bluuebunny/crossref_metadata_2025 huggingface dataset:
Overall survival of children with brain tumors after radiation therapy in Kazakhstan.
Authors: Dushimova Zaure , Goncharova Alyona , Kaidarova Dilyara , Kopochkina Sabina
Published: June 2022

e22011

Background: Tumors of the central nervous system in children occupy the 2nd place in frequency in the structure of malignant neoplasms of childhood and the 1st place among solid tumors. They make up about 20% of all malignant neoplasms of childhood and are mainly represented by brain tumors. The purpose of the study was to analyze the survival rate depending on various factors during radiation therapy (RT) of brain tumors in children. Methods: Retrospective study included 277 patients who received RT from 2016 to 2020 at the Pediatric Oncology Center of the Kazakh Research Institute of Oncology and Radiology. The average follow-up time was 34.3 months. The median age was 9.5 years. RT was performed on a linear accelerator “TrueBeam”, in a single dose of 1.8 Gy, total 50.4-54.0 Gy, 5 fractions per week. Survival distributions was estimated by Kaplan and Meier curves and survival differences were evaluated using the log-rank test. IBM SPSS Statistics V23 was used for statistical analyses. Results: The overall survival (OS) rate of 277 patients was 70.8%, with an average life time of 55.6 months, 95% confidence interval (CI) (51.9 - 59.2). Children under 10 years of age showed a 12.5 % worse OS compare to children after 10 years of age. In patients with unconfirmed morphological verification, OS is 31.5% worse than in children with confirmed morphological verification. In children with grade I-II tumor differentiation, OS was 30.6% higher than in children with grade III-IV tumors. The method of RT (conformal RT, IMLT), gender of patients did not have a statistically significant effect on OS. Conclusions: Our study showed that OS rate depends on various factors, such as age, presence of morphology verification, and the degree of tumor differentiation. RT allows to achieve better survival in patients older than 10 years who received RT with a morphologically confirmed diagnosis of GI-II. RT is one of the main treatments for brain tumors in children.[Table: see text]
Self-reported well-being of cancer survivor (CS)-caregivers: An analysis of the Behavioral Risk Factor Surveillance System (BRFSS).
Authors: Wang Qian , Jiang Changchuan , Xie Hui , Theodoropoulos Nicholas , Wen Chi , Li Yannan , Shapiro Charles L.
Published: June 2022

e22022

Background: With the advancement in cancer therapies and supportive care, the 5-year survival rate for all cancers combined has surpassed 67%, indicating an increased proportion of CS are going back to their life roles, including providing care to others. Being a caregiver is associated with an increased risk of physical and mental distress, depression, and sleep disturbance. Nevertheless, the well-being of “dual role” CS-caregivers remains unknown. Methods: Data were extracted from the BRFSS survey from 2016, 2018, and 2020. Outcome variables included self-reported poor general health, physical health, mental health, depression, physical inactivity, and inadequate sleep. Weighted multivariable logistic regression models were used to calculate the odds of self-reported well-being comparing CS-caregivers to non-CS caregivers. Results: 20% of CSs were caregivers. Among a total of 18,590 caregivers, 18,124 (weighted N=12,311,109) were non-CSs and 466 (weighted N= 287,807) were CSs. CS-caregivers were significantly more likely to have poorer general and physical health and be physically inactive than non-CS caregivers (Table). Differential impacts on the well-being of CS-caregiver were also observed by the female sex and less than 5 years since cancer diagnosis. Conclusions: One in five CS is a caregiver, translating into 3.4 million CS in the US population. CS-caregivers experience diminished well-being across a variety of measures than non-CS caregivers. These data suggest CS-caregivers may need additional psychosocial support. Future prospective longitudinal studies are needed to investigate the outcomes in this growing and vulnerable population.[Table: see text]
Colorectal cancer mortality rates and socioeconomic factors in Brazil: Association with income inequality and availability of medical doctors.
Authors: Maselli-Schoueri Jean Henri , Werneck De Carvalho Luis Eduardo , Paiva Laercio da Silva , de Almeida Roediger Manuela , de Abreu Luiz Carlos , Fonseca Fernando Luiz Affonso , Adami Fernando
Published: June 2022

e22516

Background: Colorectal cancer mortality is expected to rise in the upcoming years in Brazil, especially in less developed regions. It is also known that socioeconomic factors play a role not only in the development, but also in the outcome of this disease. Methods: Ecological study that analyzed secondary data from 2016-2018 to examine the relationship between both income-inequality and the amount of doctors per inhabitant on colorectal cancer mortality in Brazil and its Federative Units. All data were gathered from Brazil’s public health system. Mortality was standardized by the World Health Organization’s population and analyzed by sex and age. Income-Inequality was measured using the Gini index, obtained from the United Nations Development Programme. The number of doctors was obtained from the Unified Health System and also calculated as the rate per 100,000 inhabitants. For this study, linear regression was performed using stepwise selection/backward elimination. Results: In the present study, we found that female sex (β -0.616, IC95% -1.308;0.075), the number of gastroenterologists (β -2.506, IC95% -3.702;-1.309), clinicians (β -0.107, IC95% -0.155; -0.0600), and the number of general surgeons (β -0.845, IC95% -1.188; -0.501) were negatively associated with colorectal cancer mortality, whereas higher income (β 0.02, IC95% 0.001;0.003), the amount of doctors in the public health system as a whole (β 0.090, IC95% 0.064;0.116), generalists (β 1.760, IC95% 0.987; 2.533) and oncology surgeons (β 14.252, IC95% 3.937; 24.566), were positively associated with cancer mortality. Conclusions: Colorectal cancer presents different mortality rates depending on sex, socioeconomic status and availability of medical doctors and specialists, whether for diagnosis and higher notifications or treatment and lesser deaths form the disease.
Gender disparities in multiple myeloma publications.
Authors: Dweik Aala , Dweik Hadeel , Mian Hira , Mohan Meera , Schinke Carolina D. , Al Hadidi Samer
Published: June 2022

