bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical cancer outcomes with the elimination of access to care disparities.
Authors: Agloria Maliha , Cheema Faisal , Burton Gary Von , Mills Glenn Morris , Shi Runhua , Takalkar Amol , Armaghany Tannaz 
Published: March 2020

e17585 Background: Previous studies suggest lack of insurance and quality of care variations may drive disparities in cervical cancer (CC) survival, while equitable care may close these gaps. SEER based CC mortality between 2005-9 amongst white (W) and black (B) patients (pts) was 2.2 and 4.3/100,000 respectively. To define the role of equitable care on racial disparities we selected a population of pts with CC treated irrespective of the insurance status at the Feist-Weiller Cancer Center (FWCC). We hypothesized that disparities would be less pronounced at FWCC due to equitable care. Methods: A retrospective cohort study of 151 pts with FIGO Stage I-IV cervical cancer who had clinical staging, PET imaging and treatment at FWCC between 2005-9. Collected information included age, race, date of diagnosis, histology, stage, retroperitoneal lymph node (RPLN) status, treatment received, distance from the cancer center and payer status. The treatment parameters and outcomes were compared between ethnic and financial groups. Overall survival (OS) was assessed by using the Kaplan-Meier method and compared by log rank test. Results: Patients included 88 B, 66 W and 3 other pts with median age 46 years (23 – 84). Payer status included 45% uninsured, 35% medicaid, 15% medicare, and 5% other insurance. Histological type, stage, distance from treatment center and RPLN were equally distributed between groups. All pts completed standard treatment. There was no difference in PFS (p = 0.80) and OS (p = 0.23) between ethnic groups. In concordance with prior studies the following were associated with decreased OS; non-squamous histology, 15% pts (p=0.05), advanced stage (1b2-IV; p=0.04) and RPLN on imaging, 7% pts (p=0.008). Conclusions: Cervical cancer disparities are differentially distributed across the US hospital systems. There were no disparities identified at our institution relative to payer status with all pts receiving currently recommended treatment standards. Our findings indicate that delivery of equitable care can eliminate survival differences. Future research should assess the effect of emerging Accountable Care Organizations on the elimination of racial disparities in cancer treatment outcomes.
Keeping guidelines current: A six-month evaluation of Wiki-based lung cancer guidelines.
Authors: Olver Ian N. , von Dincklage Jutta , Garrett Andrew , Holliday Laura , Vuletich Christine 
Published: March 2020

e17587 Background: The challenge for clinical practice guidelines is keeping them regularly updated with new evidence, and widely disseminated in a cost effective manner. This is difficult with printed guidelines and so Cancer Council Australia developed an internet based wiki platform for guidelines and assessed the impact of wiki lung cancer treatment guidelines 6 months after their development. Methods: The key steps in guideline development of identifying questions, literature searching, appraisal of papers, experts writing evidence-based recommendations and wide public consultation and dissemination were integrated in an access-protected wiki. Google web analytics was used to monitor usage. New papers are added and the writers continuously engaged in updating their questions. The evaluation spanned 6 months from May to November 2012. Results: The lung cancer guidelines had 67 clinical questions and 2076 articles were critically appraised. In the first month during public consultation there were 1055 visits to the site and 2955 visits in the following 5 months. The guidelines were accessed from a mobile device by 7% for consultation and 11% subsequently. During the consultation 80% of visits were from Australia, 6% New Zealand, 4% USA and 2% UK. In the consultation period 56% visits resulted from organic search traffic, 31% direct access and 13% referrals and subsequently 72% from searches, 19% direct and 11% referrals. The guideline partner Cancer Australia was the major source of referral (26% during consultation and 25% subsequently) as well as Cancer Council’s main website 9% during the consultation and 38% subsequently. Facebook was responsible for 6-8% of referrals highlighting the role of social media in promoting guidelines. The average highest visit duration by a country was 9.06 minutes in the consultation month (Australia) and 7.24 for Canada. Bounce rates vary widely from 20% (Germany) to above 70% (USA, UK, India). Conclusions: Both clinicians and the public will engage with wiki guidelines and they reach a wide international audience.
The relationships of reduction in pain with other symptoms for cancer patients treated with stereotactic body radiation therapy.
Authors: Mendoza Tito R. , Wang Xin Shelley , Rhines Laurence D , Selek Ugur , Sharp Hadley J. , Cleeland Charles S. , Chang Eric L. 
Published: March 2020

