bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining significant adverse events (AEs) in advanced colorectal cancer (Adv CRC) patients in the community oncology practice setting
Authors: Kwan P. G. , Koeller J. M. , Simon J. , McKibbin T. 
Published: March 2020

6017 Background: In contrast to clinical trials, standard (ie WHO) AE criteria are rarely used in community practice (CP). Because focusing on clinical decisions has more utility, we define a clinically significant (sig) AE as one resulting in deviation from planned chemo delivery. AEs are broadly categorized as tox resulting in a regimen change, a dose decrease, a delay, or an extra visit/hospitalization. Methods: Retrospective study. From 7/05–12/05 a team of oncology RPhs went on-site to 4 large US clinics (OH, NV, ME, FL), capturing all available Adv CRC pts receiving chemo. Pt, regimen, line of therapy, drug, cycle (cy), treatment (tx), toxicity (tox), and delay information were recorded. Delays were categorized as admin/other delays or tox-related delays. Pts who expired before 1/1/03 were excluded. Results: 207 pts (74 expired) received 2,444 cycles (79% from ‘04–05) Avg age = 65 years, 50% male and median ECOG PS = 1. Median survival = 17 mo. Six hundred two sig AEs (24.6% of cycles, combined endpt) were recorded (see Table ). The top regimens (cycles) were: 1st line - Folfox4 (427), IFL (259), Roswell Park (157), CapeOX (89), Folfox 6 (76), Cape Single Agent (73), Folfiri2 (62); 2nd line - Folfox4 (115), CPT11 Single Agent (96), CapeOX (71), IFL (60), Cape Single Agent (57), Roswell Pk (53), Folfiri2 (47). MoAb (cetuximab/bevacizumab) was added in 48% of regimen cycles. Of interest, single agent cpt11 (+MoAb in 80% of cy) is a common 2nd-line regimen. Two other references describe this regimen (Saltz Proc ASCO 2001; Cunningham NEJM 2004). Our data confirm this regimen’s tolerability. Conclusion: In the tx of Adv CRC, there is a wide variation in community oncologist prescribing patterns. We defined regimen tox based on criteria focusing on clinical decision making and showed the feasibility of measuring tox-related delays apart from other non-tox delays. Toxicity reported in this fashion may prove valuable for oncology administrators seeking to employ disease management strategies. [Table: see text] [Table: see text]
Predictive factors for the underutilization of adjuvant chemotherapy in colon cancer in Southwestern Sydney
Authors: Ng W. L. , Gabriel G. , Moylan E. 
Published: March 2020

6070 Background: Adjuvant chemotherapy improves survival in stage III and high risk stage II colon cancers and is therefore recommended in current treatment guidelines. Despite this, retrospective studies demonstrate that utilization rates remain suboptimal in Australia and other countries. In this study we aimed to identify predictive factors for adjuvant chemotherapy underutilization in the Southwestern Sydney Area Health Service (SWSAHS). Methods: We examined data collected on all patients with a diagnosis of stage II or III colon and rectosigmoid cancers from SWSAHS colorectal database between 1997 and 2003. Follow-up and survival were calculated until October 2005. SPSS was used for statistical analysis and Kaplan-Meier for survival analysis. Results: 704 patients were identified. The overall adjuvant chemotherapy utilization rate was 48% (68% for stage III and 26% for stage II). Overall 5 year survival was 69% for patients who received adjuvant chemotherapy compared with 39% for those who did not receive chemotherapy (p<0.001). The main predictive factor identified for not receiving chemotherapy in both stages was increasing age. Rates of utilization of adjuvant chemotherapy for stage III colon cancer were 90% (<50 yrs), 81% (50–69 yrs) and 50% (70+ yrs). The trend was similar for stage II patients with corresponding utilization rates of 69%, 37% and 10%, respectively. The difference in chemotherapy utilization by age groups is highly significant (p<0.001). Other factors including sex, health insurance status, site of primary colon cancer and index of relative socioeconomic disadvantage did not show significant difference in chemotherapy usage. We were unable to evaluate the effect of co-morbidity on chemotherapy use from our database. Conclusions: Increasing age is the single most important predictive factor in the underutilization of adjuvant chemotherapy in colon cancer despite evidence that the elderly can accrue the same benefit from adjuvant chemotherapy as their younger counterparts. No significant financial relationships to disclose.
Bupropion in the tratment of sexual dysfunction in women diagnosed with breast cancer: An open-label, fixed dose study
Authors: Mathias C. , Moraes E. , Bastos C. , Athanazio R. , Nunez G. , Alban L. , Braghirolli I. , Del Giglio A. , Pondé E. , Moore H. 
Published: March 2020

