bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hispanic race and outcome of metastatic (MET) colorectal cancer (CRC): Biology or health care (HC) setting?
Authors: Shabihkhani Maryam , Yu Steven , Yang Dongyun , Lenz Heinz-Josef , Barzi Afsaneh 
Published: March 2020

e17559 Background: Hispanics (H) have lower CRC related mortality compared to Whites (W). However, over the past decade H have appreciated less improvement in CRC mortality. Given that treatments (TX) for early stage CRC is unchanged we speculate that the gap is due to poorer outcome in the MET setting. Delivery of HC is identified as one of the factor for poor outcomes. We examined the relationship between HC delivery (public or private hospital) and TX as the drivers of poorer outcome in H. Methods: We identified CRC patients (pts) with at least one cycle of chemotherapy (CT) in the first line MET setting at Los Angeles County Hospital (LAC-public hospital) and Norris Cancer Center (NCC-Private hospital) between 2004-2011. Demographics; tumor and TX related factors were collected. Primary endpoint was TTP (time from first day to progression on first line CT). Descriptive statistics were used to describe the population and where appropriate chi-square, Wilcoxon, and log-rank tests were used for comparison between the groups. Results: 251 pts, 45%H, 26%W, 20% Asian (A) and 9%Black (B) were included. The median age of the population was 55 (21-82) years. 55% of pts were male.74 % of pts had de-novo MET disease. 48% of pts had left sided, 27% right sided and 25% rectal cancer. 71% of pts treated at LAC and 29% at NCC. 46% of pts at LAC and 56% at NCC received bevacizumab (BEV) as part of their TX (p= 0.26). Median TTP in H was 10.2 months (m) (95% CI: 8.1-11.8), and in W was 16.8 m (95% CI: 11.2-27.2; P<0.05). Hispanics who were TX at LAC had longer TTP in comparison to H at NCC (p= 0.01). In multivariate analysis, race remained a significant predictor of TTP (p=0.001). Conclusions: H are the largest and fastest growing minority in the US, identification of factors of disparate outcome is crucial. This study revealed a significant association between race and TTP. Use of BEV for MET CRC became a standard TX in 2004 and since then TX is mostly unchanged. Our cohort received homogenous TX with regards to use of BEV. The results show that H regardless of HC setting have shorter TTP than W suggesting an inherent biological difference in the tumor or response to TX. Future biomarker studies will shed light on the cause.
Does faster rituximab infusion for patients with NHL lower cancer care costs?
Authors: Reyes Carolina , Dai Minghan , Goertz Hans-Peter , Dawson Keith L , Hornberger John C. 
Published: March 2020

e17561 Background: Rituximab in combination with chemotherapy is recommended for non-Hodgkin’s lymphoma. A faster (90-minute) infusion schedule for rituximab has been found to be safe and feasible in NHL patients who tolerate their first infusion administered at the standard rate (Phase III study RATE trial; NCT00719472). This study’s objective was to assess the economic impact of adopting the 90-minute rituximab infusion from a US societal perspective. Methods: The analysis complied with the jointly published Good Research Practice guidelines of the International Society of Pharmacoeconomic and Outcome Research and the Society of Medical Decision Making. The target population was US patients in 2013 with previously untreated diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) who were scheduled to receive rituximab plus CHOP or CVP. Costs included direct medical costs (drug and administration cost, pre-medication cost, cost of adverse events) and indirect costs (income foregone by patients and informal caregivers due to visit duration for infusion). Data sources included RATE trial, Medicare Fee Schedules, and US Labor Department statistics. Results: Of the 23,519 newly diagnosed DLBCL and FL patients in the target population, the estimated direct medical costs and foregone (patient and caregiver) income for conventional infusion totaled $825,005,088 and $9,293,180 respectively. The 90-minute infusion reduced direct medical costs by $2,205,689 (0.3%) and foregone patient income by $3,628,185 (39%). The average cost savings for each patient was $42 per infusion and $248 per course. The factors that most influenced savings included cost to treat adverse events, administration costs, and patient wage rates. As a result from a shorter infusion duration, the increased center capacity may lead to a larger saving as the fixed center costs can be distributed across more patients. Conclusions: In the context of tremendous focus on affordably improving population health, this study confirms that compared with conventional rituximab infusion regimen, a novel, validated regimen that is 3-4 fold faster to administer and is as safe results in direct medical savings and reduces productivity loss for patients and caregivers.
Medical oncologists’ clinical experiences and comfort levels with 20 recently approved agents.
Authors: Love Neil , Anderson Kenneth Carl , Flaherty Keith , Kantarjian Hagop M. , Lynch Thomas James , O'Shaughnessy Joyce , Sartor A. Oliver , Venook Alan Paul , Zelenetz Andrew David , Moss Jonathan , Kelly Gloria , Ziel Kathryn 
Published: March 2020

