bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival of melanoma patients with brain metastases treated with ipilimumab combined with stereotactic radiosurgery.
Authors: Tazi Karim , Chiuzan Cody , Shirai Keisuke 
Published: March 2020

e20019 Background: Historically, melanoma with brain metastases has a poor prognosis and is a major contributor to patient morbidity and mortality. Recently, the use of ipilimumab has improved overall survival in stage IV melanoma; however, the outcome of patients with brain metastases remains unclear. In this retrospective medical record review, we report the outcome of patients with stage IV melanoma with brain metastases treated with ipilimumab and brain stereotactic radiosurgery (SRS). Methods: All patients with metastatic melanoma treated with ipilimumab from April 2010 to March 2012 were identified and stratified by presence (A) or absence (B) of brain metastases. All patients with brain metastases received SRS. Performance status, dates of stage IV diagnosis, brain SRS and cycle 1 of ipilimumab administration were recorded. We used the Disease Specific Graded Prognostic Assessment (DS-GPA) to estimate the predicted survival. Overall survival was defined as time (months) from the date of the stage IV diagnosis and the time of ipilimumab administration to death or last follow-up. Survival curves were estimated using the Kaplan-Meier method, and compared using a two-tailed log-rank test. Results: Twelve of 30 patients treated with ipilimumab had brain metastases. Median age was 66 years. Median DS-GPA score was 3 (estimated mean survival of 8.7 months). Four patients (33%) in group A and 6 patients (33%) in group B died as of last follow-up. Median number of SRS treatment was 1 (1 to 4), and median total treated lesions were 3 (1-14). Median survivals from date of Stage IV for A and B were 29.1 and 32.9 months, respectively (p=0.67). The estimated 2 year survival rates from date of cycle 1 ipilimumab administration for A and B were 58% (95% CI: 32-100%) and 55% (95% CI: 32-93%), respectively. Ten out of 12 patients in group A maintained an ECOG PS of 0-1 as of last follow-up. Conclusions: Survival of patients with melanoma brain metastases treated with ipilimumab combined with SRS may be comparable to patients without brain metastases. Ipilimumab and SRS do not seem to adversely impact quality of life.
Role of prostaglandin pathways in radiotherapy-induced mucositis.
Authors: Grunberg Steven M. , Vithala Madhuri V. , Vizzard Margaret , Adams Nathan Bradley , Gagne Havaleh Marie , Brundage William , Ashikaga Takamaru 
Published: March 2020

e20509 Background: Pathways associated with proinflammatory molecules are upregulated in oral mucositis. Lalla (Support Care Cancer 18:95, 2010) found an association between mucositis pain scores, tissue COX-1, and salivary prostaglandins in 4 patients receiving dose-dense chemotherapy. We investigated whether similar changes would be seen with radiotherapy (XRT)-induced mucositis. Methods: Patients receiving XRT including the oropharynx were evaluated at 4 time points, before XRT, midway through XRT, end of XRT, and 1 month after XRT. Subjective report of pain and objective mucositis scores were recorded. Patients also provided a 5-minute stimulated saliva specimen at each time point collected on ice with a protease inhibitor cocktail. Proteins were estimated using a Bradford assay. Prostaglandins were measured using ELISA assays. Results: 8 evaluable patients entered the study, including 7 male/1 female, median age 60 (range 48-66), primary site (oropharynx 1, unknown primary 1, base of tongue 3, tonsil 1, tongue 1, supraglottis 1), median XRT 7000 rads (range 6000-7200 rads), concomitant chemotherapy (cisplatin 7, none 1), histology (squamous 7, mucoepidermoid 1). Pain and mucositis scores increased during XRT and improved at 1 month after XRT. No increase in COX-2 levels was seen. Salivary PGD2, PGE2, and PGF2 increased from baseline with the greatest increase 1 month after XRT. There was a significant time effect for PGF2 (p=0.028) and marginal time effects for PGD2 (p=0.107) and PGE2 (p=0.069). Conclusions: Increased salivary prostaglandins are seen during and after XRT-induced oral mucositis, suggesting a role for proinflammatory mediators and providing a possible therapeutic target. Clinical trial information: NCT01252498. [Table: see text]
Patient-reported sources of breast cancer survivorship care four years after diagnosis.
Authors: Friese Christopher Ryan , Hawley Sarah T. , Griggs Jennifer J. , Hamilton Ann S. , Graff John , Katz Steven J. 
Published: March 2020

