bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of the risk for subsequent primary cancer among survivors of adult-onset cancers in the United States.
Authors: Sung Hyuna , Hyun Noorie , Yabroff K Robin , Jemal Ahmedin 
Published: May 2020

12060 Background: The number of cancer survivors who develop new cancers is projected to grow in the US. Few studies, however, have provided a comprehensive overview of the contemporary pattern in the risk of subsequent primary cancer (SPC) among survivors of adult-onset cancers. Herein, we evaluate overall and type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer types and sex. Methods: We assessed the excess risk of SPCs among 1,442,374 persons aged 20-84 years who were diagnosed with first primary cancers from 1992-2010 and survived ≥5 years in the 12 Surveillance, Epidemiology, and End Results registries. We expressed the risks using excess absolute risk (EAR) per 10,000 person-years and standardized incidence ratio (SIR) by first primary cancer types and sex, compared to those expected in the general population. We also estimated percent contributions of each specific type of SPCs to the total EAR for all first primary cancers combined by sex. Results: The overall risk of SPCs was higher than expected for 24 of the 34 first primary types among male survivors and for 28 of the 35 first primary types among female survivors. The greatest SIR and EAR were estimated after laryngeal cancer in both men (SIR = 1.74, 95%CI = 1.67-1.82; EAR = 159.3, 95%CI = 143.6-175.5) and women (SIR = 2.48, 95% CI = 2.26-2.73; EAR = 202.7; 95%CI = 171.8-236). There were 290 type-specific associations with significantly higher risk of SPC, 36% of which being reciprocal, predominantly among smoking-associated, HPV-associated, and hematologic cancers. The SIRs in men ranged from 1.05 (95%CI = 1.00-1.10; EAR = 1.69) for lung/bronchus cancer after colorectal cancer to 73.9 (95%CI = 58.3-92.3; EAR = 23.3) for anal cancer after Kaposi sarcoma; and in women the SIRs ranged from 1.08 (95%CI = 1.02-1.15; EAR = 0.36) for pancreatic cancer after breast cancer to 19.9 (95%CI = 15.0-26.0; EAR = 39.5) for oral cavity/pharyngeal cancer after laryngeal cancer. For all first primary cancers combined, lung/bronchus cancer comprised the greatest proportion of the total EAR of SPCs, 34.6% in men and 29.1% in women, followed by urinary bladder (11.8%) and oral cavity/pharynx (7.5%) in men and by corpus uterus (12.9%) and colorectum (7.6%) in women. Conclusions: Despite the substantial heterogeneity in the risk of SPCs across the first primary types, only a few cancers comprised a considerable proportion of the total excess risk among survivors. Better understanding of contributing factors to these patterns will inform survivorship care plans and care delivery.
Fatigue in long-term survivors with ovarian cancer: Results of Expression VI – Carolin meets HANNA – Holistic analysis of Long-term survival with ovarian cancer—The international NOGGO, ENGOT and GCIG survey.
Authors: Woopen Hannah , Keller Maren , Braicu Elena Ioana , Zocholl Dario , Krabisch Petra , Boxler Tamara , Barretina-Ginesta Maria Pilar , Mendiola Cesar , Lafleur Judith , Reimer Daniel Uwe , Heinzelmann-Schwarz Viola A. , Samartzis Eleftherios Pierre , Vardar Mehmet Ali , Taskiran Cagatay , Vergote Ignace , Van Nieuwenhuysen Els , Sehouli Jalid 
Published: May 2020

