bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for hospitalization in elderly cancer patients receiving chemotherapy
Authors: Kleiner J. M. , Culakova E. , Dale D. C. , Crawford J. , Poniewierski M. S. , Wolff D. A. , Lyman H. 
Published: March 2020

9035 Background: Chemotherapy-associated hospitalization is a major source of morbidity and cost in cancer care, particularly for elderly (age ≥ 65) cancer patients. Hospitalization in the elderly often leads to an irreversible decline in functional status unrelated to the acute event that prompted hospital admission. Currently, little is known about the risk factors that may lead to increased risk of hospitalization in elderly patients receiving chemotherapy (CTX). Methods: 871 patients with solid tumors or lymphoma initiating a new CTX regimen were prospectively enrolled at 60 randomly selected US community oncology sites between 8/2004 and 10/2005. Of these, 361 elderly patients aged 65–91 were identified and followed. Primary endpoint of this investigation was hematologic toxicity and hospitalization was secondary. Pre- CTX patient data were analyzed for increased risk of hospitalization in univariate analysis using the chi-square test. Results: A total of 155 (18%) patients were hospitalized resulting in 215 hospitalizations. Median time to first hospitalization was the second cycle of CTX. 81/361 (22%) of elderly patients were hospitalized compared to only 74/510 (15%) of younger patients (p=0.003). The rate of hospitalization increased in a linear fashion between ages 65–80. Reasons for hospitalization in the elderly included infection, fever, or febrile neutropenia (36%), cardiopulmonary disease (CPD) (12%), vomiting or dehydration (13%), other gastrointestinal (11%), transfusion (8%), thrombosis (4%), CTX administration (4%), and other (13%). Major independent pre-CTX factors that predicted hospitalization in the elderly included male gender (p=0.0004), hemoglobin <11 g/dL (p=0.02), abnormal platelet count (<150k or >350k) (p=0.05), CPD (p=0.03), creatinine >1.5 mg/dL (p=0.05), and ≥ 2 concomitant medications (p=0.0008). Elderly patients with lung cancer (p=0.001) and lymphoma (p=0.05) had significantly higher rates of hospitalization when compared to other solid tumors. Conclusions: These data suggest that the risk of hospitalization increases in elderly cancer patients with age and that pre-CTX factors may be useful in identifying a subpopulation at increased risk for hospitalization. No significant financial relationships to disclose.
A validated risk model for early neutropenic events in older cancer patients receiving systemic chemotherapy
Authors: Shayne M. , Culakova E. , Dale D. C. , Poniewierski M. S. , Wolff D. A. , Crawford J. , Lyman H. 
Published: March 2020

9036 Background: A prospective, nationwide study was undertaken to develop and validate a risk model for early neutropenic events (NE) in older cancer patients undergoing chemotherapy. Methods: 1,386 patients =65 years of age with lung, breast, colorectal, ovarian cancer or lymphoma were prospectively registered at 117 randomly selected sites. Data on up to 4 cycles were collected upon initiation of chemotherapy. A logistic regression model for cycle 1 NE consisting of febrile neutropenia (FN; fever/infection and absolute neutrophil count nadir <1x109/L) or severe neutropenia (SN; neutrophils <.5x109/L) was derived on 1,378 patients with available data. Validation was performed using a split sample random selection process. Results: No significant differences in distribution of NE or predictive factors were observed between derivation dataset (n=922) and validation dataset (n=464). Major independent baseline clinical risk factors for cycle 1 NE in the derivation model (DM) included: anthracycline based regimens (p<.001), non-chemotherapy immune-modulatory agents (p=.003), elevated bilirubin (p=.016), reduced glomerular filtration rate (p<.001), cancer type (p=.02), planned relative dose intensity =85% (p=.027), and regimens containing cyclophosphamide (p<.001), etoposide (p=.002) or ifosfamide (p=.032). Reduced risk of cycle 1 NE was associated with myeloid growth factor (MGF) prophylaxis (p<.001). DM R2 was 0.478 and c-statistic 0.88 [95% CI 0.86–0.91; p<.001]. At median predicted risk of cycle 1 NE of 7%, model test performance (MTP) showed: sensitivity 90%; specificity 59%; and predictive value positive and negative of 32% and 97%, respectively. Cycle 1–4 FN risk in the DM was 16.6% and 3.3% among high and low risk patients, respectively. The validation model (VM) R2 was 0.508 and c-statistic 0.89 [95% CI: 0.86–0.93; p<.001]. MTP in the VM demonstrated: sensitivity 90%; specificity 65%; predictive value positive and negative of 36% and 97%, respectively. Cycle 1–4 FN risk in the VM was 16.8% and 1.6% in high and low risk patients, respectively. Conclusions: This validated risk model demonstrated good discrimination between older cancer patients at decreased risk for NE, and those at increased risk who may benefit from targeted prophylaxis with MGF. No significant financial relationships to disclose.
An analysis of elderly patients (pts) treated on a phase III trial of cisplatin (P) plus etoposide (E) with concurrent radiotherapy (CRT) followed by docetaxel (D) vs observation (O) in pts with stage III non small cell lung cancer (NSCLC)
Authors: Sgroi M. M. , Neubauer M. , Ansari R. , Govindan R. , Bruetman D. , Fisher W. , Johnson C. , Breen T. , Yiannoutsos C. , Hanna N. 
Published: March 2020

