bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of geographic distance from a cancer centre on choice of systemic therapy in metastatic colorectal cancer
Authors: Seal M. D. , Pond G. R. , Wilkieson T. , Hotte S. J. 
Published: August 2020

e17559 Background: There is little data on whether geographic distance from patient residence to a treatment facility is a predictor of systemic therapy utilization or clinical trial (CT) enrollment. Therefore a retrospective chart review was undertaken to investigate this variable. Methods: Consecutive patients with metastatic colorectal cancer (mCRC) assessed by a medical oncologist at the Juravinski Cancer Centre (JCC), Ontario during 2006 were selected. Patients with pathology other than adenocarcinoma and those with complete surgical resection of metastases were excluded. Distance and time to JCC were calculated using online mapping software. The study received full ethics approval. Results: 276 patients were included with full data available on 169 patients. Median travel time and distance to JCC were 23.0 minutes (min) and 19.2 kilometers (km), respectively. The maximum travel time was 120 min and 87% of patients lived within 60 min of JCC. Distance and time were highly correlated (p<0.0001). Overall, 43% of patients had discussed a CT with their oncologist and 20% enrolled in a CT. Patients living >50 km from JCC were less likely to discuss a CT (38%) or participate in a CT (15%) than patients who lived 25–50 km (39% and 19%) or <25 km (47% and 23%) from JCC. These trends did not attain statistical significance (odds ratio [OR] = 0.88, 95% CI = 0.66–1.17, p = 0.39 for CT discussion, OR = 0.76, 95% CI = 0.54–1.08, p = 0.13 for CT enrollment). Distance was not a statistically significant (p = 0.42) predictor of number of treatment regimens, however, 44% of patients <25 km from JCC received 3 or more lines of treatment compared with 33% of patients ≥25 km away. No association with survival was observed. Conclusions: Patients with mCRC living ≥25 km from JCC received fewer systemic regimens and were less likely to discuss or enter a CT. These trends were not statistically significant. Data collection is ongoing to increase the power of this study. No significant financial relationships to disclose.
Analysis of the costs of bevacizumab plus cisplatin and gemcitabine versus cetuximab plus vinorelbine and cisplatin in patients with advanced non-small cell lung cancer (NSCLC) in France: Results from a cost modelling study
Authors: Chouaid C. , Vergnenègre A. , Florentin V. , Walzer S. 
Published: August 2020

e17560 Background: New treatment options for advanced NSCLC can offer improved survival over standard chemotherapy (CT). Bevacizumab (BEV), a humanized monoclonal antibody (MAb) directed against VEGF when combined with CT increases overall survival (median 13.6 months in the AVAiL study) and progression-free survival (PFS) in patients with advanced NSCLC compared with CT alone. Cetuximab (CTX), an IgG1 MAb which targets the epidermal growth factor receptor, achieved a median survival of 11.3 months when combined with CT in the FLEX study; marketing authorization is anticipated during 2009. The aim of this study was to compare the costs of treating patients with BEV plus cisplatin and gemcitabine (BCG) versus CTX plus vinorelbine and cisplatin (CVC) in France. Methods: A Markov model was used to compare drug and administration costs associated with treating advanced NSCLC with either BCG or CVC. The model assumes patients move from non-progressive to progressed disease to death, according to transition probabilities derived from an indirect comparison of the efficacy of BCG and CVC in terms of PFS using data from the respective pivotal trials and appropriate indirect comparison methodology. Cost data were derived from local sources. Drug costs assumed CT was given for up to 6 cycles, that CTX was administered at an initial dose of 400 mg/m2 followed by 250 mg/m2 weekly until progression and that BEV was administered at 7.5 mg/kg every 3 weeks until progression. The model estimated average drug and administration costs per patient treated with either BCG or CVC. Results: The mean cost for BCG and CVC was €23849 and €35678 respectively, resulting in a saving of €11829 per patient for BCG. The acquisition of BEV was less costly than the acquisition of CTX (€15374 vs €23530) and, BCG acquisition and administration costs were lower than CTX's respectively, €19756 versus €24750 and €4093 versus €10928. Conclusions: Targeted therapy using BEV is less costly than CTX in France, and therefore, from a budget perspective offers the best value for money approach to improving outcomes in patients with advanced NSCLC. [Table: see text]
Implementation of an integrated cancer care network
Authors: Latreille J. , Samson A. , Tran U. , Mimeault C. , Boily C. , Laflamme B. , Loutfi A. 
Published: August 2020

