bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing cutaneous side effects associated with erlotinib in head and neck cancer (HNC) and non-small cell lung cancer (NSCLC) patients (pts)
Authors: Oishi K. J. , Garey J. S. , Burke B. J. , Herbst R. S. , Kim E. S. 
Published: April 2020

18538 Background: Erlotinib is an oral epidermal growth factor receptor (EGFR) targeted therapy. It is approved for therapy in NSCLC pts after failure of at least one prior chemotherapy regimen, and in combination with gemcitabine for pts with pancreatic cancer. It has also been studied in other tumors including HNC. Erlotinib has fewer side effects compared to standard chemotherapy. Cutaneous toxicities with erlotinib have been observed in approximately 70% of pts with most cases typically mild-to-moderate. The most common manifestations are an acneiform rash, pruritus, and dryness. As rash may be a marker of clinical benefit, continuing therapy through toxicities is important. Methods: We have described effective management of skin rash associated with erlotinib by using the proposed treatment algorithm in HNC pts enrolled in a phase II study in which they received erlotinib with chemotherapy. Pts were followed by physical exams and direct questionings about rash development and treatment response as they were treated based on the grade and characteristics (pruritic, macular, pustular, dryness, ulcerative) of rash. Results: Thus far, the HNC trial has enrolled 32 pts and 28 pts are evaluable for rash and treatment responses. 19 pts developed grade 1 rash, 8 pts grade 2, 1 pt grade 3, and none grade 4. Response to rash intervention (ie downgrading the rash) included 19/19 complete responses for grade 1, 6/8 partial responses for grade 2 (the non-responding patients were referred to dermatology and improved after several other treatments) and 1/1 partial response for grade 3 were noted. 4 pts experienced dose delay and/or dose modification. In addition, 33 NSCLC pts are also evaluable for toxicity. 25 pts developed grade 1 rash, 4 pts grade 2, 4 pts grade 3, and none grade 4. Response to rash intervention included 25/25 complete responses for grade 1, 4/4 complete/partial responses for grade 2 and 3. Four pts experienced dose delays and/or dose modifications. Conclusions: Successful management of rash associated with erlotinib can be achieved using the proposed treatment algorithm thus allowing pts to continue on treatment without delays or significant dosing changes. [Table: see text]
Socio demographic correlates of pregnancy in cancer survivors using data from NHANES 1999–2002
Authors: Hammond C. , Moser R. , Jeffery D. , Harkins D. 
Published: April 2020

18542 Background: Many cancer therapies can cause infertility and impaired fecundity. These are important long term outcomes of concern for survivors, which can affect their quality of life. Little is known about the socio-demographic correlates of impaired fecundity (inability to get pregnant or carry child to term) in cancer survivors. The purpose of this study is to assess socio demographic correlates of “ever pregnant” in the general American population of cancer survivors. Methods: Using data from adult (>20 years old) female cancer survivor participants of the 1999–2002 iterations of the population based cross sectional survey, National Health and Nutrition Examination Study (NHANES), we used logistic regression to examine the relationship between “ever” being pregnant and socio-demographic variables. Results: Complete data were available for 7558 females. Cancer survivors represented 8.2 % of that population. On univariate analysis, being married and having ≤ high school education were associated with a greater likelihood of “ever” pregnant compared to those unmarried and those with greater than high school education (p < .05). In cancer survivors of reproductive age (between the ages of 20 and 50) being Black or Hispanic was associated with a greater likelihood of “ever” pregnant compared to whites (p < .05). Interestingly, differences in race, income, health insurance status, and marital status were not significantly associated with “ever” pregnant on multivariate analysis of all female survivors older than 20. Conclusions: These results suggest there are differences in impaired fecundity between different groups of cancer survivors. However, questions in NHANES were not designed to explicitly examine fertility related outcomes. Additional studies that specifically examine measures of fertility in survivors are needed to understand the burden of this undesirable outcome in survivors. No significant financial relationships to disclose.
Resource utilization by palliative surgery patients: results of the decision and outcomes in palliative surgery (DOPS) trial
Authors: Podnos Y. D. , Juarez G. , Pameijer C. , Uman G. , Ferrell B. R. , Wagman L. D. 
Published: April 2020

