bluuebunny/crossref_metadata_2025 huggingface dataset:
How to better help cancer patients face their coming death?
Authors: Goudot Francois-Xavier , Maglio Milena , Bretonniere Sandrine
Published: September 2018

e21505

Background: According to literature and medical experience, the doctor-patient relationship becomes strained when oncologists tell their patients that they have no more curative treatments to offer them. Patients often resist when they are told that it is in their best interest to meet with the palliative teams. Little is known about how to meet patients’ expectations at this advanced stage. Methods: We conducted a multicenter qualitative research in an oncology department, a hospital at home service and in an inpatient hospice care center. We met 47 patients (M = 21, F = 27, mean age = 65 yrs, mean disease duration = 5 yrs) for in-depth face to face interviews performed by a multi-disciplinary ethics team. Interviews were carried out between 1 and 3 months before death. Results: Qualitative analysis revealed 4 main results. 1/ For respondents, palliative care introduction meant impending death. 2/ Palliative care introduction meant loss of hope. Without hope, the cancer trajectory is impossible to sustain, they said. 3/ Hope was intricately interwoven with the request for more chemotherapy, even if doctors had clearly refused to provide it. 4/ The oncologist remained the referent physician, even for patients in hospice care. Patients for which the mean duration between cancer diagnosis and interview was 5 years or more, were more willing to talk about death and better accepted palliative care than patients for which the mean duration of cancer was inferior to 3 yrs. For patients with fast progressing cancer (n = 11), 10 were not willing to talk about death and 7 strongly resisted palliative care introduction. There was no difference between patients according to age, sex, type of cancer or center of inclusion. Conclusions: In the terminal phase of cancer, patients are unwilling to talk about death and are reluctant to meet with palliative care teams. Short disease duration strongly reinforces this attitude. If patients resist discussions about their impending death, should physicians continue to consider it good practice to introduce such discussions? Is it beneficent for patients?
Preference of end-of-life discussion at diagnosis in patients with advanced/recurrent cancer.
Authors: Maejima Aiko , Yoshida Saran , Kudo Shun , Bando Hiroko , Aogi Kenjiro , Tokunaga Eriko , Furukawa Masayuki , Otani Hiroyuki , Shimizu Ken , Sakamoto Yasunari , Okusaka Takuji , Morita Tatsuya , Shimizu Chikako
Published: September 2018

e21511

Background: End-of-life discussion (EOLd) including information about incurability, prognosis, the site of death, and do-not-resuscitate (DNR) status is considered indispensable for advanced care planning (ACP). However, the preference for EOLd in cancer patients has not been elucidated. Objective: To clarify the preferences of EOLd in Japanese patients with newly diagnosed advanced or recurrent cancer. Methods: A multi-center questionnaire survey was conducted on Japanese adult patients with breast cancer, pancreatic cancer, or sarcoma, who were diagnosed as incurable within the past three months. We asked patients whether they would like to have EOLd with their physician at the time of survey. Factors related to preferences of EOLd were analyzed using chi-square or Mann-Whitney U-test. Results: For 1 year from August 2015, we distributed the questionnaire to 251 patients at five centers. Responses were obtained from 159 patients (45 males, 113 females) (response rate: 63%). The median age was 65 years (range: 29-86). 93 patients (59%) answered they would like to have EOLd, while 60 patients (38%) answered they would not. In univariate analyses, elderly patients (odds ratio [OR]: 1.03; p = 0.027), patients having worse performance status (OR: 1.988; p = 0.03), and with any physical symptoms (OR: 1.533; p = 0.044) preferred to have EOLd. On the other hand, patients who perceived “being able to sufficiently fight the disease” ( p = 0.021) and “living without being aware of the disease” ( p = 0.004) as important were reluctant to have EOLd. 114 patients (72%) answered they wanted to know their life-time prognosis. Employed patients preferred to know their prognosis (OR: 8.919; p = 0.004) while patients who had received chemotherapy did not (OR: 0.313; p = 0.009). Conclusions: Even just after the diagnosis as an incurable disease, more than half of patients with advanced cancer were willing to have EOLd with their treating physician. Patients’ preference of knowing about life-time prognosis was affected by their social and medical experience.
Chemotherapy in the ICU: Association between palliative care consultation and care goal documentation.
Authors: Brown Audrey , Bensch Kenneth G , Rdesinski Rebecca , Fromme Erik K
Published: September 2018

