bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the incidence and survival outcomes in patients with lung neuroendocrine neoplasms in the United States.
Authors: Gosain Rohit , Shah Shrunjal , Dasari Arvind , Halfdanarson Thorvardur Ragnar , Mukherjee Sarbajit 
Published: May 2020

e19120 Background: The incidence and prevalence of Neuroendocrine Neoplasms (NENs) are rapidly rising. Epidemiologic trends have been reported for common NENs, but specific data for lung NENs has been lacking. Methods: We conducted a retrospective population-based analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) database, and studied lung NENs patients from 1988 to 2015. Associated population data was utilized to report the annual age-adjusted incidence and overall survival trends. Trends in the incidence and survival of large-cell lung cancer (LCLC) and atypical carcinoid (AC) were reported from 2000-2015, while that for typical carcinoid (TC) and small cell lung cancer (SCLC) were reported from 1988-2015. Results: We examined a total of 115,995 lung NENs [103,980 – SCLC; 3,303 – LCLC; 8,146 – TC; 656 – AC]. The age-adjusted incidence rate revealed decline in SCLC from 8.6 in 1988 to 5.3 in 2015 per 100,000; while other NENs showed an increase: TC increased from 0.57 in 1988 to 0.77 in 2015 per 100,000, AC increased from 0.17 in 2001 to 0.22 in 2015 per 100,000, and lastly, LCLC increased from 0.35 in 2001 to 0.41 in 2015 per 100,000. On multivariable analyses, the median overall survival (OS) and disease-specific survival (DSS) rate varied significantly by stage, grade, age at diagnosis, histological type, insurance type, marital status, and race. The 5-year OS rate among SCLC and LCLC patients was 5% and 17%, respectively, consistent with their high-grade nature. On the other hand, TC and AC, representing low-grade neuroendocrine tumors, had good 5-year OS: 84% and 64%, respectively. Conclusions: The incidence of lung NENs is rising, possibly because of advanced radiological techniques. However, we have seen a downtrend in the incidence of SCLCs likely because of declining smoking habits. Such population-based studies are essential for resource allocation and to prioritize future research directions.
Brazilian medical waste program as an intent to reduce costs and air release of carcinogens.
Authors: Cesario Fabiane Kellem Oliveira , Fontoura Renata Pereira , Cruz Amanda , dos Santos Edivaldo Bazilio , Conceição Junior Amarildo , Said Nidah , Morais Poliana , Omena Brenda , Cotrim Gabriel , Antero Gabriel , Silvestrini Anderson , Andrade Rosangela ,   ASCO Authors' Group
Published: May 2020

e19128 Background: Hospital waste management is a current sustainability challenge. The proper waste separation is principally recommended in most protocols, despite not always performed. Potentially infectious, sharp and chemical residues must be properly incinerated. Incineration increases the cost of waste management and releases hazardous gases into the atmosphere, such as dioxins. Dioxins are extremely stable compounds with an estimated half-life of 7 to 9 years in humans. As an important compound of air pollution, they have been classified as a class I human carcinogen by the International Agency for Research on Cancer. The dioxin carcinogenicity evolves action on transcriptional activation and inhibition of apoptosis. A higher serum concentration of dioxins is found in individuals who live near incinerators or who consume food produced near them.Furthermore, studies showed a 3 to 4 times higher risk of developing cancer in inhabitants of the neighborhood of waste incinerators and an association of serum concentration of dioxins and mortality from different types of cancer. Some neoplasms related to this exposure are lung cancer, soft tissue sarcomas and Non-Hodgkin Lymphoma. Methods: We present the impact of adequate division of medical waste from an institution in the Federal District - Brazil with data collected for 8 years. The residues were separated into two groups, the first being formed of residues that should be incinerated (potentially infectious, sharps and chemicals); and the second for regular garbage, which could be recyclable or non-recyclable. Results: By training the team and establishing appropriate protocols for proper segregation of materials, we achieved a saving of 66% from what would have been incinerated waste, equivalent to 76 tons, of which 71.9 tons correspond to recyclable waste. Also, the incineration cost was five times higher than the adequate disposal of regular waste. If the waste separation protocol had not been implemented, the biohazardous and chemical material would have contaminated the rest of the residues, making incineration as a final destination mandatory for all the waste, resulting in the release of more gases after incineration and a 64% higher cost. Conclusions: Despite the barriers to the classification of residues such as non-standardization and inadequate training of hospital teams, this low-cost implementation procedures significantly reduces the cost of waste management and the air release of human carcinogens.
Usefulness of Charlson comorbidity index (CCI) to predict early mortality and overall survival (OS) in acute myeloid leukemia (AML).
Authors: Dhakal Prajwal , Shostrom Valerie , Al-Kadhimi Zaid , Maness Lori J. , Gundabolu Krishna , Bhatt Vijaya Raj 
Published: May 2020

