bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between biological and self-reported measures of stress among informal caregivers of patients with prostate cancer
Authors: Witt W. P. , Pickard S. , Kuzel T. , McDade T. , Perry S. , Hung S. , Zagory J. , Lin H. , Costello S. , Colella K. , Bennett C. L. 
Published: April 2020

18506 Background: Informal caregivers of prostate cancer patients often experience chronic psychological stress that may adversely impact their physical and mental health, and their ability to care for their families and the patient. This study aims to determine the association between perceived and biological stress among informal caregivers of prostate cancer patients. Methods: A total of 24 informal caregivers of prostate cancer patients were recruited from both the Jesse Brown VA Center (Lakeside and Westside, Chicago) and the Robert H. Lurie Comprehensive Cancer Center at Northwestern University. Caregivers completed self-reported measures of stress, somatization, life events, burden, health status (SF-36) and mental health. Capillary blood spot samples from caregivers were used to examine two measures of biological stress, Epstein-Barr virus antibody titer and C-reactive protein. Results: Informal caregivers had a mean age of 63 years and were mostly female and spouses of patients with prostate cancer. Many had preexisting co-morbidities, including 45.8% with hypertension, 45.8% with arthritis, and 33.3% with diabetes. Nearly 30% had been hospitalized in the last 12 months. 33.3% of caregivers experienced at least one major life event in the last year and 62.5% had symptoms of somatization illness. Caregivers with symptoms of somatization illness had higher mean Epstein-Barr antibody titers as compared with those without symptoms (Mean EBV antibody titer: 198.3 versus 141.8, respectively (p < 0.05)). Caregiver-reported measures were not correlated with C-reactive protein levels. Caregivers with higher levels of strain perceived more stress in their lives (p < 0.05), but showed relatively high self-esteem (mean = 30.6, SD = 2.8, on a 7–35 scale). Conclusions: These preliminary findings suggest that informal caregivers who report symptoms of somatization illness exhibit signs of relative suppression of the cell-mediated immune processes as a result of the reactivation of the Epstein-Barr virus. Final analyses will be conducted that control for potential confounders and will further elucidate if caregiver stress is associated with suppression of the immune system. No significant financial relationships to disclose.
The palliative care network as a model of continuity of care in oncologic departments
Authors: Tassinari D. , Poggi B. , Fabbri A. , Massa L. , Nicoletti S. , Pecci A. , Ricci G. , Raffaeli W. 
Published: April 2020

18518 Background: Although medical oncology and palliative care are often distant dimensions in the treatment of patients with cancer, it is a common notion that an integration could improve the outcome in a comprehensive assistance to the patient. Methods: To create a Palliative Care Network (PCN) in our Department, we promote the creation of a multidisciplinary team (MT) with oncologists (2), palliativists (1), psychologists (1), social workers (2) and nurses (3) with the aim of favouring the continuity of care along all the phases of the disease. The MT gathers the competences of the oncologic and palliative care units, and is coordinated by the responsible of the supportive and palliative care unit of the district. All the patients were evaluated before entering into the project and classified in three levels with different care burden. In all the patients admitted to the PCN a palliative support is planned since the early phases of metastatic disease. The palliative care project are weekly updated by the MT. The outcomes of the PCN are evaluated every six months for activity and annually for efficacy. Results: 4589 patients have been admitted in 2003–2005 period (419 in Hospice). 2441 (53.2%), 1533 (33.4%) and 615 (13.4%) patients were classified respectively in the three increasing severity levels, and an “intensive” palliative approach was needed in 2547 (55.5%) patients. The main problems referred by the patients or their families were symptoms control, pain control, the need of psychological or social support, the need of a continuity of care along the terminal phases of the disease. Preliminary data seem to suggest a positive impact of the shared approach against the symptoms of advanced or terminal disease, and an interesting level of satisfaction by patients and caregivers seems to be confirmed in a preliminary assessment. Conclusions: The continuity of care is considered an index of the quality of care and an integrated model of palliative care should be elaborated in every oncologic district; oncologic departments seem to represent the ideal dimension where favouring an integration between medical oncology and palliative care and every effort should be made to realize this kind of integration. No significant financial relationships to disclose.
Intrathecal drug delivery versus comprehensive medical management as it may impact inpatient length of stay, readmission, and inpatient cost of care
Authors: Isaacs J. D. , Stearns L. J. , Poling W. H. , Milton D. , Nasternak J. , Romano C. 
Published: April 2020