e21516

Background: Patients receiving chemotherapy in the intensive care unit (ICU) are at high risk of morbidity and mortality. A growing consensus supports proactively addressing goals of care (GOC) - prognosis, goals, fears, and treatment preferences - rather than waiting until treatment options are exhausted. Palliative care consultations frequently address GOC but most often occur late in cancer care. We hypothesized that palliative care consultation is associated with an increased likelihood of GOC documentation. Methods: We reviewed electronic medical records of all patients who received chemotherapy for a cancer diagnosis in OHSU ICUs from 2010-2015, collecting patient demographics, cancer diagnoses and comorbidities, timing of palliative care consultation, chemotherapy administration, GOC documentation, and survival at 30 and 180 days following ICU discharge. Survival and diagnosis were also checked against the OHSU Tumor Registry. Results: 214 patients met our inclusion criteria. Demographics reflect the Oregon population, but with a male predominance (64.5% male, N = 138). A majority of ICU patients receiving chemotherapy had a hematologic malignancy (80%, N = 172), and acute respiratory failure as the reason for ICU admission (42%, N = 90). The majority (84%, N = 179) survived their ICU stay and 67% (N = 143) survived 30 days post-ICU discharge, whereas 50% (N = 108) died by 180 days post-ICU discharge. Documentation of GOC discussions was found for 95 patients (44%) and was more likely in patients receiving palliative care consult (71/72 = 99%) compared to those who did not (24/142 = 17%), p < 0.0001, Fisher’s exact test. 63% of conversations occurred after chemotherapy had already been given (60.6% when palliative care was consulted, 70.8% when not, p = 0.4656). Conclusions: Chemotherapy in the ICU was associated with a 16% chance of dying in the ICU and a 50% 6 month mortality overall. Despite this, only 44% had documented GOC conversations and 63% of the conversations occurred after chemotherapy was initiated. Palliative care consultation was not associated with earlier GOC conversations. We recommend routine GOC conversations be initiated by oncologists prior to giving chemotherapy in the ICU setting.
Systematic reviews and meta-analyses in geriatric oncology.
Authors: Poniewierski Marek S. , Lyman Gary H.
Published: September 2018

e21517

Background: Cancer incidence for most malignancies increases with age with the majority diagnosed after age 65. Aging is also associated with an increasing number of major comorbidities and greater risk and consequences of treatment-related complications. Geriatric Oncology has emerged as a subdiscipline within oncology focused on clinical management and research related to the elderly. Methods: A comprehensive search of the English language literature between 1990-2016 was undertaken for systematic reviews or meta-analyses (SRMAs) related to geriatric oncology. Titles, abstracts and full text manuscripts when needed were reviewed. 1,088 potentially eligible records were identified including 703 not limited to elderly patients, 89 not cancer studies and 236 not SRMAs. Results:More than half of 61 eligible studies were published in the last five years including systematic reviews in 42 (69%), meta-analyses in 42 (69%) and both in 23 (40%). Studies came from Europe (30), US (14), Canada (9), Asia (7) and South America (1) with elderly age cutoffs ranging from > 60 to > 80. While 17 reviews included multiple cancer types, 44 were limited to lung cancer (9), colorectal cancer (8), breast cancer (7), multiple myeloma (5) and lymphoma (4). Research focus was survivorship or end-of-life (41), treatment (24), geriatric assessment (11) and supportive care (8). Studies were limited to randomized controlled trials (37), non-RCTs (9) and both (16). The primary outcome was overall survival (39), progression free or relapse-free survival (15), response or recurrence (11), treatment-related toxicity (21) and geriatric assessment or frailty (9). More than half of SRMAs included < 10 studies while 20% included > 30 with the number of subjects in included trials ranging from 153 to > 15,000. Conclusions: The development of Geriatric Oncology has spanned nearly three decades. While a strong evidence base of published research including rigorous SRMAs in Geriatric Oncology has only emerged over the past decade, steady growth across a range of topics and outcomes relevant to cancer in the elderly is apparent.
Adjuvant chemotherapy related toxicities and their impact on treatment cessation in elderly patients with breast cancer.
Authors: Iqbal Muhammad , Manthri Sukesh , Robinson Kathy , Mocharnuk Robert S. , Desai Meghna R.
Published: September 2018

e21527

Background: Data from the National Cancer Institute’s Surveillance Epidemiology and End Results program show that the incidence of breast cancer is 243.1 per 100,000 in women 65 years of age and older. Guidelines regarding the management of older breast cancer patients are lacking due to their underrepresentation in adjuvant therapy trials and conflicting evidence regarding the benefits of therapy. The objective of this study was to investigate the frequency of adjuvant chemotherapy related side effects and their correlation with early termination of therapy in elderly breast cancer. Methods: We collected retrospective data in patients with in situ or invasive breast cancer diagnosed after the age of 65.Docetaxel & cyclophosphamide, doxorubicin & cyclophosphamide, tratuzumab in combination and other regimens were studied. Fisher’s exact test was used to determine an association between grade 3 or 4 toxicities and therapy termination. Binary logistic regression was used to assess whether a specific toxic effect could predict for early discontinuation of therapy. Treatment termination was defined as inability to tolerate the proposed number of chemotherapy treatment cycles. Results: Among 269 eligible cases, 72 (26.76%) patients were offered adjuvant chemotherapy. Most patients (n = 58, 80.55%) accepted chemotherapy but 14 (19.44%) refused. Nausea (n = 16, 27.6%), vomiting (n = 8, 13.8%), diarrhea (n = 12, 20.7%), stomatitis (n = 3, 5.2%), hypersensitivity (n = 3, 5.2%), rash (n = 10, 17.2%), hepatotoxicity (n = 1, 1.7%), neuropathy (n = 12, 20.7%), cognitive changes (n = 3, 5.2%), bone pain (n = 5, 8.6%), anemia (n = 15, 25.9%), thrombocytopenia (n = 7, 12.1%), neutropenia (n = 16, 27.6%), cardiotoxicity (n = 1, 1.7%), hospitalization due to neutropenic fever (n = 5, 8.6%) and pneumonia (n = 2, 3.4%) were observed. Among 17 patients who discontinued chemotherapy, 23.5% reported bone pain (OR = 12, 95%CI:1.22-117.2, p = 0.024) and 47.1% developed neutropenia (OR = 3.55, 95%CI:1.04-12.13, p = 0.054). Other toxicities were not significantly associated with therapy discontinuation. Conclusions: The odds of terminating chemotherapy early increases for those who experience grade 3 or 4 bone pain and neutropenia.
Impact of adjuvant endocrine therapy related toxicities on treatment cessation in elderly breast cancer.
Authors: Iqbal Muhammad , Manthri Sukesh , Robinson Kathy , Mocharnuk Robert S. , Desai Meghna R.
Published: September 2018

