bluuebunny/crossref_metadata_2025_split huggingface dataset:
The predictive value of pretreatment 18-FDG- PET CT in locally advanced nasopharyngeal cancer patients treated definitively with induction chemotherapy followed by concurrent chemoradiotherapy.
Authors: EL Lathy Hala AHMED , Khder Gehan , Rostom Yousry , Refaat Tamer 
Published: March 2020

e17013 Background: This study aimed to evaluate the role of pretreatment [18F] fluorodeoxyglucose positron emission tomography (18F-FDG-PET) as a predictor of disease-free survival (DFS), and overall survival (OS) in locally advanced nasopharyngeal carcinoma (LANC) patients treated definitively with docetaxel-based induction chemotherapy followed by concurrent chemoradiation (CRT). Methods: After obtaining the institutional review board approval, we conducted a retrospective analysis of LANC patients (T1,N1-3 and T2-T4,anyN disease) treated definitively between January 2007 and December 2011 with induction chemotherapy docetaxel , cisplatin, and 5- flurouracil (TPF) followed by CRT utilizing weekly cisplatin and had pretreatment 18F-FDG-PET. We examined the association between the pretreatment primary tumor maximum standardized uptake value (SUVmax) and the treatment outcomes. The disease-free survival (DFS), and overall survival (OS) were calculated by the Kaplan-Meier method, and the differences were evaluated on logrank test. The prognostic significance was assessed by univariate and multivariate analyses. Results: The study included 38 eligible LANC patients. The 4-year OS and PFS rates were 94.9% and 84.7%, respectively. The median OS and PFS intervals were not reached. On univariate analysis, the 4-years DFS was significantly higher in patients with pretreatment SUVmax ≤ 8 compared to > 8 (92.3% vs 56%, P = 0.017). It was also significantly correlated to pretreatment T stage (P=0.001), N stage (P=0.011) and the treatment response (P < 0.001) and treatment breaks (P< 0.001). On a multivariate analysis, the SUVmax category was the only factor correlated with 4-year DFS (hazard ratio = 13.2, 95% C I 1.27-136.8, P= 0. 030) but not for OS (P = 0.068). Conclusions: This study shows that the pretreatment primary tumor SUVmax is a potential independent prognostic predictor of clinical outcomes in patients with LANC treated definitively with TPF induction chemotherapy followed by CRT. Further randomized controlled clinical III trials are needed to provide clear evidence of this benefit.
Key determinants of patient experience in oncology: Results from a national online survey.
Authors: Lis Christopher G. , Wood Steve , Rodeghier Mark , Taylor Harold , Grutsch James F. , Gupta Digant 
Published: March 2020

e17502 Background: Evaluation of patient experience provides important data on the patient’s perception of the quality of care and treatment delivered by physicians, paramedical staff and the hospital as a whole. There are limited data on the most significant determinants of patient experience in the oncology setting. In a national sample of cancer patients, we investigated the key self-reported factors influencing overall patient experience. Methods: A national random sample of 724 patients undergoing treatment for cancer in a hospital setting between Jan 2009 and Dec 2011. Using a combination of professional and scholarly literature and focus groups, the survey instrument was developed employing an identified set of 13 patient experience factors, an overall patient experience measure and relevant demographic variables. Patients were invited via messages appearing randomly on oncology-oriented physician profile pages, content pages and hospital profile pages from the Healthgrades web properties. Patients were asked to rate their cancer treatment experience on a 5-point scale from “very poor” to “very good” on the 13 patient experience factors. Participants were also asked to identify factors that contributed the most to their overall patient experience. Results: 181 were males and 543 were females. Age distribution was 5-24 (n=8), 25-44 (n=95), 45-54 (n=197), 55-64 (n=259) and 65+ (n=159). Top 5 tumor types were breast (n=284), gynecological (n=78), colorectal (n=47), lung (n=34) and prostate (n=28). Tumor stage at the time of receiving care was I, 210; II, 149; III, 133; IV, 128; and unknown, 104.481 (66.4%) patients were “very satisfied” with their overall experience. The three most important determinants of patient experience as reported by patients were "a compassionate team of care providers" (49.2%), "a knowledgeable, competent physician” (48.9%) and "treatment as a human being and not just a person with a disease" (28.3%). Conclusions: We identified three key determinants of overall patient experience in oncology. Oncology care providers can use data on patient experience to design and track quality improvement over time as well as recognize and expeditiously resolve unmet needs of patients in real-time.
Accelerating the clinical trial start-up process for early-phase cancer studies: A test of process change to support rapid activation in an academic medical center.
Authors: Hurley Sheilah K , Miller Therica M , Flores Stella Rebecca , Dunn Keren , Schroeder Ryan , Yatawara Mahendra , Figlin Robert A. , Mita Monica M. , Sandler Howard Mark , Piantadosi Steven 
Published: March 2020

