bluuebunny/crossref_metadata_2025_split huggingface dataset:
Final results of a study comparing short-course and long-course radiotherapy (RT) for local control of metastatic spinal cord compression (MSCC)
Authors: Rades D. , Lange M. , Veninga T. , Stalpers L. J. , Bajrovic A. , Adamietz I. A. , Rudat V. , Schild S. E. 
Published: August 2020

9522 Background: Many MSCC patients live long enough to develop a recurrence in the irradiated spinal area. This is the first prospective study comparing different RT schedules for local control (LC) of MSCC. Methods: 265 patients treated with RT alone (1/06–12/07) were included in this prospective non-randomized study. The primary goal was to compare short-course (1×8 Gy/5×4 Gy, N=131) and long-course RT (10×3 Gy/15×2.5 Gy/20×2 Gy, N=134) for 1-year LC. Secondary endpoints were motor function and 1-year survival (OS). Dutch patients received short-course, and German patients long-course RT. The analysis of LC (no MSCC recurrence in the irradiated spinal area) included the 224 patients with improvement or no change of motor deficits during RT. The difference in 1-year LC was previously reported to be 14% between short- and long-course RT. For a statistical power of 90 % (significance level 5%), ≥218 patients were required to detect this difference. Univariate analyses (UVA) for LC and OS were performed with Kaplan-Meier-method and log-rank test, multivariate analyses (MVA) with the Cox proportional hazards model. UVA and MVA for motor function were performed with the ordered-logit-model. Eleven additional factors were evaluated. Results: 1-year LC was 61% after short-course RT and 81% after long-course RT (P=0.005). On MVA, improved LC was only associated with long-course RT (P=0.018). Motor function improved in 37% after short- and 39% after long-course RT (P=0.95). Improved motor function was associated with better performance status (P=0.015), favorable tumor (P=0.034), and slower development of motor deficits (P<0.001). 1-year OS was 23% after short- and 30% after long-course RT (P=0.28). On MVA, improved OS was associated with better performance status (P<0.001), no visceral metastases (P<0.001), involvement of 1–3 vertebrae (P=0.040), ambulatory status (P=0.038), and bisphosphonates (P<0.001). Conclusions: Long-course RT was associated with better LC, similar functional outcome, and similar OS compared to short-course RT. Patients with a favorable OS prognosis should receive long-course RT, and those with a poor OS prognosis should receive short-course RT. [Table: see text]
Left ventricular dysfunction in patients receiving cardiotoxic cancer therapies: Are clinicians responding appropriately?
Authors: Telli M. L. , Yoon G. , Kao D. , Matsuda K. , Witteles R. M. 
Published: August 2020

9527 Background: Cancer survivors treated with anthracyclines and/or trastuzumab are at risk for cardiotoxicity. Left ventricular (LV) systolic dysfunction (symptomatic or asymptomatic) represents a Class I indication for therapy with beta-blockers and angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) according to American College of Cardiology/American Heart Association heart failure guidelines. We designed this study to examine treatment practices for patients with cancer therapy-associated LV dysfunction, and the real-world adoption of treatment guidelines. Methods: After IRB approval, we identified all patients who received anthracycline and/or trastuzumab cancer therapy at Stanford University from October 1, 2005 to October 31, 2007 using an institutional pharmacy database. Out of 6,530 total cycles of chemotherapy administered, we identified all unique patients who had at least one echocardiogram performed before and after the start of chemotherapy using an institutional echocardiography database. Details of the chemotherapy regimen, cardiac risk factors, cardiac imaging results, concomitant medications, and referrals/consultations were examined for these patients. Results: A total of 88 patients met inclusion criteria. Ninety-two percent were treated with anthracyclines, 25% with trastuzumab in combination with anthracyclines, and 8% with trastuzumab alone. Mean baseline ejection fraction (EF) was 60%, with 13% of patients having a baseline EF below normal. A total of 41% had LV dysfunction (EF less than 55%) during or after cancer therapy. Of these patients, 56% received beta-blocker therapy, 47% received ACE-I or ARB therapy, and 50% were referred for cardiology consultation. Of the patients with asymptomatic LV dysfunction (75% of the LV dysfunction cohort), 41% received beta-blocker therapy, 33% received ACE-I or ARB therapy, and 37% received cardiology consultation. Conclusions: In real-world clinical practice, many cancer survivors with cardiotoxicity are not adequately evaluated and treated from a cardiovascular standpoint. Multidisciplinary collaboration between oncologists and cardiologists is needed to improve the quality of care for these patients. No significant financial relationships to disclose.
Changes in body composition in women with breast cancer on aromatase inhibitors: A two-year trial
Authors: Van Londen G. J. , Perera S. , Vujevich K. , Rastogi P. , Lembersky B. , Brufsky A. , Vogel V. , Greenspan S. 
Published: August 2020

