bluuebunny/crossref_metadata_2025_split huggingface dataset:
A phase I study of SHR6390, a cyclin-dependent kinase 4/6 inhibitor in patients with advanced breast cancer (ABC).
Authors: Zhang Pin , Xu Binghe , Gui Lin , Wang Wenna , Xiu Meng , Zhang Xiao , Sun Guilan , Zhu Xiaoyu , Zou Jianjun 
Published: May 2020

1095 Background: SHR6390 is a novel inhibitor of cyclin-dependent kinase 4/6 (CDK 4/6). This study was conducted to evaluate the tolerability, pharmacokinetics, safety, and preliminary antitumor activity of SHR6390 in patients (pts) with advanced breast cancer (ABC). Methods: In this open-label, single-arm phase I study, pts who had failed standard therapy were enrolled to receive oral SHR6390 in 3 + 3 dose-escalation pattern at doses of 25−175 mg. Eligible pts were given a single-dose of SHR6390 in week 1, followed by once daily continuous doses for three weeks, and one week off in 28-day cycle. Based on the tolerability, pharmacokinetics, and activity data revealed from the dose-escalation phase, three dose cohorts were selected to expand to 8−10 pts. The primary endpoints were maximum tolerated dose (MTD) and pharmacokinetics. Results: Between Apr 15, 2016 and Dec 21, 2018, 40 pts were enrolled. All pts were diagnosed of hormone receptor positive and HER2-negative ABC. 45.0% of pts had at least three prior chemotherapies and 55.0% had at least two prior endocrine therapies. SHR6390 100 mg, 125 mg, and 150 mg cohorts were expanded to 10 pts, respectively. No dose limiting toxicity was observed and the MTD was not reached. Adverse events (AEs) of grade ≥3 were observed in 22 (55.0%) of 40 pts, being neutropenia (52.5%), leukopenia (35.0%), thrombocytopenia (5.0%), and hypertension (2.5%). No serious AEs were reported. At the doses of 50−175 mg, median time to peak concentration was 2.5−4.0 h, and mean terminal half-life was 40.3−51.4 h with single-dose SHR6390. Following multiple dosing, steady state SHR6390 was observed on day 8. The steady state areas under the concentration and peak concentration increased slightly greater than the increase rate of dose, with steady state Cmax at day 21 of 41.1, 53.4, 87.0, 115.0, 126.0, and 155.0 ng/mL in 50, 75, 100, 125, 150, and 175 mg cohorts, respectively. The disease control rate was 62.5% (25/40, 95% CI 45.8% to 77.3%). Two pts (5%, one in 125 mg, one in 150 mg cohort) achieved partial response, with responses lasting 169 and 356+ days, respectively. Conclusions: SHR6390 showed acceptable safety profile and dose-dependent plasma exposure in pts with ABC. The recommended phase II dose was 150 mg. Preliminary evidence of clinical activity was observed, warranted further study. Clinical trial information: NCT02684266 .
The incidence and impact of brain metastasis in patients with hereditary BRCA1/2 mutated invasive breast cancer in a prospectively followed cohort.
Authors: Garber Haven , Lehner Michael , Raghavendra Akshara Singareeka , Gutierrez-Barrera Angelica M. , Tripathy Debu , Litton Jennifer Keating , Arun Banu , Ibrahim Nuhad K. 
Published: May 2020

