bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxicity induced by radiochemotherapy with weekly paclitaxel versus weekly cisplatin in patients with advanced head and neck cancer
Authors: Stanculeanu D. L. , Tache A. , Cringeanu A. , Mitulescu D. , Scheusan R. , Dragomir M.
Published: March 2020

16534

Background: Head and neck cancers represent about 8 % of the total solid cancer cases. For advanced head and neck cancer (HNC) patients, the effects of disease and the side effects of aggressive treatments have the potential to severely affect quality of life. Combined chemoradiotherapy increase rates of locoregional control, but it may cause severe side effects, mainly painful mucositis. In our study we evaluated the chemoradiotherapy induced toxicities in patients treated with concomitant radiochemotherapy using weekly paclitaxel or cisplatin for advanced head and neck cancer. Methods: From April 2003 to December 2005 46 patients with locally advanced head and neck cancer were enrolled onto this study. Patients characteristics: 35 male and 11 female; mean age 62,5; performance status ECOG 0–1, carcinoma histological confirmed. All patients received external beam radiation using DT= 45 Gy, 1,8 Gy/fr, 5 fr/week in combination with chemotherapy: arm A (20 pts) - Paclitaxel 35 mg/mp days 1,8,15,22,29; arm B (26 pts)- Cisplatin 20 mg/mp days 1,8,15,22,29. Results: 40 patients have completed the planed treatment; 4 patients have interrupted treatment because of toxicity; there were 2 toxic death due to neutropenic sepsis and metabolic disorders in arm A. Toxicity grade 3–4 was hematological - neutropenia - 14, 6 % pts in arm A vs. 7, 8 % pts in arm B; gastrointestinal - nausea 6,7 % pts in arm A vs. 5,6% pts in arm B; neurological - neuropathy 5,4 % pts in arm A vs. 0 pts in arm B; dermatological - radic dermitis 4,3% in arm A vs. 4,1% in arm B; oral mucositis 33,6% in arm A vs 27,8% in arm B. All this patients received analgesics and anti-inflammatory drugs, systemic and/or topical. Other toxicities were not significantly related. Conclusions: This study confirmed that radiochemotherapy has shown to provide clinical benefit response and disease stabilization in patients with locally advanced head and neck cancer. Unfortunately, this concomitant therapy was significantly associated with hematological toxicities and oral mycosis. The most severe side effect was oral mycositis grade 3–4, especially in the paclitaxel arm.

No significant financial relationships to disclose.
Epidemio-clinic and evolutionary profile of laryngeal cancer at oncology department of Mohamed VI University Hospital
Authors: Benhamidoune M. , Tahri A. , Aiterraisse M. , Derhem N. , Bouras N. , Tahiri F.
Published: March 2020

16536

Background: Larynx cancer is one of the most frequent cancers of the superior airways. Narrowly linked to the chronic tobacco use, often associated with other addictive behaviours notably chronic alcoholism. It touches males in more than 90% of cases, with preponderance between 40 and 59 years old. It is often epidermoïd carcinoma of which the overall prognosis is one of the better within the cancers of the superior airways. Methods: Our study concerned 58 cases of larynx cancer treated at the oncology department of Mohamed VI university hospital in Marrakech between October 2002 and December 2005. Results: The mean age was of 55 years. 90% patients were males and 62% of urban origin. The tobacco use was discovered in 91% of the cases and the alcoholism in 40%. Symptoms at diagnosis were essentially dysphonia in 95% and dyspnea in 88% of case the lather having necessitated a tracheotomy in urgency in 55% of cases. The pathology showed that it was exclusively an epidermoïd carcinoma, well differentiated in 80% of the cases, 80% of the patients were initially locally advanced (T3 - T4), while 5% only had a localized stage . 27% of patients received a radiation therapy after surgery (total laryngectomy + lymphadenectomy in all cases) and 61% an exclusive radio-chemotherapy. 5% were lost from view before the beginning of the radiotherapy. On the assessable patients, 73% were in complete remission. Conclusions: The delay to the diagnosis in our country strongly darkened the prognosis of this cancer. The adoption of an information and sensibilisation strategy (anti-tobacco campaign) is necessary.

No significant financial relationships to disclose.
Concurrent radiation therapy and weekly docetaxel in elderly patients with oropharyngeal carcinoma
Authors: Minea L. N. , Anghel R. , Oprea L. , Georgescu T. , Bacinschi X. , Isacu I. , Tarlea A.
Published: March 2020

