bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between fatigue level and irradiated volume of the whole body, lung and heart in breast cancer patients receiving adjuvant radiotherapy after breast-conserving surgery
Authors: Rucinska M. , Langkjer S. T. 
Published: March 2020

19608 Background: Fatigue - an unpleasant, persistent, subjective sense of tiredness - is one of the most common symptoms experienced by cancer patients. It is multidimensional and is associated with both - malignancy itself and the anti-neoplastic treatment. The aim of the study was to assess the level of fatigue during and after adjuvant postoperative radiotherapy in breast cancer patients and evaluate its correlation with the irradiated volume of the whole body, lung and heart. Methods: 48 patients (age 33–76 years, mean 57 years) with early breast cancer after breast-conserving surgery were treated with adjuvant radiotherapy (48Gy/24fractions/5weeks; 12 patients received boost 10Gy/5fractions/1week to the tumor-bed). The patients′ subjective feeling of fatigue intensity was measured according to 10- score visual analog scale (VAS) before the start and weekly during radiotherapy, as well as 14 days and 3 months after radiotherapy. Results: Fatigue intensity increased gradually during radiotherapy (mean fatigue-VAS before and in the last week of treatment was 1.21 and 2.31 respectively; p=0.004). 14 days after the end of radiotherapy, the fatigue intensity was still higher than before treatment (1.88 and 1.21 respectively; p=0.04), but 3 months later, fatigue was lower than at the pretreatment level (n.s.). Irradiation of the large volume of the whole body was correlated with higher fatigue level during and after radiotherapy. If 15% or more of the unilateral lung volume received 20Gy, patients reported higher fatigue level than patients receiving 20Gy for less than 15% of the unilateral lung volume. There were no statistical differences in fatigue level between patients with different percentage of the heart volume receiving irradiation. Patients with boost did not manifest higher fatigue level. Conclusions: Fatigue increased over the course of radiotherapy, but 3 months after the end of therapy it was reduced to lower than at the preliminary level. There was a positive correlation between fatigue level during and after radiotherapy and the irradiated whole body and lung volume, but not heart volume. No significant financial relationships to disclose.
The variations in symptom clusters related to well-being in palliative care patients during the final weeks of life
Authors: Olson K. L. , Hayduk L. , Cree M. , Tsui Y. , Quan H. , Hanson J. , Lawlor P. 
Published: March 2020

19612 Background: The purpose of this study was to determine whether the relationships between symptoms and well-being, as experienced by palliative care patients, changed as patients approached death. Methods: Data were extracted from a database that included Edmonton Symptom Assessment System scores collected from palliative care patients on Day 7 of Weeks 5 (n=123), 2 (n=115), and 1 (n=113) prior to death between 1995 and 2000. The model contained 18 effect parameters. Based on standard sample size requirements for structural equation modeling of 10 cases per indicator variable, the study was adequately powered for all three time points. The majority of patients had advanced cancer and were receiving care in either a tertiary palliative care or hospice setting. All participants had Folstein Mini- Mental Status Examination scores of 22 or higher at the time of original data collection. A causal model, based primarily on clinical discussions, linking pain, anxiety, nausea, shortness of breath, drowsiness, loss of appetite, tiredness, depression, and well-being was proposed. The model was tested against the data from all three time points, using LISREL, version 8.7.2s. Results: The model fit the data for all time points, but was revised slightly based on the modification indices. The final Goodness of Fit Test values were χ2= 4.2 (d.f.=8, p=.84), χ2= 13.3 (d.f.=9, p=.15), and χ2= 5.5 (d.f.=9, p=.79) respectively. With respect to tiredness, depression and well-being, the model explained at least 70% of the variance at Week 5, between 57% and 83% of the variance at Week 2, and 42% to 58% of the variance in Week 1. Nausea was unimportant in all of the models. The two strongest effects, persisting over all three time periods, were those linking anxiety to depression, and drowsiness to tiredness, reflecting strong stability in patient rankings even as health declined and treatment changed. Conclusions: The symptom clusters in this study changed over time, in disagreement with existing research that assumes the relationships between symptoms within symptom clusters remain stable. An improved understanding of alterations in symptom clusters may contribute to improved control of patient comfort, quality of life, and quality of death. No significant financial relationships to disclose.
Wisconsin Comorbidity Assessment Scale (WCAS): A novel, comprehensive, performance-based assessment scale of geriatric syndromes and medical comorbidities in older cancer patients
Authors: Krishnamachary M. K. , Swain-Eng R. J. , Barnet J. , Maloney J. , Stewart J. A. , Asthana S. 
Published: March 2020