e17588 Background: Radiotherapy attenuates pain in patients with spinal metastases. A newer technology is stereotactic body radiotherapy (SBRT) that allows for high dose radiation to be accurately given to a target while sparing nearby tissues. Although a previous study reported improvement in pain, fatigue, disturbed sleep, drowsiness, sadness, fatigue, distress, lack of appetite, nausea, and difficulty remembering after SBRT, it did not examined the quantitative relationship of pain reduction with improvement in symptom burden. Methods: Cancer patients (n=149) with mechanically stable, non–cord-compressing, spinal metastases (n=166) were treated by SBRT in a phase I/II study. Patients received a total dose of 27–30 Gy, typically in three fractions. Symptoms were measured repeatedly using the M. D. Anderson Symptom Inventory (MDASI). Linear mixed model was fitted with pain as the dependent variable and other symptoms as predictor variables to determine the effect of other symptoms on pain throughout the treatment trajectory. Opioid use was a covariate in the analysis. Results: As reported previously, there were significant reduction in pain (p=0·00003) disturbed sleep, drowsiness, sadness (all p<0·0001), fatigue, distress, lack of appetite, nausea, and difficulty remembering (all p<0·05) during the six months post-SBR. Based on our linear mixed models, a 1-point reduction in fatigue (p<.001) is associated with 0.26 reduction in pain. Similarly, a 1-point reduction in in sleep disturbance (p<.001), numbness (p<.001), distress (p<.005), lack of appetite (p<.01) and dry mouth (p<.03) were associated with reductions of 0.25, 0.22, 0.16, 0.15, and 0.14 in pain, respectively. Opioid use was significantly reduced after SBRT. Conclusions: Significant reduction in pain from SBRT is associated with improvement in symptom burden. These findings may provide insights into how symptoms are interrelated during cancer treatment.
Evaluation of chemotherapy within last two weeks of life: Patterns of care.
Authors: Thomas Sachdev P. , Rice Michele A. , Ho Timmy-Tai A , Heard Bridgette , Harper Jamie , Fishkin Paul A. S. 
Published: March 2020

e17590 Background: The discontinuation of chemotherapy within the last two weeks of life is a vital Quality Oncology Practice Initiative (QOPI) assessment measure. In the last two weeks of life, continuation of chemotherapy may contribute to death rates as much as 20%. An aggressive approach to therapy may not be related to improved patient outcomes. We assess patterns in patient deaths and chemotherapy treatment at the end of life in the metastatic setting. Methods: Charts were collected and reviewed retrospectively between October 2009 and December 2012 from one, large QOPI certified, oncology/hematology group; that sees over 3500 new cancer patients per year at 14 locations along central Illinois. The receipt of chemotherapy within two weeks before patient expiration was identified from past billing charges. Results: A total of 5,560 patients died during the three year period. 154 (2.8%) patients received chemotherapy within two weeks of their expiration; median age was 67 years (range 42-89). By line of treatment, 48% of patients who received chemotherapy within the last two weeks of life were in their first line of therapy, with 44% of those patients having received only the first cycle. Only 14% of patients had received >3 lines of chemotherapy. By diagnosis, lung cancer had the highest number of patients treated in the last two weeks of life (29%). Conclusions: It is expected that deaths within two weeks of chemotherapy occur in heavily treated patients who are receiving multiple cycles of salvage chemotherapy regimens. At our center, we found that many of these patients died just after initiation of first line therapy. Moreover, patient death rates were observed to be much lower than what has been reported in other studies. This provides insight into the patterns of cancer care near the end of life. Better tools are needed to identify which patients are at higher risk of early death following initiation of chemotherapy when disease is diagnosed at an advanced stage.
Prognostic value of preoperative surgical morbidity risk-stratification using morphometric data obtained from routine abdominal CT scans in the setting of pancreatic cancer resection.
Authors: Grimm Shawna , Shelton Tiffani Dawn , Goldman Charles David , Franko Jan 
Published: March 2020

