bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Oncology Symptom Control and Information Resource (OSCIR): Using information technology to improve the management of cancer treatment-related side effects
Authors: DeAngelis C. , Giotis A. , Charbonneau L. F. , Zannella S. 
Published: March 2020

17031 Background: Management of treatment related side effects remains a challenge despite availability of effective therapies and management guidelines. The main reasons include ineffective assessment of the patient's experience, inability to access prevention and management guidelines in a timely manner, poor documentation and inefficient communication within the patient's care team. We postulate treatment related side effects could be more effectively managed using software designed to assist assessment and improve communication of the patient's experience. Methods: Software specifications included internet-based wireless capability, linking to existing electronic databases and facilitated data entry (drop down menus, check boxes, pop up windows, etc.). Oncology literature was reviewed to identify appropriate symptom assessment questionnaires, prevention and treatment strategies. The National Cancer Institute Common Terminology Criteria for Adverse Events v.3.0 was adapted. An iterative process was used for software development; content and functionality was discussed with programmers on an ongoing basis. This process is aimed at providing software that more completely meets the needs of users. Feedback from oncology pharmacists was sought regularly. Results: OSCIR has been developed to facilitate the assessment and management of nausea, vomiting, diarrhea, constipation, mucositis, and palmar-plantar erythrodysesthesia. Each side effect module includes onset and resolution, signs and symptoms, automated grading, non- and pharmacological management. Program features include downloading of electronic demographic information, chemotherapy regimen, laboratory results, call back roster, and communication tools. Conclusions: Using the iterative process we have created a program that addresses the needs of pharmacists involved in the assessment and management of treatment-related side effects. Further development will incorporate feedback from other members of the patient's care team and will include additional side effects and features. No significant financial relationships to disclose.
20-year epidemiology and treatment experience with lung cancer in Manitoba, Canada
Authors: Pitz M. W. , Musto G. , Kliewer E. , Navaratnam S. 
Published: March 2020

17041 Background: Surgical techniques, radiotherapeutic technology, and systemic therapies have evolved to improve the care of lung cancer patients. We sought to determine the impact of these improvements on the outcome and pattern of care for patients diagnosed with lung cancer in Manitoba. Methods: Patients diagnosed with non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) from January 1, 1986 to December 31, 2005 were identified from the Manitoba Cancer Registry (MCR). Demographic, diagnostic, treatment, and outcome data were extracted and analyzed to determine changes over time. Joinpoint Regression Program 3.0 was used for linear regression analysis. Results: 10 679 diagnoses of NSCLC (84.3%) and 1983 diagnoses of SCLC (15.7%) were identified from the MCR. The mean age at diagnosis for NSCLC was 68.7 years, with an increasing linear trend over time (slope (m) = .19, p < .001). There was a trend away from primary surgical treatment (m = -.30, p = .005) and chemotherapy and/or radiotherapy (CRT) (m = - .29, p=.015) and towards no active treatment (m = .59, p < .001). A positive linear trend in survival was seen for patients with NSCLC whose primary treatment was surgical (m = .70, p<.001). For patients treated with CRT, there was an inflection point at 1994 with no trend prior (m= .03, p = .92) and a significant positive trend after (m = .58, p = .029). Overall survival of all NSCLC patients did not follow a trend from 1986 until 1998 (m = -.01, p = 0.97), but has shown a significant linear trend after the 1998 inflection point (m = .96, p = .036). The mean age at diagnosis for SCLC was 66.7 years, with no significant change over time (m = .075, p=.088). There was no significant improvement in survival over time with CRT (m = .13, p=.25) or in the proportion treated with CRT (m = 0.20, p=.51). Conclusions: Oncologic treatment has been administered more selectively to patients with NSCLC over time. There has been improved survival of NSCLC patients treated surgically and non-surgically that has translated into an improvement in the overall survival of NSCLC patients in Manitoba. There has been little change in the treatment pattern and outcome of patients with SCLC over time. No significant financial relationships to disclose.
A 10-year history of lung cancer practice guideline development: Process, productivity and impact
Authors: Evans W. K. , Smith C. A. , Ung Y. 
Published: March 2020

