bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician and practice characteristics influencing tumor board attendance: Results from the provider survey of the Los Angeles Women's Health Study
Authors: Scher K. , Tisnado D. M. , Rose-Ash D. , Rastegar A. , Adams J. , Ko C. Y. , Ganz P. A. , Kahn K. L. 
Published: August 2020

e17501 Background: Coordination of care has grown in importance with the advent of new modalities of treatment requiring specialized expertise. In cancer care, multidisciplinary approaches have shown improvements in quality of care and patient satisfaction. Tumor boards provide a mechanism for improving coordination of care. We evaluated physician and practice characteristics that predict frequency of tumor board attendance. Methods: This cross-sectional study utilizes data obtained by surveying physicians of a population-based sample of women with incident breast cancer. Physicians were queried regarding tumor board attendance, specialty (medical oncologist [MO], radiation oncologist [RO], surgeon indicating that the hospital at which most breast cancer surgeries are performed has an American College of Surgeons accredited program [ACOSSg] and surgeon without such affiliation [non-ACOSSg]), physician characteristics (gender, race, teaching involvement, patient volume, number of offices, ownership interest), and practice setting (practice type, size, reimbursement). Univariate, bivariate, and multivariate analyses were performed for the dependent variable characterizing provider report of frequency of tumor board meeting attendance. Results: Most surveyed physicians (83%) report attending tumor board weekly (58%) or monthly (25%). Weekly participation was reported by 63%, 92%, 47%, and 32% of MOs, ROs, ACOSSgs, and non-ACOSSgs (p < 0.01). Specialty and higher patient volumes are significant predictors of more frequent attendance, after adjustment for practice size and type. In comparison to the most prevalent specialty category (low volume ACOSSgs), high volume MOs attend more (p = 0.01), and low volume non-ACOSSgs attend less frequently (p = 0.00). Conclusions: Tumor board attendance implies increased participation in multidisciplinary care, but specific subsets of providers are less frequent users. This not only has implications for choosing providers, but also for efforts to increase attendance. Tumor board agendas and formalized institution wide policies could be designed to further engage low frequency attendees as a means to promote multidisciplinary care and improve health outcomes. [Table: see text]
Retrospective assessment of adherence to ASCO Surveillance Guidelines following treatment for stage II and III colorectal cancer (CRC)
Authors: Davies J. M. , Lupichuk S. , Batuyong E. , Hilsden R. J. , Easaw J. 
Published: August 2020

e17517 Background: The 2005 ASCO guidelines for surveillance following adjuvant therapy for CRC outlined recommended surveillance tests and their frequencies including history and physical examination, CEA testing, CT scan and colonoscopy. The purpose of this study was to assess the impact of these guidelines post treatment of stage II and III CRC in the Calgary Health Region (CHR) before and after implementation of a computer generated, personalized discharge letter (DL). Methods: Cohort 1 patients completed adjuvant chemotherapy or radiotherapy for stage II and III CRC between September 1, 2006, and November 30, 2007, prior to implementation of the DL. Cohort 1 was retrospectively identified from the Alberta Cancer Registry. Registry data was collated with laboratory data and diagnostic imaging data is forthcoming. Adherence to the guidelines at 1-year follow-up in cohort 1 was measured. Prospective data collection on patients who completed adjuvant treatment after implementation of the DL (cohort 2) is ongoing. Comparison of adherence rates to surveillance testing between the two cohorts will be reported upon study completion. Results: For cohort 1, 209 of 238 patients referred to the cancer centre were from the CHR and hence included in the analysis. The average age was 65 and 53% were male. Most patients (136/209) had stage III CRC. 1/209 had a local recurrence only. 27/209 progressed to metastatic disease during the 1-year follow-up period, of which 23 of these patients were initially diagnosed with stage III CRC. CEA adherence (≥4 tests taken within 1-year follow-up period) was 38.3% (95% CI 31.7–44.9). CT scan adherence and use of “inappropriate” surveillance testing for cohort 1 will be available at the meeting. Conclusions: This study assesses compliance with the 2005 ASCO CRC surveillance guidelines at 1-year follow-up post adjuvant treatment at a tertiary cancer centre. Analysis of cohort 1 reveals that adherence to CEA testing is suboptimal. The next phase of this study will assess the impact of a DL, sent to patients and primary care providers outlining recommended surveillance tests and dates, on adherence rates. No significant financial relationships to disclose.
Breast cancer testing strategies and the utilization of targeted therapies: Data from the real world
Authors: Haas J. , Phillips K. A. , Hassett M. J. , Liang S. , Keohane C. , Armstrong J. , Toscano M. 
Published: August 2020

