bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tumor-related symptoms (TRS) assessment in patients (pts) with advanced non-small cell lung cancer (NSCLC) treated with gefitinib or erlotinib: Preliminary results of an observational study.
Authors: Mansueto Giovanni , Narducci Filomena , Quadrini Silvia , Mentuccia Lucia , Grande Roberta , Sperduti Isabella , Gamucci Teresa 
Published: March 2020

e20619 Background: Edmonton Symptoms Assessment Scale (ESAS) is a validated tool in palliative care, which evaluates physical symptoms through a numeric scale (0-10). Symptoms improvement as a predictive factor for response rate (RR) in pts with advanced NSCLC treated with tyrosine-kinase inhibitors (TKIs) has not yet been evaluated. To this purpose, we performed an observational retrospective study. Methods: Pts with advanced NSCLC treated with gefitinib or erlotinib were eligible. Primary outcome was the association between treatment response and tumor-related symptoms (TRS) (pain, asthenia, dyspnea) improvement. ESAS was performed at day 1 and 14 of each 28-d cycle. Symptoms' scores were divided into: not clinically relevant (0-4, NCR) and clinically relevant (5-10, CR). Sample size estimation was 115 to 165 pts to be needed for the expected difference in the primary outcome. Differences between symptoms' groups were analyzed with the paired-data McNemar-test. All the associations were estimated using the Chi-Square test. Kaplan-Meier method was used for survival calculation. Uni- and multivariate survival analysis were carried out using the Cox regression model. Results: Here we report data about 73 consecutive pts; median age: 69 years, males 68%, ECOG PS 0-1 86%, smokers 68%, EGFR-mutated 22%. Treatment was gefitinib (23%) or erlotinib (77%). RR: RC/RP 14%, SD 20%, PD 66%. Median follow-up was 7 months. 63% of pts had at least one CR TRS at baseline. Among these pts, a significant reduction (p<0.0001) of TRS during treatment was observed (Table). Our preliminary data show a significant association between dyspnea/asthenia and RR (p=0.01). At the multivariate analysis, TRS improvement correlates with both PFS and OS. Also related with survival were PS, EGFR status (PFS) and RR (OS). Conclusions: Our preliminary data show that TRS improvement is significantly associated with treatment response and appears to be a prognostic factor during treatment with TKIs. [Table: see text]
Predictors of adequate financial resources 5 years after breast cancer diagnosis in low-income women.
Authors: Patil Sujata , Blinder Victoria Susana , Gany Francesca , Maly Rose C. 
Published: March 2020

e20620 Background: Financial security is often viewed as a social determinant of health, especially in low income populations. Among low-income breast cancer patients, identifying early predictors of financial security could aid researchers in developing tools to improve long-term financial stability. Methods: A consecutive sample of 921 low-income, underinsured/uninsured women treated for stage 0-III breast cancer was surveyed 6 months following diagnosis. Women were surveyed again at 18, 36 and 60 months. Eligible participants were English/Spanish speaking women enrolled in California’s Breast and Cervical Cancer Treatment Program. The relationship between clinical, demographic, economic, health variables and adequacy of financial resources at 60 months was explored using logistic regression. Results: Of 590 women with complete data at 60 months, 45% said they did not have adequate financial resources 60 months following the diagnosis of breast cancer. Of these women, 74% (n=197) did not have adequate financial resources at 6 months, and 26% (n=70) went from having adequate financial resources at 6 months to not at 60 months. In univariate analyses, predictors of 60 month financial inadequacy included: employment status at 6 months (p=.017), ethnicity (p<.001), number of people living in the home (p=.004), age (p=.024), and adequate financial resources at 6 months (p<.001). In multivariate analyses, ethnicity (p=.008) and adequate financial resources at 6 months (p<.001) were independent predictors. Compared to non-Latina whites, Latinas had the lowest odds of having adequate financial resources at 60 months (adjusted OR: 0.51 95% CI: 0.32-0.82), followed by all other ethnicities (adjusted OR: 0.80 95% CI: 0.44-1.44). Conclusions: Financial stability after breast cancer diagnosis continues to be an issue faced by low income women five years following initial diagnosis. Ethnicity was an independent predictor of long-term financial stability. Latinas were especially likely to have inadequate financial resources 5 years after diagnosis. Long-term financial stability was not associated with any of the treatment and health or disease-related measures.
Quality-of-care provided to prostate cancer (PC) patients for prevention and treatment of osteoporosis-induced by androgen deprivation therapy (ADT): Results of a chart audit.
Authors: Chahin Rehab , Breunis Henriette , Alibhai Shabbir M.H. 
Published: March 2020