12065 Background: Long-term survivors (LTS) with ovarian cancer may be cured from cancer but frequently experience long-term toxicities such as fatigue with a huge impact on quality of life. Aim of this study was to evaluate factors associated with fatigue in LTS. Methods: Within the study “Carolin meets HANNA” ( www.carolinmeetshanna.com ) long-term survivors with ovarian cancer (LTS) were recruited since 11/2016. Long-term survival was defined as an ovarian cancer diagnosis more than eight years ago. Results: Until 12/2019 473 LTS could be recruited. 211 LTS (44.5%) have experienced fatigue. At the time point of recruitment in 23.4% (111 LTS) fatigue was still present. LTS with fatigue were not more frequently under current treatment compared to LTS without fatigue (p = 0.348). LTS with fatigue were not younger at initial diagnosis (50.4 vs. 51.9 years, p = 0.228). 58.6% of LTS with fatigue compared to 41.5% without fatigue have developed recurrent disease (p = 0.002) and LTS had more frequently more than one recurrence (66.1% vs. 51.7%, p = 0.055). Fatigue was associated with worse health status (2.9 vs. 2.2 on a scale from 1-5, p < 0.001). Fatigue was associated with medical complaints in general (82.0% vs. 43.0%, p < 0.001). Symptoms such as nausea and vomiting (p < 0.001), loss of appetite (p < 0.001), constipation (p < 0.001), diarrhea (p < 0.001), weight loss (p = 0.001) and bloating (p < 0.001) were more frequent in LTS with fatigue. This also accounts for cognitive disorders (39.6% vs. 10.5%, p < 0.001), depression (23.4% vs. 7.4%, p < 0.001), polyneuropathy (39.6% vs. 13.2%, p < 0.001) and cardiovascular disease (11.7% vs. 3.6%, p = 0.002). LTS with fatigue regard themselves more frequently as cancer patient (73.9% vs. 40.8%), p < 0.001). Conclusions: Fatigue is still very common in LTS despite the long survival time. Fatigue is associated with worsened health status and other long-term side effects underlining the impact on LTS. There is a high need for survivorship clinics that should ask for and, if necessary, should address still existing side effects such as fatigue.
Effects of GC4419 (avasopasem manganese) on chronic kidney disease in head and neck cancer patients treated with radiation and cisplatin.
Authors: Steinbach Emily J. , Monga Varun , Furqan Muhammad , Laux Douglas Earl , Zepeda-Orozco Diana , Jetton Jennifer G. , Saunders Deborah , Dunlap Neal , Curtis Amarinthia , Fairbanks Robert , Bell Sarah , Anderson Carryn M. , Beardsley Robert Alan , Holmlund Jon , Spitz Douglas , Allen Bryan G. 
Published: May 2020

12071 Background: Nephrotoxicity is a major complication of platinum-based chemotherapy and ranges in incidence from 31-68%. The effects of platinum-based chemotherapeutics on long-term renal outcomes (chronic kidney disease, CKD) profoundly affect morbidity and mortality. Concurrent chemoradiotherapy (CRT) including cisplatin is standard for locally advanced squamous cell head and neck cancer (HNC) but is accompanied by the risk of CKD. In a randomized, multi-center, placebo-controlled Phase 2b trial ( NCT02508389 ) of GC4419 (avasopasem manganese) in HNC patients receiving CRT, avasopasem reduced the duration, incidence, and severity of severe oral mucositis (Anderson et al, JCO 2019). Avasopasem did not appear to alter the safety profile of CRT in that trial, including incidence of adverse events of kidney injury or azotemia. Methods: Pre- and post-treatment markers of kidney function including blood urea nitrogen (BUN), serum creatinine (sCr), and estimated glomerular filtration rate (eGFR) were retrospectively evaluated for a subset of 52 of the trial patients who received 3 cycles x 100 mg/m2 cisplatin plus placebo or 30 or 90 mg of avasopasem intravenously prior to RT, and 7 comparator patients who received the same CRT outside the study. Kidney function was evaluated between 3- and 24-months post-completion of cisplatin-radiation therapy by two-way analysis of variance (ANOVA) as defined by the Kidney Disease Improving Global Outcomes (KDIGO) CKD staging. Results: Baseline patient characteristics were skewed towards a male population but were balanced across all treatment arms with regards to baseline kidney function (comparator + placebo, n = 19; 30 mg GC4419, n = 18; 90 mg GC4419, n = 15). Treatment with 90 mg GC4419 demonstrated normal BUN values (10-20 mg/dL) at 3, 6, and 18 months and normal sCr values (0.6-1.2 mg/dL) between 3 and 24 months as compared to the placebo arm + comparator group, which exhibited statistically elevated BUN and sCr (p < 0.05). Treatment with 90 mg GC4419 also demonstrated significantly higher eGFR between 3 and 24 months post-chemoradiation (p < 0.05) compared to the placebo arm + comparator group. 90 mg GC4419 treatment significantly reduced the incidence of CKD compared to the placebo arm and comparator group, as determined by fold change in sCr values and eGFR measurements < 60 mL/min (stage G3a/b, G4, or G5 CKD). Conclusions: Avasopasem has the potential to reduce the incidence and severity of CKD in patients receiving cisplatin therapy. Clinical trial information: NCT02508389 .
Cutaneous pigmentary changes related to anticancer therapy in African Americans.
Authors: Barrios M.S Dulce M. , Noor Sarah J. , Lacouture Mario E. 
Published: May 2020

