bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of pectoralis muscle area and survival outcomes after chemotherapy.
Authors: Gu Christina , Wiederin Jason , Jewett Patricia , Blaes Anne Hudson 
Published: May 2020

e24094 Background: Chemotherapy use may be associated with muscle wasting, a marker of frailty that can predispose individuals to poor outcomes. We assessed the association between pre-treatment pectoralis muscle area and overall mortality following chemotherapy. Methods: We identified individuals diagnosed with breast cancer (N=221), lymphoma (N=216), or sarcoma (N=115) who received chemotherapy at the University of Minnesota Masonic Cancer Clinic and had CT scans prior to chemotherapy 2009-2014. Using CoreSlicer, right pectoral muscle area was measured at baseline and indexed to body surface (right pectoralis muscle area [cm2] / body surface [m2]) and divided into quartiles. Restricting to individuals who started chemotherapy within 6 months after their CT, we used cox regression (adjusted for age, sex, cancer type, stage, ever-smoking, BMI, and chemotherapy type) to assess associations between baseline muscle area and overall survival, testing for nonlinear effects using cubic splines. Results: 536 individuals (66% female) were identified who were treated with anthracyclines based chemotherapy (N=408), Trastuzumab (N=64), or both (N=64). Mean baseline muscle area was 14.9 (4.6) cm2 in females and 26.3 (9.3) cm2 in males. Median follow-up was 4.6 years. Larger baseline pectoralis muscle area (per m2 body surface) was associated with improved survival (adjusted model, overall effect, P=0.01), with some nonlinear effects (P=0.05). With muscle area (per m2 body surface) categorized as quartiles, individuals in the 3rd and 4th quartiles were at lower risk of dying (compared with people in the 1st quartile, hazard ratios 0.59 and 0.55 respectively, 95% CI range 0.35-0.90, P=0.01). There were no differences comparing the 4th vs the 3rd quartile (P=0.79), or the 2nd vs the 1st quartile (P=0.5). Conclusions: We found a protective association between larger right pectoral muscle size (relative to body surface) and overall survival after chemotherapy. There may be ceiling and threshold effects given evidence for nonlinear effects, since neither the 2nd vs. 1st quartile, nor the 4th vs. 3rd quartile comparisons in the categorical model were significant. Hazard ratios and confidence intervals of overall mortality by pectoral muscle area at baseline indexed to body surface, N=536, 2009-14. [Table: see text]
Trajectories of sexual dysfunction and its risk factors in women with gynecologic cancer across radiation therapy and healthy controls.
Authors: Bai Jinbing , Tsementzi Despina , Patel Pretesh R. , Shelton Joseph W , Dolan Mary , Arluck Jessica , Bruner Deborah 
Published: May 2020

e24097 Background: Women with gynecological cancer (GynCa) reported an increased risk for acute and long-term sexual dysfunction across cancer treatments, especially radiation therapy (RT). However, limited data exist on the course of sexual dysfunction across RT and its risk factors are unknown. This study sought to characterize women’s sexual dysfunction trajectories and identified risk factors of persistent sexual dysfunction. Methods: Using a longitudinal study design, patient-reported sexual dysfunction, demographic and clinical data were collected. Women receiving RT for GynCa older than 18 years or age, race, and BMI matched healthy controls were enrolled. Female Sexual Function Index (FSFI) was used to assess women’s sexual dysfunction. Patients completed all the questionnaires pre-RT, at the end of RT, 6- and 12-month post-RT. Group-based trajectory modeling was used to identify trajectories of sexual dysfunction and risk factors of persistent sexual dysfunction. Results: Eighty-two patients were analyzed, including 36 GynCa patients receiving RT and 46 healthy post-menopausal women, comprising of 33 Blacks, 44 Whites, and 5 others. Three trajectory groups of sexual dysfunction (total FSFI score) were identified: low risk (17.4%), moderate risk (12.3%), and high risk (70.4%). All three trajectory groups were significantly different from each other (p<0.01). Similarly, three trajectories were identified for each of six FSFI domains: desire (low [6.3%], moderate [62.5%], high [31.2%], p<0.01); arousal (low [38.1%], moderate [46.4%], high [15.4%], p<0.01); lubrication (low [49.7%], moderate [44.6%], high [5.7%], p<0.01); orgasm (low [43.8%], moderate [31.3%], high [24.9%], p<0.01); pain (low [25.5%], moderate [64.2%], high [10.3%], p<0.01); and satisfaction (low [8.3%], moderate [61.4%], high [30.3%], p<0.01). Risk factors of sexual dysfunction were high pH (p=0.007) and without chemotherapy (p=0.019). Young women had more arousal (p=0.011); high education level was associated with high arousal (p=0.039); low pH was associated with high arousal (p=0.018) and orgasm (p=0.036). No risk factors were found for desire and satisfaction domains. BMI, surgery, and study cohort (cancer vs healthy) were not predictors of sexual dysfunction trajectories. Conclusions: This study identified three trajectories of sexual dysfunction. Low education, high pH, no chemotherapy, and elder women were risk factors of severe sexual dysfunction. Sexual dysfunction interventions should address these risk factors.
Violence and chronic pain in cancer patients in northeastern Mexico.
Authors: Alcorta-Garza Adelina , Alcorta-Nuñez Fernando , Alcorta-Garza Antonia Gloria , Gonzalez Guerrero Juan Francisco , Gonzalez-Alcorta Celia Beatriz , Montiel-Labastida Jan Alejandro , Garza-Rodriguez Maria Lourdes , Vidal-Gutiérrez Oscar ,   Adelina Alcorta-Garza
Published: May 2020

