bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomized prospective open labeled study of oral amoxicillin-clavulanate with intravenous ceftriaxone and amikacin in low risk febrile neutropenia
Authors: Dominic J. F. , Kumar L. , Kochupillai V. , Raina V. , Sharma A. , Bakshi S. , Seth T. , Kapil A. 
Published: April 2020

18551 Background: Empiric oral antibiotic administration is a treatment option in low risk febrile neutropenia. Methods: Low risk febrile neutropenia patients (expected neutropenic duration <7 days with no comorbid features) between 15 and 75 years of age were randomized to receive either oral amoxicillin-clavulanate 625 mg twice daily and levofloxacin 500 mg once daily or intravenous (i.v.) ceftriaxone 2 g and amikacin 15 mg/kg once daily. Most patients were treated on out patient basis. The primary end point was response to therapy- defervescence of fever within 72 hours with improvement in any clinical manifestation of infection and no recurrence of fever for 48 hours without use of antipyretics. Use of growth factors was not permitted except in treatment failure. The study was cleared by the institute ethics committee. Results: Sixty four episodes in 53 patients were evaluable, 33 in the i.v. group and 31 in the oral antibiotics group. The underlying diagnosis was bone and soft tissue sarcomas in 32 episodes, hematological cancers in 22 and other solid cancers in 10. The groups were equally matched for age (median 25 years in the i.v. arm and 19 years in the oral arm), gender, type of cancer, baseline absolute neutrophil count (median 200/μL in both arms) and duration of neutropenia (5 days and 4 days in the i.v. and oral groups respectively). A focus of infection was identified clinically in 15% of episodes and microbiologically in 11% of episodes; 57% of which were gram positive organisms and the rest gram negative. Seventy two percent (95% confidence interval 58% to 88%) in the i.v. arm and 77% (95% confidence interval 63% to 92%) in the oral arm responded to therapy. The only serious toxicity was one episode of convulsions in the i.v. group. All treatment failures received second line i.v. antibiotics. There was no mortality in either group. Comparing the two groups for equivalence (assuming a 25% difference between the two arms as unequal) the two groups were found to be equivalent with a power of 59% (p = 0.03). Conclusion: Oral antibiotics have comparable efficacy as intravenous antibiotics in the management of low risk febrile neutropenia. No significant financial relationships to disclose.
Osteonecrosis of the jaw associated with intravenous bisphosphonate therapy—A single institution experience
Authors: Wallace E. M. , Quintyne K. I. , Cantwell B. M. , Calvert P. M. , Leonard G. D. 
Published: April 2020

18553 Background: Osteonecrosis of the jaw (ONJ) is a debilitating disease that has been associated with cancer therapy. Recently a link between ONJ and chronic intravenous (IV) bisphosphonates has been suggested. We assessed the incidence of ONJ and its risk factors in patients treated with IV bishosphonates at our institution. Methods: All patients with a cancer diagnosis treated at our institution with at least four cycles of either IV Zoledronic Acid, Pamidronate, or a combination of both, from 2000–2005 were evaluated using outpatient records. Patients with ONJ were identified and their characteristics were compared to all patients receiving bisphosphonate therapy. Results: One hundred and twenty-one patients were evaluated, 36 Male and 85 Female. Median age- 62 (Range 34–85). Seventy-six had metastatic Breast cancer, 25 Prostate, 7 Lung, 3 Colorectal, 3 Renal, 2 unknown primary, 1 each of Penile, Bladder, Seminoma, Lymphoma and Melanoma. Forty patients received Pamidronate infusions alone, 51 Zoledronic Acid alone and 30 a combination of the two. The median number of Pamidronate infusions was 8 (Range 4–10), Zoledronic infusions 10.7 (Range 4–32), and a combination of pamidronate and zoledronic acid was 12 (Range 5–66). Three patients developed ONJ. All 3 patients were female, had a median age of 62 (range 52–74) and had metastatic breast cancer. The median number of bisphosphonate infusions prior to the development of ONJ was 35 (Range 18–47). All patients had chest wall radiotherapy and 1 had chemotherapy and steroids. No patients had dental procedures or prolonged antibacterial therapy. Conclusions: ONJ is a complication associated with IV Bisphosphonate therapy. Our study suggests that female sex, zoledronic acid, and prolonged administration of bisphosphonates, may confer an increased risk for the development of ONJ. Further prospective studies with adequate power are needed to clarify what patients are most at risk for developing ONJ and what measures are needed to prevent its occurrence. No significant financial relationships to disclose.
A collaborative demonstration project: Depression screening in patient with cancer
Authors: Adkins B. W. , Titus-Howard T. , Massey V. , Washburn N. , Molinaro J. , Lang B. , Bruning W. L. , Lanoue K. 
Published: April 2020

