bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of intravenous morphine for breakthrough pain in terminal cancer patients admitted to hospice center.
Authors: Chung Ik-Joo , Cho Sang-Hee , Hwang Jun-Eul , Ahn Jae-Sook , Choi Won-young , Shim Hyun-Jeong 
Published: March 2020

e20621 Background: The adequate opioid dose to be administered for breakthrough pain(BTP) is still controversial. Dosing recommendations are based on patient’s(pts) total daily opioid dose. Intravenous morphine(IV-M) has been found to be effective and safe for the management of BTP. However, physicians are often reluctant in using large doses of IV-M because of the possible adverse events in terminal cancer pts. The aim of this study was to evaluate whether pts were treated appropriately for their BTP in hospice setting. Methods: A total of 94 consecutive terminal cancer pts who were admitted in the Hospice and Palliative Care Clinic at Jeonnam Regional Cancer Center from June 2012 to Nov 2012 were analyzed in this study. Results: In total, 1,213 BTP events treated by IV-M were recorded and the mean number of events per pts was 13.6 (95% confidence interval (CI) 10.5-15.4). The mean dose of IV-M was 13.9mg (95% CI 12.5-14.5mg, range 3-90mg) and was equivalent to 7.1% of the total daily opioid dose. For each episode, pain intensity and opioid-related symptoms were recorded at the base (T0) and within 30 minutes after (T1). Pain intensity decreased from a mean of 5.1(on a 0-10 numeric scale) at base to 1.8 at T1. A decrease in pain of more than 30%, 50% and 70% was observed in 1179 (97.2%), 958 (78.9%) and 460 (37.9%) BTP events, respectively. In 21 episodes, no changes in pain intensity were observed and a further dose of IV-M was given. Doses of more than 10mg, 30mg and 50mg of IV-M were given for 456 (37.6%), 200 (16.5%) and 104(8.6%). No differences in age, sex and pain location were found. Adverse effects were uncommon, moderate nausea/vomiting in 32 episodes, drowsiness in 15 episodes, and confusion in one episode. Conclusions: In the current study, IV-M was safe and effective for almost all episodes of BTP. This study shows that IV-M did not result in life-threatening adverse effects in terminal cancer pts, including older pts and those requiring relatively large doses.
Daily assessment of quality of life during 100 courses of radiation: Pain, anxiety, problems or concerns, and need to see physician.
Authors: Howell David D. 
Published: March 2020

e20625 Background: Patients (Pts) undergoing radiation therapy (RTRx) may have pain, anxiety, distress or other symptoms impacting on quality of life (QOL) at the time of initiation of RTRx. Pts may also develop (or have an exacerbation of) one or more of the above during RTRx. During RTRx, pts are seen at least weekly by the treating physician (MD), and are seen daily by the treating radiation therapy technologists (RTT). Pts may develop problems between weekly MD visits which may benefit from MD interventions. A system was developed where pts would be asked four questions (4?) to assess QOL each treatment day by the RTT: 1) Are you having pain, and if so, how would you rate it on a scale of zero to 10? (PainQ); 2) Are you having anxiety or distress today? (ADQ); 3) Are you having new problems or concerns? (ProConQ); 4) Do you want to see the physician today? (CMDQ). This information was used in pts management. Methods: 100 RTRx courses were reviewed for demographics including gender, age, primary malignancy, region treated, # of visits and total RTRx dose, as well as detailed information from the 4? instrument. Results: Of the 100 pts, 56 were male. Disease distribution: Breast-22; Prostate-20; Head and Neck-20; Lung-13; Brain-7; Other-18. For the ADQ, 83 did not report anxiety or distress; 17 reported anxiety on one or two occasions. For the ProConQ, 35 reported none, 34 reported yes on 1 or 2 occasions, 22 reported yes on 3 to 5 occasions, and 9 reported yes on greater than five occasions; 29 reported yes on 2 days in a row, and 15 reported yes to problems or concerns on 3 days in a row. For the PainQ, 31 reported no pain throughout RTRx, with 22, 23, and 25 reporting pain of any magnitude for 1 to 5, 6 to 10, and greater than ten days, respectively. 22 reported pain greater than 6 on at least one occasion. For CMDQ, 26 of pts did not request additional visits, 71 and 3 requested to see the MD an additional 1 to 5, and 6 to 10 times. Conclusions: A simple instrument prompting a 4? QOL query to pts undergoing RTRx may prompt the need for further evaluation and interventions between scheduled MD visits. This may facilitate more expeditious interventions for RTRx related toxicity as well as for treatment dependent or independent QOL symptoms and needs.
Paulinia CUPANA (PC) (GUARANÁ) dry extract for breast cancer (BC) women with HOT flashes (HFS): Results of a PILOT study.
Authors: Del Giglio Auro , del Giglio Adriana Braz , silva Oliveira Saulo , Zanellato Rebecca Melo , Cavicchioli Livia tiemi , Reifur Lucas , Lerner Tatiana Goberstein 
Published: March 2020

