bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer disparities among patients with advanced metastatic breast cancer.
Authors: Saravia Diana , Elson Leah , Liang Hong , Bilani Nadeem , Elimimian Elizabeth Blessing , Nahleh Zeina A.
Published: June 2021

e18566

Background: We previously elucidated sociodemographic factors associated with risk-of-death, in a subgroup of patients with Stage IV human epidermal growth factor 2 (HER)+ breast cancer. To further understand determinants of disparities in all subgroups of stage IV breast cancer, this study sought to evaluate factors which are predictive of overall survival (OS) in a cohort of patients with metastatic breast cancer (MBC), according to the following subtypes: 1) estrogen receptor (ER)+ or progesterone receptor (PR)+ and (HER)-, (2) (ER+ or PR+) and HER+, (3) (ER- and PR-) and HER-, or (4) (ER- and PR-) and HER+. Methods: Study population included patients with MBC, extracted from the National Cancer Database, treated between 2010 and 2016. Descriptive statistics were used to summarize patient characteristics, and chi-square tests were performed to compare patient characteristics, by ethnic group (white, black, Hispanic, Asian, and other). Multivariate Cox regression models with backward elimination (using significance level of p<0.05) were utilized to compare overall survival among patient cohorts. In addition, Kaplan-Meier survival curves of patient cohort were also produced. Statistics were performed using SAS. Results: Records from n= 47,032 patients were included, the majority were 50 years or older, white, and treated with hormonal therapy. With a median follow-up time of 2.3 years, disparities in OS were observed; black patients were more likely to suffer death (HR=1.12 (1.08-1.16), p<0.0001), compared to white patients. Additional factors contributing to risk of death in MBC included: being male (HR=1.12, (1.02-1.23), p=0.019), having visceral involvement compared to bone only (HR=1.52, (1.05-1.28), p<0.0001), income < $38,000 (HR=1.13 (1.09-1.17), p<0.0001), being on government insurance (HR=1.24, (1.20-1.27), p<0.0001, and having Triple Negative Breast Cancer (ER- and PR-) and HER- status (HR=1.68 (1.60-1.75) p<0.0001). Patients who receive chemotherapy, not hormonal therapy (HR=1.25 (1.2 – 1.3), p<0.0001), were found to have worse prognosis possibly reflecting biology of disease at presentation and lack of specific targeted therapy. Conclusions: This study confirms that sociodemographic disparities exist in OS among patients within the same stage of MBC, and regardless of receptor status subtypes. Clinical practice should focus on closing disparities gaps for those with advanced and MBC, especially among Black, impoverished, and male patients. Better treatment approaches should be sought for patients with visceral metastasis and those diagnosed with triple negative receptor status, who continue to suffer from worse outcomes.
Association of febrile neutropenia (FN) risk factors (RFs) with incident FN in U.S. commercial and Medicare advantage patients receiving intermediate-risk chemotherapy for non-myeloid cancers between 2009 and 2019.
Authors: Li Edward C. , Bell Elizabeth J. , Campbell Kimberley J. , Lal Lincy S. , Peterson-Brandt Jesse , Lyman Gary H.
Published: June 2021

e18607

Background: FN after myelosuppressive chemotherapy may result in significant morbidity/mortality and increase healthcare costs due to interventions such as hospitalization. For patients receiving chemotherapy at intermediate-risk of FN, guidelines recommend assessing patient-specific FN RFs to decide whether to provide primary prophylaxis. However, there is a paucity of real-world data that quantifies the FN risk based on patient RFs when receiving intermediate-risk chemotherapy. Thus, we examined the association of FN RFs with incident FN in the first and subsequent cycles in patients at intermediate-risk of chemotherapy-induced FN within the real-world. Methods: This retrospective cohort study used the Optum Research Database to identify US commercial and Medicare Advantage patients with a non-myeloid malignancy who were treated between 01 Jan 2009 and 31 Dec 2019 with a first-line intermediate-risk chemotherapy regimen. The following FN RFs were identified based on ICD or procedure codes on claims during the 6 months prior to chemotherapy, unless otherwise stated: radiation, neutropenia, liver dysfunction, renal dysfunction, age > 65 years, metastases to the bone, and surgery during the 30 days prior. FN was defined as ICD codes for neutropenia and fever on a claim. Patients without previous FN were followed for FN from five days after index through the earliest of the following: 1) FN, 2) 31 Dec 2019, 3) death, 4) health plan disenrollment, or 5) end of chemotherapy line or cycle (depending on time frame of interest). Cox regression was used to calculate HRs for incident FN. Results: The study included 13,937 patients, and the most common RFs were 1) recent surgery (84%), 2) age > 65 (67%), and 3) liver dysfunction (31%). Compared to patients with no individual RFs, each additional RF was associated with a greater risk of FN during both the first and subsequent cycles, although confidence intervals were large (Table). Conclusions: Among patients at intermediate-risk of chemotherapy-induced FN, patients with more individual RFs for FN had a higher risk of FN during both the first and all cycles. These results underscore the importance of RF analysis in prophylaxis decisions for patients at intermediate-risk of chemotherapy-induced FN.[Table: see text]
COVID-19 related outcomes for hospitalized patients (pts) with solid malignancies (SM).
Authors: Chi Jeffrey , Chitty David , Kohn Nina , Shen Janice , Lopez Carlos Alberto , Hines Adam , Wu Vernon , Yang Jung-In , Goldberg Bradley Harris , Saif Wasif M.
Published: June 2021

