bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does age contribute to distress in new geriatric oncology patients?
Authors: Saiganesh Harish , Khurshid Humera , Raza Sakeena , Dizon Don S. 
Published: May 2020

e24023 Background: As part of routine practice at the Lifespan Cancer Institute (LCI), all new patients are screened with the NCCN Distress Thermometer (DT). There is little to no data comparing initial distress levels among patients 65 and older recently diagnosed with cancer and how this might change with increasing age. This study sought to describe distress at initial presentation among two cohorts: patients 65 to 74 years and those 75 years and over. Methods: We have retrospectively reviewed 1800 patients at Lifespan Cancer Institute so far, all of whom were initially seen between the years 2014-2017. Data related to demographics, tumor type, initial distress score, and sources of distress were gathered using our electronic medical records. Categorical data were analyzed using Fisher’s Exact Test or Chi-Square. Multinomial logistic regression was performed for multivariate analysis. All analyses were performed in STATA 15.0. Results: At time of diagnosis, 898 (49.9%) patients were over 65 years. Of those, 577 (64%) had distress thermometers and were included in this analysis. The median age was 72 (range 65 to 92), 66.9% were female, and 42.5% were married or partnered; 393 (68.1%) were under 75 years and 184 (31.9%) were 75 or older. The major cancers represented included breast (44%), lung (19.6%), and prostate (17%) cancers. The presence of severe distress (DT score of 4 or higher) did not significantly differ by age cohort (45.3 versus 45.7%, respectively, p > 0.5) but differed by tumor group (p < 0.001). Compared to people under 75 years, more of those 75 and older reported sadness (27 versus 20%, respectively, p < 0.05), issues with memory and concentration (12 versus 7.6%, p < 0.1) and trouble with getting around (14.7 versus 8.4%, p < 0.05). On multinomial logistic regression, only tumor group and reporting sadness on the DT remained significant factors for severe distress, whereas age did not. Conclusions: There is no significant difference in distress reporting among geriatric patients with cancer who are under 75 compared to those 75 and older. Tumor type and sadness at the initial presentation were associated with severe distress in this group of people.
Outcomes for geriatric patients evaluated in a same-day multidisciplinary central nervous system clinic for radiation oncology and neurosurgery in a community hospital setting.
Authors: Paez Wencesley A. , Gheewala Rohi , Jaboin Jerry J. , Thomas Charles R. , Ciporen Jeremy N. , Mitin Timur 
Published: May 2020

e24034 Background: The geriatric cancer population is rapidly increasing in the United States. Management of geriatric patients with central nervous system (CNS) disease requires a patient-centric, multidisciplinary approach together with meticulous assessment of their outcomes, as clinical studies guiding treatment recommendations are lacking in this patient population. We have previously reported the outcomes of our multidisciplinary community hospital-based CNS clinic, RADIANS, where both radiation oncology and neurosurgery specialists simultaneously evaluate patients in a same-day, single-setting clinic. We have sought to analyze the outcomes of the geriatric patient population of our RADIANS clinic. Methods: We identified patients 65 years and older in our IRB-approved RADIANS Prospective Patient Registry for CNS Disease. Descriptive statistics were used to report patient characteristics, diagnoses, treatments and outcomes, and patient satisfaction scores. Results: Between August 2016 and February 2020, 56 patients 65 years and older (mean age 74.6, range: 65-94; 32 women and 24 men) were evaluated in the RADIANS clinic. Mean distanced traveled by patients to clinic was 43.4 miles (med = 8.3; range = 0.6-341). Patient-reported Satisfaction Score was 4.81 (0-5 Scale, 5-very satisfied). The most common referral source was medical oncology. Forty-two patients had malignant CNS disease (brain mets-18; spine mets-12; both-4; primary brain-6; primary spine-2), 14 had benign CNS disease. Post-evaluation treatment: radiation therapy (RT) only (n = 20), neurosurgery (NS) only (n = 6), both RT and NS (n = 14), and no RT/NS intervention (n = 16). Fractionated stereotactic radiosurgery was most common RT delivered; craniotomy with tumor resection was most common NS performed. Treatment outcomes: local tumor control = 39/40 (97.5%); radiation necrosis/radiation-induced myelitis = 0/34 (0.0%). Conclusions: This is the first report of outcomes in geriatric patients with CNS malignancies treated in a community hospital-based multidisciplinary clinic. We show excellent outcomes comparable to younger patients with CNS malignancies, as well as patient satisfaction and ability to travel great distances to receive multidisciplinary care.
Impact of cancer related stress on illness beliefs and glycemic control in breast cancer survivors with comorbid diabetes.
Authors: Lin Jenny J. , James Janey , Goel Mita , Harris Yael T 
Published: May 2020

