bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality-of-life index: Implications for prognosis in colorectal cancer
Authors: Neelam R. , Lis C. G. , Citrin D. L. , Williams S. , Vashi P. G. , Lammersfeld C. A. , Wodek T. , Grutsch J. F. , Granick J. , Gupta D. 
Published: March 2020

16032 Background: Quality of Life (QoL) assessment is important to evaluate the impact of disease and treatment in patients with advanced cancer. Recently, it has been hypothesized that patient satisfaction with their QoL may have a prognostic role in cancer, however, there is little evidence in the literature to support this view. The Ferrans and Powers Quality of Life Index (QLI) is one such instrument. QLI defines QoL as a person’s sense of well-being that stems from satisfaction or dissatisfaction with the areas of life that are important to him/her. The purpose of this study was to determine whether baseline QLI would predict length of survival in patients with colorectal cancer undergoing care in a non-clinical trial setting. Methods: We examined a case series of 177 colorectal cancer patients treated at Cancer Treatment Centers of America between 04/01 and 11/04. QLI measures global QoL and QoL in four major subscales: health and physical, social and economic, psychological and spiritual, and family. All scores range from 0 to 30 with higher scores indicating better QoL. QLI subscales were dichotomized at the median to split the patient population into 2 distinct groups. Kaplan Meier method with Log Rank test was used to calculate survival. Results: Of 177 patients, 46 were newly diagnosed and 131 had prior treatment history. The median age was 53 years (range 25– 85 years). 8 patients had stage I disease, 16 stage II, 51 stage III, and 77 stage IV. Table 1 describes the median survival for all QLI subscales. Conclusions: Baseline levels of patient satisfaction with their health and physical functioning provided useful prognostic information in colorectal cancer. Interestingly, the other subscales that evaluate various existential and economic issues did not provide statistically significant differences in survival. These findings need to be evaluated further to ascertain which subscales of QLI have a role in predicting patients’ prognosis. [Table: see text] No significant financial relationships to disclose.
Quality indicators for end-of-life breast cancer care: Is there agreement between stakeholder groups?
Authors: McIntyre P. , Grunfeld E. , Mykhalovskiy E. , Cicchelli L. , Dent S. F. , Zitzelsberger L. , Paszat L. , Earle C. 
Published: March 2020

16034 Background: Quality indicators (QIs) are tools designed to measure quality of care and help enhance quality through identifying areas needing improvement. Breast cancer offers a disease model to examine QIs for end-of-life (EOL) care. The objective of this study was to assess agreement among stakeholder groups in two Canadian provinces on QIs for EOL breast cancer. Methods: A qualitative study design using a modified Delphi method and focus groups at each study site. After a literature review, an expert panel identified 19 QIs that were potentially measurable using administrative data. The Delphi panels and focus group sessions incorporated the 19 QIs as discussion topics in Halifax, NS and Ottawa, Ont. The Delphi panels involved a multidisciplinary group of oncology health care professionals. Separate focus groups were conducted with women with metastatic breast cancer and bereaved caregivers. All group sessions were audio-taped, transcribed verbatim, audited and a thematic analysis was conducted. Results: A total of 23 health care professionals, 16 patients, 7 bereaved caregivers participated in the study. Participants attended only one group discussion, depending on group assigned. There was good agreement on QIs among patient and caregiver groups in both cities. The need for effective communication was identified as a major theme. The Delphi process yielded overall moderate agreement with QIs among health care professionals. Conclusion: Aspects of quality EOL care important to stakeholders may not be measurable from administrative data. Results from the Delphi panels indicate that patient preferences and differences in health care delivery between different jurisdictions modulated extent of agreement with QIs. No significant financial relationships to disclose.
Medical decision making under uncertainty in adult patients (pts) with multiple primary cancer (MPC)
Authors: Gil Deza E. , Loviscek L. F. , Negro F. , Calarame J. C. , Garcia Gerardi C. , Morgenfeld E. L. , Cascallar D. , Carnaval S. , Rivarola E. G. , Gercovich F. G. 
Published: March 2020