e23000

Background: Gender disparities exist in academia and are disproportionately affecting females. We conducted a cross sectional study to analyze gender disparities in MM publications in high impact hematology/oncology journals between January 1st, 2016 and December 31st, 2020. Methods: Data was collected through Medline/PubMed database search. High impact journals (impact factor > 10) with at least ten MM related publications were included. Impact factor data was based on the 2016 InCites Journal Citation Report. We used Genderize, a validated database, to determine authors’ gender. Search engines were used if gender was undetermined or did not meet a cut-off of 0.9. Unclassified genders after search were excluded from analysis. Results: A total of 679 publications with 8898 authorships were analyzed. Mean number of authors for females vs. males, per publication was 4.4 and 8.7, respectively. Females constituted a third of total authors. Female first authors, corresponding authors and last/senior authors were 34%, 21% and 18%, respectively. 17% of authors of clinical trial publications were females. Publications by country had comparable percentages (30% females as first authors in the U.S. vs. 32% females as first authors in other countries). The proportion of female authorship in 2020 when compared to 2016 was similar (33%). Between 2016 and 2020, there was slight improvement in female first authors (32%-37%), last authors (16%-21%), and corresponding authors (17%-22%). Conclusions: Gender disparities in MM publications exist and are more obvious in the last/corresponding authorship in both the U.S. and other countries. Despite improvement in proportion of female authors, it remains suboptimal when compared to the growing proportion of female physicians. Efforts should be made to identify factors that contribute to these disparities and work to resolve them.
The effect of a series of online CME activities on the multidisciplinary management of patients with GEP-NETs.
Authors: Worst Michelle Arielle , Caracio Rich , Whitney Megan , Cohen Jacob , Yao James C.
Published: June 2022

e23004

Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare, heterogenous neoplasms characterized by a wide spectrum of clinical manifestations. Management strategies are varied and include surgery, radiological intervention, cytotoxic chemotherapies, somatostatin analogs, TKIs, and novel peptide receptor radionuclide therapy (PRRT). Due to their clinical complexity, the diagnosis and treatment of GEP-NETS should involve collaboration between specialists in multiple disciplines. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of oncologists, gastroenterologists, and pathologists with respect to the use of novel systemic therapies for the multidisciplinary management of patients with GEP-NETs. Methods: The educational series consisted of 3 online, CME-certified activities. Educational impact was assessed with repeated pre-/post-education including multiple choice knowledge/competence questions and 5-point Likert scale confidence questions. Data from all oncologists, gastroenterologists, and pathologists who completed pre- and/or post-education assessments were aggregated across activities and stratified by learning theme. Relative changes in percentage of correct responses and clinicians who were confident (value of 4 or 5) were used to measure improvement in knowledge, competence, and confidence. A McNemar’s test assessed significant levels of changes reported with P values < .05 considered statistically significant. The first activity in the series launched December 2020 and the last launched February 2021; data were collected until February 2022. Results: The educational series resulted in overall statistically significant improvements in oncologists’, gastroenterologists’, and pathologists’ knowledge, competence, and confidence after education (N = 125 to 455, P < .05). Conclusions: This analysis demonstrates that oncologists’, gastroenterologists’, and pathologists’ knowledge, competence, and confidence regarding the use of novel systemic therapies in the multidisciplinary management of patients with GEP-NETs improved after education. Despite these improvements, additional educational activities are needed to address residual gaps and further increase clinicians’ ability in this clinical setting.[Table: see text]
Evaluating the impact of education on clinician integration of guidelines, real-world data, and patient perspectives on gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
Authors: Ackbarali Tariqa , Lovelace Cindy , Strosberg Jonathan R. , Benson Al Bowen
Published: June 2022

