bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of an oncology palliative care clinic for improving symptom management and patient satisfaction
Authors: Follwell M. , Burman D. , Wakimoto K. , Seccareccia D. , Bryson J. , Sirianni G. , Le L. , Rodin G. , Zimmermann C. 
Published: March 2020

19552 Background: Previous studies to assess symptom control in a palliative care clinic setting have largely been retrospective. This study prospectively assesses the efficacy of an Oncology Palliative Care Clinic (OPCC) for improving symptom management and satisfaction with cancer care. Methods: All consenting patients newly referred to the OPCC completed the Edmonton Symptom Assessment System (ESAS) and the FAMCARE Scale (modified for patient use) at baseline, one week, and one month. The primary outcomes were the ESAS distress and FAMCARE total scores, for which one-week analyses are presented (paired t-test). Individual ESAS symptom scores were also assessed in an exploratory analysis, with the p-value set at 0.01 to provide some protection from multiple comparisons. Results: 118 patients, all with metastatic cancer, have completed the one-week assessment. The mean ESAS symptom distress score at baseline was 38.31±18.34. One week after the initial OPCC assessment there was a mean decrease in the distress score of 7.94 units (95%CI 5.11–10.76, p<0.0001). The mean baseline score for patient satisfaction was 66.31±13.23, with a mean increase of 7.22 points at one week (95%CI 4.51–9.94, p<0.0001). Individual symptom scores that showed the greatest improvement were anxiety (improved 1.40 units; p<0.0001), nausea (1.16 units, p = 0.0001), dyspnea (1.08 units; p = 0.0003), insomnia (0.97 units, p = 0.0003), pain (1.01 units, p = 0.0018), drowsiness (0.93 units, p = 0.0083), appetite (0.86 units, p = 0.0023) and fatigue (0.77 units p = 0.0039). The only symptoms that did not reach statistical significance were constipation (improved by 0.71, p = 0.053) and depression (0.6 units, p = 0.018). Conclusions: One week after assessment in an OPCC, there were significant improvements in symptom distress and satisfaction with care. It remains to be determined whether or not these results will be sustained at one month. Randomized controlled trials of the effectiveness of an OPCC are needed. No significant financial relationships to disclose.
Epoetin delta in the management of anaemia in cancer patients
Authors: Zajda K. , Krzakowski M. 
Published: March 2020

19555 Background: Cancer is often associated with anaemia. Epoetin delta (Shire plc) differs from recombinant erythropoietins as it is produced in a human cell line using gene-activation technology. We report data from a controlled trial of epoetin delta (ED) and an extension study. Methods: Cancer patients with anaemia (haemoglobin [Hb] = 10.5 g/dL) were randomized to 12-weeks’ treatment with ED (150 or 300 IU/kg) or placebo (double blind). Treatment was given subcutaneously, three-times weekly. Patients were included if they were receiving chemotherapy and had at least two cycles remaining when randomized. Primary objective was to demonstrate a difference between ED and placebo in Δ Hb from baseline and the number of patients requiring blood transfusions. Target sample size was 100 patients per arm (99% power for a 1.6 g/dL difference in Δ Hb and a 29% difference in the percentage of patients requiring transfusions). Patients completing the study entered an open-label, 12-week extension in which all initially received ED 150 IU/kg. Dose could be increased to 300 IU/kg if Hb levels were < 12 g/dL after 4 weeks. Results: In total, 313 patients were randomized (100, 103 and 99 to ED 150 and 300 IU/kg, and placebo, respectively). Mean change ± SD in Hb from baseline was 2.47 ± 2.39, 2.46 ± 2.56 and 0.57 ± 1.7 in the ED 150 and 300 IU/kg, and placebo groups respectively (P < 0.0001 for both comparisons). There was no difference in the proportion of patients requiring transfusions (26.0, 21.9 and 26.9%, respectively). In the second study, Hb levels were maintained in those previously on ED and increased in those previously on placebo (2.55 g/dL). In those previously on ED, transfusion requirements were lower. ED was well tolerated. Conclusions: Epoetin delta was effective in increasing Hb levels in patients with anaemia related to cancer and longer treatment was associated with fewer transfusions. No significant financial relationships to disclose.
A randomized control study on the effects of prescriptive exercise on lean mass and fatigue in breast cancer patients undergoing treatment
Authors: Battaglini C. , Dennehy C. A. 
Published: March 2020

