bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial and ethnic disparities in presentation, treatment, and outcomes for minority populations with diagnosis of lung cancer.
Authors: Raez Luis E. , Sareli Candice , Block Mark I. , Tarrazzi Francisco , Velis Evelio , Sundadaraman Srinath , Mudad Raja
Published: March 2020

e17540

Background: There are differences in the presentation, treatment and outcome of lung cancer patients (pts), based on ethnicity, however there are not enough publications regarding these issues. Methods: Registry data on 2,255 pts with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) treated during last 10 years (2002-2011) at Memorial Health Care System was obtained. The main objective of the study was to evaluate differences in lung cancer survival according to ethnicity. Chi-square was used to compare distribution of tumor stage. Survival curves were compared using log-rank test for each of the tumor stages. Adjusted hazard ratios (AHR) and 95% confidence intervals (95% CI) were reported based on the results of a multivariate Cox regression model for overall survival (OS) with adjustment for gender, age at diagnosis, race, stage and health insurance. Results: A total of 1940 pts (86%) had the diagnosis of NSCLC, the rest were SCLC. There were 1170 (52%) females. Non-Hispanic whites (NHW) were 1,791 pts (79%), Hispanics (H) 266 (12%) and African-American (AA) 149 (7%). Fifty eight percent of patients had stage III/IV at diagnosis. 2054 of the pts were insured (91%). There was a significant difference in age at diagnosis among H (66.5 y), AA (64.4y) and WNH (69.5y). The probability of being diagnosed at a late stage (IIIB/IV) was two times higher among AA compared to NHW (OR= 1.77, P<0.05) or H (OR = 1.67, p<0.05). There was no survival difference between NSCLC and SCLC (19m vs. 16m). Females with NSCLC lived significantly longer than males (Adjusted Hazard ratio (AHR= 1.14 p<0.01). The same was true for SCLC (AHR = 1.43 p < 0.01). Significant predictors for worse survival for patients with NSCLC were: older age at diagnosis (AHR = 1.01, p<0.001), male gender (AHR=1.12, p<0.05) and late stage at diagnosis (AHR=2.27, p<0.001). Insurance and ethnicity were not significant predictors of of survival. Conclusions: There are significant disparities in presentation and outcomes among minority patients with lung cancer. We will further evaluate if other social or genetic factors can explain these disparities.
Opportunities in online education: Lessons learned from 250 e-lectures.
Authors: Berthold Dominik , Marangoni Francesca , Melcher Chatrina , Costa Alberto
Published: March 2020

e17545

Background: Continuous medical education (CME) is critical for physicians, particularly in oncology because of the rapid evolution in diagnosis and treatment of malignancies. Since the fast diffusion of the internet in highly developed as well as less developed nations, online education has become a media to reach potentially a significant number of physicians around the globe. Methods: The European School of Oncology is a non-profit organization dedicated to medical education in oncology. A structured e-learning program was launched in 2008. Interactive live lectures are held by recognized experts in the field and are actively moderated. A tailored webpage www.e-eso.net has been developed. Presenters and participants are connected from their own institutes, often in distant locations. Two formats have been developed: E-grandrounds are weekly sessions on hot-topics without commercial sponsorship. E-oncoreviews are monthly sessions designed to offer a balance and comprehensive overview on a specific topic. Participants can register for free and obtain CME accreditation. Users of the live sessions are encouraged to ask questions by email. Presentations are available online for 6 months. Applications for handheld devices have been developed. Results: Between 2008 and 2012, 4700 users from 117 nations have been registered, using the application at least once. 252 online lectures were held, generating 22.000 views (about 87 participants/presentation). The cost per session was about 4000 $US ( 45$/participant) for technical support. About 100 new users per months are currently registered. None of the presenters or participants had to travel. Conclusions: This is to our knowledge the largest online education program based on non-commercial sponsorship. Online education is feasible, potentially cost-effective and ecologically sustainable. Online education is a way to equal access to medical information for economically less favored nations.
A real-world study on implementation of new therapeutic options, especially bevacizumab, in a cohort of HER2-negative metastatic breast cancer patients treated with first-line chemotherapy.
Authors: Van Kampen Roel JW , Lobbezoo Dorien JA , De Boer Maaike , Voogd Adri C , Dercksen Wouter , van den Berkmortel Franchette W.P.J. , Smilde Tineke Jacoba , Van de Wouw Agnes W , Peters Frank PJ , Van Riel Johanna MG , Peters Natascha AJB , Borm George F , Joore Manuela A , Tjan-Heijnen Vivianne C.
Published: March 2020

