bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective analysis: Patients with ovarian cancer at National Cancer Institute of Mexico
Authors: Morales-Vasquez F. , Gallardo D. , Tirado L. , López-Basave H. N. , Cantú D. , Mendez C.
Published: August 2020

e16573

Background: Ephitelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancies among women worldwide. Little is known about reproductive factors or lifestyle determinants and ovarian cancer prognosis. The purpose of this study was to analyze the pathologic, clinical and other characteristics. Methods: This study included all EOC seen at the Institute from 2000–2006. Epidemiological and clinical variables were collected from the patients’ medical records. Exposure data on prediagnostic factors were collected through questionnaires. The cases were followed-up until December 31, 2007. Cox proportional hazard regression model was used to estimate the prognostic effect of each factor in terms of hazard ratios (HR) and 95% confidence intervals (CI), following adjustment for age at diagnosis, FIGO tumor stage and WHO grade of tumor differentiation. Results: 571 cases of ovarian cancers. Median age was 51 years, (range 18–95). 20.30%, 4.4%, and 63.5% of patients had stage I, II and III, respectively. The histological types: 52.2% serous, 17.2% endometrioid, 12.8% of mucinous origin; 62.5% underwent radical surgery, 24% with optimal cytorreduction. The mean follow-up was 60 ± 22 months. The overall three-year survival was 97.4% and 98% for mucinous and serous tumors, respectively. The survival rate was 100%, 90%, and 71.8% in stages I, II and III, respectively. After adjustment for the tumor characteristics, no clear associations were detected between reproductive history, anthropometric characteristics, factors before diagnosis (alcohol consumption, smoking and physical activity over lifetime), nor family history of breast cancer or ovarian cancer and survival Conclusions: Our findings indicate that the tumor characteristics significantly influenced the risk of death from ovarian cancer and no clear associations were detected between others factors and the survival. In this cohort the median age for ovarian cancer were 51 years old, one decade before than other reports.

No significant financial relationships to disclose.
Human papilloma virus (HPV): Burden of the disease in cervical cancer in the Extended Middle East and North Africa (EMENA). A comprehensive review
Authors: Seoud M. A. , Seoud K. M. , Lindely S. , Anis S.
Published: August 2020

e16577

Background: Cervical cancer is less common in the EMENA than in the rest of the world. The purpose of this paper is to review the prevalence of HPV in the general population (GP), in cervical intraepithelial neoplasia (CIN) and in cervical cancer (CCA) in the EMENA. Methods: We performed an extensive literature search (English and French literature). Data extracted included information on the method of HPV detection and HPV type-specific data, age, and the histology of the CCA when available. Results: In North Africa (Algeria, Morocco, and Egypt): The prevalence of HPV varied from 5%-12% in the low-risk GP and to 20%-49% in the high-risk GP such as prostitutes. In CIN it varied from 25%-90% (HPV 16 in 40%-100%). In CCA HPV was present in 61%-98% of cases (HPV 16 in 50%-73%). In the Middle East (Jordan, Lebanon, and Israel): The prevalence of HPV was 1.8%-13% in the low-risk GP, in CIN it was 32%-88% (HPV 16 in 10%-30%), and in CCA it varied from 45%-78% (HPV 16 in 31–67%). In the gulf countries (UAE): HPV was found in 4%-11% of the low-risk GP and 20%-30% in the high GP. HPV was present in 37% in LSIL and 67% in HSIL. In CCA, High-risk HPV was present in 87% of specimen in one study. In Turkey, Iran, and Pakistan: HPV was present in 1.5%-13% in the low-risk GP, and up to 42.9% in patients with abnormal smears. In CIN HPV was found in 50% to 100% (HPV 16 in up to 76%). In CCA, HPV was detected in 60%-100% (HPV 16 in 27%-95%). In the GP the age range was 30–50 years, while in CIN it was 30–60 years, and in CCA it was 30–70 years. The studies were varied with small number of patients and varied detection methods that are difficult to compare. Most were PCR, few were Hybrid Capture (I or II). Conclusions: Although the studies on the prevalence of HPV in the EMENA region are not abundant, but there is enough data to suggest that the prevalence of HPV is around 5%-12% in the GP, 30%-80% in CIN and 60%-90% in cervical cancer with HPV 16 as the most predominant type.

[Table: see text]
Common head and neck cancer treatment pathways and associated costs in the U.S. commercial managed care population
Authors: Camacho F. , Mullins C. D. , Joish V. , Choi J.
Published: August 2020

