bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of functional disability in stage IV breast cancer
Authors: Cheville A. L. , Basford J. , Troxel A. , Kornblith A. 
Published: August 2020

9567 Background: Functional disability degrades cancer patients' quality of life, exhausts caregivers and incurs significant expense yet little is know of the factors that contribute to disablement or whether the impact of these factors differs across functional domains. Better understanding of the influence that symptoms, physical impairments, and disease characteristics exert on disablement is needed in order to develop service delivery models that preserve function. Methods: To identify factors that influence functional performance in community dwelling people with stage IV breast cancer we conducted a cross-sectional study in a tertiary medical center outpatient cancer clinic. A consecutive sample of 163 community-dwelling patients with stage IV breast cancer were administered self- and clinician-rated functional metrics covering multiple domains including overall functioning, mobility, and self care. Self report measures included the Medical Outcomes Study Physical Function Subscale (PF-10) and the Older Americans Resource Study (OARS) Activities of Daily Living (ADL) and Instrumental ADL (IADL) subscales, and clinician report measures included the Karnofsky Performance Scale (KPS) and the Functional Independence Measure (FIM) Total and Mobility scores. Pain and mental health were assessed through administration of the Brief Pain Inventory (BPI) and Mental Health Inventory-17 (MHI-17), respectively. Electronic medical record review provided cancer-related and demographic information. The presence of physical impairments was determined through a comprehensive musculoskeletal and neurological physical examination including the 6 minute walk test. Linear and ordinal logistic regression models were constructed with function metrics as dependent variables. Results: Total number of physical impairments, BPI scores, and the presence of pleural effusions were highly significant in all models (p<0.01). Exertional intolerance and age were associated with PF-10 and OARS-ADL scores (p<0.01), while the presence of a pre-morbid disability was associated compromised mobility. Conclusions: Potentially remediable factors; pain intensity, cumulative impairment burden and pleural effusions, degrade all functional domains in patients with stage IV breast cancer. No significant financial relationships to disclose.
Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) to characterize cachexia in newly diagnosed advanced cancer patients
Authors: Vigano A. , Trutschnigg B. , Morais J. A. , Chaudhury P. , Lucar E. , Metrakos P. , Hassanain M. , Molla H. , Hornby L. , Kilgour R. D. 
Published: August 2020

9574 Background: Our objective was to evaluate whether the scored PGSGA questionnaire in advanced cancer patients (ACP) might relate better then weight loss (WL) alone to the nutritional, functional, biological and quality of life features of cachexia (C) and to some complications related to this syndrome. Methods: 214 newly diagnosed ACP with non-small cell lung and gastrointestinal primaries were categorized according to PG-SGA triage intervals of 0–1, 2–8 and ≥9 and also according to WL ≤5% or >5%. Baseline assessments included: hand-grip strenght, body composition by DXA, selective measures of symptom and quality of life (QoL), CBC and differential counts, albumin and CRP. Survival hospitalization rates and data on chemotherapy tolerability were recorded during patient follow-up. Beta coefficients (β), odds ratios (OR), and hazard ratios (HR) were estimated to compare patients with >5% WL to those with ≤5% WL and to compare patients with PGSGA of 0–1 to those with 2–8 and ≥9 scores. All analyses were controlled for gender, age, diagnosis (lung/GI), treatment (radio/chemo), survival (at 8 weeks), and medications. Results: PGSGA was better than the simple recording of WL in defining a population of patients that differed for WBC 109/L(>5% WL β: 0.25 vs. 2–8 PGSGA β: 0.57 and ≥9 PGSGA β: 1.72), CRP mg/L (4.12 vs. 2.16 and 17.49), albumin g/L(-0.63 vs -2.60 and -4.45); weakness 0–10 (1.57 vs.1.56 and 3.32), anorexia 0–10 (2.36 vs. 2.36 and 5.17); Brief Fatigue Inventory 0–90 (17.75 vs. 9.89 and 25.15); McGill QoL 10–0 (-0.95 vs. -0.64 and -2.29); grip strength lbs.(-4.04 vs. -8.82 and -8.06); body fat kg. ( -8.74 vs. -5.94 and -11.72). PGSGA was able to better identify patients with higher rates of both hospitalization (2.6 vs. 1.62 and 9.46) and dose reduction of chemotherapy (1.2 vs. 0.58 and 1.74). Finally, PGSGA was able to better characterize patient survival as compared to WL alone (>5% WL HR: 1.85; 2–8 PGSGA HR: 1.6 and ≥9 PGSGA HR 3.35). Conversely, WL alone was associated with higher probability of a sarcopenia diagnosis by DXA (>5% WL OR: 1.56)Conclusions: Our data support the use of the PGSGA versus the simple recording of WL for identifying C, monitoring its clinical course and predicting possible complications of this syndrome in ACP. No significant financial relationships to disclose.
Code status documentation in the outpatient electronic medical records of patients with metastatic cancer
Authors: Greer J. , Temel J. , Admane S. , Solis J. , Lynch T. , Pirl W. 
Published: August 2020