e18626

Background: Pts with malignancies are at risk for developing severe complications of COVID-19 with high mortality rate. We retrospectively analyzed COVID-19 related outcomes for hospitalized pts with SMs. Methods: We collected data on hospitalized pts with SMs and COVID-19 from 3/1/20 to Jan 1/1/21. Diagnosis COVID-19 was confirmed by RT-PCR of nasopharyngeal swabs. We assessed the association between the 30-day mortality and potential prognostic variables such as tumor types, cancer status, timing of treatment, types of anticancer therapy using logistic regression analyses. Results: A total of 246 hospitalized pts with SMs had COVID-19. Median age was 70 years, 87 (35%) were ≥75 years, 151 (61%) were female. The most common SMs were breast (56 [23%]), non-small cell lung (44 [18%]) and colon (31 [13%]). 154 (63%) pts were on active anticancer therapies. Of those 88 (35.5%) received treatment within 2 weeks, 16 (16.5%) within 4-12 weeks, 99 (39.9%) >3 months prior to COVID-19 diagnosis. 101 (65%) pts received cytotoxic chemotherapies, 26 (16.8%) received immune check point inhibitors (ICIs), 17 (11%) received targeted agents such as anti-EGFR therapy and 11 (7.1%) received monoclonal antibodies. Overall 30-day mortality was 42%, however, all pts with melanoma (7/7) died. The 30-day mortalities for pts who received anticancer treatments within 4 weeks, 4-12 weeks and >12 weeks of COVID-19 diagnosis were 47%, 50%, and 37%. For pts who never received treatment, 30-day mortality was 31%. For pts were in remission, stable disease and progressive disease, the 30-day mortalities were 32%, 35% and 62%. The 30-day mortalities for pts who received cytotoxic therapy, monoclonal antibodies, targeted therapies and ICIs, were 38%, 46%, 41% and 69%. Logistic regression analysis showed that pts who were >80 years of age (OR 3.6, 95% CI 1.6-8.1), had progressive disease (OR 3.4, 95% CI 1.8-6.5) or treated with ICIs (OR 3.6, 95% CI 1.5-8.7) were associated with higher 30-day mortality. Conclusions: COVID-19 associated 30-day mortality is high for hospitalized pts with SMs. Early surveillance of clinical deterioration could be helpful for hospitalized SMs pts with risk factors identified here. Further studies are needed to discern the observed association between ICIs use and worse COVID-19 outcome.[Table: see text]
In-hospital outcomes of percutaneous coronary intervention with drug-eluting stent in patients with localized and metastatic cancer.
Authors: Gauto Estefania , Del Cid Fratti Juan , Salazar Miguel , Macchi Hugo , Upadhyay Banskota Shristi Upadhyay , Baral Binav , Weir Catherine , Ahuja Kriti , Cattoni Juan Adolfo
Published: June 2021

e18631

Background: Patients with localized and advanced malignancy are usually excluded from randomized clinical trials of drug-eluting stents and anti-platelet therapy. We aimed to evaluate short term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with localized and metastatic malignancy. Methods: Analysis from the Nationwide inpatient sample January 2016 to December 2018 of patients with localized and advanced malignancy admitted for a percutaneous coronary intervention with drug-eluting stents. Primary outcome was in-hospital mortality. Secondary outcomes were post-procedural complications and healthcare-utilization. Multivariate regression analysis was performed to adjust for confounders. Results: During 2016 – 2018 a total of weighted 1, 244, 550 PCI with DES were performed. 97.9 % in patients without cancer, 1.6% (n=21,125) patients with localized cancer and 0.3 % (n=4,765) with metastatic cancer. During hospitalization patient with cancer were more likely to develop respiratory failure, need for mechanical ventilation, AKI, and to receive blood products. After multivariate regression analysis patients with localized malignancy did not have any difference in-hospital mortality, total charges, cost, cardiac arrest or post procedural bleeding but had less LOS, respiratory failure, AKI requiring HD, post-procedural CVA and higher post-procedural blood transfusion when compared with patients without cancer. Conclusions: Patients with metastatic malignancy have higher in-hospital mortality when compared to patients without cancer. Patients with localized or advanced malignancy do not have higher in hospital complications. Blood transfusion is higher in patients with malignancy but is not related to procedure.[Table: see text]
Cancer-related outcomes in oncology patients admitted to physical rehabilitation facilities.
Authors: Huang Julie , Ramdhanny Angela , Daly Alison , Akerman Meredith , Braunstein Marc Justin
Published: June 2021