e20622 Background: Men with PC on ADT are at risk of developing decreased bone mineral density (BMD) and osteoporosis, frequently associated with increased risk of fractures and related consequences. Guidelines recommend referral to specialized clinics for bone health care, but the quality of care in osteoporosis clinics and benefits to patients has never been reported. Methods: Charts for 67 consecutive men (mean age 74.2 y) on ADT referred to the osteoporosis clinic at the Toronto General Hospital, Toronto, Canada, between 2010 and 2011, were reviewed by a single reviewer using a structured data abstraction sheet. The following quality of care issues were examined: (a) bone health services provided to PC patients receiving ADT, i.e. screening, preventing, and treating osteoporosis; (b) use of Canadian guidelines and fracture risk assessment during ADT for targeting the appropriate therapy. Results: 56 (83.6%) were receiving continuous ADT and 11 (16.4%) intermittent for a mean duration of 27.4±30.7 months at the time of baseline visit. 19.4% had their first BMD before starting ADT and 50.7% during the first year. At initial consultation, 55.2% were taking <1000 mg calcium daily from all sources, while 26.9% were taking more than 1200 mg; 22.4% were taking Vitamin D ≥ 3 months, 81.8% of them had a blood level of Vitamin D ≥ 75 nmol/L. Based on a validated fracture risk assessment tool (CAROC), the 10-year fracture risk was moderate in 28 (41.8%) and high in 9 (13.4%). 71.4% of the patients with a sedentary lifestyle were advised to increase exercise or were referred to a formal exercise program. Of the 39 (70%) and 24 (39.2%) of patients who were not taking appropriate amounts of calcium and vitamin D, respectively, 100% were recommended to adjust their intake to guideline levels. All the patients with high fracture risk were recommended to take bisphosphonates. Conclusions: The osteoporosis clinic performed a comprehensive assessment and recommended guideline-based bone health care for the vast majority of men on ADT, suggesting a systematic approach to assessing bone health is associated with high rates of guideline-adherent care.
Effect of hyponatremia on cancer patients' in-patient rehabilitation length of stay.
Authors: Nelson Megan , Palmer J. Lynn , Fu Jack Brian , Williams Janet L. , Yadav Rajesh R. , Guo Ying 
Published: March 2020

e20626 Background: The incidence of hyponatremia in cancer patients has been reported as high as 47%. Hyponatremia is associated with gait and attention impairments, increased falls, increased risk of fractures, and osteoporosis. Our aim is to determine if hyponatremia impact cancer patients’ rehabilitation length of stay, functional outcome, and survival. Methods: Retrospective study was conducted in a tertiary cancer center on two hundreds and ninty-five patients who underwent inpatient cancer rehabilitation between January 27, 2009 through July, 31, 2010. Hyponatremia incidence, rehabilitation length of stay (LOS), functional independence measure (FIM) for ambulation and transfers, and survival information were collected. Results: The incidence of hyponatremia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na<130 mEq/L) hyponatremia was 11 and 15 days, respectively, which was significantly longer than patients with eunatremia (10 days; P = .03). FIM change for ambulation and transfers during inpatient rehabilitation stay was not significantly different, nor was survival significantly different, between different patient groups. Conclusions: A high percentage of patients have hyponatremia upon admission to our inpatient cancer rehabilitation unit, and this is associated with a prolonged rehabilitation LOS.
Advanced cancer survival in a rural community: The impact of hospice services.
Authors: Cowall David Eric , Holdai Veera 
Published: March 2020

