bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of delay to seeking medical attention in patients with synovial sarcoma and association with inferior outcomes.
Authors: Seto Tiffany , Song Meena , Russell Elisabeth , Sam Danny , Pan Minggui 
Published: May 2020

e23556 Background: Synovial sarcoma is an aggressive soft tissue sarcoma that predominantly affects young patients with high rate of relapse and mortality. Systemic study of patients’ presenting symptoms and possible delay of seeking medical attention is lacking. Methods: We retrospectively reviewed the electronic records of all patients diagnosed with synovial sarcoma from 2005 to 2016 within Kaiser Permanente Northern California to identify the pattern of presenting symptoms and its correlation with outcomes. Results: Of the 77 patients with synovial sarcoma, 64 had early stage disease and 13 had metastatic disease at diagnosis, with median age at diagnosis of 47 years. Anatomically, 48 patients had primary disease at the extremity, 12 trunk, and 17 visceral. Median duration of follow up is 40 months. The median time from symptom to first medical appointment (TTM) is 3 months (range 0.1 to 180 months). Nine out of 13 patients who presented with metastatic disease were visceral primary. For the 60 patients with an extremity/trunk primary, patients who presented with pain without a palpable mass had a median duration of TTM of 12 months, compared to the TTM of 3 months for patients who presented with a palpable mass. The relapse rate (RR) and disease-free survival (DFS) for patients with an extremity/trunk primary who presented with pain but without a palpable mass were significantly worse when compared to patients who presented with a palpable mass (RR 50% vs. 26.5%, and DFS 27 vs. 42.5 months, p < 0.005). TTM was inversely correlated with DFS for the 64 cases with early stage disease and for the 60 cases with extremity/trunk primary (p < 0.00000001). Of the 11 patients with a foot primary, a similar pattern of TTM and DFS was also observed. Conclusions: Patients with synovial sarcoma who presented with pain but without a palpable mass had longer TTM, worse DFS and higher RR compared to patients who presented with a palpable mass. Longer TTM was associated with worse DFS.
Utility of immune checkpoint inhibitors (ICI) in 3 patients (pts) with sarcomas of antigen presenting cells (follicular dendritic cell sarcoma [FDCS], histiocytic sarcoma [HS]).
Authors: Lee Mee-young , Bernabe Ramirez Carolina , Ramirez Daniel C. , Maki Robert G. 
Published: May 2020

e23574 Background: FDCS and HS are rare tumors arising from sustentacular cells of the lymph node, rather than lymphocytes. Surgical resection is often employed in case of localized disease, but for unresectable disease, anthracycline-based therapy is commonly used. PD-L1 staining is reportedly positive in 50-80% of FDCS. As a result, we treated 3 patients (pts) with ICI ipilimumab and nivolumab (Ipi/Nivo), and demonstrated the activity of these agents in these rare cancers. Methods: Two FDCS pts and one HS pt, all with B symptoms at the start of treatment, received Ipi/Nivo in the approved dose/schedule (Table). The HS patient was HIV(+) with undetectable viral load on treatment. One FDCS patient received radiation therapy to an active site of disease during immunotherapy. We reimaged patients every 2 months for the first 6 months, then less frequently. PDL-1 IHC and mutation data were available in all cases. Results: Mutation burden varied from low to intermediate; mutations in kinase genes were also observed. Case 1 (FDCS) demonstrated RECIST 1.1 complete response, but also received radiation, and Case 2 (FDCS) had RECIST partial response. Both continue on treatment 9 months after initiation. Case 3 (HS) demonstrated a minor response to treatment, then disease worsened after 4 months, and he subsequently received radiation to the residual site of disease. All patients showed resolution of B symptoms on ICI. Conclusions: We treated these pts with ICI based on their role as antigen presenting cells, as well as their high PD-L1 expression. We speculate that FDCS and related tumors such as HS represent extreme examples of cancers that have evidence of tertiary lymphoid structures, increasingly recognized as important in ICI responsiveness. Prospective clinical trials of ICI in these diagnoses will help us understand the basis of immune responses to ICI in other cancers. [Table: see text]
Evaluation of patient and healthcare provider (HCP) knowledge, attitudes, and behavior for safety and use of pexidartinib.
Authors: Salas Maribel , Julian Michele , Drogaris Leonidas , Islam Zahidul , Henderson Mackenzie , Stemhagen Annette , O'Donnell Natalie , Tu Nora 
Published: May 2020

