bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital.
Authors: Bowers Reid Christian , Thompson Michael A. , Korman Sandra Tomany , Sana Sherjeel , Pant Manish Krishna , Sanchez Federico Augusto 
Published: May 2020

e14142 Background: An Anemia Clinic program was started Sept. 2016 as part of system wide implementation of Patient Blood Management (PBM) initiated in 2015. Methods: The Anemia Clinic accepted referrals for non-cancer anemia, predominantly preoperative cardiovascular surgery (CVS) Pts. Hgb thresholds were < 13 g/dL in men and < 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte. Nutrient deficiencies were supplemented. Pts with CKD or chronic disease were considered for erythropoiesis stimulating agents. Results: PBM implementation resulted in a drop in packed red blood cell (PRBC) usage (Table). Of CVS Pts pre-operatively anemic in 2019, 180 were referred to the Anemia Clinic and 301 were not. Anemia Clinic identified iron (N = 114), vitamin B12 (N = 24), and folate (N = 18) deficiencies. The percentage of Pts who received PRBCs after Anemia Clinic referral was not statistically different from those who were not referred (65.6% vs. 61.8% Chi-Square p = 0.44). Of preoperatively anemic Pts who were transfused in 2019, an average of 2.34 PRBCs were used in the referred group vs. an average of 2.21 PRBCs in those in the not referred group (Poisson Means p = 0.46). Length of stay (LOS) which was a median 10d ( P25= 7d, P75 =17d) in the referred group vs a median 12d ( P25= 7d, P75 =19d) in the non-referred group was not statistically different between groups (Smirnov p = 0.39). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges. For 2019 through Nov. the referred group had an O/E = 1.03 (observed LOS μgeo = 11.58 days, expected LOS μgeo = 11.21 days, N = 167). The not referred group had an O/E = 1.06 (observed LOS μgeo = 12.24 days, expected LOS μgeo = 11.58 days, N = 272). Conclusions: PBM decreased PRBC use through systematization of best practices during the initial year. Subsequent addition of Anemia Clinic services has not decreased PRBC use further. There is a trend toward shorter LOS for patients referred to Anemia Clinic but it is not statistically significant. Our methods improved nutrient deficiency identification which may improve both later health outcomes not detected here and access to treatment for hematologic malignancies. [Table: see text]
Incremental oncology workload generated by immunotherapy in the first-year of treatment.
Authors: Cinausero Marika , Garattini Silvio Ken , Minisini Alessandro Marco , Valent Francesca , Riosa Chiara , Iacono Donatella , Macerelli Marianna , Andreotti Victoria , Giavarra Marco , Vitale Maria Grazia , Fasola Gianpiero 
Published: May 2020

e14143 Background: The rapid development of immunotherapy (IO) has transformed the cancer therapy landscape with growing impact on oncology workload. Given the few data on this topic, we conducted a study to estimate the shift in workload generated by any new metastatic cancer patient treated with IO and referred to the Oncology Department of the Academic Academic Cancer Center of Udine, Italy, within the 12 months of first consultation. Methods: We collected from our “Data Warehouse” electronic accountability system all new diagnosis of metastatic cancer between 01.01.2017 and 31.12.2018, resulting in a first consultation and leading to a second clinical episode during the following year, in order to assess the oncology workload. The population was divided into patients that received IO (anti-CTLA-4/PD-1/PDL1) versus patients treated with “other treatments”. Mean number per patient and standard deviation were calculated for clinical episodes (first consultations, treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up and inpatient oncology advices). The total number of patients treated and the number of episodes were recorded. Mean numbers of episodes in the IO group and “other treatments” group were compared using Student’s t-test (significance p < 0.005). Follow-up data was collected up to 31.12.2019. Results: A total number of 969 patients were considered (854 “other treatments” group and 115 IO group), resulting in a total of 12407 clinical episodes over the period of 12 months (first consultations excluded). Compared to “other treatments” group, patients in the IO group generated a greater workload in terms of treatment sessions (9.59 vs 6.83 per patient, p < 0.0001), re-evaluations (2.55 vs 1.88, p = 0.0002), and unplanned presentations (2.19 vs 1.51, p = 0.08). On the other hand, follow-up visits workload was greater for “other treatments” group (0.83 vs 0.63, p = 0.0002). No differences were found regarding hospitalizations and inpatient oncology advices. Further analysis will be presented. Conclusions: IO represents a new frontier in oncology landscape, leading to outcome’s improvement and longer lasting treatment periods. The estimate of oncology workload generated by new diagnosis of metastatic cancer requiring IO, is crucial for implementing more sustainable systems and for planning clinical activities.
Underutilization of low-dose computed tomography in a high-risk population.
Authors: Ashraf Sara , Konala Venu Madhav , Jafri Mohammad Ali Syed 
Published: May 2020

