bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrolyte imbalances in patients admitted with chemotherapy-induced febrile neutropenia: Patterns and impact on outcomes, a single-centre study from Pakistan
Authors: Shaikh A. J. , Masood N. , Adil S. N. , Bawany S. A. , Khan A. A. , Kumar S. , Lal A. , Zaidi A. , Niamutullah N. 
Published: August 2020

e20586 Background: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity of chemotherapy. Various factors have been studied to be associated and affect outcome of patients admitted with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and impact has been only scarcely studied. This study was conducted with the aim to observe the trends of electrolyte abnormalities seen synchronously in patients admitted with chemotherapy induced febrile neutropenia and their possible influence on the outcomes. Methods: This was a prospective, observational study. A total of 215 patients admitted with FN between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0. Toxicity profile was graded according to CTC version 3.0. Results: Febrile neutropenia was seen to be almost equally distributed among patients with solid or hematological malignancies. Males and females were seen to be affected almost equally as well. A total of 83.5% patients demonstrated some degree of electrolyte abnormalities. Hypokalemia, of any grade, was seen in 48% of patients, 51.4% having grade I, 33.3% grade III and 15.2% had grade IV hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia was seen in 54.3% patient, 94.7% having grade I decline. About 12% of patients with electrolyte deficit also had a co-existing Vomiting or diarrhea or both. Average length of stay was 5.7 days in patients having coexisting electrolyte abnormalities, compared to 4.2 days in those who had not. Out of 90 patients who requires special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalities. Conclusions: This analysis, which is perhaps first of its kind, suggests that electrolyte abnormalities are frequently observed in patients presenting with FN, independent of co existing vomiting or diarrhea. They can have a negative affect on the outcome such patients. Therefore the incidence and impact of electrolytes abnormalities on FN outcomes should be elaboratively studied further. No significant financial relationships to disclose.
Pain, depression, asthenia, and insomnia: Prevalence of this symptoms cluster and its impact on health-related quality of life in a cohort of advanced cancers
Authors: Blasco A. , Galan A. , Almenar D. , Gironés R. , Diaz R. , Alberola V. 
Published: August 2020

e20607 Background: Pain (P), depression (D), asthenia (A), and insomnia (I), alone or in combination, are some of the most important and invalidating cancer symptoms. But little is known about the relationship between the symptoms of this cluster, and its impact on health-related quality of life (HRQoL). This analysis has been carried out to better know the prevalence of this symptoms cluster and its impact on HRQoL in cancer patients (pts). Methods: An observational and longitudinal multicentre study was carried out on a sample of cancer pts with breast, lung or colon cancer, any site and period of disease duration, receiving chemotherapy. Data were collected at inclusion and 3 months later. Sociodemographic data, key clinical indicators, as well as P, D, A and I complaints or diagnosis were collected. HRQoL was assessed by means of Nottingham Health Profile (NHP) scale (a generic health measure. Analyses were focused on baseline cross-sectional data). Results: A total of 116 pts were analyzed: 73.3 men, 61 years old (SD=9,1), 2.9 years (SD=2,3) since diagnosis, 16.4 % breast, 54.3% lung, and 29.3% colon cancer; 97.4% with metastasis. At least one symptom cluster under study was presented in 69% of pts: >25% a symptom alone, ≈25% two symptoms, >15% three symptoms, <3% all symptoms in the cluster. Pts could be classified in 13 of the 15 symptoms cluster possible combinations (according to their symptoms complaints/diagnosis) ranging from 0.9% to 12.9%. The two symptoms cluster combinations which did not obtain representation included D + I, while the two symptoms cluster combinations more frequents always included pain. It has been observed that a more quantity of symptoms worst physical and psychological NHP scores. Conclusions: The prevalence of the studied symptoms cluster in cancer pts is high (≈70%) and divers in combinations (13 different symptoms profiles). The quantity of prevalent symptoms cluster is clearly associated with HRQoL. [Table: see text] No significant financial relationships to disclose.
Clinical impact and follow-up of taste disturbances following myeloablative or nonmyeloablative chemotherapy and stem cell transplantation
Authors: Mayer F. , Weidmann J. , Federmann B. , Schwarz S. , Hartmann J. T. , Kanz L. , Bethge W. 
Published: August 2020

