bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective study examining PROs and other geriatric outcomes in older adults with prostate cancer undergoing chemotherapy.
Authors: Manokumar Tharsika , Aziz Salman , Rizvi Faraz , Breunis Henriette , Joshua Anthony Michael , Tannock Ian , Alibhai Shabbir M.H. 
Published: March 2020

9555 Background: Treatment of metastatic castration-resistant prostate cancer (mCRPC) with chemotherapy improves disease control and survival in older men (age 65+) based on large clinical trials. Its effects, though, on more frail elderly men are not well understood and chemotherapy may negatively impact frailty, daily function, physical performance, and quality of life (QOL), particularly outside the clinical trial setting. Methods: Men aged 65+ with mCRPC starting first-line chemotherapy were enrolled in this prospective observational pilot study. Physical function was assessed with the timed up and go (TUG) test, timed chair stands, and grip strength. Frailty was evaluated using the Vulnerable Elders Survey (VES-13) questionnaire in addition to functional status (OARS-IADL), social activities limitations and social support (MOS measures). Patients completed the FACT-P and FACT-G to measure prostate-specific QOL and general QOL, respectively. Assessments were completed before each cycle of chemotherapy. Pre-post within-group comparisons were done using student’s T-tests and linear regression. Results: 25 patients (mean age 75) receiving Docetaxel + Prednisone were enrolled, 3 of whom died and 2 dropped out. Both general and prostate-specific QOL improved over a median of 6 cycles. Patients’ instrumental activities of daily living (IADL) scores remained stable. On average, grip strength was stable and lower extremity function improved on both the TUG and Timed Chair Stands. At baseline, 13 of 25 patients (52%) were frail (VES score 3+). Of the patients that completed chemotherapy, 40% were frail. Conclusions: Contrary to our hypotheses, QOL did not decline in this frail elderly cohort, IADL function remained stable, and physical function remained stable or improved during first-line chemotherapy. Frailty also did not increase at the end of treatment as hypothesized. Older men with mCRPC appear to tolerate first-line chemotherapy fairly well in terms of QOL and geriatric domains.
Outcomes of severe sepsis in very elderly (age >80 years) patients with metastatic cancer.
Authors: Touqir Zahra , Shaheen Shagufta , Upadhyay Shivanck , Marak Creticus Petrov , Kumar Gagan , Guddati Achuta Kumar 
Published: March 2020

9558 Background: With better treatment and prolonged life expectancy of cancer patients, more elderly patients with metastatic cancer are being treated aggressively for sepsis. There has been philosophical debate about how aggressive the treatment should be for very elderly patients with metastatic disease admitted to intensive care unit with severe sepsis. The data with regards to the outcome of severe sepsis in those above 80 years with metastatic disease is very limited. Methods: Using the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample 2007-2008, patients older than 80 years, discharged with severe sepsis were identified using ICD-9-CM codes. Those with metastatic disease were identified using ICD-9-CM codes 196-199. The outcomes studied were mortality and discharge disposition. We also examined the rates of invasive mechanical ventilation, blood transfusion, use of central venous catheter, tracheostomy and dialysis. The outcomes were compared to those who did not have cancer. Chi square test was used to compare the variables. Significance was defined as p value <0.05. Results: There were 458,443 discharges with severe sepsis in patients aged ≥80 years. Of these 3.3% had metastatic disease. The in-hospital mortality was significantly higher in those with metastatic disease (43.7% vs. 33.3%, p<0.001). The discharge disposition of the very elderly is shown in the Table. The rates of invasive mechanical ventilation, tracheostomy, use of central venous lines and dialysis were similar in both the groups. Blood transfusions were observed to be higher in metastatic group. Conclusions: Resource utilization in elderly with severe sepsis is similar regardless of the presence of metastatic disease. However, the mortality is significantly higher in those with metastatic disease. Of the survivors, only a fraction reaches home with independent functioning. Involvement of palliative care services at an early stage and addressing code status promptly during the beginning of each hospitalization may help relieve resource and financial burden to health care providers. [Table: see text]
Cancer patients with ECOG-PS higher than 1: Who are those who benefit of palliative chemotherapy?
Authors: Caires-Lima Rafael , Protásio Bruno Mendonça , Caires Inacelli Queiroz de Souza , Rocha Lucila Soares Da Silva , De Oliveira Julia Andrade , Guerra Raquel Bezerra , Mak Milena Perez , Hoff Paulo M. , Castro Gilberto 
Published: March 2020

