bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized trial of a perioperative geriatric intervention for older adults with cancer.
Authors: Qian Carolyn L. , Knight Helen P. , Ferrone Cristina R. , Kunitake Hiroko , Fernandez-del Castillo Carlos , Lanuti Michael , Qadan Motaz , Ricciardi Rocco , Lillemoe Keith D. , Kaslow-Zieve Emilia R. , Azoba Chinenye C. , Franco-Garcia Esteban , O'Malley Terrence A. , Jackson Vicki A. , Greer Joseph A. , El-Jawahri Areej , Temel Jennifer S. , Nipp Ryan David 
Published: May 2020

12012 Background: Older adults with gastrointestinal (GI) cancers undergoing surgery often experience poor outcomes, such as prolonged postoperative (post-op) length of stay (LOS), intensive care unit (ICU) use, and readmissions. Involvement of geriatricians in the care of older adults with cancer can improve outcomes. We conducted a randomized trial of a perioperative geriatric intervention in older adults with GI cancers undergoing surgery. Methods: We randomly assigned patients age ≥65 with GI cancers planning to undergo surgical resection to receive a perioperative geriatric intervention or usual care. Intervention patients met with a geriatrician preoperatively in the outpatient setting and post-op as an inpatient consultant. The geriatrician conducted a geriatric assessment and made recommendations to the surgical/oncology teams. The primary end point was post-op LOS. Secondary end points included post-op ICU use, readmission risk, and patient-reported symptom burden (Edmonton Symptom Assessment System [ESAS]) and depression symptoms (Geriatric Depression Scale). We conducted both intention-to-treat (ITT) and per protocol (PP) analyses. Results: From 9/13/16-4/30/19, we randomized 160 patients (72.4% enrollment rate; median age = 72 [65-92]). The ITT analyses included 137/160 patients who underwent surgery (usual care = 68/78, intervention = 69/82). The PP analyses included the 68 usual care patients and the 30/69 intervention patients who received both pre- and post-op intervention components. In ITT analyses, we found no significant differences between intervention and usual care in post-op LOS (7.2 v 8.2 days, P = .37), ICU use (23.3% v 32.4%, p = .23), and readmission rates within 90 days of surgery (21.7% v 25.0%, p = .65). Intervention patients reported lower depression symptoms (B = -1.39, P < .01) at post-op day 5 and fewer moderate/severe ESAS symptoms at post-op day 60 (B = -1.09, P = .02). In PP analyses, intervention patients had significantly shorter post-op LOS (5.9 v 8.2 days, P = .02) and lower rates of post-op ICU use (13.3% v 32.4%, p < .05), but readmission rates were not significantly different (16.7% v 25.0%, p = .36). Conclusions: Although this perioperative geriatric intervention did not have a significant impact on the primary end point in ITT analysis, we found encouraging results in several secondary outcomes and for the subgroup of patients who received the planned intervention. Future studies of this perioperative geriatric intervention should include efforts, such as telehealth visits, to ensure the intervention is delivered as planned. Clinical trial information: NCT02810652 .
Impact of palliative care on end-of-life outcomes in hematologic malignancies.
