bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metoclopramide versus setrons in delayed emesis in moderate emetogenic chemotherapy: A meta-analysis
Authors: Jordan K. , Mueller F. , Hinke A. , Behlendorf T. , Feyer P. , Roila F. , Schmoll H. J. 
Published: August 2020

e20538 Background: In the actual antiemetic ASCO and MASCC guidelines 5-HT3-RAs but not metoclopramide (MCP) are recommended as prophylaxis option for delayed emesis (DE) in moderate emetogenic chemotherapy (MEC). However, MCP was part of the former guidelines in this setting. As there are no clear study results showing a consistent advantage of 5-HT3-RAs over MCP in delayed emesis a metaanalysis would give more conclusive informations. Methods: In a Medline search 15 potential studies comparing a 5-HT3-RA vs. MCP in DE in patients receiving MEC were identified. Efficacy was classified as complete delayed response (no vomiting 24h-120h after chemotherapy). In 4 studies insufficient data for discrimination of acute and delayed emesis were given and in 5 studies additional antiemetics in one arm or MCP/ 5-HT3-RA were administerd only on demand. For each indivudual study odds ratio was calculated. Combined odds ratios were generated according to the methods developed by the Peto group. Results: Six studies (N=700) could be included in the final analysis. The comparison of 5-HT3-RAs and MCP revealed similar efficacy in the prevention of DE in patients receiving MEC (OR fixed 1.01, 95% CI: 0.75, 1.36, OR random 1.26, 95% CI: 0.64, 2.46). A second analysis (N=895) including the study with additional dexamethasone application in the DE phase confirms no advantage of one drug over the another (OR fixed 1.02, 95% CI: 0.79, 1.22, OR random 1.19, 95% CI: 0.70, 2.04). Conclusions: This is the first meta-analysis of all available randomized trials comparing 5-HT3-RAs and MCP in the delayed phase of MEC demonstrating no apparent difference in efficacy. MCP is a less expensive alternative to setrons in this setting. However, the results of this meta-analysis have to be interpreted with cautious due to the potential carry over effect from the acute phase and heterogeneity of the included studies. Despite these limitations, it should be discussed to recommend MCP again for the propyhlaxis of delayed emesis for MEC when preparing the new antiemetic guidelines. No significant financial relationships to disclose.
Human immunodeficiency virus/acquired immunodeficiency syndrome–related cancer in the pre- and post-highly active antiretroviral therapy era in a national cancer center of a resource-limited country: 1988 to 2007
Authors: Cuéllar Ponce de León L. E. , Miranda Rosales L. M. , Biminchumo Zagástegui C. , Rosales Cusichaqui R. , Flores C. , Mas López L. , León Chong J. 
Published: August 2020

e20550 Background: The introduction of the highly active antiretroviral therapy (HAART) has changed the clinical course of acquired immune deficiency syndrome (AIDS) related to cancer. The goals were to describe the the characteristics of AIDS related to cancer before and after HAART in patients in a Hospital of a resource-limited country. Methods: This was an observational, retrospective and cross sectional study. Comparisons analyzed with X2 test. Survival estimated with Kaplan-Meier estimates. Results: The population included 426 (52.2%) patients. The mean age was 39 y.o. The main group was heterosexual 51.1%. The number of invasive cervical cancer (CC) and AIDS-related lymphomas (ARLs) increased in the Post HAART era; the number on non-HIV/AIDS related to cancer has decreased. During the first period none of patients had antiretroviral therapy, living patients was 62% in the Post HAART era (p< 0.01). Conclusions: The introduction of HAART has reduced the number of non-VIH/AIDS related cancer, but have increased the CC and LNH and improved the survival of patients. [Table: see text] No significant financial relationships to disclose.
Association of cytokines with quality of life among breast cancer survivors: A randomized pilot study exploring the effect of Tai Chi Chuan
Authors: Darling T. V. , Mustian K. M. , Heckler C. E. , Peppone L. J. , Janelsins M. C. , Morrow G. R. 
Published: August 2020

