bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comprehensive cancer cachexia staging and its impact in the outpatient oncology setting: A phase II study
Authors: Blum D. , Hess J. , Omlin A. , Jurt G. , Strasser ABHPM F. 
Published: August 2020

e20530 Background: Symptom management in advanced cancer is based on appropriate and feasible syndrome staging. To test whether 1. various factors predict involuntary weight loss [WL], 2. patients [pts] attending a cachexia clinic [CC] improve nutritional intake [NI], and 3. eating-related distress [ERD] is a consequence of cachexia or psychological issues. Methods: The multidisciplinary CC (nurse, nutritionist, psycho-oncologist, palliative cancer care physician) applies standardized assessments (Symptom Visual Analogue Scales [VAS, 0=none, 10=severe], 2-day NI diary [% of calculated needs: calories, protein], secondary causes for impaired NI, weight history (2 months WL), Body Mass Index [BMI], C-reactive Protein [mg/dl, normal 8), ERD-VAS, Hospital Anxiety Depression Scale, spirituality [FICA]). Interventions include nutritional counseling, palliative cancer care and psychosocial supportive measures. Descriptive analysis, Spearman‘s Rank correlation and Factor analysis (Eigenvalue >1) were performed. Results: 58 pts (age 65 years [mean; range: 38, 85]; 28F/30M; cancer types: 24 GI, 13 GU, 12 lung/ENT, 9 other; survival 151 days [7, 776]) had 6.9% WL (-6, 22; 21%<2%), 21 kg/m2 BMI (15, 26), 52 CRP (1, 272; 32% normal), 5.6 anorexia, 1.6 anxiety, 6 HADS-A, 1.3 depression, 9 HADS-D, 68% of NI needs (1466kcal [400, 2700], 47g protein [15, 108]). WL correlated with NI kcal (r=-.29, p=.038) and protein (-.3,.035), not anorexia (.16), BMI (.032) or CRP (-.08); a 2 factor model (NI/anorexia/WL [.83/.79/.70], CRP/BMI [.86/.75] explains 67% variability. At second visit (21 days; 13, 64) 15/19 pts increased kcal (400kcal) and 15/16 protein (32g) NI, 6/17 weight. ERD correlated with anorexia (r=.56, p=.001) and depression (.48,.002), not anxiety (.23), WL (.038) or survival (-.15). A 3 factor model (ERD/anxiety/depression [.71/.85/.92], anorexia/survival [.82/.65], WL [.84]) explains 75% variability. Conclusions: A combination of clinical variables seems needed to characterize patients with involuntary WL. Most patients attending 2 consecutive cachexia clinic visits respond to multidimensional interventions. ERD seems to be associated both with loss of appetite and depression, not by WL or survival. Further testing of this intervention seems justified. [Table: see text]
Effect of bexarotene on platelet counts in patients undergoing cancer treatment: An analysis of clinical trials in lung cancer and leukemia
Authors: Tsai D. E. , Wang W. , Reshef R. , Vogl D. , Stadtmauer E. , Andreadis C. , Carlson A. , Luger S. 
Published: August 2020

e20533 Background: Bexarotene (Bex) is an oral retinoid X receptor agonist with activity against cutaneous T cell lymphoma and currently under investigation for other malignancies. In patients receiving this agent for acute myeloid leukemia (AML), we noted increases in platelet counts. We therefore reviewed the available clinical trial data on Bex and its effects on platelet counts. Methods: We analyzed platelet count data from 3 Bex clinical trials encompassing non-small cell lung cancer (NSCLC) and AML. Results: In two phase III trials of Bex in NSCLC, patients underwent carboplatin + paclitaxel (CarP, n=587) or cisplatin + vinorelbine (CisV, n=613) and were randomized to receive concurrent Bex or placebo. More patients on Bex than on placebo had an increase in platelet count of at least 50 K/uL (55% vs. 27% for CarP, p<0.0001; 81% vs. 66% for CisV, p<0.0001) over pre-treatment baseline. The median increase in platelet count was higher on Bex than on placebo (69 vs 0 K/uL for CarP, p<0.0001; 168 vs. 95 K/uL for CisV, p<0.0001) and was maintained while on treatment. In both NSCLC trials, the median time to platelet increase >50 K/uL on Bex was 22 days. Similar findings were seen in a phase I monotherapy trial in AML where 5/18 (28%) patients achieved platelet transfusion independence with peak platelet counts of 40–91 K/uL. Conclusions: Clinically significant increases in platelet counts were seen in all 3 clinical trials examined. These data suggest that Bex improves platelet counts in patients with a variety of cancer types, both as monotherapy and with concurrent chemotherapy. Its effect on megakaryopoiesis and its potential role as a supportive care measure should be further evaluated. [Table: see text]
Confidence in knowledge discussing fertility changes with cancer treatment
Authors: Duffy C. M. , Allen S. M. 
Published: August 2020