e17001

Background: For the treatment of head and neck cancer (HNC), different modalities (chemotherapy, radiation, surgery, or chemoradiotherapy) can be used either independently or in combination with others. Information regarding real-world treatment pattern is limited. The purpose of this study was to identify common treatment pathways and associated costs. Methods: The study was performed using data from a large U.S. commercial managed care claims database. Adult subjects (≥18) diagnosed with HNC between January 1, 2006, to December 31, 2006, (index-period) were identified based on a pre-selected ICD-9-CM codes. All subjects were HNC diagnosis-naïve 12 months prior to their index dates (first date of HNC diagnosis) and followed for 12 months post index date. Treatment modalities were identified based on the Healthcare Common Procedure Coding System used in the U.S. Pathways were constructed by reflecting time of and between modality administration claims. Results: 6,570 subjects were identified. The average age was 61 years (±14.9) and 44% (n = 2869) were female. Midwest (31%) and east (31%) region had a higher (p < 0.01) representation, compared to south (20%) and west (18%). Only 2,257 subjects (34%) received some type of treatment modality and were categorized into 20 mutually exclusive treatment pathways. Of these, 82% (n = 1,843) received single modality, 18% (n = 398) received a combination of 2, and 0.7% (n = 16) received a combination of 3 modalities. Among single modality pathways, radiation (34%; n = 619) was most common, however, cheomoradiotherapy (26%; n = 485) had the highest average patient cost ($98,440). Within double modalities, radiation followed by chemotherapy (24%; n = 95) was most common, however, chemoradiotherapy followed by surgery (4%; n = 16) had the highest average cost ($146,374). Within triple modalities, surgery followed by radiation then chemotherapy (50%; n = 8) was most common and costly ($95,868). Conclusions: The most common treatment pathways one year post HNC diagnosis used a single modality; however, the average patient costs within multiple modalities were higher. Further study is required to investigate if these patterns are comparable to current guideline recommendation.

[Table: see text]
EZH2 expression and correlation with Ki-67 and p53 in head and neck squamous cell carcinoma
Authors: Choi J. , Ahn M. , Park Y. , Oh Y. , Park K. , Jeong H. , Son Y. , Baek C. , Ahn Y.
Published: August 2020

e17018

Background: Polycomb group proteins are transcriptional repressors that silence specific sets of genes through chromatin modification. The enhancer of zeste homolog 2 (EZH2), considered a member of the polycomb group proteins, is overexpressed in aggressive forms of several malignancies. However, the role of EZH2 expression in head and neck cancer has not yet been fully determined. This study was conducted to investigate the clinical value of EZH2 expression in head and neck cancer and its correlation with Ki-67 and p53 expression. Methods: Expression of EZH2, Ki-67, and p53 was determined by immunohistochemical staining of tissue microarrays from specimens of 138 cases of head and neck squamous cell carcinoma. Results: High EZH2 expression was observed in 51.5%. 44.2% were positive for p53. The percentage of Ki-67 staining was significantly greater in the EZH2 positive group (12.37 ± 8.51) than in the EZH2 negative group (4.73 ± 6.06, p < 0.001). EZH2 expression was significantly correlated with p53 expression (p = 0.003) and smoking history (p = 0.021). However, we found no significant differences in other clinicopathological parameters (age, sex, primary tumor size, and lymph node metastasis) and survival between the EZH2 positive and negative groups. Conclusions: These results suggest that high EZH2 expression may be associated with tumor cell proliferation and cell cycle regulation in head and neck cancer.

No significant financial relationships to disclose.
Daily concurrent chemoradiotherapy with docetaxel (DOC) and cisplatin (CDDP) using superselective intra-arterial infusion via superficial temporal artery for T3 and T4 head and neck cancer: Possibility of organ preservation in advanced head and neck cancer
Authors: Mitsudo K. , Shigetomi T. , Nishiguchi H. , Fukui T. , Yamamoto N. , Furue H. , Ueda M. , Ohhara Y. , Iwai T. , Tohnai I.
Published: August 2020

e17020

Background: Superselective intra-arterial chemotherapy via a superficial temporal artery (HFT method) has become feasible for daily concurrent radiotherapy and chemotherapy for head and neck cancer. We used this novel method for head and neck cancer, and evaluated its efficacy. Treatment consisted of superselective intra-arterial infusions (docetaxel total 60 mg/m2, cisplatin total 100 mg/m2) and concurrent radiotherapy (total 40 Gy) for 4 weeks as preoperative therapy. Thirty-five patients with stage III and IV oral cancer underwent surgery after this treatment, of whom pathological complete response (CR) was obtained in 31 (88.6%). In this study, the possibility of organ preservation in cases of advanced head and neck cancer was evaluated based on this result. Methods: Eligibility included T3 or T4 squamous cell carcinoma of head and neck. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m2, cisplatin, total 150 mg/m2) and concurrent radiotherapy (total 60 Gy) for 6 weeks. Organ preservation was demonstrated in cases when the biopsy specimen of the primary lesion showed grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) after the completion of all treatments. Results: Thirty two patients (21 male and 11 female) were eligible for evaluation. A relapse was detected in 11 cases (34.4%): primary sites, 7 cases (21.9%); cervical lymph node and distant metastasis, 2 cases (6.3%); primary site and distant metastasis, 1 case (3.1%); cervical lymph node, 1 case (3.1%). Seven patients (21.9%) died. The Kaplan-Meier method was used to estimate the 3-year and 5-year survival rates, which were 81.3% and 78.1%, respectively, and the 3-year and 5-year locoregional control rates, which were 68.8% and 64.5%, respectively. No major complications such as cerebral infarctions or other neurological complications developed in any patient. Conclusions: These results of the present study demonstrate that this is a promising new treatment strategy for advanced head and neck cancer, thus contributing to patients’ QOL.