18543 Background: The number of cancer patients is increasing. Though many cancer treatments are successful at improving survival, most tumors recur and become incurable. A spectrum of symptoms then manifest, many requiring operations. As this happens and the focus becomes symptom management, health system resources used often differ from other scenarios. This study seeks to define the type and breadth of perioperative resource utilization after palliative operations. Methods: Prospectively, patients with advanced malignancies getting palliative operations were followed 3 months postoperatively. In addition to demographics, all encounters with any medical personnel and healthcare resources used were captured by a thorough chart audit and entered into a database. Results: Of the 106 patients entering the study, 67 remained after 3 months. Patients suffered from a mean of 2 symptoms, pain being most common. Patients had a mean of 25.4 encounters (range 1–94). Most commonly, the encounters were with the departments of surgery, medical oncology, and radiation oncology. Half of the encounters were with physicians while 47% were with physician extenders and 3% with supportive staff. Eighty-seven percent of encounters were scheduled. Half occurred in the clinics, 21% in urgent care, and 29% by phone. Fifteen patients were readmitted, most often for symptom management (52%). The 54 patients receiving supportive care referrals had a mean of 2 different referrals per patient and were primarily social work, nutrition, and rehabilitation. Two pain management referrals were initiated. Conclusions: Patients undergoing palliative operations use no more resources than those having curative procedures. Because of disease persistence, the types of resources used differ. Defining these differences is important as health systems plan for the increase in aged with incurable cancers. Early referral to supportive care specialists, vital as symptoms worsen, remains underutilized. Without inclusion of these professions, patient quality of life and distress are not being helped as much as possible. Medical and surgical oncologists should aggressively assess and manage symptoms and consult colleagues to comprehensive symptom management. No significant financial relationships to disclose.
Effectiveness of darbepoetin alfa 300 mcg every 3 weeks in patients with chemotherapy-induced anemia
Authors: Hernandez E. , Dibenedetto J. , Kotasek D. , Ganly P. , Silberstein P. , Tomita D. , Lillie T. , Boccia R. V. 
Published: April 2020

18545 Background: Patients (pts) receiving chemotherapy (CTX) often experience anemia resulting in decreased quality of life. We performed a post hoc combined analysis of 2 clinical studies of darbepoetin alfa (DA) 300 mcg every 3 weeks (Q3W), allowing for comparison of larger treatment groups. Methods: Eligibility criteria of the 2 studies were similar: pts ≥ 18 yrs old with nonmyeloid malignancy, anemia (hemoglobin [Hb] < 11 g/dL), and receiving CTX. Study 1 (20030232) was a phase 3, randomized, placebo-controlled, double-blind, study involving 16 wks of treatment with end of treatment phase (EOTP) visit at wk 19. Study 2 (20030206) was a single-arm, open-label, phase 4 study involving 13-wks of treatment with EOTP visit at wk 16. Efficacy endpoints included: percentage of pts achieving target Hb (≥ 11 g/dL without RBC transfusion [TFN] within 28 days), pts requiring TFNs between wk 1 and EOTP, pts requiring TFNs between wk 5 and EOTP, pts with a ≥ 3-point change in FACT-F score, and pts achieving ≥ 1-g/dL increase in Hb after 4 wks of therapy. Results: In both studies, 61% of pts were women and 79% were white. The mean (SD) age was 64.5 years (12.1) for Study 1 and 62.6 years (13.3) for Study 2. The most common tumor type was breast (26% in Study 1; 29% in Study 2). Mean (SD) baseline (BL) Hb values were 10.1 (0.9) and 10.1 (0.7) g/dL for Study 1 and Study 2 respectively, and mean (SD) baseline FACT-F scores were 27.3 (12.8) and 27.9 (12.3) respectively. See Table for endpoints. Combined analysis showed that increasing Hb by ≥ 1 g/dL after 4 wks of therapy was a poor predictor of clinical outcomes (avoidance of TFN, sensitivity = 56.2%; achievement of Hb target, sensitivity = 57.8%). Safety outcomes were similar and expected for this population. DA appeared to be well-tolerated. No pts exhibited neutralizing antibodies to DA. Conclusions: This combined analysis provides further evidence of the effectiveness of DA Q3W dosing in this pt population. This dosing interval may facilitate the administration of DA in synchronization with Q3W CTX regimens. [Table: see text] [Table: see text]
A Phase III randomized study comparing the effects of oxandrolone (Ox) and megestrol acetate (Meg) on weight (wt), lean body mass (LBM) and quality of life (QOL) in solid tumor patients (pts) receiving chemotherapy (chemo)
Authors: Lesser G. J. , Case D. , Sharp S. , Choksi J. , Miller A. , Atkins J. N. , Shaw E. 
Published: April 2020

