bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel immunotherapy combinations for betel-nuts related HNSCC: One institutional experience in Taiwan.
Authors: Chen Jo-Pai , Lu Wei-Chen , Hong Ruey-Long , Kuo Sung-Hsin 
Published: May 2020

e18502 Background: The treatment of HNSCC in Taiwan is still very challenging. Betel nut chewing might contribute to (1)strong invasion; (2)easy recurrence; (3)poor response to traditional therapies. In our retrospective analysis for 75 patients receiving front-line EPF, patients, with rapid progression within 3 months after previous CCRT, had significantly worse survival with only 2.6 months; however, the survival increased significantly to 7.5 months in the same population if under later-line immunotherapy. Methods: From 2016 to early 2020, 46 R/M HNSCC patients receiving immunotherapy-containing regimens in Yun-lin Branch of National Taiwan University Hospital were reviewed. Results: These patients consisted of 2 HPV and 44 non-HPV; 24 pembrolizumab and 22 nivolumab; 18 with afatinib(11 pembrolizumab & 7 nivolumab); 7 with bevacizumab; 9 with chemotherapy. The objective response rate was 48%(22/46) and clinical benefit was 80%(37/46). 20 patients were still under use(8 afatinib with pembrolizumab; 4 afatinib with nivolumab). 1 patient under afatinib and pembrolizumab had hyperprogression but then got pCR after bevacizumab & strong CT. 1 patient had rapid skin metastasis over previous radiation fields after pembrolizumab, bevacizumab, and CT. 5 patients under afatinib & pembrolizumab developed autoimmune cholestasis(3 also with pneumonitis). Afatinib with nivolumab had similar efficacy but less toxicity. 18 patients receiving afatinib combined with anti-PD1(11 failing EPF, 14 with pleural/pericardial/skin metastases, 13 rapid progression within 3 months after CCRT) had 67% response rate(12/18) and 89% clinical benefit(16/18). 11 patients under afatinib & anti-PD1, who had failed EPF, had the response rate in 55%(6/11). 7 patients under front-line afatinib & anti-PD1 had the response rate in 86%(6/7). Post-progression use of anti-PD1 with other treatments were seen in 12 patients(esp. 1 with nivolumab & ipilimumab; 3 with Avastin, taxane, cisplatin). 7 patients got benefits and had longer survivals. Conclusions: Novel immunotherapy-containing combinations are of clinical significance in refractory betel-nuts related HNSCC in Taiwan. Afatinib has several immuno-modulatory effects in high risk patients(pleural/pericardial/skin metastases failing EPF, rapid progression within 3 months after definite CCRT). Afatinib with anti-PD1 may be a good option to avoid hyperprogression for more immunotherapy efficacy. Adding on CTLA4 blockage to previous afatinib/anti-PD1 after progression seemed potential for further studies.
End-of-life health care utilization (EOLHCU) in patients with recurrent, metastatic head and neck squamous cell carcinoma (RMHNSCC) treated with immune checkpoint inhibitors (IO).
Authors: Chalker Cameron , Santana-Davila Rafael , Voutsinas Jenna M. , Wu Vicky , Hwang Victoria , Baik Christina S , Barber Brittany , Futran Neal D. , Houlton Jeffrey , Laramore George E , Lee Sylvia , Liao Jay Justin , Parvathaneni Upendra , Martins Renato G. , Eaton Keith D. , Rodriguez Cristina P. 
Published: May 2020

