bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complementary and alternative medicine: What do oncology healthcare providers think?
Authors: Tung C. S. , Sun C. C. , Cohen L. , Frenkel M. , Ramondetta L. M. , Smith J. A. , Parker P. , Bodurka D. C. 
Published: August 2020

e20614 Background: The use of complementary and alternative medicine (CAM) is growing as the oncology patient (pt) population increases. The purpose of this study was to assess current CAM practice patterns of oncology healthcare providers. Methods: We distributed a 20-page anonymous survey to all physicians (), mid-level practitioners, clinical pharmacists, and dietitians at a comprehensive cancer center. The survey examined factors influencing a provider's inquiry towards pt CAM use, as well as current perception and use of 15 different CAM modalities, such as meditation, acupuncture, chiropractic, and herbal therapy. Descriptive statistics, chi-square, and Student's t-test were used for analysis. Results: 671/1,601 (42%) surveys were returned with s comprising 50% of the responses. 83% of respondents believed CAM has a role in cancer care. Over 70% indicated that massage, meditation/prayer, relaxation techniques, and acupuncture have potential uses, primarily to relieve symptoms not controlled by conventional therapy (tx) (47%) and as psycho-social-spiritual support (47%). Respondents estimated 28% of pts utilize CAM; 25% of respondents and 19% of pts initiated CAM discussions during pt visits. Those in medicine-based fields were more likely to discuss pt CAM use compared to surgical specialities (30% vs. 19%, p<0.01), but there was no significant difference in comfort level to discuss CAM modalities. s were less likely to discuss CAM use compared to all other providers (21% vs. 31%, p<0.01). s were also less comfortable discussing herbs (37% vs. 51%, p<0.01), massage (73% vs. 82%, p<0.05), meditation/prayer (71% vs. 82%, p<0.05), and relaxation tx (67% vs. 77%, p<0.01) compared to all other providers but more comfortable discussing acupuncture (63% vs. 55%, p<0.05). Respondents cited lack of knowledge in CAM as the primary reason for not discussing CAM with pts. Conclusions: Past studies estimate that >50% of patients use at least one form of CAM. Our study suggests that oncology providers critically underestimate the number of patients incorporating CAM into their treatment. Improving provider education on CAM therapies is essential to improve patient-physician communication regarding potential risks and benefits of CAM with traditional cancer therapies. No significant financial relationships to disclose.
Histological differentiation of skin toxicity between cetuximab, erlotinib and panitumumab (single ErbB1) and lapatinib (dual ErbB1/2) epidermal growth factor receptor inhibitors
Authors: Newman M. , Gerami P. , Guitart J. , Lertsburapa T. , West D. , Rosen S. , Cianfrocca M. , Lacouture M. 
Published: August 2020

e20617 Background: Epidermal growth factor receptor inhibition by monoclonal antibodies and tyrosine kinase inhibitors has demonstrated activity in solid tumors. However, blockade of EGFR in skin results in disabling skin toxicity that may lead to therapeutic dose modification or interruption. This study compares cutaneous histological alterations among four EGFR inhibitors (EGFRIs): cetuximab (C), erlotinib (E), lapatinib (L) and panitumumab (P). Methods: Punch skin biopsies from patients with papulopustular rash were collected from 8 patients per each EGFRI (n=32). Two dermatopathologists performed independent blinded assessment of epidermis, dermis, follicle and inflammatory infiltrates. Histologic features were rated as 0 (absent) or 1 (present), with the exception of dyskeratosis, rated from 0 (absent) to 2 (severe) and infiltrate, rated from 0 (absent) to 3 (most prominent). Where variation occurred, scores were reconciled and combined for analysis. Results: Epidermal atrophy was observed for C, E, L and P (range 0–1, median 1, 1, 0, 0.5, respectively) and neutrophilic follicular infiltrate was observed for C, E, L and P (range 0–3, median 0.5, 3, 0, 3, respectively). Neutrophilic dermal infiltrate (range 0–3) and follicular neutrophilic pustules (range 0–1) were most prevalent in P (median 0.5), whereas the median for C, E and L was 0. A mononuclear dermal infiltrate (range 0–3) was least prevalent with C (median 0) while E, L and P had a median of 0.5. Concretions (range 0–1) were most prevalent for E (median 1), whereas the median for C, L and P was 0. Conclusions: Lapatinib, a dual ErbB1/2 inhibitor, induced the least structural disarray and inflammation in the skin as measured by median scores for epidermal atrophy, neutrophilic dermal and follicular infiltrates, neutrophilic pustules and lack of bacterial concretions. These histological data confirm a more benign pattern of rash with lapatinib compared to single ErbB1 inhibitors. [Table: see text]
An observational study of the impact of ethnicity on patients treated for non-small cell lung cancer (NSCLC) in the second-line setting with pemetrexed: Preliminary results in African Americans
Authors: Girvan A. C. , Peltz G. , Pennella E. , Pohl G. , Faries D. , Marciniak M. D. , Obasaju C. K. , Stepanski E. J. , Schwartzberg L. S. , Adjei A. A. 
Published: August 2020

