bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trastuzumab-mediated cardiac dysfunction (CDx) outside of clinical trials: Single Asian center experience
Authors: Park J. , Han S. , Oh D. , Kim J. , Lee H. , Kim Y. , Im S. , Kim T. , Bang Y. 
Published: August 2020

e20732 Background: Trastuzumab is an effective drug for the treatment of HER2 positive breast cancer (BC) and CDx has been reported as a major toxicity. The purpose of our study was to investigate the trastuzumab mediated CDx in practice setting and the treatment outcome at single Asian center. Methods: We retrospectively analyzed 181 HER2-overexpressing BC patients (pts) who were treated with trastuzumab containing regimen between January 2005 and December 2007 at Seoul National University Hospital. We investigated the incidence of CDx and the degree of reversibility using echocardiography (EchoCG) and identify the risk factors to predict CDx. Results: Among 181 patients (pts), 112 were treated for palliative purpose and 139 had previously received anthracycline-based chemotherapy. Baseline EchoCG results were available in 129 pts (median age 47; range 25–79) and median left ventricular ejection fraction (LVEF) was 59% (range 45–70). Median follow-up duration was 21 months. LVEF decreased more than 5% points in 37 out of 129 (28.6%). According to the national cancer institute common terminology criteria for adverse events, grade (G) 2 and G 3/4 CDx developed in 4 (3.1%) and 8 (6.2%) pts respectively. Seven pts experienced symptomatic heart failure (HF). 3 among 5 pts who experienced discontinuation of trastuzumab could resume trastuzumab after median 146 (range 94–163) days of discontinuation. Median LVEF was 54% (range 45–63) at baseline in pts who experienced G2–4 CDx and deceased to 45% (range 30–49) after median 175 (range 65–415) days of trastuzumab treatment. HF treatment was initiated in 9 pts. 4 pts received angiotensin converting enzyme inhibitors (ACEI), 3 pts angiotensin receptor blockers (ARB) and 2 pts ACEI or ARB with diuretics. Occurrence of CDx (G2–4) was associated with higher anthracycline cumulative doses (p=0.039) and lower baseline LVEF (p=0.003). The incidence of symptomatic HF was related with past medical history such as hypertension (p=0.019) and lower baseline LVEF (p=0.005). Among the pts who had G2–4 CDx, LVEF was restored to 54% (range 40–59) which was similar to baseline at median 187 (range 56–477) days after the diagnosis of CDx. Conclusions: The majority pts with trastuzumab-mediated CDx were asymptomatic and LVEF could be reversible. No significant financial relationships to disclose.
Analysis of resilience scores in a cohort of solid tumors ambulatory cancer patients in chemotherapy treatment
Authors: Ferreira Filho A. F. , Wunder A. P. , da Silva D. L. , Slomka L. , Machado M. W. , dos Santos M. P. , Graeff S. , Freitas D. , Friedrich A. 
Published: August 2020

e20736 Background: Resillience is the ability to successfully cope with change or misfortune, allowing a person or a group to regain balance and keep going despite adversity and also to find meaning amidst confusion and tumult. It is a positive personality characteristic that enhances individual and group adaptation. Very scanty data exists regarding its quantification and distribution in cancer patients. The objective of this study is to evaluate and describe resilience scores in a population of ambulatory solid tumors cancer patients receiving chemotherapy treatment. Methods: Individual Resillience scores were measured by the Wagnild and Young Scale, validated for portuguese language from Brazil. It is composed by 25-item questions, scored on a 7-point scale from 1 = disagree, to 7 = agree, with all items worded positively. Possible scores range from 25 to 175 with higher scores reflecting higher resilience. During the year 2008, this scale was applied to 48 ambulatory solid tumor cancer patients in chemotherapy treatment at Oncosinos / Hospital Regina in Novo Hamburgo, Brazil. The study was approved by the Ethics comitte and all patiens signed the informed consent form. Results: The mean age of patients was 52 years (19–76) and 34 (70%) were women. The most common cancer types were: breast (48%), colo-rectal (21%) and prostate (8%). Most patients (47%) had stage IV disease and were in palliative chemotherapy treatment. Stage III cancer was present in 40% and stages I and II in 13% of patients. The mean score of resilience was 141+ 12 (101–174). The scores demosntrated a normal statistical distribution. No statistical differences in the mean resillience scores were detected between groups of patients as defined by: sex (P=0.11), age > or < 50 years (P=0.9), cancer type (P= 0.78), disease staging (P= 0.9), or the chemotherapy treatment intention, if palliative or curative (P=0.91). Conclusions: The resilience scores in this cohort of patients display a statistically normal distribution. Our results suggest that the total resillience score is an intrinsic individual characteristic that is independent of cancer stage, cancer type, age and sex of the patients. Further research is necessary to clarify the implications of these findings. No significant financial relationships to disclose.
Voriconazole-induced QT-corrected (QTc) interval prolongation, bradycardia, hypothermia, mydriasis in an immunosuppressed patient with Ewing
Authors: Alkhallaf S. , Cornille H. , Markowska B. , Lankri Z. , Delepine N. 
Published: August 2020

e20738 Background: Invasive aspergillosis is an important cause of increased mortality and morbidity in immunocompromised patients. Early treatment of probable aspergillosis by voriconazole is recommended by many authors. Nevertheless direct possible lethal complications must be taken into account. Methods: we describe a case of voriconazole adverse events in a 18 y old patient treated for aplasia by antibiotics and caspofungin. He remained febrile: Voriconazole initiated for digestive mycosis, caugh, endemic aspergillosis. Second injection was badly tolerated ( fever 40 °, dyspnea, chills, myalgias, hypotension) leading to stop Voriconazole. Few hours later, bradycardia (36 bpm/mn), QT c interval prolongation (QTc 482ms), bilateral mydriasis, hypothermia appeared. Others risks for cardiac events were studied: prior cardiotoxic chemotherapy; lightly low calcemia and magnesemia, negative T ondes, traducing major potassium deficit in cardiac cells, in spite of initially normal kaliemia (4.6 mmol/l) mild hypokalemia (3.3 meq/l). Systemic infection was eliminated, cerebral MRI normal, blood dosage of voriconazole at 80 h and 96 h after last dose negative. We discontinued potentially arrhythmogenic drugs. Specific treatment consisted of electrolyte disturbances correction, IV atropine, scopolamine patch. 24 h holter ECG revealed neither torsades de pointes nor ventricular tachycardia. QT c interval remained longer for 3 days. Onde T was normalised at day 6, with disappearance of bradycardia and hypothermia,without any cardiac event. Results: Azole family antifungal agents were pointed out as arrhythmogenic (QTc prolongation, torsades de pointes) in combination or alone. Few data reported bradycardia and QT c prolongation with voriconazole, although the drug package insert warns about such reactions. Furthermore, none case of mydriasis was reported but noted in Pfizer American data file(< 2% of case). Conclusions: Careful monitoring of QTc prolongation and bradycardia in patients receiving voriconazole is mandatory, particularly those with electrolyte disturbances, concomitant QT prolonging drugs, and /or receiving toxic cardiac chemotherapy. No significant financial relationships to disclose.
Toward the elimination of medical oncology admissions
Authors: Mintzer D. M. , Zheng S. , Sprandio J. 
Published: August 2020

e20740 Background: While medical oncology is growing in volume, it is increasingly becoming an outpatient enterprise. Issues leading to hospital admissions in the past are commonly either prevented or managed on an outpatient basis. We sought out trends within our practice on the frequency and reasons for hospital admissions. Methods: Computerized office visit and hospital admissions data were obtained on admissions by physician and year, for Pa. Oncology-Hematology Associates from 2000–2007. A retrospective chart review was also done for one physician from 6/08–12/08 to determine the reasons for admission. Results: While the total number of patients seen per year increased by 40% over the review period from 2000–2007, the relative number of admissions has steadily declined. Adjusting the number of admissions per patients in the practice (since the overall increase in volume partially masks the decline in admission frequency), the reduction in admissions is further evident. The frequency of admissions for the 4 senior oncologists showed a 50% reduction in admissions per patient over the past 8 years. Of 56 admissions reviewed from 6/08–12/08, 20 were related to infections (although only a minority were neutropenic), 13 for symptom management of disease progression, 6 for anemia/bleeding, 3 for bowel obstruction, 3 for non-infectious complications of treatment, and only 1 for chemotherapy administration. Conclusions: Trends in our practice indicate a continued decline in the frequency of admissions per patient. Elective admissions for diagnosis, work-up, and chemotherapy are rare. Improved medications for symptoms related to cancer, its complications and treatment-related toxicities and improvements in palliative care (psychosocial support, communication about prognosis and treatment goals, and end-of-life care) have contributed to decreased admissions. Increasingly, even patients with incurable disease are managed from diagnosis to death entirely as outpatients. Optimizing outpatient management and avoiding admissions in medical oncology has major implications for practice quality, patient quality of life, cost and allocation of health care resources. No significant financial relationships to disclose.
Feasibility and economic viability of home-based supportive care
Authors: Cerny C. A. , Mutti A. , Ferreira D. M. , Jardini D. P. , Cecyn K. Z. , Suzuki E. , Ceschim P. C. 
Published: August 2020

e20741 Background: Oncological treatment is becoming more complex and more costly. When their symptoms worsen, many patients seek an Emergency Room and arrive without a good performance-status. This causes insecurity to the attending physician, and it also represents a huge chance that this patient would receive an avoidable admission. With the appropriate home-support it is possible to attend the majority of patient's demands, offering a good quality clinical support.Home administration of some drugs is more comfortable and helps to eliminate some taxes that are commonly charged by private clinics. Methods: We performed an analysis of a private healthcare company's database.To avoid seasonality and high impact on costs of terminally ill patients occurring at an analyzed month, we selected a six months interval, from January to June 2008. Results: About 500 patients are active each month at the home-care program. They received from simple monitoring to 24 hour home nursing support. Hematological malignancies, as expected, require more resources.Home based supportive care could prevent the majority of avoidable hospital admissions. Conclusions: Home based supportive care can meet the basic needs of clinical support during chemotherapy and the demands of comfort at the end of life, in order to reduce avoidable hospital admissions. This contributes to reducing the cost of treatment. [Table: see text]
Reproductive health importance in oncology care
Authors: Zaren H. A. , Patel A. , Radeke E. K. , Uy A. B. 
Published: August 2020

e20744 Background: Based on a case series of patients, we recognized a disparity between patients’ reproductive health goals and conveyed health information by providers on reproductive health issues. The objective of this study was to assess the reproductive health interest amongst cancer care providers. Methods: This observational study was performed using a 13 item questionnaire that was administered to 15 healthcare professionals in oncology and allied health fields. The items in the questionnaire related to information regarding the importance of cancer care, sexuality, fertility preservation and contraception. Results: Of the providers surveyed, 11 were medical doctors, 3 were nurses, and 1 was indicated as other. On a scale of 0 to 10, 86.6% (n=13) rated cancer care as extremely important (10), 33% (n=5) felt the same for fertility preservation, and 46.6% (n=7) for sexuality. In a rank of importance, cancer care was first, followed by sexuality, fertility, and contraception. Only 33% (n=5) of providers always asked patients about interest in fertility preservation and with regards to contraception, only 33% (n=5) offer contraception to reproductive age patients. Conclusions: Although most providers felt that sexuality and fertility are important to women diagnosed with cancer, their practice and information provision does not reflect these findings. This highlights the significance of bringing closer together the goals of the health care providers with their actual practice to improve patient care. No significant financial relationships to disclose.
Use of Port-A-Cath in pediatric cancer patients: Experience from a tertiary cancer center in south India
Authors: Singh T. , Satheesh C. , Ankit J. , Sajeevan K. V. , Appaji L. , Arunakumari B. , Padma M. , Mamatha H. S. 
Published: August 2020

e20747 Background: Implanted subcutaneous (s.c.) central venous port accesses including Port-A-Cath (PAC) facilitate the administration of chemotherapy or blood products and are frequently used in children with cancer. We present our experience of PACs in paediatric cancer patients from a tertiary cancer centre in South India. Methods: A total of 20 patients with paediatric malignancies requiring PAC were included in the study. Aim was to review our experience of PAC and analyse the outcome in paediatric cancer patients in Indian setting. A record of all complications and final outcome were analysed. Results: A total of 20 PAC were placed. Disease distribution included ALL(80%), AML(5%), NHL(5%), neuroblastoma (5%) and RMS (5%). PAC has been in place for 2 to 36 months (cumulative 400 months). Portal infection (Coagulase-negative staphylococci) was observed in four patients of whom 3 patients had their PAC removed (portal occlusion also seen in one of the pt). Conclusions: Although, catheter-related infections demanded PAC removal in 15% of our patients, their benefits (excluding cost 300 $) argue for continued PAC use in the paediatric cancer population as it is safe and has many advantages compared to traditional CVCs in use. Strict indications, meticulous implantation technique, and adequate handling are, however, mandatory. No significant financial relationships to disclose.
2008 oncology trends: Views from payors, specialty pharmacy, and oncology providers
Authors: Holcombe D. G. 
Published: August 2020

e20750 Background: Kikaku International Research was engaged by Genentech USA to conduct survey research among four key stakeholder groups involved in the financing, management and delivery of cancer care and drugs. Methods: Surveys were distributed and collected from January to June 2008. Survey questions addressed issues on volume of services, utilization of specialty pharmacy, management methodologies and degrees of involvement, volume and staffing levels in oncology practice, oncology physician staffing and retirement, payor evaluations, cost and impact of public and private payor reimbursement policies, Average Selling Price (ASP) and Medicare Modernization Act (MMA) issues and use of guidelines/pathways. Results: Managed Care Organizations: Ninety (90) managed care professionals responded. Key findings addressed: anticipated shifts in cancer spending from the medical benefit to the pharmaceutical benefit, adoption of ASP-based reimbursement and revaluation of professional fees. Specialty Pharmacy Providers: Forty-two (42) specialty pharmacy professionals responded. Key findings: total revenues and volume from cancer drugs and supportive care, distribution of drugs to patients and physician offices, Injectable drugs and oral drugs precription volume, patient education and disease management. Oncologists - Surveys were returned by 139 oncologists. Key findings: workloads and patient loads, income declines, drug margins declines, buy and bill volume. Oncology Practice Managers: Sixty (60) oncology practice managers responded to surveys about practice management, billing and reimbursement. Key findings: payer coverage and reimbursement policies, ASP rates, health plan contracts, negotiation of fee schedules. Conclusions: The conclusions of each section of the survey, when combined in aggregate, paint a picture of a very complex topic with wide variation in both approach and recommendations for how each segment addresses the specialty. Disconnects, challenges and opportunities observed in evaluating the responses include perspectives on ASP, Medical vs pharmaceutical benefit, contract negotiations, disease management, pharmaceutical management. [Table: see text]
Proliferation heterogeneity in synovial sarcoma (SS) defines different patterns of clinical outcome: A retrospective study of 32 patients
Authors: Grisanti S. , Consoli F. , Ferrari V. D. , Bercich L. , Amoroso V. , Rangoni G. , Cetto G. L. , Dei Tos A. P. , Facchetti F. , Marini G. 
Published: August 2020