16037 Background: Evidence-based Oncology (EBO) is founded in clinical trials, medical expertise and patient’s quality of life. Pts with MPC are excluded from clinical trials and there is a lack of clinical expertise as regards to these cases. With the aim to analyze the clinical reasoning for treatment recommendation on those pts, we interviewed oncologists in charge (doc’s) at Instituto Oncológico Henry Moore (IOHM) and Universidad del Salvador (USAL). Methods: The medical records of 8,500 pts from IOHM’s database over last eight years (1997–2005) were reviewed in order to measure the incidence and characteristics of MPC pts. A total of 35 oncologists in charge were identified and participated on a survey which had ten points. The 10 items should be ranked in order of importance: 1 = the most important one and 10 = the least one. Results: One hundred and seventy eight MPC pts (2.09%) were detected, and the oncologist in charge was asked to complete the survey. All doc’s completed the survey. The following table shows the rank and the scoring for each item. (See table below) Conclusions: Four domains ( I to IV) in medical decision making for the treatment of MPC pts were identified: I = PS; II = Characteristics of the tumor; III = Morbidity from therapy and IV = Pt preferences. The pt and family preferences were ranked in the last place and it could reflect a paternalistic approach. To our understanding, this is a good model to test clinical skills and biases in medical treatment selection. [Table: see text] No significant financial relationships to disclose.
Advanced colorectal cancer treatment and outcome in the community oncology setting
Authors: Koeller J. M. , Kwan P. , McKibbin T. , Simon J. 
Published: March 2020

16040 Background: The treatment of advanced (adv) colorectal cancer (CRC) is currently a moving target due to the availability of new agents and a multitude of clinical trials. It is of interest to see how community oncologists have responded to these changes, and what effect they have had on outcome (survival). We report the chemotherapy treatment (tx) of adv CRC in the community oncology setting. Methods: This is an IRB-approved retrospective study. All available patient (pt) records with adv CRC, treated with chemotherapy, and having expired between 2003 and 2005, or who were still alive at data capture were included. Results: Two hundred and seven pts (60% newly diagnosed; 40% recurred), from 4 clinics (FL, OH, NV, ME) receiving 2444 cycles (3% in 2002; 18% in 03; 40% in 04, 39% in 05) were identified. Fifty percent of pts were male, the mean age was 65 yo, and the ECOG P.S. were 21%-0; 49%-1; 25%-2; 5%-3. Pts received a mean of 12 cycles of tx. A large variation in regimen usage was seen. Forty-three percent of pts received only 1 line of tx including 20+ regimens (top 10: Folfox4; IFL; 5FU/leuc; CapeOx; Folfox6; Xeloda; Folfiri2; Folfox7; CPT-11, Folfiri1), 24% received 2 lines of tx including 18+ regimens 2nd line (top 10: Folfox4; CPT-11; CapeOx; IFL; Xeloda; 5FU/leuc; Folfiri2; Folfox6; Cetuximab; Folfiri1), 15% received 3 lines of tx including 16+ regimens 3rd line (top 10: Folfox4; CapeOx; CPT-11; Xeloda; 5FU/leuc; IFL; Cetuximab; Xeliri; Folfiri1; Bevacizumab). In addition, 9% of pts received 4 lines of tx and 5% received 5 or more lines of tx. Of interest, looking at 1st line tx, IFL decreased and Folfox4 increased over the study period. Biologics were found in 48% of cycles (bevacizumab 35%; cetuximab 13%). Seventy-seven percent of pts had significant toxicity. Toxicity defined as a dose or regimen change, toxic delay or a return visit was seen in 23% of cycles (combined endpoint). Survival was available for 74 pts (81% of deaths were reported in 2004/05). Overall median survival was 17 months (<66 yo - 20.3 mo; >65 yo - 11.5 mo; newly diagnosed - 19.0 mo; recurred - 14.3 mo). Conclusions: Community oncologists utilized a multitude of agents/regimens in the tx of adv CRC. This may be appropriate in light of all the recent changes in disease tx strategy. Although, survival rates are near those published in the literature. [Table: see text]
Autologous peripheral blood stem cell transplantation in first remission in adult patients with Burkitt and lymphoblastic lymphoma: A single center phase-II study
Authors: Ataergin S. , Arpaci F. , Pektas M. , Beyzadeoglu M. , Ozet A. , Komurcu S. , Ozturk B. , Kuzhan O. , Ozturk M. 
Published: March 2020

