bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prediction model for chemotherapy-associated thrombocytopenia in cancer patients
Authors: Kuderer N. M. , Francis C. W. , Crawford J. , Dale D. C. , Wolff D. A. , Culakova E. , Poniewierski M. S. , Lyman G. H. 
Published: April 2020

8616 Background: Thrombocytopenia (TP) can lead to serious complications, however, little is known about the incidence and risk factors for chemotherapy-associated TP. A prospective, nationwide cohort study was undertaken to better define the impact of TP in cancer treatment. Methods: 2,842 patients with cancer of the breast, lung, colon, ovary or lymphoma initiating a new chemotherapy regimen have been prospectively enrolled at 115 randomly selected US community oncology practices between 2002 and 2005. Risk factors for chemotherapy-associated TP were identified, a multivariate logistic regression model based on pretreatment characteristics was developed, and test performance characteristics were estimated. Results: Over a median of 3 cycles of chemotherapy, minimum recorded platelet counts were: ≥150K in 53% of patients; 100–150K in 26%; 75–100K in 8%; 50–75K in 6% and <50K in 7%. Significant independent predictive factors for platelets <75K include type of cancer (P<.0001), type of chemotherapy including gemcitabine-based (P<.0001), anthracycline-based (P<.0001) and platinum-based (P<.0001) regimens, prior chemotherapy (P<.0001) or surgery (P=.005), age (P=.015), Caucasian ethnicity (P=.022), body surface area (P=.0001), planned relative dose intensity ≥85% (P=.082), diabetes (P=.018), pulmonary disease (P=.011), abnormal baseline platelets (P<.0001), hematocrit (P=0.030), alkaline phosphatase (P=.072) or albumin (P=.017). Model fit was good (Chi-square, P<.0001), R2 = 0.735 and c-statistic = 0.816 [95% CI: 0.792–0.840, P<.0001]. Model test performance characteristics [95% CI] at a ≥20% risk of TP include: sensitivity 56% [51–61]; specificity 88% [87–89]; likelihood ratio positive 4.63 [4.02–5.33]; likelihood ratio negative 0.50 [0.45–0.57]; and diagnostic odds ratio 9.22 [7.23–11.75]. Validation of the model is underway. Conclusions: This prediction model based on pretreatment factors identifies with high specificity patients at risk for clinically important chemotherapy-associated thrombocytopenia early in the treatment course. It may provide a valuable tool for guiding chemotherapy and new supportive care measures. [Table: see text]
Switching from methadone to a different opioid: What is the equianalgesic dose ratio?
Authors: Walker P. W. , Bruera E. , Pei B. , Kaur G. , Zhang K. , Jeanine H. , Curry E. , Palla S. , Mansell M. 
Published: April 2020

8617 Background: Methadone (ME) is a highly effective opioid agonist used for difficult pain syndromes. However, the rotation from ME to another opioid may be difficult because of the absence of a uniformly accepted conversion ratio. Methods: We retrospectively reviewed consecutive medical records of Pts undergoing an opioid rotation from ME to an alternative opioid. For inclusion, Pts were required to have received ME for at least 3 days prior to the switch and reach a stable dose of the alternative opioid(s) during 7 days following. Stable dose was defined as a 30% or less change in opioid dose from one day to the next. For purposes of analysis, on the day before the switch, doses, were divided into ME doses and the oral morphine equivalent daily dose (MEDD), based on medication and route of all other opioids taken on that day, using standard equinalgesic tables. All doses after the switch were converted to the MEDD. For Pts receiving ME and a second opioid prior to the switch, the MEDD of the second opioid was subtracted from the MEDD calculated for the day when stable dose was reached. The remainder was used to calculate the equianalgesic raio with the previous ME dose. Results: Records on 39 Pts met inclusion criteria. Excluded from analysis were 5 Pts who were restarted on ME in < 8 days, 2 whose opioid dose markedly decreased of post switch, and 3 due to concerns about reliability of multiple routes used for fentanyl. Data from 29 Pts, 10 female, mean age 48 ±14.4 were evaluable. The ratio for: oral ME to MEDD was 1:4.7 (CL 3.0–6.5)(n=16), IV ME to MEDD was 1:13.5 (CL6.6–20.5)(n=13), p=0.06. ME dose is significantly correlated to stable MEDD after switching opioids for both ME IV and oral (Spearman=0.86,p=0.0001 and Spearman=0.72, p=0.0024, respectively. Mean day of achieving stable dose was on day 2.5 ±0.2 for IV ME and day 2.6±0.3 for oral ME. Conclusions: These dose ratios are new findings that will assist in switching Pts more safely to alternative opioids, when side effects or pain problems occur.An important difference in analgesic potency appears to exist between IV and oral ME. Further research with prospective studies is required. No significant financial relationships to disclose.
Adherence to prescribed oral medications: Understanding the barriers to optimizing hormonal therapy in breast cancer (BC)
Authors: Kirk M. , Hudis C. 
Published: April 2020

