bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlates of hospice use in elders with cancer
Authors: Owusu C. , Koroukian S. , Madigan E. 
Published: August 2020

9579 Background: Use of hospice has remained relatively low. We aim to identify correlates of hospice in elders with cancer, hypothesizing that the presence of functional limitations and geriatric syndromes are associated with hospice use, independently of age and comorbidities. Methods: The study population included Ohio residents age 65 years or older, diagnosed with breast (n=774), prostate (n=271), or colorectal cancer (n=1,011) during the period 07/1999–12/2001, receiving care through the Medicare fee-for-service system, and first receiving home health care (HHC) in the 30 days before or after cancer diagnosis. This strategy was aimed at obtaining clinical data at baseline, as documented in the HHC Outcome Assessment Information Set (OASIS). Our data source consisted of records from the Ohio Cancer Incidence Surveillance System (OCISS) linked with Medicare data, and the OASIS. In addition to descriptive analyses, multivariable logistic regression analysis was conducted to evaluate the association between hospice use, comorbidity, functional limitations, and geriatric syndromes, after adjusting for patient and tumor attributes. Results: Respectively across the anatomic cancer sites, hospice was used by 9.8%, 22.5%, and 25.1%, of patients. Hospice use increased significantly with age, and was higher among men than women. No differences in hospice use were observed by race, Medicaid status, or the presence of comorbidities. Conversely, hospice use was significantly higher (p < 0.001) among patients with functional limitations (24.0% vs. 16.5% in all others), and those with geriatric syndromes (23.8% vs. 15.3% in all others). Results from the multivariable logistic regression analysis indicated that comorbidities and functional limitations were not associated with hospice use, whereas patients with geriatric syndromes were 1.5 times as likely as those without geriatric syndromes to use hospice (adjusted odds ratio (AOR): 1.5, 95% confidence interval (1.2–1.9). Conclusions: The findings highlight the importance of clinical data that extend beyond comorbidities, when analyzing hospice use. Given marked differences in the disease trajectory across the anatomical cancer sites, future studies should analyze these associations separately in breast, prostate, and colorectal cancer patients. No significant financial relationships to disclose.
Vitamin D deficiency, incidence, and response to oral supplementation among various gastrointestinal malignancies
Authors: Gilmore C. , James J. , Zubal B. , Thomas D. , Tan B. 
Published: August 2020

9586 Background: Vitamin (vit) D dficiency is prevalent amongst patients (pts) with colorectal and pancreatic cancers. Data for other GI malignancies are limited and the impact of short-course vit D supplementation is unclear. Methods: An IRB-approved retrospective review of 202 pts with GI cancers from 12/2007 to 9/2008 was done to evaluate the incidence of vitamin D deficiency defined as serum 25-OH vit D levels of ≤ 30 ng/ml (severe=<10 ng/ml; moderate=10–20 ng/ml; mild=21–30 ng/ml) and incidence of ‘low-normal' (31–50 ng/ml) and normal (>50 ng/ml) vit D levels. Oral supplementation with vit D at 50,000 ‘u' weekly x 8–12 weeks were done and serum levels were redrawn at 2–3 months for pts with low normal and deficient vit D, respectively. Results: 87.6% of all 202 pts is vit D deficient (61% severe to moderate). (see Table ). 92 pts were re-evaluated after 2–3 months of oral vit D supplementation. Among this cohort, the incidence of pts with vitamin deficiency decreased from 91.3% to 57.6% after first re- evaluation. Severe/moderate deficiency rates also decreased from 71.7% to 13%. There were no significant difference in response between males/females, age < or ≥ 65, caucasian or non-caucasian or tumor type. Conclusions: Vitamin D levels should routinely be evaluated for patients with GI maligancies. Oral supplementation decreases the rate 'any' vit D deficiency from 91% to 57%, and of 'severe to moderate' deficiency from 72% to 13%. Prospective studies on the impact of vit D deficiency and supplementation on various clinical outcomes among patients with GI cancers would improve supportive care management of these patients. [Table: see text] No significant financial relationships to disclose.
Relationship of sensory symptoms and motor function in patients with chemotherapy-induced peripheral neuropathy (CIPN) utilizing the EORTC QLQ CIPN20: NCCTG study N06CA
Authors: Wolf S. L. , Qin R. , Barton D. L. , Sloan J. A. , Liu H. , Aaronson N. K. , Satele D. V. , Green N. B. , Mattar B. I. , Loprinzi C. L. 
Published: August 2020