e20556 Background: While advances in cancer treatment can increase breast cancer (BC) survival, cancer treatment side effects can decrease quality of life (QOL). Cancer cardiotoxicity is a major side effect of chemotherapy and radiotherapy that leads to cardiovascular disease (CVD). The combined burden of cancer and cancer cardiotoxicity drastically affects QOL. Cytokine-mediated inflammatory profiles are dysregulated by cancer treatments and are implicated in the pathogenesis of CVD. Tai Chi Chuan (TCC), an exercise mode with an energy expenditure equivalent to brisk walking, has been shown to improve cardiovascular function and QOL among BC survivors. The purpose of this pilot study was to explore how TCC affects cytokines and how cytokine changes are related to QOL changes among BC survivors. Methods: This pilot study compared the effects of 12 weeks (3, 60 min. sessions/week) of TCC with support therapy on IL-2 and IL-8 and on QOL among 21 BC survivors (mean age=51; range 33–78). Cytokine responses were obtained via serum ELISA and QOL were assessed via the FACIT measurement system pre- and post-intervention. Results: Mean levels of IL-2 decreased in the TCC group (CS=-8.82) but increased in the control group (CS=4.60). Mean levels of IL-8 increased in the TCC group (CS=0.32) but decreased in the control group (CS=-3.82). ANCOVA, controlling for baseline, revealed no treatment effect for IL-2 but there was a statistical trend suggesting a possible treatment effect and baseline interaction for IL-8 (p=0.1). Bivariate analyses revealed a negative association between overall QOL and IL-8 (p=0.07), functional QOL (e.g. ability to work) and IL-8 (p=0.03), as well as physical QOL (e.g. energy level) and IL-8 (p=0.01) in the TCC group. Correlations also showed a negative association between overall QOL and IL-2 (p=0.05) and between functional QOL and IL-2 (p=0.005) among the control group. Conclusions: These findings suggest that TCC-induced changes in cytokines may be associated with changes in QOL, specifically in the physical and functional domains. Future research is needed to verify these pilot study findings and should focus on cardiotoxic effects associated with physical and functional QOL. NCI grant 1R25-CA102618 and Sally Schindel Cone. No significant financial relationships to disclose.
Efficacy and safety of routine intravenous iron replacement therapy for chemotherapy-induced anemia in the community setting
Authors: Sen K. , Taylor W. C. , Shea T. C. , Peterson J. L. , Logue-Hunter J. 
Published: August 2020

e20563 Background: Anemia occurs frequently during cancer chemotherapy and contributes to the development of fatigue. Erythropoiesis-stimulating agents (ESAs) are successfully utilized in this setting but recent studies have raised concerns regarding their potentially harmful effects. Iron deficiency, real or functional is a common problem among cancer patients. In addition to bleeding and poor oral intake new studies have hypothesized that cancers as well as chemotherapy can lead to overproduction of the hormone hepcidin that shifts usable iron to the storage pool. We hypothesized that chemotherapy induced anemia (CIN) could be reversed simply by increasing the supply of usable iron by intravenous iron infusion and adopted this practice empirically at our UNC affiliated community practice. Methods: We conducted a retrospective chart review of 50 patients with documented CIN. Each received treatment with intravenous iron preparations to provide between 1,000–4,000 mg of elemental iron over a period of 1–4 weeks based on serum iron and % saturation. The goal was to identify the frequency of transfusion, ESA use, adverse events and overall cost effectiveness of this approach. Results: Intravenous iron therapy (IIT) led to an average 3g/dL increase of hemoglobin in 80% of all patients with a hemoglobin level at or below 10g/dL during chemotherapy. Transfusion could be avoided in 95% cases. Total usage of ESAs to maintain the target hemoglobin level above 10g/dL during chemotherapy was reduced by 50% of the standard recommended dose. Total cost of infusing 1,000 mg of IIT was roughly 60% of a single 40,000 unit dose of erythropoietin. We recorded a 4% incidence of grade I-II and 2% incidence of grade III-IV adverse events but no fatalities. Adverse events were significantly more frequent among young females and Hispanics. Conclusions: A prospective study should be designed to confirm the encouraging result of this review. IIT may become a standard component of anemia management during chemotherapy. It appears to be safe and cost effective, can be given alone or in combination with ESAs and we found it suitable for routine use in community cancer clinics. No significant financial relationships to disclose.
Use of percutaneous kyphoplasty to treat painful vertebral compression fractures (VCF) in solid tumors
Authors: Elrafei T. N. , Hazza M. , Tindel N. 
Published: August 2020

