bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care training and burnout in oncology fellows
Authors: Schellhorn S. , Lessen D. S. , Levine R. L. , Panagopoulos G. , Arnold R. M. , Block S. D. , Buss M. K. 
Published: August 2020

9540 Background: Burnout among physicians is associated with fatigue, exhaustion, and depression, and can result in increased medical errors and sub-standard patient care. We sought to determine rates and predictors of burnout in oncology fellows. Methods: As part of a larger study on fellows' attitudes, education, and experiences in palliative care, we administered the 22 item Maslach Burnout Inventory (MBI) to second year U.S. oncology fellows. The 104 item instrument, modified from a survey of medical students, was revised after field testing and a pilot survey. The MBI measures three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); higher EE and DP scores and lower PA scores indicate burnout. Bivariate and multivariate analyses were used to find associations between burnout and fellow demographics, attitudes, and educational experiences. To accommodate for multiple testing, p<0.01 was considered statistically significant. Results: The response rate was 63.2% (254 of 402 eligible fellows). Gender, race, and location of medical school (U.S. vs. other) did not differ between respondents and non-respondents. Among respondents, 28.1% reported high EE, 30.0% reported high DP, and 26.8% reported low PA. Over half reported burnout in at least one domain (32.9% in one, 16.5% in two, and 5.5% in all three domains). The following associations were found on multivariate analyses. Fellows who identified as white had higher rates of EE (p=0.0006) while EE was lower in those who: 1) rated their program's overall teaching ‘very good‘ or ‘excellent‘ (p=0.005), 2) felt prepared to address spiritual issues around end-of-life care (p=0.002), and 3) felt prepared to manage their own feelings about illness and dying (p=0.008). Fellows who identified as white (p=0.008) or reported dreading encounters with emotionally distressed family members (p=0.0002) had higher DP. The only factor associated with higher PA scores was agreement that doctors have a responsibility to help patients prepare for death (p<0.0001). Conclusions: Over half of oncology fellows experience at least one domain of burnout. Higher quality teaching within their fellowship program and higher levels of self-assessed preparation to care for patients at the end of life are associated with lower levels of burnout. No significant financial relationships to disclose.
Outcomes of stereotactic body radiotherapy (SBRT) in 175 patients with stage I NSCLC aged 75 years and older
Authors: Senan S. , Haasbeek C. J. , Antonisse M. E. , Slotman B. J. , Lagerwaard F. J. 
Published: August 2020

9545 Background: Patients aged 75 years or older comprise more than 40% of all new cases of lung cancer. SEER data show lower compliance rates with guideline-recommended therapy in such patients. The elderly have increased post-surgical mortality and morbidity, and frequently require convalescence at extended-care facilities. SBRT is an image-guided technique used to deliver high biological doses of radiation in 3–8 fractions, in an outpatient setting. We report on clinical outcomes of SBRT in patients aged 75 years or older. Methods: Since 2003, 175 consecutive patients (67% male; 32% female) were treated with SBRT at a single center. The median age was 79 years, with 47% of patients aged 80 years or older. 56% of patients had T1 lesions and 44% T2 tumors. 79% of patients were considered medically inoperable and 21% declined to undergo surgery. Eligible tumors measured 6cm or less in maximal diameter, and all underwent an 18FDG-PET scan that revealed no metastases. The median age-adjusted Charlson co-morbidity score was 7 (range 2–12), and 25% had GOLD Class III or higher chronic obstructive pulmonary disease. Risk-adapted SBRT schemes were used with the same total dose of 60 Gy in 3 (31%), 5 (53%) or 8 fractions (16%) depending upon risk for toxicity. Quality of life was scored prospectively using validated EORTC instruments. Results: All patients completed planned SBRT and survival rates at 1 and 3 years were 85% and 46%. Survival rates correlated with performance score (p<0.01) and pre-SBRT lung function (p<0.01). Actuarial local-, regional- and distant failure rates at 3 years were 11%, 8% and 21%, respectively. 60% of patients reported no early side effects, and fatigue (31%), cough (6%), dyspnea (5%), local chest wall pain (3%) and chest wall erythema (2%) were observed in others. Severe late toxicity was uncommon, with RTOG Grade 3 or higher radiation pneumonitis observed in 2%, radiation-induced rib fractures in 2%, chronic chest wall pain in 3%, and non-malignant pleural effusion in 2% of cases. Conclusions: In a population consisting of frail elderly patients with stage I NSCLC, SBRT achieved high local control rates with minimal toxicity. This indicates that active diagnostic and therapeutic approaches are justified in elderly patients who may be unfit for surgery. [Table: see text]
Influence of age on receipt of chemotherapy for adult Medicaid beneficiaries with metastatic colorectal cancer
Authors: Klepin H. D. , Song E. Y. , Geiger A. M. , Tooze J. A. , Foley K. L. 
Published: August 2020

