bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neutropenic complications with carboplatin AUC 5 and paclitaxel 175 mg/m2 (CP) regimen in Indian patients: A community-based single center experience.
Authors: Bharthuar Anubha , Chopra Shamit 
Published: March 2020

e19607 Background: In most oncology clinical trials, the majority of patients are of Caucasian ethnicity. It is often difficult to apply the same chemotherapy with equal dose intensity in Indian patients due to increased risk of complications. The exact incidence of complications & whether the difference in chemotherapy tolerability is due to genetic or environmental factors remain unclear. We provide a community-based single center experience with the commonly used CP regimen in Indian patients. Methods: A retrospective study of all patients who received CP regimen (Cockroft Gault formula for CrCl) from September 2010 to December 2011 was undertaken. Incidence of neutropenic complications, G-CSF utilization & pRBC transfusion was determined. Results: Fifty six patients received 194 cycles of CP (range 1-8 cycles, median 3 cycles, mean paclitaxel dose 256mg, mean carboplatin dose 431mg, average BSA 1.56). Clinical characteristics : male 16, female 40; age range 34 - 82 yrs, median 55 yrs; site - breast 6, ovary 19, cervix/uterus 11, esophagus 8, others 12; stage – I/II/III 7, IV 42; histology – SCC 21, Adenoca 34. After the 1st cycle, there were 8 neutropenic complications (14%)- 4 patients (7%) with neutropenia (ANC<1500 cells/mm3) and 4 patients (7%) with neutropenic fever. Forty-two patients received the 2nd cycle, & in total 12 patients required G-CSF support (28%). There were 3 deaths, 2 due to neutropenic fever & sepsis. Average baseline hemoglobin was 11.5gm/dl with 5 episodes of pRBC transfusion. Conclusions: Although the incidence of neutropenia in Indian patients receiving CP is not higher than previous reports (20-25%), there is a much higher incidence of neutropenic fever (over the reported 1-2%) & death, resulting in high G-CSF utilization. This raises several issues such as the role of prophylactic antibiotics, impact of environmental & socio-economic factors (compromised nutritional status & hygiene, lack of disease insight & lack of access to urgent health care). We will need to implement additional measures, increase patient & family awareness by frequent education & counseling so as to reduce complications & improve clinical outcomes in Indian patients.
Predictors of palliative care (PC) referral for advanced cancer patients.
Authors: Tanco Kimberson , Hui David , Kim Sun Hyun , Kwon Jung Hye , Zhang Tao , Kang Jung Hun , Rhondali Wadih , Chisholm Gary B. , De la Cruz Maxine , Karuturi Meghan Sri , Bruera Eduardo 
Published: March 2020

e19613 Background: We previously examined factors associated with delayed PC referral. Little is known about the actual proportion of patients referred to PC. We determined the proportion of patients who had a PC consultation at our cancer center and the predictors of referral. Methods: All adult patients in the Houston area who died of advanced cancer between 9/1/2009 and 2/28/2010 while under the care of our institution were included. We collected baseline demographics and data on PC referral. Multivariate logistic regression was used to examine factors associated with PC referral. Results: 386/912 (42%) decedents had a PC referral, and 179 (46%) were seen initially as outpatients. In multivariate analysis, PC referral was associated with younger age (odds ratio (OR) 0.98 per year; 95% confidence interval (CI) 0.97-0.99; P<0.001), married status (OR 1.5; 1.1-2.0; P=0.005), and gynecologic cancer (OR 1.9, 1.1-3.5, P=0.02 relative to lung). Among patients with a PC referral, outpatient consultation was more likely among patients with head and neck cancer (OR=5.5, 1.7-17.6, P=0.004 relative to lung). In contrast, hematologic malignancy was associated with decreased PC referral (OR=0.59, 0.36-0.97, P=0.04), fewer outpatient PC consultations (OR=0.3, 0.1-0.7, P=0.01) and less time from referral to death (Table). Conclusions: Younger, married patients and those with gynecologic cancer were more like to be referred to palliative care. Head and neck cancer patients were more often seen as PC outpatients. Patients with hematologic malignancies had fewer PC referrals and often late in the disease trajectory compared to patients with solid tumors. [Table: see text]
Use of high white blood cell (WBC) count to predict poor survival outcome in gastrointestinal (GI) cancer with thrombotic event.
Authors: Lee Myung Ah , Lee Guk Jin , Hong Ji Hyung , Lee Hee Yeon , Roh Sang Young 
Published: March 2020