No significant financial relationships to disclose.
Impact of human papillomavirus (HPV) E6/E7 gene silencing on the expression of biomarkers that distinguish HPV+ versus HPV16- head and neck squamous cell carcinomas (HNSCC)
Authors: Gouveris P. , Rampias T. , Sasaki C. , Psyrri A.
Published: August 2020

e17024

Background: Three studies (Pyeon et al, Slebos et al, and Schlecht et al) have identified biomarkers that distinguish HPV+ versus HPV- HNSCC using cDNA microarrays. We sought to determine whether the identified biomarker differences are a direct consequence of HPV16 E6 andE7 oncogene expression. Methods: We selected genes that were found to have altered expression in HPV16+ HNSCC compared to HPV16-. Short hairpin RNAs targeting HPV type 16 E6 and E7 genes were delivered by retrovirus infection to HPV16+ oropharyngeal cancer cell lines 147T and 090. cDNA microarray analysis was performed (slides represented approximately 35000 genes) to determine the transcriptional profile before and after E6/E7 silencing. Results: E6/E7 gene silencing affected the expression of the following genes: RFC4, CDKN2A, MCM6, NASP, EP300, E2F2, PCNA, KLK6, ANGPT1, DNAJCI, PRKCG (Table). Conclusions: Expression of several biomarkers that distinguish HPV16+ from HPV16- HNSCC is regulated by E6/E7 gene expression. Targeting E6/E7 will be an effective therapeutic strategy in HPV16+ HNSCC since alteration of key molecules that increase the malignant potential of these tumors is controlled by E6/E7 expression. [Table: see text]

No significant financial relationships to disclose.
Prognostic impact of radiology response and tumor volume among patients with locally advanced squamous cell carcinoma of the head and neck (LASCHNC) treated with concomitant chemoradiation
Authors: Herchenhorn D. , Souza A. L. , Souza A. M. , Boasquevisque E. T. , Boasquevisque E. M. , Dias F. L. , Small I. , Knust R.
Published: August 2020

e17035

Background: There are no validated prognostic factors to predict response of chemo/RT in LASCHNC. Tumor volume as well as post-treatment CT radiology response have been studied in small retrospective series. An analysis of tumor volume and CT radiology response-score to endoscopic and pathologic responses as well as disease free survival was performed. Methods: In a single institution phase I-II study LASCHNC of oropharynx, hypopharynx and larynx were treated with concurrent radiation, cisplatin and erlotinib. 34 patients (pts) underwent a base line and post treatment CT (after 6 weeks), endoscopic evaluation and biopsy. Tumor volume was measured by multiplying the longest diameter by 0,523. (Cancer Res Clin Oncol. 2005), CT post-treatment changes score used as proposed by Pamejier et al., using a 3-point CT-score: 1 = expected post-treatment changes; 2 = focal mass with a maximal diameter of < 1 cm and/or asymmetric obliteration of laryngeal tissue planes; 3 = focal mass with a diameter of > 1 cm, or < 50% estimated tumor volume reduction. Results: Median tumor volume (mTV) was 21cm3 (0.3 to 178), median disease free survival (mDFS) in pts with tumor volume greater than mTV was 20.4 months and not reached in patients with tumor volume lower than mTV, log-rank 5.9, p = 0.015. The median tumor volume reduction by CT was 84% (-62 a 100%), 8pts were classified as score 1 (23.5%), 1pt score 2 (2.9%), 25pts score 3 (73%). There was a tendency for shorter DFS for those with a score 3, log-rank 3.05, p = 0.08. With a median follow-up of 24 months, 88% of score 1.2 are alive, versus 56% of score 3. Conclusions: There is a great variability in TV in LASCHNC, small tumor volumes were related to longer DFS and there is no correlation between tumor reduction and post-treatment CT score.

No significant financial relationships to disclose.
Evaluation of speech outcomes in oral and oropharyngeal cancers
Authors: Dwivedi R. C.
Published: August 2020

e17039

Background: The aim of the study was to review the literature on oral and oropharyngeal cancers for speech outcomes over the last 8 years. Study design: Systematic review of published studies between 2000 and 2008. Methods: A comprehensive literature search for speech outcomes was performed on PUBMED/MEDLINE, EMBASE, CINAHL, and Science citation index from 2000 to 2008 using the key words- speech, voice, articulation, acoustic analysis etc in oral and oropharyngeal cancers. The reference lists from the selected relevant articles were also inspected and any other pertinent publications were added to the final review. Articles published in all languages on human subjects, and all types of studies were included. Sixty eight articles satisfied the inclusion criterion and their findings were tabulated, analysed and evaluate based on the modality used for evaluation - questionnaire evaluation (QE), perceptual evaluation (PE) and acoustic analysis (AE). Results: 39/68 studies used questionnaires; 30/68 used PE and 2/68 used acoustic analysis. Questionnaires with PE were used in 5 studies. Thirty three/ 68 were retrospective, 28/68 prospective and 7/68 were cross-sectional studies. The finds suggest that the Frequency and quality of abnormal phonation depends on postoperative deficits. Oral (vs. oropharyngeal) cancers, advanced (vs. early), associated comorbidities (vs. without comorbidities), flap reconstruction (vs. primary closure), irradiated (vs. non-irradiated) and Mandibulotomy (vs. without mandibulotomy) have poor speech outcome. Preservation of Tip of tongue and FOM, lateral type excision, smaller excision, greater tongue mobility, primary closure and younger patients have better speech outcome. Conclusions: No validated scoring system for PE has been used; QE needs to be done with speech/ dysarthria specific questionnaires. Most studies suffered because of their retrospective nature, single modality evaluation, small sample size and short duration of follow-up. There is a clear paucity of acoustic analysis studies in oral and oropharyngeal literature and further longitudinal studies are needed.

