bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting length of survival for adult, outpatient oncology patients using clinic visit data.
Authors: Brown Laura E. , Decker Brian , Decker David A. 
Published: March 2020

9095 Background: The ability to predict a patient’s length of survival (LOS) has the potential to become an extremely valuable tool to aid in patient care, treatment, and end-of-life decisions made by the patient, their clinician, and extended support network. Methods: This preliminary study constructed models to predict LOS. Data from 10,667 patients was collected in an Electronic Medical Record over two years with LOS determined by matching records with the Social Security Death Index. The patient information available to construct the models consisted of basic patient demographics (single-entry information: e.g., age, cancer diagnosis, cancer stage, gender), transcriptions of physicians’ notes (to mine for other factors), and laboratory values (time-series or time-stamped information: e.g., weight, blood pressure, hemoglobin, creatinine, medication and treatments administered, etc.). A 5-fold nested cross-validation experimental design was used to train (using several possible representations of the data), test, and compare least-squares and support vector regression (SVR) models. Evaluations based on standard error are reported. Results: Linear, polynomial (up to 4th degree), and radial basis kernels were considered for SVR with the best model selected as the 2nd order polynomial. Preliminary results show that the best linear least-squares model is able to predict LOS with a standard error of +/- 34 days. The best support vector regression model has a slightly better prediction performance with standard error of +/- 32 days. Conclusions: This preliminary research shows the feasibility of predicting LOS from outpatient, clinical data. Further work is planned to improve the model performance, test other models, and determine which clinical indicators in oncology are most important for accurate predictions.
Clinical trial participation as part of end-of-life (EOL) cancer care: Associations with medical care near death and bereaved caregivers’ mental health.
Authors: Phelps Andrea Catherine , Zhang Baohui , Prigerson Holly Gwen 
Published: March 2020

9102 Background: Clinical trial participation is necessary to improve existing therapies, encouraged by national guidelines, and common among advanced cancer patients. The relationships between trial participation and important EOL outcomes such as aggressive care are unknown. Methods: Coping with Cancer Study, an NCI-funded multicenter prospective cohort study of advanced cancer patients and their caregivers, enrolled September 2002 – February 2008. Patients were interviewed at baseline, and clinical trial participation was documented by chart review. Patients were followed to death, (median 4.4 months from baseline). Medical care and quality of life (QOL) in the last week of life was assessed by caregiver interview and chart review. Caregiver interview 6 months post-bereavement assessed QOL and mental health (Structured Clinical Interview for the DSM-IV). The primary outcome was aggressive EOL care (ventilation, resuscitation, or chemotherapy in the last week of life). Secondary outcomes were bereaved caregivers’ mental health and QOL. Propensity-score weighting balanced patient characteristics (e.g. clinical variables, EOL preferences) that differed by trial participation. Propensity-score weighted regression models estimated the effect of trial participation on outcomes. Results: Of 246 patients followed to death with non-missing propensity scores, 27 were clinical trial participants. In propensity-score weighted analyses, trial participation was significantly associated with aggressive EOL care [29.6% v 9.1%; adjusted OR (AOR), 12.14; 95% CI, 3.65-40.36], ICU admission, mechanical ventilation, chemotherapy, and a trend toward inferior QOL near death (p = 0.069). Of 180 matched caregivers, trial participation predicted less mental illness [AOR, 0.15; 95% CI 0.04-0.57], major depression [AOR, 0.25; 95% CI, 0.08-0.80], but was unassociated with QOL (p = 0.15) in adjusted analyses. Conclusions: Clinical trial participation is associated with increased risk of aggressive EOL care for advanced cancer patients, but better mental health for bereaved caregivers.
Understanding the symptom experience of breast cancer outpatients: The validity and utility of the M.D. Anderson Symptom Inventory (MDASI).
Authors: Mendoza Tito R. , Zhao Fengmin , Cleeland Charles S. , Wagner Lynne I. , Patrick-Miller Linda J. , Fisch Michael 
Published: March 2020

