bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subclinical cardiac toxicity and health-related quality of life (hql) in childhood cancer survivors
Authors: Cox C. L. , Rai S. N. , Rosenthal D. , Phipps S. , Hudson M. M. 
Published: March 2020

9018 Background: Despite substantial information about late cardiotoxicity, little is known about its impact on the adolescent/young adult survivor's health-related quality of life (HQL). Using cross-sectional data, we assessed how HQL and New York Heart Association (NYHA) functional classification are related to survivors’ cardiac performance, cardiac risk factors, and treatment history. Methods: HQL indicators were examined in 164 long-term survivors of pediatric cancer (age 16–40 years), who had (n=132; 10 years (mean) after diagnosis of predominantly leukemia or lymphoma) or had not (n=32; 11 years (mean) after diagnosis of predominantly solid tumors) received anthracyclines and/or thoracic irradiation. Survivors underwent extensive noninvasive clinical and laboratory cardiac risk evaluation and completed a self-report questionnaire on selected subscales of the SF-36 (HQL). Results: Reported general health was lower in the cardiotoxic-therapy group (P = 0.05). Sex, current age, time since diagnosis, cardiac function, and cardiac risk factors were independent predictors of HQL subscales and NYHA class in multivariable analysis. Female sex and higher LDL cholesterol interacted to predict diminished reported vitality (P = 0.04) and physical health (P = 0.05) shown in table . Conclusions: Even in the absence of clinically evident cardiotoxicity, cardiac dysfunction and cardiac risk were strongly linked to decreased HQL and NYHA class, particularly among female survivors. Reduced HQL may be an indicator of unidentified sequelae that should be investigated and monitored. No significant financial relationships to disclose. [Table: see text]
Interval between first palliative care consultation and death in patients with advanced cancer
Authors: El Osta B. , Palmer J. , Paraskevopoulos T. , Pei B. , Roberts L. , Poulter V. , Chacko R. , Bruera E. 
Published: March 2020

9028 Background: Most referrals to acute palliative care (PC) services occur late in the trajectory of the disease, although an earlier intervention can decrease patients’ (pts) symptoms distress. The purpose of this study was to determine the time interval between first palliative care consultation (PC1) and death (D) in pts diagnosed with advanced cancer (aCA) at our comprehensive cancer center and whether such interval has increased over time. Methods: The study group was 2,868 consecutive pts who had their PC1 during a 30-month period. We reviewed the charts for information about demographics, cancer type, date of cancer diagnosis, aCA diagnosis, PC1, and D. aCA was defined as locally recurrent or metastatic. Results: 1,404 pts (49%) were female, 1,791 (62%) were < 65 years old, 2,563 (89%) had solid cancer, and 2,004 (70%) were white. The median PC1-D, aCA- PC1, and aCA-D intervals were 40, 114, and 243 days respectively. The median PC1-D interval (days) was: 47 for pts with solid cancer vs 14 for pts with hematological malignancy (p < 0.0001); 44 for pts < 65 years old vs 36 for pts = 65 years old (p = 0.002); 45 for females vs 37 for males (p = 0.004); 40 for white pts vs 41 for pts from other ethnicities (p = 0.42). The median PC1-D interval in 5 consecutive half-years was 46, 56, 42, 41, and 34 days respectively (p = 0.02). The total number of pts referred for PC1 in this period increased 20%, from 544 to 654. The ratio of PC involvement period in the aCA-D interval (PC1-D/aCA-D) decreased from 0.30 to 0.26 over the 5 half-year periods (p = 0.0004) ( Table ). Conclusions: Patients with solid cancers, younger pts, and females pts were referred earlier to acute PC. Referral timing was not affected by ethnicity. The interval between first palliative care consult and death has decreased over time. Education is needed among referring physicians to increase this interval. Further research on increasing acute PC access and its impact on PC1-D interval is needed. [Table: see text] No significant financial relationships to disclose.
Prediction of early death risk in the elderly with cancer: Results of a prospective multicentric study of 364 patients under chemotherapy
Authors: Soubeyran P. , Rainfray M. , Mathoulin-Pélissier S. , Blanc-Bisson C. , Mertens C. , Blanc J. , Ceccaldi J. , Imbert Y. , Dauba J. , Fonck M. 
Published: March 2020

