bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteonecrosis of the jaw: Long-term follow-up shows variable rate of healing
Authors: Hu M. I. , Hoff A. O. , Toth B. B. , Altundag K. , Guarneri V. , Cui J. , Hortobagyi G. N. , Gagel R. F. 
Published: March 2020

9061 Background: Osteonecrosis of the jaw (ONJ) is a rare but clinically significant disorder recently reviewed in a large retrospective study (Hoff et al, 42nd ASCO Annual Meeting 2006, Abstract #8528). A subset of the ONJ patients from that study with breast cancer or multiple myeloma (MM) was followed at the University of Texas M.D. Anderson Cancer Center (UTMDACC) dental clinic. This analysis describes the natural history of ONJ in this subset. Methods: Thirteen of 29 ONJ patients treated with intravenous bisphosphonates (IVBP) at UTMDACC and 1 treated elsewhere were evaluated in the dental clinic for > 6 months (MM, n=7; breast cancer, n=7). The maximum length of exposed bone was measured at each visit. Patients received a standard regimen of conservative dental care with debridement when indicated. Results: All 14 patients received zoledronic acid (median cumulative dose 72 mg; range 24–152) and 10 also received pamidronate (median cumulative dose 1,710 mg; range 90–2,700). They were followed for a median duration of 17.1 months (range: 7.1–67.3). The mean length of exposed bone at initial evaluation was 11 mm (SD: 8.4). Each patient demonstrated fluctuating clinical courses. The lesion from baseline to the last visit progressed in 7 patients (median increase of 13 mm), remained stable in 2, regressed in 2 and resolved in 3. Persistent ONJ was seen if IVBP was stopped (n=8), decreased in frequency (n=1) or continued at the same dose/frequency (n=2). Complete resolution occurred in 3 MM patients, where IVBP was discontinued, decreased in frequency or replaced by weekly oral alendronate. Conclusions: Our experience shows that ONJ resolved in 21% but persisted in the majority of patients with a duration of up to 5 years with conservative dental care. Further studies are needed to evaluate the pathogenesis and healing process of ONJ. No significant financial relationships to disclose.
Measures of aggressive care in advanced non-small cell lung cancer (NSCLC) patients
Authors: McCannon J. , Jackson V. A. , Billings J. A. , Pirl W. F. , Greer J. , Lynch T. J. , Temel J. S. 
Published: March 2020

9063 Background: Data suggests that cancer care has become more aggressive over the last decade. Patients with advanced NSCLC have a short life expectancy and achieve only a modest survival benefit from chemotherapy. Investigating the aggressiveness of care during and at the end of life (EOL) is a key first step to better understanding quality of care in this patient population. Methods: This exploratory study uses previously defined measures of aggressive care (Earle, JCO 22(2), 2004) to evaluate a small cohort of patients with advanced NSCLC. We performed a pilot study of integrated palliative care in good performance status (PS) patients with newly diagnosed advanced NSCLC, which has been previously reported. This is a retrospective chart review of patients accrued at Massachusetts General Hospital (MGH) using the electronic medical record and case report forms for data collection. Results: 46 patients were enrolled from 10/03 to 6/05 (median age 65.5, 28 female). 43 (93%) patients had stage IV disease and the remainder had stage IIIB with effusions. 45 (98%) of patients had PS 0–1. 39 (85%) patients died at the time of chart review with a median follow up of 29.3 months. Using Earle's data as a benchmark more patients in this study received and began new chemotherapy at the EOL. Patients were also more likely to present to the emergency room (ER) and be admitted to the hospital. While more patients were admitted to hospice before death, the length of stay (LOS) in hospice was shorter and many patients still died in acute care hospitals. Conclusions: This study supports the finding that current cancer care is aggressive with many patients receiving chemotherapy at the EOL and having a short LOS in hospice. [Table: see text] No significant financial relationships to disclose.
The effect of methadone on the QTc interval in advanced cancer patients
Authors: Reddy S. , Dalal S. , Swafford J. , El Osta B. , Pei B. , Palmer J. , Bruera E. 
Published: March 2020

