bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions of chemotherapy influencing treatment decisions in women with hormone-positive tumors.
Authors: Proverbs-Singh Tracey , Fei Kezhen , Franco Rebeca , Bickell Nina 
Published: March 2020

e19621 Background: Women with hormone receptor positive (HR+) breast cancer can benefit from chemotherapy (CTX). Unnecessary therapy can adversely affect patient morbidity.. While tumor biology affects decision making, patient perception of cancer recurrence is also important. In this study we determine whether women with HR+ tumors (>1cm) who undergo CTX, have stronger beliefs in the efficacy of CTX than women who do not get therapy. Methods: Women participating in a Breast Cancer Patient Assistance Trial in 2006-2010 were surveyed about their cancer knowledge and beliefs about its treatment; charts were abstracted 6 months later to measure treatments received. A Nottingham Prognostic indicator (NPI), which uses stage, tumor size, and lymph node involvement was calculated. Chi-square and logistic regression analyses examined associations between receipt of CTX and tumor stage, NPI, physician recommendation, patient demographics and beliefs about CTX. Results: Women with HR+ tumors 130/211(62%) received CTX and 197/211(93%) received hormonal therapy. Gene array analysis was performed in 46/211 (22%), and of these (7/46 [15%]) had high recurrence scores and received CTX. Women treated with CTX vs those without CTX were younger (mean 52.5 yrs vs 62.3 yrs, p<0.0001), had higher stage cancer (stage II: 65% vs 23%, p<0.0001), worse NPI (poor prognosis:15% vs 2% p<0.0001), more physician recommended CTX (92% vs 34%, p<0.0001) and increased concern about recurrence without CTX (very worried 70% vs 15%; p<0.0001). Multivariate analysis found that physician recommendation, poor NPI and moderate NPI were most strongly associated with receiving CTX [RR= 3.2, (95% CI:1.8-5.6), 1.7, (95%CI:1.3-2.2); 1.6, (95%CI:1.2-2.0)], respectively, followed by women’s worry (RR=1.3; 95%CI: 1.0-1.6), and belief that CTX allows women to live longer (RR=1.1; 95%CI: 1.0 - 1.2). Older age was associated with less use of CTX (RR= 0.99; 95%CI: 0.978-.995). Conclusions: Physician recommendation, disease severity, concerns about recurrence and beliefs about CTX’s effectiveness influence the utilization of CTX in HR+ breast cancer. Patients may benefit from education to make informed decisions.
Deciding to withhold or withdraw (WH/WD) anticancer therapy (ACT) in advanced cancer patients: Physicians and patients points of view and interactions.
Authors: Beaussant Yvan , Tournigand Christophe , Pazart Lionel , Mathieu-Nicot Florence , Cretin Elodie , Deconinck Eric , Bouleuc Carole , Godard Aurelie , Maindrault-Goebel Frederique , Cuynet Patrice , Aubry Regis 
Published: March 2020

e19623 Background: ASCO highlighted the need to improve communication with and decision making for pts with advanced cancer. This study explores the decision-making process for pts with advanced cancer when the question to WH/WD ACT is raised, with a cross-analysis of physicians and pts points of view. Methods: Multi-center qualitative study in 5 oncology and hematology units, based on semi-structured single interviews with referent oncologists and their pts. An epidemiological survey was performed to identify the prevalence of such decisions. Results: Of the 839 pts hospitalized during a given week, the question to WH/WD ACT was raised in 3.4% of cases (n=29) and in 12,8% when excluding ambulatory pts (n=26 of 202). All 29 referent physicians and 21 pts were interviewed. Futility and poor general condition were the most frequently cited reasons to WH/WD ACT. Subjective determinants related to the physician/patient relationship and their respective experiences were also predominant in all interviews. Although most physicians reported attempting to fully inform pts about their poor prognosis and treatment options, only a minority were able to anticipate the option to WH/WD ACT in these discussions. The fear to remove pts’ hope and to increase anxiety, and a feeling of capitulation and abandonment were the main obstacles they pointed out. For pts, hope and struggle attitudes were predominant, as well as anxiety about their situation and confidence in the physicians’ decisions. More than 80% of pts declared leaving the physician to decide alone. Most of them expected to be involved in the decisions, but only 1/3 reported being actually aware of this questioning. Conclusions: In this study, oncologists faced the difficult decision whether to continue, WH/WD ACT for 1/7 hospitalized patient. The uncertainty of the benefit/risk assessment seemed to strengthen the subjective determinants of the questioning. Pts and physicians mutual willingness to maintain hope reinforced an attitude of “not giving up”. Communication training of health professionals and integrative palliative care could favor the ethical questioning and improve care through the respect of pts’ preferences.
Risk factors for fractures in patients on hormonal therapies for breast cancer and DCIS.
Authors: Ladha Abdullah , Mathew Josy 
Published: March 2020