9587 Background: CIPN is characterized by adjectives not covered directly by most common measures of pain and functional limitations. Possible descriptors include numbness, tingling and shooting/burning pain. A prospective neuropathy treatment trial provided data to explore the relationship between self-reported aspects of this symptom. Methods: Baseline EORTC QLQ CIPN20 data and NCI CTCAE V3.0 (CTC)neuropathy grade (I-IV) were provided for all patients on trial. Spearman correlation coefficients and Kappa's coefficients of agreement were calculated between individual items and subscales of the CIPN20 as well as the CTC neuropathy scale. Simple regression models were applied to examine the association between the sensory symptoms and motor function in the fingers/hands (F/H). 200 patients provided 80% power to detect a correlation coefficient of 0.20 with a 5% Type I error. Results: A majority of patients reported “quite a bit” to “very much” numbness (57%) or tingling (62%) in F/H compared to “a little” or “not at all” (numbness (43%), tingling (38%)) by the CIPN20. In contrast, only 13% of the participants had grade III/IV neuropathy determined by the CTC scale. Fewer patients reported the higher two levels of CIPN20-measured shooting/burning pain in F/H (20% “quite a bit” to “very much”). Numbness and tingling were highly correlated (kappa=0.56), while neither were in high agreement with shooting/burning pain (kappa= 0.05 (tingling) and 0.14 (numbness)). The CIPN20 sensory and motor subscales were significantly associated with each other (p<.0001) but were not or only weakly associated with the CTC. Specifically, tingling, numbness, and shooting/burning pain were not associated with the CTC (R=0.16, 0.18 and 0 .11, respectively). Using the CIPN20, all three sensations; numbness, tingling and shooting or burning pain were strongly associated with motor function. Conclusions: The most common moderate to severe CIPN symptoms were numbness and tingling with shooting/burning pain being less common. Shooting/ burning pain appears to be a separate symptom experience from numbness and tingling. The CTC neuropathy grading scale appears to be less sensitive than the CIPN20 in picking up sensory symptoms. No significant financial relationships to disclose.
Symptom burden in cancer survivors: A report from the American Cancer Society's studies of cancer survivors
Authors: Shi Q. , Smith T. , Mendoza T. , Kaw C. , Cleeland C. S. 
Published: August 2020

9598 Background: Cancer survivors may have persistent symptoms as a result of the cancer or the late effects of cancer treatment, although few studies have assessed symptom burden after completion of cancer therapy. We described symptom burden and risk factors for high symptom burden in a population-based sample of cancer survivors. Methods: Cancer survivors were drawn from 11 state cancer registries and surveyed by telephone or mail approximately 1 year after diagnosis; 3697 respondents completed the Modified Rotterdam Symptom Checklist (RSCL-M) and Profile of Mood States-37 (POMS-37). Factor analyses were used to generate composite scores from RSCL-M and POMS-37.Two-step cluster analyses using these composite scores were performed to identify cancer survivors with high symptoms. Results: Six composite scores (pain, nausea/vomiting, fatigue, poor bowel and bladder control, weight loss, and unspecified symptoms) were generated for physical symptoms (RSCL-M). Five composite scores (anxious/depressed, miserable, energetic, exhausted, and annoyed) were generated for mental symptoms (POMS-37). Cluster analyses revealed that 20% of survivors reported both high physical and high mental symptoms. Multivariate logistic regression revealed risk factors associated with high physical and high mental symptoms: younger than 55, household income lower than $40,000, high school or lower education level, unemployed when diagnosed with cancer, lack of health insurance, distant cancer, one or more comorbid conditions, diagnosis of lung cancer, and previous chemotherapy. Conclusions: One of five cancer survivors in this survey belonged to a group with high physical and mental symptoms, which were associated with certain risk factors. These findings will help clinicians and researchers identify subgroups of survivors most likely to report high symptoms and therefore most in need of symptom management. The high symptoms reported by survivors without insurance may have policy implications. No significant financial relationships to disclose.
Smoking and quality of life among elderly survivors of non-smoking related cancers in a prospective cohort study
Authors: Jang S. , Prizment A. , Lazovich D. 
Published: August 2020

