bluuebunny/crossref_metadata_2025_split huggingface dataset:
Objective assessment of sentinel node tumor burden and its impact on sentinel node localisation in breast cancer
Authors: Goyal A. , Douglas-Jones A. , Newcombe R. G. , Mansel R. E. 
Published: March 2020

605 Background: Extensive tumor infiltration of the draining lymph nodes may prevent the migration of tracer to the sentinel node(SN), adversely affecting SN identification. Methods: A total of 202 breast cancer patients underwent SN biopsy using 99mTc albumin colloid and Patent Blue V injected peritumorally. This was followed by standard axillary clearance in all patients at the same operation. Tumor burden in the SN was assessed by measuring the size of metastasis, percentage replacement(PR) of the SN by tumor and by documenting extranodal invasion(EI). Digital images of the marked slides were acquired and measurements were made using Image Pro Plus software. Results: The overall SN identification rate was 94.6% (191/202), of which 5 were false negatives. Only 18% (2/11) of patients with failed SNB had evidence of nodal metastases on completion axillary clearance. A total of 83 positive SNs were removed from 64 patients. Radioisotope count in the SNs decreased with increasing PR of the SNs by tumor (p=0.005). 30% (24) of the nodes removed were not hot (counts<10 times the background count). The mean PR by tumor of these nodes was 55% (SD 36) as compared to 33% (SD 33) for hot nodes (p=0.009). 20% (16/81) of the positive SNs showed EI. 69% (11) of nodes with EI were not hot (radioisotope count ratio <10) and would not be localised if the radioisotope was used alone. SNs with EI had a lower radioisotope count compared to SNs without EI (p<0.0001). The mean PR by tumor of nodes with EI was 70% (SD 26) compared to 32% (SD 33) of nodes without EI. This shows that extranodal growth of the tumor would occur once the node is >50% replaced with tumor. There was no correlation between radioisotope uptake and size of metastasis in the SN. There was no correlation between blue dye uptake and tumor burden in the positive SN. Conclusion: In an individual SN, the PR by tumor and EI are markers of lymphatic obstruction and significantly associated with reduced radioisotope uptake. These results suggest that >50% replacement of the node by tumor will compromise the lymphatic flow and may lead to failed localisation of the node if the radioisotope is used alone. However, the SN tumor burden does not affect blue dye uptake. This result provides an argument for using a combination of blue dye and radioisotope for SN biopsy. No significant financial relationships to disclose.
Adjuvant axillary radiotherapy for breast cancer: Is CT planning with nodal contouring better than traditional planning?
Authors: Chung C. , Keyes M. , Kwa W. , Weir L. , Parsons C. 
Published: March 2020

606 Background: Historically, adjuvant radiotherapy planning for breast cancer has been based on clinical mark-up then subsequently bony landmarks. The objective of this study is to investigate whether individualized CT-based nodal contour guided planning of axillary fields in breast cancer improves nodal coverage and minimizes dose to normal tissues. There have been no previous studies addressing this issue. Methods: Thirty 4-field radiotherapy plans were selected as ‘traditional’ plans: 15 without nodal contours (traditional field placement) and 15 with radiation oncologists’ nodal contours. The following structures were contoured on each patient CT, regardless of previously contoured structures: level I, level II/III, supraclavicular(SCV)/infraclavicular(ICV) lymph nodes, ipsilateral brachial plexus and lung. Dose volume histograms (DVHs) of the listed contoured structures were obtained for the 30 original plans. All 30 patients were then re-planned with the same anterior dose prescription as the original plan (4000cGy/16 fractions (#) or 4500cGy/25#) but adjusted depth of midplane dose prescription based on nodal depth; MLC blocking was adjusted to the ‘study’ nodal contours. DVHs of the contoured structures for the new nodal-based plans were compared with the DVHs of the original plans, using two-tailed paired t-tests. Results: Volume receiving 90% dose (V90) was significantly improved for SCV nodes: original plan 84.67% vs nodal plan 95.76%(p=0.0005). V90 were similar for level I and level II/III nodes, but hot spots in these nodal groups were significantly hotter in the original vs nodal plan: mean hot spot for level I 120.8% vs 116.3%(p=0.0008), mean hot spot for level II/III 118.1% vs 113.2% (p=0.000003). Dose to 90% of the brachial plexus (D90) was significantly higher in the original vs nodal plan: 79.92% vs 40.92%(p=0.0028). V20 lung were not significantly different. Mean total body dose was significantly higher in the original vs nodal plan 831.8cGy vs 677.7cGy (p=0.0015). Conclusions: CT-based nodal contour guided planning significantly improves coverage of the nodes, particularly supraclavicular nodes, while markedly reducing the dose to critical normal structures, such as brachial plexus. No significant financial relationships to disclose.
Cancer clinical trials (CCT) awareness and attitudes in cancer survivors (Ca surv)
Authors: Comis R. L. , Colaizzi D. , Miller J. D. 
Published: March 2020