e24053 Background: Cancer and diabetes mellitus (DM) are leading causes of death in the US and survivors with comorbid DM have a significantly higher mortality. Furthermore, posttraumatic stress disorder (PTSD) can be triggered by life-threatening illnesses such as cancer; however, little is known about the impact of cancer-related PTSD (Ca-PTSD) on illness beliefs and glycemic control. We undertook this study to assess factors associated with DM management in breast cancer survivors with DM. Methods: We recruited women with Stage 0-IIIA breast cancer diagnosed in the past 10 years, who had completed chemotherapy and/or hormonal therapy and had pre-existing DM on ≥1 oral DM medication. The Impact of Event Scale-Revised (IES-R) was used to assess distress caused by cancer. A total IES-R score of ≥33 identified those with probable Ca-PTSD. Cancer and DM related beliefs were assessed using the Illness Perception Questionnaire. Objective adherence to DM medication was assessed using electronic caps that record bottle openings. Wilcoxon rank-sum tests were used to examine the relationship between Ca-PTSD and illness beliefs. Pearson correlation tests were used to assess the relationship between cancer related stress, DM medication adherence, and glycemic control. Results: Of 111 women recruited to date, mean age was 65.4 years and 37% were black, 31% white, 14% Hispanic, 6% Asian, and 8% other. Of these, 15% had probable Ca-PTSD. Survivors with Ca-PTSD were more likely to believe the consequences of cancer and DM were more severe (median score 23.5 vs. 19.0 [p < 0.001] and 24.0 vs. 16.0 [p < 0.001], respectively), that cancer and DM were more cyclical or recurrent (15.0 vs. 9.0 [p = 0.002] and 13.0 vs. 8.5 [p = 0.002], respectively), and there was greater emotional impact due to cancer and DM (24.0 vs. 16.5 [p < 0.001] and 23.0 vs. 14.0 [p < 0.001], respectively). Additionally, those with Ca-PTSD were less likely to understand their cancer (14.0 vs. 20.0, p = 0.004). Furthermore, as cancer-related stress scores increased, glycemic control worsened (r = 0.23, p = 0.03) and DM medication adherence decreased (r = -0.23, p = 0.04). Conclusions: Breast cancer survivors with comorbid DM who have Ca-PTSD are more likely to have negative beliefs about both cancer and DM. Cancer-related stress is also associated with poorer glycemic control and DM medication adherence. Providers should be aware of the impact of cancer related stress on beliefs about comorbid illnesses and increase interventions that support cancer survivors to better manage their comorbidities.
Prospective investigation of immunotherapy-induced fatigue by rest and stress echocardiography.
Authors: Zingarelli Roman , Aras Mandar A , Bibby Dwight , Fang Qizhi , Daud Adil , Schiller Nelson B , Tsai Katy K. 
Published: May 2020