16517 Background: Optimal therapeutic modality and duration of adult Burkitt and lymphoblastic lymphoma (LL) are still unknown. Despite long-lasting and intensive chemotherapy administration, post-therapy relapses are common. Methods: In this single center phase-II prospective study, high-dose therapy (HDC) and autologous peripheral blood stem cell transplantation (APSCT) was done during the first remission following induction and consolidation therapy for 18 patients with Burkitt (n: 5) and LL (n: 13) without bone marrow and central nervous system involvement at presentation. Cyclophosphamide, vincristine, prednisolone, adriamycin with or without L-asparaginase induction regimen was followed by dexamethasone, cytarabine, and cisplatin consolidation therapy with total body irradiation and cyclophoshamide conditioning. Results: Mean patient age was 24.6 (range: 21–55) years and male to female ratio was 5 to1. 44% (8/18) of the patients were in the intermediate and high-risk groups of International Prognostic Index. Median treatment duration until APSCT was 104 days (range: 87–128). 83% and 17% of the patients were in complete and partial remission before transplantation. One patient with Burkitt lymphoma out of 5 (20%) and 6 patients with LL out of 13 (46%) have died of progression. Overall survival (OS) at 113-month follow-up for all patients was 59.03% with 59.26% of disease-free survival (DFS). However, LL cases revealed OS and DFS rates of 50.35% and 50.77%, respectively. Only one early death (5.5%) was noted due to liver toxicity following HDC and APSCT. Conclusions: In conclusion, this single center phase-II study reveals an acceptable toxicity, short treatment period and high survival rate in adult Burkitt and LL cases, suggesting APSCT to be a good treatment option in the first remission. No significant financial relationships to disclose.
Complete remission after induction therapy of donor cell derived secondary AML in a CML transplant patient
Authors: Fauser A. A. , Kraut L. , Trebeljahr G. , Thiele B. , Gulzad N. , Roemer E. 
Published: March 2020

16523 Background: Malignant diseases arising from donor derived cells are an exceptionally rare condition with approximately 20 cases only reported in the literature. We report on diagnosis and salvage chemotherapy of a CML transplant patient relapsing with donor cell derived secondary MDS resp. AML. Methods: Chimerism analysis were performed by quantitative short tandem repeat (STR) DNA detection in bone marrow as well as in peripheral blood, detection limit 0.5%. Standard procedures were used for all other methods. Results: In a female patient transplanted with a HLA-DRB1 mismatched female unrelated donor in July 1998 for Ph+ CML, secondary MDS was diagnosed in March 2005 transforming into secondary AML in June 2005. The results from chimerism analysis after diagnosis of sMDS resp. sAML in this transplant patient, i.e. no detection of the STR pattern of the recipient, clearly confirmed a donor cell derived sMDS resp. sAML almost 7 years after allogeneic BMT. Cytogenetics showed a normal female karyotype, and no molecular aberrations were detected by FISH resp. PCR. After diagnosis of sAML the patient received 2 induction courses consisting of FLAG-Ida and MTC regimen, respectively. Bone marrow analysis after the first and second course revealed no evidence of blasts whereas the MDS continued to be detectable. Cytogenetics during and after reinduction therapy were normal. Repeated chimerism analysis showed complete donor chimerism (> 99.5%). Thus, a complete remission of donor cell derived sAML using conventional induction chemotherapy was achieved. This remission is now lasting 6 months without intensification. Medical evaluation of the donor did not reveal any disturbed or malignant hematological disorder. Conclusions: This is an interesting case of rare donor cell derived leukemia and its successful treatment. The question arises with regard to altered stromal factors in the bone marrow of the patient as potential cause of the disease. No significant financial relationships to disclose.
The evidence base for the risk and management of thrombosis in hematological malignancies patients
Authors: Hassan F. M. 
Published: March 2020

