bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Web-based model to track patients’ self-reported symptoms related to anticancer treatment toxicities
Authors: Fasola G. , Aprile G. , Della Mea V. , Noselli M. , Puglisi F. 
Published: March 2020

17021 Background: Discrepancies outcropped when traditional modalities in collecting information regarding toxicities suffered by patients being exposed to anticancer treatments have been compared to direct self-reports. Owing to the availability of easily accessible informatics technologies, we hypothesized that a Web-site could be an accurate and reliable tool to directly record toxicity data. Methods: A database schema was designed, implemented with MySQL database management system and interfaced with the Web by using Java 2 Enterprise Edition on the Tomcat application container. A simplified, patient-adapted definition of type and NCI-CTCAE grade of the 15 commonest toxicities has been inserted into the database for reporting. The Web site has two areas, both accessible only with username and password, respectively devoted to patients and physicians. Through home Web access, each patient can report toxicities by choosing and grading any of them. Web site usability has been tested by 8 non-professional users with simulated scenarios. After a quick training, the users were asked to report the described toxicities. Time needed for reporting and reporting errors have been recorded. Results: The average time needed for entering a report has been 10 minutes. Users correctly reported the toxicities provided in the scenarios, but difficulties were noted in the correct identification of the week when entering reports for two or more weeks of therapy. Conclusions: In order to track patient-reported toxicities we developed a prototype Web-based model. Potential utilities of the system are being tested to demonstrate: 1) accuracy, allowing patients to easily report types and grades of the experienced toxicities; 2) flexibility, allowing patient-reporting either weekly or on demand; 3) capability to integrate and to assemble with an electronic patient record and a computerized physician order-entry. The latter capability will be provided by a patient portal with secure authentication and access being developed by the Regional Healthcare Authority. Comparative randomized analysis in 100 consecutive outpatients between clinical interviewing and Web-reported toxicity has been planned. No significant financial relationships to disclose.
Are doctors themselves responsible for delay in cancer management?
Authors: Karwasra R. , Bhanot S. , Goel R. 
Published: March 2020

17027 Background: In developing countries poor results of cancer management are believed to be due to late presentation of patients because of poverty, illiteracy and lack of cancer awareness. But the scenario changed little despite regular cancer awareness campaigns in last few decades. Methods: 1,006 cancer patients were assessed for time of onset of symptoms, time of presentation to physician, time taken in diagnosis & initiation of anticancer treatment to identify the level of delay in cancer management and factors responsible. Results: 81.3% of the patients belonged to low socioeconomic group. 61.9% were illiterate & 43.7% were laborers. Literacy level of 84.5% of patients was under metric level and 50.3% had no awareness about cancer. 55.4% patients presented to qualified medical practitioners, 38.9% to non-qualified medical practitioners & 5.5% to qualified non-medical practitioners working as primary care physicians. Almost 80% of patients had delay in cancer management at various levels, the maximum being at diagnosis level. 67.3% patients presented to primary care physician within a month of onset of symptoms without delay. In 68.6% patients the diagnosis of cancer was delayed by more than one month once they presented, the physicians being responsible for this delay in 60.4 % cases. Though non-qualified physicians almost never diagnosed cancer but even 58% of the qualified medical physicians delayed the diagnosis of cancer in the symptomatic patients. In 77.1% patients, physicians did not suspect cancer and disposed off the patients on symptomatic treatment. Literacy of the patients affects awareness and has bearing on the pattern of consultation whereby most of the literates consulted qualified physicians while most of the illiterates consulted non-qualified physicians resulting in delay. Conclusions: Presentation of the cancer patient depends upon reaction to the symptom and therefore despite illiteracy and poverty, majority of symptomatic patients present without delay to their primary care physicians. Delay occurs at diagnosis level in most of the patients and physician is the most common factor responsible for this delay. Tendency to treat the symptoms rather than making diagnosis of the patient and poor oncology knowledge to differentiate symptoms of cancer may be the reasons for this. No significant financial relationships to disclose.
The impact of race on outcome of autologous transplantation in patients with multiple myeloma
Authors: Verma P. S. , Howard R. S. , Weiss B. M. 
Published: March 2020

