bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction models of locally advanced rectal cancer prognosis incorporating perioperative longitudinal clinical data: A retrospective longitudinal cohort study.
Authors: WU Jeng You , Su Chia-Yu
Published: June 2024

e15624

Background: For locally advanced rectal cancer, neoadjuvant chemoradiation(CCRT) followed by surgery is a standard treatment. Clinical T/N stage, whether pathological complete remission (pCR) after neoadjuvant CCRT or not are well recognized tumor features that predict disease prognosis. Although the parameters that determine pathologic stage are the strongest predictors of postoperative outcome, other clinical, molecular, and histologic features may influence prognosis independent of stage. The aim is to compare the predictive efficiency, between different models for overall survival in rectal cancer patients. Methods: This retrospective study is approved by TMU-JIRB(Protocol Number: N201809032).This is also a single institute study. 175 newly-diagnosed patients with locally advanced rectal cancer were retrospectively enrolled between Jan.2011 and Dec.2016. Basic information include sex, age, body weight, body height, previous medical history were recorded. CEA level, chemotherapy regimen, type of surgery, and distance between tumor and anal verge were also collected. Chemotherapy regimen of CCRT including 5FU+LV, capecitabine (Xeloda), FOLFOX, and FOLFIRI are recorded. Surgical resection was then followed 4-8 weeks after completion of CCRT. The 2010 AJCC tumor response grading (TRG) system was used to report treatment response of proctectomy samples. The progression free survival (PFS) and overall survival (OS) are then calculated. PFS is defined as survival without any recurrence or distant metastasis before Dec 31st, 2023. A comprehensive evaluation was conducted by incorporating all these machine learning models together. The aim was to compare their predictive efficiency, with models such as Random Forest, Naïve Bayes, KNeighbor, SVM, Decision Tree, Logistic Regression, XGBoost, and LightGBM. Results: 175 patients (104 men and 71 women) were enrolled in this study. The median follow up time was 7.1 yrs. The BMI was 24.05 ± 0.03 for men and 24.20 ± 0.07 for women. 32 (17.3%) patients achieved pCR, TRG 0. Clinical staging cT3 (78.8%) and nodal positive (78.8%) are the most common tumor feature in this study group. The median age of male and female patient is 58.6 and 56.1 respectively. Upon applying various machine learning models, different predictive accuracies emerged. The Random Forest, KNeighbor, and SVM models all achieved an accuracy of 0.9250. Naïve Bayes had an accuracy of 0.8620, while the SVC model registered at 0.9310, and XGBoost was slightly behind at 0.9286. SVC model is marking the best-performing model in this evaluation. Conclusions: This multicenter retrospective data-driven deep learning prediction model informed that SVC model yielded the best predictive results. Further prospective clinical trials and external validation of this prediction model are needed to further reinforce our findings.
Digital droplet PCR-based detection of KRAS, NRAS, and BRAF mutation in plasma samples from patients with colorectal cancer.
Authors: Kim Jin-Soo , Kim Mi Young , Lee Donghwa , Shin Rumi , Park Jin Hyun , Ko Jun Ho , Choi In Sil , Heo Seung Chul , Kang Mi Ran
Published: June 2024

e15626

Background: Digital droplet PCR (ddPCR) is known for high sensitivity to detect mutated DNA in plasma. The aim of this study was to investigate the concordance of KRAS, NRAS and BRAF mutation detection in patients with colorectal cancers (CRCs) between plasma samples (PSs) and tissue samples (TSs) in pair. Methods: We prospectively collected paired PS and TS from patients with CRC (N = 200) who underwent surgery or biopsy for metastasis at Seoul National University Boramae Medical Center from Mar 2017 to January 2020. The ddPCR was performed using QX200™ Droplet Digital PCR System (Bio-Rad, USA) according to the manufacturer's recommended protocol with PCR kits developed for each gene (Gencurix, South Korea). Results: A total of 187 TSs and PSs were valid for ddPCR. Among these, 111 had results for KRAS, 51 had results for NRAS and 21 had results for BRAF, which were tested through routine clinical practice (RCP) using the pyrosequencing or Sanger sequencing method. The experiment's outcomes were analyzed for KRAS, NRAS, and BRAF, respectively. The analysis initially compared the results of RCP TS and ddPCR TS, and subsequently, intended to compare the mutation detection rates between TS and PS by comparing the results of ddPCR TS and ddPCR PS for FFPE/PS paired specimens. For KRAS, compared to RCP TS, the sensitivity of ddPCR TS was 100%, specificity was 66.7%, and the overall concordance rate was 79.3%. In TS/PS paired specimens, the sensitivity of ddPCR PS for ddPCR TS results was 38.5%, specificity was 97.6%, and the overall concordance rate was 64.7%. For NRAS, compared to RCP TS, the sensitivity of ddPCR TS was 100%, specificity was 98.0%, and the overall concordance rate was 98.0%. In TS/PS paired specimens, the sensitivity of ddPCR PS for ddPCR TS results was 33.3%, specificity was 100%, and the overall concordance rate was 97.4%. For BRAF, sensitivity of ddPCR TS was not available (no RCP positive sample), specificity was 85.7% compared to RCP, corresponded to a concordance rate of 97.0%. The sensitivity of ddPCR PS for ddPCR TS results was 71.4%, specificity was 100%, and the overall concordance rate was 97.4%. The sensitivity of ddPCR PS for ddPCR TS results was 71.4%, specificity was 100%, and the overall concordance rate was 97.4%. Conclusions: The present study showed that ddPCR has high accuracy in detecting KRAS, NRAS and BRAF mutation in plasma samples from patients with CRC. Analysis of PS could be useful in early response assessment and longitudinal disease monitoring for patient with metastatic CRC with specific mutation.
Efficacy of chemotherapy followed by chemoradiation versus initial chemoradiation as part of the total neoadjuvant therapy for patients with locally advanced rectal cancer: An NCDB analysis.
Authors: Dhahri Amina , Alnimer Yanal Mufeed , Selene Insija Ilyas , Patel Reema Anil , Hao Zhonglin
Published: June 2024