e23580 Background: Pexidartinib, a kinase inhibitor, is approved for treatment of adult patients with symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery. Due to risk of serious and potentially fatal liver injury, pexidartinib is available via a Risk Evaluation and Mitigation Strategy (REMS) Program. A requirement of the REMS is to conduct a qualitative evaluation of stakeholder Knowledge, Attitudes, and Behavior (KAB) of risks via surveys. The objective of the qualitative evaluation is to review key risk message questions with respect to understanding, relevance, clarity and provide recommendations on alternative language, phrasing, and structure. Methods: Anonymized, one-on-one 45–60-min phone interviews with patients and HCPs were conducted by UBC. Patients ≥18 y, diagnosed with TGCT (prioritized) or metastasis/sarcoma of the connective tissue, with different levels of education and fluent reading/speaking English were included. To participate, HCPs were required to treat patients with TGCT (prioritized) or metastasis/sarcoma of the connective tissue, treat patients ≥75% of their time, and clearly read/speak English. Participants were required to complete an Interview Release Form (IRF) and confirm access to a computer/tablet. Participants had little/no familiarity with pexidartinib materials. All interviews followed a standard process, used a pre-scripted guide on general instructions, confidentiality, safety event reporting, rapport building and assessment of health literacy (patients only). Feedback regarding understanding, relevance, and clarity were used to recommend potential alternate language/phrasing. To receive compensation participants were required to execute/return the IRF. Results: Twelve patients were interviewed, majority 67% had TGCT; mean age 52 y; 58% female; 42% reported some college/associates degree. 12 HCPs were interviewed, 67% treated patients with TGCT; 100% male; mean years practicing 22; all spent 75% or more time seeing patients; primary specialty Orthopedics. Areas of confusion/misunderstanding were reported, and questions were then revised. Patient findings: complexity and wordiness; HCP findings: repetition/difficulty reading, and some terminology was not self-explanatory. Conclusions: Feedback from HCPs and patients was received to improve the key risk messages of the KAB. Qualitative research is recommended to improve comprehension and data quality collected.
Analysis of hospice duration and metrics in cancer patients in rural Appalachia.
Authors: Manthri Sukesh , Mansurov Alay , Brooks Bill , Singal Sakshi , Jaishankar Devapiran 
Published: May 2020

e24006 Background: Several factors influence the duration of hospice care/average length of stay (ALOS) for cancer patients choosing hospice, including patient and family acceptance of hospice, availability of services, demographics, provider preferences, advances in treatment options, and type of cancer. Cancer diagnoses account for 30.1 % of Medicare hospice beneficiaries. Based on the national hospice and palliative care organization (NHPCO) summary released in 2019 the median length of stay on hospice for cancer patients is 19 days. The purpose of this study is to analyze the length of stay on hospice, and other metrics in a rural Appalachian community given the paucity of published data. Methods: A retrospective chart review (IRB approved) of all adult patients enrolled in three different hospice agencies (total 106) over two years (2016 and 2017) in a rural community in Southern Appalachia. We looked at the interval from metastatic diagnosis to hospice admission, interval from last oncological treatment to hospice admission and length of stay on hospice. Results: Medianinterval from metastatic diagnosis to hospice admission was 143 days (range 6-2948 days). The median interval from the last oncological treatment to hospice admission was 35 days (interquartile range 15-83 days). The median length of stay on hospice was 24 days (interquartile range 7.5 to 52.5 days). ALOS for patients with prostate, colorectal, breast and lung cancer were 77.33, 103.8 (skewed by a single patient-741 days, minus outlier-33 days), 38.9, 31.70 days, respectively. Conclusions: Few studies in the past have focused on the length of stay on hospice and even fewer have analyzed metrics as noted in our study. The median duration of hospice care in this community (24 days) was modestly better than the national data (19 days). This study provides unique data on median interval from the last treatment to hospice admission (35 days) is longer than the time on hospice (24 days). We infer socio cultural barriers to hospice acceptance in the Appalachian community and a need for education. It may be invaluable to assess if similar barriers to acceptance of hospice are a factor in other communities and would be worthy of further study and research.
Patient factors associated with changes in functional status during systemic cancer therapy in older adults: A systematic review.
Authors: Lam Vivian , Loh Kah Poh , Webber Katey R , Padam Simran , Sedrak Mina S. , Musinipally Vivek , Grogan Madison , Presley Carolyn J , Grandi Janice , Sanapala Chandrika , Digiovanni Grace , Castillo Daniel , Walter Louise Christie , Wong Melisa L. 
Published: May 2020

