bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sequential (ST) versus combination (CT) chemotherapy in older patients (pts) with advanced colorectal cancer (aCRC): A retrospective analysis of the CAIRO study
Authors: Doornebal J. , Wymenga A. , Antonini N. , van der Graaf W. T. , Koopman M. , Punt C. , Timmer-Bonte J. 
Published: August 2020

9542 Background: Although older pts have been underrepresented in clinical trials, studies support the efficacy of chemotherapy in older pts with aCRC. We retrospectively evaluated efficacy, tolerability, and quality of life (QoL, EORTC QLQ C30) of older (group 1: ≥ 70 yrs) vs younger pts (group 2: < 70 yrs) who participated in a randomized phase III trial of ST vs CT in CRC (Koopman et al, Lancet 2007). Moreover, differences between ST vs CT were analyzed in both age groups. Methods: All 803 eligible pts were randomized between ST - 1st line capecitabine (Ca) 1250 mg/m2 bid d1–14 (group 1: n = 104/group 2: n = 297), 2nd line irinotecan (Ir) 350 mg/m2 d1 (1:63/2:189) and 3rd line Ca 1000 mg/m2 bid d1–14 + oxaliplatin 130 mg/m2 d1 ([CAPOX], 1:34/2:119) - and CT - 1stline Ca 1000 mg/m2 bid d1–14 + Ir 250 mg/m2 d1 (1:95/2:307), 2nd line CAPOX (1:33/2:165). Cycles were given q 3 weeks. Results: Baseline characteristics, median number of administered cycles and median relative dose intensities were comparable. Group 1 vs 2: Overall survival (OS) and progression free survival (PFS) were comparable (OS: ST: 17.6 vs 16.0 months, HR 1.127 [0.883 - 1.437], CT: 19.8 vs 16.8 months, HR 0.913 [0.708 - 1.178]). A better RR was observed in 1st line ST for group 1 (30% vs 17%). Grade 3–4 toxicity was more common in 1st and 2nd line ST in group 1 (overall grade 3–4 toxicity 54/59% vs 40/43%). However, significant decreases in overall QoL, fatigue, appetite loss, and diarrhea were only reported in CT for group 1. ST vs CT: OS was comparable (1: 17.6 vs 19.8 months; 2: 16.0 vs 16.8 months). A better RR (17% vs 40%) and longer PFS (5.4 vs 7.8 months) were only observed in CT for group 2. Cumulative overall toxicity over all subsequent lines of treatment was worse for ST in group 1 (85% vs 69%). However, significant decreases in overall QoL, symptomatic appetite loss, nausea and vomiting and diarrhea were only reported in group 1 for CT. Conclusions: Older pts derived comparable benefit from both chemotherapeutic strategies compared to younger pts. CT did not result in any benefit in terms of efficacy in older pts. Despite the higher incidence of grade 3–4 toxicities, both efficacy and QoL results support the preference of ST in fit older aCRC patients. No significant financial relationships to disclose.
Geriatric assessment of older adults with cancer: Baseline data from a 500 patient multicenter study
Authors: Hurria A. , Mohile S. , Lichtman S. , Owusu C. , Klepin H. , Gross C. , Hansen K. , Klapper S. , Togawa K. , Tew W. 
Published: August 2020

9546 Background: As the cancer population ages, a brief, comprehensive measure is needed to characterize the “functional age” of a patient, in order to optimize treatment decisions and evaluate outcomes based on factors other than chronological age. A geriatric assessment (GA) evaluates factors other than age that predict morbidity and mortality in older adults. The goals of this study are to describe the results of a GA performed in 500 older adults with cancer from 7 participating institutions and to evaluate the feasibility of completing this assessment in oncology practice. Methods: The GA is comprised of validated measures of functional status, comorbidity, cognition, psychological status, social functioning and support, and nutritional status (Hurria et al, Cancer 2005). The GA was completed prior to the start of a new chemotherapy regimen in patients age ≥ 65 with a solid tumor or lymphoma. Results: 500 patients (mean age 73; range 65–91) completed the GA. The most common tumor types were lung (29%), GI (29%) and breast/gyn (22%) cancer; 57% had stage IV disease. The GA revealed that 41% of patients needed assistance with instrumental activities of daily living despite a mean physician-reported KPS of 85 (range 50–100), 92% had ≥1 comorbid medical conditions (mean 2.5; range 0–9), 95% took ≥ 1 medications (mean 5; range 0–23), 16% had ≥ 1 falls in the past 6 months, 6% had gross cognitive impairment on the Blessed Orientation-Memory-Concentration Test, and 39% had > 5% weight loss in the past 6 months. The mean time to complete the GA was 27 minutes (range 10–80); 94% were satisfied with the GA length and 70% were able to complete the GA without assistance. Multivariate logistic regression identified the following sociodemiographic and disease variables predict the need for assistance with completion of the GA: age ≥ 80 (p=0.02), high school education or less (p<0.01), non-white race (p<0.01), and the presence of metastatic disease (p=0.01). Conclusions: This brief GA is largely self-administered, can be completed by the majority of older patients without assistance, and identifies important deficits and problems that may impact morbidity and mortality. Prospective data are being acquired to identify factors in the GA that predict chemotherapy toxicity in older adults with cancer. No significant financial relationships to disclose.
Recommendation of adjuvant chemotherapy and trastuzumab in older adults with HER2-positive breast cancer: A survey of oncologists
Authors: Pal S. K. , Naeim A. , Wong F. L. , Chung C. T. , Bhatia S. , Mortimer J. , Somlo G. , Hurvitz S. , Villaluna D. , Hurria A. 
Published: August 2020