e15629

Background: Results from multiple trials lead to modern management for locally advanced rectal cancer, with total neoadjuvant therapy (TNT) followed by surgery. However, the best sequence of different treatment modalities is unclear. Methods: We used the National Cancer Database (NCDB) to identify patients with locally advanced rectal adenocarcinoma. We divided patients into different categories based on the timing of chemo and radiation therapy relative to surgery. We used chi-square and Wilcoxon rank test for unadjusted comparison. To compare treatment efficacy with initial chemotherapy to concurrent chemoradiation in downstaging (clinical to pathological stage), we used a linear mixed effect model (LME) with adjustments on age, sex, race, facility type, and year of diagnosis. Also, we evaluated the probability of having positive lymph nodes in the pathological specimen (N+) in the multivariable logistic regression model with adjustment on the clinical stage in addition to the previously mentioned variables. All analyses were done using R 4.6.2. Results: A total of 100509 patients were identified. Only 695 patients received six cycles of neoadjuvant chemotherapy before concurrent chemoradiation (TNT chemotherapy), and 8677 patients received upfront radiation therapy with neoadjuvant chemotherapy administered within 12 weeks of neoadjuvant radiation therapy (TNT radiation). Patients whose start date of chemotherapy or radiation after surgery were excluded. The median age of participants was 63 (IQR = 54-63), and 83% were white. Patients who had TNT chemotherapy were younger (56.4 VS 59.5, P-value < 0.01), had clinically and pathologically advanced stage (IIIB, IIIC) compared to TNT radiation (64%VS 37% and 33%VS 29%, P-value < 0.01). Patients who received TNT radiation had an upgrade in their pathological stage compared to their clinical stage by 0.67 points in the LME (P value < 0.01). In multivariable logistic regression. TNT chemotherapy had a 17% lower risk of (N+) with an OR of 0.83 (0.95 CI 0.59-1.16). However, it was not statistically significant. The two groups had no difference in OS, with a median OS of 137 months (0.95 CI 110 -NR) and 143 (0.95 CI 137-151), respectively. Conclusions: Upfront chemotherapy before starting chemoradiation could be associated with more significant downstaging. Future trials to validate our finding is warranted. [Table: see text] [Table: see text]
Antibiotic exposure and colon carcinogenesis: In-depth profiling of a 492-patient cohort, with a focus on antibiotic classifications and subtypes.
Authors: Chudy-Onwugaje Dilichukwu , Salem Ahmed Elsayed , Roland Bani
Published: June 2024

e15643

Background: To investigate whether the use of specific antibiotics is associated with an increased risk of colon cancer incidence. Methods: We conducted a retrospective cohort study comprising 492 patients diagnosed with colon cancer between 2012 and 2022, with no prior malignancies and a minimum 5-year follow-up period. We collected demographic data, medical histories, and records of antibiotic exposure, categorizing antibiotics systematically based on the Anatomical Therapeutic Chemical (ATC) classification system. Patient antibiotic histories, including drug names, dosages, durations, and therapeutic indications, were included. Antibiotics were classified as broad-spectrum, narrow-spectrum, or extended-course. We performed univariate and multivariate logistic regression models and used propensity score matching to control for potential confounding variables, such as age, gender, co-morbidities, and concurrent medications. Subgroup analyses were conducted to identify specific antibiotic classes associated with an increased risk of colon cancer. Results: The mean age of the cohort was 65.7 years (SD ± 8.3), with an equal gender distribution. Adenocarcinoma was the predominant histological subtype (429 cases, 87%), with rare subtypes accounting for the remaining cases. Common co-morbidities included hypertension (226 cases, 46%), diabetes mellitus (108 cases, 22%), and hyperlipidemia (88 cases, 18%). The most frequently prescribed antibiotics were fluoroquinolones (158 cases, 32%), followed by cephalosporins (108 cases, 22%), and macrolides (88 cases, 18%). Extended-course antibiotics were administered in 138 cases (28%). Preliminary analysis revealed a statistically significant correlation between the use of extended-course antibiotics and the risk of colon cancer (Odds Ratio = 1.89, 95% Confidence Interval: 1.32-2.71, p < 0.05). No substantial association was observed with broad-spectrum or narrow-spectrum antibiotics. Subgroup analysis identified specific agents within the extended-course antibiotics, such as fluoroquinolones and clindamycin, with an elevated risk profile. Conclusions: This study suggests a potential association between the use of extended-course antibiotics and the development of colon cancer. Further validation through larger-scale, prospective studies is strongly recommended to confirm these findings. Further in-depth mechanistic inquiries, particularly in cellular signaling pathways and microbial interactions within the gut microbiome, are warranted to elucidate the underlying biological mechanisms driving this association.
The microbiome landscape of early-onset colorectal cancer: A systematic review.
Authors: Hong Daniel , Tian Ruiyi , Kim Hyun , Doering Michelle , Cao Yin
Published: June 2024