1096 Background: Previous reports suggest the incidence of brain metastasis is higher in patients with hereditary BRCA1 mutations compared to BRCA1 noncarriers among breast cancer patients who develop recurrent disease. PARP inhibitors are now standard therapies for metastatic breast cancer patients with germline BRCA1 or BRCA2 mutations ( gBRCA1/2) based on their efficacy in treating systemic disease. However, as management of systemic disease improves, a concern is that patients with hereditary BRCA mutations may experience higher rates of disease progression in the CNS. We aimed to estimate the incidence of brain metastasis in breast cancer patients with gBRCA1/2 using a prospectively maintained gBRCA database and to assess the impact of brain metastasis on survival. Methods: To determine incidence, we queried a prospectively maintained electronic database that included patients referred to the MDACC genetics department and who underwent gBRCA1/2 testing. We identified patients with stage I-III invasive breast cancer who were treated between 2000-2017 and assessed for disease recurrence and brain metastasis. To expand our cohort for descriptive characteristics (separate from the incidence analysis), we queried the Breast Medical Oncology database for patients with brain metastasis who had undergone BRCA1/2 testing outside the genetics department or at outside institutions. Results: Of 474 patients with Stage I-III breast cancer and gBRCA1, 77 (16.2%) developed distant metastasis (median f/u: 9.1 years). Of these patients, 34/77 (44.2%) developed brain metastasis. In comparison, 42 of 318 (13.2%) of gBRCA2 patients with Stage I-III breast cancer developed distant recurrence (median f/u: 8.4 years), and 7/42 (16.7%) experienced brain metastasis. In gBRCA1 patients with brain metastasis, 45/48 (83.8%) had triple negative disease, and the median time from diagnosis to brain metastasis was 2.45 years. The brain was among the initial sites of disease recurrence in 24/48 (50%) of gBRCA1 patients. For gBRCA1 patients with distantly recurrent disease, median OS from diagnosis was 3.19 years for patients with brain metastasis vs. 5.37 years for patients without brain mets (HR 0.54; 95% CI 0.34 to 0.85; P = 0.0082). Conclusions: Brain metastasis is frequent among breast cancer patients with recurrent disease and hereditary BRCA1 mutations. Development and testing of agents with intracranial activity is critical for improving long-term outcomes in gBRCA1 patients with metastatic breast cancer.
Caring for transgender cancer patients: Shortcomings of medical education.
Authors: Gil Deza Ernesto , Abal Mariana , Gil Deza Lourdes , Garcia Gerardi Carlos , Martin Reinas Gaston , Tognelli Flavio , Gercovich Daniela , Gonzalez Cesar , Jaunarena María del Huerto , Lovisolo Rubén , Navigante Alfredo , Montiel Monica , Nunell Marcelo Andres , Smolje Leonel , Fernandez Mariano G , Kaminski Estefania E , Muino Marcelo , Danussi Inés , Morgenfeld Eduardo L. , Gercovich Felipe G. ,   USAL-HM ECOE 2019
Published: May 2020

11002 Background: Caring for transgender patients requires specific knowledge and skills. Medical schools spend less than 5 hours on average training for treatment of LGBT patients (Obedin-Maliver, JAMA, 306 (9), 971). This paper assesses the knowledge on the topic and skills of postgraduate Oncology students from Universidad del Salvador at the Observational Standard Clinical Examination (OSCE) 2019 (JCO 34 (15), Abstract e18150, 2017). Methods: At one of the stations of OSCE 2019, students had thirty minutes to complete a clinical record of a simulated transman patient with ovarian cancer stage IIIC. Based on the real case of Robert Eads, actors were trained with the documentary on his life “Southern Comfort”. Students were assessed on: A) knowledge of the transman condition, B) use of preferred gender pronoun by the patient, C) discontinuation of testosterone treatment, D) recommendation of genetic study, E) treatment of ovarian cancer according to NCCN guidelines, F) moral discomfort with LGBT patient care. All interviews were filmed or recorded by an observer. All films, recordings and clinical records were reviewed to rate the students' performance. Results: A total of 25 postgraduate Oncology students took the OSCE 2019. Assessment: A) 5/25 (20%) lacked knowledge of the transman condition, B) 3/25 (12%) did not use the patient's preferred gender pronoun, C) 17/25 (68%) discontinued testosterone, D) 23/25 (92%) requested genetic study, E) all students treated ovarian cancer according to NCCN guidelines, F) none expressed moral discomfort with LGBT patient care. Conclusions: 1) It is feasible to assess the knowledge and skills required for treatment of transgender patients in Oncology. 2) We found shortcomings of student's medical training regarding transgender patients: one in five did not understand the patient's condition, three did not use the patient´s preferred gender pronoun during the interview and more than half suspended the necessary hormone therapy for their condition. 3) This emphasizes the need to deepen our medical and communication skills in order to assist the transgender population and should be included in future ASCO-ASH milestones for specialty accreditation.
Effect of video-based patient education on pancreatic cancer knowledge and behavior.
Authors: Turell Wendy , Ackbarali Tariqa , O'Reilly Eileen Mary , Alsante Matthew , Pucci Kathryn , Del Nido Elizabeth A 
Published: May 2020