e17599 Background: Patient frailty is imparative to surgical planning, post-operative morbidity and mortality, and ultimately the ability to undergo adjuvant therapy in cancer treatment. Sarcopenia has been correlated with long term survival in the setting of pancreatic resection for cancer. However, it has not been evaluated in the early post-operative setting. Here, we evaluate the prognostic value of morphometric parameters measured on abdominal CT scans in fifty patients undergoing pancreatic resections and comparing with postoperative complications. Methods: Post-operative complications of fifty patients who underwent pancreatic resection for suspected neoplasm were graded via Clavien Dindo classification and then correlated with standardized morphometric measurements from CT scans. Results: Thirty-two men and 18 women (age 63±13 years) underwent pancreatic resection for cancer. Total psoas muscle area (2555±791 vs 1821±805,p=0.008), L4-alba distance (113±29 vs 119±27,p=0.597), rectus muscle (10.1±2.5 vs 7.8±4.5,p=0.016) and SQ fat thickness (20±11 vs 29±10,p=0.024). Logistic regression modeling including age, gender, and total psoas area predicted complication occurance (pseudo R2=0.350, p=0.008) and their number (pseudo R2=0.191,p=0.002), but not grade 3 and higher complications (pseudo R2=0.68,p=0.451) or pancreatic leak (pseudo R2=0.020,p=0.873). Similar results were obtained when age and gender variables were combined with rectus muscle thickness (pseudo R2=0.422), L4-alba distance (pseudo R2=0.377), and SQ fat thickness (pseudo R2=0.392). In each case, > Grade 3 complications and pancreatic leak was not predicted with morphometric data, age and gender. Conclusions: There are significant age and gender-related differences in morphometric data obtained from abdominal CT scans. Prognostic models provide statistically significant prediction of complication occurrence, but explain only up to 42% of variability in complication occurrence. Moreover, clinically important complications (grade 3 and higher) and pancreatic leak was not predicted with this model based on our limited dataset.
Cytarabine plus mitoxantrone versus cytarabine plus clofarabine as second-line therapy in AML.
Authors: Gul Zartash , Jain Asheesh , Slone Stacey A. , Raufi Ali , Van Meter Emily Marie , Lawson Amber , Hayslip John W. , Monohan Gregory , Howard Dianna S. , McDonagh Kevin T. , Alkadhimi Zaid 
Published: March 2020

e18001 Background: There are no comparative studies that can provide guidance about the choice of second line therapy in AML patients (pts). Methods: We retrospectively evaluated 30 consecutive pts who underwent reinduction chemotherapy for AML with mitoxantrone and cytarabine (ACM) or cytarabine and clofarabine (ACC). Results: Baseline characteristics of the pts are described in the Table. Ten pts achieved remission after initial induction therapy in ACM group and 4 pts in ACC group (P=0.71). Median length of remission was 314 days (d) (81-874 d) in ACM group and 178.5 d (57-232 d) in ACC group (P=0.13).After reinduction in ACM and ACC groups 9 and 3 patients achieved remission respectively (P=0.4).One pt in each group underwent allogeneic stem cell transplant. After a median follow-up of 11.2 m (ACM) and 10.5m (ACC), 9 and 6 pts had died in ACM and ACC groups respectively. Causes of death were progression (ACM=2pts, ACC= 1pt), end organ failure (3 pts each) and unknown (ACM=4pts, ACC=2 pts). Median Overall survival (OS) was 18.4 months (m) in ACM and 13.1 m in ACC group (P=0.49). After reinduction therapy OS was 8.3 and 6.9 m in ACM and ACC groups (P=0.72). In our patient cohort we did not find any baseline characteristics that were associated with OS or achievement of remission after reinduction therapy. Conclusions: In our pt cohort both ACM and ACC regimens demonstrated the ability to induce remission as a possible bridging strategy to allogeniec stem cell transplant. Larger studies are needed to compare these two regimens as well as evaluate any baseline characteristics which correlate with OS or achievement of remission. [Table: see text]
Philadelphia-positive acute lymphoblastic leukemia in daily practice: A multicenter experience.
Authors: Goker Hakan , Tekgunduz Emre , Sari Ismail , Pala Cigdem , Dogu Mehmet Hilmi , Ozturk Erman , Turgut Burhan , Korkmaz Serdal , Sirinoglu Demiriz Itir , Buyukasik Yahya , Kabukcu Hacioglu Sibel , Kaynar Leylagul , Civriz Bozdag Sinem , Altuntas Fevzi 
Published: March 2020