e21528

Background: According to American Cancer Society estimates, 252,710 new cases of invasive breast cancer will be diagnosed in women in the U.S. in 2017. Elderly breast cancer patients tend to be undertreated due to age, potential toxicities of adjuvant therapies and intrinsic ageist biases. The purpose of this study was to investigate the incidence of adjuvant endocrine therapy related side effects and their impact on discontinuation of therapy in geriatric breast cancer population. Methods: Data were collected by retrospective medical record review at our institution among breast cancer patients diagnosed after age 65. Adjuvant endocrine therapy included tamoxifen, letrozole, anstrozole and fulvestrant. Grade 3 and 4 toxicities were analyzed by Fisher’s exact test to determine an association with therapy discontinuation. Binary logistic regression was used to assess whether a specific toxic effect could predict for early therapy termination. Treatment termination was defined as inability to complete the proposed duration of endocrine therapy. Results: Out of 269 eligible cases, 221 (82.15%) patients were offered endocrine therapy based on their tumor’s ER and PR receptor status. A total of 216 (97.73%) patients received endocrine therapy while 5 (2.26%) declined treatment. Frequencies of osteopenia (n = 22, 10.2%), osteoporosis (n = 18, 8.3%), arthralgia (n = 35, 16.2%), hot flashes (n = 49, 22.7%), vaginal dryness (n = 3, 1.4%), weight gain (n = 7, 3.2%), fluid retention (n = 4, 1.9%), mood swings (n = 3, 1.4%), deep venous thrombosis (DVT, n = 3, 1.4%), pulmonary embolism (PE, n = 3, 1.4%) and stroke (n = 2, 0.9%) were reported by patients who received endocrine therapy. Among the 44 patients who terminated endocrine therapy early, 38.6% listed arthralgia as the chief cause (OR = 5.37, 95%CI:2.33-12.39, p = 0.0001). We detected no significant correlation between endocrine therapy cessation and other side effects. Conclusions: Arthralgia and hot flashes were the most common side effects observed in elderly breast cancer patients receiving adjunct endocrine therapy. We found that the elderly patients tend to discontinue treatment more often if they develop endocrine therapy related arthralgia.
Impact of modifiable risk factors on clinical outcomes in geriatric patients with breast cancer.
Authors: Manthri Sukesh , Iqbal Muhammad , Desai Meghna R. , Mocharnuk Robert S. , Robinson Kathy
Published: September 2018

e21546

Background: Tobacco use remains the single largest contributor to preventable death in the U.S. Women who consume alcohol have a 15% higher risk of hormone-receptor-positive breast cancer and obese women are at higher risk of developing breast cancer compared to non-obese women after menopause. There is limited information about the combined impact of smoking, alcohol and BMI on clinical outcomes among elderly patients . The purpose of this study was to analyze the effects of smoking, alcohol and BMI on clinical outcomes in geriatric breast cancer patients. Methods: Among 1659 patients in the institutional Breast Cancer Registry database, a total of 269 patients with histologically confirmed invasive or in-situ breast cancer with age 65 years or older at the time of diagnosis were reviewed in an IRB approved fashion. Clinical outcomes included assessment of the following risk factors: current/former smoking, current/former alcohol usage and BMI at time of diagnosis. Kaplan-Meyer and Cox proportional hazards methods were used to calculate clinical outcomes which included overall survival (OS) and disease free survival (DFS). Results: There were 110 (40.9%) never smokers, 41 (15.2%) current smokers and 80 (29.7%) former smokers. A total of 129 (48%) of women had never consumed alcohol, 73 (27.1%) currently consumed alcohol, and 19 (17.1%) previously consumed alcohol. Mean BMI at the time of diagnosis was 30.62. The OS and DFS was longer among patients who were never smokers compared to current and former smokers (P = 0.0125, P = .0.0077) (P = 0.0107, P = 0.0146). There was also no statistically significant decrease in OS, DFS among those who never consumed alcohol compared to current and former alcoholic users (P = 0.7516, P = 0.2027) (P = 0.8892, P = 0.2432). Neither was there a statistically significant decrease in OS, DFS based on BMI at time of diagnosis (P = 0.5045) (P = 0.5233). In patients with combined cigarette and alcohol usage with BMI > 25, there was also no statistically significant decrease in OS (P = 0.3572). Conclusions: In patients 65 years old or older diagnosed with breast cancer, prognosis for current or former smokers is worse compared to never smokers. Alcohol consumption and BMI have no impact on DFS or OS.
Functional trajectories before and after a new cancer diagnosis among community-living older adults.
Authors: Presley Carolyn Jean , Hurria Arti , Han Ling , Leo-Summers Linda S , Gross Cary Philip , Allore Heather G , Davidoff Amy J. , Gill Thomas M
Published: September 2018