e15646

Background: The rise of early-onset colorectal cancer (EOCRC, age < 50 years old) necessitates the examination of potential risk factors to enhance prevention and control strategies. Microbial dysbiosis has been hypothesized as a potential contributor, yet studies are limited. To guide future research, we systematically reviewed studies of the EOCRC microbiome, emphasizing methodological heterogeneities. Methods: We systematically reviewed available literature for microbiome studies involving EOCRC and synthesized findings according to comparison groups (healthy/later-onset CRC [LOCRC]), sample type (fecal /tumor), and analyses (taxonomic/metabolomic). Results: Collection, storage, extraction, and analytical methods varied across the 10 studies included out of 2073 studies. There were 377 unique EOCRC patients, of which most originated from China (193 EOCRC cases), the United States (52 EOCRC cases), and Japan (42 EOCRC cases). Six studies analyzed 224 unique EOCRC fecal samples (4 performed 16S, 5 performed WGSS, 4 performed metabolomic); five compared EOCRC against healthy individuals and five to LOCRC. Four studies utilized 153 unique EOCRC tumor samples (3 performed 16S, 1 performed WGSS, 1 performed metabolomic); two compared with tumor-adjacent normal tissue, one to colonic tissue of healthy individuals, and four to LOCRC. Among studies comparing fecal samples of EOCRC to healthy individuals, EOCRC exhibited increased levels of Fusobacterium and Escherichia-Shigella, known for metabolizing 5-Fluorouracil, while butyrate-producing taxa like Faecalibacterium, protective against CRC, were diminished; EOCRC also showed decreased lung-associated pathogens and Clostridium difficile, but increased oral pathogens. Among studies comparing fecal samples of EOCRC to LOCRC, EOCRC fecal samples were more abundant in oral/gastrointestinal pathogens, with varying findings on Fusobacterium nucleatum. Faecalibacterium prausnitzii was more abundant in EOCRC than LOCRC, whereas Escherichia-Shigella was less abundant. Fecal metabolomic studies displayed increased LPS-related pathways and bile acids in EOCRC compared to healthy individuals. Compared to tumor-adjacent normal tissues or colonic tissues of healthy individuals, EOCRC tumors were characterized by higher levels of Fusobacterium, Actinomyces, and Escherichia coli ( E. coli), fewer butyrate producers, and more Bacteroides fragilis. Conclusions: While data is limited and methodologies varied, emerging evidence suggests that EOCRC may have unique microbial signatures compared to both healthy individuals and LOCRC. This may signal unique pathogenesis for EOCRC and present potential for prevention, early detection, and intervention. It is essential to harmonize study methods and analytical approaches to advance understanding of the role of microbiome in EOCRC.
COVID-19 breakthrough infections in patients with colorectal cancer: A propensity-matched score analysis.
Authors: Alsakarneh Saqr , Qasim Hana , Sallam Yazan , Khamees Ibrahim , Al-Obaidi Ammar , Adam Mohammad
Published: June 2024

e15655

Background: Previous data showed that cancer patients are more prone to have severe outcomes due to SARS-CoV-2 infection. While there are promising data on anti-mRNA antibodies titer post-COVID-19 vaccination in solid malignancies, concerns arise regarding durability of this immune response. We aim to evaluate the risk of breakthrough COVID-19 infection in colorectal cancer patients (CRC). Methods: We conducted a retrospective cohort study using TriNetX, a population-based database that sources data from electronic medical records (EHRs) of 61 health care organizations in the US. Using ICD-10 codes, we created two cohorts of patients with vaccination against COVID-19: with CRC and without CRC. Within each cohort, we collected data on demographics, and several risk factors for COVID-19. We performed propensity score matching (PSM) of 44 variables to control for confounding. Primary aim of our study was to compare the risk of COVID-19 breakthrough infection between CRC patients and control group. Odds ratio (OR) and 95% confidence interval (CI) were used to report associations for the propensity-matched cohorts. Results: A total of 6,152 vaccinated CRC patients were identified (mean age = 68.3 ± 12.7, females: 47.4%). In CRC vaccinated patients, (68.9%) were White, (12.50%) were African Americans, (8.3%) were Hispanics/Latino individuals. 6051 received 2 doses, and 2087 received 3 doses of COVID-19 messenger RNA vaccine. Vaccinated CRC patients were found to be at significantly higher risk for breakthrough COVID-19 infections compared to patients without CRC (adjusted odds ratio [aOR] = 1.46; [95% confidence interval (CI): 1.33 - 1.59]). Sub-group analysis based on the number of vaccines administered revealed consistent findings, with aOR of 1.39 [1.27 - 1.52] after 2 doses, and 1.36 [1.18 - 1.57] after 3 doses. There were no differences in risk of breakthrough infection based on gender or age groups in patients with CRC (P > 0.05). Conclusions: Our study showed that CRC patients are at a significantly elevated risk of breakthrough COVID-19 infections. Our study provides a valuable finding that may enlighten public health measures and clinical interventions for this vulnerable patient population. Further research is warranted to investigate the biological mechanisms that contribute to the breakthrough infections COVID-19 among CRC patients. [Table: see text]
The impact of glucagon-like peptide-1 receptor agonists on proteasome inhibitor-associated cardiotoxicity in patients with multiple myeloma.
Authors: Chang Yu-Cheng , Chiang Cho Han , Tang Zhiting , See Xin Ya , Chiang Cho Hung , Chi Kuan-Yu , Chang Yu , Gao Wenli
Published: June 2024

