bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy.
Authors: Navari Rudolph M. , Nagy Cindy K , Gray Sarah E 
Published: March 2020

9064 Background: Olanzapine (OLN) has been shown to be a safe and effective agent for the prevention of CINV. OLN may also be an effective rescue medication for patients who develop breakthrough CINV despite having received guideline directed CINV prophylaxis. Methods: A double blind, randomized phase III trial was performed for the treatment of breakthrough CINV in chemotherapy naïve patients receiving highly emetogenic chemotherapy (HEC) (cisplatin, >70 mg/m2, or doxorubicin, >50 mg/m2 and cyclophosphamide, > 600mg/m2 ) comparing OLN to Metoclopramide (METO). Patients who developed breakthrough emesis or nausea despite prophylactic dexamethasone (12 mg IV), palonosetron (0.25 mg IV), and fosaprepitant (150 mg IV) pre chemotherapy and dexamethasone (8 mg p.o. daily, days 2-4) post chemotherapy were randomized to receive OLN, 10 mg orally daily for three days or METO, 10 mg orally TID for three days. Patients were monitored for emesis and nausea for the 72 hours after taking OLN or METO. Eighty patients (median age 56 yrs, range 38-79; 43 females; ECOG PS 0,1) consented to the protocol and all were evaluable. Results: During the 72 hour observation period, 30 of 42 (71%) patients receiving OLN had no emesis compared to 12 of 38 (32%) patients with no emesis for patients receiving METO (p<0.01). Patients without nausea (0, scale 0-10, M.D. Anderson Symptom Inventory) during the 72 hour observation period was: OLN: 67% (28 of 42); METO 24% (9 of 38) (p<0.01). There were no Grade 3 or 4 toxicities. Conclusions: OLN was significantly better than METO in the control of breakthrough emesis and nausea in patients receiving HEC.
Humoral and cellular immune response after influenza vaccination in patients with postcancer fatigue and patients with chronic fatigue syndrome.
Authors: Prinsen Hetty , de Vries Jolanda , Stelma Foekje , Mulder Sasja , Van Herpen Carla , Leer Jan Willem , Elving Lammy , Bleijenberg Gijs , Van Laarhoven Hanneke W.M. 
Published: March 2020

9070 Background: Postcancer fatigue (PCF) is a frequently occurring problem, impairing quality of life. Patients with chronic fatigue syndrome (CFS) also suffer from severe fatigue symptoms. We hypothesized that in fatigued patients (PCF and CFS) alterations in immune response could explain fatigue symptoms. Therefore, we examined whether the humoral and/or cellular immune response after influenza vaccination differed between fatigued patients and non-fatigued individuals and between PCF and CFS patients. Methods: PCF (n=15) and CFS patients (n=22) were vaccinated against influenza. Age and gender matched non-fatigued cancer survivors (n=12) and healthy controls (n=23) were included for comparison. Antibody responses were measured at baseline and at day 21 by a hemagglutination inhibition test. T cell responses were measured at baseline and at day 7 by a lymphocyte proliferation and activation assay. Results: Both patient groups developed seroprotection rates comparable to the accompanying control groups. Functional T cell reactivity was observed in all groups. Proliferation at baseline was significantly lower in fatigued patients compared to non-fatigued individuals. A significant increase in proliferation from baseline to day 7 was observed in fatigued patients, but not in controls. At day 7, proliferation was not significantly different between fatigued patients and non-fatigued individuals. CD4+CD127-FoxP3+ expression was significantly higher in PCF patients compared to non-fatigued cancer survivors. Conclusions: We observed a lower T cell proliferation at baseline in fatigued patients compared to non-fatigued individuals, suggesting a difference in the baseline state of the immune system between fatigued patients and non-fatigued individuals. Furthermore, the difference in CD4+CD127-FoxP3+ expression between PCF and CFS patients suggests subtle differences in immune state between these two fatigued patient groups. However, since humoral and cellular immune responses after vaccination did not differ significantly between fatigued patients and non-fatigued individuals, vaccination of fatigued patients (PCF and CFS) can be effective.
Inflammatory markers and symptom burden in patients with multiple myeloma undergoing autologous stem cell transplantation.
Authors: Williams Loretta A. , Wang Xin Shelley , Johnson Valen E. , Liu Ping , Shah Nina , Mendoza Tito R. , Reuben James M. , Cohen Evan N. , Gilmore Katherine R. , Ilagan Venus M , Cleeland Charles S. 
Published: March 2020