11005 Background: Treatment outcomes for pancreatic cancer are optimized when patients/caregivers are engaged, informed and supported participants in their care. However, challenges exist regarding care engagement, disease and treatment related education, and the attainment of adequate psychosocial support. To address these needs, we created video-based patient education activities with the National Pancreas Foundation to empower patients/care with information and resources on pancreatic cancer facts, diagnosis, medical management, and strategies to minimize side effects and maximize quality of life. Methods: One 1-hour patient education activity was broadcast live and online, followed by on-demand release, in 2018-2019 at CancerCoachLive.com and via Facebook Video for 12 months. Features included panel discussions, slides, live polling and Q&A, and video vignettes of real patient experiences. Knowledge-focused test questions were administered at 3 time points (pre-activity, immediate post-activity, and 2-mos [follow-up] post). Behavioral and communication-focused questions were also asked at follow-up. Data from these questions, live poll responses, and learner-submitted questions pre-event and during live Q&A were analyzed to determine engagement, lessons learned and continuing patient needs. Results: In total, 6,276 patients took part in the activity. Patient questions prior to and during the activity focused on basic knowledge about pancreas gland function, tumor development, disease escalation, and medical management. In-session polling results revealed that prognosis and life expectancy were the top concerns for participants. Two months post-education evaluation showed: 33% reported improved communication with their healthcare providers (HCPs) regarding pancreatic cancer; 46% reported improved feelings of being more “in-control” of health care decisions; 25% reported improved care behaviors for their health. Reports of improved HCP communication were specific to: side effect management, clinical trials availability, treatment option knowledge, and confidence related to engaging in discussions. Knowledge improvements were observed for 3 of 4 questions related to facts about the pancreas, pancreatic cancer, and treatment.Conclusions: Patient/caregiver education on pancreatic cancer yields gains in knowledge and behavior, improves patient/caregiver engagement, improves treatment decision-making, and maximizes quality of life.
Enhancing cancer literacy among Appalachian Kentucky middle and high school students.
Authors: Hudson Lauren , Prichard Chris , Weiss L. Todd , Vanderford Nathan 
Published: May 2020

11008 Background: Kentucky has the highest rates of overall cancer incidence and mortality in the United States and the Appalachian region of the state experiences the highest burden of the disease. Poor health behaviors, poverty, poor health care access, low education levels, and low health literacy drive the cancer disparities in Kentucky. Inadequate health literacy is associated with lower participation in preventive measures, which can increase one’s risk of developing cancer. Increasing cancer literacy among youth represents an opportunity to potentially decrease cancer disparities across Kentucky. In a recent study, we piloted a cancer education intervention in Kentucky middle and high schools to determine if such an intervention could enhance students’ cancer literacy. Through the study, we documented a significant increase in students’ short-term cancer literacy levels (Hudson L. et al. Journal of Cancer Education, in press). Methods: This quantitative survey research study aims to examine the long-term effects of the cancer education intervention on the cancer literacy of Kentucky middle and high school students. An online pretest cancer literacy survey consisting of 10 items was administered to a new set of 164 participants from six new schools, followed by the delivery of a cancer education presentation. Immediately following the presentation, participants took a posttest with identical items to the pretest. A follow-up identical test is being administered 3 months after the initial intervention to determine participants’ longer-term knowledge retention. Results: Replicating our prior work, significant (p < 0.0001) increases in both average and median percent of correctly marked items (average: pretest = 50% versus posttest = 77%; median: pretest = 50% versus posttest = 80%) and scores on each individual question were observed immediately following the intervention. Additionally, the average rating as to how the intervention influenced students considerations toward encouraging a family member or friend to change their habits following the intervention was 8 (1 = extremely unlikely;10 = extremely likely). Conclusions: This work demonstrates an increase in cancer literacy levels after the educational intervention and indicates that the information motivates participants to share cancer prevention information with others. A follow-up survey will measure participants’ longer term knowledge retention levels. These data may suggest that a school-based educational intervention can change behaviors that can lower cancer incidence and mortality rates.
Gender variation in clinical activity and Medicare payments among medical oncologists and hematologists.
Authors: Konda Manojna , Roy Arya , Parikh Richa , Fugere Tyler , Gullapalli Manoja , Pandey Yadav , Verma Rashmi 
Published: May 2020