9064 Background: Methadone (ME) has been used increasingly for pain control and for maintenance in drug addiction programs. Its use is increasing in cancer patients (pts), mainly as part of opioid rotation. Some recent reports suggest that ME may prolong QTc interval and cause torsade de pointes in pts on high dose ME. The purpose of our study was to determine the effect of initiation of ME on QTc interval in pts with cancer pain. Methods: We enrolled 101 pts in this prospective study. These pts had never been on ME before. Pts were followed clinically and electrocardiographically for QTc changes from baseline. EKG was obtained at baseline (QTc0), 2 (QTc2), 4 (QTc4), and 8 (QTc8) weeks. We recorded other contributing factors for QTc prolongation such as medication interactions with ME and electrolyte disturbances. QTc is prolongation is defined as > 430 ms in males and > 450 ms in females. In our study, significant QTc prolongation was defined as = 10% increase from baseline or QTc = 500 msec. Results: 74 pts (73%) had normal QTc (group A) and 27 pts (27%) had prolonged QTc (group B) at baseline. Significant increase in QTc in group A males occured in 1 of 16 (6%) at week 2, 2 of 10 (20%) at week 4, and 0 of 8 (0%) at week 8. Significant increase in QTc in group A females occured in 3 of 32 (10%) at week 2, 1 of 21 (5%) at week 4, and 0 of 12 (0%) at week 8. These pts had multiple contributing factors for QTc prolongation. QTc > reference for males occured in 6 of 16 (37%) at week 2, 4 of 10 (40%) at week 4, and 1 of 8 (12%) at week 8; in females, 1 of 32 (3%) at week 2, 3 of 21 (14%) at week 4, and 1 of 12 (8%) at week 8 ( Table 1 ). 2 of 27 pts (7%) from group B had a significant prolongation at week 2: one of them had an increase from 498 to 509 ms, then to 512 at week 4 and 486 at week 8. Conclusions: Baseline prolonged QTc is a common finding. QTc prolongation = 500 ms is rare in pts receiving ME for cancer pain. No data exists for other opioids. There was one case of temporary increase in QTc > 500 ms. There was no evidence of severe arrhythmias or torsade de pointes clinically or on EKG. ME dose was = 50 mg/day in the majority of these pts. [Table: see text] No significant financial relationships to disclose.
Pre-admission escalation rate of daily opioid consumption (PERDOC), and total morphine equivalent daily dose on the first complete day of admission (D1-MEDD) to a tertiary-level palliative care unit (TPCU): Correlates and predictors in patients with advan
Authors: Lawlor P. G. , Nekolaichuk C. L. , Lowe S. S. , Kelly A. , Fainsinger R. L. , Watanabe S. , Bruera E. D. 
Published: March 2020

9065 Background: Although animal laboratory studies attest to opioid tolerance (OT), it can be difficult in clinical practice to determine whether substantive escalation in opioid dose (average of >5% per day between initial daily dose and maximum daily dose to date) is due to disease progression (DP) or decreased opioid responsiveness, which in turn may be due to OT or other factors. Our study aims were to determine (1) the frequency of PERDOC>5%, (2) the correlates and predictors of PERDOC>5% and D1-MEDD. Methods: We retrospectively examined TPCU patient database records for demographics, physician rating of PERDOC in the Edmonton Staging System (ESS) for cancer pain classification, Edmonton Symptom Assessment System (ESAS) scores, and D1-MEDD. Consecutive 1st admission data on patients surviving >3 days were included in the initial analysis. Using complete data, logistic regression and multiple regression models were created with PERDOC>5% and logn D1-MEDD, respectively, as dependent variables. Results: From 1,351 patients who met the initial descriptive analysis eligibility criteria, 1212 (90%) had an ESS rating for PERDOC. The prevalence of PERDOC>5% was 274/1212 (19.3%). Bivariate analysis (N=969, complete data) showed that PERDOC>5% was positively associated (p<0.05) with younger age, neuropathic pain component (NPC), a pathological level of psychological distress (PLPD), substance abuse, higher D1-MEDD, and higher ESAS pain score (ESAS-P). In the multivariate analysis, NPC (Odds ratio: 2.1, 95% confidence interval: 1.5–2.9), PLPD (1.7, 1.2–2.6), and higher D1-MEDD (2.2, 1.03–4.7) were the strongest independent positive predictors, and ESAS-P (1.01, 1.003–1.02) remained as a weaker predictor. In the D1-MEDD regression model, positive predictors (p<0.05) were younger age, NPC, incident pain, PERDOC>5%, PLPD, ESAS-P and ESAS anxiety scores. Conclusions: Aside from OT and DP, the multiple predictors identified for PERDOC>5% and D1-MEDD underscore the need for a systematic multidimensional assessment of cancer pain that incorporates psychological and physical characteristics. No significant financial relationships to disclose.
End-of-life decisions by adults with cancer: Role of religious practices and spiritual beliefs
Authors: Navari R. M. , Buckingham L. M. 
Published: March 2020