e24113 Background: Chronic cancer pain generates fear and anguish in cancer patients. It is suffered by 64% of patients with metastatic or terminal disease, 59% of patients in early and intermediate stages, and 33% of patients cured from cancer. They require a psychosocial support network. This network has been proposed as an essential tool to reduce the negative impact of the symptoms and psychosocial implications of cancer on the quality of life of patients. Patients with dysfunctional family networks can add to the pain of suffering cancer when they suffered or suffer violence. Cancer and pain test all personal resources and the patient's support network where family functioning is capital for quality of life. Methods: Descriptive, comparative and correlational study. A sample was taken for convenience with the prior consent of the patients who attend the outpatient clinic of the Pain Clinic of the Oncology Service, of the University Center Against Cancer of the University Hospital “Dr. José Eleuterio González” in Nuevo León. The questionnaires were applied during a session of 25 to 30 minutes. It was requested to answer the scales to assess the level of intra-family functioning, intra-family violence, quality of life, measuring psychosocial and health variables; as well as for the detection of the type and quality of psychosocial support perceived by the subjects. Results: A total of 207 research subjects were included in the study, the average age was 49 years of age (minimum 12, maximum 81 years of age), 23% men and 77% women. Marital status: married 52%, home-based 63%; monthly income less than $120 USD (n = 75, 37%). The quality of life index and chronic cancer pain had a high linear correlation with the variables of family violence, psychosocial support, family functioning, somatic symptoms, among other variables studied. Fatigue was the symptom most frequently associated with the decrease in the quality of life index. Conclusions: The satisfaction of perceived social support is a factor associated with the quality of life in patients with chronic cancer pain, however, the number of caregivers is not. There was no relationship between the size of the network and satisfaction with it. Also, the symptoms associated with chronic cancer pain affect the quality of life, identity, social functionality and roles, which in turn impact the quality of life perceived by the patient. This study supports our comprehensive intervention programs and new protocols to promote the quality of life of cancer patients.
Patterns of inpatient palliative care consultation for patients with brain and spine metastases.
Authors: Howell Elizabeth , Price Meghan , Dalton Tara , Williamson Theresa , Kamal Arif , Goodwin Rory 
Published: May 2020