16539

Background: Orofaringeal cancer is one frequent localization in developing countries like Romania. Our purpose is to evaluate the compliance and efficacy of concurrent weekly docetaxel and radiation therapy as definitive treatment for elderly patients with oropharyngeal carcinoma. Methods: 20 patients, over 65 years of age, with primary oropharyngeal cancer, who were treated with concurrent docetaxel and radiation therapy, were reported between January 2003 and December 2005. The distribution depending on stage was: stage II - 4 patients, stage III - 6 patients, stage IV - 10 patients (IV A - 7 patients and IV B - 3 patients). The total dose of radiotherapy was 70 Gy. Chemotherapy was delivered weekly and consisted in Docetaxel 20 mg/sqm. 4 more cycles of chemotherapy (docetaxel 75 mg/sqm day 1 and cisplatin 75 mg/sqm day 1 every three or four weeks according to hematologic tolerance) were administrated after concurrent radiochemotherapy. Results: Only 2 patients interrupted the radiochemotherapy due to related toxicities, especially acute grade III - IV mucositis. Grade III - IV hematological toxicities were observed in 5 patients, and grade III - IV mucositis in 4 patients. At the time of analysis 18 patients are alive and 11 of them are disease free. Conclusions: Concurrent weekly docetaxel and radiation therapy did not affect patients’ compliance to treatment; acute toxicities were in acceptable limits. Concurrent radio - chemotherapy was well tolerated and results and acute toxicities were comparable with younger patients. Elderly cancer patients should be offered optimal treatment depending on their functional status not on chronological age.

No significant financial relationships to disclose.
Implementation of the California Oncology Emergency Preparedness Plan (COEPP): Updated results of an ASCO-supported state oncology society (SOS) project for patient (PT) protection
Authors: Moss R. A. , Presant C. A. , Lamb M. , Tucker S. , Howard F.
Published: March 2020

17003

Background: Following the Katrina disaster MOASC began developing a plan to provide continuity of care to cancer PT in the event of a disaster. ASCO provided grant support to further develop the plan and begin implementation. COEPP included oncologist (ONC) and PT education and enrollment, developing a simple, portable, PT owned data storage system, ensuring drug availability, establishing offsite data storage, and implementing a communications system. This report updates the progress and problems encountered in this process. Methods: A committee was formed to develop the plan. ONC were educated through the MOASC website and meetings. A PT wallet card (WC) was developed as an initial method to store clinical data. Drug companies were contacted to provide support and emergency drugs. Communication avenues were identified. Attitudes of ONC were surveyed through interviews. Results: ONC readily agreed to join the COEPP. The PT WC have recently begun to be distributed. PT have been enthusiastic to participate. HIPPA compliant digital storage is being explored, but lack of standardization remains a problem. These efforts have required considerable time expenditures by committee members. Drug companies have expressed enthusiasm, and to date, one company has provided a sizable grant. Drug manufacturers and drug wholesalers have separate emergency plans for determining who is responsible for ensuring drug availability to PT and storing current distribution data. However, ONC membership in COEPP continues to increase, and WC have been widely accepted by PT indicating success of the initial part of the program. Educational materials and WC examples will be distributed at the poster. Conclusions: COEPP, while still early in development, is becoming a successful model of emergency preparedness to protect continuity of care for cancer PT. Adequate funding is required for network development, coordination, legal protections, eventual digitization of treatment records, coordination of drug availability, and ONC and PT educational materials. With grants, this model plan can be implemented in other regions by SOS.

No significant financial relationships to disclose.
Time to treat: A system redesign focusing on decreasing the time from suspicion of lung cancer to diagnosis in a community hospital
Authors: Lo D. S. , Zeldin R. A. , Skrastins R. , Fraser I. M. , Newman H. , Monavvari A. , Ung Y. , Joseph H. , Downton T. , Meharchand J.
Published: March 2020

17005

Background: Multiple physician visits, numerous investigations, and serial wait times often result in a lengthy process from the onset of lung cancer-related symptoms until diagnosis. An unpublished retrospective chart review from a Toronto community hospital indicated suboptimal delays for patients from onset of symptoms until the diagnosis of lung cancer. Methods: The Time to Treat Program (TTT), consisting of a streamlined referral system and a clerical facilitator to fast-track patients through a diagnostic pathway algorithm, was designed for patients with clinical or radiological suspicion of lung cancer. Data on patient visits and investigations were collected. Pre- and post-implementation data on median wait times were compared. Results: From April 2005 to December 2006 over 120 physicians referred 188 females and 226 males. For the majority of patients (95.2%), the reason for referral was chest x-ray findings suspicious for lung cancer. After TTT implementation, the median time from suspicion of lung cancer to referral for specialist consultation decreased from 19.9 days to 10 days, and the median time from such referral to the actual consultation date decreased from 16.8 days to 5.3 days. The median time from specialist consultation to CT scan decreased from 52.1 days to 4 days and the median time from CT to diagnosis decreased from 39 days to 12.4 days. Overall, the median time from suspicion of lung cancer to diagnosis decreased from 127.8 days to 30 days. For 25% of the patients in the TTT it took 13 or fewer days from suspicion of lung cancer to diagnosis, while for 5% of the patients it took 90 days or more. Half of the patients in the TTT had a diagnosis by 24 days from the time of suspicion. Of all patients in the TTT, 33% were eventually diagnosed with lung cancer. The time from suspicion to diagnosis took longer for patients who eventually had confirmed lung cancer than those who did not: 36.5 days vs. 28.7 days. Conclusions: By addressing process issues in the work-up of lung cancer, the TTT was effective in shortening the time from suspicion of lung cancer to diagnosis and reduced time intervals at each step in the process. Earlier diagnosis of lung cancer may allow increased treatment options for patients.