19560 Background: Loss of lean mass during cancer treatment has been correlated with increases in fatigue (F) levels. Exercise is related to decreases treatment related fatigue and has been shown to thwart muscle loss. Methods: Twenty female subjects, ages ranging from 35 to 70 years, were recruited for the 21 week study. A randomized two-group (exercise and control) design with multiple measurements [Pre-surgery (PS), Post-surgery (POS), 1st assessment during Chemotherapy (Chemo1), 2nd assessment (Chemo 2), 3rd assessment (Chemo 3), and at the end of the experiment (FA)] was used. Percent of lean body mass (%LBM) and F levels were measured as dependent variables. Also, creatine kinase (CK) and total caloric intake (TCI) were measured to explain changes in %LBM and F. Data were analyzed using a two-way mixed model ANOVA with repeated-measures. Results: No significant difference in %LBM from PS to FA (p = 0.82) was observed. However, a significant interaction effect between groups and %LBM from PS to FA was observed (p<0.000). Post hoc analyses revealed significant difference in %LBM between groups at the FA (p = 0.004). Significant differences in F scores were observed between PS and FA (p=0.008). Post hoc analyses revealed significant difference in F scores between groups at Chemo 1, (p=0.001), Chemo 2, (p=0.005), and FA (p=0.000). No differences in CK were noted, however significant differences were noted between groups at PS (p=0.000) and FA (p=0.000) for TCI. Conclusions: The results suggest that initiating a regular individualized prescriptive exercise immediately following surgical recovery and continuing through at least 12 weeks during chemotherapy treatment positively impacts %LBM and deceases F when compared to patients not involved in any exercise. No significant financial relationships to disclose.
Safety of transdermal scopolamine in pediatric patients for chemotherapy-induced nausea and vomiting (CINV)
Authors: Weber L. M. , Alexander D. , Finkelstein M. , Chen S. 
Published: March 2020

19568 Background: Transdermal scopolamine has been used for over 25 years in the treatment of nausea and vomiting, but little information is available on its safety in pediatric patients. The antiemetic guidelines established at our hospital allow children between 8 and 15kg to receive a ½ patch every 3 days and children greater than 15 kg to receive 1 patch every 3 days as an adjunct agent for CINV. The goal of this study was to assess the safety of transdermal scopolamine in hospitalized pediatric patients during chemotherapy treatment. Methods: A retrospective chart review was conducted at Children’s Hospital and Clinics of Minnesota from April to September 2005. A total of 82 hospital admissions (41 patients) were reviewed for adverse effects specific to scopolamine using the National Cancer Institute’s Common Terminology Criteria for Adverse Events. Results: Mean patient age was 8 years (1–20 years) and the average length of patch use was 6 days (2–31 days). Of the 82 admissions reviewed, a total of 20 adverse events occurred (24%) in 14 patients. Median weight was significantly greater for patients experiencing the following adverse events compared to patients that did not: headaches (p=0.009), mental status changes (p=0.01) and hallucinations (p=0.003). Age > 12 years (p<0.001) and use of the patch > 4 days (p<0.01) were significantly correlated with the incidence of an adverse event. 75% of patients did not experience an adverse effect from transdermal scopolamine therapy when used 4 days or less. Conclusions: Transdermal scopolamine is a safe adjuvant for treatment of CINV in pediatric patients; however, as many as 1 in 5 may suffer adverse events. When used for more than 4 days the risk of adverse events increases. Older children and adolescents are more prone to adverse events. No significant financial relationships to disclose.
Human recombinant erythropoietic agents (rHuEPO) do not induce changes in circulating levels of endoglin and vascular endothelial growth factor (VEGF) in anaemic cancer patients
Authors: Ocana A. , Rodríguez-Barbero A. , Pericacho M. , Bellido L. , Fonseca E. , Delgado C. , Soto de Prado D. , Cruz- Hernández J. J. , López-Novoa J. M. 
Published: March 2020

