional association with frailty. Identifying HNHR patients with cancer may assist clinicians in the implementation of targeted clinical interventions that may prevent or reverse frailty status and associated poor clinical outcomes. More research is needed to better determine the impact of cancer on frailty diagnosis.
Impact of specific oncologic and geriatric parameters in predicting chemotherapy toxicity and death in elderly cancer patients.
Authors: Gholam Dani E , Stephan Elie , Bassil Nazem , El Haddad Kamal , Antonios Diane , Gerges Zeina , Chebib Amale , Haydar Mazen , El Bikai Rana
Published: June 2022

e24026

Background: Cancer is mainly a disease of the elderly with more than 75% of patients aged 65 years and more at diagnosis. Comprehensive geriatric assessment (CGA) is usually used to assess elderly cancer patients¹. However, its sensitivity in predicting their outcome is questionable. Methods: We investigated whether specific oncologic and geriatric markers could predict chemotherapy toxicity and cancer-related death in a prospective single center study with 110 chemo-naive patients with advanced cancer. All patients underwent a CGA. Frailty markers as defined by Fried2 as well as basic oncologic data were collected. Bivariate and multivariate analysis were done to assess the relation between the different variables and major toxicity. A Cox regression model for survival analysis was also performed. Results: Median age is 74 years [65-90 years]. 46% have stage IV disease. 27% have aggressive cancer as defined by Hurria et al3. Grade III-IX chemotherapy-related toxicity occurred in 22% of patients. Combined chemotherapy drug regimens, loss of appetite in the last 3 months and polypharmacy at baseline were predictive of chemotherapy toxicity in multivariate analysis. After a median follow-up of 12 months, 59% died of disease progression. In multivariate analysis, advanced cancer stage, initial loss of > 5% body weight within 1 year, altered physical activity and Activity of Daily Living (ADL), anemia and heavy comorbidities (CIRS – G score) were predictive of poor outcome (Table). Conclusions: In elderly cancer patients, poor nutritional status and heavy comorbidities are predictive of both chemotherapy intolerance and death. In addition, markers such as anemia, advanced cancer stage, altered physical activity and impaired ADL predict early death. Balducci L. The Oncologist 2000. Fried LP. J Gerontol A Biol Sci Med Sci 2001. Hurria A. J Clin Oncol 2011. Clinical trial information: 02-02-18. [Table: see text]
Evaluation of the geriatric 8 (G8) screening tool in a multi-ethnic Asian population of older adults with cancer: Results from Geriatric Oncology Longitudinal End to eNd (GOLDEN) Study.
Authors: Chen Matthew Zhixuan , Rais Nydia Camelia , Tey Jeremy Chee Seong , Ling Natalie Mun Wai , Ng Yean Shin , Chun Meiling , Said Noorhanah Mohd , Eng Wan Nghee , Ho Francis , Pang Shien Ling Angela
Published: June 2022

e24029

Background: The Geriatric 8 (G8) questionnaire has been validated predominantly in Western populations as a screening tool to identify vulnerable older adults with cancer who would benefit from comprehensive geriatric assessment (CGA). Given the paucity of evidence of the performance of this tool in a multi-ethnic Asian population, there is a need to determine whether the established cut-off score of 14 should be adjusted for improved performance in this population of older adults. Methods: Prospective cross-sectional study was done in older adults aged ≥ 65 years in the outpatient setting of an academic tertiary cancer center, the National University Cancer Institute, Singapore (NCIS). G8 questionnaire and CGA were conducted for eligible patients. The performance of the G8 screening tool in identifying patients who would benefit from a CGA was evaluated using receiver operating characteristic (ROC) curve analysis: area under the curve (AUC), sensitivity (Sn), and specificity (Sp). Results: 180 participants (mean age 74 years) were included in the study. 40.5% were female. 90% were Chinese, 7% were Malay, 2% were Indian. 57.8% were pre-frail and 12.8% were frail. The top five cancers in our study population were colorectal (30%), lung (25%), head and neck (12%), upper gastrointestinal (10%) and gynecological (7.0%). ROC analysis showed an AUC of 0.73 (95% CI 0.65 – 0.80) with an optimal cut-off score of 13 (Sn 71.7%, Sp 74.0%). Conclusions: G8 performed well in identifying older adults with cancer who would benefit from a CGA, in a multi-ethnic Asian population. In our cohort, we found that a slightly lower cut-off score of 13 performed better, and should be taken into consideration as part of daily oncology practice in Asia. Future research efforts should go into examining the biological aspects of frailty in this population.
Immuno-senescence and elevated central carbon metabolism in hematopoietic stem cell compartment upon aging.
Authors: Beiro-Poisa Laura , Landry Jonathan J.M. , Ho Anthony D.
Published: June 2022