e20624 Background: African-Americans are more likely to develop and die from lung cancer than persons of any other ethnic group. Historically, African-Americans have been under-represented in oncology clinical research. This prospective, single-arm, observational study evaluates the impact of ethnicity on disease control rate (DCR) (CR + PR + SD)) in patients (pts) with non-small lung cancer (NSCLC) being treated with pemetrexed (Pem) in the second-line setting. Methods: Eligibility criteria include stage IIIB or IV NSCLC pts receiving Pem for second-line therapy with no restrictions on performance status. An accrual of 200 African-Americans, 200 Hispanics, 200 Asian-Americans, and 400 Caucasians is planned to test the hypothesis that subjects from these minority populations with advanced NSCLC will have DCRs that are not inferior to Caucasian subjects during second-line treatment with Pem in routine clinical practice. This report describes observations from an early examination of the data of the Caucasian and African-American pts enrolled. Results: 293 pts have been enrolled in this study including 243 Caucasians and 34 African-Americans. Demographics of Caucasians: M/F (136:107); median age 66 (range 37–88); histology adenocarcinoma/squamous/other/unknown (141:67:33:2). Demographics of African-Americans: M/F (21:13); median age 64 (range 43–80); histology adenocarcinoma/squamous/other/unknown (22:9:3:0). DCR in Caucasians: 38% (CI= 28–47%: 3 CR, 8 PR, and 34 SD in 120 of the 243 pts). DCR in African-Americans: 61% (CI=36–86%: 0 CR, 0 PR, and 11 SD in 18 of the 34 pts). Updated safety and efficacy data will be available. Conclusions: Preliminary results based on limited data do not indicate an inferior response for African-American pts compared to Caucasian pts being treated with Pem for NSCLC in the second-line setting. Additional data are needed to establish a definitive conclusion. [Table: see text]
Erythropoiesis stimulating agent (ESA) administration at Hb <10 g/dL for chemotherapy-induced anemia (CIA) following the National Coverage Decision (NCD)
Authors: Hulnick S. A. , Hess G. , Hill J. , Viswanathan H. N. , Nordyke R. J. 
Published: August 2020

e20627 Background: Medicare coverage of ESA treatment for CIA was changed in 7/07 to a hemoglobin (Hb) < 10 g/dL prior to administration. We describe the proportion of ESA administrations at Hb < 10 g/dL over four quarters following the NCD. Methods: A retrospective analysis of ESA administrations from 7/07 - 6/08 using Varian and Impac electronic medical records for 304,654 cancer patients from 91 practice sites across 19 states. Episodes of ESA treatment were identified within chemotherapy episodes. A > 42 day gap in ESA use identified a completed ESA episode and a > 90 day gap in chemotherapy identified a chemotherapy episode. Hb ≤ 7 days prior to ESA administration date was identified for each ESA episode. The percent of ESA administrations at Hb < 10 g/dL was measured from Q3 07 to Q2 08 for darbepoetin alfa (DA) and epoetin alfa (EA) stratified by age. Results: For patients age ≥ 65, the percent of ESAs administered at Hb < 10 g/dL increased from Q3 07 to Q2 08 for initial and maintenance administrations. A less pronounced trend was observed in patients age < 65. Maintenance administrations at Hb < 10 g/dL in patients age < 65 were significantly lower for EA vs. DA. Conclusions: ESA administrations have been increasingly administered at Hb < 10 g/dL. A higher proportion of Medicare-eligible patients received maintenance ESA administrations at Hb < 10 g/dL. [Table: see text] [Table: see text]
Evaluation of the influence of physical problems, emotional problems, and extent of disease on the distress level (DL) in breast cancer (BC) women
Authors: Cedrych I. , Heyda A. , Lukaszczk-Widel B. , Lange B. , Syska-Bielak A. , Skladowski K. 
Published: August 2020

