bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective claims database analysis of elderly compared with nonelderly patients (pts) with newly diagnosed hepatocellular carcinoma (HCC)
Authors: Sanyal A. J. , Moyneur E. , Barghout V. 
Published: August 2020

9552 Background: HCC is the most common type of liver cancer in the US and its incidence has been rising. We assessed whether differences existed in risk factors and treatment practices in pts with HCC by age. Methods: De-identified, individual-level healthcare claims data from a database (MarketScan MedStat) covering all US census regions for ≥18 million lives in 2002–2008 were retrospectively analyzed. Pts had ≥2 claims for primary HCC (ICD9 155.0), continuous healthcare coverage, >180 days of coverage before HCC, and no prior claims for secondary liver cancer (ICD9 197.7). Pts were followed longitudinally from HCC diagnosis until end of healthcare coverage or 3/31/08. Pts were stratified by age (<65 or ≥65 y), and treatment was analyzed using prevalence and time to initiation. Results: Of 4,153 pts with HCC identified, 46.3% were ≥65 y. Risk factors in the groups were nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH, 59% for <65 vs 50% for ≥65), hepatitis C (32% vs 11%), diabetes (29% vs 40%), alcoholic cirrhosis (16% vs 7%), and hepatitis B (9% vs 3%). Treatments were similar between groups; however, more pts in the younger group received transplantation, IV chemotherapy, and hospice care ( Table ). Twice as many older pts did not receive any of the considered treatment compared with younger pts. Sorafenib, approved for unresectable HCC in 11/07, was used in a limited number of pts in the groups. Most noncurative treatment options were initiated sooner in pts ≥65 y than those <65 y, whereas the opposite holds for the 2 main curative treatments (transplantation and cancer removal surgery). Conclusions: Regardless of age, principal risk factors associated with HCC were NAFLD/NASH, diabetes, and hepatitis C. Based on this retrospective claims analysis, variations between treatment options and time to initiation did differ between the groups, suggesting that underlying comorbidities and practice patterns affect treatment options in elderly and nonelderly pts with HCC. [Table: see text] [Table: see text]
Predictors of deep vein thrombosis (DVT) in newly diagnosed multiple myeloma (MM) patients with and without prophylactic recombinant erythropoietin (EPO) therapy
Authors: Coleman E. A. , Anaissie E. J. , Kennedy R. L. , Lockhart K. D. , Stewart C. B. , Bailey C. 
Published: August 2020

9554 Background: DVT, a complication among newly diagnosed MM patients, is most common during the first 3–4 months of therapy. EPO, given to treat anemia in patients receiving chemotherapy, has been associated with increased DVT risk and the mechanism, thought to be related to rise in hemoglobin, remains unknown. Methods: All 604 patients with newly diagnosed MM who completed the induction phase (∼ 3–4 months) of treatment were included. Induction consisted of multiagent chemotherapy with upfront randomization to thalidomide (THAL) or no THAL. 122 patients were also enrolled in an exercise study that included prophylactic EPO. Venous thromboembolism, defined as Doppler confirmed DVT and/or pulmonary embolus during induction, was the primary endpoint. Univariate analyses provided group comparisons. Logistic regression analysis determined predictors of DVT. Results: EPO and No EPO groups were similar for THAL use, age, race, gender, BMI, DVT history, and key baseline laboratory values except for lower cytogenetics risk score (p = 0.010) and higher albumin (p = 0.005), hemoglobin (p = 0.025) and fibrinogen (p = 0.0005) in the EPO group. EPO patients had a higher incidence of DVT 25 (20.5%) vs. 47 (9.8%) (p = 0.001). Risk factors for DVT by univariate analysis were THAL (p =0.001) and baseline platelets > 350,000/μL (p = 0.018) but not hemoglobin (at baseline or throughout study). There were no significant differences in MM response or survival between the groups with and without DVT. Compared to the No EPO group, EPO-treated patients had a better MM response (p = 0.023) and a higher survival (p = 0.0005). The main predictors of DVT by logistic regression were THAL and prophylactic EPO. Conclusions: THAL and prophylactic EPO predict for higher risk of DVT among newly diagnosed MM patients. Hemoglobin levels were not related to higher risk of DVT. DVT and EPO did not decrease treatment response or survival. No significant financial relationships to disclose.
Childhood, adolescent, and young adult cancer survivors (CAYACS) research program of British Columbia: Data linkage: Results to date
Authors: Rogers P. C. , Lorenzi M. , Broemeling A. , Glickman V. , Goddard K. , Pritchard S. , Sheps S. , Siegel L. , Spinelli J. , McBride M. 
Published: August 2020

