bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of compliance in colposcopy clinic follow-up among the uninsured
Authors: Wenzel L. , Chase D. , Hawk J. , Osann K. , Tewari K. 
Published: August 2020

e20511 Background: Despite successful screening programs for cervical cancer, ethnic disparities persist. The no-show rate for follow-up appointments after HPV-related abnormal pap smears approximates 50% in high risk populations. We sought to identify factors that may influence follow-up compliance in a multi-ethnic, low income population at risk for cervical cancer. Methods: A longitudinal cohort study was conducted by chart review for all patients identified as having had a colposcopy exam for HPV-associated cervical dysplasia at a southern California inner city clinic from 2006 to 2007. Compliance was defined as obtaining a pap smear within 3 to 14 months from the initial colposcopy. The following variables were evaluated in a multivariate logistic regression model to identify factors which predicted follow-up compliance: race, age, preferred language, insurance, income, marital status, cytology, histology, history of a LLETZ, and pregnancy status. Results: During the study period, 438 patients attended the colposcopy clinic. This approximates 52% of the 912 scheduled clinic appointments during 2006. Patients’ median age was 28 years, 41% were Spanish speaking, with an estimated median income of less than $20,000 for half of the sample. Approximately 71% of patients had temporary publically-funded insurance. Only 55% (239/438) returned for recommended follow-up pap smear. In univariate and multivariate analysis, neither language, Spanish surname, median income, age, histology, nor insurance status predicted adequate follow-up (p=ns). A history of having undergone a large loop excision of the transformation zone (LLETZ) was the only factor which significantly predicted compliance with recommended follow-up pap smear (OR=1.76; 95% CI 1.08–2.895). Conclusions: Follow-up compliance for this high-risk, low income population is very poor. Identifying factors which predict noncompliance could inform strategies to improve care. In this analysis a history of LLETZ was the only variable which predicted whether follow-up care occurred as recommended. Results suggest that intensive, culturally-sensitive colposcopy clinic-based educational interventions should be developed and evaluated. No significant financial relationships to disclose.
Treatment of chemotherapy-induced breakthrough nauea and vomiting
Authors: Navari R. M. , Gray S. E. 
Published: August 2020

e20536 Background: Patients may experience breakthrough nausea and vomiting (BNV) despite adequate prophylaxis for chemotherapy-induced nausea and vomiting (CINV). BNV presents a difficult situation as treatment of ongoing nausea and vomiting is challenging. We investigated three different drug classes for the treatment of BNV: phenothiazines (prochlorperazine)(Pro), dopamine-serotonin receptor antagonists (metoclopramide) (Meto), and a corticosteroid-thiobenzodiazepine combination (dexamethasone plus atypical antipsychotic olanzapine) (Dex-Olan). Methods: Adult patients, receiving moderately emetogenic chemotherapy and CINV prophylaxis with a 5-hydroxytryptamine-3 receptor antagonist and Dex pre-chemotherapy and Dex post-chemotherapy according to ASCO guidelines, who experienced BNV during the five days post-chemotherapy were randomized to receive Pro, 10 mg IV, and 10 mg, po, bid for three days; Meto, 20 mg IV, and 10 mg, po, bid for 3 days; or Dex, 20 mg IV and Olan, 5 mg, po, bid for three days. All patients also received at least one liter of IV fluids during the IV phase of their treatment. Patients were excluded if they had undergone rescue therapy with any of the study agents. Beginning with the first day of treatment for BNV (day 1) and daily through day 5, patients recorded episodes of vomiting/retching, nausea, other symptoms utilizing the M.D. Anderson Symptom Inventory, and the utilization of any additional rescue therapy. One hundred six patients (median age 61, range 37 - 85, 60 males, ECOG performance status ≤ 2) consented to the protocol and 100 were evaluable. Results: A complete response (no emesis, no additional rescue) for the five days post-initiation of BNV treatment was recorded for 7 of 35 patients (20%) in the Pro regimen, 12 of 33 patients (36%) receiving the Meto regimen, and 21 of 32 patients (66%) receiving the Dex-Olan regimen. There were no Grade III or IV treatment related toxicities. Conclusion: The combination of Dex-Olan was an effective treatment for BNV and was significantly more effective than Pro or Meto alone. No significant financial relationships to disclose.
Evaluating the use of cardiac biomarkers for early detection of chemotherapy induced cardiotoxicity: A pilot study in a minority population
Authors: Bahekar A. , Grewal P. D. , Monga V. , Bhuriya R. , Molnar J. , Khosla P. 
Published: August 2020

