bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validating the Cancer and Aging Research Group (CARG) toxicity prediction tool in older men receiving chemotherapy for metastatic castration-resistant prostate cancer (mCRPC) and extending it to androgen receptor targeted agents.
Authors: Alibhai Shabbir M.H. , Breunis Henriette , Gregg Richard William , Hansen Aaron Richard , Warde Padraig Richard , Timilshina Narhari , Tomlinson George , Joshua Anthony M. , Fleshner Neil Eric , Emmenegger Urban 
Published: March 2020

11510 Background: Multiple treatment options are available for mCRPC. Being able to predict toxicity risk for different treatments in older adults can aid treatment decision-making and supportive care. The CARG tool is a promising toxicity risk prediction tool for chemotherapy, but has not been specifically validated in the mCRPC setting for either chemotherapy or androgen receptor targeted agents. We prospectively evaluated the ability of the CARG tool to predict risk of clinically relevant grade 2 and grade 3+ toxicity of treatment with chemotherapy (CHEMO) and abiraterone or enzalutamide (A/E) in older adults with mCRPC. Methods: Men age 65+ were enrolled in this prospective observational study at 3 academic centres, Princess Margaret Cancer Centre, Sunnybrook Health Sciences Centre, and Kingston Health Sciences Centre in Ontario, Canada. All grade 2 and grade 3+ toxicities were documented during cycle 1 of CHEMO or in the first 3 months of A/E via structured interviews and chart review. Lab abnormalities were documented only if resulting in emergency room visits, requiring treatment, or affecting subsequent oncologic treatment. Toxicity was rated using the Common Terminology Criteria for Adverse Events version 4. Logistic regression was performed to identify predictors of toxicity. Results: 64 men starting CHEMO (primarily docetaxel 60-75 mg/m^2, mean age 73y) and 59 men starting A/E (mean age 76y) were included. Clinically important grade 2 toxicities occurred in 86% and 70% of CHEMO and A/E patients, respectively. Grade 3+ toxicities occurred in 48% and 25% of CHEMO and A/E patients, respectively. The CARG tool was predictive of grade 3+ toxicities with CHEMO, which occurred in 22%, 53%, and 71% of low, moderate, and high risk groups (p = 0.017). However, the CARG tool was not predictive of grade 2 toxicities with CHEMO, or grade 2 or 3+ toxicities with A/E (Table). Conclusions: We provide external validation of the CARG tool in predicting grade 3+ toxicity in older men with mCRPC undergoing CHEMO. Grade 2 toxicities are very common with both CHEMO and A/E, and grade 3+ toxicity occurs in 1 in 4 older men on A/E. Additional efforts to identify men at higher risk of toxicity from various mCRPC treatments are warranted. [Table: see text]
Predictors of suicide risk in adolescent and young adults (AYA) with cancer.
Authors: Lewin Jeremy Howard , Thompson Kate , Moncur Donovan , Mancuso Sam 
Published: March 2020

11519 Background: Whilst AYA accounts for a small proportion of annual cancer cases, the complexity of this subgroup places them at a disproportionately high risk of psychological distress and poor mental health. This study aimed to identify patient and disease characteristics associated with suicide in AYA patients. Methods: A retrospective analysis of AYA (aged 15-39) between the years 1973 to 2015 from the Surveillance, Epidemiology, and End Result Research database were included. A training and test set were used to develop a model predicting suicide. The SMOTE sampling algorithm was used for the training set due to severe class imbalances. A random forest model was trained with 10 clinical features (cancer subtype, age, sex, race, marital status, diagnostic year, number of in situ/malignant tumours, chemotherapy, surgery, and radiation therapy) with recursive feature elimination (RFE) via 10-fold cross validation. Results: There were 139,394 AYA included with 974 (0.7%) having a documented suicide or self/inflicted injury yielding an incidence of 1499 suicides / 100,000 person years. The standardized mortality ratio (SMR) for AYA was 34.4 (95% CI: 32-37)(Aged 15-24: 47.4 (39-57); Aged 25-39: 32.3 (29-35)). Suicide rates increased over time (1973-1980: SMR = 18.0 (15-22); 2001-2015: SMR = 127.0 (102-155)). Univariate analyses observed high rates of suicide in: females (43.8 (38-51)); single/unknown relationship status (47.1 (42-52)); “other” race (85.2 (52-132)) and by cancer type: leukaemia (77.1 (42-129)), soft tissue sarcoma (73.7 (57-94)), unspecified malignancy (71.0 (9-256)) and brain (63.6 (43-91)). We randomly assigned AYAs to a training set (n = 97,576) and test set (n = 41,818), stratified by cause of death. All 10 clinical features were retained with RFE. The prediction model achieved an AUC of 0.59, accuracy of 0.78, sensitivity of 0.40 and specificity of 0.78. Conclusions: Risk of suicide in AYA is high compared to normative data, further heightened in females, single/unknown relationship and certain tumour subtypes. The prediction model performed poorly, potentially related to the exclusion of mental health variables, which are not collected by the SEER dataset. Our findings suggest that dedicated psychosocial supports and targeted mental health assessments are critical components of care for AYA.
Is there a shift in use of subacute rehabilitation (SAR) instead of hospice referral since immunotherapy became available?
Authors: Yeh Jonathan , Knight Louise , Kane Joyce M. , Doberman Danielle , Gupta Arjun , Smith Thomas J. 
Published: March 2020

