bluuebunny/crossref_metadata_2025_split huggingface dataset:
QTc interval in advanced cancer patients
Authors: Trivanovic D. , Dobrila-Dintinjana R. , Mavric Z. , Stimac D. , Petkovic M. 
Published: August 2020

e20658 Background: The purpose is to identify prognostic factors that may have impact on survival in patients with advanced cancer. Methods: We retrospectively reviewed the data of patients who had biopsy proven advanced solid cancer disease in stage IV and no history or evidence of any prior cardiac disease. Univariate and multivariate stepwise Cox proportional hazard regression analysis were performed to identify independent predictors of one year survival. Results: Between 1/01 and 9/05, 143 patients (83 male and 60 female) with advanced cancers were evaluated in our institution. The primary site of disease was lung (28%), pancreas (19%), colon (15%), rectum (13%), breast (12%), and other (13%). The median follow-up was 12,5 months, median overall survival (OS) was 8.1 months, and 1-year OS rate was 62%. Median age was 65 years. OS was significantly related to the following pre-treatment prognostic factors: Age ≥65 (years), anaemia (hemoglobin level <13.2 g/dl), Eastern Cooperative Oncology Group performance status (ECOG PS) 0–1, and prolonged QTc interval in electrocardiogram (ECG). However, multivariate analysis revealed only prolonged QTc as independent prognostic parameter with 1-y survival status. Using 440 ms as the cut off value, the QTc interval was prolonged in 32 patients (22%) with median survival of 45 days and normal in 111 patients (78%) with median survival of 280 days. During the one-year 25 patients (78%) died in group with prolonged QTc interval while in group with normal QTc interval died 63 patients (57%). Conclusions: The results of our study indicate that a prolonged QTc interval (> 440 ms) is an adverse prognostic sign in patients with advanced cancer and without cardiac disease which correlates with increased mortality rates within one year after the diagnosis. Our findings suggest that QTc prolongation may be a good adjunct in risk stratification of patients with advanced cancer who are being considered for aggressive treatment regimens. [Table: see text] No significant financial relationships to disclose.
Clinical consequences of profound anemia
Authors: Devagiri M. , Ford P. 
Published: August 2020

e20666 Background: Although there is an emerging trend to reduce blood transfusions, there is still very little randomized data outside of the critical care setting that identifies the risks and benefits of transfusion support. Many clinicians base the decision to transfuse primarily on the hemoglobin (Hb) level independent of symptoms. Little is known about the clinical consequences of profound anemia although there is concern that withholding transfusion will result in adverse outcomes in those with advanced age or underlying cardiovascular conditions. Methods: A retrospective chart review of 32 patients declining blood transfusions from January 2004 to June 2008 was performed to evaluate the clinical consequences of anemia. This population included a broad range of medical, surgical and obstetrical cases and their ages ranged from 84 to 28yrs (mean 53.03). The initial Hb ranged from 3.2 to 6.8 (mean 5.04).12 patients had Hb levels less than 4.9 and 3 patients had levels less than 4. Our non blood approach included simultaneous interventions to stimulate erythropoiesis, control bleeding, enhance hemostasis, minimize blood loss and maintain hemodynamic stability. Results: 6/32 patients (18.75%) had cardiac complications related to anemia like congestive heart failure, myocardial ischemia, and cardiac arrest. They occurred predominantly in patients with underlying cardiovascular disease (4/7) with increased tendency in patients with structural heart disease like Hypertrophic Obstructive Cardiomyopathy (HOCM) and critical Aortic stenosis (3/3) at Hb levels of 4.8 and 5.6. Patients without any pre-existing cardiovascular illness tolerated very low levels of Hb of 2.5 and 4 before they had cardiac arrest from anemia. 2 patients above the age of 70 tolerated the Hb levels of 2.7 and 3.3 without complications. 2 of 3 patients with Hb less than 3 had no complications.4 deaths are noted. Conclusions: This study illustrates that patients without cardiovascular co-morbidity tolerate levels of Hb as low as 3.3 without significant events. However patients with structural heart disease like Aortic stenosis and HOCM have shown the signs of decompensation at a lower degree of anemia which suggests that they need transfusion at lower degree of anemia. No significant financial relationships to disclose.
Cardioprotective effect of telmisartan in cancer patients treated with epirubicin
Authors: Mantovani G. , Mercuro G. , Dessì M. , Madeddu C. , Serpe R. , Massa E. , Cadeddu C. , Piras A. 
Published: August 2020

