bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between ECOG PS, age, and components of the Comprehensive Geriatric Assessment (CGA) in an elderly colorectal cancer (CRC) cohort
Authors: Polite B. N. , Bylow K. A. , Hemmerich J. , Martens C. , Karr E. , Rosenbaum C. , Holmstrom C. , Kindler H. L. , Dale W. 
Published: August 2020

e20603 Background: 75% of CRC patients (pts) are age 65 and older. The ability of ECOG PS and age to predict underlying frailty in older pts has been questioned. This prospective multi-center observational study explores the association between EGOG PS, age and a comprehensive geriatric assessment (CGA) in older CRC pts. Methods: CRC pts aged 65 and older who were eligible for chemotherapy based on disease characteristics are being prospectively enrolled. ECOG PS and CGA measures, including functional status, cognition, comorbidity, and affect, were obtained prior to initiation of chemotherapy using validated, standardized measures. Results: 35 elderly CRC pts enrolled between March 2006 and December 2008. Age: 65–69 46%, 70–74 23%, 75–79 11%, >80 20%; gender: female 65%; race: Caucasian 52%, African-American 46%; stage IV disease: 80%. Baseline ECOG PS: 0 60%, 1 32%, 2 8%. Age did not correlate with any components of the CGA except for dependence in any ADLs (rho 0.4, p=0.03). Associations between the components of the CGA and ECOG PS are shown in the table . Conclusions: Neither biologic age nor ECOG PS were robust proxies for rigorously measured functional status in this elderly CRC cohort. This was especially true for the ECOG 0 and 1 pts where, for example, 80% of the ECOG 0 pts had impaired performance on the Short Physical Performance Battery. Work on this expanding cohort is ongoing to determine correlations with these assessments and the ability to tolerate and complete prescribed chemotherapy regimens. If predictive, the CGA could help better target established geriatric interventions to those elderly pts at greatest risk regardless of their age or performance status. [Table: see text] No significant financial relationships to disclose.
Functional outcome of malignant spinal cord compression treated with radiotherapy alone: A prospective analysis
Authors: Spensley S. , Gilmore J. A. , Kenny J. , Dunne M. , Clayton-Lea A. , Thirion P. G. 
Published: August 2020

e20623 Background: Malignant spinal cord compression (MSCC) is a major oncological complication. The management of Impending Malignant Spinal Cord Compression (IMSCC) remains unclear. Radiotherapy (RT) is often the sole management of both entities. Our aim was to prospectively evaluate the functional outcome of MSCC and IMSCC. Methods: All pts with MSCC and IMSCC treated by RT in our institution were screened for 2 national trials (ICORG 05–03/07–11). Non-eligible pts were prospectively evaluated and followed with assessment of mobility (modified Tomita scale) and sphincter function (continence/ incontinence/catheter) at baseline and 5 weeks posttreatment. Results: From 08/07 to 11/08, 54 pts [23 IMSCC, 31 MSCC] were followed. 31 pts were male. The median age was 60.5 y (30–86). The primary tumours were haematological [13 pts], lung [10], prostate [8], renal cell [6] and breast [5]. 51 pts had diagnostic MRI. The compression level was cervical in 6 pts, thoracic in 27, lumbosacral in 16, and 5 had multiple levels. 2D RT was used with varying radiation schedules: 20Gy/5fractions (f) [32 pts], 30Gy/10f [12] and other [10]. At baseline, normal mobility was found in 29 pts, mildly impaired mobility in 15 and immobility in 10. 7 pts had sphincter dysfunction. At 5 weeks, 38 pts (16 IMSCC, 22 MSCC) were evaluable (37 for mobility score, 38 for sphincter function). 10 pts had died and 6 were lost to follow up. Overall mobility was stable, improved or worse in 28 pts, 3 pts and 6 pts respectively. The mobility score was worse in 4 pts with IMSCC and 2 pts with MSCC. Improvement of mobility score was seen in 2 pts with MSCC. Among the 7 pts with baseline sphincter dysfunction, 2 pts improved. New sphincter dysfunction after RT was seen in 2 pts with IMSCC. Conclusions: The functional outcome of MSCC treated by RT alone remains poor, with minimal mobility and sphincter improvement. Functional outcome of pts with IMSCC is worrying with a worsening of mobility and/or occurrence of sphincter dysfunction in a large number of patients. No significant financial relationships to disclose.
Prediction of treatment response in anemic patients with cancer using darbepoetin alfa (DARB)
Authors: Camara O. , Hartmann M. , Egbe A. , Koch I. , Runnebaum I. 
Published: August 2020