e24030

Background: Aging is associated with decline of hematopoiesis, compromised innate immunity, and propensity for malignancies. Aging of the hematopoietic stem and progenitor cell (HSPC) compartment is caused by accumulation of senescent cells and elimination of the latter rejuvenates innate immunity in animal models. Methods: HSC (CD34+) were isolated from the bone marrow of healthy human subjects (age range 20 – 74 years; n = 18) and separated by FACS in 3 distinct subsets with high, intermediate, and low glucose uptake (GU) capacity (GUhigh, GUinter, GUlow). Single-cell RNA-sequencing (scRNAseq) studies, followed by gene ontology (GO) analysis of biological processes, analysis of cell cycle, and gene set enrichment analysis (GSEA) were performed. Results: While the percentages of GUinter and GUlow subpopulations remain relatively constant with age, the proportion of GUhigh subset increases continuously with age (from 0.2% in adults < 30 years to 6,7% in > 60 years). GO analysis revealed that the GUhigh subset showed a significantly higher expression of genes involved in myeloid development, cell cycle arrest, inflammation and stress response, apoptosis, and significantly lower expressions of genes involved in lymphoid development. GSEA confirmed that the gene sets for cell cycle arrest, senescence associated secretory phenotype (SASP), anti-apoptosis/survival and P53 pathways are significantly up-regulated in the GUhigh subset. The latter shows therefore all deregulations that are inherent hallmarks of senescence. Most of the molecular deregulations are similar to those found in murine models of aging, but there are significant differences. In addition, cell cycle analysis revealed that the proportion of cells in the G1 phase was significantly reduced in the GUhigh subset. Comparing the frequencies of old to young GUhigh, GUlow cells along the cell cycle progression ranks showed a significant depletion of cells in late G1 phase among GUhigh cells but not in the other subsets. The frequencies of non-cycling cells in the GUlowsubset have remained high (> 70%) irrespective of age, thus providing evidence for the quiescence status of the GUlow subset, as well as for persistence of HSPC with “young phenotype”. Conclusions: Our series of proteome and single cell transcriptome analyses have shown that the GUhigh subpopulation is highly enriched in senescent HSPCs. This property may be exploited to enrich, visualize, and trace senescence in human bone marrow. Cell cycle analysis has revealed a significantly shortened G1 phase that is linked to dedifferentiated state in the senescent HSPC. Our results indicate a dependency of senescent HSPCs on elevated glucose metabolism as well as on anti-apoptotic factors for survival. These may represent ideal targets for elimination of senescent HSPC to restore innate immunity as demonstrated in murine models.
Active Living After Cancer (ALAC) program: An avenue to improve physical functioning and moderate-intensity physical activity in gynecologic cancer survivors.
Authors: Unke Jenna , Wilson Jordan , Mitchell Stacy J , Montes Giselle , Basen-Engquist Karen , Fleming Nicole D.
Published: June 2022

e24034

Background: Active Living After Cancer (ALAC) is a 12-week evidence-based program funded by the Cancer Prevention and Research Institute of Texas (CPRIT) to provide physical activity and survivorship education to cancer survivors. Given the limited data evaluating the effects of physical activity educational programs in gynecologic cancer survivors, we aim to assess the effects of the ALAC intervention in this patient population. Methods: A retrospective analysis was performed on gynecologic cancer survivors who participated in ALAC from 2017 to 2021. The 12-week ALAC program included weekly meetings (in-person or virtual) led by a facilitator providing physical activity behavioral skills training, leading 10 minutes of exercise, and discussing topics related to cancer survivorship. Surveys and functional testing assessments were collected pre- and post-program which included: The Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) and 30-second sit-to-stand. A patient-reported outcomes survey was used to assess patient perceived benefits and program satisfaction. Results: Thirty-two patients participated in ALAC and 22 completed pre- and post-program assessments. The mean age of participants was 60.2 years (range 50.7-69.7 years) and mean number of classes attended was 8 (range 0-12 classes). Prior cancer diagnoses included 14 cervical, 11 uterine, and 7 ovarian cancers. A significant improvement was seen pre- and post-ALAC in moderate-intensity physical activity minutes (n = 17, 97 vs 252 minutes, p = 0.007) by GSLTPAQ and 30-second sit-to-stand test (n = 16, 12.3 vs 15.8 repetitions, p = 0.003) in our cohort. The post-ALAC patient reported outcome survey (n = 22) revealed improvement in emotional well-being (90%), physical well-being (91%), physical activity level (100%), comfort speaking openly in a group (85%), and willingness to discuss their cancer journey (66%). Overall, 95.3% of participants were satisfied with the ALAC program and 100% of participants would recommend the ALAC program to other cancer survivors. Conclusions: Educational physical activity-based programs like ALAC improve physical functioning and moderate-intensity physical activity in gynecologic cancer survivors. Further studies on the long-term health benefits of structured educational programs which promote active lifestyles in gynecologic cancer survivors are needed in larger patient cohorts.
Completion of electronic patient reported outcome measures among diverse cancer patients treated in an integrated health system.
Authors: Adjei Boakye Eric , Tam Samantha , Zatirka Theresa , Neslund-Dudas Christine , Su Wan-Ting , Cannella Cara E , Chang Steven S. , Movsas Benjamin
Published: June 2022

