bluuebunny/crossref_metadata_2025 huggingface dataset:
What information do patients need about their disease or treatments and what they want for end of life?
Authors: Martin Reinas Gaston , Gil Deza Ernesto , Morgenfeld Eduardo L. , Gercovich Daniela , Tognelli Flavio , Gercovich Natasha , Montiel Monica , Garcia Gerardi Carlos Fernando , Rivarola Edgardo G. J. , Gercovich Felipe G.
Published: March 2020

e20656

Background: As it is very important for Doctors, Patients (Pt) and Family to know everything related to end of life we thought it was unavoidable to develop a survey for that purpose. Methods: Between Oct 15th and Nov 15th, 2012, 1003 Pt out of 3795 Pt that were assisted at the IOHM were given the option to participate in an anonymous survey about diagnosis, prognosis, efficacy and toxicity of treatments, as well as interest in palliative care (PC), clinical investigation (CI), psychological support (PS), spiritual care (SC) for an eventual situation of coping with the end of life dilemma. Results: A total of 845 out of 1,003 (84%) Pt elected to participate. Population: Sex: fem: 332, male: 207, left blank (LB): 306. Mean age 58y (range 18 – 94). Married: 355, unmarried: 211, LB: 279. Children Yes 460 No/LB: 385. Highest educational level achieved: primary Studies:186, high School: 348, universitary:216. LB: 98. Employed:382, retired: 240, unemployed: 112, LB 111. Disclosed diagnostic and stage of disease: 470 (56%). The following results are expressed as a percentage of 845 pt: Are aware of the diagnostic (82%); Pt interested in knowing everythingabout their prognosis (85%) or their treatment’s efficacy (67%) or toxicity (52%). Pt interested in: PC (85%), CI (80%), PS (74%), SC (58%). If they were to choose a place for dying: 40% chose to die in the hospital, 30% at home, 29% did not answer and 1% was indifferent. It was possible to detect a marked increase in the amount of answers with regards to last wishes as the stage of the disease worsened (Chi square= 0.011). Pt were asked to rate the survey: 95% considered it good or very Good, 56% found it useful, 36% thought it necessary, while 23% would recommend it. Conclusions: 1) Most of the pt know their diagnosis, would like to know their prognosis and need to know everything about efficacy and toxicity of treatments. 2) 40% of the pt would prefer to die in the hospital, but analyzing this choice at earlier stages of disease may be inappropriate. 3) PC and CI are of interest to both sexes but women are more likely to request PS and SC. 4) Although the survey was considered good by 95% of pt and more than 50% found it useful, only 23% would recommend it, which speaks about the sensitive quality of these topics.
Characteristics of patients with prolonged survival after breast cancer brain metastases (BCBM).
Authors: Tomasevic Zorica , Kovac Zeljko , Tomasevic Zoran
Published: March 2020

e20659

Background: BCBM development predicts short survival for majority of pts. However, 10%, of pts survive up to 2 yrs, and some of those pts has extended survival to more than 2 yrs after BM. Whether there are differences between pts in those arbitrary determined subgroups with prolonged survival is still unknown. The aim of this paper is to analyze and compare characteristics of BCBM pts with survival after BM (BMs) between ≥ 12 - 24 months and ≥ 25 month. Methods: A 193 consecutive BCBM pts have been registered during 5 yrs (January 2008-December 2012). All BM were confirmed by CT/MRI. All pts underwent BM treatment: WBRT 160 (83%); postoperative WBRT in 32 pts (17 %); gamma knife in 7 pts (3,6 %). BMs is known for 169 pts and was median 5,5 months (range 1-72+ months). Only pts with BMs ≥ 12 months were considered for this analysis. Results: 39/169 pts (23%) with median BMs 19 months (range 12-72+) were identified and divided in 2 groups (see Table). MBC in other organ sites, predominantly non visceral, was present in 45% pts (A) and in 40% (B), at the time of BM diagnose. There was no statistically significant difference between group A and B. Conclusions: Despite BM, a subgroup of pts still has indolent MBC course with median BMs of 19 months, and 6% has BMs of median 35 months. There were no statistically significant difference between standard clinical/pathological parameters Therefore, other characteristics, both patients and BC/BM must be considered. Better understanding of crucial characteristics of this subgroup of BCBM pts, is needed because these pts might potentially represents the best candidates for future BM preventive strategies. [Table: see text]
Development of a tailored, computerized, breast cancer risk assessment and decision support tool: What do clinicians want?
Authors: Collins Ian M. , Keogh Louise A. , Steel Emma , Mann Bruce , Emery Jon , Pirotta Marie , Moreton Jane , Butow Phyllis , Trainer Alison , Antoniou Antonis C. , Cuzick Jack M. , Hopper John L. , Phillips Kelly-Anne
Published: March 2020