19569 Background: The expression of Erythropoietin (EPO) receptors on cancer cells and the correlation of EPO receptor levels with angiogenesis and progression in some cancers have suggested that EPO could acts directly as an angiogenic factor. The purpose of this study was to assess the effect of treatment with human recombinant erythropoietic agents (rHuEPO) in cancer patients with chemotherapy-induced anaemia on Endoglin and Vascular Endothelial Growth Factor (VEGF) circulating levels as a possible marker of angiogenesis. Methods: Endoglin and VEGF were measured in serum samples from 25 cancer patients with chemotherapy-induced anaemia before and after 3 to 4 weeks of treatment with rHuEPO (Epoetin alfa 150 UI/Kg three times per week; darbepoetin alfa 150 mcg/weekly). A group of 28 healthy voluntaries were used as control. Endoglin and VEGF were analyzed using an ELISA commercial Kit (R&D Systems; Ciudad-Pais). T- student test was used to study the association between variables. Paired comparisons before and after treatment were performed using the Wilcoxon rank-sum test. Results: VEGF serum levels were significantly higher in cancer patients than in controls (476,66±72,56 pg/ml versus 227,34±24,58 pg/ml, p<0.001, respectively). Endoglin levels were significantly higher in patients than controls, although this difference did not reach statistical significance (4.75±0.30ng/ml versus 4.18±0.12 ng/ml, p=0.075). Similar results were found in the different subgroups of patients (Breast cancer, endoglin p=0.019; VEGF p=0.009; Colon cancer, endoglin p=0.084; VEGF p<0.001). Using the Wilcoxon rank-sum test no statistically significant differences in endoglin (p=0.510) and VEGF (p=0.313) serum levels were found between samples obtained before and after treatment with rHuEPO agents. When considering the type of rHuEPO, no differences were observed. In a similar manner, no difference was observed depending on chemotherapy regimen or cancer type. Conclusions: Although the follow up is short and the number of patients is small, our exploratory results do not support that rHuEpo treatment in anaemic cancer patients induce angiogenic serum markers. No significant financial relationships to disclose.
Pulmonary toxicity of cytotoxic agents: A meta-analysis
Authors: Takiguchi Y. , Tada Y. , Kurosu K. , Sakao S. , Tatsumi K. , Nagao K. , Kuriyama T. 
Published: March 2020

19573 Background: Pulmonary toxicity is one of the most serious adverse effects of cytotoxic agents, and affected patients require discontinuation of the anti-cancer therapy, and it even proves fatal in many cases. Its incidence, however, may be considerably biased, as it may be influenced by many factors such as intercurrent medications or co-morbidities. The purpose of our study was to evaluate the incidences of pulmonary toxicity by cytotoxic agents in published data relating to prospective randomized comparative studies. Methods: A Medline literature search was conducted to extract prospective randomized comparative studies (either phase II or III) that included docetaxel, paclitaxel, irinotecan, vinorelbine and gemcitabine. Comparisons had to be performed between regimens with and without one of these agents, in addition to best supportive care with or without other common agent(s), so as to be able to clearly attribute the toxicity to the agent. Reports lacking detailed toxicity data were excluded. Results: The table below summarizes the results of the finally evaluated 47 studies (5 to 12 per agent) fulfilling the criteria. As many studies showed no pulmonary toxicity, standard statistical methods for meta-analysis were not applicable. Conclusions: The present study analyzing data in prospective randomized comparative studies might minimize bias of the relative incidence of pulmonary toxicity. Pulmonary toxicity was rarely encountered in randomized comparative studies. No increase in frequency was shown by the inclusion of any of the five cytotoxic agents. [Table: see text] No significant financial relationships to disclose.
The protective effect of proanthocyanidin on the methotrexate-induced intestinal damage
Authors: Gulgun M. , Erdem O. , Oztas E. , Kismet E. , Koseoglu V. , Balamtekin N. , Kesik V. , Ozcan O. 
Published: March 2020