e19614 Background: There are some known risk factors for deep vein thrombosis in cancer patients, such as primary site of cancer, white blood cell count (WBC), hemoglobin (Hb), platelet count (PLT). We investigated the association between these factors and the overall survival as prognostic factor in gastrointestinal (GI) cancer patients. Methods: All the patients with gastrointestinal cancer, who developed deep vein thrombosis or pulmonary thromboembolism through the clinical course, were retrospectively reviewed between January 2009 and June 2011 at Seoul St. Mary’s Hospital. According to treatment, patients were classified into two groups; the chemotherapy group and the supportive care group. Results: Of the fifty-six patients, median age was sixty three year-old. Stomach cancer was most common 35% , pancreatic cancer 31%, colorectal cancer 19%, and biliary cancer was 15%. There were three pattern of thrombosis: 19 (34%) deep vein thrombosis (DVT) only, 12 (21%) pulmonary thromboembolism (PTE) only, 25 (45%) combined DVT with PTE. WBC count above 11,000/µ° showed the poor overall survival than other group (median survival 3.4 months vs. 1.7 months, respectively, p=0.015) However, other risk factor did not show any significant association (Hb: p=0.521, PLT: p=0.295) In chemotherapy group, twelve (55%) patients had progressive disease and ten (45%) patients had stable disease at the time of thrombotic event. There was no statistically significant association between thrombosis and tumor response. The chemotherapy group had tendency of better survival outcome than the supportive care group without statistical significance (median survival 2.4 months vs. 5.3months, p=0.07). Conclusions: In GI cancer patients, elevated white blood cell count above 11,000/µ° can be important prognostic and risk factor for thrombosis with poor survival outcome. And the response of chemotherapy seemed to have no influence on thrombotic event during chemotherapy. This is very limited study due to small sample size and retrospective analysis, and heterogenous type of cancer. Further large study should be warranted to define the thrombotic risk factor as prognostic marker.
Rate of pathologic fractures associated with zoledronic acid treatment in both breast and prostate cancer patients with bone metastases: Findings from real-world clinical practice.
Authors: Regan David H. , Wollschleger Dennis J , Harwin William N. , Szabo Stephen , DiBenedetto Joseph , Namjoshi Madhav 
Published: March 2020

e19615 Background: Recent papers by Stopeck et al (J Clin Oncol, 2010), and by Fizazi et al (Lancet, 2011) evaluated rates of pathologic fractures (PF) in breast cancer (BC) and prostate cancer (PC) patients with bone metastases, and concluded that 23% and 15% of the patients on zoledronic acid (ZOL) respectively had a PF. Since these results were obtained within a randomized controlled trial environment, it is very important to compare these rates to those observed in actual practice. The objective of this study was therefore to determine the rate of PF among both BC and PC patients with bone metastases treated with ZOL in clinical practice. Methods: A patient chart review was conducted in two institutions, Florida Cancer Specialists (FCS) and Georgia Cancer Specialists (GCS) to determine the rate of PF in BC and PC patients with bone metastases initiating ZOL. BC and PC patients with confirmed diagnoses who initiated ZOL treatment from 2005 thru 2007 were included in the study. The patients were required to have been on ZOL for a minimum of 18 months following initiation of treatment. Demographic information, baseline clinical characteristics, and outcomes related to the treatment of bone metastases were assessed. Results: A total of 207 BC patients and 178 PC patients were included in the sample. Median age in the BC group was 65, and in the PC group was 74. In the BC cohort, of the 207 patients, only 17 (8.2%) patients had a PF. In the PC cohort, of the 178 patients, only 8 (4.5%) patients had a pathological fracture. When evaluated by institution, only 5 (4.7%) BC patients, and 4 (4%) PC patients from FCS had a pathological fracture; and only 12 (12%) BC and 4 (5.2%) PC patients from GCS had a pathological fracture. Conclusions: The findings from this study indicate that the rate of pathological fractures associated with ZOL treatment in clinical practice is very different from that observed in a randomized controlled trial setting. Physicians, payers and policy makers should carefully consider these findings in both clinical pathway decisions and formulary inclusion.
Prospective study on the association of depression and anxiety on quality of life, treatment adherence and prognosis in patients with advanced non small cell lung cancer.
Authors: Nunez-Valencia Carolina , Angulo Patricia , Macedo Omar , Dorantes Yuzmiren , De la Mata Dolores , Onate-Ocana Luis F. , Arrieta Oscar 
Published: March 2020