9555 Background: Long-term survivors of childhood and adolescent cancers are at risk for late mortality and morbidity. Using database linkages we assessed the extent of these issues and health care utilization in a population based cohort in British Columbia. Methods: Retrospective cohorts of 3,483 survivors (>5 years from diagnosis), and representative comparison groups, have been identified from population-based registries. Linkages were made with administrative databases of risk factors and outcomes. Late mortality, second cancers, late morbidity, health services utilization, continuity of care, and educational outcomes, among those diagnosed before age 20 between 1970 to 1995, and followed to 2000, have been examined. Results: Survivors experienced a 9-fold increase in mortality (SMR 9.1, 95% CI 7.8–10.5). Risk of developing a second cancer was 5 times higher than in the general population (SIR 5.0, 95% CI 3.8–6.5). Survivors had three times the odds of being hospitalized (OR 2.97, 95% CI 2.56–3.45) in a three-year period (1998–2000). Survivors were significantly more likely than the population group to consult any physician (excluding oncologists) (adj. RR 1.61, 95% CI 1.51–1.70). Survivors were found to experience a drop in continuity of primary health care as they aged and transitioned into adult care. Survivors were significantly more likely than their peers to receive special education (32.5% vs. 14.1%), most significantly among CNS survivors who received cranial irradiation. Conclusions: Survivors of childhood and adolescent cancers have severe long term health issues and increased health care utilization. Survivors of CNS tumors were at highest risk of poor health and educational outcomes measured. Data linkage provides useful insights for survivorship research. No significant financial relationships to disclose.
Prevalence of renal insufficiency in cancer patients: Data from the IRMA-2 study
Authors: Janus N. , Oudard S. , Beuzeboc P. , Gligorov J. , Ray-Coquard I. , Morere J. , Spano J. , Pourrat X. , Deray G. , Launay-Vacher V. 
Published: August 2020

9559 Background: The IRMA-1 study reported the high prevalence of renal insufficiency (RI) in 4,684 cancer patients, with a glomerular filtration rate (GFR) <90 and <60 ml/min/1.73m2 for 52.9% and 12.0%, respectively. Furthermore, almost 80% of patients were receiving nephrotoxic drugs or drugs necessitating dosage adjustment. The IRMA-2 study was started one year later, in different patients, and consisted of 2 phases: 1) a cross-sectional study, similar to IRMA-1, and 2) a 2-year retrospective follow-up of the patients to describe the evolution of their renal function along with time. Data from the phase 1 were compared to the results of IRMA-1 in terms of RI prevalence. Methods: Data were collected for cancer patients presenting at one of the 19 IRMA-2 centers in March 2005: type of tumour, sex, age, weight, serum creatinine (SCR), and anticancer drugs. Dialysis, myeloma and lymphoma patients were not included. The prevalence of SCR>110 μmol/L was assessed. GFR was estimated with the aMDRD formula, anticancer drugs necessitating dosage adjustment and those potentially nephrotoxic were identified. Results: 4,945 patients (breast 1816, colorectal 747, lung 463, ovarian 294, prostate 251) were included in the IRMA-2 study. Median age 60.0, mean weight 66.2, 62.8% were women. The prevalence of an elevated SCR (SCR>110μmol/l) was 7.2% (vs. 7.2% in IRMA-1), that of a GFR < 90 ml/min/1.73m2 was 50.2% (vs. 52.9%) and that of a GFR < 60 ml/min/1.73m2 was 11.9% (vs. 12.0%) ( Table ). 73.2% of treated patients (n=3882) were receiving at least one drug needing dosage adjustment and 75.5% received at least one nephrotoxic drug (vs. 79.9 and 80.1%, respectively). Conclusions: The results of IRMA-2 and IRMA-1 confirm the high prevalence of RI in cancer patients, on 2 different cohorts of nearly 5,000 cancer patients each. This underlines that estimating renal function in cancer patients is mandatory and that this highly frequent co-morbidity should be considered. [Table: see text] No significant financial relationships to disclose.
Coping with cancer: Associations between coping methods and use of intensive life-prolonging care near death
Authors: Phelps A. C. , Maciejewski P. K. , Nilsson M. , Balboni T. A. , Wright A. A. , Trice E. , Block S. D. , Prigerson H. G. 
Published: August 2020