e20609 Background: Stem cell transplantation (SCT) after myeloablative (MA) or non-myeloablative (NMA) chemotherapy is a successful treatment option for a variety of diseases. Although alterations of taste and smell are frequently encountered after these modalities, no systematic evaluation is available so far. Methods: A questionaire was developed covering aspects of the dietary pattern and changes in the perception of taste and smell. Clinical data were gathered from the charts. The study was approved by the institutional review board. Data of the first 100 of 200 planned patients’ (pts) are presented. Results: pts were surveyed after a median of 22 months from SCT (range 1–292), their age ranged from 20–76 years. Indications for SCT included acute leukemia (n=38), myeloproliferative disease (n=20), lymphoma (n=13), and others (n=29). Pts received an allogeneic graft after MA (n=48) or NMA (n=32) conditioning, 20 pts received an autologous one. 75% of pts reported moderate to severe changes in taste perception on a semiquantitative visual analogue scale during the acute phase of SCT with no differences between the three groups (73%, 79%, 75%). 28% of the pts reported a complete regression at the time of survey, 25% still suffered from moderate to severe changes. This finding was more prevalent after allogeneic SCT (30% after MA conditioning, 28% after NMA) compared to pts with autologous grafts (10%). Whereas pts without persisting changes in taste perception lost a median of 3 kg of body weight, pts suffering from severe changes lost 15 kg. Conclusions: Taste disturbances are a common after SCT. Symptoms are persistant in one third of the pts. In the allogeneic setting, no differences exist between MA and NMA conditioning. The lower incidence of persiting changes in taste perception after autologous SCT might be attributed to the absence of graft versus host disease or the dispensability of immunosuppression. Changes in taste perception correlate with weight loss. No significant financial relationships to disclose.
Efficacy of palonosetron (PAL) compared to other serotonin inhibitors (5-HT3R) in preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately or highly emetogenic (MoHE) treatments: Systematic review and meta-analysis
Authors: Clark O. , Engel T. , Clark L. , Paladini L. , Faleiros E. , Pegoretti B. 
Published: August 2020

e20620 Background: Chemotherapy-induced nausea and vomiting (CINV) are frequent side effects of cancer treatment, with negative effects on quality of life. CINV may be acute (occurring within 24 hours after the chemotherapy) or delayed (up to 7 days after it). There are currently five serotonin inhibitors (5-HT3R) available on the market. PAL has the longer half-life, but there are controversies regarding if a better control of CINV (particularly delayed) is obtained with it. This controversy is reflected in recommendations of practice guidelines. Objective: To perform a systematic review and meta-analysis of all randomized controlled trials comparing a single intravenous dose of PAL 0,25mg with other 5-HT3R in patients receiving MoHE chemotherapy. Methods: We searched several databases, including MEDLINE, EMBASE, LILACS, and CENTRAL. The primary endpoints were the incidence of acute and delayed nausea and vomiting. The side effects of each treatment were analyzed. A subgroup analysis on the impact of added corticosteroids was performed.The results of individual studies were pooled in a meta-analysis, using the RevMan 5.1 software. The results are expressed as Risk Ratio (RR) and the correspondent 95% Confidence Interval (CI). Results: We included 4 studies, with 1,298 patients. PAL was compared to ondansetron, granisetron and dolasetron. Patients in PAL group had less nausea, either acute (RR=0.75; CI= 0.64 to 0.88; P = 0.0004) or delayed (RR= 0.73; CI= 0.66 to 0.82; P < 0.00001). They also had less acute vomiting (RR = 0.78; CI= 0.67 to 0.90; P = 0.0008) and delayed vomiting (RR= 0.75; CI= 0.67 to 0.84; P < 0.00001). There were no statistical differences in side effects like headache (RR = 0.83; P = 0.29), dizziness (RR = 0.40; P = 0.12), constipation (RR = 1.35; P = 0.30) or diarrhea (RR = 0.67; P = 0.44). Patients receiving PAL presented less nausea and vomiting regardless of the use of corticoids. There was no statistical heterogeneity in the analises. Conclusions: PAL was more effective than the other 5-HT3R in preventing acute and delayed CINV in patients receiving MoHE treatments, regardless of the use of concomitant corticosteroids. [Table: see text]
Utility of Schwartz Center Rounds in fostering compassion, communication, teamwork, and caregiver support
Authors: Mann P. , Schapira L. , Lynch T. , Penson R. 
Published: August 2020