e17570 Background: The rapid pace of current oncology drug development has provided medical oncologists (MO) and patients with many additional treatment options, but minimal publicly accessible information exists on how new agents are incorporated into practice. Methods: From 12/15/2012 to 1/21/2013,100 US-based MO were recruited to complete a survey assessing the diseases they treat and their prescribing experiences with 20 oncologic drugs approved between 9/2009 and 11/2012. MO who manage related cancers were asked to self-report on a 3-point scale their comfort level using these agents. A modest honorarium was provided. Results: See Table. MO generally had limited clinical experience, even with drugs used in common cancers. Multiple clinical and logistical factors were cited for not using agents. For only 4 of the drugs did more than half of MO self-rate their prescribing confidence as 3 (very confident). Conclusions: Variation in MO use of recently approved drugs is multifactorial, and the suboptimal comfort levels reported here may reflect the natural evolution of clinical experience over time. Further research is needed to determine if an improved information infrastructure would better and more rapidly prepare MO to incorporate these and other soon-to-be-approved agents into practice. [Table: see text]
Correlation of insurance status, ethnicity, and race with pathologic risk in retinoblastoma: A Children's Oncology Group (COG) study.
Authors: Green Adam L. , Langholz Bryan , Chintagumpala Murali M. , Cockburn Myles , Chevez-Barrios Patricia , Albert Daniel , Eagle Ralph , Rodriguez-Galindo Carlos 
Published: March 2020

e17573 Background: Insurance status affects cancer diagnosis and outcome in adults, but the impact has not been well studied in pediatric cancer. In children with retinoblastoma, time to diagnosis correlates with tumor invasiveness and patient survival, and therefore the disease can be a model to study the effect of demographic variables on delays in diagnosis. Methods: Our patient population consisted of all 203 patients from the United States enrolled on Children’s Oncology Group ARET0332, a study of patients with unilateral retinoblastoma requiring enucleation. All surgical specimens underwent central review by three pathologists to determine the presence of well-defined histopathologic features that correlate with a higher risk of disease progression. Data on insurance status, ethnicity, and race were collected for each patient. For variables not collected, including English proficiency, income, and educational attainment, analyses were conducted indirectly by matching patient zip code with census data for each variable. Results: On univariate analysis, a higher rate of high-risk pathologic findings was found in patients of Hispanic ethnicity (p=0.021) and non-white race (p=0.037), and in those with Medicaid or no insurance (p=0.035). On multivariate analysis, although no one variable correlated with high-risk features independently from the others, Hispanic ethnicity had the greatest impact on risk. Zip code-based analysis did not show significant differences in rates of high-risk findings based on English proficiency, income, or education. Conclusions: Hispanic ethnicity, non-white race, and Medicaid or no insurance all correlated with high-risk pathologic features in a large group of retinoblastoma patients who had central pathology review, and we believe these findings are due to delays in diagnosis for these groups. Future work should use direct methods to study the impact of other variables, including English proficiency, since indirect, zip code-based analysis may be inadequately powered to do so. Further effort should also focus on where in the diagnostic process delays exist, so that interventions can be designed to overcome barriers to care for these groups.
Disparities between high-impact clinical trials in oncology and disease burden.
Authors: Pfanzelter Nicklas , Jeurkar Neha , Finkelman Brian S. , Mamtani Ronac 
Published: March 2020