e17549

Background: Treatment of patients with metastatic breast cancer is changing rapidly and real-world data are scarce. Effective implementation of new drugs becomes increasingly important, also from a societal perspective. We questioned how and to whom bevacizumab (BEV) was given in the past few years, also in comparison to the EMA registration trial (NEJM 2007;357:2666-76). Methods: A cohort study was performed, including 480 consecutive breast cancer patients diagnosed with distant metastases in eight Dutch hospitals in the years 2008/2009. We analyzed the real world uptake of first-line chemotherapy with or without BEV in patients with a HER2 negative tumor. Results: Of the 193 HER2 negative patients, 33 received taxane (TAX)-BEV, 29 TAX monotherapy, 63 anthracyclines and 41 capecitabine as first-line chemotherapy after diagnosis of distant metastases. Median follow-up was 2.1 (0.08-3.3) yrs. Median progression-free survival was 7.3 (range 4.3-13.0), 2.7 (1.0-6.2), 5.0 (4.2-5.9) and 4.0 (1.1–4.6) months, respectively (p-value 0.02). Overall survival was 28.4 (14.0-nr), 30.9 (18.2-nr), 17.7 (13.7-22.1), and 24.7 (13.7-28.2) months, respectively (p=0.11). Patients treated with TAX-BEV were younger than those with TAX monotherapy (15% > 65 yrs vs. 27% > 65 yrs; p=0.05), had less co-morbidity and more often received adjuvant chemotherapy (81% vs. 57%; p= <0.0001), also as compared to the EMA registration trial (39%). Patients treated with non-TAX (non-BEV) chemotherapy were older (33% > 65 yrs) and were less likely to have received prior adjuvant chemotherapy (38%). Conclusions: We conclude that real world uptake of BEV was lower than expected and was offered to a selected population. Patient selection differed from the EMA registration trial, which may explain the lower progression-free survival. We recommend the use of broader inclusion criteria in future clinical studies and/or more strict adherence to these criteria in daily practice to guarantee effective implementation of new drugs. Funding: Netherlands Organization for Health Research and Development (ZonMw: 80-82500-98-8003) and Roche Netherlands.
An evaluation of pharmacologic costs of complete liver resections in unselected advanced colorectal cancer patients.
Authors: Bonetti Andrea , Muraro Silvia , Giuliani Jacopo , Mercanti Anna , Furini Lara , Durante Emilia , Greco Filippo , Trolese Anna Rita , Piacentini Paolo , Moratello Giacomo , Tognetto Michele
Published: March 2020

e17551

Background: The aim of this study is to evaluate the pharmacological costs of conversion chemotherapy in an unselected population of advanced colorectal cancer patients. Methods: Phase III studies evaluating chemotherapy regimens for advanced colorectal cancer patients were considered. The percentage of reported complete liver resection in each arm was used to calculate the number of patients needed to treat (NNT) to get a complete liver resection. This number was multiplied by the number of cycles administered before the resection (assuming 6 cycles for biweekly chemotherapy or 4 cycles for chemotherapy given every three weeks). Calculation is based on an “ideal patient” (BSA 1.8 sqm; weight 70 Kg).The costs of drugs are at the Pharmacy of our hospital and are expressed in €. Results: Results are summarized in the Table. Conclusions: The pharmacological costs to obtain a complete resection of liver metastases from colorectal cancer varies widely across the different chemotherapy regimens commonly used and is influenced by the efficacy of the treatment and by the costs of drugs used. Schemes containing a “biological” are associated with an increased of costs. [Table: see text]
Potential cost savings of a continuous quality improvement (CQI) program as part of an oncology medical home.
Authors: Winn Daniel , Wong Winston , Cooper Joseph , Olson Tim , Trehan Ram Swarup , Scott Jeffrey A. , Feinberg Bruce A.
Published: March 2020

e17579

Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer care clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 as an attempt to further decrease cancer care costs. The medical home program encouraged physician commitment to an intensive CQI program. We analyzed the potential savings of this program over 1 year. Methods: Data were collected from April 2011 to May 2012. The CQI measurements were obtained from a monthly online survey, completed by medical home participating practices, regarding patient (pt) accrual, clinical profiles, treatment regimens, adverse events, clinical outcomes, and end-of-life care. Two components of the CQI program were analyzed: (1) a 24-48 hour post-treatment follow-up contact by nurses triggered by the initial visit for chemotherapy, and (2) an end-of-life initiative comprised of queries to identify patterns of care in the final days of pts with terminal cancer. Results: Fourteen practices (31 physicians, 478 pts) joined the medical home program. Of the 51 pts who received cycle 1 day 1 of chemotherapy, 38 (75%) were contacted by a nurse within 24-48 hours. Clinical interventions were made for 15 of 38 pts (39%); 5 (13%) involved a return to the clinic. Fifteen pt deaths occurred in year 1. Five (42%) of these pts were in hospice for 0-7 days prior to death, 2 (17%) for 8-14 days, and 4 (33%) for 15+ days. Twelve (80%) of these pts received hospice referral. One pt (6.5%) received chemotherapy within 14 days of death. Seven pts were hospitalized within 14 days of death, and 3 (20%) pts died in the hospital. Conclusions: The nurse follow-up program resulted in prevention of no less than 5 and as many as 15 emergency room visits, and 3-10 related hospitalizations were likely prevented by this intervention. A CQI program can positively impact savings through presumed reductions in emergency room and hospital admissions. Combining these reductions with an end-of-life care initiative represents a great opportunity for cost savings.
Financial impact of an oncology medical home on participating providers.
Authors: Trehan Ram Swarup , Wong Winston , Winn Daniel , Cooper Joseph , Olson Tim , Scott Jeffrey A. , Feinberg Bruce A.
Published: March 2020