9040 Background: When it is time to decide for or against chemotherapy in elderly patients (pts) with cancer, physicians face the difficult balance of risks and benefits. Too much often, decision is based on empirical feelings rather than reliable and objective factors which are frequently lacking. Yet, elderly pts can benefit from chemotherapy in many situations. Method: To help physicians in the decision process of chemotherapy through identification of factors predicting early death (< 6 months) from the onset of chemotherapy, we performed a prospective accrual of pts older than 70 with various types of cancer treated by 1st line chemotherapy. Baseline geriatric assessment (GA) (MMS, Get up and go, ADL, IADL, MNA, GDS15 , CIRS-G). Treatment was applied by the oncologist according to current standards disregarding GA results. Factors tested were: age, sex, advanced disease, renal and cardiac function, blood counts, performance status (PS), comorbidities and GA data. Results: 364 pts were accrued in 12 centres. Localisations were: lymphomas (110), colon (101), stomach (37), lung (37), pancreas (23), prostate (20), bladder (18), ovary (14) and unknown origin carcinomas (4). Main characteristics: median age (77.5 y. - range: 70- 99), sex ratio H/F (1.43), advanced tumours (66% - metastatic cancer or aaIPI 2–3 for lymphomas), PS>1 (28%), creatinine clearance <50 ml/mn (42%). GA showed 32% of pts ADL-dependent, 70% IADL-dependent, risk of falls in 12.4%, 19.2% MMS<24, 30% GDS15 >6, 63.4% MNA<23.5, 38.2% = 1 CIRS-G gr. 3–4 category. 357 pts have been followed up for more than 6 months and 59 pts died during this period. Only advanced disease (OR: 4.2 - CI95:1.7–10.3) and MNA score (OR: 4.5 - CI95: 1.75–11.6) predicted early death in logistic regression model. In advanced tumours, risk of early death varied from 11% in pts with MNA>23.5 to 40% in pts with MNA<17. Conclusions: In pts older than 70 with cancer, disease extension and MNA could predict for early death. MNA, performed by a trained nurse, should probably be added to routine pre- treatment work-up in these pts to screen for multidisciplinary assessment and management by oncologists and geriatricians. Sponsored by PHRC, sanofi-aventis, Amgen, Pfizer [Table: see text]
Clinically significant fatigue in recurrence-free prostate cancer survivors
Authors: Storey D. J. , McLaren D. , Shipway M. , Butcher I. , Liggatt S. , O'Dea R. , Smyth J. F. , Sharpe M. 
Published: March 2020

9044 Background: In the absence of definitive evidence of best disease control, treatment decisions for early prostate cancer should consider likely long term side effects and quality of life. Fatigue is an acute side effect of treatment but there are no data about long term clinically significant fatigue (CSF) in recurrence free prostate cancer survivors. This study presents the prevalence, associations and predictors of CSF after radical prostatectomy (RP) or radiotherapy (XRT). Methods: A postal questionnaire survey of 416 recurrence free men treated at a regional cancer centre >1 year previously. CSF was defined as global Brief Fatigue Inventory score >3. Other measures: Hospital Anxiety and Depression Scale (HADS), International Prostate Symptom Score (IPSS), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, clinical and demographic information. Relationships between these factors and CSF were explored in univariate and then multivariate logistic regression analyses. Results: 91% (377/416) of questionnaires were analyzable. Mean age was 72 years (SD 6.1) and median time since treatment was 56 months (range 13–233). The prevalence of CSF was 29% (108/377) overall; 22% (29/133) post RP and 33% (79/244) post XRT. Univariate and multivariate associations of CSF predictors are shown below. Patients with CSF also had poorer quality of life, physical, role, and social function (all p<0.001). CSF was not associated with age, social deprivation category or time since treatment. Conclusions: Almost a third of recurrence free prostate cancer survivors have CSF. RP is associated with less CSF post treatment than XRT, but treatment type did not remain statistically significant in a multivariate analysis controlling for other factors. Depression at outcome had the strongest association with CSF. Other associated variables were IPSS>7, comorbid medical conditions and anxiety. Care should focus on optimising the identification and management of these conditions to improve fatigue. [Table: see text] No significant financial relationships to disclose.
Second neoplasm and cerebrovascular disease in over five-year survivors with CNS germ cell tumor
Authors: Sugiyama K. , Arita K. , Kurisu K. , Sawamura Y. 
Published: March 2020