12074 Background: Pigmentary disorders are known to disproportionately affect individuals with darker skin, including African Americans (AAs)— a historically underrepresented population in oncology research. However, reports on the prevalence and characterization of anticancer-therapy related cutaneous pigmentary changes in this population are lacking. Methods: A retrospective analysis of AA cancer patients that ever received a hematopoietic stem cell transplantation (HSCT) and/or systemic oncologic therapy within six months prior to diagnosis of cutaneous hypo- or hyperpigmentation at our institution between 4/18/2012 and 8/26/2019 was conducted. Clinical and management characteristics were summarized; severity of pigmentary changes was assessed using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v.5.0). Results: From a total of 1342 AA patients evaluated by oncodermatologists during the study period, 121 (9%) met inclusion criteria. Average age in this cohort was 52, and 102 (84%) were women. Breast (63, 52%), gastrointestinal (14, 12%), and hematologic malignancies (13, 11%) comprised the majority of cancer diagnoses. Most (93, 77%) patients had skin hyperpigmentation (84, 69%) or hypopigmentation (9, 7%) as a primary CTCAE diagnosis; the rest had secondary post-inflammatory hyperpigmentation (28, 23%). A higher proportion (105, 87%) of pigmentary alterations was attributed to single agents [i.e. chemo- (55, 46%), radiation (16, 13%), targeted (12, 10%), endocrine (9, 7%), and supportive oncologic (6, 5%) therapy] versus combination treatment (16, 13%). Five (4%) patients had graft versus host disease associated with allogeneic HSCT, four (80%) of which presented as cutaneous hypopigmentation. Hand foot syndrome (24, 20%), acneiform rash (24, 20%), and radiation dermatitis (16, 13%) were commonly diagnosed dermatologic adverse events (dAEs), generally classified as mild/grade 1 (67, 55%) in severity. For management, skin lightening agents +/- emollients (36, 30%) or emollients alone (25, 21%) were highly recommended. Topical corticosteroids +/- emollients were prescribed just as frequently as reassurance and/or avoidance of sun exposure (22, 18%). Conclusions: Cutaneous pigmentary changes related to cytotoxic chemotherapy, radiation and/or targeted oncologic therapy are common in AA cancer patients. Undertreatment of these dAEs, possibly due to under-recognition in darker skin, warrants further investigation to assess impact on quality of life and help improve management in this population.
Patient-reported distress and healthcare utilization in patients with advanced cancer.
Authors: Hildenbrand Jordan Danielle , Park Heesu , Casarett David , Ellis Alicia , Herring Kris , Kamal Arif , Power Steve , Troy Jesse D , Wolf Steven , Zafar Yousuf , LeBlanc Thomas William 
Published: May 2020

12093 Background: The National Comprehensive Cancer Network (NCCN) defines distress as an unpleasant, multidimensional experience that may interfere with patient behavior, emotions, and ability to cope with illness. Distress screening is a critical aspect of comprehensive cancer treatment, but the relationship between patient-reported distress and healthcare utilization remains unclear. We assessed this relationship in patients with advanced cancers historically associated with high utilization, specifically non-small cell lung cancer (NSCLC) and non-colorectal gastrointestinal (NCRGI) cancer. Methods: We extracted data from the electronic medical record of adult patients with metastatic NSCLC and NCRGI cancers who were receiving active treatment, visited outpatient Duke Cancer Institute clinics between July 2013 and January 2017, and completed at least two self-report NCCN Distress Thermometer (DT) and Problem List (PL) surveys as part of routine clinical care between July 2013 and March 2019. Mixed effects logistic regression was used to estimate the odds of hospitalization or emergency room (ER) visit within either 3 or 6 months after each self-reported DT, with adjustment for age at first distress score, sex, primary tumor site, race (white vs. non-white) and duration of participation (i.e., time from first distress score to 3 months after the last distress score) information from the EMR. Results: A total of 11,027 DT scores were collected from 848 patients, with 508 (60%) having NSCLC, 340 (40%) having NCRGI cancer, and 192 (23%) reporting actionable distress (i.e., DT score ≥4). Actionable distress was associated with higher odds of hospitalization or visiting the ER within 3 months (OR = 1.37; 95% CI = 1.19, 1.58; p < 0.001) and 6 months (OR = 1.19; 95% CI = 1.03, 1.37; p = 0.019) after DT self-report. Patients who had an average DT score of ≥4 were more likely to report the following problems at least once: worry (89% of patients), nervousness (79%), fatigue (95%), pain (92%), sleep problems (79%), and eating problems (79%). Conclusions: Patient-reported distress is associated with greater healthcare utilization in patients with advanced NSCLC and NCRGI cancers who are receiving active treatment. These patients report high burden of physical and emotional problems. Actionable distress may be a useful indicator of patients in need of specialist palliative care interventions.
Scalp cooling to prevent chemotherapy induced alopecia (CIA) in black patients: Differences in efficacy?
Authors: Dilawari Asma Ali , Alintah Princess , Paxman Richard , Chitalia Ami , Gallagher Christopher , Tiwari Shruti Rakesh , Dash Chiranjeev , Adams-Campbell Lucile L. 
Published: May 2020