e18643

Background: Admission to a physical rehabilitation facility (RF) can improve mobility and quality of life metrics in cancer patients, however, limited data exist on how these admissions impact cancer-related outcomes. We hypothesized that admissions to a RF following hospitalization delays cancer-directed treatment and increases mortality compared to those who are discharged home. Methods: A retrospective chart review identified oncology patients who were being treated with either intravenous or subcutaneous cancer-directed therapy between 2010-2020 and admitted to either a RF or home following hospitalization. Exclusion criteria were patients not on active cancer-directed treatment or going to hospice. Comparisons of RF vs. home were made using a chi-square test or Fisher’s exact test for categorical outcomes. Median days to next chemotherapy for each group were assessed with Kaplan-Meier/Product-Limit Estimates with a corresponding 95% confidence interval. Results: Of 189 patients, 24 were admitted to a RF and 165 went home. The median age of the study population was 65.6 years, with more males (66.7%) admitted to a RF vs. discharged home (49.7%), and both groups having >50% advanced stage cancer; primarily GI malignancies (25.9%) (Table). There was a statistically significant increase in the percent of patients who experienced delays in the time to their next anticipated chemotherapy date in the RF group vs. home (70.8% vs. 30.3%, P<0.0001), as well as median days to next chemotherapy (38.5 vs. 22, P<0.007). 30-day readmission rates were higher in patients at a RF vs. home (50% vs 29%, P<0.04). There were no significant differences in mortality comparing RF vs. home at 3, 6, or 12 months from the index inpatient hospitalization. Conclusions: Hospitalized oncology patients who were admitted to a RF had significant delays in cancer-directed therapy. Despite the smaller sample size of patients in a RF, their 30-day readmission rates were higher, suggesting a need to carefully select patients who can afford delays in cancer treatment.[Table: see text]
Development of an aid to decision-making form (ADF) integrated into a major institutional program in oncology: A tool to support care goal identification.
Authors: Vigouret-Viant Laurence , Legoupil Clemence , Bardet Aurelie , Laurent Celine , Ducreux Michel , Laurent Sophie , Mateus Christine , Dauchy Sarah , Blot François
Published: June 2021

e18646

Background: For cancer patients, life-threatening complications may be difficult to anticipate, leading to complex medical decision-making processes. Since 2015, the Gustave Roussy Cancer Center has implemented a major institutional program including a Decision-Aid Form (ADF), outlining the anticipation of appropriate care for patient in case of worsening evolution. Methods: Between January and May 2017, all patients transferred from Site 1 to Site 2 of the hospital were prospectively included. In this study, we assessed the acceptability of the ADF, its using and its impact on the patient’s becoming. Results: Out of 206 patients included, 89.3% had an ADF. The planned stratification of care was notified in practically all cases. Conversely, the involvement of the palliative care team was notified in only 29% of the ADF. The value of the WHO/ECOG Performance Status was limited, varying between physicians. Finally, the field “information for patients and relatives” was insufficiently completed. Although a possible transfer to Intensive Care Unit was initially proposed in two-thirds of the patients, the majority (76%) of the 35 patients experiencing an acute event received exclusive medical or palliative care. The level of therapeutic commitment suggested by the ADF was never upgraded, and often revised towards less aggressive care, and especially without excess mortality for the patients who were initially designated to be eligible for intensive care. Moreover, the patient's survival at 6 months seems to be correlated with the anticipated level of care recorded on the FAD (Log-rank P value < 0,0001). Conclusions: The results of our study suggest that setting up a care stratification file in advance is possible in a French cultural setting and it could be helpful for clarifying prognosis assessment. To achieve complete acculturation, our extensive institutional program remains a cornerstone for the development of advance care planning. Since 2017, this program has widely spreaded ADF which is now integrated into the electronic medical record. Each physician can complete and modify the patient's ADF at any stage of the patient's disease course.
Diagnostic discrepancies in second opinion pathology reviews in a community-based cancer center.
Authors: Pedroza Albert , Wedel Whitney , Lintel Nicholas , Horn Adam , Copur Mehmet Sitki
Published: June 2021

e18650

Background: Tracking diagnostic discrepancies is a common quality indicator in anatomic pathology. Many cases are re-reviewed as care is transferred from one facility to another. Most published data on these discrepancies is from the perspective of the tertiary receiving facility. Disparities in patient access to pathology expertise and technologies in small community hospitals can affect the accuracy of cancer diagnosis and the quality of care. Mary Lanning Healthcare (MLH) is a regional community hospital with a well-established referral pattern to several neighboring health systems. As part of a quality assurance process, we evaluated the diagnostic concordance rate of our cancer related pathology diagnoses with the referred institutions. Methods: Between 2017 and 2020, a cohort of cancer related cases was identified where the initial diagnosis was at MLH, then as part of coordinated care, a second pathologic interpretation was rendered at another instution. Data regarding specimen type, discrepancy in original diagnosis, nature and severity of discrepancy, disagreement in histologic grade, concordance or lack thereof with third party reviewers, and distribution among reviewing pathologists were collected. Results: A total of 521 cancer related cases (890 specimens) were sent to 16 facilities for second opinion. There were 46 (5%) discrepancies. Majority of them 45 (98%) were minor. Third party review of one major discrepancy came back in agreement with our original diagnosis. The most common discrepancy was interobserver variability in findings without strictly defined criteria. A change in histologic grade was the second most frequent deviation with prostate and breast being the most common sites. Upgrades and downgrades to the original diagnoses were nearly evenly split (19 to 21). A total of 33 pathologists were involved. While one reviewing pathologist generated 30% of all discrepancies, 3 other pathologists accounted for 67%. Conclusions: Accurate pathologic diagnoses significantly impact clinical outcomes. Our data which represents a rural community-based cancer program identified an overall discrepancy rate in the range of 0.1 to 1.1% for second opinion review. The vast majority of differences were minor in nature with no change in patient care and could be attributed to expected interobserver variability.[Table: see text]
Analysis of reasons for emergency department (ED) visits and resulting hospital admissions in breast cancer patients: A retrospective study from rural cancer center in Maine.
Authors: Patwari Anannya , Bhatlapenumarthi Vineel , Brann Courtnery , Waldrip Jackson , Caruso Victoria , Curtis Adam , Chodkiewicz Catherine
Published: June 2021