e17581

Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer care clinical pathway in the United States in August 2008. Due to early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of patient care. The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services. This would allow physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. We analyzed the financial impact of the medical home program on participating physicians 1 year after implementation. Methods: Intravenous drug codes plus the evaluation and management codes for patient visits and chemotherapy administration were used in the analysis. We analyzed amounts paid to participating practices for chemotherapy, supportive care treatments, and nondrug services for year +1 to the amounts paid for the same services for year -1. We also analyzed the medical home fee schedule for year +1 when compared to the first-generation fee schedule applied to program year +1 utilization. This was calculated by repricing year +1 claims to the first-generation fee schedule and comparing that cost to what was actually paid under the medical home fee schedule. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. Average amounts paid to physicians were 4.7% higher for year +1 compared to the prior year. The average cost difference for year +1 based on the medical home fee schedule versus the first-generation fee schedule was -5.7%. If physicians had chosen not to join the medical home program their revenues would have increased by 11%. Conclusions: Drug cost inflation was a significant contribution to savings in this model and directly impacts the observed lower average reimbursement to medical home participants versus their pathway program peers. Providers are likely to seek remedies for continued participation.
Oncology medical home: Payer return on investment (ROI).
Authors: Wong Winston , Cooper Joseph , Winn Daniel , Olson Tim , Trehan Ram Swarup , Scott Jeffrey A. , Feinberg Bruce A.
Published: March 2020

e17582

Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of care. We analyzed payer ROI after year +1 of the medical home program. Methods: The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services allowing physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. Physicians were encouraged to commit to an intensive continuous quality improvement (CQI) program, which included an end-of-life initiative and a post chemotherapy nurse call-back program that would lower costs by decreasing emergency room and hospital admissions. Physicians participating in the first CFBCBS pathway program were eligible to join the medical home program; physicians who chose not to join made up the control group. Data were collected from April 2010 to March 2012. Medical home ROI was calculated by subtracting the total weighted cost per patient for the medical home group from the total risk-adjusted cost per patient for the control group multiplied by the total number of patients in the medical home program. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. The control group was comprised of 39 practices (103 physicians, 2031 patients). Total weighted cost per patient for the medical home program for year +1 was $26,702. Risk-adjusted cost per patient for the control group for year +1 was $30,670. The medical home program provided a gross savings of $2,016,868 compared to the first CFBCBS pathways program. Conclusions: Significant savings can be achieved in a provider group already compliant with a mature pathways program. A CQI program can directly and favorably impact patient outcomes and ROI via presumed reduction in emergency room and hospital admissions.
Resource and quality information provided by compliance with NCCN hereditary breast cancer guidelines.
Authors: Levonian Peter J. , Landercasper Jeffrey , Vang Choua , Marcou Kristen , Al Hajj Rima , Al-Hamadani Mohammed
Published: March 2020

e17583

Background: NCCN provides guidelines for breast cancer genetic risk assessment and testing. Measuring compliance with NCCN Guidelines (NG) can identify quality gaps. Methods: After IRB approval, a retrospective review of a prospective database of breast cancer patients was conducted to measure compliance with NG for genetic counseling and BRCA testing. Entry criteria were breast cancer patients with diagnosis and treatment at our center, during the 3 year period ending 12/31/11. Genetic counselors (GC) used NG and BRCAPRO modeling in all patients. Surgeon and GC pedigree analyses were compared. A change to the history was significant if the GC identified information that led to increased or decreased cases of breast or ovarian ca. Results: Surgeons constructed pedigrees in 675 breast cancer patients and referred 42% (286/675) to the GC. The decision to refer was NCCN compliant in 671/675 (99%). The GC corrected the pedigree in 14% (39/286); nearly all due to the GC identifying extra breast or ovarian cancers. The mean BRCAPRO probability in referred patients was 7.2%. Fifty-nine percent (170/286) of patients seen by the GC received a recommendation for BRCA testing. The NG compliance rate for testing was 98% (170/174). Of 174 BRCA tests offered to patients, 74% (128/174) underwent testing. In tested patients, there were 4% BRCA1+, 5% BRCA 2+, and 1% uncertain variants. Total patient charges for 128 tests were $696,000 ($4000/test). If the threshold for testing was BRCAPRO > 5% or >10%, then 69 ($276,000) and 45($180,000) (p<0.001) patient charges would have occurred, and no patient with BRCA + status would have been missed. Conclusions: High rates of NCCN guideline compliance for genetic counseling and testing are achievable. Our GC's improve accuracy of pedigree assessment and demonstrate adherence to NCCN guidelines, resulting in more testing compared to BRCAPRO modeling. The balance between different methods to trigger testing, their sensitivity, and cost deserves more study, but the observational data contained herein provides information for provider and payer stakeholders regarding estimated GC resources and cost of care.
Cervical cancer outcomes with the elimination of access to care disparities.
Authors: Agloria Maliha , Cheema Faisal , Burton Gary Von , Mills Glenn Morris , Shi Runhua , Takalkar Amol , Armaghany Tannaz
Published: March 2020