19619 Background: Elderly patients with cancer have potential for multiple geriatric syndromes that influence treatment and outcomes. No single clinical assessment tool has targeted all the major geriatric syndromes and their interaction on cancer management and outcomes. We developed WCAS to evaluate cognitive and physical function, risk of falls and gait disorders, polypharmacy, and medical comorbidities. Methods: Eighteen newly diagnosed patients with breast cancer (age 55–82), were enrolled prior to cancer treatment. Cognitive function was evaluated with a comprehensive battery of neuropsychological tests targeting the domains of memory, executive function, attention, language, and praxis. Physical function skills were assessed with novel performance-based tasks (e.g., bed-making) and computerized assessments of balance, gait and risk of falls. Cancer treatment included surgery in all patients with variable use of adjuvant radiation and medical therapy. WCAS was administered at baseline and at month 6. Results: Ten subjects have completed both baseline and month 6 visits. Surgical treatment occurred at a mean of ten days after baseline assessment (SD 6.7). The mean (SD) of the age, years of education and baseline Mini Mental Status Exam (MMSE) was 66 years (7.3), 15.2 years (3.7) and 29.3 (1.1). From baseline to month six assessment performance on the WAIS Digit Symbol test, a measure of working memory and processing speed, declined (mean change −11.7, p<0.01). Likewise, the performance on the WAIS letter number sequence test (mean change −1.3, p=0.09) and the MMSE (mean change −1.1, p=0.12) declined. Interestingly, four subjects with pre-existing hypothyroidism on replacement treatment showed a greater decline (p<0.01) in memory than those without this common condition. Conclusions: Findings indicate that breast cancer diagnosis and therapy can be associated with significant decline in aspects of cognition in older adults with cancer. These changes can last at least 6 months and are more pronounced in those with hypothyroidism. Larger, longer term prospective studies utilizing WCAS are necessary to confirm our preliminary findings. No significant financial relationships to disclose.
Development of symptom assessment tool for terminal cancer patients
Authors: Koh S. , Lee K. , Hong Y. , Kang J. , Woo I. , Lee M. , Choi S. 
Published: March 2020

19634 Background: A symptom assessment is important to control the terminal cancer patients’ symptoms successfully and improve their quality of life. Our research team has developed the objective assessment method for the terminal patients’ symptoms and compared the results with the patient self-reported outcomes using Memorial Symptom Assessment Scale (MSAS). Methods: From September in 2004, the 121 inpatients without anti-cancer therapy in terminal stage of cancer were evaluated in Kangnam St. Mary's Hospital. The 17 common symptoms were graded as four categories; none(0), mild(1), moderate(2), and severe(3) with reference to NCI-CTC and WHO toxicity criteria. An attending physician assessed 17 symptoms at the similar hour every day. Among the inpatients, those who had clear consciousness and could communicate normally were investigated every week to evaluate the frequency and severity of common symptoms and their distress degree using MSAS. Results: Only 54 patients (44.6%) could be examined to evaluate the symptoms by MSAS. However, the symptoms estimated by our assessment tool were less serious in the terms of severity and distress degree than that patients felt actually. This tendency was shown more obviously in the mental symptoms; Drowsiness (p=0.0001), Nervousness (p=0.0001), and Anxiety (p=0.005). However, the physical symptoms had no statistical difference between the results from patients and physician. Conclusions: Patient-reported outcomes using MSAS could be obtained from 44.6% of the inpatients with terminal cancer every week. However, the objective assessment tool to evaluate the common symptoms of terminal cancer patients can be applied for all patients including the incommunicable, every day. Furthermore, this assessment tool may be more suitable for examining the physical symptoms of terminal cancer patients. No significant financial relationships to disclose.
A pilot crossover study to evaluate the use of Regenecare topical wound gel in patients with cutaneous toxicity caused by epidermal growth factor receptor (HER1/EGFR) inhibitors
Authors: Wong S. , Osann K. E. , Lloyd K. P. , Vasko C. M. , Arcinas R. L. , Mummaneni M. 
Published: March 2020