e21547

Background: We characterized distinct functional trajectories among older adults in the year before and after a new cancer diagnosis and identified factors associated with functional decline. Methods: Among a cohort study of persons 70+ y, we identified 170 participants (lung (15.7%), breast (12.4%), prostate (7.8%); 31.8% incurable at diagnosis)) with an incident cancer diagnosis from 1998-2014. We followed their functional course using 13 basic, instrumental, and mobility activities measured during monthly interviews. To identify functional trajectories, we fit a group-based trajectory model of the 13-item disability scale 12-months before and 12-months after the cancer diagnosis. Regression modeling determined predictors of functional decline, defined as a higher count on the 13-item disability scale. Results: Three pre-cancer functional trajectories were identified (mean age at diagnosis: 83 y (73-105 y); similarly, 3 post-cancer functional trajectories were identified among the 158 non-decedents. Participants with severe disability pre-diagnosis remained severely disabled post-diagnosis. Approximately 40% of participants with mild or moderate disability pre-diagnosis transitioned to a worse functional trajectory post-diagnosis (see Table). Moderate and severe disability pre-diagnosis were significantly associated with functional decline post-diagnosis (moderate vs. mild aRR: 3.10; 95% CI: 2.24-4.30; severe vs. mild aRR: 5.71; 95% CI: 3.60-9.07). Depressive symptoms (RR, 1.40; 95% CI: 1.02-1.91), and incurable stage (RR, 2.16; 95% CI: 1.54-3.03) were also associated with functional decline. Conclusions: Approximately 40% of older adults experienced functional decline after a new cancer diagnosis. Pre-cancer diagnosis functional trajectory, depressive symptoms, and incurable stage were significant predictors of post-diagnosis functional decline. [Table: see text]
Patients making potentially life threatening delays in reporting neutropenic sepsis: Grounded theory study.
Authors: Oakley Catherine Mary , Taylor Cath , Ream Emma , Metcalfe Alison
Published: September 2018

e21560

Background:Internationally the mortality rate for neutropenic sepsis (NS) is 2-21% (in patients who develop it). Within the United Kingdom NS causes around 700 deaths annually. Clinicians are concerned about patient delayed reporting of NS which may increase healthcare costs, mortality and chemotherapy delays, which can affect prognosis. Methods: Constructivist grounded theory was used to gain insight into the reasons for patient delays. Observations (n = 13 hours) of women with breast cancer being provided with information about NS by oncology doctors and nurses and 31 in-depth interviews. Analysis (and development of categories and supporting properties) commenced with the earliest data gathered and a rich theoretical picture was built through comparing perspectives, pursuing areas of inquiry and recruiting participants who became of interest. Data were collected until saturation. A coding framework was applied to examine and explain connections between categories. Results: 35 participants. 13 women with breast cancer (median age, 56 years, 8 Caucasian, 9 adjuvant, 4 metastatic), 9 carers (partners, family or friends, 50% lived with patients) and 13 clinicians (4 oncologists, 7 chemotherapy nurses, 2 emergency department clinicians, most doctors were male, most nurses were female). The majority of patients and carers were highly educated ( > degree level). All patients except 1, delayed reporting NS symptoms (2.5 hours - 8 days), sometimes repeatedly. The final grounded theory suggests patient delays are due to an interplay of behaviours between clinicians, patients and carers where they subconsciously collude to underplay the seriousness and possibility of NS occurring.Moderators of delay included metastatic disease, bereavement, fatalism, religious beliefs and quality of relationships with clinicians. Conclusions: Relationships with clinicians directly impacted on delayed patient reporting of NS.Findings have implications for health risk communication, development of holistic service models and the design of future research to develop interventions, to promote earlier recognition and treatment for this important chemotherapy complication.
Cancer-related distress screening in a radiation oncology clinic: A snapshot view of a Veterans Administration (VA) institution screening program.
Authors: Lomauro Timothy A. , Dawson George Anthony , Magda Lori , Tobias Kristen , Kelly Maria D.
Published: September 2018

e21562

Background: The emotional and psychosocial stress experienced by cancer patients are significant factors impacting cancer treatment outcomes and quality of life. Increased emphasis upon programmatic approaches to identifying distress has evolved to current evidenced-based treatment guidelines as reflected by American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have identified distress screening standards of care. This report is a snapshot of the results of a distress screening program in a VAMC Radiation Oncology clinic. Methods: Calendar year 2016 data was chosen for this quality improvement review. We wanted to assess the effectiveness of psychosocial distress screening process now routinely done in Radiation Oncology. Distress screening was completed utilizing the NCCN Distress Thermometer. The program’s goal was to administer distress screening to all patients at the time of their initial consultation and to follow up screening as appropriate. Results: The mean age of the patients was 68.6 years; 98% were male. The treatment population was 58% Caucasian, 38% African-American, 2% Hispanic, and 2% other. The most prevalent cancer diagnoses were: Prostate, 52%; Lung, 13.9%; Head & Neck Cancer, 7.2%, Skin, 4.6%; Esophageal or Gastric Cancer, 3.1%; Brain, 2.0%; and Breast, 2.0% Screenings were completed on 161 of 193 (83%) new consults in Radiation Oncology; 47.6% of patients screened scored at or above the established cut score of 4. Referrals to Oncology Psychology were initiated for 29.5% of total sample. Significant mental health co-morbidities were identified in the treatment population studied; 58.5% of patients had at least one mental disorder diagnosis. Examples: PTSD, Major Depressive Disorder, Substance Use Disorder, and Adjustment Disorder. Conclusions: Results reflect the usefulness of the distress screening process in identifying adjustment issues specific to cancer patients' experience, as well as exacerbations of existing mental health conditions. The screening process facilitated referral to specialty (Oncology Psychology) and general (Mental Health Clinic) services.
Patient-reported distress in myelodysplastic syndromes and its relationship with clinical outcomes.
Authors: Troy Jesse D , deCastro Carlos , Pupa Mary Ruth , Samsa Greg P. , Abernethy Amy Pickar , LeBlanc Thomas William
Published: September 2018