e20628 Background: The intensity of end-of-life (EOL) cancer care in a rural community has been previously reported (Cowall et al: J Oncol Pract 8: 40e-44e, 2012) using a random sample of all cancer deaths from Wicomico County, Maryland for calendar years 2004-2008. We now examine the impact of hospice services on survival in this same population. Methods: Significance (P-value) of diagnosis to death median survivals (MS) between different groups was calculated by log-rank analysis. Hazard ratios (HR) with 95% confidence intervals (CI) were obtained using Cox regression analysis. Results: 179 patients from our sample did not receive hospice services, and 211 were enrolled in hospice at some point during their illness. MS were 6.0 and 9.0 months respectively (P= 0.050, HR 1.222, CI 1.000-1.492). In the lung cancer subset, 54 patients did not receive hospice services and 78 were enrolled in hospice. MS were 5.0 and 7.0 months respectively (P=0.034, HR 1.468, CI 1.030-2.093). Other subsets were too small for analysis. Conclusions: Prolongedsurvival was significantly associated with hospice services in our sample, and that effect was more pronounced with lung cancer patients. The hospice effect on survival may reflect some combination of the following: hospice services result in better symptom management as well as counseling against toxic therapies at EOL and/or the bias of some patients against toxic treatments even before hospice enrollment.
Analysis of fatigue in non-small cell lung cancer patients treated with second-line pemetrexed.
Authors: Li Li , Winfree Katherine B. , Pennella Eduardo J. , Girvan Allicia C , Pohl Gerhardt , Obasaju Coleman K. 
Published: March 2020

e20629 Background: Cancer-related fatigue can be attributed to both treatment (tx) and the disease. Fatigue is a common adverse event (AE) of cancer tx and can profoundly affect patient (pt) well-being. It is unclear how often fatigue is a reason for dose adjustment, treatment delays, and discontinuations. Methods: To assess fatigue in pemetrexed (pem)-treated pts, we conducted post-hoc analyses of a prospective observational study of non–small cell lung cancer (NSCLC). Pts who received ≥ 1 dose of pem in routine 2nd-line medical care settings (N=434) were included in the analysis.Pt-reported fatigue scores were obtained from the MD Anderson Symptom Inventory-Lung Cancer (0 - not present to 10 - as bad as you can imagine) at the beginning of cycles (C) 1, 2, 4, 6 and at tx end. Physician (phys)-reported scores were obtained from AE assessments (grades 1-4) at C 2, 4, 6 and at tx end. Associations between pt-/phys-reported fatigue and dose reduction/treatment delays were explored using chi-square/exact tests at each cycle. Logistic regression explored the association between severe fatigue occurrence and possible confounders (α=0.05). Results: The table shows phys-reported fatigue incidence (%). Overall, 94% of pts reported some fatigue across all assessed cycles with 83% of pts reporting fatigue at baseline; 47% of pts reported severe fatigue (score ≥7) overall with 29% reporting severe fatigue at baseline. A significant association between severe phys-reported fatigue and treatment delay was observed only at C2 (p=0.02). After adjusting for possible confounders, low income and age ≤70 years were associated with severe pt-reported fatigue. ECOG PS ≥1, stage IV disease, and historical fatigue were associated with severe phys-reported fatigue. General pt- and phys-reported fatigue did not differ among racial groups. Conclusions: While pts and phys reported similar amounts of fatigue in general, pt-reported incidence of severe fatigue was higher. Factors related to severe fatigue differed between pts and phys. Fatigue had little influence on tx adjustments. [Table: see text]
Patterns of hospice use in patients with hematologic malignancies.
Authors: Sexauer Amy , Cheng M. Jennifer , Riley W. Anthony , Knight Louise , Smith Thomas J. 
Published: March 2020

e20638 Background: Despite advances in treatment there are still 70,000 deaths among U.S. patients with hematologic malignancies (HM). Nationally, fewer than 2% of HM patients use hospice and there is scarce published experience about palliative care programs for HM patients. The limited hospice use has been because of perceived HM special needs including curative intent, a less predictable course and the potential use of expensive anti-neoplastics, antibiotics, and transfusions. Methods: Study design: A single center retrospective review. Study endpoint(s): 1. What proportion of HM patients at the Sidney Kimmel Comprehensive Cancer Center (SKCCC) were referred to and utilized hospice? 2. What are the locations of hospice services? 3. What is the median hospice length of stay (LOS)? Results: The patient characteristics were summarized using descriptive statistics. Fifty-nine HM patients were referred to hospice over this 30-month period. Only 53 patients (age 64, 26 women) utilized hospice services, representing about 20% of the estimated 250 HM decedents during this time period. Of the 53 patients, 34 received home hospice and 17 were admitted to inpatient hospice. The median home hospice LOS was 9 days (SD 12) and inpatient hospice 6 days (SD 11). Nine patients with open access hospice received only a few blood transfusions, and only one patient received radiation therapy. Conclusions: HM patients usually are referred late or not at all for hospice services. Of the patients who use “open access” hospice, there is infrequent utilization of expanded services. Studies evaluating integration of palliative care with usual HM care, triggers for hospice referral, and new open access models are needed.
Efficacy of scalp cryotherapy in preventing alopecia among patients with breast cancer patients receiving adjuvant docetaxel and cyclophosphamide.
Authors: Cigler Tessa , Fiederlein Barbara , Schneider Sarah E. , Chuang Ellen , Vahdat Linda T. , Donovan Diana , Welch Roberto , Cobham Marta E. , Moore Anne 
Published: March 2020