9548 Background: Although advances in systemic treatment for metastatic colorectal cancer (CRC) have improved survival, it is unclear if this treatment is administered routinely among vulnerable individuals. Our objective was to describe treatment patterns for low income individuals with metastatic CRC and evaluate the influence of age on delivery of treatment in the context of patient, community, and health care setting characteristics. Methods: Matched North Carolina Cancer Registry and Medicaid claims data were used to identify a cohort of 390 patients with metastatic CRC diagnosed between 1999 and 2002. We assessed the relationship between treatment delivered within one year of diagnosis and characteristics of the patient (age, gender, race/ethnicity, comorbidity), community (percent poverty, percent rural), and health care setting (academic medical center, surgery volume). Treatment delivery was categorized into: 1) receipt of any chemotherapy, 2) local therapy only, and 3) no treatment. We fit a logistic regression model comparing receipt of any chemotherapy to local treatment only and another comparing receipt of any chemotherapy to no treatment. Results: Patients' mean age was 65.1±14.6 years; 56.0% were female and 45.5% were non-white. Only 27.7% received chemotherapy, while 50.3% received local therapy only and 22.0% received no treatment. After adjusting for comorbidity and all other covariates, patients aged <75 years were more likely to receive chemotherapy than patients ≥75 (versus local treatment only, OR=3.2, 95% CI=1.7–6.1; versus no treatment, OR=3.9, 95% CI=1.9–8.3). Absence of significant comorbidity was associated with use of chemotherapy only when compared to those who received no treatment (OR=3.1, 95% CI=1.6–5.9). Race/ethnicity, community, and health care setting characteristics were not associated with treatment. Conclusions: Use of chemotherapy in this low income cohort was low compared to published reports in other populations. Younger age was the only characteristic in this analysis which was consistently associated with receipt of chemotherapy. These results suggest that older low income patients may represent a particularly vulnerable population with regard to treatment disparity. No significant financial relationships to disclose.
Use of the Comprehensive Geriatric Assessment (CGA) in elderly patients (pts) with solid tumors to predict mortality
Authors: Honecker F. U. , Wedding U. , Rettig K. , Huschens S. , Bokemeyer C. 
Published: August 2020

9549 Background: The internet based IN-GHO-Registry, a project of the Initiative for Geriatric Hematology and Oncology, supported by ORTHO BIOTECH, Division of Janssen-Cilag GmbH, Germany, prospectively collects data of elderly cancer pts. We report data from 1130 pts with solid tumors. Results of a CGA, physicians' and pts' judgement of fitness were studied in relation to mortality within 5–7 months. Methods: Demographic data, data on activities of daily living (ADL), instrumental activities of daily living (IADL), Karnofsky-Performance-Statuts (KPS), comorbidity (Charlson score), number of co-medication, mobility (Timed-Up&Go), cognition (MMSE), and depression (SCID screening) were collected. Age, results of CGA, physicians' rating (fit vs compromised vs frail) and pts' self rated fitness for treatment (Likert scale 1= very fit to 6 = very unfit) were analysed for association with death. Follow-up (FU) was scheduled 5–7 months after inclusion. Results: 1130 pts, mean age 76.3 years (SD 4.7; range 69–95), 44% male, were included. Main diagnoses were gastrointestinal tumors (38%), breast cancer (12%), and lung cancer (11%). Physicians rated 58% of pts fit, 37% compromised, and 5% frail. Pts' self rating of fitness: 1 = 19%, 2 = 30%, 3 = 28%, 4 = 17%, 5 = 5%, 6 = 1%. During FU (median 177 days), 272 pts (24%) died. Mean age (76.5 vs. 76.3; p=0.75) was not associated with death. However, sex (male vs female, p<0.001), BMI (24.4 vs 25.9; p<0.001), Charlson-score (6.3 vs 5.5; p<0.001), number of co-medication (4.5 vs 3.7; p<0.001), ADL score (87.9 vs 93.9; p<0.001), IADL score (6.2 vs 7.0; p<0.001), KPS score (75% vs 83%; p<0.001), MMSE (25.6 vs. 26.2; p=0.045), categorical Timed-Up&Go (less than 10s, 10–20s, more than 20s; p<0.001), categorical SCID (0, 1, 2; p=0.012), physicians' rating of fitness (fit, compromised, frail; p<0.001) and mean pts' rating of fitness (3.1 vs. 2.4; p<0.001) were significantly associated with death during FU. Conclusions: Pts characteristics as assessed by CGA and not age are associated with death in elderly pts with solid tumors. [Table: see text]
Cancer in the oldest old population in the United States: Current statistics and projections
Authors: Gundrum J. D. , Go R. , Kwong R. 
Published: August 2020

