bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paclitaxel-based high-dose chemotherapy (HDCT) for relapsed or refractory germ cell tumors (GCTs): Clinical outcome and quality of life (QOL) in long-term survivors.
Authors: Carmichael Courtney , Sun Virginia , Ferrell Betty R. , Frankel Paul Henry , Margolin Kim Allyson , Pal Sumanta Kumar 
Published: March 2020

e16563 Background: HDCT is a viable and potentially curative approach for patients with relapsed or refractory GCTs. However, no comparative data exist to define the optimal chemotherapeutic strategy. Herein, long-term follow-up data and QOL assessments are provided for an expanded cohort of patients treated with high-dose paclitaxel, etoposide, carboplatin, and ifosfamide (TECTIC). Methods: Details of the TECTIC regimen and clinical follow-up data for an initial 33 patients have been previously reported (Margolin Biol Blood Marrow Trans 2005). Surviving patients were surveyed using a modified EORTC Quality of Life Questionairre-30 (QLQ-C30) and the Functional Assessment of Cancer Therapy-Taxane (FACT-T) questionnaire; results were compared to relevant historical cohorts using a 2-sample t-test. Cardiovascular morbidity (CM) was ascertained through queries regarding use of antihypertensive (AH) or cholesterol-lowering (CL) agents, and presence/absence of diabetes mellitus (DM). Results: Forty-six patients received protocol-based therapy. Of these, 17 patients were progression-free at a median of 112.7 mos (49.5-170.2), and 6 patients remain alive following progression with a median overall survival (OS) of 64.4 mos (43.6-147.1). Median progression-free survival (PFS) and OS were 11.8 mos (95%CI 5.8-NR) and 21.7 months (95%CI 12.7-NR), respectively. Of the 23 patients still alive, 18 patients were accessible and consented to telephonic interview. As compared to historical cohorts (Rossen J Clin Oncol 2009), survivors had a higher global health scale score (87.04 v 75.62; P=0.02) but a lower physical functioning score (68.89 v 92.66; P=0.0001) by the QLQ-C30 scale. No difference in FACT-T scores were observed as compared to historical cohorts (Cella Cancer 2003). Four patients (22%) had DM. Three patients (17%) and 4 patients (22%) reported use of AH and CL agents, respectively. Conclusions: HDCT with the TECTIC regimen produces durable remissions in patients with relapsed or refractory GCTs, with acceptable QOL and CM in long-term survivors.
Breast cancer in the elderly: An area for improvement.
Authors: Jasra Sakshi , Sharma Vipra , Cohen Alice J. , Jabel Nicole 
Published: March 2020

e16565 Background: Treatment (TX) of breast cancer (BC) in elderly (E) patients (pt) can be problematic due to the increased co-morbidities (CM), multiple medications, and cognitive dysfunction related to age. Due to this many E pt are less likely to have standardized treatment (TX). This study was undertaken to assess if pt over the age of 70 diagnosed with BC received TX based on NCCN guidelines and what CM led to selection of therapies. Methods: A retrospective review at a tertiary care medical center identified 108 pt over the age of 70 with BC from 2001-2011. Clinical data was obtained regarding race, age, stage (ST) at diagnosis, TX, CM, estrogen receptor (ER), progesterone receptor (PR), and HER2neu receptor (H2N) status. Results: Of the 108 pts, 22% were Caucasians, 66% were African-American, 3% Asian, 6% Hispanic, and 2% other. The age range was 70 to 96 years, mean of 75. Staging was as follows: 23% DCIS, 24% ST I, 28% ST II, 9% ST III, and 7% ST IV. 66% were ER positive (+), 60% PR+, and 87% H2N negative. H2N status was not available on 9% of the pts. In 92% of the pt surgical intervention (SI), either lumpectomy (L) with radiation therapy (RT), or mastectomy (M) was done (see table below). 8% of pt either refused SI or were lost to follow-up. ER/PR+ pt hormone therapy (HT) was started in 95% of pt. 3% of ER/PR+ pt refused HT. In stage II and III 60% of pt had adjuvant chemotherapy (CT), only 5% refused CT. In ST IV 30% had HT alone, 50% with CT and HT, and 25% with RT to chest wall for local recurrence. Only 23% of H2N positive pt received Herceptin. 52% of the CT used in stage II and III was cyclophosphamide, methotrexate, fluorouracil (CMF). CM in the CMF pts were as follows 90% cardiovascular disease (CAD), 53% arthritis (AR), 13% history malignancy, and 13% pulmonary disease. In the pt who refused SI, and/or CT the most common CM were 70% CAD, 50% AR, and 25% dementia. Conclusions: The majority of the E BC pt in this cohort had significant CM that made TX challenging. Some pt were not offered appropriate CT (i.e., trastuzumab) due to CM. Age impacts BC TX, but should not hinder the pt receiving optimal tx. Further studies with women over the age of 70 with BC is required to determine the most appropriate TX in this subset of pts. [Table: see text]
Patient and caregiver satisfaction with ambulatory oncology care: Agreement and predictors.
Authors: Hannon Breffni , Jayasuriya Chami , Swami Nadia , Le Lisa , Zimmermann Camilla , Rodin Gary 
Published: March 2020