e20546 Background: Doxorubicin and trastuzumab are associated with characteristic Type I and Type II cardiomyopathy. As breast cancer survival improves and concern about long-term cardiotoxicity grows, we will need appropriate markers to detect cardiotoxicity before measurable myocardial systolic dysfuntion. Recent data and several guidelines suggest that Troponin-I and B-type natriuretic peptide (BNP) may serve as cardiac biomarkers for early detection of cardiotoxicity. This study seeks to evaluate feasibility and utility of these markers in an outpatient oncology clinic setting. Methods: As a quality care initiative in a high risk minority patient population for cardiac disease, 55 consecutive patients who received doxorubicin and/or trastuzumab for the treatment of breast cancer had serum Troponin-I and BNP measured prior to each dose of doxorubicin, and every three months on trastuzumab. All patients also had normal baseline left ventricular ejection fraction (≥ 50%) measured by MUGA scan. IRB approval was obtained and medical records were reviewed independently by two authors. Results: Of the 55 patients, two did not have adequate data; 58% of patients received dose dense doxorubicin; 15% of patients received trastuzumab. Significantly more number of patients had troponin-I rise as compared to BNP. Total 7 (13%) patients had abnormal LVEF by MUGA scan following chemotherapy. Five (71%) of these patients had rise in Troponin-I/BNP. Negative predictive value of biomarkers was 91%, with sensitivity of 71% and specificity of 44%. Conclusions: Use of standard cardiac biomarkers to detect early cardiotoxicity is feasible with a high negative predictive value for Troponin I and BNP in the first 90 days following chemotherapy with doxorubicin and/or trastuzumab. Patients with normal markers may not need intense cardiac monitoring. [Table: see text] [Table: see text]
Physical and mental health correlates of pregnancy following breast cancer
Authors: Gorman J. , Roesch S. , Pierce J. , Parker B. , Madlensky L. , Saquib N. , Newman V. 
Published: August 2020

e20552 Background: The possibility and safety of pregnancy after breast cancer is an important issue for many younger breast cancer survivors and their health care providers. Current research does not indicate that survival is negatively affected by pregnancy. However, the “healthy mother bias”, suggesting that survivors who go on to become pregnant are a self-selected healthier group based on their prognosis, has led to cautious interpretation of these findings. No studies have systematically evaluated the potential for this bias. Methods: This nested case-control study includes 81 participants, age 40 or younger at diagnosis, from the Women's Healthy Eating and Living Study (WHEL) (N=3,088). Our sample includes 27 cases who went on to have a child after breast cancer and 54 controls, matched on age and stage at diagnosis, who did not. We used hierarchical linear modeling to accommodate longitudinal data with individuals nested within matched sets (cases and controls). The primary aim was to evaluate the association between summary scores of health and successful pregnancy after breast cancer. The outcome variables, physical health summary score (PHSS) and mental health summary score (MHSS), were taken from the RAND 36 item health survey (SF-36). Covariates were added for adjustment and to improve model precision. Results: Controlling for other variables in the model, mean PHSS were not different among cases compared to controls (B=0.14, p=0.96) (n=152). MHSS were marginally higher among cases (B=6.40, p=0.08), as compared to controls (n=154). This difference is considered clinically significant. Conclusions: While based on a small sample size, this preliminary study did not find evidence of a healthy mother bias based on scores of physical health. However, mental health was marginally better among those who went on to have a child, indicating that the role of mental health should be evaluated in future research. No significant financial relationships to disclose.
The role of cancer Nurse coordinator in foregut malignancy: Workload and costing considerations in the Australian setting
Authors: Wade F. M. , Pavlakis N. , Receveur I. , Leibman S. , Smith G. S. 
Published: August 2020

