bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospitalizations following cancer diagnosis: National values for frequency, duration, and charges.
Authors: Halpern Michael T. , Zhang Fanni , Enewold Lindsey 
Published: May 2020

12039 Background: US medical care costs for cancer are projected to be $158 billion in 2020. Hospitalization is a substantial component of these costs; however, little is known about national patterns of hospitalization among individuals with cancer. This study used Medicare data to determine national rates and charges for hospitalizations among older cancer patients. Methods: We used data from 100% of individuals diagnosed with cancer in SEER-Medicare in the most recent 5 years available, 2011-2015. Analyses determined proportion of patients hospitalized, number/duration of hospitalizations, and charges by patient clinical and sociodemographic characteristics within 12 months of diagnosis. Results: Among 307,944 unique patients, 65% were hospitalized in the first year following diagnosis. Rates ranged from 34% for patients with in situ disease to 82%-84% for patients with advanced disease; 31% had 2 or more hospitalizations. Hospitalization rates were lowest among skin melanoma (25%) and breast (42%) cancer patients, highest for brain/nervous system (97%) and ovarian (96%) cancer patients. Hospitalized patients had a mean of 2.1 hospitalizations; mean days per hospitalization within 12 months was 8.8 (median 4). Duration of hospitalization varied little by stage at diagnosis. Mean days per hospitalization was shortest for thyroid and prostate cancer patients (5.7 & 6.0 days), longest for colorectal cancer and leukemia patients (10.6 & 11.3 days). DRGs varied substantially by cancer type; DRG for chemotherapy administration was more frequent among hospitalizations for patients with hematologic malignancies or distant stage disease. Mean Medicare charge (2016 $) per hospitalization was $67,368 (median $41,973), and was lowest for breast cancer patients ($48,021), highest for leukemia patients ($91,799). Patient charges per hospitalization averaged $1107 (median $1317) and showed little variation by cancer type or stage. Conclusions: Most older individuals experience at least one hospitalization within 12 months of cancer diagnosis. Frequency, duration, and charges of hospitalizations vary by cancer type and stage. This nationally representative information will aid in projecting cancer care costs and potential economic impacts of new therapies and treatment program.
Investigating the disparate enrollment of older adults on phase I clinical trials: Evolving participation patterns of patients 65 years and older w advanced cancer on phase I trials.
Authors: Subbiah Ishwaria Mohan , Buzdar Aman , Ileana Dumbrava Ecaterina Elena , Fu Siqing , Janku Filip , Karp Daniel D. , Naing Aung , Pant Shubham , Rodon Jordi , Tsimberidou Apostolia Maria , Yap Timothy A , Subbiah Vivek , Meric-Bernstam Funda , Hong David S. 
Published: May 2020

12044 Background: While safety and dose-finding remain the primary objective of Phase 1 trials, the potential for clinical benefit has taken a greater meaning in the last decade with the novel therapies. With data from phase I trials being submitted for regulatory approval, the finer details of these studies are under even more scrutiny: in particular, do the trial participants reflect the general patient population for whom the drug may be indicated? To that end, we investigated age-based enrollment on phase I clinical trials over time. Methods: We queried a prospectively maintained database at a major phase I trials center to identify eligible patients and demographic + clinical variables including phase I trial characteristics, age at date of enrollment into 3 age-based cohorts: AYA ages 15-39y, mid-age 40-64y, older adults aged 65y+. We calculated descriptive statistics, and explored correlations (Pearson/Spearman) and associations (linear regression) between age and independent variables. Results: Over a 3-year period (1/1/17 to 12/31/19), we identified 6267 pts enrolled on 338 phase I trials. Median overall age 58.4y (range 15.5-95.1y). 729 (12%, median age 34.8y) were AYA, 3652 (58%, median age 55.4y) mid-age and 1886 (30%, median 70y) older adults, of whom 870 pts were aged 70-79y and 76 pts aged 80y+ (18 being >85y). There was no association b/w senior participation and year of enrollment (2017 31%, 2018 29%, 2019 30%, b/w age and type of therapy (i.e. targeted vs immunotherapy, etc.) or b/w age and # of drugs given on trial (single agent vs combo) (all p > 0.05). Conclusions: Older adults remain underrepresented on phase I trials esp. when compared to incidence of cancer in that age group (30% enrollment vs 60% incidence), a discordance more staggering in the oldest old pts (85y+; only 18 pts enrolled over 3 yrs when compared to 140,690 pts 85y+ w a new cancer dx in just 2019). Once enrolled, older adults received similar types of phase I therapies with comparable number of drugs as compared to middle age patients, i.e. older adults were just as likely to get immunotherapy or targeted therapy as well mono- vs combo therapy as mid-age pts. [Table: see text]
Association of geriatric conditions with survival and health care use in older adults with colon cancer living in long-term care facilities.
Authors: Lage Daniel E , Nipp Ryan David , El-Jawahri Areej , Temel Jennifer S. , Williams Grant Richard , Kenzik Kelly 
Published: May 2020

