bluuebunny/crossref_metadata_2025 huggingface dataset:
Comorbidities in patients with sarcoma: Insights from the National In-Patient Database from 2006 to 2014.
Authors: Cuartas Mesa Maria Cristina , Quelal Analuisa Karol , Litvin Rafaella , Deenadayalan Vaishali , Olafimihan Ayobami Gbenga , Ibrahim Muhammad Bilal , Bittar Gianfranco , Martinez Trevino Enrique Francisco , Nieto Alejandro
Published: June 2023

e23534

Background: Sarcoma represents a rare solid malignancy in adults. Given the likelihood of metastatic disease, the prognosis is usually poor. Comorbidities are independent determinants of prognosis, and cardiovascular and respiratory diseases are the most common. We aimed to study the prevalence, trends, and outcomes of CVD and pulmonary circulation disorders in patients admitted with sarcoma over eight years. Methods: We present a retrospective analysis of hospital admissions for soft tissue malignancies between 2006 and 2014 from the NIS database using its respective ICD-9-CM code. We obtained the prevalence of cardiovascular diseases (HF, CAD, HTN) and pulmonary circulatory disorders (PE, PHTN). We assessed yearly trends with the Cochran-Armitage trend test. Using multivariate binomial logistic regression (adjusting for sex, race, age, and Elixhauser comorbidities) we calculated adjusted odds ratios (aOR) to identify the association of these comorbidities with in-hospital mortality. Results: Between 2006-2014 there were 352320 admissions with a primary diagnosis of soft tissue malignancies. Of them, 55.8% were males, 60% were white, and 57.5% were 50 years old and older. In 39% of the population, CVD was present: HTN 35.5%, CAD 8.5%, HF 4.5%. The rate of pulmonary circulatory disorders was 2.5%: PE 1.7%, and pulmonary hypertension 0.9%. In-hospital mortality accounted for 3.7% of admissions. The CVD yearly prevalence increased from 34.6% in 2006 to 41.7% in 2014 (p < 0.001). Pulmonary circulatory disorders rose from 1.7% in 2006 to 3.3% in 2014 (p < 0.001). Pulmonary circulatory diseases were associated with high in-hospital mortality aOR 3.02 (CI 95% 2.44-3.73, p = 0.00). Cardiovascular disease was not statistically significantly associated with an increased rate of in-hospital mortality aOR 1.04 (CI 95% 0.93-1.15, p = 0.53). Conclusions: In sarcoma patients, it is essential to quantify their comorbidities as these often influence their chosen therapy. Cardiovascular disease affected one-third of the patients. However, despite the low prevalence of pulmonary circulatory disorders, they were associated with high in-hospital mortality. Further studies are needed to understand the causality and underlying physiopathology.
Epidemiology, survival, and treatment of liposarcoma subtypes: An analysis of the national cancer database.
Authors: Kennard Jared , Silberstein Peter T. , Braaten Marco
Published: June 2023

e23535

Background: Liposarcomas are a soft tissue sarcoma which grow in adipose tissue, mainly in the subcutaneous fat of the limbs, and are the most common type of soft tissue sarcoma. Relatively little is known about the epidemiology, prevalence, and survival of various histological subtypes of liposarcoma, therefore, in the largest study to date, we analyzed this patient population using the NCDB. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with Liposarcoma from 2004 to 2019 using the histology codes 8850, 8851, 8852, 8853, 8855, and 8858 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: We identified 19,351 patients with liposarcoma. Mean age at diagnosis was 59 years for all subtypes and 83.3% of patients were white. Well-differentiated tumors were the most common histological subtype (34.8%), conferred the longest overall survival, and were the largest tumors on average. Round-cell tumors were the rarest (2.4%) and had smaller average tumor size than other subtypes. Patients with the de-differentiated subtype (20.5%) experienced the lowest median survival (70.5 months; p < 0.05) and an increased hazard ratio (HR = 2.8; p < 0.05) after controlling for other subtypes, age, and stage at diagnosis. Surgery was the mainstay of therapy with 90% of patients receiving surgery. 11.2% received additional adjuvant chemotherapy and 2.8% received adjuvant radiotherapy. Round cell and Myxoid tumors were most amenable to resection (89.8% and 88.9% of patients having no residual tumor) compared to only 64.4% of dedifferentiated tumors with complete surgical resection. Conclusions: Liposarcomas are a heterogeneous group of tumors which carry unique patterns of presentation, treatment, and prognosis. Well differentiated tumors are common and amenable to treatment; de-differentiated tumors are more aggressive and remain difficult to fully treat.
Factors associated with overall and cancer specific mortality in primary cardiac sarcoma.
Authors: Bangolo Ayrton , Fwelo Pierre , Nagesh Vignesh , Jarri Amer , Chacko Angel Ann , Dey Shraboni , Proverbs-Singh Tracy Ann , Atoot Adam
Published: June 2023