e18682

Background: Reducing ED visits in patients with cancer is cost saving and is particularly relevant during the COVID pandemic. Methods: We analyzed the number of ED visits occurred in our breast cancer population between July 1 2019 and August 31 2020 including demographics, stage distribution, treatment type within the month of ED visit, reason, time of the day, day of the week the visit occurred. Results: A total of 101 patients had 162 visits. 38 (38%) had more than 1 ED visit. Majority (36%) had stage 4 disease at the time of ED visit. The top 5 reasons for ED visits were fall and injury (N=30), GI (N=24), cardiac (N=17), respiratory symptoms (N=14) and cancer related pain (N=11). The median age in patients with ED visit due to fall injury/pain was 75 and non-fall injury/pain was 55 years. The most common reasons for chemotherapy induced ED visits were GI related (N=8) and Neutropenic fever (N=7). Cyclophosphamide/doxorubicin was the common regimen associated with neutropenic fever. A total of 72 (44%) visits resulted in hospital admissions. Most common symptom categories requiring hospital admissions were cardiac (82.3%), sepsis/cellulitis (81.8%), respiratory (64%), cancer related pain (54.5%) and GI (50%). Most were on endocrine therapy at the time of their visit (N= 59) and 31 were on no treatment at all. Falls were unrelated to disease or treatment and occurred in patients above age 70. Visits occurred during working hours from 6AM to 5PM, with peak incidence on Mondays and Fridays. Conclusions: Reducing ED visit in cancer patients is a worthwhile endeavor particularly in the context of the COVID pandemic. The main reason for ED visits were falls and injuries that were unrelated to disease or treatment in breast cancer patients. As a result, we are implementing systematic physical therapy assessment for our breast cancer population over age of 60 at our cancer center and call us first campaign, to get an opportunity to intervene prior to going to the ED as majority of the ED visits occurred during working hours.[Table: see text]
Frequency, characteristics, and subsequent treatment (Tx) of real-world patients (pts) who discontinue hedgehog inhibitors (HHIs) as first-line (1L) systemic Tx for advanced basal cell carcinoma (aBCC).
Authors: Cowey Charles Lance , Chen Chieh-I , Aguilar Kathleen M. , Davies Kalatu , LaFontaine Patrick R. , Fury Matthew G. , Bowler Timothy Geoffrey , Golozar Asieh , Jalbert Jessica J.
Published: June 2021

e18740

Background: HHIs are the only approved 1L systemic Tx for aBCC and Tx options following HHI Tx failure are limited. The objective of this study was to assess frequency, characteristics, and subsequent Tx patterns of pts with aBCC discontinuing 1L HHIs due to toxicity or disease progression. Methods: We conducted a retrospective cohort study using electronic health records of pts treated in The US Oncology Network (Network), a community-based network of > 450 oncology clinics. We identified adults (18+ years) with aBCC, not treated for another primary malignancy in the past 3 years, with ≥2 Network visits who discontinued 1L HHI monotherapy between January 2012 and November 2019 due to documented toxicity or progression without evidence of complete response (CR) who subsequently initiated second-line (2L) systemic Tx (2L initiators) or not (2L non-initiators). To exclude pts potentially using neoadjuvant HHIs, we required 2L non-initiators to be followed for ≥90 days after HHI discontinuation and excluded pts who underwent surgery or radiation during this period. Index date was Tx initiation for 2L initiators and 90 days after HHI discontinuation for 2L non-initiators. We describe cohort attrition and characteristics of 2L initiators and 2L non-initiators as well as Txs initiated among 2L initiators. Results: We identified 138 aBCC pts treated with HHIs regardless of line of therapy with fully accessible charts: 115/138 (83.3%) received HHIs as 1L systemic therapy for aBCC; 73/115 (63.5%) discontinued 1L HHIs; 37/73 (50.7%) discontinued due to documented toxicity or progression without evidence of CR. 4/37 pts (10.8%) initiated 2L systemic Tx (1 carboplatin & paclitaxel; 1 cemiplimab; 1 nivolumab; 1 pembrolizumab) within a median of 75 days (range: 2‒130) from HHI discontinuation. 2L initiators were 68.7 years of median age (range: 48.4‒71.1); 100% female; 75% White; 75% immunocompetent; 100% treated with 1L vismodegib for a median of 8.6 months (range: 6.8‒42.2); 100% discontinued 1L HHIs due to documented disease progression. We identified 15 2L non-initiators; median age 80.2 years (range: 49.6‒90+); 20% female; 100% White; 86.7% immunocompetent; 100% treated with 1L vismodegib for a median of 6.8 months (range: 1.9‒20.6); 93.3% discontinued 1L HHIs due to documented toxicity and 6.7% due to progression. Conclusions: In this small cohort of aBCC pts discontinuing 1L HHIs, ̃50% discontinued due to toxicity or disease progression. There was no clear standard of care among pts who experienced HHI Tx failure, with only a minority initiating subsequent 2L Tx. Effective Tx strategies for pts who do not respond to or cannot tolerate HHIs are needed.
Real-world treatment patterns, adherence, costs, and healthcare resource utilization associated with Waldenström macroglobulinemia in the United States.
Authors: Yang Keri , Castillo Jorge J. , Ratiu Anna , Delinger Rachel , Zimmerman Todd , Tang Boxiong
Published: June 2021