e20631 Background: HFs are very disturbing for BC patients, affecting about two thirds of them. PC is an amazonic plant that was shown to have anti-fatigue activity for BC women undergoing chemotherapy. Methods: we included BC women at least 3 months after finishing their treatment with at least 14 HFs per week. Patients received 50 mg PO of PC dry extract twice daily for 6 weeks. We assessed both HF frequency and its severity and patients graded their own toxicities weekly. We employed a phase II Simon design in which 9 out of 15 patients would be required to have at least a 50% decrease in their HF severity score. Results: We included 24 women with a median age of 50.2(36-65). Only 18 started PC and 15 completed the 6 weeks of the study. Three patients declined participation right after starting PC for difficulty in participation and for noncompliance. Ten out of 15 patients had a more than 50% decrease in their HF severity score. Throughout the 6 weeks of treatment we observed statistically significant decreases in HFs number (p =0.0331) and Severity Scores (p=0,0039). As compared to week 0, patients reported worsening of anorexia (1), insomnia (1), nausea (1), fatigue (1), sweating (1), constipation (1), anxiety (1), humor change (1) and headache (1). None of these toxicities warranted discontinuation of the study. Conclusions: We conclude that PC was effective for HF control achieving the pre-specified threshold with acceptable toxicity and warrants further confirmatory studies.
Utilization of intravenous bisphosphonates (IVBs) in patients with bone metastases (BMets) secondary to breast, lung, or prostate cancer (BC, LC, PC).
Authors: Hagiwara May , Cong Ze , Chung Karen , Delea Thomas E. 
Published: March 2020

e20665 Background: Cancer patients with BMets are predisposed to skeletal complications. Bone targeted therapies such as denosumab or IVBs reduce the risk of these complications. The objective of this study was to characterize patterns of IVB use in these patients. Methods: This was a retrospective, observational study using the Thomson MedStat MarketScan Commercial and Medicare databases (9/02 - 6/11). Subjects were all persons with ≥1 claim with a diagnosis (Dx) of BC, LC, or PC and ≥1 claim with a Dx of BMets. The date of first BMet Dx claim was the “index date”. Key exclusion criteria were Dx of other primary cancer, receipt of IVB pre-index, or <6 mos continuous enrollment pre-index. Cumulative incidence of treatment initiation (first IVB claim, death as competing risk), interruption (gap of >60 days between IVB claims, discontinuation as competing risk), and discontinuation (last IVB claim) were analyzed. Results: Cumulative incidence of initiation of IVB at 12 mos post-index was greatest for BC followed by PC and LC (Table). IVB treatment interruption at 12 mos ranged from 16% (LC) to 31% (PC). IVB treatment discontinuation at 12 mos ranged from 46% (BC) to 83% (LC). Cumulative incidence of initiation of IVB at 12 mos declined with age in all tumor types: e.g., in BC, from 62% at age<50 years to 47% at age 75+ years. Conclusions: IVBs are used more frequently in patients with BMets secondary to BC than PC or LC. Many patients interrupt or discontinue IVB therapy within 12 mos. of initiation, potentially impacting effectiveness. [Table: see text]
Toward integration of palliative care into cancer care: A study on profile of psychosocial and clinical complications among attendees of a Nigerian oncological center.
Authors: Olagunju Andrew Toyin , Aina Olatunji Francis , Olagunju Tinuke Oluwasefunmi , Sarimiye Foluke Oladele 
Published: March 2020