9547 Background: Though substantial evidence supports the use of adjuvant trastuzumab in patients with HER2-positive breast cancer, a lesser amount of data is available to guide use of this therapy in older adults. The objective of the current study is to understand how patient age and health status impact the oncologists' decision to recommend adjuvant therapy in older women with HER2-positive breast cancer. Methods: Medical oncologists (n=151) participated in an online survey comprised of case scenarios with patients of varying age (70, 75, 80, 85) and health status (good, average, poor) with a T2(4 cm) N2(4+ LN) ER(-), HER2(+) breast cancer. Oncologists could offer the hypothetical patient treatment with chemotherapy and trastuzumab, chemotherapy alone, trastuzumab alone, or no therapy. The influence of age and health status on treatment recommendations was assessed using a generalized linear mixed-effects model. Results: With increasing age and deterioration of health status, the recommendation for chemotherapy with trastuzumab decreased (P<0.0001 for both). In contrast, recommendation for trastuzumab alone or no therapy increased with advancing age (P<0.0001 for both) and deteriorating health status (P<0.0035 and P=0.059, respectively). Chemotherapy alone was not frequently recommended, irrespective of age or health status. Conclusions: Given the relative dearth of evidence-based data for adjuvant treatment of HER2-positive breast cancer in older adults of varying health, oncologists recommend a diverse array of therapeutic approaches for this subgroup. Increasing age and declining health status lead to more frequent recommendation of trastuzumab alone or no therapy, and less frequent recommendation of chemotherapy with trastuzumab. [Table: see text] [Table: see text]
NT-ProBNP prediction of major chemotherapy-related toxicity and death in lymphoma patients
Authors: Salar A. , Sanchez-Gonzalez B. , Alvarez-Larran A. , Comin J. , Gonzalez J. R. , Gimeno E. , Gomez M. , Garcia F. , Bruguera J. , Besses C. 
Published: August 2020

9569 Background: NT-Pro BNP provides diagnostic and prognostic information in many heart syndromes, but its role in oncologic patients is not established. Methods: We studied the association between NT-ProBNP levels and the risk of major toxicity associated with chemotherapy and death from all causes in 116 consecutive patients with lymphoma treated with curative intent. High resolution ultrasound echocardiography and serum NT-ProBNP levels were prospectively done previous the start of chemotherapy. Charlson Comorbidity Index was retrospectively calculated. A major toxicity event was defined as: when chemotherapy had to be discontinued, when chemotherapy had to be changed to a less intensive regimen, and treatment-related death. Results: High blood levels of NT-proBNP were associated with previous cardiologic history but not with left ventricular ejection fraction. With a median follow-up of 16 moths (0–49 months), 25 patients had a major toxic event with first line chemotherapy and 16 had died at last follow-up. The threshold of NT-ProBNP with better predictive accuracy for major toxicity-free and overall survival was 900 pg/mL. Patients with levels of NT-proBNP greater of 900 pg/mL had an adjusted hazard ratio (HR) for major toxicity after first-line chemotherapy for lymphoma of 6.4 (95%CI, 2.7–15.1). Two additional independent factors predicting higher major toxicity associated with chemotherapy were albumin < 3.5 g/mL (HR 3.5, P=0.008) and number of extranodal sites ≥ 2 (HR 3.1, P<0.007). For prediction of death from all causes, patients with a NT-ProBNP greater of 900 pg/mL had an HR of death of 15.3 (95%CI, 4.8–48.8; P<0.001). ECOG ≥ 2 was also significant for predicting death (HR 3.6; 95%CI, 1.1–11.6; P=0.03). The NT-Pro BNP added prognostic information beyond that provided by conventional risk factors, including IPI, left ventricular ejection fraction and Charlson comorbidity index. Conclusions: NT-ProBNP is the stronger marker for predicting major toxicity after first-line chemotherapy and death from all causes in patients with lymphoma and provides prognostic information beyond that provided by conventional lymphoma risk factors and comorbidity indexes. No significant financial relationships to disclose.
Exploration of hereditary cancer and feasibility of genetic services at the end of life
Authors: Quillin J. M. , Bodurtha J. N. , Siminoff L. A. , Smith T. J. 
Published: August 2020