9037 Background: Concurrent CRT is standard treatment for pts with unresectable stage III NSCLC. HOG LUN01–24 is a phase III trial testing if consolidation D improves survival following EP/XRT. Few data are available on outcomes in elderly pts. We performed a subset analysis to determine the efficacy & tolerability of EP/XRT & consolidation D in elderly pts (≥70 yrs) vs younger (<70) pts. Methods: Patient (n=203), disease characteristics, survival & toxicity were compared for pts age ≥70 (n=52) vs <70 (n=151). Results: Median age for elderly was 73 vs 60 for younger pts. 34% of each group were women. Younger pts had a trend towards PS 0 (61% vs 53% elderly), FEV-1 > 2 L (48% vs 43% elderly), stage IIIB disease (61% vs 53% elderly). Younger pts were more likely to be current smokers (51% vs 15% elderly). 74% of younger pts were randomized vs 67% of elderly. During EP/XRT, elderly pts were more likely to discontinue treatment due to toxicity (12% vs 2%) & require hospitalization (40% vs 28%). Selected G3/4 toxicities during EP/XRT in elderly vs younger pts: neutropenia (42 vs 28%), anemia (9 vs 5%), febrile neutropenia (FN) (6 vs 11%), esophagitis (23 vs 15%), dehydration (15 vs 7%). Elderly pts were less likely to complete 3 cycles of consolidation D (76 vs 84%). Selected G 3/4 toxicities during consolidation D were similar between elderly (n=18) and younger pts (n=55), including FN (11.1 vs 10.9%). There was no difference in MST for older pts vs younger pts (17.2 vs 21.2 mos), p=0.3255. Conclusion: Chemoradiation is associated with higher rates of G 3/4 toxicities in elderly pts, including hospitalization rates. Elderly pts had lower rates of completing D, but similar incidence of D-related toxicity. There was no difference in MST between the age groups. No significant financial relationships to disclose.
Network analyses to define chemotherapy toxicity clusters in patients with colorectal cancer (CRC)
Authors: Aprile G. , Ramoni PhD M. , Keefe D. , Sonis S. 
Published: March 2020

9045 Background: CRC patients undergoing CT are likely to experience multiple concurrent toxicities. Rather than appearing singularly, the hypothesis that certain toxicities occur in clusters may suggest a common pathobiology. We used Markov networks (MN), a probabilistic graphical born at the confluence of statistics and artificial intelligence describing the dependency among set of variables, to identify clusters of CT-induced toxicities, to examine how clusters are connected to each other, and how single toxicities are related to a specific cluster. Methods: Using a standardized data collection tool, we retrospectively reviewed electronic medical charts of 300 consecutive CRC pts receiving FOLFOX, FOLFIRI or 5-FU to record baseline demographic and clinical information. Toxicities were recorded using NCI-CTC criteria during the first cycle of CT. Following the standard Bayesian approach, the MN clustering the CT-induced toxicities was learned from the data as the network with the highest posterior probability given the data. Results: The network, in which associations between toxicities are represented as links, identified five strongly-related symptom clusters: a constitutional cluster involving fatigue, anorexia, and weight loss; a gastrointestinal cluster where dehydration was the connector between diarrhea, constipation and bloating on a side and taste nausea and vomiting, taste alteration, fever and chills on the flipside; a dermatological cluster composed by dry skin, HFS, rash and itching and connected with hemorrhage/bleeding and wound complication toxicity. Furthermore, we noticed strong connections between cough, dyspnea and infection, with palpitation and pain and we detected another cluster where depression and anxiety where connected with cystitis. Conclusions: The application of network analyses to define CT-induced toxicity clusters is new. The technique was effective in defining the relationships between individual toxicities associated with cycle 1 therapy. The lack of randomness between the relationships defined by the network provides a strong suggestion that each cluster shares a common pathobiological basis, which may provide an opportunity for intervention. [Table: see text]
Survey of arm activity after breast cancer
Authors: Lee T. S. , Kilbreath S. L. , Sullivan G. , Refshauge K. M. , Beith J. M. 
Published: March 2020