9561 Background: Palliative chemotherapy (PC) is a treatment option in pts with metastatic cancer. Although pts with ECOG-PS > 1 are underrepresented in clinical trials, they are often treated with PC in daily practice. We aimed to identify factors associated with poorer survival and lack of benefit of PC in this subset of pts. Methods: We conducted a case-control retrospective analysis of 301 consecutive pts with solid tumors and ECOG-PS > 1 when initiated PC, selected from 2514 pts who died between Aug/2011 and Jul/2012 in a tertiary cancer care institution or its hospice. Cases were defined as those pts who survived < 90d after the first cycle of first line PC, and controls were those who had a longer survival. Frequencies were compared by chi-square test or Fisher exact test. Risks were estimated by odds ratios (OR) and logistic regression analysis. Overall survival (OS) was calculated by Kaplan-Meier method and curves was compared using log-rank test. Results: 142 cases/159 controls were included: median age 58/63 y.o. (p=0.09; t-test) and 49%/50% female (p=0.941; chi-square). Gastrointestinal and lung cancers were the most frequent primaries (31 and 17%, respectively). Factors associated with poorer OS were age > 60 y.o. (OR 1.7; 95%CI 1.0–2.6), ECOG-PS > 2 (1.9; 1.2–3.1), weight loss > 10% (1.8; 1.1-2.8), hemoglobin < 10 g/dL (2.6; 1.6-4.2), albumin < 3 g/dL (2.7; 1.5-5.1), serum creatinine (sCr) > 1 mg/dL (2.8; 1.6-5.0), C-reactive protein ≥ 5 mg/L (8.6; 1.0-72.9), altered mental status (4.2; 1.4-13.2) and in-hospital PC (3.2; 1.9-5.2). Cases were more likely to experience grade ≥ 3 toxicity (43 vs. 28%; p=0.005), die of toxicity (16 vs. 6%; p = 0.0007) and not be offered palliative care only (47 vs. 71%; p<0.0001). mOS was 204 and 34d among controls and cases, respectively (HR 0.177; 95%CI 0.015-0.033, p<0.0001). Median time to death was 39.5d (0-1103). Logistic regression analysis identified ECOG-PS > 2 (OR 2.3, p=0.044) and sCr > 1 mg/dL (OR 11.2, p=0.0002) as independent predictors of 3-mo fatality. Conclusions: ECOG-PS > 2 and elevated sCr were identified as independent predictors of poor OS in these pts. PC needs to be prescribed with caution in ECOG-PS > 1 pts, since it seems to offer no benefit in OS and could lead to abbreviation of life.
Safety and quality assurance of MR-guided focused ultrasound (MRgFUS) in palliation of painful bone metastases.
Authors: Meyer Joshua E. , Chen Lili , Ghanouni Pejman , LeBlang Suzanne , Hurwitz Mark 
Published: March 2020

9565 Background: Palliation of bone metastases is typically performed with radiation therapy (RT). However, a significant minority of patients cannot obtain durable relief from RT. MRgFUS combines non-invasive focused ultrasound with MR guidance. Preliminary phase III results comparing MRgFUS to sham treatment have demonstrated efficacy. This study examines the safety of this procedure in a large prospective, multi-center study. Methods: Patients with a painful bone metastasis were randomized (3:1) to either MRgFUS or sham treatment for the single most painful lesion. Sham patients were given the opportunity to cross over after 2 weeks. Each adverse event (AE) was recorded prospectively and scored for severity and relation to treatment. Results: Thirty-seven patients were enrolled to receive sham treatment and 115 to receive MRgFUS. Sites of treatment were: 102 pelvis, 28 thorax, 7 lower extremity and 2 upper extremity. Seventy-seven target lesions were osteolytic, 29 were osteoblastic and 33 were mixed. Treatment was discontinued prior to completion in 8 treatments. Of these, 7 were pelvic targets and 6 lesions were osteolytic. The most common reasons for discontinuation were pain (4) and patient movement (2). Forty-seven percent of treatment patients and 2.7% of sham patients reported at least one AE. Of 76 AEs, 67 were considered non-significant and anticipated, 57 being intra-procedure pain. Four significant events included 2 possibly related fractures at treated lytic lesion sites, 1 grade 3 skin burn and 1 patient with neuropathy. Four patients experienced events unrelated to study treatment and 1 patient experienced temporary apnea from anesthesia described as incidental. Conclusions: MRgFUS is a safe treatment for palliation of painful bone metastases. Ninety-three percent of MRgFUS treatments were carried out to completion. Three percent of patients experienced significant AEs, including 2 fractures of treated lytic tumors. These safety data reinforce and confirm previous experience with this technology and encourage its use for patients not suitable for RT. Clinical trial information: NCT00656305.
The Minneapolis-Manchester Quality of Life Instrument (MMQL): Reliability and validity of the Adult Form (AF).
Authors: Bosworth Alysia , Goodman Elizabeth L. , Wu Eric , Francisco Liton , Robison Leslie L. , Bhatia Smita 
Published: March 2020

