bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk assessment and medical decision model for prophylaxis and treatment of hyperuricemia and tumor lysis syndrome (TLS): International expert panel analysis
Authors: Cairo M. S. , Cornelis M. , Baruchel A. , Bosly A. , Cheson B. , Pui C. , Ribera J. M. , Rule S. , Younes A. , Coiffier B. 
Published: March 2020

17006 Background: Hyperuricemia, a major component of TLS, has historically been prevented and treated using allopurinol and alkalinization, and recently managed effectively by rasburicase (recombinant urate oxidase) in children and adults at high risk of TLS. We sought to determine the risk factors associated with TLS and develop a risk adapted medical decision model for the prevention and treatment of hyperuricemia in TLS. Methods: TLS risk scoring was performed by an expert panel, based on an odds ratio evaluation of 68 patient characteristics and cancers with known TLS risk. The RAND Appropriateness Method (RAM) (1–3 inappropriate, 4–6 uncertain, 7–9 appropriate) was utilized to investigate the appropriateness of prevention and treatment in 92 different scenarios. All appropriateness ratios were validated using a set of 36 clinical cases. The strategies analyzed included no therapy, hydration (± diuretics [DI]), rasburicase, allopurinol, and allopurinol + alkalinization. Results: Risk factors (±SD) identified included age ≥ 60 years (1.6±0.5), decreased renal function (2.7±1.1), renal tumor infiltration (1.5±0.3), initial cytoreductive therapy (2.5±1.2), acute lymphoblastic leukemia with WBC ≥50x109/L [Burkitt 8.6±5.3; pre-B 4.3±2.4; T-cell 4.6±2.8]; and non-Hodgkin lymphoma with LDH≥ 2x normal [Burkitt 6.6±3.0; lymphoblastic 3.2±2.8; diffuse large B-cell 2.4±1.9]. Hydration (± DI) was considered appropriate while no treatment and allopurinol + alkalinization were inappropriate in all scenarios. For prophylaxis, rasburicase was more appropriate than allopurinol (8.5±0.5 vs 4.9±2.1; p<0.025) in patients with hyperuricemia and/or at high risk of TLS, whereas allopurinol was more appropriate than rasburicase (6.2±1.0 vs 4.9±1.9; p<0.05) in those at low or moderate risk. In patients with TLS and normal urine output and uric acid, allopurinol and rasburicase were considered equally appropriate (5.0±0.9 vs 5.8±0.3). Conclusions: In summary, in addition to hydration (± DI), rasburicase is appropriate for patients at high risk of TLS and/or with hyperuricemia, and allopurinol for those with low risk of TLS and/or normal uric acid concentration. [Table: see text]
Long-term survival following colon cancer surgery: Variation associated with choice of anesthesia
Authors: Christopherson R. , James K. E. , Tableman M. , Marshall P. , Kline A. L. , Johnson F. E. 
Published: March 2020

17015 Background: VA Cooperative Trial 345 randomized patients having abdominal surgery to unsupplemented general anesthesia (UGA) or epidural-supplemented general anesthesia (ESGA). The long-term clinical significance of the type of anesthesia for patients having surgery for colon cancer has not been well studied. We compared survival of patients with colon cancer randomized to ESGA to survival of those randomized to UGA. Methods: Survival of colon cancer patients was not a primary trial end point. We conducted a post hoc analysis of the colon cancer patients in the trial using TNM staging data from patient records. A Cox survival model was used to test the effects of pathological stage, type of anesthesia and other covariates on survival. Results: 177 patients were evaluable. In both trial arms, survival was similar (P = 0.23) until 4.56 years. After 4.56 years, patients assigned to UGA had significantly better survival (P = 0.01). In both trial arms, the survival in patients without metastases was similar initially, but those who received UGA had significantly better survival later. A similar statistically significant pattern was evident in patients with metastases. The long-term survival benefit of UGA was even more pronounced among patients with metastases and a diagnosis of alcoholism. Conclusions: This study provides the first evidence that ESGA may worsen long-term survival in colon cancer patients, especially those with metastases and alcoholism. Epidural anesthesia affects visceral blood flow, immunological parameters, post-operative pain and other physiological variables, which could explain these findings. Additional studies to confirm or refute these unexpected findings are warranted. No significant financial relationships to disclose.
The adequacy of pain treatment in advance stage non-small cell lung cancer: A longitudinal study
Authors: Mendoza T. , Wang X. , Mobley G. , Palos G. , Cleeland C. 
Published: March 2020