9553 Background: The oldest old, defined as people age ≥ 85 years, in the U.S. is projected to double from 4.3 million in 2000 to 9.6 million in 2030. Since cancer is the number one cause of death, it is critical to assess the current and projected cancer burden in this population. Methods: We obtained data from the Surveillance, Epidemiology and End Results (SEER) program. We included patients who had a previous cancer before age 85, but excluded benign tumors, myeloproliferative, and myelodysplastic neoplasms. Incidence was reported per 100,000 person years and age-adjusted to the 2000 U.S. standard population. For current statistics, we included years 2001–2005. Trend analyses were based on 1973–2005 data. Results: The oldest old represents 7.2% of annual new cancers cases diagnosed and 10.5% of cancer deaths in the U.S. The 10 leading cancers by incidence (both sexes and decreasing order) are colorectal (388.9), lung (287.7), breast (250), prostate (211.5), urinary bladder (162.5), non-Hodgkin lymphoma (110.9), leukemia (85.1), melanoma (65), renal (46.4), and uterine (40.2). The incidences of melanoma, non-Hodgkin lymphoma, renal, and lung cancers are increasing, while those of leukemia, prostate, breast, and colorectal cancers are decreasing. The top 5 causes of cancer deaths are lung and bronchus (21%), colorectal (15%), pancreatic (7.1%), prostate (5.9%), and breast cancers (5.3%). Cancer specific survival (CSS) has been increasing continuously since 1973 for melanoma, non-Hodgkin lymphoma, breast, colorectal, prostate, and urinary bladder cancers but decreasing in recent years for colorectal, breast, prostate, and uterine cancers. CSS for leukemia, lung, renal, and uterine cancers showed no change over time. If the current incidence trends for each cancer continue in a linear fashion, it is projected, using 1973–2005 data, that in 2030, the oldest old will represent 8.8% of annual new cancers cases diagnosed and 13.6% of cancer deaths. Conclusions: Cancer incidence and mortality trends in the oldest old differ from the general population. Because the oldest old are likely to have multiple co-morbid conditions, there is a need to find better ways to diagnose and treat cancers in this unique segment of the population. No significant financial relationships to disclose.
Hospitalization rates among survivors of childhood and adolescent cancer: A report from the Childhood Cancer Survivor Study (CCSS)
Authors: Kurt B. A. , Nolan V. G. , Ness K. K. , Neglia J. P. , Tersak J. M. , Hudson M. M. , Armstrong G. T. , Leisenring W. M. , Robison L. L. , Arora M. 
Published: August 2020

9556 Background: Survivors of childhood cancer have a high burden of chronic health conditions following cancer therapy, but the risk for subsequent hospitalization has not been reported. Methods: Hospitalizations during 1996–2000 among a cohort of 10,367 5-yr survivors of childhood cancer (diagnosed 1970–1986) and 2,540 siblings were ascertained. Age-and gender-stratified standardized incidence ratios (SIRs) for hospitalization were calculated using the sibling cohort and U.S. population from the National Hospital Discharge Survey (NHDS). Associations between demographic, cancer/treatment-related risk factors and non-obstetrical hospitalization among survivors were evaluated in multiple variable logistic regression models. Results: At follow-up, survivors were a mean of 20.9 yrs. from diagnosis (SD: 4.6, range: 13.3–32.2) and mean age of 28.6 yrs. (SD: 7.7, range: 13–51). Overall hospitalization rates among survivors were 1.5 times (95% CI 1.44–1.52) that of siblings and 1.2 times (95% CI 1.16–1.22) that of the U.S. general population. Increased risk of hospitalization was noted irrespective of gender, age at follow-up, or cancer diagnosis, with highest SIRs noted for male (SIR=12.7, 95% CI 9.5–15.8) and female (SIR=72.1, 95% CI 58.8–85.5) survivors aged 45–54. Females (OR=1.2, 95% CI 1.04–1.3) and survivors with a chronic health condition (OR=1.6, 95% CI 1.5–1.8) were more likely to have been hospitalized for non-obstetrical causes after adjusting for age at diagnosis, age at follow-up, cancer diagnosis, household income, insurance, and history of relapse/second malignancy. Among survivors, those with Hodgkin's lymphoma had the highest hospitalization rates for neoplastic, infectious, endocrine, pulmonary and cardiovascular causes. CNS malignancy survivors had the highest hospitalization rates for neurologic, psychological and external (e.g. traumatic) causes. Conclusions: Therapy for childhood and adolescent cancer is associated with a significant increase in subsequent hospitalization rates. Regular medical follow-up and early intervention for chronic health conditions may help to limit severe toxicity that would require hospitalization. No significant financial relationships to disclose.
Hospitalization of hyperglycemic lung cancer patients during treatment
Authors: Martin B. E. , Mott F. , Song J. 
Published: August 2020