18520 Background: Long lengths of stay (LOS) and high readmission rates partly explain the high medical costs of treating cancer patients. Uncontrolled pain is the number two reason for hospital readmission. Aggressive measures and treatment strategies for relieving intractable cancer pain can require the implantation and management of intrathecal (IT) drug delivery systems. The objective was to examine LOS, episodes of readmission, intensive care (ICU) stays, and discharge status among patients treated with IT versus comprehensive medical management (CMM) for pain. Methods: Retrospective case-control medical record review methods were employed. Sixty-three randomly selected cancer patients who received an IT were matched on gender, age group, and primary diagnosis to 63 who did not. Results: The total LOS for the 63 non-IT patients was 567 days. The total LOS for the 63 IT patients was 301 days. The mean LOS among the non-IT patients was 9 days. The mean LOS among the IT patients was 4.7 days. Total LOS for the non-IT patients was statistically significantly higher. Among the 63 non-IT patients 94 total inpatient episodes were experienced. Among the 63 IT patients 68 total inpatient episodes were experienced. The likelihood of a non-IT patient readmitting was nine-fold higher than the IT patients and statistically significantly different. The total Intensive Care Unit (ICU) days for the 63 non-IT patients were 60 days. The total ICU days for the 63 IT patients were 30 days. The total ICU for the non-IT patients was not statistically significantly higher. The likelihood of a non-IT patient expiring while an inpatient was fourteen-fold higher than the IT patients and was statistically significantly different. The average cost per episode was 22% higher among the IT group versus the non-IT group. Conclusions: The implantable IT system for pain management among cancer patients experiencing intractable pain may be a significant influence on patient LOS, readmission, and ICU episodes even though it represents a 22% increase in average inpatient costs per episode. Controlled studies examining these hospital indicators as primary outcomes for these patients by evaluating the IT drug delivery system as compared to CMM are warranted. No significant financial relationships to disclose.
Lymphedema is common among post-operative cancer survivors
Authors: Cormier J. N. , Davidson L. , Xing Y. , Evans W. J. , Armer J. M. 
Published: April 2020

18524 Background: Lymphedema (LE) is associated with the surgical treatment of a number of tumors and is a serious long-term condition with significant medical, economic, and quality of life consequences. Early detection and management are critical to preventing LE progression and complications. We examined the literature to ascertain the incidence and identify factors associated with an increased postoperative risk for LE. Methods: We systematically reviewed the oncology literature (1972–2005) to identify studies that examined postoperative LE. Data pertaining to the type of malignancy, the surgical procedure performed, the criteria used to define LE, and the median follow-up time were extracted. The incidence of LE was summarized using weighted averages. Results: We identified a total of 122 reports of postoperative LE (N = 24,095 patients), which were broken down by cancer type as follows: breast cancer (n = 45), melanoma (n = 31), gynecologic (GYN) malignancies (n = 30), genitourinary (GU) malignancies (prostate n = 6, penile n = 6, bladder n = 2), and sarcoma (n = 2). When only prospective studies (n = 74, 61%) were considered, the incidence of LE following axillary node dissection (AND) in patients with breast cancer was 19% compared with 8% following AND for melanoma. The incidence of lower extremity LE following inguinofemoral and/or pelvic lymph node dissection for melanoma was 30% compared with 24%, 14%, and 20% for GYN malignancies, GU malignancies and sarcomas. The relative risk of postoperative lower extremity LE increased two-fold in patients who received radiation therapy. Methods of measuring LE included extremity circumference (n = 17 studies) with various defined thresholds (>1 cm [n = 8], >2 cm [n = 7], and >3 cm [n = 2]). Fourteen studies used volume measurements, while the remainder used an ad hoc clinical grading method. The lowest incidence of LE was seen in studies with the shortest follow-up. Conclusions: LE is a common condition resulting from the surgical treatment of a number of different malignancies. To enhance the quality of postoperative care in cancer survivors, objective LE measurement and symptom assessment should be part of standard practice during both early and long-term follow-up. No significant financial relationships to disclose.
Hub colonization of central line catheters in children with cancer
Authors: Norville R. , Horvath B. , Lee D. , Hyde A. , Gregurich M. , Hilburn J. , Starke J. , Versalovic J. , Mueller B. , Hockenberry M. 
Published: April 2020

