bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sociodemographic factors associated with cancer treatment completion among women with breast cancer at Butaro Cancer Center of Excellence (BCCOE) in Rwanda.
Authors: Natarajan Abirami , Rudolfson Niclas , O'Neil Daniel , Schleimer Lauren , Dusengimana Jean Marie Vianney , Keating Nancy Lynn , Shulman Lawrence N. , Mpunga Tharcisse , Sebahungu Fidel , Nguyen Cam , Umwizerwa Aline , Fadelu Temidayo , Shyirambere Cyprien , Kigonya Catherine Ndagire , Butonzi John , Pace Lydia E. 
Published: May 2020

e19220 Background: Many barriers exist to delivering comprehensive breast cancer care in low-income countries. We examined sociodemographic factors associated with treatment completion among women receiving care for breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer facility. Methods: We retrospectively measured treatment completion rates in women with early and locally advanced breast cancer diagnosed at BCCOE between July 1, 2012 and December 31, 2016. We defined treatment completion as receipt of surgery, 4 cycles of chemotherapy, and initiation of hormonal therapy for estrogen receptor positive (ER+) breast cancer. We used logistic regression to examine associations between socio-demographic and clinical factors and treatment completion. Travel time was estimated using a geographic information systems model using the WHO tool AccessMod 5.0. Results: Of 212 eligible women, 138 (65%) had surgery and 141 (66%) received 4 cycles of chemotherapy. Among 139 women with ER+ cancer, 59% initiated hormonal therapy. Overall 56% received all indicated treatment including surgery, chemotherapy, and hormonal therapy (if ER positive); 44% did not complete indicated treatment. Women who lived closer to the hospital ( <50 minutes travel time) were more likely than other women to complete treatment (OR 4.2; 95% CI 1.1-15.1). Women with early-stage disease were also more likely than women with locally advanced disease to complete treatment (OR 2.2, 95% CI 1.1-4.4). Among 100 women with available information about ubudehe (Rwandan social categorization used as a proxy for socioeconomic status), rates of treatment completion were higher for women who were eligible for social support (ie: transportation support or insurance subsidy) than women who were not (74% v. 63%), although this difference was not statistically significant (p= 0.51). Conclusions: Significant barriers exist for breast cancer patients receiving treatment in this low resource setting; nevertheless, over half of the patients completed therapy. Interventions are needed to facilitate care for women with long travel times and locally advanced disease to reduce disparities in outcomes for this population of patients. Further research is needed to determine the role of social support in treatment completion.
Pegfilgrastim on-body injector: Post-market performance analysis.
Authors: Maahs Lucas , Tang Amy , Al Saheli Zaid , Jacob Brigid , Polasani Rishika , Hwang Clara 
Published: May 2020

e19226 Background: Granulocyte colony-stimulating factors (G-CSF) are widely used in medical oncology for the prevention of neutropenia and its complications. On-body injectors (OBI) have an advantage over the traditional injection (TI) method of not requiring a second visit to the oncology clinic the day after chemotherapy, but these devices are subject to failure. The objective of this study was to assess the efficacy of OBIs in the real world. Methods: Adult women with breast cancer diagnosed between June 2015 and June 2016 treated with cytotoxic chemotherapy and a G-CSF were retrospectively identified from the medical records of Henry Ford Hospital (Detroit, MI, USA). The primary outcome was the incidence of severe neutropenia (SN), defined as an absolute neutrophil count (ANC) ≤500. Secondary outcomes included incidence of neutropenia (ANC ≤1500), neutropenic fever, and mortality. A secondary analysis of the data was performed to identify predictors of SN. Results: A total of 837 cycles of chemotherapy were analyzed. The OBI was used in 395 cycles and the TI in 442. The OBI group had patients that were older, had higher ANC, were more often black, had worse performance status, and were more often smokers. The incidences of SN, neutropenic fever and neutropenia were not different between groups (Table). Mortality was not different between groups when adjusted for confounding variables (OR 1.8, 95% CI 0.9-3.6, p=0.09). Patients with a lower baseline ANC and white ethnicity were at a higher risk for SN. TAC (docetaxel, doxorubicin and cyclophosphamide combined) carried the highest risk for SN among the chemotherapy regimens used. Conclusions: There was no difference in the efficacy of the OBI and TI methods for preventing SN, neutropenic fever, neutropenia, and death. Independent predictors of SN included the chemotherapy regimen used, baseline ANC and ethnicity. [Table: see text]
Will oncologists and patients make trade-offs between efficacy and toxicities in first-line treatment of advanced HER2 negative breast cancer?
Authors: Amin Suvina , Tolaney Sara M. , Cambron-Mellott M. Janelle , Beusterien Kathleen , Maculaitis Martine C. , Kusdra Leonard , Mulvihill Emily , Shinde Reshma , McLaurin Kimmie 
Published: May 2020