e20675 Background: The integration of palliative care into cancer management is abysmal in this context and paucity of empirical evidence constitutes constraint for policy formulation and their translation into cancer care. This study assessed psychosocial and clinical complications among Nigerian cancer subjects. We postulated the interplay of psychosocial and clinical factors would constitute evidence for palliative care. Methods: This is an observational study among 200 adult participants with histological diagnosis of cancer recruited using systematic random sampling. Eligible participants were interviewed by the researchers using socio-demographic/clinical profile questionnaire, Centre for Epidemiological Studies Depression Scale Revised (CES-DR) and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Data analyses were done using SPSS-15. Results: The commonest type of malignancy was breast cancer (51.0%); cervical cancer 29.5%, colorectal and prostatic cancers were 10.5% and 9.0% respectively. Slightly less than half (49.0%) of subjects had advanced cancer. Most subjects (36.5%) had symptoms for over a year at presentation. Two-thirds (66.0%) had pain, 52% had weight loss and 20.0% had external ulcer. Ninety-eight (49.0%) subjects had depressive symptomatology (CES-DR score ≥16), while prevalence of depression based on SCAN was 27.5%. Depression was significantly associated with higher educational status (p=0.003), unemployment (p=Ÿ0.004), unmarried status (p=0.004), advanced cancer stage (p=0.006), longer duration of cancer (p=0.048), pain (p<0.001), physical complications (p<0.001). However, unmarried status, unemployment, pain and duration of cancer still correlated with depression following logistic regression. Conclusions: In this study, preponderance of physical, psychosocial complications, advanced stage illness and high symptoms burden suggest that integration of palliative care into cancer management should be the rule rather than exception. Lastly, further research on palliative care with translation of resulting research based evidence into cancer care is implied.
Application of multiphoton/CARS tomography for detecting early stages of chemotherapeutically induced dermal side effects.
Authors: Lademann Juergen , Patzelt Alexa , Zastrow Leonhard , Chekerov Radoslav , Sehouli Jalid , Weinigel Martin , Koenig Karsten , Darvin Maxim E. 
Published: March 2020

e20688 Background: A wide variety of chemotherapeutics is available for systemic cancer therapy. Many of them are known to induce dermal side effects (DSE), although the pathomechanisms often remain unclear. Recently, it was found that pegylated liposomal doxorubicin (PLD) is delivered to the skin via the sweat. The palmar and plantar region provides the highest density of sweat glands and the thickest stratum corneum serving as reservoir, and thus seems to be the predestined area to develop a palmar plantar erythrodysethesia (PPE). Due to its specific fluorescent properties PLD is easily detectable. DSE can also be induced by other chemotherapeutics, however, as there are lacking fluorescence properties, the pathomechanism is difficult to verify. In the present study, a multiphoton/CARS (coherent anti-Stockes Raman scattering) tomograph was used to detect early stages of skin inflammation during therapy with various chemotherapeutics. Methods: The investigations involved 12 patients under chemotherapy with e.g., capecitabin, docetaxel and 5 FU. The patients had a history of 2 to 4 cycles of chemotherapy and were free from clinical signs of DSE at the time of investigation. An internationally unique system was used combining multiphoton tomography permitting cellular structures to be clearly imaged without contrast agents and CARS microscopy which detects lipids. Results: In the present study the lipid structure of patients under chemotherapy was compared to that of healthy volunteers determined in preliminary investigations. While no inflammation was visible on any patient’s skin surface, pathological changes were detected in deeper lipid structures revealing an early stage of DSE. Conclusions: Changes in the lipid structure are independent of the applied chemotherapeutic and imply an early stage of an inflammatory process. Thus, multiphoton/CARS tomography permits early DSE diagnostics before pathological changes manifest themselves on the skin surface. The method is suited to investigate the pathomechanism of DSE of various chemotherapeutics and can help to develop prevention measures such as the topical application of antioxidants during chemotherapy as proposed for PPE.
A new model of early supportive care and symptoms management: The experience of Pisa medical oncology.
Authors: Antonuzzo Andrea , Vasile Enrico , Lucchesi Maurizio , Ginocchi Laura , Galli Luca , Brunetti Isa Maura , Ricci Sergio , Falcone Alfredo 
Published: March 2020

e20711 Background: Recent advances in medical oncology research and new possibilities of care create a growing number of treatment-related complications. Due to these clinical relevant toxicities a significative number of patients have to admit to our hospital emergency rooms in the recent years. Data from different institutions in Italy suggest that an integrated model of supportive care dedicated to symptoms management and not only, is more effective for cancer patient’s care. Methods: In the last seven months of 2012 we started the “supportive care-team” activity giving a dedicated-room inside the day hospital offering to the patients a direct and early management of chemotherapy toxicities (mucositis, febrile neutropenia, etc.) and “new drugs” induced toxicities (cutaneous, hypertension/cardiovascular, infective, etc.). The medical and nurse team does receive the patient without appointment, based on the severity of clinical problems and give a mobile phone consult all days in the morning. Patients receive symptomatic therapy, i.v. fluid infusions, collecting of blood samples, corrections of medical therapies (e.g. pain therapy), venous accesses management for one-day or more until resolution and physicians are able to organize further specialists evaluations. Moreover, there are strictly linked specialists such as anesthesiology involved in all cases of severe drugs adverse reactions. Other two ancillary support activities the for patients are offered by the psychologist and chaplain daily inside the day hospital. Results: During all 2012 we have delivered 13.365 courses of anticancer therapies in 1,358 patients. All these were outpatients. During the last 7 months of 2012 we have made 761 unplanned visits (median number/day 6, range 0-13) and the team did respond to 1,138 phone calls (median number/day 9, range 2-24). Conclusions: These analysis does attempt to answer to the main question of reducing hospitalizations and their related costs. Our new organizative model prompt to maintain much more the management of oncologic patients inside the oncologic department and to increase the feasibility of patient’s continuos care, improving symptoms control and patient’s quality of life.
Phase III study of NEPA, a fixed-dose combination of netupitant (NETU) and palonosetron (PALO), versus PALO for prevention of chemotherapy-induced nausea and vomiting (CINV) following moderately emetogenic chemotherapy (MEC).
Authors: Aapro Matti S. , Rossi Giorgia , Rizzi Giada , Palmas Marco , Grunberg Steven 
Published: March 2020

LBA9514 The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Saturday, June, 1, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
Integrating concept maps into a medical student oncology curriculum.
Authors: Brondfield Sam , Seol Allen , Hyland Katherine , Teherani Arianne , Hsu Gerald 
Published: March 2020

10506 Background: Proliferating knowledge domains have prompted medical schools to reconsider how best to facilitate multidisciplinary learning. Concept maps promote knowledge retention and integration; however, the feasibility and utility of integrating concept maps into a medical student oncology curriculum as a learning and assessment tool have not previously been described. Methods: In 2015-2016, all 152 second-year University of California, San Francisco (UCSF) medical students in a hematology/oncology course produced a concept map about a single cancer type over four weeks. Two of three graders independently scored each map using a standard rubric. We used linear regression to calculate the Pearson correlation coefficient between graders and between concept map scores and preclinical examination scores, USMLE Step 1 scores, and clerkship grades. We sent course evaluations to 50 randomly selected students (as is typical in the UCSF curriculum) and performed an inductive content analysis of open-ended comments about concept mapping. Results: We graded all 152 concept maps. Inter-rater reliability was excellent ( r = 0.95 or greater between the graders). Concept map scores did not correlate with preclinical or clinical performance. 43 of 50 students (86%) rated the helpfulness of concept mapping on a 5-point agreement scale (1=strongly disagree; 5=strongly agree). The median rating was 3, and the mean (SD) rating was 2.81 (1.44). 22 of 50 (44%) students submitted comments about concept mapping. Some (9 of 22) found concept mapping useful, expressing themes such as “learning the material better” and delving into the “details.” Others (7 of 22) did not, expressing themes such as preferring “other study methods” and feeling that concept mapping was “busy work” or “stressful.” Conclusions: Integrating concept maps into a medical student oncology curriculum was feasible, and we demonstrated reliability evidence as an assessment tool. Future studies should explore whether integrating concept maps earlier in medical school, producing multiple concept maps over time with training and feedback, or developing concept maps collaboratively may increase utility as a learning and assessment tool.
TeamX integrative oncology scholars: Harnessing the potentials of students in shaping oncological care.
Authors: Hung Kin Wai (Tony) , Hui Ka-Kit , Kim Irene S. , Busch Silvia Orvietani 
Published: March 2020