9046 Background: Survivors of childhood and adolescent brain tumors are at risk for long-term effects of treatment (Tx). This study investigates details on second neoplasm and cerebrovascular disease of long-term survivors with CNS germ cell tumors (CNSGCTs). Methods: The authors reviewed clinical data on 203 institutional patients (pts) who had a CNSGCT and survived more than 5 years. Median age of initial Tx was 15.0 years and median follow-up period was 168 months (60–448 months). Results: Among these pts, 32 pts (15.4%) suffered from second neoplasm and/or cerebrovascular disease. Median age of 32 pts was 14.6 years at the initial Tx. Median interval to event was 151 months (24–456 months). The secondary events, therefore, occurred at the third decade of age. The second neoplasm included 8 cavernous angiomas, 7 GBMs, 3 meningiomas, 2 G-III glioma, 1 hemangiopericytoma, and 1 leukemia. Four cavernous angiomas caused a hematoma. The cerebrovascular disease included 14 steno-occlusive diseases of circle of Willis, 1 aneurysm, and 1 dural AVF. Four pts sufferred from both neoplasum and cerebrovascular disease. All 32 pts had previously received radiotherapy and 6 pts had undergone chemotherapy. Radiation field included whole ventricle system or whole brain involving basal cistern with the dose of more than 40 Gy, except for one who received 24 Gy followed by P-E chemotherapy. Eight of 32 pts died and 14 pts had additional sequelae due to these secondary events. Conclusions: The risk of lethal malignant neoplasm and disabling cerebarovascular disease after Tx for CNSGCTs is extremely large. Long-term follow-up system to monitor and prevent late sequelae should be established. No significant financial relationships to disclose.
Incidence and significance of thromboembolic events (TE) in patients with gastrointestinal (GI) and non-GI malignancies on systemic cytotoxic therapy
Authors: Asmis T. R. , Templeton M. , Trocola R. , Pincus N. , Randazzo J. , Marinela C. , Kelsen D. P. , Shah M. A. 
Published: March 2020

9049 Background: Although venous thromboembolic events (TE) are commonly associated with solid tumor malignancies, the precise incidence and significance of TE in cancer patients has not been well established. We previously reported a high incidence of TE in patients with GI malignancies enrolled on clinical studies at Memorial Sloan Kettering (MSKCC) (Asmis, GI ASCO 2007), and now explore the prognostic impact of TE in GI and non-GI malignancies. Methods: All patients above the age of 18 enrolled on prospective, investigator-initiated therapeutic clinical trials at MSKCC from January 1, 2003 to December 31, 2005 were reviewed. Serious adverse event monitoring was recorded prospectively and patients were followed regularly as per their protocol. All patients with Grade 3–4 TE were identified and confirmed at chart review. 100 patients without TE were audited to verify TE status, and 4 patients with TE were identified(sensitivity 96.8%, 95%CI 92.1–99.1%; specificity 100%, 95%CI 96.2–100%). Patients were followed for survival. All records were reviewed for baseline anticoagulation use, prior therapy, and date of cancer diagnosis. Results: 2482 patients with solid tumor malignancies were enrolled from 2003 to 2005: median age 58 (range 18–90), 43% female, 7% baseline anticoagulation, 44% previously untreated. 122 (4.8%, 95%CI 4%- 5.7%) had a TE. TE is associated with decreased median survival in patients with non-GI malignancy (10 months vs. 19.5 months) (p=0.0003), whereas the development of TE was not associated with reduced survival in GI malignancies (16.7 months vs 15.6 months (p=0.45)). Conclusions: In patients with non-GI solid tumors, the development of a venous thromboembolism is significantly associated with poor survival. Understanding why this is the case may provide insight to tumor biology and an opportunity to positively impact patient survival. [Table: see text] No significant financial relationships to disclose.
Unusually high rates of hypersensitivity to cetuximab in the middle-southern United States: Association with atopic phenotype
Authors: Allen R. M. , Goldberg R. M. , Berlin J. , Spigel D. , Stinchcombe T. E. , Sanoff H. K. , Hayes D. N. , Lin L. , O'Neil B. H. 
Published: March 2020