12045 Background: Older adults with colon cancer residing in nursing homes are at risk for experiencing geriatric conditions such as cognitive decline, limitations in activities of daily living (ADLs), needing pain medications, and incontinence, due to cancer and its treatment. We sought to investigate these factors pre- and post-diagnosis and explored their relationship with health care use and survival. Methods: We identified 483 patients age 65+ with colon cancer from 2011-2015 in SEER-Medicare with linked quarterly nursing home assessments from the Minimum Data Set both pre- and post-cancer diagnosis. We determined the number of geriatric conditions (cognitive functioning, limitation in any ADL, pain medication use, bowel/urinary incontinence) at the pre- and post-cancer diagnosis assessment. We created four groups based on changes in these factors from pre- to post- assessment: improved (n = 105), worsened (n = 25), remained limited (n = 240), never limited (n = 113). Regression models estimated how changes from pre- to post-cancer diagnosis were associated with number of emergency department (ED) visits, hospitalizations, and survival, adjusted for age, sex, race/ethnicity, insurance status, cancer stage, number of pre-cancer comorbidities, urban/rural status, and time from diagnosis. Results: Overall, 55.3% of patients were age > 80 at diagnosis, with 64.8% female; 73.3% non-Hispanic white; and 9.9% Stage IV. Pre- versus post-diagnosis, 20.7% vs. 34.8% of patients were limited in cognitive functioning, and 75.4% vs. 77.8% were limited in ADLs. About a third of patients required pain medication, and about half of patients had urinary incontinence, which did not change pre- and post-diagnosis. Patients who remained limited had higher rates of ED visits (Risk ratio [RR] 1.05, p < .01) compared to those never limited. Those who worsened had higher rate of hospitalization (RR 1.44, p < .01) and ED visits (RR 1.63, p < .01). 12-month and 5-year survival was 46.7% and 6.1%, respectively. Factors associated with worse survival in a multivariable model included: remaining limited at both assessments (OR 1.52, p < .01), worsening from prior (OR 2.00, p = .01), as well as older age and higher cancer stage. Conclusions: Older adults with colon cancer residing in nursing homes have high prevalence of geriatric conditions and differential health care use and survival based on the presence of geriatric conditions, highlighting the need to consider geriatric conditions when providing cancer care to this population.
Geriatric assessment (GA) predictors of 1y mortality in older adults with gastrointestinal (GI) malignancies: Results from the CARE study.
Authors: Williams Grant Richard , Dai Chen , Al Obaidi Mustafa , Giri Smith , Kenzik Kelly , McDonald Andrew Michael , Smith Crystal Young , Gbolahan Olumide B. , Paluri Ravi Kumar , Richman Joshua , Bhatia Smita 
Published: May 2020