e24060 Background: Immune checkpoint inhibitors (ICI) effect durable responses in cancer patients (pts). Myocarditis is rare but fatigue is commonly reported, and whether ICI-induced fatigue is due to subclinical cardiac toxicity is unknown. We hypothesized that pts on ICI develop changes on rest and stress echocardiogram (echo) that correlate with fatigue. Methods: A prospective observational study was performed to monitor cardiac function in pts receiving ICI. Our cohort consisted of pts (n = 10) with stage III/IV melanoma, ECOG 0-1, deemed safe to exercise, without unstable cardiac symptoms. ICI-naïve pts received anti-PD1 alone or in combination with anti-CTLA-4, in adjuvant or metastatic setting. Rest transthoracic echo and dynamic staged exercise stress echo testing was conducted at baseline (prior to ICI) and at 3 and 6 months (mo) following ICI. Various echo parameters at rest and stress were compared. irAEs were detailed and surveys administered at baseline and post-follow up. Results: 10 pts (9 men, mean age 56 yrs) completed baseline cardiac testing of whom 7 completed follow up testing at 6 mo (6 anti-PD1 monotherapy, 1 metastatic combination therapy). Of these 7 pts, 5 (71%) reported increased fatigue per CTCAE at 3 or 6 mo follow up and all 7 had irAEs (3 rash, 1 colitis, 1 diarrhea, 1 hypophysitis, 1 arthralgia, 1 xerostomia). Among resting echo parameters, left ventricular outflow tract velocity time integral (LVOT VTI) was significantly reduced at 6 mo compared to baseline (22.6 ± 3.4 vs 20.0 ± 2.5, p = 0.0047), albeit still within normal range. No other resting echo parameters changed. Among exercise echo parameters, there was no difference in METs achieved, time of exercise, blood pressure or heart rate between time points. Of note, of 7 subjects who completed 6 mo testing, 2 (29%) were unable to achieve previous peak stage of exercise during testing. Conclusions: Though no echo parameter significantly correlating with fatigue was reported, nearly one-third of a small cohort of pts were unable to achieve peak exercise 6 mo after starting ICI. This combined with the statistical reduction in LVOT VTI suggests functional limitation and warrants further study. Post-follow up surveys are pending and may further inform issues important in ICI survivorship. [Table: see text]
Quantitative assessment of proprioceptive dysfunction in cancer survivors post oxaliplatin-containing chemotherapy.
Authors: Wang Allison B. , Housley Stephen Nick , Cope Timothy C. , Flores Ann Marie , Perreault Eric J. 
Published: May 2020

e24071 Background: Oxaliplatin (OX) is commonly used for gastrointestinal cancers but can cause chronic neurotoxicity with long-term motor impairments (e.g. dexterity loss, poor balance, and falls). These impairments are often attributed to OX-induced sensory neuropathy that disrupts touch, vibration, and proprioception in distal limbs. However, some cancer survivors report motor impairments even in the absence of sensory neuropathy. Recent animal studies suggest OX induces global signaling dysfunction in muscle proprioceptors that may account for the motor impairments in the absence of sensory neuropathy. However, this mechanism has yet to be investigated in cancer survivors. We hypothesize that cancer survivors will display impaired proprioceptive function compared to age-matched healthy controls using quantitative techniques that are more sensitive than current clinical measures. Methods: We assessed use of proprioception for controlling upper extremity position, force, and posture using target reaching, force matching, and postural stability tasks, respectively. A haptic robot quantified motor performance in all tasks, performed with and without visual feedback to disambiguate proprioceptive from vision. The dominant hand and wrist were fixed in an orthosis emphasizing elbow and shoulder use since these joints are less likely to have sensory neuropathy. Self-reported symptoms and functional limitations were measured with the QLQ-CIPN20 questionnaire. Accuracy and trial-to-trial variability for each task were compared between cancer survivors and controls using linear mixed effect models. Results: Thirteen cancer survivors (0 – 20 months post OX-treatment) and 7 controls completed the study. Without visual feedback, cancer survivors had significantly decreased accuracy (p < 0.001) and increased trial-to-trial variability (p < 0.05) in all tasks compared to controls. Deficits in force matching were correlated with self-reported motor dysfunction on the QLQ-CIPN20 (r = 0.87, p < 0.001). Conclusions: Proprioceptive deficits occur in cancer survivors who received OX-treatment and are associated with motor dysfunction. This identified mechanism of motor impairment may present opportunities for targeted interventions.
Efficacy and toxicity of extending bone modifying agents beyond two years for bone metastases in breast or castrate-resistant prostate cancer patients: A systematic review.
Authors: Ng Terry L. , Tu Megan M. , Ibrahim Mohammed FK , Basulaiman Bassam Mohammed , McGee Sharon , Srikanthan Amirrtha , Fernandes Ricardo , Vandermeer Lisa , Stober Carol , Sienkiewicz Marta , Jeong Ahwon , Saunders Deanna , Awan Arif Ali , Hutton Brian , Clemons Mark J. 
Published: May 2020