9051 Purpose: To confirm the anecdotal observation that pts in North Carolina (NC) and Tennessee (TN) treated with cetuximab (C-mab) experience hypersensitivity reactions (HSR) at a much higher rate than that reported nationally and internationally (= 3%). Methods: Data from pts treated with C-mab on clinical trials (CTs, n = 88) at 3 research sites in TN and NC were analyzed for grade 3 or 4 HSR. Additional information was obtained from medical records under IRB approval at the University of North Carolina (UNC) for 90 pts (including 35 pts on CTs) to determine whether history of other significant allergy was a risk factor for HSR. Prior allergy was defined as history of H1 antagonist use, or notation in the medical record of significant drug allergy (excluding narcotic allergies), bee sting allergy, eczema, allergic reactive airways disease, or food allergy. Pearson's or Fisher's exact tests were used for comparison of proportions. Results: Data for 88 pts on CTs and an additional 55 pts treated outside of CTs was included in this analysis. Pts had a variety of tumor types, the most frequent being colorectal and lung For the CT group (n = 88), the overall rate of grade 3 to 4 HSR was 21.6%, significantly higher than the rate noted in any large published trial (p < 0.0001 for comparison to data from Cunningham et al). All HSRs occurred during the first dose. There was no apparent protection from HSR afforded by premedication with dexamethasone in either the CT cohort or the overall UNC cohort. Upon examination of medical records of 90 pts treated at UNC (14.4% gr 3/4 HSR overall), there was a strong relationship between prior allergy history and chance of HSR; 10/28 pts with any HSR vs. 7/62 without allergy history (p = 0.006), and grade 3/4 HSR occurred in 8/28 versus 5/62, respectively (p = 0.01). Conclusions: At the sites in neighboring Southern US states studied, HSR was far more common than reported in national studies. History of prior allergy is a strong predictor of HSR, although is not specific enough to be used as the sole means of excluding pts from therapy. Further investigation of more specific predictors of HSR in the US Middle South is warranted, and pts being treated with C-mab in the region should be observed particularly closely during their first infusion. No significant financial relationships to disclose.
Bisphosphonate-induced osteonecrosis of the jaw: Risk factors and diagnostic utility of bone scans
Authors: O'Connor T. L. , Padmanabhan A. , Wilding G. , Sullivan M. , Solomon L. , Lamonica D. 
Published: March 2020

9052 Background: Osteonecrosis of the jaw (ONJ) is a serious long-term effect of intravenous bisphosphonates. We report characteristics of patients with ONJ at Roswell Park Cancer Institute (RPCI) and utility of bone scans in its diagnosis. Methods: Patients were identified using RPCI database. ONJ diagnosed was staged using the system used for jaw osteoradionecrosis (Schwartz et al, Am J Clin Oncol, 2002). Controls included patients receiving bisphosphonates between July 2002 and 2006. Routine whole body bone scans were reviewed for jaw uptake. Statistical analysis was done using SAS 9.1. Results: Three hundred and fifty-four patients received intravenous bisphosphonates between July 2002 and 2006. Twenty-four (7%) were diagnosed with ONJ. Among patients with ONJ, fifteen (63%) had breast cancer, eight (33%) had multiple myeloma and one (4%) had lung cancer. Mean age was 56.8 years. (SD= 9.1) Thirteen patients (54%) had tobacco use, five (21%) had diabetes, nine (37.5%) had hypertension and twenty-three patients (96%) received chemotherapy. Five patients (21%) had caries, three (12.5%) had dental surgery, nine (37.5%) had periodontal disease, thirteen (54%) had extractions and one (4%) had prior dental trauma. Twenty-two patients (92%) presented with pain. Twelve patients (50%) had ONJ Stage 1, eight (33%) Stage 2 and four (17%) Stage 3. Median duration of exposure to bisphosphonates was 39 months. The difference between the average number of infusions in the ONJ group (11.2, CI: 11.3, 20.3) and control group (7.2, CI: 6.2, 8.2) was found to be significant (p<0.0009). Three patients (12.5%) had progressive ONJ. Thirteen patients with ONJ had bone scans and twelve (92%) showed jaw uptake. Among controls, one hundred and eighty-three had bone scans and one hundred and twenty-eight (70%) showed jaw uptake. This difference was not significant. (p=0.114, two-tailed Fisher's exact test). Conclusions: In our study, chemotherapy, smoking, prior dental extractions and the number of bisphosphonate infusions appear to be risk factors for ONJ. It has been recently reported (Chiandussi et al., Dentomaxillofacial Radiol. 2006) that bone scans can be used as a screening tool for ONJ, however, in our series jaw uptake on bone scan was not a reliable predictor for the development of ONJ. No significant financial relationships to disclose.
A meta-analysis of anticoagulants as cancer treatment: Impact on survival and bleeding complications
Authors: Kuderer N. M. , Khorana A. A. , Lyman G. H. , Francis C. W. 
Published: March 2020