9600 Background: Although the effect of smoking on quality of life (QOL) has been examined among survivors of lung or head and neck cancers, little is known about how smoking affects QOL among elderly survivors of non-smoking related cancers. Methods: The Iowa Women's Health Study (IWHS), a prospective cohort study initiated in 1986, collected self-reported QOL using the SF-36 in 2004. Cancer diagnosis and treatment among cohort participants were obtained from Iowa's cancer registry. Behavioral and health characteristics, including smoking status, were collected from periodic follow-up questionnaires between 1986 and 2004. We included 1,920 women, aged 55 to 69 years at baseline, who developed breast, colorectal, or endometrial cancers and responded to the 2004 questionnaire. We compared age-adjusted and multivariate-adjusted mean scores for eight SF-36 scales between nonsmokers (no reported smoking in 1986 or 2004), quitters (reported smoking in 1986 but not 2004), and persistent smokers (reported smoking in 1986 and 2004). Results: Among 1,920 cancer survivors, 1,720 (89.6%) were nonsmokers, 141 (7.3%) were quitters, and 59 (3.1%) were persistent smokers. After age adjustment, quitters had lower scores for vitality, physical functioning, mental health, social functioning, and general health scales compared to nonsmokers. Persistent smokers scored worse on the physical functioning, mental health, role emotional, and social functioning scales compared to nonsmokers. Except for mental health, these differences in QOL scores were attenuated after further adjustment for physical activity. Accounting for other factors, including baseline general health perception and education, cancer type, surgery, radiation therapy, chemotherapy, and length of survival, or occurrence of hypertension, diabetes, heart disease, stroke or fracture by 2004 did not change the differences observed between survivors who had ever reported smoking versus nonsmokers. Conclusions: Quitters and persistent smokers tended to fare worse than nonsmokers on many QOL scales. In most instances, these differences were explained by lower levels of physical activity which may have been a consequence of smoking. No significant financial relationships to disclose.
Mood state and melanoma outcome in the Multicenter Selective Lymphadenectomy Trial
Authors: Garreau J. R. , Faries M. , Ye X. , Morton D. 
Published: August 2020

9603 Background: Emotional state has been linked to cancer survival, but its influence on the outcome of early melanoma is unclear. The Multicenter Selective Lymphadenectomy Trial (MSLT-I) randomized patients with clinically localized cutaneous melanoma to wide local excision (WEX) plus observation or to WEX plus sentinel lymph node biopsy (SNB). Clinical endpoints included disease-specific and disease-free survival. A substudy of this phase III trial evaluated the impact of mood state on survival, and the impact of recurrence on mood state. Methods: Patients were asked to complete a 65-question form within 6 months of enrollment (baseline) and every 12 months thereafter. This questionnaire measured 6 identifiable mood states (vigor-activity, tension-anxiety, depression, anger-hostility, fatigue-inertia, confusion-bewilderment) of the Profile of Mood States (POMS), a validated mood scale for assessing responses to therapy. Self-reported data from the questionnaires were linked to demographic and clinical variables. Results: Of 2,001 patients accrued to MSLT-I, 1,620 completed the questionnaire at baseline. The baseline distribution of POMS variables was similar in the two treatment arms (data not shown). Patients with more vigor at baseline had a significantly longer disease-free and overall survival ( Table ), even after adjusting for age, tumor thickness, site, and ulceration status (p <0.001). Among 136 patients who completed a questionnaire within 6 months after recurrence, comparison of baseline and post-recurrence responses revealed significant changes in mood state: tension, fatigue and confusion increased, whereas vigor decreased (p = 0.0004, 0.0171, 0.0089, and 0.0028, respectively). Conclusions: Vigor, a measure of energy and optimism, is directly correlated with disease-free and overall survival in early melanoma. The negative impact of recurrence on mood state suggests that SNB as a tool for preventing recurrence might also improve mood state and psychological well-being. Supported by NIH CA29605. [Table: see text] No significant financial relationships to disclose.
Single-day regimen of palonosetron (PALO) and dexamethasone (DEX) for the prevention of emesis associated with moderately emetogenic chemotherapy (MEC): Subgroup analysis from a randomized phase III trial
Authors: Celio L. , Bajetta E. , Denaro A. , Bichisao E. , Frustaci S. , Ardizzoia A. , Piazza E. , Fabi A. , Capobianco A. , Isa L. 
Published: August 2020