e17585

Background: Previous studies suggest lack of insurance and quality of care variations may drive disparities in cervical cancer (CC) survival, while equitable care may close these gaps. SEER based CC mortality between 2005-9 amongst white (W) and black (B) patients (pts) was 2.2 and 4.3/100,000 respectively. To define the role of equitable care on racial disparities we selected a population of pts with CC treated irrespective of the insurance status at the Feist-Weiller Cancer Center (FWCC). We hypothesized that disparities would be less pronounced at FWCC due to equitable care. Methods: A retrospective cohort study of 151 pts with FIGO Stage I-IV cervical cancer who had clinical staging, PET imaging and treatment at FWCC between 2005-9. Collected information included age, race, date of diagnosis, histology, stage, retroperitoneal lymph node (RPLN) status, treatment received, distance from the cancer center and payer status. The treatment parameters and outcomes were compared between ethnic and financial groups. Overall survival (OS) was assessed by using the Kaplan-Meier method and compared by log rank test. Results: Patients included 88 B, 66 W and 3 other pts with median age 46 years (23 – 84). Payer status included 45% uninsured, 35% medicaid, 15% medicare, and 5% other insurance. Histological type, stage, distance from treatment center and RPLN were equally distributed between groups. All pts completed standard treatment. There was no difference in PFS (p = 0.80) and OS (p = 0.23) between ethnic groups. In concordance with prior studies the following were associated with decreased OS; non-squamous histology, 15% pts (p=0.05), advanced stage (1b2-IV; p=0.04) and RPLN on imaging, 7% pts (p=0.008). Conclusions: Cervical cancer disparities are differentially distributed across the US hospital systems. There were no disparities identified at our institution relative to payer status with all pts receiving currently recommended treatment standards. Our findings indicate that delivery of equitable care can eliminate survival differences. Future research should assess the effect of emerging Accountable Care Organizations on the elimination of racial disparities in cancer treatment outcomes.
Keeping guidelines current: A six-month evaluation of Wiki-based lung cancer guidelines.
Authors: Olver Ian N. , von Dincklage Jutta , Garrett Andrew , Holliday Laura , Vuletich Christine
Published: March 2020

e17587

Background: The challenge for clinical practice guidelines is keeping them regularly updated with new evidence, and widely disseminated in a cost effective manner. This is difficult with printed guidelines and so Cancer Council Australia developed an internet based wiki platform for guidelines and assessed the impact of wiki lung cancer treatment guidelines 6 months after their development. Methods: The key steps in guideline development of identifying questions, literature searching, appraisal of papers, experts writing evidence-based recommendations and wide public consultation and dissemination were integrated in an access-protected wiki. Google web analytics was used to monitor usage. New papers are added and the writers continuously engaged in updating their questions. The evaluation spanned 6 months from May to November 2012. Results: The lung cancer guidelines had 67 clinical questions and 2076 articles were critically appraised. In the first month during public consultation there were 1055 visits to the site and 2955 visits in the following 5 months. The guidelines were accessed from a mobile device by 7% for consultation and 11% subsequently. During the consultation 80% of visits were from Australia, 6% New Zealand, 4% USA and 2% UK. In the consultation period 56% visits resulted from organic search traffic, 31% direct access and 13% referrals and subsequently 72% from searches, 19% direct and 11% referrals. The guideline partner Cancer Australia was the major source of referral (26% during consultation and 25% subsequently) as well as Cancer Council’s main website 9% during the consultation and 38% subsequently. Facebook was responsible for 6-8% of referrals highlighting the role of social media in promoting guidelines. The average highest visit duration by a country was 9.06 minutes in the consultation month (Australia) and 7.24 for Canada. Bounce rates vary widely from 20% (Germany) to above 70% (USA, UK, India). Conclusions: Both clinicians and the public will engage with wiki guidelines and they reach a wide international audience.
The relationships of reduction in pain with other symptoms for cancer patients treated with stereotactic body radiation therapy.
Authors: Mendoza Tito R. , Wang Xin Shelley , Rhines Laurence D , Selek Ugur , Sharp Hadley J. , Cleeland Charles S. , Chang Eric L.
Published: March 2020

e17588

Background: Radiotherapy attenuates pain in patients with spinal metastases. A newer technology is stereotactic body radiotherapy (SBRT) that allows for high dose radiation to be accurately given to a target while sparing nearby tissues. Although a previous study reported improvement in pain, fatigue, disturbed sleep, drowsiness, sadness, fatigue, distress, lack of appetite, nausea, and difficulty remembering after SBRT, it did not examined the quantitative relationship of pain reduction with improvement in symptom burden. Methods: Cancer patients (n=149) with mechanically stable, non–cord-compressing, spinal metastases (n=166) were treated by SBRT in a phase I/II study. Patients received a total dose of 27–30 Gy, typically in three fractions. Symptoms were measured repeatedly using the M. D. Anderson Symptom Inventory (MDASI). Linear mixed model was fitted with pain as the dependent variable and other symptoms as predictor variables to determine the effect of other symptoms on pain throughout the treatment trajectory. Opioid use was a covariate in the analysis. Results: As reported previously, there were significant reduction in pain (p=0·00003) disturbed sleep, drowsiness, sadness (all p<0·0001), fatigue, distress, lack of appetite, nausea, and difficulty remembering (all p<0·05) during the six months post-SBR. Based on our linear mixed models, a 1-point reduction in fatigue (p<.001) is associated with 0.26 reduction in pain. Similarly, a 1-point reduction in in sleep disturbance (p<.001), numbness (p<.001), distress (p<.005), lack of appetite (p<.01) and dry mouth (p<.03) were associated with reductions of 0.25, 0.22, 0.16, 0.15, and 0.14 in pain, respectively. Opioid use was significantly reduced after SBRT. Conclusions: Significant reduction in pain from SBRT is associated with improvement in symptom burden. These findings may provide insights into how symptoms are interrelated during cancer treatment.
Evaluation of chemotherapy within last two weeks of life: Patterns of care.
Authors: Thomas Sachdev P. , Rice Michele A. , Ho Timmy-Tai A , Heard Bridgette , Harper Jamie , Fishkin Paul A. S.
Published: March 2020

