bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nausea and vomiting during high-dose interleukin-2 (HD IL-2) therapy.
Authors: Fesler Mark , Chu Melinda Bernabe , Armbrecht Eric , Fosko Scott , Hsueh Eddy C. , Richart John M. 
Published: March 2020

e20661 Background: Nausea and vomiting (N/V) are two common side effects during HD IL-2 therapy. They may be severe enough to cause electrolyte imbalances or lead to missed doses, which may compromise response. Our aim was to describe the incidence of N/V during HD IL-2 therapy at our institution. Methods: A retrospective chart review of patients treated with HD IL-2 therapy (720,000 IU/kg per dose intravenously; 14 doses, 2 cycles per course, maximum 2 courses) from January 1999 to June 2011 at Saint Louis University was performed. Patients received scheduled PO ondansetron 24 mg daily and prochlorperazine 10 mg IV or PO every 4 hours as needed per standard protocol. Additional antiemetics were ordered at the clinician’s discretion. Data regarding incidence of N/V and use and type of rescue medication for N/V were recorded. Results: 104 patients were identified (68 melanoma and 36 renal cell carcinoma). Median age was 53.7 years (17.7-77.7 years) and there were 66 men and 38 women. Only 3.8% of patients (4 out of 104) were able to complete HD IL-2 therapy without rescue medication. All patients (n = 100) who needed rescue therapy received prochlorperazine on day 1 of treatment (acute phase) and at least 1 additional day during days 2-6 of each admission (delayed phase). Metoclopramide (n = 23) was the most common supplemental antiemetic ordered followed by promethazine (n = 16), meclizine (n = 5), and palonsetron (n = 3). Conclusions: Almost all patients who underwent HD IL-2 therapy had N/V that necessitated rescue therapy during both the acute phase and the delayed phase. Decreasing the incidence and severity of N/V may increase patients’ quality of life during this demanding regimen. Current protocols are single-institution based, but generally include daily 5HT-3 antagonists and prochlorperazine as needed. Our data suggests that this regimen is inadequate. One challenge to management is that steroids, which are commonly used as adjuncts, are contraindicated during immunotherapy. Additional therapeutic options are still needed. Recently new drug targets, including neurokinin-1 receptor (NK1R) inhibitors, have been approved to treat N/V during chemotherapy. NK1R inhibitors may be of assistance during immunotherapy with HD IL-2 in the future.
Practice patterns of bevacizumab-induced hypertension in cancer patients.
Authors: Escalante Carmelita P. , Lahoti Amit , Palla Shana L. , Lu Maggie , Overman Michael J. , George Marina , Abisaid Baker Rana , Palasamudram Shakar Saketh , Durand Jean-Bernard 
Published: March 2020

e20664 Background: Vascular endothelial growth factor (VEGF) inhibitors such as bevacizumab (BV) can result in side-effects such as hypertension (HTN), proteinuria and acute kidney injury (AKI). The objectives are to evaluate practice patterns of BV-induced HTN; to assess frequency of BV dose reduction, withdrawal and delay due to HTN, proteinuria and AKI; and to determine the time course for initial resolution of BV-induced HTN, proteinuria and AKI. Methods: We retrospectively reviewed random charts of 75 cancer patients (pts) treated with BV from 1/1/2009 to 9/30/2011. This included demographic, clinical and outcome parameters. Descriptive statistics were utilized. Results: 37 (56%) were males with median age 56 years (range 19-84). Most had lung (14, 19%), breast (11, 15%), and colorectal cancer (10, 13%). 69 (92%)had metastatic disease. 70 (93%) pts were on BV with other antineoplastic agents. 37 (49%) had a diagnosis of HTN at study entry. The median days from first BV treatment (tx) to first hypertensive reading was 7 (0-279) and days to receiving new or dose increase of HTN meds was 49 (0-283). 44 (59%) pts had 2 consecutive readings ≥ 140 or ≥ 90 mmHg during BV tx and 49 (65%) during post-tx follow-up of 6 months or less. 14 pts received new or dose increase of HTN meds during tx. The most frequent HTN meds used were diuretics (26%), beta blockers (21%) and calcium channel blockers (17%). The average number of new HTN meds at last BV tx was 1.5. No pt had BV dose reduced due to HTN, proteinuria or AKI. BV was withdrawn in 2 (3%) due to HTN, 2 (3%) due to proteinuria and 1 (1%) due to AKI. 5 pts had a delay due to HTN (4) and AKI (1). 57% (8 /14) of pts receiving additional HTN meds during BV tx had first dose decrease of additional HTN meds post-tx at a median of 30.5 (11-162) days. The median number of days to resolve first proteinuria and first AKI was 20 (1-193) and 14 (0-34) days, respectively. Conclusions: HTN occurred in a majority with few receiving extra HTN meds although meeting HTN criteria. Patients continued to have HTN post-tx. However, despite HTN, few stopped BV due to cardiovascular events. Further education regarding HTN guidelines may be necessary and should be considered.
Simultaneous assessment of targeted anticancer therapy-associated mucocutaneous adverse events.
Authors: Boers-Doets Christine Bettine , Gelderblom Hans , Epstein Joel Brian , Lacouture Mario E. , Kaptein Ad A 
Published: March 2020