e14145 Background: Lung cancer is the leading cause of cancer death in the United States, contributing to one-quarter of all cancer-related deaths. State statistics reveal per capita that Kentucky has the highest incidence and mortality rate for lung cancer. One would assume that in a community setting in Kentucky, the rate of utility of low dose Computed Tomography (CT) and detection of lung cancer would be high. Methods: We did a retrospective analysis of Low Dose Computed Tomography (CT) for lung cancer screening based on the United States Preventative Services Task Force (USPSTF) guidelines from 2017-2019 at a community hospital in Ashland, Kentucky. Charts were reviewed to analyze the number of patients who received screening, total number of patients diagnosed with lung cancer, and how many patients could have received screening based on the guidelines. We also analyzed how many are alive and those that are deceased. Results: Our analysis showed that a total of 175 patients were diagnosed with lung cancer at the hospital in 3 years. Out of these, 118 had qualified for screening (67%) based on USPSTF guidelines. Only seven patients received screening (5.9%). All seven patients who received screening are currently alive. Forty-eight patients (41%) are now deceased that could have had the screening but did not. Conclusions: Low dose screening CT is being underutilized in the community setting with high incidence and mortality from lung cancer. The mortality rate is high likely from the late detection of the tumor. Implementation of guidelines to the general population for lung cancer screening will require systems to facilitate identifying eligible patients. It also involves training of physicians with information that should be delivered during the shared decision-making conversation. We also suggest low dose screening CT to be included in global quality pay for performance program for primary care providers which includes screening for breast and cervical cancer as well as smoking cessation.
Effects of the growing prevalence in oncology: A real-world study on the estimated workload.
Authors: Garattini Silvio Ken , Minisini Alessandro Marco , Valent Francesca , Riosa Chiara , Andreetta Claudia , Cardellino Giovanni Gerardo , Mansutti Mauro , Rizzato Simona , Rossetto Ciro , Sacco Cosimo Stanislao Pio , Follador Alessandro , Fasola Gianpiero 
Published: May 2020

e14148 Background: The increasing prevalence of cancer patients due to new effective treatments is leading to a growing demand in oncology activities, thus requiring a re-modelling towards more sustainable systems. The aim of this study is to estimate the workload generated by each new cancer patient referred to the Oncology Department of the Academic Cancer Center of Udine, Italy, within the two years from first consultation. Methods: We have utilised our electronic “Data Warehouse” accountability system to retrieve anonymous aggregate data of the 2-year oncology workload generated by each new diagnosis, leading to an initial consultation, occurring between 01.01.2012 and 31.12.2017. Initial consultations with no clinical episode in the following 12 months were excluded. Mean value per patient and standard deviations were calculated for the following clinical activities: treatment sessions, unplanned presentations, hospitalisations, re-assessments, follow-up visits and inpatient oncology advices. The total number of patients treated and of episodes were recorded. Follow-up data was collected up to 31.12.2019. Results: During the observation period, 7,454 newly diagnosed patients were referred to our Oncology Unit, resulting in a total of 92,830 clinical activities occurring over an 8-year period. In 1,788 pts (24.0%) only follow-up was needed; 3,152 pts (42.3%) were referred for adjuvant treatment and 2,514 (33.7%) for advanced disease management. Overall, the mean number of clinical activities per patient within the first 2 years was: 6.04 pre-treatment evaluations (52.9%; SD 8.81; 45,003 total episodes), 2.00 follow-up visits (17.5%; SD 1.89; 14,922 total episodes), 0.42 hospitalisations (3.7%; SD 1.21; 3,141 total episodes), 0.36 inpatient oncology advices (3.2%; SD 0.83; 2,705 total episodes), 1.57 re-assessments (13.8%; SD 2.28; 11,723 total episodes) and 1.02 unplanned presentations (8.9%; SD 2.17; 7,601 total episodes). Subgroup analysis in the different tumors and settings are ongoing. Conclusions: The landscape of cancer care is changing due to the growing prevalence of cancer patients that experience longer overall survival. Trying to estimate the amount of clinical activities generated by any new diagnosis is crucial for implementing new models of oncology management and for programming an adequate workforce supply.
Overcoming clinical trial accrual barriers at UPMC: A successful experience.
Authors: Reyes Vincent Edgar , Evans Terry L. , VanderWeele Robert Alan , Marsh Christopher Ritchie , Peracha Sajid M. , Kiefer Gauri J. , Tageja Nishant , Choksi Rushir J. , Pappu Bhanu , Wozniak Antoinette J. , Ferris Robert L. , Marks Stanley M. 
Published: May 2020