9576 Background: Advanced care planning is an essential component of cancer care for patients with incurable malignancies. However, the extent to which clinicians clearly document end-of-life care discussions and code status preferences in ambulatory medical records is unknown. The goal of the study was to investigate the rate of code status documentation in the electronic longitudinal medical record (LMR) of patients with metastatic cancers. Methods: We conducted a retrospective review of outpatient medical records of 2498 patients with metastatic solid tumors seen at an academic cancer center from 10/1/06 through 2/29/08. An electronic database was used to gather information on patient demographics, cancer type, and visits to the cancer center. The sample consisted of patients with metastatic breast, colorectal, non-colorectal gastrointestinal (GI), bladder/kidney, ovarian, prostate, and lung cancers. For the study endpoints, we queried the LMR to determine completion and designation of code status, which could be documented as follows: full code, do not resuscitate (DNR)/do not intubate (DNI), or DNR/DNI with specific resuscitation requests. Multiple logistic regression was used to identify independent predictors of code status completion and resuscitation preference. Results: Among the 2498 patients, 508 (20.3%) had a documented code status. Code status was documented more frequently in patients with metastatic non-colorectal GI (193/609, 31.7%) and lung (179/583, 30.7%) cancers compared to patients with genitourinary malignancies (bladder/kidney [4/89, 4.5%], ovarian [4/93, 4.3%] and prostate [7/365, 1.9%] cancers). Independent predictors of having documented code status included cancer type and a greater number of visits to the cancer center. Younger patients and black patients were less likely to be designated as DNR/DNI. Conclusions: Despite the incurable nature of metastatic cancers, a minority of patients had a code status documented in the outpatient medical record. Given the importance of advanced care planning for those with terminal illness, interventions are needed to encourage discussion and documentation of end-of-life care preferences in patients with advanced cancer. No significant financial relationships to disclose.
J-HOPE study: Evaluation of end-of-life cancer care in Japan from the perspective of bereaved family members
Authors: Miyashita M. , Morita T. , Sato K. , Tsuneto S. , Shima Y. 
Published: August 2020

9577 Background: The Japan Hospice and Palliative Care Evaluation (J-HOPE) study was conducted in 2007 and 2008. The aim of the study was to evaluate the quality of end-of-life care at regional cancer centers (CCs), inpatient palliative care units (PCUs), and home hospices (HHs) in Japan from the perspective of bereaved family members. Methods: A nationwide cross-sectional mail survey was conducted in 2007 and 2008. The survey was sent to bereaved families 6–18 months after the death of a patient at 56 CCs, 100 PCUs, or 14 HHs. Outcome measures were the good death inventory, the care evaluation scale, and overall satisfaction with care. The protocol of this study was approved by the institutional review boards of each participating institution. Results: Of the 13,181 bereaved family members that received the survey, 8,163 (62%) participants returned their responses. Among bereaved family members, significantly fewer responded that patients were free from physical distress at CCs (50%) than PCUs (80%) and HHs (73%) (P<0.0001). Significantly fewer patients trusted the physicians at CCs (79%) when compared with PCUs (83%) and HHs (88%) (P<0.0001). Significantly fewer patients were valued as people at CCs (83%) than PCUs (93%) and HHs (95%) (P<0.0001). In addition, significantly fewer participants felt physicians should have worked to improve the patients' symptoms more quickly at CCs (55%) when compared with PCUs (78%) and HHs (77%) (P<0.0001). Significantly fewer participants felt nurse should improve their knowledge and skills regarding end-of-life care at CCs (51%) when compared with PCUs (76%) and HHs (78%) (P<0.0001). A total of 51% of participants reported that nurses should improve their knowledge and skills regarding end-of-life care. Finally, significantly fewer participants were satisfied with the end-of-life care provided by CCs (80%) when compared with PCUs (93%) and HHs (94%) (P<0.0001). Conclusions: Overall, the bereaved family members appreciated the end-of-life care provided by CCs, PCUs, and HHs in Japan. However, in some situations, the quality of end-of-life care provided by CCs was lower than that provided by PCUs and HHs. No significant financial relationships to disclose.
Effect of adherence to monthly zoledronic acid treatment on risk and frequency of skeletal complications and follow-up duration in breast cancer patients
Authors: Hatoum H. T. , Lin S. , Smith M. R. , Lipton A. 
Published: August 2020