9054 Background: Post-operative education of women with breast cancer is inconsistent as guidelines provide conflicting advice regarding how vigorously women can use their arm. Current post-operative advice about lymphoedema focuses on the avoidance of strenuous arm activity and exercise, but common physiotherapy practice advocate this to address possible impairments after surgery such as loss of shoulder range and weakness. Methods: A 30-minute survey based on the Protection Motivation Theory was developed to explore the relationship between patients’ perception of what they can do with their affected arm following breast cancer treatment and their intention to use their affected arm. In addition, patients’ cancer and treatment characteristics, demographics, arm and chest symptoms, and arm function were assessed by the survey. The survey was pre-tested, and then distributed to 175 consecutive breast cancer survivors at 6–15 months after breast cancer treatment. Results: Of the women surveyed, 91(52%) had sentinel node biopsies, 67 (38%) had axillary dissection, 14 (8%) had no surgery to the lymph nodes, and 3 (2%) were unknown. There was a high incidence of shoulder restriction and upper limb pain in both women who had sentinel node biopsies and women who had axillary dissections ( Table 1 ). The majority of women who had sentinel node biopsies (51%) and axillary dissections (61%) perceived it was necessary for them to avoid strenuous arm activity. Overall, women who intended to avoid strenuous arm activity were found to have a greater likelihood of reporting upper limb swelling (LR=17.6, p=0.000) and weakness (LR=10.9, p=0.001). Conclusion: Women who had sentinel node biopsies intended to avoid strenuous arm activities even though they have a negligible risk of lymphoedema, placing them at risk of developing secondary musculoskeletal problems. [Table: see text] No significant financial relationships to disclose.
A systematic review of the incidence of venous thromboembolism (VTE) and effectiveness of prophylaxis in patients with multiple myeloma (MM) receiving thalidomide
Authors: Wu C. M. , Lee A. Y. 
Published: March 2020

9056 Background: Thalidomide (T) is effective for treating MM but is associated with an increased incidence of VTE, especially when combined with other agents. Consequently, prophylaxis in patients receiving T-containing regimens has been recommended. However, the true risk of VTE is uncertain and the effectiveness of prophylaxis has not been established. We performed a systematic review to determine the incidence of VTE and the effect of prophylaxis in MM patients receiving T-containing regimens. Methods: MEDLINE and EMBASE were searched from 1966 to 11/16/2006. Only randomized controlled trials (RCT) and prospective cohort studies (PC) were included. Studies evaluating post-transplant maintenance therapy were excluded. Both authors independently screened and reviewed identified publications, and extracted data of pre-specified variables. Incidence estimates were calculated as proportions along with 95% CI. Results: 363 papers were identified but only 80 were relevant and reviewed. 45 studies (6 RCT and 39 PC) involving 1,886 patients receiving T-containing regimens met inclusion criteria. 9 studies clearly stated objective testing was used to confirm a diagnosis of VTE. The incidence of VTE is summarized in the table . We found 12 trials that used prophylaxis. None included appropriate control groups to allow assessment of effectiveness. Based on limited data, the incidences of VTE with prophylaxis were: ASA 13.9% (95% CI 9.1–19.9%), fixed low- dose warfarin 21.9% (95% CI 16.9–27.5%), therapeutic-dose warfarin 0% (95% CI 0–5.5%), and low molecular weight heparin 13.3% (95% CI 10.5- 16.6%). Conclusions: The incidence of VTE in MM patients receiving T-containing regimens ranges from 3% to 22%, depending on the patient type and agents used. Given the lack of level I/II evidence, recommendation for routine prophylaxis for patients receiving T- containing regimens is premature. A safe and effective antithrombotic regimen has yet to be identified. [Table: see text] No significant financial relationships to disclose.
Inpact of a ten week mind-body medicine intervention on peristent fatigue following breast cancer treatment: 6 month follow- up
Authors: Helzlsouer K. J. , Appling S. E. , Scarvalone S. , McBeth M. , Gallicchio L. , Hoffman S. 
Published: March 2020

