bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions and barriers towards clinical trials participation in Asian cancer patients.
Authors: Soh I Peng Thomas , Tay Cheong Kiat Julian , Ho Gui Yi , Pang Angela , Voon Pei Jye , Ling Winnie Hui Yee , Tan Chee Seng , Lee Soo-Chin 
Published: March 2020

e19523 Background: There is currently limited data on the perceptions and attitudes of Asian cancer patients towards therapeutic clinical trials (CTs). Understanding this is crucial to their successful execution. Methods: From May to December 2011, we surveyed cancer outpatients at the National University Cancer Institute, Singapore, and collected data on patient demographics, tumor information, awareness, perceptions, and willingness to participate in CTs. Results: 240 patients were surveyed, including 85 (35%) who had previously participated, 141 (59%) who had never participated, and 14 (6%) who had refused participation in a CT. The majority was Chinese (78.8%) or Malay (16.7%), 57.5% was female and median age was 56 years (range 22-83). There were no differences in demographics between patients who had, had not or refused participation in a CT. 135 patients (56%) had prior awareness of CTs, and were more likely to be female (p=0.027) or had metastatic disease (p=0.002). 111 (46%) patients were willing to participate in CTs given the opportunity, and were more likely to have prior awareness of CTs (76.6% vs 38.8%, p<0.001), to believe that CT sponsorship covers only the cost of trial drugs (52.3% vs 24%, p<0.001), and to state that paying for non-trial related or standard expenses was reasonable (35.1% vs 19.4%, p=0.006), compared to patients who were not willing to participate. Patient age, gender, education, income, or availability of health insurance did not influence willingness to participate. The majority of patients who had participated in CTs (66/85, 78%) reported only positive experiences, while 13 (15%) reported mixed experiences, and only 2 (2.4%) reported only negative experiences. The feeling of being treated as ‘guinea pigs’ (n=7), and fear of toxicities (n=5) were the main reasons cited for refusal to participate in CTs. Conclusions: Asian patients have moderate awareness of CTs, and slightly less than half the patients surveyed were willing to participate in CTs. Prior knowledge of CTs was associated with increased willingness to participate, and improving awareness through education could facilitate enrollment.
Palliative inpatient chemotherapy: Clinical benefit or harm?
Authors: Ali Maria , Cripps M. Christine , Balchin Katelyn , Spencer Jennifer , Wheatley-Price Paul 
Published: March 2020

e19527 Background: Palliative chemotherapy (CT) is given with the goals of palliating cancer symptoms and prolonging life. Patients with a poor performance status (PS) generally derive less benefit from CT and may experience greater toxicity. Advanced cancer patients admitted to hospital generally have a poor PS, and yet palliative CT is often administered to hospitalized patients. The evidence to support palliative CT in hospitalized patients is scarce. We hypothesize that palliative in-patient CT does not result in meaningful clinical benefit. Methods: With ethics approval, a retrospective chart review was undertaken to report outcomes from in-patient CT at the Ottawa Hospital Cancer Centre between April 2008- January 2010. From hospital pharmacy records, all advanced solid tumor patients receiving in-patient palliative CT were identified. Patients receiving radical, curative, neo- or adjuvant therapy, or those admitted for an inpatient regimen, were excluded. The primary endpoints were overall survival following CT, place of discharge from hospital, and whether further CT was received. Results: We report 199 in-patients (23% breast cancer, 22% small cell lung cancer, 16% NSCLC, 39% other) who received CT (median 1 cycle, range 1-5) during the study period. The median age was 61 (range 19-88); 59% were female. The main reasons for hospital admission were dyspnea (31%) or pain (29%). At baseline 25% were anemic, 36% had leucocytosis and 70% were hypoalbuminemic (<30g/l). 67% were receiving 1st line CT. The median overall survival was 4.5 months (95% CI: 3.2 - 5.8). Longest survival was seen in SCLC patients (7.3m). 77% of patients were discharged home, but 17% died during the admission. 72% of patients received further systemic therapy. Factors significantly associated with shorter survival were hypoalbuminemia (HR 1.52, 95% CI 1.06- 2.18, p=0.02), and therapy in 2nd line or beyond (HR 2.10, [1.37-3.23], p<0.001). Receiving treatment beyond 1st line, and baseline leucocytosis, were both significantly associated with patients being less likely to be discharged home or receive further CT. Conclusions: While in-patient palliative CT is associated with short survival, many patients remain well enough to be discharged home and receive further therapy.
An evaluation of the drug interaction potential of netupitant with digoxin.
Authors: Baumann Sybille , Olivari Tilola Silvia , Spinelli Tulla , Timmer Wolfgang 
Published: March 2020