e24083 Background: Randomized clinical trials evaluated bone modifying agents (BMAs) such as bisphosphonates and denosumab for bone metastases for 1-2 years in duration even though BMA therapy is commonly administered for much longer. A systematic review on the risk-benefit of continuing BMAs for longer than 2 years in breast cancer or castrate-resistant prostate cancer was conducted. Methods: Medline, Embase and Cochrane Register of Controlled Trials were searched (1970 - February 2019) for randomized studies, observational studies, and case series reporting on BMA efficacy and toxicity beyond 2 years. Efficacy was assessed by skeletal-related event (SRE) rates and quality of life metrics. Toxicity was assessed by rates of osteonecrosis of the jaw (ONJ), renal impairment, hypocalcemia, and atypical femoral fractures (AFF). Results: Of 2107 citations, 64 studies were identified. A total of 3 prospective and 9 retrospective studies were eligible. Data beyond 2 years was limited to subgroup analyses in all studies. Three studies [zoledronate (ZOL) (n = 481), pamidronate (PAM) (n = 87), PAM-ZOL (n = 43) ibandronate (n = 30)] reported on SRE-related endpoints. Only one study reported SRE rates based on duration of BMA exposure and showed reduced SRE rates from 27.6% (0-24 months) to 15.5% ( > 24 months) over time. None reported on quality of life. All 12 studies [denosumab (n = 948), ZOL (n = 1036), PAM (n = 163), PAM-ZOL (n = 522), ibandronate (n = 118)] reported on at least one toxicity outcome. Data from 7 bisphosphonate studies (n = 1077) and 1 denosumab study (n = 948) reported on ONJ incidence. In 3 studies (n = 67, n = 221, n = 948), ONJ incidence ranged from 1-4% in the first 2 years and from 3.8-18% beyond 2 years. In another study (n = 252), the cumulative hazard of ONJ was 0% (1% ZOL), 3% (7% ZOL), 7% (21% ZOL) and 11% (21% ZOL) at 12, 24, 36, and 48 months, respectively (p = 0.005); 4 remaining studies reported 1 (n = 181), 3 (n = 57), 7 (n = 99) and 2 (n = 200) cases of ONJ, all after 24 months. Incidence of clinically significant hypocalcemia ranged from 1-2%. Incidence of severe renal function decline was ≤ 3%. AFF occurred in two subjects in one of two studies after 37 and 79 months of BMA exposure. Conclusions: Although the evidence informing the use of BMA is heterogeneous and based on retrospective analysis, BMA exposure beyond 2 years is associated with reduced SRE risk and increased ONJ incidence. Prospective randomized studies addressing the use of BMA for more than 2 years is needed with greater emphasis on quality of life.
Nasal vestibulitis: An MNCCTN natural history trial—Nasal vestibulitis symptoms associated with paclitaxel, docetaxel, and other chemotherapy agents.
Authors: Cathcart-Rake Elizabeth Jane , Zahrieh David , Smith Deanne s. , Young Susan , Wolfe Eric G. , O'Connor Amanda , Thome Stephan , Lacouture Mario E. , Register Terra , Piens Jill , McCue Shaylene , Loprinzi Charles L. 
Published: May 2020

e24086 Background: Nasal vestibulitis has been infrequently described as a side effect of cancer-directed therapy; however, a preliminary study reported that 71% of patients undergoing taxane chemotherapy experienced nasal vestibulitis symptoms. This natural history trial describes the incidence, characteristics, and severity of nasal vestibulitis symptoms among patients undergoing paclitaxel, docetaxel, and non-taxane chemotherapy. Methods: Eligible participants who reported baseline (prior to starting chemotherapy) nasal symptoms ≤ 2 on a 10-point scale were enrolled in this trial upon initiation of a new treatment regimen, involving paclitaxel or docetaxel, or non-taxane chemotherapy. Participants completed nasal symptom logs each time they received a dose of therapy until either the regimen was stopped or four months had passed. The proportion of patients reporting new nasal symptoms was estimated within each cohort with the 95% exact confidence interval (CI). A cumulative incidence model was utilized to quantify the incidence of treatment-emergent nasal symptoms within each cohort, while controlling for age, sex, smoking history, and history of asthma or allergies. Results: Thirty-five participants received paclitaxel, 21 received docetaxel, and 25 received other types of chemotherapy. 86.4% of participants were female, mean age was 60.2 ± 11.2 years; 93.8% of participants completed 2 or more surveys. A higher percentage of participants in the paclitaxel cohort experienced new nasal vestibulitis symptoms than participants in the other two cohorts. The percentage (95% CI) of participants with nasal symptoms, for patients receiving paclitaxel, docetaxel, and non-taxane chemotherapy were 74.3% (56.7%, 87.5%), 47.6% (25.7%, 70.2%), and 44.0% (24.4%, 65.1%), respectively. Epistaxis was reported by 60% of participants in the paclitaxel cohort. Paclitaxel-receiving participants also reported nasal dryness (48.6%), scabbing (40.0%), and pain (20.0%). Nearly half of participants reported moderate symptoms (4-7 out of a 10-point scale), with 8.6% reporting symptoms as severe (8-10 on a 10-point scale). Conclusions: Nasal vestibulitis is a common side effect of chemotherapy, especially paclitaxel chemotherapy.
Excessive mortality in 1,353 five-year survivors of nasopharyngeal cancer.
Authors: Chiang Chi Leung , Cheung Ching Lung , Hingley James Philip , Sing Chor Wing , Fong Ka Shun , Lam Tai Chung , Lee Victor Ho-Fun , Au Kwok Hung , Chow James Chung-Hang , Cheung Yin Ting , Ngan Roger Kai-Cheong , Choi Cheuk-Wai , Lee Anne WM , Wong Ian Chi Kei 
Published: May 2020