e24117 Background: Patients diagnosed with brain and/or spine metastases (BSM) face high symptom burden and complex clinical decision-making. Through expertise in pain and symptom management, facilitation of end-of-life planning, and caregiver support, specialty Palliative Care (PC) can provide a crucial component of the care for these patients. No prior study has formally evaluated the rates of inpatient PC referral in BSM patients, nor the patient-specific factors that may affect consultation rates within this context. Methods: Analysis was performed of the rates of PC consults in a cohort of BSM inpatients admitted to three tertiary medical centers: one major academic center and two smaller affiliate centers. Patients were identified using a combination of ICD-9 and -10 codes and surgical provider lists to aggregate brain and spine metastases patient cohorts at each institution. Patient demographics, surgical status, and readmission data were collected. PC utilization was assessed by flagging encounters within which an inpatient consult to PC was placed. Results: 2608 total discharges were analyzed, with 2397 brain metastasis and 301 spine metastasis discharges. Average rate of inpatient PC consultation over the 3.5 year study period was 13.6% for brain metastasis patients and 11.0% for spine metastases patients. Rates of PC utilization differed significantly by patient race (11.6% in white vs. 17.0% in non-white patients, p = 0.02). Patients who received surgery had significantly lower rates of PC consultation in both brain (3.5% vs 15.6%, p < 0.001) and spine (5.5% vs 14.1% p < 0.001) cohorts. The large academic center had the lowest utilization as compared to two smaller affiliate centers, with 6.4% of brain and 7.6% of spine metastasis patients receiving PC consults. For both cohorts, Neurology was the discharging service with the highest rates of PC utilization, consulting PC for 37.7% of brain and 42.9% of spine metastasis patients respectively. Over time, PC utilization increased for brain, but not spine, metastasis patients. Conclusions: Despite their high symptom burden and low overall survival, BSM patients have low rates of inpatient PC consultation. Utilization appears to vary by patient demographics and surgical status, as well as discharging service and practice setting. These single-institution patterns may ultimately provide a microcosm for national patterns and trends at similar institutions, and further work is needed to identify the specific barriers to optimally utilizing specialty PC in this population.
Early referral to palliative care: Where are we in Brazil?
Authors: Santos Andre Filipe Junqueira , Monteiro Aurélio , Duarte Carolina Sarmento , Silva Carolina Gomes Jacobina , Gomes Sarah Ananda , Vieira Clarissa Miranda 
Published: May 2020

e24118 Background: The American Society of Clinical Oncology (ASCO) recommends that patients with advanced cancer receive dedicated palliative care services concurrently with active treatment within 8 weeks of diagnosis and maintaining follow up for at least 12 weeks. The adherence to these standards in Brazil is unknown. Objective: To evaluate adherence to ASCO recommendations of early referral to a palliative care team at a multicentric outpatient oncological clinic in Brazil using the following indicators: (i) whether patients were enrolled in palliative care services within 8 weeks of diagnosis and (ii) whether patients were followed up for a minimum of 12 weeks. Methods: All palliative care physicians within a network of 15 outpatient oncology clinics (Oncoclinicas Group) prospectively recorded time to care post-diagnosis with advanced cancer by ASCO guidelines and duration of follow up time throughout the 1-year duration of the study. The number of patients enrolled in care within 8 weeks of diagnosis and followed for at least 12 weeks was recorded. An initial goal of adherence was set at 50% for each indicator. Results: Of 1016 patients, we studied 579 data numbers. 26% of patients were referred within 8 weeks of their advanced cancer diagnosis and 23% were followed for 12 weeks or more. Conclusions: These data indicate that even with a recognition of ASCO recommendations for timely palliative care referral, patients in Brazil are often seeing palliative care teams too late. The possible main causes of this late referral in Brazil are: (i) lack of adequate knowledge about the real meaning of palliative care and (ii) a lack of understanding of how a multidisciplinary team acts positively in the patient's experience. We believe that the best way to change this reality is through continuing education about Palliative Care, reinforcing the intention of continuous care: strengthening bonds, facilitating communication, reaching better symptoms control and practicing patient-centered care.
Changes in physical activity from pre-diagnosis to first five years post-diagnosis: A prospective cohort study in Chinese breast cancer patient.
Authors: Lei Yuanyuan , Yeo Winnie , Ho Suzanne C. , Cheng Ashley Chi Kin , Kwok Carol 
Published: May 2020