e24035

Background: Patient reported outcome measures (PROMs) are derived entirely from patients’ perspectives and complementary to traditional clinical assessment. Use of PROMs as a symptom communication tool has been demonstrated to improve quality of life, decrease health care utilization, and improve overall survival in clinical trial settings. However, clinical trial enrollment is known to be biased, often excluding those with the most difficulty accessing care. Henry Ford Cancer Institute has implemented a PROMs platform integrated with routine clinical care throughout the vertically integrated health system for all cancer disease sites. The purpose of this study is to compare patient characteristics in those responding to and those without response to PROMs to understand potential disparities. Methods: All patients with a diagnosis of cancer and a visit with an oncologic provider were offered an opportunity to complete PROMs between September 16, 2020 to July 19, 2021. Domain-specific National Institute of Health’s computer adaptive technology Patients-Reported Outcomes Measurement Information System (PROMIS) instruments in pain interference, physical function, fatigue, and depression were offered prior to a visit using a patient-facing electronic portal or via iPAD at the time of visit. Patient level demographic, insurance, ZIP code level socioeconomic status and clinical data were compared across PROMs responders and non-responders using multivariable logistic regression. Results: A total of 3,226 patients were included in the study, of whom 1,652 (51.2%) responded to PROMs. The mean age of the patients was 60 years (SD = 13) and 60.5% were females. Most were of white race (68.8%) and were married (56.1%). There was similar distribution of patients with private (43.7%) and Medicare (41.6%) insurance. After adjusting for age, sex, race, marital status, education, income, insurance and stage, patients who were single (aOR = 0.78; 95% CI: 0.65—0.94) or had Medicare insurance (aOR = 0.68; 95% CI: 0.55—0.83) were less likely to respond to the PROMs. Patients diagnosed with early-stage (stages 0,1,2) disease (aOR = 0.79; 95% CI: 0.67—0.93) were less likely to respond to PROMs, but those with unknown stage (aOR = 1.27; 95% CI: 1.04—1.56) were more likely to respond to PROMs compared to those diagnosed with late-stage (stages 3,4) disease. There was no significant association between race and PROMs response. Conclusions: Patients who are single, have Medicare insurance, and early-stage disease are less likely to respond to PROMs. Future implementation efforts need to focus on these populations to ensure equitable availability of PROMs as a tool for symptom communications in patients with cancer.
A cross sectional survey to assess knowledge, attitude, and practice of Yoga among cancer patients at a tertiary care hospital in Rishikesh, India.
Authors: Sehrawat Amit , Malik Sweta , Mudgal Shikha , Dogra Twinkle , Barnwal Suresh Lal , Chaturvedi Jaya , Nath Uttam Kumar , sundriyal Deepak
Published: June 2022

e24040

Background: The global cancer burden continues to rise, putting individuals under severe physical, mental, and financial stress. Yoga may aid chemotherapy patients to improve their quality of life. The purpose of this survey is to learn more about the gaps in knowledge, attitude, and practice of Yoga and barriers. Methods: The cross-sectional time-bound survey was conducted on cancer patients of age 18 years and above receiving cancer treatment at the outpatient clinic of AIIMS Rishikesh. We collected data of 738 cancer patients, bivariate and multivariate analysis was done to understand the level of awareness of the importance of Yoga as an alternative therapy. Results: Of 738 cancer patients who participated, 90.2% had heard about Yoga. Among those aware of yogic practices, only 15.9% knew that Yoga is an alternative therapy across the world. Knowledge of yogic importance was associated with age (OR = 1.16, 95% CI = 1.07-1.26, p = 0.002), education (OR = 0.5, 95%CI = 0.4-0.6, p < < .001), religion (OR = 1.16, 95%CI = 1.1-1.2, p < < .001). Attitude towards Yoga with the belief that it helps maintain mental health has a positive association with education (OR = 0.9, 95% CI = 0.8-0.9, p = 0.03). Almost 56% of cancer patients had never practiced Yoga. The identified barriers in yogic kriya practice were lack of time, interest, and facilities. Conclusions: The knowledge of the benefits of Yoga on health was high in adolescent young cancer patients. Still, the motivation towards yoga practice is limited due to various factors like lack of infrastructure, time, belief. The gap between knowledge, attitude, practice, and barriers can be overcome by conducting effective yogic programs for this population.
Low doses of advanced glycation end-products and fructosilation products promotes premature cell death of human cardiac cells and increases drug resistance of human breast cancer cells exposed to doxorubicin through NLRP3 and MyD88 pathways.
Authors: Quagliariello Vincenzo , Iovine Martina , D'Aiuto Giuseppe , Buccolo Simona , Maurea Carlo , Bonelli Annamaria , Paccone Andrea , Canale Maria Laura , Maurea Nicola
Published: June 2022