18546 Background: Involuntary wt loss is a significant problem in pts with cancer and may lead to a decline in QOL, limit treatment options and reduce survival. Wt loss in these pts disproportionately represents a loss of muscle mass. Meg, a synthetic progesterone derivative, promotes wt gain mostly through an increase in adipose tissue rather than in LBM. Ox is a potent oral anabolic steroid with minimal androgenic activity which promotes wt gain primarily through increased LBM. Methods: Prospective, randomized phase III trial comparing the effects of Ox and Meg on wt, body composition and QOL in pts with solid tumors and wt loss receiving chemo. Body composition was serially assessed by Bioelectrical Impedance Analysis. QOL was evaluated with the FACT-G and the Anorexia/Cachexia subscale (FAACT). Eligibility: age ≥18; PS: 0–2; life expectancy ≥6 mos; near normal organ function; and progressive wt loss on chemo. Ineligibility: full dose anticoagulation; hormonally responsive or hematologic malignancies; and ongoing or planned treatment with corticosteroids (antiemetic use allowed), estrogens or progestins. The primary endpoint was LBM after 12 wks of drug therapy. Study design allowed 90% power for detecting a 1.5 kg difference between treatment groups using a 5% two-sided level of significance. A max of 155 pts were to be accrued. An interim analysis was planned after 62 pts had completed 12 wks on study. Results: As of 12/05, 74 pts have been accrued (72 eligible): median age 64 yrs, 42% females and 62% stage 4 disease. 25 pts (arm 1:8, arm 2:17) have completed 12 wks of therapy and 20 remain on study. 76 Grade 3/4 toxicities (arm 1:23, arm 2:53) and 1 grade 5 arrhythmia (arm 2) have been recorded. Accrual is ongoing and differing trends in wt gain and body composition between arms are emerging. Conclusions: This is the first and only trial comparing these two commonly utilized therapies for cancer-related anorexia/cachexia. Differences in efficacy, particularly effects on LBM, QOL and toxicity which emerge from this trial are likely to influence symptom management standards of care in the oncology community. Supported by Savient Pharmaceuticals and NCI grant 1 U10 CA81851. No significant financial relationships to disclose.
Information needs of hematologic cancer survivors
Authors: Soloe C. , Bandel K. , Jarblum M. , Willacy E. , Squire S. , Driscoll D. , Kepner J. , Gansler T. 
Published: April 2020

18547 Background: Little is known about how information needs of cancer survivors/patients (S/P), caregivers (CG), and non-caregiver relatives (NCG) evolve during the cancer experience. Methods: We conducted structured interviews of 21 leukemia, lymphoma, and multiple myeloma S/P, 13 CG, and 19 NCG, and asked them to prioritize information needs during the 4 cancer experience phases from a list of 13 topics. This research was supported by the Division of Cancer Prevention and Control of the Centers for Disease Control and Prevention. Results: Information preferences varied (Friedman’s test, P < 0.0001) by phase of the cancer experience. Topics ranked highest (median rank in parentheses) before treatment, during treatment, after treatment, and at relapse, respectively, were diagnostic tests (2), cancer/ cancer types (2.5), treatment options (3.4), hospitals/cancer centers (3.5), and insurance/financial issues (4); coping with treatment side effects (3), insurance/financial issues (4.5), treatment options (5), hospitals/cancer centers (5), and long term side effects (5); long term side effects (2), tests to detect recurrence (2), risk factors (3), diagnostic tests (4), and support groups (5); and tests to detect recurrence (3), insurance/financial issues (3), cancer/cancer types (4), diagnostic tests (5), and treatment options (5). Across the cancer experience, the highest priority topics for S/P, CG, and NCG, were cancer/ cancer types (4), treatment options (4), long term side effects (5), and risk factors (5); diagnostic tests (4.5), coping with side effects of treatment (5), and treatment options (5); and treatment options (3), diagnostic tests (4), and 5 other topics tied for 3rd place (6). In-depth, semi-structured interviews conducted with the surveys provided additional detail regarding responses collected in the prioritization exercise. Conclusions: Clinicians can help S/P, CG, and NCG by offering role- and cancer continuum-targeted information. No significant financial relationships to disclose.
Prospective evaluation of epoetin-alfa (EA) vs epoetin-beta (EB) vs darbepoetin (DE) in anemic cancer patients (pts) receiving chemotherapy (CT): Early results of an independent observational survey by the Italian ReVERTO network
Authors: Pollera C. F. , Nelli F. , Gamucci T. , Sperduti I. , Giampaolo A. M. , Moscetti L. , Tonini G. , Mentuccia L. , Nardi M. , Cortesi E. 
Published: April 2020