6061 Background: A web-based survey of attitudes and awareness of Ca surv towards CCT was performed from 3–4, 2005. The survey instrument was developed jointly by the Coalition of Cancer Cooperative Groups (CCCG) and Northwestern Univ (NU) and executed by NU and Knowledge Networks (KN). Methods: Ca surv were obtained from a panel of 40,000 adults through KN, based on a US households national probability sample who agree to weekly surveys in exchange for a free WebTV box and ISP service. 2,029 panel members reported a cancer diagnosis. 1,788/2,029 (88%) agreed to participate. Results: Ten-percent of Ca surv were aware that CCT participation was an option. In 73%, a physician was the source of the CCT awareness. Awareness was related to time since diagnosis (< 9 yrs vs > 9yrs); gender (females > males); age (younger > older), and education (baccalaureate vs less). Awareness varied according to cancer type: leukemia, 26%; breast, 15%; lymphoma and lung, 14%; prostate, 12%; melanoma and renal cell, 10%; colorectal and bladder; 6–3%. Awareness was dependent (p < .01) on type of treatment: surgery 5% (n, 880); surgery and RT, 7% (n, 181); RT, 10% (n, 107); chemotherapy, 18% (n, 488). Of the last group, 44% enrolled into CCT; 33% declined and 11% were either ineligible or not offered a CCT. Those who declined were concerned that the new approach might be “less effective” (40%) and about “randomization” (18%). CCT Ca surv reported a high level of satisfaction on a 0 (worst) to 10 (best) scale: “treated with dignity and respect”, 9.6; “overall very positive experience”, 9.3; “recommend to a family member or friend”, 8.8. Conversely, the response to “I felt like a guinea pig” was 1.7. Conclusions: In summary, assessing issues such as awareness, participation and accrual onto CCT must adjust for key demographic, disease and treatment related factors. The CCT experience is valued and appreciated by Ca surv as they move the field forward. No significant financial relationships to disclose.
Cost of chemotherapy-related febrile neutropenia
Authors: Weycker D. , Malin J. , Glass A. , Oster G. 
Published: March 2020

