bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment completion and toxicity of trastuzumab or trastuzumab + lapatinib in older patients (pts): BIG 2-06; NCCTG N063D (Alliance).
Authors: Ponde Noam Falbel , Agbor-Tarh Dominique , Dal Lago Lissandra , Korde Larissa A. , Hilbers Florentine , Jackisch Christian , Werner Olena , Gelber Richard D. , Jatoi Aminah , Dueck Amylou C. , Moreno-Aspitia Alvaro , Sotiriou Christos , de Azambuja Evandro , Piccart Martine 
Published: March 2020

11553 Background: Little is known about the toxicity of trastuzumab (T) or of trastuzumab + lapatinib (T + L), approved in the advanced setting, in older pts. We have performed a sub-analysis of the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO) trial focused on treatment completion and toxicity of T and T+L in older pts (aged ≥65 years (yr)). Methods: The ALTTO trial (NCT00490139, NCCTG N063D) randomised 8381 pts with early HER2+ BC into 4 arms and we included the T and T+L arms in our analysis. Eligible pts for our study were those having received at least one dose of assigned treatment. Treatment completion was evaluated through the rate of temporary treatment interruptions (TTI), permanent treatment discontinuations (PTD) and lapatinib dose reductions (LDR). Toxicity was evaluated via a selected set of adverse events of interest (AEIs). Risk factors for TTI, PTD, LDR and AEIs were assessed, including comorbidities and polypharmacy at baseline (defined as use 5 or more co-medications) and AEIs during treatment. Results: A total of 430 pts≥65-year-old were identified for this sub-analysis, out of a total of 4190 pts with a median age of 68 yrs (range 65-80). Older pts were more likely to have comorbidities (70% vs 38%). Treatment completion was worse among older pts in the T+L arm but not in the T arm (Table). AEIs were more common in the T+L arm in all patients, with older patients having higher AEI rates (78.04% in older vs 63.38% in younger), particularly diarrhea (60.75% vs 38.0%). Identified risk factors (multivariate) for worse treatment completion in the T and T+ L arms included concomitant use of chemotherapy and the occurrence of grade 3 adverse events, among others. Conclusions: T + L has worse treatment completion and is more toxic in older patients, while T was well tolerated. Identifiable risk factors at baseline and during the course of treatment could be used to aid in regimen selection and management for both T and T + L in their respective indications. Support: UG1CA189823, Novartis;https://acknowledgments.alliancefound.org. [Table: see text]
Obesity paradox in older cancer patients for middle and long-term mortality: A prospective multicenter cohort study of 2,071 patients.
Authors: Martinez-Tapia Claudia , Diot Thomas , Oubaya Nadia , Paillaud Elena , Poisson Johanne , Gisselbrecht Mathilde , Caillet Philippe , Baudin Aurélie , Pamoukdjian Frédéric , Bastuji-Garin Sylvie , Laurent Marie , Canoui-Poitrine Florence 
Published: March 2020

11555 Background: Overweight and obesity are associated with numerous adverse health outcomes. However, among older adults, substantial literature suggests an improved survival among overweight and obese patients. This phenomenon, referred to as the “obesity paradox” remains controversial. In the context of cancer, the association between overweight/obesity and mortality is complex due to the concomitant weight loss and cachexia. We aim to assess the impact of high Body Mass Index (BMI) on mortality in a large population of older cancer patients. Methods: We studied patients aged ≥70 from the ELCAPA prospective open-cohort (2007-2016; 10 geriatric oncology clinics, Great Paris urban area). Endpoints were 12- and 48-months mortality. A variable combining BMI at cancer diagnosis and weight loss (in the 6 months preceding the diagnosis) was created. BMI categories considered: underweight, (BMI < 22.4kg/m²), normal weight (BMI 22.5-24.9), overweight (BMI 25-29.9), and obese (BMI ≥30); weight loss (WL) categories: < 5%, 5- < 10%, ≥10%. Univariate and multivariate Cox proportional-hazards analysis were conducted in males and females. Results: A total of 2071 patients were included (mean age, 81; female, 48%; metastases, 49%; main localizations: digestive (37%), urinary (26%), breast (16%); underweight (30%), normal weight (23%), overweight (33%), obese (14%)). After adjustment for age, smoking, inpatient status, cancer site, metastasis, performance status and comorbidities, overweight women with < 5% WL were at lower risk of 12- and 48-months mortality compared to normal weight women with < 5% WL (aHR = 0.56; p = 0.043 and 0.65; p = 0.031, respectively). Obese women with < 5% WL had a lower mortality risk only at 48-months (aHR = 0.63; p = 0.036). The obesity paradox was stronger in overweight metastatic women. Overweight or obese women with 5- < 10% or ≥10% WL had no reduced risk of mortality compared to normal weight women. Overweight and obese men had no reduced risk of mortality irrespective of weight loss. Conclusions: By taking into account initial weight loss, we did not found evidence for obesity paradox in older patients with cancer except in the subgroup of women with minimal weight loss. Clinical trial information: NCT02884375.
Association of obesity with breast cancer outcome in relation to cancer subtypes.
Authors: Lohmann Ana Elisa , Soldera Sara V. , Pimentel Isabel , Ribnikar Domen , Ennis Marguerite , Amir Eitan , Goodwin Pamela Jean 
Published: March 2020