9575 Background: Cancer patients cope with advanced illness in a variety of ways, including relying on their religious beliefs. Religious coping has been associated with preference for aggressive care near death, yet little is known about how religious and other coping mechanisms effect the use of intensive life-prolonging care at the end-of-life (EOL). We sought to determine how patient coping mechanisms affect the use of intensive life-prolonging EOL care among advanced cancer patients. Methods: The Coping with Cancer Study is a US multi-site, prospective, longitudinal cohort of 345 advanced cancer patients enrolled January, 2003 -August, 2007. The Brief COPE assessed active coping (e.g., problem solving), emotional-support based coping (e.g., getting comfort from others), and behavioral disengagement (e.g., giving up the attempt to cope). The Brief RCOPE assessed positive religious coping (e.g., seeking a strength and guidance from God) and negative religious coping (e.g., believing illness is God's punishment). Patients were followed until death, a median of 122 days after baseline assessment. The main outcome was receipt of intensive life-prolonging care, defined as receipt of ventilation or resuscitation in the last week of life. Results: Greater use of positive religious coping prospectively predicted receipt of intensive life-prolonging care (AOR, 5.43; p<0.001), ventilation (AOR, 4.40; p<0.01), resuscitation (AOR, 5.19; p<0.05), and death in the intensive care unit (AOR, 2.76; p<0.05) in the last week of life, controlling for confounding factors and other examined coping styles. In analyses that adjusted for significant confounding influences, behavioral disengagement was associated with DNR order completion (AOR, 2.80; p<0.01), and prospectively predicted lower rates of intensive life-prolonging care (AOR, 0.20; p<0.05), and ventilation (AOR 0.13, p<0.05). Conclusions: The manner in which patients cope with advanced cancer predicts receipt of intensive life-prolonging care at the EOL. Specifically, positive religious coping predicts the receipt of aggressive medical care near death. No significant financial relationships to disclose.
Prevalence and risk factors of vitamin D insufficiency in cancer
Authors: Hauser K. A. , Karafa M. , Seyidova-Khoshknabi D. , Davis M. P. , Walsh D. 
Published: August 2020

9581 Background: Low vitamin D has been linked to increased cancer incidence and reduced prognosis. Little is known about prevalence and risks of insufficiency in cancer. Methods: Electronic medical records of all adult solid tumor patients treated at The Cleveland Clinic in 2006–2007 were reviewed. Data extracted: demographics (age, gender, race), cancer site (primary and metastatic, ICD-9 codes) and first 25 hydroxy vitamin D level [25OHD] during the study period. Laboratory data (calcium, hepatic and renal function), medications prescribed (anticonvulsants, antineoplastic, corticosteroids, vitamin D) and treatment procedures (chemotherapy and radiotherapy) in 2 months preceding vitamin D were recorded. Clinical factors were compared between those tested for 25OHD vs not, and those insufficient (25OH D ≤30ng/ml) vs not (25OH D >31ng/ml) by Chi square or T-tests. Stepwise logistic regression identified independent predictors of vitamin D insufficiency. Results: n=39,254. 19,030 (48%) were female, mean age 63 (± 14), 86% Caucasian. Most common cancers: breast (19%), prostate (18%), skin (13%). 2,100 (5%) had vitamin D tested. They were more likely female (66% vs 47%), and to have breast, hepatobiliary, skin or thyroid cancer, than those not tested (both p<0.001). 1446 (69%) were insufficient, and 200 (10%) were frankly deficient (25OHD ≤12ng/ml). Insufficiency was associated with male gender, race (African American), month of test (Feb-Apr, Oct), cancer type (hepatobiliary, genitourinary, pancreas, upper gastrointestinal), metastatic disease, low albumin, high bilirubin and AST, and lack of antineoplastic or vitamin D medication (all p<0.01). Multivariable predictors were cancer type, test month, African American race, low albumin, and lack of antineoplastic or vitamin D medication (all p<0.01). Conclusions: Vitamin D insufficiency is highly prevalent among cancer patients tested. This study is limited by selection bias but indicates need for prospective vitamin D evaluation in cancer. No significant financial relationships to disclose.
Risk of bleeding in cancer patients treated with the angiogenesis inhibitor bevacizumab: A meta-analysis
Authors: Sher A. F. , Chu D. , Wu S. 
Published: August 2020