9570 Background: Cancer survivors are at risk for deficits in health-related quality of life (HRQL). Youth (8-12y) and adolescent (13-20y) versions of the MMQL have been developed to address survivor-specific issues and are currently in use; the MMQL-AF has now been developed to assess HRQL in cancer survivors aged 21-55y, enabling cross-sectional and longitudinal assessment of childhood cancer survivors as they age. Methods: The MMQL-AF was administered to 499 adults: 65 patients undergoing cancer therapy, 107 off therapy, 327 healthy controls (matched on sex, age, education). Factor analysis was performed; items with factor loadings ≥0.40 were retained. The following psychometric properties were evaluated: internal consistency reliability (Cronbach’s alpha), construct validity (concurrent administration of SF-36), known-groups validity (score comparisons across the 3 groups), and stability (intraclass correlations from patients completing MMQL-AF twice, 2 weeks apart). Results: Among patients, 46% had hematological malignancies, 33% were males, 64% were non-Hispanic whites; median age was 40y. Factor analysis resulted in retention of 44 items across 6 scales: social functioning (n=9), physical functioning (n=12), cognitive functioning (n=7), outlook on life (n=4), body image (n=5), and psychological functioning (n=7).Internal consistency was 0.8-0.9 for scales and 0.95 overall.The MMQL-AF distinguished between known groups; healthy controls scored significantly higher (better HRQL) than patients on 4 of 6 scales. Off-therapy patients scored higher than on-therapy patients on physical functioning.The MMQL-AF scales correlated highly with SF-36 scales hypothesized to tap similar domains (all P values <0.001), demonstrating construct validity.Intraclass correlations were 0.82-0.95 for scales and 0.98 overall (all P values <0.001), indicating high stability. Conclusions: MMQL-AF is a reliable and valid self-report instrument for measuring multi-dimensional HRQL in cancer survivors aged 21-55y. Development of this instrument ensures availability of a tool that can assess HRQL from 8-55y, thus addressing needs of childhood cancer survivors as they age.
Differences in psychosocial factors among diverse women enrolled in a phase III cooperative group metastatic breast cancer trial (CALGB 40502/Alliance).
Authors: Polite Blase N. , Allred Jacob B , Rugo Hope S. , Cipriano Toni Marie , Cirrincione Constance , Gehlert Sarah J. , Paskett Electra D. , Hudis Clifford , Winer Eric P. 
Published: March 2020

9581 Background: Previous metastatic breast cancer trials have shown lower overall survival among African American (AA) women. Studies have also shown links between higher comorbidities and lower levels of social support and survival. Whether these factors differ by race and ethnicity is not known. Methods: Breast cancer patients enrolling in a phase III cooperative group metastatic breast cancer trial completed a self-administered survey measuring psychosocial and socio-demographic factors and comorbidities. Results were analyzed by self-identified race/ethnicity and evaluated by other measured variables. Results: 703 out of 799 patients completed the survey (88%). Questions were answered by greater than 95% of participants. The table shows differences broken down by Race/Ethnicity. AA and Hispanic (H) patients were more likely to have trouble paying for medications and have incomes less than 15K per year. AA were less likely to be married, and had lower levels of social support. Differences in income did not mediate these social support differences. Marital status did not mediate lower social support for AA (p=0.79) but did so for whites (p<0.001) Conclusions: Compliance with the questionnaire was quite high. Differences in social support by race were apparent and were mediated by different factors according to race. Future efforts will analyze the impact of these factors on survival and as mediators for potential racial and ethnic differences in survival. [Table: see text]
Depression and self-reported memory problems in adult-onset cancer survivors.
Authors: Jean-Pierre Pascal , Winters Paul 
Published: March 2020