12047 Background: Chronologic age is an imperfect predictor of morbidity and mortality in older patients with newly-diagnosed GI malignancies. Identifying patients with GI malignancies that are at increased risk of mortality within the 1st year remains challenging given no prior studies have focused on this population, yet is critical to developing personalized treatment plans. To fill this gap, we examined predictors of 1y mortality using variables from a patient-reported GA in a prospective cohort of older adults with GI malignancies. Methods: Cancer and Aging Resilience Evaluation (CARE) is a prospective registry of older adults (≥60y) with cancer seen at UAB (J Geri Onc 2019; PMID 31005648). Patients with GI malignancies with GA completed within the timeframe of 3 mo. before and up to 6 mo. after diagnosis were included. Vital status (up to 12/7/2019) was ascertained by linking participants to LexisNexis. Multivariable Cox regression analysis was used to estimate associations between GA variables and 1y mortality, adjusting for age at cancer diagnosis, race, cancer stage (IV vs. I-III), cancer group (high risk: pancreatic, hepatobiliary, esophageal vs. low risk: colorectal, GIST, neuroendocrine, etc.), and planned chemotherapy (yes/no). Results: A total of 356 participants met eligibility criteria. Mean age at enrollment was 70y; 56.4% were females; 25% black; 47.1% had high-risk cancers. In unadjusted analysis, high-risk cancers, cancer stage, malnutrition, impaired performance status, limitations in social activities, impaired instrumental activities of daily living (IADL), physical health, mental health, anxiety, and ≥3 comorbidities were associated with higher 1y mortality. Our base model (demographic and clinical variables) demonstrated good discrimination (c statistic 0.758), but was improved with the addition of all significant GA variables (c-statistic 0.810). Fatigue and malnutrition were identified as the strongest predictors among the GA variables, and a model adding those to the base model retained high discrimination (c-statistic 0.804). The estimated 1yr survival was 53.1% for those with both fatigue and malnutrition compared to 88.1% in those with neither. Conclusions: Among older adults with GI malignancies, malnutrition and fatigue were the strongest GA predictors of 1yr mortality after adjusting for age and clinical factors. These findings provide evidence for developing targeted interventions in older patients with newly-diagnosed GI malignancies to reduce 1y mortality.
An international cohort study investigating the impact of age on clinical outcome in patients with hepatocellular carcinoma treated with sorafenib.
Authors: Sharma Rohini , Hajiev Saur , Aval Leila Motedayan , Bettinger Dominik , Arizumi Tadaaki , Pirisi Mario , Rimassa Lorenza , Personeni Nicola , Pressiani Tiziana , Giordano Laura , Kudo Masatoshi , Thimme Robert , Park Joong-Won , Taddei Tamar Hamosh , Kaplan David Edward , Ramaswami Ramya , Pinato David James , Allara Elias 
Published: May 2020

12049 Background: There is no consensus on the effect of sorafenib dosing on efficacy and toxicity in elderly patients with hepatocellular carcinoma (HCC). Older patients are often empirically started on low dose therapy with the aim to avoid toxicities whilst maximising clinical efficacy. We aimed to verify whether age impacts on overall survival (OS) of patients with HCC, and whether a reduced starting dose of sorafenib impacts on OS or rates of toxicity experienced by the elderly. Methods: In this international, multicentre cohort study, patients with a confirmed diagnosis of advanced-stage HCC receiving sorafenib were recruited from seven specialist centres. Demographic and clinical data including development and grade of sorafenib toxicity and sorafenib starting dose were collected prospectively. Survival time (months) was recorded prospectively. Outcomes for those < or > 75 years were determined Results: A total of 5598 patients were recruited; 792 (14.1%) were over the age of 75. The elderly were more likely to have larger tumours ( > 7cm)(39 vs 33%, p = 0.07) with Child-Pugh A liver function(67 vs 57.7%) and less portal vein thrombosis compared to those < 75years(22.1 vs 29.4)(p < 0.001). They were more likely to be commenced on lower starting dose of sorafenib i.e 400mg/200mg (38.7 vs 37.2%, P < 0.01). In terms of OS, there was no difference in the median OS of those >75 years and patients < 75 (7.3months vs 7.2months; HR 0.98 (95% CI 0.90–1.06), p = 0.63). There was no relationship between starting dose of sorafenib, 800mg vs 400mg/200mg, and OS between those < or > 75years. The elderly experienced a similar incidence of grade 2-4 sorafenib-related toxicity compared to < 75years(74.3 vs 61.7%, p = 0.051)(except for anorexia (14.0 vs 7.2%, p < 0.01) and rash (3.1 vs 6.3%, p < 0.05), irrespective of the dose prescribed. The elderly were more likely to discontinue sorafenib due to toxicity (27.0 vs 21.6%, p < 0.01). This did not vary between different starting doses of sorafenib. The mean duration of treatment was similar between those < and > 75 and, again, the starting dose of sorafenib did not affect treatment duration in the elderly. Conclusions: The median OS in the elderly is the same for that of patients under 75 years and is independent of the dose of sorafenib prescribed. Therefore, sorafenib should be offered to elderly patients and they should not be excluded from therapy
Living life post cancer treatment (LLPCT): An assessment of a 12-week multidimensional wellness intervention to improve quality of life and physical activity in cancer survivors.
Authors: Marino Christopher C. , Dwyer Colleen , Poppenberg Janette T. , Brufsky Jill , Zhai Shuyan , Van Londen G J. 
Published: May 2020