e16567 Background: Little is known about the level of agreement between patient and caregiver individual reports of satisfaction with healthcare, and no such study has been conducted in the advanced cancer setting. Our aims were to assess the level of agreement in satisfaction with oncology care, between patients with advanced cancer and their caregivers, and to identify factors associated with satisfaction. Methods: Patients with advanced cancer and their caregivers were recruited from ambulatory oncology clinics. Satisfaction with care was measured using FAMCARE- patient and caregiver versions. Patients completed measures of symptom severity (ESAS) and quality of life (FACT-G, FACIT-Sp). Caregivers completed a quality of life measure (CQOL-C). Agreement between patient and caregiver satisfaction scores was assessed using ICC and weighted kappa statistics; multivariable regression was used to determine individual predictors of satisfaction. Results: For the 191 patient-caregiver pairs, caregivers were less satisfied than patients (mean FAMCARE score 67.5 vs. 65.7 out of a possible 90, p=0.02). Overall agreement between patients and caregivers was moderate (ICC = 0.59). Agreement for individual items on FAMCARE was low (kappa range = 0.11-0.37). Both patients and caregivers were least satisfied with information on managing pain and information regarding prognosis. Factors associated with patient satisfaction were lower education level, better quality of life, and less symptom severity; caregiver satisfaction was associated with lower education levels, and better quality of life. Conclusions: Despite considerable discrepancy between caregiver and patient ratings, there was agreement regarding which elements of care needed most improvement. Greater attention to pain control and communication regarding prognosis would further improve patient and caregiver satisfaction with care in advanced cancer
Patient-reported symptom burden and quality of life in advanced lung cancer.
Authors: Iyer Shrividya , Rider Alex , Taylor-Stokes Gavin , Roughley Adam 
Published: March 2020

e16570 Background: The main objective of our study was to assess patient reported symptom burden and impact on quality of life in advanced non small cell lung cancer (NSCLC) patients in the United States. Methods: Patients with advanced (stage IIIB/IV) NSCLC (N=450) were recruited with informed consent in a nationwide (US) lung cancer study from Oct-Dec 2011. Patient reported symptoms were assessed using the Lung Cancer Symptom Scale (LCSS) on a 0-100 visual analogue scale and included six symptoms: fatigue, appetite loss, shortness of breath, cough, pain and blood in sputum. An average symptom burden index was calculated. Quality of life was assessed using the Functional Assessment of Cancer Therapy- Lung (FACT-L).Higher scores indicate higher symptom severity on the LCSS and better quality of life on the FACT-L. Correlation between the total FACT-L score and LCSS symptom burden index was assessed. A multivariate regression analysis was performed with FACT-L total score as the dependent variable and LCSS symptom scores as predictors controlling for age, gender, stage and performance status. Results: Majority of the patients were male (59%), Caucasian (74%), smokers/ex-smokers (78%) with an average age of 64 years. Proportion of patients reporting each lung cancer symptom was: Fatigue (100%), loss of appetite (97%), shortness of breath (95%), cough (93%), pain (92%) and blood in sputum (63%). The average (SD) symptom burden index was 42.3 (21.5).The mean± SD severity scores on symptoms were: fatigue (53.2±24.7), loss of appetite (48.1±25.8), cough (48.4±29.9), shortness of breath (44.7± 27), pain (39.7± 28.1) and blood in sputum (18.4±23.6). The average (SD) FACT-L score was 71.7 (25.3). A significant negative correlation was found between the LCSS symptom burden index and FACT-L scores (ρ= -0.82; p<0.001). Loss of appetite (β=-0.204; p<0.001), cough (β= -0.145; p<0.01), pain (β=-0.265; p<0.001), shortness of breath (β = -0.145; p<0.01), age (β= 0.217; p<0.05) and performance status (β = 0.283; p<0.001) were found to be significant predictors of quality of life. Conclusions: Cough, pain, shortness of breath and loss of appetite contribute to symptom burden and have a significant negative impact on quality of life in advanced NSCLC patients.
Daily performance status-based target physical activity of early rehabilitation for hematologic malignancy patients after allogeneic hematopoietic stem cell transplantation.
Authors: Inoue Junichiro , Ono Rei , Okamura Atsuo , Kiyota Naomi , Makiura Daisuke , Kashiwa Miyuki , Miura Yasushi , Kurosaka Masahiro , Saura Ryuichi 
Published: March 2020