e24121 Background: The diagnosis of cancer can motivate patients to change their physical activity habits. No data has reported level of physical activity before and after breast cancer diagnosis in Chinese women. Methods: In an on-going prospective cohort study which involved 1462 Chinese women with early-stage breast cancer, a validated modified Chinese Baecke questionnaire was used to assess physical activity at baseline, 18-, 36- and 60-month after diagnosis. At baseline, patients recalled their habitual physical activity in the preceding 12 months before cancer diagnosis. At 18-, 36- and 60-month follow-up, patients reported their habitual physical activity over the previous 12 months. The level of physical activity at post-diagnosis was defined as the average value assessed at 18-, 36- and 60-month follow-up. Results: Breast cancer patients significantly increased level of physical activity, with median value of 0.6, 5.3, 4.4 and 3.9 MET-hours/week at baseline, 18-, 36- and 60-month follow-up. The average level of physical activity at post-diagnosis was also significantly higher than that at pre-diagnosis ( P < 0.001), with median value of 5.8 MET-hours/week. However, there was no significant difference between any two follow-ups at post-diagnosis. The proportions of participant who met the exercise recommendation (according to WCRF/AICR, 10 MET-hours/week) were low at pre- and post-diagnosis, being 20.7% and 35.1%, respectively. Compared to pre-diagnosis, most of the patients improved or had no change on level of recreational physical activity at post-diagnosis, with the respective proportion being 48.2% and 43.8%. Multivariate analysis showed that higher increase in physical activity after cancer diagnosis was observed among breast cancer patients who were married or cohabitation, unemployed (compared to full time) and had no comorbidity (compared to patients who had one comorbidity). Conclusions: Chinese breast cancer patients reported significant and long-term changes in physical activity after cancer diagnosis, which was in line with current recommendation. However, the proportion of patients who met the exercise recommendation for cancer survivors was still low. Empowering patients on the importance of durable high level of physical activity in breast cancer survivorship is warranted.
Developing survivorship services in Ghana and Tanzania.
Authors: Dharsee Nazima Jaffer , Addai Beatrice W , Murray Lisa , Shewbridge Amanda , Aresu Maria , Stanway Susannah Jane , Small Sheila , o'Gara Geraldine , Wiafe Seth A , Wiseman Theresa 
Published: May 2020

e24132 Background: The incidence of breast cancer is increasing in low- & middle- income countries (LMICs). Alongside attempts to reduce the disparity in cancer survival between high-income countries (HIC) & LMICs, it is important that survivorship is well understood and managed in an evidence based, resource and culturally sensitive manner. This project aimed to develop knowledge, skills and services concerning living with and beyond breast cancer primary treatment. Methods: This 3-phase study used mixed methods. Phase 1 used participant observation and focus group interviews (FGIs) to scope experience, resources, current practice, and challenges to implementing a recovery package. In Phase 2 nurses used the adapted Holistic Needs Assessment (HNA) with 500 women in Tanzania and Ghana, who were also offered a recovery care plan and treatment summary following their breast cancer primary treatment. Data was entered into a macro database & analysed using descriptive statistics. Phase 3 was the development of a culturally sensitive “Foundations in Cancer Care” training toolkit for nurses. The toolkit was based on a “train the trainer” model and included slides, an existing palliative care toolkit and exercises. The training programme consisted of 5 days teaching covering theory and practice. Data collection included: Initial FGIs to ascertain learning needs, confidence in knowledge & skills, assessed pre & post teaching course, and course evaluation. Data were analysed using descriptive statistics. Results: In Phase 1 six themes were identified concerning experience of breast cancer which included cultural beliefs & practices and access to treatment & support. Phase 2 data from Tanzania showed a similar level of unmet need at the end of treatment to a previous similar published analysis from the UK. Data from Ghana showed a much higher level of unmet need. Evaluation following Phase 3 showed a positive change in nurses’ confidence in their knowledge. Conclusions: This mixed methods three-phase study has documented experience, resources and current practise around breast cancer survivorship in two African centers treating breast cancer. The feasibility of using HNA to identify unmet needs in these women has been demonstrated and needs the identified. Results from the HNA informed a training toolkit which was implemented and positively received and could be adapted for use in other LMICs.
Growth differentiation factor 15 (GDF-15) as a key regulator of cachexia induced by platinum-based chemotherapy.
Authors: Breen Danna , Beaumont Kevin , Bennett Donald , Brosnan Julia , Calle Roberto A , Chabot Jeffrey , Collins Susie , Esquejo Ryan , Joaquim Stephanie , Joyce Alison , Kim Hanna , Lin Laura , Pettersen Betty A , Qiao Shuxi , Rossulek Michelle I , Walters Karen , Weber Gregory , Wu Zhidan , Zhang Bei Betty , Birnbaum Morris J 
Published: May 2020