e19618 Background: Symptoms of depression and anxiety are common in patients with lung cancer and could produce impact on health-related quality of life (HRQL) and survival. The aim of the present study is to evaluate the association of depression and anxiety on HRQL, treatment adherence and prognosis in patients with non-small cell lung cancer (NSCLC). Methods: This is a prospective study of consecutive patients with stages IIIB-IV NSCLC. Depression and anxiety were measured with the Hospital Anxiety and Depression Scale (HADS) and the International Psychiatric Interview (MINI), and HRQL with the EORTC QLQ-C30 and QLQ-LC13 questionnaires.All instruments were applied before treatment; at three and six months. Lack of adherence to treatment was considered in patients who stopped attending consultation. Overall survival (OS) was calculated with the Kaplan-Meier and Cox methods. Results: Eighty-two patients were included, mean age 58.9 years. Depression and anxiety were found in 32.9 and 34.1% - respectively - at the initial evaluation. Factors associated with depression were: female gender (p=0.034) and poor performance status (p=0.048). Depression showed association to HRQL; particularly Global health status/QoL and functional scales (i.e: Physical, Role, Emotional, cognitive and Social); Anxiety also showed association to HRQL; particularly Global health status/QoL and functional scales (all p≤0.05).Patients with depression presented a median OS of 6.8 months (95% CI 2.4-11.1) whilst non-depressed patients: 14 (10.3-17.6). Anxiety was not associated to OS. By multivariate analysis, depression has a hazard ratio of 1.9 (95% CI 1.03-3.7, p=0.042). Forty-four percent of the patients with depression had poor treatment adherence versus 14% of the non-depressed (p<0.05). Conclusions: One third of patients with advanced NSCLC presented depression and anxiety. Both were associated to decreased HRQL functional scales of QLQ-C30 and treatment adherence. Depression was independently associated to poor prognosis.
Rash to mTOR inhibitor everolimus: Systematic review and meta-analysis.
Authors: Ramirez-Fort Marigdalia K. , Case Emily Christine , Rosen Alyx C. , Wu Shenhong , Lacouture Mario E. 
Published: March 2020

e19624 Background: Everolimus is an mTOR inhibitor approved for treatment of renal cell carcinoma, subependymal giant cell astrocytoma, and progressive neuroendocrine tumors of pancreatic origin. Its use may be hindered due to adverse events, including rash. The reported incidence and risk of rash to everolimus varies widely and has not been closely investigated. Therefore, we conducted a systematic review and meta-analysis of the literature to determine the incidence and risk of developing rash. Methods: We searched PubMed and Web of Science databases and abstracts presented at the American Society of Clinical Oncology from 1998 to July 2011 using the keyword “everolimus” to identify relevant clinical trials. Eligible studies included prospective phase II and phase III clinical trials of cancer patients on 10 mg of everolimus daily with available data on incidence of rash. The summary incidence and relative risk (RR) of rash were calculated using either the random-effects or fixed-effects model, depending on the heterogeneity of the constituent studies. Results: A total of 2,242 patients with various malignancies from 13 clinical trials were included in the analysis. The summary incidences of all-grade and high-grade rash in patients on everolimus were28.6% (95% CI: 20.8 – 38.0) and 1.0% (95% CI: 0.6 – 1.7), respectively. Everolimus was associated with a statistically significant increased risk of all-grade rash (RR=3.853, 95% CI: 2.470 – 6.013, p=0.000), but the RR for high-grade rash (RR= 2.997, 95% CI: 0.633 – 14.185) was not statistically significant, with a p value of 0.166. Conclusions: Everolimus is associated with a significant risk of developing rash. Management of rash to everolimus is critical to prevent dose modifications and decreased quality of life, both of which can negatively affect clinical outcomes.
A pilot study of direct care nurse (DCN) education to improve adherence and knowledge of erlotinib in patients with non-small cell lung cancer.
Authors: Lucca Joan Vern , Hooper Catherine L. , Boucher Jean , Pedulla Lillian Vitale , Berry Donna Lynn , Marcoux J Paul 
Published: March 2020