e20559 Background: Foregut (esophageal and gastric) malignancy (FM) encompasses a number of diseases with poor outlook and complex and often morbid treatment. In keeping with world wide trends, the investigation and management of patients with FM is undertaken in the context of a multidisciplinary group consisting medical, nursing and paramedical specialists. Crucial to the delivery of co-ordinated and compassionate care is the Cancer Nurse Co-ordinator (CNC). Further, the CNC is pivotal in ensuring that benchmarks regarding intervals from diagnosis, to multidisciplinary assessment to treatment commencement are met. The aim of this study was to quantify the workload of the CNC in a newly established esophagogastric surgical unit. Methods: Clinical data and data regarding workload of the CNC in our unit was recorded prospectively. Results: Of 218 patients with newly diagnosed FM referred to our unit between November 2005 and December 2008 198 (91%) were seen by the CNC. The number of cancers arising from the esophagus or esophagogastric junction was 135 (62%), stomach 78 (36%) and small bowel 5 (2%). The interval between CNC referral and initial contact was 4 days (range -13 to 40 days) and 89 (45%) patients were seen at the initial consultation with the surgeon. The mean number of CNC contacts with individual patients was 18 (range 1–76), comprising 9 (range 0–42) face to face consultations, 9 (range 0–58) telephone contacts and 0.2 (range 0–14) email contacts. Referrals to other support services were made for 164 (83%) patients with an average of 1 referral made per patient. This workload was carried out over 29 hours per fortnight at $43 AUD per hour. The average cost per patient with FM cared for by the CNC was $491 AUD ($349 USD). Conclusions: The complex care of patients with FM is augmented by the presence of a specialist CNC. The resource requirement for CNC funding is a small proportion on the costs of overall patient treatment and represents a prudent use of finite health care resources. No significant financial relationships to disclose.
Can adjuvant homeopathy improve the control of post-chemotherapy emesis in breast cancer patients? Results of a randomized placebo-controlled trial
Authors: Ray-Coquard I. L. , Provençal J. , Hardy-Bessard A. C. , Bachelot T. , Coeffic D. , Jacquin J. P. , Guastalla J. P. , Agostini C. , Pivot X. , Bajard A. , Pérol D. 
Published: August 2020

e20566 Background: Homeopathy used as an adjunct in the treatment of chemotherapy (CT)-induced emesis has rarely been evaluated. Methods: Patients with non-metastatic breast cancer treated with 6 courses of FAC 50, FEC 100 or TAC chemotherapy were randomized to Cocculus/nux vomica/tabacum/petroleum extract (Cocculine, C) or Placebo (P) in a multicentric comparative double-blind phase III study. Anti-emetic treatment was standardized (corticoids + ondansetron). Patients were evaluated after each course. The primary endpoint was nausea measured after the 1st CT course using the FLIE (Functional Living Index for Emesis) with 5-day recall. The planned sample size was 396 evaluable patients based on a minimum expected difference in mean of 0.5 ± 1.6 on a scale from 1 (a lot) to 7 (not at all) with 5% two-sided α error and 85% power. An intent-to-treat analysis was planned. Secondary evaluation criteria were: vomiting measured by the FLIE score, patient self-evaluation (EVA) and investigator recording (NCI-CTC) of nausea and vomiting intensities, and compliance. Results: From September 05 to January 08, 431 patients were randomized (217 to P and 214 to C). Patient characteristics were well balanced between groups. Median age was 53 years, 35% of the patients experienced nausea or vomiting. In total, 403 patients (93.5%) were assessable for the primary endpoint, with few nausea episodes (FLIE nausea scores after the 1st CT course were 6.02 and 6.07 for P and C, respectively) and very good compliance (81% patients complied with the protocol). Adverse events related to nausea occurred in 51% vs. 47% of the patients treated with P and C, respectively (p = 0.48). FLIE and NCI-CTC vomiting scores were similar between the 2 arms (6.91 vs. 6.88, p = 0.47, and 20% vs. 21%, p = 0.73, for P and C, respectively). Grade II-III nausea occurred in 17.6% and 15.7% of patients receiving P and C (p = 0.62). Conclusions: No benefit of homeopathy over standard treatment was noted in this study. But surprisingly we observed lower rates of nausea and vomiting measured by patients and by investigators, than in other studies using identical chemotherapy regimens. The observation and management of emesis could modify the perception and rate of such adverse events. No significant financial relationships to disclose.
Feasibility study of neurocognitive assessment of melanoma patients treated with adjuvant interferon
Authors: Combs D. , Baker A. , Fu J. , Herring A. , Jeter J. , Cranmer L. 
Published: August 2020