e17507 Background: Clinical trial sponsors have strong scientific, financial, and regulatory interests in rapidly activating studies at participating sites. Academic medical centers have difficulty activating trials within a few weeks of sponsor agreement because, among other inefficiencies, they engage the necessary committee reviews, regulatory approvals, contracting, and budgeting in serial fashion. Incremental revisions in such workflows do not result in strong improvements. Methods: We redesigned our institutional workflow to complete clinical trial activation tasks within six weeks. Historical procedures were replaced rather than scrutinized. A high level leadership committee was required to change and integrate procedures across the medical center, and engage sponsors to improve their turnaround times. A web-based collaborative workflow tracking tool was created to help coordinate the necessary tasks and measure performance. Six clinical trials from the Cancer Center portfolio were used to test and improve the new workflow. Results: Clinical trial activation redesign took one year. For the six studies used as tests of change, the activation times were 49, 54, 78, 58, 62, and 32 days. Times in excess of 6 weeks were largely due to sponsor delays. Conclusions: Considerable effort is required to significantly alter a complex workflow like clinical trial activation. Appropriate priorities, leadership, staffing, and tools are required. Markedly shortened study activation for a small series of cancer trials taught our academic medical center lessons that will be useful for improving the process for all clinical trials, and will make us a better partner for pharmaceutical and academic sponsors as well as for investigator initiated research. [Table: see text]
The effect of cancer awareness month campaigns on internet search volume and incidence of cancer diagnoses.
Authors: Swenson Wade T. , Lindblom John M. , Reber John 
Published: March 2020

e17512 Background: Cancer awareness month campaigns are a health promotion tool used to increase public awareness about a specific cancer, its prevention, and treatment. Cancer awareness month campaigns could be most impactful in promoting awareness of cancers for which established screening guidelines exist. Currently, the United States Preventive Task Force endorses screening the general population for colon, cervical and breast cancers. We aimed to assess the effectiveness of campaigns by identifying internet search volume and monthly cancer diagnoses. Methods: GoogleTrends was utilized to identify the relative monthly volume of search terms from 2004 to 2009 as a proxy for public awareness. Search trends for“breast cancer”, “colon cancer”, and “cervical cancer” were analyzed and an average monthly search volume index (SVI) was determined. Surveillance, Epidemiology and End Result (SEER) data was analyzed during the same time period. These data were compared using Pearson's correlation coefficient and the chi square test for seasonality. The monthly trends were compared to corresponding cancer awareness month campaigns (breast cancer-October, colon cancer-March, cervical cancer-January). Results: Internet search volume was highest for colon cancer and breast cancer in the respective cancer awareness campaign months. The frequencies of breast cancer and colon cancer diagnoseswere not significantly higher in the respective cancer awareness months. Cervical cancer search volume and cancer diagnoses did not correlate with awareness campaign months. Search volume and cancer diagnoses were not well correlated for breast cancer (r=0.089) or cervical cancer (r=0.228); however, they were significantly correlated for colon cancer (r=0.386; p-value=0.0008). Conclusions: Cancer awareness month campaigns appear to raise public awareness as estimated by internet search volume for breast cancer and colon cancer. Cervical cancer awareness month campaigns do not have the same effect. There is no significant correlation between cancer awareness campaign months and cancer diagnosis incidence for either breast cancer or cervical cancer, whereas there is a significant correlation for colon cancer.
Disparities in breast cancer presentation and treatment of older women, by insurance status.
Authors: Ursem Carling , Kimmick Gretchen Genevieve , Anderson Roger T. , Hwang Wenke , Camacho Fabian 
Published: March 2020