12101 Background: The Paxman scalp cooling device has been used for over 20 years to prevent CIA, obtaining FDA clearance in the U.S. in 2017. Prior studies reported 50-80% success and high patient satisfaction yet included few or no black patients. In the U.S. this may reflect disparities in access due to cost, awareness, or availability. We opened a prospective observational study combining patient-reported outcomes with clinical assessments of alopecia and planned to deliver scalp cooling to 30 black patients receiving chemotherapy for breast cancer. Methods: Patients who self-identified racially as black, had a new diagnosis of stage I-III breast cancer, and planned to receive chemotherapy with taxane-containing regimens were eligible. Anthracycline (AC) and non-anthracycline (NAC) chemotherapy agents were included; costs for the intervention were covered by Paxman and internal philanthropic funding. Patients who declined scalp cooling were approached for enrollment as controls. Primary endpoints were grade of alopecia as measured by providers and patient self-report using Modified Dean Scale and Visual Analog Scale (VAS) respectively. Hair preservation was defined as <50% hair loss (<grade 2) by Dean and score < 50 on VAS. Secondary endpoints were alopecia by NCI grading scale and psychosocial from CADS and EORTC QLQ BR45 questionnaires. Results: 15 out of 30 planned participants enrolled by February 2020 with interim analysis and hold in accrual due to lack of efficacy. Four patients remain on treatment. Of 11 scalp cooling patients who completed chemotherapy, 0 prevented significant alopecia. Nine discontinued use of scalp cooling before completion (1 due to scheduling, 8 due to >grade 3 alopecia). The 2 patients who used scalp cooling for the duration had >grade 3 alopecia before the last cycle of treatment. Conclusions: Scalp cooling is an important supportive therapy that can reduce chance of alopecia, a bothersome side effect for patients. Our experience indicates decreased efficacy in black patients with both AC and NAC regimens. This is an important negative result to explore. Discussions with the Paxman team and providers with expertise in alopecia are underway to explore contributing factors such as hair thickness, prior hair treatments, and cap design. [Table: see text]
Palliative referrals in advanced cancer patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index.
Authors: Chan Abigail Sy , Rout Amit , Lev Irina , Yu Amy , D'Adamo Chris , Miller Kenneth David 
Published: May 2020

12102 Backgroun1d: Timely identification of palliative care needs have the ability to reduce hospitalizations and improve QOL. The Supportive & Palliative Care Indicators Tool (SPICT) is used to identify patients with advanced stage medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting and has been validated to assess 24-hour mortality risk. We used SPICT and RI in cancer patients admitted to the hospital and evaluated their roles in recognizing early palliative care needs and 6-month mortality. Methods: Advanced/metastatic cancer patients admitted to our institution from Jan 1, 2019 to June 30, 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), comorbidities, palliative/hospice care referrals, vital status, initial RI score, and computed SPICT scores were obtained. Worse clinical indicators were defined as SPICT positive if it met > 2 clinical indicators or RI < 60. Univariate and bivariate analyses were performed. Results: A total of 227 patients were included, mean age 68, 34% Caucasians, 63% Blacks, 59% female, median comorbidities of 3, with majority having lung and GI malignancies. A total of 137 (60%) were SPICT +, 47 (21%) had RI < 60, and 38 (17%) concurrent SPICT + and RI < 60. SPICT + patients were more likely to have longer hospital stay, change in code status, more palliative/hospice referrals, and increased mortality. Those with RI < 60 had similar results (Table). SPICT + patients are more likely to have RI < 60 (p = 0.0013). Conclusions: SPICT and RI are valuable tools in predicting 6-month mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer. [Table: see text]
A survey of cannabis use for symptom palliation in breast cancer patients by age and stage.
Authors: Weiss Marisa C. , Buckley Meghan , Hibbs Julianne , Leitenberger Adam , Jenkins Melissa , McHugh Terri W. , Green Nancye , Larson Sharon 
Published: May 2020

