bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions on caring for adult survivors of childhood cancer in the primary care setting
Authors: Sima J. , Perkins S. M. , Haggstrom D. A. 
Published: August 2020

9568 Background: Encouraging cure rates for childhood cancers have resulted in a population of adult childhood cancer survivors (CCS) that are at risk for late effects of cancer-directed therapy. Late effects often occur when CCS are older and receive routine medical care from internists and family practitioners. Our study identifies facilitators and barriers to providing optimal late effects screening as well as evaluating information sources primary care providers (PCPs) perceive as useful, including cancer treatment summaries, survivorship care plans, and Children's Oncology Group (COG) guidelines. Methods: We sampled 1,500 randomly selected general internal medicine and family practice physicians from the American Medical Association Physician Masterfile for a nationwide mail survey. We received 351 surveys with data. Using chi-squared tests or t-tests to compare responders and non-responders we found a higher response rate for family practice (30.2%) compared to general internal medicine (16.5%) (p<.0001). Results were tabulated for descriptive purposes and linear regression and logistic regression were used for the multivariable modeling. Results: Most (84–86%) PCPs stated that they had never received a cancer treatment summary or survivorship care plan; despite this, greater than 90% thought these documents would be useful. Most PCPs (93%) had never used COG guidelines, but 86% agreed that they would follow their recommendations. A minority of PCPs perceived that their medical training was adequate to recognize late effects of chemotherapy (27.6%), cancer surgery (36.6%), and radiation therapy (38.1%). Conclusions: PCPs have a low level of awareness about the medical problems of CCS; receive inadequate training to recognize late effects; and infrequently utilize, cancer treatment summaries, survivorship care plans, and COG guidelines. By evaluating the perceptions of PCPs, we have identified problematic areas for future investigation and have begun to lay the groundwork for incorporating follow-up care for CCS into routine general medical practice. No significant financial relationships to disclose.
Incidence of acute kidney injury in cancer patients: A population-based cohort study in Denmark
Authors: Christiansen C. F. , Johansen M. B. , Christensen S. , Langeberg W. , Fryzek J. P. , Toft Sørensen H. 
Published: August 2020

9570 Background: Although cancer patients may be at increased risk for acute kidney injury (AKI), which could then reduce their likelihood of receiving optimal therapeutic management and supportive care, the occurrence of AKI among newly diagnosed cancer patients has not been well-described. Therefore, we examined the incidence of AKI within the first year after cancer diagnosis to estimate the magnitude of this risk and better understand which patients are at greatest risk. Methods: Using the population-based Danish Cancer Registry, we conducted a retrospective cohort study of 4,427 men and women from North Jutland, Denmark (population 500,000) diagnosed with cancer from 2002 to 2003 (non-melanoma skin cancer excluded). AKI was defined according to the Risk/ Injury/ Failure/ Loss/ End-stage-renal-disease (RIFLE) criteria. We included Risk or worse: at least a 1.5 times increase in serum creatinine (sCr) from baseline. SCr levels were obtained from the Regional Laboratory Database, which collects all biochemical analyses for hospital laboratories. Baseline sCr was defined as the lowest sCr in the year before cancer diagnosis. We compared this value to the highest sCr on record during the first year following cancer diagnosis to identify those who experienced an AKI. Results: Median age for the cohort was 68.6 years, 50.9% were men, and the most common cancer sites were lung (14.2%), breast (13.7%), prostate (9.8%), colon (9.6%), rectum (5.1%), and bladder (6.3%). During the first year, 973 (22.0%) members of the cohort experienced an AKI, corresponding to an overall incidence rate of 326 per 1,000 person-years (95% confidence interval (CI) 306–347). Incidence was highest among patients aged 80 years or older (531 per 1,000 person-years, 95% CI 464–606) and in those with cancer of the liver (1,221, 95%CI 676–2,205), pancreas (1,472, 95%CI 1,130–1,917), or kidney (1,254, 95%CI 974–1,616), or with multiple myeloma (855, 95%CI 538–1,356). Conclusions: To protect against AKI, we must first identify those at risk. Our study showed that over 20% of cancer patients may experience acute kidney injury in the first year after diagnosis. Older patients and those with cancer of the liver, pancreas, or kidney, or with multiple myeloma are especially at risk for AKI. [Table: see text]
Characterization of human skeletal muscle in weight-losing pancreatic cancer patients
Authors: Brell J. M. , Hardacre J. , Schulak J. , Onders R. , Stellato T. , Sanabria J. , Schulchter M. , Strickland L. , Sprosty R. , Pink J. 
Published: August 2020

