bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment patterns among cancer patients with anemia who do not respond to erythropoietin-stimulating agents.
Authors: Girvan Allicia C , Lau Yiu-Keung , Bowman Lee , Pohl Gerhardt , Landsman-Blumberg Pamela , Shi Nianwen , Varker Helen 
Published: March 2020

e20525 Background: While broadly utilized for treatment of anemia in cancer patients, treatment with Erythropoetin Stimulating Agents (ESAs) is contraindicated in patients who fail to respond within 6-8 weeks. This study examined rates of ESA response and rates of continued ESA use following non-response in five cancer cohorts treated by community-practice oncologists. Methods: Patients with breast, head and neck, cervical, non-small cell lung cancer, or multiple myeloma initiating ESAs on or before 7/1/2011 were identified from EMRs in the ACORN Data Warehouse (ACORN, Memphis TN). The study included those with at least 6-8 weeks of ESA use and documented hemoglobin (Hb) values ≤28 days before start of ESA (“baseline”) and anytime during day 43-70 of ESA treatment. Per ASCO/ASH guidelines, patients were noted as responders if Hb increased ≥1g/dL between baseline and the Hb value closest to day 56 in the 43-70 day window, and non-responders if Hb increased <1g/dL. Non-responders were further classified as continuing or discontinuing therapy based on record of ESA treatment following determination of non-response. Results: A total of 2,197 patients were studied. ESA response rate was 45%. For non-responders, 83% continued ESAs after determination of non-response. Hb increase at end of therapy among non-responders remained lower than for patients who demonstrated initial response. Additionally, non-responders received nominally longer treatment, with a mean exposure of 169 days. Conclusions: Among cancer patients, a majority of ESA non-responders remained on ESA treatment beyond the recommended response window as defined by ASCO/ASH guidelines. Moreover, non-responders remained on treatment longer than those who demonstrated an initial response. [Table: see text]
Characteristcs associated with complementary and alternative medicine use among racially and ethnically diverse long-term cancer survivors.
Authors: Sohl Stephanie Jean , Weaver Kathryn E. , Birdee Gurjeet , Kent Erin E. , Danhauer Suzanne , Hamilton Ann S. 
Published: March 2020

e20532 Background: To identify the prevalence and predisposing, enabling and need for care characteristics of long-term adult cancer survivors who use complementary and alternative medicine (CAM) modalities. Methods: We analyzed data from the Follow-up Care Use among Survivors (FOCUS) Survey, a cross-sectional population-based investigation of the follow-up care experiences among racially and ethnically diverse long-term (i.e., five years or more post-diagnosis) cancer survivors recruited from California NCI SEER registries. Ever and last year use of CAM modalities, as well as reasons for use, were assessed. Multivariable logistic regression models were applied to identify if predisposing, enabling and need for care characteristics described in the CAM Healthcare Model were associated with CAM use in the past year. Results: Long-term cancer survivors in the study (N=1,666) were predominately female (62%) and older (mean age=69.5), with breast (24%), prostate 26(%), colorectal (25%), ovarian (13%) and endometrial cancers (12%). Forty-two percent of survivors used CAM in the past year to relieve stress (28%), treat or prevent cancer from coming back (22%), relieve cancer-related symptoms (18%) and help deal with another medical condition (18%). Certain predisposing (i.e., female gender, higher optimism) and need for care factors (i.e., experienced cancer-related symptoms in the past two years, ever had depression/anxiety) were significantly associated with CAM use (p-values<0.05). Insurance coverage, financial resources, and receipt of cancer-related follow-up care were not associated with CAM use. Conclusions: Cancer survivors report a high prevalence of CAM use even years after their initial diagnosis. It is important for healthcare providers to be aware of the higher prevalence of CAM use among subgroups of cancer survivors (i.e., female, high in optimism, have experienced cancer-related symptoms, have a history of anxiety/depression) in order to communicate effectively about these modalities with their patients.
Prospective study of the effects of adjuvant breast cancer chemotherapy on taste function and food hedonics.
Authors: Boltong Anna , Aranda Sanchia , Keast Russell , Wynne Rochelle , Francis Prudence A. , Chirgwin Jacqueline H. , Gough Karla 
Published: March 2020