e18014 Background: The prognosis of Philadelphia-positive acute lymphoblastic leukemia (Ph+ALL) is generally poor. Currently, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only accepted therapy with curative potential. Herein, we report our experience with Ph+ALL patients treated off-study. Methods: Data were collected from medical records of Ph+ALL patients diagnosed between 2005 and 2012. Survival rates were calculated using the Kaplan-Meier method and the log-rank test was used for comparison between groups. Results: This retrospective study included 41 patients (21 females and 20 males) from 7 centers in Turkey. The median age of the patients was 42 years (range, 19-70 years). Thirty (73%) patients received TKI and concurrent chemotherapy, 10 (24%) patients received chemotherapy alone and 1 (3%) patient received TKI alone. Of the patients receiving TKI, 24 (77%) received imatinib and 7 (23%) received dasatinib as induction therapy. Following induction therapy, 77% and 10% of the patients achieved complete hematologic remission and complete response with incomplete hematologic recovery, respectively. Eight (20%) patients had relapsed/resistant disease and received rescue therapy. The most common complication during therapy was febrile neutropenia (n=7, 17%). The induction mortality rate was 5% (n=2). Allo-HSCT was performed in 16 (39%) patients, 12 (75%) of whom underwent HSCT in first complete remission. Donor sources were matched siblings in 14 (88%) and unrelated donors in 2 (12%) patients. Fifteen (37%) patients died during follow-up. The Kaplan-Meier analysis revealed a median overall survival (OS) period of 12 months (range, 1-86 months) for all patients. The median OS period was 17 months (range, 5-86 months) and 2 months (range, 1-24 months) for patients who did or did not undergo HSCT, respectively (p=0.014). The Kaplan-Meier estimate of OS was 69.3% at 12 months and 49.1% at 24 months, for all patients. Conclusions: Allo-HSCT is the most important denominator of survival and the only curative therapy for Ph+ALL patients. For patients without a suitable donor or who are unable to undergo HSCT, TKI with concurrent chemotherapy is a reasonable alternative.
Prognostic factors in malignant pleural mesothelioma (MPM): A mono-institutional evaluation of Bologna Malignant Pleural Mesothelioma Group.
Authors: Adua Daniela , Sperandi Francesca , Castellucci Paolo , Melotti Barbara , Giaquinta Stefania , Fanti Stefano , Pinto Carmine 
Published: March 2020

e18509 Background: The prognostic systems currently in use in MPM, such as the EORTC and CALGB score, include the clinical and histological parameters, excluding the FDG-PET (PET) evaluation and the possibility of surgery. The aim of our study was to investigate the role of PET baseline SUV-max and surgery as prognostic factors in MPM. Methods: From April 2002to December 2012, 48 pts with a certain histological diagnosis of MPM underwent staging by PET scan before peri-operative (multimodality treatment) or palliative first-line chemotherapy (CT). Surgery was performed in 22(45.8%) pts. Pt characteristics: males 44(91.7%), females 4(8.3%); median age 65 (51-77) years; ECOG PS 0-1 45(93.7 %), PS 2 3(6.3 %); IMIG stage I-II 18(37.5%), III-IV 30(62.5%); histological subtype epithelial 40(83.3%), mixed 5(10.4%), sarcomatoid 3(6.3%); extrapleural pneumonectomy 8(16.8%), pleurectomy/decortication 14(29.2%), 17 (35.4%) VATS plus pleurodesis, 19(39.6%) no surgical procedures. Platinum based CT was performed in combination with pemetrexed in 39(81.3%) pts and with gemcitabine in 9(18.7%). According to the EORTC score 30(62.5%) pts were classified in the good prognosis group and 18(37.5%) as poor prognosis. The cut-off value of PET baseline SUV-max calculated by ROC analysis was 9; SUV-max at baseline PET was ≤ 9 in 32(66.7%) pts and >9 in 16(33.3%). Median overall survival (OS) was 12 (3-60) months. Results: Upon validating the impact of individual factors on OS using the Kaplan-Meier analysis, we found statistical significance was reached by histology (p=0.0038) and surgery (p=0.0027). In a multivariate analysis using the Cox regression system, considering OS as a dependent variable, according to age, histology, stage, PET baseline SUV-max and surgery, epithelial histology (p =0.002) and surgery (p=0.012) achieved a statistical significance. SUV-max at baseline PET was not statistically significant (p = 0.290), excluding it as a possible independent prognostic factor in MPM. Conclusions: This analysis does not indicate any prognostic value for baseline PET in MPM, confirming the importance of histological subtype and introducing surgery as a possible prognostic factor.
Medical management of pulmonary carcinoid tumors.
Authors: Chong Curtis Robert , Wirth Lori J. , Chen Aileen B. , Sholl Lynette M. , Janne Pasi Antero , Johnson Bruce E 
Published: March 2020

