bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of patient and physician factors on oncologists’ recommendations for adjuvant chemotherapy in stage III colon cancer
Authors: Krzyzanowska M. K. , Regan M. M. , Powell M. , Earle C. C. , Weeks J. C. 
Published: March 2020

6051 Background: Population-based studies indicate that elderly patients with colon cancer are less likely to receive adjuvant therapy (tx). Lack of tx may reflect patient preference, appropriate consideration of comorbid illness, or physician bias. Methods: To study physician preference for tx of elderly patients with colon cancer, a vignette-based survey was developed then mailed to a nationally representative sample of 1,000 oncologists. Patient age (61/72/83 yrs), comorbidity level (none/mild/severe CHF with symptoms on minimal exertion) and preference were varied across 8 vignettes. Physician preference for recommending tx was measured using a 7-pt Likert scale; mixed effects linear regression was used to evaluate the results. Results: 485 oncologists returned the survey (RR = 49%); 363 that had seen patients with colon cancer during the previous year were included in further analyses. Median age of the respondents was 52 (range 30–77), 73 (20%) were women. Median time since graduation from medical school was 25 yrs (range 5–53); 17% were employed in academic centers, 8% in HMOs and the remainder in the community. Patient age and comorbid illness interacted to significantly influence physician recommendations. Among patients with mild comorbidity, physician preference for tx of an 83 yr old patient was 1.1 lower than for a 72 yr old (3.8 vs 4.9 on a 7-pt Likert scale) and 1.7 lower than for a 61 yr old (each p<0.0001). This age effect was similar among patients with no comorbidity (p=0.30), with physicians’ preferences consistently higher by about 1.5 than for patients with mild comorbidity (p<0.0001). Among patients with severe comorbidity, preference for tx of an 83 yr old was only 0.9 lower than for a 61 yr old patient (p<0.0001), whereas the decrease was 2.6 for a 61 yr old with severe vs mild comorbidity. Patient preference against tx resulted in 0.3 (p<.0001) decrease in physicians’ recommendations for tx. Among physician factors, only type of employment was associated with tx recommendations with a 0.3 decrease in preference for tx (p=0.0014) among academic oncologists. Conclusions: Patient rather than physician factors have the greatest effect on oncologists’ preferences for adjuvant tx with age and severe comorbidity having the strongest effect. No significant financial relationships to disclose.
Barriers for accrual to clinical trials in adult patients (pts) with thoracic malignancies
Authors: Baggstrom M. Q. , Gilstrap E. , Skelton A. , Viswanathan A. , Morgensztern D. , Nations P. A. , Foersterling D. , Govindan R. 
Published: March 2020

6058 Background: Despite recent advances in the treatment of pts with thoracic malignancies, the outcome continues to be poor. Only about 3% of all adult oncology pts enroll in clinical trials compared to approximately 50% of pediatric pts. The proportion of adult pts enrolled in clinical trials is low, even in tertiary cancer centers. It is critical to understand the barriers for accrual to clinical trials. Methods: We reviewed the outpatient charts of all pts with thoracic malignancies (non-small cell lung cancer [NSCLC], small cell lung cancer, and esophageal cancer) referred to the thoracic medical oncology group at our institution from 11/1/2004 to 10/31/2005. Available and appropriate clinical trials are presented to the pts routinely and reasons for non-enrollment are documented. We collected information on histology, stage, performance status (PS) and co-morbid conditions. Appropriate studies at the time of initial consultation were noted from database. Results: Of 284 consecutive patient charts reviewed, 13 pts (4.6%) did not require therapy, 6 pts (2.1%) were deemed to have a non-thoracic primary on review, and 15 pts (5.3%) had already initiated therapy at the time of consultation. Of the remaining 250 evaluable pts, 88 pts (35.2%) were not enrolled because of lack of available appropriate clinical trials at the time of initial consultation. The most common categories were adjuvant therapy for early stage NSCLC and advanced esophageal cancer. Twenty-one pts (8.4%) enrolled onto a clinical trial. The most common reasons for not participating in a clinical trial include: ineligibility due to PS (28 pts, 11.2%), geographic issues (23 pts, 9.2%), patient refusal (16 pts, 6.4%) and co-morbid conditions (9 pts, 3.6%). Ten pts (4.0%) were lost to follow up. Conclusions: 1. Lack of appropriate and available clinical trials and poor PS are the two most common reasons for lack of patient enrollment in clinical trials at our institution. 2. It is critical to develop innovative clinical trials for pts with advanced esophageal cancer, adjuvant therapy in early stage NSCLC, and poor PS. 3. More work is needed to understand patient perception about clinical trials. [Table: see text]
The relationship between cancer patient treatment decision-making roles and quality of life (QOL)
Authors: Atherton P. J. , Smith T. , Huntington J. , Huschka M. , Sloan J. A. 
Published: March 2020

