bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the use of bone agents in metastatic cancer.
Authors: Kogler Jurgen Wilhelm , Hrushesky William J. , Huff Dinah , Bobolts Laura Rose , Kumar Akhil , Shimp William S. , Krook James Edward , Fishman Val , Davis Sharon , Anthony Carol , Walton Robert , Fishman Marc L. 
Published: March 2020

e20672 Background: Bone modifying agents have been shown to delay and/or prevent skeletal-related events for a range of cancers metastatic to the bone. Various studies have identified pamidronate, zoledronic acid, and denosumab as bone modifying agents, each of which confers clinical benefit. The convenience of administration and costs of these agents differ greatly. Administration spans vary from roughly 2 hours for IV pamidronate, 15 minutes for IV zoledronic acid, and minimal time for subcutaneous denosumab. The estimated cost for a single dose of pamidronate, zoledronic acid, and denosumab are $29, $890, and $1,712, respectively. Methods: All requests for pamidronate, zoledronic acid, and denosumab authorization submitted by practicing oncologists within southeast Florida were tabulated for 2010, 2011, and 2012. Comparisons for both frequency of use and cost over time were made using ANOVA and Chi Square; p<0.05 for significance. Trends were assessed by linear regression. Results: 895 requests for pamidronate, zoledronic acid, or denosumab were examined over this three year span. The use of bone modifying agents for metastatic cancer is increasing rapidly, as treatment request totaled 171, 269, and 455 for all three agents, pamidronate, zoledronic acid, or denosumab, in 2010, 2011, and 2012, respectively. Zoledronic acid requests significantly increased (p<0.001) per year between 2010 and 2011, as with 2011 and 2012. Denosumab requests are also increasing steadily and sharply in 2012. Conclusions: Each of these three agents has demonstrated clear efficacy in delaying or preventing second skeletal events among patients with metastatic cancer already involving bone. Toxicities among these three agents are comparable in the vast majority of eligible cancer patients. Relative costs should be carefully considered when choosing which agent to use as the use of these agents in general is increasing rapidly and will have a major impact upon overall cancer care costs. [Table: see text]
Survey of palliative care patients WHO work.
Authors: Glare Paul A. , Alickaj Alberta , Blinder Victoria Susana , Nikolova Tanya , Ramirez Carey , Raghavan Vidya , Crowley Janeen , Frierson Ethel Linda 
Published: March 2020

e20677 Background: There is an extensive literature on patients who return to work (RTW) after completing definitive cancer treatment. Much less is known about patients who work while on treatment. At a time of economic uncertainty as cancer becomes more of a chronic disease and palliative care is seen as offering much more than comfort care, issues affecting the working cancer patient needed to be explored. Methods: Cross sectional, anonymous survey completed once in two pain and palliative care clinics at a comprehensive cancer center by patients aged 25-65 who had been in paid employment prior to or during their treatment. Survey covered 37 items in three areas: cancer details (diagnosis, date of diagnosis, prior treatments, current disease status); occupation, work status and work ability; importance of work and factors interfering with work. Results: 97 surveys have been completed but up to 20% items missing responses. Cancer details: 54% females, median age 53, 79% working at diagnosis. Common primaries: Breast 26; CRC 14; lung 6; pancreas 4; prostate 2. 80% (67/84) reported having active disease, median 2 years since diagnosis, and 80% of them on treatment currently.Work status and attitudes of the 67 patients with active disease: 42% (29/68) are currently working, mostly full time, and typically will RTW after < 6 months off. 39% would like to work more hours. Work is important to 73% them, making 78% "feel normal", and 53% that they are “beating the cancer”. Fatigue interfered with work in 49%, pain in 38%, and side effects of pain medicines in 31%. Almost ¼ were anxious or depressed about their work situation. More than 20% experienced discrimination in the work place, but usually minor. Conclusions: Many of these patients with advanced cancer were trying to remain in the work force, even when they are on treatment and are sick enough to need to be followed in a Pain & Palliative Care clinic. Work is important to them and almost half would like to work more. Symptoms and side effects are interfering with their work ability. Some are experiencing discrimination in the work place. Interventions need to be developed to overcome some of these problems.
Predicting complications of chemotherapy-induced febrile neutropenia: A single-center experience.
Authors: Bhosale Bharatsinha Baburao , Patil Vijay , Muddu Vamshi , Singh Randeep , Dwivedi Pankaj , Noronha Vanita , Joshi Amit , Ghosh Jaya , Gupta Sudeep , Banavali Shripad , Prabhash Kumar 
Published: March 2020