Authors: Pelcovits Ari , Decker Dominic , Guyer Dana , LeBlanc Thomas William , Olszewski Adam J. , Egan Pamela 
Published: May 2020

12026 Background: Patients (pts) with hematologic malignancies (HMs) receive more aggressive end-of-life (EOL) care and often die in the hospital. The impact of palliative care (PC) on EOL quality outcomes in HMs has not been well described. In 2017 we embedded a PC specialist within our inpatient malignant hematology team to facilitate the use of early PC. We sought to determine if this practice was accompanied by a shift in EOL outcomes. Methods: We conducted a retrospective review of pts diagnosed with acute myeloid leukemia (AML) at our institution in the 2 years before (Cohort A) and after (Cohort B) implementation of embedded PC. We identified pts who received PC and if it was early (during initial inpatient stay) or late (sometime after). We then examined EOL quality outcomes: hospitalizations and intensive care (ICU) admissions in the last 30 days of life, chemotherapy use in the last 14 days of life, and use of hospice and death out of hospital (DOH), using Fisher’s exact test to compare proportions. Results: Among 139 AML pts, 46 in Cohort A, 93 in Cohort B, we identified 34 and 47 decedents in each cohort respectively. The use of PC was significantly higher in Cohort B (75% vs 43%, P= 0.0006), with a significant increase in early PC (52% vs 11%, P < 0.0001). There was no significant improvement in EOL quality outcomes between Cohort A and B, or uniquely among pts receiving early PC ( P > 0.05); however, PC use in general across all cohorts was associated with significant increase in hospice use and fewer ICU admissions ( P =0.016 and 0.0043, respectively). Among pts not receiving PC, a numerical improvement was noted in EOL metrics between Cohorts A and B ( P > 0.05; see table). Conclusions: PC for pts with AML was associated with significantly better EOL quality outcomes. We also observed improvement in EOL metrics over time among pts not receiving PC, which may indicate a culture shift with the embedded PC service, whose benefit extended to pts not directly receiving PC. Embedding a PC specialist and early PC in AML, however, was not significantly associated directly with EOL care improvements. The value of these interventions in HMs may be better measured using patient-reported outcomes and quality of life measures rather than strict EOL outcomes. Further research should consider potential differential role of PC among pts with HM undergoing aggressive/curative, or non-intense/palliative therapy. [Table: see text]
Association between chronological age and geriatric assessment (GA) to identify deficits in elderly adults with cancer: Findings from the Care Registry.
Authors: Williams Grant Richard , Al Obaidi Mustafa , Weaver Alice , Kenzik Kelly , McDonald Andrew Michael , Pergolotti Mackenzi , Smith Crystal Young , Gbolahan Olumide B. , Paluri Ravi Kumar , Bhatia Smita , Giri Smith 
Published: May 2020

12048 Background: Although ASCO and NCCN guidelines recommend that adults with cancer diagnosed at age ≥65y undergo a GA, the association between chronologic age and GA identified deficits remains understudied, and thus, the appropriate age cut-off for employing GA in clinical settings remains unknown. We addressed this gap by examining the association between chronologic age and GA deficits in older adults with cancer. Methods: The Cancer and Aging Resilience Evaluation (CARE) is an ongoing prospective registry of older adults (≥60y) with cancer at a single site. Eligible patients underwent a patient-reported GA adapted from the Cancer and Aging Research Group. The association between age categories (10y increments) and presence of GA deficits was tested using chi-squared tests of trend. Linear association between age and GA deficits was examined using Pearson correlation. Results: The median age at enrollment was 70y (60-96) for 08 participants; 58% were male. Most common cancer types were colorectal (27%), pancreatic (17%), and hepatobiliary (12%). No significant correlation was found between chronologic age and the number of GA deficits (r = 0.03). There was no association between the youngest (60-70y) vs. the oldest age groups (≥80y) with respect to the prevalence of GA deficits: frailty (33% vs. 33%, p= 0.97); impairment of activities of daily living (ADL) (20% vs. 16%, p= 0.7);impairment of instrumental ADL (50% vs 60%, p= 0.3); malnutrition (42% vs. 33%, p =0.4), cognitive impairment (8% vs. 6%, p= 0.6), falls (19% vs. 30%, p 0.1), anxiety (19% vs. 11%, p= 0.1) and depression (13.4% vs. 13.7%, p= 0.2) (Table). Prevalence of 3+ comorbidities was higher in the older patients (45% vs. 59%, p= 0.03). Conclusions: In our cohort of older adults with mostly gastrointestinal malignancies, age was not associated with GA identified deficits and the prevalence of most impairments was similar across age-groups. The use of chronologic age alone to identify which patients may benefit from GA is problematic, and adults 60yrs and above, or perhaps even younger, may derive benefits from a GA. [Table: see text]
Moving toward precision: Understanding the heterogeneity of obesity.