9578 Background: For families, optimal hereditary cancer assessment begins with an affected relative. End of life could be the last chance for testing or DNA banking. Many palliative care oncologists do not feel qualified to offer genetic services and are rarely doing so (NSGC, 2008). The genetic burden of cancer in palliative care is unknown. Methods: We investigated prevalence of hereditary cancer among dying cancer patients, previous genetic testing or DNA banking, and awareness and intentions regarding these services. In spring/summer 2008 we recruited and interviewed patients (or surrogate decision makers) from the VCUHS Palliative Care Unit. Genetic risk was characterized as “strong” using classification criteria developed by Scheuner et al. (1997) or other consensus diagnostic criteria. Statistics were assessed using SAS 9.1.3. Results: 43 (47%) patients (including 9 surrogates) agreed to participate. The most common diagnoses were leukemias/lymphomas (n=9), and cancers of the lung (n=8), colon (n=5), and breast (n=4). 8 of 43 (18.6%, 95% CI = 7.0% to 30.2%) patients had “strong” genetic risk. Currently available genetic tests could have addressed risk for several patients, especially for HNPCC and hereditary breast/ovarian cancer. None had previous testing or DNA banking. Of strong-risk patients (or surrogates), 7 (87.5%) had heard/read “almost nothing” or “relatively little” about testing. All had heard/read little or nothing about DNA banking. 83% would “probably get tested” if offered, and 72% would “probably” or “definitely” bank DNA. There were no significant differences by race/ethnicity, nor by genetic risk. Conclusions: The genetic burden of cancer may be at least as high in the palliative care population as in other clinical settings and is not being discovered upstream. Patient interest in genetic services is high, but awareness is low. No significant financial relationships to disclose.
Employment status and work-related difficulties in family caregivers of terminal cancer patients compared with the general population
Authors: Kim S. , Lee J. , Yun Y. , Kim S. , Kim S. , Do Y. , Ro J. , Park S. , Jeong H. , Kang J. 
Published: August 2020

9580 Background: This study was aimed to investigate the employment status and work-related difficulties among family caregiver of terminal cancer patients compared with the general population. Methods: A survey was administered to 381 family caregivers of terminal cancer patients at 11hospitals and 994 general populations aged more than 18 years. Results: Family caregivers of terminal cancer patients were female (66.7%) and the patient's spouse (50.9%), with mean age of 46.8years (SD, 13.5). 212(56.1%) were working before cancer diagnosis, however, only 133(36.3%) continued working currently. Compared with the general population, 233(63.7%)family caregivers of terminal cancer patients were more likely to be not working (adjusted odds ratio [aOR] =2.39; 95% confidence interval [95%CI] = 1.73 to 3.29).Those who continued working reported more easy fatigability (40.6% vs 22.4%) and reduced working hours (20.3% vs 2.1%) than general population. For those doing housework, caregiving itself (56.4%) were identified to be the most common difficulties, followed by easy fatigability (32.3%). Major reasons for not working were providing care to the terminal cancer patients (24.0%). Older age (aOR=10.37; 95%CI=2.80 to 38.41), female sex (aOR=4.28; 95%CI=2.25 to 8.13), lower household income (aOR=2.19; 95%CI=1.19 to 4.06), bearing medical cost by other than spouse (aOR=2.10; 95%CI=1.05 to 4.19), and low performance status of the patients (aOR=2.00; 95%CI=1.01 to 3.95) were significantly associated with not working. Conclusions: When compared to the general population, family caregivers of terminal cancer patients were at risk job loss from their caregiving burden, and caregiving and easy fatigability were the major work-related difficulties. Our study might help make a strategy to reduce job loss for family caregivers' caregiving burden. No significant financial relationships to disclose.
Parental decisions and outcomes regarding disclosing maternal BRCA1 and 2 test results to children
Authors: Tercyak K. , Peshkin B. , DeMarco T. , Schneider K. , Valdimarsdottir H. , Garber J. , Patenaude A. 
Published: August 2020