e18516 Background: Demographic and EOLHCU trends are undefined in the growing population of IO-treated RMHNSCC; we sought to study these in a single institution retrospective study. Methods: We identified 228 RMHNSCC pts who received ≥1 IO dose between 01/2013 and 12/2018; of these, 74 were deceased with accessible EOLHCU data such as advanced care plan documentation (ACPD) or evidence of systemic therapy or ER/hospital/ICU admission within 30 days of death (DOD). Demographic, tumor and treatment data were obtained. Overall survival (OS) was estimated using the Kaplan Meier method; multivariable analysis was performed using a Cox proportional hazards model. In an exploratory analysis, EOLHCU was compared to a cohort of 379 deceased thoracic malignancy (TM) pts using a chi-square test. This project was approved by our institutional IRB. Results: Median pt age was 62 (25 – 90). Most were male (56, 75%), white (60, 81%), current/former smokers (46, 62%); 34 (46%) smoked ≥10 pack years. Common primary sites included the oral cavity (28, 37.8%) and oropharynx (24, 32.4%). ECOG PS at IO initiation was 0 in 15 pts (20%,) 1 in 37 (50%), 2 in 20 (27%), 3 in 1 (1%), and unknown in 1 (1%). Of the 42 (57%) treated off-trial, 18 (42%) had an ECOG ≥ 2. 71 (95%) had prior curative intent therapy. 42 (57%) had distant metastases. Compared to TM, IO-treated RMHNSCC pts were more likely to have ACPD (66% vs. 45% p < 0.01), an ED visit (42.3% vs 19.5%, p < 0.01) and/or a hospital admission (42.3% vs 17%, p < 0.01) within 30 DOD. There was no difference in ICU admissions within 30 DOD (9.9% vs. 8.2%, p = 0.81), ICU deaths (7% vs. 4%, p = 0.4), or systemic therapy within 7 (4.2% vs. 2.4%, p = 0.63), 14 (8.5% vs. 6.6%, p = 0.76) or 30 (25% vs 19%, p = 0.31) DOD. Among IO-treated RMHNSCC pts, multivariable analysis revealed inferior OS with worse PS (ECOG 2-3 vs. 0: HR = 7.76, p = 0.00002, 95% CI = 3.07 - 19.64; ECOG 1 vs. 0: HR = 2.97, p = 0.008, CI = 1.33 - 6.62). OS also decreased with smoking status (current/former vs. never: HR 2.18, p = 0.007, CI = 1.24-3.84). No association was observed between ECOG PS, age or smoking status at IO initiation and any EOLHCU metric. Conclusions: At our center, a significant proportion of deceased, IO-treated RMHNSCC pts had an ECOG PS ≥ 2 and an inferior OS compared to ECOG 0/1. Exploratory comparison with a non-RMHNSCC TM cohort suggests high rates of EOLHCU within 30 DOD despite ACPD, representing an opportunity for supportive care augmentation. Whether EOLHCU differs among IO vs non-IO treated RMHNSCC is unknown and merits further study.
Impact of failure to thrive on inpatient mortality and resource utilization in patients with head and neck cancer: A nationwide analysis.
Authors: Baral Binav , Lingamaneni Prasanth , Rosen Fred R. , Shrivastava Trilok , Moturi Krishna Rekha , Vohra Ishaan , Farooq Muhammad Zain 
Published: May 2020

e18531 Background: Failure to thrive (FTT), encompassing malnutrition and cachexia, is a common comorbidity afflicting Head and Neck cancer (HNC), brought about either by progression of disease or complications of treatment. FTT can exacerbate infections or cytopenias and delay wound healing, and has shown to affect survival in HNC. This study aims to explore the effects of FTT on mortality and resource utilization among hospitalized patients with HNC. Methods: Adult patients with HNC admitted from 2012-2017 were identified from the Nationwide Inpatient Sample database. Temporal trends of resource utilization across six years were evaluated. Multivariable logistic regression was used to evaluate risk factors for malnutrition and mortality in patients with HNC. Results: A total of 448,255 patients met inclusion criteria, of which 27.2% had FTT. Mean age was 66.3 years. Patients were predominantly male (71.8%) and white (70.4%). Patients with FTT had higher mortality (6.3% vs. 3.6%, p<0.0001), longer hospital stay (9.1 vs. 5.7 days, p<0.0001) and higher hospital charges ($23k vs. $18k, p<0.0001). On multivariate analysis, risk factors for FTT included male sex, African American (AA) race and higher comorbidity burden. After adjusting for confounders, patients with FTT had higher inpatient mortality (OR 1.71, 95% CI 1.60-1.83, p<0.001). There is an increasing trend of FTT in HNC over the years, from 22.7% to 32.6% (p trend <0.001). Temporal trends in mortality, length of stay and hospital charges in those with FTT did not change significantly. Conclusions: Patients with HNC and FTT had higher inpatient mortality than those without FTT. AA patients especially were at higher risk of FTT. Inpatients with HNC and FTT had longer mean hospital stay by 3 days incurring higher healthcare costs. The study highlights an under acknowledged paradigm in HNC care and warrants further steps towards more vigilant nutritional surveillance and interventions, such as early/prophylactic enteral feeding in HNC patients. This could greatly improve quality of life and objective outcomes in HNC patients. [Table: see text]
Predictive scoring systems for distant metastases in oral cavity squamous cell carcinoma.
Authors: LU Hsueh Ju , Lai Kuan-Ming , Peng Chih-Yu , Tseng Hsien-Chun , Hsin Chung-Han , Huang Wei-Shiou , Lan Wen-San , Yang Sung-Fa 
Published: May 2020