9593 Background: Bone is the most common site of metastasis in breast cancer patients (pts). Clinical trials and outcome studies have demonstrated benefit of zoledronic acid (ZA) in reducing risk of skeletal complications (SC). This study explored relationships between persistency on ZA and the intended treatment (TX) outcomes. Methods: Female breast cancer pts with first bone metastasis (BM) diagnosed between Jan 03 to Oct 06 were identified from PharMetrics database. Persistency was defined as duration from initiating ZA TX to date of first TX gap of >45 days. Pts were divided into short (≤90 days, 230 pts), medium (91–180, 171 pts) and long (>180, 313 pts) persistency groups. TX selection bias was handled by calculating propensity scores using year of first BM diagnosis, having other metastases or >1 BM claim, use of opioids and oral bisphoshonate before BM. Propensity scores, age and Charlson's Comorbidity Index (CCI) were included in multiple regressions to investigate impact of ZA persistency on follow-up duration, risk and rate of SC. Results: 2394 pts were enrolled, with 714 (29.72%) ZA treated. Three persistency groups had similar age. Short group had higher CCI than long group (mean 8.53 vs 8.34, p<0.05). Frequency of ZA TX decreased over time in all groups. For short, medium and long persistency groups, means of follow-up durations were 9.8 (median, 7.0), 13.0 (9.0), 19.3 (18.1) months, and means of time to first SC after BM were 249 (median: 167), 323 (217), 418 (365) days. Means of SC rates were 0.27, 0.21, and 0.12 per month for patients who experienced at least 1 SC among the three groups. Medium and long persistency groups had 41% and 139% longer follow-up than short group (p<0.05). Long group had lower risk of SC than short group (HR=0.576, p<0.05). In patients who developed at least 1 SC, long group experienced 39% less SCs (p<0.005) than short group. Conclusions: TX with zoledronic acid in breast cancer pts with BM positively impacts the risk, frequency of SC and follow-up duration. Also, longer persistency on ZA TX is associated with significantly longer follow-up and lower risk of SC. [Table: see text]
Plasma cytokine concentrations and quality of life in patients with non-small cell lung cancer in a phase II trial of first-line treatment with carboplatin-paclitaxel and/or vandetanib
Authors: Hanrahan E. O. , Kim F. , Lin H. Y. , Tran H. T. , Ryan A. J. , Krebs A. D. , Lee J. J. , Johnson B. E. , Heymach J. V. , Kim E. S. 
Published: August 2020