9081 Background: We explored the association between activation of inflammatory networks and development of severe symptoms during mobilization and the acute phase of autologous hematopoietic stem cell transplantation (ASCT) for multiple myeloma (MM). Methods: From mobilization through the first 3 months after ASCT, multiple symptoms were measured repeatedly via the myeloma module of the M. D. Anderson Symptom Inventory (MDASI-MM). Serum levels of interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-a, soluble TNF receptors 1 and 2 (sTNF-R1, sTNF-R2), IL-1 receptor antagonist (IL-1RA), vascular endothelial growth factor (VEGF), macrophage inflammatory protein-1 (MIP-1a), monocyte chemoattractant protein (MCP)-1 and C-reactive protein (CRP) were collected up to 11 times per patient and assayed by Luminex. Ordinal regression modeling was used to analyze repeated-measures data. Results: Among50 MM patients, the most severe symptoms reported by werefatigue, pain, muscle weakness, disturbed sleep, drowsiness, numbness, poor appetite, and bone aches. Symptoms worsened rapidly from conditioning therapy and peaked at WBC nadir. Over time, controlling for age, sex, and MM stage, increased serum IL-6 (P=.0007) and MCP-1 (P=.0005) were significantly associated with worsening of the most severe symptoms; MIP-1a (P=.005) and VEGF (P=.002) were inversely associated with these symptoms. Increased CRP was significantly associated with worsening pain (P=.01), fatigue (P=.007), and bone aches (P=.006). Conclusions: This longitudinal study indicates a strong association between dynamic changes in circulating inflammatory molecules and the most severe symptoms in MM patients during the acute phase of ASCT. This observation, similar to IL-6-related multisymptom development around WBC nadir of allogeneic SCT (Wang et al, 2008), provides evidence of potential inflammation-induced behavioral changes in humans. Testing of anti-inflammatory interventions is warranted to further confirm the role of inflammation in the development of symptoms and identify effective mechanism-driven symptom management during ASCT.
Gender difference in vulnerability and geriatric syndromes among elderly cancer survivors.
Authors: Fan Lin , Noyes Katia , Zhang Ning , Fiscella Kevin , Mohile Supriya Gupta 
Published: March 2020

9091 Background: Few studies have evaluated the gender difference of vulnerability and geriatric syndromes (GS) among cancer survivors. Methods: Using 2003 Medicare Current Beneficiary Survey, we applied multivariable logistic regression to evaluate the association of gender with vulnerability and GS among cancer survivors. Vulnerability is measured by Vulnerable Elders Survey-13 (VES-13), which is calculated from age, self-rated health status, difficulty with physical activities and functional activities. Vulnerability is defined by a VES-13 score of 3 or higher. 8 common geriatric syndromes were assessed: sight trouble, hearing trouble, nutrition problem, incontinence, falls, depression, memory loss and osteoporosis. Cancer survivors are defined as patients with cancer diagnosed more than one year ago. Results: Among the 1,883 cancer survivors, 749 (40.0%) were male; 1,134 (60.0%) were female. Female survivors had a higher prevalence of vulnerability (47.8% vs 35.7%), and GS (65.5% vs 44.6%) than male survivors. Mean GS number was 1.19 for female survivors, while 0.77 for male survivors (p<0.001). More specifically, female survivors had significantly higher prevalence of sight trouble (7.73% vs 5.0%), incontinence (14.3% vs 7.1%), falls (28.9% vs 22.1%), depression (13.8% vs 7.7%) and osteoporosis (38.2% vs 6.7%). After adjusting for confounders, female survivors were more likely to be vulnerable (adjusted OR (AOR): 1.62; CI: 1.21-2.17; p=0.001); have a geriatric syndrome (AOR: 2.39; CI: 1.91-3.00; p<0.001); have sight trouble (AOR: 1.70; CI: 1.00-2.87; p=0.049); have incontinence (AOR: 2.48; CI: 1.67-3.69; p<0.001); have depression (AOR: 1.87; CI: 1.29-2.71; p<0.001); and have osteoporosis (AOR: 8.48; CI: 6.07-11.84; p<0.001). Conclusions: Female cancer survivors experience a higher prevalence of vulnerability and overall geriatric syndromes.
Medical oncologist’s commitment in the end of life (EoL) care of cancer patients: The caregiver's perspective.
Authors: Bascioni Romeo , Giorgi Francesca , Esperide Barbara , Basirat Farnoosh , Borriello Maria Rosaria , Brugni Manuela , Scriboni Sonia , Rastelli Francesca , Appignanesi Remo , Picciotti Giovanna , De Signoribus Giorgio , Giustini Lucio 
Published: March 2020

