bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of perfusion computed tomography (CTp) for pretherapy assessment and induction chemotherapy monitoring (IC) in patients with squamous cell carcinoma (SCC) of the head and neck
Authors: Petralia G. , Preda L. , Chiesa F. , Nolè F. , d'Andrea G. , Giugliano G. , Verri E. , Cossu Rocca M. , Bellomi M. 
Published: August 2020

e17015 Background: Reliable assessment of the response to IC is required to stratify further treatments, as responders are considered the best candidates for organ preservation strategies. We evaluated the role of CTp for pre-therapy assessment and IC monitoring in patients with SCC of the head and neck. Methods: From November 2004, 28 consecutive patients with locally advanced SCC of the head and neck were enrolled, undergoing CTp and volumetric CT before and after IC with cisplatin, administered at a dose of 100 mg/m2 iv, on day 1, and 5-fluorouracil, administered at a dose of 1,000 mg/m2 ci from day 1 to day 5, q3wks for 2 or 3 cycles. Perfusion parameters were calculated for tumor: blood flow (BF), blood volume (BV), mean transit time (MTT) and capillary permeability-surface (PS). The Wilcoxon rank sum test was used to test for differences in the pre-therapy perfusion parameters between the different tumor grades, as well as between responders and nonresponders to IC. The post-therapy perfusion parameters were compared with the pre-therapy ones by the Wilcoxon signed rank test and percent changes in perfusion parameters were correlated with percent changes in tumor volume calculated by volumetric CT after IC by the Spearman correlation coefficient. Results: Pre-therapy BF was significantly higher in G3 tumors, compared to G1 and G2 (p = 0.01) and G2 tumors (p = 0.03), and pre-therapy BV significantly higher in responders than in nonresponders (p = 0.01). Of the 20 patients who underwent post-therapy CTp, the 17 responders had significant reduction of BF (p = 0.003) and BV (p = 0.014) and increase of MTT (p = 0.04) in the post-therapy CTp, whereas the 3 non responders no significant changes in perfusion parameters. In the 17 responders, percent reduction in BF and BV showed correlation (Spearman R = 0.71, p = 0.0013 and R = 0.82, p = 0.00005, respectively) with percent reduction in tumor volume after IC. Conclusions: In our cohort of patients with SCC of the head and neck, CTp showed potential for pre-therapy assessment, as well as for IC monitoring; further studies are required to confirm our preliminary results. No significant financial relationships to disclose.
Can serial PET/CT imaging during and after chemoradiation treatment assist in individualizing therapy for patients with squamous cell cancer of the head and neck?
Authors: Greven K. 
Published: August 2020

e17022 Background: PET/CT imaging with FDG has the potential advantage over conventional imaging of demonstrating metabolic changes in tumors early in the course of chemoradiation which may aid in individualization of therapy for patients. Methods: Sixteen patients with stage III/IV head and neck cancer were prospectively entered on a study to evaluate the role of PET/CT between March 2006 and July 2007. Enrolled patients were treated with chemoradiation (CRT) and had a series of 5 PET/CT scans in the treatment position at the initiation of therapy, 2 and 4 weeks after initiation of chemoradiation and then 6 weeks and 3 months after completion of treatment. The max standard uptake values (SUV) were recorded in the primary tumors. In addition CT imaging was examined and the maximum dimensions of the primary tumor were recorded. Results: Three patients have recurred at the primary site and follow-up ranges from 15–30 months. Twelve patients had decreasing SUV 2 weeks after initiation of CRT, one stayed the same, and two increased. The change ranged from a 75% decrease to a 21% increase compared to the initial scan. All patients had stable or decreasing SUV 4 and 6 weeks after initiation of therapy (range: 0 to 100% decrease). The change in SUV at 2 weeks, 4 weeks, post RT 6 weeks and 3 months compared to baseline for the 3 patients with local recurrence and the 13 patients who remain disease free were -7%, -62%, -50%, and -16% compared to -34%, -62%, -77%, and -81%, respectively. Higher PET values were significantly associated with a higher risk of recurrence (p = 0.04). In contrast CT imaging demonstrated that tumor measurements at 2 weeks, 4 weeks, post RT 6 weeks, and 3 months steadily decreased in both groups with mean changes in the recurrence group and in the locally controlled group of -11%, -46%, -77%, and -100% and -47%, -57%, -73%, and -99%, respectively. CT measurements were not associated with the risk of recurrence (p = 0.72). Conclusions: Changes in SUV from PET/CT were significantly predictive of tumor recurrence compared to CT imaging alone. If this observation can be verified in a larger cohort of patients, individualization of treatment based on PET/CT changes may be possible in order to improve outcomes for these patients. No significant financial relationships to disclose.
ERCC-1 (E) expression and its effect on survival in patients (pts) receiving concurrent cisplatin (C) and radiation (R) for locally advanced head and neck cancer (HNC)
Authors: Lan C. T. , Amirkhan R. H. , Gray T. , Xie Y. , Dowell J. E. 
Published: August 2020