e18766

Background: Waldenström macroglobulinemia (WM) is a rare, incurable non-Hodgkin lymphoma. Given limited real-world data on WM treatment utilization, this study evaluates real-world treatment patterns and associated outcomes in the US commercially insured population. Methods: A retrospective observational study was conducted using the IBM MarketScan commercial claims and Medicare supplement database. Adults with ≥2 WM diagnoses and ≥1 WM treatment between 2014 and 2019 were identified. Patients included were newly diagnosed, initiating treatment, and enrolled continuously for 6 months before and ≥60 days following the index date, defined as the first date of WM treatment. Treatment regimens were categorized as: rituximab monotherapy, chemotherapy-based (alone or in combination), proteasome inhibitor-based (alone or in combination with rituximab), ibrutinib (alone or in combination with rituximab), and other regimens. Treatment patterns were evaluated by frequency and duration of treatment regimen. Adherence is measured by discontinuation and switching rates. Healthcare resource utilization examined included inpatient, outpatient, and pharmacy visits. Total costs were calculated as sum of inpatient, outpatient and pharmacy costs per-patient-per-month (PPPM). Treatment regimens, costs, and hospitalizations were examined overall, and by line of therapy. Results: A total of 453 patients (mean age: 67 years, 51% male) received 1st-line therapy (mean duration: 246 days); 143 (32%) patients received 2nd-line therapy (mean duration: 231 days), and 24 (5%) received 3rd-line therapy (mean duration: 212 days). The most commonly used treatment regimens by line of therapy are shown in the treatment pattern table. Discontinuation rates were 43.3%, 50.4%, and 45.8%, and the switching rates were 25.4%, 10.5%, 20.8% during 1st, 2nd, and 3rd line of therapy, respectively. The overall hospitalization rate was 20% with an average length of stay (LOS) of 2.3 days. Approximately 17% (LOS: 1.4 days), 20% (LOS: 1.8 days), and 25% (LOS: 7.0 days) of patients had a hospitalization, during 1st, 2nd, and 3rd line of therapy, respectively. Mean total PPPM costs were $26,688 in overall population, and increased by line of therapy (1st: $18,682; 2nd: $19,171; and 3rd: $36,878). Conclusions: There remains a significant clinical and economic burden with suboptimal treatment adherence in US commercially-insured patients with WM. Future studies are needed to further understand factors associated with treatment selection. [Table: see text]
Impact of COVID-19 pandemic in hospitalizations due to brain tumors from the epicenter of Latin America.
Authors: Portugal Isabella Batista Martins , Werneck De Carvalho Luis Eduardo , Schoueri Jean Henri , Rezende Leandro Fórnias Machado , Fonseca Fernando Luiz Affonso , Ferrari Gerson , de Abreu Luiz Carlos , Adami Fernando
Published: June 2021

e18785

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. In Brazil, the disease had its first case in the city of São Paulo, thus being the starting point and epicenter of this disease in Latin America. Neurological features are currently well recognized in COVID-19 indicating the neurotropic nature of the virus and include anosmia, myalgia, myositis, encephalitis, meningitis, cerebrovascular disease, Guillain–Barré syndrome, and post-infectious myelitis. CNS tumors though relatively rare (> 2% of all cancers) are a relevant source of cancer-related morbi-mortality worldwide. Although studies have reported higher COVID-19 severity in cancer patients, the consequences of the pandemic on health care for CNS tumors remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the hospital admissions (HA) due to CNS tumors in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to CNS tumors in the city of São Paulo comparing the outbreak period (January-June 2020) and a pre-pandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD-10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to CNS tumors was observed during the outbreak period (January-June 2020). Benign neoplasm of brain and other parts of CNS (-2, CI -2 to -1) and malignant neoplasm of brain (-5, CI -7 to -3) showed to be remarkably affected (see table). To our knowledge, this is the first scientific report of significant reduction of HAs due to CNS tumors during COVID-19 era. Conclusions: Our findings seem to be associated to delayed oncological diagnose and care to CNS tumor patients during the lockdown and health system collapse. A rebound help-seeking effect as well as more severe complications may present in the post‐pandemic. Further studies are needed to evaluate the impact of the ongoing pandemic in CNS neoplasms in order to strategically corroborate public health actions for short- and long-term implications of COVID-19 pandemic. [Table: see text]
Thromboprophylaxis in active cancer patients: Is it a controversial clinical issue or not? Preliminary results of ACT4CAT study.
Authors: Tsoukalas Nikolaos , Christopoulou Athina , Papandreou Christos N. , Koumarianou Anna , Athanasiadis Ilias , Peroukidis Stavros , Samelis Georgios , Psyrri Amanda , Kapodistrias Nikolaos , Nikolakopoulos Achilleas , Andreadis Charalampos , Ardavanis Alexandros , Samantas Epaminondas , Bokas Alexandros , Vassilios Barbounis , Kentepozidis Nikolaos K. , Mavroudis Dimitrios , Athanasiadis Athanasios , Papakotoulas Pavlos , Boukovinas Ioannis
Published: June 2021