9098 Background: Optimizing the impact of EoL care on cancer patients (pts) and their caregivers should be a primary goal of an oncology unit. In this study we evaluated satisfaction of family caregivers when the medical oncology team assisted pts until death. Methods: Two oncology units were reorganized to ensure continuity of care; oncologists trained in palliative care medicine assisted pts until EoL. The model assumes that the medical oncologist (MO) is the physician in charge throughout the entire disease trajectory. Relatives of pts assisted at home or at an inpatient hospice underwent a semistructured phone interview conducted by a psychologist or a social worker > 1 month after pts' death. Satisfaction was evaluated for symptoms control, communication, psychological support, overall quality of care and continuity of therapeutic relationship with the MO. A final open-ended question was included for any additional comment. Satisfaction was measured using a five-point Likert scale ranging from very dissatisfied to very satisfied and converted to a 0-to-100 scale. Results: Relatives of 65 pts were contacted, 55 accepted the interview (27 spouses, 22 sons, 5 in-laws, 1 parent); 50/55 were the leader caregiver. Patients were followed at home (41) or at an inpatient hospice (14), for 1-24 wks. Satisfaction mean scores were: symptoms control 76/100, communication 85, psychological support 82 and overall quality of care 87; a specific question on the relevance of the MO in EoL care produced a score of 87, with no negative or neutral responses recorded for this item. Of note, a common perception among caregivers was the appreciation of the MO's commitment during EoL in addition to the technical quality of the intervention. The overall satisfaction score was higher than in our previous study in which a continuity of care model was not formally adopted, with a score improvement from 55 to 87/100. Conclusions: A care pathway where the MO is involved in EoL management of cancer pts improved satisfaction of caregivers.When a longstanding and trusting relationship has been established, the pts-MO connection should not be lost to prevent feelings of abandonment.
Comparative patient-centered outcomes (health state and adverse sexual symptoms) between adjuvant brachytherapy versus no adjuvant brachytherapy in early-stage endometrial cancer.
Authors: Damast Shari , Alektiar Kaled M. , Goldfarb Shari Beth , Gerber Naamit Kurshan , Eaton Anne , Patil Sujata , Mosenkis Jeffrey , Sit Laura , Rogak Lauren J. , Leitao Mario M. , Carter Jeanne , Basch Ethan M. 
Published: March 2020

9104 Background: We performed a cross-sectional analysis of survivors of stage I endometrial cancer (EC) to examine the relationship between receipt of adjuvant intra-vaginal radiation therapy (IVRT), health state (HS), and sexual functioning (SF). Methods: Survivors were administered anonymous questionnaires containing demographic and treatment-related items, the EQ5D to measure current HS, and the Female Sexual Function Index (FSFI) to measure current SF. All were disease-free and had undergone simple hysterectomy (SH) with or without adjuvant IVRT at least one year prior to questionnaire completion. None had received chemotherapy or hormonal therapy. The study was IRB-approved under a waiver of consent. The primary endpoint was a comparison of EQ5D-health states and FSFI scores between survivors who had received SH alone and those who had received SH and adjuvant IVRT. Fisher’s exact test was used to compare IVRT and no-IVRT groups and multivariate regression was applied to find associations between factors and the outcome measures. Results: 136 (66.3%) participants had undergone SH alone and 69 (33.7%) had undergone SH and adjuvant IVRT. The SH alone group was younger; otherwise, the two groups were balanced with respect to ethnicity, marital status, education level, medical co-morbidities (diabetes, hypertension, anxiety), type of SH (laparotomy vs minimally invasive surgery-MIS), and baseline sexual activity. In the IVRT and no-IVRT groups, the median EQ5D-health states were 88 (range 40-100) and 85 (range 10-100) respectively, and the median FSFI scores were 14.1 (range 1.2-35.4) and 16.5 (range 1.2-34.8) respectively. Controlling for age and type of SH, receipt of IVRT was associated with better HS (p=0.018) and not associated with poorer SF (p=0.1399). Receipt of laparotomy (vs MIS) was associated with poorer HS and worse SF (p=0.0156 and p=0.0115, respectively), and its detrimental effect on FSFI score was more pronounced in the IVRT compared to no-IVRT group (p=0.0486). Conclusions: Compared to SH alone, receipt of adjuvant IVRT was generally not associated with poorer SF or HS.
A randomized trial of a cardiopulmonary resuscitation (CPR) video (V) in advance care planning (ACP) for progressive hepatopancreaticobiliary cancer patients.
Authors: Epstein Andrew S. , Volandes Angelo E. , Gary Kristen , Chen Ling Y. , Li Yuelin , Agre Pat , Levin Tomer , Reidy Diane Lauren , Meng Raymond D. , Segal Neil Howard , Yu Kenneth H. , Janjigian Yelena Yuriy , Abou-Alfa Ghassan K. , Kelsen David Paul , O'Reilly Eileen Mary 
Published: March 2020