18530 Background: Central venous catheter (CVC) hub sites provide bacterial access to the blood stream through migration along the external and internal surfaces of the catheter. Hub colonization rates vary from 29–38% in the adult literature. While pediatric studies were not found, one study reported the incidence of blood stream infections in neonates to be 30 times higher in catheters with hub colonization compared to catheter hubs that were not colonized. The purpose of this descriptive study was to obtain baseline cultures of CVC hubs to determine the incidence of colonization. Methods: Fifty-one catheter hub cultures were obtained from a convenience sample of 27 children with cancer. The mean age of the patients was 8.2 years (range 0.5–16.2 years); 77% were diagnosed with leukemia and 23% with solid tumors. Cultures were obtained by swabbing the threaded area of the catheter hub after removing the injection cap. A semi-quantitative culture for bacteria and fungus was obtained using standard laboratory procedures by a microbiologist. This study was conducted in a large urban hospital in the Southwest. Results: Fifty-seven percent of the hubs were culture positive. Of those positive cultures, 69%, 24%, 10% and 7% were colonized with 2, 3, 4 and 5 organisms, respectively. The most common organism cultured was coagulase negative staphylococcus. The only significant risk factor for this population was previous central venous catheter infections (p = 0.025). Sixty-nine percent of the lines were tunneled catheters. Central venous catheters were in place on an average of 75.3 days but this was not a factor in the colonization rate. Conclusions: The majority (57%) of the 51 central venous catheter hubs cultured were colonized with at least one organism. This study is the first to evaluate the rate of central venous catheter hub colonization in children with cancer. These findings support the need for more stringent guidelines for central venous catheter care. Further research evaluating the relationship between hub colonization and subsequent blood stream infection is needed. No significant financial relationships to disclose.
Darbepoetin alfa improves quality of life in cancer patients undergoing radiation, final results of a multicenter, open study
Authors: Antonadou D. , Varveris P. , Karageorgis P. , Papadopoulos V. , Georgakopoulos G. , Kyprianou C. , Panousaki A. , Athanasiou H. , Beroukas C. , Skarlatos J. , Misailidou D. 
Published: April 2020