8621 Background: Several studies have demonstrated suboptimal adherence to oral anticancer agents. Understanding barriers to treatment adherence is increasingly important with the growing number of oral agents available to treat BC. Gaining insights into the attitudes and behaviors of patients (pts) with BC regarding their prescribed treatment is necessary to identify and address factors responsible for poor adherence with oral medications. Methods: To identify barriers to adherence with oral hormonal medications, a self-reported, 30-question internet survey was posted on www.y-me.org from June 30 through October 31, 2005. Results: Of the 328 survey respondents, 65.9% were diagnosed with early BC and 53.3% were postmenopausal. Of the 60% of pts with BC who had been prescribed an oral therapy, 44.6% were prescribed tamoxifen, 31.8% anastrozole, and 7.9% letrozole. 88.6% of patients indicated that their healthcare provider discussed the importance of taking oral medications as directed. Only 44.2% reported receiving instruction on the importance of taking oral medications as directed at every office visit. For 33.3%, this topic was reportedly discussed only once, prior to treatment. 83.6% of patients indicated they were taking their oral therapy as directed, but only 57.4% rated their ability to adhere to therapy (not missing a single dose) as excellent. For 35.5%, knowing that adherence may improve clinical outcome would help them take their oral medication as directed. For 24.1%, better management of treatment-related side effects would improve their adherence to therapy. Conclusions: To improve adherence, the results of this survey suggest that healthcare professionals should discuss and emphasize 1) the importance of taking oral medications as directed and 2) the impact of adherence on clinical outcomes. Greater attention to managing treatment-related side effects may further enhance adherence to therapy. [Table: see text]
Relative efficacy of various 5- hydroxytryptamine receptor antagonists in the prevention and control of acute nausea and vomiting associated with platinum-based chemotherapy
Authors: Hamadani M. , Padmanabhan R. , Chaudhary L. , Tfayli A. 
Published: April 2020

8623 Background: The introduction of 5-Hydroxytryptamine-3 receptor (5-HT3) antagonists has represented a significant clinical advance in the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV), particularly for patients receiving highly emetogenic platinum-based regimens. However no study to date has compared the relative efficacy of Dolasetron, Granisetron, Ondansetron and Palonosetron with Dexamethasone in the prevention and control of acute CINV in patients undergoing platinum-based therapy. Methods: Retrospective data were reviewed for 207 consecutive patients receiving Platinum-based chemotherapy in our infusion center between November 1999 and August 2005. Patients receiving 5-HT3 antagonists without Dexamethasone (n=11) were not eligible for the study. Further 15 patients were excluded because of no documentation of CINV. The remaining 181 patients constitute the subject of this study. Patient characteristics including age, sex, race, diagnosis, history of heavy alcohol intake, chemotherapy regimen administered, number of cycles, and performance status at the start of therapy were noted. Primary outcome measure was complete control of acute CINV. National Cancer Institute Common Toxicity Criteria version 2.0 was used to assess toxicity. Results: The 181 patients received 572 cycles of platinum-based therapy. Dolasetron (n=157), Granisetron (n=81), Ondansetron (n=131) and Palonosetron (n=203) (each given with Dexamethasone) achieved complete control of vomiting in 89.8%, 95.5%, 92.3% and 88.1% (ρ=0.86) of cycles respectively. Respectively, complete nausea control was observed in 68.1%, 75.3%, 69.4% and 73.3% (ρ=0.35). DEX 20 mg was not superior to 10mg in complete control of nausea and vomiting (ρ=0.06 and ρ=0.67 respectively). Similarly complete control of nausea and vomiting (ρ=0.12 and ρ=0.10 respectively) was not significantly different in patients getting cisplatin compared to carboplatin based regimens. Conclusion: This study does not demonstrate a significant difference in the efficacy of the four 5-HT3 antagonists in controlling acute CINV. The higher dose of Dexamethasone confers no added benefit over the lower 10mg dose. No significant financial relationships to disclose.
Final results of a randomized study comparing two dosing regimens of epoetin alfa in patients with chemotherapy-induced anemia: 80,000 U every two weeks vs 40,000 U weekly
Authors: Henry D. H. , Kamin M. , Wilhelm F. , Williams D. , Xie J. , Woodman R. C. 
Published: April 2020