e17516 Background: Disparities are known to exist in breast cancer outcomes by age and socioeconomic status (SES), but there is little data regarding these disparities in the elderly. We studied older women in North Carolina (NC) using insurance status as an indicator of SES. Methods: From the 1999-2002 NC Central Cancer Registry, we identified women age ≥65 years presenting with nonmetastatic breast cancer, having surgery within 60 days of diagnosis, no neoadjuvant therapy, and insured by Medicare only (M) or dual Medicaid/Medicare (dMM). Chi-square tests followed by Tukey Style Multiple Comparison of Proportions were used to compare baseline characteristics and treatment received. Multivariate analyses including age, race, Charlson comorbidity, tumor size, lymph node status (LN), ER/PR status, HER2 status, and relevant treatment components, were used to determine predictors of use of chemotherapy. Results: The study population, n=3088 with mean age 75 (SD 6.69) years, included 560 dMM and 2528 M insured women. In dMM, tumors were larger (23.5 mm vs 18.5 mm, p<0.001), more likely poorly differentiated (p=0.04), and node positive (p=0.004). dMM were significantly less likely to have breast conserving surgery (vs mastectomy, p<0.001), radiation therapy after surgery (<0.001), adjuvant chemotherapy (0.007), and adjuvant endocrine therapy (<0.001). Significant predictors of receipt of adjuvant chemotherapy were: for dMM, white race (OR 0.22, 95% CI 0.06-0.78), positive LN (vs negative LN; 6.00, 1.44-25.02); for M, age 65-69 (vs 75+; 7.43, 3.64-15.18), age 70-74 (vs 75+; 4.93, 95% CI 2.38-10.22), larger tumor size (1.73, 1.09-2.74), positive LN (9.25, 4.80-17.83), and ER/PR negative (4.98, 2.29-10.85). Conclusions: Breast cancers in low SES, older patients are higher grade, larger, and more advanced, yet they less often receive adjuvant chemotherapy. Future work should focus on interventions to increase receipt of standard of care treatment among this population.
Higher incidence and mortality rates of cervical cancer in African-American women in Louisiana.
Authors: Maronge Genevieve Folse , Wu Xiao-cheng , Chen Vivien , Li Xiangrong , Boulmay Brian C. , Loch Michelle Marie 
Published: March 2020

e17522 Background: Cervical cancer [CC] incidence in the United States has decreased over the last thirty years in black and white Americans, however it is recognized that black women [BW] have higher incidence and mortality rates than white women [WW]. We evaluated race-specific incidence of CC, mortality rates of CC, and HPV vaccine usage rates in Louisiana [LA] during the last decade, the state with the second highest proportion of black Americans in the United States [US]. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) registries were analyzed for trends in incidence and mortality rate [MR] in BW and WW in LA and the US. SEER 13 and SEER 18 data were used and standardized to the 2000 US population to estimate annual age-adjusted incidence and mortality rates. Results: The incidence of CC in WW in LA was 8.2 per 100,000 from 2006 to 2009, and 7.9 per 100,000 in WW in US. The incidence in BW in LA was 13.3 per 100,000, as compared to the US at 9.7 per 100,000, a 36% higher incidence in BW. The MR in WW in LA and the US was 2.4 and 2.2 per 100,000. The MR for BW in LA was 5.8 per 100,000 and the US was 4.3 per 100,000, a 37% higher incidence in BW. WW in LA and the US showed a peak in incidence between the ages of 35 and 45 from 2006 to 2009. The incidence in BW in LA peaked at 37.1 per 100,000 at age 85 and the incidence in BW in the US peaked at 25.6 per 100,000 at age 85. HPV vaccination rates for LA females ages 13-15 in 2008 and 2009 were 16.1% and 35.4%. Conclusions: BW in LA were twice as likely to be diagnosed with CC than WW with a higher MR. Though the incidence rate of CC is decreasing in WW and BW in the US and in WW in LA, it is increasing in BW in LA and continues to trend up throughout life in BW compared to WW. The high incidence of CC in BW in LA highlights the need to improve utilization of the HPV vaccine. A screening and treatment program targeting CC was implemented within the last decade in the LA public hospital system with the goal of reducing CC incidence and mortality.
Development of a practice consensus statement of the management of locally advanced breast cancer: Expert consensus and systematic review.
Authors: Leonard Robyn , Hogeveen Sophie , Han Dolly , Wong Audrey , Ebrahim Jalal , Rajmohan Yanchini , Boileau Jean-Francois , Gandhi Sonal , Lee Justin , Dinniwell Robert Edward , Brackstone Muriel , Simmons Christine E. 
Published: March 2020