e19530 Background: The new, highly selective neurokinin-1 receptor antagonist netupitant (NETU) has been developed to provide protection from nausea and vomiting in patients receiving emetogenic chemotherapy. There is evidence from in vitro studies that NETU is a substrate for and a weak inhibitor of the P-glycoprotein (Pgp). Pgp plays a major role in the pharmacokinetics of digoxin (DIG), a cardiac glycoside with a narrow therapeutic index. The possible interaction between NETU and Pgp has been assessed by analysing the effect of NETU on DIG pharmacokinetics. Safety parameters have also been assessed. Methods: This study was an open-label, fixed-sequence design to evaluate the effect of NETU on DIG at steady state in 16 healthy volunteers (8 male and 8 female). A loading dose of 3 x 0.5 mg DIG (0.5 mg every 6 hours) was given on day 1, followed by a daily oral dose of 0.25 mg DIG for 11 consecutive days (days 2-12); NETU was administered as single oral dose of 450mg on day 8. Serial blood and urine samples were collected for the determination of the pharmacokinetic parameters. Physical examination, vital signs, electrocardiogram (ECG), adverse events, clinical chemistry, hematology, urinalysis, and overall tolerability were reported. Results: Based on the AUC(0-24h) parameter at steady-state, the extent of DIG exposure was not influenced by NETU coadministration. The confidence interval of Cmin was within the 80-125% equivalence limits, while the observed Cmax was slightly over 125%, which was not considered clinically relevant. The excretion of DIG in urine was 57% after NETU coadministration compared to 55% of DIG alone. There were no gender-specific differences in the extent of absorption (AUC) for DIG, and no safety-related influence of DIG or NETU was observed on safety and laboratory assessments, vital signs, or ECG parameters. Based on historical data NETU pharmacokinetics was not affected by DIG coadministration. Conclusions: No clinically relevant interactions occurred between NETU and DIG. The results of this study suggest that the coadministration of NETU with Pgp substrates may not require dose adjustments. Study treatments were well tolerated.
Association of race and ethnicity with hospice use in pediatric oncology patients.
Authors: Thienprayoon Rachel , Leonard David , Lee Simon Craddock , Winick Naomi Joan 
Published: March 2020

e19536 Background: Palliative care is aimed at preventing or relieving symptoms and suffering caused by a life-threatening condition. At the end of life, hospice is an important provider of palliative care. Adult minorities are underserved by hospice, but little is known regarding the prevalence of pediatric hospice use or the characteristics of its users. We sought to determine whether race and ethnicity were associated with hospice enrollment in pediatric cancer patients. Methods: We undertook a retrospective cohort study of oncology patients in our institution who died between January 1, 2006 and December 31, 2010. Inclusion criteria were patients treated for cancer or bone marrow transplant in which a hospice referral was appropriate. Exclusion criteria were age greater than 18 at diagnosis, death off treatment unrelated to cancer, transfer of care, death due to trauma or an acute process, if oncology or bone marrow transplant was not the primary service and if a patient was lost to follow up but recorded as deceased. The primary outcome variable was hospice enrollment, the primary predictor variable was race/ethnicity, and secondary predictor variables were patient diagnosis, religion and payer status. 202 patients were initially identified; 114 were eligible for the study, of which 95 were enrolled on hospice. The most common reason for ineligibility was death due to an acute process (n=46); other reasons included transfer of care (n=18), oncology not the primary service (n=9), patients lost to follow up and recorded as deceased (n=7) and death off treatment unrelated to cancer (n=2). Results: Multivariate logistic regression determined that race was significantly associated with hospice use (p=0.02), even after controlling for patient diagnosis (p=0.01) and payer status (p=0.04). In patients enrolled on hospice, race was not significantly associated with dying on hospice (p=0.10), even after controlling for diagnosis (p=0.08), payer status (p=0.15) and religion (p=0.57). Conclusions: These results indicate that cultural factors play a role in hospice enrollment in pediatric oncology. More studies are warranted to elucidate these factors, and to understand why families choose hospice for children dying of cancer.
Self-assessment system of febrile neutropenia (FN) by patients receiving ambulatory chemotherapy for solid tumor.
Authors: Kitao Akihito , Matsumoto Koji , Tanioka Maki , Negoro Shunichi 
Published: March 2020