e17564 Background: In 1998, the province of Quebec adopted its cancer control program (CP). Its goal was to establish a hierarchical and integrated cancer network of interdisciplinary teams. In 2004, a team evaluation process was initiated by the Direction de la lutte contre le cancer (ministry of health) to help implement this program. Methods: The evaluation consisted of completion of a matrix by the requesting team, a visit by a multidisciplinary group of experts and a report card. Three levels of expertise were assessed: core (all), regional (regional hospitals), and supraregional (tumor specific/complex situations). The matrix was based on the fundamental orientations of the CP, thus setting the framework for patient centered care. The conformity indicators were mainly structural and process oriented. In order to be evaluated for the subsequent mandates, teams had to conform to the core mandate. Those who did not succeed had one year to reapply. Mandates are for 4 years. Results: Teams were able to comply with most of the elements of the evaluation matrix. Sessions for clarification and coaching about this new interdisciplinary approach were necessary and helpful. A total of 153 visits were done:70 for core, 8 for regional and 75 for supraregional mandates respectively. Major health institutions such as university hospitals applied for multiple supraregional team designation. In all, 130 teams had their designation confirmed. This process highlighted some common weaknesses such as the lack of use of data for quality control. Conclusions: Acceptance of this hierarchical cancer care model was facilitated by the fact that it was in line with the integrated health care network of Quebec. The evaluation process has had an impact on the way cancer care is delivered in Quebec. This initial phase has helped implement an interdisciplinary patient centered model of care in line with the CP. Participation of different experts has also helped foster knowledge transfer and appropriation of the process. Impact on patient care and satisfaction remains to be assessed. An initial patient's questionnaire has been completed in 2008 and will serve as a control to future surveys. No significant financial relationships to disclose.
Validation of a global self-assessment and peer-review quality programme dedicated to comprehensive cancer centres: A method to assess, improve and promote quality of integrated care, research, and education in cancer centers
Authors: Saghatchian M. , Hummel H. , Otter R. , de Valeriola D. , van Harten W. , Paradiso A. , Lovey J. , Kasler M. , Fumoleau P. , Ringborg U. , Tursz T. 
Published: August 2020

e17565 Background: Oncology is a specialty requiring a combination of multidisciplinary expertises, novel technology, integration of innovation into care and research efforts in order to improve the quality of life and survival of patients. Provision of high-quality care and improvement of disease outcome should be promoted in cancer centers. Methods: The Organization of European Cancer Institutes developed an Accreditation Programme combining: 1-a quantitative questionnaire assessing the human, technical and financial resources and activities in care, research and education dedicated to oncology; 2- a set of standards and criteria for high-quality cancer management integrated in an electronic tool with a scoring system of compliance; 3- a peer-review process for review of the self-assessment outcome and on-site visits; 4- a report and improvement plan allowing to designate comprehensive cancer centers complying with required criteria for high-quality comprehensive cancer patient management. All components of the Accreditation Programme were tested in 8 different voluntary cancer centers in Europe. The objectives were to assess the feasibility, reproducibility and acceptance of the Accreditation Programme; to improve the standards and criteria in terms of understanding and consensus; to validate the peer review methodology and establish a method for reporting and implementing an improvement plan; to provide with a preliminary system of designation of comprehensive cancer centers based on criteria of high-quality integrated research, care and education. Results: The 2 consecutive pilot tests allowed to validate 1- relevant items for the quantitative questionnaire; 2-criteria and standards for high-quality integrated multidisciplinary cancer patient's management. 3-The impact of the Accreditation Programme on improvement of patients management and professionals involvement. Conclusions: The OECI Accreditation Programme is ready for dissemination. Participation to the Programme allows development of improvement plans for innovative and integrated comprehensive cancer patients management in cancer centers. No significant financial relationships to disclose.
The financial implications of a conversion from enoxaparin to dalteparin as the LMWH of choice at a comprehensive cancer center
Authors: Patterson S. G. , Johnson P. , Bradbury B. , Tata J. , Quilitz R. , Carlton R. , Bramley T. , Wetzstein G. 
Published: August 2020