e17518 Background: HER2 testing and the use of trastuzumab is considered a prototype for the translation of a genomic therapy, yet almost nothing is known about use in practice. Uncertainties about the performance of the two types of HER2 tests, immunohistochemistry (IHC) and fluorescence-in-situ-hybridization (FISH) have led to debate about how best to identify women who are most likely to benefit from this costly treatment. Similarly, little is known about the use of gene expression profiling (GEP - e.g., OncotypeDx), which offers the possibility of better recurrence estimation to tailor the use of adjuvant chemotherapy. Methods: Cross-sectional record review of women, 36–64 years, with a new diagnosis of breast cancer in 2006–2007, identified using claims from a large, national health plan (n = 392 to date). Results: Almost all women had a HER2 test (97.7%): 56.2% had IHC alone, 17.4% had FISH alone, and 24.0% had both (2.4% had documentation of a test but not test type). Data for women with both IHC and FISH is shown below. Using the maximum of all available results, 24.9% were HER2-positive, 11.1% intermediate, and 63.9% HER2-negative. Only 55.2% of HER2-positive women received trastuzumab, compared to 16.7% of women with an intermediate score, and no HER2-negative women. The majority of women (85.7%) did not have GEP. Among women with GEP, 58.9% indicated low recurrence risk, 21.4% medium risk, and 5.4% high risk. Adjuvant chemotherapy was received by 27.3%, 91.7%, and 100% respectively (p < 0.001). Conclusions: HER2 tests, primarily IHC, are widely used. There are discrepancies in classification of HER2 status based on IHC vs. FISH. We did not find evidence of overuse of trastuzumab by women who were HER2-negative. Further work should clarify whether the lack of trastuzumab for HER2-positive women is clinically appropriate. We found modest adoption of GEP, and GEP score was associated with the use of adjuvant chemotherapy. [Table: see text] No significant financial relationships to disclose.
Incidence, annualized cost, and utilization burden in patients with metastatic renal cell carcinoma
Authors: Burke J. P. , Liu Z. , Zheng J. , Johnson J. 
Published: August 2020

e17529 Background: Data on burden of metastatic renal cell carcinoma (MRCC) is scarce. The objectives of this study are to examine the incidence of MRCC and the cost and utilization burden of MRCC over time. Methods: Administrative claims data from a large, US managed care plan were used to identify commercially insured and Medicare enrollees with newly diagnosed MRCC during 01/01/03–12/31/07 and continuous enrollment 12 months prior to and at least 90 days after MRCC diagnosis. Mean (median) costs and utilization during the follow-up period were annualized. Costs were 2007 CPI-adjusted. Results: 1,427 patients were identified with newly diagnosed MRCC (average age: 62.4 years 62.6% male). The annual incidence of MRCC in the managed care plan population was 3.4, 3.8, 2.9, 3.3, and 4.4 per 100,000 enrollees in 2003 through 2007, respectively. The mean (median) annual number of ambulatory visits per patient increased among patients diagnosed in 2003 to those diagnosed in 2007, from 44.9 (33.2) to 63.7 (54.8). Mean (median) annual medical costs per patient increased by year of diagnosis from $70,797 ($33,031) in 2003 to $92,521 ($48,117) in 2007. Pharmacy costs (excluding costs for medications delivered in medical settings) increased from $5,651 ($2,004) to $13,290 ($3,609), and were approximately 7.4%-14.3% of total costs during the time period. Conclusions: This study showed an apparent slight increase in MRCC incidence rates and revealed that treatment costs and health care utilization per patient increased substantially from 2003–2007 among members of this US managed care plan. The increases in health care utilization and cost suggest the evolution in treatment options over time as more therapies become available. No significant financial relationships to disclose.
Does race affect outcomes in triple negative breast cancer (TNBC)?
Authors: Ahmed S. , Mirza M. M. , Farooq A. , Kronish L. , Jahanzeb M. , Sachdev J. C. 
Published: August 2020