e23005

Background: Targeted therapies for somatostatin receptor-positive NETs have seen significant developments in recent years. Approved and investigational somatostatin analogs for GEP-NETs are changing the treatment landscape for these cancers allowing for better management of difficult-to-treat heterogeneous tumors. To improve competence in applying these advances and to consider patient perspectives in treatment selection, an educational initiative was designed in collaboration with the Healing NET Foundation. Methods: A 1-hour CME activity was broadcast live-online in October 2021 and remains on-demand through October 2022 at OMedLive.com. The first module of the CME activity focused on real-world and quality-of-life data, and consensus guidelines related to somatostatin analogs (SSA) and peptide receptor radiotherapies (PRRT). The second module of the CME activity highlighted patient perspectives based on interviews of real patient with SSA and PRRT experience. This second section was distributed via social media through the Healing NET Foundation. Knowledge and competence questions were administered pre-, immediate post-, and 2 mos. post-activity. McNemar tests compared paired responses (pre/post & pre/2 mos) with Cohen’s d for effect size. Results: As of 01/28/22, 238 clinicians have participated in the activity, 80% of whom are physicians, advanced practitioners (NP/PA), and nurses. Through social distribution, the patient perspectives were viewed by 300 patients/caregivers. Across the four CME test questions low baseline knowledge/competence was observed when selecting treatment with SSA based on reported progression-free survival and time to deterioration of quality of life from clinical trial data. Clinical considerations based on patient perspectives and prophylactic regimens with PRRT also revealed low baseline knowledge/competence. Statistically significant improvements were seen for pre/post paired responses across all four CME questions with gains ranging from 25% to 53%. The greatest challenge managing a patient with GEP-NET, was identified as adherence to treatment schedules. At 2-mos. follow-up, 90% and 95% reported improved behavioral impact on both clinical practice and patient experience/outcomes, respectively. Qualitative data including clinician write-in examples of behavioral impact and patient perspectives from the interviews will be shared. Conclusions: Assessments reveal a positive impact of live-online education on clinical practice when sharing patient perspectives in context of clinical updates. Open-ended responses to behavioral impact questions illustrated clear improvements in clinician-reported patient experience and outcomes, clinical practice management, and knowledge of SSA and PRRT for patients with GEP-NETs.
Optimizing the fellow oncology continuity clinic: Factors associated with a meaningful experience.
Authors: Shultz Carl , Rizvi Wajeeha , Safi Salah Ud Din , Hafez Maria , Bustamante Alvarez Jean Gabriel , Daboul Nour , Kamran Amir
Published: June 2022

e23012

Background: Fellowship programs use a variety of continuity clinic models including general, disease/system specific, or both. The longitudinal timing also varies from 6-months, 1-year, or the entirety of fellowship. At WVU, we use a 6-month disease specific model where fellows rotate with a specific attending. Given the increasing complexity of care for patients with oncologic diagnoses, we sought to establish a general continuity clinic within an academic cancer institute to model the skills needed to effectively transition to independent practice. Additionally, we proposed to identify key elements that make for a meaningful continuity clinic experience. Methods: We created a 42 question, anonymous online survey comparing general clinic to the disease specific clinic and administered it to our current 2nd and 3rd year fellows. Independent variables were Likert-scale ratings (1=strongly disagree, 2= disagree, 3=neutral, 4=agree, 5=strongly agree) on four main themes: patient characteristics, clinic operations, preceptor characteristics, and educational value. Results: Seven out of seven fellows responded. The majority of them answered that 1 new patient and 4 return patients were “just right” per half day of general clinic, while 1-2 new patients and 5 or more return patients were “just right” per half day of disease specific clinic. Within the general clinic, the number of patients with lung, GU, and GI oncology was noted as “just right” while breast and other (e.g., CNS, head and neck, sarcoma) were identified as “too few”. Table shows a sample of questions asked and differences among the two clinics. The most evident disparity was autonomy of patients. A weekly, multispecialty planning session was also rated highest in terms of educational value for general clinic. Conclusions: We demonstrated a general continuity clinic can be successfully implemented within an academic cancer center. While there are pros and cons to both types, several key characteristics to a meaningful continuity clinic experience were identified including: adequate ratio of new and return patients, wide variety of diagnoses, increased autonomy and ownership of patients, consistent preceptor and support staff, and weekly planning session for increased preparation and educational value.[Table: see text]
National organization addresses multidisciplinary oncology team burnout and resiliency through multifaceted presidential theme education initiative.
Authors: Boehmer Leigh , Nelson Krista , Lucas Lorna , Townsend Lisa , Gardner Lori , Marino Monique
Published: June 2022

e23017

Background: The 2021-2022 Association of Community Cancer Centers (ACCC) President’s Theme centered on strengthening a work culture that supports professional well-being and workforce resilience. To support this theme and help ensure sustainable high quality cancer care delivery, ACCC —an education and advocacy organization for the multidisciplinary oncology care team (MDT)—designed a multifaceted professional development initiative. Educational interventions were designed to address team member burnout and building resilience, critical issues facing members of today’s oncology workforce. Methods: ACCC designed a collaborative and bi-directional peer-support educational initiative to drive the mission of the 2021-2022 ACCC President’s Theme. Professional Development opportunities included: 1) Expert-led mindfulness meditation series of 10 guided exercises tailored to help MDT members manage through social, emotional, physical, and mental health challenges. 2) Professional development themed virtual meetings, styled as “Coffee Chat Learning Sessions,” facilitated by the ACCC President, addressing emergent challenges and opportunities facing MDT members. 3) Podcast series featuring timely topics related to MDT well-being and resiliency amid the COVID-19 Pandemic. Podcast topics include a) The Business Case for Hiring Oncology Social Workers. b) Leading with Gratitude. c) Coping with Pandemic Grief. d) A Summer of Disconnect for Cancer Professionals. e) COVID-19 Self-Care. f) Real-World Lessons from COVID-19. Results: The education initiative reached a diverse cohort of oncology care community members. 76 unique professionals participated in the small group “Coffee Chat Learning Sessions” from 25 states and represented 72 unique cancer care programs, practices, and institutions. The meditation series engaged more than 1,100 users and the podcast series garnered 1,870 learners. The podcast episode titled “COVID-19 Self Care” was the third most accessed ACCC Podcast episode of all time with more than 680 views. Over 2,900 learners accessed and engaged with the ACCC President’s Theme resources across the dedicated webpage from March 2021-January 2022. Conclusions: Anecdotal learner feedback has been overwhelmingly positive regarding this professional development educational initiative. In a climate of high burnout and health care worker fatigue, the ACCC 2021-2022 President’s Theme Education program has served as a unique lifeline and resource to members of the oncology community to restore and develop resiliency, enhance well-being, and advance professional connections and peer-to-peer support to meet continued challenges. Lessons learned from these activities will guide and inform future professional development opportunities.
Facility type and it's impact on survival in Ewing's sarcoma: An NCDB analysis.
Authors: Braaten Marco , Braaten Jacob , Eaton Vincent
Published: June 2022