e19129 Background: Increasing age is associated with greater comorbidity burden. We hypothesized that comorbidity burden predicts 1-month mortality and OS in patients (pts) aged ≥60 y with AML. Methods: We utilized the National Cancer Data Base to identify pts aged≥60 y with AML diagnosed between 2004-2014. Pts were divided into 3 groups with CCI scores of 0, 1 and ≥2. Chi-square tests were used to examine the association between CCI and different variables. Logistic regression and cox proportional hazard models were used to determine predictors of 1-month mortality and OS, respectively. Results: Of 50,668 pts, 65% had CCI of 0, 24% CCI of 1 and 11% CCI of ≥2. 34% did not receive chemotherapy. 4% underwent upfront hematopoietic cell transplant (HCT). Pts with CCI of 0 were more likely to receive chemotherapy, especially multiagent chemotherapy (42% vs 39% vs 28%) and undergo HCT (4% vs 3% vs 1%). 1-month mortality was 24%, 34% and 45% for pts with CCI of 0, 1 and ≥2, respectively. In a multivariable analysis, 1-month mortality was worse with CCI of 1 (OR 1.5, 95% CI 1.4-1.6) or CCI of ≥2 (OR 2.3, 95% CI 2.2-2.5) vs CCI of 0. Lower CCI, younger age, male sex, white race, higher annual income, private insurance, multiagent chemotherapy, receipt of HCT, acute promyelocytic leukemia (APL) and diagnosis after 2009 were associated with improved OS (Table). Conclusions: In one of the largest real-world studies, we demonstrated that 1/3rd of newly diagnosed AML did not receive chemotherapy. Greater comorbidity, measured by higher CCI, was more common with increasing age, and correlated with lower likelihood of receiving chemotherapy. Higher CCI independently predicted worse early mortality and OS in older pts with AML. Trials are warranted to determine the effect of optimized comorbidity management and supportive care to reduce early mortality and improve OS. [Table: see text]
Performance of time to discontinuation and time to next treatment as proxy measures of progression-free survival, overall and by treatment group.
Authors: Walker Mark S. , Herms Lisa , Miller Paul J.E. 
Published: May 2020

e19135 Background: Real-world data sources have historically provided limited information about the occurrence of disease progression. As a result, progression-free survival (PFS), a standard effectiveness outcome measure in oncology, has been estimated using proxies such as time-to-discontinuation (TTD) or time-to-next-treatment (TTNT). Curation of unstructured electronic medical record (EMR) data make it possible to calculate PFS from directly observed progression. The aim of this research was to compare TTD and TTNT as proxy indicators with PFS determined from direct statements regarding progression in the medical record and to compare effect sizes on treatment-based groups across these endpoints. This report cites findings from the metastatic breast cancer (mBC) setting. Methods: Previously curated EMR data were collected from Concerto’s Definitive Oncology Dataset for adult, female, hormone receptor-positive/human epidermal growth factor receptor-negative mBC patients diagnosed 2008 or later who received at least one line of systemic therapy. Patients were grouped based on any receipt vs. no receipt of an aromatase inhibitor (AI) in first line (1L). Kaplan-Meier and Cox regression methods were used to calculate PFS, TTD, and TTNT in 1L and OS from start of 1L. Results: The study included 378 patients, of which 138 (36.5%) were de novo stage IV or metastatic. The mean patient age was 60.3 years (SD 13.3), 57.1% were Caucasian, and 68.3% were postmenopausal. Conclusions: Estimates of TTD and TTNT aligned closely, suggesting that nearly all patients who discontinued initial therapy received subsequent treatment. Notably, TTNT and TTD were both meaningfully shorter than PFS, suggesting that their use as proxy indicators may systematically underestimate PFS. Further, analysis based on receipt of AI indicates that comparative effects on TTD or TTNT may produce quite different results than those for PFS and OS. [Table: see text]
Use of a dynamic disease progression model to estimate prevalence and prognosis for patients with urothelial carcinoma (UC) in the United States (US).
Authors: Fleming Sarah , Solo Kirk , Ke Xuehua , Shalaby Waleed , Siefker-Radtke Arlene O. 
Published: May 2020