9582 Background: BRCA1/2 testing is key to hereditary cancer risk management. Though testing is discouraged in children, prior work suggests they are informed of their tested mothers' mutation status; decisions and outcomes of parental disclosure to children remain largely unknown. Methods: We examined predictors of parental disclosure decisions to children ages 8–21 and related outcomes in a large clinical sample (221 tested mothers, 124 untested co-parents). Parents were interviewed prior to mothers' receipt of BRCA1/2 results and 1 and 6 months later. Descriptive analyses were conducted, and bivariate analyses identified candidate predictor variables (demographic, medical, psychosocial) for inclusion in multivariate logistic regression models. Results: 63% of mothers disclosed their results to their children within 1 month of receipt (44% of co-parents also disclosed to children); this increased to 68% by 6 months (55% among co-parents). Within parenting dyads, mothers were significantly more likely than co-parents to disclose to children in the short-term (X2=18.6, p<.0001). Predictors of maternal disclosure to children included not being a BRCA1/2 mutation carrier, older child age, stronger intentions to disclose, more favorable attitudes toward pediatric BRCA1/2 testing, a more open parent-child communication history, and a decisional balance favoring disclosure (all p's<.05). When examined simultaneously, mothers who were not mutation carriers (OR=4.02, 95% CI=1.35, 11.94), mothers of older children (OR=1.30, 95% CI=1.13, 1.49), and those with stronger intentions to disclose (OR=1.39, 95% CI=1.10, 1.76) were more likely to communicate. Other outcomes of maternal disclosure included greater satisfaction with the decision to disclose and more open parent-child communication following disclosure (all p's<.05). Conclusions: This is the largest and most well-characterized study on this topic to date. Short-term rates of parental disclosure to children were high, increasing over time. Parental disclosure decisions are determined by a complex array of both child and parent factors, with some benefits identified with disclosure. Findings indicate a need for additional work, including decision support interventions for communication with children. No significant financial relationships to disclose.
Survival trends in palliative care patients with cancer: A Mayo Clinic 5-year review
Authors: Kamal A. H. , Swetz K. M. , Liu H. , Ruegg S. R. , Carey E. C. , Whitford K. , Bock F. A. , Creagan E. T. , Moynihan T. J. , Kaur J. S. 
Published: August 2020

9592 Background: Palliative care (PC) is an essential part of the continuum of care for cancer (CA) patients (pts). Little is known about the aggregate characteristics and survival of pts receiving inpatient palliative care consultation (PCC). Methods: We reviewed data prospectively collected on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic - Rochester from 2003–2008. Demographics, consult characteristics, and survival were analyzed. Kaplan-Meier survival curves and a Cox model of survival were produced. Results: 1794 total patients were seen over the five year period. Cancer is the most common primary diagnosis (47%). Growth in annual PCC has risen dramatically (113 in 2003 vs. 414 in 2007) despite stable total hospital admissions. Patient are predominantly men (52% vs. 48%, p=0.02); median age is 76. General medicine, medical cardiology, and medical intensive care unit services refer most often. Most frequent issues addressed are goals of care, dismissal planning, and pain control (29%, 19%, 17%). PCC in actively dying pts have increased with 27% of all non-operating room, non-trauma in-hospital deaths being seen. Although CA pts have the highest median survival after PCC vs. other diagnoses (17 days, p = 0.018), we observed a five-year trend of decreasing survival from admission to death and PCC to death. Median time from admission to death in CA pts is 36 days in 2003 and 19 days in 2008 (p<0.01). Median time from PCC to death is 33 versus 11.5 days (p<0.01). Despite this, median hospital length of stay and time from PCC to discharge have remained fixed at 8 and 2.5 days, respectively. A Cox model of survival to discharge and <6 months survival (hospice eligibility) shows hospital length of stay, time from consult to discharge, and dismissal location from hospital are all prognostic factors. Conclusions: Survival window for PC intervention for CA pts is lessening. With the trend of shorter survival after PCC, PC professionals have little over two days to implement a comprehensive, ongoing care plan. This highlights the importance of earlier outpatient palliative care involvement with advanced cancer patients and families. No significant financial relationships to disclose.
Is patient self-reporting more accurate than clinician reporting of symptoms for predicting survival in patients with cancer? Meta-analysis of 30 closed EORTC randomized controlled trials
Authors: Bottomley A. , Coens C. , King M. , Osoba D. , Taphoorn M. J. , Reeve B. , Ringash J. , Schmucker-Von Koch J. , Weis J. , Quinten C. 
Published: August 2020