e20641 Background: Chemotherapy induced alopecia (CIA) is a distressing adverse effect of many chemotherapy agents. The TC chemotherapy regimen (four cycles of docetaxel 75mg/m2 and cyclophosphamide 600mg/m2 given every 3 weeks apart) commonly used for aduvant therapy of breast cancer is associated with complete alopecia, with rare reports of permanent alopecia. Scalp cryotherapy has been reported to minimize or prevent CIA. Penguin cold caps are a commercially available scalp cooling product gaining increasing media attention. We conducted a prospective study aimed to assess efficacy of scalp cryotherpy in preventing CIA among women receiving adjuvant TC chemotherapy for early stage breast cancer who independently elected to use Penguin cold caps. Methods: Women at the Weill Cornell Breast Center who elected to use scalp cryotherapy with Penguin cold caps during adjuvant TC chemotherapy were asked to participate in the study. Degree of hair loss was rated by practitioner assessment using Dean’s alopecia scale (poor (>75% hair loss), moderate (50-75%), good (25-50%) or excellent (<25%)), by digital photographs, and by asking patients whether they felt a need to wear a wig or head covering due to hair loss. Assessments were made before each chemotherapy treatment and at a follow up visit between 3 weeks and 3 months after the completion of chemotherapy. Results: 17 patients have enrolled. 13 patients have completed chemotherapy. 2 patients currently undergoing chemotherapy and 2 patients who discontinued chemotherapy due to toxicity not related to alopecia are excluded from analysis. Dean’s alopecia scale score was excellent for 10 patients (77%) at every assessment. Dean’s score was good for 2 participants (15%) and moderate for 1 participant (8%) starting prior to fourth cycle of chemotherapy. Only 1 patient (8%) reported needing to wear a wig or head covering as a result of alopecia. Conclusions: Scalp cryotherapy using Penguin cold caps appears to be effective in preventing CIA among women undergoing chemotherapy with the TC regimen.
Communication of diagnosis in elderly lung cancer patients: Who is informed, what information is given, and what patients know and want to know.
Authors: Girones Regina , Aparicio Jorge , Torregrosa Maria Dolores 
Published: March 2020

e20643 Background: Lung cancer chemotherapy decisions in patients > 70 years old are complex; in order to integrate patients in the decision-making process, they must be informed. To assess the modes of communication with older lung cancer patients, we prospectively collected data in order to assess patients’ level of knowledge about diagnosis and prognosis. We examined who informed the patient, the information given and what the patient knew and wanted to know. Relationships, among other parameters were presented. Methods: 83 patients diagnosed with lung cancer from January 2006 to February 2008 were recruited from a single center. Logistic regression and multiple imputation methods were used to assess associations between patient information and independent variables. Results: In the majority of cases, families received the diagnosis of lung cancer (92.8%). Family was more protective when the patients were elderly (p: 0,036), depressed (p: 0,054), had dementia (p: 0,03), had poor performance status (p: 0,03) or complied with frailty criteria (p: 0,014). At our institution, physicians who gave cancer diagnoses were not oncologists. We received the patient diagnosed yet. We found that they usually gave cancer diagnosis preferably to family members. Only 27,7% of patients were informed that they had tumors. There was a correlation between age and more protective attitudes on the part of physicians. 73,5% of patients actively solicited information, however elderly and frail patients tended to do so less. Conclusions: A large proportion of elderly lung cancer patients do not receive adequate information about their disease prior to contact with oncologists however they do actively ask for information and speak about cancer with oncologists. Information about cancer is difficult to provide, even in elderly patients.
Providers' concordance with survivorship clinical algorithms.
Authors: Zandstra Frances Ann , Palos Guadalupe R. , Russell Ludivine , Gilmore Katherine R. , Flores Jacklyn J. , Ozeri Delrose , Rodriguez Maria Alma 
Published: March 2020