e20660

Background: End user input into the design of decision support tools is critical to enhance integration and future routine use in clinical practice. As part of the development of an evidence-based, tailored, computerized breast cancer (BC) risk assessment and management tool, we examined clinicians’ requirements. Methods: Australian breast surgeons (BSs) and primary care clinicians (PCCs) were recruited through local professional networks. Facilitated focus group discussions about current practice of assessing and managing BC risk and perceptions of the proposed tool were audiotaped transcribed and managed using QSR NVivo. A coding framework was developed based on the transcripts, data were coded and each code further analyzed to identify key themes. Results: Four focus groups, involving 12 BSs, 17 PCCs (12 doctors, 5 practice nurses) were conducted. 55 % were male, mean age 45yrs (range 25-67), mean of 14yrs in practice (range1-25+). Clinicians identified difficulties assessing and managing BC risk and lack of available tools to standardise their current inconsistent approach to risk assessment and management. Most felt confident identifying high risk women, but found differentiating women at population risk from those at moderately increased risk more difficult. They felt a tool would help them reassure anxious low to moderate risk women and avoid unnecessary onward referral or investigations and better identify and refer or manage high risk women. Desirable features in a tool included: evidence-based, accessible (web-based), visual, simple data entry process, displays absolute risk (rather than relative) and mutable risk and risk reduction estimates in multiple formats (words, pictographs, graphs) to improve comprehension, printable summary sheets. Clinicians felt that women could input risk factors before the clinic visit but that joint consumer and clinician data entry was preferable and women should only receive a risk estimate with a clinician present. Conclusions: Development of tools for BC risk assessment and management should address these clearly identified needs of end users in order to optimise translation of current and future knowledge into clinical practice.
Palliative chemotherapy during the last month of life.
Authors: Andelkovic Vladimir
Published: March 2020

e20662

Background: There is no uniform definition of medical futility, but most accept treatments offering no reasonable chance of benefiting patients will fall into this category. According to literature, chemotherapy given in the last month of life has little or no benefit to patients. Various studies suggest 9-43% of patients receive palliative chemotherapy during the last month of life. Methods: Retrospective analysis was done on electronic medical records of patients who received systemic anti cancer therapy (SACT) - cytotoxic and/or targeted therapy for solid or haematological malignancies at The Gold Coast hospital within one year period. Patients that died within 30 days of SACT administration were further classified based on their diagnosis, treatment intent, type of treatment and cause of death. Results: 770 patients received SACT between 1 November 2011 and 31 October 2012. 53 deaths (6.9%) occurred within 30 days of receiving SACT. 35 (66%) of those were due to progression of disease and 6 (11.3%) were treatment related. All treatment related deaths were due to neutropenic sepsis. For 12 deaths (22.7%), there was insufficient documentation to establish the cause of death. Only one patient with acute myeloid leukaemia (1.9%) died as a result of treatment given with curative intent. 20 patients (37.7%) were on combination treatment while 33 (62.3%) were treated with single agents. 42 patients (79.2%) received treatment that included intravenous agents, while remaining 11 patients (20.8%) were on oral treatment only. 37 patients (69.8%) were on cytotoxic treatment, 12 (22.6%) patients were on targeted therapy, and remaining 4 (7.6%) were on a combination protocol. Conclusions: Results of this audit show a lower number of patients who received palliative chemotherapy in a metropolitan public hospital in Australia during the last month of life. Defining the goal of treatment and assessing functional status of patients regularly while on treatment may help identify deteriorating patients and could avoid medically futile treatment. [Table: see text]
The differences in sexual satisfaction, quality of life, and social support between patients with prostate cancer and cervical cancer after radiotherapy.
Authors: Kieszkowska-Grudny Anna , Rucinska Monika , Nawrocki Sergiusz
Published: March 2020

e20666

Background: Cervical cancer (CxCa) and prostate cancer (PRCa) have a major impact on sexuality, quality of life (QoL) and patients (pts) require social support(SS). Study aim was to compare sexual satisfaction and activity,QoL and level of required and received SS in group of CxCa and PRCa pts min.3 months after radical radiotherapy (RTH). Methods: 97pts were included to the study:50 non-metastatic PRCa pts (54-83y, M=68,8) and47 CxCa pts (27-69y,M=54,4) after RTH. Subjects filled out:QLQ-C30,PR25,CX24, Berlin Social Support Scales (BSSS) and demographic data.The Chi2,t-Student test,and linear regression analyses were used (p<0,5). Results: However sexual activity and satisfaction in both cancer groups is significantly lower (p<0,05) than in healthy population, no differences were observed between CxCa and PRCa pts. No difference were found between general and any subscale of QoL in both groups, although men needed significantly more help with eating, dressing, washing or using the toilet. However,men felt less male than women less feminine because of cancer (p<0,001). Predictors to better femininity evaluation (R2=0,650;p<0,05)were: higher appetite, emotional functioning, perceived available instrumental support and marital status. Predictors of poor masculinity evaluation (R2=0,346;p<0,05)were: shortness of breath, age, lower perceived available emotional support. The most significant differences (p<0,05) were observed between groups in the evaluation of SS: perceived available emotional SS was higher in pts with CxCa than with PRCa, while protective-buffering SS, currently received emotional SS and general SS were higher in the group of PRCa than CxCa pts. Conclusions: QoL was similar in both groups, in some areas men needed more help that women. Sexual activity and satisfaction is lower in cancer pts in comparison with general population, but no differences were observed between CxCa and PRCa pts, however emotional SS was crucial for better sexual satisfaction. The more visible difference were found in SS, and even men with PRCa have been receiving more SS,women with CxCa perceived particular SS higher than in fact such support had experienced.
Providing cancer survivorship care plans for Spanish language speakers: Overall use and satisfaction patterns.
Authors: Hill-Kayser Christine , Vachani Carolyn , Hampshire Margaret K. , Di Lullo Gloria A. , Metz James M.
Published: March 2020