11530 Background: Immunotherapy has rapidly become mainstream treatment. Since the first drug approval in 2011, we have noted a decline in referrals from inpatient oncology to hospice, and an increase in referrals to sub-acute rehabilitation (SAR) facilities, possibly with the aim of “getting strong enough” for immunotherapy and other promising drugs. This study explores outcomes after discharge to SAR, including rates of cancer-directed therapy after SAR, overall survival, and hospice utilization. Methods: Electronic chart review of patients discharged from oncology units to SAR facilities from 2009-2017. Demographics, admission statistics, and post-discharge outcomes were gathered from discharge summaries and targeted chart searches. Results: SAR referrals increased from 28 in 2012 to 82 in 2016. Age 66, males 52%, solid tumors 58%. 358 patients were referred to SAR 413 times. 174 patients (49%) returned to the oncology clinic prior to re-admission or death, and only 117 (33%) ever received further cancer-directed treatment (chemotherapy, radiation, or immunotherapy). 219 of 358 (61%) died within 6 months. Only 3 individuals who were not on immunotherapy at time of admission went on to receive immunotherapy after discharge to SAR. Among all discharges, 28% led to readmissions within 30 days. 74 patients (21%) were deceased within 30 days, of whom only 31% were referred to hospice. Palliative care involvement resulted in more frequent do not resuscitate (DNR) code status (33 v 22%), documented goals of care (GOC) discussions (81 v 23%), and electronic advance directives (42 v 28%).(All p<0.05). Conclusions: A growing number of oncology inpatients are being discharged to SAR, but two-thirds do not receive further cancer therapy at any point, including a substantial fraction that are re-admitted or deceased within 1 month. Many patients lose the opportunity to use hospice for optimal end of life care, as few SAR facilities offer this. These data can help guide decision-making and discharge planning that aligns with patients’ goals of care. More clinical data are needed to predict who is most likely to benefit from SAR and proceed to further cancer therapy.
Prognostic factors among older adults with advanced non-small cell lung cancer (NSCLC): A multisite cohort study.
Authors: Wong Melisa L. , Miaskowski Christine , Smith Alexander K. , Boscardin W. John , Cohen Harvey Jay , Hurria Arti , Lam Vivian , Ursem Carling Jade , Blakely Collin Michael , Gubens Matthew A. , Jahan Thierry Marie , McCoach Caroline Elizabeth , Allen Gregory Maners , Rotow Julia , Dixit Niharika , Musinipally Vivek , Webber Katey R. , Walter Louise Christie 
Published: March 2020