e21511 Background: SS is an aggressive soft tissue sarcoma (STS) characterized by a constitutive overexpression of the bcl-2 proteins and high proliferation rate (Ki67). The aim of the study was to evaluate prognostic value of proliferative activity and apoptosis in SS. Methods: A retrospective analysis of 32 patients treated at three oncology centers between January 2000 and August 2008 was conducted. Histologic diagnosis of SS was confirmed by FISH analysis of t(X;18). Bcl-2 and Ki67 were determined by immunohistochemistry at baseline and after neoadjuvant chemotherapy (CT). A cut-off value of 20% was established for Ki67. The bcl-2 gene status was evaluated by FISH in neoadjuvant subgroup. Treatment-induced pathological response (pCR) was defined as tumor necrosis of 100%. Endpoints were recurrence rate (RR), disease-free survival (DFS) and overall survival (OS). Clinical and pathological variables were considered in uni- and multivariate analysis. Results: 13/32 patients received an anthracycline/ifosfamide-based chemotherapy (CT) before surgery. 8 pts received concomitant radiotherapy. A median number of 3 cycles of neoadjuvant CT was administered. All patients underwent surgical resection and pathologic assessment of the coexpression of bcl-2 and Ki67 was evaluated in the resected specimens. At baseline, all samples showed immunoexpression of bcl-2 and 9/13 had Ki67 more than 20%. After neoadjuvant CT, Ki67 was downregulated <20% in 11/13 samples and bcl-2 was negative in 4/13 pts. At FISH analysis, bcl-2 gene was neither rearranged nor amplified. After a median follow-up of 21 months (range 13–64 months), 9/13 pts without pCR experienced progression disease and 5 of them were dead of SS. At uni- and multivariate analysis, both pCR and downregulation of bcl-2 and Ki67 activity had a significant impact on DFS and OS (p=0.03). Conclusions: 1. Downregulation of bcl-2 and Ki67 index after treatment could be a predictor of recurrence and overall survival. 2. SS is characterized by cellular heterogeneity in which a high proliferative compartment coexists with low proliferative/anti-apoptotic compartment with different response to treatment. No significant financial relationships to disclose.
Management of complicated tumor response (CTR) to tyrosine kinase inhibitors (TKI) in gastrointestinal stromal tumor (GIST) patients (pts) with locally advanced/metastatic disease
Authors: Coco P. , Fumagalli E. , Morosi C. , Messina A. , Bertulli R. , Stacchiotti S. , Gronchi A. , Casali P. 
Published: August 2020

e21512 Background: Bleeding, perforation, and infection may complicate TKI therapy in GIST. Their incidence and best management are not completely known yet. Methods: Between May 2001 and December 2008, 278 pts were treated with imatinib or sunitinib, respectively, as first or second line therapy. Pts experienced bleeding, perforation and colliquation with superimposed infection were recorded and reviewed. Results: CTR occurred in 24 pts (9%) after a median time of 241 days from treatment start (8–2090 days). In 5 pts the complication took place after increasing the dose. Before complication, according to RECIST criteria, a partial response (PR) and a stable response (SD) were respectively documented in 16 and 8 pts . Radiologically assessed bleeding in closed lesions was seen in 13 pts (5%). All but one were treated conservatively with supportive care and blood transfusions. The other pt required surgical resection of his peritoneal bleeding lesion. Nine pts (3%) developed colliquation with bacterical superinfection: 5 were treated with antibiotics, 4 had their lesions drained. Two pts underwent emergency surgery due to perforation with a superimposed infection. In 21 out of 24 pts the event resolved without sequelae. Three pts died: 2 developed massive haemorrhage, 1 had a bowel perforation. After stopping treatment for a median interval of 10 days (2–63), all but one restarted treatment at the previous dose. No further complications were seen after the first event. Eight pts are still on treatment with a SD, 2 pts switched to a second line therapy due to progressive disease (PD), 11 died due to PD. Conclusions: Bleeding, perforation and colliquation with superimposed infection may occur at different time intervals from treatment start. Even if supportive care and medical therapy are successful in most of cases, pts should be carefully monitored because these complications can be life-threatening. Surgery should be considered in case of failure of conservative treatment. Reintroduction of the therapy at the same dose is feasible and well tolerated. [Table: see text]