e19228 Background: Treatment options for HER2- metastatic breast cancer (mBC) have greatly increased with the approval of new agents in the first-line (1L) setting: CDK4/6 inhibitors, PARP inhibitors, and atezolizumab. This study evaluated which treatment attributes patients (PTs) and oncologists (ONCs) prioritize in triple-negative and hormone-ineligible HR+/HER2- mBC PTs. Methods: US PTs with HER2- mBC, recruited via advocacy groups, and ONCs, recruited via a healthcare research panel, completed an online, cross-sectional survey. Preferences were assessed via a discrete choice experiment, where participants selected between hypothetical treatment profiles with varying attribute levels associated with 1L mBC therapies; attributes were developed through prior qualitative research with PTs and ONCs. Hierarchical Bayes was used to estimate attribute-level preference weights. Results: PTs (N=169; 69% triple-negative, 30% HR+) averaged 54 years old; treatment history included chemotherapy (92%), hormone therapy (35%), CDK4/6 inhibitor or mTOR inhibitor (24%), and immunotherapy (2%). ONCs (N=117) averaged 16 years in practice; 78% practiced in a community setting. Improving overall survival (OS) by 15 months was most important to PTs and ONCs and was at least twice as important as each of the other attributes (Table). All grade neuropathy was more important to ONCs than PTs; all grade nausea, alopecia, and grade 3/4 immune-related adverse events (AE) were more important to PTs than ONCs. Most ONCs (81%) reported that PTs prefer an oral therapy over IV; 51% of PTs agreed and 25% neither agreed nor disagreed. In the context of treatment goals, ONCs (67%) perceived that PTs are more focused on efficacy than quality of life (QoL); fewer PTs (29%) agreed. Conclusions: PTs and ONCs are willing to make trade-offs between efficacy and toxicities. However, PTs place higher value than ONCs on toxicities impacting QoL while aiming to increase survival. [Table: see text]
Contrasting fake news in oncology: The first declaration of good communication.
Authors: Berardi Rossana , Papa Roberto , Scandali Valerio Mattia , Torniai Mariangela , Blasi Maurizio , Brusa Andrea , Elisei Franco , Gregori Gian Luca , Laurenzi Giancarlo , Marinelli Luca , Marinelli Massimiliano , Mazzoli Graziella , Volpini Fabrizio , Caporossi Michele 
Published: May 2020

e19231 Background: Nowadays, in the “era of technology”, websites, online journals and social media give access to an extraordinary amount of medical information; moreover, many patients and their families employ websites and social media searching for additional clarifications about their own malignancies and the prescribed treatments. Misleading news are often disseminated generating false expectations, exaggerated anxiety and confusion even on officially supported websites. In oncology setting, disinformation is perhaps more deleterious than in other fields, with a considerable impact on single patients as well as on families and, more in general, on Public Health. In order to promote the best interaction between the world of health and the world of communication, a table of experts was established with the aim to draft a shared document identifying strategies to overcome barriers between communication and health care as well as to propose common criteria for an effective dissemination of medical information. Methods: On the basis of the "consensus conference" method in the RAND/UCLA variant, a modified version of Delphi methodology, a literature research has been conducted with the aim to select studies related to the best practices applied to health journalism regarding oncology setting. Results: Sixteen articles met the inclusion criteria, from which 72 recommendations were extracted and submitted to experts in communication and health professionals included in the technical table. After the evaluation of this panel, 57 recommendations scored more than 7 representing the selected statements shared together by communication experts and health professionals. This consensus and the drawn up shared document represent a concrete attempt to found a renewed and strategic alliance between health and communication operators in order to produce useful and reproducible indications for an effective dissemination of medical information. Conclusions: As the “American Declaration of Independence”, our “Declaration of Good Communication” has identified high-impact recommendations for the best management of patients, providing simple but fundamental concepts and recommendations about effective communication especially in oncology setting.
The use of antihypertensive medications in cancer patients on chemo immunotherapy: Protection or not?
Authors: Baralo Bohdan , Hossain Samia , Ellangovan Rithikaa , Kulkarni Ajinkya , Keshava Vinay E. , Thirumaran Rajesh 
Published: May 2020