e17590

Background: The discontinuation of chemotherapy within the last two weeks of life is a vital Quality Oncology Practice Initiative (QOPI) assessment measure. In the last two weeks of life, continuation of chemotherapy may contribute to death rates as much as 20%. An aggressive approach to therapy may not be related to improved patient outcomes. We assess patterns in patient deaths and chemotherapy treatment at the end of life in the metastatic setting. Methods: Charts were collected and reviewed retrospectively between October 2009 and December 2012 from one, large QOPI certified, oncology/hematology group; that sees over 3500 new cancer patients per year at 14 locations along central Illinois. The receipt of chemotherapy within two weeks before patient expiration was identified from past billing charges. Results: A total of 5,560 patients died during the three year period. 154 (2.8%) patients received chemotherapy within two weeks of their expiration; median age was 67 years (range 42-89). By line of treatment, 48% of patients who received chemotherapy within the last two weeks of life were in their first line of therapy, with 44% of those patients having received only the first cycle. Only 14% of patients had received >3 lines of chemotherapy. By diagnosis, lung cancer had the highest number of patients treated in the last two weeks of life (29%). Conclusions: It is expected that deaths within two weeks of chemotherapy occur in heavily treated patients who are receiving multiple cycles of salvage chemotherapy regimens. At our center, we found that many of these patients died just after initiation of first line therapy. Moreover, patient death rates were observed to be much lower than what has been reported in other studies. This provides insight into the patterns of cancer care near the end of life. Better tools are needed to identify which patients are at higher risk of early death following initiation of chemotherapy when disease is diagnosed at an advanced stage.
Prognostic value of preoperative surgical morbidity risk-stratification using morphometric data obtained from routine abdominal CT scans in the setting of pancreatic cancer resection.
Authors: Grimm Shawna , Shelton Tiffani Dawn , Goldman Charles David , Franko Jan
Published: March 2020

e17599

Background: Patient frailty is imparative to surgical planning, post-operative morbidity and mortality, and ultimately the ability to undergo adjuvant therapy in cancer treatment. Sarcopenia has been correlated with long term survival in the setting of pancreatic resection for cancer. However, it has not been evaluated in the early post-operative setting. Here, we evaluate the prognostic value of morphometric parameters measured on abdominal CT scans in fifty patients undergoing pancreatic resections and comparing with postoperative complications. Methods: Post-operative complications of fifty patients who underwent pancreatic resection for suspected neoplasm were graded via Clavien Dindo classification and then correlated with standardized morphometric measurements from CT scans. Results: Thirty-two men and 18 women (age 63±13 years) underwent pancreatic resection for cancer. Total psoas muscle area (2555±791 vs 1821±805,p=0.008), L4-alba distance (113±29 vs 119±27,p=0.597), rectus muscle (10.1±2.5 vs 7.8±4.5,p=0.016) and SQ fat thickness (20±11 vs 29±10,p=0.024). Logistic regression modeling including age, gender, and total psoas area predicted complication occurance (pseudo R2=0.350, p=0.008) and their number (pseudo R2=0.191,p=0.002), but not grade 3 and higher complications (pseudo R2=0.68,p=0.451) or pancreatic leak (pseudo R2=0.020,p=0.873). Similar results were obtained when age and gender variables were combined with rectus muscle thickness (pseudo R2=0.422), L4-alba distance (pseudo R2=0.377), and SQ fat thickness (pseudo R2=0.392). In each case, > Grade 3 complications and pancreatic leak was not predicted with morphometric data, age and gender. Conclusions: There are significant age and gender-related differences in morphometric data obtained from abdominal CT scans. Prognostic models provide statistically significant prediction of complication occurrence, but explain only up to 42% of variability in complication occurrence. Moreover, clinically important complications (grade 3 and higher) and pancreatic leak was not predicted with this model based on our limited dataset.
Cytarabine plus mitoxantrone versus cytarabine plus clofarabine as second-line therapy in AML.
Authors: Gul Zartash , Jain Asheesh , Slone Stacey A. , Raufi Ali , Van Meter Emily Marie , Lawson Amber , Hayslip John W. , Monohan Gregory , Howard Dianna S. , McDonagh Kevin T. , Alkadhimi Zaid
Published: March 2020

e18001

Background: There are no comparative studies that can provide guidance about the choice of second line therapy in AML patients (pts). Methods: We retrospectively evaluated 30 consecutive pts who underwent reinduction chemotherapy for AML with mitoxantrone and cytarabine (ACM) or cytarabine and clofarabine (ACC). Results: Baseline characteristics of the pts are described in the Table. Ten pts achieved remission after initial induction therapy in ACM group and 4 pts in ACC group (P=0.71). Median length of remission was 314 days (d) (81-874 d) in ACM group and 178.5 d (57-232 d) in ACC group (P=0.13).After reinduction in ACM and ACC groups 9 and 3 patients achieved remission respectively (P=0.4).One pt in each group underwent allogeneic stem cell transplant. After a median follow-up of 11.2 m (ACM) and 10.5m (ACC), 9 and 6 pts had died in ACM and ACC groups respectively. Causes of death were progression (ACM=2pts, ACC= 1pt), end organ failure (3 pts each) and unknown (ACM=4pts, ACC=2 pts). Median Overall survival (OS) was 18.4 months (m) in ACM and 13.1 m in ACC group (P=0.49). After reinduction therapy OS was 8.3 and 6.9 m in ACM and ACC groups (P=0.72). In our patient cohort we did not find any baseline characteristics that were associated with OS or achievement of remission after reinduction therapy. Conclusions: In our pt cohort both ACM and ACC regimens demonstrated the ability to induce remission as a possible bridging strategy to allogeniec stem cell transplant. Larger studies are needed to compare these two regimens as well as evaluate any baseline characteristics which correlate with OS or achievement of remission. [Table: see text]
Philadelphia-positive acute lymphoblastic leukemia in daily practice: A multicenter experience.
Authors: Goker Hakan , Tekgunduz Emre , Sari Ismail , Pala Cigdem , Dogu Mehmet Hilmi , Ozturk Erman , Turgut Burhan , Korkmaz Serdal , Sirinoglu Demiriz Itir , Buyukasik Yahya , Kabukcu Hacioglu Sibel , Kaynar Leylagul , Civriz Bozdag Sinem , Altuntas Fevzi
Published: March 2020