e20511 Background: Breast cancer survivors remain “lost in transition” after active treatment due to changing needs and fragmented care. We sought to describe the patterns of breast cancer survivorship care in a diverse sample to identify factors associated with receipt of survivorship care by medical oncologists (med onc). Methods: We conducted a mailed survey to 2,290 women who resided in the Los Angeles and Detroit SEER registry catchment areas with a confirmed invasive breast cancer case from 6/05-2/07. Women were then surveyed approximately 4 years after diagnosis (n=1,536). On the follow-up survey, women were asked to identify their main provider of breast cancer follow up care: med onc, surgeon, primary care physician (PCP)/other physician. We examined the relationship between report of med onc as main provider of survivor care and: age, race/ethnicity, insurance, tumor stage, receipt of chemotherapy, and care by med onc reported on the baseline survey. Bivariate analyses and logistic regression were used to examine med onc-led survivorship care and the factors above. Results were weighted to account for sample selection and non-response. Results: 858 women had invasive disease at time of diagnosis: 65.2% reported med oncs as the main provider of survivorship care, followed by PCP/other physicians (24.3%) and surgeons (10.5%). Of the women who did not receive chemotherapy, 56% reported med onc-led survivorship care, compared with 79% of chemotherapy recipients. In multivariable logistic regression, black women were less likely than white women to report med onc-led survivorship care (OR 0.49, 95% CI 0.34-0.71). Privately-insured patients were more likely than Medicaid recipients to report med onc-led care (OR 2.00, 95% CI 1.16-3.45). Women with higher disease stage, those who received chemotherapy, and those who saw a med onc at baseline were significantly more likely to report med onc-led survivorship care. Conclusions: The oncology workforce shortage compels the identification of optimal and efficient survivorship care models. A mismatch may exist between chemotherapy receipt and med onc-led care. Our data suggest clear guidelines are needed to direct patients to the providers most appropriate to manage their care.
Association between musculoskeletal symptoms and serum vitamin D levels in women receiving aromatase inhibitor treatment.
Authors: Shapiro Alice C. , Swenson Karen K , Nissen MaryJo , Adlis Susan , Maybon Laura , Anderson Elsie , Zwicky Karen E 
Published: March 2020

e20560 Background: Up to 40% of women with estrogen positive (ER+) breast cancer treated with aromatase inhibitors (AIs) experience musculoskeletal symptoms (AIMSS) such as bone pain, joint pain, joint stiffness, and muscle weakness that negatively impact functional ability. Previous reports indicate that vitamin D insufficiency is common in this patient population and that D supplementation might attenuate AIMSS by affecting muscle, bone and/or nerve metabolism. To test the association between AIMSS and serum 25(OH)D levels, we analyzed data collected as part of a pilot prospective study assessing instrument effect sizes to measure AIMSS. Methods: Data were analyzed from 58 women, age 61 ± 10 y with a history of ER+ breast cancer stage I-IIIa. AIMSS symptoms were measured at baseline (pre AI) and 6 mo using the Breast Cancer Prevention Trial Musculoskeletal Subscale (BCPT-MS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Australian-Canadian Hand Osteoarthritis Index (AUSCAN). Serum 25(OH)D was measured by radioimmunoassay (Diasorin liaison, Stillwater, MN). Linear regression analysis was used to determine the association between changes in AIMSS scores (dependent variables) and changes in serum 25(OH)D from baseline to 6 mo, adjusting for age and season. Results: From baseline to 6 mo there were significant increases on all AIMSS measures (BCPT-MS, WOMAC and AUSCAN p<0.02). These increases in AIMSS measures were not associated with the change in serum 25(OH)D from baseline to 6 mo (Δ =11 ng/ml ± 12; p<0.001). Conclusions: Worsening of symptoms during the initial 6 months of AI therapy was not associated with changes in serum 25(OH)D levels. These results suggest that short-term supplementation with 25(OH)D does not attenuate the symptoms of AIMSS in post-menopausal women with ER+ breast cancer during the first 6 mo of AI therapy. However vitamin D insufficiency was uncommon in this study population (mean 25(OH)D at baseline 31 ng/ml ± 10 and 42± 13 ng/ml at 6 mo). Well controlled clinical trials are needed to further our understanding of these relationships. Clinical trial information: NCT01074320.
Hexafil: Individualized or guideline-concordant G-CSF usage—Is there a bridge?
Authors: Tesch Hans , Chang DeLi Tilly , Ottillinger Bertram 
Published: March 2020