e19144 Background: Quantifying the distribution and prognosis of patients with UC as a function of disease stage may allow the impact of existing and novel therapies to be assessed in the real-world setting. We present a dynamic progression model that estimates the incidence, prevalence, and mortality of UC clinical state (CS) in the US. Methods: This UC dynamic progression model used US estimates of UC incidence and distribution of stage at diagnosis from the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) database to establish new patients. Progression and mortality for each CS were based on published clinical trials and OPTUM claims data. The simulation started in 1990, introducing incident patient cohorts allocated across initial CSs (Table). Historical therapy distributions were applied for each year as additional incident UC cohorts were introduced into the model. This proprietary model built to annual point prevalence dynamically through historical incidence, progression and mortality. Results: Based on the progression model, point estimates of prevalence, incidence and annual mortality hazard are provided by stage of disease (Table). For all stages of UC, the model estimated a prevalence of 719,387 patients in 2019. For stage II/III and metastatic UC (mUC) disease, the model estimated that 5,205 and 12,499 patients will die in 2019, respectively. This combines to 17,704 which closely aligns with the SEER estimate of 17,670. Conclusions: This dynamic UC progression model provides estimates for incidence, prevalence, and mortality of UC by clinical state at diagnosis. Incorporating associated claims and clinical data with this model could estimate the benefits of newer therapies as they become available. [Table: see text]
Utilizing a novel four-drug regimen to reduce the incidence of infusion-related reactions for first-dose rituximab infusions: An institutional review of rituximab infusion-related reactions in lymphoma patients.
Authors: Bartels Trace , Moore Logan , Persky Daniel Oscar , Kumar Abhijeet , Abraham Ivo , McBride Ali 
Published: May 2020

e19148 Background: Rituximab is a chimeric monoclonal anti-CD20 antibody utilized in the treatment of several disease states including B-cell non-Hodgkins Lymphoma. Infusion-related reactions (IRR) with rituximab occur with an incidence of up to 77% during the first infusion. The occurrence of an infusion reaction adds to the cost and time of rituximab administrations, especially with prolonged chair time and increased nursing and physician support, and decreased quality of life. The University of Arizona Cancer Center (AZCC) initiated a four-drug premedication regimen consisting of dexamethasone, famotidine, diphenhydramine, and acetaminophen. Our study examined the frequency of first-dose rituximab infusion reactions with our premedication regimen as compared to other published regimens. Methods: A retrospective chart review for all first-dose rituximab infusions was conducted for lymphoma patients treated with BR or RCHOP regimens from 11/2013 through 6/2019 at the AZCC. Data points collected included baseline patient demographics as well as rituximab infusion data. Results: In our study, the median age of the patient population was 64 years (range 22-89), 60.5% were males, and the average BSA was 2 m2 (range 1.39-3.04). The average rituximab dose was 750 mg (range 521-1140) and the average infusion time was 301 minutes (range 197-512). IRR with first time Rituximab was seen in 19 patients out of 81 total patients (23.5%). Of these IRR, 52.6% occurred in BR versus 47.4% in RCHOP. The most frequent IRR symptoms seen included flushing, itching, feeling hot, and tingling. The average infusion time for IRR patients was 334 minutes versus 284 minutes in patients not experiencing IRR. Grade 2 reactions were reported in 14 patients (73.7%) with grade 3 IRR’s reported in 5 patients (26.3%). Onset of IRR occurred on average during the first 61.6 minutes of the start of infusion (range 10-108 minutes). Conclusions: A novel four drug premedication regimen consisting of corticosteroids, antihistamines H2RA antatagonist and analgesic, resulted in a much lower rituximab infusion reaction rate (23.5%) than what has been previously reported in literature using standard premedications ( > 50%). The utilization of this four drug combination therapy provides the means to reduce first dose rituximab IRR in patients while maximizing patient care and increasing the number of patients who were able to receive Rapid Rituximab during their next cycle of chemotherapy.
Transitioning adriamycin ifosfamide mesna (AIM) chemotherapy in sarcoma patients to the outpatient setting: Evaluation of outpatient chemotherapy in an oncology care model setting.
Authors: Banh Cindy , Valsvik Kendall , Arredondo Alejandra , Notbohm Kassie , Kumar Abhijeet , Cranmer Lee D. , Kraft Andrew S. , Abraham Ivo , McBride Ali 
Published: May 2020