e21564

Background: The National Comprehensive Cancer Network (NCCN) defines distress as an unpleasant emotional experience associated with the psychosocial complications of cancer. Patients with myelodysplastic syndromes (MDS) are at risk for distress given the largely incurable nature of this hematopoietic malignancy and its symptom burden, yet associations with clinical outcomes are unknown. Methods: We retrospectively reviewed patient-reported distress from ambulatory adult MDS patients visiting a single tertiary care medical center from July 2013-Sept 2015. Demographic, diagnostic, treatment, and comorbidity information were abstracted from records along with the NCCN Distress Thermometer (DT) and Problem List (PL). Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression, controlling for age and risk stratification at diagnosis (Low or Intermediate/High Risk by IPSS, IPSS-R, or WPSS), ever use of therapy (hypomethylating agents/lenalidomide/growth factors/transfusions/chelation), Charlson comorbidity score, ever-report of fatigue, and frequency of fatigue. Results: We abstracted 376 DT (median = 1, range = 0-10) from 606 visits and 110 patients (median = 2 DT/patient, range = 1-16). NCCN guidelines suggest DT > = 4 should be evaluated for referral to specialty services to address unmet needs. Fifty-four patients (49%) had at least 1 DT > = 4 and 20 (18%) had 2 or more DT > = 4. Ninety-eight patients (89.1%) reported 1,379 problems during 23,613 person-days of follow-up (median = 4 problems/patient/visit, range = 1-23). The 5 most frequent were fatigue (181 times; 78 patients), pain (95 times; 46 patients), worry (80 times; 45 patients), sleep (78 times; 41 patients), and tingling hands/feet (68 times; 33 patients). After adjustment for risk stratification, a single-point increase on the DT was associated with an increased risk of death (HR = 1.18, 95% confidence interval: 1.01, 1.36). Conclusions: The distress burden is high inMDS, and patient-reported distress scores are associated with clinical outcomes after controlling for typical prognostic variables. Distress should be further studied as a marker of prognosis and of unmet needs in this population.
Sexual function, anxiety, and surgical decision making in BRCA mutation carriers.
Authors: Oliver Matthew T. , Kwait Rebecca , Kent Laprise Jessica , Scalia Wilbur Jennifer , Spinette Sarah , Raker Christina , Gutierrez Julia , Robison Katina , Legare Robert Duffy , Gass Jennifer S. , Stuckey Ashley
Published: September 2018

e21572

Background: To describe BRCA mutation carriers’ perspectives on quality of life from prophylactic surgical decision making. Methods: A cross-sectional survey of BRCA mutation carriers identified from a genetic counseling database at an academic women’s oncology program was conducted using Research Electronic Data Capture. Survey items included Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale, and investigator-generated questions. Statistical analysis was performed using Fisher’s exact test and Wilcoxon rank-sum or Kruskal-Wallis tests. Results: 66 BRCA mutation carriers completed the survey (39% response rate) with a median age of 50 (range 18 to 79); 23% of respondents were pre- or perimenopausal and 11% reported a history of ovarian/fallopian tube cancer. Overall, 25% of respondents reported anxiety regarding the timing of bilateral salpingo-oophorectomy (BSO) or mastectomy. Women who had a BSO were less likely to be sexually active and had lower total FSFI scores, with arousal and desire approaching significance compared to women without BSO (p = 0.05). Women who had a BSO had slightly higher median total anxiety scores, but were not more likely to have abnormal levels of anxiety. Women who were < 40 years of age at discovery of mutation were more likely to have had a discussion regarding preimplantation genetic diagnosis (p < 0.0001), more likely to have anxiety regarding prophylactic surgery and childbearing (p < 0.0001), and more likely to say BRCA mutation impacted their decisions about childbearing (p = 0.001) compared to women > 40. 57% of women age 18-39 at time of mutation diagnosis delayed BSO for childbearing as compared to none of the women > 40 (p < 0.0001). Only 20% of the pre- or perimenopausal women used hormone replacement therapy after BSO. Conclusions: BRCA mutation carriers face challenging decisions concerning prophylactic surgical management. Counseling sessions often focus on effective risk reducing surgeries but may not directly address other emotional and physical consequences of prophylactic surgery. Counseling regarding use of hormone replacement therapy is an area identified in this study that may improve quality of life issues seen in women undergoing prophylactic BSO.
Health promotion after breast cancer treatment.
Authors: Gopalakrishnan Dharmesh , Goraya Shazia Tanvir , Banjac Svetlana , Yanda Courtney , Abraham Jame , Grobmyer Stephen R. , Pederson Holly Jane
Published: September 2018