9571 Background: Decreased body mass (cachexia) is a common cause of functional decline in pancreas carcinoma (PC) and other malignancies. The etiology is unknown. Characterization of human PC skeletal muscle, in regard to proteolysis and gene expression, compared to control muscle may reveal information about pathophysiology. Methods: Biopsies of rectus abdominus muscle were performed in weight-losing PC patients all stages (A) during cancer-related surgery and in cancer-free controls undergoing ventral hernia repair (B). Caspase-3, pAkt, and urinary 3-methylhistidine (u3-MH) were assessed by Western blot and high-performance liquid chromatography. Fat-free mass (FFM), body mass index (BMI), and time to progression were recorded. Muscle from five patients (median weight loss 21%) and five controls were analyzed for gene expression patterns using Affymetrix Human Genome U133 A 2.0 array chip. Two hundred differentially over- and under-expressed genes were examined in group A for potential association with cachexia. RT-PCR confirmation of six candidate genes was performed. Results: Thirty-eight patients were enrolled. Median weight loss in group A (N=27) was 14.5% (5% - 34%). No differences were noted between groups in caspase-3 and pAkt expression. Baseline u3-MH (p=0.86) and FFM (p= 0.28) did not differ; baseline BMI was lower in group A (p=0.04). BMI follow-up measurements (N=17) were significantly decreased (p=0.0005). In 65% patients, progressive disease was noted within median time of 3 months. RT-PCR established up-regulation of CHRNA1 and LMO7, but not GDF8. mRNA down-regulation for TRIM63, IGF-BP6, and MYH-1 was confirmed. Conclusions: Muscle proteolysis in human PC skeletal muscle was not demonstrated, perhaps due to unmeasurable proteolysis or use of non-informative endpoints. BMI decreased in group A with PD; further studies need tight control of BMI variables. New hypotheses about cachexia include neuromuscular junction dysfunction, as CHRNA1 has specific role in ion channel gating; this is disrupted in the paraneoplastic Eaton-Lambert syndrome. This is first study analyzing human muscle in weight-losing PC and proves symptom management multidisciplinary research is feasible in academic setting. Supported by American Cancer Society pilot grant. No significant financial relationships to disclose.
Prognostic significance of the “surprise” question in cancer patients
Authors: Moss A. H. , Lunney J. R. , Culp S. , Auber M. , Kurian S. , Rogers J. , Dower J. , Abraham J. 
Published: August 2020

9588 Background: In patients with advanced cancer, failure to accurately estimate and communicate prognoses can lead to overly aggressive care at the end of life with less attention to important palliative care issues such as pain and symptom management and patients’ values and goals for care. The “surprise” question—would I be surprised if this patient died in the next year?—has been recognized as an innovation to improve end-of-life care in the primary care population by identifying patients with a poor prognosis who are appropriate for palliative care. It has not been previously tested in cancer patients. The purposes of this study were to determine the feasibility and outcomes of the use of the “surprise” question in a cancer center population. Methods: Between July and November 2007, oncologists prospectively classified consecutive breast, lung, and colon cancer patients being seen at the Mary Babb Randolph Cancer Center of West Virginia University into “Yes” and “No” groups based on the surprise question. Patients were followed and their status at the end of one year-alive or dead-was determined along with patient demographics, type of cancer, and stage at presentation. A multivariate Cox proportional hazards regression analysis was used to identify variables associated with patient death. Results: Oncologists classified 826 of 853 prospective patients (97%), with 131 (16%) classified into the “No” group and 695 (84%) into the “Yes” group. At the end of the year, 71 patients had died; 41% of the “No” patients compared to 3% of the “Yes” patients (P <.001). The surprise question ‘No‘ response was more predictive of patient death than stage of cancer, cancer type, or age (hazard ratio 7.53, P value <.001). The “Yes” patients lived longer than the “No” patients (359.8±32.8 days versus 270±131.5 days, P <.001). The sensitivity of the surprise question “No” response was 75% and the specificity was 90%. Conclusions: We conclude that the surprise question is a simple, feasible, and effective tool to identify cancer patients with the worst prognoses who should receive the highest priority for palliative care interventions, particularly advance care planning. No significant financial relationships to disclose.
Evaluating cancer patient satisfaction before and after daily multidisciplinary care for thoracic surgery inpatients
Authors: Adolph M. D. , Taylor R. M. , Ross P. M. , Vaida A. M. , Moffatt-Bruce S. D. 
Published: August 2020