e20671

Background: Cancer survivorship care plans may be communication aides to assist healthcare providers and empower survivors. A paucity of information exists regarding the provision of survivorship care plans to the Spanish speaking population. Methods: The LIVESTRONG Care Plan is an Internet-based tool for creation of survivorship care plans, originally launched in 5/07. It is available at www.livestrongcareplan.org, and via OncoLink, a cancer information website based at the University of Pennsylvania, serving over 3.9 million pages/ month to 185,000 unique IP addresses. A direct link on the homepage directs users to the Spanish version. All information is provided and translated by oncology nurses and physicians. Results: Since launch of the tool, 293 Spanish care plans have been created (1% of total care plans). Care plans in Spanish have been created by survivors in 78% of cases, and healthcare providers in 22%. This differs from the entire user population, in which use by HCP approaches 50% (p=< 0.001). Spanish-speaking users are 52% female, and 82% Latino/a, and less likely from the US (60% vs 87% , p=0.02), also being from Mexico (15%), Spain (10%), Chile (9%), Puerto Rico (5%) and Venezuela (3%). Spanish users were most often survivors of breast (20%) GU (33%) and GI (20%) cancers (vs general population 50%, p = 0.03; 10%, p = 0.04; 11%, p = 0.03, respectively). Only 8% of Spanish-speaking users report having received previous survivorship information vs 13% in the overall group (p=0.07). All users (100%) of the Spanish version rate experience and satisfaction with the care plan as “very good” or “excellent.” Average time for completion of Spanish plans was 9:28 min. Conclusions: Most users of the Spanish plan are survivors who have not received this information before, from the US and several Central/South American countries. They are highly satisfied with the information provided. Healthcare providers are proportionally less likely to use the Spanish version of the plan than survivors are.
Oncologists’ perceptions of rounding alongside palliative care physicians: Results of a post-intervention survey study.
Authors: LeBlanc Thomas William , Tulsky James A , Abernethy Amy Pickar , Jones Christopher A , Galanos Anthony N , Riedel Richard F.
Published: March 2020

e20674

Background: In August 2011, a new rounding model was instituted on the inpatient solid tumor oncology service at Duke. This model incorporated a palliative care physician as a second attending on service, alongside the rounding solid tumor oncologist. We sought to assess the oncologists’ perceptions of this model, and of palliative care, 1 year later. Methods: We developed a 15-item survey assessing 3 domains: (1) perceptions about palliative care in general, (2) lessons learned from palliative care colleagues, if any, and (3) changes in the experience of rounding on the solid tumor oncology service. Faculty were invited to participate by e-mail, via an anonymous web link. All oncology faculty who rounded at least 2 weeks since August 2011 were included. Results: Response rate was 73% (8 of 11). 75% (N=6) of respondents had rounded both before and after the new model was instituted. 75% reported a more positive perception of palliative care (N=6), 88% (N=7) reported learning new ways to manage cancer patients’ symptoms, and 100% agreed that the palliative care physician brings a valuable skill set to the team. Only 1 respondent felt that palliative care physicians detract from oncologic issues, and none thought the palliative care physicians discuss hospice too early. 88% (N=7) reported greater willingness to round on the service under the new model, and 100% agreed that rounding was more enjoyable since the addition of the palliative care attending to the team. 100% agreed that palliative care is a necessary component of comprehensive cancer care, and that palliative care should have a presence in the outpatient cancer clinics; 88% (N=7) reported feeling comfortable doing palliative care in their own clinical practice. All agreed that “palliative care” is different from “hospice care.” Conclusions: Rounding alongside palliative care physicians on an inpatient oncology service may improve oncologists’ perceptions of palliative care, teach them new symptom management skills, and improve their willingness to do inpatient rounding. Fears about palliative care physicians inappropriately introducing hospice too early for patients with solid tumors may be unfounded.
A comparative analysis of 3DCRT, IMRT, and VMAT in the palliative treatment of spinal metastases.
Authors: Kunhiparambath Haresh , Laviraj M. A , Gupta Subhash , Sharma Dayanand , M Rajendran , Julka Pramod Kumar , Rath Goura Kishor
Published: March 2020

e20679

Background: Radiotherapy is very important in the palliation of spinal metastases. Traditionally, a simple two-dimensional single direct posterior spinal field giving unnecessary exit dose to the normal structures is used. The studies evaluating the recent advances like 3DCRT, IMRT, VMAT for spinal metastases are rare. Present study evaluates these three modalities for the treatment of spinal mets. Methods: Ten patients with metastases to the body of lumbar spine were included. Planning CT was done with the patient supine on Philips wide bore CT (for 3 mm). The CT images were transferred online to the Pinnacle TPS V.8.0M. Tumor and the critical structures like spinal cord, kidneys, liver and bowels were contoured on pinnacle. 3DCRT was planned on pinnacle with seven equidistant beams. The CT images with the contoured structures were sent to Monaco TPS V.3.10.02. IMRT (seven equidistant fields) and VMAT (a single 360 degree arc in 25 degree increments) were planned on Monaco. Dose: 30 Gy in 10 fractions. PTV indices analyzed: D mean, D2 (dose received by the hottest 2 percent volume), D98 (dose received by 98 percent), homogeneity index HI [(D2-D98)/D50)], and conformity index CI (PTV volume/volume of PTV covered by 95 percent isodose). Dmax and D2 (dose received by hottest 2cc) for the spine, V12, V18 and V28 (percent volume receiving the respective dose) for the kidneys, D50 (dose received by the 50 percent volume) of liver, V15 (percentage volume of bowel receiving 15 Gy) were evaluated. The average were calculated and compared. Statistical analysis was done by SPSS Version 14. Results: The Table shows that there is no much significant difference between the three plans for the PTV indices. But for the normal structures, VMAT provides the least dose followed by IMRT. Conclusions: VMAT is superior to IMRT and both are better than 3DCRT for normal tissue sparing in the palliative RT for spinal metastases. [Table: see text]
Retrospective analysis of erlotinib in the treatment of patients over 70 years with NSCLC: Our experience in the geriatric oncologic unit.
Authors: Leo Silvana Assunta , Accettura Caterina , Romano Giampiero , Cocciolo Alessandro , Giampaglia Marianna , Gnoni Antonio , Licchetta Antonella , Saracino Valeria , Lorusso Vito
Published: March 2020