e23539

Background: Primary cardiac sarcomas (PCS) are extremely rare malignant tumors involving the heart. Only isolated case reports have been described. There is a paucity of data on the epidemiological characteristics of PCS. Virtually all types of sarcomas have been reported in the heart. For most types, only isolated case reports have been described. We used a nationally representative database to evaluate the independent prognostic factors amongst patients with PCS. This study has the objective of investigating the epidemiologic characteristics, survival outcomes and independent prognostic factors of PCS. Methods: We enrolled a total of 362 patients with PCS, between 2000 and 2017, by retrieving the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of PCS. Variables with a p value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors.All statistical tests were performed by using Software STATA 16.1. The SEER database is a publicly available dataset for which there was no need for IRB approval. Results: The male gender (50.83%), and non-Hispanic whites (58.84%) were the most represented groups in our cohort. The most encountered histologic subtype was angiosarcoma (42.51%), which represented nearly half the cases. Multivariate cox proportional hazard regression analyses of factors affecting all-cause mortality and PCS related mortality among US patients between 2000 and 2017 demonstrated Higher overall mortality in age 80+ (HR = 13.261, 95% CI 5.839-30.119, p = 0), followed by age 60-79 (HR = 1.916, 95% CI 1.213-3.025, p = 0.005); and advanced disease with distant metastasis (HR = 2.013, 95% CI 1.355-2.99, p = 0.001), followed by regional involvement (HR = 1.518, 95% CI 1.041-2.214, p = 0.03). Lower OM rate was observed in patients with rhabdomyosarcoma (HR = 0.364, 95% CI 0.154-0.86, p = 0.021) and widowed (HR = 0.506, 95% CI 0.263-0.977, p = 0.042). Age 80+ (HR = 11.177, 95% CI 4.449-28.08, p = 0) and advanced disease with distant metastases (HR = 2.117, 95% CI 1.37-3.271, p = 0.001) have the highest cancer specific mortality. Patients with rhabdomyosarcoma (HR = 0.344, 95% CI 0.128-0.929, p = 0.035) have a lower CSM. Conclusions: In this United States population-based retrospective cohort study using the SEER database, we found that age at diagnosis and advanced disease at diagnosis were independent factors predicting poor prognosis. Furthermore, patients with rhabdomyosarcoma had a lower mortality compared to other histologic subtypes. Surgical resection of the primary tumor did not significantly impact the overall mortality or the cancer-specific mortality.
Italian report of expanded access for nab-sirolimus in patients with malignant perivascular epithelioid cell tumor (PEComa).
Authors: Sanfilippo Roberta , Fabbroni Chiara , Fumagalli Elena , Franza Andrea , Provenzano Salvatore , Collini Paola , Greco Francesca Gabriella , Duca Matteo , Casali Paolo Giovanni
Published: June 2023

e23541

Background: Malignant perivascular epithelioid cell tumor (PEComa) is a rare aggressive sarcoma, with no approved treatment in Europe, while the mechanistic target of rapamycin (mTOR) inhibitor nab-sirolimus has been approved in US. In Europe, an expanded access program is available for patients with advanced or metastatic PEComa. Methods: We retrospectively collected data of patients with advanced/metastatic PEComa treated at our institution from December 2020 through 3rd February 2023 with nab-sirolimus. Nab-sirolimus was administered as an intravenous infusion over 30 minutes at a dosage of 100 mg/m2 on days 1 and 8 of each 21-day cycle. Results: At the time of this analysis, 10 patients were treated with nab-sirolimus and 8 are evaluable for response. Of them, 4 patients received nab-sirolimus as their first mTOR inhibitor therapy, while 4 had already received another mTOR inhibitor, being discontinued for PD. Amongst patients not pretreated with mTOR inhibitors, 2/4 had a PR as their best response, 1/4 obtained SD and 1/4 obtained PD. Amongst patients pretreated with another mTOR inhibitor, all but 1 obtained PD as their best response and 1/4 had SD. The majority of nab-sirolimus-related adverse events were grade 1 or 2 and were manageable for long-term treatment. No grade 4 treatment-related adverse events were observed. Amongst the 10 patients treated with nab-sirolimus, tumor profiling is available for 6 patients, being ongoing for the other 4. Conclusions: nab-Sirolimus is active in patients with malignant PEComa. Activity is mainly confined to those not already treated with other mTOR inhibitors.
Clinical outcomes of soft tissue sarcoma in the Philippines: A single-center experience.
Authors: Maaño Omar Paningbatan , Gorospe Agnes Evangelista , Pascual-Panganiban Anna Marie
Published: June 2023