9605 Background: Significant subpopulations of cancer inpatients in the SUPPORT trial were dissatisfied with their pain control. (Desbiens, Wu et al. 1996) The hospitalized thoracic surgical patient is a person at risk for uncontrolled symptoms and burdens due to advanced cancer at time of presentation. Methods: This is a retrospective, observational, study of 1188 thoracic surgery patients undergoing elective surgical procedures for lung cancer at an NCI-approved cancer hospital over a 3-year period. Patients with primary and secondary lung cancer, undergoing elective thoracic surgery procedures were evaluated before (n=660, “Period 1”) and after (n=528, “Period 2”) an 8-month, daily, collaborative multidisciplinary Intervention Period to improve pain control and to facilitate transition for discharge. The collaborative process also identified thoracic surgical patients who needed more complex symptom management and additional support for advanced disease. Patient satisfaction with pain therapy and referrals to hospice were analyzed before and after the intervention period. Results: Pain satisfaction scores improved from baseline in each sequential period (Period 1 = 9.0 SD 1.71, Intervention Period = 9.4 SD 1.37, and Period 2 = 9.5 SD 1.03, p<0.0001). The percentage of patients referred to hospice increased from 0.15% to 1.7% (p<0.0001). Conclusions: Innovative collaboration between thoracic surgery specialists and a palliative medicine service improved patients’ satisfaction with pain control. The collaborative relationship resulted in an increase in referrals to hospice for patients with advanced cancer. These improvements were sustained by the thoracic surgery service after a daily collaborative intervention period ceased. No significant financial relationships to disclose.
Inflammation genes and pain severity in lung cancer patients
Authors: Reyes-Gibby C. C. , Shete S. , Wu X. , Kurzrock R. , Spitz M. 
Published: August 2020

9618 Background: While studies suggest that variants in infammation genes explain individual variation in pain severity, these studies only assessed one or a few candidate genes. Given that pain is a complex trait, multiple genes with relatively small effects are likely to influence vulnerability to pain. In this study, we evaluated a comprehensive panel of 59 single nucleotide polymorphisms (SNP) in 37 inflammation genes in newly diagnosed non-Hispanic Caucasian lung cancer patients (n=667) and assessed their association with pain severity. We also assessed the extent to which clinical and demographic factors explain pain severity in this population. Methods: Patients rated their pain “during the past week” on an 11-point numeric scale, (0= ‘no pain’ and 10= ‘pain as bad as you can imagine’) at presentation, prior to initiating cancer therapy. A score > 7/10 was considered to indicate severe pain. Logistic regression analyses were conducted to assess the extent of association between genetic polymorphism and pain severity. All SNPs were genotyped using SNPlex. Results: Results showed that 16% of the sample reported severe pain. As expected, severe pain was more prevalent among those with advanced stage of disease (OR=2.34; 95% CI=1.50–3.65), younger age (OR=0.47; 95%CI=0.30–0.75), depressed mood (OR=3.68; 95%CI=1.96–6.93) and fatigue (OR=3.68; 95% CI=1.96–6.93). Of the 59 SNPs, we initially found SNPS in 6 genes [IKB 3’-UTR(C/T), TNFA -308GA, TNFB Arg13Cys, IL2-330T/G, IL8–251 T/A, COX2 3’-UTR(T/C)] to be significantly associated with severe pain. Controlling for clinical and demographic variables, we found that carriers of CC alleles for COX2 3’-UTR T/C (OR= 3.24; 95% CI=1.12, 9.39) and carriers of TT alleles for IL2-330T/G (OR=1.68; 95%CI=1.04, 2.73) persisted as significant correlates of severe pain. Conclusions: Because genetic polymorphisms are stable markers, understanding the extent to which genetic variability plays a role on cancer-related pain may prove useful in identifying patients at high-risk for pain development and importantly, could help in understanding patients who might benefit most from symptom intervention, and ultimately in developing personalized and more effective pain therapies. No significant financial relationships to disclose.
Pattern of utilization of pegfilgrastim in patients with chemotherapy-induced neutropenia: A retrospective analysis of administrative claims data
Authors: Skarin A. T. , Vekeman F. , Laliberté F. , Afonja O. , Lafeuille M. , Barghout V. , Duh M. S. 
Published: August 2020