19576 Background: Methotrexate (MTX) induced mucositis is an important dose-limiting side effect for which there is no definitive prophylaxis or treatment. This study was designed to investigate whether proantocyanidin, grape seed extract from Vitus Vinifera, had a protective effect on the small intestine of rats with MTX-induced damage. Methods: Thirty two albino rats were randomized into experimental and control groups and divided into four groups. To the first group, MTX was applied as a single dose (20 mg/kg) intraperitoneally. To the second group, in addition to MTX application, proanthocyanidin (100 mg/kg) was given orally every day by gavage until the rats were killed. To the third group, proanthocyanidin only was administered. The fourth group was the control. All animals were sacrificied 4 days after the intraperitoneally injection of MTX for histopathologic examination and tissue malonaldehyd (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels. Results: MTX was found to lead to injury in the jejunal tissues and to increase the MDA levels. Administration of the proantocyanidin decreased the jejunal damage and MDA level which was caused by MTX treatment and increased SOD an GPx levels. Conclusions: These results suggest that proanthocyanidin may protect the small intestine of rats from MTX-induced damage. The effects of proanthocyanidin could be resulted from antioxidant properties of the proanthocyanidin. No significant financial relationships to disclose.
Treatment of colorectal cancer in elder patients
Authors: Piga A. , Miscoria M. , Aprile G. , Cozzi M. , Iaiza E. , De Pauli F. , Zanon E. , Fasola G. , Sacco C. 
Published: March 2020

19595 Background: Tumor-related mortality is higher in elder patients worldwide. This may be due to comorbidities associated with age but also, at least in part, to a cautious approach by the attending physician(s) which might result in inadequate or even denied treatment. This approach is purportedly justified by scarcity of literature reports on effectiveness, tolerance and side effects of chemotherapy and other treatments on this category of patients. Methods: We have reviewed clinical records of patients of 70 years of age or older with colorectal cancer who came to our first observation between January 2004 and April 2006. We have correlated the appropriateness of therapeutic decisions, based on adherence to clinical standards, to the clinical characteristics of the patients and in particular to number and degree of coexisting morbidities. Chi square test was used for analysing the association between variables. Results: We have reviewed the records of 193 patients with colorectal cancer, to a total of 215 events, including 22 relapses in the same patients, in which a new therapeutic decision was involved. Adjuvant treatment was omitted in 40% of patients with stage III colon cancer, and 38% of patients with stage III rectal cancer. Chemotherapy was also omitted in 34% of patients with stage IV colon cancer and 35% of patients with stage IV rectal cancer. Even when patients received treatment, preference was given to drugs and regimens of low toxicity. Therapeutic decisions appeared in most cases based on age rather than number and severity of comorbidities. On the other hand, once the decision to treat was taken, the treatment was given as programmed, although 21% of patients received drug doses lower than 75% of projected dose; reasons for abandoning the treatment were progression and toxicity in stage IV, and more often patient's refusal in stage III. Conclusions: In a disease where standards of treatment are well defined, elder patients often receive inadequate treatment or no therapy at all. Although the justification for inadequate treatment is or should be poor clinical conditions of patients, this is not apparent from review of clinical records. Efforts should be made to have in elder patients standardised evaluation of physical status and comorbidities on a regular basis. No significant financial relationships to disclose.
Technology exchange for cancer health network
Authors: Yunus F. , Teresa W. , Jahanzeb M. , Karen F. , Minhaus S. , Yunus R. , Sydow P. , Merkel M. , Kersey R. , Gray S. 
Published: March 2020