e19548 Background: Febrile neutropenia is one of the oncology emergencies, which usually should be timely assessed and treated at the hospital. In some areas of Japan, however, medical resources are limited in especially nights and holidays. In Hyogo Cancer Center department of medical oncology, majority of pts have breast and gynecologic (GYN) malignant disease, those who are relatively young and without COPD. These pts may be managed by a self -assessment system of FN, although the feasibility is still unknown. Methods: Self assessment system consists of three steps, such as, prescription of Ciprofloxacin 1200mg b.i.d., educating pts by the team (doctors, pharmacists, and nurses) with written material, and evaluation at the hospital if febrile episode (FE) continues for longer than 48 hours. FE is defined as body temperature higher than 38 °C. Frequency of FE, admission to the hospital, ICU stay, and 30 days mortality rate were assessed retrospectively. Results: From Aug. 2006 to Oct. 2011, 476 pts were treated in ambulatory chemotherapy center under self-assessment system. Median age was 58 years old (range; 17 - 82), 87 % of them were under 60 years old. Literacy rate was 100 %. All had solid tumors, 75 % of them had breast (n= 157) or GYN (ovary and primary peritoneal cancer; n = 155, cervix; n = 40, corpus; n = 4) malignancy. Platinum based regimens (n = 184) and anthracycline based regimens (n = 131) were dominant. FE occurred in 159 pts (33.4%). Forty three pts (9%) were admitted to the hospital. Two pts were admitted to ICU. 30 days mortality rate was 0 %. The median MASCC score of admitted pts was 21 (range; 14 - 21). About half (47 %) had high risk score (< 20). Conclusions: In areas with limited resources, self assessment of FN can be an alternative option, although that should be applied to young and literate pts educated by skilled medical team.
Effect of the patient's age on radiotherapy-based adverse effect.
Authors: Okur Yillar , Yucel Birsen , Atasever Akkas Ebru , Eren Mehmet Fuat , Babacan Nalan Akgul , Kacan Turgut , Kilickap Saadettin 
Published: March 2020

e19575 Background: We aim to determine the acute side effects of radiotherapy and the contribution of age to side effect occurrence in patients treated with radiotherapy. Methods: The data of 346 patients having treatment at Cumhuriyet University Radiation Oncology Department in 2010 and 2011 were analyzed. The patients were evaluated according to Radiation Therapy Oncology Group (RTOG) one a week after starting to radiotherapy. Results: There were 167 women (48%) and 179 men (52%). Two-hundred-forty-seven (71%) of the patients were under the age of 65, 99 (29) were above the age of 65. Eastern Cooperative Oncology Group (ECOG) performance situation was 0, 1 and 2 in 278 (80%), 51 (15%) and 19 (5%) patients. Stage 1, 2, 3 and without metastasis stage 4 were found in 30 (9%), 105 (30%), 172 (50%) and 39 (11%) patients. Radiotherapy was applied to 55 head and neck regions (16%), 31 brains (9%), 86 breasts (25%), 30 thoraxes (9%), 52 abdomens (15%) and 90 pelvises (26%). Fifty-four patients (55%) of above the age of 65 received radiotherapy, 45 patients (45%) received chemoradiotherapy. One-hundred-twenty-six patients (51%) of under the age of 65, received radiotherapy and 121 patients (49%) received chemoradiotherapy. For all the patients, the ratio of radiotherapy dependent side effects was 89% (307). The verage time for occurrence was two weeks. When the treatment was over, the number of patients who lost more than five kg was 42 (12%). ECOG difference was seen in 70 (18%) patients. Twelve of them (4%) showed recovery in ECOG performance, 50 (16%) patients showed disruption. Seventy-nine patients (23%) had a interruption in treatment because of the side effects. The occurrence of dermal side effects was higher in the group of patients below the age of 65 and the occurrence of genitourinary side effects was higher in patients above the age of 65. Thedifferences for both of the side effects were statistically significant. Other side effects and time showed no difference between the patients under 65 and patients above 65. Conclusions: The age does not affect the acute side effects of radiotherapy or chemoradiotherapy, so that both groups can tolerate radiotherapy and chemoradiotherapy.
Feasibility of computer-based self-administered cancer-specific geriatric assessment (SA-CSGA) in older pts with gastrointestinal malignancy (GIM).
Authors: McCleary Nadine Jackson , Wigler Devin , Berry Donna Lynn , Sato Kaori , Hurria Arti , Ng Kimmie , Abrams Thomas Adam , Chan Jennifer A. , Enzinger Peter C. , Fuchs Charles S. , Wolpin Brian M. , Schrag Deborah , Meyerhardt Jeffrey A. 
Published: March 2020