e18536 Background: At least 10% of patients with oral cavity squamous cell carcinoma (OCSCC) would progress to distant metastases (DM). Median overall survival (OS) after distant metastases is only one year and rare biomarkers are available to predict distant metastatic events. Methods: A total of 595 OCSCC patients who underwent curative surgical resection at Chung Shan Medical University Hospital were enrolled from Jan 2010 to Dec 2016. The clinical–pathological variables were compared using the χ2 test. Cox proportional-hazards analyses were performed for distant metastatic free survival (DMFS), defined from the date of initial diagnosis to the date of distant metastasis. Two scoring systems for predicting distant metastases were established for patients with pathologic regional lymph node –positive (pN+) or –negative (pN–), separately. Results: Nearly 10% (8.9%, 53/595) of patients with OCSCC would progress to DM during follow-up [20.6% (28/136) and 5.4% (25/459) for patients with pN+ and pN–, respectively]. Most of the distant metastatic lesions developed within 3 years after initial diagnosis (overall, 84.9%, 45/53; patients with pN+, 92.9%, 26/28; patients with pN–, 76.0%, 19/25). For patients with pN+, rapidly locoregional recurrence (≦6 months), lymphovascular invasion, and lymphocyte-monocyte ratio(<2.5) were the independent factors for DMFS. In addition, rapidly locoregional recurrence, elderly (age > 65), and close surgical margin(≦5mm) were independent for those with pN–. If each of the independent factors was scored one point to predict DM occurring within 3 years after the initial diagnosis, two scoring systems were established for the corresponding patients with pN+ or pN–, separately. The area under the curves of these two scoring systems for the corresponding patients with pN+ and pN– were 0.737 and 0.825, respectively (Table). Conclusions: The established scoring systems effectively predict distant metastases for OCSCC patients. [Table: see text]
Prevention of cisplatin nephrotoxicity (CN) in head and neck cancer patients receiving concurrent chemoradiation (CCRT) by adding oral rehydration solution (ORS) to short hydration regimen: A randomized open-label controlled trial.
Authors: Maisrikrod Aungsumal , Sakdejayont Siwat , Rongmuang Jakkapan , Sathitruangsak Chirawadee , Sunpaweravong Patrapim , Dechaphunkul Arunee 
Published: May 2020

e18560 Background: CN remains a frequent occurrence despite receiving standard fluid hydration, particularly for head and neck cancer patients undergoing CCRT. We aimed to investigate whether adding ORS to short hydration regimen can reduce CN. Methods: We conducted a randomized open-label controlled trial in patients with head and neck cancer receiving CCRT with 3-weekly cisplatin (≥ 60 mg/m²). Eligible patients were randomly assigned to receive short hydration regimen (2000 mL of normal saline on day 1) alone or in combination with 2000 mL of ORS on days -1, 2 and 3 of each cycle. All patients were instructed to drink at least 2000 mL of fluid. The primary end point was the incidence of ≥ gr 1 creatinine (Cr) elevation on day 8. The planned sample size was 160 (80 patients each arm). Results: Thirty-five patients in ORS group and 34 patients in control group (43% of planned sample size) were enrolled. Baseline characteristics were balanced between the two groups, except more patients in ORS group underwent surgery (35.3% vs. 22.9%), and had less feeding tube prophylaxis (76.5% vs. 88.6%), although there were not statistically significant. The mean dose of cisplatin on day 1 was significantly higher in ORS group (91.2 mg/m2 vs. 85.1 mg/m2, p=0.01). There was no difference of volume of total fluid intake and toxicities between the two groups. Less percentage of patients in ORS group developed ≥ gr 1 Cr elevation as shown in the Table, although there were not statistically significant. Conclusions: Although our interim analysis showed no significant difference of CN between the groups, there was a trend that addition of ORS might prevent acute and chronic kidney injury secondary to cisplatin. The completed enrollment is warranted to confirm this early findings. Clinical trial information: TCTR20200207005 . [Table: see text]
Early mortality in children with cancer in the National Institution of Pediatrics, Mexico.
Authors: Diaz Ramirez Karla , Zapata Tarres Marta 
Published: May 2020