9584 Background: Bleeding is a serious adverse event associated with bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor (VEGF) used extensively in the treatment of cancer. Currently the overall risk of bleeding remains unclear. This study was conducted to determine the overall risk of bleeding associated with bevacizumab in cancer patients by a meta-analysis of randomized controlled trials (RCT). Methods: Databases from PUBMED and the Web Science from January 1966 until July 2008 and abstracts presented at the American Society of Clinical Oncology (ASCO) conferences from January 2000 to through July 2008 were searched to identify relevant studies. Eligible studies included prospective RCTs in which standard anti-neoplastic therapy was administered with and without the use of bevacizumab with available data of bleeding. Summary incidence rate, relative risk (RR), and 95% confidence interval (CI) were calculated employing fixed- or random-effect models based upon the heterogeneity of the included studies. Results: A total of 13048 patients with a variety of solid tumors from 20 RCTs were included for analysis. Among patients receiving bevacizumab, the incidence of all-grade bleeding was 36.3% (95% CI: 28.0 - 45.5), and the RR was 3.1 (95% CI: 2.4 - 4.1) as compared to controls. The incidence of high grade (grade 3 or above) bleeding with bevacizumab was 2.7% (95% CI: 2.0 - 3.6%), and the RR was 1.8 (95% CI: 1.2 - 2.7). The risk of bleeding varied with the dose of bevacizumab, with RR of 3.0 (95% CI: 2.4 - 3.6) at 5mg/kg/week and 1.6 (95% CI: 1.3 - 2.0) at 2.5mg/kg/week. The risk of bleeding with bevacizumab may vary with tumor type, with higher risk seen in patients with colorectal cancer (RR=6.6, 95% CI: 3.6–12.2) and renal cell cancer (RR=3.7, 95% CI: 2.6–5.5). Bevacizumab is associated with different patterns of bleeding, with epistaxis being the most common. The incidence of all grade epistaxis with bevacizumab was 33.8% (95% CI 24.5–44.6) with a RR of 3.1 (95% CI 2.4 - 4.0). Conclusions: There is a significant increase in the risk of bleeding in cancer patients receiving bevacizumab. The risk may vary with the dose of bevacizumab and tumor type. No significant financial relationships to disclose.
Impact of renal insufficiency on cancer survival: Results of the IRMA-2 study
Authors: Launay-Vacher V. , Janus N. , Spano J. , Gligorov J. , Ray-Coquard I. , Beuzeboc P. , Morere J. , Pourrat X. , Deray G. , Oudard S. 
Published: August 2020

9585 Background: Data are scant on the potential impact of renal insufficiency (RI) on the morbidity and mortality of cancer patients. The IRMA-2 study was started to evaluate the potential association between RI and cancer survival. Methods: Data were collected for cancer patients presenting at one of the 19 IRMA-2 centers in March 2005. Data included: sex, age, weight, serum creatinine, type of tumour, metastasis (bone and/or visceral). GFR was estimated with the abbreviated MDRD (aMDRD) formula at the inclusion. RI was defined as an aMDRD <60 mL/min/1.73m2. Patients were retrospectively followed during 2 years after the inclusion. Survival analyses were performed with the log-rank test, survival median with the Mann-Whitney test, multivariate analysis with the Cox regression. Results: 4267 cancer patients (breast 1601, colorectal 575, lung 407, ovarian 269, prostate 224) with available data (aMDRD and follow-up) were included in the analysis. Median age 59.0, mean weight 66.2, 62.9% were women. 51.2% of these patients were alive at the end of the follow-up. RI was strongly linked to mortality (p<0.0001), when analysing all type of patients and tumors. When the same analysis was performed for non-metastatic patients (n=2382), RI was also associated with mortality (p<0.0001). Similar results were found when comparing the survival medians of the same populations ( table ). Finally, 2 Cox models adjusted for sex, age, and the 5 main types of tumor were associated with a significant increase in the risk of death for patients with aMDRD<60 as compared to patients without ( Table ). Conclusions: IRMA-2 is the first large scale study reporting an association between RI and a reduced cancer survival. Cancer patients with aMDRD<60 seemed to be more at risk of death for the following 2 years even in non metastatic patients. IRMA-2 underlines that assessing, monitoring and managing renal function in cancer patients is crucial in order to prevent or at least minimise renal dysfunction because of its potential impact on survival. [Table: see text] No significant financial relationships to disclose.
Characteristics of patients who refuse medically appropriate do not resuscitate orders (DNR) upon admission to a palliative care (PC) unit in a comprehensive cancer center
Authors: Parsons H. A. , de La Cruz M. , Delgado-Guay M. O. , Akitoye A. E. , Chacko R. , Poulter V. , Bruera E. 
Published: August 2020