e17033 Background: E is a DNA repair gene involved in the nucleotide excision repair pathway. Overexpression of E has been associated with resistance to C in patients with ovarian, gastric, and lung cancer. We retrospectively analyzed tissue from HNC pts who received concurrent C and R to determine if E expression was a significant independent predictor of survival. Methods: Eligible HNC pts had squamous cell histology and received definitive concurrent C and R at the Dallas VAMC. Tissue was immunostained for E using ERCC-1,clone 8F, 1:100 dilution (Abcam, Cat#ab2356, Cambridge, MA) diluted in ChemMate buffer (Ventana Medical Systems, Tucson, AZ) on a BenchMarkXT automated immunostainer using the UltraVIEW system with horseradish peroxidase and diaminobenzidine (DAB) chromogen (Ventana Medical Systems, Tucson, AZ) per the standard protocol of the UT Southwestern Pathology Immunohistochemistry Laboratory. E scoring was determined by 2 pathologists blinded to clinical outcomes. Scoring was as follows: 0 = 0% of tumor nuclei were positive, 1+ = less than 50%, 2+ = 50–75% and 3+ = 75–100%. Results: 73 consecutively treated patients were analyzed. Median age 59 (range 41 - 80); 99% male; 7% stage II, 19% stage III, 73% stage IV; primary site - 4% oral cavity, 56% oropharynx, 14% hypopharynx, 23% larynx, 3% nasopharynx; Tumor grade - 60% moderately differentiated, 4% well differentiated, 15% poorly differentiated, 21% not specified; Performance status 0–25%, 1–45%, 2–8%, unknown-22%; E scoring was 0 in 0%, 1+ (14%), 2+ (42%), 3+ (44%). In univariate analysis, E staining 3+ was not predictive of survival with a hazard ratio (HR) of .796 (95% CI .44–1.43; p = 0.44). In multivariate analysis, the only significant predictor was hypopharynx with a HR of 3.18 (95% CI 1.02–9.88; p = 0.046). HR for age > 60 was 2.16 (95% CI .96–4.86; p = 0.06). E staining 3+ was not predictive of survival with a HR of .69 (95% CI .3–1.56; p = 0.37). Median survival (MS) for the whole group was 2.8 years (y); 5y survival - 41%. MS for the E 3+ pts - 2.1y; 5y survival 38%. MS for the E < 3+ pts - 2.9y; 5y survival 44% (p = not significant). Conclusions: In our retrospective review of HNC patients receiving concurrent C and R, E staining was not a significant predictor of survival. No significant financial relationships to disclose.
VTE prophylaxis across the continuum of care in U.S. cancer patients
Authors: Amin A. , Lin J. , Ryan A. 
Published: August 2020

e17510 Background: The period of VTE risk in cancer patients extends beyond the hospital stay. This analysis evaluated VTE prophylaxis patterns for US cancer patients across the continuum of care. Methods: Premier's Perspective inpatient data were cross-matched with Ingenix LabRx outpatient data from the I3 database (January 2005-December 2007) to assess VTE prophylaxis patterns in medical cancer patients at risk of VTE (according to the American College of Chest Physicians 2004 guidelines) and with no contraindications for anticoagulation. Inpatient anticoagulant groups were assigned based on the drug the patient received during hospital stay and were followed by their outpatient prophylaxis use. Patients were evaluated on drug utilization, diagnoses and clinical practice patterns during and after hospitalization. Results: Overall, 75.3% of 2,337 cancer patients did not receive anticoagulation during their hospital stay. Of the 577 patients receiving prophylaxis, 66% received UFH and 25% received enoxaparin ( Table ). The mean length of hospital stay was 3 days after which 97.9% of patients did not receive any prophylaxis within the following 30 days. Of the 50 patients who received outpatient prophylaxis, 60% received warfarin alone and 22% received both enoxaparin and warfarin. Conclusions: This unique analysis presents VTE prophylaxis patterns across the continuum of care. Most cancer patients did not receive anticoagulation in the inpatient or outpatient settings. Further efforts are needed to identify optimal VTE prevention in cancer patients, namely the duration of prophylaxis and how healthcare providers can increase awareness. Financial and editorial support was provided by sanofi-aventis US, Inc. [Table: see text] [Table: see text]
Systematic review of research trends in cancer cachexia: Insights from the literature and funding agencies
Authors: Braiteh F. S. , Pratt G. , Kurzrock R. , Bruera E. 
Published: August 2020