e20568 Background: Vertebral compression fractures are a major source of morbidity in metastatic carcinoma. Kyphoplasty involves inflation of a balloon for painful kyphotic deformity restoring the vertebral body to its original height and creating a cavity for percutaneous injection of polymethylmethacrylate (PMMA). Contraindications include epidural spinal cord compression. Although it is FDA approved for cancer-associated VCF most of the data is in the myeloma population. Methods: We retrospectively assessed by electronic medical records the safety and efficacy of kyphoplasties performed by the orthopedic spine service in a single institution between 12/03 and 2/08. We identified those patients who had kyphoplasty as the only spine procedure and excluded those patients with incomplete documentation of pain scores. Comparison was made between patients selected for pathologic compression fractures and benign compression fractures secondary to trauma or osteoporosis. Results: Review of 447 consecutive orthopedic spine cases identified 40 kyphoplasty patients, 30 of which met the inclusion criteria - 21 with benign compression fractures secondary to osteoporosis/trauma and 9 with malignant disease (3 breast CA, 2 lung, 1 cervix, 1 RCC, 2 myeloma). 49 kyphoplasties and 23 concurrent spine biopsies were performed in this group. Median age was in the cancer group was 55 (37–81) vs. 68(41–93) in benign group. One patient had prior radiation in the cancer group. The average preoperative visual analog pain score was 7 (range 3–9) and postoperative pain score was 2.0 (0–9) in the cancer group. The average preoperative visual analog pain score 6.8 (0–9) and post-operative score was 0.8 (0–4) in the benign group. Most procedures did not require general anesthesia. There were no reported PMMA extravasations, and no hematologic or neurologic complications in either group. Conclusions: Kyphoplasty provided marked pain relief in patients with VCF secondary to solid tumors and myeloma. The results are comparable to non-cancer population in safety and efficacy, and are feasible in selected cancer patients with pain due to pathologic compression fractures. [Table: see text]
A longitudinal evaluation of oral mucositis in patients receiving radiation therapy (IMRT) with/without chemotherapy (CTX)
Authors: Dodd M. J. , Cho M. , Miaskowski C. , Quivey J. 
Published: August 2020

e20572 Background: Oral mucositis is a major side effect of RT ± CTX to the head and neck. A variety of instruments and techniques have been used to quantify oral cavity changes during treatment. Few studies have reported on the evaluation of oral mucositis using both subjective and objective methods. A secondary aim in our study testing an innovative mouthwash is to increase our understanding of using subjective and objective methods for measuring oral mucositis, functional status, and weight changes over time. Methods: Patients reported functional status, pain and investigators measured oral mucositis and weight at four times (beginning of RT [T1], onset of mucositis [T2], end of RT [T3], and healing of mucositis [T4]) over a 10 - 15 week period, using the Karnofsky Performance Status [KPS]) and the Oral Mucositis Assessment Scale (OMAS). The OMAS measures researcher-evaluated ulceration/pseudomembrane formation and erythema in specific sites in the mouth, and self-report by patients, rating severity of mouth pain, ability to swallow and chew. Results: Of 51 head and neck cancer patients enrolled, 3 never developed mucositis. Mean days to onset of mucositis was 15.58 (SD 6.85), and mean days to healing of mucositis was 77.86 (SD 40.1). Mucositis pain scores (possible range 0–45) were moderate at T2 (x=6.25, SD 3.5) and T3 (x=12, SD 5.0). Subjective pain, chewing, and swallowing scores were positively correlated with each other (r= .31 - .73, p<.05) and objective oral mucositis scores were positively correlated with each other (r= .49 - .77, p<.01), however, no significant correlations were obtained between the subjective and objective scores. In both the RT-only group as well as the RT+CTX group, weight significantly decreased from T1 to T4, and KPS significantly decreased from T1 to T3. RT+CTX patients showed lower KPS and greater weight loss from T1 to T4 (X=10lbs) compared to the RT-only group (X=3 lbs), but neither was significantly different. Conclusions: During RT+CTX, patients need more supportive care to maintain functional status and avoid weight loss. Lack of correlations between the subjective and objective scores is interesting in that they are measuring something quite different, which may provide some insight into underlying mechanisms. No significant financial relationships to disclose.
Renal function evolution in cancer patients. Results of the IRMA-2 study
Authors: Oudard S. , Janus N. , Gligorov J. , Beuzeboc P. , Ray I. , Morere J. , Spano J. , Pourrat X. , Deray G. , Launay- Vacher V. 
Published: August 2020