e20536 Background: "Taste changes" are commonly reported by people receiving chemotherapy. It is unclear to what extent this relates to altered taste function or changes to other aspects of the eating and drinking experience such as food liking or appetite. Methods: Women (n = 52) prescribed adjuvant chemotherapy underwent testing of taste perception, appetite and food liking before, during and after chemotherapy. Taste sensitivity was measured by correct or incorrect identification of prototypical tastants sweet, salt, sour, bitter and umami. Perceived intensity of each tastant was measured on a 10cm Visual Analogue Scale. Liking of standard sweet and savory foods was measured on the 9-point hedonic scale. Appetite was measured on a 10-point scale. McNemar’s test was used to determine whether proportion of correctly identified tastants changed significantly from baseline at follow-up assessments. Mixed-effects models were used to estimate and test change in mean taste intensity, food liking and appetite from baseline at follow-up assessments. Results: Significant adverse effects were observed for taste identification, liking of sweet food and appetite close to chemotherapy administration. Notably different patterns of change were observed for identification of individual tastants. Conclusions: The demonstrated changes in taste function and food hedonics could be used to guide pre-chemotherapy education and have implications for dietary choice and nutritional outcomes. [Table: see text]
Comparison of the effects of subcutaneous APF530, intravenous granisetron, moxifloxacin, and placebo on the QT interval in humans.
Authors: Mason Jay , Moon Thomas E , O'Boyle Erin , Dietz Albert J 
Published: March 2020

e20539 Background: This study evaluated effects of subcutaneous (SC) APF530 (sustained-release granisetron) and intravenous (IV) granisetron on placebo-adjusted change from baseline in QT corrected with the Fridericia method (QTcF) over 48 h (ddQTcF), using moxifloxacin as an active control. The FDA recently required a label warning regarding risk of QT prolongation by granisetron and other 5-HT3antagonists for chemotherapy-induced nausea and vomiting on the basis of anecdotal reporting. Methods: Normal healthy subjects received 1 of 4 treatments in a 4-period crossover: APF530 1 g SC (20 mg granisetron; 2 x therapeutic dose), IV granisetron 50 µg/kg (5 x therapeutic dose), oral (PO) moxifloxacin 400 mg, or placebo. Drugs were given at the start of each 10-day period. 12-lead ECGs and blood samples for pharmacokinetic evaluations were taken at prespecified times. Results: 51 subjects completed the study. APF530 had no clinically significant effect on QTcF. Maximum adjusted mean change (ddQTcF) was 3.75 ms for APF530 1 g at 3 h (Table). While CI excluded 0 at 3 and 12 h, upper boundaries of 6.89 and 6.70 ms were well below the level of FDA concern (10 ms). Mean APF530 Cmaxwas 35.8 ng/mL, twice that observed in patients receiving the standard dose. IV granisetron also had minimal effect on ddQTcF, while moxifloxacin produced the expected large change. Pharmacokinetic and pharmacodynamic modeling revealed a very small granistetron-ddQTcF gradient; the linear model predicted a ddQTcF value of 1.37 ms at the highest concentration observed in patients (97.8 ng/mL). Conclusions: No clinically significant QT prolongation occurred with SC APF530 up to 1 g, despite achievement of mean Cmax greater than that in previous studies. APF530 was well tolerated. Clinical trial information: NCT01416259. [Table: see text]
Effects of physical activity on symptoms in prostate cancer survivors.
Authors: Shedlock Kathleen , Porock Davina , Brown Jean K. , Burton Harold , Horvath Peter , Berry Donna Lynn 
Published: March 2020