6075 Background: Failing to meet patient expectations for participating in treatment decisions impacts satisfaction with care, but it is unknown whether this translates into QOL deficits. As part of a larger survey of cancer survivors conducted by the American Cancer Society (ACS), data were gathered on the role patients in Minnesota preferred and the role actually experienced during the treatment decision-making process. Methods: Patients who were diagnosed with one of the ten most common cancers in 2000 completed a survey containing the Profile of Mood States (POMS), the SF-36, and the Control Preferences Scale (CPS). Fisher’s exact tests compared role preference distributions across demographic categories. Two-sample t-tests compared the POMS and SF-36 scores between patients whose preferred role preference was concordant with the role experienced and those with discordant preferred and actual roles. Results: 33% of the 599 consenting patients preferred an active role in treatment decision-making, 52% preferred a collaborative role, and 13% preferred a passive role. The actual roles experienced were 33% active, 50% collaborative, 17% passive. Over 88% of patients had concordant preferred and actual roles. Patients with concordant roles had higher SF-36 physical scores (45 vs 40, p=0.004), higher vitality (50 vs 42, p=0.005), less fatigue (70.2 vs 60.1, p=0.001), better concentration (84 vs 79, p=0.008) and better overall mood (77 vs 73, p=0.006). Role preference differed across gender (p=0.0002) in that more women preferred a collaborative role than men (57.8% vs 45.5%) and fewer women preferred a passive role (9% vs 17.3%). Patients under age 50 experienced more active roles in treatment decisions than those aged 50+ (p=0.04). Patients reporting an active actual role had higher SF-36 physical scores (p=0.005) and higher POMS vigor subscale scores (p=0.04). There were no differences in QOL scores for preferred roles. Conclusions: Patients who experienced discordance between their preferred role and their experience reported substantial QOL deficits in both physical and emotional domains. Oncologists can improve patient satisfaction with care and QOL by meeting patient expectations with respect to the amount of input they have in making treatment decisions. No significant financial relationships to disclose.
Cancer patients’ reported illness and treatment related concerns, perception of availability and use of available information: The influence of socio-demographics
Authors: Jean-Pierre P. , Roscoe J. A. , Morrow G. R. , Hofman M. , Fiscella K. , Griggs J. , Carroll J. , Figueroa-Moseley C. , Mattar B. I. , Wade J. L. 
Published: March 2020

6077 Backgrounds: Studies that examine the roles of socio-demographics in illness perception and healthcare communication among cancer patients are relatively absent. Methods: This sample included 973 (904 whites, 69 non-whites) patients undergoing treatment for cancer at 20 geographically separate sites. Concerns over understanding the diagnosis and treatment plan were assessed on a 5-point-scale (“1=no concern” to “5=a great deal of concern”). Patients were also asked if: a) whether or not information was available to them, b) if yes, did they used it or not, and c) would more information have been helpful. χ2-analyses and ANCOVAs, were conducted to examine group differences in education, occupation, and concern over understanding the diagnosis and treatment plan. Logistic regressions were conducted to assess the independent association of race to patients’ beliefs that additional information would have been helpful. Results: χ2 analyses showed no significant difference between whites and non-whites in education and occupation (Ps > .05). Subsequent ANCOVAs showed significant group differences in concerns over understanding the diagnosis (F(1, 967) = 9.13, p = 0.003) and treatment plan (F(1, 967) = 7.95, p = 0.01), after adjusting for education, occupation, age, and gender. Additionally, χ2 showed significant group differences in beliefs that more information would have been helpful (p < .05). More non-whites (70.3%) than whites (53.1%) indicated that additional information would have been helpful to understanding the diagnosis. Similarly, more non-whites (69.4%) than whites (53.4%) indicated that additional information would have been helpful to understanding the treatment plan. Subsequent logistic regressions confirmed that race independently predicted patients’ indications that more information would have been helpful to understanding the diagnosis (OR = 1.96, 95%CI = 1.12, 3.42) and treatment plan (OR = 1.84, 95%CI = 1.05, 3.22). Conclusion: The findings underscore the need for oncology professionals to consider and integrate information about socio-demographics in their intervention and communication with racial/ethnic minority patients. Supported by NHI PHS-grant U10-CA37420 No significant financial relationships to disclose.
What do adjuvant and metastatic breast cancer patients (BC) expect from their doctors? Final results of a german survey in 617 patients:
Authors: Oskay-Oezcelik G. , Lehmacher W. , Mirz R. , Christ H. , Kaufmann M. , Bamberg M. , Werner L. , Wallwiener D. , Overkamp F. , Hindenburg H. J. , Sehouli J. 
Published: March 2020