e19627 Background: Hormonal therapy with aromatase inhibitors (AI) or tamoxifen (TAM) is standard of care for hormone receptor positive breast cancer and DCIS. Fractures are a complication of treatment with AI due to accelerated bone loss. Risk factors for fracture in patients on hormonal therapy (HT) for breast cancer and DCIS are poorly defined. Methods: All 71 patients with breast cancer or DCIS seen in the bone and mineral clinic of our institution from 2000 to 2010 were analyzed. Data on demographics, pathology, type and duration of HT, bone mineral density studies (BMD), number and site of fractures were collected. Statistical analysis: t test, chi square test and Fisher’s exact test for categorical data. Results: The age of the patients ranged 40 to 97 years. 65 patients had ER positive breast cancer, 6 patients had DCIS. 9 patients had fractures.41 patients were on an AI alone, 8 were on TAM alone and 14 were on both sequentially. Fractures involved: vertebral compression, femur, hip, distal radioulnar, rib, hand and feet bones. Patients who had osteoporosis at the femur, osteoporosis or osteopenia in the lumbar spine or forearm in the initial BMD study were found to have an increased risk of fracture (P<0.05). Patients who were on TAM and AI sequentially had an increased risk of fracture (P<0.05) compared AI alone. The use of bisphosphonates and the duration of use were significantly associated with fracture (P<0.05) as these patients already had osteoporosis. The age, race, duration of AI use and the use of calcium and vitamin D were not found to be significantly different in patients who had fractures compared to those who did not. In the 24 patients who had two BMD studies, there was no significant change in the BMD overall. Conclusions: Patients with osteoporosis or osteopenia at baseline have an increased risk of fracture with the use of hormonal therapies for breast cancer and DCIS. This risk was not eliminated by the use of bisphosphonates. Sequential use of tamoxifen and aromatase inhibitors increase the risk of fractures. Bone mineral density studies done prior to the initiation of hormonal therapy for breast cancer maybe useful estimating the risk of fracture while on treatment.
Fatigue control in metastatic colon cancer treated with capecitabine and oxaliplatin.
Authors: Peria Fernanda Maris , Sá Lilian Andrade , Oliveira Harley Francisco , Vettori Josiane Cheli , Tirapelli Daniela Pretti da Cunha , Vieira Nivaldo Farias , Perdona Gleici da Silva Castro 
Published: March 2020

e19628 Background: Fatigue is one of the most frequent symptoms in cancer patients, characterized by profound fatigue that is not relieved by rest. This symptom can be identified at the time of diagnosis and could affects up to 90% of patients undergoing cancer treatment. There are some instruments available in the literature that can characterize the presence of fatigue through clinical questioning. Methods: Considering the large population of patients with metastatic colorectal cancer treated with chemotherapy and the prevalence of fatigue in these patients, this study evaluated the presence of fatigue in 27 metastatic colon cancer patients before the first, second, third and fourth cycles of fist line palliative chemotherapy regimen containing CAPOX (capecitabine and oxaliplatin) by applying the evaluation questionnaire FACIT-F fatigue. Results: The results post Friedman chi-squared test demonstrated that there was no improvement of fatigue during these four cycles of CAPOX palliative chemotherapy (p=0,2574). The FACIT-G analysis demonstrated no worsening of quality of life (p=0,2411) during and between the four cycles of chemo. All different parameters included in FACIT-F questionnaires: emotional (p=0,2629), physical (p=0,3199), familiar (p=0,1456), functional (p=0,8662) and specific fatigue topic (p=0,7569) confirmed no difference between the cycles. Conclusions: Despite the metastatic stage of colon cancer patients and concurrent chemotherapy treatment, there was no fatigue improvement during the four first CAPOX chemo cycles courses and there was the maintenance of quality of life.
Trends in hepatitis B virus screening in a large U.S. cancer center.
Authors: Hwang Jessica , Fisch Michael , Lok Anna , Zhang Hong , Vierling John , Suarez-Almazor Maria 
Published: March 2020