18531 Background: Anaemia is a poor prognostic factor for patients undergoing radiotherapy (XRT) and has been associated with decreased response to treatment. Darbepoetin alfa has been proven effective in treating anaemia and in improving QoL. The purpose of this study was to assess the efficacy, safety and the impact on QoL of darbepoetin alfa in these pts. Methods: Patients with Hb level 10–12 g/dl, PS ECOG <2, and life expectancy >6 mos were administered darbepoetin alfa SC 150 mcg once weekly during the 6 wk course of conventional XRT (2 Gy/5 days/week). All pts received iron supplem. Blood transfusion was given for Hb <9 g/dl. Complete blood counts, serum iron, folate, B12, ferritin, serum LDH, bilirubin and reticulocyte count were measured weekly. The primary study endpoints were changes in Hb level during XRT, number of transfusions and evaluation of QoL. Results: Between Mar 2002 and Feb 2004, 140 pts were entered, 116 were evaluable. Mean Hb at baseline was 10.95 ± 1.76. There was a significant increase (17.1%) in mean Hb levels from 2nd wks onwards with the peak value at wk 10 from XRT initiation. Hb significantly increased to 12.03 ± 2.39 (p < 0.001), 12.63 ± 2.10 (p < 0.001) and 12.96 ± 2.33 (p < 0.001) at 3,6 and 10 wks, respectively. Blood transfusion was necessary in 3 pts (2.6%). None of the pts experienced serious adverse events. There was a significant difference in physical well being score between Hb levels (p = .016) regardless the period of time (p = .17). Pts with high Hb levels had higher functional well being scores (p = .002) regardless time for the interaction (p = .24).There was a significant difference in mean fatigue score between Hb levels (p=.019) and a significant time by group interaction (p = .03).Pts with high Hb levels tend to have a higher social well being score than those with lower Hb (p = .08) while the differences were similar over time (p = .89).Those with Hb ≤ 12 g/dL had a tendency for increased emotional scores at 6 wks (p = .07) while the differences were similar over time (p = .138). Conclusion: Hb levels were significantly increased from baseline, irrespective of tumour localisation and stage. This increase reached the maximum value during wk 10 and remained significant 2 mos post XRT. QoL was significantly improved in these pts. No significant financial relationships to disclose.
Spirituality correlates positively with higher quality of life and negatively with depression in a sample of low income brazilian cancer patients
Authors: Del Giglio A. , Ramos E. , Bensi C. G. , Centofanti G. , Frankfurt S. , Garcia A. , Tannuous N. G. 
Published: April 2020

18534 Background: Brazil has a multicultural mostly poor population with many different kinds of religious affiliations. Since cultural, psychological, spiritual and social factors may influence the quality of life (QOL) of cancer patients, we wanted to evaluate spirituality and its relation to depression and the QOL in a sanple of these patients. Methods: We surveyed 72 adult cancer patients through three questionnaires: a general one, the FACIT-Sp QOL questionnaire, as well as the Beck depression inventory, all of them already validated in Portuguese. From the FACIT-Sp questionnaire we obtained also the general quality of life (FACT-G) score. We evaluated correlations between variables with Chisquare, Fisher and ANOVA tests. Since multiple univariate correlations were assessed in this study, we considered significant only p values equal or bellow 0.005. We employed multiple regression analysis to evaluate if depression and spirituality would independently correlate with QOL. Results: We included 72 patients. The mean age was 52 years, 63.9% were female, 58.3% were married, 20.8% were regularly employed, and 59.7% had studied up to elementary school only. For most patients (66, 2%) their religious faith was the most important factor that helped them to cope with their disease. We found no statistical correlations between the scores of the questionnaire FACIT-Sp and any of the demographic variables. We observed significant correlations between higher scores of spirituality (ANOVA p < 0.001) with the absence of depression. Likewise higher scores of QOL (ANOVA p < 0.001) correlated with lack of depression. By multiple regression analysis both the spirituality dominion of the FACIT-Sp and the Beck depression inventory score correlated independently and significantly with general QOL measured by the FACT-G questionnaire’s score (p = 0.025 and p = 0.004, respectively). Conclusions: Despite the small sample size of our study, it was possible to show that religion is highly regarded by our patients and that it may influence their quality of life independently from depression. Furthermore, spirituality may also be a protective factor against depression. Therefore, physicians respect and encourage their religious practices. No significant financial relationships to disclose.
Long term analysis of recurrences in patients treated by multimodality approach for local treatment of early rectal cancer—Liverpool’s Experience
Authors: Sun Myint A. , Elam F. , McDonald A. , Hershman M. J. 
Published: April 2020