17016 Background: Pain is a prevalent symptom in advance stage non-small- cell lung cancer (NSCLC). Previous studies have shown these patients to be at risk for inadequate pain management. This longitudinal study evaluated pain and analgesic management in this patient population. Patients were treated at a major tertiary cancer center. Methods: Data from 102 patients receiving chemotherapy were used. Their pain was assessed weekly using the pain item from the M.D. Anderson Symptom Inventory, administered through an interactive voice response system. Analgesic orders were collected three times every two cycles of chemotherapy across 18 weeks (T1, T2 and T3). Adequacy of pain management was evaluated by the Pain Management Index (PMI). Chi-square tests were used to test for differences in proportions. Results: This analysis was based on all available data, as sensitivity analyses of pain trajectory by dropout as a function of time did not show differences. At baseline, 60% of 102 patients reported pain (ratings of 1 or greater on a 0- 10 scale) with the following distributions: 39% mild, 14% moderate and 7% severe. The proportions of patients with moderate to severe pain were 21%, 15%, 17% and 20% at baseline, T1, T2 and T3, respectively. The proportion of patients with moderate to severe pain did not increase over time. According to the PMI, there were 21%, 18%, 15% and 21% of patients who were inadequately treated at baseline, T1, T2 and T3, respectively. The percentages of patient receiving orders for strong opioids were 19%, 25%, 26% and 41% at baseline, T1, T2 and T3, respectively. Conclusions: About 80% of patients seen in a major tertiary cancer center were adequately treated for pain, while about 20% of patients experienced moderate to severe pain. Both these percentages were seen over time and did not significantly change during the course of their cancer treatment. These may be accounted for by a significant increase in the prescription orders for strong opioids by twice as much during the latter stage of their treatment. No significant financial relationships to disclose.
The use of the internet for medical information and a needs assessment for a web based educational resource: A survey of Canadian medical oncology trainees and training program directors
Authors: Horn L. , Berry S. , Chung J. , Vijayaratnam S. , Verma S. 
Published: March 2020

17022 Background: Medical Oncology trainees develop their skills and knowledge through formal educational sessions, independent learning and clinical rotations. The internet serves as a source of up to date information and a potential educatinal resource. Despite the existence of many websites with oncology related information, there has not been a comprehensive assessment of how medical oncology trainees and program directors use the internet to meet educational objectivs. Method: In the first phase of developing a new educational website (OncologyEducation.com), we surveyed medical oncology trainees and program directors from training programs across Canada to assess how they accessed the internet to determine the elements they considered essential for a trainee-oriented site. Results: 12 out of 13 Canadian medical oncology training programs participated in our survey. A total of 12 program directors and 23 trainees responsed to our survey for a 74.5% response rate. 71.4% of respondents spend up to 10 hours per week on the internet for work related reasons. Pubmed and UptoDate were the most frequently visited sites. Respondents reported using the internet for email (97.1%), answering clinical questions (88.6%), accessing practice guidelines (80%), and literature updates (71.4%). Respondents expressed a need for an educational website stressing the following content: (1) Key updates by disease sites (2) Access to pivotal journal articles (3) Access to upcoming conferences/information (4) Links to other medical sites/medical oncology sites (5) Fellowship Opportunities. Conclusion: The internet is an important resource for supplementing the training of medical oncology trainees. The development of an educational website based on the needs assessed in this survey is warranted. Upon development of the website it will be evaluated for effectiveness and impact on oncology training and clinical practice. No significant financial relationships to disclose.
Lobular invasive pleomorphic breast cancer (BC) should be isolated from the classic type
Authors: Gil Deza E. , Japaze H. , García Gerardi C. , Diaz C. , Gercovich N. , Morgenfeld E. , Rivarola E. , Russo M. , Frahm I. , Gercovich F. G. 
Published: March 2020