12108 Background: Most US states have legalized medical cannabis for the treatment of serious conditions, including cancer. It is not well known which symptoms breast cancer patients seek to control with cannabis. Methods: Members of the Breastcancer.org and Healthline communities were invited to participate in this survey between 12/16/2019 and 1/19/2020. Eligibility criteria included age ≥18 years, resident of the US and a breast cancer diagnosis within the past 5 years. Eligible respondent data were analyzed for the symptomatic profile of cannabis users. Symptoms were compared between two groups using a Chi-square test of independence. The survey was led by Socanna, conducted by Outcomes Insights, and supported by a grant from Ananda Health/Ecofibre. Results: Among the 832 respondents who completed screening, 725 met the eligibility criteria, and 612 (84%) completed the survey. The median age of respondents was 57 years, and 85% had non-metastatic disease An estimated 42% of respondents have used medical cannabis to treat symptoms or side effects of breast cancer. Medical cannabis users reported using cannabis to treat insomnia (70%), joint and muscle aches, discomfort, stiffness, or pain (59%), anxiety (57%), and stress (51%). The medical cannabis users less than 50-year-old were more likely to use cannabis to treat these symptoms than their over 50-year-old counterparts, however, the differences were not statistically significant. Medical cannabis users under age 50 used cannabis significantly more than over 50 to treat nausea/vomiting (58% vs 40%; p = 0.010) and inflammation (34% vs 20%; p = 0.021). Medical cannabis users with metastatic disease were more likely to use medical cannabis to treat chronic pain 60% vs 41%; p = 0.017) than non-metastatic users. Post-surgery patients were most likely to use cannabis for nerve pain; and those who were beyond treatment, for stress. Patients suffered an average of 5 symptoms. Conclusions: A significant proportion of breast cancer patients reported using cannabis to treat a combination of symptoms from their cancer and its treatment. Although younger patients are somewhat more likely to use this form of palliative management, older patients are suffering from the same symptoms and their use is nearly as high. More research is needed on the personalization of safe and effective symptomatic management with medical cannabis, for people of all ages, stages, and forms of treatment.
The Quebec Cannabis Registry: a pharmacovigilance and effectiveness study on the use of medical cannabis in cancer patients.
Authors: Vigano Antonio , Canac-Marquis Michelle , Gamaoun Rihab , Beaulieu Pierre , Neron Andrée , Moride Yola , Martell Marc O , Desroches Julie , Perez Jordi 
Published: May 2020

12109 Background: The Quebec Cannabis Registry (QCR) was launched in 2015 to allow physicians to prescribe medical cannabis (MC) in the province of Quebec, Canada. This study aimed to investigate the safety and effectiveness of MC in cancer patients using pharmacovigilance data prospectively collected for up to 24 months. Methods: Patients were enrolled in the QCR between May 2015 and October 2018 and followed every 3 months. Study outcomes included adverse events (AE), pain severity and interference (Brief-Pain Inventory), wellbeing (Revised-Edmonton Symptom Assessment Scale) and overall health scale (EQ5D5L) at baseline and at each follow-up (F-UP). Significance of changes over time were assessed using repeated-measures ANOVA. Results: Out of the 2991 patients enrolled in the QCR, 358 (12.8%) were cancer patients (mean age 57.7 (± 14.6); 171 (47.8%) males). The main cancer types were breast (16.2%), lung (11.7%), leukemia (11.5%) and colorectal (11.2%). MC was prescribed primarily for pain (72.1%), anxiety (4.7%), nausea (4.5%), anorexia (3.9%), and insomnia (3.1%). A total of 13 patients (3.6%) reported AE with only three being serious (one unrelated to MC: stroke; and two possibly related: diarrhea, from CBD oil overdose and pneumonia from smoking MC). Mean scores significantly (p < 0.05) improved between baseline and 3 months F-UP for pain severity (4.8 ± 1.5 vs 4.1 ± 1.8), pain interference (4.6 ± 1.8 vs 3.8 ± 1.7), and the overall health scale (60 ± 21 vs 71 ± 18). Well-being scores also significantly improved between baseline and 6 months F-UP (4.4 ± 2.1 vs 3.5 ± 2.8). Conclusions: Population-based data shows that cancer patients can benefit safely and effectively from MC as a complementary treatment, when prescribed and monitored under medical-nursing supervision.