e17540 Background: Cancer cachexia affects about 250,000 patients in the US worsening treatment outcome and quality of life. To evaluate the scholar contribution to cancer cachexia, we analyzed the cachexia literature and funding support. Methods: In May 2008, we conducted a search of the major databases Medline, Web of Sciences, and Scopus of all publications with MeSH heading “cachexia” or keywords “cachexia, cachectic, cachexic” since 1982, distinguishing “original research” from “review” articles. To examine the trend over time, we compared the publication rate in the field of cachexia to that of published manuscripts in reference fields (cancer, AIDS, Alzheimer's disease, and CHF). To study the federal funding for cachexia research, we examined the Computer Retrieval of Information on Scientific Projects database. Only descriptive statistical analysis was adopted because of the heterogeneity of methods. Results: We identified 1990 published manuscripts, 677 (34%) of which are “reviews”. Out of the 2,890 country of origin affiliations, the US is the lead contributor (N = 1,105; 38%). In the last 5 years, the ratio of “review” articles in cachexia increased significantly (49%), compared to cancer (17%), and science publications (8%). Unlike the of publications in reference fields, the increase in cachexia has been mostly due to the dominance of “review” articles (ratio of original/review of 0.928 in cachexia, versus 0.417 in CHF, 0.337 in Alzheimer and 0.206 in AIDS). Nevertheless, published cachexia articles in journals with high impact factors (IF ≥ 4.0) remains similar (8.49%) to that of science research (8.63%) with a predominance of “review’ articles. Only one in four published manuscripts (24%) acknowledged federal support. Cachexia research support by US federal agencies declined significantly in the last decade (with a peak of 161 awards in 1999 down to 40 in 2006), the NCI remains the leading funding agency (17%). Only 275 out of the total of 121,997 NCI- awards over 25 years (0.22%) were awarded to cachexia research, with a clear decline in the latest decade by 50% (0.14% vs. 0.29%). Conclusions: Advances in the field of original cancer cachexia research have been very limited, perhaps related to the lack of federal research funding support, which is on the decline. No significant financial relationships to disclose.
Use of growth factors associated with docetaxel and paclitaxel in patients with early-stage breast cancer in a community oncology center
Authors: Boklage S. H. , Chen L. , Christiansen N. P. , Sullivan S. D. , Hay J. W. , Mullins C. D. 
Published: August 2020