e24008

Background: Patients with multiple myeloma undergoing proteasome inhibitor therapies face an elevated risk of cardiotoxicity. Existing evidence in the non-cancer population indicates that glucagon-like peptide-1 receptor agonists (GLP1a) can mitigate the risk of cardiovascular events. We hypothesize that GLP1a may reduce the risk of cardiotoxicity in patients with multiple myeloma undergoing proteasome inhibitor therapies. Methods: We conducted a retrospective, propensity score-matched cohort study by utilizing the TriNetX Analytics Network database, which contains de-identified data spanning over 250 million patients. We included adult patients with multiple myeloma and type 2 diabetes mellitus who received proteasome inhibitor therapy. We matched patients treated with GLP1a and those treated with Dipeptidyl Peptidase 4 (DPP4i) in a 1:1 ratio based on predetermined clinical variables. The primary outcome included major adverse cardiovascular events, defined as a composite of heart failure and heart failure hospitalization, myocardial infarction, and ischemic stroke. Other outcomes included individual cardiovascular events, atrial fibrillation/flutter, and all-cause mortality within 3 years of proteasome inhibitor therapy. Results: We matched 183 patients on GLP1a to patients on DPP4i. The prevalence of hypertension, ischemic heart disease, and use of proteasome inhibitors was similar between cohorts. In a Cox proportional hazard analysis, patients who received GLP1a had an approximately 50% lower risk of major adverse cardiovascular events (HR, 0.53 [95% CI: 0.29-0.96]) compared to those who received DPP4i. Furthermore, GLP1a was associated with a reduction in heart failure and heart failure hospitalization, ischemic stroke, and all-cause mortality. The risks of myocardial infarction and atrial fibrillation/flutter were comparable between the two cohorts. Conclusions: GLP1a were associated with a reduction in major adverse cardiovascular events and mortality among patients with multiple myeloma and diabetes mellitus receiving proteasome inhibitors. [Table: see text]
Sweet syndrome in the setting of breast cancer: A literature review.
Authors: Lee Amanda , Paracha Awais , Hussain Fahad , Dillon Kayla , Arshad Maha , Li Emma , Kwait Brittany , Shrivastava Sneha , Gostanian Nouneh J.
Published: June 2024

e24044

Background: Sweet syndrome (SS) or acute febrile neutrophilic dermatosis typically present as patients with pyrexia, neutrophilia and rash with dermal neutrophilic dominance on biopsy. While the association of SS with malignancy is well-documented, the connection of sweet syndrome and solid tumors especially breast cancers is not explored enough. It is important to understand these associations better understand the disease course of SS in the setting of breast cancer. We aim to examine the different triggers, subtypes of breast cancer associated with SS, and differences in presentation and resolution time. Methods: A literature review from 1/1950-11/2023 was conducted for co-existing diagnoses of BC and SS in the PubMed Database. Search terms included Sweet Syndrome or Acute febrile neutrophilic dermatosis with Breast Cancer with subtypes. Key outcomes included: trigger identification, breast cancer subtypes, and treatment options. Findings were analyzed via a thematic lens. Results: A total of 34 cases of female BC patients with SS were identified with triggers divided into subtypes of surgery (47%), medication (20%), paraneoplastic (20%), and radiation therapy (11%). Depending on the trigger, average time to presentation varied with drug-triggered being the shortest (3.3 months) followed by radiation (8.5 months) while surgery (50 months) and paraneoplastic- associated (57 months) had similar presentation times. Although the time to presentation time for paraneoplastic-associated SS was the longest, 50% of these cases were associated with underlying progression of cancer. Regarding treatment and resolution time, 26 cases of SS resolved after treatment with treatment mainstay including oral (65%) and topical (12%) steroids. Analyzing triggers specific treatment outcomes, drug (2.7 days) and radiation-induced SS (7 days) had shorter average resolution times while paraneoplastic- associated (10.5 days) and surgery-associated SS (18.5 days) had longer resolution times. 5 cases that documented initial relapse or recurrence of SS after initial treatment were associated with paraneoplastic –induced sweet syndrome. On further analysis, among the 15 cases mentioned the BC type associated with SS- the most common breast cancer subtype was invasive ductal carcinoma of the breast (47%) followed by metastatic carcinoma (20%), adenocarcinoma (13%) and invasive lobular carcinoma (6%), canalicular breast carcinoma (6%) and unspecified malignant tumor of the breast (6%) regardless of the trigger mentioned. Conclusions: Oncologists should always consider SS on the differential for BC patients presenting with fever and rash given the varied presentation times depending on type of trigger. Treatment should be started promptly and continued for an adequate amount of time depending on the trigger to better mitigate complications in breast cancer patients.
Curcumin add-on improves quality of life in patients with locally or advanced head and neck cancer receiving nutritional intervention.
Authors: Thambamroong Tawasapon , Seetalarom Kasan , Saichaemchan Siriwimon , Peechatanan Khunthong , Phavirunsiri Jarearnjit , Prasongsook Naiyarat
Published: June 2024