e20563 Background: G-CSF is frequently used to prevent/treat chemotherapy (CT)-induced neutropenia (CIN) in cancer patients. The non-interventional observational study HEXAFIL on the use of biosimilar filgrastim (EP-2006) was conducted to provide further insight into G-CSF usage with respect to guidelines (EORTC, ASCO) in Germany. Methods: Patients who signed informed consents were enrolled. Data were documented for up to 3 consecutive G-CSF-supported CT-cycles. Rates of modified CT-treatments (dose modification/discontinuation of drug) were calculated by the number and percentage of patients affected; data presented are based on the first CT-cycle. In/Exclusion criteria: www.germanctr.de . Results: A total of 709 breast cancer patients were included in this interim analysis (9/2012). Only 2.0% of all patients experienced febrile neutropenia (FN) and 8.7% neutropenic complications. A majority of patients received primary (49.4%, PP) or secondary prophylaxis (33.6%, SP) with the biosimilar G-CSF. However, 17.1% were treated interventional (TX). Median G-CSF treatment duration was 4d with median start on day 6 after CT. Of all documented patients, 96.3% received CT without modifications; in 3.0% of the patients dose of CT was modified and in 0.8% CT drug was discontinued. To investigate potential effects of guideline-concordant G-CSF treatment the following populations were selected: patients with FN-risk > 20% and (1) G-CSF initiation < day 5 after CT (ie, “guideline-concordant” GL; N=104) or (2) G-CSF initiation starting > day 6 after CT (ie, “individualized” IND; N=169). As expected, IND-patients experienced FN twice as often as GL-patients (4.1% vs 1.9%). Moreover, CT treatment had to be modified in 6.5% of IND-patients compared with only 1.0% of GL-patients. Conclusions: A total of 96.3% of all analyzed patients receiving biosimilar G-CSF-supported CT-cycles had no modification to their CT-regimen. Data indicate that IND-patients showed a higher rate of CT disturbances/FNs and, as a consequence, should “cross the bridge” to potentially benefit from guideline-concordant treatment. However, further data are required to detail the impact of individualized G-CSF treatment. Clinical trial information: DRKS00000313.
Differences in pain, symptom burden, and opioid use among cancer pain patients with active versus non-active disease.
Authors: Bouffard Karina J , Koyyalagunta Lakshmi , Abdi Salahardin , Hernandez Mike , Novy Diane M. 
Published: March 2020

e20568 Background: Many cancer survivors with non-active disease suffer with pain and other symptoms. This study investigated differences in symptoms and opioid use among cancer pain patients with active versus non-active disease. Methods: Data were obtained from 518 consecutive new patients seen at the Pain Management Center of MD Anderson Cancer Center from 01/01/09 to 06/30/09. Measures: Usual pain was rated on the Brief Pain Inventory. The Edmonton Symptom Assessment Scale (ESAS) was used for ratings of fatigue, shortness of breath, poor appetite, depression, anxiety, drowsiness, difficulty thinking clearly and insomnia. Opioid use was calculated in morphine equivalency daily dose (MEDD) milligrams based on the sum of long- and short-acting opioids used per day. Analyses of Data: Independent samples t-tests were used to make comparisons between patients with active versus non-active disease on continuous variables. Chi-square tests were used to make comparisons across disease status on categorical variables. Results: 349 patients had active disease; 169 patients had non-active disease. Patients with active disease received significantly higher MEDD (125.6 ± 158.8 mg) versus patients with non-active disease (74.4 ± 87.0 mg). Patients with active disease reported significantly higher mean scores on fatigue, poor appetite, and drowsiness. Average weekly pain scores were comparable and moderately high for both groups of patients. Other symptoms and clinical characteristics were not significantly different across disease status. Conclusions: Plausible explanations for the higher opioid use and symptom burden among patients with active disease are cancer treatments and disease progression. A higher level of pain medication is often needed to achieve pain management during active treatment or following recent surgery. The finding of higher fatigue, poor appetite, and drowsiness among those with active disease is also consistent with the symptom burden expected from treatment. Although patients with active disease have a greater symptom burden and need for pain medication, there is a need for pain and symptom management among patients in the non-active disease phase of survivorship.
Weight loss in solid tumors: Clinical features and prognostic importance.
Authors: Shrotriya Shiva , Aktas Aynur , Estfan Bassam N. , Rybicki Lisa A. , Walsh Declan 
Published: March 2020