e17548 Background: Docetaxel and paclitaxel are widely used in treating breast cancer (BC), and both have hematologic toxicity commonly managed by costly growth factors (GFs). However, the extent of GFs use in real-world clinical practice has not been well documented. Methods: The Georgia Oncology Specialist Database was used and contained chemotherapy, medical and pharmacy claims, and lab results for nearly 170,000 patients with various types of cancer (2003–2008). Patients with stage I-III BC receiving docetaxel- or paclitaxel-containing regimens as adjuvant therapy were followed from 1 week prior to docetaxel or paclitaxel (index drug) initiation to the earliest of death, loss to follow-up, switch in taxane, or end of 90-day period post last dose of index drug. Incidence of GFs use per person-year was compared using univariate negative binomial (NB) model, median time to first GFs use was compared using Wilcoxon test. Multivariate analyses were performed on number of utilizations and time to first utilization adjusting for potential confounders. Results: Compared with paclitaxel (n = 433), docetaxel cohort (n = 216) had lower incidence per person-year of erythroid stimulating agents (ESAs) use (8.01 vs. 11.72, p = 0.008), while similar incidence of myeloid growth factors (MGFs) use (8.51 vs. 5.07, p = 0.541). Lower MGFs utilization in docetaxel patients (ratio of number of utilization = 0.821, p = 0.033), and similar ESAs utilization (ratio of number of utilization = 0.920, p = 0.305) were found. While descriptive analysis showed paclitaxel patients received first ESAs sooner than docetaxel patients (median length: 23 vs. 7 days, p < 0.001), and no difference in time to first MGFs use (median 8 days for both); multivariate analyses found docetaxel patients received first MGFs sooner (ratio of days = 0.828, p = 0.039), and no difference in time to first ESAs use (ratio of days = 1.091, p = 0.419). Conclusions: This analysis suggests that docetaxel is associated with lower utilization of MGFs. Studies examining the economic impact of GFs use associated with taxanes will need to be conducted. A potential limitation of this study is that the potential selection bias may not be fully adjusted. [Table: see text]
Sniffing out cancer from real breath samples by means of nanomaterial-based electronic nose device
Authors: Abdah-Bortnyak R. V. , Haick H. , Billan S. , Peng G. , Trock E. , Shachada N. , Kuten A. 
Published: August 2020

e17552 Background: Several studies have shown that characteristic patterns of volatile organic compounds (VOCs) appear to be elevated in the alveolar breath of cancer patients, as compared to healthy controls. It has been shown, that VOCs’ composition acts as a fingerprint for the distinction of a certain cancer from other cancers, including the cases where various cancers have similar type of biomarkers. The goal of the current study is to establish a background to ultimately achieve a simple-to-use device that can detect such patterns of cancer when exhaling into it. Methods: Breath samples were collected from 40 healthy volunteers and 75 patients having known conditions in six main categories: (I) 40 healthy controls; (II) 30 patients with lung cancer; (III) 15 patients with breast cancer; (IV) 20 patients with colon cancer; (V) 5 patients with prostate cancer; and (VI) 5 patients with head and neck cancer. The breath of the volunteers was examined by means of gas chromatography linked with mass spectrometry technique (GC-MS) as well as by an electronic nose device that is based on molecularly modified Au nanoparticles to check the feasibility of the electronic nose in cancer detection via breath samples Results: GC-MS results showed that each category of cancer has a unique pattern (or mixture) of VOCs. In parallel to these findings, results indicate the ability of nanomaterial-based electronic nose devices to differentiate between “healthy” and “cancerous” breath, and, furthermore, between the breath of patients with different cancer types, with >92% sensitivity. Conclusions: The electronic nose technology has a high potential for assessing various types of cancer via simple exhalation procedure. The results provide a launching pad towards obtaining an inexpensive, compact tool that is amenable to widespread screening and that has a potential for direct and real-time monitoring (2–3 minutes only). No significant financial relationships to disclose.
A reasonable methodology to estimate the relationship between workload and human resources demand in a cancer unit
Authors: Fasola G. , Aita M. , Bin A. , Follador A. , Mansutti M. , Pella N. , Puglisi F. , Sacco C. , Troiero G. , Aprile G. 
Published: August 2020

e17555 Background: Costs of cancer care account for a growing proportion of European health care spending. Despite the rising price of new cancer drugs draws the attention of medical oncologists and decision makers, personnel spending takes the largest share of health care costs. Nonetheless, few data exist about the relationship between workload and human resources demand in a cancer unit. Here we describe an empirical model to determine staffing requirements according to the annual number of patients. Methods: The Department of Oncology at the University Hospital of Udine, Italy, is a computerized Unit within the regional cancer network taking care of about 1,500 pts/year. Each clinical episode is recorded on a centralized database. Standard time limits are set for different types of consultation. We queried the database to obtain the total number of consultations for every pt taken charge of by the Unit during 2006. Considering both the time scheduled for each type of visit and the number of yearly working hours per employee, we could reach a reasonable estimate of the annual physician and nurse hours per pt and of the number of needed personnel. Results: In 2006, each case generated an average of 16 clinical evaluations, with small differences among breast, lung and colorectal cancer. Corresponding physician- and nurse-time per pt was of 8 and 16 hours, respectively. For the first year - in Units with a mean number of 1,500 pts/year - this translates into a global amount of about 12,000 physician- and 24,000 nurse-hours and a needed number of 7 physicians and 13 nurses, respectively. In the second year, the same cases induced a mean of 4.5 consultations; using a similar approach, the demand for additional time and resources could be estimated as well. Conclusions: A preliminary assessment of the time required for different types of consultation, together with a centralized recording of each clinical episode, allows a reasoned estimate of needed time and personnel resources, thus providing a simple tool to determine the total staff expenditure of a cancer unit. No significant financial relationships to disclose.
Perception and knowledge of clinical trials and factors affecting participation of regional and rural cancer patients of North Queensland
Authors: Sabesan S. S. , Burgher B. , Varma S. , Piliouras P. 
Published: August 2020