e20681

Background: Erlotinib is a potential treatment option for elderly patients with advanced NSCLC; it has demonstrated a survival advantage vs BSC in the BR.21 study after 1st/2nd line failure and a good safety profile in elderly pts. Methods: Wereviewed the medical records of pts over 70 yearstreated with Erlotinib in the last 5 years in our Unit in order to correlate response to pts characteristics. EGFR mutation status (Ems) was not determined in any pts. Response was evaluated by CT scan every 2 months. Results: Since October 2006 we have treated 84 elderly pts with stage IIIb/IV NSCLC as 2nd/3rd/4th line of therapy. Median age was 75 (range 70-90), 62 (73.8%) were males and 22 (26.2%) women, respectively. Histology was ADK in 46 (54.8%), SQM in 31 (36.9%), other in 7 (8.3%). Stage IIIb/IV was 19/65 (22.6%/77.4%). PS was 0 in 7 (8.3%), 1 in 67 (79.8%), 2 in 9 (10.7%), 3 in 1 (1.2%) pts. With regard to smoking status,15 (17.8%) pts were never smoker, 59 (70.2%) ex smoker and 10 (12%) currently smoker. Patients treated as 2nd/3rd/4th line were 59/23/2 (70.2%/27.3%/2.4%). Overall, 3 pts achieved PR (3.6%), 33 SD (39.3%), 48 PD (57.1%). The characteristics of responding pts were: female, ADK, never/ex smokers, PS 0/1, 2nd line. Clinical benefit rate was 42.8%, 60.8% in ADK (28/46), 16.1% in SQM pts (5/31), 42.9% in other pts (3/7). The median duration of response (Mdr) was 20.3 months (range 11-36), Mdr of SD was 34 (range 7-55). Responding pts had a median survival of 43 months (range 34-59). Conclusions: In our series of elderly pts, Erlotinib was more effective in female, PS ≤ 2, ADK, and 2nd line. This drug can be considered a good alternative to chemotherapy in elderly pts with ADK and good PS, irrespective of mutational status of EGFR.
Factors predicting the outcome in febrile neutropenia: A study from a tertiary cancer center in India.
Authors: Kalpathi Krishnamani , Gundeti Sadashivudu , Kota Rajesh , Gullipalli Muralidhar , Linga Vijay Gandhi , Digumarti Raghunadharao
Published: March 2020

e20684

Background: Febrile neutropenia (FN) is common in patients undergoing chemotherapy. The risk dramatically increases in those with absolute neutrophil count (ANC) less than 100/ mm3. Methods: In this 2 year studyall FN patients admitted at our center between January 2011 and November 2012 were analyzed for clinical profile, microbiologic isolates, mortality and factors affecting outcome. IBM statistic SPSS version 19 was used to analyze the data. Results: There were 333 episodes of FN during the study period. Majority (89.7%) of FN episodes occurred in patients with hematologic malignancies and 87% of episodes had ANC< 500. Induction, consolidation and maintenance related episodes were 125 (37.5%), 125 (37.5%) and 17 (5.1%) respectively. First line antibiotics (cefipime, Cefaperazone- Sulbactum + aminoglycoside), second line antibiotics (carbapenam) and antifungals were used in 44.4%, 15.6 % and 34% episodes respectively. Gram negative organisms accounted for 51.6% of the isolates. Prognostic significance between mean serum bilirubin, serum creatinine and outcome was noted, with higher deaths in patients with bilirubin > 1.5 mg% (12.2% vs 0.7%) (p= 0.000) and creatinine > 1.2 mg% (16% vs 1%) (p=0.000). Isolation of an organism and infiltrates on chest X-ray had a significant association with outcome(p= 0.017 and 0.002) respectively. Patients who had multiple component transfusions vs single component ones were at a significantly higher risk of death ( 6 deaths vs 1)(p= 0.002). There were 20 (6%) possible,33 (10%) probable and 9 (2.7 %) proven fungal infections, with significant association with outcome (p=0.000). The risk of death in those with fungal infection was 14.323 (95%CI - 2.70-75.952). Preemptiveantifungal use had a higher percentage of prolonged (> 8 days) and profound neutropenia in contrast to the empirical group (77.2% vs 65.2%) and (91% vs 83.8%), resulting in 3 deaths in the preemptive group (6.8% vs 0%) (p=0.02). The overall mortality was 2.1%. Conclusions: Leukemias are the leading cause of FN at our Institute with 2.1% mortality. Higher bilirubin, creatinine, chest imaging favoring pneumonia, positive isolates and multiple transfusions had significant association with mortality.
A cross-section questionnaire to evaluate patients’ satisfaction with totally implanted access ports (Port-a-Cath; PAC) and analysis of PAC-related complications at a tertiary care center.
Authors: Minichsdorfer Christoph , Fuereder Thorsten , Berghoff Anna Sophie , Marta Gabriel , Maehr Bruno , Gnant Michael , Zielinski Christoph , Bartsch Rupert
Published: March 2020