e23549

Background: Soft-tissue sarcomas (STS) are a heterogeneous group of uncommon tumors that account for less than 1 percent of all adult malignant tumors. Data are scarce in the Asia-Pacific region, especially in the Philippines. This study aims to evaluate the epidemiology and clinical outcomes of STS from a private tertiary hospital in the Philippines. Methods: All adult patients treated at St. Luke’s Medical Center (SLMC), Quezon City and Global City, between January 2010 and December 2020 were reviewed. Continuous variables are described in median and categorical variables are described in count and percentage. Kaplan-Meier curves for overall survival (OS) and recurrence-free survival (RFS) were compared by the Log-Rank test. Results: One hundred eighty-seven patients diagnosed with STS were eligible for the study. The median age at diagnosis was 53 years old; the majority were male (54.55%). The most common histologic subtypes were liposarcoma (19.79%), pleomorphic sarcoma, undifferentiated (16.58%), and leiomyosarcoma (11.76%). Most were diagnosed with localized disease (90.9%), with the lower extremities (44.39%) as the most common primary site. The median tumor size was 10.3 cm, primarily high grade (46.52%). Nodal involvement on diagnosis was 4.28%. Twelve patients (6.42%) presented with de novo metastasis; lung (45%) was the most common site. The majority had surgery (81.82%) on the primary tumor, with 56.86% achieving R0. Eighty patients (42.78%) had radiotherapy; the majority were given post-operatively (N = 60). Sixty-three patients (33.68%) received systemic therapy. Out of 170 patients with localized disease, 70 (40%) had disease recurrence, mostly local recurrence (57.14%). The 3-year OS and RFS were 58.67% and 55.20%, respectively, for the entire cohort; for localized disease was 95.06%. There was a statistical difference in OS between distant vs local recurrence (23.28% vs 49.11%)(p < 0.001), nodal involvement (p = 0.041), surgery (p < 0.001), and radiotherapy (p = 0.001). Conclusions: Most STS seen and diagnosed in SLMC is mostly localized disease but with lower rates of resection than in other countries in the Asia-Pacific region. The clinicopathologic features, treatment modalities received, histological subtype, and primary anatomical site are similar to other data. The low survival rate may be attributed to the site of recurrence, nodal involvement, and treatment pattern received.
Clear cell sarcoma: The OSU experience.
Authors: Tinoco Gabriel , Husain Marium , Kim Hangil , Xu Menglin , Liebner David A.
Published: June 2023

e23554

Background: Clear cell sarcoma (CCS) is an ultra-rare translocation-driven sarcoma. Often affects young adults with no sex preponderance, and whites have a higher occurrence. Frequently present as a slow-growing mass in the extremities or trunk. The EWSR1–ATF1/CREB1 mutation is pathognomonic. The optimal treatment has not been outlined, but it is extrapolated from soft tissue sarcomas. The role of systemic therapies still needs to be fully elucidated, largely due to limited data. This is one of the largest single-institution cohorts reported. Methods: Patients evaluated at The Ohio State University James Comprehensive Cancer Center between January 1, 2010, and April 1, 2022, were included. Data collected included baseline demographic variables, pathologic and molecular features, treatment regimen, and outcomes. Due to a small cohort size, descriptive statistics were performed instead of formal power calculations. Results: A total of five patients were identified. 3 of 5 were white (60%), and 2 of 5 patients were black (40%). The mean age at diagnosis was 46 years, median at 43 years, ranging from 29 to 66 years. 3 of the 5 patients were female (60%), and 2 were male (40%). The mean size of the tumor at presentation is 5.62 cm. 2 of the 5 patients had stage 1 disease at presentation (40%), one had stage 3 (20%), and 2 had Stage 4 (40%). 3 out of 5 patients received treatment with curative intent. 4 patients had primary in the abdomen/lower back or lower extremities (80%). 4 patients received chemotherapy, and these patients received 3 to > 5 cycles. 3 of the 4 on chemotherapy progressed (50%). A patient who received Sunitinib had the shortest time to progression, at 30 days (or 4.3 weeks). The patient who experienced the longest time to progression received Pazopanib, with progression occurring after 339 days (or 48 weeks). Within the early-stage patients, one of the three underwent surgery progressed (33.3%). None of the two patients that received radiation progressed (0%). 3 of 5 participants (60%) eventually expired during the study dates (2 with metastatic disease at diagnosis and 1 with localized disease). All patients received next-generation sequencing. One of these patients demonstrated positive expression levels for PD-L1. The median tumor mutation burden (TMB) value was 11.86 ranging from 2.06 to 28.16. Conclusions: We found that CCS has a high rate of disease progression despite the multimodality approach, and there is a high mortality associated with the disease. Due to the sample size of this single institution study, we cannot identify significant associations between clinical and demographic factors and treatment outcomes in clear cell sarcoma. However, these results stress the importance of multi-institutional (national and international) collaboration around ultra-rare subtypes of sarcoma to provide more significant patient data, improve outcomes, and design clinical trials for these patients.
Differential overall survival and treatment for non-dedifferentiated liposarcoma in academic and non-academic facilities: An NCDB analysis.
Authors: Czaplicki Alec , Bine Christopher , Nielson Eric , Braaten Marco , Silberstein Peter T.
Published: June 2023

e23556

Background: Liposarcoma is a malignant soft tissue tumor sarcoma which most commonly arises in subcutaneous fat of the limbs and abdomen. Previous studies found overall survival and treatments to vary between patients treated at academic and non-academic facilities. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with non-dedifferentiated liposarcoma from 2004 to 2019 using the histology codes 8850, 8851, 8852, 8853, 8855, and 8857 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: Of the 15,256 patients queried, 72% were treated at an academic/research facility (AF). Patients treated at an AF had an improved median survival compared to a non-academic facility (NA) (184 months versus 154 months; p < 0.001). After controlling for stage, income, and therapy type, treatment at an AF was associated with an independent decrease in hazard (HR = .824; p < 0.001). AF patients disproportionately came from a higher income bracket and were more likely to carry private insurance. Additionally, AF patients were more likely to receive surgery, have margins with complete tumor resection, and receive adjuvant chemotherapy (p < 0.001). There were no significant differences in stage or metastasis at presentation between the two groups. Conclusions: Patients with non-dedifferentiated liposarcoma treated at an academic/research facility had improved overall survival, higher rates of surgery, higher rates of chemotherapy, and better surgical margins compared to patients treated at a non-academic facility.
Affecting burden and cost of care for the caregiver of dependent patients with advanced stage of cancer who had an arrangement for expected death at home.
Authors: Palanupap Kanokrat
Published: June 2023