e19238 Background: Antihypertensive medications is a widely used in the cancer patients due to comorbid hypertension. The following analysis was devoted to find if any particular group can provide nephroprotective effect for patient that is receiving chemo immunotherapy. Methods: A retrospective cohort of the 95 patients, who received chemo immunotherapy in the infusion center of Mercy Fitzgerald Hospital in 2018-2020 were analyzed. We divided patient in 4 groups. Those who were receiving beta-blockers - group 1, angiotensin-converting enzyme/angiotensin receptor blockers – group 2, dihydropyridine calcium channel blocker – group 3, non-dihydropyridine calcium channel blocker – group 4. KDIGO criteria were used to identify patients with Acute Kidney Injury (AKI). Chi-square test was used to estimate if there is association between using specific group of anti-hypertensives medications and AKI. Results: 12 out of 95 patients in the study developed AKI. In group 1 5 had AKI and 23 not, p = .032. Group 2 included 3 patient who developed AKI and 22 who did not, p = 0.91. Group 3 group had 6 patients with AKI and 10 without, p = 0.001. Group 4 had 10 patients and none of them had AKI, p = 0.16. Conclusions: In our study we found that patient who were using the dihydropyridine calcium channel blocker (amlodipine) had a higher incidence of the AKI then patients, who were using other groups of the anti-hypertensive medications. Large prospective studies may be necessary to confirm that use of amlodipine in patients who undergo chemo immunotherapy is associated with higher incidence of the AKI and should be avoided in the treatment of this patients.
mHealth for breast cancer patient navigation: What patients want—What clinicians need.
Authors: Farha Maen , Hill Mary A , Rosendall Kelly , Smith Kelly M 
Published: May 2020

e19244 Background: mHealth interventions support patient behavior change, promote adherence to treatment provide patient education, and clinical decision support. Research on mHealth interventions has focused on unidirectional communication from providers to patients. mHealth to support patient navigation through multidisciplinary breast cancer care (MBCC) has not been realized. Our team explored the information needs and perceived benefits and barriers to the design and adoption of mHealth solutions to support patient-centered MBCC. Methods: We conducted a prospective cohort study with patients and family members of patients with breast cancer (Stage 0-III), clinicians and practice staff participated semi-structured interviews/focus group to explore stakeholder perceptions of mHealth across the domains of: information needs, communication, technology preferences, and barriers and facilitators to adoption and implementation. Transcripts were analyzed using concurrent content analysis and recruitment continued until saturation of themes was achieved within each stakeholder group. Results: We conducted 22 interviews and 5 focus groups with 49 participants generating 466 individual responses. Patients, clinicians, and staff found existing communication pathways (e.g., calls to office, patient portal) sufficient in meeting patient’s needs. Family members and caregivers saw the potential of mHealth as beneficial to decision-making and treatment adherence. Patient access to health information on a smartphone between visits was perceived positive to support care organization. Clinicians and staff recognized the need for patient engagement to optimize treatment outcomes. Concerns about workload, privacy and security, and misinterpretation of information shared in mHealth apps were perceived as barriers to adoption. Recommendations included EHR integration, existing “in-box” management workflow, and team engagement in information management processes. Conclusions: mHealth can play a pivotal role in supporting patient-clinician-family dynamics for MBCC. Designers of mHealth should carefully consider the relative value of applications to the clinical workflow, patient and family needs, and identify team-based approaches to supporting adoption and implementation.
The utility of routine endocrinopathy testing in patients treated with ipilimumab for solid malignancies.
Authors: Jester Grant , Almukhtar Talat , Tseng Jennifer 
Published: May 2020