6085 Background: An increasing number of breast cancer patients in western countries are accessing the Internet for medical information. The following study was condcuted to explore the information needs and preferences with special focus on doctor-patient communication. Methods: A questionnaire was developed and validated in a phase-I study and was than administered to breast cancer patients both via internet (online) or via a print-version consisting of 62 questions. Results: A total of 617 patients were interviewed, 552 by online version (online group) and 65 by printed questionnaire (print group). The median age of the online group was 47 years (21–85), for the print group 53 years (40–92). 65% of the patients were treated with the intention of cure, 35% of the patients had a metastatic disease. The median time of consultation communicating the information “You have breast cancer”, was 15 minutes (0–300). The most effective and “patient-relevant source of information and explanations of treatment options was the consultation with their physician (84%). When asked to suggest areas for improvement, most frequent answers were: more alternative therapies should be offered by physician (54%); physicians should have more time for explanations (51%); cooperation between involved physicians should be optimized (39%). Most relevant questions for patients are: “Do I receive the adequate treatment?” (89%); “How many patients with my disease does my physician treat?” (46%); “Can I be enrolled into a trial?” (46%). An independent second opinion centre was desired by 94% of the patients, but only 20% know such an institution. Conclusions: This study underlines the need to give patients with breast cancer all details on treatment options and cancer managements. No significant financial relationships to disclose.
The influence of radiation therapy on survival among Medicaid-enrolled breast cancer patients treated with breast conserving surgery
Authors: Foley K. L. , Camacho F. , Levine E. A. , Kimmick G. , Balkrishnan R. , Anderson R. 
Published: March 2020

609 Background: A growing body of evidence indicates that breast cancer patients treated with breast conserving surgery (BCS) without radiotherapy (RT) have a greater risk of cancer recurrence and mortality compared to those receiving BCS plus RT. Most of the research to date has not included or accounted for women with lower socioeconomic status. Methods: Using cancer registry, Medicaid claims, and Social Security death index data, we evaluated receipt of RT and mean 6-year overall and cancer-specific survival among Medicaid-enrolled breast cancer patients treated with BCS (n=230). Logistic regression was used to assess predictors of RT. The Kaplan-Meier method was used to determine survival by RT status and a multivariate Cox proportional hazards regression model was used to evaluate the role of RT on overall and cause-specific survival while controlling for demographic, clinical, and comorbid factors. Results: 65% of women received RT. Overall, 82% of the sample survived the 5–6 year study period, with death rates of 16% compared to 51% among those who did and did not receive RT, respectively (p<.001). Among the 24 individuals who died from cancer, 8 (33.3%) received radiation and 16 (66.7%) had not. After controlling for demographics, clinical factors, and comorbidity, use of RT was associated with a statistically significant decrease in all-cause mortality (hazard ratio = 0.42, 95% CI 0.21–0.85) and cancer-specific mortality (hazard ratio = 0.22, 95% CI −0.09–0.57). Conclusions: We found under-use of radiation following BCS in this Medicaid-enrolled population of breast cancer patients. Furthermore, omission of RT was associated with a greater than two-fold increased risk of death and almost a five-fold increase in cancer-specific death. Measures to improve RT use among poor women receiving BCS need to be implemented. No significant financial relationships to disclose.
Gemcitabine-related thrombocytosis: Does it increase the risk of thrombosis?
Authors: Ahmed S. , Shahid R. K. , Sami A. , Yadav S. , Ahmad I. , Mirchandani D. , Popkin D. , Haider K. 
Published: March 2020