e19149 Background: The combination of doxorubicin, ifosfamide and mesna (AIM) significantly improves outcomes among patients with advanced soft tissue sarcomas. The rising cost of inpatient care, alternative payment model changes and patient preferences has prompted institutions to consider shifting therapy to the outpatient setting. However, the safety and feasibility of outpatient AIM chemotherapy is not well established. The University of Arizona Cancer Center developed an Outpatient Program (OP) to facilitate administration of traditional inpatient chemotherapy regimens in the outpatient setting. We transitioned AIM based chemotherapy to the outpatient setting based on selective criteria and caregiver support. The transition to outpatient treatment could lead to large cost-savings implications under the oncology care model. Methods: The current retrospective analysis evaluated the safety and efficacy of outpatient AIM chemotherapy for sarcoma administered in the outpatient setting. An economic study evaluated AIM in the outpatient setting, address, cost of labs, chemotherapy and bed days saved from transitioning chemotherapy from the inpatient setting. Results: Twenty-one patients with soft-tissue sarcoma were treated with outpatient AIM, for a total of 83 cycles. The median age was 60 (27-73) with 6 females and 15 males being evaluated. The median number of cycles per patient was 3.9 (range, 1-6), an average of 4.68 days of infusion days per cycle. Notable side effects included three patients ifosfamide-induced neurologic syndrome and 2 with hematuria. Acute grade 3 and 4 hematological toxicities were observed in 16 and 15 of patients, respectively with 11 occurrences of febrile neutropenia in 9 patients. Of the 21 patients, 15 patients (71%) were hospitalized at least once and 9 patients (43%) were hospitalized due to neutropenic fever. Total bed days saved by transitioning AIM outpatient was 390, for a total hospital cost savings of $1,043,250. Current costs savings for laboratory, chemotherapy and patient assistance access is still being tabulated. Conclusions: The combination of ifosfamide and mesna as a continuous outpatient infusion is feasible and well-tolerated using proper selection of patient and caregiver evaluation. This new model of administration provides an opportunity to decrease cost of care, improve patient satisfaction and reduce utilization of healthcare resource for community and academic cancer center sites.
Implementation of 11 system-wide, disease-specific, multidisciplinary tumor boards connecting 24 hospitals in an integrated health care system.
Authors: Clayton Brook , Nielsen Craig , Jensen Jane , Tonkin Allison , Urie Paul , Yeatman Timothy Joseph , Barney Brandon M. , Van Meter Margaret Elizabeth McCormick , Lewis Mark Andrew , Miles Jodie , Zendejas Ivan , Avizonis Vilija N. , Dodson Mark W. , Low Clarke Alan , Gill David Michael , Hunter Grant Kirton , Bowles Tawnya Lynn , Hoda Daanish , Haslem Derrick S. 
Published: May 2020