No significant financial relationships to disclose.
Extent of lymphadenectomy and survival in stomach cancer
Authors: Wong S. L. , Ji H. , Birkmeyer J. D.
Published: March 2020

17008

Background: Based on population-based studies, some investigators have posited that patients undergoing more extensive lymphadenectomy as part of their resection for stomach cancer had improved late survival rates. Such findings have prompted calls for the use of total lymph node counts as a quality indicator for hospitals. However, apparent relationships between number of lymph nodes resected and survival may be confounded by patient selection bias and provider factors. It is not clear that hospitals with higher lymph node counts have better outcomes than other hospitals. The purpose of this study is to examine relationships between total lymph node counts and survival for stomach cancer. Methods: Using the national Surveillance Epidemiology and End Results (SEER)-Medicare linked database (1992–2002), we first identified all patients undergoing major resections for gastric cancer (n=3,049). Hospitals at which the procedures were performed were categorized into 3 groups (terciles) according to the median number of nodes examined. We then assessed 5-year survival rates for each hospital group, adjusting for potentially confounding patient and hospital characteristics. Results: Hospitals with the highest median lymph node counts had slightly higher 5-year survival rates than those with the lowest node counts (31% vs. 28%; unadjusted HR for mortality 0.90, 95% CI 0.81–1.00). Hospitals with higher lymph node counts tended to treat lower risk patients and had lower procedure volumes. Adjusting for these confounding patient and provider characteristics further weakened the apparent relationship between survival and lymph node counts by hospital (adjusted HR, high vs. low hospital tercile, 0.96; 95% CI 0.85–1.09). Conclusions: Apparent relationships between total lymph node counts by hospital and 5-year survival rates after resection for stomach cancer are relatively weak and explained in large part by confounding patient and provider factors. Stronger evidence should be required before moving forward with this metric as a hospital quality indicator.

No significant financial relationships to disclose.
Development of quality indicators for non-Hodgkin lymphoma
Authors: Wennekes L. , Ottevanger P. B. , Raemaekers J. M. , Schouten H. C. , De Mulder P. H. , Grol R. P. , Hermens R. P.
Published: March 2020

17017

Background: Indicator development to monitor quality of care for non-Hodgkin lymphoma's (NHL) is difficult because NHL represents variable disorders with different and fast changing treatment policies. This study aimed to generate a set of valid indicators for NHL, using a systematic consensus method. Methods: Recommendations from evidence-based guidelines were collected as potential indicators. A multidisciplinary panel of 14 experts rated and discussed these recommendations on the usefulness as an indicator in three rounds using the Rand-modified Delphi procedure. This procedure was innovated with a flow chart from diagnostics to follow-up that showed which recommendations were crucial for the continuation of the care process. Experts were enforced to develop indicators for diagnostics, treatment and follow-up and the organization of care. Results: From a list of 99 recommendations 10 potential indicators for diagnostics, 10 for treatment and follow-up and 8 for the organization of care were selected. All potential indicators for diagnostics and treatment were crucial according to the flow chart. Six indicators were relevant for only a few patients and were rejected. Another six were merged into two. For diagnostics 8 indicators remained including taking a biopsy, evaluation of morphology and immune phenotype, the World Health Organization- classification, staging with CT-scanning of neck, thorax and abdomen, bone marrow aspirate and crista biopsy according to Ann Arbor, blood counts and the International Prognostic Index. For treatment 3 indicators remained regarding treatment with R-CHOP in optimal dose intensity for diffuse large B-cell lymphoma and response evaluation according to Cheson. For organization of care 7 indicators remained including waiting times, multidisciplinary consultations, adequate reporting and accredited expertise and facilities. Conclusions: This study showed that relevant quality indicators can be developed for a complex malignancy like NHL. Our innovations with the flow chart made a relevant contribution to the selection method and we managed to develop indicators for each part of the care process. They are currently tested for validity and feasibility. The use of these indicators makes it possible to monitor and improve the quality of care for NHL.

No significant financial relationships to disclose.
Preferences for breast cancer prevention among BRCA mutation carriers
Authors: Jacobson J. , Patel P. , Bharthuar A. , Hershman D. , Hill K. , Warner E. , Plewes D. , Messner S. , Erichson R. , Grann V.
Published: March 2020

17018

Purpose: Breast cancer screening with MRI is a new option available to patients with BRCA 1/2 mutations. We analyzed preferences for this modality and 10 other breast cancer- related health states and preventive measures among women without cancer or known high risk and women with BRCA mutations. Methods: Following IRB approval, we administered a time trade-off questionnaire to mutation carriers and to women without breast cancer or known high risk. We used Kruskal-Wallis test to compare the two groups with respect to continuous variables, chi-square tests to compare proportions, and the Wilcoxon signed rank test for pairwise comparisons. We then developed logistic regression models to analyze the association of mutation carrier status and demographic factors with willingness to trade time for each of the 11 health states. Results: Two-hundred-four women (44 mutation carriers and 160 without breast cancer or known high risk) responded to the questionnaire. Both groups assigned the highest preference rating to mammography and the next-highest to MRI, but the differences in ratings were not statistically significant. Both groups assigned the lowest preference ratings to having a child with a mutation and the next lowest to ovarian cancer. In pairwise comparisons, both groups ranked oophorectomy higher than ovarian cancer (p <0.01), but mutation carriers did not rank prophylactic mastectomy significantly differently from breast cancer (p=0.38). In the logistic regression models, mutation carrier status was not a statistically significant predictor of willingness to trade time for any health state, but younger age, lower income, and nonwhite race/ethnicity were associated with willingness to trade time for certain health states. Conclusion: Our data indicate that MRI is as acceptable as mammography to respondents, and that the preferences of BRCA 1/2 mutation carriers are similar to those of other women. Age and other demographic factors may be more important than mutation status in determining preferences. The preference ratings of individuals should not be inferred from demographic characteristics or mutation status. However, such ratings can help to clarify the quality of life implications of clinical decision-making and health care policy regarding breast cancer prevention.