e19631 Background: In the past 5 years, national hepatitis B virus (HBV) screening recommendations differed with respect to populations that should be screened to prevent reactivation, which may occur in patients with hematologic or solid malignancies. Previous studies showed that up to 60% of oncologists are not screening. We sought to compare the HBV screening patterns over time in a large US cancer center in relationship to the 2010 ASCO Provisional Clinical Opinion (PCO) which includes recommendations to screen patients with hematologic malignancies prior to receipt of certain cancer therapies. Methods: Retrospective cohort study of patients with newly diagnosed cancer registered at MD Anderson (1/04 - 4/11) who received chemotherapy. Screening was defined as testing for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before chemotherapy. We compared screening rates among patients with hematologic malignancies vs. solid tumors. Using Chi-square tests, we compared screening rates before and after the PCO. A generalized linear regression model was used to detect changes in the rates of HBV screening over time for patients based on cancer type. Results: During our study period, 141,877 patients were registered, and 13% (n=18,877) received chemotherapy. Of these, 18% (n=3475) had HBV screening: 1% (n=42) were HBsAg+/anti-HBc+, while 7% (n=242) were HBsAg-/anti-HBc+. The overall screening rate significantly increased from 18% before the PCO to 23% after the PCO (p<0.01). After the PCO, the screening rate among patients with hematologic malignancies increased from 69% to 79% (p<0.01), and among patients with solid tumors from 3.8% to 5% (p=0.05). Overall, the rate of increase of HBV screening among patients with hematologic malignancies was higher than for patients with solid tumors (p<0.01). Conclusions: Rates of HBV screening increased after the PCO, although the rate of increase was greater among patients with hematologic malignancies than solid tumors. Because reactivation is an important and preventable cause of morbidity and mortality in patients with either hematologic or solid malignancies, further efforts are needed to screen patients at risk by identifying predictors of reactivation of HBV infection.
Testosterone replacement for fatigue in male hypogonadic patients with advanced cancer: A preliminary double-blind placebo-controlled trial.
Authors: Pulivarthi Kalyan , Dev Rony , Garcia Jose , Palmer J. Lynn , Bruera Eduardo , Del Fabbro Egidio 
Published: March 2020

e19643 Background: Hypogonadism affects two thirds of men with advanced cancer. Uncontrolled studies show fatigue, anorexia, depression,and insomnia are associated with low testosterone in men with cancer. Testosterone replacement improves quality of life and diminishes fatigue in patients with non-cancer conditions. The primary goal of this study was to evaluate the effect of testosterone replacement on fatigue in hypogonadal males with advanced cancer, by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)at day 29. Methods: Randomized, double-blinded placebo controlled at two centers. Clinic outpatients with advanced cancer, bioavailable testosterone (BT) <70ng/dL, hemoglobin>9g/dL, and moderate to severe fatigue assessed by a score >3/10 on the Edmonton Symptom Assessment Scale (ESAS) were eligible.Contraindications to testosterone therapy or other causes of fatigue such as hypothyroidism, hypercalcemia, or chronic kidney disease excluded subjects. Weight-based intra-muscular testosterone or a sesame seed oil placebo administered every 14 days to achieve a BT level 70-270ng/dL. Initial sample size was for fifty evaluable patients per group. One-sided t test was used to analyze differences in FACIT scores between arms. Results: Accrual was slower than anticipated with a final total of 43 eligible males randomized to testosterone(19) or placebo(24). Neither age nor site was statistically significant (<0.05) between arms. 14 placebo and 12 testosterone treated patients were evaluable for the primary outcome.No statistically significant difference was found for FACIT-F total scores between arms, with a trend for testosterone to improve scores (-5.5±19 for placebo, 3.9±14 for testosterone, p=0.09) using a one-sided t test. Adverse events were similar between groups. There were no significant differences in secondary outcomes of ESAS scores, Hospital Anxiety and Depression Scale, hand-grip or 6 minute walk. Conclusions: Testosterone replacement in hypogonadal male patients with advanced cancer had a trend to improve fatigue and quality of life in this preliminary trial.
Moderate-to-severe symptoms among survivors of early-stage breast cancer.
Authors: Zonder Helene B. , Mortimer Joanne E. , Behrendt Carolyn E. , Smith Robin , Zomorodi Meghan 
Published: March 2020