e20572 Background: Large cancer databases provide valuable information on weight change and its impact on different clinical parameters. Body weight change in adults with solid tumors was examined in outpatients. The objective was to determine if demographics, clinical and biochemical indices are predictive of weight loss (WL). The effect of WL and other parameters on survival were also assessed. Methods: Electronic medical records (EMR) for outpatient visits from a tertiary cancer center were retrospectively reviewed. Body weight and other clinical parameters on first visit (V1) - within a year post diagnosis - last visit (V2) ≥3 weeks after V1. WL at V2 from V1 categorized as: ≤5%, 5.01-10%, >10%. Results summarized by descriptive statistics, level of association and survival analysis. Results: N = 5901; Mean age (±SD): 61 ± 12 years; 82% were Caucasians; 16% African Americans. Common cancers were genitourinary (GU) 31%; gastrointestinal (GI) 16%; breast 15%; lung 15%; head and neck 6%; brain 5% and others 12%. Metastatic disease in 18%. Bone, brain, lymph nodes – common. 45% had radiotherapy and 41% chemotherapy. Median (min, max) weight, kgs: V1=81(32.0, 223), V2=79.4(34, 221). Median duration (min, max), days V1→V2: 195 (22, 1080). Weight loss V1→V2: ≤5% (73%), 5.01-10% (13%) and >10% (14%). Median change in BMI V1→V2: -0.2 (-19, 13). Median change systolic/diastolic blood pressure (BP) V1→V2: -3(-99, 80)/-1(-57, 47). Change in REE V1→V2: -13(-890, 365). Median survival for 5.01-10.0% WL= 9.4 months, >10.0% = 5.3 months and not observed for ≤ 5%. Conclusions: Majority lost ≤ 5% of body weight by V2. WL maximum for head and neck cancer and GI. High BMI predicted greater WL compared to normal or underweight. ≤5% WL had a survival advantage 5.01-10% and >10%. WL remained prognostic for survival even after adjusting for other prognostic factors.
Assessment of communication about palliative care between physicians and their cancer patients prior to admission to the palliative care unit (PCU).
Authors: Storek Benjamin , Nickel Sebastian , Markwordt Janett , Behzadi Asita , Thuss-Patience Peter C. , Sturm Isrid 
Published: March 2020

e20575 Background: Discussions on palliative care are particularly challenging for both cancer patients (pts) and their treating physicians. From the pts perspective, prior to their admission to the PCU, information about palliative care is often lacking and their opinions are not adequately respected. In our study, we evaluated 1) whether pts were satisfied with the received information about palliative care prior to admission to the PCU, 2) the pts level of understanding about palliative care options and 3) pts wishes for their stay at the PCU. Methods: n=180 from n=273 pts participated in the study (time period: 12 months). A standardized palliative care assessment was performed on the day of admission. Study interview was performed within 48h after admission; the questionnaire contained free response and multiple-choice questions. Analysis: Likert scaling method with descriptive statistics using SPSS. Results: Baseline characteristics: n=92 male, n=88 female, median age 64 (range 26-89), 53% with an ECOG 3, n=25 hematological and n=155 oncological malignancies. Symptoms: 56% had 8-14 physical symptoms, 36% had 3-4 emotional problems, 38% had high levels of distress. Prior knowledge about palliative care: 38% did not know what a PCU was and 31% believed it was a unit for dying patients. 44% received none, 26% some information about palliative care prior admission. 42% did not feel well informed, 34% felt they received some information on palliative care. Prior information about the disease: 27% felt minimally, 64% felt well informed about their current disease state. The following points were not addressed from the physicians: living will 57%, health care proxy 59%, home care supply 70%, hospice 70%, psychooncological care 52%, prognosis 43%. Wishes of pts on the PCU: improvement in their general condition 47%, pain relief 30%. Conclusions: Our study shows that the majority of pts do not feel sufficiently informed about palliative care prior to the admission at the PCU. A communication barrier between physicians and their pts may explain patient’s views. The data confirm the importance of early integration of palliative care in addition to oncological care.
Modified Khorana risk score for prediction of venous thromboembolic events in cancer patients receiving chemotherapy: An Australian single institution experience.
Authors: Heller Wolfgang H , Khalafallah Alhossain A , Li Rebecca Yuan , Arora Anurag , Latif Maimoona , Nepal Sujana , Loi Sie Wuong , Grabek Daniel , Robertson Iain K 
Published: March 2020