e17566 Background: To assess the financial implications of a conversion from enoxaparin to dalteparin as the low molecular weight heparin (LMWH) of choice at a large, comprehensive cancer center. Methods: A full class review of LMWH's was conducted in September of 2007 resulting in dalteparin replacing enoxaparin as the LMWH of choice. The Pharmacy and Therapeutics Committee approved automatic substitution with notification of the prescribing physician. The one exception to the policy was conversion if the patient was on enoxaparin at home, the policy would allow for continuation of therapy. Once the policy was approved, laminated dosing conversion cards and pre-printed order sets were developed. Multiple in-services were held prior to the official conversion date of October 15, 2007, to address any issues and to facilitate the conversion. Cost comparisons were made within individual settings adjusting for utilization levels. Results: In the fiscal year prior to the conversion from enoxaparin to dalteparin the cancer center purchased nearly $360,000 of enoxaparin for the inpatient and infusion center settings. In the year following the LMWH change, the total projected cost for LMWHs is $244,000, resulting in a 32% cost savings of $115,000. Conclusions: The change from enoxaparin to dalteparin resulted in significant cost savings for the cancer center. Additional studies are underway to examine the clinical outcomes of the LMWH change. No significant financial relationships to disclose.
Why are patients lost to follow-up in a gynecologic oncology clinic?
Authors: Garcia V. C. , Manalo A. M. , Toral J. B. , Siasu M. L. 
Published: August 2020

e17571 Background: The aim of this study is to investigate why patients are lost to follow-up in a gynecologic oncology clinic. Methods: Patients who had been lost to follow up previously, and eventually followed up between April and August 2007 were given a consent form and questionnaire to answer. An approximately equal number of patients who were not lost to follow-up were given the same questionnaire as controls. The first part of the questionnaire included the age, marital status, location, diagnosis/type of gynecologic cancer, type of intervention, educational attainment, occupation and monthly income. The second part asked directly the reason why they were lost to follow-up. Data were recorded in a computerized database via Microsoft Excel. Descriptive statistics were presented in mean, median, standard deviation, minimum, maximum and frequencies. Differences between patients who failed to follow-up (LF) and their controls (NLF) with respect to demographics, disease and treatment characteristics were assessed by an x2 test or independent t test, depending on the variable. SPSS version 15 was used to perform all analyses. A p < 0.05 was considered significant. Results: There were 50 patients who were not lost and 52 patients who were lost to follow-up. The demographic characteristics between these two groups; i.e., age, marital status, location, diagnosis/type of gynecologic cancer, type of intervention, educational attainment, occupation, and monthly income of patients were all not statistically significant. The most common reason why patients were lost to follow-up was they had no money. Other reasons included: symptoms became better or problems resolved, the follow up was at an inconvenient time and I had family commitment. Conclusions: Patients expressed that the main reason for not following-up was the lack of funds. The majority in these respondents lived below the minimum salary wages. No significant financial relationships to disclose.
Video linked medical oncology clinics: A novel way to improve patients’ access to medical oncology services in rural Australia
Authors: Marr I. , Sabesan S. 
Published: August 2020