e24022 Background: Maintaining function and preventing functional decline during cancer treatment is critically important to older adults. This systematic review characterized and identified patient factors associated with functional change during systemic cancer therapy in older adults. Methods: Following PRISMA guidelines, we searched PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials for articles examining changes in function during systemic cancer treatment published in English through 1/11/19. Studies were eligible if they included adults age >65 and analyzed associations between patient factors and change in function. At least two independent investigators reviewed each article with discrepancies resolved by consensus. Major findings were summarized; no meta-analysis was planned a priori given the heterogeneity in studies. Results: We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 69 studies, which enrolled > 11,000 patients with cancer. Most studies enrolled adults of all ages; 20% included only adults age >65 and 13% only adults age >70. A quarter of studies enrolled patients with lung cancer while 22% included all solid tumors and hematologic malignancies. The majority of studies evaluated function during chemotherapy (96%) with 9% including targeted therapy and 4% immunotherapy. Function was primarily measured with patient-reported outcomes (93% of studies). Reporting of functional change was heterogeneous with many reporting change scores or means at multiple time points. Among studies that reported the percentage of patients who developed functional decline, results ranged widely from 6% to 90%. Functional improvement occurred among 2% to 57% of patients. The most common patient factors associated with functional decline during systemic cancer therapy were older age (n = 8 studies), fatigue (n = 8), worse baseline performance status (n = 8) and physical activity (n = 5), and anemia (n = 5). Only 10 studies examined factors associated with functional recovery, identifying 12 unique patient factors. Conclusions: Among older adults with cancer, functional changes during systemic cancer therapy are common. Interventions to target modifiable patient factors associated with functional decline are needed to help patients maintain or improve function during treatment. Additionally, evaluating both functional decline and improvement is necessary to better characterize functional trajectories during systemic cancer therapy.
Breast cancer, placing drug interactions in the spotlight: Is polypharmacy the cause of everything?
Authors: Domínguez-Alonso José Alberto , Conde-Estévez David , Pi-Figueras Maria , Servitja Sonia , Digón Ana , Albanell Joan , Tusquets Ignacio 
Published: May 2020