e17020 Background: For hematologic malignancy patients receiving allogeneic hematopoietic stem cell transplantation (allo-SCT), the maintenance and/or increase of physical activity (PA) after allo-SCT possibly lead to favorable outcomes. However, it remains to be clarified how much intensity of daily rehabilitation should be prescribed. The aim of this study was to evaluate target PA according to daily performance status (PS) in these patients. Methods: Twenty-seven allo-SCT patients were enrolled in this study (13 males, 14 females, the median age; 47 years). Written informed consent was obtained from all patients. Donor types were bone marrow (n = 12), peripheral blood stem cell (n = 6), and single-unit cord blood (n = 9). All patients received our established exercise program supervised by physical therapists just after neutrophil engraftment in a bioclean room. As an alternative value of PA, daily steps (DS) were measured by using a uniaxial pedometer (Lifecorder EX, Suzuken Co. Ltd., Nagoya, Japan), and Eastern Cooperative Oncology Group PS after allo-SCT were also assessed daily for each individual. The data were statistically analyzed by using ANOVA and Scheff 's tests. Results: A correlation between DS and PS was observed. After the early physical intervention, the mean DS of patients with PS 1, 2, or 3 in a bioclean room were 2,411 ± 1,068, 1,205 ± 572, and 597 ± 216 steps/day, respectively. DS significantly declined by about 50% according to one grade deterioration of PS. Conclusions: As the target PA correlated with PS seems to be existence, we should plan daily activity in a bioclean room to keep more than above-mentioned mean DS according to daily PS for allo-SCT patients.
Possible association of postmeiotic segregation increased 2 (PMS 2) gene deletion and myelodysplastic syndrome.
Authors: Shah Trushil , Gerstner Gregory James , Sutaria Jaini 
Published: March 2020

e17021 Background: Postmeiotic segregation Increased 2 (PMS2) gene is one of the gene family members found in clusters on chromosome 7 involved in DNA mismatch repair. Mutations in this gene are associated with hereditary nonpolyposis colorectal cancer and Turcot syndrome. PMS-2 defects are not extensively studied and hence there is still considerable potential to detect new hemato-oncological associations with same. Chromosome 7 defects are the most commonly associated genetic abnormalities associated with myelodysplastic syndrome (MDS). Here, we describe a case of a patient with known PMS 2 gene deletion presenting with early onset MDS. Methods: A 52 year old caucasian female came in to our oncology clinic for evaluation after being diagnosed with DCIS of right breast. She underwent surgical resection followed by tamoxifen and surviellance mamograms. She developed gradual onset of fatigue, prompting follow-up laboratory tests which revealed WBC of 8,600, Hgb of 8.5, MCV of 101, and Plt 383,000. B12, folate, and iron studies were normal. Bone marrow biopsy revealed cellularity 80% and cytogenetics with trisomy 8.This lead to diagnosis of myelodysplastic syndrome, refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS). Patient is currently treated with supportive transfusions after lack of benefit of darbopoietin (baseline epo level 67). Family history is pertinent for a son who died at age 21 from colon cancer and a daughter diagnosed at age 22 with colon cancer, who survives. Her daughter subsequently tested positive for G750 PMS-2 from her father and complete deletion of PMS2 from her mother (our patient). Results: PMS2 gene deletion might predispose patients to MDS. Conclusions: Given the common link with chromosome 7 abnormalities, it is therefore possible that there is an associated increased risk of MDS in PMS-2 patients. While our patient did not have any general abnormalities by karyotype, current assays and general karyotyping are of potentially limited value unless specific mutation points are identified. Therefore, additional evaluations may be necessary to better identify at-risk patients.
MicroRNA-137 and microRNA-29a expression in non-small cell lung cancer diagnosis and prognostic.
Authors: Ming Zhao 
Published: March 2020