e19250 Background: It is recommended to periodically screen for endocrine immune-related adverse events during the administration of ipilimumab(ipi) and nivolumab(nivo) immunotherapy. ACTH and TSH levels are used to screen for possible autoimmune dysfunction of the pituitary and thyroid glands. Patients treated with immunotherapy at our institution undergo pre-set laboratory testing of ACTH and TSH levels prior to initial administration, and then a minimum of every 6-8 weeks depending on the treatment interval and physician preference. We aimed to evaluate the impact of routine endocrinopathy testing on clinical management and the overall utility of this testing. Methods: This is a retrospective chart review of patients treated at the UF Health Cancer Center Orlando with ipilimumab and the combination of Ipi/Nivo immune checkpoint inhibitors for solid malignancies over a 28-month period. We collected ACTH, TSH, Cortisol, and T4 laboratory data during the first 100 days of treatment and analyzed the electronic medical record for endocrinopathy diagnoses, influencing factors for ACTH results, and changes in clinical management as a result of routine ACTH screening. Results: In total, 7 patients were treated with ipilumumab single agent, and 35 patients were treated with Ipi/Nivo combination. An Immune related endocrinopathy was diagnosed in 6(14%) patients. 20 (48%) patients had at least one abnormally low ACTH value during the first 100 days of treatment. 75% of patients with abnormally low values had an ACTH level checked while on steroids. 62% of abnormally low ACTH tests did not have an accompanying cortisol level ordered. 57% of patients had ACTH testing performed in both the morning and afternoon. None of the patients with abnormally low ACTH levels had documentation which supported that ACTH/TSH testing led to brain imaging or additional pituitary hormone testing. None of the patients had their immunotherapy medication delayed or stopped as a result of routine ACTH testing. Conclusions: ACTH testing in patients treated with immunotherapy is frequently abnormal and can be exceedingly difficult to interpret. ACTH testing at our institution was often performed in the setting of multiple changing variables and abnormal values were frequently not investigated further. Routine ACTH testing did not impact clinical management.
Rare triple-negative breast cancers (TNBC): An NCDB analysis.
Authors: Elimimian Elizabeth Blessing , Samuel Thomas A. , Liang Hong , Bilani Nadeem , Elson Leah , Nahleh Zeina A. 
Published: May 2020

e19253 Background: The literature on rare triple negative breast cancer (TNBC) histology types is sparse; herein we present the clinical demographic and treatment patterns as well as overall survival (OS) for rare (< 10%) types of breast cancers that typically present as TNBCs: Medullary carcinoma (MedC), Adenoid cystic carcinoma (ACC), and Metaplastic breast cancer (MetC). Methods: Records of patients with a confirmed diagnosis of MedC, ACC, and MetC between 2010 and 2016 in the National Cancer Database (NCDB) were analyzed. Patients with an unknown stage were excluded. Univariate analyses and multivariable Cox-regression models were performed in SAS v. 9.4. Results: A total of 8,479 records were analyzed. MetC was the most commonly diagnosed histologic type in our cohort with 6,867 (81%) patients versus 255 (3.0%) MedC patients and 1,357 (16%) ACC patients. MedC presented earlier in life, with a median age of 53 years versus 62 years for ACC patients, and 63 years for MetC patients. The proportion of TNBC varied by histology type for MedC (70.4%), ACC (77.0%), and MetC (79.0 %). Patients with ACC were less likely to receive radiotherapy (52.4%) and chemotherapy (12.9%) compared to MedC (61.2%, 74.5%) and MetC (49.7%, 68.6%) respectively. On Cox multivariate regression, age ≥60 (HR 4.7), stage ≥3 [compared to patients with stage 0&1] (HR 5.7), and not receiving radiotherapy (HR 2.0) or chemotherapy (HR 1.25) conferred worse overall survival for MedC. Similarly, among patients with ACC, age ≥60 (HR 3.5), stage ≥3 (HR 5.3), and lymph node involvement (HR 4.8) were adverse prognostic indicators as well as not receiving radiation therapy (HR 1.47). Among MetC, lung metastasis (HR 2.6), stage ≥3 (HR 4.5), but also not receiving chemotherapy (HR 1.8) or radiation therapy (HR 1.47) was associated with worse survival outcomes. All p-values for cox regression is <0.0001. The 5-year OS was 92.6% for patients with MedC, 92.0% for ACC patients, 69.3% for MetC patients; all p-values <0.0001. Conclusions: This analysis describes rare types of TNBCs: MedC (most common), ACC, and MetC. We noted heterogeneity among these 3 rare types of TNBC, with the worst 5-year OS noted for MetC. Poor prognostic factors for MetC include advanced stage, lung metastasis, older age, and not receiving chemotherapy or radiation therapy. Future research focusing on rare subtypes of breast cancer is desirable and would potentially inform the optimal management of these breast carcinomas.
Stratification of patients by tumor type using molecular profiling in real-world data.
Authors: Antonopoulos Alyssa , Eldridge Elizabeth , Managadze George , Stupka Elia , Lakhani Hakim , Mahmood Sadiqa 
Published: May 2020