e20678 Background: Identifying the parameters associated with increased complications would help to formulate a cost-effective and rational therapy in patients with chemotherapy induced febrile neutropenia. Methods: We prospectively collected data from January 2007-December 2011 of consecutive episodes of neutropenic fever at our centre. Clinical features, laboratory characteristics and MASCC score were analysed to identify patients at higher risk for developing complications. Complications were defined as either of the following event: failure of first line antibiotics, organ failure, delay in next cycle of chemotherapy, inpatient admission and death. Results: Three hundred and eighty-eight febrile neutropenia (FN) episodes in 373 patients were included, 256 episodes of FN in hematolymphoid malignancies and 132 episodes of FN in solid tumours. The median age was 31 years (11-76 years). Two hundred and forty-four (65.4%) patients were male. One hundred forty-nine patients (39.94%) had FN during previous cycles, while primary GCSF prophylaxis was used for 205 (52.84%) cases. The median haemoglobin, nadir neutrophil count & median number of days with severe neutropenia (< 1X109/L) were 7.9 gm/dl, 0.04X109/L and 4 days respectively. A clinical focus of infection was present in 174 (44.8%) episodes, with gastrointestinal being the commonest in 70episodes (40.23%). High risk MASCC score (<21) was present in 156 episodes (40%). Complications were seen in 133(34%) instances. On Univariate analysis, age, type of malignancy, prophylactic growth factor use, clinical focus of infection, day of FN, MASCC score, nadir Hb and platelet count were significantly associated with complications. All predictive factors except age and nadir Hb could independently predict complication on multivariate analysis. Conclusions: Clinical and laboratory parameters in addition to MASCC score could help in identifying patients with FN who require hospitalisation and more intensive management strategies.
Are “Allow Natural Death” orders preferable to “Do Not Resuscitate” orders for patients with advanced cancer?
Authors: Emuron Dennis Omoding , Miljkovic Milos , Rhodes Lori , Abraham Joseph , Miller Kenneth David 
Published: March 2020

e20685 Background: Over twenty years after the passage of the Patient Self-Determination Act, patients’ preferences regarding end-of-life (EOL) care are often unknown to physicians. The aim of this study was to assess the knowledge and attitudes of cancer patients regarding EOL care, and to compare “Do Not Resuscitate” (DNR) and “Allow Natural Death” (AND) orders. Methods: Adult patients with advanced cancer were invited to participate. The first 50 consenting patients were surveyed regarding their prognosis and attitudes about critical care and resuscitation. We presented them with hypothetical scenarios in which a decision on their code status had to be made if they had 1 year, 6 months or 1 month left to live. Twenty-five patients were given a choice between being “full code" and DNR, and then 25 patients had a choice between "full code" and AND. Results: Almost half the patients (49%) were not aware that their illness was terminal. Fifty percent reported having a living will. However, only 19% reported that their doctors knew their wishes regarding EOL care. In contrast, greater than 78% reported knowledge of intubation, tracheotomy, feeding tubes, and cardiopulmonary resuscitation (CPR). The proportions of participants choosing full resuscitation compared to the DNR or AND options did not differ significantly from 50% (p-values > 0.54). Their choices did not vary by age, sex, race, type of cancer, education or income level (p-values > 0.05). Patients' attitudes towards CPR, tracheostomy and feeding tubes were not significantly associated with their choice of "DNR" (p-values > 0.17), but those who wanted these interventions were significantly less likely to choose "AND" (p-values < 0.002). As many as 38% of the patients without a living will chose "DNR", while 11% opted for "AND" (p-values < 0.03). Conclusions: In this small sample of patients with advanced cancer many were unaware of their poor prognosis, and few informed their physicians of their EOL preferences. The wording of DNR and AND orders was not associated with patients' EOL preferences. Contrary to our expectation, the "Allow Natural Death" phrasing might be less acceptable to patients who view life-prolonging measures favorably.
Patterns of treatment (tx) with bone-modifying agents (BMA) in patients with bone metastases (mets).
Authors: Quigley Jane M , Hernandez Rohini Khorana , Cetin Karynsa , Pirolli Melissa A. , Quach David , Liede Alexander 
Published: March 2020