e24000

Background: The terminal stage cancer patients suffer from disease and related therapeutic processes, lead to increasing need for caring from their caregivers. This affects the quality of life(QOL) of caregivers. Currently, there is no data on burden of caregivers who caring for cancer patients who are choose to die at their home. Objective: This study examined burden of caregivers, impact on QOL and satisfaction of caregivers for patients with terminal cancer, comparing in the group of patients who die at home versus at hospital, comparing in regular care group(RC) versus palliative care group(PC). Methods: The semi-qualitative-quantitative study enrolled caregivers of advance cancer patients who had PPS < 60 at Ramathibodi Hospital from Dec 2021-Nov 2022. We assessed participants on 3-time-points (enrolment, 1, 2 months) for QOL and burden via telephone interviews, questionnaires by EQ5D5L and Zarit Burden. If the patients passed away, we interviewed caregivers in qualitative study. Analysis responses were recorded, transcribed and organized thematically analyzed. Analysis stratified on care with palliative care or not, and place of death. Results: We enrolled 108 participants, child (56%) and spouses (29%). They spent carring time average of 16.56 hr/day. 52 patients have passed away: home death(34) and hospital death(18). No significant difference in burden score and QOL between RC and PC. Burden score significantly increasing when time of death approach in both groups. However, significantly higher satisfaction score in caregivers of patients who died at home(P < 0.001). In patient who died in hospital, early integrated palliative showed significantly higher satisfaction score(P = 0.046). Qualitative analysis revealed 3 primary themes, 1) caregiver burden is increasing and chronic stress condition until the death of their loves and still continue post their death 2) need more help in coping and nursing strategies, more early palliative care can relieve their distresses 3) opinion of the caregivers in group of hospital death, If they could turn back time, they would have promised to look after their lovers better in changing the pass away at their home. Conclusions: Caregivers for terminal cancer patients have a high burden. However, caregiver of patients who died at their home rather have more satisfaction. Early integrated palliative care improves satisfaction in caregiver of patients who died at hospital. [Table: see text]
Integrating ayurveda rasayana therapy with standard of care therapies in patients with glioblastoma multiforme improves caregivers' quality of life: A prospective study.
Authors: Bendale Yogesh Narayan , Birari-Gawande Poonam , Patil Anandrao , Kadam Avinash , Bendale Yogesh Narayan
Published: June 2023

e24001

Background: Caregivers of cancer patients frequently suffer from poor quality of life (QoL) due to stress related to caregiving. This stress is more severe in patients with very aggressive cancer which has the potential to negatively affect patients' functional independence. Glioblastoma multiforme (GBM) is an incurable disease with a poor prognosis. For caregivers of patients with glioblastoma, the burden of care can be high. Integration of conventional therapy with unconventional complimentary therapies which improves Patient reported outcome measures (PROM) can significantly improve caregivers' quality of life. Hence there is a great scope of integrative therapies while treating GBM patients. The present study was conducted with an aim of evaluating the impact of an Integrative cancer care program consisting of Ayurveda and Conventional standard of care in caregivers of patients with GBM. Methods: Caregivers of patients with high-grade GBM who opted for Ayurveda Rasayana therapy after a minimum of three months of starting conventional care for GBM were included in the study. Caregiver's Quality of life was evaluated using Caregiver’s QoL score (CarGOQoL) questionnaire at baseline and after 30, 60 and 90 days of initiating the Rasayana therapy. Results: The study included 21 male and 23 female caregivers with mean age 50.8 (±2.73) years. A total of 44 patients were included at baseline whereas at the sample size at day 30,60 and 90 were 40, 37, and 33 respectively. The CarGOQoL scores showed statistically significant improvement on day 30 ( P < 0.05) which further improved on day 60 ( P< 0.01) and then remained stable (Day 60 compared with day 90 P > 0.05) on day 90. Conclusions: Caregivers of GBM showed improved QoL after integrating Ayurveda Rasayana therapy with conventional Standard of care therapies. Complimentary therapies that are known to improve PROMs in cancer patients can directly impact caregivers' QoL. Hence the possibility of an integrative approach should always be explored while treating GBM patients.
Attachment avoidance and anxiety impacting dyadic coping and communication in patients with metastatic sarcoma and their family caregivers.
Authors: Daum Courtney , Singer Jonathan , Schneider Sydnie , Shen Megan J. , Loggers Elizabeth Trice
Published: June 2023