e18803

Background: Cancer Associated Thrombosis (CAT) is an increasing challenge for oncology patients since oncologists sometimes are reluctant to mitigate the risk with thromboprophylaxis. Active cancer patients while receiving chemotherapy have a 7fold risk of thrombosis compared with no cancer patients. Anticoagulation holds a prominent place in prevention of CAT usually with Low Molecular Weight Heparins (LMWHs). Methods: ACT4CAT is prospective observational study conducted by HeSMO across Greece, aiming to record the clinical practice of CAT prophylaxis in patients with solid tumors. Ambulatory, high thrombotic risk, active cancer patients who received thromboprophylaxis enrolled after signing informed consent. Results: Preliminary results collected from 18 oncology departments. From 431 enrolled patients 322 (65.4%) had completed the study. Tumor types included: lung 28.8%, gastrointestinal 39.8%, gynecological 7.0%, breast 4.4%, urological 7.0% and others 20%. Majority of patients (88.2%) received High-Risk for Thrombosis Chemotherapy Agents (HRTCAs) such as platinum agents (55.9%), antimetabolites (44.7%) and immunotherapy (12.6%). In 1st line were 62.1%, 2nd line 18.4%, adjuvant 8.9% and neoadjuvant 2.4%. The following table depicts: age, gender, metastatic disease, Khorana score ≥2 and HRTCAs. All patients received thromboprophylaxis for 5.3±3.6 months with: tinzaparin 90.8%, fondaparinux 5.5%, bemiparin 1.5%, enoxaparin 1.2%, apixaban 0.5% and rivaroxaban 0.5%. Intermediate doses received 70.9% of patients regardless clinical setting (1st, 2nd, adjuvant & neoadjuvant: 70.2%, 79.2%, 51.3% and 70.0% respectively, p = 0.0254), although intermediate doses were used more in metastatic stages (OR:2.4 95%CI: 1.4-4.2, p = 0.0028). Nine thrombotic events reported (2.1%, 95%CI: 1.1-3.9%), irrespective of clinical setting but with a trend towards prophylactic doses. Eleven grade 1 bleedings reported (2.6%, 95%CI: 1.4-4.5%), despite clinical setting or dose used. Conclusions: Thromboprophylaxis in ambulatory active cancer patients with high thrombotic risk is safe and effective. Oncologists are alerted about CAT negative influences in cancer patients’ prognosis. Apart from Khorana score, factors such as metastases, use of HRTCAs and drug-drug interactions influence the clinical decision of thromboprophylaxis in active cancer patients mainly with LMWHs and quite often with intermediate doses regardless clinical setting. Clinical trial information: NCT03909399. [Table: see text]
Reduction in prostate cancer hospitalizations in the COVID-19 pandemic epicenter of Latin America.
Authors: Portugal Isabella Batista Martins , Adami Fernando , Schoueri Jean Henri , Rezende Leandro Fórnias Machado , Fonseca Fernando Luiz Affonso , Ferrari Gerson , de Abreu Luiz Carlos , Werneck De Carvalho Luis Eduardo
Published: June 2021

e18814

Background: The novel SARS-CoV-2 coronavirus disease 2019 (COVID-19) has disrupted health care systems worldwide since December 2019 causing atypical pneumonia and affecting multiple body organs. In Latin America, COVID-19 had its first case in the megacity of São Paulo, Brazil, thus being the starting point and epicenter of this disease. In this context, prostate cancer (PC) is the most common non-skin cancer among men and its preventive healthcare is substantial to public health surveillance. Additionally, PC raises particular interest during COVID-19 outbreak as PC androgen-deprivation therapies have shown to mitigate SARS-CoV-2 infection, which suggests an association between SARS-CoV-2 and PC cells. Thus, the consequences of the COVID-19 outbreak on male genital cancers care remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the incidence of hospital admissions (HA) due to malignant neoplasms of male genital organs in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to malignant neoplasms of male genital organs in the city of São Paulo comparing the outbreak period (January-June 2020) and a pre-pandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD-10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to malignant neoplasms of male genital organs was observed in PC, but not other malignant neoplasms of male genital organs during the outbreak period (January-June 2020). PC (-19, CI -36 to -1) showed to be remarkably affected while other male genital cancers (-1, CI -5 to 3) did not (Table). Conclusions: Our findings seem to be associated to delayed oncological care delivery to PC during the lockdown and health system disruption. Further studies are required to evaluate the impact of the ongoing pandemic in malignant neoplasm of male genital organs, particularly PC, in order to strategically corroborate public health actions for implications of COVID-19 pandemic. Linear regression of hospital admissions for the years 2017-2020 (January until June) due to malignant neoplasms of male genital organs (chapter II of the ICD-10). Municipality of São Paulo, São Paulo, Brazil.[Table: see text]
The association between myelodysplastic syndromes (MDS) and inflammatory bowel diseases (IBD): Analysis of Nationwide Inpatient Sample (NIS) database.
Authors: Barbi Mali , Gurunathan Sakteesh , Pradhan Kith , Halmos Balazs , Gritsman Kira , Verma Amit K.
Published: June 2021