17024 Background: Lobular invasive BC represents between 5 and 10% of all breast tumors. The MD Anderson Hospital has published a study of 122 pt with lobular invasive carcinoma classic type (LIC) with a better long-term outcome than pt with invasive ductal carcinoma (JCO 23:41, 2005). In most papers, the lobular invasive pleomorphic type (LIP) represents a small number of cases and can be easily confused with the NOS carcinoma. The aim of this study is to compare the onset and prognosis of patients (pt) with LIP vs LIC breast cancer. Methods: A search in the IOHM database of 1169 BC was carried out. All of them had been reviewed by two pathologists and classified according the USA Association of Directors of Anatomic and Surgical Pathology's recommendations. The entire cohort was diagnosed and treated at the IOHM. Only those with lobular invasive BC were included in this paper. Results: Between Oct 97 and Nov 06, 116/1169 pt (10%) were diagnosed with invasive lobular carcinoma. Seventy pt (60%) were LIC, and 46 pt (40%) were LIP. Characteristics of the Population: All pt were females. Both groups were comparable in terms of age (median age for both groups = 60 yo) Staging: LIP presented in more advanced stages: A) LIP group: Stage I: 14 pt; II: 22 pt; III: 8 pt; IV: 2 pt B) LIC group: Stage I: 42 pt ; II:13 pt; III: 15 pt; (p:0,001). The LIP group had a higher histological grade (p:0,0001), and more multifocality (p: 0.023), and vascular invasion (p:0,0001) than the LIC group. There were no differences in hormonal receptors status or the ductal extensive component. The retrospective determination of the Her2/neu status is underway. Treatment: Both groups were treated similarly according to the different stages of the illness. Follow-Up: The average follow up time was 23 months (range 4–102) and the LIP group showed a worse prognosis than the LIC group as measured by a higher rate of metastasis (LIP: 12 pt - LIC: 4 pt) (p:0,002) and a higher mortality rate (LIP: 6 pt - LIC: 0) (p:0,003). Conclusions: 1- The LIP carcinoma is a more aggressive variant and has a worse prognosis than the LIC. 2- The incidence for LIP is higher than expected, as it stands for 40% of the total cases in our study. 3- The results justify the establishment of a clear cut differentiation between the classical and pleomorphic types. No significant financial relationships to disclose.
A prospective evaluation of combined modality therapy for breast cancer with ipsilateral supraclavicular node metastases
Authors: Dienstmann R. , Noronha Filho H. , Branco L. G. , Lima C. F. , Rodrigues G. J. , Freitas L. C. , Rezende L. M. , Small I. A. , Bines J. 
Published: March 2020

17025 Background: Based on retrospective data, the most recent breast cancer staging classification changed the status of ipsilateral supaclavicular node mestastases from M1 to N3c. This carried along with it modifications in the treatment of a small subset of breast cancer patients. The aim of this study is to prospectively evaluate surgery and radiation therapy besides systemic treatment in pts with stage IIIC breast cancer. Methods: Phase II single-institution trial. Eligibility: patients with non-metastatic breast cancer and pathological confirmation of ipsilateral supraclaviclular node metastases. Treatment: FAC (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2) q 21 days × 6; followed by modified radical mastectomy (MRM); adjuvant radiotherapy and tamoxifen (if estrogen and/or progesterone receptors positive - ER/PR). Results: Since May 2002, 22 patients entered the trial, with a median follow-up of 25 months (4–50). Median age was 50 years (29–69). Median tumor size was 6 cm (2.5–15), most patients had T4 disease (77%) and ER/PR positive tumors (64%). All patients underwent MRM after neoadjuvant FAC. Clinical response: 1 (5%) complete, 20 (90%) partial, 1 (5%) minor response. Until December 2006, 13 patients progressed and 7 died. Five patients (23%) had loco-regional relapse and 5 (23%) developed brain metastases. Median estimated progression-free survival was 41 months (14.1–67.8) with median survival not reached. The estimated 2-year progression-free and overall survival rates were 32% and 67%, respectively. Conclusions: Our results, collected in a prospective fashion, are in agreement with previous retrospective studies. Combined-modality treatment for breast cancer with ipsilateral supraclavicular node metastases is recommended. No significant financial relationships to disclose.
Choice of adjuvant and first-line metastatic chemotherapy (CT) for colorectal cancer (CRC) treated in the Carolinas
Authors: Rowe K. , Patwardhan M. , Herndon J. E. , Martin M. G. , Zafar Y. , Morse M. , Abernethy A. P. 
Published: March 2020