17044 Background: CCO's Program in Evidence-based Care at McMaster University, has developed and disseminated clinical guidance documents through provincial DSGs for 10 years. The 37 member Lung DSG includes medical oncologists (17), radiation oncologists (11), thoracic surgeons (4), nurses (2), and a research coordinator. Pathologists (3), community/patient representatives (2), a medical resident and medical sociologist have previously been members. Methods: The LDSG has used the practice guideline (PG) development cycle described by Browman GP et al (JCO 1998; 16(3):1226–31). Results: 31 reports have been published in peer-reviewed journals, including 25 guidelines; all PGs are posted on the CCO website. Topics were initially selected on the basis of known practice variability (chemotherapy for Stage IV NSCLC) or clinical controversy (combined modality therapy for Stage III NSCLC); PGs for single chemotherapy drugs (6) or chemotherapy usage in specific situations (7) have dominated DSG activity; 5 PGs on radiotherapy alone and 3 on RT as part of CMT have been completed; recent PGs have been written for rare tumours (mesothelioma, thymoma) and diagnostic imaging (PET). Initially, PGs were based solely on published RCT evidence. Evidence from publicly accessible abstracts/meeting presentations, and Phase II trials (in the absence of higher quality evidence) is now considered. For rare tumours (thymoma), the DSG has used a Delphi consensus methodology. Knowledge transfer occurs through the DSG meeting process (twice yearly face-to-face; 2–4 teleconferences), practitioner feedback (PF), publications, presentations and web posting. PF using a standardized feedback questionnaire is generally high (59.9%) but varies by PG and discipline; PF is incorporated into final guideline documents. Guideline recommendations for the use of vinorelbine, gemcitabine, taxanes and erlotinib in NSCLC have been successful in securing government funding. No significant financial relationships to disclose.
National multi-center epidemiological study on prevalence and treatment of cancer-related symptoms
Authors: Novik A. A. , Ionova T. I. , Kalyadina S. A. , Kishtovich A. V. , Fedorenko D. A. , Wang S. X. , Cleeland C. S. 
Published: March 2020

17048 Background: This outcome measure of cancer-related symptoms was conducted in Russia in 2005–2006 to have a better understanding of the current status of symptom management among patients with advanced cancer. Specific aims of this study are to describe the prevalence of pain, fatigue, and other cancer-related symptoms among cancer patients being treated in multiple sites across Russia and to assess current symptom treatment and response to it across different centers. Methods: The sample size included 500 patients with advanced cancer from 10 cancer centers: male/female - 216/284, mean age 53.6. Symptom status was assessed using M.D. Anderson Symptom Inventory and Brief Pain Inventory at two time points. We used descriptive statistics to describe symptom prevalence and severity. Pain Management Index (PMI) was calculated for each patient to examine whether or not analgesics were prescribed to treat pain according to the World Health Organization's guidelines for cancer pain management. Results: The following distribution of patients according to the malignancies was observed: breast cancer (31%), hematological malignancies (30%), lung cancer (19%), gastrointestinal tumors (13%), gynecological tumors (8.4%), others (3%). As a result, the most severe symptom was fatigue (4.2) ranging from 1.5 to 5.0 across the centers. Its prevalence was 85 %. Other pronounced symptoms were pain (3.4; ranging from 0.9 to 7.0 across the centers), distress (3.0), sadness (2.9), and sleep disturbance (2.9) with their prevalence of 65.8%, 71.8%, 71.6%, and 70.0% respectively. Out of the total sample, 130 patients had only mild symptoms and 360 - at least one symptom as moderate-to-severe. Among them there were 136 patients who had 5 or more moderate- to-severe symptoms and 13 patients who had 10 or more such symptoms. Fatigue was treated only in 131 patients (26%, including blood transfusion and erythropoietin therapy); among them the decrease in fatigue level was achieved in 35% patients. Inadequate pain management was provided for 43% of patients. Conclusions: The results of this symptom outcome study provide the initial data on symptom control in Russia and allow establishing the framework for identifying the patients who experience poor symptom assessment and management. No significant financial relationships to disclose.
Implemention of a Division of Internal and Hospital Medicine in a free-standing comprehensive cancer center
Authors: Gross R. 
Published: March 2020