9062 Background: Persistent fatigue following breast cancer treatment, which affects up to 40% of breast cancer patients, is the result of diverse patient and treatment factors. The multi-dimensional underlying etiology of fatigue calls for broad based interventions aimed at managing stress, improving diet and exercise patterns and short term cognitive therapy supporting attitudinal and behavioral changes. A pilot study was conducted to obtain preliminary efficacy information for a ten week group-based mind body intervention to treat persistent fatigue among breast cancer survivors. Methods: The quasi-experimental study design used a before/after evaluation of fatigue scores. Subjects were women who were between six months and five years post-completion of adjuvant chemotherapy and/or radiation therapy for breast cancer and who had a baseline fatigue score of ≤ 50 as measured by the vitality subscale of the SF-36 Health Survey. Twenty- one women entered the study. Three participants dropped out after attending only two of the ten weekly sessions and are excluded from the analysis. Main outcome measures were change in severity of fatigue as measured by the Piper Fatigue Scale and vitality subscale score of the SF-36. Results: At baseline, the mean age of participants was 52.7 years; 66.7% were Caucasian and 23.7% were African-American. Median time since breast cancer diagnosis was 2.9 years. The mean Piper fatigue score improved from 6.0 (SD 1.5) at baseline to 4.0 (SD 2.1) at the end of the ten week intervention (p< 0.001). Fatigue scores at two and six months post-intervention were 3.2 (SD 2.9; p= 0.001) and 4.1 (SD 2.1; p= 0.02), respectively. Similarly the SF-36 vitality subscale score improved following the intervention with persistent improvement at 6 months (p=0.02). Conclusion: A holistic integrated mind body medicine intervention holds promise for long-term impact on reducing fatigue following breast cancer treatment. Sponsored by Susan G. Komen Breast Cancer Foundation No significant financial relationships to disclose.
Incidence and risk factors of bisphosphonate associated osteonecrosis of the jaws
Authors: Stumpe M. , Chandra R. , Yunus F. , Samant S. 
Published: March 2020

9074 Background: Intravenous bisphosphonate therapy has been used for treatment of various benign and malignant bone diseases, including bony metastasis. Recent single case reports have described osteonecrosis (ON) of the mandible or maxilla as a previously unknown complication of this therapy. Methods: Records of 638 patients treated with intravenous pamidronate or zoledronic acid were reviewed to determine the incidence of jaw ON. Number of infusions, dosing interval, dosage administered, and duration of treatment were analyzed to determine risk factors for the development of this complication. Results: Mean age of the study group was 67 years and 61% were female. The most common primary malignancies included prostate, lung, breast, and multiple myeloma. The overall incidence of osteonecrosis was 6/638 (0.94%). Patients treated with pamidronate (n=336), zoledronic acid (n=169), and both agents (n=133) had an incidence of ON of 1.2%, 0%, and 1.5% respectively (p=NS). No significant relationship was observed between the incidence of ON and demographic parameters, primary tumor, cumulative drug dose, or dosing interval. However, patients who developed ON had a significantly greater mean number of infusions (20.7 versus 10.7, p=0.016) and significantly greater mean hours of infusion time (42.7 versus 17.7, p=0.0036) than those who did not develop the complication. Underlying dental disease appears to be associated with ON. Conclusions: This review represents the largest single series to date of patients treated with IV bisphosphonate therapy. The findings suggest positive correlation between the development of ON and drug exposure as measured by number of infusions and total infusion hours. However, this data must be interpreted with caution as the overall incidence of the complication was low (<1%), precluding rigorous statistical analysis. Dental comorbidity should be addressed prior to initiation of bisphosphonate therapy. No significant financial relationships to disclose.
Disrupted sleep the night before breast cancer surgery is associated with increased post-surgical pain
Authors: Wright C. E. , Montgomery G. H. , Goldfarb A. , Pace B. , Silverstein J. H. , Weltz C. , Bovbjerg D. H. 
Published: March 2020