e20628 Background: Despite recent treatment advances, BC diagnosis is still synonymous to death, and suffering and provides emotional impairment in most of patients. Thus the distress assessment and management is the essential component of comprehensive BC patient care.The aim of the study was to recognize DL in the group of BC patients (pts) at the different stages of the disease and treatment period and to evaluate the most important distress causes and sources. Methods: In 60 BC women (median age 58 years, range: 37–86) diagnosed within last two years, the measurement of distress level was performed using the Distress Thermometer scale with the problem list attached, according to NCCN practice quidelines recommendation for distress assessment. The median time from the diagnosis to the distress data collecting moment was 3.9 months. Most pts were postmenopausal (70%), have positive family cancer history (60%) and suffered from other diseases (75%); 45% of them presented stage III of BC (stage I - 26%, II - 23%, IV - 5%). Chemotherapy received 55% of pts, surgical treatment 65% and radiotherapy 46%. At the moment of DL evaluation 61% of pts were remained free from BC symptoms and 72% from strong stressful event during last year. Results: The median DL in the whole group was 5 (range 0–10) and in 76% of pts the level was 4 or higher. Problem-list evaluation revealed that 96% of pts had physical, 90% emotional, 38% practical and 20% family problems. Both univariate and multivariate analysis revealed the independent and positive correlation with DL for: physical problems (p=0.000009), peripheral blood granulocytes level (p=0.000024), strong-stressful event passed during the last year (p=0.005) sadness (p=0.01) The surgical cancer treatment was correlated with DL negatively (p=0.008). Conclusions: DL evaluation has shown that the DL was associated mostly with practical, emotional and physical problems and the history of personal stressful event in the near past. BC surgery is a strong source of anti-distress. These data indicate a need of DL assessment with not neglecting the individual medical and psychosocial history of each patient to provide best psychological support, expecially in women who are not qualified to, or are before surgery. No significant financial relationships to disclose.
Fertility preservation and timing of cancer treatment
Authors: Kumar A. , Mhaskar A. , Vadaparampil S. , Djulbegovic B. , Quinn G. ,   The Moffitt Fertility Preservation Group
Published: August 2020

e20629 Background: Cancer survival rates have increased steadily over time and young cancer survivors desire quality of life, including the ability to have a family. Cancer treatments, due to its toxic nature, can permanently or temporarily affect fertility. However, advanced fertility preservation measures are available and should be pursued before toxic chemo or radiation therapy. Evidence from observational studies indicate patients want to be informed of the adverse effects of cancer treatments on their fertility. Despite conflicting evidence on the efficacy of early treatment, the urgency of starting treatment early for maximum benefit has been cited as the most common reason for not discussing fertility preservation with patients.Accordingly, we conducted a systematic review and meta-analysis to assess if early treatment leads to better outcomes. Methods: A comprehensive literature search was performed of MEDLINE and Cochrane databases from 1966–2008 for all phase III randomized controlled trials (RCT) comparing early versus late treatment in cancer patients as first line therapy. Data were extracted and pooled on benefits (overall survival) and harms (treatment related mortality). Results: Initial search yielded 570 trials, of which 8 RCTs met the inclusion criteria. 3 RCTs assessed the efficacy of early versus deferred treatment in prostate cancer, 3 in multiple myeloma, and 1 each in lung cancer and chronic lymphocytic leukemia (CLL). Overall, pooled data showed survival benefit with early treatment (Hazard ratio [HR]=1.16,95%CI 1.05–1.28). However, the benefit with early treatment was restricted to prostate cancer(HR=1.21,95%CI 1.09–1.35). There was no survival difference between early and deferred treatment in multiple myeloma (HR=1.11,95%CI 0.67–1.84), CLL (HR=0.89,95%CI 0.49–1.59) or lung cancer (HR=0.95,95%CI 0.72–1.24). Pooled results excluding prostate cancer RCTs did not show a survival benefit with early treatment (HR=0.97,95%CI 0.78–1.21). No trial reported data on harms. There was no significant heterogeneity among trials. Conclusions: The totality of the evidence shows except in prostate cancer, deferment of treatment does not lead to decreased survival, and provides a unique window to oncologists to address the issues related to fertility preservation if desired by patients. No significant financial relationships to disclose.
Effect of interval between diagnosis of advanced cancer and cessation of active anti-cancer treatment on survival in terminally ill cancer patients
Authors: Kim Y. , Lee J. , Choi W. , Park J. , Kim H. , Lee S. , Kim D. , Lee J. , Bang Y. , Heo D. S. 
Published: August 2020