e17591 Background: Recent research has identified a discrepancy between NIH funding in oncology and various measures of disease burden by tumor type. We sought to identify whether this disparity exists in recent high impact publications. Methods: 833 clinical trials published in five high impact general medicine and clinical oncology journals between January, 2009 and October, 2012 were reviewed. 692 trials were included in this analysis after excluding those that studied >1 tumor type. Disease burden was measured as person-years of life lost (YLLs), reported in the Surveillance, Epidemiology, and End Results database, and disability adjusted life years (DALYs), reported by the World Health Organization. We used a chi square goodness of fit test to compare the overall distribution of trials by tumor type to the distribution of annual YLLs and DALYs. Results: Breast cancer was the most published tumor, accounting for 14% of all trials, followed by lung (13%) and colorectal (7%) cancers. More than half of the trials (56%) were for patients with metastatic disease, and most (81%) were phase 2 and 3 clinical trials. Nearly half of all publications studied targeted therapies (45%), and the majority received industry support (61%). 67% of trials with a comparator arm met their primary endpoint. The distribution of trials by cancer site differed significantly from the distribution of both measures of disease burden (YLLs and DALYs) (both p<0.001). The findings were unchanged in analyses that accounted for the total number of subjects enrolled in the trials (both p<0.001). The most underrepresented malignancies based on burden of disease were lung and pancreatic cancers, while the most overrepresented were breast cancer, leukemia, and melanoma. Conclusions: The number of trials published by tumor type does not directly reflect the burden of these diseases in the population as assessed by YLL or DALY. Future studies examining potential confounders such as funding availability by cancer type or number of unpublished clinical trials may further clarify the observed disparities.
Managing health care in a universal bed model system to improve patient outcomes and cost savings after lobectomy procedures.
Authors: Sales V L , Nam Brian T. , Abi Jaoude Wassim , Key Jamie M , Horton Wendy M , Weigel Tracey L. 
Published: March 2020

e17595 Background: We measured our outcomes before and after thoracic universal bed (UB) model implementation for patients undergoing lobectomy for primary lung cancer. Methods: 630 patients with primary lung cancer underwent lobectomy: 198 open thoracotomy (OL) patients before (1/2001-12/2005) and 432 patients (1/2006-12/2011) either via OL (n= 258) or via video-assisted thoracoscopy (VATS) (n=174) after transitioning to the thoracic UB model. Results: Discharge mortality was zero post-UB implementation (vs. 2% pre-UB; p<0.05). 30-day mortality was equivalent (pre-UB 4% vs. UB: OL1%, VATS 0%; p=0.2). Postoperative complications were lower in the UB model (Pre-UB 41% vs. UB: OL 26%, VATS 20%; p <0.001), and similar for OL vs. VATS post-UB (p=0.2). Median length of ICU stay was 0 days (pre-UB IQR 29 vs. UB: OL IQR 14, VATS IQR 3; p <0.001; UB: OL vs. VATS; p=0.2). Median length of stay (LOS) was decreased in the UB model and in VATS post-UB (pre UB 5 days vs. UB: OL 3, VATS 2 days; p < 0.001; UB OL vs. VATS, p < 0.001, respectively) with no difference in readmissions (8% vs. 7%, 8%; p=0.9; UB: OL vs. VATS, p=1.0 respectively). Mean total hospital costs fell 37% from $ 24,423 per patient to $ 15,434 post- UB (p<0.05), and similar for OL vs. VATS in the UB model (OL $ 15, 711 vs. VATS $15,022; p=0.2). Home-discharge was more common in UB patients (pre-UB 91% vs. UB: OL 98%, VATS 94%; p <0.05), and similar for OL vs. VATS post-UB (p=0.1). Postoperative chemotherapy and or radiotherapy treatment were similar (pre-UB 31% vs. UB: OL 37%, VATS 22%; p=0.9). Survival rates were similar at 1, 3, 5 years (pre-UB 89%, 72%, 62% vs. UB: OL 89%,69%, 63%, VATS 92%, 81% and 69%, p=0.6). Complications, LOS and chest tube duration were independent predictors of higher cost in the multivariable analysis in favor of the UB model. Non-home discharge and absence of initial postoperative follow-up within or ≥ 4 months were independent predictors of perioperative mortality and poor survival, respectively, in favor of the UB model. Conclusions: The thoracic UB care model is patient-centered, outcomes-driven, value-based approach focused on safety of patients and efficiency of postoperative care.
Utility of the baseline cardiac imaging in the treatment decision for young patients with acute leukemia.
Authors: El Sayed Ali , Dillon Patrick Michael , Densmore John , Patrie James , Sanoff Hanna Kelly 
Published: March 2020