e17558 Background: The best treatment option for most cancers is participation in clinical trials. Participation in trials is generally low and among rural patients it is likely to be even lower. The aim of this study was to assess knowledge about and attitudes towards clinical trials among rural and regional cancer patients of North Queensland. Methods: A questionnaire-based survey was conducted in outpatient clinics at the Townsville Cancer Centre on all types of cancer patients. Results: The mean age of the 178 participants was 56 years and 45.4% lived in rural or remote areas. Median distance to the trial centre (Townsville) for rural participants was 180 km (range 80 - 1300 km). Being asked whether they would take part in a RCT, 13.2% of participants said no, 56.3% said yes, and 30.5% were unsure. There were no significant relationships between willingness to participate and rurality (p = 0.896) or education level (p = 0.943). For the majority of patients, the number of clinic visits and blood tests required did not matter. Cost of travel (41.1% rural/remote; 23.5% regional; p < 0.001) and the need for family or friends to accompany (38.9% rural/remote; 24.1% regional; p = 0.021) were more important for rural/remote than regional patients as factors affecting participation. Only 16.4% of participants were aware of early studies. After education, percentage of patients willing to participate in phase I and II studies were 57% and 84%, respectively. Rural patients were less willing to participate in phase I studies than regional patients (33.9% vs 52.6%, p = 0.029). Conclusions: Rural patients are as interested in participating in clinical trials as urban patients except for phase 1 trials and should not be excluded because of rurality. Knowledge of trials is poor and there is a need for education early. Cost of travel seems more important for rural patients and as such budgets should include cost of travel to encourage participation of rural patients. No significant financial relationships to disclose.
Distribution and determinants of patient satisfaction in oncology with a focus on health-related quality of life
Authors: Lis C. G. , Rodeghier M. , Gupta D. 
Published: August 2020

e17578 Background: Cancer patients usually undergo extensive and debilitating treatments, which makes patient satisfaction with care in oncology an important health care assessment measure. We conducted a study to examine patients’ experiences with the care they receive and to investigate the clinical, demographic and quality of life (QoL) factors that can predict satisfaction in a large heterogeneous sample of cancer patients. Methods: A case series of 538 cancer patients treated at Cancer Treatment Centers of America (CTCA) at Midwestern and Southwestern Regional Medical Centers between August 2006-December 2007. A patient satisfaction questionnaire developed in-house by CTCA was used. The questionnaire covered the following dimensions of patient satisfaction: hospital operations and services, physicians and staff, and patient endorsements for themselves and others. QoL was assessed using EORTC QLQ-C30. The available clinical, demographic and QoL factors were evaluated for predictive significance using univariate (t-test or chi-square test) and multivariate logistic regression. Results: The response rate for this study was 24.4%. The mean age of our patient population was 54.1 years (SD = 10.5, range 17–86), with a slight preponderance of females (57.2 %). Breast cancer (n = 124, 23.0 %) and lung cancer (n = 101, 18.8%) were the most frequent cancer types. 481 (89.4%) patients were “very satisfied” with their overall experience with CTCA. Age and several QoL function and symptom scales were predictive of satisfaction upon univariate analysis. However, in the multivariate modeling, only those with a score above the median on the fatigue measure (i.e., worse fatigue) had reduced odds of 0.28 of being “very satisfied” with CTCA (p = 0.03). Conclusions: We found that fatigue was an independent significant predictor of patient satisfaction. This finding argues for special attention and programs for cancer patients who report higher levels of fatigue. Such efforts will help lessen the effect of fatigue on their daily functioning, and may increase their satisfaction with treatment. No significant financial relationships to disclose.