e24002

Background: In research, how people act in close relationships is described as “attachment styles” which are composed of multiple attachment style dimensions (ASDs). Attachment avoidance is characterized by the need to isolate from the relationship (i.e. withdrawing and increased independence) while attachment anxiety is defined as needing reassurance and higher dependence. These two insecure ASDs are correlated with reduced quality of life for cancer patients (PT) and the family caregivers (CG). In ovarian cancer, PT and CG ASDs were correlated to dyadic coping, however 27% of PTs were disease-free. Attachment insecurity may be exacerbated by active treatment and uncertain prognosis. Therefore, we investigated the relationship between ASDs, and CG and PT reported dyadic coping and illness-specific communication. Methods: Metastatic sarcoma PTs and their CGs were recruited prospectively for a longitudinal, survey study investigating dyadic coping at Fred Hutchinson Cancer Center from Feb. 2022 – Dec. 2022. Participation rate for eligible PTs was 42% and 68% for CGs. Results are of participants who identified as intimate partners (individuals and dyads were allowed to participate). Attachment avoidance and attachment anxiety were measured via Relationship Structures Questionnaire. Dyadic coping and communication were measured via Dyadic Coping Inventory and Illness-Specific Relationship Talk (ISRT), respectively. Results: Sixty-nine participants enrolled: 43 PTs and 26 CGs (25 dyads). Participants were primarily non-Hispanic and white (91% PTs; 85% CG) with mean age 64 years ( SD= 13.1; range = 26-89). 61% of PTs identified as men; 60% of CGs identified as women. CGs with attachment anxiety were more likely to report worse coping and less ISRT, while PTs with attachment anxiety were more likely to report only worse coping (See Table 1). However, PTs with attachment avoidance were more likely to report both worse coping and ISRT. Conclusions: Advance cancer PTs and their CGs with insecure ASDs report worse coping and communication. Screening for insecure ASDs may identify PTs and CGs who would benefit from supportive care, including psychotherapy. Future research should investigate this in a larger, more heterogenous population at earlier in the rare cancer trajectory and the effect of ASDs on PT, CG, and clinician communication. [Table: see text]
Education modalities for serious illness communication training: A scoping review on the impact on clinician behavior and patient outcomes.
Authors: Lavecchia Melissa , Myers Jeffrey , Bainbridge Daryl , Incardona Nadia , Levine Oren Hannun , Steinberg Leah , Schep Daniel , Vautour Joanna , Kumar Shilpa Jyothi , Seow Hsien
Published: June 2023

e24003

Background: Several clinician training interventions that address serious illness communication have been developed over the past decade. While numerous studies report the impact on clinician attitude, confidence and intention to change practice, less is reported on individual education modalities and their impact on actual behavior change and patient outcomes. This study's aim was to examine what is known about the education modalities used in serious illness communication training and their impact on clinician behaviors and patient outcomes. Methods: A scoping review using the Joanna Briggs Methods Manual for Scoping Reviews was conducted of studies that specifically measured clinician behaviors or patient outcomes. Ovid MEDLINE and EMBASE databases were searched for English-language studies published between January 2011, and November 2021. Results: The search identified 1132 articles: 60 met inclusion criteria describing 49 unique interventions. Common education modalities used were a single workshop (n = 18), multiple workshops (n = 8), single workshop with coaching (n = 7), multiple workshops with coaching (n = 5); though they were inconsistently structured. Studies reporting improved clinician skills tended to be in simulation settings with neither clinical practice nor patient outcomes explored. While studies reporting behavior changes or improved patient outcomes did not confirm improvements in skills. As multiple modalities were commonly used and often embedded within larger quality improvement initiatives, the impact of individual modalities could not be determined. Conclusions: To advance the evidence of the benefits of serious illness communication training, well-defined education modalities and consistent outcome measures for behavior change and patient outcomes are needed.
Outcomes of pancreatic malignancy in octogenarians: A single tertiary center experience.
Authors: Al-Jumayli Mohammed , Negrete Najar Juan Pablo , Sehovic Marina , Rodriquenz Maria Grazia , Sam Christine , Vonnes Cassandra , Tralongo Antonino Carmelo , Extermann Martine
Published: June 2023

e24008

Background: Pancreatic adenocarcinoma (PC) is generally diagnosed at a late stage, with a dismal prognosis. Patients aged 75-84 years constitute 28% of all patients. Surgery is the only way to cure, however, some surgeons have been hesitant to offer surgery to patients with advanced age due to lack of evidence available about the effectiveness and safety of treatments for this age group. Deficits accumulation frailty indices (FI) utilize readily available clinical data and easily obtained patient-reported information to predict hospitalization and mortality of older individuals. The goal of this large sample study is to profile octogenarians with PC. Methods: From 2015-2017, 440 patients over the age of 70 with biopsy confirmed PC were retrospectively reviewed. Among those, the outcomes of 129 (29.3%) pts older than 80 years of age were evaluated including patient’s characteristics, local control, systemic therapy, comprehensive geriatric assessment domains, specific geriatric outcomes and survival duration. Results: Median patients' age was 83 years (range 83-91) and 61(47.4%) were female. Patients with ECOG 0-1 at diagnosis were 109 pts (84.4%). Based on the FI, 28 patients (21.7%) were fit, while 79 (61.2%) were prefrail and 22 patients (17.1%) were frail. 33 patients (25.5%) presented as stage IV disease and 96(74.5%) as locally advanced PC. 46 patients (35.6%) had elective surgical resection. 53 patients (41.1%) received chemotherapy, 14 (10.8%) neoadjuvant, 17(20.9%) adjuvant and 12 (17.1%) palliative therapy. Among patients who had surgery, 10 (21.7%) had grade ≥3 adverse events and 6 (13%) had unplanned hospitalization. Median overall survival of resectable patients was 25.3 months. There was no statistically significant difference in survival after surgery in patients older than 80 years of age compared to younger than 80. Results of the multiple linear regression indicated that there was a moderate collective significant effect between the frailty index, ECOG, surgery, WT loss, albumin level, Cr clearance, Hb, and survival, (F(3,120) = 22, p < .001, R = 0.35, R = 0.34). Frailty index (p = .027), ECOG (p < .001) and surgery (p = .009) were significant individual predictors of the outcomes. Conclusions: Among older adult, Fit octogenarians experienced similar rate of mortality as patients younger than 80years old after elective pancreatic cancer surgery. Specific factors may also affect the outcome of surgery for older adults with cancer. These should be considered when assessing patients’ health and selecting them for surgery. A thorough preoperative evaluation can help ensure a better postoperative outcome.
Limited and uneven geriatric cancer drug trials worldwide.
Authors: Hui-Yao Huang , Leng Ye , Cui Dandan , Fang Yuan , Tang Yu , Li Ning
Published: June 2023