e20630 Background: Although various prognostic factors have been proposed to predict survival in terminally ill cancer patients, accurate prognostication is still a challenging task for oncologists. The objective of this study was to evaluate whether the time interval between diagnosis of advanced cancer and cessation of active anti-cancer treatment (ATP; active treatment period) can predict survival in terminally ill cancer patients. Methods: We prospectively evaluated 79 patients with advanced (recurrent or metastatic) cancer who were determined as terminal stage, namely cessation of active anti-cancer treatment and transition to palliative care, by attending oncologists. ATP and other known prognostic factors including clinical symptoms and signs, performance status, laboratory tests, and clinical prediction of survival (CPS) were analyzed. Results: Of the 79 patients, 46 were male (58%) and 33 were female (42%) with a median age of 60 years (range, 21–82). Median overall survival after being diagnosed with advanced cancer was 11.6 months (95% confidence interval (CI), 8.02–15.18), and survival after being determined as terminal stage was 1.9 months (95% CI, 1.38–2.42). According to 3 ATP categories (< 3months, 3–12 months, and >12 months), terminal stage survival were 1.0 month, 1.8 months, and 3.6 months, respectively (p=0.002). On multivariate analysis, short ATP, non-colorectal cancer, fatigue, and Karnofsky performance status less than 50 were significantly associated with a poor prognosis. Conclusions: Our study suggests that ATP is an independent prognostic factor for survival in terminally ill cancer patients who cannot receive active anti-cancer treatment anymore. Future prognostic models should include ATP as a prognostic variable. No significant financial relationships to disclose.
Phase II study of AVR118 in the management of cancer related anorexia/cachexia
Authors: D'Olimpio J. T. , Chasen M. R. , Sharma R. , Diego M. , Gullo V. , MacDonald N. 
Published: August 2020

e20631 Background: AVR118 represents a new class of cytoprotective drugs in managing symptoms associated with anorexia\/ cachexia. In a previous study in patients with advanced HIV-AIDS, an improvement in appetite, strength and alertness was noted. The precise mechanism of action is not understood, but activity may be related to AVR118's adenosine based components. Other active components include guanosine and branched chain amino acids leucine and valine. Objective: To determine the effect of AVR118 on appetite, early satiety and nutritional intake in patients with advanced cancer. Secondary endpoints include changes in performance status, lean muscle mass and quality of Life (QOL). Methods: Eligible adult patients received 4.0 ml of AVR118 subcutaneous daily injections. Patients underwent bi-monthly evaluations during the 28 day initial treatment (phase A) Evaluations included Karnofsky performance status, Edmonton Symptoms Assessment Scale (ESAS), Patient Generated Subjective Global Assessment (PG-SGA), Simmonds Functional Assessment, Dyspepsia Symptom Severity Index, Weight, Lean Body Mass, skin fold thickness and grip strength. Patients who benefited from phase A could elect to continue with therapy (phase B). Results: Currently, of 16 enrolled patients 7 have completed phase A. All 7 patients chose to continue with AVR118 treatment (phase B). Improvements in anorexia and PG-SGA scores were seen in 7/7 and 6/7 patients respectively. Weight stabilization or gain was observed in 5/7 patients. All other parameters showed no significant difference. There was AVR118 has been well tolerated and no serious side effects have been reported. Conclusions: Based on these positive results, the primary endpoints have been achieved and the study will be expanded from 14 to 30 patients. [Table: see text]
Incidence of chemotherapy-induced nausea and vomiting after highly and moderately emetogenic chemotherapy in the era of NK-1 receptor antagonists. Perception versus reality
Authors: Majem M. , Moreno E. , Perez J. , Calvo N. , Feliu A. , Gich I. , Tibau A. , Mangues M. A. , Barnadas A. 
Published: August 2020