6091 Background: Gemcitabine is an antimetabolite agent that has demonstrated activity in various solid and hematological malignancies. Although thrombocytopenia is a known side effect, gemcitabine-related thrombocytosis has been uncommonly reported. Chemotherapy increases the risk of thrombo-embolism in patients with cancer. The study aimed to identify the incidence of gemcitabine-related thrombocytosis and to determine whether it has been associated with an increased risk of thrombo-embolism. Methods: Medical records of 175 consecutive adults patients with a malignant disease who received gemcitabine at Saskatoon Cancer Center were reviewed. Patients with history of prior thrombo-embolism or with baseline thrombocytosis were excluded. Fisher’s Exact test was done for statistical analysis. Results: 149 eligible patients with median age of 62 (26–83) and M:F of 1.01:1 were identified. 141 (95%) patients had advanced malignancy and 61 (41%) had received prior chemotherapy. 106 (71%) patients received combination of chemotherapy and 95% of those patients received gemcitabine in combination with a platinum compound. Median number of cycle was 3 (1–8). Median platelets count prior to commencement of gemcitabine was 285 × 109 (44–449). 83 (56%) patients experienced thrombocytopenia whereas 69 (46%) patients experienced thrombocytosis within 3 weeks of treatment with gemcitabine. Median post-gemcitabine platelet count in patients with thrombocytosis was 622 × 109 (457–1385). 15 (10%) patients experienced thrombocytosis with each cycle of gemcitabine. Median duration of thrombocytosis was 2 weeks (0.5−5). 13 (9%) of 149 patients experienced a vascular event (venous, n=9; arterial, n=4) within 6 weeks of treatment with gemcitabine. Median platelet count prior to the vascular event was 268 × 109 (79–669). All except one patient had advanced malignancy and 85% had received combination of chemotherapy. 5 of 69 (7%) patients with thrombocytosis experienced a vascular event compared with 8 of 80 (10%) patients without thrombocytosis (p=0.77). Conclusions: Gemcitabine has been associated with an increased incidence of thrombocytosis. However gemcitabine-related thrombocytosis is a transient phenomenon and has not been associated with an increased risk of a vascular event. No significant financial relationships to disclose.
Utility of the SEER-Medicare data to identify medical androgen deprivation therapy
Authors: Oleynick J. U. , Albertsen P. C. , Barry M. M. , Walker-Corkery E. M. , Yao S. , Lu-Yao G. L. 
Published: March 2020

6113 Background: Researchers are increasingly using SEER-Medicare data to measure the use of various cancer therapies. However, the validity and completeness of Medicare data as a source of information for identifying medical androgen deprivation has not been established. In this study, we compared the classification of ADT use based on SEER-Medicare linked data and medical record review. Methods: Among patients who were included in the Prostate Cancer Outcomes Study (PCOS) aged 65 or older and have Medicare part A and B coverage as their primary health insurance, their use of medical androgen deprivation therapy (ADT) identified from the SEER-Medicare data was compared with the results of medical record review. The linkage of the datasets was accomplished by using encrypted IDs. Two algorithms were evaluated. Algorithm A defines ADT use liberally, if at least one of the following HCPCS codes is present: J1950, J9202, J9217, J9218, or J9219. Algorithm B, developed by the authors to identify consistent androgen deprivation, defines ADT only if there is evidence of treatment lasting for 3 months or longer, indicated by either the 12-month treatment J9219 or at least 3 months of treatment with J9202 or J9217. Results: For the 673 patients eligible for this validation study, algorithm A has a sensitivity of 92.5% and a specificity of 85.2% in identifying medical ADT compared to medical record review (see table ), while algorithm B has a sensitivity of 81.8% and a specificity of 88.9% ( Table 1 ). When the study was further restricted to patients with Medicare insurance only (N=142), both algorithms improved: 96.2% sensitivity and 85.6% specificity for algorithm A, and 88.5% sensitivity and 91.1% specificity for algorithm B. Conclusions: Both algorithms have reasonable sensitivity and specificity. Medicare claims can be used to track ADT use for the treatment of prostate cancer in the Medicare population. [Table: see text] No significant financial relationships to disclose.
What is the probability that new cancer treatments are better than standard treatments?
Authors: Djulbegovic B. , Kumar A. , Soares H. P. 
Published: March 2020