e24027 Background: Breast cancer is the most prevalent and lethal cancer among women. Forty one percent of cases occur in people ≥ 65 years. Decision on cancer treatment is particularly challenging among this group of age given its comorbidities and polypharmacy (PP). The main objectives are the analysis of potential drug-drug interactions (PDDI) in elderly breast cancer patients between daily medications and oncospecific therapy and their probable associations with age, BMI, Mini Nutritional Assessment (MNA), frailty and PP and the adverse effects during oncospecific treatment. Methods: A cohort of 77 patients ≥ 70 years with breast cancer underwent a Comprehensive Geriatric Assessment (CGA) by a Geriatrist at a university hospital. Baseline characteristics of the patients, demographical data, cancer stage, and oncospecific and daily treatments, as well as the complications and derived adverse effects were retrospectively collected using electronic medical records. Moreover, frailty categorization, daily medication number, comorbidities, Lawton and Barthel Index, malnutrition, MNA, BMI were prospectively collected using CGA report. PDDI between daily and oncospecific treatments were analyzed. Results: The median age of patients was 85 years (range 72-95). The median number of daily medications at CGA was 6 drugs (range 0-22) and most of the patients had PP at CGA and during oncospecific treatment (73% and 91%, respectively). Out of 719 PDDI, 530 (74%) were moderate ( r2= 0.72) and the median number of drugs during oncospecific treatment ( r2= 0.73) was 9 (range 3-26). Overall, by using Kruskal Wallis, 59 patients (77%) had any adverse effects statistically associated with frailty categorization and MNA ( p < 0.05). Furthermore, there was a tendency with oncospecific treatment, BMI and age ( p = 0.098, 0.089 and 0.062, respectively). The distribution of major, moderate and minor as well as total PDDI was statistically associated with PP at CGA and during oncospecific treatment ( p < 0.05). Conclusions: CGA should be applied in oncology elderly patients not only to assess clinical outcomes and categorize them in each frailty group but also to analyze PDDI by using specific web databases, thereby improving PP, PDDI and economic costs.
Integrating touchscreen-based geriatric assessment and frailty screening for adults with acute myelogenous leukemia to drive personalized treatment decisions.
Authors: Wujcik Debra , Papadantonakis Nikolaos , Wall Sarah Allison , Kasner Margaret T. , JAMY OMER HASSAN , Dudley William , Ingram Stacey A. , Lawhon Valerie , Son UI , Dudley Matthew 
Published: May 2020

e24030 Background: AML is a disease of older adults, with median age of 68 years at presentation. NCCN guidelines suggest comprehensive geriatric assessments (GA) be included in clinical practice to guide treatment decisions. Utility of GA in older AML patients in a real-world environment is not yet established. We tested the feasibility of using a modified GA (mGA), administered by patient self-report on a touchscreen computer, real-time use and utility by clinicians and the correlation of mGA results on treatment decision-making. Methods: Sixty-two patients were recruited from three sites to complete a tablet-based mGA screening at a treatment decision-making time point. The mGA consists of the Frailty Index (FI) that includes four domains: age, activities of daily living, instrumental ADLs, and comorbidities. Falls within the past 6 months and patient reported health interference with function are also assessed. Results are displayed for the clinician to inform the treatment discussion. Results: Participants were mean age 73 years (range 61-88), 63% male, and 90% white. Frailty Index result was 32% fit, 40% intermediate, and 28% frail. Providers were asked the fit/frailty status prior to seeing the results of the mGA. Of 53 provider responses, there was 57% (n=30) provider concordance with the mGA result; 9% (n=5) said fit when mGA said intermediate and 17% (n=9) said intermediate when mGA said frail. When asked their goals of care, nearly all (n=60, 97%) patients agreed with the statement “my cancer is curable”, yet 30% (n=19) disagreed the treatment goal was to get rid of all the cancer. Nearly half (n=30) indicated they want to make treatment decisions together with the provider rather than provider or patient making decision alone. 73% (45/62) of patients were satisfied with the ease of using the survey and took an average 16.3 minutes to complete. Patient self-reported presence/severity of eight symptoms at baseline (see Table). Conclusions: A simple electronic tool may provide valuable insight into patient understanding of disease to better tailor patient-provider discussion and treatment decision-making. Providers overestimated fitness 26% of the time. Final results will be presented to include the outcome at 3 months by Frailty Index. [Table: see text]
Perspectives on healthcare providers’ role in health promotion among cancer survivors.
Authors: Halilova Karina I. , Ivankova Nataliya V. , Rogers Laura Q. , Pisu Maria , Kevin Fontaine R. , Martin Michelle Y. , Herbey Ivan I. , Thompson Lieu , Anusiewicz Colleen V. , Pekmezi Dorothy , Oster Robert A. , Schoenberger-Godwin Yu-Mei M. , Demark-Wahnefried Wendy 
Published: May 2020