e17526 Background: For locally advanced breast cancer patients (LABC), there are currently limited, if any, up-to-date protocol guidelines. The objective of this paper was to develop a consensus of opinion amongst Canadian oncologists, and to determine if Canadian oncologists agreed with the relevant literature. Methods: A modified Delphi survey protocol was used to determine consensus of opinion amongst 83 Canadian experts identified by peers as leaders in LABC. Consensus was defined as > 85% agreement. Concurrently, a systematic review of the literature was performed to identify randomized controlled trials (RCTs) in this field (limits imposed were “humans”, “English language” and “RCT”). The protocols utilized in the RCTs were compared to the results of the consensus survey to determine if expert opinion in Canada is evidence-based or experiential. Results: Consensus of opinion amongst experts was obtained across all areas of patient management except for use of MRI in the workup of patients with LABC. 81% stated MRI would be required prior to initiation of therapy and 68% stated repeat MRI would be required prior to surgical planning in cases where lumpectomy is considered an option. Expert consensus reflected the published literature well in the areas of: clinical assessment with caliper at each cycle, option of lumpectomy if good clinical response, radiotherapy to loco-regional lymph nodes, and no further adjuvant chemotherapy outside of a clinical trial if residual disease is found at the time of surgery. On most other aspects of patient management the Canadian consensus was more conservative than the published literature, except for the use of salvage radiotherapy in the setting of progression on therapy, where the literature was more conservative than the Canadian opinion. Conclusions: A national practice consensus has been developed for the management of LABC which reflects the published literature or is more conservative than the published literature. The only area of clinical equipoise nationally is on the utility of MRI both pre and post neoadjuvant therapy. A further study assessing the appropriate role of MRI clinically in the treatment of LABC patients is warranted.
Cancer of unknown primary (CUP): A population-based analysis of temporal change and socioeconomic disparities.
Authors: Urban Damien , Rao Aparna , Bressel Mathias , Lawrence Yaacov Richard , Mileshkin Linda R. 
Published: March 2020

e17535 Background: CUP is the 4th most common cause of cancer death. With advanced diagnostic investigations and treatment of cancer, we hypothesized that the proportion of cancers diagnosed as CUP and survival outcomes of CUP have changed and examination of these changes may identify socioeconomic disparities in the US. Methods: We analysed trends in CUP diagnosis and outcome within the SEER registry between 1973-2008. The relationship between demographic and tumour characteristics with survival was investigated. Results: The incidence and percentage of all cancers diagnosed as CUP have decreased over time (incidence 8.9 vs 6.2 per 100,000 and percentage 3.9% vs 1.9% of all cancer diagnoses in 1973 vs 2008 respectively). Significantly more females were labelled as CUP without a pathological confirmation (25% vs 20% in males, p<0.001). A higher proportion of CUP was diagnosed in females, blacks and residents of less affluent or less educated counties. The 5 year survival significantly improved in those with squamous histology (SqC) but only marginally in those with non-SqC CUP. The improvement in survival over time within SqCC was more pronounced among some socioeconomic groups (SEG; Table). For the entire cohort, factors associated with a longer survival on multivariate analysis included: white race; female; <65 years old; most recent decade at diagnosis; grade 1; SqC; married; a histologic diagnosis and treatment with radiotherapy (all p<0.001). Despite the improvement in survival with radiotherapy (RT), the use of RT was less frequent in females and blacks. Conclusions: The percentage of cancers diagnosed as CUP is decreasing but prognosis remains poor, particularly in non-SqCC CUP. However, significant disparities in the diagnosis and survival between SEG exist, suggesting inequalities in access to diagnostic investigations and treatment. [Table: see text]
Antiemetic prescribing practices using a computerized physician order entry system.
Authors: Kadakia Kunal C. , Leal Alexis D. , Seisler Drew K. , Qin Rui , Fee-Schroeder Kelliann C. , Grendahl Darryl , Sorgatz Kristine , Loprinzi Charles L. 
Published: March 2020