e19262 Background: While Next-Generation Sequencing (NGS) tests become increasingly more common for diagnosis, molecular characterization, and treatment, a significant amount of molecular data derives from single-gene or analyte tests. Single gene test information is stored in disparate sources including electronic medical record (EMR) and data access for clinical use remains a challenge. A solution that harmonizes biomarker data beyond standard NGS-centric data and linked to rich clinical data is required for the complete patient picture. Methods: Health Catalyst’s extended real-world database, Touchstone includes a molecular data mart that integrates data from provider and life sciences proprietary NGS panels, Laboratory Information Systems, and other repositories. A portion of the data is derived from single-gene tests documented in the EMR. Biomarker data from EMRs was extracted from six health systems via a proprietary pipeline for extracting biomarker data. The algorithm relies on a curated ontology for molecular terms and publicly available terminologies for human genetics. Minor transformations extract pertinent variant information where available to harmonize with NGS-level data. Results: Over 44 thousand molecular labs from over 24 thousand patients were identified with this method. The oncology classes for which molecular data was identified in the greatest number of patients include skin, hematological, breast, digestive, and lung cancers (Table). PRTN3, EGFR, BRAF, JAK2, ERBB2, and KRAS are among the most commonly tested genes. Conclusions: Integrated real-world clinical and biomarker data from single gene tests can inform clinical decision-making and support clinical trial recruitment across a broader set of patient population. [Table: see text]
The impact of primary pancreatic tumor location on clinical outcomes in advanced disease: Results from the chord consortium.
Authors: AlJassim AlShareef Abdulaziz , Pauls Mehrnoosh , Vickers Michael M. , Cheung Winson Y. , Meyers Brandon M. , Kim Christina , Goodwin Rachel Anne 
Published: May 2020

e19267 Background: Pancreatic cancer is the fourth leading cause of cancer-related death with an average life expectancy of approximately six months following diagnosis. It is essential to understand the behavior of cancer cells to predict pattern of progression. Previous studies have shown that location of pancreatic adenocarcinoma has an influence on overall survival (OS) with worse OS among patient whom developed pancreatic cancer in the tail of pancreas. The objective of this study was to determine if location of the primary pancreatic adenocarcinoma (head/neck vs. body vs. tail) has an influence on overall survival and study pattern of metastasis to lung, liver and peritoneum base on primary tumor site. Methods: A retrospective cohort design was used to identify cases of advanced adenocarcinoma pancreas and to assess disease and treatment-related characteristics. Medical records from all adult patients diagnosed with metastatic pancreatic cancer across five Canadian academic cancer centers in Canada from 2014 to 2019 were reviewed using a national Research Electronic Data Capture (REDCap) database. Prognostic variables including age, Charlson comorbidity index, ECOG, cigarette smoking, nodal status, sites of metastases, and type of first line chemotherapy were collected. Cox proportional hazards model was used to examine the association between anatomical location of pancreatic cancer and survival, adjusted for measured confounders. Analyses were completed using SAS, where alpha of 0.05 was defined as the level of significance. Results: A total of 1161 participants were included in the study. The primary origin of pancreatic cancer included head/neck (51.8%), tail (20%) and body (16%). Metastatic sites included peritoneum (n = 170), lung (n = 145), and liver (n = 563). Peritoneal metastasis originated from tail (21.3%) and body (16.8%) and less from head /neck (9.1%) (P < 0.001). Liver metastasis originated from body (52.7%) and tail (66%) and less from head/neck (37%) (P < 0.001). Lung metastasis originated from body (13.6%) and tail (19.6%) and less from head/neck (7.8%) (p < 0.001). Multivariate analyses (MVA) showed that primary tumour location was not associated with overall survival (p > 0.05). Conclusions: Pancreatic lesions that originate in the body and tail were more likely to metastasize to lung, liver and peritoneum. Anatomical location of the primary pancreatic cancer was not associated with overall survival.