17029 Background: Multiple myeloma (MM) is the most common hematologic malignancy in African-Americans (AA), with historically double the mortality of Caucasians (C). Monoclonal gammopathy of undetermined significance (MGUS) is also three times more frequent in AA than C. There has been limited data exploring racial differences in survival during the era of high dose chemotherapy with autologous stem cell transplantation (ASCT). Methods: We retrospectively analyzed the records of all C (n=55) and AA (n=36) MM patients who underwent ASCT over 10 years. Presenting demographic, clinical features and response to therapy by the Bladé criteria were obtained from medical records. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier method, and compared using the log-rank test. Results: The median age at diagnosis for AA was 52 years (30–75 years), compared to C at 56 years (39–79 years), p=0.006. There was no statistical difference in presenting ISS stage (AA: I- 50%, II- 28.1%, III- 21.9%; C: I- 51.2%, II- 20.9%, III- 27.9%), or values for presenting hemoglobin, calcium, and creatinine. There was a trend for increased skeletal involvement at diagnosis in the C group (82% vs. 69%, p=0.08). AA presented with an increased CRP (1.2 mg/dl vs. 0.25mg/dl, p=0.05). The most commonly used induction and conditioning regimen was VAD (78% AA vs. 70% C), and Mel 200 (72% AA vs. 65% C), respectively. Response to induction: CR: AA- 6%, C- 5%, p=1.00; PR: AA- 64%, C- 56%, p=0.519. Response to ASCT: CR: AA- 17%, C- 26%, p=0.438; PR: AA- 56%, C- 46%, p=0.519. At a median follow-up of 46.7 months, PFS was 60.5 months and 43.7 months (p=0.490), for AA and C, respectively; OS was 95.2 months and 68.5 months (p=0.421), for AA and C, respectively. Conclusion: In this series, AA with MM present at a younger age, with an increased CRP and a trend for less skeletal involvement than C at diagnosis. Despite a trend for less CR rates in AA, there was a trend for increased PFS and OS compared to C. This suggests there are biologic differences in MM between the races that may result in different therapeutic outcomes. One possible explanation would be the known higher frequency of MGUS in AA resulting in a reversion to a stable, indolent MGUS-like state after ASCT. These findings should be confirmed in larger studies. No significant financial relationships to disclose.
Using the FACT-Neurotoxicity Subscale to evaluate quality of life in patients from across the globe
Authors: Arnold B. J. , Du H. , Eremenco S. , Cella D. 
Published: March 2020

17032 Background: Translation of Patient Reported Outcomes measures is an essential component of research methodology in preparation for multinational clinical trials. One such measure is the FACT-Neurotoxicity Subscale (FACT-Ntx) which is aimed at the evaluation of quality of life of cancer patients suffering from neurotoxicity, a side effect of certain treatments. Methods: This study set out to linguistically validate the FACT-Ntx for use in Denmark, India, Lithuania and S. Africa. The sample consisted of 176 patients (96 males & 80 females), with varying cancer diagnoses and a mean age of 51 years, speaking 11 languages: Afrikaans (15), Danish (25), Gujarati (15), Hindi (15), Kannada (15), Lithuanian (15), Malayalam (15), Marathi (15), Punjabi (15), Tamil (15) and Telugu (16). The FACT-Ntx was translated using standard FACIT methodology. Patients diagnosed with cancer, at any stage, receiving any treatment experiencing neurotoxicity completed the respective translated version and participated in cognitive debriefing interviews to give their opinion on any problems with the translations or the content of the FACT-Ntx. Statistical analyses (descriptive statistics, one-way ANOVA and reliability analyses) were performed on the quantitative data. Participant comments were analyzed qualitatively. Results: The FACT-Ntx translations showed good reliability and linguistic validity. The internal consistency of all languages combined was .86. All items correlated at an acceptable level. The Ntx score differed across self-reported Performance Status Rating (PSR) groups (nonparametric Kruskal-Wallis test p<.0001). A nonparametric Generalized Linear Model (GLM) approach (with multiple comparison adjusted significance level 0.017) showed a difference between ‘PSR=0’ and ‘PSR=1’ (p=0.0002) and a difference between ‘PSR=0’ and ‘PSR=2’ (p<.0001), both with ‘PSR=0’ patients reporting less neurotoxicity. Conclusions: The FACT-Ntx has shown acceptable reliability and linguistic validity in 11 languages. The instrument has also shown adequate sensitivity in differentiating patients with no symptoms and normal activity from patients reporting some symptoms. We consider these translations acceptable for use in international research and clinical trials. No significant financial relationships to disclose.
Comparison of various breast cancer detection methods with survival rates
Authors: Misra S. , Tarr S. , Pratt D. 
Published: March 2020