e24055

Background: Advanced glycosylation end-products (AGEs) are non-enzyme, protein glycosylation products caused by glucose-induced metabolic disorder, and play an important role in aging, cancer, metabolic syndrome and cardiovascular diseases. We aimed to assess whether AGEs and fructosilation products, such as methylglyoxal (MG) and N-carboxymethyllysine (N-CML) could increase susceptibility to cell damages induced by doxorubicin. Methods: Human cardiomyocytes were pre-exposed for 24h with low doses (50 mmol/L) of methylglyoxal (MG) or N-carboxymethyllysine (N-CML). After, cells were exposed to subclinical concentration of doxorubicin (at 100 and 200 nM) for 48 and 72h. After the incubation period, we performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity, study of lipid peroxidation (quantifying cellular Malondialdehyde and 4-hydroxynonenal), intracellular Ca2+ homeostasis. Moreover, pro-inflammatory studied were also performed (activation of NLRP3 inflammasome; expression of peroxisome proliferator-activated receptor-α; mTORC1 Fox01/3a; transcriptional activation of p65/NF-κB and secretion of cytokines involved in cardiotoxicity (Interleukins 1β, 8, 6). Expression of p53 was also performed through western blot method. Results: Pre-exposure to methylglyoxal (MG) but especially to N-carboxymethyllysine (N-CML) increase cell mortality to doxorubicin of 48-53% compared to control. Pre-exposure to N-CML promotes premature death of cardiomyocytes to doxorubicin through NLRP3-driven pathways. Notably, MG and N-CML increased significantly the cardiotoxicity through NLRP3 inflammasome, Myd88 myddosome and cytochrome C-mediated apoptosis. Pre-exposure to N-CML and MG increase the secretion of interleukin-6 that increase cell apoptosis through a paracrine and autocrine mechanism. Induction of IL-6 reduces the expression of p53 resulting in the induction of the apoptotic process. Conclusions: These observations suggest that AGEs and fructosilation producs promotes premature cardiotoxicity of human cardiac cells exposed to doxorubicin by activation of NLRP3, Myd88-related pathways and downregulation of p53.
A nutraceutical combination of spirulina, reishi and moringa exerts significant cytoprotective effects againts doxorubicin and trastuzumab cardiotoxicity.
Authors: Paccone Andrea , Quagliariello Vincenzo , De Anseris Raffaele , Ostacolo Carmine , Buccolo Simona , Iovine Martina , Maurea Carlo , Conforti Gabriele , Caronna Antonietta , Maurea Nicola
Published: June 2022

e24056

Background: Anthracycline and trastuzumab are essential adjuvant therapies for a variety of cancers, particularly breast, and gastric and esophageal cancers. Whilst prolonging cancer-related survival, these agents can induce drug-related cardiotoxicity. Cardioprotective agents used to mitigate cardiotoxicity, such as angiotensin antagonists, angiotensin receptor blockers and beta‐blockers, are often poorly tolerated in these patients due to intravascular volume fluctuations, which are further escalated by the hemodynamic side effects of these agents. Spiruline, Reishi and Moringa are nutaceuticals with anti-inflammatory effects that are currently used in cancer patients to improve quality of life and fatigue. We hypothesize that the combination of Spirulina, Reishi and Moringa could reduce inflammation and cardiotoxicity of anthracyclines and trastuzumab. Methods: Human cardiomyocytes were exposed to subclinical concentration of doxorubicin and trastuzumab (200 nM) alone or in combination with a formulation composed by Spiruline, Reishi and Moringa (at 10, 25 and 50 µg/ml) for 48h. Cell viability, apoptosis and necrosis were performed. Quantification of malondialdehyde and intracellular Ca2+ were performed through spectrophotometric methods. Anti-inflammatory studies were also performed (expression of NLRP3, TLR4/MyD88 pathways, nuclear expression of NF-kB). Intracellular concentration of IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL17-α were also performed. Results: Spiruline, Reishi and Moringa in combination increased synergistically the cell viability during exposure to doxorubicin and trastuzumab. The nutraceutical formulation reduces intracellular Ca2+ overload (-48,8% vs cells treated only to anticancer drugs; p < 0,001), lipid peroxidation (- 47,2 % compared to cells exposed only to anticancer drugs; p < 0,001). The expression of MyD88 and NLRP3 inflammasome were also reduced (-36,3 and -28,58 % vs cells exposed only to anticancer drugs, respectively; p < 0.001). Notably, Spiruline, Reishi and Moringa increased of 26,3% the production of IL-10 and IL-2. Cytokines involved in cardiotoxicity and chemoresistance were reduced, such as IL-1α and IL-1β (-18,3 and -27,4 % vs DOXO-TRA group), IL-6 (-31,2 % vs DOXO-TRA group) and IL17-α (-27,3 % vs DOXO-TRA group) (p < 0.01 for all). Conclusions: During exposure to doxorubicin and trastuzumab, the combination of Spiruline, Reishi and Moringa exerts cardioprotective and anti-inflammatory effects. Their properties are mediated by the reduction of iCa2+ content that consequently reduces lipid peroxidation and the expression of NLRP3- MyD88. These results indicating the potential use of this nutraceutical formulation in preclinical models of anthracycline and anti HER2 antibodies-mediated cardiotoxicity.
Gender features of the chronic pain effect on some vascular endothelial growth factors and their skin receptors on the B16/F10 melanoma model.
Authors: Kotieva Inga Movlievna , Frantsiyants Elena M.
Published: June 2022