17070 Background: In 2004, the Moffitt Cancer Center implemented a Division of Internal and Hospital Medicine. As a free-standing Comprehensive Cancer Center, Moffitt serves complex cancer patients with a wide range of nononcologic medical needs. These co-morbidities had previously been managed through a combination of subspecialty consultations and ‘out-of-specialty‘ care by the attending oncologist or hematologist. With the rapid growth of hospital medicine as an established specialty, Moffitt recognized an opportunity to reduce fragmentation and variation in noncancer care, minimize disruptions to the focused practices of the cancer specialists, cope with resident workload constraints, and enhance efficiency of inpatient care. The institution commited to the establishment of a dedicated internal and hospital medicine program. Methods: The presentation includes a descriptive accounting of this comprehensive project, from initial planning to implementation and consolidation. Scope of services provided, staffing ratios, and unanticipated challenges and opportunities are described. A survey of stakeholder physicians was undertaken to assess perceived value for various aspects of the program. Opportunity for discussion will be provided for those considering implementation of similar services in their host institution. Results: The new program was successfully implemented and is comprised of an active inpatient service, an inpatient consultation service, a high-risk preoperative evaluation and co-management service, a 24-hour urgent care service, and a limited outpatient clinic. There are 5 physicians and 4 midlevel practitioners in the program, which is closely integrated with the internal medicine residency program of the University of South Florida. Conclusions: An Internal and Hospital Medicine program in a free-standing cancer center appears to provide perceived patient care benefits, peer satisfaction, and utilization efficiencies based on initial survey data. No significant financial relationships to disclose.
General epidemiology and survival rate of malignant and non-malignant brain and central nervous system tumors in Nice area (France)
Authors: Chamorey E. , Lebrun C. , Fontaine D. , Vandenbos F. , Michiels J. , Paquis P. , Frenay M. 
Published: March 2020

17078 Background: The aim of this cohort study was to produce descriptive epidemiological data from the Group of Neuro- Oncology of Nice (GNON) database. Data were collected from the Comprehensive Cancer Center and the University Hospital of Nice (France). Methods: All cases that have been discussed during multidisciplinary meetings of neuro-oncology were entered. Data were compared with the Central Brain Tumor Registry of the United States (CBTRUS) report taken as reference tool. Follow-up information was obtained from the patient medical chart and from the national death registry. Results: 1,395 patients (718 males, 677 females) were registered in the data base. There were 938 tumors of neuroepithelial tissue (percentage of all reported cases in our study: 67.9%, median age in our study; 58 yrs, percentage in CBTRUS report: 43.6%, median age in CBTRUS report: 53 yrs), 55 tumors of cranial and spinal nerves (4.0%, 53 yrs; 8%, 52 yrs), 270 tumors of meninges (19.5%, 59 yrs; 31.4%, 63 yrs), 54 lymphoma and hemopoietic neoplasm (3.9%, 68 yrs; 3.1%, 60 yrs), 16 germ cell tumors, cysts and heterotopias (1.2%, 17yrs; 0.6%, 16yrs), 12 craniopharyngioma (0.9%, 50 yrs; 0.7%, 48 yrs), 9 chordoma/chondrosarcoma (0.6%, 65 yrs; 0.2%, 48 yrs), 27 unclassified tumors (2.0%, 46 yrs; 6.1%, 68 yrs). The table shows the survival rates at one, three and five years respectively for some selected brain and central nervous system tumors (results from the CBTRUS report in parentheses). Conclusions: A comparison between results from the CBTRUS and GNON data base showed some similarities and didn't point out any major unexplainable discrepancy. [Table: see text] No significant financial relationships to disclose.
Modelling the direct costs of chemotherapy-induced neutropenia treatment in Portuguese hospitals clinical practice
Authors: Saramago P. , Andreozzi V. , Ferreira J. M. , Félix J. 
Published: March 2020