e20645 Background: The utility of algorithms to guide clinical practice related to long-term survivorship care is unclear. In 2012, lymphoma survivorship algorithms for Hodgkin’s and Large B-Cell were developed as part of an institutional clinical practice initiative to enhance survivors’ outcomes. Here we describe providers’ concordance with minimum standards recommended in survivorship lymphoma algorithms. Methods: Concordance, the primary outcome, was defined as whether minimum recommendations, summarized in lymphoma algorithms, were provided during a survivorship visit. Concordance was measured using a “yes/no” response format assessing whether a provider’s recommendations were consistent with algorithms’ minimum standards including: 1) physical examination, 2) laboratory and imaging testing, 3) cancer screening procedures, and 4) health promotion education. Data were abstracted from electronic medical records and Passports (summary care plans). Secondary outcomes were number of survivors seen and Passports issued. All data included in these analyses were de-identified. Results: From 05/01 to 09/30/2012, all 63 survivors seen in the Lymphoma Survivorship Clinic received a Passport. Providers individualized Passports based on a survivor’s needs relevant to disease surveillance, life-style changes, screening recommendations, and specific procedures to assess for a recurrence or late treatment effects. Results indicated 100% of survivors received a physical exam, adult vaccinations, and cardiovascular screening. Similar rates were achieved for CBC testing, chest X-rays, assessing survivors’ psychosocial distress, and counseling survivors on screening recommendations specific to breast, cervical, colorectal and prostate cancers. Additionally, rates for skin exam recommendations were 97%. Conclusions: Based on concordance results, providers met the minimum recommendations listed in the lymphoma algorithms. Future research is needed to assess the impact of providers’ use of algorithms on survivors’ outcomes and feasibility of replicating concordance analyses in other clinical care settings.
Chemotherapy-associated thrombosis in cancer outpatients: Risk factors and decision making of a prophylactic approach.
Authors: Torchio Martina , Franceschetti Benvenuto , Cavali Carla , Zanirato Sonia , Olgiati Angelo , Gristina Valerio , Danova Marco 
Published: March 2020

e20647 Background: Venous thromboembolism (VTE), is a negative predictor of survival in pts with advanced cancer. International guidelines don’t recommend routine prophlaxis but suggest to consider pts, undergoing chemotherapy (CT), with high risk of VTE. Many clinical risk factors for cancer-associated VTE have been evaluated in a 5 parameter-based (body mass index, platelet and leucocyte counts, hemoglobin value and tumor site) scoring system, the Khorana score, utilized to indicate a prophylactic approach. We prospectively applied this score in cancer outpts beginning CT and an implementation based on 6 addictional factors analysis (sex, age, central venous catheter, CT-agents, antiangiogenetic drugs, erithropoiesis stimulating agent) to evaluate their impact in pts assignment into risk groups. Methods: We studied adult pts, followed at our Department from August 2011 to December 2012, with advanced cancers (breast, NSCLC, colorectal, pancreatic/gastric, urogenital, LNH, Hodgkin's disease, HD, and MM), receiving a first or second line standard CT. We stratified pts into three risk groups (score 0= low; score 1-2=intermediate; score 3-4-5=high) considering both the Khorana scoring system and its implementation. Results: We analyzed 169 pts (103F/66M, median age 62.3, range 35-80 yrs), pt population included: 38 breast, 32 colorectal, 31 LNH, HD and MM, 27 urogenital, 22 NSCLC and 19 pancreatic/gastric. With the Khorana score 49 pts were assigned to the low risk, 87 pts to the intermediate risk (57 with score=1, 28 with score=2), 16 pts (9.4%) to the high risk group (9 with score=3, 4 with score=4, 3 with score=5). When we considered 11 parameters 37 pts (21.8%) were assigned to the high risk group. Conclusions: A more comprehensive quantification of VTE risk, also considering new independent factors, is mandatory for a correct decision making of an antithrombotic-prophylactic approach.