6072 Background: Sexual morbidity after chemotherapy and hormonal therapy for breast cancer can seriously affect patients’ quality of life. Bupropion is an antidepressant that has been reported to increase libido. Objective: To investigate the improvement of sexual function in female breast cancer patients using bupropion. Methods: We performed an eight week open trial using bupropion in women diagnosed with breast cancer who had received chemotherapy and were currently receiving adjunctive hormonal therapy. The Arizona Sexual Experience Scale (ASEX) was used. The ASEX scale includes five questions that evaluate sexual function in the following areas: libido, excitability and ability to reach orgasm. Women received oral Bupropion 150mg/ daily for eight weeks and were evaluated prior to the initiation of the study and again during Weeks 4 and 8. Results: Twenty patients were included in the study. At the beginning of the study, the mean ASEX score was 23.45 [21.67–25.24] 95% CI. After four weeks of treatment, we observed a reduction in the mean ASEX score that persisted until the end of the study, at eight weeks: 18.45 [16.59–20.31] 95% CI, p = 0.0003) and 18.95 (SD ± 5.02 [16.60–21.30] 95% CI, p = 0.0024), respectively. Conclusions: In this non-controlled open trial bupropion 150 mg/daily was associated with improved sexual function in women receiving adjuvant systemic treatment for breast cancer. No significant financial relationships to disclose.
Conventional cautions regarding online information: Do they predict accuracy of breast cancer websites?
Authors: Meric-Bernstam F. , Walji M. , Sagaram D. , Sagaram S. , Johnson C. W. , Bernstam E V. 
Published: March 2020

6086 Introduction: Cancer patients and oncologists are increasingly using the Internet. Online information is affecting patient decisions regarding treatment. Therefore, multiple organizations published advice on how to screen out problematic information online. In the present study, we sought to determine whether existing quality assessment tools can screen out false or inaccurate breast cancer information online. Methods: Using 15 representative search queries on five popular search engines and only the first page of results, we generated a list of 1,585 Web pages. After eliminating irrelevant, broken and duplicate links 343 unique web pages were downloaded and evaluated for website characteristics, information accuracy and 15 quality criteria: authorship identified, author credentials identified, physician credentials stated, author affiliation stated, sources clear, general disclosures, attribution/references provided, disclosure of ownership, date created displayed, date of last update displayed, date of creation or last updated displayed, editorial process stated, internal search engine present, feedback mechanism provided and copyright notice. Quality criteria were evaluated by an independent evaluator blinded to the accuracy information. Accuracy was determined independently by a pair of clinically trained evaluators. Results: Of 343 pages evaluated, 41 false/misleading statements were displayed on 18 distinct pages. The presence of an internal search engine was correlated most strongly (r = .196, r2 = .038) with health information accuracy. However, all quality criteria (alone or in combinations tested exhaustively) were linearly associated with less than 7% of the variance in number of inaccuracies per website. Conclusion: Currently available technical quality criteria do not identify false or misleading online information about breast cancer. At this time, directing patients to websites with known content appears to be the only way to ensure patients will not encounter false or misleading online information. No significant financial relationships to disclose.
Method of detection of local recurrence in patients following breast conserving surgery and its utility for surveillance
Authors: Taback B. , Hansen N. , Conway K. , Giuliano A. 
Published: March 2020