e24090 Background: Survival of NPC patients has improved in past decades. Yet, survivors continue to face elevated risks of life-threatening late effects. Their impact on late mortality remains poorly quantified. Methods: 1353 five-year NPC survivors diagnosed between 1997 and 2013 at Queen Mary Hospital were reviewed. Their demographics and treatment data were taken from electronic medical records. Survival probability, standardized mortality ratios (SMRs) and absolute excessive risk were calculated for overall and cause-specific deaths. Results: At median follow-up time of 12.4 years, 412 (30.5%) five-year survivors had died at the time of analysis. 66.2% of deaths attributed to non-recurrence death. Estimated 10-, 15-, and 20-year survival probability were 81.4%, 67.6%, and 57.3% respectively. Compared to Hong Kong general population, absolute excessive risk of death from any causes was 17 deaths per 1000 person-years; overall SMR was 3.52 (95% CI: 3.19 to 3.87, p<0.001). Increases in cause-specific mortality were seen for death due to pulmonary (SMR: 6.75; 95% CI: 5.67 to 7.98) and secondary malignancy (SMR: 1.41; 95% CI: 1.06 to 1.83). Conclusions: Five-year NPC survivors still face excessive mortality long after diagnosis, and majority of death was from non-recurrence death. Further analyses are needed to determine predictive factors of excessive mortality. [Table: see text]
First phase implementation of cardio-oncology program in the middle-income country of Costa Rica at Hospital Metropolitano healthcare system.
Authors: Wiernik Andres , Pakonen Jessica , Flores Luis Diego , Preinfalk Giselle , Arab Graciela , Sprok Jose , Fernandez Loretta , Lami Leonardo , Solano Carlos , Acuña Raquel 
Published: May 2020

e24091 Background: Developing a cardio-oncology program in a middle-income country like Costa Rica can present unique opportunities and challenges. Hospital Metropolitano is a health care system in Costa Rica with a network of two hospitals, 36 clinics, and over 150,000 patients enrolled in its health plan, Medismart. Here we summarize our program, and the initial results of the implementation phase, hoping that institutions with similar resources in low-and-middle-income countries will use this as guidance to develop their own cardio-oncology program. Methods: A cardio-oncology committee was established in May 2019 and includes medical providers, clinical coordinators, administrative workers, and nursing and laboratory staff. A 4-month pre-launch period was established to create an institutional protocol after we reviewed guidelines and literature from similar programs in the United States and Europe. The protocol targets both active cancer patients undergoing treatment and cancer survivors. The program was launched in September 2019 and is currently in the first phase of implementation. Results: During the first phase of implementation, the program was limited to the outpatient setting and patients were referred exclusively by the medical oncology providers from our health care system. In this period, 28 patients met criteria for referral and all enrolled according to our protocol. The median age of our patients was 49 (range 16-77). 25 patients (89%) were female and 20 (71%) had a diagnosis of breast cancer. At the time of enrollment, 21 (75%) were receiving active cancer treatment and 7 (25%) were identified as cancer survivors. All patients are being followed prospectively. A committee review at the end of the first phase of implementation revealed that the most important challenges that the program needs to address for the second phase of implementation include the following: 1) patient education and outreach, 2) cost of care associated with the interventions recommended by the protocol, and 3) data tracking/registry given the lack of an electronic medical record. Conclusions: Our program represents a real-life experience of the challenges and opportunities that institutions in middle-income countries need to consider when launching such initiatives. To our knowledge, this is the first cardio-oncology program formally established in Central America and we are committed to continue to measure our outcomes prospectively and share these with the global oncology community.