e20671 Background: We previously showed on 31 cancer patients (pts) that early cardiac abnormalities occurred at epirubicin (EPI) doses of 200 mg/m2 and persisted throughout subsequent EPI doses and even up to 18 months. Early contractility impairment, i.e. Strain rate (SR) reduction was detected by tissue doppler imaging (TDI) associated with high levels of inflammatory/oxidative stress markers. Renin-angiotensin system activation has been suggested to play an important role in the pathogenesis of Anthracycline-induced cardiotoxicity. Methods: A phase II placebo-controlled study was designed to investigate the possible role of telmisartan (an antagonist of angiotensine II type I receptor) in preventing both early preclinical and late myocardial damage induced by EPI. The correlation with changes of biochemical/inflammatory markers was also assessed. Planned sample size was 100 pts (50 pts per arm). Inclusion criteria: 18–70 y, histologically confirmed cancer, previously untreated and candidates for an EPI-based regimen; LVEF ≥55%; ECOG PS 0–2, no history of cardiac disease and previous mediastinal irradiation. Eligible pts were randomized to receive telmisartan 40 mg (1 tablet)/day or placebo starting 1 week before EPI until 6 months after the end of EPI administration. TDI as well as inflammatory/oxidative stress markers were assessed at baseline, 24 hours and 7 days at EPI doses of 100, 200, 300, and 400 mg/m2. Results: At December 2008 we enrolled 27 pts (M/F: 7/20, mean±SD age 58±14 years): 14 telmisartan and 13 placebo. 15 pts completed EPI treatment (8 telmisartan and 7 placebo). A significant reduction of SR peak was observed at 200mg/m2 of EPI in the placebo arm. Viceversa no significant TDI changes occurred in the treatment arm. Proinflammatory cytokines did not change in both arms whilst reactive oxygen species increased significantly in the placebo arm. Conclusions: The study is in progress. No significant financial relationships to disclose.
Myelophthisis in solid tumors: Old aspects, new concepts (ONCOLGroup study)
Authors: Lujan M. , Cardona A. F. , Yepes A. , Carrasco-Chaumel E. , Reveiz L. , Otero J. M. 
Published: August 2020

e20672 Background: Myelophthisis is a form of bone marrow failure due to replacement of hematopoietic tissue by abnormal tissue, most commonly metastatic carcinomas. This results in extramedullary hematopoiesis, typically in the spleen leading to premature release of hematopoietic cells into the circulation. Peripheral blood findings of myelophthisis may include nucleated red blood cells, tear drop forms, giant platelets, and immature leukocytes. Overall, this picture is usually called leukoerythroblastosis. Methods: This retrospective study included 89 patients (pts) with solid tumors and myelophtisis that had been treated from 1991 to 2006 in a single reference center in Bogotá. We made a detailed analysis of pts characteristics and outcomes. Results: Mean age was 47.5±17.2 years, there was homogeneous gender distribution (F46/M43) and 62% pts had a PS ≥60%. Twenty-seven pts (30%) had breast cancer, pathology followed by primary unknown tumours (21%), rabdomiosarcoma (10%), prostate adenocarcinoma (10%), gastric carcinoma (7%) and others (22%). At the time when myelophtisis was documented 72% and 50% of pts had osseous and visceral metastasis respectively; 81 pts presented anaemia (Hb 9.8 ± 1.2 gr/dl), mean platelet count was 174,000 and mean leukocyte count was 24,283 ± 5,447. Forty-three pts received chemotherapy following the diagnosis of medullar infiltration, and normal leukocyte count was being seen in 40% of them after such treatment. Nine episodes of febrile neutropenia were found; median overall survival (OS) following the diagnosis of neoplasia and myelophtisis were 13.8 months and 2.2 months respectively. The factors related to lower survival rate were the presence of Hb ≤8.5 gr/dl (HR: 0,54, CI95% 0,32–0,95; p = 0.04), >3 metastasis sites (HR: 0,67, CI95% 0,45–0,92; p = 0.03), visceral disease (HR: 0,72, CI95% 0,66–0,89; p = 0.04) and febrile neutropenia caused by chemotherapy (HR: 0,52, CI95% 0,37–0,60; p = 0.02). Conclusions: Myelophtisis is a serious condition modifying the OS of patients having solid tumours. Treatment for this subgroup should be selected bearing in mind its potential haematological toxicity. No significant financial relationships to disclose.
Incidence and management of bevacizumab associated hypertension in outpatient oncology clinic
Authors: Jee C. , Brockstein B. , Hui W. , Lawton J. , Harper A. , Carro G. 
Published: August 2020