e20669 Background: Mucocutaneous adverse events (mcAEs), including papulopustular rash, xerosis, pruritus, paronychia, hand-foot skin reaction, edema, taste alterations, oral pain and ulceration, hair-, periungual-, and ocular changes occur in the majority of patients during targeted anticancer therapies. Different mcAEs can be present with a variable symptom burden and affect upon patients’ quality of life. Use of standardized targeted therapy specific tools allows comparison of outcomes from different studies and in meta-analyses, advancing patient care and improving outcomes. A mcAE specific assessment tool about symptom burden is currently not available. A questionnaire which assesses both targeted therapy specific patient reported outcomes (PRO) measures and healthcare provider reported outcomes (HPRO) measures is warranted, therefore. Methods: A three-phase process was utilized for item generation, item reduction and scale construction. A comprehensive literature review was performed in PubMed, CINAHL and Embase, and study protocols were screened. Keywords were assessment, questionnaire, tool, EGFRI, and rash. All items with potential relevance for the tool were selected for further evaluation. Twentyone EGFRI treated patients filled out the draft-questionnaire. Results: The search resulted in a simultaneous tool in the form of 61 PRO, and 50 HPRO items. Both tools assess experienced mcAEs inclusive number of papules and pustules, area involved, severity and duration of the symptoms, used products, effectiveness of various (medical) interventions, treatment adherence and distress from the symptoms. Patient input resulted in the addition of 1 item, modification of 7 items, and deletion of 2 items. Conclusions: A novel tool has been generated to assess the experienced mcAEs and effectiveness of supportive care interventions. Since the patient and the provider report mcAEs simultaneously, the provided data are directly comparable, facilitating assessment of quality of life and, therefore, improving quality of medical care.
Prevalence of antibiotic resistant strains in fecal surveillance cultures of patients from a new tertiary care cancer center in eastern part of India.
Authors: Radhakrishnan Vivek Sulekha , Goel Gaurav , Das Dipmala , Ravichandran Sriram , Khushoo Vishvdeep , Bhave Saurabh Jayant , Chakrapani Anupam , Nair Reena , Bhattacharya Sanjay , Chandy Mammen 
Published: March 2020

e20686 Background: Drug resistant organisms are a very common cause of infections in critically ill patients in India. Surveillance Cultures is part of a multi-factorial approach to control MDRO[Multi-Drug Resistant Organisms]. Colonization surveillance may have the potential to improve empiric antimicrobial treatment in a critical care setting. Methods: Design: Retrospective. Setting: Newly started Comprehensive Cancer Center in Eastern part of India. Period: Dec 2011 - Jan 2013. Review of fecal surveillance cultures of patients undergoing intensive chemotherapy for hematological cancers or haemopoietic stem cell transplant. Fecal Surveillance cultures were done prior to Intensive Chemotherapy using a method based on Landman D et al (J Clin Microbiol 2005). Results: 48 patients [35 male,13 female] admitted with diagnoses of AML(22), ALL(6), APL(1), Acute Mixed Lineage Leukemia(1), MDS(1), Hodgkin Lymphoma(1), DLBCL(1), Fanconi Anemia(1), Multiple Myeloma(4), and Myeloproliferative Disorder(1) had information on Fecal Surveillance Cultures. Mean age: 35yrs [range; Male: 6-67yrs, Female:10-59yrs]. Total Samples collected: 67. Median sample per pateint: 1(range 1-4). All samples excepting one, grew MDRO isolates (98.5%). No. of Isolates:136 [95 gram negative bacilli (GNB), 41 gram positive cocci (GPC)]. Among GPC isolates, resistance to Ampicillin, Vancomycin, High level Gentamycin, and Linezolid were 86.5% (32/37), 7.3%(3/41), 60.9%(25/41) and nil(0/41) respectively. Among GNB isolates, resistance to Cefotaxime, Ciprofloxacin, Co-Amoxiclav, Gentamycin, Amikacin, Piperacillin-Tazobactum, Meropenem and Colistin were respectively 90.8%(79/87), 67.4%(60/89), 67.4%(60/89), 45.2%(43/95), 23.4%(22/94), 39.7%(37/93), 25.8%(24/93) and 6.4%(5/78). In the coliform group, the prevalence of ESBL/Amp-C producing isolates was 91.7%. Carbapenamase production was noted in 25.8% of GNB isolates. Conclusions: There is a very high prevalence of background antimicrobial resistance in the enteric flora of patients receiving intensive chemotherapy at our center. The causes of widespread MDRO in our setting needs further studies.
An Irish breast cancer survivorship study: Are we meeting our patients' needs?
Authors: Naidoo Jarushka , Hayes Ellen , Teo MinYuen , Calvert Paula , Horgan Anne M. , O'Connor Miriam 
Published: March 2020