19643 Background: Acneform rash, including pain and pruritus, presents as a dose-limiting toxicity for HER1/EGFR (epidermal growth factor receptor) inhibitors which can lead to secondary skin infection. Antibiotics and corticosteroids are treatment options with minimal or moderate success. Better rash management is desirable for optimal use of these agents. Regenecare™ Gel contains 2% lidocaine for local pain management, marine collagen to promote tissue formation, aloe vera to promote circulation and emollient effect, and sodium alginate to absorb exudates. This study evaluates the effectiveness of Regenecare™ Gel in relieving the clinical symptoms of HER1/EGFR inhibitors-induced skin rash. The secondary objective assesses patient tolerability and satisfaction. Methods: A single center, prospective pilot cross- over study of 10–15 cancer patients treated with HER1/EGFR inhibitor. At the occurrence of grade 2 skin rash, subjects who signed an informed consent started applying study gel on the right side of the face and then crossed-over to both sides of the face after 1 week. Subjects were examined weekly for facial evaluations and photographs. The study continued for a total of six weeks. Results: Eight patients were enrolled with 6 evaluable (3 cetuximab, 2 panitumumab, 1 erlotinib). A summary of the itch and pain score responses are outlined below. Comparative analysis for Treatment vs. No Treatment show significant improvement with respect to self-reported level of itch (p=0.019) and pain (p=0.033). All patients tolerated the study gel without any adverse effect and 5 patients were very satisfied with the effectiveness of the gel. Conclusions: Regenecare™ Gel appears effective in relieving EGFR inhibitors rash-associated pruritus and pain based on these preliminary analyses. Study is ongoing for further assessment. No significant financial relationships to disclose. [Table: see text]
Hypocalcemia induced by bisphophonates in cancer patients with vitamin D deficiency
Authors: Yazbeck C. F. , Gonzalez-Angulo A. M. , Shaw S. A. , Waguespack S. G. , Vassilopoulou-Sellin R. , Busaidy N. L. 
Published: March 2020

19644 Background: The use of bisphosphonates for treatment of hypercalcemia, bone pain and reduction of skeletal morbidity in metastatic breast cancer is increasing. Moreover, vitamin D deficiency is commonly associated with cancer. Hypocalcemia has been reported following IV bisphosphonate use. Methods: We present the clinical and lab findings in 6 cases of bisphosphonate-induced hypocalcemia, caused by unmasked vitamin D deficiency. Results: Our 1st patient was diagnosed with breast cancer and developed metastases 6yrs later. She was given Zolendronic acid 4 mg IV with a baseline calcium level (Ca) of 9.7 mg/dl, normal albumin, and elevated alkaline phosphatase. 3 days later, she developed symptomatic severe hypocalcemia with tetany: Ca dropped to 6.1 mg/dl with recovery. After her 2nd dose of Zolendronic acid, Ca dropped again to 6 mg/dl with normal albumin, intact parathyroid hormone (PTH) of 637 pg/ml (range 10–65) and 25-hydroxy vitamin D levels (25-OHD) of 4 ng/ml (range 20–100). Our 2nd patient presented with metastatic breast cancer and was treated with Zolendronic acid for hypercalcemia with a baseline Ca of 13 mg/dl, PTH-related protein of 2.8 pmol/l (range <1.8) and PTH of 7 pg/ml. She then developed hypocalcemia with corrected Ca of 7.7 mg/dl and 25-OHD of 13 ng/ml. Our 3rd patient with breast cancer was also treated with Zolendronic acid for bone metastases and hypercalcemia. She then presented with symptomatic hypocalcemia: ionized Ca level of 1.09 mmol/l (range 1.13–1.32), PTH of 211 pg/ml and 25-OHD of 13 ng/ml. Our other 3 cases had similar presentations to the above and will be discussed in detail. All 6 cases were treated with ergocalciferol and long-term oral calcium and vitamin D therapy. All of our cases presented with symptomatic hypocalcemia with vitamin D levels less than 30ng/mL. Conclusions: Since bisphosphonate use is increasing in cancer patients and vitamin D deficiency is not an uncommon finding in this population, consideration should be given to routine checking of 25-OHD levels before initiating treatment with bisphosphonates and supplementing with calcium and vitamin D when necessary (<30ng/mL). This could potentially prevent further morbidity. Further prospective studies would be needed for early replacement with vitamin D and calcium in those with vitamin D deficiency. No significant financial relationships to disclose.
Management of pain in patients (PTS) receiving active therapy for cancer
Authors: Campora E. , Schellino M. , Ardissone F. , Balbo A. , Bandiera A. , Borea M. , Cimino S. , Floccia M. , Mura M. , Salamone F. , Di Lonardo A. 
Published: March 2020