17081 Background: Neutropenia (N) and febrile neutropenia (FN) are common adverse effects of chemotherapy, resulting in increased risk of infections and hospitalizations. Both conditions account for substantial health resource utilization (HRU). The objective of this study was to evaluate HRU patterns for patients (PTS) experiencing N or FN in “real world” practice and to model the corresponding HRU cost profiles. Methods: Breast and lung cancer PTS receiving granulocyte colony stimulating factor (GCSF) to treat chemotherapy- induced neutropenia (absolute neutrophil count [ANC] =1500 cell/μL) were selected from 8 Portuguese hospitals. In the absence of a comprehensive database PTS having neutropenia were originally identified from hospital pharmacies GCSF prescription lists; afterwards, HRU frequency (hospitalization, clinical visits, complementary examinations, medication, transfusions) in relation to N or FN (ANC =1000 cell/μL and body temperature= 38.5°C over one hour) was reviewed retrospectively from clinical records. Treatment costs attributed to N/FN were calculated by multiplying HRU frequency by unit costs from the Portuguese Ministry of Health costs database. To account for the skewed nature of the data costs were modelled using generalized linear models with gamma distribution and log link. Results: The study included 50 PTS with breast cancer and 48 with lung cancer. Mean (SD) age was 60.0 (12.5) years and 61.2% were women. Mean (SD) ANC at first N was 724 (433) cell/μL. FN (mean (SD) ANC 440 (370) cell/μL) was developed by 16.5% of PTS. Mean (SD) total cost of N treatment was 922 (1162) € (28% hospitalization, 5% clinical visits, 3% complementary examinations, 54% medication, 10% transfusions). Controlling for PTS clinical and sociodemographic characteristics, total treatment cost were 3.2 (95%CI:1.9–5.2) times higher for PTS with FN (p<0.001) when compared to N PTS, 4.4% (95%CI: 0.1–7.7) greater for every 100 cell/μL decrease in ANC (p=0.03) and 2.5% (95%CI: 1.0–4.1) higher per additional year of age at N or FN diagnosis (p=0.002). Conclusions: Chemotherapy-induced neutropenia direct treatment costs were substantially incremented in febrile patients. [Table: see text]
A multi-center, open-label study to evaluate the safety and efficacy of pentostatin, cytoxan, and rituxan (PCR) in the treatment of previously untreated or treated, stage III or IV, low-grade CLL
Authors: Mena R. R. , Robles R. , Auerbach M. , Moezi M. , Headley D. 
Published: March 2020

17508 Background: The decision to treat indolent CLL is often based on progressive bulky disease, worsening symptoms, and increasing hematological variations. When treatment is indicated, these lymphoproliferative disorders are sensitive to combination immunochemotherapies utilizing pentostatin (P), a purine analog, cyclophosphamide (C), a DNA alkylator, and rituximab (R), an anti-CD20 monoclonal antibody. PCR represents a promising new approach in the treatment of patients with low grade CLL. Methods: Eligibility criteria allow previously treated and treatment-naïve patients diagnosed with low-grade stage II/III/IV CLL (modified Rai classification). Treatment consisted of intravenous infusions of P (4 mg/m2), C (600 mg/m2), and R (375 mg/m2) on day 1 of a 21-day cycle for a total of up to 10 cycles. Clinical evaluations (including CT scan) were performed after cycles 2, 4, 6, 8, and 10 (if necessary). Results: The intent-to-treat (ITT) population consisted of 80 CLL patients (median age 64, range 35–83) who received a total of 368 cycles (median 5 per patient). ECOG status at enrollment was 0 (68.4%), 1 (27.6%) and 2 (3.9%). The overall response rate of the 59 evaluable patients was 61% (CR 6.8%, Cru 16.9%, PR 37.3%). 7 cases of grade 4 neutropenia, 2 cases of grade 4 respiratory distress, and 1 case of grade 4 anemia were reported. 5 deaths, all in elderly patients (>70 years old), have been recorded, due to acute respiratory failure, myocardial infarction, pulmonary edema, sepsis, and one unknown cause of death. Conclusions: This immunochemotherapeutic regimen is active in Grade II/III/IV CLL and the incidence of significant toxicities was low with deaths occurring only in elderly (>80 YO) patients. The presented results are preliminary and this study is currently on-going. No significant financial relationships to disclose.
Medical costs associated with imatinib (IM) non-compliance in chronic myeloid leukemia (CML) patients (pts)
Authors: Wu E. Q. , Feng W. , Johnson S. , Beaulieu N. , Cremieux P. , Cortes J. 
Published: March 2020