e20567 Background: Interferon α-2b (IFN) is the only approved adjuvant therapy for patients diagnosed with high-risk melanoma. Cognitive and mood alterations have been consistently reported during IFN therapy. Rigorous documentation of the magnitude and duration of these changes is lacking. Here, we assess the feasibility of conducting a quantitative study of such effects. Methods: We enrolled patients with at least stage 2B melanoma who were eligible to receive adjuvant IFN. Controls were those IFN-eligible, but not receiving it or those with unresectable melanoma eligible to receive dacarbazine-based chemotherapy (DTIC). Six cognitive function tests were administered: mini-mental status exam (MMSE), Hopkins Verbal Learning Test-Revised (HVLT), controlled oral word association, Ruff 2 and 7 (R27), Trail Making Tests A and B, and the Profile of Mood States-Short Form (POMS). Test results were compared at baseline and after the high-dose phase of IFN, 1–3 months of observation, or first cycle of chemotherapy. Results: A supervising neuropsychologist trained personnel in study instrument administration. Fourteen patients (4 IFN, 8 Obs., 2 DTIC) were seen for a total of 26 testing visits. Study visits lasted 30–40 minutes, and were coordinated with patient clinic schedules. Interpretable test results were obtained in 98% of 144 instrument administrations. Three unrelated administration errors occurred. Differences between observation and IFN patients were seen in the MMSE, HVLT, R27 and POMS, but were not statistically significant. Based on our HVLT data, a total of 17 subjects per arm are required to demonstrate a statistically significant difference (alpha=0.05, beta=0.10). Conclusions: Our pilot results indicate that administration of this test battery is feasible in this population and is a promising tool to quantify adverse cognitive effects of IFN therapy. Such baseline data will allow development of measures to mitigate such effects. [Table: see text]
Early switching from morphine to methadone plus acetaminophen in the analgesia of oncologic patientes: A randomized, double-blind, placebo-controlled study
Authors: Cubero D. I. , David Filho W. J. , del Giglio A. 
Published: August 2020

e20579 Background: The objective of this study is to evaluate the efficacy of methadone as substitute for morphine and to investigate if the addition of acetaminophen could reduce the time to attain an equianalgesic methadone dose and to improve the level of analgesia of oncologic patients. Methods: Fifty patients in regular use of morphine with a stable dose for at least 1 week were submitted to the sudden change of this opioid for methadone and randomized in a double blind way to receive acetaminophen (750 mg PO every 6 hours) or placebo for a 7-day period. Data regarding level of pain and side effects were collected and a quality of life questionnaire (QLQ-C30) was applied. Results: Substitution of morphine for methadone resulted in improvement of the toxicity profile with reduction in obstipation (p < 0.001) and xerostomia (p = 0.03). There was improvement in the Numeric Pain Scale (p = 0.03) as well as a significant improvement in the functional level and symptomatology according to the QLQ-C30 questionnaire. Addition of acetaminophen did not reflect improvement in analgesia and also reduction in time of stabilization of methadone doses. At the end of the study most patients (70.8%, p 0.001) preferred to continue with methadone instead of returning to morphine. Conclusions: Early switching from morphine to methadone showed to be safe and efficient in the reduction of side effects improvement of analgesia allowing a comfortable dosage at a lower cost. In this scenario the association with acetaminophen did not reflect improvement of analgesia or reduction in time for equianalgesia. No significant financial relationships to disclose.
Lifestyle modifications including complementary and alternative medicine and quality of life among women at high risk for breast cancer
Authors: Malaka D. O. , Lee R. , Lewin R. , Cummings S. , Curlin F. , Bradbury A. , Olopade O. 
Published: August 2020