e24017

Background: Conducting geriatric trials is the most feasible way to address the vast underrepresentation of older adults in clinical trials of cancer therapies. This study is a globally comprehensive examination of geriatric cancer drug trials worldwide over the last decade. Methods: Up-to-date information on cancer drug trials in older adults aged over 59 years from the beginning of 2012 to the end of 2021 was collected from Trialtrove and Pharmaprojects. The number of identified trials was the dependent variable and corresponding analysis was conducted from the perspective of time trend, status quo and comparisons by region and country, sponsor type and cancer type, study status and phase. Results: 582 geriatric cancer drug trials were identified, with 292 trials for solid cancer while the other 290 trials were for hematological malignancies. Among them, 307 were single-region studies, 407 were initiated by academic groups, and 96 were terminated. Decreasing trends in the annual number of all trials (-3.8% per year) were observed over time, especially in solid tumor (-9.2% per year). For all these trials, 303 were conducted in Asia; this number was significantly higher than that in Europe (174), North America (129), Oceania (27) and South America (8). Similar difference was found in participation rate in trials by academic groups ranging from 59.5% in Asia to 0.5% in South America. In terms of development time, 86 and 176 were initiated before drug and indication approval, respectively, and the remaining 320 were initiated after indication approval. Phase II trials accounted for the highest proportion of trials (68.4%), while phase I trials accounted for the lowest proportion (7.2%). Compared with the hematological malignancies, trials on solid tumor had a higher terminated rate(18.8% vs 14.1%, p= 0.032) and were less likely to initiated before drug approval(6.5% vs. 23.1%, p< 0.0001) . Treatment was explored for 21 different cancers, with leukaemia, lung cancer and lymphoma being the most common. Conclusions: Geriatric trials of cancer drugs are scarce and partially prematurely terminated. Moreover, the number of geriatric trials has decreased and differs according to region. Global guidance and regulatory supervision are needed to facilitate the acquisition of adequate evidence on drug risk-benefit profiles in older adults, and thus to achieve high-quality care and safe medication. [Table: see text]
Pilot trial of the feasibility, acceptability, and potential efficacy of a pain management intervention adapted for older adults with cancer in rural settings.
Authors: Shen Megan J. , Stokes Tammy , Yarborough Sarah , Harrison Jill
Published: June 2023

e24021

Background: Among the growing older adult U.S. population, under-treated cancer pain is a major public health concern. Those living in rural areas are even more vulnerable due to less access to care, patients’ concerns around the over-use of pain medication, and patients’ preferences for non-pharmacological interventions. There is a clear need for interventions designed to improve pain management among this vulnerable population. Methods: In this study, older adults with cancer (age 65+ years) were enrolled in an open arm trial in rural Tennessee to test feasibility, acceptability, and potential efficacy of a previously developed intervention, Ca-HELP, to improve pain communication with one’s oncologist. Prior to the trial, the original Ca-HELP intervention was adapted for use among older adults in rural settings. Feasibility was examined through accrual and intervention completion rates. Acceptability was measured through single-item questions assessing helpfulness, difficulty, and satisfaction with the intervention. Intervention efficacy was assessed using mean score differences from pre- and post-intervention assessments of pain self-management, self-efficacy for communicating with physicians about pain severity, pain severity, and misconceptions about pain. Mean score differences were analyzed using one-tailed paired samples t-tests, with an alpha level = 0.05. Results: A total of n = 30 patients were enrolled in this trial, adequately powering this trial (0.85) to detect moderate effect size differences. Participants were 56.7% female, predominately white (80.0%), less educated (53.3% less than high school), and lower income (50.0% household income less than $21,000). Fidelity rates of 90% for communication consistency (pacing, volume, introduction to purpose of intervention) and 100% for delivery of intervention components were observed. This intervention was highly feasible, with a 100% accrual rate and 100% intervention completion rate. Regarding acceptability, all patients (n = 30) rated the intervention as helpful, with the majority rating it as “very helpful” (n = 24, 80.0%). Most patients rated the intervention as “not at all difficult” (90.0%), enjoyed participating in the intervention (70.0%), and were “very satisfied” with the intervention (83.3%). Pre/post changes in outcomes indicated significant improvements in pain self-management and self-efficacy for communicating with physicians about pain severity, as well as significant reductions in pain severity and pain misconceptions (all p < .05). Conclusions: Results of this study indicate the adapted version of Ca-HELP was feasible, acceptable, and had potential efficacy for improving pain related outcome measures among older adults with cancer in a rural setting. Clinical trial information: NCT04262232 .
Toxicity profile, palliative care and hospice utilization of geriatric patients with hepatocellular carcinoma treated with atezolizumab plus bevacizumab in the veteran health administration.
Authors: Lucero Kana , Alkadimi Munaf , Boyle Lauren Diaz , Fierro Maria Elena , Franklin Kathleen , Mader Michael , Nooruddin Zohra
Published: June 2023