No significant financial relationships to disclose.
Towards adaptive radiation therapy: Image-based tumor shrinkage modeling in head and neck cancer
Authors: Chao M. , Xie Y. , Le Q. , Xing L.
Published: August 2020

e17050

Background: Understanding the kinetics of tumor growth/shrinkage represents a critical step in quantitative assessment of therapeutics and realization of adaptive radiation therapy. We established a novel framework for image-based modeling of tumor change and demonstrate its performance with a number of synthetic images and clinical cases. Methods: Due to the nonconservation of tissue, similarity-based deformable models are not suitable for describing the tumor growth/shrinkage process. Under the hypothesis that the tissue features in the tumor volume or the boundary region are partially preserved, we model the tumor kinetics by a two-step procedure: (1) auto-detection of homologous tissue features shared by the planning CT and subsequent on-treatment CBCT images using the Scale Invariance Feature Transformation (SIFT) method; (2) establishment of voxel-to-voxel correspondence between two input images for the remaining spatial points by a basis spline interpolation. The correctness of the tissue feature correspondence is doubly assured by a bi-directional association procedure, in which the SIFT features are mapped from planning CT to CBCT and reversely. Only the associations common to both mappings are used in Thin Plate Spline (TPS) interpolation. A synthetic digital phantom experiment and five clinical head and neck cases are used to assess the performance of the proposed technique. Results: Image contents of the digital phantoms are modified in various ways. It is found the proposed technique can identify any of the changes faithfully. The subsequent feature-guided TPS interpolation reproduces the “ground truth” with an accuracy better than 1.3mm. For the clinical cases, the new algorithm works reliably for a volume change less than 30%, suggesting the time span between two consequent imaging sessions should not be unreasonably far away in order for the model to function properly. Conclusions: An image-based tumor kinetic model has been developed to better understand the tumor response to radiation therapy. The technique provides a solid foundation for future head-and-neck adaptive radiation therapy.

No significant financial relationships to disclose.
The impact of time of medical oncologist visit on survival among elderly patients with stage IV prostate cancer: An analysis using SEER-Medicare data
Authors: Mullins C. D. , Onukwugha E. , Seal B. , Hussain A. , Hussain A.
Published: August 2020

e17509

Background: The association between physician referrals and treatment receipt has been established in other disease settings. The impact of time to a medical oncologist or hematologist/oncologist (MOH) visit on survival has not been examined in patients (pts) with advanced prostate cancer (A-PC). The objective of this study is to determine whether the time to a MOH visit is associated with survival. Methods: The SEER-Medicare database was used for the analysis. Pts aged >65 diagnosed with A-PC between 1994 and 2002 and who visited a urologist post-diagnosis were included. Pts who saw a MOH before the urologist visit were excluded. For pts who saw a MOH, time to a MOH visit was identified using the diagnosis date and the urologist visit as starting points. Survival models were used to examine the effect of the time (in months) to MOH visit on survival, controlling for demographic, clinical, continuity-of-care, and ecological measures. Results: There were 6,498 pts in the sample (mean age 76 years, 82% White race). PC-specific mortality was 38%. Two-thirds (67%) of patients did not visit a MOH after visiting a urologist. Among those with a visit to a MOH, an additional month from diagnosis till the MOH visit was positively associated with PC mortality (HR: 1.03; p < 0.001) - i.e. a shorter time to a MOH visit was associated with PC survival. Similar results were obtained using the month of the urologist visit as the starting point (HR: 1.02; p < 0.001). Conclusions: Among A-PC patients who are referred to an oncologist, each additional month between diagnosis/urologist visit and the oncologist visit is associated with an increased relative risk of mortality.

[Table: see text]
ENACCT's pilot education program (PEP): A model to enhance understanding of cancer clinical trials for community providers and community leaders
Authors: Michaels M. , Blakeney N. , Schapira L. , Britton A. , Swords L. , Bitow N. , Gibbs B. , Yeun S. , Rytkonen B. , Goodman R. ,   NOVA Research Company
Published: August 2020