19645 Background: The World Health Organization (WHO) estimates suggest that moderate to severe pain is experienced by one- third of pts receiving active therapy for their disease and by 60–90% of patients with advanced disease. Procedures that make pain assessment and effective management strategies a routine part of every patient care are recommended. The aim of this study was to integrate nursing intervention with physician management of cronic cancer pain experienced by pts receiving active therapy for cancer. Methods: An Oncology Nurse measured pain in all patients (universal screening) presenting at the Day Hospital for active therapy. Pain was measured using a validated instrument: the Visual Analog Scale (VAS). The pain intensity VAS scale is a 10 cm line anchored on either end by the terms least possible pain and worst possible pain. In addition. the Memorial Pain Assessment Care (MPAC) that consists of 3 VAS scales that measure pain intensity, pain relief and mood and a set of pain severity descriptors adapted from the Tursky rating scale was used. Results: From April 2004 to June 2006 a total of 704 pts were evaluated for pain, 334 (47%) males and 370 (53 %) females with median age 65 years (range 19–85). Results of pain measurement can be synthesized as follows: Pts with VAS = 4 were referred to the oncologist on the same day that pain was measured and analgesics were prescribed according to intensity and type of pain. Conclusions: Results indicate that pain can be universally evaluated and successfully managed in an Oncology Day Hospital. Assessment and treatment of cancer pain should be integrated into routine cancer care. Intervention by the oncology nursing staff is an integral part of effective cancer pain management. No significant financial relationships to disclose. [Table: see text]
Preventing the Preventable—Improving thromboprophylaxis in oncology in-patients
Authors: Stevens R. , Jones R. , Oliveras S. , Abdullah T. , Leonard R. 
Published: March 2020

19648 Background: Cancer and its treatments are well recognised risk factors for venous thromboembolism (VTE). The risk of VTE complications in malignancy can be increased with surgery, chemotherapy (including adjuvant chemotherapy), hormone therapy and central indwelling catheters. Low molecular weight heparin (LMWH) has been shown to safely reduce the incidence of VTE in cancer patients however it is often not a standard of care within the oncology in-patient setting. Method: A retrospective study was carried out on admissions to the oncology ward for 1 month. Individual VTE risk was assessed using the modified THRiFT II risk assessment model and it was documented whether patients received any form of prophylaxis and the incidence of VTE. Following this study a VTE prophylaxis protocol was designed and implemented on the oncology ward and a repeat prospective study was carried out. Results: The initial study showed that in the very high risk group only 15% patients received thromboprophylaxis. 4 episodes of VTE occurred during the initial study period and these all occurred in patients stratified as very high risk. On the repeat study the results showed 50% of patients assessed as very high risk were now receiving prophylaxis. There was also a reduction in the rate of inappropriate prophylaxis from 17% to 0% in those assessed as lower risk. Conclusion: Primary prevention of VTE helps to reduce the morbidity and mortality associated with this common complication of malignancy. This study shows how a simple risk assessment model coupled with raised awareness of VTE risk improved the prophylaxis of those at highest risk and also reduced inappropriate usage in those at lesser risk. No significant financial relationships to disclose.
Preliminary results of an open-label study to evaluate the efficacy and tolerability of aprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with carboplatin-containing chemotherapy regimen in patients with ovarian cancer
Authors: Timmins P. F. , Kredentser D. , Hancock K. C. , Messing M. , Boehm K. A. , Mull S. , Ilegbodu D. , Asmar L. 
Published: March 2020