e17543 Background: TNBC is associated with a worse prognosis than luminal subtypes. There is discordance among studies assessing the impact of race on outcomes of TNBC. Our objective was to assess whether African American (AA) vs. Caucasian (CA) race predicted survival outcomes for women with TNBC treated at a single institution in Memphis, TN. Secondary objectives were to examine the association of race with patient and tumor characteristics. Methods: Patients with stage I-III TNBC were identified from our breast cancer database and confirmed by review of pathology reports. Event free survival (EFS) was measured from the date of surgery to the date of first recurrence (locoregional, distant, or contralateral), death from breast cancer or last follow-up. Breast cancer specific survival (BCSS) was measured from the date of surgery to the date of death from breast cancer or last follow-up. Fisher's exact test was used for association between variables, Kaplan Meier method for survival estimates, and log rank test for survival comparison between groups (p < 0.05: significant). Cox proportional hazards models with patient, tumor and treatment variables were fitted for EFS and BCSS. Results: Of the 105 patients with TNBC, 71% were AA. There was no significant association between race and stage at diagnosis (p = 0.68). 71% of AA women were < 55 years old and 43% were pre-menopausal vs. 50% and 23% of CA women respectively. There was a trend towards association of race with age and menopausal status (p = 0.08). Ninety three percent of the patients received neo/adjuvant chemotherapy. With a median follow up of 26 months, 26% of AA vs. 20% of CA women had an event (p = 0.62). Overall 3 year EFS and BCSS estimates were 69% and 82% respectively. Racial differences in EFS and BCSS for AA vs. CA (65% vs. 80% and 78% vs. 89%, respectively) did not achieve statistical significance (log rank p = 0.22 for EFS and 0.26 for BCSS). Race was not a significant predictor of EFS or BCSS on uni-variable or multi-variable analysis. Stage at diagnosis retained significance for EFS and BCSS on uni-variable and multi-variable testing. Conclusions: Race did not affect outcomes in our cohort of TNBC patients treated similarly. The high event rate underscores the poor prognosis of TNBC and the need for more effective therapies. No significant financial relationships to disclose.
Longitudinal analysis of quality of life (QoL) within a randomized phase III trial in patients (pts) with metastatic pancreatic adenocarcinoma (MPA)
Authors: Bonnetain F. , Maillard E. , Seitz J. , Mitry E. , Ychou M. , Gasmi M. , Raoul J. , Mariette C. , Bedenne L. , Dahan L. 
Published: August 2020

e17544 Background: The FFCD phase III trial in pts with MPA comparing LV5FU2-P followed by gemcitabine (arm A) versus the opposite sequence (arm B) had failed to demonstrate a significant difference in median OS. To longitudinally compare QoL according to treatment sequence we have explore definitions of time until definitive deterioration (TUDD) of QoL scores according to minimal clinically important difference (MCID) cut off. Methods: From August 2003 to May 2006, 202 pts with measurable MPA, PS 0–2, non prior CT were included in 33 centers, 102 in arm A and 100 in arm B. QoL was evaluated using EORTC QLQ-C30 every 8 wks up to death. We focused analyses on the following scores: global health (GH), emotional functioning (EF), physical functioning (PF), fatigue (FA), and pain (PA). TUDD were estimated using Kaplan Meier, and compared using log-rank tests. They were defined as the time interval between randomization and the first occurrence of a decrease in QLQ-C30 score ≥ 5 points without any further improvement in QoL score ≥ 5 points or any further available QoL data. These analyses were repeated using a 10 points MCID, and by including deaths as event. Results: Amongst the 202 pts, 179 had completed at least one QoL questionnaire (89%) and the mean number of available QoL data was 3 (SD: 2.14). Using a 5 points MCID as well as 10 points, TUDD of the 5 scores did not differ according to treatment arm. About 25% of patients reported definitive score deteriorations≥ 5 points and 15%≥ 10 points. Including death as event for a 5 points MCID, median TUDD of GH score was 5.2 months (4.3–6.2) in Arm A and 6.1 months (5.1–6.1) in Arm B (log rank p = 0.50). Median TUDD of FA score was 4.8 months (3.5–6.3) in Arm A and 5.6 months (4.2–7.7) in Arm B (log rank p = 0.76). Median TUDD of scores was reached after median PFS and at median time of second-line PFS. While treatment had no impact, multivariate Cox model showed that tumor localization and progression were independently associated with TTDU (p < 0.05). Conclusions: We have investigated QoL analyses modalities using survival techniques dealing with binding drop out missing data and with an easier clinical interpretation of results. Progression seems to negatively impact QoL. No significant financial relationships to disclose.
Economic guidelines for oncology products: Adaptation of the Canadian Agency for Drugs and Technologies in Health (CADTH) technology assessment guidance document
Authors: Mittmann N. , Evans W. K. , Rocchi A. , Longo C. J. , Au H. J. , Husereau D. , Isogai P. K. , Krahn M. , Coyle D. ,   Working Group on Standardized Pharmacoeconomic Guidelines in Oncology
Published: August 2020