e23505

Background: Previous studies have reported a significant association between facility type and survival in cancer patients. This study aimed to investigate the impact of treatment facility type on overall survival for Ewing’s Sarcoma. A secondary objective was to identify differences in distribution of demographic variables between facility types. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with Ewing’s sarcoma from 2004 to 2018. Four facility types were identified: Academic/Research Programs, Community Cancer Programs, Comprehensive Community Center Programs, and Integrated Network Cancer Programs. Descriptive statistics and Kaplan Meier curves were used to measure survival in these patients and Chi-square was used to evaluate differences in demographics. Data was analyzed using SPSS and statistical significance was set at α = 0.05. Results: Of 269 patients queried, 49% were treated at an academic facility. Academic Programs had the longest median survival of 54 months; Community Cancer Programs had the shortest median survival of 9 months. Statistically significant survival differences were found between all facility types on log-rank comparison (p < 0.050), except for survival between Integrated Network and Community Cancer Programs (p = 0.162). Academic Programs had the highest overall survival when compared to Community Cancer Programs (p = 0.000), Comprehensive Community Cancer Programs (p = 0.026), and Integrated Cancer Networks p = (0.003). Chi-Square analysis revealed an association between facility type and cancer stage at diagnosis (p = 0.044) as well as between facility type and primary payer status (p = 0.026). Notably, 58% of patients treated at Community Programs presented with stage IV disease and 41% were insured by Medicare. Additional log-rank comparisons and Kaplan Meier curves showed private insurance was associated with significantly higher survival compared with Medicaid (p = 0.043), Medicare (p = 0.001) and uninsured patients (p = 0.010). Patients treated at Comprehensive Community (70%) and Academic Programs (67%) had the highest proportion of patients with private insurance. Conclusions: This study showed that Ewing Sarcoma patients treated in an Academic/Research program facility experienced increased survival compared with other facility types. Patients treated at Community Cancer Programs were more likely to present with stage IV disease and were more likely to be on Medicare. Future studies may investigate additional factors that influence potential barriers to care for Ewing Sarcoma patients.[Table: see text]
Odds of stage IV bone cancer diagnosis based on socioeconomic and geographical factors.
Authors: McMahon Kevin , Eaton Vincent , Tupper Connor , Morris Matthew , Merwin Matthew , Srikanth Kishan , Silberstein Peter T.
Published: June 2022

e23506

Background: There are significant differences in prognosis for osteosarcoma, Ewing Sarcoma, chondrosarcoma, & chordomas based on stage at diagnosis. 5-year survival at early stage vs late stage is as follows; osteosarcoma 75% vs 27%, Ewing sarcoma 82% vs 39%, chondrosarcoma 78% vs 22%, and chordomas 87% vs 55%. This study seeks to evaluate the socioeconomic and geographical factors that affect the odds of late-stage bone cancer diagnosis. Methods: This study retrospectively evaluated the risk of stage I vs stage IV cancer at diagnosis in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma & chordoma) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2018. Patients were identified by ICD-O-3 codes and patients with other malignancies were excluded. Cross Tabulations with Chi-square analysis was performed to evaluate frequencies of different socioeconomic and geographical characteristics between groups. Multivariable binary logistic regression was performed to evaluate relationships between socioeconomic and geographical factors and the odds of stage IV cancer. Statistical significance was set at α = 0.05. Results: 11,945 patients with stage I or stage IV primary malignant bone tumors were identified. Odds of stage IV bone cancer at diagnosis increased in patients of greater age (odds ratio [OR] = 1.011, 95% confidence interval [CI]: 1.003-1.018). Odds of stage IV bone cancer at diagnosis were decreased with female sex (OR = 0.747, 95% CI: 0.647-0.862), private insurance (OR = 0.519, 95% CI: 0.367-0.732), Medicare insurance (OR = 0.664, 95% CI: 0.456-0.965), or with diagnosis at comprehensive cancer center programs (OR = 0.549, 95% CI: 0.371-0.814), academic/research programs (OR = 0.339, 95% CI: 0.232-0.495), or integrated cancer network programs (OR = 0.392, 95% CI: 0.261-0.587). No significant relationship was identified between stage at diagnosis and race, ethnicity, Charlson-Deyo score, income, education, region, travel distance, or urban/rural status. Conclusions: Odds of stage IV bone cancer at diagnosis are greater with increasing age, male sex, non-private or non-Medicare insurance status, or treatment at community cancer programs.
Primary site and survival in ewing sarcoma: A National Cancer Database (NCDB) analysis.
Authors: Tupper Connor , Silberstein Peter T. , Eaton Vincent
Published: June 2022