9586 Background: Memory impairments are debilitating adverse effects of cancer and its treatments. Depression may predispose or exacerbate memory problems. We examined the relationship between depression and memory problems in adult-onset cancer survivors. Methods: We included data from individuals who completed the National Health and Nutrition Examination Survey, a nationally representative, stratified, multistage probability sample of the civilian, non-institutionalized population of the United States from 2005 to 2010. We excluded individuals with a history of brain cancer or stroke since these conditions are expected to cause cognitive problems because of direct brain insults. We determined the prevalence of depression and its relationship to memory problems in cancer survivors by weighting our results proportionally. We controlled for demographic predictors of memory problems. Results: The sample included 14249 adults (6875 men and 7274 women) age 20 years and older. There were 6959 Whites, 2792 Blacks, 3903 Hispanics, and 589 other race/multiracial. Overall, individuals in the United States with a history of depression were 8.4 times more likely to report memory problems (Odds Ratio (OR), 8.406; 95%CI, 6.73 to 10.64). We further explored the depression-memory relationship in a subsample of cancer survivors. Adjusting for age, sex, race-ethnicity, education, income, and general health, cancer survivors with a history of depression were approximately 5 times more likely to report memory problems (N=1283; OR, 4.921; 95%CI, 2.141 to 11.313) than those without a history of depression. Other predictors of memory problems were age (≥ 60 years old, OR = 4.756, 95%CI, 1.957 to 11.560) and lower income (OR, 3.721; 95%CI, 1.951 to 7.098). Conclusions: The likelihood of memory problems is higher in cancer survivors with a history of depression. Future studies are needed to systematically delineate the depression-memory problems relationship, and to inform the development of interventions to treat these conditions for cancer survivors.
Nonalcoholic fatty liver disease after adjuvant therapy in nonmetastatic breast cancer.
Authors: Duman Berna Bozkurt , Gunaldi Meral , Tasdogan Burcak Evren , Usul Afsar Cigdem , Paydas Semra , Gumurdulu Yuksel 
Published: March 2020

9587 Background: Nonalcholic fatty liver disease (NAFLD) is an important health problem in the general population. Also NAFLD developing after treatment is very important in cases with cancer especially having long term life expectancy like breast cancer. The aim of this this study is to explore the rate and risk factors of NAFLD in cases with breast cancer receiving adjuvant therapy. Methods: In this prospective study, 201 cases with breast cancer treated by chemo and/or anti-hormonal treatment were included between years 2010-2012. Patients who had ductal carcinoma insitu and metastatic disease and also chronic HBV and HCV infections, chronic liver diseases with other reasons and liver cirrhosis were excluded. Body mass index (BMI) was calculated based on the following formula: weight in kilograms divided by height in meters squared. Diabetes mellitus, hypetension and hyperlipidemia, if there is in past medical history, were documented. NAFLD was deteced by abdominal ultrasound imaging and there was no history of alcohol consumption. Biopsy was performed in 2 patients who had refractory high transaminasis. Results: The patients were divided into three groups. Group I: Patients without NAFLD, Group II: Patients with NAFLD before cancer treatment, Group III: Patients with NAFLD after cancer treatment. There was no difference for age and menopousal status between three groups. Diabetes mellitus, hypetension and hyperlipidemiawere not important risk factors for the development of NAFLD after cancer treatment. (p values 0,085, 0,525, 0,207, respectively). BMI was found to be higher in cases with NAFLD and the occurrence of NAFLD was detected more frequently in obese patients (BMI>30 kg/m2) (p=0,001). Tamoxifen, LHRH analougs and aromatase inhibitors were not found to be asociated with NAFLD (p=0,7, 0,8, 0,5, respectively) while the combination of fluorouracil, antharcycline and cyclophospamide was found to be a risk factor in the development of NAFLD (p=0,02). Conclusions: High BMI (both before and after treatment), obesity and fluorouracil, antharcycline and cyclophospamide combinationin were found to be important risk factors for the occurrence of NAFLD.
Psychosocial health in survivors of adult versus childhood cancer.
Authors: Phillips Charles A , Hardcastle Emily , Desjardins Leandra , Ruiz Rachel , Bemis Heather , Arrington Jasmine , Feldman Rachel , Murphy Alexandra , Compas Bruce , Friedman Debra L. 
Published: March 2020