e24051

Background: The CurChexia study, NCT04208334, is a phase IIa randomized control trial. The study demonstrates the benefits of adding 4,000 mg of curcumin to the standard nutritional intervention. This addition helps to increase muscle mass and delay the decrease in other body composition parameters. However, clinicians require treatment that maintains or improves the quality of life (QoL) of head and neck cancer patients. In this report, we present the QoL data. Methods: Patients participating in the study were required to complete the EORTC QLQ-C30 version 3.0 questionnaire in the Thai edition. The questionnaire was given at the beginning of the study, at the end of week 4, at the end of the study, or in week 8. The results were scored following the EORTC scoring guidelines and compared between the group that received the curcumin add-on and the standard nutritional intervention (control). The patients needed to complete all sections of the EORTC QLQ-C30, and no data was missing. Results: Ten of the 20 patients were given curcumin, while the others were in the control group. Based on the EORTC QLQ-C30, there was an improvement in the median global health status, but it was not significant between the curcumin and control groups. However, the curcumin group improved all functional status parameters, particularly physical functioning ( p= 0.001) and emotional functioning ( p= 0.023). Regarding symptom scales, curcumin significantly reduced pain symptoms ( p= 0.033) and increased appetite ( p= 0.001) compared to the control group. The other parameters that could have affected QoL did not show significant differences between the two groups. Conclusions: The CurChexia study indicates that curcumin has shown promising results in improving muscle mass, enhancing quality of life, and increasing appetite, thereby establishing its position as a noteworthy phytonutrient. However, it is important to note that further research is necessary to understand the extent of its benefits fully. Clinical trial information: NCT04208334 .
The role of integrating palliative care with systemic anticancer treatment at end-of-life: A single center experience.
Authors: Tiyanont Tanin , Thokanit Nintita Sripaibookij , Kasemsup Vijj , Sirachainan Ekaphop , Semsarn Siriporn , Chansriwong Phichai
Published: June 2024

e24067

Background: This study examines the utilization of systemic anticancer treatments, including chemotherapy, targeted therapy, and immunotherapy, in advanced cancer patients. Specifically, it aims to underscore the impact of integrating palliative care in the administration of anticancer treatment during the last months of life. Methods: A retrospective chart review of patients who received chemotherapy, targeted therapy, and immunotherapy at Ramathibodi Hospital and passed away between January 1, 2019, and December 31, 2022. Demographic data, cancer type, modality, intent, and route of anticancer therapy, as well as health scheme and referral to palliative care services, were collected. Information regarding systemic anticancer treatments administered at 2 weeks, 1 month, 3 months, and 6 months preceding death underwent thorough analysis. Logistic regression was employed to assess odds ratios (OR) and 95% CIs for factors influencing decision-making regarding anticancer treatments. Results: Among the 542 deceased patients, 378 had received anticancer treatments within the last 6 months of life. The distribution of anticancer treatments categorized by timing—6 months, 3 months, 1 month, and 2 weeks before death—was 378 (69.7%), 388 (71.6%), 206 (38.0%), and 129 (23.8%), respectively. Older adults constituted nearly half of the population (45.2%). The utilization of anticancer treatments, particularly in the realms of targeted therapy and immunotherapy, at the terminal stages of life is showing a discernible upward trend. Palliative care consultations were present in 26.9% of cases during cancer care. The presence of palliative care consultation was significantly associated with lower odds ratios of receiving end-of-life anticancer treatments at 2 weeks and 1 month before death (OR: 0.55 [95% CI: 0.33 to 0.89], p = 0.016 and 0.54 [95% CI: 0.36 to 0.85], p = 0.004, respectively). Specifically, integrating palliative care reduced the use of chemotherapy in treatment at 2 weeks and 1 month before death (OR: 0.51 [95% CI: 0.27 to 0.98], p = 0.042 and OR: 0.55 [95% CI: 0.33 to 0.90], p = 0.019, respectively). However, the data showed a decrease in the number of patients; nonetheless, no statistically significant differences were observed in the utilization of targeted therapy and immunotherapy. In our analysis, we examine the factors influencing the utilization of anticancer treatments, reveal that there were no significant differences observed among other factors, including age, cancer type, and health scheme. Conclusions: Integration of palliative care into oncology services significantly correlated with a reduced risk of receiving anticancer treatments, particularly chemotherapy, within the last 30 days of life for advanced cancer patients. Insufficient evidence exists to ascertain the impact of palliative care on the utilization of targeted therapy and immunotherapy.
Pain, palliation, and opioid use patterns: A nationwide analysis of neoplasm-related pain admissions and trends (2016-2020).
Authors: Gor Rajvi , Gwalani Pranav , GOR DHAIRYA , Shah Anand , Thakur Rahul Kumar , Kumar Abhishek
Published: June 2024

e24068

Background: Neoplasm-related pain (NRP) remains a significant contributor to the diminished quality of life in cancer patients. We aimed to study the epidemiological characteristics and trends among patients hospitalized for NRP from 2016 to 2020. Methods: A retrospective study of patients hospitalized for primary or secondary diagnosis of NRP from 2016-2020 was conducted using the National Inpatient Sample (NIS) database. Temporal trends in the prevalence, mortality rate (MR), length of stay (LOS), hospitalization cost, palliative care consults, and opioid use/dependence/abuse (OUD) were assessed using linear regression or the Cochran-Armitage test. Further, the NIS database was searched to identify all patients admitted with a diagnosis of OUD. Amongst them, the proportion of patients with a coexisting diagnosis of NRP was calculated. Analysis was done using R 4.3.2 and SAS 9.4. Results: 174,530 cases with NRP were identified from 2016-2020, with a median age at hospitalization of 61(IQR: 52,70). The number of hospitalizations increased from 28,036 in 2016 to 41,013 in 2019 and then dropped to 38,040 in 2020 (p < 0.001). The total inpatient MR was 7.8%, decreasing from 8.5 % in 2017 to 7.0% in 2020 (p < 0.0001). The mean cost of hospitalization increased significantly from $64,162.5 in 2016 to $82,943.8 in 2020 (p < 0.001). There was no significant change in the mean LOS. The number of palliative care consults increased from 29.8% in 2016 to 31.5% in 2019 and then dropped to 31.3% in 2020 (p < 0.001). Among 174,530 NRP patients, 5,844 (3.4%) had a coexisting diagnosis of OUD, which increased from 832 (3.0%) in 2016 to 1419 (3.7%) in 2020 (p < 0.001). A total of 737,971 patients with a diagnosis of OUD were admitted from 2016-2020, of which 5844 (0.79%) had a coexisting diagnosis of NRP. Conclusions: We observed increased hospitalizations for NRP and related palliative care consults from 2016 to 2019, with a subsequent decline in 2020. This drop could be related to the impact of the COVID-19 pandemic. Despite the rise in the cost of hospitalizations, there has been a declining trend in MR, potentially due to improved quality of care. The gradual rise in the coexistence of OUD among NRP patients is notable. Yet, NRP patients remain a minority within the broader context of OUD-related admissions, underscoring the need for nuanced, patient-centered approaches in NRP management. [Table: see text]
The effect of energy from reiki treatments on sleep quality for patients with breast and prostate cancer on hormone therapy.
Authors: McGuire Jeremy , Gada Umang , Fung Chunkit , Gilmore Nikesha , Janelsins Michelle Christine , Peppone Luke Joseph
Published: June 2024