9105 Background: CPR is an important advance directive topic in patients with progressive cancer; however such discussions are challenging. Previous work by Volandes et al suggests that V images help, however whether V educational information about CPR engenders broader ACP discourse is unknown. Methods: A randomized trial of an educational V or narrative (N) in patients with progressive hepatopancreaticobiliary cancers was conducted. The V and N were 3 minutes long and contained an identical description of CPR. Primary endpoint: ACP documentation 1-month post-test (either a formal advance directive or a documented ACP discussion), 80% powered with 0.01 type-I error rate for estimated advance directive completion rates of 70% V arm vs. 25% N arm with a sample of 56 subjects. Secondary endpoints (exploratory): impressions of the study information; pre and post knowledge of and preferences for CPR and mechanical ventilation; and follow-up longitudinally (to death or 6 months post-test). Results: 56 subjects consented and analyzed. 1-month post-test ACP documentation was not significantly higher in the V arm (12/30, 40.0%) vs. the N arm (4/26, 15.4%); Fisher’s exact test, OR = 3.583 [95% CI: 0.886 – 17.937], p = 0.07. Knowledge increased in both arms after the intervention. Preferences for CPR changed in V arm but not in N arm; for mechanical ventilation, there was no change in either arm. The majority of subjects in both arms reported the information as helpful, comfortable to discuss, and recommended to others. Longitudinally, outcomes were similar between V & N arms, respectively: % advance directives completed (63% & 58%); median days from test to advance directive (60 & 72) and advance directive to death (21 & 20); median ACP documentation after 1 month (0 & 1); median hospital admissions (1 & 1), days of stay (5 & 7), ICU stays (0 & 3) and CPR/mechanical ventilation (1 & 3). 52% of all subjects died by study end, the majority in hospice care. Conclusions: This first randomized trial addressing downstream ACP effects of V vs. N decision tools demonstrated a trend towards more ACP documentation in V patients. Further research into these types of educational media is needed.
Polymorphisms in genes OPRM1, β-arrestin 2, STAT6, and COMT and clinical outcome to opioid therapy.
Authors: Cros Sara , Buges Cristina , Ginés Alba , Martinez Cardús Anna , Ruiz de Porras Vicenç , Capdevila Laia , Carcereny Enric , Martinez-Balibrea Eva , Abad Albert 
Published: March 2020

9129 Background: Morphine sulfate is the most widely used opioid in oncologic pain. There is a high variability in response between individuals. The objectives are to correlate the variability in response (R) and tolerability with polymorphisms within OPRM1, β-arrestin 2, STAT6 and COMT gene sequences. Methods: DNA from 44 oncologic patients (pts) with an EVA score > 6 was prospectively analyzed using allelic discrimination techniques and automatic sequencing. Pts (never treated with opioids) received morphine sulfate 10 mg per day. Pain was assessed by EVA score and toxicity was evaluated according to the most common opioid side effects. Symptomatology was reassessed after 72 hours. Chi-squared and Fisher’s tests where used to analyze data. Results: 17 pts (38.6%) responded with an EVA < 3. 6 pts (13.6%) did not experience toxicity, 36 pts (81.8%) had mild side effects and 2 pts (4.5%) had severe side effects. There was no relation between R rate (RR) and tolerance. 76.5% of pts responding to treatment had a CC/CT β-arrestin 2 genotype and this was associated with a better RR (CC/CT R = 46.4% vs. TT R = 25% p = 0.16). The 2 pts having severe side effects belonged to CC/CT group. COMT genotypes AA/GA were associated with a higher RR (83.3%pts) and better tolerance (100% pts with no toxicities). OPRM1 genotype GG was associated with both treatment failure (0% responded) and worse tolerance (any toxicity = 100%; severe side effects = 33%). Only 2,4% pts in the AA/GA genotype experienced some toxicity (p = 0.041). Although STAT6 genotypes were not associated with RR, tolerance was better in those pts with an AA or GA genotype with 97.5% pts showing either mild or no side effects (p = 0.007). Conclusions: Common variants in β-arrestin 2, COMT, OPRM1 and STAT6 genes have shown to predict for opioid-associated response and side effects in oncologic patients. Further studies are needed to assess factors determining the variability in response and tolerance to opioid treatment.
Cognitive symptoms in non-Hodgkin lymphoma survivors: Prevalence and discussion with doctors.
Authors: Arora Neeraj K , Jensen Roxanne E , Forsythe Laura Pence , Mitchell Sandra A. , Bellizzi Keith M , Aziz Noreen , Rowland Julia Howe , Hamilton Ann S. , Potosky Arnold L. 
Published: March 2020