e19004 Background: Children cancer represents the first cause of mortality by disease worldwide. Early mortality is defined as death within the first four weeks since the patient’s admission to the hospital, and it is an indicator to evaluate attention quality. It is considered that early mortality rate must be less than 5% in acute lymphoblastic leukemias, although it is not standardized in solid tumors. The aim of this study was to evaluate the early mortality rate in a third level pediatric center. Methods: We have conducted a retrospective analysis of oncology patient records dating from January 2012 to April 2017 diagnosed and treated in the National Institute of Pediatrics in Mexico. Patients who died in the first four weeks from diagnosis were included in our study. Clinical characteristics were analyzed with an univariate analyses using measures of central tendency for quantitative data and proportions for qualitative. We used SPSS-20 for all analyses. Results: A total of 1500 patients were diagnosed with neoplastic disease at the Institute within 2012 and 2017, 34 (2.26%) of them had an early death. Median age of diagnosis was 5 years. Central nervous system (CNS) tumors were the predominant group associated to early mortality (23.5%), followed by hepatocarcinoma, acute lymphoblastic leukemia (ALL), neuroblastoma, diffuse intrinsic pontine glioma (DIPG), and Wilms tumor (5.9% each). 70.6% had metastatic disease at diagnosis. Main cause of death was progression of disease (60%), followed by infectious complications (35%). Only one patient was treated by palliative care. Conclusions: In spite of children cancer care innovations, early death rates are still high, mainly because of delay in diagnosis at advanced stages of the disease. Another important factor in low-middle income countries is treatment abandonment, which is higher in patients who live in precarious conditions and live in isolated communities and must travel long distances to get medical attention. As healthcare professionals from a low-middle income country, we still have a lot to do to prevent our patients early mortality.
"Does better understanding of cancer care needs impact outcomes...?" The experiences of the Kigali City Cancer Challenge innovation.
Authors: Ntizimira Christian Ruchaho 
Published: May 2020

e19016 Background: Launched in January 2017 at the World Economic Forum in Davos, Switzerland, City Cancer Challenge (C/Can) is a multisectoral initiative supporting cities to take the lead in the design, planning, and implementation of cancer treatment solutions. C/Can serves as a unique platform to increase the number of people with access to quality cancer care in cities through a truly multisectoral approach. With access to both technical and financial resources, cities are supported to strengthen their capacity, leadership, and accountability in the delivery of cancer care, and engage in the design and implementation of cancer treatment and care solutions that meet the needs of their population. In 2018 during the World Health Assembly, the City of Kigali has been selected as the first African City Cancer Challenge alongside with Porto-Alegre from Brazil. Methods: The Needs Assessment questionnaire was designed to provide in-depth information on the delivery of cancer treatment and care services in a city. The objective is to generate systematic and reliable data on the availability. Results: Conclusions: The Kigali C/Can has developed an innovative solution from adapted from Rwandan patients, by Rwandan patients and for Rwandan patients through a city process which include a multi-sectorial decision-makers that was not happened before. [Table: see text]
Medicare compared with private insurance for the treatment of cancer.
Authors: Martinez-Knouse Phillip , Hancock Christie , Nabrinsky Edward , Lestingi Timothy M. , Bitran Jacob D. 
Published: May 2020