18556 Background: A demonstration project testing the feasibly of implementing a depression screening work flow algorithm was initiated by the anti-depression committee at one of six ambulatory care sites in the Kansas City Cancer Center (KCCC) system. The object of the study was to develop a process of work flow that would assist in identifying patients with depression and facilitate appropriate interventions by providers. Methods: A flow chart was developed illustrating critical decision-making points in the screening for depression by physicians and nurse practitioners (NP). The population included half radiation therapy and the other half chemotherapy. Patients completed the PHQ-2 a two question prescreen to assess initial symptoms of depression, including feeling depressed, down or hopeless and/ or little interest or pleasure in activities. A positive response to one of these 2 questions prompted the administration of the PHQ-9 a validated depression screening instrument. The PHQ-9 scoring criteria was used to assist the physician and NP with taking the appropriate action such as the initiation of antidepressant therapy and/or referral to mental health provider, follow up for subsequent appointments and/or reassessment. Results: Seventy-one patients were tracked to evaluate the process of recognition and management of depression from April 2004 to January 2005. Of the 71 patients 37% (N = 26) scored positive on at least one question on the two question prescreen. Of the 26 patients scoring positive 27% (N = 7) of these patients had less than 3 follow up visits while 73 % (N = 19) had greater than 3 follow-up visits by the KCCC providers. Of the patients that answered positively to one of the two prescreen questions 69% (N = 18) completed the full PHQ-9 and their scores were recorded. Conclusions: The development of a new model in a community-based oncology practice allows for integrating clinically proven techniques for diagnosing and treating depression. It will allow for the committee to make recommendations for changes in the process before it is implemented on a larger scale at all KCCC outpatient sites. No significant financial relationships to disclose.
The use of Internet as an information resource among cancer patients at a Canadian cancer centre
Authors: Verma S. , Fralick J. , Sue J. , Wu M. , Dranitsaris G. , Clemons M. , Piliotis G. 
Published: April 2020

18561 Background: Understanding the nature of Internet use among cancer patients is important to facilitate patient-education interventions and for providing optimal patient care. This questionnaire study is designed to evaluate Internet use by cancer patients at a cancer centre. Methods: Cancer patients attending ambulatory clinics at a single Canadian cancer centre were approached by their health care staff. Participants filled out self-administered questionnaire collecting information on demographics, frequency of Internet usage, timing of Internet use during treatment course, type of information sought, and information on patient’s comfort level and satisfaction with Internet use. Results: Of the total 250 participants, 174 (70%) had used the Internet before and 76 (30%) had never used the Internet. Users were more likely to be younger, female, have English as their first language, and be of Caucasian descent. Individuals with breast cancer were also more likely to have used the Internet than pts with other malignancies. Of the Internet users (n = 174), the majority (87%, n = 152) accessed the Internet once per week or more, and felt strongly confident (44%, n=76) in navigating the Internet. 29 users (17%) felt that the information on the Internet was not trustworthy. Of the users, 136 (78%) used the Internet to access information on cancer, and reportedly more often before visiting the cancer centre (50%, n = 70) and before starting initiating cancer treatment (78%, n = 106). The users seeking information on cancer were most likely to look for information on cancer treatment (87%, n = 118) and side effects (74%, n = 100). The top three visited sites were those for Canadian cancer society, Google, and American cancer society. Conclusions: Despite wide availability and accessibility of Internet, it is still not being used as a cancer information tool by many of our patients. By ensuring that accurate and comprehensive information is available on the Internet, perhaps even more patients will use this medium as their information resource, to better understand their diagnosis and make optimal treatment decisions. No significant financial relationships to disclose.
A proposal for an abbreviated onco-geriatric assessment in daily practice
Authors: Girre V. 
Published: April 2020