e17573 Background: To improve the access of Mt Isa patients to medical oncologists, Townsville Cancer Centre runs weekly medical oncology clinics via videolink. Aim of this study was to assess patient satisfaction, safety of chemotherapy delivery, and cost effectiveness of such technology. Methods: Between 2006 and 2008, 42 patients were seen. A questionnaire based survey was conducted by telephone to assess patient's level of satisfaction and quality of communication. Safety of chemotherapy delivery was evaluated by retrospective chart audit. Results: 25 patients completed the questionnaire. Six were new patients and the rest were for review leading to more than 90 encounters. Satisfaction: 100% of those interviewed were satisfied with the care given by the Townsville Cancer Centre. Of these 88% felt they developed a friendly relationship with the specialist. 90% felt medication could be taken without any concerns after videolink. 27% of patients interviewed felt examination was needed by the specialist, but 92% of the patients would rather see the specialist via videolink than travel to Townsville. Overall 96% felt it saved time, money and was convenient. Responses, apart from the question about the need for physical examination by the specialist, were more than 80% in agreement. Safety: 32 patients received active therapy. 60% were treated with palliative intent and the rest adjuvant. The median number of cycles was 5 (1–8). A total of 4 patients were admitted for complications- 2 for febrile neutropenia and 2 for emesis.There were no treatment related deaths. Cost effectiveness: Factors for consideration were cost of patient and specialist travel and accommodation,cost of interruption of routine clinics at specialists’ home, cost of video link apparatus and maintenance and cost of disturbance of quality of life for patients and doctors resulting from travel. Conclusions: Satisfaction with video linked clinics is high. It saves travel time for the patients and specialists and seems to be cost effective. It is safe to supervise chemotherapy administration using this technology. Therefore, this method of service delivery could be adopted by medical oncology departments to improve services to the rural and remote areas. No significant financial relationships to disclose.
A medical decision tree for the prophylaxis (P) and treatment (T) of tumor lysis syndrome (TLS): An international TLS consensus panel
Authors: Goldman S. , Coiffier B. , Reiter A. , Younes A. , Cairo M. S. ,   on behalf of the International TLS Expert Panel
Published: August 2020

e17575 Background: We (MC) previously established a definition of laboratory (LTLS) and clinical TLS (CTLS) and associated grading system (Cairo et al, BJH. 2004). Additionally, we recently reported an evidence based review of guidelines for the P and T of TLS (Coiffier et al, J Clin Oncol. 2008). Rasburicase (R), a recombinant urate oxidase, results in a more rapid and total reduction of uric acid (UA) compared to allopurinol (A) in children at high-risk of TLS (Goldman/Cairo et al, Blood. 2001) and a rapid reduction in UA in adults at high-risk of TLS (Coiffier et al, J Clin Oncol. 2003). It still remains to be determined which patients at risk of developing TLS should receive R versus A as initial TLS prophylaxis. Methods: We convened an international panel (N = 17) of experts in pediatric and adult hematological malignancies and solid tumors (ST) to develop a medical decision tree for the P and T of TLS based on the risk classification (low, medium, high) and management recommendations of Coiffier et al (J Clin Oncol. 2008) Results: Patients without evidence of LTLS were assigned to either low-risk disease (LRD), medium-risk (MRD), or high-risk (HRD). Risk factors included pathological classification stage, bulk, disease burden (WBC/LDH) and renal impairment/involvement. HRD was assigned to patients with either B-ALL, ALL/AML ≥100K/mm3, BL/LL stage III/IV, and/or high LDH, DLBCL/PTCL/MCL/ATL with bulky and elevated LDH and patients with MRD with renal impairment/involvement. MRD consisted of ALL ≤100K/mm3, AML 25–100K/mm3, BL/LL stage I/II and low LDH, childhood ALCL, DLBCL/PTCL/MCL/ATL non-bulky but elevated LDH, CLL treated with targeted therapy, and LRD with renal impairment/involvement. LRD consisted of ST (except bulky sensitive to cytotoxic therapy [MRD]), CML, MM, HL, other NHL and AML <25K/mm3. Conclusions: This medical decision tree will facilitate the practice of management of the P and T of TLS and hopefully improve the quality of care in a cost effective manner. *all authors have equal authorship and contribution [Table: see text]
Concomitant pemetrexed/carboplatin chemotherapy with 3-D conformal radiotherapy followed by pemetrexed/carboplatin consolidation chemotherapy in locally advanced non-small cell lung cancer in a Chinese population
Authors: Ma S. , Xu Y. , Yu X. 
Published: August 2020