9560 Background: Approximately 20 million Americans have type 2 diabetes mellitus. This same group is at significant risk of developing malignancy. Evidence suggest that diabetics with colon and breast cancer experience inferior treatment outcomes. There are few direct comparisons of treatment outcome and/or treatment tolerability in those with and without hyperglycemia. There are no such comparisons in lung cancer patients. We anticipate those with hyperglycemia will tolerate treatment less well than those with euglycemia. With this premise, we assessed hospitalization risk between lung cancer patients with normal or elevated baseline serum glucose (BSG) prior to initial chemotherapy cycle. Methods: After obtaining institutional IRB approval, tumor registry analysis identified 364 consecutive individuals diagnosed with lung cancer between 2005 and 2007 at our institution. One hundred and fifteen were excluded: 71 not treated, 17 duplicate entries, 16 stage 1A lung cancer, 8 missing data, 2 glucose under 60 mg/dl, 1 admitted for chemotherapy. Demographic and cancer specific data were obtained from the registry. Chart review yielded: BSG, date of first chemotherapy cycle, date of hospitalization, neutrophil count at admission, radiation therapy 30 days before/after treatment. Data presented was analyzed using multivariate logistic regression. We utilized WHO strata for fasting whole blood glucose measurements. Those presenting with grade 3 (or greater) neutropenia were excluded. Results: See Table . Conclusions: Lung cancer patients with hyperglycemia are more likely to be hospitalized in the 30 days following their first cycle of cytotoxic chemotherapy. We used the WHO glucose strata to analyze our data. Compared to those with normal BSG, those with BSG between 110 and 126 mg/dl were twice as likely to be hospitalized, and those with BSG over 126 mg/dl had four times the risk. We feel this simple metric will improve clinician's treatment decisions. Prospective analysis of diabetic cancer outcomes is needed. [Table: see text] No significant financial relationships to disclose.
Risk of mortality in patients with cancer experiencing febrile neutropenia
Authors: Barron R. , Michels S. L. , Reynolds M. W. , Tomic K. , Yu J. , Lyman G. 
Published: August 2020

9561 Background: Febrile neutropenia (FN) is a serious and potentially life-threatening condition that may develop in patients with cancer treated with chemotherapy. The risk of mortality from FN is not well characterized in clinical practice. Methods: Patients with cancer receiving chemotherapy in clinical practice were identified from the HealthCore Integrated Research Database, a geographically diverse spectrum of fully adjudicated longitudinal claims data from 13 health plans with over 20 million US lives. Patient enrollment data, full medical care, prescription drug use and mortality (confirmed using the National Death Index) were examined for each eligible patient. Patients experiencing FN were compared to propensity score-matched patients not experiencing FN within tumor types of Non-Hodgkin lymphoma (NHL), breast, lung, colorectal and ovarian cancer. Study endpoints included overall mortality (anytime during follow-up) and early mortality (during a chemotherapy course). Logistic regression was used to calculate odds ratios (OR), adjusted for demographics, comorbidities, and other covariates. Results: Matched FN and control groups each contained 5,176 patients. Crude incidence rates of overall and early mortality were significantly higher for patients in FN group compared to controls for all tumor types [7.9/1000 person-months (PM) (95% confidence interval [CI] = 7.3, 8.5) vs. 5.6/1000 PM (CI = 5.1, 6.1), P < 0.0001; and 3.4/1000 PM (CI = 3.1, 3.9) vs. 2.4/1000 PM (CI = 2.1, 2.8), P = 0.0001, respectively]. Within tumor strata, lung cancer had the highest mortality rates and breast cancer had the lowest; NHL had the largest magnitude of difference between FN and controls (overall mortality: 7.2/1000 PM [CI = 5.3, 9.7] and 3.3/1000 PM [CI = 2.1, 5.1], P = 0.0035; early mortality: 3.0/1000 PM [CI = 1.8, 4.8] and 1.5/1000 PM [CI = 0.8, 3.0], P = 0.1103). Logistic regression demonstrated a significant increase in risk of overall and early mortality in patients with FN compared to controls (OR = 1.77 [1.53, 2.05] and OR = 1.73 [1.41, 2.11]) respectively. Conclusions: The crude and adjusted risk of mortality in patients experiencing FN is almost two-fold higher than comparably matched patients without FN. Prevention of FN is of high importance and should be carefully considered in clinical practice. [Table: see text]
The epidemiology of herpes zoster in patients with invasive cancer
Authors: Habel L. A. , Ray G. T. , Horberg M. , Yawn B. , Castillo A. , Li Y. , Silverberg M. , Quesenberry C. , Tran T. 
Published: August 2020