e20643 Background: Malignant diseases along with chemotherapy or radiotherapy often result in anemia. Anemia is adversely correlated with the patient quality of life. Darbepoetin alfa (DARB) is an erythropoietic protein that works in a similary way as the body´s natural erythropoietin. The aim of this prospective study is to assess factors that are predicitive of treatment response under DARB. Methods: Between November 2002 and November 2007 overall 116 patients out of 120 projected were included in this trial. Patients with breast cancer, ovarian cancer or cervical cancer who were treated with chemotherapy, chemoradiation entered in the study. The initial hemoglobin level had to be less than 6.8 mmol/l. The primary endpoints were the evaulation of the effect of DARB(2.25 ug/kg/week) on erythropoietin level,on the hemoglobin level, on the transferrin receptor, on ferritin and creatinine. Secundary endpoints were the number of non responders and the effect of iv. iron. Patients were considered responders if hemoglobin increased by greater than 1.24 mmol/l or up to 7.44 mmol/l without red blood cells transfusion during a four week treatment. Results: 116 patients were recruited. The median age was 61(range 28–79). 44% were breast cancer patients, 39% suffered from ovarian cancer and 17% had cervical cancer. Overall 46% had adjuvant treatment. The median duration of DARB treatment was 6.1 weeks(range 0.1–37.6). 47% of the patients responded. Hemoglobin level increase more than 1.24 mmol/l was detected in 9 patients. 6 patients meet the criteria hemoglobin level more than 7.44 mmol/l. Both criteria had 29 patients.The median hemoglobin increase was 1.8 mmol/l(range 0.8–4) in responders and 0.5 mmol/l(-0.9–2.1) in non responders. Responders had significantly lower serum creatinin levels as non responders(p= 0.037). Hemoglobin increase was within the first 3 weeks significantly faster in responders as in non responders(p=0.0020). The transferrin receptor increase was also significant faster in responders(p=0.0036). Conclusions: An early hemoglobin increase was the most predictive factor for response to DARB. [Table: see text]
Evaluation of supportive care needs: Comparison between patients and physicians’ perception
Authors: Vignot S. , Delgado M. , Levy-Soussan M. , Taillade L. , Rocher M. , Lopez S. , Lassauniere J. , Spano J. , Khayat D. 
Published: August 2020

e20649 Background: In order to optimize supportive care for cancer patients, we proposed them to fill a short questionnaire evaluating their potential complaints and we evaluated the concordance of their answers with the perception of their referent physician. Methods: Patients seen in consultation in an oncology unit were proposed to answer anonymously to 7 questions designed to identify potential social, psychological, nutritional problems or uncontrolled pain. Their physician answered to a similar questionnaire. Physicians were blinded to patients’ answers. Results: 155 patients accepted to complete the questionnaire. Median age was 60 yrs [21–85], 45% of patients were in metastatic setting. 70% of patients reported at least one problem, especially in the field of potential social problems (35%) or sleep disorders (25%). Concordance between patients and physicians was high for psychological support need (81%) or nutritional problems (87%) but was lower for social problems (62%) or uncontrolled pain (69%). Physicians tended to underestimate patients’ problems and missed social issues for 30% of patients or sleep disorders for 18% of patients. On the contrary and surprisingly, physicians overestimate patients’ complaints about uncontrolled pain (underestimation in 9% of cases but overestimation in 20% of cases for the item). Conclusions: Discordance between physicians and patients’ perception of supportive care needs emphasizes the importance of extending the use of screening tolls in daily practice. No significant financial relationships to disclose.
Incidence of chemotherapy-induced nausea and vomiting in 2008
Authors: Martin I. , Montheil V. , Ropert S. , Alexandre J. , Goldwasser F. , Durand J. P. 
Published: August 2020