e24061

Background: Patients with oncological pathology, especially with the progression of the disease, often have chronic pain[1]. Pain effects singly can cause dysfunction of the vascular system, which could be an additional risk of the tumor process progression. The aim of the study was to identify gender-specific chronic pain effects on some vascular endothelial growth factors and their skin receptors in the B16/F10 melanoma model. Methods: The study was conducted on mice of the C57BL/6 line (females, males; age 8 weeks, weight 21-22 g, n = 48, 12 animals in each group). Two weeks after the ligation of the sciatic nerve melanoma B16/F10 was transplanted under the skin in the back of the main groups of animals (I- females, II-males); control groups were held the same procedure without ligation (III-females, IV-males). The levels of VEGFA, sVEGFR1, VEGFC, sVEGFR3 were determined in intact skin by ELISA. All manipulations were carried out in accordance with the European Convention for the Protection of Vertebrates Used for Experimental and Other Scientific Purposes (ETS 123). Results: Chronic pain contributed to the accumulation of VEGF-A, sVEGF-R1, VEGF-C in the skin and the reduction of sVEGF-R3 in all animals: in females - 2.7 times, 2.9 times, 6.1 times and 6.1 times, accordingly, in males - 3.1 times, 3.7 times, 3.5 times and 7.2 times, accordingly. Consequently, in males the amplitude of fluctuations of VEGF and their receptors in the skin against the background of pain was higher than in females, except for VEGF-C, the amount of which increased in females more than in males, despite its identical initial level in the skin of animals of both sexes. As a result, the skin of males with pain contained more VEGF-A, sVEGF-R1 and sVEGF-R3, accordingly, by 1.4 times (p < 0.05), 2.0 times and 1.9 times (p < 0.05) and less VEGF-C - by 1.8 times (p < 0.05). Conclusions: Chronic neuropathic pain had different effects on changes in the level of vascular endothelial growth factors and their receptors in intact skin in females and males of melanoma B16/F10 tumor carriers. The gender characteristics of the effect of chronic pain on neoangiogenesis may be associated with different rates of growth and development of the malignant process in male and female mice in the experiment. References [1] Kotieva I.M. et al. Chronic pain and accumulation of growth factors in perifocal tissues of melanoma and impact on malignancy and early metastasis. Journal of Clinical Oncology . 2018. Т. 36. № S15. С. e21621.
Mortality and prognostic factors in hospitalized COVID-19 patients with cancer: An analysis from a large healthcare system in the United States.
Authors: Tarockoff Meri , Raez Luis E. , Uribe Carlos Carracedo , Niu Jianli , Sareli Candice , Sundararaman Nithya , Ion Jayme , Eckardt Paula , Hussein Atif Mahmoud
Published: June 2022

e24063

Background: Coronavirus 19 (COVID-19) is a severe global pandemic and a public health challenge. Patients with COVID-19 and cancer are at an increased risk of poor clinical outcomes. Data is lacking in evaluating outcomes in patients with different cancers, races and ages; particularly in Florida with high proportion of elderly and the largest racial/ethnic disparities. We evaluated the in-hospital mortality of COVID-19 positive cancer patients. Methods: We used retrospective data of COVID-19 patients hospitalized at the Memorial Healthcare System between March 1, 2020 and January 18, 2021. Over 4,870 patients with COVID-19 were evaluated, of which 265 (5.4%) had cancer. The primary endpoint was in-hospital mortality in patients with cancer and COVID-19. Mortality was analyzed in COVID-19 patients with/without a cancer history. We used descriptive statistics to synthesize outcomes and characteristics from the study population. Univariate and multivariate logistic analysis were performed to define baseline clinical characteristics potentially associated with mortality in cancer patients with COVID-19. Results: 4,870 patients with COVID-19 were evaluated and 265 had malignancy. The study included all different races including Non-Hispanic Whites (NHW) 816 (16.8%), Hispanics 2,271 (46.6%), African-Americans (AA) 1,534 (31.5%) and other minorities 248 (5.1%). Of cancer patients, 24.1% NHW, 43% Hispanic, 28.7% AA and 4.2% other minorities. Amongst races, NHW with cancer accounted for the highest number of COVID-related deaths representing 37.5%, while Hispanics and AA accounted for 18.4% and 19.7% respectfully. Amid cancer subtypes, 24.6% of hematological cancers resulted in mortality and 23.5% of solid cancers resulted in mortality, but no statistical significance was seen. Additionally, after adjusting for age, gender, and race, cancer was linked to an increased in-hospital mortality. Lastly, older age (> 65), elevated creatinine levels (Cr) and elevated C-reactive protein (CRP) were associated with increased risk of death. Conclusions: Patients with COVID-19 and cancer had worse outcomes. Cancer subtypes included hematological and solid cancers, with similar in-hospital mortalities. Although NHW were the smallest group, they had the highest rate of in-hospital deaths amongst cancer patients with COVID-19, in comparison to Hispanics, the largest group in the study, had the least amount of in-hospital deaths. Additionally, factors such as advanced age, elevated Cr and CRP were associated with increased risk of COVID-related deaths. The findings indicate the need for close surveillance and monitoring of these patients as they are more likely to have complications such as mortality from COVID-19.
Palliative care integration and end-of-life outcomes in veterans with metastatic colon cancer.
Authors: Aung Ye , Kapoor Vidit , Datta Paromita
Published: June 2022