11014 Background: While physician sex has been shown to impact salary even after adjusting for productivity, gender-based differences in clinical activity and reimbursement for oncologists and hematologists are not completely understood. We evaluated the differences in Medicare reimbursement for male and female physicians in medical oncology and hematology. Methods: A retrospective analysis using Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File (POSPUF) for the year 2017 was performed to identify charges and total payment information for individual oncologists and hematologists. Mean values were compared using two-sample t-test, and the medians were compared by Wilcoxon rank-sum test. Results: A total of 8553 oncologists and hematologists (2710 women and 5843 men) were included in the POSPUF in 2017. Female physicians submitted a mean of 16,754 fewer charges (95% CI, −19,696 to −13,812; P < .0001), collected a mean of $173,632 less in revenue (95% CI, −201,184 to −146,080; P < .0001), and submitted a mean of 5.65 fewer unique billing codes (95% CI, - 6.69 to - 4.61; P <.0001) compared to their male counterparts. Women represented 219 of the 1069 most highly productive oncologists and hematologists (20.4%) and collected a mean of $281,263 (95% CI, −417,517 to −145,008; P < .0001) less than similarly productive men. Conclusions: This study suggests that female oncologists and hematologists submit fewer Medicare charges and receive lower Medicare payments compared to male providers. Even among similarly productive hematologists and oncologists, women collected less revenue than men. Further research is required to explore causes for this difference. [Table: see text]
Is burn-out-syndrome a problem among oncology workers? Incidence and effective tools to achieve improvement.
Authors: Cunquero Tomas Alberto Jacobo , Ortega Inmaculada , Gomez Ana , Lobo De Mena Miriam , Ramirez Belloch María del Rocío , Gil Raga Mireia , Iranzo Vega , Fernandez Diaz Amaya Belen , Shaheen Ihsan , Meri Abad Marina , Núñez Abad Martin , Franco de la Rosa Milagros , Aparisi Francisco , Safont Aguilera Maria Jose , Godes Maria Jose , Berrocal Alfonso , Caballero Cristina , Blasco Ana , Camps Carlos 
Published: May 2020

11016 Background: Burn-Out Syndrome (BOS) is defined by (1) emotional and physical exhaustion; (2) cynicism and depersonalization; and (3) no personal nor professional fulfillment. It affects up to 78% of oncology-related workers (doctors, nurses and nurse-assistants, among others). This may decrease quality in both patient assistance and institutional processes. However, there is lack of resources for its diagnosis and management. Our objective is to: (1) determine the incidence of BOS in our team; (2) analyze potential causes; and (3) decrease in 20% the percentage of BOS affected workers. Methods: From October 2018 to November 2019, 20 nurses and nurse-assistants participated. Process map and Ishikawa fish-bone diagram were design to analyze BOS potential causes and to design appropriate interventions after Priority/pay-off matrix description. To do so, participants were asked to fulfill a personal detail questionnaire at the beginning, and adapted versions for the GHQ-12 and Maslach Index questionnaires after each intervention. To track the improvement process, a PDSA cycle was fulfilled and re-evaluated overtime. Project developed through the ASCO Quality Training Program and the Fundación ECO support. Results: Population main characteristics: 87% women, 47-year-old median age. 12 nurses, 6 working in the clinic. 90% with more than 5 years of experience in Oncology. At baseline, 75% healthy (GHQ-12), BOS cause risk: exhaustion 70%, depersonalization 45%, fulfillment 55%. Two interventions developed to improve exhaustion BOS risk: (1) ergonomy tips; and (2) self-assessment and self-help tools. 9 subjects lost after 2nd intervention. After interventions, 34% exhaustion risk reduction and 100% healthy workers (GHQ-12). Conclusions: After two interventions, we have achieved an improvement of 34% lowering the risk of suffering BOS among our workers. Health perception improved to 100%. The loss of 9 subjects after the 2nd intervention may be a bias when interpreting the final results. Giving the appropriate tools to medical oncology workers helps reduce BOS risk significantly
The experience of first-year hematology and oncology fellows after implementing a wellness chief fellow at an academic cancer center.
Authors: Rogers Sherise C. , Walker Alison R. , Otterson Gregory Alan , Dettorre Janet 
Published: May 2020