9528 Background: Aromatase inhibitors (AIs), the preferred adjuvant therapy of postmenopausal breast cancer patients, induce severe hypo-estrogenemia which differentiates them from the Estrogen-Receptor-Agonists-Antagonists (ERAAs). Little is known about the effect of AIs on body composition. We sought to examine the impact of AIs on body composition, and whether any changes correlate with gonadal hormone levels. Methods: We analyzed a two year double-blind trial (Risedronate's Effect on Bone loss in Breast CAncer, REBBeCA). 81 chemotherapy-induced newly postmenopausal nonmetastatic breast cancer patients had been randomized to risedronate 35 mg once weekly or placebo and followed, some of whom were on or started AI during the trial. Measures included body composition by whole body DXA-scan and serum sex hormone levels. Combining the two treatment arms, we estimated and compared body composition changes in those on (AI) and not on AIs (no-AI) using a linear mixed model, and examined correlations with serum hormone levels. Results: By 24 months, 41 women were on an AI. Over 2 years, lean mass increased by 1159g (p=0.0003) in women on an AI and did not change (85g; p=0.7684) in the no-AI group (adjusted difference, AD=1047g; p=0.0004). Percent fat did not change (0.0; p=0.9344) in those on an AI and increased (1.2; p=0.0097) in the no-AI group (AD=1.6; p=0.0433). The change in estradiol was associated with changes in lean mass (correlation r=0.42, p=0.0020) and percent fat (r=-0.48, p=0.0003). Conclusions: The use of AIs is associated with a decrease in fat mass and an increase in lean mass. The changes in estradiol are associated with alterations in body composition. The mechanisms and implications of these changes need to be studied further. [Table: see text]
A randomized controlled trial evaluating a topical treatment for chemotherapy-induced neuropathy: NCCTG trial N06CA
Authors: Barton D. L. , Wos E. , Qin R. , Mattar B. , Green N. , Lanier K. , Bearden J. , Kugler J. , Rowland K. , Loprinzi C. 
Published: August 2020

9531 Background: Chemotherapy induced peripheral neuropathy (CIPN) is a prevalent dose limiting toxicity for several important cancer treatment agents. CIPN can impair function and cause distress. There are no proven pharmacologic treatments for established CIPN currently. This double blind randomized placebo controlled trial evaluated a compounded topical gel for this problem. The novelty of this treatment is that it might incorporate several agents with different mechanisms of action to provide relief locally without negative systemic effects. Methods: Patients with CIPN (rated ≥4 out of 10) for at least one month, related to previous and/or concurrent exposure to neurotoxic agents, were randomized to baclofen 10 mg, amitriptyline HCL 40 mg and ketamine 20 mg in a pluronic lecithin organogel (BAK-PLO) vs placebo (PLO) to determine its effect on numbness, tingling, pain, and motor function. Exclusion criteria included other causes and/or current treatment for peripheral neuropathy. The primary endpoint was the baseline adjusted sensory subscale of the EORTC QLQ-CIPN20, at 4 weeks. Results: Between February and May 2008, 208 patients were enrolled onto this trial. Four week data are shown in the table below, higher numbers being better. The percentage of patients that had improvements of at least 10, on a 100 point scale, in the motor subscale was statistically significantly higher in the BAK-PLO arm, p=.04. There were no unwanted toxicities associated with the BAK-PLO that were significantly different from placebo and no evidence of CNS or systemic toxicity. Conclusions: Topical treatment with BAK-PLO appears to moderately improve symptoms of CIPN. This topical gel was well tolerated without systemic side effects. [Table: see text] No significant financial relationships to disclose.
Predictors of aggressive end-of-life care among Hispanic and white advanced cancer patients
Authors: Trice E. D. , Nilsson M. E. , Paulk E. , DeSanto-Madeya S. , Wright A. A. , Balboni T. A. , Steiglitz H. , Maciejewski P. K. , Block S. D. , Prigerson H. G. 
Published: August 2020