e20540 Background: Physical activity (PA) in prostate cancer (PC) survivors improves general QOL and fatigue, but the relationship between PA and genitourinary symptoms in PC survivors is unknown. The incidence of sexual dysfunction may be as high as 68% during active surveillance and 78% in men receiving conventional therapies. PA has mitigated erectile dysfunction in non-prostate cancer populations. Objective: To determine the relationships among PA, age, co-morbidities, mental and physical health and symptoms, particularly related to sexual dysfunction, experienced by men with PC prior to therapy. Methods: Study Design: Correlational/cross sectional secondary analysis of de-identified data from 258 men with early stage PC prior to initiation of therapy. Variables: Habitual PA (Baecke Questionnaire- BAQ), physical (PCS) and mental health (MCS) (SF-36) and urinary, bowel and sexual dysfunctional symptoms (UCLA Prostate Cancer Index). Analysis: Descriptive statistics; correlations; hierarchical regressions to assess moderating and mediating relationships. Results: Mean Age = 63.2 + 8.1 yrs. BAQ activity scores, ranged from 2.2 to 12.1 (M and SD= 6.8+1.9), indicating low levels of PA. PCI mean scores = 92+13, urinary; 88 +13, bowel; 52 +29 for sexual. PA was negatively correlated with sexual symptoms (r=0.31; p<0.001). Physical health was negatively associated with all symptoms and age, but positively correlated with PA (r=0.21; p=0.001). Physical health mediates effects of age for urinary symptoms and partially for sexual symptoms. PA’s relationship to sexual dysfunctional symptoms was independent of age and was at least partially mediated by physical health. Conclusions: Urinary, bowel and sexual symptoms experienced by men at time of diagnosis were similar to men of similar age without PC, indicating age as the dominant predictor of symptoms. This study identified potential mechanisms of symptoms in early stage PC that warrant further testing. Symptoms related to sexual dysfunction may be especially amenable to PA.
Self report assessment and support for cancer symptoms: Impact on hospital admissions and emergency department visits.
Authors: Berry Donna Lynn , Hong Fangxin , Blonquist Traci , Halpenny Barbara , Siefert Mary Lou , Partridge Ann H. 
Published: March 2020

e20552 Background: Attending to symptoms and side effects promotes safe and effective delivery of cancer therapies. Educated and supported patients (Pts) may be able to self-manage symptoms (Sx) and know when to contact the clinician, avoiding emergency department visits (EDV) or hospital admissions (HA). The web-based Electronic Self Report Assessment for Cancer (ESRA-C) is an easy-to-use, automated program for assessing and teaching about symptom and quality of life issues (SQI) and has been shown to improve communication and reduce symptom distress over the course of active therapy. The purpose of this secondary analysis was to explore the impact of the ESRA-C intervention on rates of EDV and HA. Methods: AdultPts with all cancer types and stages treated in medical and radiation oncology at a comprehensive cancer center used ESRA-C to self-report SQI during new anti-cancer therapy, with summary reports delivered to clinicians. Patients were randomized to assessment-only ESRA-C (control) or the ESRA-C intervention adding self-monitoring and education and coaching between clinic visits. We analyzed group differences on EDV and HA using descriptive statistics and a two group unequal variance t-test. Results: Among 663 Pts, 34 out of 327 control Pts made 47 EDV vs 30 out of 336 intervention Pts made 42 visits. Likewise, 36 control Pts had 59 HA vs 36 intervention Pts who had 41 HA during the study duration. The majority of EDV (87%) and HA (88%) were Sx-related. The frequency of Sx-related events (EDV or HA) was higher in the control (n=94) vs the intervention group (n=71). The mean number of unplanned events were 0.29 and 0.21 per patient in the control and intervention groups, respectively (p=0.24). Conclusions: Although the trial sample size was not planned to test differences in EDV or HA, the ESRA-C intervention, compared with assessment alone, may have reduced symptom-related EDV and HA in a large sample of patients during active cancer treatment. If we are able to reduce Sx-related unplanned visits and admissions from more than 1 of 4 patients to 1 of 5 patients with an automated, patient-centered system, we can anticipate substantial cost savings when scaled to the volume of most comprehensive cancer centers. Clinical trial information: NCT00852852.
The effect of anesthesia choice on post-operative outcomes in women undergoing exploratory laparotomy for gynecologic malignancy.
Authors: Rivard Colleen Lee , Dickson Elizabeth Louise , Vogel Rachel Isaksson , Teoh Deanna Gek Koon 
Published: March 2020