e14152 Background: UPMC Hillman Cancer Center Medical Oncology Network is one of the largest integrated community oncology network in the United States. A large gap exists between trial participation rates and the willingness of patients and physicians. There are numerous barriers to clinical trial accrual in the medical oncology community. UPMC identified and created solutions to overcome barriers, and thus dramatically increase clinical trial accrual in 2019. Methods: A physician led advisory board was created to identity problems and find solutions to increase clinical trial accrual in the community. Processes that were implemented in the community to increase physician engagement included identifying more community friendly clinical trials, highlighting high impact clinical trials, and reprioritizing available clinical trials. Also, community physician champions were selected and directly linked with the academic faculty by disease site at UPMC Hillman Cancer Center. Other marketing tools were utilized like a newly developed mobile clinical trial app, community physician dedicated clinical trial retreat, and clinical trial newsletter. High volume community sites were identified as flagship clinical trial accrual centers. Results: With the implementation of physician led initiatives, total (interventional + non interventional) clinical trial accrual increased in the UPMC medical oncology network from 216 in 2018 to 660 in 2019. In 2019 there were 631 interventional trial accruals and 363 therapeutic trial accruals. In 2018 there were only 186 interventional trial accruals and 46 therapeutic trial accruals. Conclusions: The community oncology-directed initiatives created a culture change among the community physicians. UPMC implemented new processes in the medical oncology network that significantly increased clinical trial accrual. [Table: see text]
Stereotatic radiosurgery for residual lesions of pineal nongerminomatous germ cell tumors after conventional radiotherapy: A retrospective study.
Authors: Lai Mingyao , Li Juan , Hu Qingjun , Zhou Jiangfen , Wen Lei , Zhou Cheng , Zhou Zhaoming , Li Shaoqun , Shan Changguo , Cai Linbo 
Published: May 2020

e14516 Background: To evaluate the safety and efficacy of stereotatic radiosurgery (SRS) in treating residual lesions of pineal non-germinomatous germ cell tumors (NGGCTs) after conventional radiotherapy. Methods: The patients admitted to Guangdong Sanjiu Brain Hospital from 1 January 2008 to 31 December 2018 who diagnosed with pineal NGGCTs pathologically or clinically were retrospectively analyzed. Among those, the patients received conventional radiotherapy with or without SRS were included. The residual lesions after radiotherapy were defined with a maximum diameter > 10mm. Prognosis related parameters such as local control rate, progress-free survival, overall survival and treatment-related toxicity were determined. Results: The median follow-up time was 34 months (range 8-142 months). The objective response rate and disease control rate were 71.4% and 95.2%, respectively. Three-year progression-free survival rate was 85.2% and 3-year total survival rate was 88.0%. The univariate analysis revealed that both age and concurrent chemotherapy were not correlated with the prognosis (P = 0.286, 0.824). Partial tumor resection before radiotherapy and chemotherapy, AFP>500ng/ml, and no more than 4 cycles of adjuvant chemotherapy were poor prognostic factors (P = 0.037, 0.010, 0.006). Moreover, no acute radiation response was observed after treatment with SRS. Only 1 out of 27 patients (3.7%) had brain neurotoxicity related to a prolonged course of radiochemotherapy. Conclusions: SRS for residual lesions of NGGCTs following conventional radiotherapy appears to be well tolerant and improved local control. However, the combination of conventional radiotherapy and SRS warrants further investigations in a large-scale randomized controlled clinical trials.
Therapeutic effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy with concomitant temozolomide alone in children with DIPG: A single-center experience with 82 cases.
Authors: Lai Mingyao , Li Juan , Hu Qingjun , Li Shaoqun , Zhou Jiangfen , Zhou Cheng , Wen Lei , Zhou Zhaoming , Shan Changguo , Cai Linbo 
Published: May 2020