No significant financial relationships to disclose.
Development of a Web-based model to track patients’ self-reported symptoms related to anticancer treatment toxicities
Authors: Fasola G. , Aprile G. , Della Mea V. , Noselli M. , Puglisi F.
Published: March 2020

17021

Background: Discrepancies outcropped when traditional modalities in collecting information regarding toxicities suffered by patients being exposed to anticancer treatments have been compared to direct self-reports. Owing to the availability of easily accessible informatics technologies, we hypothesized that a Web-site could be an accurate and reliable tool to directly record toxicity data. Methods: A database schema was designed, implemented with MySQL database management system and interfaced with the Web by using Java 2 Enterprise Edition on the Tomcat application container. A simplified, patient-adapted definition of type and NCI-CTCAE grade of the 15 commonest toxicities has been inserted into the database for reporting. The Web site has two areas, both accessible only with username and password, respectively devoted to patients and physicians. Through home Web access, each patient can report toxicities by choosing and grading any of them. Web site usability has been tested by 8 non-professional users with simulated scenarios. After a quick training, the users were asked to report the described toxicities. Time needed for reporting and reporting errors have been recorded. Results: The average time needed for entering a report has been 10 minutes. Users correctly reported the toxicities provided in the scenarios, but difficulties were noted in the correct identification of the week when entering reports for two or more weeks of therapy. Conclusions: In order to track patient-reported toxicities we developed a prototype Web-based model. Potential utilities of the system are being tested to demonstrate: 1) accuracy, allowing patients to easily report types and grades of the experienced toxicities; 2) flexibility, allowing patient-reporting either weekly or on demand; 3) capability to integrate and to assemble with an electronic patient record and a computerized physician order-entry. The latter capability will be provided by a patient portal with secure authentication and access being developed by the Regional Healthcare Authority. Comparative randomized analysis in 100 consecutive outpatients between clinical interviewing and Web-reported toxicity has been planned.

No significant financial relationships to disclose.
Are doctors themselves responsible for delay in cancer management?
Authors: Karwasra R. , Bhanot S. , Goel R.
Published: March 2020

17027

Background: In developing countries poor results of cancer management are believed to be due to late presentation of patients because of poverty, illiteracy and lack of cancer awareness. But the scenario changed little despite regular cancer awareness campaigns in last few decades. Methods: 1,006 cancer patients were assessed for time of onset of symptoms, time of presentation to physician, time taken in diagnosis & initiation of anticancer treatment to identify the level of delay in cancer management and factors responsible. Results: 81.3% of the patients belonged to low socioeconomic group. 61.9% were illiterate & 43.7% were laborers. Literacy level of 84.5% of patients was under metric level and 50.3% had no awareness about cancer. 55.4% patients presented to qualified medical practitioners, 38.9% to non-qualified medical practitioners & 5.5% to qualified non-medical practitioners working as primary care physicians. Almost 80% of patients had delay in cancer management at various levels, the maximum being at diagnosis level. 67.3% patients presented to primary care physician within a month of onset of symptoms without delay. In 68.6% patients the diagnosis of cancer was delayed by more than one month once they presented, the physicians being responsible for this delay in 60.4 % cases. Though non-qualified physicians almost never diagnosed cancer but even 58% of the qualified medical physicians delayed the diagnosis of cancer in the symptomatic patients. In 77.1% patients, physicians did not suspect cancer and disposed off the patients on symptomatic treatment. Literacy of the patients affects awareness and has bearing on the pattern of consultation whereby most of the literates consulted qualified physicians while most of the illiterates consulted non-qualified physicians resulting in delay. Conclusions: Presentation of the cancer patient depends upon reaction to the symptom and therefore despite illiteracy and poverty, majority of symptomatic patients present without delay to their primary care physicians. Delay occurs at diagnosis level in most of the patients and physician is the most common factor responsible for this delay. Tendency to treat the symptoms rather than making diagnosis of the patient and poor oncology knowledge to differentiate symptoms of cancer may be the reasons for this.