9067 Background: Religious practices and spiritual beliefs may affect end of life care decisions. Methods: Adult patients with advanced common cancers (Stages III, IV; lung, breast, prostate, colon) who were within one year of their diagnosis and were receiving active treatment in two community oncology practices, were interviewed (30 questions, 20–30 minutes) during an outpatient office visit to determine the major influences on end of life decisions. Specific attention was given to advance directives, influences on end of life decisions, discussions with family and physicians, and the role of religious practices and spiritual beliefs. 353 consecutive patients were invited to be interviewed and 339 patients (median age 66.2 yrs, 52.7% female, 57% married, 58% Caucasian, 30% African-American, 62% Christian, 61% high school education) completed the interview and were evaluable. Results: Fifty-one percent of the patients had an advance directive. The major influences on end of life decisions were family discussions (63%), quality of life (56%), personal experiences (50%), religious/spiritual beliefs (48%), financial burdens (41%), physician discussions (39%), and specific individuals (10%). Factors associated with having an advance directive were religious or spiritual affiliation, participating in regular religious or spiritual practices, and having discussed end of life decisions with their family or a physician. Patients had little knowledge of their religion's specific recommendations on end of life care and had few discussions with a religious professional on these issues. Conclusions: Health care providers need to recognize the influences on end of life decisions, as well as the role of patients’ religious practices and spiritual beliefs. No significant financial relationships to disclose.
African-American and caucasian female cancer patients’ cancer and treatment information needs and preferred information sources
Authors: Matsuyama R. K. , Grange C. , Lyckholm L. J. , Smith T. J. 
Published: March 2020

9073 Background: Patients need information to maximize access to appropriate care, make informed decisions about treatment and communicate with their physicians and other healthcare providers. This study examined information needs related to cancer care and preferred information sources across ethnicities. Methods: A cross-sectional telephone survey was conducted with a random sample of 107 African-American and Caucasian female cancer patients from a university-affiliated cancer clinic. Descriptive analyses characterize patient demographics and information preferences. Multiple logistic regression tested variations in preferences by ethnicity. Results: There were significant differences in what African-American and Caucasian cancer patients considered their primary sources of information about their cancer and treatment. More African-Americans (36%) than Caucasians (9%) said they go to healthcare providers other than their physicians (e.g., nurses, nursing assistants, p=0.002) and use the library (14% vs. 7%) for information about their disease and treatment (p=0.002). Caucasian patients more often said they go to physicians (61% vs. 40%, p<0.01) or the internet (23% vs. 10%, p=0.04) for their information. More African-Americans (84%) than Caucasians (59%) rated information about counseling for emotional support as extremely important (p<0.01) and rated information about issues such as transportation and legal advice as extremely important (75% vs. 55%, p=0.05). There were no differences between ethnicities in desire for information about disease, treatment, side effects, and chances of getting better. Conclusions: All patients desired accurate and comprehensive information about their disease, prognosis and treatment. Significant differences were found between African-Americans and Caucasians in type and means of information. African-American patients were more likely to obtain information from providers other than physicians, and Caucasians were more likely to use the internet. These findings have implications for training professionals and developing programs to provide information to patients about their cancer treatment. No significant financial relationships to disclose.
Poverty is not the main obstacle for quality cancer care in diagnosed cases: Experience of 520 cases from Bangladesh
Authors: Hoque E. , Hossain M. , Karim S. , Begum R. , Rahman M. 
Published: March 2020