e18005 Background: Anthracyclines, the backbone of acute leukemia induction regimens, are associated with risk of cardiotoxicity. Routine cardiac imaging is routinely performed before induction treatment with anthracycline based regimens (ABR).There is no standard guideline on the optimal method of LVEF assessment, nor consensus for the treatment implication of a borderline LVEF finding. The NCCN recommends cardiac imaging for patients with prior heart disease, prior anthracycline use, or clinical symptoms of cardiac dysfunction. We examine the role of routine pre-induction cardiac imaging in young adults diagnosed with acute leukemia. Methods: A database search at the University of Virginia identified patients newly diagnosed with ALL and AML (including APML), between the ages of 18 and 49 from 2000 to 2011. Baseline demographics, pre-treatment cardiac imaging, and the induction chemotherapy regimen chosen were abstracted. Results: A total of 71 patients with ALL or AML were identified. Thirty-three patients (46.5%) were female, and the average age was 36.1 (SD=9.9 years, range 18 to 49 ). Median baseline LVEF was 62.5 (range 54-74). Out of 71 patients, 25 had a borderline LVEF between 50% and 60%.The lowest baseline EF was 54%. Among 25 patients with borderline LVEF, all received ABR for induction. Conclusions: In patients under age 50 with newly diagnosed acute leukemias, pre-treatment cardiac imaging did not alter standard induction therapy with ABR. This suggests that induction therapy should not be delayed to await baseline LVEF assessment. A potential cost saving may be achieved in this population. Routine cardiac imaging may be more helpful in older adults or patients with prior cardiac history or anticipated need for consolidation with an ABR (ie APML).
Hepa systems in hematology clinic to ameliorate the increased fungal infection risk owing to environmental changing.
Authors: Gurman Gunhan , Ozen Mehmet , Yilmaz Gulden , Coskun Belgin , Topcuoglu Pervin , Ozturk Bengi , Ozcan Muhit , Arslan Onder , Ilhan Osman , Beksac Meral , Ismail Balik , Akan Hamdi 
Published: March 2020

e18009 Background: Building constructions around Hematology inpatient clinics are always a major concern for Aspergillus infections in immunocompromised patients. The use of HEPA (High Efficiency Particulate Arresting) filters can be helpful in reducing fungal infections. This quasi-experimental study was designed to measure the efficacy of HEPA filters in such a construction period. Methods: In May 2011, Portable HEPA filters have been placed in patient rooms where hematological malignancies were treated, because of the massive construction 10 meters from the clinic. Infection rates and survival 6 months before and after the installment were compared to see the effect of HEPA filters. A total of 413 patients were treated in the department during this 1-year period. Results: There were no statistical differences between antifungal prophylaxis or treatment regimens in groups. After HEPA filter installation the rates of fungal or non-fungal derived infection and pneumonia and length of hospital stay did not deteriorate in AML and ALL patients. Also, infection rates and infection-related mortality did not increase in AML group, moreover these rates decreased in ALL patients in the construction period. These findings were shown in Table. Conclusions: Despite the construction and the summer months, which environmental Aspergillus contamination is more frequently seen, there was no increase in fungal infections during Post-HEPA period. That may reflect a positive effect of HEPA usage even in AML patients. HEPA filters may be used as a protective system in hematology departments, in such a construction period. [Table: see text]
Tumor necrosis factor inhibitors and acute leukemia in two cases.
Authors: Ozen Mehmet , Keskin Onur , Kucuksahin Orhan , Ilgen Ufuk , Topcuoglu Pervin , Turgay Murat , Toruner Murat , Gurman Gunhan 
Published: March 2020