e20660 Background: The authors determined the incidence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) among new patients (pts) receiving chemotherapy with modern antiemetic prophylaxis in 2008. Methods: A prospective observational study of adult cancer pts receiving, for the first time, moderately or highly emetogenic chemotherapy (MEC or HEC) was performed. Study participants were called on day 2 and day 8, after first and second cycle, to evaluate acute and delayed emesis according a 10-item questionnaire. All patients received, before and after their chemotherapy, the optimal antiemetic prophylaxis according to the 2006 Update of ASCO Guideline for Antiemetics. Results: 131 consecutive pts were enrolled between January and June 2008. At cycle 1, on 124 assessable pts for acute emesis: 68 pts received MEC and 18, HEC. 5.6% developed acute vomiting (5.9% for MEC and 5.6% for HEC) and 33.1%, acute nausea (39.7% for MEC and 44.4% for HEC). At cycle 1, on 101 assessable pts for delayed emesis: 5% experienced delayed vomiting (5.1% for MEC and 6.3% for HEC) and 17.8%, delayed nausea (18.6% for MEC and 31.3% for HEC). At cycle 2, on 121 assessable pts for acute emesis: 62 pts received MEC and 18, HEC. 8.3% developed acute vomiting (6.5% for MEC and 16.3% for HEC) and 31.4%, acute nausea (35.5% for MEC and 44.4% for HEC). At cycle 2, on 96 assessable pts for delayed emesis: 5.2% experienced delayed vomiting (3.3% for MEC and 9.1% for HEC) and 19.8%, delayed nausea (23% for MEC and 27.3% for HEC). Conclusions: Though the application of the last antiemetic recommendations, CINV, especially nausea, remained a substantial toxicity for patients receiving chemotherapy, pointing out the need for improved therapeutic intervention. [Table: see text]
Incidence of febrile neutropenia (FN) with pegfilgrastim (PF) on day of chemotherapy (D1) versus 24–72 hrs later (D2)
Authors: Kumar P. , Ingle A. M. , Miller S. , Woods M. , Thomas S. P. 
Published: August 2020

e20664 Background: Docetaxel, doxorubicin hydrochloride, and cyclophosphamide (TAC) is a commonly used adjuvant chemotherapy (C) regimen in patients (pts) with high risk breast cancer (BC). Pegfilgrastim (PF) is a long acting G-CSF known to decrease the risk of FN. It is typically given the day after C. Illinois CancerCare (ILCC) is a large oncology practice that provides cancer care to many communities in Illinois. For patients with limited access to medical care, in past PF has been given on same day as C. In this study we have compared the incidence of FN in pts who received PF on the same day as TAC (D1) versus those who received it 24–72 hrs after C (D2). Methods: All pts treated for BC at ILCC between 09/2004 and 08/2008, and received TAC and PF were deemed eligible. Logistic regression was used to analyze the association between incidence of FN and type of regimens. Results: Of the 56 eligible pts (55 females), mean age 52.9 yrs (range 27.8–84.8 yrs), 43 patients received PF on D1 and 13 pts received PF on D2. 7 of 43 pts that received PF on D1 developed FN as compared to 1 of 13 pts that received PF on D2. There was a 2.1 times greater probability of developing FN in pts that received PF on D1 versus the pts who received it on D2; 95% CI (0.28–15.6). We did not observe a statistical significance for the above association in univariate analyses or after adjusting for age, stage of disease and receptor status (p>0.05). The lack of significance could be due to small patient population. Conclusions: The odds of developing FN in patients who received PF on the same day as TAC was 2.1 as compared to pts who received it on D2, this difference was statistically not significant. [Table: see text]
Comorbidities, concominant medications, and clinical guidelines/algorithms in treating elderley patients with hormone receptor positive early breast cancer
Authors: Robinson A. 
Published: August 2020

e20680 Background: Guidelines and algorithms have been published for aspects of BC care such as adjuvant hormonal therapy, f/up testing, and mgmt of hormonal S/Es. This study examined how CPG's for BC address comorbidity in older patients, and applicability to frail elderly. Patterns on the use of adj hormonal therapy in patients > 60, number of comorbidities, and concurrent medications was assessed at a single institution. Methods: Guidelines were obtained by searching the National Guideline Clearinghouse, as well as Pubmed. Guidelines on adjuvant anti-estrogen use for women with BC, follow-up, the use of bisphosphonates, and management of arthralgia in endocrine therapy treated patients were assessed. For the chart review, 290 consecutive patients over the age of sixty were reviewed for medication use, comorbid medical conditions, and anti-estrogen use. Results: The examined clinical guidelines and algorithms did not discuss the applicability of recommendations for older patients or those with multiple comorbidities. Fifty percent of patients in our sample had conditions where NSAID/COX2 use would be contraindicated. The median number of concurrent medicines at initial consult was 4. Patients >70 were significantly more likely to not receive adjuvant hormonal therapy (21% vs. 10%, p=0.025). Conclusions: CPG's do not address the applicability of treatments in patients with multiple comorbidities or the frail elderly. Older patients may be significantly less likely to receive adjuvant hormonal therapies. A significant proportion of patients in our sample had risks for SAE's from the use of NSAIDs, which are commonly recommended to manage arthralgias associated with hormonal therapies. Assessing commonly used hormonal treatment and side-effect management drugs for potential interactions with concurrent medications is an important clinical step in personalized therapy. No significant financial relationships to disclose.
Palliative care (PC) education for medical students: An unresolved need
Authors: Sala R. A. , Zanini K. , Juarez S. , Rapelli C. , Pendido A. , Aronna A. , Fein L. E. 
Published: August 2020