e19644 Background: This cross-sectional survey describes the prevalence of moderate/severe symptoms among patients in a survivorship clinic. Methods: We administered QoL questionnaires (FACT-B, SF-36, HADS) to pts. treated for stage I-III disease at a survivorship visit. For symptoms reported by at least 18/55 subjects, we identified risk factors using logistic regression. Results: Subjects (n=55) were age 55.9(+8.9) yrs at study, age 52.6(+9.3) at dx, and median 23.7 (range 6.3-157.2) mos. from dx of stage I (30.9%), II (54.5%), or III (14.6%) disease. Systemic treatment included chemotherapy only (20.0%), endocrine therapy only (30.9%), or both therapies (49.1%). Currently, 65.5% were on endocrine therapy. Symptoms experienced “quite a bit” or “very much” during the past wk were: hot flashes (45.5%), joint pain (30.9%), weight gain (30.9%), loss of libido (30.9%), vaginal dryness (27.3%), and night sweats (27.3%). In the past mo., 43.6% accomplished less than they would have liked due to physical health, and 30.9% felt worn out at least “a good bit of the time”. Sleep quality was rated “fairly to very bad” (32.7%), and 25.5% felt fatigued at least half the day during the past week. Vigorous activities were “limited a lot” for 36.4%, and increased with age at dx. Fre-quent hot flashes were associated with age < 50 years (6.40, 1.75-23.35) and being within 1year of dx (10.67, 1.05-108.69). Adjusted for age at dx, poor quality of sleep increased with stage of disease (9.68, 2.25-41.69, per step increase) and was associated with having received endocrine therapy only (9.98, 1.40-71.03) and being within the first year after dx (9.54, 0.76-119.47). Conclusions: Limitation in activities, poor quality of sleep, and symptoms of hormonal suppression are common among survivors of early stage breast cancer. Poor quality sleep and frequent hot flashes appear to decrease in prevalence 1 yr after dx, but other common symptoms do not. A longitudinal cohort study is underway.
Ovarian tissue cryopreservation in a prepubertal girl after fertility impairing therapy.
Authors: Gosiengfiao Yasmin C. , Reynolds Marleta , Rajaram Veena , Lockart Barbara , Smith Kristin , Xu Min , Woodruff Teresa K. 
Published: March 2020

e20001 Background: Advances in cancer therapy have improved the long-term survival of patients suffering from malignancies. High doses of alkylating agents and radiation are known to cause infertility in cancer survivors. Ovarian stimulation is not an option for prepubertal females, leaving experimental ovarian tissue cryopreservation (OTC) as the only option for preserving the reproductive potential of prepubescent girls. Little data is available regarding the condition of a prepubertal ovary after cancer treatment is received. This case study demonstrates the possibility of OTC post cancer treatment in a prepubertal female. Methods: A 9-year-old girl with multiply recurrent vaginal rhabdomyosarcoma presented for fertility preservation upon local recurrence of her tumor. Prior therapy included 32,200 mg/m2 of cyclophosphamide, 9,000 mg/m2 of ifosfamide and vaginal brachytherapy after ovarian transposition. A unilateral oophorectomy was performed with therapeutic partial vaginectomy, total hysterectomy and bilateral salpingectomy. A 1 cm section of the ovary was dissected and sent to pathology. The ovarian tissue planes were separated and the cortical tissue removed from the medulla. The cortical tissue was then cut into approximately 2 cm x 0.5cm x 0.1cm strips. 80% of this tissue was cryopreserved using a slow-freeze method for the patient’s future reproductive use and 20% was provided to the Oncofertility Consortium for research as per the ovarian tissue cryopreservation protocol. Results: Follicle stimulating hormone (FSH) level prior to oophorectomy was 0.5 mIU/mL (Normal 1-6 mlU/mL).The ovary was small and fibrotic. Microscopically, primordial follicular density was 1.41/mm2. No follicles of more mature stage were noted. There was no evidence of malignancy in the tissue. Conclusions: The presence of viable follicles in the ovarian tissue suggests that fertility preservation may still be possible even in patients who have received therapy that is considered to be likely to impair fertility. For this patient, who was scheduled to have an invasive surgery, adding on ovarian tissue cryopreservation presented a very minimal risk with a potential for a great benefit.
Country specific serum IgE reactivity profile and concordance with allergic history among acute lymphoblastic leukemia children and controls.
Authors: Lariou Maria Stella , Dikalioti Stavroula , Dessypris Nick , Pourtsidis Apostolos , Baka Margarita , Polychronopoulou Sophia , Piperopoulou Fani Athanasiadou , Moschovi Maria , Fragandrea Ioanna , Kalmanti Maria , Germenis Anastassios , Petridou Eleni 
Published: March 2020