9620 Background: We have recently shown non-inferiority in preventing acute and delayed nausea and vomiting associated with MEC between the PALO plus 1-day DEX and PALO plus 3-day DEX regimens. Planned analysis stratified by type of chemotherapy (anthracycline + cyclophosphamide [AC] group or patients receiving at least one moderately emetogenic agent according to modified Hesketh classification) has been performed. Methods: A total of 332 chemo-naïve patients with solid tumors were randomized to receive a single IV dose of PALO 0.25 mg plus DEX 8 mg IV on day 1 of chemotherapy (arm A; n=166) or the same regimen followed by DEX 8 mg orally on days 2 and 3 (arm B; n=166). Endpoints included complete response rates (CR: no emetic episodes [EE], no rescue antiemetics; primary endpoint) and proportion of patients with no EE throughout the 5 days after the first cycle of chemotherapy. Subgroups were analyzed by two-sided chi-square test. Results: Per-protocol population included 324 patients (65% women; median age 57.5 years); 35% received AC regimens, and 65% other MEC regimens. There were no significant differences between arms in CR rates according to the type of chemotherapy: 1) CR rates on AC regimens (arm A, 55.8% versus arm B, 60.7%; p=0.599); and 2) CR rates on other MEC regimens (arm A, 68.5% versus arm B, 72%; p=0.576). No significant differences between arms were also observed in the rates of patients with no EE: 1) emesis-free patients on AC regimens (arm A, 78.8% versus arm B, 73.8%; p=0.528); 2) emesis-free patients on other MEC regimens (arm A, 83.8% versus arm B, 90%; p=0.184); 3) nausea-free patients on AC regimens (arm A, 38.5% versus arm B, 44.3%; p=0.533); and 4) nausea-free patients on other MEC regimens (arm A, 58.6% versus arm B, 64%; p=0.418). Conclusions: The single-day regimen of PALO and DEX can provide effective protection against acute and delayed emesis from AC- and MEC-based regimens while avoiding to unnecessarily prolong treatment with DEX. No significant financial relationships to disclose.
Bone health practices in men on androgen deprivation therapy (ADT): A population-based analysis of 25,802 patients
Authors: Alibhai S. M. , Duong-Hua M. , Sutradhar R. , Cheung A. M. , Fleshner N. E. , Warde P. , Paszat L. 
Published: August 2020

9631 Background: ADT is used in up to 1 in 2 men with prostate cancer. Osteoporosis and fragility fractures are important side effects of ADT. Guidelines recommend 2 important bone health practices for men on ADT - measurement of bone mineral density with dual x-ray absorptiometry (DEXA) and use of bisphosphonates in men at risk of osteoporosis. The implementation of these guidelines in practice is not well known. Methods: Using linked administrative databases, we identified 25,802 men (mean age 75.9 y, range 66–100 y) with prostate cancer who were treated with at least 6 months of ADT or who underwent bilateral orchiectomy in Ontario, Canada between 1995 and 2005. Performance of DEXA and prescription of bisphosphonates were captured using specific procedure codes and drug identification numbers, respectively. Prior use of DEXA and bisphosphonates, as well as prior diagnoses of osteoporosis and fragility fracture, were captured with specific diagnostic codes and a 3 y look-back period. Annual rates per 100 person-years were determined for both outcomes. Results: Among 25,802 men, 3.09% had a DEXA more than one year prior to starting ADT, and 3.14% had a prior diagnosis of osteoporosis. Within 2 years of starting ADT, the rate of undergoing DEXA rose from 0.50 per 100 person-years in 1995 to 19.47 in 2005. Rates of DEXA testing were higher among those with a prior diagnosis of osteoporosis, prior DEXA test, or prior fragility fracture but did not reach rates above 50 per 100 person-years in any of these groups. Bisphosphonate use increased from 0.27 per 100 person-years in 1995 to 3.18 in 2005 among prior non-users. More men on ADT were started on a bisphosphonate in the third year after starting ADT as compared to the second year, and rates were higher in year 2 than year 1. Less than one-third of men starting a bisphosphonate underwent any DEXA testing within 12 months of bisphosphonate initiation. Conclusions: Rates of DEXA testing and bisphosphonate use have increased over time among older men starting ADT, but significant gaps and delays remain in the quality of bone health care in this population. No significant financial relationships to disclose.
Cytokine-mediated changes associated with improvements in cancer-related fatigue induced by exercise: Results from a randomized pilot study of cancer patients receiving radiotherapy
Authors: Mustian K. M. , Fisher S. , Adams J. , Janelsins M. , Palesh O. , Darling T. , Peppone L. , Heckler C. , Williams J. , Morrow G. 
Published: August 2020