e18010 Background: Inhibitors of tumor necrosis factor alpha (anti-TNF agents) are commonly used in Crohn’s disease and rheumatoid arthritis. Relationship between TNF inhibitors and development of malignancy, e.g., lymphoma and solid tumors, is defined recently. However, a few authors reported leukemia. Crohn’s disease and also azothioprine may also be associated with leukemia. Here, we are presenting two acute myeloid leukemia (AML) cases using azothioprine and anti-TNF inhibitors for Crohn’s disease. Methods: Observational case report. Results: Case 1: A 56-year-old male patient with active Crohn’s disease for 4 years was refractory to first line mesalazine, corticosteroid and azothioprine treatment. So, anti-TNF monoclonal antibody (moAb) (Adalimumab) had been given. After second dose of adalimumab treatment AML (AML-M2 as FAB) developed. Case 2: A 38-year-old male had been diagnosed with ankylosing spondylitis for 7 years and Crohn’s disease for 2 years. He had been treated with salazopyrin and indomethacin. Anti-TNF etanercept (50 mg/wk) was started 30 months ago due to severe active pulmonary disease. After 1 year, he developed active Crohn’s disease. So, the treatment changed to infliximab. Also, mesalazine and azothioprine were added to treatment. On the 18th month of the infliximab t(15;17) positive acute promyelocytic leukemia were developed in the patient. Conclusions: Blocking TNF with anti TNF agents may cause blocking apoptosis and inhibit natural killer activity. So, antitumoral activity of natural killer cells is blocked by these agents. TNF alpha gene mutation has been associated with CLL, lymphoma, myelodysplastic syndrome and secondary AML. Azothioprine may also increase leukemia, lymphoma and solid tumors risk at patient on anti TNF treatment. Following the diagnosis of Crohn’s disease without immunomodulator treatment a case had developed acute leukemia in the literature. In our patients, anti-TNF, azothioprine and inflammatory bowel disease may be cause acute leukemia cumulatively. Physicians should be careful and regularly check the patients using anti-TNF agents in considering of malignancy development. In conclusion, the pathogenesis of leukemia development after TNF blockage should be clarified.
Induction chemotherapy with docetaxel plus carboplatin followed by concomitant chemoradiotherapy (CRT) in locally advanced non-small cell lung cancer (NSCLC).
Authors: Abdel Halim Inas Ibraheim , El-Sadda Wael , El Ashry Mohamed , Elmashad Nehal Mohammed 
Published: March 2020

e18505 Background: Lung cancer remains the leading cause of cancer death in both men and women. One third of patients with NSCLC presents with localized unresectable disease. With the adavance in the diagnostic and therapeutic procedures, the median survival has shown substantial improvement. The aim of the study was to evaluate the efficacy of induction chemotherapy with docetaxel and carboplatin followed by chemo-radiotherapy in locally advanced NSCLC. Methods: A total of 30 patients (25 males and 5 females) aged between 49–60 years (mean age 51 years) with NSCLC stage III A (10 pts) stage III B (20 pts) were enrolled in the study. Patients received docetaxel 75 mg/m2 IV plus carboplatin AUC 5 on day 1 every 21 days for 4 cycles in combination with G-CSF. Patients then received radiotherapy (RT) at a dose 40-45 Gy depending on patients' tolerability combined with a low dose of carboplatin AUC 2 on the 1st day of each week during RT. Patients underwent CT chest and bronchoscopy before treatment and after completion of treatment to assess response and time to progression, patients with PR and SD received further 2 cycles of DC. Results: Of all patients received 4 cycles of IC were enrolled, 3 pts (10%) demonstrated CR, 9 pts (30%) had PR, 15 pts (50%) had SD and 3pts (10%) had PD. Twenty seven pts underwent CRT, 25 of these pts have completed CRT, five pts had CR, 15 pts had PR and 5pts had SD. No grade 4 toxicities were detected. The most common grade 3 toxicities were mucositis (6%), neutropenia (12%) and alopecia 50%. The median time to progression and median survival were 7 months and 9 months, respectively. Conclusions: IC with docetaxel and carboplatin followed by CRT with weekly carboplatin is feasible effective therapeutic strategy with manageable toxicity in patients with locally advanced NSCLC.