e17501 Background: Current staging methods are inadequate for predicting the outcome of treatment of non–small-cell lung cancer (NSCLC). We investigated whether microRNA expression proﬁles can predict clinical outcome of NSCLC patients. Methods: We studied frozen specimens of lung-cancer tissue from 76 randomly selected patients who underwent surgical resection of NSCLC. Using real-time reverse-transcriptase polymerase chain reaction (RT-PCR) analysis, we chosed U6 as the internal control for real-time RT-PCR because it is invariant in clinical cancer specimens. We obtained microRNA137 and 29a expressions level in 76 NSCLC patients and evaluated diagnoisis value and the association between the level of expression and survival. Results: This microRNA137 is with diagnosis value, microRNA29a expression level signature is an independent predictor of the cancer relapse and survival of NSCLC patients. Conclusions: Our microRNA signature is closely associated with relapse-free and overall survival among patients with NSCLC.
Mediastinal lymph node staging in patients with non-small cell lung cancer (NSCLC) with F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT).
Authors: Mendez Miriam , Maximiano Constanza , Huelves Miriam , Doger de Speville Bernard Gaston , Ibeas Patricia , Ruiz-Valdepeñas Andrea , Palka Magda , Diaz Gema , Gomez David , Provencio Mariano 
Published: March 2020

e17503 Background: Lung cancer is the leading cause of cancer-related deaths in the Western world. CT and mediastinoscopy are the standard for staging modalities in recent years; PET has emerged as a complement to other techniques. Mediastinal lymph node (MLN) staging is important because it establishes subsequent treatment. The aim of the present study is to analyze the relationship between mediastinal staging by endobronchial ultrasound-guided transbronchial needle aspiration, mediastinoscopy, lymphadenectomy and PET. It also analyzes the patient characteristics like age, sex, histology. Methods: The study prospectively evaluated 42 patients from August 2009 to March 2011. All of them had MLN staging by PET and pathology (tumor resection with systematic lymph node dissection, transbronchial needle aspiration or mediastinoscopy). Univariable date analysis was conducted using Pearson's chi-square test. P values were considered statistically significant if <0.05. Results: The study group comprised 42 patients, 83% men and 17% female, mean age of 66 years. The primary tumor cell type: 45% squamous cell, 33% adenocarcinoma and 19% large cells. 40 patients were smoking. The most frequent location of tumor was upper lobes (58%). The most common stage found after surgery was stage I (42%), stage II (19%), stage III (A: 29%, B: 5%) and stage IV (5%). The kappa statistic for diagnostic agreement between CT and PET was 0.53 (p<0.001). About MLN staging, PET has a sensitivity of 61% and specificity of 53% , positive predictive value 61% and negative 53%. Conclusions: The present study attempts to find the relationship between tumor involvement found in PET and resected tumor specimens obtained from the mediastinum. Our sensitivity and specificity were not concordant with those previously reported; this may be due to the learning curve at our center or the shortness of our series. In contrast we conducted histological examination of all involved MLNs, supporting our data and shows that this confirmation can lead to a change of therapeutic strategy in some cases.
Management of locally advanced non-small cell lung cancer (NSCLC) at a community hospital: A retrospective analysis.
Authors: Spranklin Laura Jane , Heflin Jon Willis , Calvo Alejandro R. 
Published: March 2020