11540 Background: Prognosis in NSCLC is vital for clinical decision making. With the aging US population and rapidly changing treatment landscape, we aimed to identify prognostic factors among older adults with advanced NSCLC receiving chemo-, immuno-, and/or targeted therapy. Methods: We conducted a prospective cohort study of adults age ≥65 with advanced NSCLC starting a new non-curative systemic treatment (chemo-, immuno-, and/or targeted therapy) at a Comprehensive Cancer Center, Veterans Affairs Medical Center, and safety-net hospital. Prior to treatment initiation, patients completed a geriatric assessment including cognition, function, comorbidities, mood, social support, and quality of life. Cox proportional hazards models were performed to identify prognostic factors for overall survival (OS). Results: In a sample of 51 patients, median age was 73 (range 65-94). The majority of patients had stage IVB (59%) or IVA (39%) NSCLC. Current treatment included immunotherapy (37%), targeted therapy (29%), chemoimmunotherapy (18%), and chemo (16%). Most patients had received prior NSCLC treatment (80%): chemo (51%), targeted therapy (35%), immunotherapy (22%), radiation (RT; 47%), and/or surgery (19%). At enrollment, 73% had an abnormal Montreal Cognitive Assessment score < 26 (MoCA; median score 23) and 35% had an abnormal Timed Up and Go time ≥13.5 secs (TUG; median time 12.7 secs). Median OS was 12.5 months. In univariable analyses, stage IVB disease (HR 6.99, 95% CI 1.55-31.5), prior RT (HR 2.98, 95% CI 1.08-8.21), worse MoCA score (HR 1.15 per 1 point change, 95% CI 1.03-1.28), and longer TUG time (HR 1.13 per 1 sec change, 95% CI 1.05-1.23) were associated with worse OS. Of note, age, current NSCLC treatment, line of therapy, and Karnofsky Performance Status were not associated with OS. In multivariable analysis, MoCA score was the only statistically significant prognostic factor (HR 1.15, 95% CI 1.01-1.30). Conclusions: We found that abnormal pretreatment cognition is very common and an important prognostic factor among older adults with advanced NSCLC. Pretreatment screening for cognitive impairment should be considered to inform prognostication, decision making, and treatment planning.
Older adults’ preferred and perceived roles in decision making about palliative chemotherapy: Their decision priorities, and information preferences.
Authors: Moth Erin , Kiely Belinda Emma , Martin Andrew James , Naganathan Vasi , Della-Fiorentina Stephen A. , Honeyball Florian , Zielinski Rob , Steer Christopher B. , Mandaliya Hiren A. , Ragunathan Abi , Blinman Prunella 
Published: March 2020

11546 Background: We sought older adults’ preferred and perceived roles in decision-making about palliative chemotherapy; their decision-making priorities; and information received and desired. Methods: Patients aged ≥65 years with incurable cancer who had discussed palliative chemotherapy with an oncologist and made a decision about whether or not to receive palliative chemotherapy were invited to complete a written questionnaire. Preferred and perceived decision-making roles were assessed by the Control Preferences Scale (CPS). Associations with preferred decision-making role were examined using Wilcoxon rank sum tests. Factors important in making a decision about chemotherapy, and receipt of and desire for information were described. Results: The 179 respondents had a median age of 74 years (range 65 to 92 years). Most were male (114, 64%) and had chosen to receive chemotherapy (148, 83%). Half (92, 52%) were vulnerable by the Vulnerable Elders Survey-13 (score ≥3). Preferred decision-making roles (n = 173) were active in 39%, collaborative in 27%, and passive in 35%. Perceived decision-making roles (n = 172) were active in 42%, collaborative in 22%, and passive in 36%, and matched the preferred role for 63% of patients. Preference for an active role was associated with being single/widowed (p = 0.004, OR 1.49) and declining chemotherapy (p = 0.02, OR 2). Factors ranked most important when making a decision about chemotherapy (n = 159) were “doing everything possible” (30%), “my doctor’s recommendation” (26%), “my quality of life” (20%), and “living longer” (15%). A minority expected chemotherapy to cure their cancer (14%). Most had discussed expectations of cure (70%), side effects (88%) and benefits (82%) of chemotherapy, though fewer had received quantitative prognostic information (49%) than desired this (67%). Conclusions: Older adults showed varied preferences for involvement in decision-making about palliative chemotherapy, and most played the role that they preferred. To facilitate shared decision-making, oncologists should seek patients’ decision-making preferences, priorities and information needs when discussing palliative chemotherapy.
Impact of health behavior change on health utility (HU) and financial toxicity in head and neck cancer (HNC) survivors.
Authors: Eng Lawson , Hueniken Katrina , Brown M. Catherine , Hope Andrew , Giuliani Meredith Elana , Selby Peter , Chan Kelvin K. , Mittmann Nicole , Xu Wei , Goldstein David Paul , Liu Geoffrey , de Almeida John R. 
Published: March 2020