e20690 Background: Bone mets can lead to serious and debilitating skeletal-related events (SREs: fracture, spinal cord compression, and surgery or radiation to bone). Three BMAs are approved in the US for prevention of SREs in cancer patients (pts) with bone mets: 2 intravenous bisphosphonates (IV BP) with recommended dosing every 3-4 weeks (pamidronate [PAM] and zoledronic acid [ZA]), and 1 RANK ligand inhibitor with subcutaneous injection every 4 weeks (denosumab). Monitoring real-world tx trends is important, particularly as low persistence has been linked to higher rates of SREs (Hatoum et al 2008). Methods: A retrospective cohort was defined from the Oncology Services Comprehensive Electronic Records (OSCER) database, which includes medical records from >500K pts treated at 76 US oncology practices. Adult solid tumor pts with bone mets who initiated tx with a BMA between Jan 2011 and Oct 2011 were included and followed for 12 mos after tx initiation. Pts were either naïve (no BMA in previous 6 mos) or transition (different BMA received in previous 6 mos). Results: The cohort was composed of 1445 denosumab pts (62% naïve) and 1807 IV BP pts (99% naïve). Pt characteristics were similar, although denosumab pts were somewhat more likely to have prostate cancer than IV BP pts (30% vs 25%). Denosumab pts were more likely to receive regular tx during follow-up and less likely to switch tx than IV BP pts (Table). Trends were consistent across tumor types and for naïve vs transition pts. Conclusions: This descriptive analysis reports on tx patterns for pts with bone mets since the availability of denosumab in Dec 2010. Denosumab represented almost half (44%) of pts initiating a BMA and one-third of pts naïve to tx. Uninterrupted tx was more common for denosumab pts than IV BP pts, regardless of tumor type. Trends, including reasons for and consequences of tx interruption, should be monitored as the pt experience develops. [Table: see text]
Role of bone scan in routine practice for early recognition of bisphosphonate-related osteonecrosis of the jaws (ONJ): Pro and con.
Authors: Fusco Vittorio , Tommasi Luigi , Muni Alfredo , Rouhanifar Hamed , Testori Ornella , Fasciolo Antonella , Benzi Luca , De Martino Iolanda , Randi Lorenza , Guglielmini Pamela Francesca , Pertino Antonella 
Published: March 2020

e20694 Background: The literature on the role of 99mTc-MDP bone scan (BS) in the diagnosis and follow-up of bisphosphonate-related ONJ is limited and unconsistent. Following data are in favour: a) BS is an imaging technique with high sensitivity; b) sporadic cases of early jawbone (maxilla or mandible) uptake have been reported, occasionally even months or years before the clinical evidence of ONJ (bone exposure); c) the jaw BS uptakes can change on different stages of ONJ disease (acute/symptomatic or less); d) the BS is performed periodically in patients with skeletal metastases to check out the status of disease activity and the response to specific treatments; consequently the research of ONJ does not involve additional costs. Vice versa, some limitations include: a) BS is a technique with low specificity; bone traumatic, inflammatory, degenerative lesions can determine an uptake; b) a non-negligible proportion of patients (even without any tumor disease) shows jaw uptakes, due to dental diseases widely seen in the general population (abscesses, denture ulcers,periodontal disease,etc.); c) even in BP-related ONJ suspected cases, jaw uptake may be due to infections that are not necessarily connected to the osteomyelitis component of ONJ; d) bone necrosis (sequestrum) is usually not uptaking at the BS, but it can appear as a downtaking area surrounded by an uptaking area. Methods: We conducted a retrospective study of 59 BS performed in 15 ONJ patients treated with BPs (8 with breast cancer,6 prostate cancer,1 renal cell carcinoma). Two Nuclear Medicine specialists reviewed 18 "baseline" BS (before treatment with BP), 14 BS in the 6-12 months prior to diagnosis of ONJ, 13 BS performed at the diagnosis time of ONJ (or within 6 months), 14 BS collected after the diagnosis of ONJ. Results: 6-12 months prior to diagnosis, 10 BS were positive (jaw uptakes in ONJ sites) and 4 negative. At the moment of ONJ diagnosis, 12 out of 13 exams resulted positive and one doubtful. Conclusions: These retrospective data will be used to design a case-control study with different patient groups, inluding ONJ cases, patients treated with BP and not suffering from ONJ, and cancer patients not receiving BPs.
Electronic medical record (EMR) order sets, counseling, and complementary therapy for chemotherapy induced nausea/vomiting (CINV) control.
Authors: Nora Richard E. , Greenlaw Roger , Macy Lori 
Published: March 2020