19598 Background: The Technology Exchange for Cancer Health Network (TECH-Net) is a collaborative, multi-state effort to implement a systematic care program to improve cancer management in the rural communities of west Tennessee, north Mississippi and east Arkansas. This Health Information Technology (HIT) project uses a two-pronged approach to total clinical decision support: (1) provide access to oncology, hematology, and other specialists through the dedicated telehealth network of the University of Tennessee's Health Science Center in conjunction with the University of Tennessee Cancer Institute; and (2) rely on a distributed electronic health record (EHR) with integrated decision support systems for online management of cancer protocols, electronic orders, and medication management. Methods: Patients with a cancer diagnosis requiring treatment for at least one year are eligible to participate. The ultimate goal for this project is to enroll 250 patients (125 rural, 125 urban) and compare quality, safety, and cost outcomes for patients receiving rural Telehealth care versus “routine” urban care. Telehealth patients see their oncologist in person at the rural sites for initial care, and see their physician via telemedicine for approximately one-half of their subsequent visits. This approach allows the clinician to make in-person clinical assessments on a regular basis while still taking advantage of the time savings associated with telemedicine. Results: 163 patients have been enrolled in the study (127 rural, 36 urban) over 18 months. Patient satisfaction has been high - 95 % of patients indicated their telemedicine visit was as good as or better than an in-person office visit. Cost analysis comparing cost savings (physician travel time) with telemedicine costs (equipment, high speed lines) indicates that the cost-benefit depends critically on distance to the rural facility and number of physician trips avoided. Initial cost data indicate that telemedicine must save at least 5 hours of physician travel time per month to break even. Conclusions: Telemedicine offers a feasible method for increasing access to oncology care in rural areas that is well-accepted by both patients and clinicians. No significant financial relationships to disclose.
The impact of intra-operative high field magnetic resonance imaging on clinical decision making during oncologic neurosurgical procedures
Authors: Weinberg J. S. , Shah K. , Rao G. , Jackson E. F. , Suki D. , Sawaya R. , Schellingerhout D. 
Published: March 2020

19599 Background: Existing image guided surgical (IGS) technology used during resection of brain tumors is based on preoperative imaging modalities and are limited by their inability to demonstrate extent of resection (EOR) and compensate for anatomical changes which occur as a result of surgical manipulation (e.g. brain shift, tumor resection, spinal fluid loss). Having the ability to perform MRI during brain tumor surgery obviates many of these limitations. The purpose of this study was to determine the impact of intra-operative imaging with a high field MRI on brain tumor resection. Methods: Since September 2006, a total of 23 patients with brain tumors underwent resection at The University of Texas M. D. Anderson Cancer Center with intra-operative MR guidance (BrainLAB IGS system integrated with a 1.5T Siemens Espree scanner). For each patient, appropriate imaging was performed prior to craniotomy. Resection was then performed using image guidance. Surgeons completed a questionnaire documenting the reason for the scan and provided an estimation of EOR prior to and after the intraoperative scan. Multiple intraoperative scans were performed at the discretion of the operating surgeon. Results: In 23 patients, 25 scans were performed. The patients had a diagnosis of glioma (21), lymphoma (1), and schwannoma (1). Reasons for performing a scan included: evaluate EOR in 23 (92%) or update the IGS system in 2 (8%). Surgeons indicated in 21/23 (91%) scans performed to evaluate the extent of resection that they would have terminated the surgery prior to the scan. In 9/21 cases (43%), further surgery was performed after the scan to maximize EOR. In 10/24 (42%) cases, the pre-scan estimate of residual tumor matched the post-scan amount. The amount of residual tumor was correctly assessed (within 10%) prior to review of the MRI in 19/24 cases. The correlation between the pre-scan estimation of residual tumor and actual post-scan tumor was high (correlation coefficient 0.81, p<0.05). Conclusions: High field intra- operative MRI with high spatial resolution is a useful adjunct to a neurosurgical oncology practice and alters surgical decision making in a significant number of cases. [Table: see text]