11561 Background: Health behavior changes including tobacco cessation and increasing physical activity (PA) are important aspects of cancer survivorship. Understanding how these behaviours impact on HU and financial toxicity will help when evaluating survivorship programs. We evaluated the impact of tobacco cessation and PA on HU, function and financial toxicity among HNC patients (pts). Methods: HNC pts from Princess Margaret Cancer Centre completed questionnaires at baseline (diagnosis) and 12 months between 2014-2018 evaluating tobacco use, PA with the Godin questionnaire, cancer related monthly out of pocket costs (OOPC), HU using HU Index Mark 3, function using Lawton Brody Scale (LBS) and lost annual income. Multivariable linear regression analyses evaluated the impact of health behaviour change on OOPC, HU, LBS and lost income. Results: Among 296 pts, mean age 61, 76% male; 29% smoked at diagnosis, 60% quit 1 year after; 26% met PA guidelines at diagnosis, 52% continued to meet guidelines at 1 year. 19% of those not meeting PA guidelines at diagnosis, met them at 1 year. Among all, mean HU [SEM] was 0.84 [0.01] (baseline), 0.80 [0.01] (12 months); mean monthly OOPC [SEM] were $171 [27] (12 months); mean annual lost individual income was $25897 [2945]. Among smokers at diagnosis, those continuing to smoke at 1 year lost a mean of $21272 (95% CI [$2783-39761] P= 0.03) more in individual annual income compared to pts who quit, adjusted for baseline income and education. Current smokers who quit smoking at 1 year had an adjusted mean increase in HU of 0.15 ([0.00-0.30] P= 0.05) greater than pts continuing to smoke. Pts who continued meeting PA guidelines at 1 year had an adjusted mean increase in HU scores of 0.11 ([0.02-0.20], P= 0.02) compared to those reducing PA levels after diagnosis. Changes in PA and tobacco were not associated with change in function or OOPC; improving to meet PA guidelines after diagnosis was not associated with HU or lost income ( P> 0.05). Conclusions: Quitting smoking and maintaining PA levels after diagnosis were associated with improvements in HU scores; quitting smoking reduced lost income. Cancer survivors should be made aware of the potential economic impact of behaviour change.
Cardiovascular disease risk in survivors of 20 adult cancers.
Authors: Strongman Helen , Gadd Sarah , Matthews Anthony , Mansfield Kathryn , Stanway Susannah Jane , Lyon Alexander R. , dos-Santos-Silva Isabel , Smeeth Liam , Bhaskaran Krishnan 
Published: March 2020

11571 Background: There are concerns about long-term cardiovascular disease (CVD) risk in cancer survivors, but few studies have quantified the risks for a wide range of cancers and specific CVD outcomes. Methods: Using UK electronic health records, we identified cohorts of adults alive one year after a cancer diagnosis at 20 different sites. Risks of a range of CVD outcomes were compared to age, sex and general practice matched cancer free controls using Cox regression; crude and adjusted models were compared to investigate the role of shared cancer/CVD risk factors (e.g. smoking and diabetes). Results: 126 120 cancer survivors and 603 144 controls were followed over a median (IQR) 4.6 (2.5-8.1) and 5.6 (3.2-9.2) years. Crude and adjusted hazard ratios (HRs) were similar. In adjusted models, there was strong evidence (p<0.01) of increased risk of CVDs among cancer survivors compared with controls: venous thromboembolism (VTE, 18 cancers), heart failure/cardiomyopathy (7 cancers), arrhythmia (4 cancers), and stroke (3 cancers). In stratified analyses HRs were higher in younger people and continued beyond 5 years post diagnosis. Conclusions: We found increased long term CVD risk among survivors of several cancers compared to the general population, which varied by cancer site and specific CVD outcome.[Table: see text]
Body weight changes in young breast cancer survivors and associated predictors.
Authors: Sella Tal , Tan-Wasielewski Zhenying , Rosenberg Shoshana M. , Poorvu Philip Daniel , Ruddy Kathryn Jean , Gelber Shari I. , Tamimi Rulla M. , Schapira Lidia , Come Steven E. , Peppercorn Jeffrey M. , Borges Virginia F. , Partridge Ann H. , Ligibel Jennifer A. 
Published: March 2020