e20698 Background: EMR order sets entry can standardize CINV therapy and reduce errors. EMR CINV control, impact of counseling and use of complementary therapies for nutrition and control of CINV are rarely reported. Methods: Patient interview regarding CINV, nutrition education, weight change, and use of other therapies for nutrition and nausea control. Patients initially medicated with parenteral short T1/2 5HT3 antagonist and dexamethasone and oral prochlorperazine. Antiemetics changed at physician discretion. Medical records review for chemotherapy, antiemetics, and weights. Interviews conducted by a research coordinator who did not counsel, prescribe, or treat the patients. Results: 79 patients participated after minimum 2 and maximum 6 cycles of chemotherapy, 24 males and 55 females, age range 38-87 years. 76/79 received moderately or highly emetogenic chemotherapy. 78/79 reported good control of CINV at the time of interview. 38/79 reported decrease in appetite or dysgeusia associated with chemotherapy. 7 patients had change short to long T1/2 5HT3 antagonist. 9 patients had oral aprepitant added. All patients were prescribed oral prochlorperazine and ondansetron, but home use was not assessed as part of the study. 77/79 recalled dietary counsel, but recollection of source and content was not consistent with curriculum or medical record. 8 patients had weight loss >10 pounds, 4 patients had weight gain >10 pounds during chemotherapy. 18 patients reported weight change at least 10 pounds different from measured change. 28/79 patients used calorie and/or protein supplements. 24/79 used ginger related products. 7/79 reported improvement in dysgeusia or appetite with use of plastic utensils. Conclusions: CINV control can be achieved for most patients with combination antiemetics prescribed by EMR order set. Some patients require additional or alterative therapy. A substantial number of patients access nutritive or complementary therapy for CINV control. Patients’ recall of dietary counseling was poor, possibly related to timing of education. Patient reports and possibly perception of chemotherapy associated weight changes are frequently inaccurate.
Cognitive decline as a result of impaired sleep and glucose levels during chemotherapy treatment in breast cancer patients.
Authors: Moyers-Ruiz Liliana , Hickish Tamas , Mayers Andrew , Thompson Simon 
Published: March 2020

e20713 Background: Sleep efficiency might be altered during chemotherapy treatment. Cognitive decline has been associated with sleep disruption, impaired glucose levels, and chemotherapy treatment. We hypothesize that the biological factors considered in this study are playing an important role. Anecdotical reports have shown discrepancy with neuropsychological batteries results, therefore a qualitative interview and memory self-reports will be conducted for the cancer group. Methods: A sample of 32 Breast cancer patients and 29 healthy controls has been recruited in the Dorset area in the UK. The chemotherapy group will be tested three times within de course of their treatment (baseline, mid-treatment, after treatment). The radiotherapy participants will be tested three times within a period of four months, and the healthy control group two times within a four-month period. A subset of chemotherapy participants will be tested six months after chemotherapy. A neuropsychological battery is being used to assess cognitive function, and sleep efficiency is analysed using a sleep monitor and validated self-reports; Furthermore, glucose levels will be analysed for the chemotherapy group, and an online semi-qualitative interview will be conducted for cancer patients for a thematic analysis, along with a Prospective Memory questionnaire. Results: Preliminary data shows that sleep efficiency is disturbed during the course of chemotherapy, although not statistically significant, there is a trend in decreased sleep efficiency percentage when we compared baseline and mid-chemotherapy assessment The strongest tendency is observed on the PSQI self-report, showing an increase in Global PSQI score . Glucose levels show an increase during mid-treatment, although preliminary analyses show no significant effect. Memory data is still under scrutiny and more data will be reported at the poster presentation, along with assessments for times three and four. Conclusions: The inclusion of a semi-qualitative study will add a very important information to this study when test results are compered with anecdotical and self-reports.
NEPA, a fixed-dose combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting (CINV) following repeated chemotherapy cycles: Results of a phase III trial.
Authors: Jordan Karin , Rossi Giorgia , Rizzi Giada , Palmas Marco , Gralla Richard J. 
Published: March 2020