18539 Background: Local treatment of early rectal cancer with curative intent is highly controversial. Three years ago, we reported our results in 100 patients treated by multimodality approach. We have updated our results and analyse the pattern of recurrences in155 patients treated up to 2005 Methods: From Jan 1992 to Jan 2005, local treatment was offered to 155 patients with low rectal carcinoma. The majority of patients were elderly with the mean age of 76 years( range 33–101). There were 87 males and 68 females. 109 had surgery; TEM (79 patients) and TAR(30 patients). Forty six patients had radical radiotherapy alone.Locally treated patients were followed up regularly with DRE and sigmoidoscopy. CT and MRI scans were done at 0,12 and 24 months. Results: Local recurrence only occured in 13 patients (8.3%). Four patients had local and distant recurrence (2.5%). Overall local recurrence occured in 17 patients (10.8 %). Salvage surgery was carried out in 11 patients(10 APER and 1 local excision). Two had retreatment with Papillon. A total of 13 patients had salvage treatments (76.5%). At median follow-up of 40 months (range 12–168) only 72.7% of patients were still alive. Five patients (3.2%) developed distant metastases only and one had nodal recurrence. Cancer specific survival was 96% and colostomy free survival was 93%. Conclusions: Local treatment of early rectal cancer is a complex issue that needs to be address and discuss. As ageing populationis likely to increased in the next decade demands on local treatment will increase. It is important to balance the benefits of radical surgery in terms of lower local recurrence against increase mortality and morbidity from such procedures especially in elderly patients, versus slightly higher local recurrences and much lower mortality and morbidity from conservative treatments such as TEM and Papillon contact radical radiotherapy. Our study has shown that local treatment is safe and effective treatment for elderly patients with medical co morbidity. In our experience, salvage surgery can be offered for recurrences in the majority of patients but long term close follow-up is necessary. A careful case selection and multimodality treatment is essential for successful out come. No significant financial relationships to disclose.
Antithrombotic prophylaxis (AP) and catether-related infections in cancer patients (pts) carrying central venous devices (CVD): An observational study
Authors: Fagnani D. , Franchi R. , Porta C. , Giordano M. , Scanni A. , Bertolini A. , Duro M. , Ardizzoia A. , Filipazzi V. , Cimminiello C. 
Published: April 2020

18550 Background: Recent data underline the possibility to reduce catheter-related infections in cancer pts having placed a central line by using low-dose heparin. Here we report the results of an observational prospective study aimed at recording management and outcome, including infective complications, of pts affected by solid tumors undergoing a CVD placement. Methods: The study was named “Registro CVD-POLO NORD” and involved 18 centers of oncology in Lombardia (Italy). Starting from January 2003 and with an accrual period of 30 months, 1418 pts entered the study and their data were recorded. Both bloodstream infections and local infections of the subcutaneous pocket were considered as catheter-related infections. Results: On September 2005, 1253 pts had a follow-up of at least 4 months, the median follow-up period being 6 months. Of them, 424 subjects (34%) received a continuous AP consisting mainly of very low-dose warfarin. CVD-related infections occurred in 46 pts (3.6%, 95 CI 2.6%–4.7%). In the table the frequency of infective complications is reported according to type of cancer, stage of disease, treatment with chemotherapy (CT) and administration of AP. The use of central venous catheter (CVC) and peripherally inserted central catheter (PICC) as well as CT were significantly more associated with infections. On the contrary, low-dose warfarin appeared to be protective. No difference was found as regard to the primary tumor site. There were no major bleeding complications among subjects receiving AP. Conclusions: Confirmatory of previous reports, our data underscore the increased risk of infections related to the use of certain devices and CT administration. The role of fibrin deposition in favouring bacterial colonization of CVD seems to be confirmed by the protective effect of low-dose warfarin which represents a feasible way to obtain a long-term reduction of catheter-related infections. [Table: see text] No significant financial relationships to disclose.