e14518 Background: To retrospectively analyze the therapeutic effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy with concomitant temozolomide alone for pediatric diffuse intrinsic pontine glioma (DIPG), and to evaluate the value of temozolomide in the treatment of pediatric DIPG. Methods: The clinical data of children with confirmed DIPG in Guangdong Sanjiu Brain Hospital between January 1, 2010 and December 30, 2019 were collected. The inclusive criteria included (1) receiving a total radiotherapy dose of 54 Gy in 27 fractions, (2) treated with concomitant temozolomide chemotherapy, and (3) with or without adjuvant temozolomide chemotherapy. Results: A total of 82 pediatric patients were eligible for the study, with a median age of 7 years (range 2-16 years). The median follow-up was 8.6 months (range 2-28 months) and the median survival time was 9.4 months. The median survival time of 66 patients treated with radiotherapy with concomitant and adjuvant temozolomide was 9.8 months, longer than 7.5 months of the other 16 patients treated with radiotherapy with concomitant temozolomide alone, with statistical differences (P= 0.010). Moreover, bevacizumab and nimotuzumab didn't bring survival benefits to patients with disease recurrence or progression. Hematological toxicity (Grade IV) was not found. Conclusions: Radiotherapy with concomitant and adjuvant temozolomide prolongs the survival time of children with DIPG.
Effect of early integration of diabetic services in primary brain tumor patients receiving radical radiotherapy on steroid-induced diabetic complications and hospital admission.
Authors: Keshwani Karim , Raymond Lorna , Shawe-Taylor Marianne , Lowe Hannah , Plowman Piers N. , Lewis Rachel 
Published: May 2020

e14522 Background: Corticosteroids are commonly used in neuro-oncology both in the perioperative setting and with chemotherapy and radiotherapy to manage cancer and treatment-associated cerebral oedema and neurological deficits. Corticosteroids are associated with significant morbidity. We sought to identify primary brain tumour patients affected by steroid complications within our centre, the repercussions on their treatment and whether these consequences are avoidable. Methods: This retrospective study curated the last 50 primary brain tumour patients treated radically and therefore at risk of long term steroid use between November 2018 and August 2019. Patient demographics, tumour and treatment type, as well as diabetic and steroid history were collected. A second cohort of primary brain patients undergoing radical radiotherapy were recruited between November 2019 and January 2020. HbA1c blood tests were performed and NICE guidelines used for HbA1c diagnostic criteria with referral to diabetic services and outcomes recorded. Results: Tumour types ranged from Glioblastoma (36%), meningioma (32%), oligodendroglioma (16%), astrocytoma (14%) and hemangioblastoma (2%). 12 (24%) had a known diabetes diagnosis. Forty-two (84%) had an operation (biopsy (30%), partial (18%) or full debulking (16%). 82% of patients were exposed to dexamethasone at some point during their neurosurgical or oncological treatment. Initial doses varied but 36% were placed on 8mg twice daily. Steroid-induced hyperglycaemia occurred in 8 (16% of the cohort) with admission to hospital as a consequence in half of these cases, of whom two were newly diagnosed diabetes patients. HbA1c testing prior to or during treatment occurred in 16 (32%) patients. In the second cohort, All 15 patients (100%) had HbA1c testing with 5 (33%) patients diagnosed with diabetes or at risk of diabetes. Diabetic team advice was sought and recommended blood glucose testing in all these patients with oral hypoglycaemic and/or insulin dose modification in 3 (60%). There were no hyperglycaemic recordings or subsequent admissions to hospital in this cohort. Conclusions: We therefore recommend HbA1c testing and early diabetic team involvement in all primary brain tumour patients receiving radical radiotherapy.
Effect of cumulative dexamethasone dose during concomitant chemoradiation on lymphopenia in patients with newly diagnosed glioblastoma.
Authors: Ahn Stephen , Park Jae-Sung , Song Jin Ho , Jeun Sin-Soo , Hong Yong-Kil 
Published: May 2020