6120 Background: How often new treatments tested in phase III randomized controlled trials (RCT) are superior to standard treatments is not known. To accurately answer this question three factors have to be considered: publication rate, quality of trials and the choice of the adequate comparator intervention. Methods: All consecutive RCTs conducted by 6 National Cancer Institute sponsored cooperative groups from 1955 to 2000 were reviewed. Data on primary outcomes from published and unpublished trials were analyzed. The results were assessed for the possible effects of bias, random error and choice of comparator intervention. Results: We abstracted data from 444 trials, involving 566 comparisons, enrolling more than 150,000 patients. Hazard ratio (HR) for overall survival favored experimental treatments 0.96 [99%CI (0.94, 0.98), p<0.0001]. Treatment related mortality (TRM) was worse with innovative treatments (HR 1.45 [99%CI (1.24, 1.69)], p<0.0001). In absolute difference this amounts to <0.4% in survival and 0.38% in TRM. Although the distribution of successes was on average similar between experimental and standard treatments, we found that one in 14 trials lead to discovery of a treatment that improved survival by 50%. The findings were not affected by publication bias, methodological quality, treatment type, disease, or comparator. Conclusions: In clinical trials of new cancer drugs, experimental treatments in cancer which have progressed to testing in RCTs are, on average, as likely to be inferior as to be superior to standard treatments. Individual treatments may be more or less successful but this cannot be predicted and can only be known after a trial is conducted. This pattern of treatment success is not accidental, but is directly related to moral principle for conduct of clinical trials known as equipoise or uncertainty principle (BMJ2005;331:1295). Such uncertainty makes it easier for patients to decide whether to participate in such trials, and for researchers to justify the clinical trial system, which has led to advances in treatment of cancer. No significant financial relationships to disclose.
Molecular signatures generated with RNA Isolated from formalin-fixed paraffin-embedded tumor specimens differentiate metastatic and non-metastatic primary breast cancer
Authors: Tanaka K. , Shimizu D. , Kuramochi H. , Cooc J. , Williams M. , Li R. , Chen P. , Danenberg K. D. , Danenberg P. V. , Lenz H. J. 
Published: March 2020

614 Background: Breast cancer can be either non-metastatic (locally-advanced) or metastatic, with the latter giving rise to a considerably worse prognosis. Because tissue from patients is generally available only as FFPE specimens, we investigated whether distinct molecular “signatures” could be obtained for these breast cancer types using RNA isolated from archival FFPE specimen blocks in gene expression arrays. Methods: FFPE specimens were available from 15 non-metastatic tumors and 12 primary tumors along with their matching metastases. Up to 5 10-micron sections of each were microdissected to isolate areas of tumor tissue. RNA was extracted using a proprietary procedure of Response Genetics, Inc. and was then amplified and labeled. The resulting cRNA was hybridized to the U133 plus 2.0 GeneChip. An unsupervised PCA analysis of the samples resulted in the first principal component separating 2 distinct groups which consisted of the non-metastatic and metastatic tumors. A differentially expressed gene list between metastatic and non-metastatic CRC was determined. These data were also analyzed for differential canonical pathways using Ingenuity Pathway Analysis. Results: Hierarchical clustering analysis segregated locallyadvanced primary tumors and metastatic primary tumors intotwo clusters with distinct gene signatures. A T-test with unequal variance assumption identified 1595 differentially expressed probe sets with FDR (false discovery rate) = 0.005 (p=0.00015). However, comparison of primary tumors with their liver metastases using a paired T-test showed only 18 differentially expressed probe sets at FDR=0.05 and 1019 genes with significance p value ≤ 0.005. Pathway analysis showed significant deregulation of FGF signaling, G2/M DNA damage cell cycle checkpoint, IL-2, IL-4 and EGF signaling between locally advanced and metastatic primary tumors. Conclusion. We have demonstrated the feasibility of identifying metastatic and non-metastatic tumors by microarray analysis using FFPE breast cancer tissue. This result is currently being validated in a separate larger cohort of patients. [Table: see text]