9538 Background: Some ethnic/racial minority cancer patients (e.g. African Americans) have been shown to receive more life-prolonging care at the end-of-life (EOL) than white patients. Nevertheless, few studies have investigated whether Hispanic cancer patients receive more aggressive care than white patients and limited information exists on the predictors of aggressive care among Hispanic patients. The present study examined rates and predictors of aggressive EOL care among Hispanic and white cancer patients. Methods: Subjects participated in a US multi-site, prospective study between September 2002 - August 2008. Data were derived from interviews, conducted in English or Spanish, of 292 self-reported Hispanic (N=58) or white (N=234) stage IV cancer patients and their caregivers. Patients were followed until death, a median of 118.5 days later. Caregiver post-mortem interviews documented patient care in the last week of life. “Aggressive EOL care” was operationalized as cardiopulmonary resuscitation and/or ventilation and death in an intensive care unit. Aggressive EOL care was regressed on the following baseline, patient-reported, independent variables: a preference for life-prolonging care, EOL treatment discussion, do-not-resuscitate (DNR) order, terminal illness acknowledgement, and religious coping. Logistic regression models were stratified by ethnic status and controlled for significant confounds (e.g. socioeconomic status). Results: Hispanic and white advanced cancer patients were equally likely to receive aggressive EOL care (5.2% and 3.4%, respectively; p=0.878). Although religious coping and treatment preferences predicted aggressive EOL care for white patients (adjusted odds ratio 7.76 [p=0.025] and 13.20 [p=0.008]), they were not predictive among Hispanic patients. Hispanic patients were less likely than white patients to have DNR orders (22.4% vs 50.4%; p=0.007). For both white and Hispanic cancer patients, no patient who reported an EOL discussion or DNR order at baseline received aggressive EOL care. Conclusions: Given that EOL discussions and DNR orders may prevent aggressive EOL care among Hispanic cancer patients, further efforts to engage Hispanic patients and their caregivers in these activities may reduce aggressive EOL care. No significant financial relationships to disclose.
National survey of oncology fellows on palliative care education
Authors: Buss M. K. , Lessen D. S. , Von Roenn J. , Sullivan A. M. , Arnold R. M. , Block S. D. 
Published: August 2020

9541 Background: Palliative care (PC) is recognized as an integral part of the practice of oncology, yet many oncologists report inadequate training in critical PC domains, such as symptom management, psychosocial care and communication skills. We sought to assess the quantity and quality of PC education within oncology fellowships. Methods: Second year fellows enrolled in US oncology fellowships were invited to complete a 104 item survey that was modified from a national telephone survey of medical students and residents. Topics included: 1) quality and quantity of teaching and education, 2) observation and feedback, 3) knowledge, 4) attitudes and preparation. Items were designed to allow comparison between PC and non-PC topics. To reduce Type I errors from multiple testing, an alpha level of 0.01 was considered statistically significant. Results : Of 402 eligible fellows, 63.5% responded (n=254). Respondents were: 52% male, 62% White, 27% Asian and 64% US medical school graduates. One-quarter (26%) had completed a PC rotation and 68% reported exposure to palliative care during their fellowship. On a 5-point Likert Scale, fellows rated teaching on PC less highly than the overall quality of fellowship teaching (3.0 v 3.7; p<0.001). Fellows rated attending oncologists less favorably in performing PC skills compared to other oncology skills: managing pain in the terminally ill versus managing spinal cord compression (3.9 v. 4.5; p < 0.001); discussing the decision to stop chemotherapy versus discussing chemotherapy side effects (3.8 v. 4.2; p < 0.001). Fellows were less likely to be observed (81% v 93%; p =0.005) or receive feedback (80 v 93%; p= 0.02) on end-of-life (EOL) discussions than bone marrow biopsies. Many fellows reported not receiving explicit education on PC topics: managing depression at the EOL (68%), opioid rotation (67%), telling a patient she is dying (42%) and hospice referral (37%). Fellows who completed a PC rotation were more likely to report explicit teaching on opioid rotation (p =0.005) and hospice referral (p = 0.002). Conclusions: Our study reveals opportunities for improving the PC training of oncology fellows. No significant financial relationships to disclose.
Predictors of prostate cancer-specific mortality in elderly men with intermediate-risk prostate cancer treated with radiation therapy
Authors: Nanda A. , Chen M. , Moran B. J. , Braccioforte M. H. , Dosoretz D. , Salenius S. , Katin M. , Ross R. , D'Amico A. V. 
Published: August 2020