e17514

Background: While nearly 20% of adult cancer patients are eligible for cancer clinical trials, less than 3% of cancer patients participate. Rates of participation are lower among communities of color and the medically underserved. Enhanced community engagement and provider training about cancer clinical trials can potentially result in greater awareness, access, and ultimately, patient accrual. Methods: A three-year Pilot Education Program was developed to explore the impact and feasibility of a community-driven outreach and education intervention focusing on community members, community health care providers, and cancer researchers in three medically underserved communities. Using a train-the-trainer model, PEP sought to raise clinical trial awareness among peers and encourage public inquiries about clinical trials. Workshops for clinical trials staff addressed recruitment and retention practices. Additionally, community sites worked to reduce local policy barriers to clinical trials participation.PEP used web-based surveys, interviews, focus groups and field observation to evaluate impact. Results: Seventy-five trainers were recruited. PEP reached 882 community members (63% minority), 374 health care providers (16% minority) and 61 cancer clinical trial staff. Approximately 5,800 individuals were exposed to educational activities through extended community outreach activities and dissemination of educational materials. Among those completing evaluation surveys, 66% of community leader trainees said they spoke to others about cancer clinical trials. Seventy-two percent of health care providers agreed their role is to inform patients about the possibility of receiving treatment through a clinical trial. Among cancer clinical trial staff, 80% indicated intention to work with community groups on cancer clinical trials education. Seventy-seven unique patient profiles were created with a national cancer clinical trials matching service also associated with PEP. Conclusions: Results from ENACCT's Pilot Education Program suggest promise in improving knowledge among community leaders and health care providers, and fostering greater peer-to-peer education about cancer clinical trials.

[Table: see text]
Patients’ experiences with navigation for cancer care
Authors: Carroll J. , Humiston S. G. , Salamone C. M. , Jean-Pierre P. , Epstein R. M. , Fiscella K.
Published: August 2020

e17520

Background: Patient navigation is a promising strategy for improving cancer care. We examined (1) how navigation influences patients’ perspectives on their cancer care and (2) the most effective (i.e., meaningful or valuable) aspects of navigation from the patient's viewpoint. Methods: We conducted post-study patient interviews from a randomized controlled trial (usual care vs. patient navigation services) from cancer diagnosis through treatment completion. Patients were recruited from 11 primary care, hospital and community oncology practices in Monroe County, NY. We interviewed patients about their specific experiences with cancer care including their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance. Results: Thirty-five patients (32 female, 3 male) newly diagnosed with breast (n = 28) or colorectal (n = 7) cancer who completed the study and were interviewed from May 2007 through March 2008. Patients who received navigation were very positive about their experience. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving (such as with insurance or financial stressors), and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to usual care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support. Conclusions: Cancer patients value navigation. Instrumental benefits were the most important expectations for navigation from navigated and non-navigated patients. However, when describing their actual experience of navigation, navigated patients frequently mentioned receiving emotional support as well as assistance with information needs, problem-solving, and logistical aspects of cancer care coordination.

No significant financial relationships to disclose.
The association between breast cancer patients’ general health perception and organizational characteristics of the hospital
Authors: Pfaff H. , Steffen P. , Nitzsche A. , Kowalski C.
Published: August 2020

e17523

Background: The purpose of this study is to investigate the impact of organizational characteristics of the hospital on general health perception in postoperative primary breast cancer patients after discharge from hospital. Methods: Patients undergoing treatment for primary breast cancer in all certified breast centers in North Rhine-Westphalia (Germany) were invited to self-administer a questionnaire on health-related quality of life after discharge. Survey period was February to July 2007. 3,285 patients from 94 hospitals returned the questionnaire. The data were supplemented by disease and treatment characteristics reported by the oncologists (e.g. TNM-classification, type of surgery). Patient data were combined with information on hospital characteristics provided by hospital administrators. A multilevel analysis was applied to analyse the impact of organizational characteristics of the hospital (no. of annual breast cancer surgeries, breast care nurses employed, teaching hospital) on general health perception as reported by the breast cancer patients after discharge. Analyses were controlled for sociodemographic variables (age, marital status, education), type of surgery (mastectomy vs. BCT), and severity of disease (TNM-classification). Results: In the multilevel analysis performed organizational characteristics of the hospital do not contribute to patients’ general health after discharge. Only the variable “breast care nurses employed” is close to being positively associated with better general health at p < 0.05. In the model lymph node status (p < 0.05), metastases (p < 0.05), type of surgery (p < 0.01), age (p < 0.001), and education (p < 0.01) contribute to the explanation of the variance in general health perception. Conclusions: In the breast centers under investigation organizational characteristics of the hospital do not have an impact on primary breast cancer patients’ general health after hospital discharge. A possible reason is the high degree to which the treatment process itself is standardized.

No significant financial relationships to disclose.
Comparison of epoetin alfa (EPO) and darbepoetin alfa (DARB) utilization in cancer chemotherapy patients treated in a hospital outpatient setting
Authors: Vekeman F. , LaFeuille M. , Bailey R. , Tak Piech C. , McKenzie R. S. , Lefebvre P.
Published: August 2020

e17524

Background: With recent changes in erythropoiesis-stimulating agent (ESA) labeling and coverage limitations by the Centers for Medicare and Medicaid Services, it is important to examine the evolution of EPO and DARB real-world utilization in cancer patients receiving chemotherapy in a hospital outpatient setting. Methods: Electronic outpatient records (2006–2007) from >500 hospitals in the Premier Perspective Comparative Hospital Database were analyzed. Subjects were ≥18 years, had ≥1 cancer diagnosis, received chemo during newly initiated ESA therapy, and ≥2 doses during the treatment episode (classified by quarter of ESA initiation). Mean cumulative dose and dose ratio of EPO:DARB were calculated. 2% of patients with extreme doses were excluded. Results: 7,259 outpatient treatment episodes were identified (EPO 3,568;DARB 3,691). EPO patients were slightly younger (years; EPO 62.7;DARB 64.0, p<.0001), had lower proportion of women (EPO 62.2%;DARB 65.4%, p=0.0044), and had slightly longer mean treatment duration (EPO 3.1 months; DARB 2.9 months, p=0.0009) compared to DARB patients. Mean cumulative dose (SD) per treatment episode was EPO 263,582 (210,167) Units and DARB 1,005 (678) mcg, corresponding to a dose ratio of 262:1 (Units EPO: mcg DARB). Over time, mean cumulative dose, mean treatment duration, and dose ratio reflected a downward trend for both groups ( Table ). Conclusions: This analysis reported a mean dose ratio of 262:1 (Units EPO: mcg DARB) in cancer chemotherapy patients from a hospital outpatient setting. Recent changes in ESA prescribing information and coverage appear to have decreased ESA utilization and the EPO: DARB dose ratio over time.