e23510

Background: Ewing sarcoma is the one of the most common primary malignancies of bone, with an incidence of about 1 case per million in the United States. Ewing sarcoma typically affects the pelvis, axial skeleton, and femur. However, this cancer can affect other bony regions and, to the author’s knowledge, all possible primary sites have not been investigated in-depth in regards to tumor location and the effect it may have on outcomes. The aim of this study is to conduct such an investigation to see whether or not the primary site of the tumor in osteosarcoma patients may have an effect on survival. Methods: Using the NCDB, patients diagnosed with Ewing sarcoma between 2004-2018 were identified using ICD-O-3 histology code 9260. The cohort was analyzed to investigate survival outcomes in different primary sites. Univariate analysis was then performed assessing patient length of survival for each primary site subtype. Data was analyzed using SPSS and statistical significance was set at α = 0.05. Results: A total of 4284 patients with known primary site that had survival data were included. The sites with the best survival were the skull, face, and mandible and upper limb. Patients with primary tumor of the skull, face, and mandible survived significantly longer than all groups other than the upper limb (all p < .01). Upper limb patients survived significantly longer than all groups other than the skull, face, and mandible and lower limb (all p < .05). The labeled primary site with the lowest survival was the pelvis, sacrum, and coccyx and significantly lower than the lower limb, vertebral column, and ribs, sternum, and clavicle (all p < .01). Survival of patients with primary site of the upper limb versus lower limb, and vertebral column versus ribs, sternum, and clavicle did not differ (each p > .05). Conclusions: This study found numerous survival differences between patients diagnosed with Ewing sarcoma of different primary sites. Labeled primary sites of the skull, face, and mandible and upper limb were associated with best survival while the pelvis, sacrum, and coccyx were associated with worst survival. Future studies may benefit from investigations into variables that may impact the survival differences we have presented including staging, treatments, time from diagnosis to treatment, and insurance status.[Table: see text]
Molecular features of undifferentiated sarcoma of soft tissue and carcinoma.
Authors: Liu Yuan , Wang Yingyi , Chen Rongrong
Published: June 2022

e23519

Background: Both undifferentiated sarcoma of soft tissue and undifferentiated carcinomas can arise in multiple tissue and are with an aggressive clinical course. While undifferentiated sarcomas that remain a diagnosis of exclusion and show extreme genomic complexity, less is known about undifferentiated carcinoma. Methods: Sixty-two patients diagnosed as undifferentiated sarcoma (n = 36, 10 bone/limbs, 9 abdomen, 9 pelvis, and 8 chest/intrathoracic) or carcinoma (n = 26, excluding undifferentiated carcinoma of nasopharynx and thyroid, 15 chest/intrathoracic, 8 abdomen, and 3 pelvis) were recruited in the study. Mutational analysis was performed by next-generation sequencing of 1021 tumor related genes, which enabled analysis of TMB and MSI as well. PD-L1 expression data was available in 24 patients. Results: Fifty-eight patients (93.5%, 58/62) had at least 1 mutation identified and 542 SNV, 115 CNV and 5 fusions were identified in total in the 62 patients. The top 5 mutant genes were TP53 (56.5%, 35/62), TERT (11.3 %, 7/62), SMARCA4 (9.7%, 6/62), LRP1B (9.7%, 6/62), and MLL2 (9.7%, 6/62). Interestingly, mutation in TP53 was more common in undifferentiated carcinoma (73.08%, 19/26) than sarcoma (44.44%, 16/36, p = 0.0377). Two ERBB2 CNV and 1 KIF5B-RET fusion were identified in 2 gastric carcinoma and 1 lung large cell carcinoma. However, no carcinoma but 2 sarcoma (1 polymorphic undifferentiated sarcoma in the limb and 1 undifferentiated small round cell sarcoma in the lung) showed MSI-H, with TMB as high as 22.08 and 65.28 respectively, while the median TMB was 3.84 mutations/Mb. Among the 24 patients with PD-L1 data, 16 were > 1%, and 5 were > 50%, with no significant difference between undifferentiated carcinoma and sarcoma. Conclusions: In spite of the genome complexity in undifferentiated sarcoma of soft tissue and carcinoma, there was limited actionable mutations in these two aggressive tumors. However, immunotherapy should be considered since over half of these patients were PD-L1 positive and nearly a quarter of them had high PD-L1 expression.
Nested set information derived from fusion genes in Ewing sarcoma and other cancers.
Authors: Anderson Peter Meade , Manning Luisa-Marie , Rubin Brian , Chan Timothy A. , Kilpatrick Scott E. , Hanna Rabi , Tu Zheng Jin
Published: June 2022