e21586

Background: With significant advances in breast cancer (BC) treatment and improvements in long-term survival, high-quality, coordinated survivorship care is important. Methods: In this retrospective study of patients who were diagnosed with BC (Stages 0 to 3) in 2012 and had > 1 year of follow-up within our network (mean follow-up 3.2 yrs), we analyzed BMI trends and compliance with age appropriate health measures. One-sample t-test was used to compare average BMI at diagnosis and year 3. p < 0.05 was considered as statistically significant. Results: Of 643 patients studied, 99.5% were female, 83% were Caucasian, and 27% were ≤ 50 years of age at diagnosis (mean age 59 yrs). 17% had DCIS and 83% had invasive cancer (Stage I – 40%, II – 33%, III- 10%). 40% had a BMI > 30 Kg/m2. BC Surveillance: 89.4% of patients with residual breast tissue or tissue flaps had surveillance mammograms during 3 years of follow-up (Year 1 - 90.0%, 2 - 89.8%, 3 - 88.3%), in compliance with current guidelines. Weight management: There was a statistically significant increase in BMI from diagnosis to year-3. This trend was consistent across different age, race, and baseline BMI groups (See Table). Colon cancer screening: 49% of eligible patients had completed age appropriate screening colonoscopies either prior to diagnosis or during the course of follow-up. Bone health: Among patients who were on aromatase inhibitors, 76% had a documented DEXA scan. Vaccination: Vaccine coverage for eligible patients was low – 63% for pneumococcal, 38% for herpes zoster, and 30% for annual influenza vaccines. Conclusions: While compliance with BC surveillance is high among patients following treatment for BC, adherence to many other important health maintenance practices is low. Renewed focus on these measures, such as weight management, bone health, vaccination and screening for other cancers, represents an important opportunity to improve not only cancer-related outcomes but also the overall health and well-being of BC survivors. [Table: see text]
Changes in sperm banking rates within the first seven months of a formal male oncofertility program.
Authors: Lopategui Diana Maria , Ibrahim Emad , Yechieli Raphael , Brackett Nancy , Ramasamy Ranjith
Published: September 2018

e21587

Background: Oncofertility counseling is an essential part of the care for cancer patients with risk of infertility. In June 2016, our institution formally initiated a standardized program for fertility preservation, including nursing and physician education. After the first 7 months of functioning, we here examine the sperm banking rates amongst male cancer patients, and its variation respect previous years. Methods: We retrospectively reviewed the charts of men newly diagnosed with cancer at our institution. We assessed the rates of sperm banking amongst this patient population before the implementation of a standardized fertility preservation program, and again after: from January 2011 to May 2016 and from June 2016 to December 2016, respectively. Results: Sperm banking rate amongst male cancer patients before the initiation of the program was 3.3% (30 out of 902 patients). Along the 7 months after initiation of the program, rate of fertility preservation increased 6.2 folds, up to 20.6% (21 out of 102). Patients undergoing sperm banking through the fertility preservation program were aged 14 to 62 years old; mean ± standard deviation = 25.9± 6.9 years. Two of the patients were minors under care of Pediatric Oncology department. 76.7% of the samples (17 patients) were obtained by masturbation. In the other 4 patients, viable sperm could not be preserved from ejaculation, but it was successfully obtained by testicular or epidydimal sperm extraction. Conclusions: The initiation of a formal fertility preservation program at our institution quickly increased the rate of sperm banking; in more than 6 folds within its first 7 months of functioning. Oncofertility is an essential component of the care of oncologic patients in reproductive age or younger, and our results manifest the benefit of a standardized program at academic institutions. Counseling in fertility preservation should be offered to all patients at risk prior to initiation of oncologic treatment.
Impact of perioperative blood transfusion on survival among women with breast cancer.
Authors: Nadeem Rashid , Cha Mina , Arafeh Dinah , Khan Hiba , Yousaf Muhammad , Turkman Banan , Memon Raheel , Nadeem Amin , Sajid Hassan , Jawed Shafaq
Published: September 2018

e21591

Background: Blood transfusion has immune-modulating effect which may affect outcome in women with breast cancer including cancer recurrence and survival. Methods: PubMed, Embase and Cochrane libraries were searched by utilizing different combinations of keywords: blood transfusion, survival, mortality and breast cancer. Inclusion criteria were: (1) English articles and (2) studies with an adult population with the diagnosis of breast cancer undergoing resection which may or may not have received blood transfusion. Four hundred and seventy studies were reviewed, 13 studies meeting inclusion criteria were pooled for Meta-analysis. Results: Twenty five datasets from 13 studies with total N = 7384 subjects (transfused 2264, not transfused 5120) were pooled. Survival rates recorded at a specified time frame, this range from 4-12 years. Major confounding factors effecting survival in this population may include age, presence of other chronic illnesses, spread of breast cancer to lymph nodes, stage of cancer and extent of cancer treatment. Type, group and number of blood units transfused may also play a role. Survival rates among not transfused group range from 34% to 79% while in transfused group range from 41% to 78%. Significant heterogeneity was detected among studies; therefore random effect model was used. Comparing women without blood transfusion, women with transfusion have Odd ratio of overall survival 0.79 (0.72 to 0.86, I2= 47.3, P = 0.001). we also performed sensitivity and subgroup analysis. Conclusions: Perioperative blood transfusion appears to adversely impact survival among women with breast cancer
Sexual activity and function in male cancer patients receiving targeted an immune therapies.
Authors: Tsai Katy K. , Kamal Puneet , Ramstein Joris , Algazi Alain Patrick , Daud Adil , Smith James F
Published: September 2018