10516 Background: Teams are critical in delivering patient-centered care amid the challenge of health care workforce shortages. While conventional team-based collaborative care model involves physician and non-physician professionals, roles for pre-professional students in teams are largely educational and arguably underutilized. Methods: In a collaborative effort with the University of California Los Angeles (UCLA) Center for East West Medicine (CEWM), TeamX Health, a 501(c)3 nonprofit organization, designed an innovative, team-based curriculum for pre-professional students with our aims to harness the potentials of students in shaping the present and future delivery of oncological care. Over a 10-week academic quarter, students are challenged to explore the evolving evidence-based specialty of integrative oncology, and delivered as a “capstone project”, a creative solution to problems facing cancer patients today. Results: From April 2018 through October 2018, two 6-student cohorts have completed the curriculum. 10 participants (83%) were undergraduates and 2 (17%) were post-graduate alumni. Participants were selected based on a competitive application process with commitment to engage in the 2-hour weekly learning session. Sessions were taught in team-based learning format, covering topics ranging from cancer prevention, survivorship, symptoms management, nutrition, complementary therapies, integrative medicine models, and informatics. At completion of the curriculum, cohort one launched a health promotion YouTube channel addressing the physical and emotional burden for cancer survivors, and cohort two published a website for patients and caregivers to share their cancer journey serving as a greater social support platform. Conclusions: Redesigning the educational experience for pre-professional students may unlock unexpected possibilities to shape how we learned from and care for our patients. Harnessing the potentials for all levels of stakeholders ought to be part of defining team-based collaborative care.
Creation and development of the National Cancer Control Plan in Russia.
Authors: Petrovsky Alexander , Tjulandin Sergei , Tryakin Alexey , Stilidi Ivan S. , Davydov Mikhail , Avksentieva Maria , Ledovskih Yulia 
Published: March 2020

10524 Background: The absence of the National Cancer Control Plan (NCCP) did not allow to develop оncology in Russia. Methods: Since 2015 experts of the N.N. Blokhin Russian National Comprehancive Center and Russian Oncology Association has initiated the creation of a National Anti-Cancer Strategy. Results: In 2016, the working group presented the first version of this Strategy to the professional community for wide discussion, which was transferred to the Russian Ministry of Health after a broad discussion in 2017. This strategy included prevention, screening, early diagnosis, treatment, rehabilitation and palliative care in patients with malignant tumors. In parallel, we created National Clinical Cancer Guidelines, which were approved by the professional community, and then we submited them to the Ministry of Health in 2017. Also in the period of 2017-2018, updated principles of creating clinical and statistical groups (CSG) were developed based on the calculation of the real costs of each type of surgery, radiation therapy and drug treatment. More than 1,000 different standards we established for each case of hospitalization and their cost has been calculated. Then, based on these calculations, we ranked four types of treatment (surgery, radiation therapy, chemotherapy and chemoradiation), each of which has 3, 5, 10 and 6 levels, respectively. These calculations formed the basis of the NCCP approved by the Government and the President starting from 2019 with an unprecedented additional level of funding of almost 1 trillion rubles (an increase of almost two times). The major goal of the Russian NCCP is to decrease mortality level from 202 to 185 (8,5%) per 100 000 population by the year of 2024. Conclusions: The еffort of the professional community with due consideration and consolidation with the Ministry of Health allows implementation of the NCCP on a national level.