611 Background: It is estimated that approximately 10% of all breast cancer patients will develop local recurrence (LR) at 10 years. Routine surveillance for detection of early breast cancer recurrence is widely performed despite lack of conclusive evidence for an improvement in patient quality of life or potential for cure. A number of historical studies evaluating the effectiveness of routine screening for LR following treatment for early-stage breast cancer have suggested that the diagnosis of LR is more frequent during a routine visit and occurring in asymptomatic patients. However, differentiating the method of detection is not often elucidated. In this study we evaluated the manner in which patients presented with an isolated LR in clinical practice. Methods: Our routine patient follow-up consists of physical exam and mammogram every 6 mos for the first 2 years following breast conserving surgery (BCS) and yearly thereafter. We queried our prospectively collected breast cancer database (1632 patients from July 1986 - July 2004) for patients with an isolated LR following BCS (n=59 (3.6%); two patients had bilateral LRs). Medical records were not available for three patients. Results: At a median follow-up of 45 mos (range: 5–122 mos) there were 58 evaluable LRs: 15 DCIS, 31 infiltrating ductal carcinoma (IDC), 6 infiltrating lobular (ILC), 2 mixed IDC/ILC, 3 invasive cancers NOS and 1 unknown. Patient presentation was as follows: 25 were diagnosed by self-exam, 28 on screening mammogram, 2 were diagnosed by physician (includes one referral), and 3 unknown. Mammogram detected recurrences were more frequent among patients with DCIS whereas self-detected recurrences were more common in patients with IDC (79% vs 33% and 21% vs 67%, respectively; P<0.2). Mean tumor size was larger in self-presentation (2.1 cm; range: 0.8–4.5 cm) than in mammogram detected group (1.6 cm; range 0.4–6 cm). Conclusions: These findings demonstrate the value of mammography as compared to patient detected LRs. Whether a survival advantage exists remains uncertain. Nevertheless routine physician examination in this setting is highly insensitive and its further utility must be considered when devising cost-effective strategies for surveillance of breast cancer patients. No significant financial relationships to disclose.
Does ovarian cancer survival differ by who gives the chemotherapy?
Authors: Silber J. H. , Rosenbaum P. R. , Polsky D. , Ross R. N. , Schwartz J. S. , Even-Shoshan O. , Armstrong K. , Randall T. C. 
Published: March 2020

6110 Background: Medical Oncologists (MOs) specialize in administering chemotherapy while Gynecologic Oncologists (GOs) specialize in the surgical management of gynecologic cancers as well as providing chemotherapy. We asked whether survival differed according to the type of specialist providing the chemotherapy after ovarian cancer surgery. Methods: Using merged SEER-Medicare clinical and administrative data from the years 1991 through 2001 we identified all patients who were diagnosed with ovarian cancer after the age of 65 and who received chemotherapy from a GO after surgery performed by any type of surgeon. Using optimal matching and a propensity score based on 35 prognostic characteristics, we identified similar patients who were operated on, and staged, by nearly identical types of surgeons but who received chemotherapy from an MO. Results: We identified 344 patients who were given chemotherapy for ovarian cancer by GOs after having undergone surgery by either GOs (76%), Gynecologists (16%), or general surgeons or other surgical specialties (8%). Patients given chemotherapy by MOs were matched to these patients. Both groups had nearly identical surgical specialists, age, year of treatment, stage, tumor grade, race and 32 other prognostic factors. There was no difference in overall survival between the GO or MO groups (P = 0.45, paired Prentice-Wilcoxon test). The 5 year survival was 35% (± 2.6%) for the GO group and 34% (± 2.6%) for the MO group. However, MOs administered chemotherapy over more weeks than did the GOs (patient mean = 16.5 Vs 12.1 weeks, P < 0.0023, Wilcoxon rank sum test) and MO patients had more weeks that included at least one of the following chemotherapy associated adverse events (neutropenia, anemia, thrombocytopenia, diarrhea, dehydration or mucositis) than did the GO group (patient mean = 16.2 Vs 8.9 weeks, P < 0.0001, Wilcoxon rank sum test). Conclusions: Despite differences in training, specialty emphasis, and practice style concerning the use of chemotherapy (MO patients had more weeks of chemotherapy and more weeks with chemotherapy associated adverse events than GO patients), we found no difference in survival between patients who received chemotherapy administered by gynecologic oncologists and medical oncologists. No significant financial relationships to disclose.
Effect of follow-up provider source on outcomes of patients with hematologic malignancies receiving hematopoietic stem cell transplantation
Authors: Loberiza F. R. , Villanueva M. H. , Devetten M. , Ganti A. K. , Maness L. J. , Bierman P. J. , Bociek R. G. , Armitage J. O. , Vose J. M. 
Published: March 2020