11557 Background: Obesity at breast cancer (BC) diagnosis is associated with poor outcome, although the magnitude of effect in different BC subtypes is uncertain. Here we report on the association of obesity at BC diagnosis with disease-free (DFS) and overall survival (OS) in the following subtypes: (i) hormone receptor (ER/PgR) +ve, HER2-ve, (ii) HER2+ve, any ER/PgR and (iii) triple negative (TN). Methods: We searched MEDLINE, EMBASE and COCHRANE databases to December 31, 2018 and meeting presentations (past 5 years) using predefined search terms. Study eligibility, data abstraction were performed independently by two authors; those reporting hazard ratios (HR) for obesity and DFS/OS in BC subtypes were included. Using Review Manager pooled HRs were computed and weighted using generic inverse variance in fixed and random effects models (results were similar, random effects are presented). Results: Of 10,702 titles, 26 studies (108,793 patients) were included. Pooled HR for DFS for obese vs non-obese were (i) ER/PgR+ve HER2-ve 1.21 (95% Confidence interval, CI; 1.12-1.31, p < 0.00001), (ii) HER2+ve, any ER/PgR 1.16 (95%CI, 1.06-1.26; p = 0.0006) and (iii) TN, 1.13 (95%CI; 1.05-1.22 p = 0.002). Pooled HRs for OS were (i) ER/PgR+ve, HER2-ve 1.45 (95%CI; 1.30-1.62 p < 0.00001), (ii) HER2+ve any ER/PgR 1.21 (95%CI; 1.10-1.34 p = 0.0001) and (iii) TN 1.13 (95%CI, 1.04-1.23, p = 0.003).PooledHR for OS (but not DFS) were somewhat higher in observational vs interventional studies in (i) ER/PgR+ve, HER2-ve 1.57 vs 1.36, HER2+ve any ER/PgR (ii) 1.37 vs 1.09 but not (iii) TN 1.12 vs 1.22 (p = 0.21, 0.03 and 0.48, respectively). Conclusions: Obesity was associated with a worse outcome in all BC subtypes. Higher HR for OS in observational studies in (i) ER/PgR+ve, HER2- and (ii) HER2+ve any ER/PgR BC may reflect selection of healthier patients for intervention trials.
Neurocognitive outcomes in adult survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study.
Authors: Hesko Caroline , Liu Wei , Srivastava Deokumar , Brinkman Tara M. , Diller Lisa , Gibson Todd M. , Oeffinger Kevin C. , Leisenring Wendy , Howell Rebecca M. , Armstrong Gregory T. , Krull Kevin R. , Henderson Tara O. 
Published: March 2020