e20677 Background: Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor is utilized to treat a wide range of cancers. However, clinical trials of bevacizumab reported the incidence of hypertension (HTN) up to 36%. A national guideline has not been established to manage bevacizumab-induced HTN. The incidence and management of bevacizumab associated HTN were evaluated in an outpatient oncology clinic. Methods: A randomized, retrospective chart review of 100 patients who received at least one dose of bevacizumab from 1/1/07 to 12/31/07 was conducted. The overall incidence and management of hypertension were evaluated. Other bevacizumab associated toxicities were compared in patients with or without hypertension. Results: The overall incidence of bevacizumab-induced HTN was 31% (95%CI: 22%-40%) with CTC (v 3.0) grade 3 HTN rate of 10%. The number of patients with a history of HTN or uncontrolled BP prior to bevacizumab therapy was significantly different across the four HTN grade groups (p= 0.0019). Out of 31 patients who had grade 1–3 HTN, 8 patients (26%) were managed by the oncologists, 8 patients (26%) by the primary care physicians, and 15 patients (48%) had no management. Bevacizumab was held in 3 patients due to high blood pressure (BP) resulting in one patient discontinuing bevacizumab therapy. The odds of other bevacizumab associated adverse events in patients with grades 1–3 HTN was 2.776 times than that of patients with grade 0 HTN (p=0.0201). Conclusions: Bevacizumab was associated with HTN in 31% of patients. Patients with history of HTN or uncontrolled BP prior to initiating bevacizumab were at an increased risk to develop a higher grade of HTN. Management of bevacizumab-induced HTN could be improved since BP of 63% of patients with grades 2 and 3 HTN was not adequately controlled. No significant financial relationships to disclose.
Optimizing medication management: The pharmacists’ role and the cancer patients’ view
Authors: Meier K. , Wagner W. , Thor-Wiedemann S. , Wiedemann G. J. 
Published: August 2020

e20684 Background: The safety of cancer patients given antineoplastic drugs as an outpatient treatment strictly depends on patients’ compliance to the information given by physicians and other health care professionals. On that note, pharmacists play an important part because they supply the cancer patients with the prescribed drugs and influence the actual intake of the medication. It has been shown in several large-scale studies that at least one third of all cancer patients do not take their vital medication. Is this missing compliance partially caused by insufficient or lacking information by the pharmacists? The patients‘ view. Methods: 312 (out of 514 invited) cancer patients from all parts of Germany undergoing cancer treatment filled in a questionnaire (Picker Institute, Germany) asking about the use of pharmacist services in 47 pharmacies and their satisfaction with the information received. Results: In pharmacies with an oncological focus 50% of the cancer patients received specific counselling. Other pharmacies provided oncology-specific information to 6%. 18% of the surveyed patients would have liked counselling but did not receive any. 17% were not interested in further information. Patients were disappointed about the lack of information regarding medication (25% of the patients), nutrition (43%), supportive therapy (35%), complementary medicine (51%). Complete satisfication with the information given was achieved in counselling regarding medication (30%), nutrition (22%), supportive therapy (28%), and complementary medicine (10%). Conclusions: The majority of the surveyed cancer patients were not satisfied with the information regarding medication, supportive therapy, nutrition, and complementary treatments provided by pharmacists. Our data have implications for pharmacist education and may help to improve patient support and compliance by ameliorating consulting skills. No significant financial relationships to disclose.
Psychosocial impact of prostate cancer surgery on sexual intimacy
Authors: Krupski T. L. , Mouraviev V. , Mayes J. , Polascik T. 
Published: August 2020