6112 Background: Studies have shown that involvement of trained physicians is associated with favorable outcomes of patients receiving hematopoietic stem cell transplantation (HSCT). At the University of Nebraska Medical Center (UNMC), most patients are shifted back to the care of their referring physicians in the first 100 days. We evaluated whether the practice of shifting care of patients from specialists to primary care providers (PCP), referred to as patient care oscillation, in HSCT results in optimal outcomes. Methods: Data from 666 patients who underwent HSCT for malignant hematologic disorders between 2000 and 2003 were analyzed. Cox proportional hazards regression analyses were done to compare the relative risk of relapse/progression and mortality at 100-days and 1-year between patients whose care remained with specialists (transplant MDs at UNMC or community oncologist) versus those who were transferred back to the care of referring PCPs while adjusting for patient and disease factors. Results: Rate of patient care oscillation varies according to type of transplant. In allo-HSCT, 50% of patients received follow-up care from PCPs, 30% from community oncologists, while 20% remain at UNMC for follow-up. In auto-HSCT, 70% of patients received follow-up care from PCPs, 20% from community oncologists, while 10% remain at UNMC for follow-up with transplanting physicians. Outcomes after HSCT according to type of transplant is shown in the table. Conclusions: These preliminary findings suggest that in both allogeneic and autologous HSCT, the risk of disease progression/relapse and mortality may be independent of the type of follow-up care provider. However, further studies are needed to determine whether the practice of shifting the care of HSCT patients results in similar medical care utilization, post-transplant complications, re-hospitalizations and patient satisfaction. Patients likely to benefit from specialized versus primary care should be identified. [Table: see text] No significant financial relationships to disclose.
Prescription compliance and persistency in chronic myelogenous leukemia (CML) and gastrointestinal stromal tumor (GIST) patients (pts) on imatinib (IM)
Authors: Tsang J. , Rudychev I. , Pescatore S. L. 
Published: March 2020

6119 Background: IM (Glivec, Gleevec) is an oral targeted therapy with unprecedented efficacy in CML and GIST. Prescription compliance and persistency of pts receiving IM were measured by analysis of pt-level pharmacy claims data. Methods: Compliance and persistency were determined by analyzing the prescription-filling activity of pts (N=4043) compared with the prescribing activity of their physicians (N=3316) using pt pharmacy records accrued over 24 months (1/03–12/04). Observed average daily consumption (DACON) and average prescribed days of therapy were calculated and compared. Also, compliance and persistency were examined by pt demographics and initial IM dose prescribed. Results: Overall compliance (defined as medication possession ratio = apparent mg taken/mg prescribed) was 75%, with CML pts showing slightly greater compliance (78%) than GIST pts (73%). Fifty percent of pts were 100% compliant, the greatest compliance being found in pts initially treated with IM 300 or 400 mg/day (77%). Persistency (time on therapy without significant gaps in refills) averaged 255 days over 24 months. The most persistent pts were those initially given 300 or 400 mg/day (13.0 and 12.9 months, respectively). DACON was 400 mg/day for 65% of patients, but fluctuated above and below 400 mg/day in 18% and 17% of pts, respectively. Conclusions: This is the first assessment of pt compliance and persistency with prescribed IM therapy. Although less pronounced than with most other non-oncology products, suboptimal compliance and persistency with IM are a concern as doses <300–400 mg may result in plasma levels lower than needed to eliminate cancer cells. Patient support programs and improved communication on the importance of adhering to recommended dosing could potentially optimize outcome and further reduce risk of relapse and progression. [Table: see text]
Outcome of interventions to identify family history and risk management for women with breast cancer in the ambulatory setting
Authors: Washburn N. J. , Simmons S. , Sommer V. , Adkins B. , Gerken P. , Rogers M. , Wilson B. , Lang B. , Hickman B. , Barnhart C. , Ethirajan S. 
Published: March 2020