11563 Background: Long-term survivors of neuroblastoma may be at risk for neurocognitive impairment due to young age at diagnosis and intensive multimodal therapies. Methods: 837 survivors of neuroblastoma (57% female; median [range] age 25 [17-58] years, age at diagnosis 1 [0-21] years) and 728 siblings (56% female; age 32[16-43] years) self-reported neurocognitive problems using a neurocognitive questionnaire. Impairment was defined as scores ≥90th percentile of siblings in emotional regulation (ER), organization, task efficiency (TE), and memory. Multivariable log-binomial models evaluated associations with treatment exposures, era and chronic conditions (Grade 2-4 CTCAE v5) adjusting for sex, age, and race. Analyses were stratified by age at diagnosis (≤1 and > 1 year) as proxy for risk group. Results: Rates of impairment were 19.7% (ER), 25.3% organization, 21.9% TE and 19.4% for memory. Survivors had 50% higher risk of impaired TE (≤1 year relative risk [RR] 1.48, 95% confidence interval [CI] 1.08-2.03; > 1 year: RR 1.58, CI 1.22-2.06) and ER (≤1 year RR 1.51, CI 1.07-2.12; > 1 year RR 1.44, CI 1.06-1.95) versussiblings. Among survivors ≤1 year at diagnosis, treatment with platinum (RR 1.74, CI 1.01-2.97), hearing loss (RR 1.95, CI 1.26-3.00), cardiovascular (RR 1.83, CI 1.15-2.89) and neurologic (RR 2.00, CI 1.32-3.03) conditions were associated with higher risk of impaired TE. Female sex (RR = 1.54, CI, 1.02-2.33), cardiovascular (RR 1.71, CI 1.08-2.70) and respiratory (RR 1.99, CI 1.14-3.49) conditions were associated with higher risk of impaired ER. Among survivors > 1 year at diagnosis those treated in 1970-79 vs. 1990-99 had 80% higher risk of impaired ER (RR 1.77, CI 1.02-3.06). Hearing loss (RR 1.56 (1.09-2.24), respiratory (RR 2.35, CI 1.60-3.45) and cardiovascular (RR 1.74, CI 1.12-2.69) conditions were associated with higher risk of impaired TE. Conclusions: Adult survivors of neuroblastoma are at-risk for neurocognitive impairment. Differences associated with age at diagnosis, chronic disease and treatment exposures may inform risk-stratified inventions to improve neurocognitive outcomes. Reduced risk in later eras may reflect improved supportive care and knowledge of late effects.
Polypharmacy risk among five-year cancer survivors.
Authors: Hsu Christine D. , Lund Jennifer Leigh , Nichols Hazel 
Published: March 2020

11565 Background: Cancer survivors are increasing in the United States. Survivors often face cancer sequelae and side effects from treatment, which can arise during treatment or even months or years later. Survivors may therefore experience greater medication burden than the general population, increasing concerns for polypharmacy and risk of drug interactions and non-adherence. The objective of this study is to characterize prevalence of polypharmacy by cancer history in a nationally-representative sample of U.S. adults. Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2003-2014, we identified 32,330 individuals 20 years or older, 1,672 of whom had been diagnosed with cancer (excluding non-melanoma skin) at least five years before the survey. The association between cancer history and polypharmacy (5+ medications) was examined using Poisson regression models to calculate multivariable risk ratio (RRs) and 95% confidence intervals (CIs), adjusted for education, ethnicity, marital status, and age at survey. Results: Among five-year cancer survivors, 35% had a diagnosis within 5-9 years of the survey year, 26% within 10-14 years, 13% within 15-19 years, and 26% had a diagnosis 20 or more years before the survey year. Breast cancer was the most common type of cancer (23%), followed by cervical cancer (18%), prostate cancer (12%), and colon cancer (7%). Prevalence of polypharmacy was higher in cancer survivors (33.6%; 95% CI: 30.7-36.6%) than in those with no cancer history (13.0%, 95% CI: 12.4-13.7%) (RR: 1.32, 95% CI: 1.20, 1.45). Polypharmacy prevalence differed by age group (4.83% in 20-39 year olds; 40.37% in 40-64 year olds; 54.8% in 65 years and older), and within each age group, risk of polypharmacy was higher in cancer survivors than in those with no cancer history, with the most pronounced difference in cancer survivors 20-39 years old (RR: 2.93, 95% CI: 1.69-5.09), followed by 40-64 year olds (RR: 1.52, 95% CI 1.27-1.83) and those 65 years and older (RR: 1.17, 95% CI: 1.07-1.29). Conclusions: Cancer survivors are more likely to experience polypharmacy burden than those with no cancer history. Findings from this study can increase awareness about the unique challenges cancer survivors face and encourage medication reconciliation services.
Effect of race/ethnicity on long-term cytopenias and major infections in adolescent young adult breast cancer survivors.
Authors: Sauder Candice , Goldfarb Melanie , Gingrich Alicia , Li Qian , Wun Theodore , Keegan Theresa 
Published: March 2020