e23521

Background: Ewing family tumors including Ewing sarcoma (ES) and desmoplastic small round cell tumor (DSRCT) are characterized by EWSR1 and ETS fusion partners including EWS-FLI1, EWS-ERG, EWS-WT1, and others. Since 2019 our Next Generation Sequencing (NGS) sarcoma panel (N = 338) identified both fusion partners and exons containing the EWS breakpoint in ES and DSRCT. Hence, it should be possible to learn more about the exact breakpoints of EWS fusion genes. The molecular diversity and functionality of these fusion transcripts, especially the exact sequence, which could be identical, similar, or unique, may have significant biological implications for diagnostics and treatment options. We have used in-frame analysis of EWS gene fusion breakpoints to identify corresponding polypeptides spanning the breakpoints of the most common EWS gene fusions to provide useful insights about ES and DSRCT. Methods: Pathology reports and EWS gene fusions were analyzed using the Cleveland Clinic NGS panel which is based on anchored multiplex polymerase chain reaction (PCR) enriched for 34 gene targets. The amplicons were subjected to massively parallel sequencing with 151x2 cycle pair-end reads. An informatics pipeline was used for read alignment (GRCh37 as reference genome), fusion identification, and annotation. The DNA sequence across fusion junction and translational amino acid sequences were extracted for comparison in a preliminary teaching set (37/338 EWS fusions). Results: EWS-FLI1 fusions at exon 7-7 (chr22:29683123-chr11:128675261) and exon 7-6 (chr22:29683123-chr11:128651853) were the most common fusion genes in ES (N = 24/32;75%). Other ES gene fusions included exons 10-6, 7-10, 9-8, 7-2 EWS-FEV, 7-8 EWS-ERG, 7-9 EWS-ERG, and 10-9 EWS-ERG. EWS-WT1 gene fusions (chr22:29683123-chr11:32414301) in DSRCT exon 7-7 occurred in 4 of 5 cases (80%). In frame analysis of the common gene fusions in 75% of ES and DSRCT (total n = 37) yielded identical corresponding polypeptides that span the breakpoint (table). Conclusions: Analysis of ES and DSRCT fusion genes provides evidence that cancer-specific fusion genes are associated with common identical breakpoints and corresponding in-frame polypeptides. Our results show that the identification of in-frame polypeptides from the fusion gene sequencing can identify potential nested sets of cancer-specific mRNAs and polypeptides. This information may become relevant for diagnostic and therapeutic targets future vaccines and diagnostics against ES and DSRCT as well as other cancers characterized by fusion genes or frameshift mutations. [Table: see text]
A retrospective analysis of gender disparities in clinical outcomes of patients diagnosed with non-uterine leiomyosarcoma.
Authors: Hana Caroline , Nano Olger , Samuels Shenae , Hussein Atif Mahmoud , Wadhawan Ashna
Published: June 2022

e23547

Background: The effect of gender in sarcoma patients in various organ systems has been the subject of several studies, many of which show no overall survival (OS) difference between male and female genders. Tumor size and grade have been noted to be independent predictors of local recurrence and disease specific survival in a prospective study of patients with non-uterine leiomyosarcoma by Gaddy et. al. however, gender had no effect on OS. Methods: The 2004-2016 National Cancer Database (NCDB) was queried for males with leiomyosarcoma (LMS) and females with extrauterine leiomyosarcoma (EULMS) using topographical codes C490-C496, and C498-C499. Data included: patient’s age, race, year at diagnosis, tumor grade, size and stage, lymph node involvement, receipt of surgical treatment, chemotherapy or palliative care treatment, surgical margins, time to treatment in days, OS (months between the date of diagnosis and date of death or censored at last contact), and long-term survival defined as survival for 60 months or more. Univariate analysis was used to determine significant predictors of binary survival status (i.e. alive or dead), significant factors were then included in a multivariate analysis. Using Stata/SE 15.1, Kaplan-Meier (KM) method with log-rank test was used to compare and estimate OS rates between the 2 groups. Results: The total number of patients was 13537, with 6311 males (46.6%) and 7226 females (53.4%). The OS in females was 57.2 months compared to 72.0 months in males (P < 0.001). Men were also more likely to achieve long-term survival (36.1%) compared to females (34.4%, P < 0.001). Men with LMS had a lower percentage of chemotherapy use compared to females (18.7% vs 25% respectively, P < 0.001) and palliative care use (3.0% vs 3.5%; P = 0.013). Lower likelihood of survival among both groups was noted in older age (OR = 0.96; P < 0.001 in males; OR = 0.97, P < 0.001 in females), tumor stage > I (OR = 0.64, P = 0.005 in males; OR = 0.56, P < 0.001 in females) and positive surgical margins (OR = 0.76, P = 0.013 in males; OR = 0.87, P = 0.009 in females). Contrarily, increasing year of diagnosis was associated with an increased likelihood of survival (OR = 1.51, P < 0.001 in males; OR = 1.27, P < 0.001 in females). Larger tumor size was also associated with decreased likelihood of survival, but only in the female group (OR = 0.39, P = 0.001). Conclusions: Our analysis shows that males with LMS had a higher OS and higher percentage of long-term survival compared to females. The only factor affecting survival that was different between the 2 groups was the tumor size, which was associated with significantly decreased likelihood of survival in females. No clear explanation for this different survival could be extrapolated from the clinical data collected. Further studies are recommended to investigate the genetic, epigenetic, and possibly hormonal factors that may affect survival in LMS.
Surgical treatment of locally advanced retroperitoneal sarcomas.
Authors: Gevorkyan Yuriy A. , Katelnitskaya Oksana V. , Kit Oleg I. , Maslov Andrey A. , Soldatkina Natalya V. , Petrov Dmitriy S. , Kolesnikov Vladimir E. , Savchenko Dmitriy A. , Tolmakh Roman E. , Dashkov Andrey V. , Ilchenko Sergei A. , Vashchenko Larisa N. , Kasyanenko Vladimir N.
Published: June 2022