e19033

Background: The co-occurrence of MDS and IBD has been gradually recognized in the literature. Yet, large-scale national studies are required to investigate this observed association further. We aimed to delineate the clinical features, outcomes between the concurrent of MDS with IBD and MDS or IBD alone in a nationally representative database. Methods: Data were obtained from the NIS 2010-2014, using appropriate ICD-9 codes to identify patients who were admitted with a principal diagnosis of MDS with IBD as secondary (MDS-1/IBD) and MDS without IBD and patients who were admitted with a principal diagnosis of IBD with MDS (IBD-1/MDS) and without MDS. We assessed the mortality rate as the primary outcome, mean length of stay (LOS), and rate of blood transfusion as secondary outcomes by Pearson χ2 -test and univariate regression (logistic regression). Results: We identified 190 hospitalizations for MDS-1/IBD and 4895 hospitalizations for IBD-1/MDS. The mean LOS was higher for MDS-1/IBD group than for IBD or MDS only (11.7 vs. 6.1 and 7 days). However, the mortality rate in the MDS-1/IBD group was lower than in patients with IBD or MDS only (2.6% vs. 3.8% and 4.4%). While the rate of blood transfusion was higher among males in the MDS group, it was significantly higher among females when there is a concurrent MDS-1/IBD. However, the differences were not significant when MDS is not the primary diagnosis i.e IBD-1/MDS. In univariate analysis, age and Charlson comorbidity index were significantly associated with an increased mortality rate when there are IBD and MDS than MDS or IBD alone. Conclusions: While unable to assess appropriateness, NIS data indicate that there are significant differences in outcomes such as mean LOS, rate of blood transfusion and mortality rate when there is a concurrence of MDS and IBD than MDS or IBD alone. The underlying pathogenicity remains unclear and warrants additional study.[Table: see text]
Cachexia is an independent factor for negative clinical and functional outcomes in lymphoma patients receiving CART therapy.
Authors: Roy Ishan , Smilnak Gordon John , Burkart Madelyn , Williams Corinne , Hamilton Elizabeth , Miyata Sarah , Thorp Katherine , Ma Shuo , Winter Jane N. , Pro Barbara , Gordon Leo I. , Karmali Reem
Published: June 2021

e19504

Background: Cachexia is a known independent factor for negative outcomes in several cancer populations at early and late stages, but has not been in investigated in cancer patients receiving Chimeric Antigen Receptor T-cell therapy (CART). Our objective was to evaluate the relationship between cachexia and clinical and functional outcomes in patients with lymphoma receiving CART. Methods: Design: Retrospective cohort study including 70 adult patients with aggressive B-cell lymphomas (Diffuse Large B-cell or Mantle Cell Lymphoma) who received CART. Cachexia markers: body weight loss (BWL), BMI, albumin, creatinine, and neutrophil-to-lymphocyte ratio (NLR) – each captured at diagnosis, pre-collection, CART initiation, and through day 360 post-CART. Outcome measures: Primary outcomes: Disease relapse after CART and 90-day mortality. Secondary outcome: Need for rehabilitation services post-acute care (inpatient rehabilitation or home physical therapy). Statistical analyses: Linear regression modeling, area under the curve analysis, and multivariate modeling (any univariates with p < 0.25). Co-variates: age, ECOG PS, IPI, cell of origin, MYC status, number of prior cancer therapies, time from diagnosis to CART, and need for bridging / steroid pre-CART. Results: In longitudinal modeling from diagnosis to day 360, CART patients who relapsed had linear associations over time with BWL since diagnosis (p < 0.01), NLR (p < 0.0001), creatinine (p = 0.045), and albumin (p < 0.001). In univariate analyses (see table): at pre-collection, high NLR and BWL increased odds of relapse; at treatment, high NLR and CRP increased odds of mortality; and at D30, and BWL and high NLR increased odds of relapse and mortality, respectively. In multivariate analyses (see table, # = independent association), BWL and high NLR independently associated with relapse and mortality, respectively. Significant covariates included need for bridging (p = 0.02), steroid therapy pre-CART (p < 0.01), and time from diagnosis to CART (p = 0.02). Secondarily, BWL and low albumin pre-CART increased odds of needing rehabilitation services, with BWL independently associating in multivariate models (OR = infinity, p < 0.001). Conclusions: Cachexia markers, such as BWL from diagnosis and NLR, are candidate predictors of relapse and mortality after CART. Specific markers could also assign patients to neo/adjuvant rehabilitative and medical therapies targeted towards cachexia. Overall, this study suggests that cachexia may alter the clinical and functional trajectory of lymphoma patients receiving CART.[Table: see text]
Clinical characteristics and outcomes of adult lymphoma-associated hemophagocytic lymphohistiocytosis (HLH).
Authors: Lee Christina Y. , Wills Beatriz , Vardhana Santosha Adipudi , Moskowitz Alison J.
Published: June 2021