e20687 Background: Breast cancer survivors account for the majority of cancer survivors in Ireland. There are no published data on the issues facing this group of patients. This study investigates the needs of a cohort of Irish breast cancer survivors who completed hospital-based follow-up and were recently discharged to their general practitioners (GP’s.) Physical, psychological, social and spiritual concerns were investigated. Secondary aims were to assess patient satisfaction with discharge from hospital-based services, satisfaction with GP follow-up, and the benefit of a survivorship discharge pack. Methods: A cohort of patients in the South East Cancer Centre was identified. Inclusion criteria were: a history of localized breast cancer, completion of adjuvant therapy within the last 5 years, and discharge to the patient’s GP in the last 6 years. An anonymous questionnaire was developed from standardized survivorship questionnaires, and ethical approval obtained. Subgroup analyses were completed for age and time since diagnosis using Fisher’s exact and Cochran-Armitage tests. Results: 80 patients were identified. 44 patients (55%) completed and returned the questionnaire. 5 patients were excluded (6%). The median age was 53 years (range: 41-65 years.) The commonest concerns were fatigue (51%), fear of recurrence (69%) and concerns regarding second cancers (69%.) 23 patients (59%) were satisfied with discharge to their GP and 25 patients (64%) were content with GP follow-up. 23 patients (59%) reported that a treatment summary would be of benefit. 27 patients (67%) felt they would benefit from a discharge pack. Patients under 60 years of age were more likely to report physical concerns (p=0.012). Patients reported fewer physical and psychological concerns over time after diagnosis (p-trend <0.001). Conclusions: This is the first Irish breast cancer survivorship study. Irish breast cancer survivors had ongoing concerns, but were satisfied with GP follow-up care. The current model of care could potentially be improved by the provision of a discharge pack that includes a treatment summary.
Detection of free radical formation in human skin upon systemic application of chemotherapeutics.
Authors: Patzelt Alexa , Zastrow Leonhard , Darvin Maxim E. , Chekerov Radoslav , Sehouli Jalid , Lademann Juergen 
Published: March 2020

e20689 Background: A wide variety of chemotherapeutics is available for systemic therapy of cancers some of which, e.g., pegylated liposomal doxorubicin (PLD), paclitaxel, docetaxel, and capecetabin may induce dermal side effects (DSE). PLD is most prominent for its risk to induce palmar plantar erythrodysethesia (PPE). Recent investigations have shown that PLD escapes onto the skin surface with the sweat, and penetrates into deeper dermal layers like topically applied destroying the tissue via radical forming processes. PPE seems to be avoidable if antioxidant-containing ointments are applied previous and during therapy. To which extent this prevention strategy is feasible also for other chemotherapeutics was investigated in the presented study. Methods: The investigations were performed on 20 patients aged between 53 and 72 years who underwent their 2ndcycle of therapy with any of the aforementioned therapeutics. These volunteers exhibited no or only a mild form (grade I) of PPE at the timepoint of investigation. Using an optical skin scanner, the radical formation was indirectly measured via the decline of the antioxidant concentration immediately before and 2-4 h after the chemotherapy, respectively. Results: In about 50% of the volunteers treated with paclitaxel and in about 30% treated with capecetabin, the antioxidant concentration distinctly declined during chemotherapyThis decline was predominantly found in patients with a weak initial antioxidative protection system. Conclusions: Thus, the application of an antioxidant-containing ointment seems to be also a reasonable prevention measure for patients under therapy with other chemotherapeutics. Analyzing the antioxidant concentration with the optical skin scanner is a simple, non-invasive option to investigate any chemotherapeutic for radical forming processes in the skin during patient treatment.
Living with terminal hepatocellular carcinoma: The patient and family perspective.
Authors: Hansen Lissi , Rosenkranz Susan J. , Vaccaro Gina M. 
Published: March 2020