e20574 Background: In 2007, the IRMA-1 study reported the high prevalence of renal insufficiency (RI) in cancer patients. Because of this high frequency, the IRMA-2 study started to investigate the evolution of renal function in cancer patients. Methods: Data were collected for cancer patients presenting at one of the 19 IRMA-2 centers in March 2005. Data included: sex, age, weight, serum creatinine (SCR), haemoglobinemia, type of tumour, metastasis (bone and/or visceral) anticancer drugs. Dialysis, myeloma and lymphoma patients were not included. Glomerular filtration rate was estimated with the abbreviated RD (aRD) formula at the inclusion. Patients were retrospectively followed during 2 years after the inclusion, every 6 months, from March 2005 (T0) to March 2007 (T24). Results: 4945 cancer patients (breast 1816, colorectal 747, lung 463, ovarian 294, prostate 251) were included in 19 cancer centre in France. Median age 60.0, mean weight 66.2, 62.8% were women. Mean GFR decreased from 90.8 ml/min/1.73m2 to 83.7 over the two years (table). Meanwhile, the prevalence of RI increased, reaching 62.9% and 17.5% for a GFR<90 and <60, respectively at T24 (table). Among the 4945 patients, 193 (7.6% of the 2525 patients who were alive at the end of the study) had a SCR determination at each time point. Among the 641 patients with a SCR at T0 and at T24, 41.6% of those with a GFR>=90 at T0 had a GFR<90 at T24. Furthermore, 17.7% of patients with mild renal insufficiency (60 to 90) at T0 had a GFR<60 at T24. Conclusions: IRMA-2 shows that renal function decreases rapidly in cancer patients with a loss in GFR of more than 3.5 mL/min/1.73m2 per year. This suggests that cancer patients are more exposed to a deterioration of renal function and that it should be closely monitored with at least a regular estimation of renal function, for instance every 6 months. So far, such a follow-up is not performed in clinical practice. Furthermore, drug therapy should be reevaluated, dosages adjusted when necessary, and some potentially nephrotoxic drugs changed for less or non-nephrotoxic drugs if possible. No significant financial relationships to disclose.
Integrative medicine consultation with cancer patients: Does it affect patients concerns and well-being?
Authors: Frenkel M. , Peterson N. , Swint K. , Cohen L. 
Published: August 2020

e20581 Background: Increased numbers of cancer patients are searching for additional options outside of their conventional medical care to improve their clinical outcome, quality of life, and overall wellbeing. Complementary and integrative medicine (CIM)) is one of the main options that patients are incorporating. The objectives of this study were to assess the outcome and value of an integrative medicine clinical consultation. Methods: Patients attending academic integrative medicine clinic evaluated their concerns and wellbeing using the Measure Yourself Concerns and Wellbeing (MYCaW) scale, a validated tool assessing outcome of complementary consultation for cancer patients. Prior to each visit patients completed the MYCaW and listed their two main concerns, the severity of the concern (0 = does not bother me at all to 6 = bothers me greatly), and their wellbeing (0 = as good as can be to 6 = as bad as can be). All patients met with a physician who provided an integrative consultation that included discussion of nutrition, supplements, exercise, useful complementary therapies, and the mind-body-spirit connection. At the follow up visit (usually 2–3 months later) patients completed the MYCaW to evaluate if the initial concerns were met. