bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparative analysis of 3DCRT, IMRT, and VMAT in the palliative treatment of spinal metastases.
Authors: Kunhiparambath Haresh , Laviraj M. A , Gupta Subhash , Sharma Dayanand , M Rajendran , Julka Pramod Kumar , Rath Goura Kishor 
Published: March 2020

e20679 Background: Radiotherapy is very important in the palliation of spinal metastases. Traditionally, a simple two-dimensional single direct posterior spinal field giving unnecessary exit dose to the normal structures is used. The studies evaluating the recent advances like 3DCRT, IMRT, VMAT for spinal metastases are rare. Present study evaluates these three modalities for the treatment of spinal mets. Methods: Ten patients with metastases to the body of lumbar spine were included. Planning CT was done with the patient supine on Philips wide bore CT (for 3 mm). The CT images were transferred online to the Pinnacle TPS V.8.0M. Tumor and the critical structures like spinal cord, kidneys, liver and bowels were contoured on pinnacle. 3DCRT was planned on pinnacle with seven equidistant beams. The CT images with the contoured structures were sent to Monaco TPS V.3.10.02. IMRT (seven equidistant fields) and VMAT (a single 360 degree arc in 25 degree increments) were planned on Monaco. Dose: 30 Gy in 10 fractions. PTV indices analyzed: D mean, D2 (dose received by the hottest 2 percent volume), D98 (dose received by 98 percent), homogeneity index HI [(D2-D98)/D50)], and conformity index CI (PTV volume/volume of PTV covered by 95 percent isodose). Dmax and D2 (dose received by hottest 2cc) for the spine, V12, V18 and V28 (percent volume receiving the respective dose) for the kidneys, D50 (dose received by the 50 percent volume) of liver, V15 (percentage volume of bowel receiving 15 Gy) were evaluated. The average were calculated and compared. Statistical analysis was done by SPSS Version 14. Results: The Table shows that there is no much significant difference between the three plans for the PTV indices. But for the normal structures, VMAT provides the least dose followed by IMRT. Conclusions: VMAT is superior to IMRT and both are better than 3DCRT for normal tissue sparing in the palliative RT for spinal metastases. [Table: see text]
Retrospective analysis of erlotinib in the treatment of patients over 70 years with NSCLC: Our experience in the geriatric oncologic unit.
Authors: Leo Silvana Assunta , Accettura Caterina , Romano Giampiero , Cocciolo Alessandro , Giampaglia Marianna , Gnoni Antonio , Licchetta Antonella , Saracino Valeria , Lorusso Vito 
Published: March 2020

e20681 Background: Erlotinib is a potential treatment option for elderly patients with advanced NSCLC; it has demonstrated a survival advantage vs BSC in the BR.21 study after 1st/2nd line failure and a good safety profile in elderly pts. Methods: Wereviewed the medical records of pts over 70 yearstreated with Erlotinib in the last 5 years in our Unit in order to correlate response to pts characteristics. EGFR mutation status (Ems) was not determined in any pts. Response was evaluated by CT scan every 2 months. Results: Since October 2006 we have treated 84 elderly pts with stage IIIb/IV NSCLC as 2nd/3rd/4th line of therapy. Median age was 75 (range 70-90), 62 (73.8%) were males and 22 (26.2%) women, respectively. Histology was ADK in 46 (54.8%), SQM in 31 (36.9%), other in 7 (8.3%). Stage IIIb/IV was 19/65 (22.6%/77.4%). PS was 0 in 7 (8.3%), 1 in 67 (79.8%), 2 in 9 (10.7%), 3 in 1 (1.2%) pts. With regard to smoking status,15 (17.8%) pts were never smoker, 59 (70.2%) ex smoker and 10 (12%) currently smoker. Patients treated as 2nd/3rd/4th line were 59/23/2 (70.2%/27.3%/2.4%). Overall, 3 pts achieved PR (3.6%), 33 SD (39.3%), 48 PD (57.1%). The characteristics of responding pts were: female, ADK, never/ex smokers, PS 0/1, 2nd line. Clinical benefit rate was 42.8%, 60.8% in ADK (28/46), 16.1% in SQM pts (5/31), 42.9% in other pts (3/7). The median duration of response (Mdr) was 20.3 months (range 11-36), Mdr of SD was 34 (range 7-55). Responding pts had a median survival of 43 months (range 34-59). Conclusions: In our series of elderly pts, Erlotinib was more effective in female, PS ≤ 2, ADK, and 2nd line. This drug can be considered a good alternative to chemotherapy in elderly pts with ADK and good PS, irrespective of mutational status of EGFR.
Factors predicting the outcome in febrile neutropenia: A study from a tertiary cancer center in India.
Authors: Kalpathi Krishnamani , Gundeti Sadashivudu , Kota Rajesh , Gullipalli Muralidhar , Linga Vijay Gandhi , Digumarti Raghunadharao 
Published: March 2020

e20684 Background: Febrile neutropenia (FN) is common in patients undergoing chemotherapy. The risk dramatically increases in those with absolute neutrophil count (ANC) less than 100/ mm3. Methods: In this 2 year studyall FN patients admitted at our center between January 2011 and November 2012 were analyzed for clinical profile, microbiologic isolates, mortality and factors affecting outcome. IBM statistic SPSS version 19 was used to analyze the data. Results: There were 333 episodes of FN during the study period. Majority (89.7%) of FN episodes occurred in patients with hematologic malignancies and 87% of episodes had ANC< 500. Induction, consolidation and maintenance related episodes were 125 (37.5%), 125 (37.5%) and 17 (5.1%) respectively. First line antibiotics (cefipime, Cefaperazone- Sulbactum + aminoglycoside), second line antibiotics (carbapenam) and antifungals were used in 44.4%, 15.6 % and 34% episodes respectively. Gram negative organisms accounted for 51.6% of the isolates. Prognostic significance between mean serum bilirubin, serum creatinine and outcome was noted, with higher deaths in patients with bilirubin > 1.5 mg% (12.2% vs 0.7%) (p= 0.000) and creatinine > 1.2 mg% (16% vs 1%) (p=0.000). Isolation of an organism and infiltrates on chest X-ray had a significant association with outcome(p= 0.017 and 0.002) respectively. Patients who had multiple component transfusions vs single component ones were at a significantly higher risk of death ( 6 deaths vs 1)(p= 0.002). There were 20 (6%) possible,33 (10%) probable and 9 (2.7 %) proven fungal infections, with significant association with outcome (p=0.000). The risk of death in those with fungal infection was 14.323 (95%CI - 2.70-75.952). Preemptiveantifungal use had a higher percentage of prolonged (> 8 days) and profound neutropenia in contrast to the empirical group (77.2% vs 65.2%) and (91% vs 83.8%), resulting in 3 deaths in the preemptive group (6.8% vs 0%) (p=0.02). The overall mortality was 2.1%. Conclusions: Leukemias are the leading cause of FN at our Institute with 2.1% mortality. Higher bilirubin, creatinine, chest imaging favoring pneumonia, positive isolates and multiple transfusions had significant association with mortality.
A cross-section questionnaire to evaluate patients’ satisfaction with totally implanted access ports (Port-a-Cath; PAC) and analysis of PAC-related complications at a tertiary care center.
Authors: Minichsdorfer Christoph , Fuereder Thorsten , Berghoff Anna Sophie , Marta Gabriel , Maehr Bruno , Gnant Michael , Zielinski Christoph , Bartsch Rupert 
Published: March 2020

e20693 Background: PACs are used for the administration of intravenous drugs. These devices have therefore become valuable tools for the application of chemotherapy in cancer patients (pts). Methods: During the period from 11.2012 to 01.2013, pts were invited to answer a simple questionnaire concerning quality-of-life and satisfaction with their respective PAC. Retrospective data regarding to PAC-related complications were collected by searching patient’s medical history. PAC-related thrombosis were defined as non-compressibility of the axillary or subclavian vein on ultrasound; PAC-related infections were defined as documented bacteraemia with a positive blood culture taken from the device in the absence of positive peripheral blood cultures. Results: A total number of 116 pts were included. Mean time since PAC implantation was 16.9 months. Complications during implantations occurred in 8 pts (6.9%), with bleeding and haematoma being the most frequently observed events; three patients experienced postsurgical pneumothorax (2.6%). Complications arising after PAC implantation consisted of infections (9 pts; 7.7%), drug extravasation (8 pts; 6.9%), PAC malposition (3 pts; 2.6%), and thrombosis (1 pt; 0.8%). PAC infections were caused most commonly by Pseudomonas aeroginosa (3 cases). One quarter of all pts reported that their PAC interfered activities of daily life. In 15 cases (13%) the PAC caused pain, especially when moving the arm (11 pts; 9.5%); only 6% reported that PAC punctuations were more painful than accessing a peripheral vein. 98 pts (84%) agreed that the PAC alleviates the administration of therapy. Indeed, the vast majority (84%) would once again choose a PAC for chemotherapy administration. Conclusions: PACs are valuable tools to ease the burden of chemotherapy administration. Most patients were satisfied, as PACs provide a relatively easy and safe way of venous access. Nevertheless, implantation and maintenance of these systems carry potential risks.
Quality of life and symptom burden in Chinese cancer patients: Results of a multicenter research project.
Authors: Mei Qi , Hu Li-ya , Chen Yuan , Yu Shi Ying , Payne Sheila 
Published: March 2020

e20695 Background: McGill QOL Questionnaire is a well known tool in the evaluation of both psychological and physical states in cancer patients. A number of translations have been made. It is widely used in western developed countries, yet little research has been performed in caner patients in Mainland China who speak Mandarin. Methods: In the first application of the MQOL-Chinese version, which was translated from the MQOL-English version, reliability, content and construct validity testing has been performed among the 126 cancer patients, screened from Tongji Hospital, a medical unit which can deliver comprehensive cancer palliative care. And then 170 patients from 4 different hospitals in China were randomly selected to fill in this scale. Results: First Test-retest reliability of the questionnaire is highly favorable, and all MQOL scores are internally consistent. Using a scientific Stratified Analysis, in the psychological domain, men report less negative emotions than females (question 5\6\8 P=0,002 \0,047\0,016), and patients with head and neck cancer have less negative emotions than those with thoracic cancer (question14 P=0.035).Furthermore, cancer patients less than 20 years old tend to be mentally stronger while people at 40-60 years old seem to have the greatest psychological burden (question6/7 P=0.034/0.017). In the semi-open questions in the second part about the physical domain, poor appetite is reported as the most troublesome problem (M=6.6/10, SD=2.77), while sleep problems rank the least distessing (M=4.2/10,SD=2.15).In the fourth part of the open questions, feeling encouraged is the most frequently mentioned, and physical and economic burden rank the 2nd and 3rd respectively. Conclusions: First of all, the MQOL-Chinese version is a valid instrument for measuring quality of life for cancer patients in Mainland China who speak Mandarin. Moreover, the outcomes above indicated that the psychological and physical domain need to receive more attention, and economic burden is also an urgent problem which needs to be improved among cancer patients especially in China, which is still a developing country with a huge population.
Annual rhythm in filgrastim use in southeast Florida.
Authors: Huff Dinah , Hrushesky William J. , Davis Sharon , Bobolts Laura Rose , Kumar Akhil , Shimp William S. , Krook James Edward , Kogler Jurgen Wilhelm , Fishman Val , Anthony Carol , Walton Robert , Fishman Marc L. ,   Oncology Analytics, Inc.
Published: March 2020

e20697 Background: Circadian, seasonal and annual temporal organization characterizes earth-evolved life forms. Cellular proliferation in human bone marrow shares this temporal organization. Careful clinical trials have documented that bone marrow damage from a range of cytotoxic anti-cancer drugs is predictably greater and lesser when these drugs are given at specific times of day and seasons of the year to human beings with cancer. Filgrastim is a human growth factor, which is given to stimulate the production of neutrophils that have been depressed to low levels by cancer chemotherapy, in order to prevent infectious complications. We hypothesized that administration of filgrastim, stimulated by dangerously low neutrophil counts, would be initiated non-randomly with reproducible seasonality and annual rhythmicity. Methods: All claims from contracted healthplans submitted by oncologists in southeast Florida were tabulated by month of service date, during the calendar years of 2010, 2011, and 2012 (n=2,506). These numbers were de-trended, tested by linear regression, ANOVA and multi-component least squares cosine curve fitting for annual rhythmicity. Results: Similar stable annual time structures characterize filgrastim use in this population for each of these three years. An overall increasing trend (p 0.004) was present in its use during this three year span. Time of year effects were present (ANOVA p<0.058), demonstrating a prominent annual rhythm (p 0.006). The annual use pattern peaks during late winter and early spring and is lower in summer and fall. Conclusions: A large literature documents expected annual rhythmicity of cytotoxic drug bone marrow damage as reflected in circulating neutrophil count. Substantial annual rhythms characterize the clinical use of filgrastim in southeast Florida for this indication. The relative contributions of “snowbird” migration and the temporal organization of hematopoiesis remain to be fully elucidated. [Table: see text]
Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute (MWCI).
Authors: Jang Sekwon , Ranpura Vishal Navnitray , Wood Lynne , Stephanie Heller , Self Linda 
Published: March 2020

e20700 Background: MWCI has participated in Quality Oncology Practice Initiative (QOPI) since 2008. Adherence to pain assessment and intensity documentation was high, but lower in plan of care for moderate/severe pain documentation (69%, compared to QOPI aggregate of 79%) during the Fall 2011 round. One potential explanation for the discrepancy was lack of communication between the nursing staff assessing the pain and the physician treating pain. We hypothesized that the use of pain card can improve the communication between nurses and doctors, as well as prompt physicians to document the plan of care for moderate/severe pain. Methods: MWCI created a team of physicians, nurses, quality resources and administrative staff in December 2011. We abstracted up to 10 patients charts per oncologist for those patientswho reported moderate to severe pain (pain score of more than 3 of 10 on numeric rating scale) each quarter during 2012.We used data for quarter 1 and 2 as a baseline. We implemented the use of pain card by nurses to report pain for these patients to the physician in quarter 3 and 4. Chi square test was used to compare documentation rate in the first two quarters and last two quarters. Results: The total number of charts evaluated, pain documentation as well as confidence intervals for each quarter are shown in the Table. Our results show significant improvement in pain documentation by physician in last two quarters compared to first two quarters (p =0.0007). Conclusions: Our study demonstrates pain card improved communication between nurse and physician resulting improved documentation of pain by physician. [Table: see text]
End-of-life care in patients with primary malignant brain tumors: A systematic literature review and analysis.
Authors: Walbert Tobias , Khan Muhib Alam 
Published: March 2020

e20703 Background: 80–85% of all adult brain tumors are high-grade glioma (HGG). HGG are typically treated with maximal surgical resection, followed by radiotherapy with concurrent and adjuvant chemotherapy. The median survival for anaplastic glioma is estimated to be 2-5 years and 15 months for patients with glioblastoma. Quality of life (QoL) has become an increasing important outcome assessed in clinical trials as well as in the standard care of brain tumor patients. Despite the inevitable disease trajectory, not much is known about symptoms and needs of brain tumor patients and their caretakers at the end of life. There appears to be a lack of published literature on this important aspect of neuro-oncology. Methods: A systematic literature search was conducted in PubMed and Cochrane covering the years between 1946 through 2012. In total, 7146 article citations were found. After first review 942 abstracts were obtained. Based on content 82 articles were examined separately by both authors and it was agreed to eliminate 67 of them because they did not include a significant number of primary brain tumor patients or the focus was not on end of life care and symptoms. Results: Only 7 of the retained articles contained specific patient data and did not just reflect opinions of authors or reviews of the topic. Only one study was performed prospectively. Three studies assessed symptom management in inpatients, 2 in outpatients and 2 in a combined setting. Studies included between 29 and 169 patients. Drowsiness and loss of consciousness was the most common symptom (85%–90%). Poor communication (64% and 90%), focal deficits (29%– 62%), seizures (3%–67%), dysphagia (10%–85%), headache (4%–62%), and fatigue (25%–67%) were also frequent. Interventions included hydration (87%-93%), urinary catheter (89%), steroids (62%-80%), anti-epileptic drugs (45%-76%), oxygen (48%), tube feeding (13%) and palliative sedation (13%). Conclusions: There is 1 prospective study and only a total of 7 studies describing detailed end of life symptoms. None of the studies addressed caregiver quality of life. More research is needed to develop purposeful interventions to address end of life symptoms and QoL in patients with HGG.
Chemotherapy in the elderly (≥65) cancer patient: The relationship between premorbid level of function and treatment tolerance in a metropolitan Australian hospital.
Authors: Christie Hayden , Lovat Katherine Mary , Sanmugarajah Jasotha 
Published: March 2020

e20706 Background: The proportion of elderly patients treated by oncologists is gradually increasing due to demographic changes. This section of the population is generally underrepresented in clinical trials. This results in minimal guidance to dosage and tolerance. Improving assessment strategies in this group can help reduce the negative impact on quality of life from toxicity and hospital admission, which is also of benefit to the health system. Assessment of independence in the community and co-morbidities could provide a simple strategy to aid this process. Methods: Patients ≥65 years referred to the Medical Oncology clinic at the Gold Coast Hospital, Qld, Australia, undertook a questionnaire before their first out-patient appointment. This was used in conjunction with patient charts to determine patient assessment of level of function, knowledge of diagnosis and treatment aims, and also treating Oncologist assessment of function and predicted tolerance. Results: 75 patients were recruited. Patient characteristics are summarised below. 71% of patients were offered chemotherapy, 79% accepted, with 59% being for palliative treatment. 43% required dose reduction at some stage. Of those, 56% had 2 or more co-morbidities, 50% required assistance with IADLs and 22% with PADLs. 17% had an ECOG of ≥2 and 33% were aged ≥76. We are unable to comment on completion of treatment as many are still ongoing. Conclusions: Dose reduction is common in this population, with a correlation between this and self-reported performance status. It is proposed that the use of patient reported screening tools like this are a useful guide to determine need for dose reduction. Larger studies are needed to investigate this relationship further. [Table: see text]
Hyperglycemia as a prognostic factor in cancer.
Authors: Levy Daniel Eduardo , Marantz Adolfo B. , Niepomniszcze Jose Leonardo , Vicente Hector A , Martin Reinas Gaston Flavio 
Published: March 2020

e20715 Background: Cancer and diabetes are two diseases with great impact on global health. Evidence suggests that sustained hyperglycemia is associated with cancer prognosis and a greater risk of getting this disease. Numerous studies, including meta- analysis, sustain this correlation based on the theory that sustained hyperglycemia influences in abnormal cell growth as a cell stimulating factor and both pathologies share comorbid factors. Methods: we analyze in a descriptively and retrospective way our patients record in a clinical oncology service at the Bernardino Rivadavia Hospital, in a period from June 2008 to August 2011. In all 325 patients we identify : age, sex, neoplasic disease, stage of disease and quantitative glycemic status pre-treatment (to rule out the possible effects of chemotherapy on glycemia values). In the statistical analysis, patients were grouped according to their stage of cancer disease by AJCC TNM seventh edition and their serum glycemia values. Results: Out of 325 patients (N), 252 (77.5%) were female and 73 (22.5%) were male, the age range was 18 to 94 years with an average 61.82 years. .The discrimination of the sample by stage was: stage 1 (54 patients), stage 2 (88 patients), stage 3 (93 patients), stage 4 (90 patients). The media blood glucose by stage were for stage 1: 98 mg / dl, for stage 2: 98.7 m / dl, for stage 3: 102 mg / dl and for stage 4: 107 mg / dl, being under 110 mg / dl 12.5% of the patients in the stage 1, 14.3% of patients in stage 2, 14% of patients in stage 3 and 23.3% of patients in stage 4. Conclusions: Our observation allows us to orient ourselves to the correlation between hyperglycemic condition and prognosis of cancer.This correlation, while existing for all stages of cancer disease is most notorious for advanced metastatic stages (stage 4), and can be converted into a useful tool for the comprehensive assessment of patients.
Emotional burden and distress among caregivers of cancer patients.
Authors: Sidhu Harpreet , Alikhan Mir Asif , Glasser Michael 
Published: March 2020

e20722 Background: Due to the nature of the disease, caregivers of patients with cancer encounter high levels of burden and distress. Very little research has examined the needs of cancer caregivers and ways to address these needs. Health providers might overlook the emotional aspects of a disease and diagnosis, being occupied and busy with other aspects of patient care. Methods: Questionnaires with a focus on personal physical health, emotional health, care received, and medical care in general were handed out to patients and family members. Health providers were given similar questionnaires. Results: There were 45 participants in total: 18 health providers, 10 patients, and 17 family members. Similarities or differences between the attitudes of family members, health providers, and patients were found. Providers more negatively assessed the effect of a patient’s cancer on the well-being of family members than did patients/family members. Family member physical health was more negatively rated [P < 0.001] by providers, as was family member emotional health [P< 0.001]. Providers were also more likely to check distresses on the NCCN distress thermometer than were patients/family members. Responses were similar between urban and rural participants. Conclusions: Family members did not feel that the cancer diagnosis had affected their overall well-being in an overtly negative way. Health care providers believed that the cancer diagnosis had more of a negative effect on family member well-being. Future studies should look at attitudes of doctors/physicians versus other health providers to family member well-being after a patient’s cancer diagnosis.