e20640 Background: Schwartz Center Rounds are a multidisciplinary forum where clinicians discuss difficult emotional and social issues that arise in caring for patients with the goal of improving the patient-caregiver relationship. Rounds were initiated at the MGH Cancer Center in 1997 and have since grown to include 165 sites including 24 cancer centers nationwide. We report on a recent evaluation of the impact of Rounds. Methods: The Schwartz Center Rounds evaluation focused on three major research questions: 1) Do professional caregivers have increased insight into the non-clinical aspects of care after attendance at Rounds? 2) Is there increased teamwork among caregivers after attendance? 3) Do caregivers perceive increased support after attendance at Rounds? The evaluation included a retrospective survey of 256 caregivers at six sites where Rounds had existed for ≥ 3 years; 44 semi-structured interviews with participants at these sites; and pre/post surveys of 222 caregivers from ten hospitals newly implementing Rounds. Results: The highest percentage of attendees were nurses (35%), followed by physicians (23%), social workers (15%), psychologists (4%), physical therapists (6%) and clergy (5%). After attending Rounds, participants reported increased insight into psychosocial aspects of care; enhanced compassion; increased ability to respond to patients’ social and emotional issues; enhanced communication amongst caregivers; greater appreciation of colleagues’ roles and contributions. Attendees reported decreased feelings of stress and isolation and a greater sense of teamwork. Participants reported that Rounds discussions led to changes in institutional practices or policies. Conclusions: Schwartz Center Rounds provide a forum for discussion of challenging psychosocial and emotional issues arising during clinical care. Evaluation data suggests this educational strategy may enhance compassion, professional support, communication, teamwork, and instigate institutional changes that enhance patient care. We are currently exploring other outcomes, including but not limited to the impact of rounds on quality of patient care and patient safety. [Table: see text]
Cancer-related anemia: Correlation analysis among serum levels of hemoglobin, IL-6, hepcidin, albumin, and erythropoietin
Authors: Takahashi S. , Kosaka T. , Hattori M. , Fujimoto-Ouchi K. , Shimonaka Y. , Yasuno H. , Noguchi M. , Mori K. , Ogata E. 
Published: August 2020

e20655 Background: Hepcidin is a peptide hormone that regulates iron re-utilization and has been implicated as causing anemia by restricting the delivery of iron to erythrocyte progenitors. A potent inducer of hepcidin in hepatocytes is IL-6, an inflammatory cytokine. In the present study, we investigated the relationship between cancer-related anemia and inflammatory activity, including the cytokines. Methods: Anemia in newly diagnosed patients (pts) with solid tumors or malignant lymphoma was studied excluding pts showing evidence of myelosuppression and hepatic and renal failure. The characteristics of anemia in cancer pts were compared with those in mice bearing human lung large cell cancer LC-6-JCK. Hematological assessment was conducted using clinical practice methods. Serum levels of cytokines were determined by ELISA. Hepcidin was measured by LC/MS/MS. Results: Thirty parameters were analyzed in 11 pts. Clustering analysis of the 30 parameters resulted in 3 clusters including hemoglobin (Hb)/albumin (Alb), IL-6/hepcidin/ferritin, and erythropoietin (EPO). Hb levels showed weak negative correlation with IL-6 and hepcidin and a positive correlation with Alb levels (R=0.763, P=0.006). In addition, IL-6 levels weakly correlated with hepcidin and Alb. Hepcidin correlated with ferritin (R=0.729, P=0.011). Correlations were observed between quality of life in cancer pts and anemia parameters including Hb and IL-6. Mice bearing LC-6-JCK tumors developed anemia with characteristic parameters similar to cancer pts with anemia ( Table ). A rat anti-mouse IL-6 receptor monoclonal antibody prevented the development of anemia in the LC-6-JCK model. Conclusions: Present results suggest that cancer-related anemia associates with IL-6, Alb and inflammatory acute phase reaction including hepcidin and ferritin. Further analysis of anemia in cancer pts and murine models would be useful for investigating the mechanisms of cancer anemia. [Table: see text] No significant financial relationships to disclose.
Cytoreductive surgery combined with peritoneal intraoperative heated chemotherapy for management of peritoneal carcinomatosis in 59 adults older than age 65
Authors: Bereder I. , Guerin O. , Boulahssass R. , Couderc A. , Mailland V. , Macone F. , Mounier N. , Habre J. , Karimdjee- Soilihi B. , Bereder J. 
Published: August 2020