17033 Background: The role of mammography (MG) but not of breast self-exam (BSE) and clinical breast exam (CBE) in breast cancer detection and survival is well documented. This study compares the different methods of breast cancer detection and subsequent survival rates, analyzing the differences even within the same stage of the disease. Methods: Retrospective review of 1,259 patients was done using the hospital Tumor Registry data. Only patients with stage I, IIA and IIB are included and were diagnosed between April 1992 to December 2005 with follow up ranging from June 1993 to August 2006. The detection methods studied include BSE, CBE, MG and ultrasonography (USG). Parametric tests were conducted. Results: Mean age of the sample was 62 years (range 24–96). There were 293 BSE, 64 CBE, 885 MG, 17 USG detected breast cancer patients. Mean size of mass at presentation was 19 mm (range 1–110). Mean survival time for patients detected with breast cancer till August 2001 was 76 months (range 1–163). 67% patients survived 5 years or more and 12% survived more than 10 years. Mean survival for BSE/CBE and MG/USG group was 43 and 57 months respectively. This difference in survival is significant p< .05; The average survival time by stages I, IIA, IIB for BSE was 47, 45, 38 months, for CBE it was 43, 39, 51 months, for MG it was 57, 59, 50 months and for USG group it was 52, 47, 95 months respectively. Even within the same stage, the method of detection affected survival with the BSE and CBE group having less survival rates (Tukey Test mean difference 0.54, 95% C.I 42–66 and 0.38, 95% C.I 15–61) respectively than the MG group. Survival time also positively correlated with cancer recurrence (r =.7), family history (r = .06) and negatively correlated with age (r = -.09), size of tumor (r = -.09), estrogen receptor positivity status (r = -.06) all with (p < 0.05). We believe this study underestimates overall survival rate as the last follow up date was taken as an end point and also the survival rates are not disease specific survival. Conclusions: MG/USG group show higher survival rates compared to BSE/CBE across the early stages of breast cancer. Even within the same stage, the method of detection affects survival with MG/USG detected cases having more favorable outcomes. May be our current staging system for breast cancer is inadequate and needs revision. No significant financial relationships to disclose.
Effects of implementing an electronic system for the collection of patient reported symptoms on clinic note transcription length
Authors: Cobb P. W. , Kofstad M. , Bealer C. 
Published: March 2020

17035 Background: Recent advances in information technology have made the goal of incorporating patient-reported symptoms possible. Initial studies have examined the validity of these systems but no systematic work has been done to examine the impact on overall practice efficiency. The PACE (Patient Assessment, Care, and Education) System captures patient-reported symptoms, quality of life, social and family history changes, and other clinical data at every office visit. The PACE System includes the Patient Care Monitor (PCM), a standardized, comprehensive assessment of a patient's condition that allows for a self-reported review of systems (ROS) via a wireless, touch screen computer tablet. The purpose of this study was to determine if implementation of the PCM had an impact on total transcription length. Methods: The study utilized a retrospective within subjects control design comparing transcription length by physicians practicing both with and without the PCM. The PACE System was implemented in October 2004 in a main outpatient oncology site in Billings, MT (PACE site). The analysis compared transcription length by physicians who practice in the Billings office where the PACE system was available, and also in four sites in Montana and Wyoming where the PACE system was not available during the same time period (January to October 2006). All available, consecutive physician notes were analyzed from eligible physicians during the analysis period. Results: Four physicians met inclusion criteria and 8,150 notes were analyzed. The average number of dictation words at PCM sites was 406.7 as compared to 485.5 at non- PCM sites (a 16% reduction). The average number of dictation lines at the PCM sites was 54.0 as compared to 58.5 at non-PCM sites (an 8% reduction). Conclusions: Increases in the use of information technology in outpatient oncology necessitate increased understanding of the validity and utility of these systems. This study of the PACE system suggests that there may be an efficiency benefit by implementing patient self-reporting systems. No significant financial relationships to disclose.
Identification of cancer care and protocol characteristics associated with recruitment rate in breast cancer clinical trials in Ontario
Authors: Lemieux J. , Goodwin P. J. , Pritchard K. , Gelmon K. , Bordeleau L. , Duchesne T. 
Published: March 2020