Authors: Hung Kin Wai (Tony) , Dong Tien , Elashoff David , Mayer Emeran , Jacobs Jonathan , Lagishetty Venu , Gupta Arpana (Annie) 
Published: May 2020

12054 Background: Obesity is a global health epidemic and has been linked to detrimental impact on cancer incidence, recurrence, and mortality. Growing evidence have recognized the complex biopsychosocial relationship including microbial phenotypes that undermines the carcinogenic potential and heterogeneity of obesity. A precision understanding on obesity while at its infancy is necessary to accelerate reduction of its impact on cancer outcomes. Methods: With our aim to better understand the biopsychosocial relationship on obesity, we conducted a cross sectional study in healthy and obese individuals. Univariate and multivariate logistic regression models were used to examine obesity and its association with sociodemographic (age, gender, ethnicity, education, income, and marital status), clinical (waist to hip ratio), dietary-behavioral (daily calorie, fat, carbohydrate, protein consumption, and preference on cultural diet), and biological factors (gut microbiome). Parameters were controlled and corrected for multiple hypothesis testing. Gut microbial data using 16S rRNA sequencing were analyzed for alpha diversity, beta diversity, and association of taxa abundance. Results: Among 171 participants between July 2013 and August 2018, individuals were found to have a higher BMI if they were Hispanic [Adjusted Odds Ratio (AOR) 3.36, 95% CI 1.27-8.90], had an obese waist to hip ratio (AOR 8.51, 95% CI 3.45-21.02), and consumed an American diet (AOR 4.82, 95% CI 1.74-13.34). Multivariate permutation analysis controlling for BMI, sociodemographic, clinical, and dietary parameters found that Hispanic have a significantly different microbiome profile than non-Hispanic (p = 0.042). While microbial species richness (Chao1) were similar (p = 0.22), Hispanic had a lower microbial species evenness (Shannon) compared to non-Hispanic (p = 0.029). Differential expression of microbial species revealed a positive correlation of Firmicutes:Bacteroidetes ratio in individuals with higher BMI and consumed an American diet whereas a negative correlation to Hispanic ethnicity. Conclusions: Obesity association to Hispanic ethnicity uniquely expressed through microbial signature despite sociodemographic, clinical, and dietary differences. Microbial characterization as an emerging predictive marker for oncology therapeutics may also serve as selection biomarker in onco-obesity practices and clinical trials. Addressing ethnic disparities guided by microbial phenotypes may unlock novel understanding of obesity heterogeneity and transform its impact on cancer care.
The impact of high intensity interval training on functional performance, body composition and quality of life in a diverse group of cancer survivors.
Authors: Beebe-Dimmer Jennifer Lynn , Finlay David , Ruterbusch Julie J. , Baird Tara , Simon Michael S. , Abrams Judith , Harper Felicity W. K. 
Published: May 2020

12057 Background: Given the well-documented benefits of regular exercise to cancer survivors, in 2012, an expert panel assembled by the American Cancer Society recommended that patients engage in at least 150 minutes per week of moderate-to-vigorous physical activity. However, few patients meet this goal. We have also observed racial differences in reported participation in regular exercise among cancer survivors living in Metropolitan Detroit, Michigan. Methods: The CAPABLE study is a 12- week pilot exercise intervention that introduces cancer survivors to the sport of CrossFit. We evaluated the impact of this unique, high-intensity interval training method on functional performance, cardiovascular endurance, body composition and health-related quality of life (HRQOL) as measured by the Functional Assessment of Cancer Therapy (FACT) instrument. All measures were summarized at baseline and program exit. Paired signed rank tests were used to assess change in each of these measures over time. Results: Of the 48 participants enrolled in the pilot, 37 (77%) were considered adherent to the program (attending at least 75% of sessions over the 12-week period). The mean age of participants was 58.5 years, 73% identified as African American and the majority of participants were breast cancer survivors (N = 20). The mean body mass index (BMI) at baseline was 32.8 kg/m2 decreasing to a mean of 31.7 kg/m2 at exit (BMI change -1.1, p < 0.001). Similar changes were observed in % body fat measured by bioelectrical impedance. There were significant improvements in all measures of functional performance over 12-weeks (all p < 0.001). We observed significant and meaningful improvements in reported HRQOL measured by the FACT survey, overall (FACTG total change +9.5 (p < 0.001)) and in each one of the individual domains (physical, social, emotional, and functional well-being). Conclusions: We observed significant improvements in performance, body composition and quality of life among cancer survivors introduced to a high-intensity interval training program. Understanding and eliminating barriers to programs like these are critical to improving outcomes and reducing cancer health disparities. Clinical trial information: NCT03750981 .