No significant financial relationships to disclose.
The impact of race on outcome of autologous transplantation in patients with multiple myeloma
Authors: Verma P. S. , Howard R. S. , Weiss B. M.
Published: March 2020

17029

Background: Multiple myeloma (MM) is the most common hematologic malignancy in African-Americans (AA), with historically double the mortality of Caucasians (C). Monoclonal gammopathy of undetermined significance (MGUS) is also three times more frequent in AA than C. There has been limited data exploring racial differences in survival during the era of high dose chemotherapy with autologous stem cell transplantation (ASCT). Methods: We retrospectively analyzed the records of all C (n=55) and AA (n=36) MM patients who underwent ASCT over 10 years. Presenting demographic, clinical features and response to therapy by the Bladé criteria were obtained from medical records. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier method, and compared using the log-rank test. Results: The median age at diagnosis for AA was 52 years (30–75 years), compared to C at 56 years (39–79 years), p=0.006. There was no statistical difference in presenting ISS stage (AA: I- 50%, II- 28.1%, III- 21.9%; C: I- 51.2%, II- 20.9%, III- 27.9%), or values for presenting hemoglobin, calcium, and creatinine. There was a trend for increased skeletal involvement at diagnosis in the C group (82% vs. 69%, p=0.08). AA presented with an increased CRP (1.2 mg/dl vs. 0.25mg/dl, p=0.05). The most commonly used induction and conditioning regimen was VAD (78% AA vs. 70% C), and Mel 200 (72% AA vs. 65% C), respectively. Response to induction: CR: AA- 6%, C- 5%, p=1.00; PR: AA- 64%, C- 56%, p=0.519. Response to ASCT: CR: AA- 17%, C- 26%, p=0.438; PR: AA- 56%, C- 46%, p=0.519. At a median follow-up of 46.7 months, PFS was 60.5 months and 43.7 months (p=0.490), for AA and C, respectively; OS was 95.2 months and 68.5 months (p=0.421), for AA and C, respectively. Conclusion: In this series, AA with MM present at a younger age, with an increased CRP and a trend for less skeletal involvement than C at diagnosis. Despite a trend for less CR rates in AA, there was a trend for increased PFS and OS compared to C. This suggests there are biologic differences in MM between the races that may result in different therapeutic outcomes. One possible explanation would be the known higher frequency of MGUS in AA resulting in a reversion to a stable, indolent MGUS-like state after ASCT. These findings should be confirmed in larger studies.

No significant financial relationships to disclose.
Using the FACT-Neurotoxicity Subscale to evaluate quality of life in patients from across the globe
Authors: Arnold B. J. , Du H. , Eremenco S. , Cella D.
Published: March 2020

17032

Background: Translation of Patient Reported Outcomes measures is an essential component of research methodology in preparation for multinational clinical trials. One such measure is the FACT-Neurotoxicity Subscale (FACT-Ntx) which is aimed at the evaluation of quality of life of cancer patients suffering from neurotoxicity, a side effect of certain treatments. Methods: This study set out to linguistically validate the FACT-Ntx for use in Denmark, India, Lithuania and S. Africa. The sample consisted of 176 patients (96 males & 80 females), with varying cancer diagnoses and a mean age of 51 years, speaking 11 languages: Afrikaans (15), Danish (25), Gujarati (15), Hindi (15), Kannada (15), Lithuanian (15), Malayalam (15), Marathi (15), Punjabi (15), Tamil (15) and Telugu (16). The FACT-Ntx was translated using standard FACIT methodology. Patients diagnosed with cancer, at any stage, receiving any treatment experiencing neurotoxicity completed the respective translated version and participated in cognitive debriefing interviews to give their opinion on any problems with the translations or the content of the FACT-Ntx. Statistical analyses (descriptive statistics, one-way ANOVA and reliability analyses) were performed on the quantitative data. Participant comments were analyzed qualitatively. Results: The FACT-Ntx translations showed good reliability and linguistic validity. The internal consistency of all languages combined was .86. All items correlated at an acceptable level. The Ntx score differed across self-reported Performance Status Rating (PSR) groups (nonparametric Kruskal-Wallis test p<.0001). A nonparametric Generalized Linear Model (GLM) approach (with multiple comparison adjusted significance level 0.017) showed a difference between ‘PSR=0’ and ‘PSR=1’ (p=0.0002) and a difference between ‘PSR=0’ and ‘PSR=2’ (p<.0001), both with ‘PSR=0’ patients reporting less neurotoxicity. Conclusions: The FACT-Ntx has shown acceptable reliability and linguistic validity in 11 languages. The instrument has also shown adequate sensitivity in differentiating patients with no symptoms and normal activity from patients reporting some symptoms. We consider these translations acceptable for use in international research and clinical trials.