9130 Background: Several studies have documented the negative impact of chemotherapy on patients’ cognitive functioning. However, this concern has been understudied among non-Hodgkin Lymphoma (NHL) survivors. Methods: We analyzed survey data from a population-based study of survivors diagnosed with aggressive NHL in Los Angeles County 2-5 years prior to the study; data were collected between 2003-2005. We assessed prevalence of cognitive symptoms (CS) by a single item screener that asked if in the past 6 months survivors experienced problems with memory, attention, or concentration; if yes, we asked if they discussed the problem with a doctor. Frequency of CS was assessed by a 4 item scale that measured how often survivors experienced different CS in the past 4 weeks (none, a little, some, most, all the time). Logistic regression analyses identified correlates of reporting CS (yes/no) as well as discussion with a doctor (yes/no). Analyses were based on data from 358 survivors who had received chemotherapy and saw a doctor for follow-up care in the past year. Results: 134/358 survivors (37%) reported CS, many reporting difficulty some, most, or all the time with memory (64%), attention (58%), concentration (57%), and problem solving (46%). Survivors with higher education, who were not married/partnered, and who had more comorbidities were more likely to report CS (p<0.05 for all). Report of CS was not associated with age, NHL grade, time since completion of chemotherapy, or having been treated with radiation or bone marrow/stem cell transplant. Of the 134 survivors who reported CS, only 43% discussed them with a doctor. Survivors who reported being given information about late effects of treatment were more likely to discuss CS than those who were not (OR: 3.4, 95% CI 1.4-8.5, p<0.01). Conclusions: One in three NHL survivors reported CS following chemotherapy; however, a majority did not discuss these with a doctor. Periodic screening for CS in NHL survivors may be needed and would provide an opportunity to improve patient-clinician communication about this issue. Additionally, research that identifies mechanisms that cause CS in this population is warranted in order to develop targeted behavioral and medical interventions.
Prospective cohort study of chemotherapy-associated toxicity and supportive care in oncology practice.
Authors: Culakova Eva , Dale David C. , Poniewierski Marek S. , Kuderer Nicole Maria , Wogu Adane , Crawford Jeffrey , Lyman Gary H. 
Published: March 2020

9135 Background: Neutropenic complications remain important dose-limiting toxicities of cancer chemotherapy associated with considerable morbidity, mortality and cost. The risk of the initial neutropenic event is greatest in the first cycle when most patients are receiving full dose chemotherapy. Methods: A prospective cohort study of adult patients with solid tumors or lymphoma receiving a new chemotherapy regimen was conducted at 115 U.S. practice sites between 2002 and 2006. Chemotherapy-associated toxicities were captured in up to 4 cycles including severe neutropenia (SN), febrile neutropenia (FN), and infection. Documented interventions included colony-stimulating factor (CSF) and antibiotics use and reductions in chemotherapy relative dose intensity (RDI). Results: Results are available on 3,638 patients starting chemotherapy of which 3,301, 2,937, and 2,199 went on to cycles 2, 3, and 4, respectively. The majority of neutropenic and infection events occurred in cycle 1. A significant inverse relationship was observed between subsequent reductions in neutropenic and infectious events and efforts to reduce these complications (Table). Most patients with stage 4 solid tumors underwent reductions in chemotherapy RDI. Patients with lymphoma and stage 1-3 solid tumors were less likely to undergo dose reductions with half or more receiving prophylactic CSFs during treatment. Approximately 15% of patients also received prophylactic antibiotics. Conclusions: While the risk of neutropenic complications remains greatest during the initial cycle of chemotherapy, clinician efforts to reduce the risk of these events vary with cancer type and stage. Reduced dose intensity is evident in two-thirds of patients with advanced solid tumors whereas the CSFs are employed in half to two-thirds of patients with early stage solid tumors or lymphoma. [Table: see text]