9071 Background: There is substantial laboratory evidence that anticoagulants, in particular the low-molecular-weight heparins (LMWH), exert an antitumor effect, while clinical trials have reported conflicting results. This study represents the first comprehensive systematic review and meta-analysis of the evidence from randomized controlled trials (RCTs) evaluating specifically the impact of anticoagulants on survival and safety in cancer patients without venous thromboembolism (VTE). Methods: An exhaustive systematic literature review of RCTs was performed without language restrictions, including a comprehensive search of electronic databases through May 2006 with subsequent weekly updates to the end of 2006 (Medline, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, DARE, and major conference proceedings) and relevant article references. Two reviewers extracted the data independently. Primary study outcomes were 1-year overall mortality and all bleeding complications. Major and fatal bleeding complications were secondary outcomes. The meta- analysis was performed utilizing the Mantel-Haenszel method. Results: All identified 11 RCTs were performed in solid tumor patients. Anticoagulation significantly decreased overall mortality across all studies with a relative risk (RR) of 0.905 (95%CI: 0.847–0.967; p=0.003). The survival improvement appears not to be due to the prevention of fatal VTE. All bleeding complications (RR=2.309; 95%CI: 1.928–2.764; p<0.0001) and major bleeding events (RR=2.598; 95%CI; 1.936–3.488; p<0.0001) occurred more frequently with anticoagulation. The relative risk for mortality was 0.877 (95%CI: 0.789–0.975; p=0.015) with LMWH, compared to warfarin (RR=0.942; 95%CI: 0.854–1.040; p=0.239). Warfarin resulted in higher rates for all and major bleeding complications compared to LMWH (p<0.0001, respectively). Conclusions: Anticoagulants significantly improved overall survival in cancer patients while increasing the risk of bleeding complications. Despite these encouraging findings, given limitations of available data and the potential for life-threatening complications, the use of anticoagulants as antineoplastic therapy cannot be recommended until additional RCTs confirm these results. No significant financial relationships to disclose.
Ten-year reproduction rates (10-RR) after cancer treatment: Comparison between patients (cases) and the normal population (controls)
Authors: Cvancarova M. S. , Magelssen H. , Fossa S. 
Published: March 2020

9075 Background: Reproduction rates in cancer survivors are sparse, and the impact of the number of pre-diagnosis children and age at diagnosis on post-diagnosis parenthood is unknown. We assessed 10-RRs in cases and age- and gender- matched controls. Methods: After merging the Hospital Registry and the Medical Birth Registry of Norway, we analyzed 6,071 cases treated from 1971 to 1997 and aged 15–45 at diagnosis, and 30,355 controls, all born after 1950. All were followed from the recorded or simulated date of diagnosis. The primary outcome was the first post-diagnosis pregnancy (median observation time: 10 years, range: 0–35 years). 10-RRs and hazard rates (HRs, controls as reference) were computed by Cox proportional hazard multivariate regression models adjusted for age at diagnosis, stratified by gender and number of pre-diagnosis children. Results: 45% of cases and 56% of controls were childless at diagnosis. The table below displays 10- RRs and HRs for all cases and controls and the most frequent cancer types (cases given first). When 10-RR of cases is higher or not significantly different from the rates for controls, the cell is highlighted. In general, 10-RRs are the highest for those with one-time pre-diagnosis paternity. Conclusion: Contrary to observations in females, 10-RRs of the first post-cancer paternity in males are significantly increased for cases compared to controls. In addition, the 10-RR for male cases with one pre-diagnosis child exceeded the rates for males who were childless at diagnosis. Overall, 10-RRs are associated with gender, cancer type and pre-diagnosis parenthood. [Table: see text] No significant financial relationships to disclose.