11017 Background: Hematology & Oncology trainees are high risk for burnout. Risk factors include early stage in career, female gender and isolation. From previous assessment, the program discovered that the feeling of isolation was a problem experienced by our trainees. Our first-year fellows are challenged with multiple acclimations and the intense demands of inpatient service. As a result, we developed the leadership position of Wellness Chief Fellow to address the specific needs of this population during academic year 2019. Methods: The Wellness Chief (WC) is a third-year Hematology and Oncology Fellow with good communication skills and knowledge of resources at the academic cancer center. The WC gave a Wellness lecture during first-year orientation to emphasize the prioritization of personal wellbeing throughout fellowship. The WC developed a list of wellness resources within the hospital system and local community and shared these with the fellows. The WC also provided quarterly one-on-one confidential mentoring to first year fellows. These meetings were informal and semi-structured. Topics included adjusting to the academic center and their new fellowship role, moving to a new city, current support system, clinical and research mentorship, life challenges and self-care. Mid-year, the first-year fellows were surveyed regarding their experience. Results: Eight fellows participated in one-on-one mentoring and 5 completed a mid-year evaluation. 4/5 fellows were new to the city. All trainees felt that mentoring helped them adjust to fellowship. 4/5 stated that they found a clinical mentor and 3/5 have a research mentor and started a research project. 4/5 acknowledged that they have a friend in the fellowship program and 5/5 stated that they do have someone to go to if they were experiencing a challenging life event. All fellows reported gaining something valuable after each mentoring session. 3/5 subjectively experienced burnout within 6 months of the fellowship program. One person stated they experienced burnout once per week and 2 reported monthly burnout. Conclusions: A Wellness Chief Fellow can buffer the effects of isolation within the first-year fellowship experience by providing mentoring and resources during a challenging acclimation period.
Optimizing management of glioblastoma: Educational impact on clinicians.
Authors: Worst Michelle Arielle , Carothers Ann , Parikh Kinjal , Brauer Lisa , Lombardi Giuseppe , Cloughesy Timothy Francis 
Published: May 2020

11026 Background: Glioblastoma multiforme (GBM) is a rare, malignant tumor of the central nervous system (CNS) with poor prognosis. Nearly all patients experience recurrence due to GBM’s heterogeneity and there is currently no standard approach to treatment. Despite having few targeted agents with demonstrated efficacy, molecular testing is utilized due to its value in improving diagnostic accuracy and prognostic stratification. Moreover, recent data has shown an increase in promising data with regards to treating GBM using various mechanisms. Because of the clinical conundrum GBM poses and the lack of available treatment options, clinicians are challenged to stay current with new data and how best to integrate new agents into treatment paradigms. The objective of this study was to assess the changes in oncologists’ and pathologists’ knowledge through participation in education regarding optimal GBM treatment. Methods: The educational activity was a 30-minute online, video discussion segmented into 3 parts with synchronized slides and 2 faculty. Educational effect was assessed with a repeated pairs pre-/post-assessment study with a 3-item, multiple choice, knowledge questionnaire and one confidence assessment question. For all questions, each participant served as his/her own control. Pre- and post-assessment scores were compared to determine the relative changes in the proportion of correct responses. A chi-square test assessed statistical significance at the P < 0.05 level. The activity launched 26th June 2019; data were collected until 19th August 2019. Results: Overall significant improvements were seen after education for oncologists (N = 62, P < .001) and pathologists (N = 67, P < .01). The relative improvement was 67% for oncologists and 45% for pathologists (pre-/post-assessment average correct response rates were 30%/50% and 29%/42%, respectively). Following the activity, 55% of oncologists and 51% of pathologists had a measurable improvement in confidence in their ability to differentiate among late-stage investigational agents for GBM based on mechanism of action. Conclusions: Participation in an online, CME intervention consisting of a series of video discussions, totaling 30-minutes, resulted in statistically significant improvements in knowledge and confidence of oncologists and pathologists, that may lead to improvements in clinical care. As new data and agents emerge, new educational activities are necessary to reinforce knowledge, close persistent gaps, and increase oncologists’ and pathologists’ confidence in this clinical setting.