e17572 Background: Economic evaluations (EE) are routinely used by decision-makers in Canada. CADTH's “Guidelines for the Economic Evaluation of Health Technologies: Canada” Third edition, 2006, provide guidance on the conduct of EEs for all therapeutic products. The consistency and quality of oncology EEs are variable and therapeutics in the cancer care environment presented unique challenges in decision making. Several chapters of the CADTH document adequately defined methods for the conduct of an oncology EE. However, some chapters required more specific guidance to improve the quality of oncology EEs. The goal was to provide direction on methods for the conduct of high quality EEs in oncology. Methods: The Working Group on Economic Analysis, NCIC CTG and CADTH jointly initiated this project and formed a working group (WG) of oncologists, health economists, decision makers and economic analysts. The WG identified CADTH chapters where oncology-specific guidance would be required. In-person and teleconference meetings provided content and structure for the document. Formal reviews by external academic experts, cancer agencies, patient groups and the pharmaceutical industry were conducted. Feedback was reviewed by the WG and incorporated as appropriate. Results: Chapters requiring guidance included: target population, comparators, perspective, effectiveness, modeling, type of evaluation, valuing health, time horizon, costs and resources, sensitivity analysis and equity. Guidance included clarity around CADTH methodology and recommendations for oncology products. For example for the effectiveness chapter, there was guidance around the use of intermediate outcomes (progression free survival vs. overall survival) and type of evidence (phase II vs. phase III). Overall recommendations for chapters will be presented. Conclusions: The oncology adapted economic guidelines provide specific guidance on the conduct of EEs for oncology products and will be published as an addendum to CADTH's third edition document. Their use should lead to more consistent application of EE methodologies for anti-cancer drugs and higher quality information for decision-makers at a national and perhaps international level. No significant financial relationships to disclose.
Neutrophil dynamics and death in postchemotherapy septic neutropenia
Authors: Othieno-Abinya N. A. , Kiarie G. W. , Mlombe Y. , Wanzala P. 
Published: August 2020

e17579 Background: Mortality rates from septic neutropenia vary between studies, ranging from 7% to 30%. We observed the mortality rate for patients hospitalized for postchemotherapy septic neutropenia was 28.6% in one of our studies. Many deaths appeared to have occurred at the time of neutrophil recovery. We attributed this to immune reconstitution inflammatory syndrome akin to what is seen in HIV/AIDS. Methods: Records of patients who died during hospitalization with septic neutropenia. Results: Twenty one patients, 14 males (67%) and 7 females (33%) were included, age range 14–67 years. Six (28.6%) had World Health Organization (WHO) grade 0 neutropenia at the time of death, none had grade 1, one (4.8%) had grade 2, one (4.8%) grade 3, and 14 (67%) had grade 4. The last absolute neutrophil count (ANC) at death ranged between 0.005 and 6.3 x 109/litre. Ten patients (47.6%) died during neutrophil upswing and 11 (52.4%) during neutrophil decline. Thirteen patients (61.9%) also had grade 4 thrombocytopenia but no death was attributed to bleeding. Five of 18 (27.8%) had WHO grade 3 renal function impairment, and six (33.3%) had grade 2 impairment. The main cause for renal function disturbance was hypotension that was usually sudden and unexplained. There was no correlation between ANC and renal function impairment (p > 0.5). Conclusions: Death from septic neutropenia could not be attributed to neutrophil dynamics and by extension immune reconstitution from this study. Neutropenia grade 4 still stood out as a major predictor of death. Larger prospective studies are required to address this issue. No significant financial relationships to disclose.
A comparative study of single-dose pegfilgrastim versus daily filgrastim in patients with acute myeloid leukemia
Authors: Kunivayalil S. , Jain A. , Satheesh C. , Tejinder S. , Lakshmaiah K. , Suresh T. M. , Lokanatha D. , Babu G. 
Published: August 2020