e24069

Background: Metastatic Colon Cancer is associated with an overall poor prognosis with an estimated 5 year survival rate < 14% according to SEER data. There has been a movement in national society guidelines to advocate for increased utilization and integration of palliative care for all patients with metastatic solid tumors. Here through retrospective chart review we examined the impact of palliative care consultation on end of life outcomes at the Audie L Murphy Veterans Affairs Medical Center in San Antonio. Methods: With the help of the VA tumor registry we compiled a list of 103 Veterans diagnosed with metastatic colon cancer and who were seen from January 2013-December 2021 at the Audie L Murphy VAMC. Data was abstracted from electronic chart review in CPRS and analyzed to compare differences in end of life outcomes between patients that received palliative care and those that did not. Statistical significance was calculated using Fisher's Exact Test. Results: Overall 53/79 (67%) of Veterans were seen by a palliative care physician prior to death which is higher than the national average 45%. There was an overall high rate of completion of advance directives in this clinic 82/103 (79.6%), however, patients who were seen by palliative care were more likely to have completed advance directives (90.8% vs 60.5%, p < .001). Patients seen by palliative care were also more likely to have their setting of death occur outside of the hospital (86.4% vs 64%, p < .04), they were also less likely to be admitted to the ICU < 30 days prior to death (9.8% vs 30.4%, p < .04) and they were less likely to receive CPR < 30 days prior to death (3.9% vs 22.3%, p < .03). We did not find any statistically significant differences in hospice enrollment rates, (79.2% vs 56% p < .057) nor did we find any differences in chemotherapy < 30 days prior to death (15.4% vs 19.2% p < .75). Our study was limited by the smaller sample size of patients not receiving palliative care. Of note our population was overwhelmingly male (97%) and the average age at diagnosis of metastatic disease was 65.6. Conclusions: Overall the utilization of palliative care in Veterans with metastatic colon cancer is associated with better advanced care planning and decreased aggressiveness in end of life care. These results are consistent with other studies and our retrospective analysis provides more data supporting the increased utilization of Palliative Care for Veterans with metastatic colon cancer.
Palliative care utilization and mortality in patients who received inpatient chemotherapy.
Authors: Anderson Justine , Handa Shivani , Petrone Giulia , Chowdhury Nobel , Kwon Deukwoo , Bhardwaj Aarti Sonia , Jain Priya , Smith Cardinale B. , Berger Natalie S
Published: June 2022

e24074

Background: Early integration of palliative care (PC) into advanced cancer care has been shown to improve quality of life and prognostic understanding. However, there is a paucity of data on utilization of inpatient PC consultation and survival outcomes in patients (pts) receiving inpatient chemotherapy (IC). Methods: A retrospective review was performed at a single academic center of pts receiving IC between Jan 2016 and Dec 2017. We evaluated utilization of PC services, reasons for consult, code status, disposition, and 60-day mortality. Descriptive statistics and odds ratios (OR) were estimated from logistic regression models with mixed-effect, taking into account correlations from multiple admissions per patient. Cumulative incidence plot and Cox proportional hazard regression models were used to assess the association between mortality and study covariates. Results: Of 880 admissions, 733 (83%) were hematologic malignancies (HM) and 147 (17%) were solid tumors (ST). PC consults were more likely in ST than HM (OR 3.19, 95% CI 1.85 - 5.50) and for KPS ≤50% (OR 22.20, 95% CI 11.51- 42.79). Of 159 PC consults, 91 (57%) were for pain and 25 (16%) for goals of care. 66 pts (10%) who received IC died within 60 days of admission, 44 (67%) HM and 22 (33%) ST (p = 0.002). In pts who died within 60 days, 63% had PC consult. Median time from admission to PC consult was 2 days for ST and 9 for HM. Of those with PC consult, 40% had a change from full code to DNR/DNI and were more likely to have a health care proxy (HCP) assigned (OR 7.31, p = 0.001). PC consults were also associated with significantly higher odds of discharge to hospice (OR 10.52, 95% CI: 4.3-25.6; p = < 0.0001; Table). Mortality risk was higher in those admitted for symptoms/complications related to their disease or with progression (HR 3.24, 95% CI (2.50-4.19), p < 0.001) and in those with advanced stage disease: Stage 3 (p = 0.033); Stage 4 (p = 0.0003). Of the pts who died within 60 days, 33 (50%) died during the admission and 24 (36%) in hospice. Conclusions: Significant 60-day mortality after receiving IC is consistent with aggressive end-of-life care. Pts with ST and those with poor performance status more frequently utilized inpatient PC services; however, there is opportunity to increase utilization amongst pts with HM and introduce PC earlier in the inpatient clinical course. PC consultations improve advanced care planning with appropriate transitions in code status, HCP assignments, and discharge to hospice.[Table: see text]
Effectiveness of NEPA, an oral fixed-dose combination of NEtupitant and PAlonosetron in the prevention of chemotherapy-induced nausea-vomiting in patient receiving highly emetogenic chemotherapy regimens.
Authors: Jadhav Amit Y , Gupta Sudeep , Biswas Ghanashyam , MV Chandrakanth , Dattatreya Palanki Satya , Thomas Boben , Gupta Sumant , Bhagat Sagar B , Patil Saiprasad , Barkate Hanmant B
Published: June 2022