9624 Background: Pegfilgrastim is a long-acting granulocyte colony-stimulating factor (G-CSF) used to prevent or treat febrile neutropenia associated with myelosuppressive anticancer therapies. According to the prescribing information, pegfilgrastim should not be administered within 14 days before or 24 hours after cytotoxic chemotherapy because of the potential for myeloid toxicity. This study examined use patterns of pegfilgrastim in real-life practice. Methods: Analysis of health insurance claims data in 2000- 2007 from > 35 large health plans across the US was conducted. Patients who had a cancer diagnosis and chemotherapy within 120 days of their first pegfilgrastim injection were identified. The proportion of pegfilgrastim injections that were followed by administration of chemotherapy within 11 and 9 days was calculated. Analysis was also stratified by cancer type [Non-Hodgkin's lymphoma (NHL), lung, breast]. Results: A total of 13,526 cancer patients received 57,118 pegfilgrastim injections. NHL, lung, and breast cohorts comprised 2,722, 2,772, and 4,955 patients, respectively. Mean age (SD) was 55.0 (11.6) and women represented 65.9% of study population. Among all cancer types, 19.2% of pegfilgrastim injections had a chemotherapy claim within the following 11 days. This pattern of use was the highest in NHL (18.9%), followed by lung (17.1%), and breast (16.2%). Similar results were observed in the 9-day sensitivity analysis (see Table ). Conclusions: Based on the retrospective analysis of this administrative claims database, the use of pegfilgrastim within 11 days of an administration of chemotherapy was observed in 15–20% of cases which is inconsistent with the recommended guidelines. Pegfilgrastim use in these situations may have the potential to increase sensitivity of rapidly dividing myeloid cells to cytotoxic chemotherapy. Further research is being conducted to assess the related clinical and economic impact of this pattern of usage. [Table: see text] [Table: see text]
Use of physical activity as a health tool for cancer patients and oncologists
Authors: Karvinen K. , DuBose K. D. , Allison R. R. 
Published: August 2020

9634 Background: Regular physical activity can be beneficial to health for both patients and their providers. Research suggests that health care providers can potentially provide an important role in changing patients’ health behaviors. The purpose of this study is to (a) explore factors that influence whether or not oncologists recommend physical activity to their patients and (b) to examine physical activity levels of oncologists. Methods: 199 practicing medical and radiation oncologists throughout the United States responded to a mailed survey (response rate = 30%). Oncologists self-reported their physical activity promotion practices, their own physical activity behaviors, and provided demographic and practice related information. Results: Approximately 64% of oncologists reported inquiring about their patients’ physical activity on most or all visits. Further, 57% of oncologists reported regularly meeting American College of Sports Medicine guidelines for physical activity (i.e., 150 minutes of moderate or 60 minutes of vigorous physical activity per week). Potential predictors of physical activity promotion (i.e., age, ethnicity, number of years practicing, tumor types treated and own physical activity participation) were tested using univariate statistics. A logistic regression analysis indicated that number of years practicing (OR = 2.84, 95% CI = 1.465–5.521) and their own physical activity participation (OR = 1.87, 95% CI = 1.025–3.426) were both significant and independent predictors of physical activity promotion. No other factors were identified as predictors of physical activity promotion. Conclusions: Approximately half of oncologists do not meet public health physical activity guidelines and fewer than two thirds regularly inquire about the physical activity levels of their patients. Data from this study suggest that these findings are linked: inactive oncologists tend to promote physical activity less to their patients. More physical activity adoption by oncologists may ultimately lead to increased activity levels in their patients, leading to greater health benefits for both patients and providers. No significant financial relationships to disclose.
Is best supportive care really best supportive care?
Authors: Lee R. , Von Roenn J. 
Published: August 2020