9077 Background: Cancer management is expensive everywhere. In the developing countries poverty is always blamed for as to be the main obstacle for quality cancer care. According to WHO report (globocan) 1.295 to 1.36 million people in Bangladesh suffer from cancer. Our health care service is not extensive to diagnose all these cases. A number of diagnosed cases do not get standard specific treatment of cancer. The objective of the study is to find out the main possible reason behind it. Methods: We made a prospective analysis of pre-diagnosis and post-diagnosis expenses using hospital documents & taken interview with specific questionnaire form of 520 cases regardless of age, indication and management who are treated from January 2002 to December 2005 in NICRH, City General Hospital & Bangladesh Medical College Hospital. We calculated the total expenses incurred to each case before specific diagnosis (EBD). These include all investigations, and non-specific treatment costs from the onset of symptoms up to the specific diagnosis. We have estimated the total expenses after diagnosis (EAD). This includes planned specific cancer management according to diagnosis. We made a ratio in percent between them (EBD/EAD×100). Results: 219 cases (42%) spent = 100% of EAD before diagnosis. 94 cases (18%) spent = 200% of EAD before diagnosis. The more this ratio, less the quality of management they could afford. Among them 349 cases (67%) failed to complete planned management, 57 cases (11%) failed to receive any planned management. Only 114 cases (22%) completed their planned management. Queries revealed that 78% patients who failed to complete planned management is due to their financial exhaustion for high pre-diagnostic expenses. Conclusions: We conclude that poverty is not the main obstacle for quality cancer care in diagnosed cases of Bangladesh. High unnecessary pre-diagnostic expenses, which result in financial exhaustion, is one of the major obstacles for quality cancer care. Further study is required to determine how to reduce the redundant pre-diagnostic expenses & find out other removable factors for quality cancer care in developing countries like Bangladesh. No significant financial relationships to disclose.
Preliminary effects of bright light on sleep in women with breast cancer
Authors: Ancoli-Israel S. , Rissling M. , Trofimenko V. , Parker B. A. 
Published: March 2020

9094 Background: Studies have shown that women with breast cancer undergoing chemotherapy report disturbed sleep. Studies have also suggested that these women have very little bright light exposure, yet it is known that bright light may improve sleep. We present preliminary data from an on-going study that addresses whether bright light improves sleep in women with breast cancer undergoing chemotherapy. Methods: 11 women (mean age=50.3 yrs, SD=8.4, range: 35–70 yrs) diagnosed with stage I-III breast cancer, scheduled to receive at least 4 cycles of adjuvant anthracycline-based chemotherapy participated. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and objective measures of sleep were assessed with 72-hours of actigraphy (Ambulatory Monitoring, Inc. and Respironics) at baseline (pre-chemotherapy) and during the last week of cycle 4 (C4). Participants were randomized into two treatment groups: bright white light (BWL; n=7) and dim red light (DRL; n=4). Both groups were instructed to self-administer light therapy for 30 minutes every morning throughout 4 cycles of chemotherapy. Results: In the BWL group, total sleep time (TST) increased by 41 min (SD=69), while wake time stayed approximately the same. In the DRL group TST decreased by 32 minutes (SD=30), while wake time increased by 27 minutes (SD=39). Subjectively, PSQI sleep latency subscale for BWL was reduced from 2.6 (SD=3.0, range=0–5) at baseline to 1.9 (SD=2.3, range=0–6) at C4, while for DRL, mean sleep latency increased from 2.7 (SD=2.5, range=0–5) at baseline to 3.0 (SD=3.0, range=0–6) at C4. PSQI total score for BWL decreased from 12.0 (SD=4.7, range=7–19) at baseline to 10.9 (SD=4.2, range=5–16) at C4 while for DRL it decreased from 8.3 (SD=3.1, range=5–11) at baseline to 7.7 (SD=5.1, range=2–12) at C4. Conclusions: Preliminary results suggest that bright white light may increase the number of hours of sleep in women undergoing chemotherapy, as well as decreasing sleep latency and improving sleep quality. As additional data are collected, we will be able to establish the significance of these effects. Supported by: CBCRP 11IB-0034, NCI CA112035, Litebook Company and the research service of the VASDHS. No significant financial relationships to disclose.
Procollagen-I-propeptide and β-crosslaps are prognostic markers for pretherapeutic estimation of treatment success of combined radio- and bisphosphonate therapy in patients with bone metastases—A phase-II study
Authors: Wagner W. , Radmard A. , Bach M. , Loitsch C. , Krukemeyer M. G. , Wiedemann G. J. 
Published: March 2020