e24162 Background: Platinum-based drug use in cancer treatment is restricted by dose-limiting side effects, including nausea/emesis, anorexia and weight loss that reduce patient quality of life and limit treatment adherence. Cisplatin increases GDF-15, a cytokine that induces aversion, anorexia and weight loss in preclinical models. GDF-15 signals through the hindbrain receptor glial cell-derived neurotrophic factor receptor alpha-like (GFRAL) and cisplatin-induced weight loss was attenuated in a GFRAL knockout mouse. Methods: In the current study, using mouse and/or nonhuman primate models, we examined whether GDF-15 inhibition via a potent and selective monoclonal antibody (mAB1) prevents platinum-induced emesis, anorexia, weight loss, with increased survival. Results: Circulating GDF-15 levels in NSCLC and colorectal cancer were higher (~1.5 fold) in patients on platinum therapy compared to non-platinum-based therapy. Higher levels of circulating GDF-15 were also associated with greater weight loss in colorectal cancer patients prior to receiving FOLFOX as part of cancer treatment. In wildtype mice, cisplatin, oxaliplatin and carboplatin each increased circulating GDF-15 (≥ 5-fold) and induced anorexia, skeletal muscle wasting, and weight loss. These effects were prevented in GDF-15 knockout mice, however only a partial blockade of carboplatin was observed. The GDF-15 neutralizing efficacy of mAB1 was confirmed by reversing AAV-GDF-15-induced weight loss in wildtype mice. In nonhuman primates, cisplatin treatment for 5 days (96% of the daily recommended clinical dose) also increased circulating GDF-15 ( > 5-fold), and induced anorexia and emesis. Treatment with mAB1 resulted in no detectable circulating levels of free GDF-15 and attenuated both cisplatin-induced anorexia and emesis. In a mouse cachectic tumor model (subcutaneous; NSCLC patient derived xenograft), cisplatin inhibited tumor growth; however, GDF-15 levels remained elevated and additional weight loss occurred compared to control. When mAB1 was given in combination with cisplatin, weight loss was reversed and tumor growth inhibition was maintained, resulting in greater survival compared to cisplatin alone. Conclusions: Taken together, these data support that GDF-15 inhibition with mAB1 holds the potential as an effective therapeutic approach to alleviate GDF-15 mediated emesis, anorexia and weight loss, with the aim to enable optimal cancer treatment as well as to improve patient quality of life and potentially survival.
Pastoral care of cancer patients: Defining utilization of services at a comprehensive cancer center.
Authors: Palmer Elizabeth , Paredes Anghela , Hyer Madison , Pawlik Timothy M. 
Published: May 2020

e24171 Background: Addressing the religious/spiritual needs of patients is an important component of comprehensive cancer care. Patients often report that providers infrequently engage them about their needs during treatment. In addition, providers cite inadequate training as a significant barrier to providing spiritual care. While patients may benefit from the presence of a spiritual care specialist during cancer treatment, the utilization and content of these services are not well defined. We sought to characterize utilization of pastoral care (PC) services, as well as delineate differences in PC utilization among patients with cancer. Methods: Data on patients being treated for cancer at a Comprehensive Cancer Center between 2015-2018 were obtained from the electronic medical record. Overall utilization, type of PC services utilized, as well as factors associated with use of PC were assessed. Analyses included descriptive statistics and logistic regression. Results: Among 14,322 cancer patients, roughly one-third (n = 5166, 36.1%) had at least one PC encounter during their cancer treatment. Interventions most frequently provided by PC included supportive presence (93.5%) and active listening (86.6%), while the most frequently explored topics were treatment expectations (59.8%), issues with faith/beliefs (42.9%), and available coping mechanisms (35.4%). Patients diagnosed with colorectal (OR:1.42, 95%CI:1.07-1.89), liver (OR:2.41, 95%CI:1.80-3.24), or pancreatic cancer (OR:1.43, 95%CI:1.02-2.00) were more likely to utilize PC services compared with other cancers. Patients that identified as Catholic (OR:1.47, 95%CI:1.17-1.84) or Christian (OR:1.73, 95%CI:1.39-2.15) were more likely to request PC services (both p < 0.001) than individuals who had no religious preference/affiliation. Among surgical patients (n = 1,174), the majority of encounters with PC services were in the postoperative setting (n = 801, 70.6%). Patients most often reported that PC helped with verbalization of their feelings (93.6%) and helped reduce stress (76.9%). Conclusions: Over one-third of patients with cancer interacted with PC and received services that often addressed both psychosocial and spiritual concerns. Overall PC utilization and types of PC services rendered varied relative to demographic and religious factors. Providers should be aware of varying patient religious/spiritual needs so as to optimize the entire cancer care experience for patients.