e24022

Background: Over the last decade, the incidence of Hepatocellular carcinoma (HCC) has increased in the geriatric population. Atezolizumab plus Bevacizumab (A+B) has become an established systemic therapy for patients with HCC. Even with the aging population and elevated prevalence of HCC amongst Veterans, limited studies have explored the safety of A+B in geriatric patients. This study aims to investigate the toxicity profile of A+B in the geriatric population as well as Palliative Care and Hospice utilization within the Veteran Health Administration (VHA). Methods: Data were extracted from the electronic medical records (EMR) for adults (deceased and living) with ICD9 and ICD10 HCC codes that received 1st line systemic therapy with A+B within the VHA between December 1, 2019, and March 1, 2023. Descriptive statistics were used to summarize baseline characteristics, toxicity profile and Palliative Care and Hospice enrollment between 3 populations aged < 65, 65-69, and > 70 years. A significant p-value of ≤0.05 was used. Results: In total, 332 patients were included in the study; 206 were deceased. Approximately 70% of patients were > 65 years. The majority in each age group were non-Hispanic white males, ECOG ≥1, CPS class A and BCLC score of C. Veterans > 70, significantly had less cirrhosis caused by viral hepatitis(p < 0.0001) and no prior local therapy (p = 0.002). There was no significant difference in either median A+B doses, cessation of therapy due to toxicities or median reported toxicities of any grade, as reported in Table 1. Most common toxicities in all age groups were fatigue, decreased appetite, proteinuria and transaminitis. There was a significant difference in Hospice enrollment in deceased patients (p = 0.027), with Veterans > 70 years more likely to enroll in Hospice. Conclusions: This is the first known study that reports geriatric advanced HCC patients with A+Z toxicities in VHA patients. This study demonstrates that A+Z can be used safely in geriatric patients. Further quality improvements projects need to be implemented to improve number and timing Hospice utilization.[Table: see text]
Association of frailty index of laboratory tests (FI-LAB) and COVID-19 clinical outcomes in veterans with cancer.
Authors: Melo Resendes Natasha , Panjrolia Ekta , Tannous Toufic , Sarasua Armando , Ruiz Jorge G. , Hasel Krystal , Sharma Janaki Neela , Hammel Iriana M.
Published: June 2023

e24023

Background: Veterans with cancer have high COVID-19-attributable mortality. Frailty, a multisystem syndrome characterized by vulnerability to stressors from loss of physiological reserve, is common in cancer patients and confers worse clinical outcomes. In hospitalized cancer patients with COVID-19 infection, the role of frailty remains unclear. Our study aim was to compare clinical and utilization outcomes of cancer patients hospitalized with COVID-19 according to frailty status. Methods: The retrospective cohort study included hospitalized veterans with cancer and acute COVID-19 infection at 7 VA facilities in Florida and Puerto Rico from March-August 2020. Frailty was assessed using a 31-item frailty index of laboratory tests and vital signs (FI-LAB) with scores grouped by tertiles. We chart reviewed VA databases to collect Veterans’ socio-demographics, COVID-19 Polymerase Chain Reaction (PCR) results, and clinical and utilization outcomes. We ran binomial logistic regression analyses to calculate the odds of inpatient death, ICU admission, ICU transfer, prolonged length of stay, new nursing home placement, 30-day readmission, 30-day mortality, 6-month,1-year, and 2-year mortality according to the tertiles, adjusted for age, BMI, sex, race, ethnicity, and other conditions with greater risk for poor COVID-19 outcomes. Patients were followed until death or August 13, 2022. Results: 143 older Veterans with cancer were hospitalized with a mean age of 74.4 years (SD = 11.5) years, 95.9% (n = 117) male, 66.4% white (n = 81), and 9.8% (n = 12) Hispanic. 122 (85.3%) met the inclusion criteria. There were no differences in baseline sociodemographic or clinical characteristics except for a higher prevalence of congestive heart failure. The upper FI-LAB tertile had a higher risk of inpatient death, OR 12.47 (95%CI:1.3-121.4), p = 0.03, 30-day post-discharge mortality, OR 9.78 (95%CI:.21-79.4), p = .03 and 2-yr post-discharge mortality OR 4.9 (1.2-19.6) p < 0.03. There were no differences in other clinical and utilization outcomes. Conclusions: In hospitalized Veterans with cancer and coexistent COVID-19 infection, patients with higher levels of frailty have a greater risk of inpatient death, 30-day post-discharge mortality, and 2-year post-discharge mortality. More studies are needed to confirm the utility of FI-LAB in hospitalized patients with COVID-19 and cancer.
Examination of real-world data from geriatric assessments in a comprehensive cancer center to explore predominant and cancer-specific domains for intervention.
Authors: Pelletier Kaitlyn , Balasubramanian Ishwarya , Sahu Kamal Kant , Cohan Jessica , Kohli Manish , Maughan Benjamin L. , Swami Umang , Agarwal Neeraj , Gupta Sumati
Published: June 2023