9562 Background: Given the limited available data, the aim of this study was to estimate the incidence of Herpes Zoster (HZ) in cancer patients. Methods: In this retrospective cohort study, we used the Kaiser Permanente Northern California cancer registry to identify adult health plan members diagnosed with an invasive hematologic malignancy (HM) or solid tumor malignancy (STM) during 2001–2005. Potential episodes of HZ were ascertained from time of cancer diagnosis through 2006 from electronic databases using inpatient and outpatient diagnoses, laboratory tests, and prescriptions for antivirals. HZ diagnoses were confirmed by abstraction and clinical review of information from patients' inpatient and outpatient medical records. Incidence rates were calculated as the number of new occurrences of HZ per person-time of follow-up. Age-standardized incidence ratios (SIRs) were computed to compare HZ rates in cancer patients to reported rates in the general population (Yawn et al, 2007). Results: Among the 4,728 STM patients (mean age 66 years, range 18–102), the rate of HZ was 12/1000 person years (py) of follow-up (total 9170 py). Among the 1504 HM patients (mean age 67 years, range 18–97), the rate of HZ was 33/1000 py (total 2355 py). The SIRs and 95% confidence intervals for STM and HM were 1.7 (1.4–2.1) and 4.5 (3.5–5.6), respectively. Among patients with HM, incidence rates were highest in the first year after cancer diagnosis (40/1000 py); rates did not appear to vary markedly over time among patients with STM. For either cancer type, HZ rates were similar for males and females and did not increase consistently with increasing age. Conclusions: Compared to the general population, the incidence of HZ was nearly 2 times higher in patients with STM and over 4 times higher in patients with HM. HZ rates did not differ markedly by age or gender. [Table: see text]
Assessing simple measures of patient-reported (PR) fatigue for oncology clinical trials: A pooled analysis of 3,915 patients
Authors: Liu H. , Sloan J. A. , Sargent D. J. , Satele D. V. , Schaefer P. L. , Halyard M. Y. , Grothey A. , Garces Y. I. , Brown P. D. , Buckner J. C. 
Published: August 2020

9563 Background: Fatigue is a prevalent and debilitating symptom reported by cancer patients (pts) which compromises a pt's quality of life (QOL). This study examined the relationship between PR fatigue and QOL as well as cancer-related symptoms (CRS) in 43 North Central Cancer Treatment Group and Mayo Clinic Cancer Center clinical trials. Methods: 3,915 pts from 43 oncology clinical trials provided baseline fatigue data on a single-item 0–100 point scale. Pts' QOL assessment included a single-item overall QOL and associated QOL domains measured by numerical analogues, the Profile of Mood States (POMS), and PR symptom assessment measures. Associations between fatigue and QOL domains were assessed by Spearman correlation coefficients. Wilcoxon rank sum test compared QOL scores between pts with clinically deficient fatigue(CDF, score ≤50) vs. no clinically deficient fatigue (nCDF, score>50). Changes from baseline in fatigue and QOL were compared by Wilcoxon rank sum test with a 20-point change defined as clinically meaningful. Results: 38% of pts reported CDF at baseline and 45% of pts reported CDF at last assessment. Fatigue was only moderately correlated at best with overall QOL, pain, POMS, social and physical function (Spearman rho's of .27,.40, .56, .38 and .38 respectively). Pts with CDF averaged over 10 points lower overall QOL, pain, POMS, social, and physical function (see table below, all p<.0001) as well as worsening CRS including sleepiness, nausea, headache, abnormal sweating, trouble sleeping, dry mouth, and sexual dysfunction (all p<.001). Pts with 20+ points worsening in fatigue declined in overall QOL, physical function, pain and POMS (all p<.0001). Conclusions: Patients with CDF suffer greater deficits in QOL and CRS. Patients report fatigue as distinctly different from overall QOL, pain, physical, social, mood status and CRS. Fatigue appears with a broad spectrum of CRS clusters. Routine measurement and management of fatigue could impact QOL and treatment-related symptoms. [Table: see text] No significant financial relationships to disclose.