19652 Background: The use of aprepitant has been shown to offer an advantage in preventing acute and delayed chemotherapy- induced nausea and vomiting (CINV). This study integrates palonosetron and dexamethasone into the regimen to determine the efficacy and safety of this combination. Methods: 50 patients (pts) have enrolled; data has been submitted for 43. Main inclusion criteria were: diagnosis of ovarian (OV), primary peritoneal (PP), fallopian tube (FT) carcinoma Stage I-IV, or papillary serous cancer of the uterus (UPSC); naive to emetogenic chemotherapy Hesketh ≥Level 4, is scheduled to receive paclitaxel 175 mg/m2 IV and carboplatin AUC=6 IV; is able to read and understand the Functional Living Index - Emesis (FLIE) questionnaire. Results: Median age was 61 years, 60% ECOG=0, 86% prior surgery; 68% OV, 14% PP cancers, 7% UPSC, and 5% FT. Metastases were noted in 30% of pts, 21% had visceral metastasis. To date, 70% of patients (32/46) have reported no vomiting, or use of rescue medications during the study and are deemed as complete responders. Based on the 35 pts for whom complete patient diaries have been submitted thus far, the complete response rate is 91% (32/25), compared to 50% (aprepitant alone [The MEC Trial]). No Grade 3–4 treatment related adverse events were reported; Grade 1–2 toxicities included neutropenia (10.5%); anemia, constipation, and nausea (7.9%, each), and fatigue, dyspepsia, and arthralgia (5.3%, each). Some of the toxicities may be related to the chemotherapy, and are not treatment-related to the aprepitant, palonsetron, or dexamethasone. Conclusions: The addition of aprepitant to palonsetron and dexamethasone appears to be very well tolerated. This combination is effective in the prevention of chemotherapy-induced nausea and vomiting when used with emetogenic therapy such as paclitaxel and carboplatin. This research was supported, in part, from a research grant from Merck & Co., Inc. Whitehouse Station, NJ. No significant financial relationships to disclose.
Evaluation of psychological distress, anxiety and depression in oncologic patients admitted to a medical oncology unit
Authors: Buralli B. , Manai S. , Camerini A. , Aiosa C. , Amadei L. , Donati S. , Tartarelli G. , Valsuani C. , Garrone O. , Amoroso D. 
Published: March 2020

19658 Background: psychological status influences patients’ compliance to treatments, quality of life and perhaps final outcome. Moreover, the screening for psychological disturbances may allow patients at risk to be identified so they can benefit from specific interventions. Methods: 133 consecutive unselected pts (76 F, mean age 63.7 ± 11.6 yrs) admitted to our Medical Oncology Unit were evaluated at hospital admittance. We employed the Italian validated version of the Hospital Anxiety Depression Scale (HADS) questionnaire, a self-administered questionnaire specifically developed to reveal states of distress (D), anxiety (A) end depression (DE) in non- psychiatric patients with an organic disease. Two cut-off values (7 and 11 points) to identify borderline (8–10 points) and probable clinically relevant cases (= 11 points) in A and DE scales were used. Scores between 15 and 21 were considered as borderline cases and >21 were considered to be of clinical relevance in total D scale. Results: mean total D, A and DE levels were 16.5 ± 11.6, 7.8 ± 4.7 and 8.3 ± 5.3 respectively. Females showed higher levels than males for all parameters (D: 17.6 ± 9.5 vs 14.2 ± 8.1, p=0.031; A: 8.6 ± 4.9 vs 6.9 ± 4.2, p=0.035; DE: 9.1 ± 5.6 vs 7.3 ± 4.7, p=0.06ns). Age-related subgroup analysis demonstrated a trend towards higher A scores in =40 yrs pts vs total population (11.0 ± 3.0 vs 7.8 ± 4.7, p=0.08ns) and significantly higher D and DE values in =80 yrs pts (22.6 ± 11.3 vs 16.2 ± 9.1, p=0.05 and 13.0 ± 6.6 vs 8.3 ± 5.3, p=0.025 respectively). Regression analysis showed in females a significant direct correlation between age - D (r = +0.46, p = 0.048) and age - DE (r = +0.62, p = 0.0019) and in males a significant inverse correlation between age - D (r = -0.52, p = 0.04), age - A (r = -0.45, p = 0.05) and a clear trend between age - DE (r = -0.42, p = 0.07ns). Conclusions: the study population presented with borderline admittance D, A and DE values. In particular, young males respect to A and old women respect to D and DE represent higher risk groups for future development of psychological abnormalities complicating disease treatment. Prospective studies are ongoing to evaluate the impact of pts recovery and/or treatment on psychological parameters. No significant financial relationships to disclose.