9589 Background: Cardiopulmonary resuscitation (CPR) has limited benefit in advanced cancer patients (pts). Refusal of medically appropriate DNR (maDNR) may cause harm and distress for pts, families, and the medical team. We conducted a retrospective study to determine the frequency of refusals of maDNR in a tertiary PC unit in a comprehensive cancer center, and characterize the differences between maDNR acceptors (A) and refusers (R). Methods: We reviewed 2538 consecutive admissions to the PC unit to find refusals of maDNR. Data were collected regarding demographical/clinical factors, 0–10 Edmonton Symptom Assessment System, DNR, CPR, and death for the first 100 R and 200 A pts. Results: DNR was considered medically appropriate for 2530/2538 (99%) admissions. 2374/2530 admissions were of unique pts, and 100/2374 (4%) refused maDNR. 3/3 (100%) R pts who coded underwent CPR versus 0/87 A pts who coded (0%, p<0.0001). 2/3 CPR pts survived code and were discharged but died in less than 10 days. Median age (62), female gender (54%), and religious affiliation were not different between R and A. African-Americans and pts with head and neck malignancies were more frequently R than others (OR=1.99, CI=1.13–3.51, p=0.02 and OR=2.62, CI=1.05–6.56, p=0.04, respectively). A had more hematological malignancies and advance directives (OR=2.66, CI=1.07–6.63, p=0.02, and OR=2.80, CI=1.68–4.66, p<0.0001, respectively). Multivariate regression analysis revealed that pts with hematologic malignancies (OR 2.69, CI=1.05–6.90 p= 0.04) and advance directives (OR 1.46, CI=1.46–4.27, p= 0.001) were associated with A. R pts presented with median (interquartile range, IR) pain of 7(4–9) vs 5(3–8, p=0.0005) nausea of 2(0–7) vs 1(0–4, p=0.05), and dyspnea of 1(0–5) vs 4(0–7, p=0.002). Median (IR) time between PC consult and death and discharge and death were 143 (49–329) days for R vs 25(10–77) for A (p<0.0001) and 85 (25–206) for R and 18 (8–35) for A (p<0.0001). Conclusions: DNR refusal in pts after PC consult is low, more frequent among African Americans, pts with head and neck cancers, pts with more pain or nausea, and is associated with longer survival. This study demonstrates possible predictors of complicated DNR discussions. No significant financial relationships to disclose.
Utilization of antineoplastic therapy (ANT) in advanced cancer patients admitted to an acute palliative care unit (APCU) at a comprehensive cancer center
Authors: Hui D. , Bruera E. , Li Z. , Palmer J. L. , de la Cruz M. , Elsayem A. 
Published: August 2020

9590 Background: Cancer patients admitted to a palliative care unit generally have a poor prognosis. The role of ANT (chemotherapy and targeted agents) in these patients is unclear. We examined the frequency, trends, factors and survival associated with ANT use in hospitalized patients who required an APCU stay. Methods: All patients admitted to APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis and ANTs utilization from day of hospitalization to discharge, and survival information were retrieved retrospectively. Results: 2604 cancer patients had the following characteristics: median age 59 (range 18–101), male 51%, hematologic malignancy 11%, median hospital stay 11 (Q1-Q3 8–17) days, median APCU stay 7 (Q1-Q3 4–10) days and median survival 22 days. During hospitalization, 393 patients (15%) received ANTs, including chemotherapy (N=297, 11%) and targeted therapy (N=155, 6%). No significant change in frequency of ANTs was detected over the 5 year period. Multivariate logistic regression analysis ( Table ) revealed that younger age, cancer primaries and longer admissions were associated with ANT use. Patients with hematologic malignancies received more chemotherapy (38% vs. 8%, p<0.001) and targeted agents (18% vs. 4%, p<0.001) compared to patients with solid tumors. ANT use was associated with longer overall survival in univariate analysis (median 25 days vs. 21 days, p=0.001); however, this was no longer significant in multivariate Cox regression analysis. Conclusions: The use of ANT during hospitalization that included an APCU stay was limited to a highly selected group of patients, and did not increase overtime. ANT use was associated with younger age, specific cancer primaries, longer admissions, and no significant improvement in survival. The APCU at our cancer center facilitates simultaneous care where patients access palliative care while on ANT. [Table: see text] No significant financial relationships to disclose.