11568 Background: Many Adolescent and Young Adult (AYA) Breast Cancer (BC) patients receive chemotherapy as part of their initial treatment. Long-term bone marrow suppression is a potential complication, but no studies have evaluated the impact of race/ethnicity on the development in AYA BC survivors. Methods: Female patients ages 15-39 diagnosed with BC during 1996-2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to statewide hospitalization data. We estimated the cumulative incidence of developing anemia, leukopenia, or major infection/sepsis (≥ 2 years after diagnosis), accounting for death as a competing risk, and examined the impact of race/ethnicity using multivariable Cox proportional hazards regression. Results: Of 14,729 patients, 48.8% were non-Hispanic white, 8.3% non-Hispanic black, 25.5% Hispanic, and 16.5% Asian/Pacific Islander. At diagnosis, 95.5% had local or regional disease (27.7% stage I, 49.4% stage II), and were mostly treated with surgery (96.2%) and chemotherapy (74.3%). The 10-year cumulative incidence of anemia (16.8% vs 11.7%), leukopenia (4.6% vs 2.1%), and major infection/sepsis (13.2% vs 7.9%) was greater following initial treatment with chemotherapy (p < 0.0001 for all vs no chemotherapy). In multivariable analyses controlling for sociodemographic factors, baseline comorbidities, treatment and stage, Blacks had the highest risk (vs. non-Hispanic whites) of medical late effects, including anemia [HR: 1.62, CI 1.41-1.86], leukopenia (HR: 1.53, CI 1.17-2.00), and major infection/sepsis (HR: 1.36, CI 1.16-1.60). Similarly, Hispanic and Asian/Pacific Islanders had a higher risk of developing anemia (HR: 1.16, CI 1.04-1.29; HR: 1.17, CI 1.03-1.33) and trended toward developing more leukopenia (HR: 1.24, CI 1.00-1.54; HR: 1.25, CI 0.98-1.61). Conclusions: AYAs of Black, Hispanic, and Asian/Pacific Islander race/ethnicity are at an increased risk of anemia and leukopenia after chemotherapy compared with non-Hispanic Whites. With improvements in prognostic testing resulting in potential decreased chemotherapy usage, there may be a decrease in long-term late effects for these young cancer survivors.
Total body irradiation (TBI) and risk of breast subsequent malignant neoplasm (SMN) after blood or marrow transplantation (BMT): A report from the BMT survivor study (BMTSS).
Authors: McDonald Andrew Michael , Chen Yanjun , Wu Jessica , Hageman Lindsey , Francisco Liton , Kung Michelle , Ness Emily , Battles Kevin , Landier Wendy , Salzman Donna E. , Weisdorf Daniel Jordan , Forman Stephen J. , Arora Mukta , Armenian Saro , Bhatia Smita 
Published: March 2020

11572 Background: The association between TBI and breast SMN in BMT recipients is not clearly defined. We address this limitation to develop evidence for screening guidelines for those at risk. Methods: Study participants were drawn from BMTSS – a multi-site retrospective cohort of patients who had received BMT between 1974 and 2014 and survived ≥2y post-BMT. Participants completed the BMTSS survey that included sociodemographics and health conditions. Breast SMN was confirmed by pathology report review. Clinical characteristics, pre-BMT and BMT exposures were abstracted from medical records. Using multivariable Cox proportional hazards models, freedom from breast SMN was measured from birth and TBI was treated as a time-varying covariate in analyses stratified by type of BMT (allogeneic; autologous). Results: 1546 female participants (allogeneic 808; autologous 738) received BMT at a mean age of 43.1±17.6y and were followed for 9.4±7.7y; primary diagnoses: HL/NHL (28%), AML/MDS (27%), PCD (19%), other (28%). TBI was used in 671 patients (allogeneic 57%; autologous 30%). Patients with pre-BMT chest radiation (n = 45) were excluded from the analysis. A total of 38 cases of breast SMN were identified (allogeneic 19; autologous 19). Allogeneic BMT: exposure to TBI (HR = 3.4; 95%CI 1.1-10.9, p = 0.04) and age at BMT < 40y (HR = 4.0; 95%CI 1.3-12.8, p = 0.02) were associated with increased risk of breast SMN. Risk of breast SMN was higher and breast SMN developed earlier among those exposed to TBI before age 40y vs. those exposed after 40y (8.7% vs. 0% by attained age 50; 10.6% vs. 5.8% by attained age 60, p = 0.003). Autologous BMT: Age < 40y was associated with a 4.8-fold higher risk (95%CI 1.1-20.1, p = 0.03) of breast SMN. TBI was associated with a 2-fold higher risk (p = 0.2). The cumulative incidence of breast SMN among those exposed to TBI at age < 40y vs. age ≥40y was 5.1% vs. 2.4% by attained age 60 (p = 0.07). Conclusions: TBI is associated with breast SMN among allogeneic BMT recipients. The risk is especially high and occurs at a younger age, among those exposed at age < 40y. These findings provide evidence for initiating screening at a young age after exposure to TBI.
Comparison of the effectiveness of oral morphine versus oral tramadol on early pain control in opioid-naive patients with moderate cancer pain.
Authors: Shilpakar Ramila , Paudel Bishnu D. , Shah Aarati , Dulal Soniya 
Published: March 2020