18548 Background: Direct comparison of EA vs EB vs DE has never been performed. In order to define the efficacy, impact on quality of life (QL) and pt’s preference, a prospective observational comparison of erythropoietic agents has been carried out. Methods: Anemic pts (hgb <11 gr/dL) scheduled to receive at least 3 cycles of CT were stratified according to 5 factors (platinum-based CT vs non-platinum; hgb ≤9,5 vs >9,5; PS ≤0–1 vs >1; previous CT vs upfront CT; and previous antianemic therapy vs not) and were autonomously assigned by 15 investigators to EA (3 times a week) or EB (3 times a week and only in pts receiving platinum-based CT) or DE (once a week) therapy. Efficacy by hgb level changes and transfusion needing was evaluated after each cycle of CT, QL by Fact-An questionnaire after 1 and 3 cycles of CT, and pt’s preference for standard vs weekly schedule at least once thereafter. Results: From 09/04 to 12/05 177 pts were recruited: 41%, 39% and 20% were assigned to DE, EA and EB, respectively. Severe anemia at baseline (≤9,5) was reported in 29% of pts, whereas 47% received platinum-based CT. Stratifying categories were well balanced among the treatment groups. Baseline mean hgb values were 9.7, 9.9, and 10 for DE, EA and EB, respectively. As of the general population, DE produced higher subsequent mean hgb increase in respect to EA and EB (Mean increase [gr/dL] for DE: 0.84, 1.58, 2.03; EA: 0.34, 0.84, 1.68; EB: 0.76, 1.54, 1.17). No difference was observed neither among pts receiving platinum-based CT, (mean increase: DE: 0.34, 1.76, 2.8; EA: 0.7, 1.27, 2.14; EB: 0.76, 1.54, 1.71) nor among pts with severe anemia at baseline (DE: 0.98, 2, 2.6; EA: 1.24, 1.94, 3.13; EB: 1.25, 2.25, 2.75). Transfusion needing ranged from 7% for DE to 3% for EB without any significant difference. To date 67% of pts completed at least one subsequent QL valuation, whereas 62% gave their preference for treatment schedule. Conclusions: Early results of our prospective analysis show that antianemic therapy with D is at least as effective as standard schedule of EA or EB. Efficacy of DE seems confirmed in pts with bad prognostic categories for anemia. Major data on QL and pt’s preference will be presented. No significant financial relationships to disclose.
Hypogammaglobulinemia increases the risk of chemotherapy associated febrile neutropenia in patients with chronic lymphocytic leukemia
Authors: Huang C. , Taylor S. , Majhail N. S. , Pabla M. , Malani A. , Singh J. 
Published: April 2020

18549 Background: Infections are the major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). Hypogammaglobulinemia, in general, increases the susceptibility to infections in patients with CLL. We conducted a case-control study to investigate whether hypogammaglobulinemia (Immunoglobulin-G (IgG) level <600 mg/dL) increases the risk of febrile neutropenic episodes in CLL patients with chemotherapy associated neutropenia (absolute neutrophil count (ANC) <0.5 × 109/L). Methods: The source cohort consisted of all consecutive patients with CLL seen at our institution between Jan 2002 to June 2005.We identified 8 cases of chemotherapy associated febrile neutropenia; controls consisted of 18 patients, with neutropenia but no fever (n = 4) or no neutropenia (n = 14). Results: The two groups were comparable except for a higher proportion of patients with Rai stage-4 disease in the febrile neutropenia cohort (100% vs. 17%, p < 0.001). Eight of the 8 patients in febrile neutropenia group were found to be hypogammaglobulinemic as compared to 2 of 18 controls (100% vs 11%, P value < 0.001). The median IgG level was 400 mg/dL (range, 300–488 mg/dL) in the febrile neutropenia group compared to 820 mg/dL (range, 121–1700 mg/dL) in the control group (p = 0.003).The relative risk of developing chemotherapy associate febrile neutropenia in the presence of underlying hypogammaglobulinemia was 4.5 (95% confidence intervals, 1.9–10.7). Conclusions: Patients with CLL who are hypogammaglobulinemic are candidates for prophylactic administration of intravenous immune-globulin prior to initiation of myelosuppressive chemotherapy. [Table: see text] No significant financial relationships to disclose.
Providing end-of-life care to patients seeking hope for cure: Improving Mayo Clinic palliative care utilization
Authors: Swetz K. , Moynihan T. , Ruegg S. , Tan A. , Atherton P. J. , Sloan J. 
Published: April 2020