9639 Background: With the growth of palliative medicine over the past decade, the paradigm of supportive care has evolved to create new standards for cancer patients. The aim of this study was to define “best supportive care” (BSC) during clinical trials of advanced solid tumors. Methods: Systematic review of the literature using Medline and the Cochrane Central Register of Controlled Trials databases. These were searched for randomized controlled trials in which anticancer therapy was compared with a BSC only arm. Results: A total of 43 studies met our inclusion criteria (publication dates, 1980–2008) with the following cancer types: 22 lung cancer, 6 colorectal, 6 pancreas, 2 gastric, and 7 other cancer types. Thirty-eight studies (88%) provided some definition of supportive care and sixteen studies (37%) used the term BSC. The average survival across treatment arms was 27.5 weeks. All but one study described the use of palliative therapies at the discretion of the treating physician without standardization. Over half of all studies (56%) specifically mentioned analgesics and radiotherapy (RT) for pain control. Other specific interventions listed were steroids (14), antibiotics (10), psychological support (10), nutritional support (9), blood transfusions (8), anti-emetics (6), and anti-depressant or anxiolytic medications (3). One-third of trials (15) reported an equivalent clinical evaluation schedule for both the BSC and treatment arms. Quality of life (QoL) was measured with a validated instrument (e.g., QLQ-30) in 55% of trials and 37% compared the utilization of at least one palliative treatment between groups. Trials using the term BSC were more likely to provide multidisciplinary therapy beyond RT and analgesics (50% vs. 19%; p<0.05). Conclusions: The management of subjects in a BSC arm of clinical trials are highly variable. Overall, the trials compare treatment versus no treatment as subjects in the BSC group likely did not receive care according to current palliative medicine standards. Future randomized clinical trials with a BSC arm should provide a comprehensive, multidisciplinary approach that is consistent with practice guidelines. A standardized BSC approach developed with palliative medicine specialists is warranted for further study. No significant financial relationships to disclose.
Chromosome enumeration probe 17 (CEP) ratio to predict chemosensitivity in HER-2 overexpressing breast cancer
Authors: Miura D. , Saitoh Y. , Iwatani T. , Kawabata H. , Inoshita N. 
Published: August 2020

e11600 Background: Precise assessment of HER-2 is critical in breast cancers and predicts benefit of trastuzumab (T). Although subset analysis of CALGB 9840 suggests benefit in FISH-negative patients with chromosome 17 polysomy (C17), clinical significance of C17 in FISH-positive patients is still less known. To analyze the epidemiologic feature of C17 in Japanese patients, consecutive operable breast cancer patients during 05–07 treated in single institution were studied. Methods: HER-2 status of consecutive 307 patients excluding DCIS and whose specimens were poor quality for study, were analyzed with Pathvysion (FISH). We defined HER- 2 (+) and C17 as HER-2/chromosome 17 ratio ≥ 2.2 and CEP ratio ≥ 2.2, respectively. Pathological response following neoadjuvant chemotherapy (NACT) was assigned according to the Japanese Breast Cancer Society (G3; no invasive or in situ residual tumor in the breast, G2; up to two thirds of primary cancer cells having pathologically severe changes or disappearance, G1; up to one third to two thirds of primary cancer cells having pathologically severe changes or disappearance). Results: HER-2 (+) was found in 22% (67/307) and C17 in 25% (77/307). Twenty-four of 67(36%) in HER-2 (+) had C17 and 53 of 240 (22%) in HER-2 (-) did C17. Among HER-2 (+), 23 cases received T-contained regimens as NACT (FEC/EC followed by PAC+T in 18 and DOC+CPA+T in 5). Six of 9 (67%) with C17 had G3 and 2 of 14 (14%) with non-C17 did G3. CEP ratio significantly predicts to have G3 (p=0.02) but HER-2/chromosome 17 ratio by logistic regression analysis. Conclusions: C17 was found in 25% of Japanese operable breast cancer patients of which was similar to that of CALGB. CEP ratio is a good predictive marker for chemo- sensitivity in HER-2 (+) subset. No significant financial relationships to disclose.