e18502 Background: Pemetrexed in combination with carboplatin has been shown to have promising activity, as well as superior toxicity profile in advanced non-small cell lung cancer(NSCLC). Radiotherapy(RT) has been shown to improve survival of patients with locally advanced NSCLC when combined with other platin doublets. This phase II study of concomitant pemetrexed/carboplatin chemotherapy(CT) with 3-D conformal RT followed by pemetrexed/carboplatin consolidation CT in locally advanced NSCLC was designed to evaluate the efficacy and safety of this novel regimen. This report presents preliminary information of 10 patients who have completed treatment. Methods: 10 chemoradiation (CRT)-naive and stage IIIA or IIIB (not effusion) with KPS≥80 patients were included in this study between February 2008 and October 2008. Patients received pemetrexed 500 mg/m2, carboplatin AUC 5 CT repeated q3 weeks for 2 cycles concomitant with RT and 3 cycles of consolidation pemetrexed (500 mg/m2) and carboplatin (AUC=5) q3 weeks. Median total dose of RT, without elective nodal irradiation, was 62 Gy (range: 60-66 Gy) with 2 Gy daily fractions. Results: 1 (10%) and 8 patients (80%) had a complete or partial response respectively, while 1 patient(10%) had progression of the disease(brain metastases). The overall response rate (90%,95% confidence interval (CI): 68%-97%) exceeded the goal per study design. After concomitant CRT, the main toxicity was neutropenia, with a median ANC nadir of 1.6, three patients had Grade 3 neutropenia, One patient had Grade 4 neutropenia. Grade 3 thrombocytopenia was seen in one patient, grade 3 esophagitis in one patient and grade 3 radiation pneumonitis in one patient. Consolidation CT was not administered to 3 patients- one due to the development of brain metastases during the first month after chemoradiation, one due to patient refusal and one due to grade 3 radiation pneumonitis. Conclusions: This preliminary data suggests that concomitant treatment was well tolerated, with promising activity and a significant improvement of QoL in a Chinese population with locally advanced NSCLC. No significant financial relationships to disclose.
Cisplatin and docetaxel plus concurrent three-dimensional (3D) conformal radiotherapy in unresectable stage III A/B NSCLC
Authors: Arcangeli L. , Orlandini B. , Torre M. , Carbonini C. , Sbarufatti A. , Vattemi E. 
Published: August 2020

e18503 Background: Concurrent chemoradiation is standard of care for most patients with unresectable stage III A/B NSCLC but no standard chemotherapy regimen/schedule has been established. We conducted an experience to evaluate the efficacy and toxicity of a combination consisting of weekly docetaxel/cisplatin and radiotherapy in patients with unresectable stage III A/B NSCLC. Methods: Unresectable stage III A/B NSCLC pts with a good performance status (ECOG PS 0–1) were eligible. Patients with stage IIIB were chemonaive, while patients with stage IIIA were inoperable after a first line platinum-based chemotherapy. Treatment consisted of docetaxel 25 mg/m2 IV infusion followed by cisplatin 25 mg/m2 IV infusion was administered weekly during concurrent thoracic radiotherapy. Concurrent 3D-conformal RT thoracic radiation consisted of 45 Gy (1.8 Gy fractions 5 days/wk for first five weeks. Results: From 2006/01 to 2008/04, 16 pts were enrolled and all were evaluable for toxicity and response. Pt. characteristics: median age- 68 years (54–77), 80% males. Nine pts had stage IIIA (56%) and 7 patients had stage IIIB (44%).Histology subtypes included epidermoid (25%) and adenocarcinoma (75%). Radiologic response was seen in 11 patients (68%). Four patients had a stable disease (25%). Disease progression has occurred in 1 pt. Six patients undergone surgery after chemo-radiotherapy (37%). Four patients (25%) underwent a radical resection without residual mediastinal malignant disease. Toxicity was mild. Conclusions: Weekly docetaxel/cisplatin with concurrent 3D-conformal RT thoracic radiation plus is a well-tolerated out-patient regimen. and is feasible by multi-physicians collaboration group. No significant financial relationships to disclose.