[Table: see text]

[Table: see text]
Third-line chemotherapy in metastatic breast cancer: A retrospective institutional assessment about clinical outcomes
Authors: Carcano F. M. , Gaui M. D. , Branco L. P.
Published: August 2020

e17538

Background: Third-line chemotherapy in metastatic breast cancer (MBC) has been evaluated in phase II trials, but there were no prospective randomized studies showing clear benefit forward third-line chemotherapy. However, some patients increased their performance and quality of life despite short survival and low response rate. We analyzed the clinical outcomes in patients using third-line chemotherapy in MBC. Methods: 400 patients using chemotherapy from 2003 to 2007 were evaluated retrospectively. The overall survival (OS) and time to progression (TTP) were assessed with Kaplan-Meier method; the log rank test was applied to correlate known prognostic factors and third-line chemotherapy. Results: 122 patients received third line chemotherapy. The median age was 51 yrs, 89% had IDC histology, 45% had positive hormone receptor, 80% received taxanes or capecitabine as third-line chemotherapy, 88% had PS (ECOG) 0–1 or unknown, 55% had non-visceral metastasis, 89% had been previously exposed to anthracycline or taxanes, and 53% received more than three lines of chemotherapy. The median OS was 8.6 mo (95% CI; 7.5–10.3) and TTP one was 3.6 mo (95% CI; 2.8–4.5); 37% were alive in 1 yr, and the clinical response rate was 19%. TTP more than 8 mo in first- and/or second-line chemotherapy affected TTP in third line (5 vs. 3 mo; p = 0.003); only PS (ECOG) 0–1 resulted better OS (13 vs. 4 mo; p = 0.001). Conclusions: The OS and TTP found are similar to the literature and reflect the poor prognosis in patients receiving third-line chemotherapy in MBC. 8-month cut off TTP in previous lines determine the TTP in third line and good PS results better OS.

No significant financial relationships to disclose.
Practice-based improvement (PBI) via web based tool (WBT) in multidisciplinary gynecologic oncology clinic (MGOC)
Authors: Arnaoutakis K. , Morse A. B. , Ambika S. , Wong G. , Parameswaran R.
Published: August 2020

e17545

PBI is a key core competency in fellowship training. Care delivery measurement is increasingly important in medical practice comprising diverse health care professionals. Our MGOC brings together oncology fellows and oncology nurse practitioners (NPs). Long-term survivorship issues like osteoporosis (OP) are important to quality of life. Surgery, chemotherapy or radiation results in early menopause which increase OP risk. Few studies document evaluation of risk of late side effects of cancer therapy. With a retrospective sequential patient (pts) sample, we used American Board of Internal Medicine Practice Improvement Module (ABIM PIM) to assess documented comprehensiveness of OP risk factor evaluation in 25 MGOC pts. ABIM PIM is WBT that enables care process and outcomes assessment in clinical settings compared with national guidelines. Part 1 includes chart abstraction tools, pts, and practice system surveys; part 2 has quality improvement (QI) tools. Part 1 evaluation showed that 68 % pts had endometrial adenocarcinoma; 20% cervical cancer; 12% uterine sarcoma or carcinosarcoma. 76% received whole pelvic radiation; 24% received brachytherapy. Mean age was 63 years (range 41–87). 67% pts had normal bone density scan. Smoking status (100%); exercise levels (84%) were well documented. Exam documented height (84%), weight (96%), height loss (76%); presence or absence of kyphosis (96%) in the majority. 64% of pts had bone density scans. Vitamin(vit) D levels were documented in 4%. No pts had complete fall risk evaluation, estimated dietary calcium (Ca)/vitamin D intake or documented adequacy of Ca or vit D intake. Counseling for appropriate Ca/vitamin D intake was poor (4%/8%). Counseling for weight bearing exercise (WBE) was poor (8%). We have targeted areas for improvement for part 2: vit D level evaluation, assessment of and counseling for adequate of Ca/ vit D intake and WBE. An improvement plan has been implemented. Reassessment of documentation adequacy will be performed on a systematic random sample of 25 pts in 6 months. The ABIM PIM in OP enables fellows and NPs to identify weaknesses in documentation practices and pt care leading to formal QI plans to address long term survivorship issue of OP in MGOC.