9096 Background: Multiple painful bone metastases are a common problem in patients suffering from breast and prostate cancer. Side effects of morphines can impair quality of life. Pain reduction can also be achieved by radiotherapy combined with bisphosphonates; however, this treatment is not successful in all patients. Methods: 35 patients with breast and prostate cancer suffering from painful bone metastases (multiple metastases in 29 cases, solitary metastasis in 6 cases: were locally irradiated (30 - 40 Gy over 3 - 4 weeks, conventional dose fractionation). In addition they received a bisphosphonate therapy (zoledronate). Before and after radiotherapy procollagen-I- propeptide and β-crosslaps were measured as parameters for the intensity of bone metabolism. Results: 24 patients experienced complete pain relief, 10 patients partial pain relief and one patient noticed no effect of treatment. The values of procollagen-I-propeptide (normal range 19–102 μg/l) and β-crosslaps (normal range <= 1,0 μg/l) were correlated with treatment success. At pretherapeutical procollagen-I- propeptide levels above 190 μg/l, all patients became entirely free of pain. All patients with β-crosslaps values above 0.5 μg/l became equally free of pain, irrespective of the number of metastases and tumour entity. The mean levels of procollagen-I-propeptide as well as β-crosslaps correlate directly and without exception with analgesia, reduction of pain or persistency of pain as final results. No correlation concerning the values was found before and after therapy. Conclusion: Procollagen-I-propeptide as well as β-crosslaps measurements before the beginning of a radio- and bisphosphonate therapy due to painful bone metastases are an excellent prognostic parameter to predict the success of therapy. Where high initial values (procollagen-I-propeptide > 190 μg/l or β-crosslaps > 0.5 μg/l) were measured, complete analgesia was achieved through therapy. Despite this clinically clear statement, a statistical significance with a t-Test was not evaluable at the current collection of patient data. Therefore, 20 more patients were examined; the results are yet to come. No significant financial relationships to disclose.
Percutaneous radiofrequency ablation of painful osseous metastases: A multicenter trial: American College of Radiology Imaging Network 6661
Authors: Dupuy D. E. , Liu D. , Hartfeil D. , Hanna L. , Blume J. , Ahrar K. , Lopez R. , Safran H. , DiPetrillo T. , Mayo-Smith W. 
Published: March 2020

9101 Background: Radiofrequency Ablation (RFA) can destroy tissue in a defined area. Single institutions have reported that RFA can reduce pain from bone metastases. To confirm this, the American College of Radiology Imaging Network (ACRIN) completed a multicenter study of RFA for bone metastases. Methods: Eligible patients had bone pain in one dominant site: tumor size < 8 cm, and location > 1 cm from the spinal cord or cauda equina. RFA was performed under CT guidance. The Memorial Pain Assessment Card was used prior to RFA and repeated daily for two weeks, and at 1 and 3 months after RFA. AEs were recorded in addition to four different pain assessment measures: pain relief, patient mood, pain intensity, and pain severity. Results: Fifty-six patients had RFA at 9 centers. Metastatic sites were pelvis (24), chest wall (19), thoracolumbar spine (8), and extremities (5). Six out of 56 patients experienced at least one adverse event of grade 3 or higher, yielding an AE rate of 10.7% (95%CI is 2.6% to18.8%). AEs attributed directly to RFA were nerve injury in 2 patients. Of the 56 participants, 43 completed the 1 month follow-up and 33 completed the 3 month follow-up. At the time of this analysis, assuming that missing data were missing at random and after adjusting for all covariates, RFA showed significant effect in reducing pain at 1 and 3 month follow-up for all 4 pain assessment measures. The average increase in pain relief from pre-RFA to 1 month follow-up is 26.4 (P<0.0001) and the increase from pre-RFA to 3 month follow-up is 17.2 (P=0.003). The average increase in mood from pre-RFA to 1 month follow-up is 21.5 (P<0.0001) and the increase from pre-RFA to 3 month follow-up is 16.3 (P=0.001). The average decrease in pain intensity from pre-RFA to 1 month follow-up is 25.9 (P<0.0001) and the decrease from pre-RFA to 3 month follow-up is 13.0 (P=0.02). The odds of being in lower pain severity at 1 month follow-up is 12.6 (P<.0001) times higher than that at pre-RFA, and the odds at 3 month follow-up is 7.1 (P<0.0001) times higher than that at pre- RFA. Conclusions: This cooperative group trial confirms that RFA can safely palliate pain due to bone metastases. ACRIN receives funding from the National Cancer Institute through the grants U01 CA079778 and U01 CA080098. No significant financial relationships to disclose.