e18512 Background: The optimal medical management of pulmonary carcinoid tumors, which comprise 1-2% of all lung cancers, remains to be determined. Methods: We conducted a retrospective review of patients with typical and atypical pulmonary carcinoid tumors treated at our institution between 1990-present. Results: We identified 29 patients treated with chemotherapy, including 21 patients with metastatic disease (19 atypical, 2 typical), and 8 patients treated with adjuvant platinum-etoposide chemoradiation (6 atypical, 2 typical, 6 stage IIIA, 2 stage IIB). At an average follow-up of 12 months there were two recurrences in the 8 patients receiving adjuvant treatment, both of whom had atypical carcinoid (1 stage IIIA, 1 stage IIB). Of patients with metastatic disease, the principal sites of metastasis were the liver (70%), bone (40%), and brain (25%); median survival after diagnosis of metastatic disease was 3.8 y with a 5 y survival of 37%. Regimens showing efficacy in metastatic disease include octreotide (92% stable disease), etoposide-cisplatin (25% disease control, 2 partial response, 1 stable disease), and temozolomide (44% disease control, 2 partial responses, 2 stable disease). Conclusions: These results support our previous finding that pulmonary carcinoid tumors are responsive to chemotherapy and that adjuvant therapy should be offered to patients with stage II or IIIA resected disease.
Use of CD30 expression in human malignant mesothelioma as a novel therapeutic target.
Authors: Dowlati Afshin , Dabir Snehal , Kresak Adam , Yang Michael , Wildey Gary 
Published: March 2020

e18526 Background: CD30 antigen is important in the diagnosis of Hodgkin’s disease (HD) and anaplastic large cell lymphoma (ALCL). CD30 is a cytokine receptor that belongs to the tumor necrosis factor superfamily (TNFRSF8) and acts as a positive regulator of apoptosis. The expression of CD30 in malignant mesothelioma is unknown. Given the remarkable success of brentuximab vedotin, an antibody-toxin conjugate directed against CD30 antigen, in treating patients with relapsed HD and ALCL, we undertook a study to validate the incidence of CD30 expression in mesothelioma and to examine its clinical correlates. Furthermore, we performed studies using cultured mesothelioma and non-small cell lung cancer (NSCLC) cell lines to determine the expression and potential targeting of CD30 antigen in vitro. Methods: Patient mesothelioma tissue specimens (n=52) were examined for CD30 expression by immuno-histochemistry (IHC) with an anti-BerH2 antibody (Cell Marque) used for the diagnosis of HD. Staining was assessed by a thoracic pathologist. Mesothelioma (H28, H2052, H2452, 211H) and NSCLC (A549, H1299) cell lines were also grown in culture and examined for CD30 expression by FACS analysis and confocal microscopy using anti-CD30 antibody (Novus Biologicals). Cells were permeabilized with Triton X-100. Results: Positive CD30 expression was noted in six out of 52 total mesothelioma specimens. Five of the six positive tumors demonstrated epithelial histology and were scored as low or intermediate grade. Membrane-associated as well as diffuse cytoplasmic staining was observed. The percentage of tumor cells stained positive varied greatly. Interestingly, no high grade epithelial tumors were scored as CD30 positive. The remaining CD30 positive tumor was a high grade, biphasic metastatic tumor. Confocal analysis of both mesothelioma cultured cells localized CD30 antigen to the cell membrane. Flow cytometry of intact and permeabilized mesothelioma cells supported the idea that CD30 antigen was located on the cell-surface. Conclusions: Our studies validate the presence of CD30 antigen on the cell surface of epithelial-type mesothelioma and indicate that selected mesothelioma patients may derive benefit from brentuximab vedotin (Adcetris).