e20693

Background: PACs are used for the administration of intravenous drugs. These devices have therefore become valuable tools for the application of chemotherapy in cancer patients (pts). Methods: During the period from 11.2012 to 01.2013, pts were invited to answer a simple questionnaire concerning quality-of-life and satisfaction with their respective PAC. Retrospective data regarding to PAC-related complications were collected by searching patient’s medical history. PAC-related thrombosis were defined as non-compressibility of the axillary or subclavian vein on ultrasound; PAC-related infections were defined as documented bacteraemia with a positive blood culture taken from the device in the absence of positive peripheral blood cultures. Results: A total number of 116 pts were included. Mean time since PAC implantation was 16.9 months. Complications during implantations occurred in 8 pts (6.9%), with bleeding and haematoma being the most frequently observed events; three patients experienced postsurgical pneumothorax (2.6%). Complications arising after PAC implantation consisted of infections (9 pts; 7.7%), drug extravasation (8 pts; 6.9%), PAC malposition (3 pts; 2.6%), and thrombosis (1 pt; 0.8%). PAC infections were caused most commonly by Pseudomonas aeroginosa (3 cases). One quarter of all pts reported that their PAC interfered activities of daily life. In 15 cases (13%) the PAC caused pain, especially when moving the arm (11 pts; 9.5%); only 6% reported that PAC punctuations were more painful than accessing a peripheral vein. 98 pts (84%) agreed that the PAC alleviates the administration of therapy. Indeed, the vast majority (84%) would once again choose a PAC for chemotherapy administration. Conclusions: PACs are valuable tools to ease the burden of chemotherapy administration. Most patients were satisfied, as PACs provide a relatively easy and safe way of venous access. Nevertheless, implantation and maintenance of these systems carry potential risks.
Quality of life and symptom burden in Chinese cancer patients: Results of a multicenter research project.
Authors: Mei Qi , Hu Li-ya , Chen Yuan , Yu Shi Ying , Payne Sheila
Published: March 2020

e20695

Background: McGill QOL Questionnaire is a well known tool in the evaluation of both psychological and physical states in cancer patients. A number of translations have been made. It is widely used in western developed countries, yet little research has been performed in caner patients in Mainland China who speak Mandarin. Methods: In the first application of the MQOL-Chinese version, which was translated from the MQOL-English version, reliability, content and construct validity testing has been performed among the 126 cancer patients, screened from Tongji Hospital, a medical unit which can deliver comprehensive cancer palliative care. And then 170 patients from 4 different hospitals in China were randomly selected to fill in this scale. Results: First Test-retest reliability of the questionnaire is highly favorable, and all MQOL scores are internally consistent. Using a scientific Stratified Analysis, in the psychological domain, men report less negative emotions than females (question 5\6\8 P=0,002 \0,047\0,016), and patients with head and neck cancer have less negative emotions than those with thoracic cancer (question14 P=0.035).Furthermore, cancer patients less than 20 years old tend to be mentally stronger while people at 40-60 years old seem to have the greatest psychological burden (question6/7 P=0.034/0.017). In the semi-open questions in the second part about the physical domain, poor appetite is reported as the most troublesome problem (M=6.6/10, SD=2.77), while sleep problems rank the least distessing (M=4.2/10,SD=2.15).In the fourth part of the open questions, feeling encouraged is the most frequently mentioned, and physical and economic burden rank the 2nd and 3rd respectively. Conclusions: First of all, the MQOL-Chinese version is a valid instrument for measuring quality of life for cancer patients in Mainland China who speak Mandarin. Moreover, the outcomes above indicated that the psychological and physical domain need to receive more attention, and economic burden is also an urgent problem which needs to be improved among cancer patients especially in China, which is still a developing country with a huge population.
Annual rhythm in filgrastim use in southeast Florida.
Authors: Huff Dinah , Hrushesky William J. , Davis Sharon , Bobolts Laura Rose , Kumar Akhil , Shimp William S. , Krook James Edward , Kogler Jurgen Wilhelm , Fishman Val , Anthony Carol , Walton Robert , Fishman Marc L. ,   Oncology Analytics, Inc.
Published: March 2020

e20697

Background: Circadian, seasonal and annual temporal organization characterizes earth-evolved life forms. Cellular proliferation in human bone marrow shares this temporal organization. Careful clinical trials have documented that bone marrow damage from a range of cytotoxic anti-cancer drugs is predictably greater and lesser when these drugs are given at specific times of day and seasons of the year to human beings with cancer. Filgrastim is a human growth factor, which is given to stimulate the production of neutrophils that have been depressed to low levels by cancer chemotherapy, in order to prevent infectious complications. We hypothesized that administration of filgrastim, stimulated by dangerously low neutrophil counts, would be initiated non-randomly with reproducible seasonality and annual rhythmicity. Methods: All claims from contracted healthplans submitted by oncologists in southeast Florida were tabulated by month of service date, during the calendar years of 2010, 2011, and 2012 (n=2,506). These numbers were de-trended, tested by linear regression, ANOVA and multi-component least squares cosine curve fitting for annual rhythmicity. Results: Similar stable annual time structures characterize filgrastim use in this population for each of these three years. An overall increasing trend (p 0.004) was present in its use during this three year span. Time of year effects were present (ANOVA p<0.058), demonstrating a prominent annual rhythm (p 0.006). The annual use pattern peaks during late winter and early spring and is lower in summer and fall. Conclusions: A large literature documents expected annual rhythmicity of cytotoxic drug bone marrow damage as reflected in circulating neutrophil count. Substantial annual rhythms characterize the clinical use of filgrastim in southeast Florida for this indication. The relative contributions of “snowbird” migration and the temporal organization of hematopoiesis remain to be fully elucidated. [Table: see text]
Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute (MWCI).
Authors: Jang Sekwon , Ranpura Vishal Navnitray , Wood Lynne , Stephanie Heller , Self Linda
Published: March 2020