9106 Background: Breast cancer and its treatments can produce multiple symptoms that cause distress and impair function. The MDASI, a patient-reported outcome measure of symptoms (sxs) and functional interference has been validated in general oncology and has the potential to inform symptom experience and guide treatment specific to breast cancer patients (pts). Methods: The Eastern Cooperative Oncology Group (ECOG) conducted the Symptom Outcomes and Practice Patterns (SOAPP) study at academic and community medical oncology clinics and included pts with breast cancer of all stages and phases of care. At baseline and 4 weeks, pts completed the MDASI. Symptom experiences and psychometric properties of the MDASI in breast cancer pts (n = 1544) were analyzed. Results: The median age was 58 years, and the race/ethnicity included 11% black and 8% hispanic. 5% had ECOG performance status (PS) ≥2. The 5 most prevalent moderate/severe sxs reported at baseline were fatigue (31%), disturbed sleep (27%), drowsiness (21%), hair loss (22%) and dry mouth (19%); moderate/severe skin rash (6%) and vomiting (4%) were the least prevalent. At follow-up, about 1/3 of patients had moderate/severe fatigue and 19% had moderate/severe pain and distress. Internal consistency and test-retest reliability were good, with Cronbach alphas of ≥0.85 and intraclass correlations of ≥0.76 for all subscales. Among those whose PS was stable or improving, the change scores in sx severity improved most for sleep disturbance, numbness/tingling, and difficulty remembering things. Significantly higher scores and moderately large effects for the severity scale were reported by pts with poorer PS (ES=.61) and those with local/regional/metastatic disease (ES=.67). Results were similar for the interference scale. Pts whose quality of life (QOL) declined showed greater increase in severity (1.1 vs .07, p<.001) from baseline to follow-up than pts whose QOL was unchanged, demonstrating sensitivity to change. Conclusions: Breast cancer pts have significant sx burden despite well-preserved PS. The MDASI is a valid, reliable, and sensitive sx assessment method for research and patient care in breast cancer outpatients.
Comparing three validated methods of patient self-reported fatigue in a prospective randomized clinical trial.
Authors: Sams Katherine , Case L. Doug , Lesser Glenn Jay , Naughton Michelle Joy , Williford Susan Kidwell , Giguere Jeffrey Kent , Garino Astrid , Vitolins Mara , Shaw Edward G. 
Published: March 2020

9108 Background: Fatigue can be measured with different validated assessment instruments in symptom management trials. Methods: Between 2004-2009, the Wake Forest CCOP Research Base protocol 97202 randomized 236 women receiving adjuvant chemotherapy for newly diagnosed breast cancer to Coenzyme Q10 supplementation vs placebo. The primary endpoint was change in self-reported fatigue. Patients (pt) were assessed at baseline, 8, 16, and 24 weeks (wk) with 3 instruments: 1) Profile of Mood States – Fatigue (POMS; 7 questions; scored 0-4); 2) Functional Assessment of Cancer Treatment – Fatigue (FACIT; 13 questions; scored 0-4); and 3) Visual Analog Scale (VAS; one scale; scored 0-10). For comparison, each instrument was rescaled from 0 to 100; higher numbers indicate worse fatigue. Results: CoQ10 did not significantly affect fatigue (Lesser G et al, ASCO Proc., 2010). All 3 measures demonstrated an increase in fatigue after chemotherapy initiation at 8 & 16 wks with trend towards baseline levels at 24 wks. The fatigue measures were highly correlated: r ≥ 0.8 for all pairwise associations at all times. However, their scores varied. The Table shows mean rescaled scores for pt below/above the median fatigue level, calculated by taking mean of the three scores averaged across the four time periods. In general, POMS tended to give the lowest and VAS the highest scores, but differences between POMS and FACIT and FACIT and VAS depended on mean fatigue level. For pt experiencing lower (<median) fatigue, FACIT and VAS scores were similar, while POMS scores were significantly lower. For higher (>median) fatigue, POMS and FACIT scores were similar, while VAS was significantly higher. Conclusions: While POMS, FACIT, and VAS scores were highly correlated, their scale scores varied depending on the level of fatigue experienced by the pt. Fatigue assessment methods in clinical trials should be selected carefully as they do not always give equivalent results. Supported by NCI/DCP grant U10 CA81851. [Table: see text]
A prospective longitudinal study of cancer-related fatigue in patients undergoing breast-conserving surgery and radiation with or without chemotherapy for breast cancer.
Authors: Torres Mylin Ann , Pace Thaddeus , Felger Jennifer , Liu Tian , Godette Karen D. , Stapleford Liza Jane , Mister Donna , Miller Andrew H. 
Published: March 2020

9122 Background: We prospectively evaluated risk factors for persistent cancer-related fatigue in women with breast cancer undergoing lumpectomy with or without chemotherapy (CTX) prior to whole breast radiotherapy (XRT). We assessed the potential role of inflammatory mediators, demographic characteristics, and treatment history including CTX. Methods: Following lumpectomy, 60 women received a definitive course of whole breast XRT (50 Gy plus a 10 Gy boost). Prior to XRT, at week 6 of XRT, and 6 weeks post XRT, subjects completed the Multidimensional Fatigue Inventory (MFI) and underwent blood draws for inflammatory mediators (protein and mRNA). Results: Independent multivariate analyses of clinical and demographic factors revealed that CTX (p<.001) , given neoadjuvantly or adjuvantly, and age <50 (p=.03) were significant predictors of higher fatigue scores post XRT. Mean MFI scores in patients treated with CTX (n=24) were 20 points higher than patients not treated with CTX (p<.001) with a clinically meaningful difference in scores being 10 points on the MFI. Gene ontology analysis of differentially expressed genes indicated increased activation of genes involved in immune and inflammatory responses in fatigued vs. non-fatigued patients (p<.001). Of the inflammatory mediators, plasma IL-6 prior to XRT was the strongest predictor of post XRT fatigue (p=.02). Moreover, plasma IL-6 concentrations prior to XRT were significantly higher in patients who received CTX (mean 4.96 vs. 2.53, p=.01). Patients who received CTX also had significantly higher levels of NF Kappa B DNA binding 6 weeks post XRT (p<.001), and transcription factor binding analysis revealed a greater representation of genes with the NF Kappa B DNA binding motif in fatigued vs. non-fatigued patients (p =.05). Conclusions: Collectively, these data suggest an interaction between CTX and XRT leading to inflammation and fatigue several weeks post XRT. This relationship was independent of whether CTX was given pre or post-operatively. Treatments targeting inflammation before XRT may reduce fatigue post therapy, particularly in patients previously treated with CTX.
The relationship among age, anxiety, and depression in older adults with cancer.
Authors: Weiss Talia , Nelson Christian J , Tew William P. , Hardt Molly , Mohile Supriya Gupta , Owusu Cynthia , Klepin Heidi D. , Gross Cary P. , Gajra Ajeet , Lichtman Stuart M. , Ramani Rupal , Katheria Vani , Zavala Laura , Hurria Arti ,   Cancer and Aging Research Group
Published: March 2020

9123 Background: Depression and anxiety are common psychological sequelae of cancer, resulting in decreased adherence to treatment regimens and longer hospital stays. In men with prostate cancer, aging is associated with reduced anxiety and increased depression. The overall goal of this study was to examine the association among age, anxiety, and depression in a cohort of older adults receiving chemotherapy (chemo). Methods: This is a secondary analysis of a prospective longitudinal study investigating chemotherapy toxicity in older adults with cancer. Eligibility included: age > 65, diagnosis of cancer, and scheduled to receive a new chemo regimen. Baseline data (pre-chemotherapy) included: age, sociodemographics, tumor and treatment factors (including tumor type and stage), geriatric assessment parameters (functional status, comorbidities, psychological state, nutritional status, social support). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Univariate and multiple regression analyses were conducted to test the relationship between age, anxiety, and depression. Results: The average age of the 500 patients (56% females) was 73.1 (range 65-91, SD+6.18) with 5% Stage I, 12% Stage II, 22% Stage III and 61% stage IV. Mean depression and anxiety scores were: 3.6+3.17; 4.7+3.60. Clinically significant depression was reported in 12.6% (n=62). Clinically significant anxiety was reported in 20.9% (n=103). In univariate analyses, there was no association between anxiety and age, or depression and age. In multivariable analyses, older age (beta= -0.07, p = 0.05) was associated with decreased anxiety, as well as lack of social support (p < 0.01) and increased number of comorbidities (p < 0.01). In multivariable analysis, depression was associated with lack of social support (p < 0.01), increased number of comorbidities (p < 0.01), and advanced stage (p < 0.01). Conclusions: This study supports previous research that anxiety decreases with age in older adults with cancer. However, depression remained constant with increasing age. Greater resources and attention to identifying and treating the psychological sequelae of cancer in older adults are warranted.
Prevalence of cancer-related fatigue in a population-based sample of colorectal, breast, and prostate cancer survivors.
Authors: Jones Jennifer M , Howell Doris , Olson Karin Lou , Jiang Haiyan , Catton Charles N , Catton Pamela , Fleshner Neil Eric , McCready David R. , Wong Rebecca , Pintilie Melania , Dirlea Mihaela , Krzyzanowska Monika K. 
Published: March 2020

9131 Background: Cancer-related fatigue (CRF) is the most prevalent and distressing cancer-related symptom and has a greater negative impact on patients' daily activities and quality of life than other cancer-related symptoms, including pain and depression. However, the prevalence and severity of persistent CRF and related disability in the post-treatment survivorship period has seldom been examined in populations other than breast cancer. The primary objective of the study was to describe the prevalence of significant CRF and associated levels of disability in a mixed cancer population sample at 3 time points in the post-treatment survivorship trajectory. Methods: Based on cancer registry data, a self-administered mail based questionnaire using Dillman's Tailored Design Method was sent to 3 cohorts of disease-free cancer survivors (6-18 months; 2-3 years; and 5-6 years post-treatment) previously treated for non-metastatic breast, prostate or colorectal cancer. Fatigue was measured using the FACT-F and disability was measured with the WHO-Disability Assessment Schedule. Clinical information was extracted from chart review. Frequencies of significant fatigue by disease sites and time points were studied and compared using chi-square test. Disability between those with and without CRF was also compared using Cochran-Armitage trend test. Results: 1294 questionnaire packages were completed (63% response rate). The FACT-F score was 39.1+10.9; 29% (95% CI: [27%, 32%]) of the sample reported significant fatigue (FACT-F≤34) and this was associated with much higher levels of disability (p<0.0001). Breast (40% [35%, 44%]) and colorectal (33% [27%, 38%]) survivors had significantly higher rates of fatigue (≤34) compared to the prostate group (17% [14%, 21%]) (p<0.0001). Fatigue levels remained relatively stable across the 3 time points. Conclusions: CRF was a significant and debilitating symptom for a substantial minority of the respondents across all 3 time points. Effective CRF management strategies are needed and have the potential to significantly reduce morbidity associated with cancer and its treatments and to improve quality of life for the growing population of cancer survivors.
Longitudinal study of hope, meaning/peace (M/P), and quality of life (QOL) in patients (pts) with ovarian cancer (OC).
Authors: Ramondetta Lois M. , Urbauer Diana , Zhukovsky Donna S. , Bevers Michael W. , Brown Jubilee , Bodurka Diane C. , Thaker Premal H. , Anderson Sonya , Gallegos Jessica , Sun Charlotte C. 
Published: March 2020