e20571 Background: The goal of this study is to examine how regional anesthesia choice in women undergoing laparotomy for gynecologic malignancy affects their pain and hospital stay. Methods: This single-institution retrospective review studied women undergoing exploratory laparotomy for suspected gynecologic malignancy from May to January 2013. Patients were in 1 of 3 groups: patient controlled analgesia (PCA), transversus abdominis plane (TAP) blocks with PCA or transthoracic epidural. Narcotic use and pain scale during the first 3 days after surgery, length of surgery, complications and length of postoperative stay were compared. P-values of <0.05 are considered significant. Results: One hundred twelve women were included (44 PCA, 30 TAP + PCA, 38 epidural). Those receiving TAP or epidural tended not to use narcotic prior to surgery, though not a statistically significant result. The length of surgery and estimated blood loss were not different between groups; however, the rate of intra-operative complications differed by pain management method (p=0.020), with those who received an epidural had the lowest rate. In the epidural group, median IV narcotic use (mg) was significantly decreased for the first three post-surgical days (day 1 p =0.014; day 2 p <0.0001; day 3 p = 0.048). Those with epidurals also had significantly lower pain scales on the second and third post-operative days compared to those with TAP or PCA alone (day 2: p=0.046; day 3: p =0.008). After adjusting for age and complications arising both during and after surgery, TAP placement increased the length of hospital stay slightly by 0.35 days (95% CI: 0.07-0.62 days, p=0.014). Conclusions: The use of epidural anesthesia for post-operative pain management in surgery for gynecologic malignancy decreases narcotic analgesia use and improves pain scale measurements without increasing complications or length of hospital stay. Further investigation with prospective randomized trials is warranted to elucidate the optimal post-operative pain management technique.
Impact of age on treatment and survival in patients with small cell lung cancer.
Authors: Takhar Harminder Singh , Sukumaran Shawgi , Ly Marleesa , Karapetis Christos Stelios , Roy Amitesh Chandra , Kichenadasse Ganessan , Koczwara Bogda 
Published: March 2020

e20577 Background: Elderly patients are underrepresented in clinical trials, yet account for significant group with small cell lung cancer (SCLC). We examined if the age of the patients, <70yrs vs >70yrs, impacted outcome. Methods: SCLC pts were identified by searching the hospital cancer registry from 1999 to 2009. Pt characteristics, management and outcomes were collated by reviewing clinical records. Survival analysis was performed. Results: From 168 SCLC pts, 49 (27 males, 22 females) had limited stage (LS) and 113 (71 males, 42 females) extensive stage (ES) SCLC. LS cohort, 27 pts were <70yrs and 22 were >70yrs. The overall group survival was not statistically different, with median overall survival of 12.4 months for <70yrs and 7.8 months for >70yrs (p=0.064). However, 44 pts who had active treatment, including chemoradiotherapy, chemotherapy alone, radiotherapy alone, there was statistically improved survival between <70yrs vs >70yrs of 12.8 months vs 8.2 months (p=0.05). There was no significant difference in proportion of pts who received active treatment between the two groups (96.2% vs 95.4% p =0.882). The number of pts completing treatment was not statistically different between the two age groups (70.8% vs 54.5% p = 0.53) In the ES cohort, 45 pts were <70yrs and 68 were >70yrs. The overall group survival was significantly worse in the >70yrs with MOS 3.8 months for >70yrs and MOS 6.9 for <70yrs (p=0.0087). In pts who had active treatment, significantly higher proportion of pts <70yrs received active treatment, including chemoradiotherapy, chemotherapy alone and radiotherapy alone, (77% versus 69%, p= 0.015). In pts who had active treatment, the survival was not statistically different, MOS <70yrs 7.4 months vs >70yrs 5.9 months (p= 0.088). Significantly less pts >70yrs vs <70yrs completed treatment (20% versus 39% p = 0.032). Conclusions: In LS SCLC, comparing treated patients <70yrs vs >70yrs, patients >70yrs had reduced survival, this may be related to patient factors or tumour biology. In ES SCLC, comparing patients<70yrs vs >70yrs, patients >70yrs had worse survival overall, less likely to receive active treatment and less likely to complete treatment, again this may reflect a difference in patient factors or tumour biology.
Characteristics and outcomes of patients admitted to the acute palliative care unit (APUC) from the emergency center (EC) versus inpatient transfers (IP).
Authors: Shin SeongHoon , Bruera Eduardo , Hui David , Kwon Jung Hye , Chisholm Gary B. , San-Miguel Maria Teresa , Allo Julio , Yennurajalingam Sriram , Frisbee-Hume Susan 
Published: March 2020