17039 Background: CT choice is influenced by many factors including published evidence, guidelines, cost, reimbursement, patient considerations, key opinion leaders, and anecdote. Substantial locoregional variation in practice patterns can exist, and therefore studies of locoregional practice provide important information on local drivers of care. Methods: Using a population-based strategy, we identified CRC patients who developed metastatic disease since 6/1/03 from 9 Duke Oncology Network community practices and 1 academic practice in North and South Carolina. Demographic, comorbidity, diagnostic, stage, initial treatment, and metastatic treatment data were abstracted by retrospective chart review, double-entered and verified for accuracy. Results: Of the first 743 charts screened, 306 were eligible (mean age 61 (SD 13), 49% male; 65% white; 22% black; 77% colon cancer and 19% rectal; stages II 8%, III 16%, IV 64%). 26 earlier stage rectal cancer patients received neoadjuvant treatment, 50% infusional fluorouracil (5FU) and 42% capecitabine (Cap). 46 colon cancer patients received adjuvant CT, including 5FU/leucovorin (LVN; 54%), 5FU/LVN/oxaliplatin (21%), Cap (9%), and 5FU/LVN/irinotecan (7%). First-line CT for metastatic colon cancer (n=149) included FOLFOX+-bevacizumab (Bev; 42%), Cap/oxaliplatin +- Bev (23%), 5FU/LVN + Bev (9%), FOLFIRI +- Bev (7%), IFL +- Bev (7%), clinical trial (7%), Cap (3%), and unknown (1%). 54% of patients received Bev overall, reflecting 49% usage before 6/05 and 69% after 6/05. CT was not offered for 25 (8%) at initial diagnosis. Conclusion: Locoregional practice patterns in the Carolinas suggest that for adjuvant treatment of CRC, oxaliplatin has been used in 21% of adjuvant and 75% of first-line metastatic colon CT regimens, and that bevacizumab use has increased to 69% of first-line metastatic CRC patients. No significant financial relationships to disclose.
Evaluating compliance (com) with hematology (H) -oncology (O) quality (Q) standards in a community-based managed care population
Authors: Bosserman L. , Presant C. , Der A. , Estrella A. , Greenburg A. , Upadhyaya G. , Vakil M. 
Published: March 2020

17050 Background: Better Q and outcomes in HO practice are associated with com with national treatment guidelines (TG). Institution of an O specific electronic medical record (EMR) within a community HO specialty practice allowed analysis of com with TG as well use of high cost treatments (HCT) data from an HMO population in a multi site HO practice are presented. Methods: HO physicians agreed to treat patients (pts) using common EMR, TG and regular treatment (tx) reviews. EMR data over 18 months for the HMO population was reviewed for diagnosis, stage, and tx. This was compared to TG of NCCN. A panel of high cost therapies (HCT) was identified by the HMO medical director, and pt treatment com with TG was tabulated. Non-com was further evaluated as acceptable alternative practice (acc) by NCCN description, recommended (rec) by academic specialist consultation or not appropriate by TG (non-app). Results: Between 1/1/04 and 6/31/05, the HMO had ∼75,000 covered lives at risk. 1210 evaluable HO pts were treated by 5 oncologists. 163 pts had benign H diagnoses (dx), 155 had malignant H dx, and 892 had solid tumor dx (breast 373, colorectal 76, lung 63, prostate 28, ovary 15). Of pt with cancer (ca), 49 had active ca but no rx, 639 had ca in complete remission and had no tx, and 256 had active ca and received tx. 102 had clinical diagnosis but incomplete evaluations, none received tx. Of HMO chosen HCT, Rituximab was given to 25 pt, and all rx was com to TG. Bevacizumab was given to 14 pt and was com in 11, acc in 1, and non-com/acc in 2. Trastuzumab was given to 8 pt, and was com in 4, acc in 3, and rec in 1 pt. IVIG was com in 1 and rec in 1 pt. Of a total 49 HCT, 8 were non-com with TG (16%), but only 2 were non-com, non-acc, and non-rec (4%). Both were associated with 1 new physician whose performance improved after pre tx review of HCT by a senior physician prior to pt tx. Conclusions: Ongoing review and feedback to physicians using EMR and national TG allows objective monitoring and improvement of Q in HO practice. Issues of concern, such as HCT, can also be detailed. Payors and practices can consider using such methods and data to negotiate fair payment for Q care. . No significant financial relationships to disclose.
Baseline diagnostic imaging in early breast cancer—Five-year analysis of a large cohort
Authors: Morris P. G. , Gray J. , O' Rafferty C. , O' Connor M. , Kennedy M. J. 
Published: March 2020