e20540 Purpose: Infertility can be a devastating side effect of cancer treatment in younger women, but approximately one third of young women fail to recall a discussion of such issues with their oncologist prior to cancer treatment. Oncologists may not discuss these issues because they lack confidence in their knowledge of treatment-associated fertility issues and fertility preserving options. We sought to determine oncologists’ confidence in their knowledge of fertility issues and the factors associated with greater confidence. Methods: A national sample of MedOnc, HemOnc, RadOnc, and GynOnc physicians was randomly drawn from the AMA Master File. Mailed recruitment letters provided a link to an on-line survey of fertility issues in cancer treatment. Only practicing oncologists who reported treating > 5 women/yr aged 21–45 were eligible to participate. Physicians were asked 8 questions regarding their confidence in knowledge of fertility changes with cancer treatments and fertility-sparing options. Responses on a 5pt likert scale ranged from 1=not at all confident to 5= very confident and a summary scale was created from participants’ answers. Multiple linear regression was conducted to determine the socio-demographic characteristics, practice settings and attitudes regarding discussing fertility issues that were associated with confidence in knowledge scores. Results: 336/1702 eligible participants responded (20%). Avg years in practice was 15.7, mean age was 48.5 and 75.2% were male. A majority were community-based (60%). Average score on confidence in knowledge scale was 2.9 (SD 0.80) with Cronbach α= 0.84. Higher confidence in knowledge scores were associated with Gyn-Onc sub-specialty, access to educational resources regarding fertility and cancer, and greater sense of responsibility to discuss fertility preservation options (p<.001). Age, sex, and practice setting were not associated with confidence in knowledge. Conclusions: This is the first nationally representative survey regarding confidence in knowledge among oncologists regarding fertility and female cancer treatments. Whether confidence in knowledge is a cause or result of resource access and sense of responsibility to discuss fertility issues should be explored in future research. No significant financial relationships to disclose.
Palonosetron compared to ondansetron in the prevention of chemotherapy-induced nausea and vomiting: Activity, safety, and cost-effectiveness evaluation
Authors: Bernardo G. , Palumbo R. , Frascaroli M. , Bernardo A. , Losurdo A. , Poggi G. , Teragni C. , Albanese D. , Amatu A. , Strada M. R. 
Published: August 2020

e20573 Background: Chemotherapy(CT)-induced nausea and vomiting (CINV) are common adverse effects in cancer patients. The control of CINV is a relevant objective for the patient's quality of life and also aims to optimize cancer treatment. 5-HT3- receptor antagonists (RAs) are commonly used to prevent CINV. Palonosetron, the only second generation 5-HT3-RA, has a significantly longer half-life and a higher binding activity than the first generation of 5-HT3RAs. Methods: To evaluate the activity, safety and farmacoeconomic profile of palonosetron compared to ondansetron as antiemetic prophylaxis for highly (HEC) or moderately (MEC) emetogenic chemotherapy, 235 consecutive chemo-naïve patients (pts) were assigned (1:1) to receive palonosetron 250 mcg i.v. plus dexamethasone 8 mg i.v. 30 min before CT on day 1 (Group A) or ondansetron 8 mg i.v. plus dexamethasone 8 mg i.v. on day 1, followed by 8 mg os twice daily over 3 days (Group B). Results: The 2 treatment groups were comparable with respect to tumour type (breast 52%, lung 20%, colorectal cancer 11%, ovarian 8%, head & neck 5%, other 4%) and emetogenic potential of CT (HEC in 78 pts, AC-based chemotherapy in 123, MEC in 35). FLIE questionnaires were completed on days 2–5. Complete response (CR) rate for the acute period was 82% in pts given HEC in group A versus 63.2% in group B, 93.4 % versus 80.6% in pts given AC and 100% versus 94.4% in pts given MEC. For the delayed period: 74.4% in group A versus 63.2% in group B for pts receiving HEC, 90.2% versus 71% in pts given AC and 94% versus 88.9% in pts given MEC. FLIE analysis showed a reduced impact of CINV on daily life in group A (p<0.05). The pharmacoeconomic evaluation showed favourable cost effectiveness profiles for palonosetron, with a saving of about 50% per cycle/per patient over ondansetron. A not significant reduced incidence of headache and constipation was observed in group A. Conclusions: Palonosetron was effective in preventing CINV following HEC, AC and MEC in both acute and delayed phases, as well as being cost effective. The CR rates were maintained throughout subsequent cycles of CT, with a significant positive impact on daily functioning and quality of life. No significant financial relationships to disclose.
Abnormal physical performance and frailty in older men with biochemical recurrence of prostate cancer (PCa) on androgen deprivation therapy (ADT)
Authors: Bylow K. A. , Hemmerich J. , Mohile S. , Stadler W. , Dale W. 
Published: August 2020