e21594

Background: Survivorship concerns–including sexual function–move increasingly to the foreground in cancer patient care as systemic therapies improve response and survival. Patients are often committed to long-term treatment with tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) despite poor characterization of their effects on sexual function. We sought to assess sexual activity and function in patients receiving TKI or ICI. Methods: A cohort of men receiving TKI/ICI at the UCSF Helen Diller Family Comprehensive Cancer Center were retrospectively identified. Eligible men were on ongoing TKI/ICI therapy. Detailed questionnaires addressing cancer history, treatment history, and sexual activity/function while receiving therapy were completed. Results: Between January 2013 to September 2016, 51 men completed questionnaires. Mean age was 46 years (SD 12, range 21-72). Most (61%) were CML patients, with 12% RCC, 10% GIST, 6% melanoma, and NET, oligodendroglioma, and HCC comprising remaining histologies. 96% were treated with TKI, and 4% with ICI (pembrolizumab). 32% identified as being married or in a domestic partnership, and 18% identified as single. Only 14% reported no attempted sexual activity. Sexual desire was described as low or very low to none in 29%, average in 39%, and high or very high in 29%. Since cancer diagnosis, 21 (41%) of patients noted a reduced amount of semen upon ejaculation, and all but 5 of those patients noted this as at least somewhat bothersome. 35% of patients reported feeling at least somewhat distressed from sexual experiences since cancer diagnosis, including concern that their time to ejaculation may leave their partners feeling unfulfilled (45%), decreased sensation of orgasm (35%), difficulty maintaining erection until completion of intercourse (23%), and pain/discomfort upon ejaculation (12%). Conclusions: The majority of men on TKI or ICI remain sexually active, with a significant portion reporting sexual dysfunction. These findings highlight the need for oncology care providers to proactively manage sexual dysfunction to improve quality of life for cancer patients. Retrospective and prospective studies are ongoing to further characterize this cohort.
Feasibility of utilizing a novel mhealth platform to deliver an evidence-based exercise intervention among testicular cancer survivors (TCS).
Authors: Fung Chunkit , Peckham Jennifer , Porto Michelle , Lin Po Lin , Sahasrabudhe Deepak M. , Guancial Elizabeth A. , Ky Bonnie , Storozynsky Eugene , Janelsins Michelle Christine , Heckler Charles E. , Culakova Eva , Bruckner Lauren B. , Mohile Supriya Gupta , Mustian Karen Michelle
Published: September 2018

e21608

Background: Cardiovascular disease results in significant morbidity among TCS. Exercise for Cancer Patients (EXCAP) is a self-directed, individually tailored intervention that improves cardiovascular fitness in cancer patients, yet this has not been tested in TCS. We conducted a randomized phase II feasibility study of a novel exercise intervention using a mHealth delivery platform for EXCAP. Methods: We developed mHealth-EXCAP, which integrates data from a wearable digital activity tracker (DAT) into a patient’s electronic medical record (EMR), allowing providers to monitor and adjust EXCAP prescriptions via a patient-centered virtual portal. We randomized TCS ( < 69 yr at diagnosis, any treatments, not in active or maintenance stage of exercise behavior) into 3 study arms: Arm 1 (mHealth-EXCAP), Arm 2 (EXCAP) and Arm 3 (usual care). TCS in both Arm 1 and 2 completed a 12 week EXCAP program with the goal of 12,000 daily steps and daily resistance exercises but Arm 1 used the mHealth platform. Arm 3 used a TCS care plan that promotes exercises. Results: 74 TCS were screened (32 ineligible; 23 declined), 19 consented and 14 (74%) completed study (3 withdrew; 2 lost to follow up) as of 1/31/17. Median age (yr) was 35 (Arm 1; n = 6), 48 (Arm 2; n = 4), and 48 (Arm 3; n = 4). In Arm 1, 83% TCS wore DAT and synced daily step data to EMR > 90% of days. EXCAP prescriptions were adjusted via EMR portal on average 5 times over 12 weeks for each TCS and their weekly daily step goals were met 73% of the time. The number of daily steps recorded by DAT and those synced from DAT to EMR differed by a mean of 1.5% steps (±1.8). Median baseline number of daily steps were 5,525 (Arm 1), 6,795 (Arm 2), and 5,904 (Arm 3) and increased by 5,236, 1,160, and 1,544 respective steps at 12 weeks, with only Arm 1 (50% TCS) achieving > 12,000 daily steps. At 3 months after intervention, 33% TCS in Arm 1 maintained > 12,000 daily steps. On average, TCS in Arm 1 performed resistance exercises 26 minutes a day/5 times a week vs. 28 minutes a day/4 times a week in Arm 2. Conclusions: mHealth-EXCAP is feasible to implement among TCS and may decrease sedentary behavior. Ongoing research will examine its effects on cardiovascular fitness and risk factors.
Nimotuzumab as a single agent palliative therapy in performance score 3 and above in EGFR expressing tumors.
Authors: Attili Suresh VS , Pawar Dilip , Sunkavalli Chinnababu
Published: September 2018