e20581 Background: Most patients admitted to APCU are transferred from inpatient oncology units. We hypothesized that EC admissions have different symptom burden and outcomes compared to IP patients. In this retrospective cohort study, we compared the symptom burden and survival between the EC and IP groups. Methods: Among all 2,568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12%) were EC patients. We randomly selected 298 IP patients as controls. We retrieved the patient demographics, cancer diagnosis, Edmonton Symptom Assessment Scale (ESAS), discharge outcomes, and overall survival from time of admission. Results: EC patients were more like to be black (22% v 11%, p=0.0006) and less likely to have hematologic cancer (5% v 14%, p=0.0003). EC patients had higher pain (5.4 v 4.6, p=0.0004), fatigue (6.7 v 6.1, p=0.0049), nausea (2.7 v 1.6, p<0.0001), insomnia (4.8 v 4.2, p=0.03) and were less likely to be delirious (41% v 55%, p=0.001). EC patients had more public insurance (44% v 38%, p=0.0142), more home discharge (29% v 11%, p=0.0001), longer admission (8 v 7 days, p=0.0002), and were 2.3x as likely to be discharged alive as compared to IP patients (p<0.0001, Wald Chi-square test). Kaplan-Meier plots and log-rank test for survival from admission of APCU for EC and IP groups were not statistically significant (Median survival after admission were 34 v 31 days, p=0.08). In multivariate analysis, EC admission (OR= 1.9, 1.2-3.0), wellbeing (OR=1.12, 1.02-1.23), dyspnea (OR=0.85, 0.79-0.92) and delirium (OR=0.39, 0.24-0.64) were independently significant for being discharge alive. The c-statistic value was 0.71. Conclusions: EC patients have higher acute symptom burden, but more likely to be discharged alive as compared to IP transfer patients. The APCU is successful at managing symptoms and facilitating discharge to the community for EC patients. [Table: see text]
Advanced pancreas and hepatobiliary (PHB) cancer patients’ impressions regarding cardiopulmonary resuscitation (CPR).
Authors: Epstein Andrew S. , Shuk Elyse , Gary Kristen , O'Reilly Eileen Mary , Volandes Angelo E. 
Published: March 2020

e20586 Background: Most cancer patients desire information about medical options at the end of life, including CPR. Such communication is part of advance care planning (ACP). Our prior studies with video educational media have produced data on patients’ categoric preferences (yes/no/unsure) for CPR, however, the thematic underpinnings of these preferences in patients with advanced cancer are not known. Methods: Qualitative thematic content analyses were performed on participants’ verbatim responses to the question “Do you have any questions or concerns?” at the end of participating in a randomized trial (quantitative data reported in full, Epstein, ASCO 2012) of an educational video (V) or narrative (N) about CPR in patients with advanced PHB cancers. Participant responses were independently coded and categorized for thematic content by two reviewers (ASE, ES). To maximize internal validity, reviewers jointly compared and reconciled differences in analyses. Results: Of 54 study participants, 26 total (41% of V arm, 56% of N arm) articulated questions, comments, or both. From these 26, 1-3 (median=1) themes were generated from each participant. There were no appreciable differences in the content or number of themes between the N and V arms. Joint analysis demonstrated thematic consensus and resulted in seven distinct themes listed in decreasing order of prevalence: (1) information about CPR affirmed existing personal beliefs/knowledge/values (many wanted to forgo CPR); (2) participants were apprehensive about ACP but wanted to discuss it; (3) ACP should be started early; (4) CPR information was helpful/acceptable; (5) physicians should be involved in ACP; (6) gaps in knowledge emerged; and (7), medical questions arose. Conclusions: The comments of these advanced PHB cancer patients demonstrate receptivity to the topic of ACP despite it being hard to discuss. These data indicate that ACP is a helpful and desired process ideally begun early by clinicians, and that video education is an appropriate and affirming conversation starter. The themes generated here will be incorporated into our future ACP studies on the relationships between cancer patient values and education about care options. Clinical trial information: NCT01105806.