e23552

Background: Surgery with negative resection margins is now considered the main treatment for retroperitoneal sarcomas improving the survival and quality of life of patients. The most common obstacle to surgery with R0 resection in locally advanced tumors is the involvement of the great vessels. The purpose of this study was to analyze the results of surgical treatment in patients with locally advanced retroperitoneal sarcomas involving the inferior vena cava or iliac veins. Methods: The study included 34 cancer patients who underwent tumor resection with major vessel resection in 2015-2021. The mean tumor size was 15.5 cm (from 6 to 41 cm). The most common tumors were moderately differentiated liposarcoma (38%) and pleomorphic liposarcoma (26%). Results: Resection of the inferior vena cava was performed in 19 cases, resection of the iliac segment - 15. Circular vein resection without reconstruction was performed in 5 patients, wedge resection - 7, segmental resection with end-to-end anastomosis - 1, replacement of the venous segment with a prosthesis - 25. Resection of adjacent organs was required in 26.5% of surgical interventions. According to the final pathoanatomical examination, the rate of complete tumor resections (R0-1) was 88.2%. During the 30-day postoperative period, mortality and complication rates were acceptable, 29% and 0%, respectively. During the follow-up period, the median disease-free survival was 13 months, and the median overall survival was not reached. Conclusions: Surgical interventions expanded due to resection of the major veins in locally advanced retroperitoneal sarcomas allow achieving a high rate of radical tumor resection and improving relapse-free and overall survival rates.
Metastasectomy in synovial sarcoma: A systematic review.
Authors: Alshamsan Bader , Delisle Megan , Smith Denise , Wang Ying , Srikanthan Amirrtha
Published: June 2022

e23555

Background: Synovial sarcoma (SS) is a malignancy with high metastatic potential. The role of metastasectomy in SS is unclear, with limited data on prognostic factors and clinical outcomes. In this systematic review, we evaluate the survival outcomes post-metastasectomy for patients with SS. Methods: A systematic review was undertaken following PRISMA guidelines. English studies reporting survival outcomes among adults and children with SS undergoing metastasectomy were evaluated. Databases were searched from inception to May 31, 2021, and included Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Two reviewers independently undertook literature evaluation and screening, data extraction and grading of studies. Risk of bias assessments utilized the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies and the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Qualitative data was summarized in descriptive format, and survival outcome data were assessed for meta-analysis. Results: Thirteen retrospective studies, published between 1993 to 2017, were included, six were cohort studies, and seven were case series. A total of 598 patients with SS were included, of whom 462 had metastatic pulmonary disease, and 309 underwent metastasectomy. The median ages of the study cohorts ranged from 14 to 51 years. The median survival period after metastasectomy ranged from 21 to 80 months. The most common prognostic factors associated with survival included a disease-free interval (DFI) of greater than 12 months and complete resection of the metastases. Conclusions: The current literature has demonstrated that metastasectomy, particularly pulmonary, is a reasonable treatment option for appropriately selected patients with metastatic SS. Individuals with a DFI of greater than one year and who can safely undergo a complete resection appear the derive the greatest benefit. Registration: This protocol has been registered within the international prospective register of systematic reviews (PROSPERO) database (registration ID: CRD42019126906).
Resource utilization and futile management in terminally ill cancer patients: A perspective from hospital-based palliative care program in Saudi Arabia.
Authors: Saeed Mohammed
Published: June 2022

e24006

Background: The palliative care needs for cancer patients are on the rise across MENA region (Middle East and North Africa) with economical and quality of health-care implications. We believe this is the first reported study in the Saudi Arabia about resource utilization and futile management from a hospital-based palliative care program for terminally ill cancer patients. Methods: The data was collected retrospectively, the data collection took palace in the year 2018. The data collection tool consisted of seven parts, 1- Patient’s information, 2- Initial diagnostic procedures, 3- Imaging procedures 4- Pathology and laboratories workup, 5- Treatment modalities (if any), 6-Healthcare facility and resources utilization, 7- Palliative care utilization. Results: A total of 103 patients were included, their median age 66 years (20-94), and (58%) were females, the majority of the cases had stage IV cancer 99 (96.1%), half of them with gastrointestinal cancer 44 (42.7%). During their stay under PCU, 59 (57.3%) had chest X-rays, 21.4% ECG and 14.6% Abdominal ultrasound, various types of Computed Topographies (CT) were done for 18 patients (17.4%). Daily multiple times glucose checking was done for all patients, and complete blood count was done for 81.6%. Only 31 patients (30%) visited the Emergency Department ED after being transferred to PCU, 83 patients (80.6%) had no outpatient clinic visit at all. The median duration for palliative care was 17 days, while the median duration for oncology service is 193 days. The majority of the patients (n = 68) died within 30 days from transfer to palliative care, among them 4 patients (4 %) died on the same day of transfer. No statistically significant differences were found between males and females regarding the days from diagnosis to palliative transfer, days from diagnosis to palliative referral, the number of visits to ED, and the number of non- ICU admissions. Conclusions: Many patients were exposed to unnecessary procedures with no clinical implications, e.g. CT scans, EKGs, daily multiple labs. There is a significant delay in transferring the patients to palliative care service, policies and regulations are needed for timely transfer to palliative care services for cancer patients. Early complex advance care planning is an essential tool to combat futile management. 100% deaths in palliative care unit may reflect limitations for palliative care providers for alternate placements. Predominant use of palliative care unit for the end of life care would drive health care cost to higher level from direct and indirect expenses.
Development of memorial Sloan Kettering (MSK) surgery stress score for older adults with cancer.
Authors: Shahrokni Armin , Tin Amy L. , Downey Robert J. , Bochner Bernard H. , Nash Garrett Michael , Kim Soo Jung , Afonso Anoushka , Korc-Grodzicki Beatriz , Vickers Andrew
Published: June 2022