e20700

Background: MWCI has participated in Quality Oncology Practice Initiative (QOPI) since 2008. Adherence to pain assessment and intensity documentation was high, but lower in plan of care for moderate/severe pain documentation (69%, compared to QOPI aggregate of 79%) during the Fall 2011 round. One potential explanation for the discrepancy was lack of communication between the nursing staff assessing the pain and the physician treating pain. We hypothesized that the use of pain card can improve the communication between nurses and doctors, as well as prompt physicians to document the plan of care for moderate/severe pain. Methods: MWCI created a team of physicians, nurses, quality resources and administrative staff in December 2011. We abstracted up to 10 patients charts per oncologist for those patientswho reported moderate to severe pain (pain score of more than 3 of 10 on numeric rating scale) each quarter during 2012.We used data for quarter 1 and 2 as a baseline. We implemented the use of pain card by nurses to report pain for these patients to the physician in quarter 3 and 4. Chi square test was used to compare documentation rate in the first two quarters and last two quarters. Results: The total number of charts evaluated, pain documentation as well as confidence intervals for each quarter are shown in the Table. Our results show significant improvement in pain documentation by physician in last two quarters compared to first two quarters (p =0.0007). Conclusions: Our study demonstrates pain card improved communication between nurse and physician resulting improved documentation of pain by physician. [Table: see text]
End-of-life care in patients with primary malignant brain tumors: A systematic literature review and analysis.
Authors: Walbert Tobias , Khan Muhib Alam
Published: March 2020

e20703

Background: 80–85% of all adult brain tumors are high-grade glioma (HGG). HGG are typically treated with maximal surgical resection, followed by radiotherapy with concurrent and adjuvant chemotherapy. The median survival for anaplastic glioma is estimated to be 2-5 years and 15 months for patients with glioblastoma. Quality of life (QoL) has become an increasing important outcome assessed in clinical trials as well as in the standard care of brain tumor patients. Despite the inevitable disease trajectory, not much is known about symptoms and needs of brain tumor patients and their caretakers at the end of life. There appears to be a lack of published literature on this important aspect of neuro-oncology. Methods: A systematic literature search was conducted in PubMed and Cochrane covering the years between 1946 through 2012. In total, 7146 article citations were found. After first review 942 abstracts were obtained. Based on content 82 articles were examined separately by both authors and it was agreed to eliminate 67 of them because they did not include a significant number of primary brain tumor patients or the focus was not on end of life care and symptoms. Results: Only 7 of the retained articles contained specific patient data and did not just reflect opinions of authors or reviews of the topic. Only one study was performed prospectively. Three studies assessed symptom management in inpatients, 2 in outpatients and 2 in a combined setting. Studies included between 29 and 169 patients. Drowsiness and loss of consciousness was the most common symptom (85%–90%). Poor communication (64% and 90%), focal deficits (29%– 62%), seizures (3%–67%), dysphagia (10%–85%), headache (4%–62%), and fatigue (25%–67%) were also frequent. Interventions included hydration (87%-93%), urinary catheter (89%), steroids (62%-80%), anti-epileptic drugs (45%-76%), oxygen (48%), tube feeding (13%) and palliative sedation (13%). Conclusions: There is 1 prospective study and only a total of 7 studies describing detailed end of life symptoms. None of the studies addressed caregiver quality of life. More research is needed to develop purposeful interventions to address end of life symptoms and QoL in patients with HGG.
Chemotherapy in the elderly (≥65) cancer patient: The relationship between premorbid level of function and treatment tolerance in a metropolitan Australian hospital.
Authors: Christie Hayden , Lovat Katherine Mary , Sanmugarajah Jasotha
Published: March 2020

e20706

Background: The proportion of elderly patients treated by oncologists is gradually increasing due to demographic changes. This section of the population is generally underrepresented in clinical trials. This results in minimal guidance to dosage and tolerance. Improving assessment strategies in this group can help reduce the negative impact on quality of life from toxicity and hospital admission, which is also of benefit to the health system. Assessment of independence in the community and co-morbidities could provide a simple strategy to aid this process. Methods: Patients ≥65 years referred to the Medical Oncology clinic at the Gold Coast Hospital, Qld, Australia, undertook a questionnaire before their first out-patient appointment. This was used in conjunction with patient charts to determine patient assessment of level of function, knowledge of diagnosis and treatment aims, and also treating Oncologist assessment of function and predicted tolerance. Results: 75 patients were recruited. Patient characteristics are summarised below. 71% of patients were offered chemotherapy, 79% accepted, with 59% being for palliative treatment. 43% required dose reduction at some stage. Of those, 56% had 2 or more co-morbidities, 50% required assistance with IADLs and 22% with PADLs. 17% had an ECOG of ≥2 and 33% were aged ≥76. We are unable to comment on completion of treatment as many are still ongoing. Conclusions: Dose reduction is common in this population, with a correlation between this and self-reported performance status. It is proposed that the use of patient reported screening tools like this are a useful guide to determine need for dose reduction. Larger studies are needed to investigate this relationship further. [Table: see text]
Hyperglycemia as a prognostic factor in cancer.
Authors: Levy Daniel Eduardo , Marantz Adolfo B. , Niepomniszcze Jose Leonardo , Vicente Hector A , Martin Reinas Gaston Flavio
Published: March 2020