9134 Background: M/P may be the most valued end point of life. How hope, faith, physical and psychological factors impact M/P is unknown. We evaluated factors affecting M/P in pts with OC. Methods: OC pts at a cancer center (CC), academic hospital (AH) and county hospital (CH for primarily uninsured) participated. Surveys completed at initiation of chemotherapy (CTX); completion of CTX; and 1 yr later. Surveys included FACT-O, -SP, Herth Hope Index, Hospital Anxiety and Depression Scale (HADS), ESAS, and Locus of Control (LOC). Results: N=115. Median age=55 yrs, married 64%, Christian 96%. CH had more AA/Hispanics pts (p=.001) and unmarried pts (p=.001). QOL and symptoms improved for all sites over time (p =.03); CH pts had the worst scores (p= <.001). CC pts expressed more hope, less anxiety and depression (A/D) compared to CH and AC pts for all time points (p=.03). CH pts had higher and increasing A/D over time while CC pts had the least (p=.02). LOC scores differed by site (p=.01). CH pts held strongest belief that life was controlled by chance and “others”; CC pts had the least. There was no association between site/time for belief of internal control over one’s life. CH pts consistently had the lowest M/P scores (p=004). Adjusting for site, disease status and time, higher M/P associated with higher hope, better QOL, symptoms and faith (p= <.0001). Lower M/P associated with increased A/D (p=.003) and symptoms (p<.0001). Poorer M/P over time correlated with belief that life was controlled by chance (p=.01) and "powerful others"(p=.02). Level of M/P did not correlate with belief of internal control over one’s life. Conclusions: M/P did not change over time. CC pts had highest M/P. Higher M/P associated with higher hope and faith, better QOL, less symptoms and A/D. Lower M/P associated with sense that life is controlled by chance and powerful others. Data show medically underserved pts have poorer QOL, more symptoms and A/D and may believe the future is determined by luck/chance and by “others”. Triaging for spiritual crisis may be important in these pts. Interventions to decrease A/D and symptoms may improve pts’ sense of M/P over the cancer journey.
Development of prognostic molecular markers in pediatric rhabdomyosarcoma based on gene expression and copy number variations.
Authors: Missiaglia Edoardo , Williamson Dan , Chisholm Julia C. , Wirapati Pratyaksha , Pierron Gaëlle , Thway Khin , Oberlin Odile , Pritchard-Jones Kathy , Delattre Olivier , Delorenzi Mauro , Shipley Janet 
Published: March 2020

9510 Background: Rhabdomyosarcoma (RMS) is the most common pediatric soft tissue sarcoma and comprises two major histological subtypes: alveolar and embryonal. The majority of alveolar tumors harbor PAX/FOXO1 fusion genes. Current patient risk stratification, unlike other pediatric embryonal tumors, does not utilize any molecular data. Therefore, we aimed to improve the risk stratification of RMS patients through the use of molecular biological data. Methods: Two independent data sets of gene expression profiling for 124 and 101 RMS were used to derive prognostic gene signatures by meta-analysis. Genomic array CGH data for 109 RMS was also evaluated to develop a prognostic marker based on copy number variations (CNVs). The performance and usefulness of these derived metagenes and CNVs as well as a previously published metagene signature were evaluated using rigorous leave-one-out cross-validation analyses. Results: The new prognostic gene expression signature, MG15, and one previously published (MG34) (Davicioni. JCO. 2010) performed well with reproducible and significant effects (HR 3.2 [1.7-5.9] p < 0.001 and HR 2.5 [1.5-4.3] p < 0.001, respectively). However, they did not significantly add new prognostic information over the fusion gene status (PAX3/FOXO1, PAX7/FOXO1 and Negative). Similarly, a prognostic CNV marker, although showing HR 2.9 [1.5-5.6] p < 0.01, was also not improving models with fusion gene status. Within fusion negative RMS, the analysis identified prognostic markers based on either gene expression or CNVs and showed significant association with patients outcome (HR 6.3 [1.5-26.3] p ≤ 0.016 and HR 11.2 [2.5-50.7] p < 0.010, respectively). Moreover, these were able to identify distinct risk groups within the COG (Children's Oncology Group) risk categories, which is currently used to guide treatment. Conclusions: Molecular signatures derived using all RMS effectively stratify patients by their risk, but most of their prognostic information is contained in the PAX/FOXO1 fusion gene status which is simpler to assay. New markers developed within the fusion negative population seem improving current RMS risk classifier and should be tested in follow-up studies.