12052 Background: Cancer survivors face unique health challenges with implications on health-related quality of life (HRQoL) and physical, social, and emotional wellbeing. With advancements in cancer treatment and aging populations, the prevalence of cancer survivors is expected to grow prompting the need for improved survivorship care delivery and comprehensive rehabilitative services. Living Life Post Cancer Treatment (LLPCT) is a community-based 12-week program that provides multidimensional support to patients of any cancer diagnosis transitioning from active treatment to post-treatment life. This single-arm intervention study aims to assess the program’s impact on HRQoL and physical activity in cancer survivors. Methods: A total of 125 participants within 2 years of treatment completion were enrolled in a 12-week program comprised of 9 sessions of engaging workshops, personalized exercise training, and nutrition and psychosocial counseling with an interprofessional team of oncology providers, social workers, exercise trainers, and dietitians. The program consisted of 8 consecutive weekly sessions followed by a 1-month follow-up session at week 12. Ninety-six (77%) participants completed the eighth or ninth session of the program and were included in the analysis. A series of questionnaires were administered at baseline and weeks 8 and 12. Primary outcomes assessed were HRQoL using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire and physical activity using average daily steps by pedometer and 2-minute step test performance. Results: Among the 96 participants (mean age 60.4 ± 11.7) who completed the program, the majority were female, white, and married. Post-intervention median FACT-G scores significantly increased from baseline at weeks 8 (+8.8, p = 0.002) and 12 (+7.3, p < 0.001). Average daily steps by pedometer increased by 1063 (p = 0.003) and 1233 (p = 0.015) and 2-minute step test performance increased by 18 (p < 0.001) and 21 (p < 0.001) steps at weeks 8 and 12, respectively. Participants reported high levels of satisfaction and improved self-efficacy to incorporate lifestyle modifications. Conclusions: These findings suggest that this 12-week intervention improves HRQoL and step-based physical activity levels in cancer survivors and could serve as a multidimensional model for post-treatment support. Further research is needed to determine if these benefits are sustained long-term.
The impact of tobacco retail density on overall survival (OS) in lung cancer survivors.
Authors: Eng Lawson , Hueniken Katrina , Norwood Todd A , Romme Gerald J , Brown M. Catherine , Hope Andrew J. , Bezjak Andrea , Sacher Adrian G. , Bradbury Penelope Ann , Shepherd Frances A. , Leighl Natasha B. , Pierre Andrew , Selby Peter , Goldstein David Paul , Xu Wei , Giuliani Meredith Elana , Evans William K. , Chaiton Michael , Liu Geoffrey 
Published: May 2020

12058 Background: Continued smoking after a cancer diagnosis is associated with poorer outcomes. We previously identified that tobacco retail outlet density is negatively associated with cessation in lung cancer survivors (ASCO 2019). However, the impact of tobacco retail density on survival has not been evaluated. We evaluated the impact of tobacco retail density on OS in lung cancer patients (pts). Methods: Lung cancer pts diagnosed from 2009-2012 were recruited at diagnosis and completed a baseline questionnaire on their socio-demographics, ECOG and smoking history. Clinicopathologic data including stage, histology and OS data were collected. Validated tobacco retail location data obtained from Ministry of Health and pt home addresses were geocoded using ArcGIS 10.6.1, which calculated tobacco outlet density within 250 meters (m) and 500m from pts. Multivariable Cox proportional hazard models evaluated the impact of tobacco outlet density on OS adjusted for significant clinicodemographic covariates. Results: Among 1411 pts, median age 66, 53% female, 8% small cell/56% adenocarcinoma/17% squamous/19% other, 28% stage 1/9% stage 2/20% stage 3/35% stage 4, 38% were current smokers at diagnosis and 40% were ex-smokers; median OS was 24 months. On average, there was one vendor (range 0-23) within 250m and four vendors (range 0-44) within 500m from pts; 33% and 60% of pts lived within 250m and 500m from at least one vendor respectively. The final baseline multivariable model consisted of age, gender, stage, smoking status, ECOG and neighbourhood marginalization index ( P< 0.05). Among all pts, not living within 250m to an outlet improved OS (aHR 0.84 [0.72-0.97] P= 0.02). Living near more outlets within 250 m (aHR 1.03 per outlet [1.00-1.05] P= 0.03) or 500 m (aHR 1.01 per outlet [1.00-1.02] P= 0.04) worsened OS. Subgroup analysis based on smoking status at diagnosis, identified that among current smokers, not living within 250m to an outlet improved OS (aHR 0.76 [0.60-0.97] P= 0.03), and among ex-smokers, living near more outlets within 500 m worsened OS (aHR 1.02 per outlet [0.99-1.03] P= 0.07); other associations showed similar directionality. Among 135 current smokers at diagnosis with follow-up smoking status, not living within 250m to an outlet continued to show a trend towards improved OS (aHR 0.57 [0.31-1.03] P= 0.06), after also adjusting for follow-up smoking status. Conclusions: Living near a greater density of tobacco outlets is associated with poorer OS among lung cancer pts. Reducing the density of tobacco outlets may be a strategy that can help improve lung cancer pt outcomes.
Impact of immune checkpoint and BRAF inhibitors on the incidence of second primary malignancies (SPM) in melanoma.
Authors: Budhathoki Nibash , Timilsina Sunita , Atluri Prashanti , Weber Jeffrey S. , Braunstein Marc Justin 
Published: May 2020