e20704 Background: Chapters contained in subjects other than PC lack the specificity and the integration of concepts to impact quality of care. Since 2005 an elective subject is part of the undergraduate curriculum of the medical school of the UNR. Teaching is case based in large groups with elective rotations to an acute care hospital PC team. Methods: To evaluate if this subject, as it is outlined, produces sensitization about PC, results of initial surveys (IS) (358) and final surveys (FS) (292) performed each year were compared and changes over time evaluated. Summary measures were calculated and hypothesis tests were done. Results: Students average age: 23 years. Female sex: 75.8%. Global answer rate of IS: 86.77% (range: 76.2% to 96%) and of FS: 76.65% (range: 68% to 85.9%). Composition of courses according to year of study. Quantity of IS and FS/ year. Differences in identification of the objectives of PC between IS and FS was statistically significant (p = 0.002) only in 2005. In 2006 (p = 0.195), 2007 (p = 0.318), and 2008 (p = 0.10) there was not statistical significance. Average 97.3% (range: 93% to 100%) of students considered the contents of the subject will impact in their practice and 95,75% (range: 91.5% to 98.5%) found them useful. 87% (range: 87.3% to 94.1%) positively changed their vision of interdisciplinary team work. Conclusions: Few students have a correct knowledge of PC at the beginning of the course; this knowledge is increased at the end of each course without reaching statistical significance except in 2005 (p = 0.002), when all the students were in the third year of study. [Table: see text] No significant financial relationships to disclose.
Dyspnea in oncologic patients as an important cause of attendance in emergency room
Authors: Serrano S. , Tobeña M. , Vidal M. , Ferrer A. , Millastre E. , Ruiz Echarri M. , Pajares I. , Lopez D. , Tres A. , Lambea J. 
Published: August 2020

e20705 Background: Attending oncologic patients in emergency room because of a large variety of symptoms due to treatments or tumor complications is very common. Our objective is to estimate the prevalence of dyspnea in oncologic patients and its etiology. Methods: From October 2007 to October 2008 we recollected 560 oncologic patients who were seen on Emergency room. It was revised cause of consultation, tumors´ location and stage, active or palliative care, diagnosis and treatment. Results: 71 of the 560 patients (12.7%) related dyspnea as cause of consultation, being the third cause of attendance in Emergency room after pain (126 patients, 22.5%) and fever (98 patients, 17.5%). The most common tumor´s location was lung in 38 of the 71 patients (53.52%), followed by colorectal cancer (11.3%) and breast (9.9%). 76.8% were advanced oncologic patients (stage IV). Diagnosis was respiratory infection in 19 patients (26.8 %) followed by malignant pleural bleeding (10 patients, 14.1%), disease progression (9 patients, 12.7%) and pulmonary embolism (5 patients, 7%). Dyspnea was a multifactorial symptom in 21 of the 71 patients (29.6%) without an etiological diagnosis. In 47 patients (66.2%) was required admission with a mortal evolution in more than 50%. Conclusions: In oncologic patients dyspnea is a frequent cause of consultation in Emergency room with high rates of morbility and mortality. It affects to patients´quality of life. When etiology is diagnosed the most common is respiratory infection. We should make an effort to offer the best supportive care. No significant financial relationships to disclose.
The effects of a brief relaxation program on heart rate variability in cancer patients
Authors: Asher A. 
Published: August 2020