6121 Background: In 2002, Kansas City Cancer Center (KCCC) performed a quality improvement (QI) project to evaluate how breast cancer patients were being assessed for family history and cancer risk management. A self-administered family history questionnaire was developed to improve the thoroughness of family history collected and education of clinicians was completed to improve the recognition of risk factors based on ASCO guidelines. Methods: Chart audits on 210 women with breast cancer at KCCC, were completed in the second quarter of 2005. All patients were under the age of 65, not undergoing chemotherapy. A risk management tool was developed. Scoring criteria for 2002 was replicated in 2005 as listed in the table . Results: In 2002, 171 pts (89%) had level 1 or 2 family history assessed compared to 207 pts (99%) in 2005, p<0.0001. In 2002, 47% had 3 generations assessed compared to 84% in 2005, p<0.0001. In 2002 and 2005, some risk factor management occurred in both groups, and was equal, 78% and 80% respectively (p=ns). Of those that had risk management 33% had level 1 in 2002 compared to 3% in 2005 (p<0.0001) a 91% reduction in identifying risk without subsequent management. In 2002, 58% had level 2, compared to 71% in 2005 (p=0.02) a 23% improvement in identification & management of risk. In 2002, 9% had level 3 compared to 26% in 2005 (p<0.0001) a 183% improvement in patients with a detailed risk assessment and/or genetic referral. Conclusions: By improving the assessment of family history and education of providers, women with breast cancer are receiving more information to reduce their risk for recurrence and complications. Patients who were identified as high risk for BRCA1 or BRCA2 mutations were referred to either a nurse practitioner or genetic counselor. [Table: see text] No significant financial relationships to disclose.
Aromatase inhibitor (AI)-associated arthralgia (A) and bone pain (BP): Frequency and characterization in clinical practice
Authors: Presant C. A. , Kelly C. , Bosserman L. , Upadhyaya G. , Vakil M. , Horns R. , Ebrahimi B. , Yeon C. , Howard F. , Rios A. 
Published: March 2020

6137 Background: Prior studies of AI have identified A and/or BP as side effects. Reported incidences have varied from 4% (IMPACT) to 35.6% (ATAC). In order to determine the frequency of A or BP in clinical practice, we reviewed a consecutive series of patients (PTs) receiving AI in community cancer centers. Methods: The charts of consecutive PTs receiving AI were reviewed, and PTs were interviewed regarding the occurrence of A or BP (ABP), severity, whether ABP was worse than before AI therapy, preexisting co-morbidities, type of therapy for ABP, and pain characterization. Results: 56 PTs were receiving AI. The type of AI used was anastrazole in 44 PTs, letrozole in 10 PTs, and exemestane in 2 PTs. The age range was 45 to 89 years. All PTs had breast cancer. The duration AI usage was 1 to 44 mo. Worsening of ABP compared to pretreatment ABP was reported in 34 PTs (61%). In 11 Pts (20%), severity was sufficient and control poor enough to result in discontinuation of AI at a median of 2 mo of AI therapy. The median severity of ABP, when present, was 7.5 on a 10 point pain scale. The character of the ABP was continuous in 20 (59%) and intermittent in 14 (41%), affected central/axial bones in 20 (36%), and peripheral bones in 35 (64%). Coexisting conditions possibly contributing to worsening of ABP occurred in 36%, consisting of degenerative joint disease 10, fibromyalgia 1, osteoporosis 4, and degenerative disc disease 1. Therapy associated with amelioration of symptoms included acetaminophen in 26%, NSAIDs in 45%, mild opiates in 11%, strong opiates in 5%, and glucosamine in 13%. The occurrence of ABP was not associated with age (68% in PTs less than 60 versus 57% in PTs over 60). The occurrence of ABP was not associated with duration of use of AI (50% of 16 Pts on AI for 3–6 mo, 75% for 7–12 mo, and 56% for over 12 mo). Conclusions: The occurrence of AI associated ABP is higher in a non-clinical trial population of PTs than reported in most clinical trials. This side effect is severe enough to cause discontinuation of needed AI therapy in 20%. Further studies are warranted to determine the mechanism of AI associated ABP, and optimal therapy. It is reasonable to consider glucosamine as well as standard analgesics in controlling this syndrome. No significant financial relationships to disclose.