16526 Background: To evaluate of hypercoagulable state and tumor procoagulant activity in hematological malignancies patients.To address the Primary thromboprophylaxis managed. Methods: Paper-based reply-paid questionnaire was distributed between patients, included the information about the duration, treatment used, sex, age, and type of malignant. We respectively analyzed 96 Patients male and female in all age groups treated for the prevention of recurrent venous thromboembolism in patients with hematological malignancies patients, against 33 (19–75 years, 15 male, 18 female) apparently healthy adults individual setting as control groups. The clinical analysis included thrombotic markers (protein S, protein C, PF1.2, TAT, PAI-1and fibrin D-dimer) were done to all patients and control. Low-molecular weight heparin (LMWH) versus Oral anticoagulant frequency distribution were compared between cases and controls using statistical analysis. Results: In total, 93 completed questionnaires were returned, respondents were reported the routine treatment of more than 10 types of haemopatopoietic and lymphoid tissues tumours. Of these, CML and CLL were most commonly treated (by 45%-62% of respondents), with lymphoma, plasma cell myeloma, AML, polythycythemia vera, and mast cell sarcoma the next most common (treated by 26%-38% of respondents). Most of patients (76%) showed a markedly elevation of PAI-1 and D-dimer and significantly elevated in whose treated Surgically, while the other thrombotic markers (protein S, protein C, PF1.2, TAT were normal compared to control groups. Conclusions: Thrombosis is a common complication in patients with haemopatopoietic and lymphoid tissues tumours that adversely affects their survival. There are several problems associated with the treatment of VTE in patients, especially with the use of oral anticoagulants. No significant financial relationships to disclose.
Response and tolerability of a 5-day azacytidine schedule in pateints with myelodysplastic syndromes
Authors: Haq B. , Rossetti J. M. , Kramer W. , Latsko J. M. , Jasthy S. , Lister J. , Shadduck R. K. 
Published: March 2020

16532 Background: Azacitidine (AZA) is a DNA methyltransferase inhibitor with activity in patients with myelodysplastic syndrome (MDS). The current approved schedule of AZA is 75 mg/m2/d for 7 days every 28 days. This schedule is inconvenient for patients and providers because of the need for weekend administration. Methods: The records of 9 patients who received AZA 100 mg/m2/d for 5 days with an anticipated 28 day cycle between 10/04 to 1/06 were reviewed to determine response, duration of response and tolerability. A minimum of two cycles were required for response evaluation (n = 8). All patients were assessed for tolerability. The International Working Group response criteria for MDS was utilized for evaluation. Results: Patients had secondary MDS (n = 4), chronic myelomonocytic leukemia (n = 2), refractory anemia (n = 2) and refractory anemia with ringed sideroblasts (n = 1). Of the 8 patients who received at least 2 cycles of therapy, 5 responded: 1 achieved partial response, 3 achieved hematologic improvement in at least one cell line and 1 remained in a stable disease state. The overall response rate was 63%. Average response duration was 6.2 months. The longest response duration was 10 months. Myelosuppression was seen in 2 of the 9 patients treated, one of whom continued treatment with growth factor support; therapy is currently on hold for the other patient. Injection site reaction was seen in 2 patients, resulting in discontinuation of treatment in one. One patient experienced severe malaise after 2 cycles and was given the standard dose for further therapy with a major hematologic improvement. Other isolated events included mouth ulcers, mild nausea and flare of erythema nodosum. Of the 5 responders, 1 later died of disease progression (after 7 cycles), 1 died of a complication of comorbidity (after 5 cycles), 1 is alive with disease progression (after 10 cycles) and 2 are continuing therapy with AZA (after 4 and 5 cycles, respectively). Conclusions: AZA 100 mg/m2/day for 5 days every 28 days seems to be tolerated as well as the 7-day treatment schedule. It also appears to have efficacy similar to the standard dose and schedule. If larger studies are confirmatory, this 5-day schedule may be more convenient for patients and providers. [Table: see text]
Phase II study of weekly irinotecan and cisplatin for refractory or recurrent non-small cell lung cancer (NSCLC)
Authors: Takiguchi Y. , Asaka-Amano Y. , Moriya T. , Kawashima T. , Mizoo A. , Kurosu K. , Nagao K. , Kuriyama T. 
Published: March 2020