Effects of radiation therapy on clonal hematopoiesis.
Authors: Modlin Leslie Ann , Wijetunga N. Ari , Patel Minal , Gao Teng , Ptashkin Ryan , Sullivan Michael R , Kelly Daniel W. , Caltabellotta Nicole , Solit David B. , Berger Michael F. , Tallman Martin S. , Diaz Luis A. , Zehir Ahmet , Papaemmanuil Elli , Levine Ross L. , Bolton Kelly L , Braunstein Lior Zvi 
Published: May 2020

12062 Background: Clonal hematopoiesis (CH), characterized by recurrent somatic mutations in blood, is a common age-associated condition that portends an increased risk of myeloid neoplasms and cardiac disease. Oncologic therapies appear to promote CH, including ionizing radiation therapy (RT) (OR = 1.4, p < 10−6) and systemic DNA-damaging agents (OR = 1.2, p = 8x10−4). How various RT parameters (e.g. target site, dose, fractionation, modality) may influence CH is unknown. Methods: CH mutations were identified via targeted, deep-coverage next-generation sequencing from paired peripheral blood and tumor samples (MSK-IMPACT). CH was defined as a somatic blood mutation with a minimum variant allele frequency of 2%. Putative driver mutations (CH-PD) were identified from OncoKB and other published sources. Clinical and RT characteristics were abstracted from medical records. To account for differences in RT dose and fractionation, equivalent radiation dose in 2 Gy fractions (EQD2) with an α/β ratio of 3 for late effects was calculated. Univariate and logistic regression modeling for associations between clinical and treatment parameters and CH were performed. Results: We identified 2,195 patients who received RT before blood draw and 7,832 who did not, encompassing 57 histologies. A median of 267 days elapsed between the end of RT and blood draw. After RT, 22% of patients had at least one CH-PD mutation (n = 486). The most common single anatomic sites radiated were pelvis, chest wall/breast, and head and neck. Conventional RT was used in 2% (n = 46), 3D-conformal in 14% (n = 308), intensity modulated RT in 36% (n = 787), volumetric modulated arc RT in 12% (n = 263), multiple techniques in 26% (n = 560), and unknown in 11% (n = 231). There was no association between RT modality and presence of CH-PD (p > 0.05 for all between group comparisons of modality). On multivariate regression after controlling for age, race, time from diagnosis to blood draw, smoking status, and for chemotherapy class, cytotoxic, immune, or targeted therapies in the entire cohort, EQD2 was associated with CH-PD (p = 0.012x10−3). Evaluating EQD2 by irradiated anatomic site, total pelvic dose by EQD2 in 10 Gy increments remained significantly associated with CH-PD (OR = 1.07, p = 0.0046), as was head and neck EQD2 (OR = 1.046, p = 0.032). Conclusions: CH-PD was associated with higher radiation dose for pelvic or head and neck RT, but not other anatomic sites after controlling for systemic therapies. RT modality was not associated with CH-PD. Ongoing work will directly evaluate the bone marrow dosimetry of various treatment approaches using phantom-based modeling.
Long-term cancer survival in cohorts of U.S. health professionals.