e20685 Background: Prostate cancer survivors live with the day-to-day consequences of the disease and its treatment. Prostate cancer, has been labeled a “relationship disease” because it impacts both partners. Traditional research does not include psychosocial aspects of sexual well-being. We designed a retrospective survey asking patients’ and their partners’ about the physiologic and psychosocial changes experienced after prostate cancer treatment. Methods: The study design is a cross sectional retrospective mailing sent to men treated surgically for prostate cancer. Questions related to physiologic changes centered around foreplay, libido, erection, orgasm and ejaculation while emotional status, relationship/partnership quality, self image, and social support comprised the psychological questions. Of the total 47 items, 18 items assessed the above concepts in binary fashion while the remaining 29 used a Likert scale. Results: After obtaining IRB approval, we mailed consents to 368 men. Only 65 men acknowledged receiving the information and 51 consented to participate. The participants were a median age of 59.6, predominantly Caucasian (80%), and treated by prostatectomy or cryotherapy. In terms of emotional status, 20% were diagnosed with depression and 10% with anxiety since their prostate cancer diagnosis and of those 32% felt it affected their sexual status. One third of the men rated their overall sexual relationship with their partner as “poor.” Of those men, 44% also perceived their partner was supportive. Over 80% felt their partnership quality was “stable,” “strong,” and “happy.” Almost half (43%) of the men experienced a decrease in self-esteem while 16% were unhappy with their physical appearance. While few men (4%) availed themselves of support groups, 18% found the advice of other patients helpful in coping with their sexuality. The side effects were unexpected in nearly half (43%) of the men. Conclusions: These preliminary findings suggest that prostate cancer treatment may be associated with psychosocial problems related to depression, anxiety, and self- esteem that impact sexual relationships. Although prospective validated questionnaires are needed to confirm these findings, better counseling through the disease trajectory may help combat these emotional issues. No significant financial relationships to disclose.
Distress as a quality indicator of cancer care
Authors: Buso M. M. , Decat C. S. , Nonino A. , Araujo T. C. , Matos Neto J. N. , Schorn P. W. 
Published: August 2020

e20686 Background: Distress is present in every phase of cancer. This high prevalence of distress showed the necessity of acting strategies that may favor the reduction or elimination of possible psychological and psychiatric disturbances. Facing this reality, the National Comprehensive Cancer Network suggested Distress Management in 1997. Today the oncological units need not only acting strategies, but also methods of evaluation of assistance quality. Methods: This study main goal was to evaluate the assistance offered in a private cancer treatment center in Brazil, using the distress prevalence during all the phases of the treatment as a quality indicator. Patients (N = 169) of both genders (37.9% male and 62.1% female), with age between 17 and 86 years (median = 53), with 18 types of cancer, took a part in this investigation. The research was authorized by an ethics committee. The procedure of gathering data included the consent of patients and the application of the Distress Thermometer (DT). The evaluation was made in three distinct stages of chemotherapy: beginning, middle and end of treatment. The data were analyzed according to the criteria defined in literature and with the software SPSS 15.0. Results: In the first stage of the evaluation, the major part of the patients showed a significative level of distress (69.8%), which is similar to literature data - In this phase the patients live with pain, losses and incertitude in relation to the prognoses. During the treatment, there was a progressive reduction in the second (32.4%) and in the last phase of evaluation (14.3%). Such fall was due to: 1) the routine of monitoring distress, the identification of the nature of distress and the intervention; 2) integration of the health team in a interdisciplinary work. Conclusions: The significative reduction of distress during the treatment points out to a good quality of cancer care. During the research it was possible to identify improvements and to reconsider some attitudes and conducts. There was a non automatization in the assistance, making it more human, individual and specific for each necessity. This result suggests the importance of DT as a quality indicator of cancer care. No significant financial relationships to disclose.
Pattern of palliative care, pain management, and referral trends in developing countries: Still far from optimum
Authors: Sharma K. , Mohanti B. K. , Sharma D. N. , Rath G. K. , Julka P. K. , Muzumder S. 
Published: August 2020