6068 Background: Febrile neutropenia (FN) is a serious complication of myelosuppressive chemotherapy that typically necessitates hospitalization. While the costs of FN have been reported to be substantial, previous studies may have underestimated these costs due to failure to account for follow-on care. Methods: A retrospective cohort study was undertaken using a US healthcare claims database. The source population included adult cancer patients who received a course of chemotherapy between 2001 and 2003. For each such patient, each unique cycle of chemotherapy was identified, and patients who developed FN within these cycles were further identified based on hospitalization for neutropenia, fever, and/or infection. Patients with FN in a given cycle (“cases”), starting with the first, were matched–on tumor type, number of cycles, chemotherapy characteristics, and propensity score–to those not experiencing FN in that cycle (“controls”), regardless of occurrence of FN in subsequent cycles; once matched, patients were removed from their respective pools. FN-related healthcare charges–including inpatient, outpatient, and drug treatment for neutropenia, fever, and infection–were tallied for each such pair of patients from the cycle day on which cases developed FN through the last chemotherapy cycle. Healthcare charges were used as a proxy for costs, as the latter were unavailable. Results are reported as means and 95% confidence intervals. Results: The study population consisted of 746 patients; 38% had breast cancer, 21% had lung cancer, and 11% had non-Hodgkin’s lymphoma. Cases and controls were similar in terms of baseline characteristics. FN-related charges totaled $40,928 (95%CI $28,783-$62,586) among cases versus $3,933 ($2,890-$5,119) for controls, a difference of $36,995 ($25,283-$58,776). Non-FN-related charges were similar in the two groups ($32,774 [$28,587-$36,061] vs. $32,253 [$29,248-$36,066]). Care subsequent to initial hospitalization accounted for $9,872 (or 27%) of the higher FN-related charges among cases. Conclusions: Costs of care during chemotherapy are twofold higher among patients who develop FN; follow-on care represents more than one-quarter of the difference. [Table: see text]
Measurement of quality of care for adjuvant chemotherapy of colorectal cancer
Authors: Morse M. , Prosnitz R. , Mantyh C. , Fisher D. , Samsa G. , McCrory D. , Cline K. , Gray R. , Patwardhan M. 
Published: March 2020

6071 Background: Although adjuvant chemotherapy (CT) is a crucial component of the therapy for stage III colon cancer and stage II and III rectal cancer patients, little is known about how best to measure whether quality care is being delivered. We sought to provide policy-makers and stake-holders with an inventory of the available measures and their usefulness. Methods: The MEDLINE and Cochrane databases were searched for all publications which might contain quality measures (QMs) pertaining to the diagnosis and treatment of patients with colorectal cancer (CRC). Our analysis was confined to QMs pertaining to adjuvant CT for CRC, based on US data, and published after 1990. Identified QMs were quantitatively rated based on the concepts of importance/usability, scientific acceptability, and validity or how well they had been tested. Results: 3,429 abstracts were reviewed, of which 843 articles underwent full text evaluation. Ultimately 74 articles met the established inclusion criteria for containing QMs, 32 of which pertained to adjuvant CT. These 32 articles contained 10 QMs, 8 of which had major flaws limiting their applicability. The two most ideal measures are presented in the table . Among the reasons some measures did not rate highly was the failure to utilize standard staging definitions or reliance on administrative inpatient databases, which do not account for chemotherapy administered on an out-patient basis. Conclusions: Very few measures of the quality of adjuvant CT for CRC have been published to date and fewer rate highly with regard to the concepts of importance/usability, scientific acceptability, and validity. Future research should focus on refining existing QMs and on developing new QMs which target important leverage points with respect to the provision of adjuvant therapy for CRC. [Table: see text] [Table: see text]
Implementation of a direct patient callback system improves compliance for additional breast imaging and early breast cancer detection
Authors: Richard-Kowalski D. , Termeulen D. , Reed M. , Reyes R. , Kuliga M. , Sanjurjo D. , Hirsch A. E. 
Published: March 2020

6073 Background: Existing patient recall systems usually involve contacting the referring physician who then notifies the patient to schedule a return visit for further imaging. We set out to determine whether a direct patient callback system would improve patient compliance in returning for additional imaging including magnification, spot compression, and ultrasound, and whether that would translate to an improvement in early breast cancer detection. Methods: Beginning on 4/1/2004, we prospectively identified all patients whose screening mammograms were read as having an incomplete assessment that required additional imaging (ACR BIRADS 0). Those patients were contacted directly via telephone to return for additional views. Results: Between 11/1/2002 and 3/31/3004, 1142 patients with incomplete screening mammography were identified and the referring physicians were contacted. 956 of 1142 (84%) patients returned and underwent additional breast imaging. Between 4/1/2004 and 12/31/2005, 1,336 patients with incomplete screening mammography were contacted directly to return for additional imaging. 1,307 of 1,336 (98%) patients returned and underwent additional breast imaging. (p < 0.0001, Fisher’s exact test). 125 of the 1,307 (8.5%) of the subsequent exams were found to be suspicious and biopsy was recommended (ACR BIRADS 4 or 5). Conclusions: Our new system of contacting patients with incomplete mammography has significantly increased our recall rate. Implementation of this system has enabled us to identify those patients whose mammograms are suspicious and ultimately diagnose breast cancer earlier. Direct patient callback has become standard policy and we are recommending this system for all radiology recall examinations. No significant financial relationships to disclose.
Impact of organization of colorectal cancer screening: Results of EDIFICE study
Authors: Coscas Y. , Serin D. , Cals L. , Eisinger F. , Blay J. , Rixe O. , Pivot X. , Bouillet T. , Roussel C. , Morere J. 
Published: March 2020