e24076

Background: Manypatients with cancer receiving hormone therapy experience difficulty with sleeping and insomnia. Reiki is a technique where therapy is delivered to the patient with either no or very light physical touch whereas traditional massage therapy uses pressure and movement by the therapist to manipulate soft tissue. Both Reiki and traditional massage therapy have been shown by others to be effective in providing benefits in sleep quality. This study is the first to compare changes in sleep quality after massage and Reiki treatments in patients with prostate and breast cancer receiving hormone therapy. Methods: Eighty-seven, breast (n = 56) and prostate cancer (n = 31), patients receiving hormone therapy experiencing self-reported fatigue ≥4/10were included in this randomized controlled trial (RCT). Patients were randomized into one of three treatment arms for 4-weeks: Arm 1 received two massage treatments, Arm 2 received two Reiki treatments and Arm 3 received four Reiki treatments. Each treatment session was approximately 75 minutes. . Participants with a baseline score of ( ≥8) on the ISI were included in this analysis. Results: 75% of all enrolled participants (n = 65) met the inclusion criteria for baseline clinically meaningful insomnia. Both Reiki and massage provided improvement in sleep quality from pre to post intervention and there was no difference between 2 and 4 Reiki sessions. Reiki significantly increased sleep quality (p > .01) with a mean decrease in total ISI score of 2.96. Massage therapy showed a trend towards improved sleep quality (p = 0.06) with a mean decrease in ISI score of 1.95. There was a clinically meaningful decrease in total ISI score (≥6) in 15% of those who received massage therapy compared to 25% in the reiki therapy group. Conclusions: Four weeks of Reiki significantly improved sleep quality in patients with breast and prostate cancer receiving hormone therapy. Reiki may be a better non-pharmacologic therapeutic for improving sleep quality. Clinical trial information: NCT02758756 .
Pilot study of early integration of interventional pain management for patients with chronic cancer pain.
Authors: Van Wieren Inga , Gorra Madeline , Jamison Robert , Enzinger Andrea Catherine
Published: June 2024

e24080

Background: Pain is a common, distressing, and costly complication of cancer. Treatment guidelines recommend consideration of interventional pain procedures in addition to pharmacotherapy, yet they are underutilized and often only considered for refractory pain despite high-dose opioids. We examined the feasibility of early integration of interventional pain management among ambulatory patients with chronic cancer pain. Methods: This single arm pilot feasibility study recruited patients from outpatient clinics at the Dana-Farber Cancer Institute. Eligible patients had metastatic or locally advanced solid tumors, persistent pain secondary to cancer/cancer treatment, average pain rating of 4 or higher (0-10 scale), and prognosis > 6 months. Patients could not be taking more than 200 oral morphine equivalents per day. Patients were systematically referred to an interventional pain specialist for consideration of pain procedures, with monthly visits for 4 months. Measures of feasibility included the proportion of patients seen by the pain specialist within 4 weeks, and the proportion undergoing pain procedures. Patients completed surveys at baseline, 2 and 4 months; using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), patients rated their satisfaction with pain clinic (range 0-10), and how often the pain doctor treated them with courtesy and respect, listened carefully, and explained things in a way they could understand (range 1-4, higher scores better). Among those undergoing procedures, patients indicated the percent pain relief they had from the procedure. Results: Between May 2022 and October 2023, 30 patients were enrolled (4 remain on study); mean age, 59.5, 50% male, with a variety of solid tumors; baseline “average pain” and “worst pain” scores were 4.3( SD,1.2) and 6.5( SD,1.6). All but one patient (96.7%) was seen in the pain clinic within four weeks; 57% (n = 17) received one or more pain procedure, with 20% (n = 6) undergoing repeat procedures. The most common procedures were neural blockade (8), celiac plexus neurolysis (n = 4), trigger point injection (n = 3), and epidural steroid injection (n = 3). Among patients receiving a procedure, the median percentage relief was 65% (IQR:30,80). Patients rated the quality of care from the pain clinic highly, with a mean score of 8.6( SD,1.6); and were satisfied with their pain physicians with a mean rating of 3.8( SD,0.4) on treating with respect, 3.7( SD,0.6) for listening, and 3.6( SD,0.6) for explaining. Conclusions: In this study of patients with cancer pain, systematic referral to interventional pain management specialists was feasible, and led to most patients receiving a pain procedure. Patients were satisfied with their pain care and reported meaningful relief of symptoms. Further study is needed to examine whether early integration of interventional pain management improves pain control. Clinical trial information: NCT05366413 .
Association of childhood trauma with choice of bilateral mastectomy for the treatment of unilateral breast cancer.
Authors: Jagielo Annemarie D. , Benedict Catherine , Zewde Nahom , Neri Eric , Nouriani Bita , Spiegel David
Published: June 2024