e20610 Background: Venous thromboembolic events (VTEs) are a common complication in cancer. The Khorana Score (KS) is widely used for the prediction of VTEs in malignancy. The KS is composed of 5 items: cancer entity, platelet count >350/nL, white cell count (WCC) >11/nL, Hb <100 g/L and body mass index ≥35 (BMI). Scores are grouped into 3 categories indicating the VTE-risk (0=low, 1-2= intermediate, 3 or more points= high-risk). Methods: All ambulatory cancer patients at our institution starting chemotherapy from January 2010 to December 2011 were included. We applied the KS and then modified by adding further cancer subtypes and metastatic status. Results: In 658 of 766 chemotherapy patients, all the data were available for calculating the KS, of whom 52 had a VTE. In multivariate analysis, associations between KS and VTE were found (P≤0.05) in pancreas (p<0.001), lung (p=0.002), stomach (p=0.008), gynaecological cancers (p=0.037), and BMI ≥35 (p=0.004), but not found in lymphoma (p=0.14), high platelet count (p=0.6) and high WCC (p=0.8), or low Hb (p=0.53). There was an increased risk for VTE in some cancers not included in the KS: breast (p=0.01), colorectal (CRC)(p<0.001), prostate (p=0.003) and oesophageal cancer (p= 0.041). The original KS score did not significantly predict VTEs. When adding cases of neoadjuvant/adjuvant (n/a) and/or metastatic (met) CRC, breast, and prostate cancer, significant associations were found, as shown in the Table. Conclusions: The original KS showed only a weak association with VTE occurrence. However, the association was improved by including other cancer entities and / or metastatic status. Major differences between our and other cohorts, such as different proportions of cancer entities and general referral patterns, could explain the discrepancies with other studies. [Table: see text]
Understanding the experience of living with non-small cell lung cancer (NSCLC): A qualitative study.
Authors: Buzaglo Joanne S. , Gayer Christopher , Mallick Rajiv , Micco Ellyn , Morris Anne , Ferris Andrea Stern , Golant Mitch , Langer Corey J. , Mullins C. Daniel , Cella David 
Published: March 2020

e20618 Background: As non-small cell lung cancer (NSCLC) treatments improve and patients live longer, it is increasingly important to develop interventions to help patients live fuller lives. We sought to identify key components of quality of life (QOL) and social support in determining therapeutic decision-making and overall value of life-extension, in patients with NSCLC. Methods: Three semi-structured focus groups (n=16) and telephone interviews (n=15) were conducted and recorded with NSCLC patients (N=31), to explore the full range of symptoms that patients considered important to QOL. A tradeoff format assessed the value of life-extension relative to QOL. Patients were asked to consider a hypothetical treatment option that offered on average a 3 month life extension. Results: Mean age was 61.6 years, 67.6% were female, 77.4% white, 61.3% were not employed/retired, 58.1% were living with a spouse/other, 93.5% had health insurance, and 48.4% were Stage III/IV. Sixty-Eight percent of patients conceptualized emotions and attitudinal orientation as symptoms of NSCLC. Key symptoms/concerns changed over time – 74% of patients reported shock and fear at diagnosis, 55% felt fear or loneliness during the beginning of therapy, 52% successfully connected with other NSCLC patients (peers) and support groups, and reported a positive shift in feelings with social/emotional support from all social networks. 26% of patients reported confusion and isolation during treatment due to education gaps. Financially, 23% of patients reported being adversely impacted by co-pays, 36% by unexpected gaps in coverage, 39% by other bills, and 52% accepted help from any/all sources. The most important factor driving treatment-decision making about life-extending therapy was the somatic (i.e., physical symptom) dimension (84% cited as important), followed by functional (32%), relational (23%), and emotional (10%) factors. Conclusions: Patients with advanced NSCLC tend to conflate emotional well-being post diagnosis with symptoms of their cancer and treatment toxicities. However, somatic QOL concerns, ahead of functional, emotional and relational QOL, emerge as the dominant driver of therapeutic decision-making.