No significant financial relationships to disclose.
Comparison of various breast cancer detection methods with survival rates
Authors: Misra S. , Tarr S. , Pratt D.
Published: March 2020

17033

Background: The role of mammography (MG) but not of breast self-exam (BSE) and clinical breast exam (CBE) in breast cancer detection and survival is well documented. This study compares the different methods of breast cancer detection and subsequent survival rates, analyzing the differences even within the same stage of the disease. Methods: Retrospective review of 1,259 patients was done using the hospital Tumor Registry data. Only patients with stage I, IIA and IIB are included and were diagnosed between April 1992 to December 2005 with follow up ranging from June 1993 to August 2006. The detection methods studied include BSE, CBE, MG and ultrasonography (USG). Parametric tests were conducted. Results: Mean age of the sample was 62 years (range 24–96). There were 293 BSE, 64 CBE, 885 MG, 17 USG detected breast cancer patients. Mean size of mass at presentation was 19 mm (range 1–110). Mean survival time for patients detected with breast cancer till August 2001 was 76 months (range 1–163). 67% patients survived 5 years or more and 12% survived more than 10 years. Mean survival for BSE/CBE and MG/USG group was 43 and 57 months respectively. This difference in survival is significant p< .05; The average survival time by stages I, IIA, IIB for BSE was 47, 45, 38 months, for CBE it was 43, 39, 51 months, for MG it was 57, 59, 50 months and for USG group it was 52, 47, 95 months respectively. Even within the same stage, the method of detection affected survival with the BSE and CBE group having less survival rates (Tukey Test mean difference 0.54, 95% C.I 42–66 and 0.38, 95% C.I 15–61) respectively than the MG group. Survival time also positively correlated with cancer recurrence (r =.7), family history (r = .06) and negatively correlated with age (r = -.09), size of tumor (r = -.09), estrogen receptor positivity status (r = -.06) all with (p < 0.05). We believe this study underestimates overall survival rate as the last follow up date was taken as an end point and also the survival rates are not disease specific survival. Conclusions: MG/USG group show higher survival rates compared to BSE/CBE across the early stages of breast cancer. Even within the same stage, the method of detection affects survival with MG/USG detected cases having more favorable outcomes. May be our current staging system for breast cancer is inadequate and needs revision.

No significant financial relationships to disclose.
Effects of implementing an electronic system for the collection of patient reported symptoms on clinic note transcription length
Authors: Cobb P. W. , Kofstad M. , Bealer C.
Published: March 2020

17035

Background: Recent advances in information technology have made the goal of incorporating patient-reported symptoms possible. Initial studies have examined the validity of these systems but no systematic work has been done to examine the impact on overall practice efficiency. The PACE (Patient Assessment, Care, and Education) System captures patient-reported symptoms, quality of life, social and family history changes, and other clinical data at every office visit. The PACE System includes the Patient Care Monitor (PCM), a standardized, comprehensive assessment of a patient's condition that allows for a self-reported review of systems (ROS) via a wireless, touch screen computer tablet. The purpose of this study was to determine if implementation of the PCM had an impact on total transcription length. Methods: The study utilized a retrospective within subjects control design comparing transcription length by physicians practicing both with and without the PCM. The PACE System was implemented in October 2004 in a main outpatient oncology site in Billings, MT (PACE site). The analysis compared transcription length by physicians who practice in the Billings office where the PACE system was available, and also in four sites in Montana and Wyoming where the PACE system was not available during the same time period (January to October 2006). All available, consecutive physician notes were analyzed from eligible physicians during the analysis period. Results: Four physicians met inclusion criteria and 8,150 notes were analyzed. The average number of dictation words at PCM sites was 406.7 as compared to 485.5 at non- PCM sites (a 16% reduction). The average number of dictation lines at the PCM sites was 54.0 as compared to 58.5 at non-PCM sites (an 8% reduction). Conclusions: Increases in the use of information technology in outpatient oncology necessitate increased understanding of the validity and utility of these systems. This study of the PACE system suggests that there may be an efficiency benefit by implementing patient self-reporting systems.

No significant financial relationships to disclose.
Identification of cancer care and protocol characteristics associated with recruitment rate in breast cancer clinical trials in Ontario
Authors: Lemieux J. , Goodwin P. J. , Pritchard K. , Gelmon K. , Bordeleau L. , Duchesne T.
Published: March 2020

17042

Background: Recruitment rate (RR) in clinical trials (CT) has been recognized to be low. Poor accrual may lead to premature closing of CT or decrease of the planned power to detect an effect if present. Methods: Objectives were primarily to identify characteristics of cancer care settings and clinical trials protocols associated with low RR and secondarily (1) to determine the RR and (2) to compare the RR between years. A cross-sectional design was used. Poisson regression was used for multivariate analysis. RR was calculated by CT, hospital and year in Ontario between 1997 and 2002. Number of patients recruited in each CT was obtained from cooperative groups and pharmaceutical companies. Number of patients with breast cancer (BC) was obtained from the Ontario Cancer Registry. Prevalence of women with metastatic BC was calculated from the British Columbia Breast Cancer Outcome Unit database. Characteristics of cancer care and protocols were collected. Results: Response rates were 84% (66/79) for hospitals, 69% (9/13) for cooperative groups and 80% (8/10) for pharmaceutical companies. Recruitment rates varied between 1.3% and 5.5% (median, p=0.0003). Characteristics of cancer care were not associated with RR (number of oncologists, breast oncologists, breast surgeons, investigators, clinical research associates and being a cancer centre or an academic centre). Among protocol characteristics, the following were associated with RR in univariate analysis: phase, randomization, type of intervention, placebo, extent of the trials (local vs. national vs. international), number of sites, population (adjuvant vs. metastatic), menopausal status, premature closing of the trial, time frame for enrolment, extra baseline and follow-up testing. In multivariate analysis, type of control arm and time frame for enrolment were significant. CT using placebo compared to an active control arm were less likely to recruit patients (relative risk 0.57, p=0.0144). CT with a time frame for enrolment greater than 9 weeks were more likely to enrol patients (relative risk 1.43, p=0.0020). Conclusions: RR is very low. No easily modifiable factors have been identified. This project was funded by the Canadian Breast Cancer Foundation, Ontario Chapter.