17514 Background: Not adhering to treatment (tx) may lead to suboptimal outcomes. This study examined associations between medical costs and IM compliance in CML pts. Methods: CML pts under age 65 were identified with ICD-9 diagnosis code (205.1X) using MarketScan Commercial Claims data between 1/1/02–12/31/05. Pts were required to be continuously enrolled in the 4 months prior to (baseline) and the 6 months following (study period) IM initiation. CML severity was categorized into 3 groups by diagnosis of CML and related comorbidities. Compliance was defined by medication possession ratio (MPR=total days of IM supply in the study period divided by 180), and stratified into 3 groups (low: <65%, medium: 65–95%, high: 95–100%). Tx interruption was defined as tx gap of 30 or more consecutive days in the study period. Costs for inpatient (IP), ER, outpatient (OP) services and OP drugs during the study period were adjusted to 2005 dollars. Costs, the number of IP admissions and hospital days were compared across different levels of tx compliance using Wilcoxon tests. A generalized linear model (GLM) was also used to compare costs controlling for age, sex, CML severity, Charlson comorbidity index, year of IM start, etc. Results: The study sample consisted of 404 pts. Compared to the high MPR group, pts in the low MPR group incurred 1.6 times the average total health care costs (p <.001), 5.9 times the IP costs (p<.001), 2.6 times the OP costs (p=.722), 2.1 times the non-IM drug costs (p<.001), and 0.39 times the IM drug costs (p<.001). Compared to the high MPR pts, low MPR pts had on average 3.8 times the IP admissions (p<.001), and 7.3 times the IP days (p<.001). Comparing costs of pts interrupting tx versus those who did not showed similar trends. GLM regression showed that 6-month total health care costs per patient in the low MPR group were 1.4 times (p<.01) those of the high MPR group. Pts who had tx interruption had 1.3 times the total health care costs (p<.01) compared to those who did not. Conclusions: This study shows that better IM compliance was associated with significantly lower health care costs in CML pts, especially for IP costs. Further analyses will be conducted to confirm whether lower compliance leads to more hospitalizations. No significant financial relationships to disclose.
Immunotransplantation for multiple myeloma using allogeneic peripheral blood stem cell transplantation
Authors: Santos E. S. , Shah S. , Rink J. , Weiner R. S. , Miller A. M. , Safah H. 
Published: March 2020

17516 Background: Despite the improvement seen in patients with multiple myeloma (MM) treated with autologous hematopoietic cell transplantation (auto-HCT), most of the patients relapse or die of their disease. The objective of the study was to decrease toxicity of allogeneic HCT for MM patients while allowing the benefit of graft-versus-myeloma effect by using a non-myeloablative HCT (NM- HCT) approach. Methods: Newly diagnosed or previously treated myeloma patients of any stage were enrolled. All patients but one received VAD regimen prior to conditioning regimen which consisted of Fludarabine at 30 mg/m2/day on days -5, -4, -3 and Melphalan at 80 mg/m2 x 2 on days -2 and -1. Graft-versus-host disease (GVHD) prophylaxis included cyclosporine 3 mg/kg intravenously on day -2 and methotrexate at 10 mg/m2 intravenously on days 3, 6, and 11. Results: A total of 8 MM patients (4 IgG, 1 IgA, 1 light chain restriction, 2 non-secretory MM) with a median age of 46 years old (range, 35 to 57 years) have been enrolled. Only one patient received 3 regimens prior to NM-HCT. The initial responses to therapy prior to NM-HCT were: 2 CR, 1 nCR, and 5 PR. All patients received identical 6/6 HLA sibling donor stem cells. All patients but one attained CR (88%) after NM-HCT. The median time for ANC engraftment (≥ 500/mm3) was 12.5 days (range, 10–22 days). Four patients developed acute GVHD grade I-II (3 skin, 1 gastrointestinal); all of them responded well to methylprednisolone treatment. Four patients developed chronic GVHD (grade I-II). The 100-day mortality rate was 12% (1 patient died at day + 96 without evidence of MM). Post-transplant, all patients have reported a Karnofsky’s scale performance status between 80%-100%. Two patients relapsed after 31 months post-transplantation. After a median follow-up of 46 months, median survival has not been reached. Only 1 patient who relapsed has received treatment including auto-HCT. Conclusions: NM-HCT is a feasible treatment option in MM patients with a manageable toxicity profile and acceptable treatment-related mortality. Longer follow-up is needed to evaluate for graft-vs- myeloma effect using this approach. No significant financial relationships to disclose.