e20694 Background: Although palliative care and pain management are essential components of oncology practice, studies show that these areas are often inadequately addressed, more so in the developing countries where palliative care and pain management units are still inadequate. Methods: We randomly selected 252 patients receiving palliative RT (radiotherapy) at our tertiary care centre for oncology, from October 2006 to august 2008. Patients with bone pain were excluded as it could add a bias. Patient's records were studied retrospectively. Results: A median follow-up of 21 weeks was available for 197 males and 55 females with a median age of 55 years. Maximum (60%) patients were of head and neck cancers followed by oesophagus (14%), lung (10%) and others. All cases belonged to stage III (27%) or IV (73%). Dysphagia (35%), growth/ulcer (34%), respiratory symptoms (12.5%) and pain (7%) were the chief indications for palliative treatment. Overall, pain was present in 154 (61%) cases, out of which 92 (60%) were referred to pain clinic. All except two consulted pain clinic with a median pain score of 8 (0–10 point scale). Eighty six (96%) patients received opioid based treatment with adequate pain relief in 33% cases and loss of follow-up in 40% cases. Only eight (3%) cases were referred to a hospice. Thirty six (14%) cases were considered for radical treatment following very good response to palliative RT. Conclusions: In this selective sample, the standard of analgesic treatment is satisfactory. However, there is a lot of scope for improvement regarding referral to pain clinic and later to the hospice. Patients’ follow-up needs to be improved along with further studies evaluating patients who are considered for further RT till radical dose. Programs to change the patients’ attitude towards palliative care, physicians’ (residents) training to improve communication skills, and institutional policies may be the promising strategies. No significant financial relationships to disclose.
Evaluation of the effect of selenium on radiation-induced toxicities in head neck cancer patients
Authors: Buentzel J. , Micke O. , Glatzel M. , Bruns F. , Kisters K. , Muecke R. 
Published: August 2020

e20698 Background: The substitution of selenium effects in activation of the selenium dependent enzyme glutathione peroxidase which is important for scavenging free radicals. Until today only limited data are available about the clinical impact of selenium regarding the toxicities due to free radical producing therapies, e.g. irradiation or chemotherapy. Methods: 39 patients (8 female, 31 male) with advanced head neck cancer were included to a randomized phase II study. All patients had shown a reduced concentration of selenium in the blood and serum (main inclusion criterium). The mean age was 63.52 ± 9.31 years. Tumour localizations: oral cancer 15 patients, oropharynx 19 patients, hypopharynx 5 patients, CUP 1 patient. Group A (n=22) received 500 μg sodium selenite at the days of radiotherapy and 300 μg sodium selenite at holidays or weekend. Group B (17) was irradiated without any selenium substitution. Both groups were well balanced according age, gender, localization and stage of the tumour. We evaluated the RTOG grade of radiation-associated toxicities once per week. Following statistical methods were used: Mantel-Haenssel-χ2-test, Fisher's exact Test. SPSS. Results: We observed the following serious toxicities (group A versus group B): dysphagia 22.7% vs. 35.3%, loss of taste 22.7% vs. 47.1%, dry mouth 22.7% vs. 23.5%, and stomatitis 36.4% vs. 23.5%. A statistical trend (Fisher's exact test) is only seen in the area of loss of taste (p=0.172). The analysis per week had only shown a significant reduction of dysphagia in the selenium group at the last week of irradiation (p=0.04). Conclusions: The small randomized trial has shown limited effects of selenium in the prevention of ageusia (loss of taste) and dysphagia due to radiotherapy because of head and neck cancer. A clinical relevant radioprotection was not observed. [Table: see text]