e20702 Background: Hepatocellular carcinoma (HCC) is a growing problem worldwide; incidence of HCC in the U.S. has increased from 1.4 to 2.4 per 100,000 primarily because of people infected by hepatitis B or C. For those diagnosed with intermediate-advanced or terminal HCC, there is no curative treatment, and duration of survival is typically one to two years. Despite a high death rate, no studies were found examining experiences of living with terminal HCC and how it may affect end of life care from perspectives of both patients and family members. Methods: This pilot study used a prospective, longitudinal descriptive design, and qualitative and quantitative methods (mixed methods). Interview and survey (symptoms, quality of life) data were collected once a month for a 6-month period from 20 patient-family member dyads. Two researchers independently coded transcribed interview data into synthesized themes using inductive analysis, and met regularly to establish consensus on coding disagreements. Results: This poster reports on interview data from a convenience sub-sample of 14 patient-family member dyads. The interview data set comprised 56 interviews (14 conducted with patients, 11 with family members, and 31 with patient-family member dyads). Of the 14 patients, 11 were male and 3 were female (mean age=61.5, range=54-68 years). Of the 14 family members, 4 were male and 10 were female (mean age=57.4, range=22-68 years). Eight patients died during the study period. Findings from patient-family member dyad interviews included 5 major themes: 1) comparing diseases—differences and similarities between HCC and other types of illnesses/cancers (e.g., breast cancer), 2) uncertainty about treatments over time, 3) symptom management, 4) lack of support, and 5) family member caregiving struggles. Differences were found between interviews conducted with patients only and family members only, including perceived challenges in patient-family member relationships. Conclusions: From this first step, knowledge gained will serve as the foundation for a larger scale study and test of future interventions to address challenges (e.g., symptom management, caregiver burden) at the end of life for these cancer patients and their family members.
Hyponatremia and cancer: Results of a retrospective analysis of 45 patients treated with a short course of low-dose tolvapan.
Authors: Cervera-Grau JM , Esquerdo Gaspar , Barrajon Enrique , Peiro Rafael , Santos Ortega Manuel , Rodriguez Villalva Silvia , De Piaggio Marina , Espinoza Venegas Macarena Paz , Montiel Rayo Ana Belen 
Published: March 2020

e20705 Background: Hyponatremia in the cancer patient is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH). Other factors may cause hypovolemic hyponatremia, diarrhea, and vomiting. It’s present in 47% of cancer admissions. Introduction of vaptans acting as V2-receptor antagonists considerably improved the unconvincing results of conventional treatment consisting of fluid restriction potentially combined with sodium supplementation and/or demeclocycline therapy. Methods: We present a retrospective analysis of hyponatremic cancer patients treated with Tolvaptan. 45 patients, [31 men 14 women], median age 69 years old. 31.1 % had lung cancer, 17,6% other tumors, 11,1% colorectal and 11,1% prostate cancer. Histology: 53,3% Adenocarinoma, 15,6% SCLC, 15,2% others and 5,6% Epidermoid.The mean of the lowest sodium level was associated with squamous histology (Na 118 mEq/L). Descriptively, older patients (>66 y) had lower levels of Na compared to those younger than 66y (Na 122 mEq/L vs Na124 mEq/L). Median of Na at diagnosis of hyponatremia was 124 mEq/L,"waiting period" days before starting treatment,1d (SD= 1,745). Duration treatment [ Sodium levels out of risk according to the doctor criteria]. Results: Participants improved significantly after treatment period (p=.000). There were no differences in TOLVAPTAN improvements between patients with ≤ 124 mEq/L vs >124 mEq/L (p=.142), but patients with Na ≤ 124 mEq/L tend to achieved higher levels of sodium at the end of treatment (p=.016). No significant differences between different histology, location, "waiting period", duration of treatment, or age. However, Men significantly improved after treatment with tolvaptan (p=.000) and women do not showed significant changes (p=.753) (women had significantly higher pretreatment sodium level than men (122.4 mEq/L vs. 126.2 mEq/L,(p= .05). Conclusions: Tolvaptan is effective in the treatment of hyponatremia in patients with differents histological cancers especially with levels lower than 124 mEq/L. Tolvaptan had good safety profile with no side effects. A short course of two days and low dose (15mg/p.o./d ) with Tolvaptan restored safe Sodium levels.
Evaluation of depression, anxiety, and stress in nonmetastatic locally advanced head neck cancer patients: Prospective study in a tertiary medical center of India.
Authors: Mazumder Koustav , Sarkar Shyamal Kumar , Ray Sudeshna , Mukherjee Anindya 
Published: March 2020