8624 Background: Epoetin alfa is typically administered weekly (QW) for the treatment of chemotherapy (CT)-induced anemia. Less frequent dosing can be more convenient for patients (pts) and healthcare providers. This is the first study to examine extended interval initial dosing with epoetin alfa 80,000 U every two weeks (Q2W) vs the standard 40,000 U QW regimen. Methods: This randomized, open-label, 13-week study enrolled pts with non-myeloid malignancies with baseline (BL) hemoglobin (Hb) ≤ 11 g/dL and CT planned for ≥ 12 weeks. Pts were assigned (1:1) to receive epoetin alfa 40,000 U QW or 80,000 U Q2W subcutaneously. Drug was held for Hb > 13 g/dL and dose was reduced for Hb > 12 g/dL or rate of rise > 1 g/dL in any 2-week period. For inadequate Hb response, 80,000 U Q2W pts were switched to 40,000 U QW and 40,000 U QW patients were increased to 60,000 U QW. The primary analysis was a comparison of the mean Hb change from BL to end of study (EOS). Results: 298 pts received ≥ 1 dose of drug (153 Q2W, 145 QW). BL characteristics were comparable between groups: 66% female, overall mean age 62 yrs, and BL Hb 10.0 g/dL. Most common tumor types were breast (25%), NSCLC (15%) and colorectal (14%). Efficacy was analyzed in 295 pts (151 Q2W, 144 QW) who had ≥ 1 post-BL Hb value. The mean Hb change from BL to EOS for Q2W was 1.27 ± 1.48 g/dL compared to 1.28 ± 1.60 g/dL for QW [difference 0, 1-sided 95% CI -0.25,–]. In the per protocol population, the difference in mean Hb change was similar. Mean Hb values over time were also similar between groups. Kaplan-Meier estimates of post-28 day transfusion rates were 11.2% in Q2W vs. 12.0% in QW. Fewer Q2W pts compared to QW pts required dose holds (21% vs 42%) or dose reductions (41% vs 59%). 13% of Q2W pts were switched to QW dosing and 37% of QW pts required a dose increase. The incidences of clinically relevant TVEs and deaths were similar in the Q2W vs QW groups (7.8% vs 7.6% and 6.5% vs 6.2%, respectively). Conclusions: Pts treated with epoetin alfa 80,000 U Q2W demonstrated similar Hb increases, transfusion rates, and safety outcomes compared to pts treated with 40,000 U QW. Epoetin alfa 80,000 U every other week is an effective regimen that may provide a more convenient dosing option for pts with CT-induced anemia. [Table: see text]
Patient wishes and physician inquiries regarding spiritual needs in an urban cancer center
Authors: Astrow A. B. , Wexler A. , Texeira K. , Sulmasy D. P. 
Published: April 2020

8630 Background: Prior studies have shown much interest in spirituality among patients in the rural South, but little is known about the spiritual needs and views of urban cancer patients. Methods: In Jan-Feb 2005, consecutive outpatients were asked to complete a questionnaire at the St. Vincent’s Comprehensive Cancer Center in New York City. The instrument included the QUEST satisfaction scale, demographic and clinical information, and questions about spiritual and religious beliefs and needs. Tests of association included correlation, t-tests, and χ2. Multivariate models were estimated using logistic techniques. Results: Of the 891 eligible patients, 81 refused, 428 cancelled their appointments or left before being approached. 13 were excluded because of incomplete questionnaires. The 369 participants had a mean age of 57.5 years; 65% were women, 67% white, 65% college-educated, 32% had breast cancer, and 67% were privately insured. Forty-seven percent were Catholic, 19% Jewish, 16% Protestant, and 6% atheist or agnostic. Sixty-six percent reported being “spiritual but not religious,” and 29% attended religious services at least once per week. Nine percent reported that staff had inquired about their spiritual or religious beliefs (0.6% by an MD), and 6% reported inquiries about their spiritual needs (0.9% by an MD). But, 82% reported that their spiritual needs were being met, and being asked about neither religious beliefs (p = .37) nor spiritual needs (p = .72) was associated with satisfaction. Still, 52% thought it appropriate for physicians to inquire about their religious beliefs and 58% thought it appropriate for physicians to inquire about their spiritual needs. Patients who described themselves as “spiritual but not religious” were less likely to think it appropriate for an MD to inquire about their religious beliefs (OR = 0.48, CI = 0.28 to 0.84), while those who attended religious services at least weekly were more likely to think it appropriate (OR = 2.86, CI = 1.45 to 5.62). Conclusions: A majority of patients thought it appropriate to be asked about their spiritual and religious beliefs and needs, but less than that reported in other settings. Few had these needs addressed by staff, especially by MDs. More religious patients were more likely to think such inquiries appropriate. No significant financial relationships to disclose.
Exercise in patients with advanced non-small cell lung cancer (NSCLC): Compliance and population characteristics of patients referred to the McGill Cancer Nutrition-Rehabilitation Program (CNRP)
Authors: Dalzell M. A. , Kreisman H. , Dobson S. , Kasymjanova G. , Roudaia E. , Agulnik J. S. , Small D. , MacDonald N. 
Published: April 2020