e21635

Background: Nimotuzumab is a humanized IgG1 monoclonal antibody against the EGFR extracellular domain that has been evaluated in solid tumors as a single agent or in combination with chemotherapy and radiation. However when used without radiation, its always used in adjunct to chemotherapy. With encouraging results of other EGFR monoclonal antibodies as single agent therapies, we explored the possibility of using Nimotuzumab as single agent by which we could avoid chemo related side effects. In view of the limited options availability for subjects with PS 3 and more we thought of choosing this population for analysis of Nimotuzumab as single agent palliative therapy in PS 3 and above EGFR expressing tumors for safety and efficacy Methods: Details of the 38 subjects with pre-treated advanced refractory or progressive solid tumors having PS of more than 2 were evaluated. Nimotuzumab was administered weekly at 200 mg/m2 as single agent for 4 weeks (induction phase) and patients were stratified into those with improved PS and those without. The subjects without PS improvement were continued on the single agent and those with improvement were offered additional chemotherapy . Nimotuzumab could be continued beyond disease progression. Results: Out of 38 patients, 18 had improvement in the PS and were offered chemotherapy later. 16 patients had stable PS and disease. 3 subjects were lost to follow up and 1 patient did not continued. The median number of nimotuzumab applications was 6 (2–11) in the induction phase and the median chemotherapy cycles were 3 (1-6). No toxicity occurred during induction phases (single agent nimotuzumab) and during chemotherapy the Grade II/IV toxicities were observed in 6 (33%) cases predominantly cytopeneas, neuropathy and diarrhea. The median PFS was 142 days (95% CI, 84 to 182), and the median improvement in QOL was 6 points on a scale of 30. Conclusions: Nimotuzumab is well tolerated and may have a role in the treatment of advanced cancers as a single agent in patients with poor performance status. 47% of the patients who are otherwise not eligible for chemo became eligible and had better QOL and longer PFS [compared to historical controls]
Reductions in exercise behavior and tumor progression in newly diagnosed glioblastoma (GBM) patients.
Authors: Peters Katherine B. , Threatt Stevie , Healy Patrick , Herndon James Emmett , Lipp Eric S , Panta Sujata , Randazzo Dina , Vlahovic Gordana , Friedman Henry S. , Desjardins Annick
Published: September 2018

e21636

Background: At diagnosis, GBM patients face the immediate challenge of significant morbidity and mortality. In this population, we have shown that better exercise behavior is an independent prognostic factor for improved survival. The association between tumor progression and exercise behavior in newly diagnosed GBM patients was explored within a clinical study investigating the use of bevacizumab (BV) with concurrent chemoradiation, followed by BV and temozolomide with the continuation of BV following progression. Methods: In this prospective single-center study, exercise behavior was evaluated using the Modified Godin Leisure Questionnaire at time of study enrollment (before chemoradiation), after chemoradiation, and then every 6 mos until study discontinuation or subject demise. Physical activity was defined as MET-hr/wk with higher number equaling a better exercise behavior. Results: 68 newly diagnosed GBM patients were initially included with a mean age of 55.4 yrs (sd = 10.7 yrs). KPS range was 70-100 with the following being 70 (n = 4), 80 (n = 28), 90 (n = 34), and 100 (n = 2). Subjects who continued study participation 6 mos after the completion of chemoradiation were divided into two groups: subjects with (n = 13) and without (n = 34) tumor progression 6 mos after chemoradiation completion. Subjects that experience tumor progression < 6 mos after chemoradiation had a lower exercise behavior at baseline in comparison to their counterparts that did not experience progression < 6 mos after chemoradiation (mean = 12.8 MET-hr/wk (sd = 22.2) vs. mean = 22.4 MET-hr/wk (sd = 28.9). Moreover, this exercise behavior decreased in subjects that had tumor progression to mean = 6.6 MET-hr/wk (sd = 7.6) and remained relatively stable in subjects that did not progress with mean = 23.9 MET-hr/wk (sd = 44.9). Conclusions: Our observations of exercise behavior over time suggest that poorer baseline exercise behavior is associated with a disease progression within 6 mos of chemoradiation completion in newly diagnosed GBM patients. Moreover, this exercise behavior continues to decline after progression. Based on these observations, a greater understanding of the role of physical functioning is merited in GBM patients. Clinical trial information: NCT01740258.
Results of implementing a novel supportive oncology screening tool for comprehensive evaluation of distress and other supportive care needs.
Authors: Trosman Julia Rachel , Gerhart James , Patel Urjeet , Khosla Paramjeet , Robinson Patricia A. , Penedo Frank J. , Diaz Aidnag , Lillis Teresa , Miranda Harry , Radeke Erika K. , Roggenkamp Betty , Pasquinelli Mary , Feldman Lawrence Eric , Martin Joanna , Lo Shelly S. , Kircher Sheetal Mehta , Garcia Sofia F. , Berardi Rosa , Weldon Christine B.
Published: September 2018

e21644

Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from NCCN Distress Problem List, IOM report and CoC standards, with validated sub-tools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue and physical function. Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public & 1 safety-net). End points included correlation of PHQ-4 score with other supportive oncology needs. Descriptive statistics, Fisher’s exact test were used. Results: 2805 patients were screened. Average scores were: PHQ4 – Anxiety and Depression 1.8 (mild > 3), Pain 4.5 (mild > 4), Fatigue 8.8 (mild > 6), Physical Function 20.2 (mild < 20), see table for additional items. Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, nutritional and specific treatment/care concerns, and lower physical function (p<.0001). Conclusions: Patients with higher anxiety and depression also have many other supportive oncology concerns. Our results support the use of a comprehensive tool capturing a spectrum of each patient’s unique concerns. This may enable earlier interventions and personalized delivery of supportive care. [Table: see text]