e24096

Background: Patients are increasingly choosing bilateral mastectomy (BMX) for the treatment of primary breast cancer (BC) despite minimal survival benefits and potential for adverse medical and psychosocial consequences. Exposure to childhood trauma is associated with dysregulation of stress response systems, threat perception alterations, increased risk-taking behaviors, and body dissatisfaction. We examined childhood trauma in relation to treatment decision-making in adulthood within a sample of breast cancer patients undergoing either BMX or more conservative BC treatment. Methods: Secondary analyses of a case-control study of the neurobiological and affective determinants of BMX choice were conducted. Cross-sectional data from the baseline survey were analyzed. Participants were recruited via institutional clinic practices, social media, and patient advocacy groups. Patients completed a medical status questionnaire and the Childhood Trauma Questionnaire (CTQ). Chi-square and Mann-Whitney U tests examined differences in treatment decision-making by childhood trauma exposure and type. Results: The sample included 137 patients with unilateral stages 0-III BC (mean age 49.2; SD = 11.2; 76.6% White; 10.9% Hispanic/Latina; 68.6% married). Seven tested positive for a BRCA gene mutation. Patients were divided between BMX (n = 66) and non-BMX (n = 71) treatment groups. On average, patients in the non-BMX group reported higher levels of childhood trauma severity (Median = 7; IQR = 0-12.5) compared to patients in the BMX group (Median = 4; IQR = 0-11.75; Mann Whitney U = 4728; small effect size; SRD = -0.11; p = .26). Patients who reported a major parental upheaval (e.g., divorce, separation) were significantly more likely to pursue non-BMX compared to BMX (small effect size; SRD = -.16; p = .047). Patients who reported any uncategorized major upheaval were more likely to choose non-BMX than BMX (small effect size; SRD = -.14), but group differences did not reach significance (p = .093) . No other statistically significant relationships were observed. Conclusions: Contrary to hypotheses, preliminary results suggest BC patients who were exposed to traumatic events in childhood may be more likely to elect conservative BC surgical treatments. Trauma-related hypervigilance to threats may cause patients to exercise more caution regarding treatment choice. More research exploring the effects of adverse childhood experiences in the BC population is warranted. [Table: see text]
ACE-BREAST-03: A phase 2 trial evaluating ARX788, an anti-HER2 antibody drug conjugate (ADC), for the treatment of HER2+ metastatic breast cancer (mBC) in patients who have been previously treated with trastuzumab deruxtecan (T-DXd).
Authors: Tripathy Debashish , Ali Kashif , Agrawal Laila , Ali Sami M. , Blau Sibel , Block Margaret , Danso Michael A. , Yardley Denise , Andersen Jay , Waks Adrienne Gropper , Jayachandran Priya , Makhlin Igor , Nikolinakos Petros , Zuniga Richard , O'Shaughnessy Joyce , Aung Sandra , Lu Janice M. , Kalinsky Kevin , Gradishar William John , Rugo Hope S.
Published: June 2024

TPS1123

Background: HER2-targeted ADCs revolutionized treatment for patients with HER2+ mBC. The HER2-targeted ADC, T-DXd, improved PFS and OS vs T-DM1 (trastuzumab emtansine) as second-line treatment for HER2+ mBC and is now the preferred treatment option in this setting. However, new treatment options are needed for patients with disease progression on T-DXd. Novel technological advances in design of the antibody, linker, and payload of ADCs may further improve the safety/tolerability and efficacy, widening the therapeutic window to address resistance to other anti-HER2 therapies. ARX788 is a next-generation anti-HER2 ADC stably conjugated to AS269 (a potent tubulin inhibitor). Proprietary site-specific oxime conjugation chemistry, enabled by incorporation of synthetic amino acids into the antibody construct, maximizes the delivery of the cytotoxic payload to tumor cells and minimizes systemic exposure of free payload. ARX788 has shown antitumor activity in heavily pretreated patients with HER2+ and HER2-low mBC, including those with prior T-DXd exposure. Methods: ACE-Breast-03 (NCT04829604) is a Phase 2 trial evaluating ARX788 in patients previously treated with T-DXd. The primary efficacy endpoint is response rate by RECIST v1.1. Approximately 40 patients will be enrolled. Eligible patients have HER2+ mBC and up to 5 prior treatment regimens for mBC, including T-DXd. Patients must have central laboratory-confirmed HER2+ mBC; new pre-treatment biopsies may be required. Patients with treated and stable brain metastases who are off steroids are eligible. Treatment includes 1.5 mg/kg Q3W ARX788 for up to 26 cycles or until disease progression. Tumor status is assessed every 9 weeks through 27 weeks and every 12 weeks thereafter. The study is currently enrolling in the US. Clinical trial information: NCT04829604 .
The Political Economics of Non-democracy
Authors: Egorov Georgy , Sonin Konstantin
Published: June 2024