8631 Background: Few studies focus on exercise in advanced NSCLC. We evaluated compliance with exercise prescription in stages 3/4 NSCLC. Methods: Patients (pts) referred to the CNRP, a multidisciplinary clinic, for weight/functional loss were evaluated for participation in a supervised exercise program. Compliance with exercise was scored as 0 (refused/home exercise), 1 (<6 sessions in 2 mo), and 2 (≥ 6 sessions in 2 mo). Gender, age, PS, stage, CRP, weight loss, and quality of life [Edmonton Syptom Assessment Scale (ESAS)] were assessed by univariate and multivariate analyses. Survival from the time of exercise prescription was calculated using the Kaplan-Meier method and compared using the log-rank test. Results: 168 pts were referred to the CNRP from April 2002 to September 2005. 92/168 (54%) were prescribed exercise. Of the 76 remaining pts, 3 (4%) refused, and 6 (8%) were on an exercise trial. Others were excluded due to bone metastasis/severe pain (50 pts, 66%), cardiovascular instability (13 pts, 17%) or poor PS (4 pts, 5%). Of the 92 who were prescribed exercise, the compliance score was 0 in 38 (41%), 1 in 37 (40%) and 2 in 17(19%). There were no significant differences in gender, age, PS, stage, ESAS, and weight loss at the time of referral among the three compliance groups. Most pts (15/17) with a compliance score of 2 were referred prior to or during initial treatment, whereas those with compliance scores of 0 and 1 were referred later in the course of treatment. Compliance with exercise correlated with survival (p<0.001). The median survival from time of exercise prescription for pts with a compliance score of 2 was 22 mo (95%CI 13.4,30.2); compared with 5 mo (95%CI 3.7,5.6) and 7 mo (95%CI 2.5,11.5) for those with compliance scores of 0 and 1 respectively. No serious adverse events occurred. Conclusion: A select group of advanced NSCLC pts can exercise safely at a moderate-high level. Those referred earlier tended to be more compliant, and their longer survival may reflect a lead time bias. Clinical trials are needed to evaluate efficacy of exercise in newly diagnosed NSCLC. No significant financial relationships to disclose.
Assessment of Knowledge and Screening in Oral, Breast, and Cervical Cancer in the Population of the Northeast Region of India
Authors: Oswal Kunal , Kanodia Rishav , Pradhan Akash , Nadkar Umakant , Avhad Mahendra , Venkataramanan Ramachandran , Sethuraman Lakshman , Caduff Carlo , Purushotham Arnie 
Published: April 2020