17002 Background: A current option for recurrent NSCLC is monotherapy with docetaxel. However, cisplatin, if tolerable, may still have power for this condition. Irinotecan is also a key drug for NSCLC. The objectives of this study were to evaluate the clinical relevance of weekly chemotherapy consisting of irinotecan and cisplatin as a 2nd-line therapy for NSCLC. Methods: Patients meeting all following criteria were eligible: proven NSCLC refractory or recurrent after previous single-regimen chemotherapy, PS (0–2), age > 15 years, adequate organ functions, measurable lesions by RECIST, life expectancy exceeding 8 weeks, and written informed consent. Patients with any of the following conditions were ineligible: previous treatment with irinotecan and/or surgery, requirement of thoracic irradiation, interstitial lung disease, pleural effusion or ascites requiring treatment, pericardial effusion, symptomatic brain metastasis, concomitant malignancy or other inadequate condition. Irinotecan (60 mg/m2 in 500 ml electrolyte soln, day 1) and cisplatin (25 mg/m2 in 500 ml saline, day 1, without further hydration) were administered every week for at least 6 courses unless encountering defined skip criteria. Calculated minimum sample size was 43 based on Simon two-stage optimal design with p0=0.10, p1=0.25, α error=0.05 and β error=0.20; planned sample size was 48. The primary endpoint was response rate, and the secondary ones were toxicity and survival time. Results: Since February 2002, 48 patients (consisting of 29 with adeno-, 14 with squamous cell, 3 with large cell carcinoma and 2 with NSCLC not further specified) with a median age of 62-years were enrolled, with 1 death before treatment. Therefore, 47 patients were eligible for evaluation of response rate and toxicity, whereas all 48 were analyzed for survival. Chemotherapy was administered for a median 6 courses (range, 0–15). Response rate was 25.5% (95% CI: 12.9–38.1%). Toxicity of grade 3 or 4 consisted of neutropenia (29.8%), thrombocytopenia (6.4%), anemia (29.8%), diarrhea (10.6%) and nausea (21.3%). MST was 10.6 months, and 1-year survival rate was 43%. Conclusions: This 2nd-line chemotherapy for NSCLC showed promising efficacy with tolerable toxicity. No significant financial relationships to disclose.
Daily set up variation in patients receiving radiation with tomotherapy for lung tumors
Authors: Mohammed N. , Mehta M. P. , Bentzen S. M. , Khuntia D. , Tome W. A. 
Published: March 2020

17005 Background: The on-board megavoltage (MV) computed tomography (CT) capabilities of a Tomotherapy unit were used to obtain the daily MVCT images of lung cancer patients. For daily patient alignment, differences between the MVCT scan and planning CT were resolved by calculating the necessary couch shifts in the X = mediolateral, Y = craniocaudal, and Z = anteriorposterior directions. Daily shifts were analyzed. Methods: 583 alignments from 36 patients with lung cancer were available for analysis. The systematic (Σ) and random (σ) errors were calculated and a covariate analysis was performed with tumor size, Karnofsky Performance Score (KPS), and presence of atelectasis. Two error minimization strategies were applied to the data - 1) shifts from fraction 1 were subtracted from subsequent shifts, and 2) the average of shifts 1–3 were subtracted from shifts 4 onward. Σ and σ were calculated for each of the 3 data sets and applied to van Herk’s margin recipe 2.5 Σ + 0.7σ. The mean, standard deviation, and standard error of the magnitude shifts for 13 patients who each received 23 fractions were analyzed by Spearman’s rank correlation test for the relationship between shift magnitude and fraction number. Results: The presence of atelectasis was significantly related to a smaller σ in millimeters, 2.8 ± 0.08 vs. 3.5 ± 0.09 (p = 1.1 × 10−8). The other covariates were not significantly related to set-up error. The 2nd error minimization strategy decreased Σ in the X, Y, and Z directions from 4.7 ± 0.6, 5.8 ± 0.9, 4.9 ± 0.6 to 2.1 ± 0.1, 4.2 ± 0.5, 3.4 ± 0.3 (p = 2.0 × 10−5, 0.13, 0.02) respectively. Calculated margins from van Herk’s equation for all data reported as (x, y, z) in mm were (13.8, 19.6, and 15.9). For strategies 1 and 2 respectively, calculated margins were reduced by (27.2%, 11.5%, 10.6%) and (46.7%, 21.5%, 23.2%). The mean magnitude of isocenter shift and the standard deviation were found to increase with fraction number (p = 1.0 × 10−6 and 5.0 × 10−5 respectively). Conclusion: The error correction strategies significantly reduced Σ but did not reduce the margins dramatically. Drift in accuracy during a long treatment course and an inability to identify subgroups of patients based on our covariates who may not need daily imaging suggests that daily image verification + correction will help reduce error and margins. No significant financial relationships to disclose.