[Table: see text]
Women from non-English speaking backgrounds living in Australia present with later stage breast cancer: A population study
Authors: Lee C. K. , Browne L. , Bastick P. , Liauw W.
Published: March 2020

17043

Background: Ethnicity may influence both the incidence and prognosis of breast cancer. We have conducted an analysis to determine if women from non-English speaking backgrounds (NESB) living in New South Wales (NSW), Australia, present with later stage breast cancer compared to women from English speaking backgrounds (ESB); and to determine whether there is an impact on their survival. Methods: Data from the NSW Cancer Registry (1980 to 2004) was used to identify women with their first presentation of breast cancer. Stage of breast cancer was classified as early (insitu or localized) versus late (regional nodal or distant metastatic spread) according to registry definitions. Country of birth was used as a surrogate for language status. Stage at diagnosis was compared between ESB versus NESB women. Logistic regression was used to determine the odds of late stage disease and Cox regression to determine survival outcomes Results: 60,676 of 75,583 cases were considered suitable for analysis. Of these 16.64% were NESB. Accounting for potential confounding variables, NESB women were more likely to have late stage disease than ESB women (OR= 1.12; 95% CI, 1.07 to 1.17). Analysis by geographical region of birth revealed women born in Middle Eastern region were most likely to have late stage disease at presentation (OR 1.41; 95% CI, 1.25 to 1.60). In multivariable analysis of all-cause mortality NESB women had a superior overall survival (HR 0.90; 95% CI 0.87 to 0.94) compared to ESB women, however, there was no difference in breast cancer specific survival between these groups by univariate analysis (logrank p=0.46). Conclusions: In New South Wales, Australia, NESB women have a delayed presentation with breast cancer as indicted by more advanced stage. However, stage-adjusted, breast cancer specific survival in NESB women is similar to the ESB women. Further studies are required to determine the reasons for delayed detection for NESB women.

No significant financial relationships to disclose.
Bilateral breast cancer
Authors: Oh J. , Park B.
Published: March 2020

17073

Background: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. The aim of this study is to assess the impact of bilateral breast cancer on the prognosis compared with unilateral breast cancer and examine clinicopathologic characteristics of Bilateral and Unilateral breast cancer. Methods: 108 patients included in this study from Jan 1980 to Dec 2005 and all information regarding medical and family history of breast cancer came from medical records and questionnaires. Results: There were 108 patients with bilateral breast cancer and its incidence was 2.3% of total breast cancer. The incidence of bilateral breast cancer after 1998 was 3.5% (90/2548) compare with the incidence before 1998 (0.9%). The mean age of patients with bilateral and unilateral breast cancer was 45.34 and 47.54 years, respectively. (p=0.032) Compared to unilateral breast cancer, bilateral group did not differ in gravida, marital status, use of HRT, but the number of case which was diagnosed with breast cancer among close relatives was more frequent (7 cases/6.5% vs 126 cases/2.8%, p=0.024). Although the most frequent histopathologic subtype was ductal carcinoma in both groups, the distribution of the histopathologic subtypes was different between the groups as invasive lobular carcinoma was present in a higher percentage of patients with bilateral breast cancer than in patients with unilateral breast cancer (6.5% vs 2.1%, p=0.002). It suggested that risk factors of developing bilateral breast cancer were family history, lobular tumor, use of hormonal therapy based on the result of multivariate regression analysis. There were no statistically significant difference in 5-year disease free survival and overall survival in both groups (bilateral: 83.25%, 89.52% vs unilateral: 82.74%, 88.79%), (p=0.3934, p=0.3114). Conclusion: In lobular carcinoma patients with family history of breast cancer during follow-up, the possibility of contralateral breast cancer should be considered more carefully and the therapeutic strategy for secondary tumor should resemble the treatment procedure for the primary tumor.

No significant financial relationships to disclose.
Pancreatic cancer in breast cancer patients: Incidence and relation with hormone receptor status
Authors: Ghabache B. , Cole J. , Vasireddy S.
Published: March 2020