e18005 Background: Prophylactic treatment with recombinant human granulocyte colony stimulating factor (rhGCSF) is used to decrease the severity and duration of neutropenia in patients receiving myelosupressive chemotherapy. It can be used during induction and consolidation chemotherapy in acute myeloid leukemia (AML). Mechanism of action of pegylated GCSF is the same as filgrastim except for delayed clearance. Few studies addressed the use of pegylated filgrasim in AML. Methods: After 24 hours of consolidation chemotherapy, 8 patients in the study arm received single dose of subcutaneous 6 mg pegfilgrastim. The control group received daily filgrastim at a dose of 5 microgram per kg.until absolute neutroophil count of 2 ×109 cells/μL for 2 consecutive days. The neutrophil recovery time, febrile neutropenia and its duration, duration of hospitalization and safety profiles were compared. Results: There were 20 episodes of pegfilgrastim administration. The median age was 41 years in pegfilgrastim arm and 39 years in filgrastim arm. Medium time to neutrophil recovery was 14 days for pegfilgrastim arm and 17 days for filgrastim arm. In the pegfilgrastim arm 12 (60%) episodes of febrile neutropenia occurred compared to 11 (55%) in filgrastim arm. The median duration of febrile neutropenia was 3 days in pegfilgrastim arm versus 4 days in filgrastim arm. The median duration of hospitalization was 15 days in pegfilgrastim arm and 18 days in filgrastim arm. Safety profile and complete remission status did not differ between the two groups. Conclusions: The present study showed favorable profile of pegfilgrastim for netrophil recovery, duration of neutropenia and hospital stay. There was no difference with regard to safety or response to treatment. No significant financial relationships to disclose.
A phase I study of tumor treating fields (TTFields) in combination with pemetrexed for pretreated advanced non-small cell lung cancer
Authors: Kirson E. D. , Weinberg U. , Betticher D. , Von Moos R. , Fischer N. , Studt J. , Buess M. , Burger N. , Palti Y. , Pless M. 
Published: August 2020

e18500 Background: TTFields (tumor treating fields) are low intensity, intermediate frequency, alternating electric fields which slow the growth of solid tumors in-vivo, and have shown promise in pilot clinical trials in patients with advanced solid tumors. TTFields are a regional treatment which acts both by interfering with microtubules polymerization and by physical disruption of the cell structure during cytokinesis. It has been shown previously that TTFields sensitize non-small cell lung cultures to Pemetrexed. In-Vivo, TTFields did not increase pemetrexed related toxicity. Methods: A prospective trial was performed in 14, pretreated, stage IIIb-IV, NSCLC patients. Patients with brain metastases were excluded, as were patients with abnormal marrow, kidney, liver or cardiac functions. Patients with history of clinically significant arrhythmias or those having pacemakers were excluded as well. Patients received Pemetrexed 500mg/m2 IV q3w together with daily TTFields (12 h/day) using a portable medical device (NovoTTF-100L). The device generated 2 direction (AP and Lat), 150 kHz TTFields. Patients were followed every three weeks and had a lung CT every 9 weeks. The primary endpoint was the safety and tolerability of the NovoTTF-100L device in combination with pemetrexed. Results: The 14 patients received an average of 4 courses of pemetrexed (Range 1–9) and a cumulative TTFields treatment time of 182 weeks. The device was well tolerated as indicated in the device log files which showed an average daily use of 11±1 hours. There were no device-related, nor pemetrexed-related SAEs. In addition, no unexpected abnormalities were evident in the lab tests or EKGs, done every 3 weeks for all patients. There were no reports of arrhythmias. The only device related AE seen in all patients was dermatitis under the electrodes. This improved with meticulous skin care, topical steroid use and in extreme cases oral steroids. One patient (7.6%) had a CR, 1 a PR (7.6%), 9 SD (69.2%) and 3 PD (23%). 77% of patients were progression free at 12 weeks and the 6 month survival was 89%. Conclusions: TTFields are well tolerated when given together with pemetrexed. The excellent safety profile and initial efficacy results reported here justify further clinical testing. [Table: see text]