No significant financial relationships to disclose.
Patient (PT) participation and disaster (D) agency (AG) coordination for oncology (ONC) PT D preparedness (PREP): Analysis of the Great Southern California Shake Out (GSCSO) drill and implications for regional and national emergency (E) planning (P)
Authors: Moss R. A. , Presant C. , Lamb M.
Published: August 2020

e17549

Background: PT E PREP is important (Katrina, Los Angeles fires 2007, 2008). MOASC developed the ONC PT E Network (OPEN) (www.open-central.com; Proc ASCO 2006 a6142, 2007 a17003 , and 2008 a6545). On Novermber 13, 2008, 28 organizations and sponsors (US and Cal govt and private) conducted the GSCSO drill with a Richter scale 7.8 earthquake. MOASC tested OPEN as part of GSCSO. Methods: In OPEN, PTs were given wallet cards with E information (diagnosis, stage, treatment, doses). As part of GSCSO, MOASC a) surveyed two practices in two counties to evaluate ONC PT motivation and PREP; and b) surveyed D AG to determine the triage program for ONC PTs who required CT. PTs in two offices pretended the ONC offices had been closed due to the D. They were asked to call the MOASC E line and advise an address to which they would evacuate where MOASC referred PTs to a participating physician for chemotherapy (CT). Results: 36 PTs participated. In office interviews, PTs had concerns about transportation to evacuation locations during the D, how they would find available phone lines during an E, and whether MOASC lines would be responsive in an E. Only 5 PTs (13.9%) contacted the MOASC E line within 24 hours. The 4 most available D AGs were unaware of how to triage ONC PTs requiring CT, and were unaware of MOASC and ASCO resources. They wanted to refer ONC PTs to E rooms which would be unresponsive to PT needs for CT. Conclusions: ONC PTs are not yet motivated for D PREP (concerns regarding current CT have higher priority). Responding AGs are not capable of correctly triaging ONC PTs for CT. Neither PTs nor doctors have a list of D AGs. State ONC societies, ASCO, and ACCC should create regional E phone response lines through state societies, regional E oncologist contacts, and a single national facilitating D response office, as well as coordinate regional and national D AGs so that PTs can be triaged to appropriate resources. National D AGs funded to coordinate responses should be the source of support for this process. Motivating ONC PTs for EP will require reimbursed practice participation.

No significant financial relationships to disclose.
Effect of insurance status and distance from treatment center on the overall survival of patients with non-small cell lung caner treated in an academic center
Authors: Armaghany T. , Mills G. , Shi R. , Runhua S. , Ataei H.
Published: August 2020

e17557

Background: A large proportion of patients withcancer treated in academic centers do not have insurance and they travel from far distances to get medical care. We have retrospectively analyzed the outcome of 230 patients with non small cell lung caner in our cancer center and evaluated the effect of insurance status and their distances from our center on overall survival. These patients have traveled from many different regional cities to our center since mid-1996 to November 2008. Methods: We have performed a multivariate analysis on 230 patients with all stages of non small cell lung cancer correcting for sex, race, age, comorbidity, stage of cancer, body mass index, histology, chemotherapy, performance status, smoking history, distance from our center and insurance status. The distance ranged from 0.4 to 343 miles with mean of 69 (standard deviation of 71) . Age ranged from 30 to 89 with a mean number of 57 (standard deviation of 10).Insurance status was divided into 3 categories of no insurance, medicaid and with insurance. Chi square test was used to compare the distribution of the stages of lung cancer patients with other categorial variables. The log rank test was used to compare the survival of different categorical variables and Cox proportional regression was used for multivariate analysis of overall survival. Results: There were no statistical significant differences on overall survival considering distance of travel or insurance status.(P value for distance was 0.505 and for insurance it was 0.648). Smokers and patients with a poor performance status (ECOG 3 and 4) had a statiatically significant worse overall survival. (P value for smoking was 0.0036 and p value for ECOG equal or above 4 was <0.0001). Conclusions: The results from our study indicate that travel distance and payer status do not effect overall survival in lung cancer patients at our center.

No significant financial relationships to disclose.
Expectations of cancer patients about clinical trials in multidisciplinary clinics
Authors: Kloecker G. H. , Janjua M. , Day J. , Lee D.
Published: August 2020

e17563

Background: Progress in cancer treatment is very much dependent on the effective interaction of several specialties. To facilitate the process, more and more multidisciplinary clinics have been created over the last decade, especially in academic settings. This approach has been more established in the academic setting to help facilitate better patient accrual to clinical trials. Although there are studies confirming the effectiveness of this approach in fulfilling practice guidelines, there is however no study of patients’ expectations at a multidisciplinary clinic, especially in regard to the patients’ attitude towards clinical trials. This study examines patients’ preferences for services offered in an academic Methods: Surveys were handed to patients at the time of the first clinic visit and at time of progressive disease. The surveys were designed as a self directed questionnaire with the following questions that were rated on an ordinate scale from not at all important (score 1) to extremely important value (score 7): to see all doctors the same day; to be treated at a university-based cancer center; to have everything completely explained; to have the first appointment within 10 days; to know your cases will be discussed at conference; to have help with transportation and medical costs; and to participate in clinical trials. Results: 94 patients were surveyed at the GI and Thoracic Multimodality Clinic. Among patients the highest preference was “to have every thing explained,” score 6.7 (6.5–7.0, CI), immediately followed by the discussion at the multidisciplinary conference, score 6.6 (6.5–6.8, CI). Clinical trials ranked lowest, score 4.8 (4.4–5.2,CI). The difference was statistically significant, p = 0.012. There was no difference between GI and Thoracic Multimodality Clinic patients. Patients with progressive cancers showed a slightly higher interest in clinical trials, but still ranking trials below most other services. Conclusions: Patients value complete explanations of the disease and management plan far more than they value clinical trials. Considering that nationwide less than 5% of cancer patients are enrolled in clinical studies, it is important for physicians to explain the merit of clinical trials to patients and public.