6078 Background: The EDIFICE study aimed to allow better understanding of population’s adhesion to the tests available for the 4 most frequent cancers: breast, colorectal, prostate and lung. In 1998 the French National Consensus Conference advocated for mass cancer screening (CS) using Hemoccult II. The departments are divided according to the existence or not of an organized program: this screening was organized in 22 departments (3 “scout” started in 1998, 9 “first wave” in 2003 and 12 “second wave” in 2004). Results are reported hereunder. Methods: This first nationwide observational study was carried out in France from January 18th to February 2nd, 2005 among a representative sample of 1504 subjects aged between 40 and 75 years and a representative sample of 600 general practitioners (GPs). Information about participating subjects included socio-demographic characteristics, attitude towards CS, and about GPs’ medical practice regarding CS. Results: Only 25% of the 970 subjects aged between 50 and 74 years had undergone a colorectal screening test. In the organized departments (OD), the rate of persons who self-report any colorectal cancer screening was 34% vs 20% in unorganized departments (UD) (OR=1.99, CI95% 1.47- 2.69, p<0.001). The rate of recent screening within a range of 2 years was 24% for OD vs 8% for UD (OR=3.35, CI95% 1.91- 5.88, p<0.01). The rate of “fear of the test and/or its results” was higher in OD: 11% versus 6% (OR=1.97, CI95% 1.11–3.49). The rate of GPs who advocated systematically for screening was 40%, 29%, 26% and 13% for scout, first wave, second wave OD and baseline UD respectively. Organization reduced the rate of screening based on colonoscopy alone from 69% persons in UD to 35% in the OD. Conclusions: The main result of this survey comparing data in the same frame of time, in the same country, is that organized programs for colorectal cancer impact of health outcomes. No significant financial relationships to disclose.
The Registry Case Finding Engine (CaFE): An automated approach for cancer patient identification from unstructured, free-text pathology reports
Authors: Hanauer D. A. , Chinnaiyan A. M. , Miela G. , Blayney D. W. 
Published: March 2020

6080 Background: A vital component to maintaining an accurate cancer registry is the identification of patients with cancer. The University of Michigan Cancer Registry identifies more than 90% of all registry patients by manually reading free-text pathology reports and their associated SNOMED codes. This method is labor and time intensive and is subject to errors of omission. Methods: We created an application to scan free-text pathology reports to identify cases of interest to the registry. It uses a custom-made list of approximately 3,300 words, phrases, and SNOMED codes to positively identify relevant cases and to eliminate non-relevant cases, including those which may mention cancer-related terms. Experienced registrars reviewed 2,451 pathology reports and marked cases of interest to the registry; this served as the gold standard. These reports were also analyzed by the Registry CaFE. The time required for case identification was recorded for both processes. Results: Experienced registrars marked 795 (32.4%) cases as being of interest compared to the CaFE which marked 1,009 (41.1%). The sensitivity of the CaFE was 100% whereas the specificity was 87.1%. An analysis of the 214 errors made by the CaFE revelead that 30 cases (14%) were due to incorrect SNOMED codes assigned by our auto-coding system (Cerner Corporation, Kansas City, MO) and 89 (41.6%) were either skin squamous or basal cell carcinomas (most non-melanomatous skin cancers are not tracked in the registry). Registrars required an average of 21 seconds per pathology report whereas the Registry CaFE processed each report in less than a second. Conclusions: The Registry CaFE identified all relevant cases and correctly eliminated most cases that were not important; it is both effective and time-saving. Future efforts directed at improving the CaFE for squamous and basal cell carcinomas would yield the largest improvement in accuracy. No significant financial relationships to disclose.
Estimating costs of care for patients with newly diagnosed metastatic colorectal cancer (mCRC)
Authors: Paramore L. C. , Thomas S. , Knopf K. B. , Cragin L. , Fraeman K. 
Published: March 2020