17042 Background: Recruitment rate (RR) in clinical trials (CT) has been recognized to be low. Poor accrual may lead to premature closing of CT or decrease of the planned power to detect an effect if present. Methods: Objectives were primarily to identify characteristics of cancer care settings and clinical trials protocols associated with low RR and secondarily (1) to determine the RR and (2) to compare the RR between years. A cross-sectional design was used. Poisson regression was used for multivariate analysis. RR was calculated by CT, hospital and year in Ontario between 1997 and 2002. Number of patients recruited in each CT was obtained from cooperative groups and pharmaceutical companies. Number of patients with breast cancer (BC) was obtained from the Ontario Cancer Registry. Prevalence of women with metastatic BC was calculated from the British Columbia Breast Cancer Outcome Unit database. Characteristics of cancer care and protocols were collected. Results: Response rates were 84% (66/79) for hospitals, 69% (9/13) for cooperative groups and 80% (8/10) for pharmaceutical companies. Recruitment rates varied between 1.3% and 5.5% (median, p=0.0003). Characteristics of cancer care were not associated with RR (number of oncologists, breast oncologists, breast surgeons, investigators, clinical research associates and being a cancer centre or an academic centre). Among protocol characteristics, the following were associated with RR in univariate analysis: phase, randomization, type of intervention, placebo, extent of the trials (local vs. national vs. international), number of sites, population (adjuvant vs. metastatic), menopausal status, premature closing of the trial, time frame for enrolment, extra baseline and follow-up testing. In multivariate analysis, type of control arm and time frame for enrolment were significant. CT using placebo compared to an active control arm were less likely to recruit patients (relative risk 0.57, p=0.0144). CT with a time frame for enrolment greater than 9 weeks were more likely to enrol patients (relative risk 1.43, p=0.0020). Conclusions: RR is very low. No easily modifiable factors have been identified. This project was funded by the Canadian Breast Cancer Foundation, Ontario Chapter. [Table: see text]
Women from non-English speaking backgrounds living in Australia present with later stage breast cancer: A population study
Authors: Lee C. K. , Browne L. , Bastick P. , Liauw W. 
Published: March 2020

17043 Background: Ethnicity may influence both the incidence and prognosis of breast cancer. We have conducted an analysis to determine if women from non-English speaking backgrounds (NESB) living in New South Wales (NSW), Australia, present with later stage breast cancer compared to women from English speaking backgrounds (ESB); and to determine whether there is an impact on their survival. Methods: Data from the NSW Cancer Registry (1980 to 2004) was used to identify women with their first presentation of breast cancer. Stage of breast cancer was classified as early (insitu or localized) versus late (regional nodal or distant metastatic spread) according to registry definitions. Country of birth was used as a surrogate for language status. Stage at diagnosis was compared between ESB versus NESB women. Logistic regression was used to determine the odds of late stage disease and Cox regression to determine survival outcomes Results: 60,676 of 75,583 cases were considered suitable for analysis. Of these 16.64% were NESB. Accounting for potential confounding variables, NESB women were more likely to have late stage disease than ESB women (OR= 1.12; 95% CI, 1.07 to 1.17). Analysis by geographical region of birth revealed women born in Middle Eastern region were most likely to have late stage disease at presentation (OR 1.41; 95% CI, 1.25 to 1.60). In multivariable analysis of all-cause mortality NESB women had a superior overall survival (HR 0.90; 95% CI 0.87 to 0.94) compared to ESB women, however, there was no difference in breast cancer specific survival between these groups by univariate analysis (logrank p=0.46). Conclusions: In New South Wales, Australia, NESB women have a delayed presentation with breast cancer as indicted by more advanced stage. However, stage-adjusted, breast cancer specific survival in NESB women is similar to the ESB women. Further studies are required to determine the reasons for delayed detection for NESB women. No significant financial relationships to disclose.
Bilateral breast cancer
Authors: Oh J. , Park B. 
Published: March 2020

17073 Background: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. The aim of this study is to assess the impact of bilateral breast cancer on the prognosis compared with unilateral breast cancer and examine clinicopathologic characteristics of Bilateral and Unilateral breast cancer. Methods: 108 patients included in this study from Jan 1980 to Dec 2005 and all information regarding medical and family history of breast cancer came from medical records and questionnaires. Results: There were 108 patients with bilateral breast cancer and its incidence was 2.3% of total breast cancer. The incidence of bilateral breast cancer after 1998 was 3.5% (90/2548) compare with the incidence before 1998 (0.9%). The mean age of patients with bilateral and unilateral breast cancer was 45.34 and 47.54 years, respectively. (p=0.032) Compared to unilateral breast cancer, bilateral group did not differ in gravida, marital status, use of HRT, but the number of case which was diagnosed with breast cancer among close relatives was more frequent (7 cases/6.5% vs 126 cases/2.8%, p=0.024). Although the most frequent histopathologic subtype was ductal carcinoma in both groups, the distribution of the histopathologic subtypes was different between the groups as invasive lobular carcinoma was present in a higher percentage of patients with bilateral breast cancer than in patients with unilateral breast cancer (6.5% vs 2.1%, p=0.002). It suggested that risk factors of developing bilateral breast cancer were family history, lobular tumor, use of hormonal therapy based on the result of multivariate regression analysis. There were no statistically significant difference in 5-year disease free survival and overall survival in both groups (bilateral: 83.25%, 89.52% vs unilateral: 82.74%, 88.79%), (p=0.3934, p=0.3114). Conclusion: In lobular carcinoma patients with family history of breast cancer during follow-up, the possibility of contralateral breast cancer should be considered more carefully and the therapeutic strategy for secondary tumor should resemble the treatment procedure for the primary tumor. No significant financial relationships to disclose.