e20716 Background: NEPA is a fixed-dose combination of netupitant (NETU), a highly selective NK1 receptor antagonist and palonosetron (PALO), a pharmacologically and clinically distinct 5-HT3receptor antagonist. Recent clinical trials have been conducted to definitively establish the superiority of the combination, NEPA, over single agent PALO in the prevention of CINV following a single cycle of highly (HEC) and moderately (MEC) emetogenic CT. This study was designed to examine the tolerability and efficacy of NEPA over multiple cycles of HEC and MEC. Methods: Trial design: multinational, randomized, double-blind, parallel group, phase III study assessing the safety and efficacy of a single oral dose of NEPA (NETU 300 mg + PALO 0.50 mg) administered only on day 1 of each cycle, and given with concomitant oral dexamethasone on day 1 (with MEC) and days 1-4 (when given with HEC) prior to repeated cycles of HEC or MEC. A standard arm 3-day oral aprepitant + PALO + dexamethasone was included as a control group with an unbalanced 3:1 (NEPA : aprepitant) randomization ratio. There was no limit to the number of chemotherapy cycles allowed. Safety was the primary objective of the study as assessed by adverse events; secondary variables included ECGs, left ventricular ejection fraction, cardiac troponin levels and laboratory tests. Efficacy was assessed as the proportion of patients with complete response (no emesis, no rescue medication). Results: 413 patients were randomized in this study with the last patient visit occurring on 13 September, 2012. The analyses will be completed by March 2013 and will be fully available by ASCO 2013. Conclusions: Few large randomized trials have documented safety and efficacy of antiemetic control with multiple cycles of chemotherapy, and especially with HEC. The in depth safety profile will provide new information for all study arms over multiple cycles. NEPA is designed to provide maximal convenience while providing high degrees of antiemetic control throughout the patient’s full course of chemotherapy. Clinical trial information: NCT01376297.
Cancer in elderly patients (CEP) in Tunisia: Retrospective study about 243 patients collected from 2002 to 2007.
Authors: Boussen Hammouda , Ayadi Mohamed Malek , Ben Nasr Sonia , Labidi Soumaya , Afrit Mehdi 
Published: March 2020

e20721 Background: To report the epidemiologic, clinical, extension, treatment and results of CEP in a Tunisian population from a department of medical oncology. Methods: We collected retrospectively cases of CEP (> 70 years) within a cohort treated in a medical oncology department in Tunisia. We analyzed the following data : age, sex, delay to diagnosis(DD), site, histologic type, stage, co-morbidities, treatment and evolution. Results: These CEP collected from 2002 to 2007 represented 16.7% of the 1507 patients treated for cancer during this period. Mean age was 77.7+/- 4.2 years(70 to 86), SR 0.93 and delay to diagnosis 7.8+/6 5,28 months(1 to 48). Lung cancer (49 cases), digestive (46 cases) and Breast cancer (29 cases) represented the most frequent anatomic sites and patients presented co-morbidities in 75 cases. 11 patients (4.5%) developed metachronous second cancers and 40 pts (16.4%) have initial metastases at diagnosis. Treatment included CT in 148 pts (61.3%), S in 85 pts (34%) and RT in 40 pts (17%). Median survival was 24 months for the whole population. Conclusions: CEP represented more than 15% of patients treated for cancer in a Tunisian serie, this age group representing presently around 6% of the Tunisian population where aging modified in the last 20 years the ages pyramid aspect. CEP are characterized by late diagnosis/consultation, frequent co-morbidities, locally advanced and/or metastatic cases and probably less aggressive treatment compared to younger patients.