e20578 Background: ADT has recognized toxicities including osteoporosis, muscle weakness and wasting, anemia, and fatigue. ADT is increasingly being used in men with biochemical recurrence (BCR) despite the fact that earlier initiation has not been shown to improve overall survival in this setting. Little is known about the impact of ADT on physical performance or the development of frailty in older patients. Methods: A case-control study (n=119) of men age 65+ with BCR on ADT ≥ 6 months with stable PSA (n=56) compared to controls with history of PCa status post radiation or surgery with no evidence of recurrence (n=63) was conducted. Frailty prevalence per Fried's criteria (validated measures of weight loss, exhaustion, grip strength, walking speed, and physical activity), Short Physical Performance Battery scores (SPPB: validated measure of balance, walking speed and timed chair stands) and falls were compared between groups. Exploratory analyses of proposed biomarkers of frailty (CRP, ESR, hemoglobin, albumin, and total cholesterol) were conducted. Results: Age, ethnicity and socioeconomic status were not different between groups. Total score on the SPPB was significantly lower in the ADT group (9.1 vs. 10.2, p = .01), indicating higher risk of incident morbidity and mortality. 7.2% of men in ADT group met Fried's criteria for frailty compared to 3.2% in control group and 58.9% met criteria for “prefrail” in ADT group compared to 41.9% controls (p=0.03 for trend). Quadriceps strength, as measured by chair stands in SPPB, was significantly worse for ADT group (p<.01). Incident falls were higher in ADT group (14.3% vs. 3.2%, p=.05). With the exception of hemoglobin (12.7 vs 14.4 g/dl, p< .01), putative frailty biomarkers were not significantly different between groups. Conclusions: Men with BCR of PCa on ADT have worse physical performance, are more frail, and have a higher incidence of falls than controls, but biomarkers suggest that mechanism of frailty is different than in the geriatric syndrome. A prospective trial is needed to establish a temporal link between initiation of ADT and frailty. No significant financial relationships to disclose.
An exploration of Pap smear history and behavior of patients with newly diagnosed cervical cancer in Taiwan
Authors: Cheng H. , Chao A. , Huang H. , Chou H. , Chang T. , Liao M. , Lai C. 
Published: August 2020