e18014

Background: The prognosis of Philadelphia-positive acute lymphoblastic leukemia (Ph+ALL) is generally poor. Currently, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only accepted therapy with curative potential. Herein, we report our experience with Ph+ALL patients treated off-study. Methods: Data were collected from medical records of Ph+ALL patients diagnosed between 2005 and 2012. Survival rates were calculated using the Kaplan-Meier method and the log-rank test was used for comparison between groups. Results: This retrospective study included 41 patients (21 females and 20 males) from 7 centers in Turkey. The median age of the patients was 42 years (range, 19-70 years). Thirty (73%) patients received TKI and concurrent chemotherapy, 10 (24%) patients received chemotherapy alone and 1 (3%) patient received TKI alone. Of the patients receiving TKI, 24 (77%) received imatinib and 7 (23%) received dasatinib as induction therapy. Following induction therapy, 77% and 10% of the patients achieved complete hematologic remission and complete response with incomplete hematologic recovery, respectively. Eight (20%) patients had relapsed/resistant disease and received rescue therapy. The most common complication during therapy was febrile neutropenia (n=7, 17%). The induction mortality rate was 5% (n=2). Allo-HSCT was performed in 16 (39%) patients, 12 (75%) of whom underwent HSCT in first complete remission. Donor sources were matched siblings in 14 (88%) and unrelated donors in 2 (12%) patients. Fifteen (37%) patients died during follow-up. The Kaplan-Meier analysis revealed a median overall survival (OS) period of 12 months (range, 1-86 months) for all patients. The median OS period was 17 months (range, 5-86 months) and 2 months (range, 1-24 months) for patients who did or did not undergo HSCT, respectively (p=0.014). The Kaplan-Meier estimate of OS was 69.3% at 12 months and 49.1% at 24 months, for all patients. Conclusions: Allo-HSCT is the most important denominator of survival and the only curative therapy for Ph+ALL patients. For patients without a suitable donor or who are unable to undergo HSCT, TKI with concurrent chemotherapy is a reasonable alternative.
Prognostic factors in malignant pleural mesothelioma (MPM): A mono-institutional evaluation of Bologna Malignant Pleural Mesothelioma Group.
Authors: Adua Daniela , Sperandi Francesca , Castellucci Paolo , Melotti Barbara , Giaquinta Stefania , Fanti Stefano , Pinto Carmine
Published: March 2020

e18509

Background: The prognostic systems currently in use in MPM, such as the EORTC and CALGB score, include the clinical and histological parameters, excluding the FDG-PET (PET) evaluation and the possibility of surgery. The aim of our study was to investigate the role of PET baseline SUV-max and surgery as prognostic factors in MPM. Methods: From April 2002to December 2012, 48 pts with a certain histological diagnosis of MPM underwent staging by PET scan before peri-operative (multimodality treatment) or palliative first-line chemotherapy (CT). Surgery was performed in 22(45.8%) pts. Pt characteristics: males 44(91.7%), females 4(8.3%); median age 65 (51-77) years; ECOG PS 0-1 45(93.7 %), PS 2 3(6.3 %); IMIG stage I-II 18(37.5%), III-IV 30(62.5%); histological subtype epithelial 40(83.3%), mixed 5(10.4%), sarcomatoid 3(6.3%); extrapleural pneumonectomy 8(16.8%), pleurectomy/decortication 14(29.2%), 17 (35.4%) VATS plus pleurodesis, 19(39.6%) no surgical procedures. Platinum based CT was performed in combination with pemetrexed in 39(81.3%) pts and with gemcitabine in 9(18.7%). According to the EORTC score 30(62.5%) pts were classified in the good prognosis group and 18(37.5%) as poor prognosis. The cut-off value of PET baseline SUV-max calculated by ROC analysis was 9; SUV-max at baseline PET was ≤ 9 in 32(66.7%) pts and >9 in 16(33.3%). Median overall survival (OS) was 12 (3-60) months. Results: Upon validating the impact of individual factors on OS using the Kaplan-Meier analysis, we found statistical significance was reached by histology (p=0.0038) and surgery (p=0.0027). In a multivariate analysis using the Cox regression system, considering OS as a dependent variable, according to age, histology, stage, PET baseline SUV-max and surgery, epithelial histology (p =0.002) and surgery (p=0.012) achieved a statistical significance. SUV-max at baseline PET was not statistically significant (p = 0.290), excluding it as a possible independent prognostic factor in MPM. Conclusions: This analysis does not indicate any prognostic value for baseline PET in MPM, confirming the importance of histological subtype and introducing surgery as a possible prognostic factor.
Medical management of pulmonary carcinoid tumors.
Authors: Chong Curtis Robert , Wirth Lori J. , Chen Aileen B. , Sholl Lynette M. , Janne Pasi Antero , Johnson Bruce E
Published: March 2020