e19637 Background: Adherence for oral anticancer agents is a major concern for patients in the ambulatory setting. Adherence rates for oral medication regimens are associated with proper knowledge and monitoring for adverse side effects including symptom management. To improve patient-reported adherence we studied feasibility of a DCN educational intervention to enhance participant knowledge and adherence to erlotinib while monitoring for side effects. Methods: A prospective, pilot study with 30 NSCLC patients was conducted. The study included a DCN structured education session utilizing an adapted educational tool (MOATT) from the Multinational Association of Supportive Care in Cancer (MASCC); followed within 72 hours by a DCN phone call to assess patient learning, adherence, and adverse side effects. Primary endpoints included participant-reported Knowledge Rating Scale (KRS) scores and adherence behaviors measured by the Morisky Medication Adherence Scale (MMAS-8). Adverse side effects and feasibility data were analyzed for each DCN/patient encounter. Results: MMAS-8 adherence scores indicated medium (n=11) to high (n=14) adherence rates and high KRS scores (mean 8.9, range of 7.5-10). Mean age of patients was 67 years (range 45-84 years), majority were female (81%), with race/ethnicity as Caucasian 80%, Asian 10%, and Black 10%. Mean number of erlotinib adverse events was 2.48 per patient and 22% reported 4 or more side effects. Patients contacted DCN 60 times between start and end of protocol. Feasibility included 90% (n=27/30) completing the protocol, mean time 30 minutes to administer educational session and 14 minutes for DCN 72-hour follow-up phone call. Documentation of visits indicated nurse education and follow-up, including monitoring side effects, provided valued supportive care. Conclusions: Data supports the need for and feasibilty of a nurse-led structured protocol to enhance adherence, knowledge, and symptom management. Further study of this education/monitoring intervention for patients initiating oral anticancer agents in the ambulatory setting is recommended.
Comorbidity and survival in veterans with non-Hodgkin's lymphoma (NHL).
Authors: Floyd Leroy Cordero , Srinivas Shanthi , Gonzalez Melanie L. , Chang Victor Tsu-Shih , Cogswell Janet , Einhorn Jan , Sullivan Maryann , Duque Lourdes , Paz-Querubin, Emma , McPherson Monica , Crump Barbara , Kasimis Basil 
Published: March 2020

e19638 Background: Predictors of survival in patients with NHL remain an area of intense interest. Our aim was to determine whether comorbidity indices can be used to predict survival in veterans with NHL. Methods: In an IRB-approved protocol, we reviewed the records of 152 veterans diagnosed with NHL from January 1997 to December 2011 at VANJHCS. Records were reviewed for demographic, clinical and pathology data including HIV, Hep B/C, ECOG PS (PS) and Veteran status- Vietnam (V), Non-Vietnam era(non-V). PS, International Prognosis Index (IPI) and Follicular Lymphoma International Prognostic Index (FLIPI) were tabulated. Comorbidity was assessed using the Charlson Comorbidity Index (CCI), the Kaplan-Feinstein Index (KFI) and the Cumulative Illness Rating Scale (CIRS). Cox regression analysis was used to determine predictors of survival using SAS v9.2. Results: A total of 152 Veterans data were analyzed; 78 V and 74 non-V; the groups did not differ by PS, stage, beta 2 microglobulin (b2m), and HIV status, IPI/FLIPI. In univariate analysis, Grade, PS, Hgb, LDH, Alb and comorbidity indices were predictors of survival. In a multivariate analysis Grade, PS, LDH were predictors of survival in both groups. Comorbidity indices were predictors of survival only in the V group. Conclusions: Grade, PS, and LDH are predictors of survival in both groups. Comorbidity indices were able to predict survival only in the V group probably because the groups differed in age and tumor grade. Supported by New Jersey Commission Cancer Research 09-1133-CCR-EO. [Table: see text]
Prevalence of recurrent thrombosis in cancer patients with isolated gonadal vein thrombosis: A retrospective study.
Authors: Tanasanvimon Suebpong , Garg Naveen , Viswanathan Chitra , Javle Milind M. , Truong Mylene , Kaur Harmeet , Garrett Chris R. 
Published: March 2020