11574 Background: Weight gain after cancer diagnosis is common in cancer survivors and has been linked to increased treatment toxicity, poor quality of life, and increased risk of second cancers and overall mortality. Young breast cancer (BC) survivors may be especially susceptible to weight changes given the impact of treatments such as chemotherapy and hormonal therapy on menopausal status. Methods: We identified women with Stage 0-III breast cancer diagnosed at ≤40 years (y) between 2006-2016 from a multi-center prospective cohort study. Clinical data including self-reported pre-diagnosis and follow-up weights were obtained using baseline and follow-up patient surveys. Participants missing baseline weight, pregnant at diagnosis/within 1y of diagnosis or with BC recurrence within 1y were excluded; those pregnant or with BC recurrence between 1-3y from diagnosis were excluded from the 3y analysis. Menopausal status at baseline and treatment-related amenorrhea (TRA) in follow-up were defined by self-reported last menstrual period. Factors associated with weight gain (>5%) were evaluated using univariate two-sided Fisher's exact test. Results: At baseline, 1y and 3y post diagnosis, 956, 899 and 687 women were eligible for analysis respectively. Median age at diagnosis was 37y (17 - 40), 65% received endocrine therapy and 74% chemotherapy. Premenopausal status was verified in 94% at baseline. Mean BMI at baseline was 24.4 (SD 5.3) kg/m2; 20% (187/956) were overweight and 12% (116/956) obese. At 1y and 3y, mean BMI increased modestly to 24.7 (SD 5.6) and 24.9 (SD 5.2), respectively with weight gain (>5%) observed in 18% (164/899) and 13% (87/687) respectively. 37% (300/804) and 32% (196/615) of eligible premenopausal subjects experienced TRA at 1y and 3y, respectively. Receipt of chemotherapy, receipt of endocrine therapy and TRA were not associated with weight gain at any timepoint. Conclusions: In this large prospective cohort of young BC survivors, mean BMI increased only modestly over time. Self-reported weight gain was not associated with treatment and not exacerbated by TRA. Further analysis to understand the effects of physical activity and other predictors of weight gain in this population are ongoing.
Combination of olanzapine and aprepitant in the prevention of chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients.
Authors: Shanthilal Mukesh , M Sathya , Jk Akshay 
Published: March 2020

11577 Background: Olanzapine and Aprepitant have been shown to be a safe and effective agent for the prevention of CINV. This study aims to compare Olanzapine, Aprepitant and their combination in the prevention of CINV. Methods: Prospective randomized controlled study in breast cancer patients receiving doxorubicin 60mg/m2 and cyclophosphamide 600mg/m2 chemotherapy. Female patient; age, ≥ 18; chemotherapy naïve; were included. Patients with seizure disorder, brain metastasis were excluded. Olanzapine group received Tablet Olanzapine 10 mg on day 1 to 3. Aprepitant group received Tablet. Aprepitant 125mg on day 1, 80mg on days 2-3. The combination group received Aprepitant 125mg on day 1, 80mg on days 2-3 and Olanzapine 10mg on day 1. All groups received Palnosteron 0.25mg and Dexamethasone 8mg on day 1. The primary end point of the study was complete response (CR) for nausea that is no nausea in the acute, delayed and overall periods. Secondary endpoint was CR for vomiting and no use of rescue drugs in all periods. Beginning with the first day of chemotherapy and daily through day 5, patients were asked to record daily episodes of nausea using a visual analogue scale from 0 to 10, with 0 indicating no nausea and 10 indicating a maximal level of nausea. They were asked to record daily episodes of vomiting (number and time) and the utilization of rescue therapy. Results: A total of 141 patients were evaluated and consented for the study. The median age was 47 years; range 29-80; CR for nausea in the acute period (within 24 hours) was 83%, 63.8% and 78.7% (p=0.078); for the delayed period (days 2-5) 59.6%, 55.3% and 63.8% (p=0.702); for the overall period (0-120 hours) 57.4%, 53.2% and 59.6% (p=0.817) for the Olanzapine, Aprepitant and combination arm respectively. CR for vomiting in the acute period was 91.5%, 91.5% and 97.9.7% (p=0.344); for the delayed period 74.5%, 85.1% and 97.9% (p=0.005); for the overall period 70.2%, 85.1% and 97.9% (p=0.001) for the Olanzapine, Aprepitant and combination arm respectively. There were no Grade 3/4 toxicities. Conclusions: The combination strategy shows trend towards better prevention of CINV. Clinical trial information: CTRI/2017/12/010864.