18565 Background: In order to describe the elderly population in Institut Curie and to determine if a brief multidimensional assessment may influence our decision to treat elderly patients with cancers we decided to realize a short assessment for each patient, 70 years and older. In a prospective study we evaluated such diverse areas as functional status, comorbidity, nutrition, polypharmacy and the presence or absence of geriatric syndromes. Methods: We studied 105 elderly cancer patients, median age 80 years with solid tumors. In addition to PS, their physical function was assessed by the activity of daily living (ADL) and instrumental activity of daily living (IADL) scales. During consultation comorbidities, Geriatric depression scale (GDS), the number of falls in the past year, concomitant medications, weight measurements and social environment were collected in a questionnaire. Cognitive functions were assesed if troubles were suspected. Blood tests were performed secondary. Results: To date 105 patients were evaluated : 10 % live in institution, 16% have no social environment, 35 % have a loss of autonomy in ADL and 7% were dependant. In the IADL: 30% presented a loss of autonomy and 24% were dependant. The median Body Mass Index (BMI) was 23.8 kg/m2, but the BMI was in 14% < 19kg/m2; 20% of the patients fall more than 2 times in the year and 53% have a suspicion of depression in the GDS in 4 items. 74% take more than 3 drugs per day. The median of comorbidities was 1.3. According to the results the decision of treatment was modified in 28% of patients. Conclusion: This questionnaire is not a replacement for the entire Comprehensive Geriatric assessment but is a reasonable prescreening instrument that may be performed in less than 15 minutes and be helpful to the clinician in his decision. No significant financial relationships to disclose.
The meanings of “hope” to patients with cancer, nearing the end of their lives
Authors: Olver I. N. , Eliott J. A. 
Published: April 2020

18567 Background: In two studies of the speech of patients with cancer about end-of-life decision-making, the word hope was often spontaneously used. In 23 patients earlier in their disease there was a difference between hope used as a noun, often objective, outside the patient’s control, and presented as “no hope”, or as a verb which was directed by patients and facilitated imagining a positive future (Qual Health Res 2002, 12: 173–193). In a second study 28 patients judged within 3 months of dying, following unprompted use of hope during interview, were specifically prompted to talk about hope. Methods: Discourse analysis was used to analyze the speech from the semi-structured interviews of the patients. The sample size was determined by data saturation. Results: All in the second study were Caucasian, average age 61, 15 males, 18 had partners and 19 were Christian, 1 Druid, and 8 listing no religion. Ten patients made reference to hope as variable in amount. In general the more the better, but even 1%, while trivial scientifically, may be important personally. The problem with quantifiable hope is that it is perceived to dwindle with the medical prognosis with which “no hope” is most often identified. Twenty patients hoped for a longer life although 19 had specifically indicated that they were dying, suggesting that this hope was not death denying. Most wanted more time to achieve tasks and be with family. Hoping recognized uncertainty yet attested to the value patients placed on various activities. Eight talked of hoping for a cure, although this was not overwhelming in the present. Some mentioned the possibility of a miracle cure, reinforced by the construction that medicine gives hope. Hope sometimes shifted from life to either an acceptable dying in 8 patients or to focus on others. The legacy to others could be objects or life lessons. Hopes can be shared by partners and can change. Two patients spoke of hope sourced from God and as enduring beyond death. Conclusions: Patients found it challenging to talk of hope in the abstract. Hope can be positive and sustaining or disillusioning when not attained. No significant financial relationships to disclose.
Improvement in anemia management with epoietin alfa (EA) in elderly and/or poor performance status (PS) patients (pts) with advanced non-small cell lung cancer (NSCLC) (GFPC 0202)
Authors: Lecaer H. , André M. , Thomas P. A. , Crequit J. , Falchero L. , Berdah J. F. , Delhoume J. Y. , Chavaillon J. M. , Lena H. , Perol M. 
Published: April 2020