PURPOSE The burden of cancer is increasing globally, with poor outcomes in terms of morbidity and mortality in patients, especially in low- and middle-income countries. Lack of awareness of the risk factors, symptoms, and signs of common cancers in addition to inadequate cancer prevention programs at the community level are a major hindrance to the early detection of cancer. METHODS A cross-sectional study was conducted in the North East Region (NER) of India, with a sample population of 1,400 participants from Assam (n = 1,000), Meghalaya (n = 200), and Nagaland (n = 200). The questionnaire developed for the study consisted of sociodemographic profile, knowledge about cancer (oral, breast, and cervical), its warning signs, risk factors, and attitude toward cancer screening. Statistical analysis was performed using STATA version 13.0. RESULTS Among all the participants, 59% had heard about oral cancer, 50% about breast cancer, and 31% about cervical cancer. A limited understanding of risk factors, symptoms, and signs was reported for oral cancer (45%), breast cancer (54%), and cervical cancer (63%). A total of 34% of participants were aware of cancer screening. Among those who were aware of cancer screening, only six people had undergone any form of cancer screening, and 71% cited media as the major source of information. CONCLUSION The level of cancer awareness is low in the NER. A multipronged approach is needed with assistance from government and nongovernment organizations for training, providing adequate human resources and equipment, and developing cancer screening infrastructure. This needs to be coupled with mass media communication and interpersonal communication through frontline health workers.
Establishing a Cancer Registry in a Resource-Constrained Region: Process Experience From Ghana
Authors: Yarney Joel , Ohene Oti Naomi O. , Calys-Tagoe Benedict N. L. , Gyasi Richard K. , Agyeman Duah Isaac , Akoto-Aidoo Charles , McGuire Valerie , Hsing Julianna C. , Parkin Max , Tettey Yao , Hsing Ann W. 
Published: April 2020

PURPOSEIn a review of cancer incidence across continents (GLOBOCAN 2012), data sources from Ghana were classified as Frequencies, the lowest classification for inclusion, signifying the worst data quality for inclusion in the analysis. Recognizing this deficiency, the establishment of a population-based cancer registry was proposed as part of a broader cancer control plan.METHODSThe registry was examined under the following headings: policy, data source, and administrative structure; external support and training; and definition of geographic coverage.RESULTSThe registry was set up based on the Ghana policy document on the strategy for cancer control. The paradigm shift ensured subscription to one data collection software (CanReg 5) in the country. The current approach consists of trained registrars based in the registry who conduct active data abstraction at the departments and units of the hospital and pathologic services. To ensure good governance, an administrative structure was created, including an advisory board, a technical committee, and registry staff. External support for the establishment of the Accra Cancer Registry has come mainly from Stanford University and the African Cancer Registry Network, in collaboration with the University of Ghana. Unlike previous attempts, this registry has a well-defined population made up of nine municipal districts.CONCLUSIONThe Accra Cancer Registry was established as a result of the lessons learned from failed previous attempts and aim to provide a model for setting up other cancer registries in Ghana. It will eventually be the focal point where all the national data can be collated.
Effectiveness of Dulaglutide in the Real World and in Special Populations of Type 2 Diabetic Patients
Authors: Morieri Mario Luca , Frison Vera , Rigato Mauro , D’Ambrosio Michele , Tadiotto Federica , Paccagnella Agostino , Simioni Natalino , Lapolla Annunziata , Avogaro Angelo , Fadini Gian Paolo 
Published: April 2020

Abstract

Context
In randomized controlled trials (RCTs) on type 2 diabetes (T2D) patients, the glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-RA) dulaglutide reduced HbA1c and body weight, but generalizability of such findings to real-world T2D patients is challenging.

Objective
We evaluated effectiveness of dulaglutide in routine clinical practice, especially in subgroups of patient that are underrepresented in RCTs.

Design
Retrospective multicenter study.

Setting
Diabetes outpatient clinics.

Patients and intervention
All consecutive patients who initiated dulaglutide between 2015 and 2018.

Main outcome measures
Changes in HbA1c and body weight were assessed up to 30 months after baseline. Effectiveness was analyzed in patient subgroups according to: prior use of GLP-1RA, persistence on treatment and dose, age, sex, disease duration, renal function, obesity, cardiovascular disease, or concomitant use of insulin or sulphonylurea.

Results
From a background population of 83,116 patients, 2084 initiated dulaglutide (15.3% switching from another GLP-1RA), 1307 of whom had at least 1 follow-up visit. Overall, dulaglutide reduced HbA1c by 1.0% and body weight by 2.9 kg at the end of observation. These effects were more pronounced in GLP-1RA-naïve patients and in those with shorter disease duration. Improvement in HbA1c was highly significant and consistent across all subgroups, including those aged ≥ 75 years, nonobese, or with chronic kidney disease. Body weight declined in all subgroups and significantly more with the 1.5-mg versus 0.75-mg dose.

Conclusions
In real-world T2D patients, effectiveness of dulaglutide on HbA1c and body weight reduction was highly consistent and significant even in subgroups of patients poorly represented in RCTs.