17079

Background: There has been a long-standing interest in the role of estrogens in pancreatic tumors and several reports regarding the expression of hormone receptors in pancreatic tumors and the relation between estrogen stimulation and the development of pancreatic cancer have been inconsistent . This raised questions about the increased risk of pancreatic cancer among breast cancer survivors and the possible role of antihormonal therapy in the prevention and treatment of these malignancies. Methods: The Tumor registry at the Ochsner Clinic Foundation in New Orleans was queried to identify new cases of pancreatic cancer among patients previously diagnosed with breast cancer. This was done by matching data on pancreatic and breast cancer diagnosed between January 1996 and January 2006. For each case of pancreatic cancer, data was collected from the initial breast cancer pathology report, this included : Cancer type, Grade, Estrogen Receptor status, Progesterone Receptor, HER- 2 Receptor status , BRCA gene mutation and cancer stage on diagnosis. Clinic notes and radiology reports were also reviewed to determine the presence of risk factors for pancreatic cancer, the interval of time between the two diagnosis and the stage of breast cancer at the time of diagnosis of pancreatic cancer. Results: A total of 2,669 breast cancer cases were reviewed and 5 cases of pancreatic cancers were found among patients with a previous diagnosis of breast cancer. In all these cases the breast cancer tumor was positive for Estrogen and Progesteron receptor and negative for Her2 overexpression. The incidence of pancreatic cancer in this subgroup of patients (Breast cancer, ER+,PR+, HER2-) was 1% much higher than the incidence in the general female population. Conclusions: In our experience patients with breast cancer might have a higher risk of developping pancreatic cancer. This is especially true for patients whose tumors over-express the estrogen and progesterone receptors and which do not over-express the Her2 receptor. Further studies are needed to evaluate the overall incidence of pancreatic cancer in this population and to determine the role of anti-hotmonal therapy in the prevention of these cancers.

No significant financial relationships to disclose.
Pleural effusions in patients treated with dasatinib: Results from two institutions, risk factors and management
Authors: Lipton J. H. , Sriharsha L. , Bogomilsky S. , Casciaro L. , Keating A. , Messner H. , Laneuville P.
Published: March 2020

17503

Background: Dasatinib (SPRYCEL, formerly BMS354825) is a multi-targeted kinase inhibitor that has been shown to be very effective in the therapy of imatinib-resistant and -intolerant Ph-positive CML/ALL patients, frequently resulting in hematologic and cytogenetic remissions. Therapy with kinase inhibitors has been limited to some extent by fluid retention, the type of which is dependent on the individual drug. Pleural effusions have been relatively more common with dasatinib. We report on the experience at two large teaching hospitals - incidence, risk factors and management. Methods: 27 patients were treated on 5 BMS Phase 2 Studies (2CP, 1AP, 1BP-M, 1BP-L, 1ALL) - 17 CP, 5 AP, 3 BP-M, 2 BP-L/ALL. All patients started on a dose of 70mg BID of dasatinib. Results: In all 13 patients developed effusions. All but 1 were Grade 2; grades 2–4 are symptomatic and require intervention. Of the 14 who did not, 9 were either withdrawn from study because of CML progression (3) or dose-reduced because of hematological toxicity (6). The development of effusions was more common in patients with more advanced disease (BC>AP>CP), in those with previous lung problems (smoking, infections), and in those maintained on starting doses of dasatinib. Effusions could develop even 1–2 years (1>100d, 2>200, 2>300d, 1>500d) after starting therapy often triggered by a lung infection. Effective management included ongoing combinations of diuretics, temporary drug discontinuation, dose reduction, and more recently a once daily drug dosing schedule (Hochhaus et al , Blood 2006, 108: 166a). One patient required thoracentesis and chest tube. Conclusions: Dose monitoring and adjustments and management of the effusions have permitted continuation of the therapy in 10 of the 13 patients with good hematological outcomes. A change in dose schedule will be most effective.

No significant financial relationships to disclose.
High-dose chemotherapy followed by autologous stem-cell transplantation for Hodgkin disease using CVB as conditioning regimen
Authors: Avila R. A. , Valdéz J. A. , Caeiro G. , Basquiera A. L. , Sturich A. G. , Berretta A. R. , García J. J.
Published: March 2020

17505

Background: Autologous stem-cell transplantation has become a widely used therapy in Hodgkin's disease. We analysed outcome, overall survival (OS) and time to progression (TTP) in relapsed patients with Hodgkin's disease undergoing autologous stem-cell transplantation (ASCT) in a single institution. Methods: Between 1996 and 2006, 28 patients (19 males and 9 females; median age 31 years old, range 10–63) underwent high dose chemotherapy with CVB regimen (cyclophosphamide 6 gr/m2, VP-16 2.400 mg/m2, and BCNU 450 mg/m2) with autologous stem-cell support. Before transplantation, 20 patients had received two lines of chemotherapy and 8 patients, three lines or more. At time of transplantation 12 (42.8%) patients were in complete remission and 16 (57.2%) in partial remission after rescue chemotherapy. The graft consisted of bone marrow (n: 6) or peripheral blood stem cells (n: 22). Results: The 100-day mortality rate was 3.57 %. With a median follow-up of 36 months for the surviving cohort, the median time of TTP and OS was of 31.4 and 55.63 months respectively and the five years TTP and OS were of 45% and 47% respectively. The most common toxicities presented were febrile neutropenia (100%) and mucositis (92%), both of them resolved completely before discharged. Patients who achieved complete response (n=20) after transplantation (evaluated at 100-day) had a better OS than patients who achieved partial response (n=8) (HR: 0.11; CI: 95% 0.03–0.49; p:0. 0036). Conclusions: High dose chemotherapy using CBV as conditioning regimen followed by ASCT is an effective treatment to achieve complete remission, which is associated with better survival in our series. This regimen presented acceptable toxicity and low mortality.

No significant financial relationships to disclose.