e19526

Background: Lymphoma is a major cause of secondary HLH, a life-threatening hyperinflammatory syndrome due to immune dysregulation. This study examines the clinical and biological characteristics, management, and outcomes of patients with lymphoma and HLH. Methods: We retrospectively reviewed 44 adult patients with combined diagnoses of lymphoma and HLH at Memorial Sloan Kettering Cancer Center between June 2012 and September 2020. Overall survival (OS) was measured from the date of HLH diagnosis to the date of death or last follow-up. We evaluated the association of demographic, clinical, laboratory, and treatment variables on survival using log-rank tests and Cox proportional hazards model. Results: Of the 44 patients, 30 (68%) had T and NK-cell lymphoma, 12 (27%) had B-cell lymphoma, and 2 (5%) had Hodgkin lymphoma. All but one patient received HLH therapy including corticosteroids (95%), etoposide (68%), and intravenous immunoglobulin (18%), which was initiated within 1 day of diagnosis in 84% of cases. Twenty-five patients (57%) received lymphoma-directed therapy with etoposide (n = 17) or without etoposide (n = 8). Five of the 15 patients who underwent targeted tumor-sequencing of 400 genes harbored a TP53 mutation and all were refractory to frontline therapy, while 7 of 10 patients without TP53 mutation demonstrated initial treatment response ( p= 0.03). The median OS (mOS) of the entire cohort was 1.4 months, with a 30-day cumulative mortality incidence of 36.4%. Most deaths were attributed to relapsed or refractory HLH (n = 25/36, 69%) and lymphoma progression (n = 6/36, 17%). Patients with T/NK-cell lymphoma-associated HLH had a mOS of 1.4 months compared to 9.2 months in B-cell lymphomas ( p= 0.09). Ten patients (23%) were diagnosed with HLH within 60 days of their initial lymphoma diagnosis and had an improved prognosis (mOS 12.8 vs 1.3 months, p= 0.006). Treatment with etoposide, either alone or as part of a lymphoma-directed regimen, was associated with significantly improved survival (HR 0.48, 95% CI 0.24-0.96) whereas lymphoma-directed therapy with or without etoposide was not (HR 0.66, 95% CI 0.34-1.29). Significant predictors of mortality included age ≥60 years, non-white race, and concurrent infection during the hospitalization. Conclusions: In this large cohort from a single U.S. institution, there was a wide range of lymphoma subtypes associated with HLH. Despite increased disease recognition and prompt initiation of standard HLH and lymphoma-directed therapies, the prognosis remains very poor. Patients treated with etoposide had improved survival, highlighting the importance of controlling hyperinflammation during initial management. Notably, TP53 mutation was associated with primary refractory HLH. Future studies will aim to elucidate the pathophysiology of lymphoma-associated HLH in order to inform novel therapeutic approaches.
Practice patterns in children, adolescents, and young adults with mycosis fungoides: Single institution study.
Authors: Hooper Madeline , Zhang Yumeng , Taylor Eric , Seminario-Vidal Lucia , Sokol Lubomir
Published: June 2021

e19553

Background: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, but management remains heterogenous. MF management is based on disease stage, comorbidities, availability, and physician preference. Few studies have assessed treatment in children, adolescents, and young adults because prognosis in these groups is generally favorable; however, optimizing therapeutic protocols for these patients will improve clinical care and reduce adverse effect incidence. Here, we retrospectively describe the practice patterns and disease response for the child, adolescent, and young adult with MF. Methods: We retrospectively reviewed clinical data on 46 patients younger than 40 years with MF treated at Moffitt Cancer Center between 2009 and 2019. Mean time to next therapy (mTTNT) was used as a surrogate marker for the duration of clinical benefit. Group differences in mTTNT for patients with early-stage MF was assessed using Kaplan-Meier analysis. P-values were calculated using the log-rank test. Results: Overall, mean age was 29.2 years (range: 6.6-39.8). Topical steroids (47.8%) and narrowband-UVB (nbUVB) (19.6%) were the most utilized first line treatments regardless of disease stage. Forty patients had early-stage MF (stage IA-IIA). Among them, mean age was 27.8 years (6.6-36.6); 55% received topical steroids and 22.5% received nbUVB first line. These patients received a mean of three (1-7) unique therapies throughout their treatment course. Other reported topicals were retinoids, nitrogen mustard and pimecrolimus. Systemic retinoids were used in one early-stage case. Used first line in early-stage disease, topical therapy resulted in a mTTNT of 25 months ( p= 0.015); mTTNT after combination and systemic therapy was 12 and 5.5 months. As second line treatment, phototherapy resulted in a mTTNT of 58 months, but this finding was not statistically significant ( p= 0.11). Topical and systemic agents used second line resulted in mTTNT of 34 and 33 months. Six patients had advanced-stage MF (stage IIB-IVB) with a mean age of 27.6 years (19.9-35.8), two of which died from the disease. Each patient received a different first line therapy: topical nitrogen mustard, systemic steroids, systemic retinoids, radiation, psoralen and UVA light, or CHOP chemotherapy. Mean number of therapies administered to this cohort was five (2-9). Conclusions: In children, adolescents, and young adults with MF, topical and phototherapies were used more frequently than systemic therapies or radiation. In early-stage disease, the longest clinical response was achieved with topical treatments. Used second line, phototherapy demonstrated promising disease response trends compared to those of other modalities. Systemic therapy does not produce durable disease response in the first line setting; however, its utility in advanced-stage disease and as a second line agent requires further research.
Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?
Authors: Wudhikarn Kitsada , Bansal Radhika , Khurana Arushi , Hathcock Matthew , Ruff Michael , Carabenciov Ivan D. , Braksick Sherri A. , Bennani N. Nora , Paludo Jonas , Villasboas Jose Caetano , Wang Yucai , Johnston Patrick B. , Ansell Stephen M. , Lin Yi
Published: June 2021

e19556

Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]