e24014

Background: The stress from oncologic surgeries for older adults may lead to poor surgical outcomes. In this study, we aim to develop a MSK Surgery Stress Score to measure the complexity of surgery for these patients. The score could then be used for future analyses using datasets where patients undergoing a variety of procedures. Methods: This is a retrospective analysis of adults aged 75 and older who underwent elective cancer surgery in our institution with hospital length of stay of at least one day in 2015 to 2020. Based on surgery stress score developed by Haga et al., we explored various models including at least one or some of these variables as linear or non-linear terms: operation time, weight (kg), blood loss (cc), type of surgery, body mass index, and incision score. The primary outcome of interest evaluated was defined as the composite outcome of death within 90-day of surgery, readmission or emergency room visit or major complications (grade 3-5) within 30 days of surgery. We additionally explored models for a secondary outcome, where minor complications (grade 1-2) were included in the definition, and lastly, we looked at major complications alone as a tertiary outcome. For each of the model and outcomes, we used a logistic regression. We then used the logit transformation of the predicted probability to represent the proposed surgery stress score. Using this score, we evaluated the area under the curve (AUC) for each outcome. Results: In total, 1573 patients were included in the study. The median age was 80 (quartiles 77, 83) and just under half (49%) were male. The median (quartile) operation time was 181 minutes (115, 259), weight was 71 kg (62, 84), blood loss was 100 mL (50, 300), and just over (51%) of patient underwent an abdominopelvic procedure. The rate of 90-day mortality was 3.8%, while the rate of 30-day major complication, readmission and emergency room visit was 7.4%, 10% and 13%, respectively Furthermore, 21%, and 35% experienced primary, and secondary outcomes, respectively. Overall, 18 predictive models for each of the outcomes were developed and assessed. AUC for our different models ranged from 0.59 to 0.73 for the different definitions of our outcomes. Among the various models, the one defined using whether patients underwent an abdominopelvic procedure, incision score, operation time, weight, and blood loss (the latter two both included as non-linear terms) appeared to the front runner. Conclusions: We explored potential models to be used as the MSK Surgery Stress Score. Currently the model is being optimized by additional work. Following optimization of the model, future studies should validate this score in other cohorts of older surgical patients with cancer.
Integration of geriatric assessment in cancer care for senior adults during COVID-19 pandemic.
Authors: Al-Jumayli Mohammed , Vonnes Cassandra , Sehovic Marina , Extermann Martine
Published: June 2022

e24027

Background: Older patients with cancer are particularly vulnerable, and the risk of mortality and morbidity during this pandemic is high. Comprehensive geriatric assessment (CGA) helps in predicating toxicity and improve outcomes. SAOP3 is validated geriatric screening tool that can efficiently identify deficits in different GA domains. It was developed to determine when a multidisciplinary team consultation with GA-intervention is required. Methods: We performed a retrospective review of institutional cancer registry. We compared 2 groups of cancer patients ≥ 70 years old who completed SAOP3 questionnaire in the pre-COVID (9/1/2019- 3/10/2020) and during the pandemic period (3/11/2020-12/31/2020). Fisher’s exact test was used to statistical analysis. Analytical models were adjusted for age, cancer histology, stage, therapy type, and GA variables. Results: 951 patients were included (499 prepandemic,452 during pandemic). Median age was 76.6 yrs. (range = 71-86). A 50.7% male, 48.3% female and 34% (323) have metastatic disease. The capture and completion rate of SAOP3 were 82% (779) and 86% (817) respectively. There was a significant psychosocial impairment during the pandemic. More patients were feeling depressed 26% (118) during Vs. 3% (15) prior pandemic (P < 0.001). The caregiver availability was different with 47% (212) during pandemic compared to 52% (259) in pre-pandemic (P = 0.0013). There was a statistically significant difference in the fall history with 4% (20) in pre-, in contrast to 10% (45) during pandemic (P = 0.003). There was a numerical difference in the cognitive impairment during the pandemic in compared to the pre-COVID [34% (171), 52% (235) respectively], but it was not statistically significant (P = 0.154). There was no difference observed in nutritional domains between the two groups. Conclusions: Data regarding patients’ domains of a CGA are crucial for optimal care. Screening with the SAOP3 questionnaire captured significant changes in CGA domains associated with the pandemic. These findings also suggest that Integration of high-yield brief geriatric screening tools such as SAOP3 is feasible in busy practice during the pandemic. It can help identify specific impairment of older cancer patients and trigger appropriate interventions to improve the quality of life and clinical outcomes.