e20636 Background: Physicians and nurses had underestimated the incidence of chemotherapy-induced nausea and vomiting (CINV) after both high emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) (Grumberg, Cancer 2004;100:2261–8; Erazo Valle, Curr Med Res Opin 2006;22:2403–10). We have assessed if physicians and nurses’ perception of CNIV in their own practices after the introduction of Aprepitant was closer to reality. Methods: A prospective, observational unicenter study of adult patients receiving their first chemotherapy cycle was performed. Medical oncologists and oncology nurses also estimated the incidence of acute (Day 1) and delayed (Days 2–5) CINV after first administration of HEC and MEC. Eligible patients completed a 6-day diary including emetic episodes, nausea assessment, and antiemetic medication use. Observed incidence rates of acute and delayed CINV were compared with physician/nurse predictions. Results: Twenty-nine physicians and nurses and 95 patients (86.3% receiving HEC and 13.7%MEC) were recruited. Acute nausea and emesis were observed in 14.3% and 2.4% respectively of HEC patients receiving Aprepitant, and delayed nausea and emesis were observed in 14.3% and 7.1% of these patients, respectively. Physicians and nurses accurately predicted the incidence of acute and delayed CINV after HEC patients receiving Aprepitant. Acute nausea and emesis were observed in 22.2% and 0% respectively of MEC patients and delayed nausea and emesis in 33.3% and 22.2% of MEC patients, respectively. All physicians and nurses underestimated the incidence of acute nausea and delayed nausea and emesis after MEC by 15, 28 and 18 percentage points, respectively. Conclusions: The addition of aprepitant in the prevention of CINV after HEC allows a better control of CINV that is perceived accurately by physicians and nurses. By contrary, physicians and nurses continue markedly underestimating the incidence of CINV after MEC. CINV still remain important targets for improved therapeutic intervention and physicians and nurses must be aware about the real incidence of CNIV. No significant financial relationships to disclose.
Study of anxiety and depression in cervical cancer survivors
Authors: Kim S. , Nam J. , Park S. , Bae D. , Park C. , Cho C. , Lee J. , Yun Y. 
Published: August 2020

e20644 Background: Cervical cancer is the second leading cause of cancer related deaths among women in Korea. However, few studies have been conducted to elucidate the psychological distress of this population. This study aimed to examine the prevalence of anxiety and depression among cervical cancer survivors, and to identify factors associated with such caseness. Methods: A total of 832 cervical cancer survivors recruited from six large hospitals in Korea completed a mailed survey, which included the Hospital Anxiety and Depression Scale (HADS), European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and QLQ-CX24. Anxiety and depression were defined by a score of ≥ 8 on the HADS subscales. With a framework that included socio-demographic, clinical, and symptom characteristics, multivariate logistic regression models were used to identify factors associated with anxiety and depression. Results: Among cervical cancer survivors, 34.3% reported HADS-defined anxiety and 39.7% reported HADS-defined depression. Anxiety was associated with having a lower income (OR=1.95, p=.021), smoking (OR=2.42, p=.002), poor body image (OR=3.26, p<.001), peripheral neuropathy (OR=2.21, p=.002), menopausal symptoms (OR=2.02, p=.004), and sexual inactivity (OR=2.35, p=.001). Depression was associated with younger age (OR=1.75, p=.006), having a lower income (OR=2.14 p<.001), drinking (OR=1.56, p=.050), poor body image (OR=4.59, p<.001), peripheral neuropathy (OR=2.34, p<.001), and sexual inactivity (OR=2.68, p=.002). Both anxiety and depression were influenced by socio-demographic factors, health behaviors, and cervical cancer-specific symptom characteristics rather than cancer- or treatment-related factors. Conclusions: Anxiety and depression were highly prevalent among cervical cancer survivors in Korea. This examination of risk factors for anxiety and depression will be helpful for the development of clinical management strategies in cervical cancer survivors. No significant financial relationships to disclose.