12061 Background: Prior studies have shown an increased risk of SPM in melanoma, however there is limited data on the incidence of SPM following the 2011 approvals of immune checkpoint (ipilimumab) and BRAF (vemurafenib) inhibitors, which have become standard of care. We present data comparing SPM rates before and after introduction of these agents for advanced cutaneous melanoma. Methods: Adult melanoma patients with regional or distant metastases were identified from SEER-18 database and divided into cohorts: 2005-2010 and 2011-2016. SPM was defined as tumors diagnosed ≥6 months from diagnosis of the primary cancer. SEER*stat was used to calculate SPM by multiple primary standardized incidence ratio based on observed (O) and expected (E) cases. The expected numbers of new cancers of specific types were estimated by assuming that incidence rates for new primary tumors corresponded to sex, age, and calendar time–specific SEER rates for similar invasive primary cancers and applying those rates to the accumulated person-years (PYR) of observation. Excess absolute risk (EAR) of malignancy per 10,000 PYR at risk was calculated as ([O − E]/PYR) × 10,000. Results: As shown in the table, from before 2005-2010, 421 of 7991 patients (5.2%) with advanced melanoma had 444 SPM (O/E ratio 2.2, 95% CI 1.9-2.4, P < 0.0001, EAR 157). In comparison, from 2011-2016, 527 of 9341 patients (5.6%) developed 584 SPM (O/E ratio 2.5, 95% CI 2.3-2.7, P < 0.0001, EAR 193). Incidence of AML, myeloma, and pancreatic cancer increased in 2005-2010, while soft tissue malignancies increased from 2011-2016. The incidence of thyroid, brain, and small bowel tumors increased in both groups from 2005-2016. Conclusions: There is a distinct pattern as well as increased latency of SPM in patients with advanced melanoma in the era of immune checkpoint and BRAF inhibitors. We speculate that reduction in chemotherapy use, augmentation of immunosurveillance, and inhibition of oncogenic pathways may impact the pathogenesis of SPM. [Table: see text]
Impact of preexisting cardiovascular disease (CVD) on treatments and outcomes of patients with breast or lung cancer.
Authors: Batra Atul , Kong Shiying , Rigo Rodrigo , Cheung Winson Y. 
Published: May 2020

12063 Background: Prior cardio-oncology and geriatric oncology research has mainly focused on cancer treatments and their late effects on cardiac health, but little information is known about how cardiac health may influence subsequent cancer treatments. This real-world study aimed to evaluate the associations of pre-existing CVD on treatment adherence and survival in patients with breast or lung cancer. Methods: We linked administrative data from the population-based cancer registry, electronic medical records, and billing claims in a large province (Alberta, Canada) over a 10-year time period (2006-2015). Multivariable logistic regression analyses were performed to identify associations of CVD with cancer treatments. Multivariable Cox proportional hazards models were constructed to determine the effect of CVD on overall survival (OS), while adjusting for receipt of cancer treatments. Results: We identified 46,227 patients with breast or lung cancer, of whom 77% were women and median age was 65 years. While 82% of patients with breast cancer were early stage, 50% with lung cancer had metastasis. The prevalence of pre-existing CVD was 20% where congestive heart failure was most frequent. In logistic regression, CVD was associated with lower odds of receiving appropriate chemotherapy (OR, 0.60, 95% CI, 0.56-0.65, P<.0001), radiotherapy (OR, 0.76, 95% CI, 0.72-0.81, P<.0001), and surgery (OR, 0.60, 95% CI, 0.54-0.66, P <.0001), irrespective of tumor site (Table). The 5-year OS was lower in patients with baseline CVD as compared to those without (46% vs 58%, P<0.0001). Upon adjusting for stage and treatment, CVD continued to correlate with worse OS (HR, 1.23, 95% CI, 1.19-1.26; P<.0001). Conclusions: Cancer patients with prior CVD were less likely to receive standard cancer therapy. Even among those who underwent cancer treatments, worse outcomes were observed in those with CVD. Early cardio-oncology and geriatric oncology engagement may reduce treatment bias and ensure that carefully selected patients with a cardiac history are still offered appropriate cancer therapy. [Table: see text]