e24090

Background: Patients receiving Highly Emetogenic chemotherapy (HEC) are > 90% risk of nausea-vomiting due to the drug's emetogenic potential and patient-related factors such as young age, female gender, low/no alcohol, H/O morning sickness and use of alternative medications. The current study was designed to assess the effectiveness of NEPA in patients receiving HEC in a real-world setting in India. Methods: An open-label, single-arm, prospective study among chemonaive patients was conducted across six centers from April 2019 to December 2021 after approval from each institutional ethics committee (CTRI/2020/02/023586). Complete response and treatment-emergent adverse events were the primary endpoints. Secondary endpoints included completion protection, complete control and severity of nausea. Results: HEC regimens were prescribed in 289 of the 360 patients enrolled in the study. Most common HEC regimen was Anthracycline-Cyclophosphamide (44.2%) followed by Paclitaxel-Carboplatin (17.9%). Average age of study population was 52.8±9.8 yrs. with male: female ratio of 1:2.1. Hypertension (17.6%) and diabetes (12.4%) were common comorbidities. Complete response in acute, delayed and overall phases were 94.4%, 94.8%, and 92.7% respectively. In overall phase, complete protection and complete control was 86.8% and 77.5% respectively. Mild, moderate and severe nausea were reported in 11.7%, 7.6%, and 2.4%, patients respectively. Adverse events were seen in 10(3.4%) patients, with leg pain being the most common 3(0.8%). One serious adverse event, unrelated to the study drug was reported. Conclusions: NEPA was effective and well tolerated in patients on a HEC regimen in the acute, delayed and overall phases with a completed response rate of > 90%. Clinical trial information: CTRI/2020/02/023586. [Table: see text]
Trends in palliative care interventions for stage IV esophageal cancer: An analysis of the NCDB.
Authors: Seraphin Michael , Silberstein Peter T. , Cichon Gregory
Published: June 2022

e24104

Background: Palliative care (PC) addresses patient quality of life and satisfaction with care. Oncological PC can be manifested through surgery, radiation, chemotherapy, and pain management. These treatments do not cure disease but improve quality of life. The survival rate for stage IV esophageal cancer is 15-20%, making it an excellent candidate for PC. This study will analyze patterns in who received each type of PC. Methods: This study looked at 8808 patients with stage IV esophageal cancer who received PC interventions from 2004-2018 in the National Cancer Database (NCDB). The NCDB listed 4 types of PC: surgical, radiation, chemotherapy/hormone therapy, and pain management. All modalities were to “alleviate symptoms, but no attempt to diagnose, stage, or treat the primary tumor is made.” Exclusion criteria was concurrent tumors and missing data. Histology subgroups were divided into adenocarcinoma, squamous cell carcinoma, and other, based on ICD-O-3 coding. Cross tabulation analysis was performed using Pearson chi-square and ANOVA tests. Kaplan Meyer curves with log-rank analysis were used to determine survival probabilities. Results: Of PC interventions, 9.0% were surgical, 42.5% radiation, 41.1% chemotherapy, and 7.4% pain management with no other treatment. From 2004-2018 pain management increased 380% and chemotherapy increased 250%. Radiation increased 32%, and surgical decreased 39%. Surgical patients were more often male (79.9%), white (87.4%), non-Hispanic (97.3%), treated at an academic/research program (39.6%), and have a mean survival of 8.6 months. The most common surgical interventions were photodynamic therapy and esophagectomy with partial gastrectomy. Radiation patients more often male (82.3%), white (83.9%), non-Hispanic (96.5%), treated at a comprehensive community cancer center (39.7%), and have a mean survival of 9.1 months. Most common phase I radiation treatments were external beams (photons) and external beams NOS. Chemotherapy patients were more likely to be male (84.5%), white (88.2%), non-Hispanic (96.8%), treated at a comprehensive community cancer program (39.4%), and have a mean survival of 13.9 months. Chemotherapy patients most often received multiagent chemotherapy and single agent chemotherapy. Pain management patients were more often male (80.2%), white (88.0%), non-Hispanic (96.5%), treated at an academic/research program (38.8%), and have a mean survival of 4.1 months. Chemotherapy patients had average age of 62, while all other interventions had an average age of 65 (p < 0.001). Conclusions: Major differences between subtypes of PC interventions included location of treatment, average age at diagnosis, and mean survival. Chemotherapy patients were diagnosed younger and had a longer mean survival time. Pain management patients had the lowest mean survival time. This data can be utilized as PC utilization increases in the United States.
Prevalence of antecipatory nausea and vomiting in cancer patients exposed to highly emetogenic chemotherapy.
Authors: Alves Rafaela de Brito , Reboucas Camilla Vieira de , Oliveira Louize Caroline Marques , Yamada Alayne Magalhaes Trindade Domingues , Cruz Felipe Melo
Published: June 2022