9078 Background: Despite the best clinical care, pain following breast cancer surgery is a virtually universal patient experience that can have pervasive negative consequences. Given the sometimes prolonged impact of such pain, and the large variability across patients, additional research on modifiable presurgery risk factors is needed. Recent experimental studies have found that disruption of even a single night's sleep is sufficient to increase pain sensitivity the next day in healthy volunteers. The possible negative effects of poor sleep prior to cancer surgery have not been investigated despite the likelihood that sleep may be particularly disrupted at that time. We hypothesized that sleep disruption the night before outpatient breast cancer surgery would predict increased postsurgery pain. Methods: Pain was measured in 24 female lumpectomy patients using the Brief Pain Inventory 7 days postsurgery. Sleep disruption (% of time awake in the sleep period) was measured using an actigraph device for 10 nights, commencing 3 days before surgery. Statistical analyses included correlation and multiple regression. Results: Sleep disruption was significantly greater the night before surgery than 3 nights before surgery (p=.047). Heightened sleep disruption the night before surgery predicted increased pain intensity and pain interference with daily life (r=-.44, p=.034; r=-.49, p=.015), This relationship remained significant for pain interference even after controlling for age, race, surgery duration, presurgery mood, postoperative sleep disturbance and pain medication (B=-.12, C.I. -.23 to -.02, p=.027). Conclusions: This study is the first to document adverse effects of prior sleep disruption on pain sensitivity in a clinical oncology context. Future research should explore mechanisms responsible for these effects and examine the impact of interventions to improve sleep prior to surgery. No significant financial relationships to disclose.
Recognized and unrecognized hyperglycemia in cancer inpatients
Authors: Kapoor S. , Cui J. , Busaidy N. , Lavis V. , Shah P. 
Published: March 2020

9079 Background: Diabetes mellitus (DM) is a recognized co-morbidity with cancers. Prevalence of DM in cancer inpatients and occurrence of acute hyperglycemic crises in cancer patients have not been reported. Methods: Chart, laboratory, and pharmacy data were evaluated retrospectively over 3 months in 2006 and cases of acute hyperglycemic crises were evaluated from 2001–2004 in a big cancer hospital. Results: Of the 2,636 unique patient admissions identified through lab and pharmacy data over a 3 month period in 2006, 1,735 (65%) met the epidemiological (fasting glucose (FG)>=126 mg/dL and/ or receiving DM therapy (Rx)) and 1,306 (50%) met the clinical criteria for a diagnosis of DM (FG>=126 mg/dL and/ or any glucose>=200 mg/dL on two different days, and/ or receiving DM Rx). Of the 463 treated patients 224 (48%) were on one therapy (excluding 38 (8.2%) on short acting insulin only); 13.4% were on combination/ long acting insulin therapy; 16% were on insulin + oral antidiabetics (OADs), and 18% were on combination OADs. On these respective therapies during hospitalization 68%, 49%, and 31% had severe hyperglycemia (glucose >300 mg/dL); and 19%, 14%, and 0% had glucose >400 mg/dL. Eighty eight with a glucose >300 mg/dL and 13 with glucose >400 mg/dL remained untreated during hospitalization. In the case study severe hyperglycemia (>300 mg/dL) predated by 54±18 (Mean±SEM) days (7 known DM on Rx) in 12 out of 22 patients admitted with acute hyperglycemic crises to cancer hospital emergency services over 4 years (14 diabetic ketoacidosis, 8 hyperglycemic hyperosmolar state). Subsequent to the hyperglycemic crises 17/22 died in 14±4 months (median survival: 12 months). In patients not known to be DM 23±6 days elapsed between starting known diabetogenic drugs and testing plasma glucose (10±4 days in known DM). Conclusions: A large number of cancer patients with diabetes remain unrecognized, untreated or inadequately treated even during hospitalizations. Our data reinforces the need for testing, recognizing and appropriately managing diabetes with an aim to prevent acute hyperglycemic complications in cancer patients. No significant financial relationships to disclose.