e20715

Background: Cancer and diabetes are two diseases with great impact on global health. Evidence suggests that sustained hyperglycemia is associated with cancer prognosis and a greater risk of getting this disease. Numerous studies, including meta- analysis, sustain this correlation based on the theory that sustained hyperglycemia influences in abnormal cell growth as a cell stimulating factor and both pathologies share comorbid factors. Methods: we analyze in a descriptively and retrospective way our patients record in a clinical oncology service at the Bernardino Rivadavia Hospital, in a period from June 2008 to August 2011. In all 325 patients we identify : age, sex, neoplasic disease, stage of disease and quantitative glycemic status pre-treatment (to rule out the possible effects of chemotherapy on glycemia values). In the statistical analysis, patients were grouped according to their stage of cancer disease by AJCC TNM seventh edition and their serum glycemia values. Results: Out of 325 patients (N), 252 (77.5%) were female and 73 (22.5%) were male, the age range was 18 to 94 years with an average 61.82 years. .The discrimination of the sample by stage was: stage 1 (54 patients), stage 2 (88 patients), stage 3 (93 patients), stage 4 (90 patients). The media blood glucose by stage were for stage 1: 98 mg / dl, for stage 2: 98.7 m / dl, for stage 3: 102 mg / dl and for stage 4: 107 mg / dl, being under 110 mg / dl 12.5% of the patients in the stage 1, 14.3% of patients in stage 2, 14% of patients in stage 3 and 23.3% of patients in stage 4. Conclusions: Our observation allows us to orient ourselves to the correlation between hyperglycemic condition and prognosis of cancer.This correlation, while existing for all stages of cancer disease is most notorious for advanced metastatic stages (stage 4), and can be converted into a useful tool for the comprehensive assessment of patients.
Emotional burden and distress among caregivers of cancer patients.
Authors: Sidhu Harpreet , Alikhan Mir Asif , Glasser Michael
Published: March 2020

e20722

Background: Due to the nature of the disease, caregivers of patients with cancer encounter high levels of burden and distress. Very little research has examined the needs of cancer caregivers and ways to address these needs. Health providers might overlook the emotional aspects of a disease and diagnosis, being occupied and busy with other aspects of patient care. Methods: Questionnaires with a focus on personal physical health, emotional health, care received, and medical care in general were handed out to patients and family members. Health providers were given similar questionnaires. Results: There were 45 participants in total: 18 health providers, 10 patients, and 17 family members. Similarities or differences between the attitudes of family members, health providers, and patients were found. Providers more negatively assessed the effect of a patient’s cancer on the well-being of family members than did patients/family members. Family member physical health was more negatively rated [P < 0.001] by providers, as was family member emotional health [P< 0.001]. Providers were also more likely to check distresses on the NCCN distress thermometer than were patients/family members. Responses were similar between urban and rural participants. Conclusions: Family members did not feel that the cancer diagnosis had affected their overall well-being in an overtly negative way. Health care providers believed that the cancer diagnosis had more of a negative effect on family member well-being. Future studies should look at attitudes of doctors/physicians versus other health providers to family member well-being after a patient’s cancer diagnosis.
Gallbladder perforation related to bevacizumab in a patient with lung adenocarcinoma.
Authors: Oyan Basak , Ozturk Mehmet Akif , Kalayci Murat
Published: March 2020

e20723

Background: Gastrointestinal perforation is one of the most important complications of bevacizumab. In patients with metastatic non-small cell lung cancer, gastrointestinal perforation has been reported with an incidence of less than 1%. Gallbladder perforation in patients receiving bevacizumab is a very rare complication. Methods: A 66-year-old male patient with stage IV lung cancer (adenocarcinoma) admitted to emergency room with the complaints of right upper quadrant abdominal pain, fever, emesis and no bowel movements, seven days after the 3rdcycle of pemetrexed-cisplatin and bevacizumab chemotherapy. CT scan of abdomen showed air images adjacent to the gallbladder suggesting a perforation and an abscess formation of 3.5x3 cm in diameter. The patient underwent surgery. There was a defect of 2 cm in gallbladder wall and there were 4 gallstones inside the gallbladder. Cholecystectomy was performed and the abscess localized between the gallbladder and liver was drained. The pathological examination showed bleeding areas and atrophy in mucosa. No tumor involvement and no microthrombi in microvessels were seen. After recovery, bevacizumab was permanently discontinued. Results: Based on reports from FDA, there are 15 cases of bevacizumab-induced gallbladder perforation, excluding the described case. When the characteristics of the patients are analyzed, it was seen that 75% of gallbladder perforations occurred within the first 6 months of therapy. Most cases were under treatment for gastrointestinal malignancies. Our case is the fifth case with the diagnosis of lung cancer. Although the coexistence of cholelithiasis in other cases is unknown, chronic inflammation in addition to the disruption of vascular regeneration by bevacizumab may increase the risk of gallbladder perforation. Conclusions: Chronic inflammation related to cholelithiasis can be a predisposing factor of bevacizumab-induced gallbladder perforation. Therefore, caution should be exercised when treating these patients with bevacizumab.
OPTiM: A randomized phase III trial of talimogene laherparepvec (T-VEC) versus subcutaneous (SC) granulocyte-macrophage colony-stimulating factor (GM-CSF) for the treatment (tx) of unresected stage IIIB/C and IV melanoma.
Authors: Andtbacka Robert Hans Ingemar , Collichio Frances A. , Amatruda Thomas , Senzer Neil N. , Chesney Jason , Delman Keith A. , Spitler Lynn E. , Puzanov Igor , Doleman Susan , Ye Yining , Vanderwalde Ari M. , Coffin Robert , Kaufman Howard
Published: March 2020