e14533 Background: Lymphopenia frequently occurs after concomitant chemoradiation (CCRT) in patients with glioblastoma (GBM) and is associated with worse overall survival (OS). A few studies have tried to identify risk factors for lymphopenia; however, the results were not clear. We aimed to identify potential risk factors for lymphopenia, focusing on the use of dexamethasone to control cerebral edema in patients with GBM. Methods: The electronic medical records of 180 patients with newly diagnosed GBM treated at our institution between 2009 and 2017 were retrospectively examined. Acute lymphopenia was defined as TLC (total lymphocyte count) less than 1,000 cells/mm3 at 4 weeks after completion of CCRT. Multivariate logistic regression analysis was used to identify independent risk factors for lymphopenia, and Cox regression analysis was used to identify independent risk factors for OS. Results: Of the 125 eligible patients, 40 patients (32.0%) developed acute lymphopenia. Female sex and median daily dexamethasone dose > 2mg after initiation of CCRT were independent risk factors for acute lymphopenia on multivariate analysis. Acute lymphopenia, extent of surgical resection, and performance status were associated with OS; however, dexamethasone use itself was not an independent risk factor for poor OS. Conclusions: Female sex, median daily dexamethasone dose > 2 mg after initiation of CCRT until four weeks after completion of CCRT may be associated with acute lymphopenia. However, dexamethasone use itself did not affect OS in patients newly diagnosed with GBM. These results should be validated by further prospective studies controlling for other confounding factors.
Impact of CD38 knockout in NK cells on daratumumab-mediated cytotoxicity and cellular metabolism.
Authors: Nagai Yuya , Kararoudi Meisam Naeimi , Ali Syed Abbas , Imus Philip H. , Pereira Marcelo , Elmas Ezgi , Borrello Ivan , Lee Dean Anthony , Ghiaur Gabriel 
Published: May 2020

e15018 Background: Multiple myeloma (MM) is a neoplasm of plasma cells. These cells express high levels of CD38 and are sensitive to daratumumab (DARA), a CD38-targeting monoclonal antibody. DARA kills MM cells via several mechanisms including antibody dependent cellular cytotoxicity (ADCC). Although DARA has improved the outcome of patients, CR is not achieved in all the cases. Besides, most patients that achieve CR will experience relapse. A potential explanation for blunted efficacy of DARA is downregulation of CD38 levels on MM cells and impaired ADCC due to depletion of CD38high NK cells during therapy. ATRA upregulates CD38 levels on target cells and was proposed to improve the efficacy of DARA. NK cell supplementation was tested in a preclinical model, but that had only a modest effect on DARA efficacy, likely due to their short life via DARA-mediated elimination. Methods: We generated CD38 knockout (CD38KO) NK cells from healthy donors via Cas9 RNPs and investigate if these cells boost DARA activity against MM. RNA-seq and cellular metabolic analysis were performed to examine the effect of CD38 deletion on NK cell function. Results: Knockout efficiency was 81.9 ± 6.9% (mean ± SD, N = 5). Very low off-target effects were seen by whole genome sequencing. When compared to paired CD38 wild type (CD38WT) NK cells, CD38KO NK cells showed lower conjugation (2.57% vs. 11.85%, N = 3, p = 0.04), less fratricide (97.3% vs. 54.2%, mean viability, N = 3, p = 0.01), and superior persistence in mice (18.16% vs. 0.42%, mean frequency in blood, N = 5, p < 0.01) in the presence of DARA. Additionally, CD38KO NK cells exhibited enhanced ADCC against all tested MM cell lines and primary samples including CD38low cell lines and primary MM cells from a patient with disease relapse on DARA. Transcriptomic and cellular metabolic analysis revealed that CD38KO NK cells have favorable metabolic shift with higher mitochondrial respiratory capacity (N = 3, p < 0.01). Although ATRA upregulates CD38 levels on MM cell lines, we observed that ATRA treatment upregulates CD38 levels on circulating NK cells in patients. ATRA upregulated CD38 levels on CD38WT NK cells, but not on CD38KO NK cells, and increased their fratricide. Thus, CD38WT NK cells showed impaired overall DARA-mediated cytotoxicity against MM cells in the presence of ATRA, even though those MM cells were sensitized to DARA. Conclusions: We present proof of concept that adoptive CD38KO NK cell therapy has the potential to maximize the efficacy of DARA against MM. Further investigation into the role of metabolic reprogramming of CD38KO NK cells is warranted.