e20582 Background: The national health insurance policy has provided a yearly Pap smear for women >= 30 years old since 1994 in Taiwan, yet the coverage rate is still unsatisfactory. The purpose of this study is (1) to investigate the Pap smear screening history of women newly diagnosed with cervical cancer and (2) to examine factors that influence participation in Pap smear screening program in these women. Methods: Patients primarily treated for cervical cancer at Chang Gung Memorial Hospital between November 2006 and June 2007 were enrolled into this prospective study. Questionnaires included (1) socio-demographic data, and (2) knowledge on Pap smear and cervical cancer. Results: Two hundred sixty-nine patients were eligible for analysis. The median age was 51 years old (range, 25–83). Of the 269 patients, 147 (54.6%) had never had a Pap smear before diagnosis, and 35 (13.0%) did not know about Pap smear. Socio-demographic factors that significantly influenced number of previous Pap smear screening (0 vs >=1) were education level, income less than 600 U.S. dollars per month, menopaused, multiple sexual partners, and increase number of sexual partners of the male consort. Of the 147 never received Pap women, the most common reasons were thought that Pap smear screening was not necessary (46.3%), embarrassment (42.0%), busy (43.5%), and worry about the screening findings (20.4%). Of the 122 patients who have received Pap smear, 56.6% patients thought that Pap smear screening was necessary, 35.2% patients worried about the disease, 24.6% were alert on their check-ups, and 20.5% did the screening for the convenience to nearby clinics. Conclusions: Public health organizations in Taiwan should put more efforts to provide women in low education level, low income and multiple sexual partners with information on Pap smear. No significant financial relationships to disclose.
To analyze efficacy and safety of pegfilgrastim versus filgrastim in patients with breast cancer
Authors: Satheesh C. T. , Tejinder S. , Ankit J. , Sajeevan K. V. , Lakshmaiah K. C. , Lokanatha D. , Govind Babu K. , Suresh T. M. 
Published: August 2020

e20587 Background: We evaluated the safety and efficacy of a single fixed 6 mg dose of pegfilgrastim (a pegylated version of filgrastim) per cycle of chemotherapy, compared with daily administration of filgrastim, in the provision of neutrophil support. Methods: Patients with carcinoma of breast, less than 65 yrs with ECOG performance status 0 or 1 treated at our institution were randomized to receive either a single 6 mg subcutaneous (s.c.) injection of pegfilgrastim or daily 5 mg/kg s.c. injections of filgrastim, after adjuvant or neoadjuvant chemotherapy with doxorubicin, cyclophosphamide and docetaxel (60 mg/m, 600 mg/m2 and 75 mg/m2, respectively)q3 wk. Duration of grade 4 neutropenia (DSN), incidence of febrile neutropenia (FN), grade 4 neutropenia (SN), IV anti-infective use (IV), hospitalization and adverse events like bony pain (BP), anemia & thrombocytopenias were assessed as safety endpoints. Results: 71 patients were analyzed from Aug 2007 to Dec 2008. The median age in pegfilgrastim group is 58 years and filgrastim is 57 years respectively. Results are shown ( Table ). The mean duration of grade 4 neutropenia (DSN) in cycle 1 was 2.0 and 1.7 days for the pegfilgrastim and filgrastim groups, respectively. Results for all efficacy end points in cycles 2–6 were consistent with the results from cycle 1. A trend towards a lower incidence of febrile neutropenia was noted across all cycles with pegfilgrastim compared with filgrastim (10.7% versus 18.6%, respectively). Conclusions: A single fixed dose of pegfilgrastim administered once per cycle of chemotherapy was comparable to multiple daily injections of filgrastim. [Table: see text] No significant financial relationships to disclose.
Clinical trials networks and enrollment of historically underrepresented populations in medical oncology trials
Authors: Berkowitz J. L. , Fernandez A. , Dichmann R. A. , Kennedy K. A. , DiCarlo B. 
Published: August 2020

e20598 Background: Oncology research is limited by the very low number of patients accrued into clinical trials. Clinical trials networks may help to overcome this limitation by allowing investigations designed through academic centers to be available to patients seen in community practices that are far from these centers. This allows for increased accrual and access for these patients while potentially increasing the pace of progress in clinical oncology research. Methods: In this study, we attempted to determine the effect that clinical trials networks can have on the accrual of cancer patients into clinical investigations. We retrospectively analyzed the records from 2002–2008 of a private practice located over 150 miles from an academic center for accrual into trials. This practice is a member of a clinical trials network affiliated with a major academic cancer center. Accrued patients were divided into subgroups based upon type of malignancy, ethnicity and whether or not they were elderly. In addition, from 2007–2008, the percentage of patients accrued into trials relative to the total number treated onsite was calculated and compared to national averages. Results: In this period, a total of 139 patients at this practice were accrued into clinical trials. By malignancy, they were as follows: breast 36%, colorectal 22%, lung 13%, prostate 8.4%, gastric and lymphoma each 3.0%, pancreatic 1.8%, melanoma 1.2% and ovarian 0.6%. The other 18 patients were in trials for either chemotherapy related anemia 7.8% or bony metastases 3.0%. Of the 139 patients, 45% were elderly and 16% were Hispanic, both markedly higher than national averages. For 2007–2008, 12% of patients that received on site treatment were accrued on to trials. For lung, colorectal, and breast cancer, the number of patients on trial as a percentage of all treated onsite were also higher than the national averages. Conclusions: Clinical trial networks allow a higher percentage of total patients to be accrued than the national average and greatly enhance the potential for both minority and elderly enrollment, two populations that have been historically underrepresented in major clinical trials. It may also help to accelerate the progress of medical oncology research towards better treatments for all patients. No significant financial relationships to disclose.
Estimating the need for palliative external beam radiotherapy in adult cancer patients
Authors: Nieder C. , Pawinski A. , Haukland E. , Dokmo R. , Philippi I. , Dalhaug A. 
Published: August 2020