18571 Background: EA at a starting dose of 40000 UI sc once weekly (qw) has been show to be effective in the treatment of chemotherapy (CT) induced anemia in cancer pts and early intervention with EA appears important for anemia prevention and reduce CT toxicity in elderly pts. Methods: In this multicenter phase II study, chemonaive pts with stage IIIB (pleural effusion) and IV 50 pts with mild co-morbidity (Charlson score) and good performans status (PS) received docetaxel 30 mg/m2 weekly (6 wks, 2 wks off) and gemcitabine 900 mg/m2 (only on day 1, 8, 22, 29) arm A and 50 pts with higher co-morbidity and/or poor performans status (PS) received docetaxel 30 mg/m2 weekly (6 wks, 2 wks off) arm B. Anemic pts with Hb <11.5 g/dl received EA 40000 UI/qw until a target = 13 g/dl with maintenance phase during CT and 28 days after the end of CT to maintain Hb 11.5 to 12.5 g/dl. Dose could be increased to 60000 UI/qw after 4 wks depending on Hb response. Quality of life (Qol: LCSS, Spitzer score) was assessed at baseline, 8, 16 and 24 wks. This trial assessed the effect of EA on Hb level after 4 and 8 wks, tranfusion requirements and Qol. Results: From Jun 2003 to Dec 2004 100 pts were enrolled, median age was 72,7 (66–82) arm A, 76,6 (70–84) arm B, median co-morbidity 1 (0–4) arm A; 1,9 (0–5) arm B. 59 pts received EA (58% arm A; 60% arm B), mean Hb level was 11.6 at the start of CT, and 10.42 before EA. Mean Hb increase after 4 wks was 0.77 ± 1.11 (p < 0.05), and 1.63 ± 1.36 after 8 wks (p < 0.05). Only 14.1% received transfusions. There was no significant change in global Qol and fatigue (LCSS). The main grade 3/4 CT toxicity was fatigue 25% and neutropenia in arm A and fatigue 50% in arm B. Conclusions: Weekly EA increase Hb level, early EA intervention maintain Qol and decrease red blood transfusions, and mild anemia is probably associated with significant impairment in toxicity in elderly pts with advanced NSCLC. No significant financial relationships to disclose.
Early vs. late treatment with darbepoetin alfa in patients with genitourinary tumors during chemotherapy
Authors: Elandt K. , Horak P. , Schieder K. C. , Leikermoser R. , Altmann R. , Albrecht A. , Reisenberger K. , Tomek S. , Fischer H. , Zielinski C. C. , Krainer M. 
Published: April 2020

18583 Background: Anemia is a common complication in patients who receive anticancer therapy. We evaluated the efficacy of darbepoetin alfa in early vs. late treatment in patients with genitourinary tumors undergoing chemotherapy. We wanted to investigate whether an early onset of treatment with darbepoetin alfa reduces frequency of red blood cell transfusion and increases patients’ QoL. Methods: Patients on chemotherapeutic treatment for a urogenital neoplasia and a hemoglobin between 10–12 g/dl were randomized between an immediate start of treatment with darbepoetin alfa 150 μg sc weekly (group A) and a Hb below 10 g/dl or clinical symptoms (group B). Results: 52 patients out of 68 (76.5%) completed the trial, 7/40 patients (17%) in group A and 9/28 patients (32%) in group B withdraw from the study. An intent to treat analysis was performed and showed a significant superiority (p = 0.023, log-rank test) for the early treatment. In group A, only 12.5% of patients (5/40) received at least one red blood cell transfusion compared to group B, where 39% of the patients (11/28) received a transfusion. In group A the mean Hb level increased steadily, starting with a baseline value of 11.0 g/dl. In week 21 a mean Hb level of 12.8 g/dl was reached, resulting in an overall increase in Hb of 1.8 g/dl. In group B, which had a comparable baseline Hb level of 10.9 g/dl, the mean Hb value decreased initially during the first 4 weeks to 10.0 g/dl. In week 21 a level of 11.4 g/dl was reached, resulting in a total Hb-increase of 0.5 g/dl. When anemia treatment was initiated early, the mean Hb level always remained in the range of 11 to 13 g/dl from the beginning of the study, in the B group the mean level of 11 g/dl was first achieved after 12 weeks. 35% in group A compared to 54% in group B (p = 0.13) experienced a dose doubling. The mean values (EORTC-QLQ-C30) of all symptom scales in group A were markedly below those in group B with the highest difference for dyspnea, 29.1 points (p < 0.001). Conclusions: Early treatment with darbepoetin alfa in patients with urogenital cancer results in optimal hemoglobin levels according to EORTC guidelines and consequently in a reduction of red blood cells transfusion. Furthermore, in patients with earlier initiation of treatment a clinically significant improvement of dyspnea can be observed. [Table: see text]
Bisphosphonates (BP)-related osteonecrosis of the jaw (ONJ): Clinical experience of the “Rete Oncologica di Piemonte e Valle d’Aosta” network
Authors: Fusco V. , Ortega C. , Goia F. , Ciuffreda L. , Ardine M. , Falco P. , Gorzeglio G. , Baraldi A. , Airoldi M. , Bertetto O. 
Published: April 2020