9543 Background: To identify clinical factors associated with prostate cancer-specific mortality (PCSM), adjusting for co-morbidity, in elderly men with intermediate-risk prostate cancer treated with brachytherapy alone or in conjunction with external beam radiation therapy (EBRT). Methods: The study cohort comprised 1,978 men of median age 71 (interquartile range [IQR], 66–75) years with intermediate-risk prostate cancer (Gleason score 7 with PSA 20 ng/mL or less and tumor category T2c or less). Fine and Gray's multivariable competing risks regression was used to assess whether presence of cardiovascular disease (CVD), age, treatment, year of brachytherapy, PSA level, or tumor category were associated with the risk of PCSM. Results: After a median follow up of 3.2 (IQR, 1.7 - 5.4) years, 15 men were observed to experience PCSM. The presence of CVD was significantly associated with a decreased risk of PCSM (AHR 0.20, 95% CI 0.04 - 0.99, P = 0.05), whereas an increasing PSA level was significantly associated with an increased risk of PCSM (AHR 1.14, 95% CI 1.02 - 1.27, P = 0.02). In the absence of CVD, cumulative incidence estimates of PCSM were higher (P = 0.03) in men with PSA levels above as compared to the median PSA level (7.3 ng/mL) or less; however, in the setting of CVD there was no difference (P = 0.27) in these estimates stratified by the median PSA level (6.9 ng/mL). Conclusions: Detection of intermediate-risk prostate cancer in elderly men without CVD at lower PSA levels is associated with a lower risk of PCSM; this risk reduction is not observed in men with known CVD. [Table: see text] No significant financial relationships to disclose.
Sexual dysfunction in women with breast cancer: Prevalence and severity
Authors: Goldfarb S. B. , Dickler M. , Sit L. , Fruscione M. , Barz T. , Atkinson T. , Hudis C. , Basch E. 
Published: August 2020

9558 Background: Sexual dysfunction (SD) is reported after chemotherapy and endocrine therapies, and causes a substantial burden on women with breast cancer. However, the prevalence and severity of SD in this population is not well defined. Improved understanding of SD may allow for enhanced treatment and interventions in patients with breast cancer undergoing active treatment, and in survivors of this disease. Methods: We developed a survey that includes a previously validated questionnaire, the female sexual function index (FSFI), and disease-specific items to characterize SD and its causes based on literature review and expert consultations. Anonymous administration of the surveys was conducted in outpatient clinic waiting areas of the M64/Breast Center Memorial Sloan-Kettering Cancer Center (MSKCC), under an IRB waiver of consent. Results: During November-December 2008, 100 women with breast cancer of any stage were each queried once. The mean age was 52 (range 26–75). 68% reported current or past hormonal treatment, and 63% reported current or past chemotherapy (84% adjuvant; 16% for metastatic disease). SD attributed to breast cancer or its treatment, defined as an FSFI score <26, was reported by 75% of respondents. Among these women, severe symptoms were noted by 38/75 (51%), and moderate by 37/75 (49%). 87/95 (92%) patients considered their sexual symptoms to be bothersome, with 59/95 (62%) noting moderate or severe levels of bother (score >=5/10). Patients attributed their SD to chemotherapy in 52/63 (83%) of cases; to hormonal therapy in 56/68 (82%) of cases; and to surgery in 68/92 (74%) of cases. Other contributors to SD were felt to include anxiety by 83% of respondents, and change in relationship with a partner by 46%. Conclusions: SD is prevalent in women treated for breast cancer and should be discussed with patients as a potential adverse effect of therapy. Assessment of sexual symptoms throughout treatment and beyond may facilitate the use of potential interventions such as lubricants, dilators, treatment modification, topical estrogens, and counseling. A longitudinal prospective trial is planned to further characterize the etiologies of these symptoms. No significant financial relationships to disclose.
Predictors of recurrent thrombosis and anticoagulant-related bleeding in patients with cancer
Authors: Lee A. , Parpia S. , Julian J. , Rickles F. , Prins M. , Levine M. 
Published: August 2020