e20002 Background: Allergy has been studied as a risk factor for several malignancies, including childhood leukemia; yet, the tentative etiological nature of this association needs to be further explored. Published studies suffer inappropriate study design and accuracy of exposure variables. In response to the latter need, this study aims to use country specific biological markers, namely levels of the most prevalent allergen-specific immunoglobulin E (IgE) antibodies in Greece as an alternative exposure measurement to history of allergy and compare their concordance with allergic history. Methods: Allergen-specific-IgEs against 24 most prevalent inhalant and food allergens were determined for 199 incident childhood acute lymphoblastic leukemia (ALL), newly diagnosed cases across Greece and registered in the Nationwide Registry for Childhood Hematological Malignancies (NARECHEM) and 113 hospital controls. K statistic was used to check the concordance between serum IgE specific allergens and allergic history overall, as well as among cases and controls. Results: Concordance between self-reported food allergy and food IgE levels in the same individual among both cases and controls was 87% and 83% for respiratory allergens. Among cases, concordance between self reported food allergies and food IgEs was 92% and 80% for controls (p-value 0.003) and the respective κ statistics were 0.28 for cases and 0.10 for controls. Concordance between self reported respiratory allergies and respiratory IgEs was 84% for cases and 81% for controls (p-value 0.57); κ statistics 0.09 for cases and 0.07 for controls. Conclusions: Much of the discordance among cases and controls (self-report false positives) might probably be a reflection of non allergic food hypersensitivity, an allergy that was surpassed or extended allergen avoidance. Other discordance (self-report false negatives) seems to be the result of food sensitization, either hypoclinical or not acknowledged as a type of allergy by mothers of the children. Nevertheless, these measurements jointly analyzed are valuable in exploring the stated hypothesis, especially in well designed prospective studies.
An oncogenetics consultation dedicated to children suffering from cancer.
Authors: Mari Véronique , Met Domestici Marie Amelie , Soler Christine , Deville Anne , Sirvent Nicolas , Poiree Maryline , Frenay Marc 
Published: March 2020

e20006 Background: When a child suffers from a cancer, parents worry about a probable hereditary cause. If a cancer occurs in the context of a genetic mutation, this can worsen the situation and make it more complicated. On the other hand, when the hereditary cause is rejected, the reinsurance for the family is clear. Methods: A partnership has been set between the Oncogenetics department in Centre Antoine Lacassagne Hospital in Nice and the Archet hospital in Nice (CHU) who takes in charge the children suffering from a cancer. Fifty little patients are seen every year in the paediatric oncology service at the Archet hospital (CHU). A consultation in oncogenetics is suggested to each family and insistently when a known syndrome is suspected. This consultation is also about to provide an other kind of care, in an other hospital, focused on the family with the aim to free of guilt the parents. Psychological care for families is in backdrop as they can express freely their questioning. Results: Twenty one families have been seen and fifteen different types of cancers recorded: mostly haematological cancers and neurological cancers. For each family, a pedigree was drawn. Data concerning the child’s disease and familial data were gathered. Most of the time, these information led to reassure the families. Therefore two Li and Fraumeni syndrome have been evoked. The first child suffered from a plexus choroid carcinoma and the second one had two distinct cancers: a nephroblastoma and a medulloblastoma. On the other hand, 2 children had had a LAL within a family with history of malignant haemopaties. Interestingly, 3 children with isolated LAL in the family where suggested to contribute to a research trial. Conclusions: This oncogenetic pediatric consultation allows to detect known hereditary predisposition syndromes and to contribute to researches in paediatric oncology. Above all, this strong bound between the oncogentics department and the pediatric oncology service permitted to reach an objective: offering families a specialised consultation with psychological support with a gap from disease.