e20657 Background: Peritoneal carcinomatosis (PC) has long been regarded as a terminal disease with short median survival. Recent success of new approach, combining surgery and intraperitoneal heated chemotherapy (HIPEC) are reported. But in the most studies patients over 65 years are excluded. We report our experience in this selected group of patients. Methods: A retrospective study was performed to evaluate toxicity and to identify the principal prognostic indicators with this combined treatment. All patients had cytoreductive surgery and HIPEC. This population of patients was compared with younger over the same period. We have excluded patient with frailty by comprehensive onco-geriatric assessment based upon cognitive, nutritional assessment and cormorbidities. Results: The study included 291 procedures in 249 patients between 2000 and 2008. 64 procedures were performed in 59 older patients (group 1) and 227 procedures in 190 younger patients (group 2). The principal etiologies of PC in group1 were recurrent ovarian cancer (N=33), colorectal cancer (N=9), peritoneal mesothelioma (N=6), pseudomyxoma (N=9) and sarcomatosis (N=2). No death occurred in post operative course and the procedure related morbidity rate was 10%. 5 years overall and free survival rate were respectively 33% and 15%. Median overall survival was 44 months and median disease free survival was 13 months. There were no difference between group1 and 2 for survival. Independent prognostic factors for survival by multivariate analysis were extent of carcinomatosis, completeness of cytoreductive surgery and performance status. Conclusions: Therapeutic approach combining cytoreductive surgery with HIPEC may achieve long-term survival in a selected group of patients with PC with acceptable mortality and morbidity. For elderly patients, this treatment could be performed in selected cases without frailty. No significant financial relationships to disclose.
Social interaction and stigmatization of cancer patients with orbitofacial disfigurement
Authors: Bonanno A. , Esmaeli B. , Nelson D. V. , Fingeret M. , Weber R. S. 
Published: August 2020

e20659 Background: Advances in cancer treatment extend the survival of orbitofacial cancer patients who undergo orbital exenteration. Survivorship creates social problems as facial deformities potentially engender social stigma (a mark of social disgrace). Stigmatization is created through social interaction and depends on reactions of “others” to disfigured patients and patients’ postures toward others. In this qualitative study, we investigated a) patterns of stigmatization in interaction with acquaintances and friends in small and large groups and b) whether interactions with family members is always positive and non-stigmatizing and interaction with strangers is always stigmatizing. Methods: In-depth interviews with 12 patients and 12 family members (8 spouses, 4 offspring and siblings) were carried out with an open-ended questionnaire. Cancer diagnoses included lacrimal gland adenoid cystic ca. (n=3), conjunctival SCCA(n=3), and 1 each of conjunctival melanoma, eyelid sebaceous gland ca., lacrimal sac transitional cell ca., orbital adenoca., orbital neuroendocrine ca., and eyelid basal cell ca. The median time from orbital exenteration to interview was 44 months. None were receiving active cancer therapy and none had cancer recurrence at interview time. Results: Patients were comfortable in interactions with friends and family members as they respond in supportive and non-stigmatizing ways. Interaction with acquaintances and strangers engender varying outcomes. In large groups, actions toward patients characterized by “benign neglect” (n=3) - kind indifference toward patients - generate non-stigmatizing outcomes. Actions characterized by sympathy (n=5) - overt support for patients - generate inconsistent patterns of interaction. “Intrusion” - unsolicited attention paid to patients - (n=4) leads to feelings of stigmatization. In small groups, intrusion creates stigmatization. Sympathy creates positive outcomes, while interaction characterized by benign neglect generates varying patterns. Conclusions: Patients should be warned about possible difficulties interacting in large and small groups. Health care professionals should be trained to address these problems through programs of social intervention for head and neck cancer survivors. No significant financial relationships to disclose.
Aprepitant/5HT-3 antagonist (EMEND) for the prevention of chemoradiation-induced nausea and vomiting (CRINV) in patients receiving gemcitabine/ 5-FU–based chemoradiation and concurrent upper abdominal radiation for pancreatic cancer
Authors: Blackstock A. W. , Aklilu M. , Lovato J. , Degrass L. , Sommer J. , Howerton R. , Mishra G. , Levine E. , McQuellon R. 
Published: August 2020