e24037 Background: To further integrate health promotion into cancer survivorship care, we explored multilevel perspectives on potential roles healthcare providers could have in promoting uptake of web-based healthy lifestyle programs among cancer survivors. Methods: In developing the Aim, Plan, and Act on Lifestyles (AMPLIFY) Survivor Health diet and exercise web-based program, we conducted 10 focus groups with 57 cancer survivors and 27 individual semi-structured interviews with stakeholders representing advocacy groups (e.g., cancer survivorship support foundations; n = 8), cancer organizations (e.g., industry, health system; n = 11), and survivors’ supportive partners (n = 8). Verbatim transcripts were analyzed by multiple coders using inductive thematic analysis with NVivo 12. Results: Survivors (49% female; 40% African-American, mean age 63.7 years) and stakeholders (60% female) stated that healthcare provider and health system recommendation and support are vital for ensuring acceptance and use of web-based healthy lifestyle programs by cancer survivors. Survivors expressed that physician’s (e.g., oncologist, other physician) recommendation and support would motivate them to join and participate. Supportive partners also endorsed the importance of provider recommendations and the key role of health system support (e.g., reminders in doctor’s office, hospitals, web-based portal, and endorsement from cancer centers). Advocacy group representatives underscored the importance of data-driven support for the effects of such programs as critical for promotion. Moreover, technology supported continuous cancer care (e.g., physician communication and feedback) were seen as critical for sustained participation. Stakeholders from cancer organizations suggested survivors in need could be identified and referred during assessments in various cancer care clinics. This group also emphasized the need to integrate evidence-based healthy lifestyle recommendations into continuing medical education, medical board certifications, support and referrals into existing standard of cancer care, and to involve other key stakeholders and larger scale health systems in promotion. Conclusions: Healthcare providers and health systems have important roles in promoting and sustaining participation in web-based healthy lifestyle programs among cancer survivors. Further work developing, testing, and refining strategies to enhance their role in promoting the acceptability and uptake of healthy lifestyle programs by cancer survivors are needed.
Gender disparity on cigarette smoking among cancer survivors: Results from the National Health Interview Survey.
Authors: Jiang Changchuan , Wang Haowei , Deng Lei , Wang Qian , Han Xuesong , Shapiro Charles L. 
Published: May 2020

e24040 Background: The smoking rate has been declining in the United States. Smoking cessation is a critical part of cancer survivorship care. Males have higher smoking rate than females in the general population. However, it remains unclear if cancer status modified the effect of gender on smoking rates. Methods: To evaluate the long-term pattern of smoking prevalence among female cancer survivors, we used the National Health Interview Survey 2000-2017 to estimate the age-adjusted current smoking rates among cancer survivors and participants without a history of cancer for men and women separately. Multivariable linear regression was used to estimate age-adjusted smoking rate in each group, using the US 2010 Census as the standardization population. We also used multivariable logistic regression to examine the whether cancer history modified the influence of gender on current smoking rate. All statistical analyses were performed with SAS 9.4 and accounted for NHIS survey design. Results: Of 526,547 participants, we identified 32,091 cancer survivors, including 11,642 male and 20,449 female cancer survivors. Male cancer survivors had a slightly lower smoking rates than non-cancer male participants (cancer survivors: 16.2%-29.7% vs non-cancer participants: 16.8%-24.4%; OR = 0.94, 95%CI 0.88-1.00, p = 0.05) after adjusting age and year of survey. However, female cancer survivors had a significant higher prevalence of smoking compared with non-cancer female participants (cancer survivors: 20.1-32.6% vs non-cancer participants: women: 12.8%-20.4%; OR = 1.45, 95%CI 1.38-1.52, p < 0.001) during the same period. The gaps in smoking prevalence between female cancer survivors and male cancer survivors were more significant than the gaps between male non-cancer participants and female non-cancer participants from 2000 to 2017 (p interaction < 0.001). Conclusions: Although more men smoke among people without a history of cancer, female survivors had a higher age-adjusted smoking rate than their male counterparts. Effective smoking cessation interventions need to target female survivors as well as male survivors. A gender-sensitive approach is required to address their specific needs in smoking cessation. [Table: see text]