17059 Background: Many patients with newly diagnosed breast cancer undergo multiple investigations as part of baseline staging, although the evidence base for this is poor. To assess the use of baseline diagnostic imaging and its benefit a review of practice was carried out. Methods: A retrospective review of all patients diagnosed with breast cancer in St James's Hospital in Dublin, Ireland over a five-year period was carried out. Baseline demographics and the appropriateness of baseline diagnostic imaging were assessed. Results: Between 01/01/2001 and 12/31/2005 781 patients were diagnosed with breast cancer in St James's Hospital, of whom 776 were women and 5 were men, with a mean age of 56.7 years. At diagnosis 266 patients (34%) underwent a bone scan, which showed evidence of skeletal metastases in 42 (15.8%). Of the patients with positive bone scans 26 (61.9%) were symptomatic with bone pain, and 16 (38.1%) were not. In the 16 patients without bone pain a diagnostic workup for metastatic disease was undertaken in 5 patients because of clinical findings, in 4 patients because of abnormal liver blood tests and in 5 patients because of radiological findings. Only two patients out of 266 who underwent a bone scan were found to have an incidental finding of metastatic bone disease, of whom one had a bone scan as part of a clinical trial. At diagnosis 261 patients (33.4%) underwent a liver ultrasound, which showed evidence of metastases in 23 (8.8%). Of these, 19 patients had abnormal liver blood tests. Four patients had metastatic disease on liver ultrasound with normal liver blood tests and of these, one patient had a malignant pleural effusion and one patient had inflammatory breast cancer and was considered high risk for metastatic disease. Only two patients out of 261 who underwent a liver ultrasound had incidental findings of liver metastases. Conclusions: Over a five-year period, occult metastases were discovered in only two patients on bone scans and in two patients on liver ultrasounds. The routine use of these imaging modalities to detect metastases in early breast cancer is not justifiable. No significant financial relationships to disclose.
Phenotypic characteristics of triple negative breast cancer in a rural population
Authors: Howard-McNatt M. , Hazard H. , Jaime A. , Vona-Davis L. 
Published: March 2020

17060 Background: Triple negative breast tumors are a basal-like subtype of breast cancer associated with the poorest clinical outcomes. Typically they are found in younger patients, African-American women, and patients with the BRCA mutation. To date, however, the epidemiology of triple negative breast cancers in a rural, Caucasian population has not been described. Methods: 96 breast cancer patients presenting with a basal-like subtype of breast cancer had tumor biopsies and demographic and epidemiologic information were collected. Standard histologic and immunohistochemical analysis was done for ER, PR, HER-2/neu status for all high nuclear grade tumors from January 2000 to December 2005 at West Virginia University Hospital. The tumor registry was reviewed to determine tumor size, stage at diagnosis, age at diagnosis, race, menopausal status, body mass index (BMI) and BRCA1/BRCA2 status. Variables in the triple negative group were then compared to all patients who were diagnosed with infiltrating ductal carcinoma between 1999–2004. Results: The basal-like breast cancer subtype was more prevalent among the 40–59 year old group (52%, 50/96) versus women <40 years (12.5%, 12/96) (p= 0.01). Most patients presented with T2 tumors (57%) and the majority had stage II disease (61%, p-value = 0.01). 67% of the population was postmenopausal and were more likely to be overweight or obese (73%, p-value = 0.03). Only one African-American patient met all criteria (2.8%). Of the 7 patients with triple negative tumors who received BRCA testing, four were BRCA1 positive. Age, tumor stage and BMI were similar between the populations of triple negative tumors and infiltrating ductal carcinoma. Conclusions: The demographic and phenotypic characteristics of basal-like breast cancers are still being defined. In contrast to previous findings, triple negative tumors in a rural area were found in middle aged, postmenopausal Caucasian women with Stage II disease and a higher BMI. This analysis will help to identify possible risk factors such as obesity in triple negative cancer subtypes and may prompt further research into differences in breast cancer survival in obese populations from rural areas. No significant financial relationships to disclose.