Authors: Cheng En , Lee Donghoon , Tamimi Rulla M , Hankinson Susan , Willett Walter C , Giovannucci Edward L. , Eliassen Heather , Tworoger Shelley , Meir Stampfer , Mucci Lorelei A. , Fuchs Charles S. , Spiegelman Donna 
Published: May 2020

12075 Background: Few studies have investigated long-term survival and causes of death among men and women diagnosed with major cancers. Methods: We estimated overall and cause-specific mortality rates for men diagnosed with prostate, lung and bronchus, colon and rectum, bladder, and melanoma cancer in the Health Professionals Follow-up Study between 1986-2010+, and women with breast, lung and bronchus, colon and rectum, uterine corpus, thyroid, and ovarian cancer in the Nurses’ Health Study (NHS) between 1976-2010+ and NHS II between 1989-2010+. Kaplan-Meier curves were used to calculate cumulative mortality rates at 5, 10, 15, 20, and 30 years and competing risk methods were used to calculate cumulative cancer-specific mortality rates of major causes at 5, 10, 15, 20, and 30 years. Additionally, among women 40-year mortality rates were calculated. Results: Except for lung and ovarian, most major cancer patients are more likely to die from other causes than the index cancer. We observed two basic patterns for cumulative cancer-specific mortality rates. The first pattern is greatly diminished risk of index cancer-specific mortality 10 years or more following diagnosis - for colorectal cancer, cancer-specific mortality rate increased by less than 3% between 10 to 30- or 40-year following diagnosis (among men, from 35.1% to 36.7%; among women, from 34.8% to 37.7%), and this pattern also applied to bladder, melanoma, or uterine corpus cancer. The second one is sustained, but nevertheless low, excess risk - prostate cancer-specific mortality rate increased gradually and almost linearly from 5.3% to 15.1% after diagnosis from 5 to 30 years, and for breast cancer, it increased likewise from 7.2% to 18.9% after diagnosis from 5 to 40 years. Conclusions: Except for lung and ovarian cancers, patients diagnosed with major cancers were more likely to die from causes other than cancer. Colorectal, bladder, melanoma or uterine corpus cancer patients surviving more than 10 years after diagnosis are unlikely to ever die from that disease. [Table: see text]
Risk of secondary hematologic malignancies in patients with ovarian cancer treated with PARP inhibitors: A combined meta-analysis of seven phase III randomized controlled trials.
Authors: Htut Thura , Ball Somedeb , Swarup Sriman , Sultan Anita , Han Myat M. , Myat Yin Mon , Hardwicke Fred L. , Tijani Lukman Aderoju , Thein Kyaw 
Published: May 2020

12076 Background: Ovarian cancer (OC) is a leading cause of death from gynecologic cancers in women worldwide. Poly adenosine diphosphate ribose polymerase (PARP) inhibitors prevent the repair of single-strand breaks and generate double-strand breaks in tumor cells and have recently shown survival benefits in OC. Yet, the impact on the risk of secondary hematologic malignancies (SHM) remains uncertain. We performed a combined meta-analysis of randomized controlled trials (RCT) to determine the risk of SHM in patients with advanced OC treated with PARP inhibitors. Methods: MEDLINE, EMBASE databases and meeting abstracts from inception through January 2020 were queried. Phase III RCTs utilizing PARP inhibitors maintenance in advanced OC were eligible. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed with I2 and Cochran's Q- statistic. Fixed effects model was applied. Results: A total of 4,445 patients with advanced OC from seven phase III RCTs were included. The study arm used olaparib or niraparib or rucaparib or veliparib or olaparib +bevacizumab while the control arm utilized placebo or bevacizumab. Randomization ratio was 2:1 in all studies. The I2 statistic for heterogeneity was 0, suggesting some heterogeneity among RCTs. The overall SHM incidence was 0.80% in PARP inhibitors group vs 0.47% in control group (RR 1.45; 95% CI: 0.68 – 3.07, P = 0.34). In patients with newly diagnosed OC (n = 3,044), the incidence was 0.59% vs 0.09% in control group (RR 2.7; 95% CI: 0.7—10.37, P = 0.15). In recurrent OC subset (n = 1,401), 1.28% were reported in both study and control arms (RR 0.96; 95% CI: 0.38-2.46, P = 0.94). SHM was noted in 1.3% in the olaparib subgroup compared to 1% in the control with RR of 1.24 (95% CI: 0.46 –3.31, P = 0.67). SHM occurred in 0.7% in the niraparib subgroup compared to 0.47% in the control with RR of 1.28 (95% CI: 0.30-5.45, P = 0.74). Conclusions: Our study demonstrated that the risk of SHM was not significantly increased in patients who received PARP inhibitors compared to control arm, despite attaining survival benefits. Further studies and long term follow up are necessary to define the actual relation and definitive incidence.