6082 Background: The cost of treatment for patients with metastatic colorectal cancer (mCRC) has become a significant component of overall cancer care due to its high incidence and the increasing duration of patient survival. This study examines the resource use patterns and costs of care for patients with incident metastatic colorectal cancer (mCRC) based on analyses of retrospective claims data from selected health plans in the United States. Methods: A case-control analysis was performed using claims data from over 70 US health plans representing 40 million lives from years 1998–2004. Incident mCRC cases were identified based on evidence of a colorectal cancer diagnosis and a metastatic disease diagnosis. Incident mCRC cases could have no other evidence of cancer in the one-year period prior to the date of their first mCRC diagnosis. Cases were matched to non-mCRC controls based on age, gender, geographic region and duration of plan enrollment. Costs were evaluated by phase of disease: diagnosis, treatment, or death phases. Ordinary least squares regressions were performed to evaluate impact of covariates in each phase. Results: Total costs in the follow-up period averaged $97,031 higher for mCRC cases (N=) than for controls. The main cost drivers for mCRC were hospitalizations ($37,369) and specialist visits ($34,582) which included chemotherapy administration. Approximately 40% of the 672 mCRC patients who qualified for the phase analysis were identified with a fatal event during follow-up. Monthly costs were similar in the diagnostic phase ($12,394) and death phase ($12,069), but were significantly lower in the treatment phase ($4,653). Both mean/median monthly costs increased over time during the study period, regardless of disease phase. Conclusion: The economic burden of mCRC is substantial for patients in commercial health plans in the U.S., and costs of care have increased substantially in recent years. Further research is needed to assess the cost impact of newer targeted therapies for the treatment of mCRC. No significant financial relationships to disclose.
Do specialized oncology units improve the detection and management of pain?
Authors: Goldberg G. R. , Litke A. , Morrison R. S. 
Published: March 2020

6084 Background: Pain is a common complaint of cancer patients and has a significant impact on quality of life. The objective of this study was to compare pain management for cancer patients admitted to dedicated oncology vs. general medicine/surgery units. Methods: Design: Secondary analysis of data obtained from a controlled clinical trial evaluating a series of interventions to improve pain outcomes conducted from 4/2002–2/2003. Setting: 1,171 bed hospital. Patients: 445 hospitalized adult oncology patients; 239 patients admitted to a specialized oncology unit, 206 patients admitted to general medicine/surgery units. Main outcome measures: Pain assessment and severity, analgesic prescribing. Analysis: T tests and chi square were used to compare patient characteristics. Hierarchical linear modeling (HLM) was used to explore the effect of a specialized oncology unit on pain assessment, severity, and analgesic and laxative prescribing. Results: The two groups did not differ significantly in patient characteristics. Mean age was 59 years, 56% were men, 61% were white, 79% had solid tumors. In multivariate analysis, patients admitted to a specialized oncology unit had significantly less pain (mean pain score for patients on oncology unit was 1.24 vs 1.68 for non-oncology unit; parameter estimate = −0.42; p<0.01). There were no significant differences in the frequency of nursing assessment of pain, opiate prescribing, or laxative prescribing for those patients receiving opioids. Conclusion: In multivariate analysis, admission to a specialized oncology unit was associated with significantly less reported pain. These findings have implications for structuring medical units for patients at high risk for pain. No significant financial relationships to disclose.