9596 Background: A randomized phase II trial (JCO 26:5407–15, 2008) compared carboplatin-paclitaxel (CP) with vandetanib (VEGFR-EGFR inhibitor) monotherapy (V) and V plus CP (VCP) 1st-line for advanced NSCLC (N=181). PFS was superior for VCP vs CP (HR 0.76). We performed analyses of quality of life (QOL) and its correlations with plasma concentrations of cytokines and angiogenic factors (CAF) among the participants in this trial. Methods: QOL was serially measured by Functional Assessment of Cancer Therapy-Lung (FACT-L) and Trial Outcome Index (TOI) scores. Concentrations of 35 plasma CAFs were measured at baseline and multiple timepoints during treatment with multiplexed bead suspension arrays and ELISAs. We performed exploratory analyses for the following associations: (1) QOL with plasma CAF levels at baseline; (2) changes in QOL with changes in plasma CAF levels. Spearman correlation coefficient, log-rank test and mixed linear models were applied in the analyses. P-value < 0.05 was considered significant. Results: Baseline QOL and plasma samples were both available for 120 patients. Lower baseline FACT-L scores (inferior QOL) were associated with higher pre-treatment plasma levels of INF-γ, IL-1RA, IL-6, IL-12, IL-15, TNF-α, RANTES, MIG, MIP-1β, MMP-9, bFGF, VEGF and sVEGFR-2 (all P<0.05). Lower baseline TOI scores (inferior QOL) were also associated with higher pre-treatment plasma levels of multiple CAFs, including GCSF, HGF, INF-α, INF-γ, IL-2, IL-6, IL-8, IL-12, IL-15, TNF-α, bFGF, sVEGFR-2 and VEGF (all P<0.05). Among all patients, decreasing TOI scores post cycle 2 (HR=2.57 [1.28,5.17], P=0.008) and cycle 4 (HR=2.58 [1.01,6.56], P=0.049) were associated with increased progression risk. Trends for FACT-L were similar, but did not reach statistical significance. Rises in GCSF, HGF, IL-2, IL-8, IL-15, MCP-1, MIP-1β, and VEGF from baseline to post cycle 2 were associated with decreased FACT-L and/or TOI scores (all P<0.05). Conclusions: High plasma concentrations of multiple CAFs pre-treatment in patients with NSCLC correlated with inferior QOL, and rises in these factors during treatment were associated with worsening QOL. This work was funded in part by grant from ACS (FK). [Table: see text]
Longitudinal course of suicidal ideation in patients with newly diagnosed thoracic cancers
Authors: Pirl W. F. , Solis J. , Temel J. S. , Admane S. , Rosovsky R. , Prigerson H. G. , Greer J. 
Published: August 2020

9606 Background: While cancer itself is associated with elevated suicide rates, thoracic cancers have the highest rates. Previous studies of suicidal ideation (SI) in cancer patients have all been cross-sectional. This study investigates the longitudinal course of SI in newly diagnosed thoracic cancer patients. Methods: Between 8/7/07–9/16/08, a prospective cohort was recruited from consecutive new patients at a thoracic oncology clinic in an academic cancer center. At initial visit and approximately every two months afterward, participants completed the Patient Health Questionnaire depression and anxiety modules, which include one item measuring SI over the prior two weeks. Participants were assessed at points of care; those not returning within follow up periods were not assessed. Factors bivariately associated with SI at initial visit were entered into multiple logistic regression models to identify independent predictors. Linear mixed effects models investigated change in SI level over time within individuals. Results: 373 participants enrolled. At initial visit, 254 (68.1%) had known lung cancers, 38 (10.2%) had esophageal cancer. 127 (34.1%) had advanced cancer. Mean age was 63.71 (11.50) and 200 (53.6%) were women. 368 completed initial assessment. At initial visit, 21 (5.7%) expressed SI and 111 (30.16%) met criteria for depressive or anxiety disorders. While ECOG performance status was associated with SI in bivariate analyses, only depression and anxiety remained independent predictors, both p=.01. Cancer type and stage were not significantly associated. Controlling for performance status, SI was more likely in those with any depressive or anxiety disorders (OR=7.14, 95% CI 2.48–20.55). Levels of SI within individuals decreased over time (p=.02). Only 2.2% (3/135) had SI at two months and none at four and six months. One participant (4.8%) with SI at initial visit had a known suicide attempt during the study period. Conclusions: Newly diagnosed thoracic cancer patients had a 6% SI rate at initial visit, slightly lower than other reports with mixed cancers. SI appears to decrease over time, with highest risk early after diagnosis. Given previous data that suicide rates are highest with thoracic cancers, our findings may suggest greater likelihood to act on SI. [Table: see text]
The predictive accuracy of survival between patient-reported versus clinician-reported pain in a cohort of 1,214 patients with metastatic cancer
Authors: Quinten C. , Martinelli F. , Coens C. , Cleeland C. S. , Flechtner H. , Gotay C. , Greimel E. , Taphoorn M. J. , Weis J. , Bottomley A. 
Published: August 2020