e20583 Background: Breast cancer (BC) patients commonly employ lifestyle modifications (LM) such as complementary and alternative medicine (CAM), but limited information exists among women who are high risk for BC (HRBC). This study's aims were to estimate the prevalence of LM use among HRBC patients, describe communication patterns, and determine correlations with quality of life (QoL) measures. Methods: Women enrolled in a multi-modality screening study for HRBC patients (≥20% lifetime risk) were distributed a questionnaire asking about the use of CAM therapies and other LM, timing of use, reasons, costs, and communication patterns. QoL measures included the Short-Form 36 (SF-36) and Beck Depression Inventory (BDI). Demographic variables and those instruments with significant correlations (p<0.05) were included in a multivariate model. Results: A total of 173 HRBC patients are enrolled on this study and 123 have completed the survey. General characteristics of these women include a median age of 45 years, 91% Caucasian, 30% have a gene mutation (e.g. BRCA1/2), and 33% have had breast and/or ovarian cancer. Ninety-nine percent reported a lifetime prevalence of LM and CAM, and nearly half of subjects (48%) did so for cancer-related reasons. The most popular LM were exercise (83%), massage (68%), yoga (44%), vitamin E (38%), and chiropractic medicine (36%). The most common cancer-related changes were low fat diet (15%), exercise (11%), and meditation (10%). Half of subjects (48%) did not discuss any of these LM with their physicians, and the most common reason was their physician did not ask. In the multivariate model for cancer-related LM, subjects having a history of BC or ovarian cancer were 6.2 times (p<0.001) more likely to use LM and CAM. Subjects with a below average SF-36 general health subscale score were 3.4 times (p<0.05) more likely to pursue non-biologically based CAM, and those with an elevated BDI (score>9) were 6.2 times (p<0.05) less likely to pursue dietary changes. Conclusions: LM including CAM are highly prevalent among women at HRBC. Oncologists should inquire about LM and CAM use and explore reasons for this including QoL. No significant financial relationships to disclose.
Evaluation of clinical use of darbepoetin alfa in patients with chemotherapy-induced anemia
Authors: Bustos A. , Cruz M. A. , Aramburo P. , Carabantes F. , Díaz N. , Florián J. , Lázaro M. , Martín de Segovia J. M. , Gasquet J. A. , Alegre A. 
Published: August 2020

e20585 Background: Chemotherapy-induced anemia (CIA) is a frequent complication of patients (pts) with cancer and could be treated with erythropoiesis-stimulating agents such darbepoetin alfa (DA). The aim of this study was to investigate the patterns of use and effect of DA to treat CIA in clinical practice conditions. Methods: This was an observational, retrospective, multicenter study performed in 58 Spanish centres. Eligible pts were ≥18 yrs, diagnosed with non-myeloid malignancies and treated with chemotherapy (CT) and DA from October 2005 to October 2006. Data on demographic and clinical characteristics, CT and radiotherapy (RT), DA administration, red blood cell (RBC) transfusions, and haemoglobin (Hb) levels were collected from DA treatment initiation up to a maximum of 16 weeks or until treatment discontinuation. Results: A total of 685 pts were included in the study. Median age was 64.66 years (range 18.54–88.95), 50.7% were women, 74.11% had ECOG status 0–1 and 71.38% had stage III/IV cancer. Solid tumours represented 72.55% of the cases. The CT regimen included platinum derivates in 33.58% of the pts. At DA initiation, mean (SD) Hb was 10.00 g/dL (1.05) Administration of DA every three weeks occurred in 54.01% of the pts. Mean (SD) DA administration was 9.20 weeks (5.31). Hematopoietic response (defined as Hb ≥ 12 g/dL or Hb rise from baseline >2 g/dL in the absence of RBC transfusions during the previous 28 days) occurred in 63.24% (95% CI 59.49–66.83) of pts. A total of 88 pts (12.85%) required RBC transfusions from week 5 to end of treatment. Mean Hb (SD) at the end of treatment with DA was 11.36 g/dL (1.73). Adverse event (AE) potentially related to DA were reported in 20 pts (2.92%) and considered severe in 6 cases (0.88%). Conclusions: The findings of this study indicate that the use of DA for the treatment of CIA in real-life, daily oncology and haematology practice, is well-tolerated and effective for increasing haemoglobin to reduce the need of RBC transfusions. [Table: see text]