e19586 Feasibility of computer-based self-administered cancer-specific geriatric assessment (SA-CSGA) in older pts w/ gastrointestinal malignancy (GIM) Background: The CSGA (Hurria, JCO 2011) is a brief geriatric assessment consisting of validated measures primarily self-administered using paper format. We developed & tested feasibility of a computer-based SA-CSGA in pts ≥70 yrs w/ GIM. Methods: From 12/2009 - 6/2011, pts ≥70 yrs receiving treatment (rx) for GIM at Dana-Farber Cancer Institute were consented to complete SA-CSGA at baseline (T1= new or change rx) & follow-up (T2 = w/in 4 wks of completing rx). Feasibility endpts are (1) proportion of eligible pts consenting; (2) proportion completing SA-CSGA at T1 & T2; (3) time to completion of SA-CSGA; (4) proportion of MDs reporting change in clinical decision-making due to SA-CSGA. Results: Of the 49 eligible pts, 38 consented (55% female, 89% White, 76% enrolling prior to new rx). Mean age was 77yrs (range 70-89), 38% completed college, 49% married, 27% live alone, and 78% retired. 50% were diagnosed w/ colorectal cancer (ca). Mean MD-rated Karnofsky Performance Status was 87.5 at T1(range 60-100), 83.5 at T2 (range 70-100). At T1, 92% used a touch screen computer; 97% completed the SA-CSGA (51% independently). At T2, all pts used a touch screen computer; 71% completed the SA-CSGA (41% independently). Reasons for not completing SA-CSGA were withdrawal of consent (n=1 at T1 & T2), transfer of care (n=3; T2) or death (n=7; T2). The dominant reason for needing assistance was lack of computer familiarity (n=17 T1, n=14 T2). Mean time to completion was 23min at T1 (range 15-58); 20min at T2 (range 13-35). Among the 8 MDs who consented to participate, SA-CSGA added information to clinical assessment for 75% at T1 (n=27) and 65% at T2 (n=17) but did not alter immediate clinical decision-making. Conclusions: The computer-assisted SA-CSGA feasibility endpt was met for older pts w/ GIM although approximately half required assistance. While the SA-CSGA added information to clinical assessment, results did not impact clinical decision-making. Reasons for this may include relatively high-functioning patients enrolled in this study.
Chemotherapy-induced changes in the physiologic reserve of elderly patients diagnosed with cancer.
Authors: Molina-Garrido MJ , Guillen-Ponce Carmen , Munoz-Sanchez MM , Olaverri Hernandez A. , Ortega Ruiperez Carolina , Santiago Crespo JA , Carrato Alfredo 
Published: March 2020

e19590 Background: Frailty is a biological syndrome of the elderly that is characterized by the loss of the reserve in multiple organ systems. The aims of this study were a) to identify the presence of frailty in the elderly with cancer, by measuring their functional reserve baseline and after chemotherapy treatment, and b) to assess which of the functional reserve parameters checked suffered a change ≥30%, suggestive of frailty. Methods: Prospective cohort study of oncologic patients ≥70 years of age, evaluated in a Spanish Unit of Cancer in the Elderly (from January 2010 to December 2011). Most of patients (88.9%) had a basal status between 0-1 (measured by the ECOG index). We collected information about the individual's physiologic reserve (skeletal muscle mass [SMM], walking speed, peak-flow, grip strength, creatinine clearance [CC] and Pfeiffer test). Parameters of functional reserve were determined at baseline and 4 months after chemotherapy was started. It was used a pre-post design, and a control group of patients not treated with chemoterapy (group B). To identify significant differences between the results of parameters of physiologic reserve it was used a t-student t test for independent groups. It was calculated the change percentage in each of these variables. Results: We analyzed data from 66 patients in group A (treatment with chemotherapy) and 68 in group B (no chemotherapy). Age average: 78.68 years. Gastrointestinal tumors (37.3%) and breast and gynecologic tumors (32.1%), others (30.6%); 28.8% were metastatic tumors. After chemotherapy, there were no significant differences in walking speed (p =0.323), handgrip strength (p =0.162), peak-flow (p =0.954), cognitive status (p =0.078) or CC (p =0.425). However, there was an increase in SMM (0.618 kg, 95% CI: 0.020 to 1.215, p =0.043). Changes after treatment were as follow: SMM and peak-flow increased by 2%, grip strength decreased by 15% and CC was reduced by 0.05%. Conclusions: The elderly physiologic reserve is not modified as a result of chemotherapy treatment, except for SMM. This change could be related to tumor response achievement. None of the physiologic reserve parameters was useful in this setting, as a "marker of frailty".
Simultaneous care in Italy’s Veneto Region Health District 8: Integrated assistance to provide better outcomes in end-of-life care.
Authors: Girardi Fabio , Paiusco Paola , Manente Paolo , Bortolin Michela , Ruggeri Maria Grazia , Biancon Antonella , Vicario Giovanni , Scelzi Elvira , Sgarbossa Gigliola , De Rossi Costanza , Vultaggio Giuseppe , Mazzola Giuseppe 
Published: March 2020