e19152 Background: Cancer treatment is becoming more complex, necessitating subspecialty expertise and multidisciplinary approaches to treatment planning. Simultaneously, there is increasing demand to provide care as close to home as possible. While tumor boards have long been an institutional backbone to providing high-quality multidisciplinary care in tertiary facilities, connecting several hospitals and dozens of cancer specialists in a large integrated healthcare system is unique and potentially transformational for smaller facilities and communities. Methods: Using highly-secure, network firewall-protected Cisco Telepresence and WebEx capabilities, 11 disease specific tumor boards (Breast, GI, Sarcoma, GU, Thoracic, Head/Neck, Melanoma, Neuro, Heme, Hepatobiliary, Gyn) were organized across Intermountain Healthcare’s 24 geographically and medically diverse hospitals spanning over 500 miles. Meetings for each of these disease-specific tumor boards have been held at least every 1-2 weeks, at set times and days since July 2019. Cases are submitted to the appropriate tumor board by individual providers from anywhere in the system. Submitted cases are reviewed by a designated subspeciality leader. Cases are either added to the system-wide agenda, or at times, the clinical decision can be resolved immediately. Included cases’ records including pathology, radiology and pertinent medical history are obtained for display and discussion. After each tumor board, recommendations and conclusions are recorded by nurse navigators for future review and consultation. Results: From July 2019 to February 2020, 1,598 patient cases were discussed. Just as relevant, 293 unique oncology providers (surgeons, medical oncologists, radiation oncologists, genetic counselors, nurse navigators, and therapists) participated in tumor board discussions. These deliberations provided insight, experience and recommendations directly related to patient care. Conclusions: Our system-wide, disease-specific, multi-disciplinary tumor boards are useful in connecting oncology providers and subspecialists. This effort has led to better collaboration, coordination and delivery of high-quality cancer care to patients throughout a large healthcare system that includes thousands of patients and dozens of cancer providers in smaller/rural communities. In addition, provider engagement has improved. Work is ongoing to prospectively evaluate the effects on treatment decisions and clinical outcomes.
Patient characteristics and outcomes at the University of Kansas Cancer Urgent Care (CUC).
Authors: Parikh Rahul Atul , Thomas Stevani , Hento Haylee , Janes Thu , Solis Gloria , McGuirk Joseph , Wright Jeff , Tsue Terry , Sun Weijing 
Published: May 2020

e19154 Background: An increasing proportion of advanced cancer patients live longer and seek urgent or emergent care due to complex treatment regimens. Prolonged wait times and excessive cost of care are common deterrents for these patients to seek care in the Emergency Department (ED). Cancer Urgent Care (CUC) was established in February 2019 with the goal to provide timely and specialized care and improve outcomes for symptomatic cancer patients. Methods: CUC is staffed by two advanced nurse practitioners and two registered nurses and operates from 7am till 7 pm, Monday to Friday. Between 2019-2020, 471 patients were seen at the University of Kansas CUC. Visit information including diagnosis, duration of stay and outcome was retrospectively collected and analyzed using the REDcap database. Patient satisfaction and feedback surveys were conducted for each visit. Results: Most common causes for which patients sought care were dehydration 41.6%, nausea or vomiting 25.9%, pain 16.8%, diarrhea 9.8%, fever 9.6%, fatigue 8%, pneumonia 6.4% and sepsis 2.1%. Nearly 34% patients seen had underlying hematologic malignancy, other common disease sites included gastro-intestinal (26.8%), genito-urinary (14.6%) and breast cancer (13%). Average time to patient evaluation was 17 minutes and patients spend a mean of 3.2 hours in the CUC. Escalation of care (ED transfer) was required in 36 patients (7.6%), a majority of which (n = 28, 78%) required inpatient admission. An additional 58 patients (12.3%) required direct inpatient admission while a majority of patients (n = 385, 79.6%) were discharged home from the CUC. Overall patient satisfaction was very high, 68% patient noted that they would have sought care in ED if they were not seen in CUC while 30% patients would have waited for their next clinic appointment to discuss symptoms. Conclusions: Greater than 90% patients seen in CUC had a diagnosis being evaluated under Chemotherapy Measure (OP-35) by CMS. CUC provides a viable mechanism to provide specialized care to cancer patients resulting in improved patient satisfaction. Additional studies are ongoing to evaluate its impact on ED utilization and cost-effectiveness.