9609 Background: The growing population of cancer survivors is characterized by two subgroups, those diagnosed as children and those diagnosed as adults. While psychosocial challenges are recognized in these survivors, little data exists comparing the psychosocial health between these two subgroups. Our objective is to compare adult and childhood cancer survivors for symptoms of depression, anxiety, somatic complaints, and post traumatic stress disorder (PTSD). Methods: At entry to the Vanderbilt Cancer Survivorship program, survivors of childhood and adult onset cancer, ages 15 – 55 years old, completed the Achenbach System of Empirically Based Assessment and the revised Impact of Event Scale. Using normalized T scores, independent sample t tests,and χ2 analyses, responses were compared to normative data for each group and responses of the two survivor groups were compared to one another. Results: There were 172 survivors of childhood cancer (M= 9 years old at diagnosis) and 125 survivors of adult cancer (M= 41 years old at diagnosis). Childhood cancer diagnoses included hematologic cancer (56%), sarcoma (17%), brain tumor (8%), and other (19%). Adult cancer diagnoses included breast cancer (45%), colon cancer (8%), hematologic cancer (14%), sarcoma (4%), and other (29%). After adjusting for age-related population norms, adult survivors were significantly more likely to have symptoms of depression (p=.011), anxiety (p=.029), somatic problems (p=.043), and PTSD (p=.004) compared to their childhood counterparts. Compared to age-expected norms, significantly more adult, but not child, survivors scored in the clinical range for depression (29%, p<.001; vs. 18% n.s) and somatic problems (23%, p=.013; vs. 12%; n.s.). Time elapsed from cancer diagnosis to completion of the questionnaires was not significantly correlated with any of the measures. Conclusions: Survivors of adult onset cancer face a significantly higher amount of psychologic distress, particularly depressive and somatic symptoms, compared to their childhood counterparts and age-expected norms. Analyses are ongoing to evaluate other demographic, disease, and treatment related risk factors that may contribute to this age-related phenomenon in order to develop interventions.
Hypocalcemia in patients with metastatic bone disease receiving denosumab.
Authors: Body Jean-Jacques , Lipton Allan , Henry David H. , Stopeck Alison , Fizazi Karim , Bone Henry G. , Saad Fred , Van Poznak Catherine H. , De Boer Richard H. , Shore Neal D. , Ibrahim Toni , Takano Toshimi , Damião Ronaldo , Wang Huei , Kostenuik Paul J. , Shaywitz Adam , Bracco Oswaldo L. , Braun Ada 
Published: March 2020

9628 Background: Patients (pts) with metastatic bone disease (MBD) are at risk of skeletal-related events (SREs). Potent antiresorptives reduce the risk of SREs, by inhibiting cancer-induced bone destruction, which also reduces release of skeletal calcium (Ca) into the bloodstream. Hypocalcemia (hypoCa) may occur if Ca and vit D intake is inadequate while taking antiresorptive agents. A combined analysis of 3 phase III trials in pts with MBD showed denosumab (DMAb) was superior to zoledronic acid (ZA) in preventing SREs. The overall safety profiles were similar; hypoCa was more common with DMAb (9.6%) than ZA (5.0%). Characteristics of hypoCa events in DMAb pts in these clinical trials and from post marketing adverse event (AE) reports are presented. Methods: Pts with solid tumors or multiple myeloma and MBD were randomized (1:1) to DMAb 120 mg SC or ZA 4 mg IV (adjusted for renal function) every 4 weeks (Q4W). Pts were advised to take daily Ca (≥ 500 mg) and vit D (≥ 400 IU); intake was collected by pt report. Albumin-corrected serum Ca was measured Q4W by central lab. HypoCa events were collected as decreases in serum Ca per central lab and investigator-reported AEs. Post marketing data from spontaneous reports of hypoCa to the sponsor's global safety department (AGS) were reviewed. Results: In the 3 trials, 2841 pts received DMAb and 2836 pts received ZA. The median Ca levels for both treatment groups were similar over time. Among DMAb pts, hypoCa was most common within 6 months of starting treatment and was more common in pts who did not report use of Ca and vit D vs those who did (15.8% vs 8.7%). Grade 3 or 4 (< 7 mg/dL; < 1.75 mmol/L) decreases in serum Ca were reported in 3.1% of DMAb pts and 1.3% of ZA pts. No fatal cases of hypoCa were reported in the trials. From May to Nov 2012, 37 cases of severe symptomatic hypoCa (seizures, tetany, prolonged QTc, altered mental state) were reported to AGS; fatal outcomes were reported for 3 other pts with advanced cancers and various comorbidities. Conclusions: HypoCa is a known risk with antiresorptive therapy, including DMAb 120 mg. HypoCa occurred less often in pts who reported taking Ca and vit D. HypoCa should be corrected prior to starting DMAb and Ca monitored during treatment. Pts should take adequate Ca and vit D while receiving DMAb. Clinical trial information: NCT00321464, NCT00321620, and NCT00330759.