e19595 Background: The number of cancer patients requiring active treatment and palliation for symptoms relief is progressively increasing, due to the possibility to significantly prolong survival even in persons affected by metastatic disease. Italian Board of Health, within the National Oncological Plan 2010-2012, gave “simultaneous care” the recognition as the most qualified model to ensure the best result regarding life expectation, quality of life, adherence to therapies. Methods: In Italy’s veneto region health district 8 a unit dedicated to palliative care works in cooperation with oncology clinic, medical wards, general practitioner, social services; periodical meetings are scheduled to review all the requests; each patient is given a multidimensional evaluation, to assess the care needs. The Unit is able to provide a daily home-care, with total parenteral nutrition if needed, management of infusional devices, invasive procedures such as paracentesis, in order to minimize the number of intervening hospital admissions. We considered the percentage of patients who received a simultaneous care approach between 2008 and 2010, the number of patients who died at home or in a hospice, the average time-period of care, the number of elapsing hospital admissions. Results: In 2008 268 new patients received assistance by the Palliative Care Unit, 273 new patients in 2009 and 434 new patients in 2010; 82 (31,3%), 70 (25,6%) and 111 (25,6%) were affected by advanced cancer, respectively; in 2008 208 patients out of 262 (79,4%) died at home or in a hospice, in 2009 224 patients out of 273 (82,1%), in 2010 376 patients out of 434 (86,7%); in 2008 the average time-period of care was 93 days (calculated as the ratio between the total number of days of assistance to patients as a whole and the number of patients), 88 days in 2009; in 2008 the average number of intervening hospital admissions was 0,26 (calculated as the ratio between the number of admissions and the number of patients), 0,28 in 2009. Conclusions: Our data show that the earlier the patient affected by advanced cancer is evaluated by Palliative care Unit, the higher is the likelihood to develop an adequate home- or hospice-base care plan.
Retrospective analysis of treatment tolerability in elderly oncological patients receiving cytotoxic therapy in a community setting.
Authors: Ho Gwo Yaw , Lovat Katherine , Bradbear Joseph , Allen Christian , Mclaughlin Laurie , Sanmugarajah Jasotha 
Published: March 2020

e19598 Background: Cancer is highly prevalent in those above the age of 65 years. Elderly oncological patients are under-represented in clinical trials and there is a lack of clinical data to guide treatment decisions in this group of patients. We evaluated the cytotoxic treatment tolerability in this group of patients in a community hospital. Methods: Cytotoxic chemotherapies and tyrosine kinase inhibitors administered in Gold Coast Hospital to patients above 65 years of age between March 2010 and March 2011 were included. Data including number of comorbidities, concurrent medicines, ECOG status and treatment drug dose adjustment were obtained. The outcomes of treatment including treatment completion, early termination and its reason, toxicities and hospital admissions during treatment were also collected. Results: A total of 206 patients were identified. Majority had an ECOG score of 0 to 1 (89%) and number of co-morbidities between 0 and 3 (96%). Eighty percent of patients had initial or subsequent treatment dose reduction. Despite this, 53% of patients (n=109) did not complete the planned treatment; 68% had disease progression but 31% was due to treatment intolerance. There was a high number of reported grade 3 and 4 toxicities (n=84) and hospitalisations during treatment (n=154). Conclusions: There is a high rate of dose reduction and noncompletion of cytotoxic treatments even in a relatively healthy elderly population. We propose further prospective study incorporating in-depth geriatric assessment to evaluate elderly patients suitability for cytotoxic treatments. [Table: see text]