e20661 Background: Significant chemoradiation-induced nausea and vomiting (CRINV) occurs in patients (pts) receiving chemoradiation for pancreatic cancer. The aim of this trial was to determine if prophylactic Aprepitant/5HT-3/dexamethasone added to standard chemoradiation resulted in less CRINV when compared to historical controls. Methods: Pts with locally advanced or resected pancreatic cancer received wkly Gemcitabine (200 mg/m2) and continuous infusion 5-fluorouracil (5-FU) or oral capecitabine with concurrent radiation (50.4 Gy). Aprepitant (125 mg p.o.) was given each Monday (day 1) of each week 1 hr before the gemcitabine infusion and on days 2 and 3 (80 mg p.o.) - 1 hour prior to the radiation. A 5HT-3 antagonist was given orally 30–60 minutes prior to the chemotherapy and dexamethasone (12 mg) was given on day 1 and repeated at a dose of 8 mg on days 2 and 3 with the aprepitant. Grade III/IV nausea was assessed using NCI CTC v. 3.0. The Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) questionnaire was completed at baseline prior to the start of all therapy, Time 1 (T#1), repeated at the end of the first week (T#2) and then repeated again at the end of the last full week of chemoradiation (T#3). Results: Of the 17 patients available for analysis, CTC grade III nausea and grade IV vomiting was observed in one patient (6%) during the entire treatment course. Utilizing the MAT at T#1, T#2 and T#3 respectively; 3/15, 4/15 and 2/13 pts reported experiencing any level of nausea. At those same time points; 0/15, 1/15 and 0/13 pts reported vomiting. The range of the average degree of nausea reported on a scale from 1–10 (worst) was 2.5 -3.67 over the study period. During treatment, 54–64% of participants reported no nausea/vomiting (N/V). For those patients who experienced N/V, it was rated as mild to moderate with only 3 of 17 requiring additional anti-emetics. Conclusions: Prophylactic Aprepitant/5HT-3/dexamethasone therapy resulted in minimal CRINV for pts receiving upper abdominal chemoradiation in this feasibility study. This regimen may be soon be integrated in to future CALGB pancreatic chemoradiation trials. [Table: see text]
Health-related quality of life and pain assessment in 36 patients with resected pancreas adenocarcinoma: Preliminary analysis
Authors: Carr B. I. , Summers D. , Menefee L. , Pierpoint S. , Yeo C. , Kennedy E. , Lavu H. 
Published: August 2020

e20692 Background: In order to begin to understand the effects of disease on the patient (pt) and possibly of the pt on the disease, we have begun a systematic psychological inventory of all our pts who have has a pancreatectomy for pancreas adenocarcinoma and have began to correlate this with disease extent, and later with survival. Methods: Prior to post-op discharge home, pts were invited to fill out a brief pain inventory (BPI-SF), BPI interference, emotional (EWB) and physical well-being score (Fact-Hep), as well as social/family and functional well-being (FWB) Fact-Hep. The data was entered into a database, together with pertinent lab results, tumor markers, and tumor characteristics from the pre-op CT scan and post-op pathology report. Data was analyzed by descriptive statistics, frequencies and Pearson Correlation (2-tailed sig). Results: Descriptive means (and ranges) were - tumor size 3.43 cm mean (2.0 min-5.2 max), bilirubin 1.26 (0.2–4.7), albumin 2.69 (1.5–3.6), Hb 10.3 (7.5–13.2), platelets 254K (109K-672K), CEA 4.7 (0.8–24), and Ca 19–9 was 987 (1.0–8127). Pain at presentation pre-op of moderate severity was present in 11% of pts and severe pain was present in 5.6% of pts (16.6% total). Pathologically, LNs were involved by cancer in 50% of pts, vascular invasion in 30%, neural invasion in 35% and any margin positive in 14%. 22% had metastases noted at surgery. Statistically significant correlations were found for tumor size and pain severity (p<.035), platelets and FWB (p<.022), albumin and Hb (p=.000), CA 19–9 and bilirubin (p<.030 i.e. high CA 19–9 and high bilirubin). There was a negative correlation between CEA (but not CA 19–9) and both EWB (p<.039) and FWB (p<.035). Pain severity correlated with depressed mood (p<.010), lower physical well-being (p<.01) and interference with life activities (p<.01). Conclusions: CEA, but not CA 19–9 correlated with both emotional and functional well-being. Baseline pain was present in only 16.6% of this cohort. We plan to follow up to examine how these parameters correlate with pt coping throughout therapy and survival. No significant financial relationships to disclose.