9632 Background: Radiation therapy (RTH) results in dysregulated inflammatory profiles which increase cancer-related fatigue (CRF). Research suggests physical exercise can have a positive influence on CRF during RTH. Exercise may mediate improvements in CRF through a self-regulating inflammatory exercise response involving cytokines and myokines (muscle contraction-induced cytokines known as exercise factors that mediate exercise benefits in other tissues) which help the body adapt to inflammation. We explored the influence of a home-based exercise intervention (HBEX), including resistance and aerobic training, on mediators of inflammation, as well as the association between changes in these mediators and CRF. Methods: Breast and prostate cancer patients (N=38; mean age=57; 71% breast/female), beginning at least 28 sessions of RTH, were randomized to a 4wk HBEX (7 days/wk) or standard care (SC; RTH with no exercise). Cytokines (IL-8, TNFα, TNFαr1, IL-8, IL-1β and IFNγ) and the myokine IL-6 were measured by enzyme-linked immunoassays and CRF was assessed via valid self-report questionnaires pre- and post-intervention. Results: ANCOVAs, controlling for baseline, revealed significant differences between groups in mean levels of IFNγ and IL-6 (p=<0.05) and a trend toward differences in IL-8 and TNFαr1 (p<0.10) with significant baseline interactions for IFNγ, IL-6 and IL-8 (p<0.05) post-intervention. ANCOVAs revealed no significant differences between groups in mean levels of TNFα and IL-1β. Pearson correlations revealed a significant inverse association between changes in IL-8 (p<0.05;r=-0.64) and CRF and a trend toward an inverse association between changes in IL-6 (p=0.10;r=-0.44) and CRF in the HBEX condition but not in the SC condition. Conclusions: These data suggest that exercise-induced changes in IL-8 and IL-6 may mediate improvements in CRF. Future phase III randomized controlled trials are needed with larger samples to fully investigate these relationships. Funded by NCI grant 1R25CA102618. No significant financial relationships to disclose.
A randomized pilot study comparing aprepitant to olanzapine for treatment of chemotherapy-induced nausea and vomiting
Authors: Shumway N. M. , Terrazzino S. E. , Jones C. B. 
Published: August 2020

9633 Background: Chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC) is prevalent. The NK1antagonist, aprepitant (APR), has been shown to decrease CINV and with increased use, cost of supportive care is rising. Recent studies have shown that olanzapine (OLN) is safe and effective for CINV when used in combination with dexamethasone and palonosetron. We conducted a randomized, double-blind, placebo controlled pilot study to evaluate the use of OLN compared to APR for prevention of CINV in patients receiving HEC. Methods: Chemotherapy naïve patients receiving HEC were randomized to an APR containing arm or an OLN containing arm [see Table ] for the first 2 cycles of treatment. Patients recorded episodes of emesis and use of rescue meds using a daily diary and symptoms using the M.D. Anderson Symptom Inventory(MDASI). 18 patients consented to the protocol and 17/18 (OLN=8, APR=9) patients were evaluable (1 lost daily diary) with a median age 60 (range 24–71) 11/18 were females. Results: Chemo regimens for OLN group included (AC=50%, cisplatin=25%, ABVD=25%, and ifos=25%) and for APR (AC=55%, cisplatin=33%, and ABVD=11%) For both cycles (C1+C2) the complete response (CR=no emesis, no rescue) during the anticipatory period (D-2, D-1) was 87.5% in the OLN group compared to 77.8% in the APR group. Acute period (D1) CR rates were 75% in OLN vs. 44% in the APR group. Delayed (D2–4) CR rates were 62.5% in OLN vs. 55.6% in the APR group. Rates of nausea (score ≥ 1 on scale of 0–10, MDASI) were 25% OLN vs. 22.2% APR for anticipatory period, 62.5% OLN vs. 44.4% APR for acute period, and 62.5% OLN vs. 66.7% APR for delayed period. There were no grade 3 /4 toxicities. Conclusions: OLN containing antiemetic regimens were well tolerated and offered similar efficacy as APR containing regimens in preventing CINV in patients receiving HEC. Larger studies are needed to evaluate non-inferiority and potential cost savings of OLN containing regimens. [Table: see text] No significant financial relationships to disclose.