9607 Background: Accurate assessment of pain involves cooperation between clinician and patient. However, in patients with metastatic disease agreement between clinician and patient ratings is known to be poor. The objectives of this meta-analysis are to investigate the degree of agreement between clinician- versus patient- reported cancer pain at entry in a cohort of patients with metastatic cancer and whether their ratings were associated with a difference in survival. Methods: Eight European Organisation for Research and Treatment of Cancer (EORTC) Randomized Controlled Trials (RCT), across different cancer sites, were eligible for this study. Pain was scored at baseline by the clinician [Common Toxicity Criteria (CTC)] and the patient (EORTC QLQ-C30). The Wilcoxon rank sign test was applied to investigate scoring differences between patient- versus clinician- reported pain and logistic regression to model whether clinical parameters, i.e., performance status, gender, age or cancer site, affected scoring differences. The model accuracy of both scorings was investigated with the Harrell's discrimination c-index (c) after correction for the clinical parameters. Results: 1214 patients provided valid patient- and clinician- reported pain data at entry. Cancer pain was specified as bone metastasis by 643 (53%) patients and not specified otherwise. The overall mean pain as scored by the clinician was 2.25 (standard deviation (SD) 1.1) and by the patient was 2.28 (SD=0.95) on a 1 to 4 scale. Scoring differences were found to be statistically significant for colorectal (p<.01), lung (p<.01), prostate (p<.01), and breast (p=0.03, but not for pancreatic cancer (p=0.49). Clinical parameters did not significantly affect the scoring differences. Pain as reported by patients (vs clinicians) showed similar predictive accuracy (c =0.62 vs 0.61, p=0.59). Conclusions: Our results provide further evidence that significant differences exist in pain reporting between clinicians and patients. Such results provide a rationale to include patient self reported pain assessment in future cancer RCTs to better assess disease status and survival prognosis. No significant financial relationships to disclose.
Quality of life in advanced non-small cell lung cancer patients receiving first-line gefitinib monotherapy
Authors: Shao Y. , Lin Z. , Hu F. , Yu C. , Shih J. , Hu W. , Chang Y. , Cheng A. , Yang P. , Yang C. 
Published: August 2020

9614 Background: Gefitinib is a potential first-line treatment option for patients with advanced non-small cell lung cancer (NSCLC), especially for patients with activating mutations in the EGFR gene. However, little is known about patient-reported health-related quality of life (HRQOL) in this patient population. The aims of this study were to explore the prognostic values of baseline HRQOL for time-to-treatment failure (TTF), as well as the predictors of repeatedly measured posttreatment HRQOL, in advanced NSCLC patients receiving first-line gefitinib. Methods: A total of 106 chemonaive patients with advanced NSCLC were enrolled in a phase II trial. Gefitinib was given at a dose of 250 mg/d. HRQOL was assessed monthly with the EuroQoL instrument (EQ-5D) and the Lung Cancer Symptom Scale (LCSS) questionnaire. Baseline HRQOL and clinical/molecular predictors of TTF were jointly examined by multiple Cox's proportional hazards model. The associations between the clinical/molecular factors and repeatedly measured posttreatment HRQOL were analyzed by fitting marginal linear regression model using the generalized estimating equations (GEE) method. Results: In this prospective study, HRQOL data were obtained from 94 patients. Baseline EQ-5D index (estimated hazard ratio = 0.286, 95% C.I.: 0.135–0.603, p = 0.001) and the presence of L858R EGFR mutation in adenocarcinoma (estimated hazard ratio = 0.520, 95% C.I.: 0.307–0.880, p = 0.015) were retained as independent prognostic factors in the final multiple Cox's proportional hazards model for TTF. According to preliminary GEE analysis of repeatedly measured posttreatment HRQOL, the patients with wild-type EGFR consistently had worse HRQOL in EQ-5D index (p < 0.0001), EQ-5D VAS score (p = 0.0002), and LCSS global score (p < 0.0001), respectively. Conclusions: In advanced NSCLC patients receiving first-line gefitinib, better baseline EQ-5D index and L858R EGFR mutation in adenocarcinoma predict longer TTF. In addition, patients with wild-type EGFR had worse posttreatment HRQOL. No significant financial relationships to disclose.