e20713 Background: Objectives were: (1) To characterize the physiologic changes of the autonomic nervous system, demonstrated by heart rate variability (HRV) high frequency (HF) spectral analysis, before and after a 15 minute, one-time, guided relaxation program for cancer patients. (2) To assess whether changes of HRV correlate with subjective feeling for anxiety, based on the Edmonton Symptom Assessment Scale (ESAS), and the summed ESAS score. Methods: 20 patients with any cancer diagnosis and normal cognition were recruited for the study. The ECG electrodes were attached and a 5-minute period of heart rate variability was recorded (HRVbefore) after 15 minutes of supine resting. The patient then began the brief relaxation program via recorded audio. Another 5 minute period of HRV was then recorded (HRVafter). The ESAS was completed before and immediately after the relaxation program. Parasympathetic activity assessed by heart rate variability, as measured by high frequency spectral analysis, was the primary outcome measure. The differences between the pre and post values of low and high frequency HRV, of the ESAS anxiety score, and of the summed ESAS score were compared using a Wilcoxan signed rank test. Results: No statistically significant differences were found in HF HRV power between the pre and post relaxation program. However, the summed ESAS scores were significantly lower after the relaxation program (p <0.001). There was also a trend of decrease in the ESAS anxiety score (p = 0.086). There was no correlation between the change in HRV HF and change in the ESAS anxiety score. Conclusions: A brief guided relaxation program can significantly improve symptoms as measured by ESAS, but not HF HRV power. No significant financial relationships to disclose.
Pretreatment correlation between hemoglobin, unintentional weight loss, and inflammatory status in patient with advanced non-small cell lung cancer (NSCLC)
Authors: Capuano G. , Pavese I. , Satta F. , Burattini E. , Tosti M. , Palladino A. , Di Palma M. 
Published: August 2020

e20718 Background: Anemia, defined as a hemoglobin level < 12 g/dL, is frequent in cancer and affect quality of life and performance status. Of all the pretreatment possible causes of cancer-related anemia, unintentional weight loss, early indicator of malnutrition, is often underestimated or completely ignored. The aim of this study is to evaluate the possible pretreatment correlation between hemoglobin level, recent unintentional weight loss (≥ 5% in the last three months) and inflammatory status (C-reactive protein ≥ 10 mg/dL) in NSCLC. Methods: 56 consecutive outpatients with NSCLC (IIIB - IV stage), 68% males, 32% females, were enrolled. Criteria for eligibility included absence of comorbidity (diabetes, hepatic or renal failure) and not previous oncological treatment All patients were evaluated for hemoglobin level (Hb), percentage of involuntary weight loss (WL) and C- reactive protein (CRP) before chemotherapy. Results: 25% of patients had a Hb level < 12 g/dL, 38% referred a recent WL ≥ 5% and 54% had a CRP ≥ 10 mg/dL. Hb was WL-related (p = 0.001) and not CRP-related (p = 0.160), WL was CRP-related (p = 0.022). In the subgroup of patients, the differences of haemoglobin concentrations were minimal, but stastically significant only when inflammatory status was associated with WL. On Table we reported the mean concentrations of haemoglobin as measured in the subgroups of patients. Conclusions: Our data suggest that an early and intensive management of weight loss might prevent or reduce anemia in NSCLC before treatment. [Table: see text] No significant financial relationships to disclose.
Acute allergic reactions to infusion chemotherapy in outpatient office practice
Authors: Mundia M. , Ali S. , Ali M. F. , Devlin D. , Nezhat F. , Mundia A. G. 
Published: August 2020

e20722 Background: Outpatient chemotherapy/biotherapy in oncologist's offices are being utilized in greater numbers, increasing the risks of acute allergic reactions. Methods: The clinical charts of patients receieving prolonged infusion chemotherapy/biotherapy treatments (1–3 hours of infusion) in a community oncologist's office setting were reviewed to determine the rate(risk), management and outcome of severe acute allergic reactions. Results: From January 2007 to December 2008, there were 1453 patient infusions conducted. 653 infusions in 2007 and 800 in 2008. All patients were premedicated with antiemetics, H2 blockers if indicated and dexamethasone. In addition starting 2008 patients also recieved diphenhydramine 25mg. There were total of 15 aute allergic reactions. 10 patients with respiratory symptoms(cough/dysponea/wheezing), 3 patients developed anaphylactic reactions, and 2 patients developed rash. Chemotherapy infusions were promptly discontinued and appropriate resusitative measures instituted. The drugs to which reactions occured included 6 to docetaxel, 3 paclitaxel, 3 carboplatin. and 3 oxaliplatin. All patients responded to resusitative measures which included IV fluids, oxygen, subcutaneous epinephrine, IV dexamethasone, and IV diphenhydramine. None required assisted ventilation or cardio version. All patients were discharged home after 1 to 3 hours of observation. Conclusions: Acute allergic reactions to anticancer therapy must be anticipated in all cases. Appropraite preventive protocols and prompt response will minimize the morbidity and eliminate mortality. No significant financial relationships to disclose.