11581 Background: Adequate pain control, an essential part of cancer care remains a challenge in resource limited countries like Nepal. Early use of morphine for Moderate Cancer Pain (MCP) and not sequential World Health Organization (WHO) analgesic ladder seems reasonable in the setting of limited access to health care. The purpose of this study was to compare efficacy of oral Morphine (MOR) with oral Tramadol (TRM) in control of pain as well as physical wellbeing in patients (pts) with MCP using Edmonton Symptom Assessment Scale (ESAS). Methods: An IRB approved randomized phase II trial was performed in opioid-naive pts with MCP as defined by pain score in Numerical rating score (NRS)of 4-6.Patients were randomized to receive MOR syrup 5 mg 4 hourly or TRM 50 mg four times a day. Titration of dose was done in both groups for 3 days as per standard recommendation for MOR or till maximum recommended daily dose for TRM. MOR was changed to prolonged release form at Day 4.The primary endpoint was number of early responders, defined as pts with at least 20% reduction in pain intensity on NRS on Day 3. Secondary outcome was number of patients with highly meaningful pain reduction, defined as decrease in pain intensity on NRS by ≥ 5 and improvement in physical well-being with ESAS at Day 7. Results: 68 pts consented and were randomized, 34 in each arm. The primary endpoint occurred in 94.1% pts in MOR and 55.9% in TRM (p <0.001). Number of patients with highly meaningful pain reduction was significantly higher in MOR than in TRM (76.5% vs. 32.35%; p<0.001). Improvement in general physical wellbeing as assessed by ESAS was better in morphine group. No difference in adverse effects was noted between the treatment arms. Conclusions: In this study Morphine was superior to Tramadol in the control of pain with statistically significant difference in the primary and secondary endpoints. So, early use of morphine skipping the WHO sequential analgesic ladder for moderate cancer pain seems a higher value option in resource scarce country with limited access to healthcare.
Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care service among gynecologic oncology patients.
Authors: Graul Ashley , Haggerty Ashley Ford , Stickley Carolyn , Kumar Pallavi , Morales Knashawn , Bogner Hillary , Burger Robert , Mark Morgan , Ko Emily 
Published: March 2020

11583 Background: This was a randomized control trial to estimate the effect of an interventional video on improving palliative care knowledge and acceptability of outpatient services in gynecologic oncology patients. Methods: Women receiving active treatment for gynecologic malignancy (persistent or progressive disease despite primary treatment) were recruited at an academic tertiary care center from 2/2018 to 1/2019 and randomized to: palliative care educational video or non-directive cancer center informational video (control). The primary outcome was desire for referral to palliative care. Function and knowledge were assessed using the Functional Assessment of Cancer Therapy (FACT-G) and the Palliative Care Knowledge Scales. Data analyses were performed using t-tests, Wilcoxon rank sum or Fisher’s exact tests with significance level of α=0.05. Results: 111 women were enrolled. Demographic characteristics were equally distributed between groups (mean age 63.4 vs 65.4 years; 78% vs 82% Caucasian, 58% vs 68% stage III, 71% vs 64% ovarian cancer, 65% vs 72% platinum-sensitive). There was no statistical difference in knowledge scores or in desire for referral to palliative care (29% vs 27%; p=0.79). Secondary analysis showed a statistically significant increase in utilization of palliative care services compared to historic institutional data (8.8% to 29.7%; p=<0.001). Further, those that desired referral had significantly worse FACT-G scores at time of referral choice (table). Conclusions: Use of a palliative care educational video did not increase knowledge or acceptability of palliative care services within this RCT. However, the rate of patients seeking palliative care referral tripled compared to historic rates. Further studies should investigate whether discussion regarding palliative care services alone may increase desire for referral, and if use of Fact-G scores may identify patients in greatest need of services. [Table: see text]