e18512

Background: The optimal medical management of pulmonary carcinoid tumors, which comprise 1-2% of all lung cancers, remains to be determined. Methods: We conducted a retrospective review of patients with typical and atypical pulmonary carcinoid tumors treated at our institution between 1990-present. Results: We identified 29 patients treated with chemotherapy, including 21 patients with metastatic disease (19 atypical, 2 typical), and 8 patients treated with adjuvant platinum-etoposide chemoradiation (6 atypical, 2 typical, 6 stage IIIA, 2 stage IIB). At an average follow-up of 12 months there were two recurrences in the 8 patients receiving adjuvant treatment, both of whom had atypical carcinoid (1 stage IIIA, 1 stage IIB). Of patients with metastatic disease, the principal sites of metastasis were the liver (70%), bone (40%), and brain (25%); median survival after diagnosis of metastatic disease was 3.8 y with a 5 y survival of 37%. Regimens showing efficacy in metastatic disease include octreotide (92% stable disease), etoposide-cisplatin (25% disease control, 2 partial response, 1 stable disease), and temozolomide (44% disease control, 2 partial responses, 2 stable disease). Conclusions: These results support our previous finding that pulmonary carcinoid tumors are responsive to chemotherapy and that adjuvant therapy should be offered to patients with stage II or IIIA resected disease.
Use of CD30 expression in human malignant mesothelioma as a novel therapeutic target.
Authors: Dowlati Afshin , Dabir Snehal , Kresak Adam , Yang Michael , Wildey Gary
Published: March 2020

e18526

Background: CD30 antigen is important in the diagnosis of Hodgkin’s disease (HD) and anaplastic large cell lymphoma (ALCL). CD30 is a cytokine receptor that belongs to the tumor necrosis factor superfamily (TNFRSF8) and acts as a positive regulator of apoptosis. The expression of CD30 in malignant mesothelioma is unknown. Given the remarkable success of brentuximab vedotin, an antibody-toxin conjugate directed against CD30 antigen, in treating patients with relapsed HD and ALCL, we undertook a study to validate the incidence of CD30 expression in mesothelioma and to examine its clinical correlates. Furthermore, we performed studies using cultured mesothelioma and non-small cell lung cancer (NSCLC) cell lines to determine the expression and potential targeting of CD30 antigen in vitro. Methods: Patient mesothelioma tissue specimens (n=52) were examined for CD30 expression by immuno-histochemistry (IHC) with an anti-BerH2 antibody (Cell Marque) used for the diagnosis of HD. Staining was assessed by a thoracic pathologist. Mesothelioma (H28, H2052, H2452, 211H) and NSCLC (A549, H1299) cell lines were also grown in culture and examined for CD30 expression by FACS analysis and confocal microscopy using anti-CD30 antibody (Novus Biologicals). Cells were permeabilized with Triton X-100. Results: Positive CD30 expression was noted in six out of 52 total mesothelioma specimens. Five of the six positive tumors demonstrated epithelial histology and were scored as low or intermediate grade. Membrane-associated as well as diffuse cytoplasmic staining was observed. The percentage of tumor cells stained positive varied greatly. Interestingly, no high grade epithelial tumors were scored as CD30 positive. The remaining CD30 positive tumor was a high grade, biphasic metastatic tumor. Confocal analysis of both mesothelioma cultured cells localized CD30 antigen to the cell membrane. Flow cytometry of intact and permeabilized mesothelioma cells supported the idea that CD30 antigen was located on the cell-surface. Conclusions: Our studies validate the presence of CD30 antigen on the cell surface of epithelial-type mesothelioma and indicate that selected mesothelioma patients may derive benefit from brentuximab vedotin (Adcetris).
Preoperative rehabilitation in patients with thoracic tumors and borderline abnormal spirometry results: Preliminary report.
Authors: Glogowska Oliwia Anna , Szmit Sebastian , Tchorzewska-Korba Hanna , Glogowski Maciej
Published: March 2020