e20599 Background: Older benchmark data suggest that 46–53% of all radiotherapy (RT) courses were administered with palliative intent. In the most comprehensive analysis from Sweden, 87 annual palliative RT courses per 100,000 inhabitants were registered in 2001, mainly for the treatment of bone and brain mets (95% CI 84–91). Despite an increase from Swedish data collected in 1992, continuous underuse could not be ruled out. Newer data accounting for the increasing life expectancy of patients with metastatic cancer are lacking. Methods: Prospective collection of data on palliative RT in adult cancer patients during a 12 months period in 2007/2008 in a well defined region of Norway. All patients (median age 70 years, 26% lung, 23% prostate, 11% breast, 7% bladder cancer, 33% others) were treated in one federal state with ∼234,000 inhabitants and had unlimited access to RT (no economical barriers, waiting time 0–14 days). Efforts were made to account for potential overuse, e.g., registration of patients who died within 2 weeks from the first RT fraction. Results: In the study population, 134 annual treatments per 100,000 inhabitants were registered (after correction for overuse, but not accounting for emerging treatment options, e.g., stereotactic RT for lung metastases; 95% CI 112–159). As some patients received simultaneous treatment to different target volumes, the annual number of target volumes amounted to 160.8 per 100,000 inhabitants (95% CI 137–188). Of these, 115.2 were related to skeletal lesions, 12.3 to thoracic tumors and 11.4 to brain mets. Due to the differences in fractionation and treatment technique from country to country and even between institutions in the same country, no data on number of fractions or fields were collected. However, each institution can easily calculate their own figures on the basis of the new data. Conclusions: To the authors’ best knowledge, this is the first patterns of care study in the last 5 years. The data derived from a region where underuse is not an issue anymore suggest that previous estimates were incorrect. If confirmed in other databases, resources for palliative RT need to be adjusted. In regions with significantly different cancer incidence, age structure and other socioeconomic factors then northern Europe, separate analyses need to be conducted. No significant financial relationships to disclose.
Changes in arm morbidities and health-related quality of life after breast cancer surgery: A five-year follow-up study
Authors: Sagen Å. , Kåresen R. , Sandvik L. , Risberg M. 
Published: August 2020

e20602 Background: Many breast cancer survivors (BCS) suffer from longterm upper limb morbidities after axillary node dissection. The purpose of this five-year follow-up study was to describe changes in long-term upper limb morbidities, physical activity level, and Health-Related Quality of Life (HRQoL) and to find factors that predict HRQoL five years after surgery. Methods: This study included 204 women aged 55 ± 9 years who had primary breast cancer surgery with axillary node dissection. The subjects were examined for arm volumes and arm lymphedema, arm pain, sensation of heaviness, shoulder function, physical activity level, and HRQoL, prior to surgery, and six months and five years after surgery. The statistical analyses used included ANOVA for repeated measures and multivariate linear regression. Results: ALE (12%), pain (36%), and sensation of heaviness (32%) in the upper limbs were still present five years after surgery. ALE was the only morbidity that continued to increase over time. The HRQoL temporarily declined after surgery, but improved in the period from six months to five years after surgery. The significant predictive factors of HRQoL five years after surgery included HRQoL prior to surgery, physical activity level at leisure time (both prior to and at six months after surgery), and duration of sick leave after surgery (in weeks). Conclusions: The HRQoL improved from six months to five years, despite the chronic arm pain and increase in ALE. Three independent predictive factors of HRQoL were identified. No significant financial relationships to disclose.