9565 Background: Anticoagulant therapy is treatment of choice for cancer-associated thrombosis. However, the risk of symptomatic recurrent thrombosis (RT) is approximately 9% on low molecular weight heparin (LMWH) and 17% on vitamin K antagonist (VKA) therapy, while the risk of anticoagulant-related major bleeding is about 5%. Given such complications are associated with morbidity and increased resource utilization, prognostic factors that identify patients at high risk for RT or bleeding would be useful for individualizing therapy. We performed a post-hoc analysis of the CLOT study (N Eng J Med 2003;349,146–53) for predictors of RT and bleeding in patients with proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) who were randomized to receive either dalteparin LMWH or VKA for 6 months. Methods: Cox proportional hazards modeling analyses were performed using prospectively collected data from the CLOT study database. Potential baseline factors associated with RT and bleeding examined in the models were identified a priori based on published literature. Factors for RT were: dalteparin, age, gender, ECOG status, smoking status, presence of metastases, tumor site, history of DVT or PE, recent surgery, cancer treatment and body mass index. Factors for bleeding were: dalteparin, age, gender, ECOG, tumor type, major surgery, cancer treatment, platelet count, body mass index, creatinine, and concurrent use of antiplatelet agents. Results: Data from 673 cancer patients were available for the analysis. There were 80 patients with RT, 31 with major bleeds and 77 with minor bleeds. Three statistically significant predictors for RT were identified (with their hazard ratio and corresponding 95% CI): dalteparin (0.52; 0.32–0.82), every 10 year increase in age (0.77; 0.66–0.90) and presence of metastases (2.59; 1.20–6.60). Of the tumour sites investigated, lung (3.51; 1.62–7.62) and unknown primaries (3.63; 1.36–1.90) were predictive of RT. None of the factors examined in the models were found to be predictive of bleeding. Conclusions: Baseline factors may identify cancer patients with a higher risk of RT despite anticoagulant therapy. The risk of anticoagulant-related bleeding is not predictable at treatment onset. [Table: see text]
Effect of chemotherapy on the risk of erlotinib-induced skin rash in cancer patients: A meta-analysis
Authors: Jia Y. , Lacouture M. E. , Su X. , Wu S. 
Published: August 2020

9573 Background: Erlotinib, an inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase, is effective in the treatment of non-small cell lung cancer (NSCLC) as a single agent and pancreatic cancer when combined with chemotherapy. Its application in other types of cancer is also undergoing extensive clinical assessment. Skin rash is a major side effect of erlotinib. This study aims to gain a better understanding of skin toxicity with erlotinib through a systematic review and meta-analysis of randomized controlled clinical trials. Methods: Relevant studies were identified from Medline (1966 to October 2008), Web of Science, and abstracts presented at the American Society of Clinical Oncology Conferences between January, 2004 and October, 2008. Eligible studies included prospective randomized controlled clinical trials in which cancer patients were treated with erlotinib at 150 mg daily as single agent or in combination with other agents. Incidence, relative risk (RR), and 95% confidence intervals were calculated using random-effects or fixed-effects models based on the heterogeneity of included studies. Results: A total of 3,562 patients with a variety of solid tumors from 12 randomized controlled clinical trials were included for analysis. The overall incidence of all-grade skin rash associated with erlotinib was 68.7% (95% CI: 63.0–73.8%) with 8.9% (95% CI: 7.7–10.3%) being high-grade (grade 3 or above). There was a significantly increased risk of skin toxicity with erlotinib in comparison with controls (all-grade: RR 3.1, 95% CI: 2.2–4.3, p < 0.001; high-grade: RR 10.1, 95% CI: 5.5–18.5, p < 0.001). Interestingly, chemotherapy may decrease the risk of skin rash associated with erlotinib. RR of all-grade skin rash was 4.7 (95% CI: 3.6–6.2) for single-agent erlotinib and 2.3 (95% CI: 2.0–2.7) for erlotinib in combination with chemotherapy; RR of high-grade skin rash was 17.3 (95% CI: 3.3–90.5) for single-agent erlotinib and 9.3 (95% CI: 4.8–17.8) for erlotinib in combination. Conclusions: Erlotinib was associated with significantly increased risk of skin toxicity among cancer patients. Its combination with chemotherapy may decrease the risk of skin rashes. No significant financial relationships to disclose.