e19645 Background: The natural history of isolated gonadal vein thrombosis (GVT) occurring in cancer patients (pts) is not well described in the medical literature. GVT in cancer pts it is of uncertain clinical significance. Methods: Utilizing a software program allowing a searchable database of radiology reports, the computerized tomographic scan (CT) reports of pts at a single cancer center from January 1, 2004 to June 30, 2011, were searched for the term “gonadal vein thrombus”. Pts included in this analysis had a diagnosis of cancer, isolated GVT (i.e. no evidence of thrombosis at another site), and at least six months of follow-up information. Results: 162 cancer pts with GVT were identified for analysis [median age 57.8 ± 12 years, right GVT 89 pts (54.9%), left GVT 59 pts (36.4%), bilateral 14 pts (8.6%)]; the majority of the pts (96, 59.3%) had a non-gynecologic malignancy. At the time of diagnosis of GVT the majority of pts were receiving chemotherapy (84, 51.9%); 70 pts (43.2%) had surgery within the prior six months (the most common being hysterectomy, 127 pts, 78.6%). The majority of pts in this study had metastatic disease (93, 57.4%) as well as active cancer (138, 85.1%, defined as GVT occurring at the time of cancer diagnosis, disease recurrence, metastatic disease, or treatment for cancer within the prior six months); median follow-up time was 22 months. A minority of pts received anticoagulation (28pts, 17.2%). Twenty-two pts (13.6%) developed a recurrent venous thromboembolic event (VTE); these events were pulmonary embolism (12 pts, 7.4%), deep venous thrombosis (5 pts, 3.1%), inferior vena cava thrombosis (4 pts, 2.5%). Median time to development of re-thrombosis was 7 months (range 2-13.5 months). Active cancer was the only risk factor significantly associated with recurrent VTE (p = 0.047); pts with prior hysterectomy had a significantly reduced risk of recurrent VTE (p = 0.036). Conclusions: Incidental isolated GVT identified in cancer pts has a high risk of recurrent VTE (13.6%). Based upon specific pts risk factors for VTE, treatment of an incidentally detected GVT in cancer pts with anticoagulation, as per guidelines for other VTE sites, may be indicated.
Vitamin D levels in patients with childhood cancer.
Authors: Tacyildiz Nurdan , oktay Tanyildiz Gulsah , Tekin Deniz , Ates Can , Dincaslan Handan , Yavuz Gulsan , Unal Emel , Kose Kenan , Ozyoruk Derya , Suskan Emine , Kucuk Omer 
Published: March 2020

e20000 Background: There is increasing interest in the possible association between cancer incidence and vitamin D through its role as a regulator of cell growth and differentiation. Although there are several studies related cancer risk and prognosis of cancer, related vit D levels in adult patients there are only few recent studies in pediatric patients. Methods: Between 2010 and 2011, D Vit levels of 45 patients (25 boys, 20 girls; age range: 6 months-17 years, median: 11 years) have been compared to D Vit levels of 22 healthy children with similar age group. Patient groups were leukemias, lymphomas, bone tumors, retinoblastoma (RB), and other tumors. Kruskal-Wallis and Spearman nonparametric correlations test of SPSS has been used for statistics. Results: Although there was no statistically significant difference for vit D levels between control group (range: 7.2-22.8; median: 14.75 ng/ml) and patients (range: 5.5-40.2; median: 16.0 ng/ml),difference between patients groups were significant (Table). Patients with RB have statistically lower level of Vit D than leukemia (p:0.016) and lymphoma groups ( p: 0.047). “Other tumors group” has lower vit D levels than leukemia group (p: 0.024). Since RB and other tumors group have younger age than other patients, Spearsman’s nonparametric correlation has been performed to exclude age effect on the results and no statistically significant correlation between D vit levels and age (p: 0.779) was found, although there was an inverse correlation between age and vit D levels in patient group (p: 0.03). Conclusions: According to our preliminary results, most of the patients and healthy children have low level of Vit D. Especially patients with RB have statistically significant lower level of Vit D than other malignancies which can be subject to future studies for confirmation of our results. In addition, etiologic studies related RB may have a new area. [Table: see text]