e17506 Background: The optimal management of stage IIIA NSCLC has not been clearly defined. Much of this controversy is due to the heterogenity of this group. The current standard for unresectable stage IIIA disease is concurrent chemoradiotherapy. In patients with resectable stage IIIA disease however, neoadjuvant treatment followed by surgery provides better outcomes but not a significant survival benefit. Our study analyzed the management of stage IIIA NSCLC patients diagnosed at Kettering Health Network (KHN) and the observed 5-year survival as compared to the current NCCN guidelines and national 5-year relative and observed survival using the SEER database and National Cancer Database statistics. Methods: This retrospective study included all patients treated at KHN for Stage IIIA NSCLC from January 2004 to December 2009. 117 cases were analyzed, 53% female and 47% male. 42% were squamous cell, 28% adenocarcinoma, and the final 30% accounting for the remaining histology. 20 patients were not candidates for therapy due to poor performance status or comorbidity. 37 of the 97 patients under active treatment underwent resection at some point during treatment and 60 patients were deemed unresectable. Results: 68% of individuals with unresectable NSCLC received definitive concurrent chemoradiation, 32% received chemotherapy alone. In regards to resectable stage IIIA, 25% were treated with neoadjuvant therapy. 54% received postoperative therapy. 21% were treated with surgery alone due to multiple factors. The observed 5-year survival was 12.2% as compared to 10% nationally. The SEER data 5-year relative survival from 2001 to 2007 for stage IIIA NSCLC is 14%. Conclusions: In this heterogenous group of patients, treatment provided at KHN was individualized and followed national trends. The majority of unresectable stage IIIA NSCLC patients at KHN received the standard approach of concurrent chemoradiation. In terms of resectable stage IIIA NSCLC, approximately 25% were treated with either neoadjuvant chemotherapy or chemoradiotherapy. Overall, the 5-year survival rate for stage IIIA NSCLC at KHN is comparable to other community hospitals however slightly lower than the national average.
Epidermal growth factor receptor mutation in small cell lung cancer patients detected by mutant-enriched liquidchip technology from plasma in China.
Authors: Lu Hongyang , Lu Zhen-Yi , Cheng Qiao-Yuan , Cai Ju-Fen , Zhang Yiping , Jia Wang Xiao , Lou CaiJin , Yu Xinmin , Qin Jing , Ye Wei-Wu , Lei Lei , Wang Zeng , Zheng Yong-Qing , Mao Weimin 
Published: March 2020

e17512 Background: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) has been widely used in non-small cell lung cancer (NSCLC), and the incidence of EGFR mutation in NSCLC is higher in China than in the United States and European countries. EGFR exons 19 and 21 mutation in NSCLC is related to response of tumors to EGFR TKIs, suggesting its usefulness as a biomarker. Some case studies reported that gefitinib-responsive small cell lung cancer (SCLC) with EGFR mutation. However, there are few large studies which reported the mutation status of SCLC patients. It is difficult to obtain tumor tissues to detect EGFR mutation in SCLC patients especially from surgery. This aim of the study is to know the EGFR mutation status in SCLC patients in China, and evaluate the feasibility of EGFR mutation detection from plasma by mutant-enriched liquidchip (MEL) technology. Methods: From September 2011 to January 2012, 27 cases of SCLC plasmas were collected at our Hospital, China. There are 6 female, 21 male. Age from 46 to 74 years old and median age is 60 years old. The stage (Veterans Administration Lung Study Group, VALSG): limited disease (LD) 6 cases, extensive disease (ED) 21 cases. Smoking history: non-smoker 8 cases, light smoker 0 cases, moderate smoker 3 cases and heavy smoker 16 cases. MEL technology was used to detect EGFR exon 19 and exon 21 mutations from plasma of 27 SCLC patients. Results: One of 27 cases was found with mutation in exon 19 of the EGFR gene. The patient with EGFR exon 19 mutation is a female and non-smoker. Conclusions: EGFR mutation is rare in SCLC patients, and may be more easily occurred in female and non-smokers. It is feasible to detect EGFR mutation for SCLC from plasma by MEL technology.