LBA9008

The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Saturday, June, 1, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
A phase III open-label study of nivolumab (anti-PD-1; BMS-936558; ONO-4538) versus investigator’s choice in advanced melanoma patients progressing post anti-CTLA-4 therapy.
Authors: Chmielowski Bartosz , Hamid Omid , Minor David R. , D'Angelo Sandra P. , Pennock Gregory K. , Grossmann Kenneth , Ascierto Paolo Antonio , Daud Adil , Dummer Reinhard , Hodi F. Stephen , Lebbé Céleste , Robert Caroline , Sosman Jeffrey Alan , Yang Arvin , Lambert Alexandre , Weber Jeffrey S.
Published: March 2020

TPS9105^

Background: Despite the recent approval of ipilimumab and vemurafenib for advanced melanoma, there is still a large unmet need for patients (pts) who have progressed on anti-CTLA-4 therapy and a BRAF inhibitor (depending on BRAF status). Programmed death-1 (PD-1) is a co-stimulation inhibitory receptor that negatively regulates T-cell activation and is upregulated in tumor-infiltrating lymphocytes. Upregulation of PD-1 is also associated with advanced disease in melanoma. Nivolumab, an anti-PD-1 receptor blocking monoclonal antibody, demonstrated durable antitumor activity in a phase 1 study in 106 pts with advanced melanoma with objective responses (OR) observed in 31% and stable disease ≥24 weeks in 6% with a manageable safety profile (Topalian SL et al; ESMO 2012 [Abstr 453P]). Here we describe a phase III study designed to compare the clinical benefit of nivolumab to chemotherapy of investigator’s choice in previously treated pts with unresectable or metastatic melanoma. Methods: In this two arm open-label study, approximately 390 pts will be randomized 2:1 to receive either nivolumab 3 mg/kg IV every two weeks (Arm A) or either dacarbazine 1000 mg/m2 IV or carboplatin AUC6/paclitaxel 175 mg/m2 IV every 3 weeks (Arm B) until disease progression or treatment discontinuation. Pts included are those with ≤2 regimens for advanced melanoma who have progressed on anti-CTLA-4 therapy as well as a BRAF inhibitor if BRAF V600-mutation positive. Pts without active brain metastases are eligible. All pts require baseline fresh biopsy to determine PD-L1 expression. Pts will be stratified by tumor PD-L1 expression, BRAF status, and prior anti-CTLA-4 best response. Tumor response per RECIST 1.1 will be assessed 9 weeks following randomization and every 6 weeks thereafter for the first year. After the first year, response will be assessed every 12 weeks until disease progression or treatment discontinuation. The co-primary endpoints are overall survival (OS) and OR rate. Secondary endpoints include progression-free survival, correlation of PD-L1 expression with clinical outcome, and health-related quality of life. Clinical trial information: NCT01721746.
A phase III, randomized, double-blind study of nivolumab (anti-PD-1; BMS-936558; ONO-4538) versus dacarbazine in patients (pts) with previously untreated, unresectable, or metastatic melanoma (MEL).
Authors: Robert Caroline , Ascierto Paolo Antonio , Maio Michele , Hernberg Micaela , Schmidt Henrik , Waxman Ian , Garbe Claus , Lebbé Céleste , Hauschild Axel
Published: March 2020

TPS9106

Background: The 5-year survival rate for late-stage MEL is currently only 15%. Despite recent advances with ipilimumab and vemurafenib, a considerable unmet need remains for pts with previously untreated, unresectable or metastatic BRAF wild-type MEL. Objective response rate (ORR) with first-line dacarbazine, a widely used chemotherapy in MEL, is 13%, with median overall survival (OS) ranging from 5.6 to 11 months. Programmed death-1 (PD-1) is an immune checkpoint receptor that negatively regulates T-cell activation through interaction with its ligand, PD-L1. This ligand is overexpressed by multiple tumor types, including advanced MEL. The PD-1 receptor blocking antibody nivolumab demonstrated clinical activity at 0.1-10 mg/kg in a phase I study in pts with advanced MEL (n = 106), with OR in 33 pts and stable disease ≥24 weeks in 6 pts. We describe a double-blind, randomized phase III study designed to compare the clinical benefit of nivolumab vs dacarbazine in pts with advanced MEL. Methods: Approximately 410 pts with untreated, unresectable stage III or stage IV MEL will be randomized 1:1 to receive either nivolumab 3 mg/kg IV every two weeks or dacarbazine 1000 mg/m2 IV every three weeks until disease progression or unacceptable toxicity. All pts must be BRAF wild-type as per V600 mutational testing. Pts will be stratified by PD-L1 status (positive vs negative/indeterminate) and metastatic (M) stage (M0/M1a/M1b vs M1c). PD-L1 positivity will be defined as ≥5% total membrane staining in tumor cells. Tumor response (per RECIST 1.1) will be assessed 9 weeks following randomization and every 6 weeks thereafter for the first year. After the first year, response will be assessed every 12 weeks until disease progression or treatment discontinuation. Treatment may continue beyond initial progression at the investigator’s discretion for pts showing clinical benefit and tolerating therapy. The primary endpoint is OS. Secondary endpoints include progression-free survival, ORR, whether PD-L1 expression is a predictive biomarker for OS, and health-related quality of life. Clinical trial information: NCT01721772.