e17538 Background: Adherence to guideline-consistent chemotherapy-induced nausea and vomiting (CINV) prophylaxis is suboptimal. The primary aim of this study was to evaluate the magnitude of compliance to institutional guideline-directed antiemetic prophylaxis using a computerized physician order entry system at a single tertiary care institution. A nurse survey was also performed to evaluate how oncology practices, within a cooperative group, manage clinician orders for the prevention of CINV. Methods: The electronic medical records of 100 consecutive patients were evaluated. The primary endpoint was the incidence of compliance to provide all aspects of institutional guideline-directed antiemetic prophylaxis for acute (Day 1) and delayed (Days 2-4) CINV for patients receiving high, moderate, low, and minimally-emetogenic chemotherapy (HEC/MEC/LEC/MinEC). Noncompliance was declared if a recommended antiemetic was not prescribed per the guidelines or if additional antiemetics were prescribed. Descriptive analyses were performed on the convenience sample. Logistic regression was applied to determine the association of potential factors with noncompliance. Results: The incidence of compliance on Days 1-4 was 94%. Half of the noncompliant events occurred on Day 1 alone and involved the omission of pre-chemotherapy prochlorperazine in patients receiving LEC (3 of 6, 50%). There was a high-degree of compliance to institutional guidelines for delayed CINV (97%). Patients receiving doxorubicin/cyclophosphamide were numerically less likely to receive institutional guideline-directed antiemetic prophylaxis, compared to patients receiving other chemotherapy regimens (OR: 0.24 (0.04, 1.36), p-value: 0.05). No other factors were significantly predictive for compliance. The nurse survey demonstrated significant variability amongst the involved institutions, with regards to antiemetic prescribing practices. Conclusions: Computerized physician order entry is associated with impressive adherence to clinician prescribing practices, according to institutional guideline-directed antiemetic prophylaxis, for preventing acute and delayed CINV.
A national treatment survey on the chemotherapy (CTX) treatment for patients (Pts) with metastatic breast cancer (MBC) in Germany.
Authors: Jackisch Christian , Untch Michael , Dall Peter , Thomssen Christoph , Albert Ute-Susann , Lueck Hans-Joachim , Bauerfeind Ingo , Scharl Anton J. ,   on behalf of AGO Organkommission Mamma
Published: March 2020

e17544 Background: The optimal CTX regimens and their sequence is the subject of ongoing debates esp. on the use of anthracycline/taxane (AT)-based adjuvant therapy (tx). Methods: Since 2004 a biennial survey is performed to evaluate routine CTX practice in MBC A total of 1,966 German sites were contacted. From 515 (26.2%) patient data were used for evaluation in order to achieve a representative sample for a chart review between June and August 2012. The current analysis is based on data from 291 sites on characteristics and tx of 741 pts undergoing first (1L), second (2L) or third (3L) line CTX for MBC in May 2012. Results: Data from 417 pts in 1L, 203 pts in 2L, and 121 pts in 3L were evaluated. Median age was 60 years (yrs). Patient characteristics were: 74% hormone receptor positive, 24% HER2-positive at primary diagnosis, 67% premenopausal, 60% had metastases in ≥ 2 organs, 66% had visceral disease. Prior tx (excluding M1 pts) was: no systemic tx 10%, endocrine tx only 13%, adjuvant CTX 58% (40% A and 44% AT-based), neoadjuvant CTX 20% (12% A and 75% AT-based). Median time from primary diagnosis to start of any treatment for MBC was 4.5 yrs for node-negative and 2.1 yrs for node-positive disease. Median time from primary diagnosis to current CTX was 4.9 yrs in 1L, 5.1 yrs in 2L and 5.8 yrs in 3L. Combination CTX was given in 21% of 1L, 12% of 2L and 9% of 3L pts, and its use decreased with increasing age. Agents used most frequently in 1L were taxanes in 61% (paclitaxel (P) 52%, docetaxel (D) 6%, nab-paclitaxel (Nab) 3%), capecitabine (X) 21%, vinorelbin (V) 19%, Epirubicin 6%, carboplatin 5%. 1L taxane tx was given to 73% of pts with prior A-based and 46% of pts with prior AT-based (neo-)adjuvant tx. Agents used most frequently in 2L were X 31%, P 20%, V 20%, gemcitabine (G) 7%, Nab 6% and in 3L V 27%, X 22%, eribulin 15%, Nab 12% P 7%, G 5%. Targeted tx was given in 54% of pts (20% trastuzumab, 4% lapatinib, and 30% bevacizumab), additional tx were bisphosphonates in 58%, and radiotherapy in 20%. Conclusions: The survey showed a high concordance of routine treatment and the existing national guidelines regarding CTX. Taxanes still dominate CTX in MBC including a significant amount of taxane rechallenge after their use in (neo-)adjuvant tx.