18552 Background: We reviewed Palliative Care Consultation Service (PCCS) referrals to attempt to promote earlier referrals, and to improve overall patient care. Methods: Eligibility for PCCS referral is life expectancy of one year or less. Data was collected prospectively on the first 461 referrals (452 individual patients) over the initial 30-month period (January 1, 2003 to July 1, 2005). Additional factors were retrospectively abstracted from documentation. Kaplan-Meier survival analysis was then performed. Results: 452 patients were seen (mean age 71.9 years), and 387 (86%) have died. Median length of inpatient stay was 8 days, with PCCS consultation requested 3 days prior to discharge. 107 patients (24%) died prior to hospital discharge. 345 patients survived to discharge, 236 (68%) died within 3 months, and 262 (76%) died within 6 months. Median survival from consultation to death was 12 days and after hospital discharge was 6 days. Secondary analysis determined that patients with malignancy had longer median survival from discharge to death than those with other diagnoses (11 days versus 3 days, p = 0.025). Median survival was longer with referrals from general surgery and surgical specialties (37 days and 8 days, respectively), compared to hematology-oncology and critical care (2 days and 0 days, respectively). Conclusions: The primary goal of the PCCS is to provide symptom control and maximize quality of life at the end of life. These data suggest palliative care services are unnecessarily delayed until too late. Education is necessary to facilitate earlier PCCS intervention. Survival analysis suggests providers are more likely to consider PCCS involvement in patients with malignancy compared with other diseases. Critical care and hematology-oncology, showed the lowest median survivals. Education efforts must be focused on these areas. Programs are underway to identify eligible patients earlier in their disease process, and educate providers about key end-of-life services provided to patients and families. No significant financial relationships to disclose.
Two studies from the JP Wilmot Cancer Center on the relationship of treatment, expectations, and race with post-treatment skin reactions reported by cancer patients
Authors: Ryan J. L. , Figueroa-Moseley C. , Bole C. , Hickok J. T. , Colman L. K. , Khanna R. C. , Lennon M. , Pentland A. P. , Morrow G. R. 
Published: April 2020

18560 Background: Cancer patients may experience skin problems while undergoing treatment. Frequency of skin reactions may be influenced skin pigmentation and/or psychological factors. Methods: A Symptom Inventory (SI) completed by 411 cancer patients nationwide before and after treatment was analyzed to determine if treatment type, race (Black versus White), and pre-treatment expectations influenced post-treatment skin reactions. Subsequent analysis of a SI completed weekly for five weeks by 167 local patients receiving radiotherapy examined severity of reported skin reactions. Results: One-way between-group ANOVA, with Bonferroni correction, showed significantly more patients receiving radiotherapy had stronger expectations of skin problems (62%) compared to patients receiving chemotherapy (40%, p = 0.001) or chemotherapy plus radiotherapy (45%, p = 0.003). Overall, expectations did not correlate with patient reported skin problems post-treatment (Spearman’s rho = 0.02, p = 0.70). Likewise, a Kruskal Wallis test showed no significant difference in severity of skin reactions reported by patients receiving radiotherapy (n = 138) and/or chemotherapy (n = 273, p = 0.56). Severe skin problems were reported more frequently by 10/18 (56%) Blacks than 90/393 (23%) Whites (p = 0.001), although no significant difference was found between Blacks and Whites in their pre-treatment expectations of skin problems (p = 0.32). Further, pre-treatment expectations of skin problems did not influence post-treatment reporting of skin problems in Blacks (Spearman’s rho = −0.02, p = 0.93) or Whites (Spearman’s rho = 0.02, p = 0.65). Similarly, the local study showed that significantly more Blacks (38%) reported severe skin reactions at the treatment site than Whites (6%). Total radiation exposure was significantly related to the severity of skin problems reported by Blacks (Spearman’s rho = 0.90, p = 0.04), but not Whites (Spearman’s rho = −0.06 p = 0.52). Conclusions: Overall, Blacks reported more severe post-treatment skin problems than Whites. How this self-reported skin damage correlates with clinical findings remains to be determined. Supported by NCI PHS grants 1R25CA102618 and U10CA37420. No significant financial relationships to disclose.