e18529

Background: The role of preoperative pulmonary rehabilitation is unclear. The aim of the study is short-term efficacy of pulmonary rehabilitation in patients with thoracic tumors and borderline abnormal spirometry results before thoracic surgery. Methods: We observed 12 patients (7 women, 5 men) in mean age of 64 (range 46-82) years. Clinical inclusion criteria were: diagnosis of thoracic tumors and reduced values of FEV1 and FVC predicting postoperative complications. Spirometry and 6MWT were chosen for evaluation of lung function and physical performance during rehabilitation. These tests were performed twice during screening phase to eliminate the factors of learning, and were repeated after first and second week of rehabilitation. Pulmonary rehabilitation included two weeks of training on the treadmill with individually selected speed, physiotherapy exercises and breathing training with using of Triflo. Results: The analyses of results of spirometry and 6MWT before and after 2 weeks of pulmonary rehabilitation indicated the significant differences in values of: 1)FEV1 (L): 1,38 ± 0,23 vs 1,61 ± 0,29 (p=0,01) 2) FEV1 (%N): 56,3 ± 13,9 vs 67,8 ± (p=0,007) 3) FVC (L): 2,24 ± 0,37 vs 2,74 ± 0,67 (p=0,03) 4) FVC (%N): 73,5 ± 15,7 vs 91,2 ± 12,7 (p=0,01) 5) 6MWT distance (m): 251 ± 79 vs 310 ± 74 (p=0,003). Although improvement after rehabilitation, 3 patients were disqualified from lobectomy due to unsatisfactory performance status. Another 3 patients experienced complications during perioperative period. Analysis of pulmonary rehabilitation efficacy showed that 6 patients with favourite outcome after thoracic surgery differed significantly in comparing to others. They achieved significantly higher difference in following parameters: 1) FEV1 (L): 0,4 vs 0,06 (p=0,02) 2) FVC (L): 0,91 vs 0,09 (p=0,02) 3) 6MWT distance (m): 93 vs 25 (p=0,016). Conclusions: A two-week pulmonary rehabilitation leads to significant improvement of lung function and physical performance in patients with thoracic tumors and borderline abnormal spirometry results. A clinically significant increase of absolute values of FEV1, FVC and 6MWT distance may indicate a favourite outcome after thoracic surgery.
Preoperative thrombocytosis as a predictor of unfavorable survival in resectable non-small cell lung cancer.
Authors: Wang Jiwen , Luo Min , Wu Hanmo , Sheng Liming , Su Dan , Mao Weimin
Published: March 2020

e18531

Background: Activated platelet is thought to promote cancer cells growth and metastasis, playing an important role in progression of cancer. However, the association between platelet counts and prognosis of patient with non small cell lung cancer (NSCLC) had not been fully elucidated. The aim of this study is to investigate the prognostic value of platelet counts in resectable NSCLC. Methods: A total of 636 primary NSCLC patients who had curatively resected surgery in Zhejiang Cancer Hospital from November 2006 to January 2011 were retrospectively analyzed. Preoperative platelet counts and clinicopathological factors were collected from the medical record database. Patients were followed up for disease progression free survival (PDS) and overall survival (OS) until January 20, 2013. The association between platelet counts and patients’ outcome were evaluated. Results: In all patients, 13.8% (88/636) had increased platelet count (>300 × 109/L), referred to as thrombocytosis. The proportion of thrombocytosis was significantly higher in male, squamous-cell carcinoma and stage III than that in female, other histological types and early stage NSCLC. Moreover, thrombocytosis was associated with significantly shortened survival. Multivariate Cox analysis showed patient with thrombocytosis not only had a 1.66 time elevated risk for disease progression (95% CI, 1.14-2.41, p=0.009), but also had and a 1.47 time risk for death (95% CI, 1.04-2.08, P=0.029), compared with that in those having normal platelet count. More interestingly, the risk for replase was increased to 3.19 times (95% CI, 1.41-7.23, p=0.006) in stage I NSCLC with thrombocytosis than that in patients with normal platelet count after stratified analysis by stage. Conclusions: Preoperative platelet count is an independent prognostic predictor in operable NSCLC, especially in early stage I NSCLC. Platelet count may serve as a useful indicator and potential target for personalized treatment with antiplatelet reagent.
Carboplatin and etoposide followed by once-daily thoracic radiotherapy in limited-disease small-cell lung cancer.
Authors: Yılmaz Ufuk , Anar Ceyda , Korkmaz Esra , Yapicioglu Sena , Karadogan Ilker , Ozkok Serdar
Published: March 2020

e18540

Background: There has been a trend to replace cisplatin with carboplatin in the treatment of small-cell lung carcinoma. The goal of the present study was to determine the efficacy of carboplatin and etoposide followed by thoracic radiotherapy in patients with previously untreated limited disease small-cell lung carcinoma. Methods: From February 2001 to March 2007, 47 patients with limited disease small-cell lung cancer were enrolled in the study. Etoposide, 100 mg/m2, was administrated intravenously on days 1-3 in combination with carboplatin, AUC 6, on day 1 every 21 days for 6 cycles. In cases considered to have non-progressive disease following induction chemotherapy, thoracic radiotherapy was given with in a once daily fraction of 2.0 Gy, 5/wk, up to 50-60 Gy. Results: Forty-one patients were evaluated. Median age was 62 (range, 40-78), 88% of patients were male. ECOG PS was 0-1 in 38 patients. Seven of the 41 patients (17.5%) had pleural effusion (one malignant) and 7 patients (17.5%) had involved supraclavicular lymph nodes. Ninety percent of patients had elevated serum lactate dehydrogenase levels. Median follow-up was 13.5 mo. A total of 209 cycles of chemotherapy was administered (median, 6; range, 1-6). Thoracic irradiation was given to 33 patients. The overall response rate to combined modality on an intention-to-treat basis was 73%. Median survival time was 13.7 months (95% CI, 10.3-17.1), and median progression-free survival was 9.5 months (95% CI, 8.6-10.4). Two- and four-year overall survival was 23% and 7%, respectively. Grade 3-4 neutropenia and leukopenia were the most common adverse events and occurred in 46.0% and 24.0% of the patients, respectively. Six (14%) patients experienced febrile neutropenia. Three patients (7%) died of sepsis and neutropenic fever. Non-hematological toxicities were mild. Conclusions: Carboplatin and etoposide chemotherapy followed by thoracic radiotherapy in LD-SCLC appears to be unsatisfactory.