18584 Background: ONJ have been recently reported in patients (pts) treated with BP, especially Pamidronate (P) and Zoledronic Acid (Z). Measures of screening, treatment, and prevention have been planned in our regional oncology network. Methods: We evaluated dental history of pts previously treated with BP and/or under treatment in 2005, finding 60 cases of ONJ, but a large number of suspected cases are under investigation/observation. Full details of oncologic and dental history have been collected so far of 43 pts. Results: Pts characteristics: sex: 14/29 M/F; median age 66 years (range 45–81); tumour: 24 breast cancer, 7 prostate cancer; 12 myeloma. BP treatment: 5 P, 14 P changed to Z, 24 Z; median number of infusions: 22 of P (range 12–52), 18 of Z (range 7–43). Site of ONJ: 33 (77%) in mandible, 9 (21%) in maxilla, 1 (2%) in both. Presenting findings included exposed bone or infections (95%), pain, mobile teeth, soft-tissue swelling, nonhealing fistulas . Dental comorbidities were present in all pts and 92 % had precipitating events, as teeth extraction, periodontal surgery, dental implants, or traumatic use of dentures. Conclusions: Our oncology network planned: a) review of all pts treated with BP since 2000, to obtain real estimates of frequency and of possible risk factors; b) screening of all pts under treatment with BP, with panoramic X-rays and maxillofacial surgeon visit (w/o CT or MR scan in selected cases); c) careful evaluation of pts candidate to be treated with BP (as above), with pretherapy dental care if necessary; d) prospective evaluation of incidence in future, after pretherapy dental care policy and avoiding (as possible) surgical dental procedures during BP treatment; e) prospective trials of evaluation of palliative treatment of ONJ and related complications in affected pts (chlorohexidine mouthwashes, antibiotics, metronidazole, hyperbaric oxygen, etc.). No significant financial relationships to disclose.
Bisphosphonate-associated osteonecrosis of the jaws: Case reports and analysis of 184 cases
Authors: Kanat O. , Ozet A. , Arpaci F. , Ataergin S. , Kuzhan O. , Komurcu S. , Ozet B. , Ozturk M. 
Published: April 2020

18595 Background: In this study, we described four new cases of bisphosphonates-related jaw osteonecrosis and reviewed the English Medical Literature for similar case reports. Methods: A MEDLINE literature search was performed from September 2003 to November 2005 for all case reports of bisphosphonates-associated jaw osteonecrosis. Results: Our patients were three female and one male with a median age of 50.5 years (range, 35–57 years). Two patients had breast cancer and two another had multiple myeloma. Two patients received pamidronate initially and were switched later to zoledronate. The two other patients were treated with zoledronate. The median duration from the first administration of bisphosphonates to the diagnosis of osteonecrosis was 48 (range, 18–75) months. Review of the literature of all published cases revealed 184 patients. Age of these patients ranged from 37 to 89 years (median, 64 years). Seventy-eight patients (43.4%) were treated with bisphosphonates for metastatic breast carcinoma, 65 (36.3%) for multiple myeloma, and 14 (7.8%) for metastatic prostate cancer. Thirteen patients (7.2%) without cancer diagnosis were treated for osteoporosis (10 patients) or Paget’s disease (3 patients). Primary disease was not specified in five patients. Eighty-two patients (46.8%) were treated with pamidronate, 47 (26.8%) treated with zoledronate, 35 (20%) treated with pamidronate initially and later were changed to zoledronate, 9 (5.1%) treated with oral bisphosphonates and 2 (1.1%) treated with oral bisphosphonates initially and subsequently switched to zoledronate. Type of bisphosphonate was not specified in ten patients. The duration of bisphosphonates treatment was available for 45 patients (24.4%) and ranged from 1 to 93 (median, 28) months. Conclusion: Oncologists and dental professionals should be aware of this potential serious complication of long-term bisphosphonates treatment and special caution should be taken before dental intervention in such patients. No significant financial relationships to disclose.