e19033 Background: Insurance status impacts access to cancer care and outcomes of cancer patients. Patients who are uninsured and those who are insured by Medicaid are less likely to receive cancer screening, more likely to present at later stages of disease, and more likely to die from cancer compared to those who are privately insured. It is unclear whether patients insured by Medicare have different outcomes than patients with private insurance. Methods: We undertook a retrospective analysis of patients treated in our practice from January 1, 2019 to March 31, 2019. Outcomes of solid tumor patients were tracked after treatment in the neoadjuvant or metastatic setting. Patients were stratified by their insurance status and we then compared treatment outcomes of patients with private insurance to those with Medicare. Results: We treated 86 patients from January 1, 2019 to March 31, 2019 including 63 women and 23 men with a median age of 62 years (range 22-88 years). Several types of malignancies were represented including 21 gynecologic cancers, 17 breast cancers, 11 lung cancers, 10 melanomas, 10 gastrointenstinal cancers, 7 lymphomas, 5 genitourinary cancers, and 5 other tumor types. Among our population, 48 patients had private insurance and 38 had Medicare. Thirty-four patients achieved either a complete response (CR) or partial response (PR), 24 with CR and 10 with PR. Of those who achieved a CR, 11 had Medicare and 14 had private insurance. Among those who achieved a PR, 5 had Medicare and 5 had private insurance. Conclusions: In this retrospective analysis, insurance type did not predict likelihood of achieving a complete or partial response to treatment. Other investigators have suggested that patients with Medicare have poorer outcomes than those with private insurance. One potential explanation for the discrepancy between their data and ours is that we have dedicated system designed to accelerate pre-certifications. Additional investigation is warranted to better understand these trends.
Multiple myeloma (MM) therapy within a Medicare insured patient population: Role of initial care setting and socioeconomic status.
Authors: Davidoff Amy J. , Long Jessica B. , Bewersdorf Jan Philipp , Shallis Rory , Zeidan Amer Methqal , Podoltsev Nikolai Alexandrovich , Wang Rong , Gore Steven , Giri Smith , Neparidze Natalia , Huntington Scott F. 
Published: May 2020

e19057 Background: Approval of MM therapies including immunomodulatory agents (IMiDs), and proteasome inhibitors (PIs), coupled with increasing evidence supporting PI-IMiD combinations, maintenance (MT), and autologous stem cell transplant (ASCT) among fit patients, have expanded options, complexity and duration of active therapy. Prior research reported race disparities in initial therapy receipt and survival differences based on provider characteristics. It is unknown whether these effects extend to longer-term management. Methods: We selected adults with MM diagnosis (dx) between 07/07-12/15 from the SEER-Medicare linked database. We required continuous Medicare Parts A, B, and D enrollment and no HMO/PPO coverage from 12 months prior to dx through death or end of study (12/16) and MM therapy initiation w/in 12 months post dx. Outcomes including line of therapy (LOT) 1 PI-IMiD combination, LOT1 length, ASCT, MT, any LOT2, and any LOT4, were constructed using claims indicators for oral and IV drugs and receipt dates. Initial provider setting was assigned as academic &/or NCI cancer center, non-teaching hospital, or community (non-hospital) based on 1st oncologist E & M visit w/in 2 months pre- or post-MM dx. We also examined race (white, black, other), Hispanic ethnicity, Part D Low Income Subsidy (LIS) receipt and linked area poverty rate. Multivariable logistic and Cox proportional hazard regressions controlled for demographics, health status, and diagnosis year. Results: The cohort (n = 5678) was 51% male, 14% Black, and 51% age ≥75 years. Initial care setting was 50% academic/NCI, 32% non-teaching hospital, and 19% community; 22%, 53%, and 19% received LOT1 PI-IMiD, LOT 2, and LOT 4, respectively. Median LOT1 length was 165 days. Relative to academic/NCI, community care was associated with lower adjusted odds of all outcomes (e.g. LOT2, aOR: .56, 95% confidence interval (CI) .48 -.65, p < .001; LOT4, aOR: .74, 95% CI .58-.95, p = .02) except LOT1 PI-IMiD. Care at non-teaching hospitals was associated with reduced odds of LOT2. Part D LIS was associated with lower odds of LOT1 PI-IMiD, while increasing % poverty was associated with lower odds of LOT1 PI-IMiD combinations, LOT1 ASCT, LOT2 and LOT4. No associations were observed with race or ethnicity and any outcome. Conclusions: In Medicare insured adults treated for MM, initial care in a community setting was associated with shorter and less complex therapy. Socioeconomic status (Part D LIS, area poverty rates), but not race or ethnicity, was a consistent predictor of MM treatment.