9597 Background: This study investigated whether patient self-reporting of symptoms improved prediction of survival as compared to clinician reporting or whether it provided an additive value when taken together with clinician assessment of the same symptoms. Methods: Patients with advanced cancer from 30 European Organisation for Research and Treatment of Cancer (EORTC) Randomized Controlled Trials were included in this retrospective pooled analysis. Clinician [Common Toxicity Criteria (CTC)] and patient (EORTC QLQ-C30) symptom assessment were reported at entry into the study. Data were obtained for six symptoms: pain, fatigue, vomiting, nausea, diarrhea and constipation. The prognostic accuracy for survival was assessed by modeling the contrast in reporting using the Harrell's discrimination c-index (c). Results: Data were available from patient and clinician assessment for pain [number of trials (t) =8, number of patients (n) =1214], fatigue [t=5, n=1237], vomiting [t=5, n=824], nausea [t=6, n=1393], diarrhea [t=6, n=815] and constipation [t=4, n=751]. Fatigue (c=0.59 vs 0.55, p<.01) and constipation (c=0.57 vs 0.52, p=0.03) as reported by patients (vs clinicians) were significantly higher in predicting survival. Patient reported pain (c=0.59 vs 0.58, p=0.17), nausea (c=0.54 vs 0.52, p=0.51), vomiting (c=0.55 vs 0.52, p=0.21) and diarrhea (c=0.51 vs 0.52, p=0.49) did not predict survival any more accurately than clinician assessment. Patient and clinician assessment combined (vs clinicians alone) improved the prognostic accuracy for fatigue (c=0.61 vs 0.55, p=0.01), pain (c=0.60 vs 0.58, p<0.01), nausea (c=0.54 vs 0.52, p=0.04), vomiting (c=0.56 vs 0.52, p=0.04) and constipation (c=0.5 vs 0.52, p=0.01), but not for diarrhea (c=0.52 vs 0.52, p=0.44). Conclusions: Our results suggest that patients’ ratings of their own fatigue and constipation have more prognostic value than clinicians’ ratings of these symptoms. Further, the prognostic value of clinicians's ratings can be improved by combining them with patients’ assessments for the symptoms pain, fatigue, constipation, nausea and vomiting. No significant financial relationships to disclose.
A patient-level pooled analysis of the prognostic significance of baseline fatigue for overall survival (OS) among 3,915 patients participating in 43 North Central Cancer Treatment Group (NCCTG) and Mayo Clinic Cancer Center (MC) oncology clinical trials
Authors: Sloan J. A. , Liu H. , Sargent D. J. , Satele D. , Schaefer P. L. , Halyard M. Y. , Grothey A. , Garces Y. I. , Brown P. D. , Loprinzi C. L. , Buckner J. C. 
Published: August 2020

9599 Background: We have previously identified overall a single-item measure for baseline quality of life (QOL) as a strong prognostic factor for survival (Tan, ASCO 2008), and that fatigue was an important component of patient QOL (Sloan, 2007). To explore whether patient-reported fatigue was supplemental or redundant to the prognostic information of overall QOL, we performed a patient-level pooled analysis of 43 NCCTG and MCCC oncology clinical trials of the effect of baseline fatigue on OS. Methods: 3,915 patients participating in 43 trials provided data at baseline for fatigue on a single-item 0–100 point scale. OS was tested for association with clinically deficient fatigue (CDF, score 0–50, n=1,497) vs not clinically deficient fatigue (nCDF, score 51–100, n=2,418). Cox proportional hazards models adjusted for the effects of overall QOL, performance score, race, disease site, age and gender. Results: Baseline fatigue was a strong predictor of OS for the entire patient cohort (CDF vs. nCDF: 31.5 mos vs >83.9 mos, p<0.0001). The effect sizes were consistent across different disease sites (GI, esophageal, head and neck, prostate, lung, breast and others). After controlling for covariates, including performance status and overall QOL, baseline fatigue remained a strong prognostic factor in multivariate models (CDF vs. nCDF: HR=1.23, p=0.02). Conclusions: Fatigue is a strong prognostic factor for OS independent of overall QOL and PS in a wide variety of oncology patient populations. Single-item measures of overall QOL and fatigue can help to identify vulnerable subpopulations among cancer patients. No significant financial relationships to disclose.