e20707 Background: Head neck cancer is one of the prevalent cancers in India. The diagnosis, treatment and the treatment outcome affect various psychological issues of the patients. The aim of the study is to assess depression, anxiety and stress of locally advanced head neck cancer patients, receiving concurrent chemoradiation. Methods: It was a prospective study done in the department of Radiotherapy, Medical College & Hospital, Kolkata from July 2012 to January 2013. Depression Anxiety Stress Scale (DASS) was used to assess the Depression, Anxiety and Stress of the locally advanced non metastatic head neck carcinoma patients. The assessment of the psychological factors was done by the DASS questionnaire in Bengali Version. Each patient was assessed by this scale after 1) breaking bad news, 2) 3 wks after starting the concurrent chemoradiation, 3) on completion of the treatment and 4) 6 weeks after completion ,assessing the response. In each time it was compared with the baseline values using paired t test. Results: Study was carried out with 45 locally advanced non metastatic head neck carcinoma patients. Among them majority are male (77.78%). It was seen that after “breaking bad news” 68.89% of patient are significantly depressed (p < .05). Depression was more among Male population, having age less than 60 years. After 3 weeks of treatment and on completion - in both scenario depression decreased but anxiety and stress increased. There was a significant positive correlation between various toxicities (eg. Mucositis, Dysphagia) on Anxiety and Stress during the course of treatment. Depression after 6weeks on completion was significantly (p < .05) depends on the type of response. Conclusions: The psychological factors of the patients suffering from locally advanced head neck cancer should be taken in consideration right after diagnosis, assessed regularly during the course of management and appropriate care may be taken accordingly.
Palliative care in patients with advanced lung cancer in a network of health service research in integrative oncology.
Authors: Schad Friedemann , Axtner Jan , Happe Antje , Kroez Matthias , Matthes Burkhard , Grah Christian , Spahn Guenther , Matthes Harald 
Published: March 2020

e20710 Background: Early palliative care was demonstrated to result in a superior survival and improvement of health related quality of live (HRQL) in patients with advanced lung cancer. Concepts of integrative oncology (IO) offer multimodal therapy strategies aiming to enhance patients’ salutogenic resources in addition to standard care. In the present study we analyzed patients with advanced lung cancer from a clinical registry in Germany. Methods: Data were collected by the Network Oncology, a clinical registry of hospitals and outpatients care specialized in Anthroposophic Medicine and integrative oncology. We analyzed 441 C34 patients of UICC stage IV that had at least one of the following additional therapies: Viscum album, embrocation, therapeutic unction’s, rhythmical massages, lymph drainage, physiotherapy, eurythmy therapy, music or drawing therapy, modeling, speech-, breathing and hyperthermia therapy. We calculated Kaplan-Meier survival based on right censored data and using Greenwoods 95% confidence intervals. Results: 43% of the patients were female and median age was 64 yr (min 32/ max 92). 84% received chemotherapy, 55% radiation and 40% surgery. Most frequent additional therapies were Viscum album (72%), embrocation (43%), therapeutic unction (42%), eurythmy therapy and physiotherapy (both 27%). Patients used combinations up to 9 different additional therapies (median ♀=3, median ♂=2) with significant difference between genders (Fisher’s exact test, < p=0.001). Median length of VA therapy was 6.4 months. Median OS was 1.05yr (95% CI: 0.83 - 1.32), 2 and 3 year survival was 31% and 20%, respectively. Conclusions: Integrative therapy concepts are of growing interest in cancer care. In this observational study patients received conventional and complementary interventions. A relevant number of lung cancer patient use IO when offered in palliative oncology. Median OS seems to be comparable to the palliative care group of Temel et al. 2010 (median OS=0.97yr, 95% CI: 0.53 – 1.41). Health service research in multimodal IO settings needs further evaluation in terms of HRQL measurement and effectiveness.