We survey recent theoretical and empirical literature on political economics of non-democracies. Nondemocratic regimes face multiple challenges to their rule, both internal, such as palace coups or breakdown of their support coalition, and external, such as mass protests or revolutions. We analyze strategic decisions made by dictators from the standpoint of maximizing the chances of regime survival in the light of these challenges, and show how it explains multiple common patterns, from hiring political loyalists to positions that require competence, to restricting media freedom at the cost of sacrificing bureaucratic efficiency, to running propaganda campaigns, organizing election fraud, purging opponents and associates, and repressing citizens. (JEL D72, D73, D82, D83, L82, O17)
Racial Disparities in the Criminal Legal System: Shadows of Doubt and Beyond
Authors: Agan Amanda Y.
Published: June 2024

Racial disparities permeate every single stage of the criminal legal process. In Shadows of Doubt: Stereotypes, Crime, and the Pursuit of Justice, Brendan O’Flaherty and Rajiv Sethi shed light on the stereotype-driven biases that contribute to these disparities. In this article, I review the compelling evidence in the book and expand upon it by outlining the myriad intertwining mechanisms contributing to racial disparities in criminal legal contact. I argue that reducing stereotype-driven biases is a crucial step toward equity, but a broader systemic overhaul is necessary to substantively address the entrenched racial biases in the criminal legal system. (JEL D83, D91, J15, K14, K42)
Ανθρωπολογικοί προβληματισμοί στο έργο του Tristram Engelhardt
Authors: Χωριανοπούλου Μαρία Κ.
Published: June 2024

Βασικός στόχος του παρόντος δοκιμίου είναι να παρουσιάσει εν συντομία και να αναλύσει τις δύο προσεγγίσεις του Engelhardt σχετικά με τη ζωικότητα. Η πρώτη αναφέρεται στα μη ορθολογικά ζώα stricto sensu, ενώ η δεύτερη, και σημαντικότερη, αναπτύσσει την οντολογική αυτοϋποβάθμιση της ανθρωπότητας, η οποία προκύπτει από την κυρίαρχη, προσανατολισμένη στην απόλαυση, κουλτούρα της εποχής μας. Αναφορικά με την πρώτη, στοχεύοντας στην άμβλυνση της πλήρους αποδοχής της χρήσης των ζώων, επικαλούμαι τις απόψεις του Ronald Dworkin περί ιερότητας, οι οποίες τεκμηριώνουν μία εύλογη εναλλακτική στάση. Σχετικά με τη δεύτερη, επιχειρώ να ανασυνθέσω κριτικά τον τρόπο με τον οποίο, σύμφωνα με τον Engelhardt, η ανθρωπότητα, έχοντας απορρίψει κάθε υπερβατική έρευνα, ενστερνίζεται ολοένα και περισσότερο την κατώτερη φύση της. Κλείνοντας, θα επισημάνω ότι αυτή η επιστροφή στην ζωικότητα μπορεί να παρεμποδιστεί από επικείμενες προκλήσεις που ήδη αφήνουν αισθητό αποτύπωμα σε παγκόσμια κλίμακα.
Νίκος Δήμου, Η αντίσταση στον Δαρβίνο και άλλα 13 ετερόδοξα κείμενα, Πατάκης, Αθήνα 2024.
Authors: Βάσση Παναγιώτα
Published: June 2024

Το παρόν κείμενο αποτελεί κριτική στο βιβλίο του Νίκου Δήμου Η αντίσταση στον Δαρβίνο και άλλα 13 ετερόδοξα κείμενα.
Idiopidae Simon, 1889 in the Brazilian Amazon: two new species and a new geographic record
Authors: Gomes João Pedro Costa , Santos Naila Amanda Sousa dos , Almeida Marlus Queiroz , Cipola Nikolas Gioia , Morais José Wellington de
Published: June 2024

Idiopidae Simon, 1889 is mostly composed of spiders known as trapdoor spiders, which create structures for shelter, hunting and protection against possible predators (Mason et al., 2013). It is divided into three subfamilies: Arbanitinae Simon, 1903, with spiders restricted to Oceania, Genysinae Simon, 1903, occurring in India, Sri Lanka, Madagascar and South America, and Idiopinae Simon, 1889, from South America, Africa, East Middle and South to Southeast Asia (Raven 1985; World Spider Catalog 2023). Idiopidae is widely distributed throughout the world, however, only two genera are present in Brazil: Idiops Perty, 1833 and Neocteniza Pocock, 1895. In this work, we describe a new species for both genera present in Brazil and a new record of Idiops.
Assessment of balance and risk of falls in people over 60 years old
Authors: Gruszczyński Norbert , Perkowski Radosław
Published: June 2024

Introduction: Falls of the elderly are a significant problem for public health and healthcare. They are also included in the geriatric giants, and the assessment of balance and risk of falls is an important part of the comprehensive geriatric assessment (CGA). It is estimated that almost one in three people over the age of 65 living independently in a community suffers one fall per year. These estimates increase with age, and in people older than 80 years, every second senior may experience at least one fall. The aim of the study was to assess the balance and risk of falls in people over 60 years of age living independently in society. Materials and methods: The study enrolled 40 seniors over the age of 60 who agreed to participate in the study and met the inclusion criteria. Three functional tests were used to assess balance and the risk of falls among seniors: the Timed Up and Go (TUG), the Four Square Step Test (FSST) and One-leg standing (OLS). Result: The study shows that as age increases, subjects perform worse on the Timed Up and Go rho = 0.38 test; p < 0.05 and in the Four Square Step Test rho = 0.53; p < 0.01. No statistically significant differences were observed between genders or age groups in the One Leg Standing test (OLS), although older people scored worse than younger age groups. There were no statistically significant associations between performance test results and BMI. The average results of the clinical tests show that the seniors in the study had good balance and a low risk of falling.