e24027

Background: Older adults (OA) with cancer have a higher risk of harm with cancer treatment. Geriatric Assessment (GA) based treatment modifications can help mitigate toxicity and functional impairment. The Geriatric Oncology Assessment and Plan (GOAL) Clinic was established with the aim of providing age-friendly care to OA with cancer at Huntsman Cancer Institute. This retrospective study presents the needs identified using GA in the real-world setting. Methods: Patients (pts) aged ≥65 years are referred to the GOAL clinic by their oncologists/hematologists for age-related concerns. A geriatrics nurse practitioner administers a GA upon initial visit, communicates specific age-related concerns with the referring provider, and subsequently manages any geriatric syndromes that may interfere with their treatment tolerance or outcomes. We analyzed GA data to identify the specific needs of OA with cancer referred to the GOAL clinic. Results: We evaluated 222 pts in the GOAL clinic between September 2020 and January 2023. The median age was 77 years, 52% were female. The most common cancer diagnosis was prostate, followed by breast, colorectal, pancreatic, and bladder. Of the pts assessed, the median Eastern Cooperative Oncology Group (ECOG) was 1, and the median body mass index (BMI) was 26.4 kg/m2. 12% of pts had a moderate to high risk for malnutrition. A Patient Health Questionnaire-9 (PHQ-9) showed minimal, mild, moderate, moderately severe, and severe depression in 35%, 20%, 14%, 7%, and 3% of pts, respectively. The Generalized Anxiety Disorder scale-7 (GAD-7) showed minimal, mild, moderate, and severe anxiety symptoms in 35%, 19%, 9%, and 7% of pts respectively. The median Mini-cog score was 4, and those who reflexed to testing with Montreal Cognitive Assessment (MOCA) had a median score of 22 out of 30 suggesting mild cognitive impairment (MCI). A greater proportion of pts with prostate cancer (PC) were overweight and had MCI by MOCA (Table 1). Multidisciplinary interventions were implemented, and GA was used to determine the appropriateness of cancer treatment. Conclusions: Cognitive dysfunction and depression were this population's most common geriatric syndromes. PC pts had a higher median BMI and greater proportion of patients with MCI than pts with other cancers. Dysmetabolic syndrome associated with elevated BMI is not a domain of GA but is pertinent to treatment toxicity in PC. MCI is not apparent on a routine oncology evaluation. Interventions are needed to prevent, screen, and treat MCI in OA with cancer, especially PC, and dysmetabolic syndrome in OA with PC.[Table: see text]
Clinical trial knowledge among cancer survivors in the United States: The role of health information technology.
Authors: Adewunmi Comfort , Atarere Joseph , Chido-Amajuoyi Onyema Greg , Onyeaka Henry , Mele Ange , Onyeaka Nelson , Abidoye Oluseyi , Johnson Andrew Thomas
Published: June 2023

e24039

Background: Clinical trials are essential in the evaluation of new antineoplastic therapies. However, studies have consistently reported suboptimal levels of clinical trial knowledge among adult cancer patients, and less than 5% of them participate in clinical trials. Health information technology (HIT) has shown promise in health promotion and may prove useful in bridging the knowledge gap in clinical trials among cancer survivors. Methods: We obtained data from 3,865 adults who completed the 2020 Health Information National Trends Survey of which 626 (16.2%) were cancer survivors. Using chi-squared tests, we examined the prevalence of HIT use in the general population and by cancer history. We also examined the impact of HIT use on clinical trial knowledge separately for cancer survivors and those with no cancer history using multivariable logistic regression models. Results: 63.8% of cancer survivors reported having some knowledge of clinical trials. Almost half of them used HIT to communicate with doctors (47.1%) and make health appointments (49.4%), about two-fifths (42.2%) used HIT in checking test results and 68.0% reported using HIT to look up health information online. In the adjusted models, the use of HIT in communicating with doctors [OR 2.79; 95% CI (1.41, 5.54)], checking test results [OR 2.47; 95% CI (1.12, 5.43)] and looking up health information online [OR 2.84; 95% CI (1.04, 7.77)] was associated with increased knowledge of clinical trials. Conclusions: Our findings suggest a positive association between HIT utilization and higher clinical trial knowledge levels. These results are encouraging given the rapid increase in mobile technology access globally and the increased use of HIT since the onset of the COVID-19 pandemic. There is a potential opportunity to leverage digital technology in improving clinical trial participation by increasing knowledge levels.