e24112

Background: Anticipatory nausea (AN) and vomiting are unpleasant symptoms observed in anticipation of chemotherapy regimens. It is best described as a learned response through classical conditioning when one or more distinctive features of the chemotherapy clinic (conditioned stimuli) associated with the administration of emetogenic chemotherapy (unconditioned stimuli) trigger the emetogenic reflex. Little is known about AN's occurrence after the advent of the new neurokinin-1 antagonist. This prospective study evaluated AN's prevalence in ambulatory breast cancer patients receiving high effective antiemetic prophylaxis and evaluated potential predictors of AN. Methods: This prospective observational study was performed at a single Brazilian Institution. Key inclusion criteria were patients aged 18 years or older with breast cancer scheduled to receive anthracycline chemotherapy with an appropriate antiemetic regimen, including a neurokinin-1 receptor antagonist, a serotonin-3 receptor antagonist, and a corticosteroid. Eligible patients used a diary to record nausea, vomiting, and use of rescue medication in the first 2-cycle of treatment through 120 after infusion. AN was assessed before chemotherapy on day 1 of cycle two. We excluded patients with nausea and vomiting presented 24h before cycle one and patients who did not receive standard antiemetic prophylaxis. Results: Between August 04, 2020, and August 12, 2021, 60 patients were screened, and 52 patients were enrolled. The mean age was 50,8 (28 – 69), the majority had stage III (53,8%) and received chemotherapy with curative intent (94%). During cycle 1, the frequency of overall nausea and vomiting was 67.31%, and severe nausea and vomiting (defined as grade > 4 at a 10-point visual scale or use of rescue medication) was 55.77%. Ten patients had AN (19.23%). The occurrence of nausea and vomiting during cycle one was the only statistically significant predictor of AN (OR = 16, 95% CI 2.4, 670.9, p-value = 0.0003). Conclusions: The prevalence of AN is still high in the era of neurokinin-1 antagonists, and failure of antiemetic control on cycle one remains the main risk factor. All efforts should be made to control chemotherapy-induced nausea or nausea and vomiting on cycle one to avoid AN. Clinical trial information: NCT04785495.
Empowering colorectal cancer patients and caregivers through clinical trials education in COLONTOWN.
Authors: Schwarze Steve , Clauer Julie , George Manju , Musick Lindsey , Seybold Nancy , Terek Adrian
Published: June 2022

e24129

Background: Clinical trials are increasingly part of the continuum of care for colorectal cancer patients, particularly those with metastatic disease. Yet most patients have limited knowledge about clinical trials, and many struggle to navigate the myriad barriers to enrollment. To bridge this gap, PALTOWN supports a broad array of activities in its COLONTOWN online community to help patients and caregivers interested in pursuing clinical trials. The function and impact of these activities is examined here. Methods: A comprehensive inventory of all clinical trial-related activity was conducted across three main sources: 1) resources and activity in COLONTOWN’s nine clinical trial-focused groups; 2) clinical trial materials posted in COLONTOWN UNIVERSITY, an online disease education center; and 3) patient feedback on clinical trial programming. Results: The MSS and MSI-High clinical trial groups in COLONTOWN serve more than 2,200 members, and more than 1,000 members are served by mutation- and location-specific trial groups. These groups have helped at least 187 members enroll in a clinical trial between 2019 and 2022. Among 10 trial-related activities, a majority (6/10) focused on sharing biomedical information, including : 1) patient-friendly descriptions of new trials; 2) explanations of trial results; 3) abstracts, articles, and videos from professional outlets such as ASCO Daily Post and OncLive; 4) patient-created resources on clinical trial basics in COLONTOWN UNIVERSITY; 5) “Doc Talks” by prominent CRC oncologists; and 6) patient advocates serving as information liaisons between patients and NCI Task Forces. A smaller number of activities (3/10) focused on psycho-social support from peers, including 1) accounts of patient experiences while seeking and participating in trials; 2) strategy discussions about how and when to pursue trials; and 3) “Alanna Project” database of members on a trial. COLONTOWN’s Clinical Trial Workshop (1/10) offers a novel approach to integrating biomedical education with psycho-social support via a four-week, peer-led clinical trial navigation program. Assessment of the cognitive and behavioral outcomes of the workshop demonstrate improvements in all four dimensions of health literacy: the ability to access, understand, appraise, and apply relevant information in the search for clinical trials. Conclusions: COLONTOWN's clinical trial programming offers comprehensive clinical trial education to patients and caregivers that leads to enrollment in trials. By embedding that education within a supportive community of peers, it enhances patients' capacity to collaborate with health care professionals in making informed decisions about clinical trials.