No significant financial relationships to disclose.
Clinical outcomes and predictive factors in patients with liver metastasis from breast cancer treated with gemcitabine and cisplatin (GC) salvage regimen
Authors: Araujo L. , Metzger Filho O. , Gomes C. A. , Moitinho M. V. , Silva A. M. , Carcano F. M. , Noronha Júnior H.
Published: August 2020

e17568

Background: Liver metastasis (mets) from breast cancer is typically associated with poor prognosis. GC is a good option, since patients (pts) have often failed anthracycline and taxane therapy and liver dysfunction may preclude these regimens. Methods: Retrospective study designed to evaluate the clinical outcomes and predictive factors in pts with metastatic breast cancer treated with GC, with special interest for liver mets. Results: From 2004 to 2007, 56 pts were treated with GC. Median age was 52.1 years, 33 pts had PS 0–1, 26 were hormone receptor (HR) negative, 32 had been treated with 3 or more chemotherapy (CT) regimens and 34 had liver mets. The median overall survival (OS) was 7,1 mo (95% CI; 4.3–9.7), the progression free survival was 3.3 mo (95% CI; 2.2–5.5) and the clinical response rate was 25%. OS was 4.0 mo (95% CI; 2.3–8.9) for pts with liver mets and 9.7 mo (95% CI; 6.9–12.9) for pts without liver mets (p = 0.03). No factor showed correlation with OS in pts with liver mets, including age < 45 years (median OS [95% CI]: 2.8 mo [1.8–11.5] versus 4.5 mo [2.5–8.9]; p = 0.74), PS 0–1 (median OS [95% CI]: 7.3 mo [2.5–11.5] versus 2.8 mo [0.8–9.7]; p = 0.55), HR positivity (median OS [95% CI]: 7.3 mo [2.0–11.5] versus 5.9 mo [1.9–9.7]; p = 0.87), bilirubin level ≥ 5 times the superior limit of the normality (median OS [95% CI]: 5.9 mo [0.5–16.7] versus 4.5 mo [2.5–9.7]; p = 0.45), progression free interval after the previous CT ≤ 1 mo (median OS [95% CI]: 4.0 mo [2.0–9.7] versus 7.1 mo [2.5–14.7]; p = 0.93) and previous treatment with ≥ 3 CT regimens (median OS [95% CI]: 7.3 mo [1.0–11.0] versus 4.0 mo [2.0–9.7]; p = 0.93). Conclusions: These data is in accordance with the literature concerning the dismal prognosis in liver mets from breast cancer and the clinical activity of GC. We could not define predictive factors in this cohort, which was probably due to the relatively small number of pts.

No significant financial relationships to disclose.
Interviews with cancer fatigue patients
Authors: Lasch K. E. , Jernigan K. A. , Scott J. A. , Piault-Louis E.
Published: August 2020

e17577

Background: Approximately 90% of patients diagnosed with cancer experience fatigue associated with the effects of treatment and/or cancer itself. Despite its high prevalence and negative impact on patients’ lives, there is no consensus on a clinical definition of cancer-related fatigue (CF). Extant qualitative research has methodological limitations, small sample sizes, and varying results regarding CF. A multi-disciplinary research consortium is developing a conceptual model of CF based on 120 qualitative interviews with cancer patients varying by cancer type and stage. Exploratory interviews were conducted to test questions and suggest sensitising concepts for an unbiased interview guide. Methods: Five cancer patients with self-reported CF were purposively sampled and interviewed between September 2007 and March 2008 by a trained interviewer to discuss their CF experiences. Verbatim transcripts were coded by two researchers using qualitative data analysis software and reviewed for consistency and reliability. Data were analyzed using a constant comparison method. Results: Patients were diagnosed with cancer on average 3.5 years ago among the following primary sites: breast (n = 2), lung, colorectal, and prostate/liver. Patients provided 14 terms to describe CF: “tired” and “lack of energy” were the most commonly reported. Patients described CF as a general lack of ability to do anything, a child-like regression, and indicated that current “tiredness” differed from pre-diagnosis tiredness. Patients also described CF in terms of frequency (i.e., duration, onset, recurrence) and intensity and identified treatment as a trigger of fatigue. Patients understood the word “fatigue,” but rarely mentioned it spontaneously. Additionally, patients mentioned that CF was not relieved by rest and impacted several areas of their lives, including activities of daily living and cognitive and emotional functioning. Conclusions: Patients’ experience with CF differs from pre-diagnosis tiredness in terms of intensity, duration, onset, and impact. These results helped to refine the interview guide and provide insight for future interventions. Further research with patients with different cancer types and stages is needed to develop a comprehensive conceptualization and measurement of CF.

[Table: see text]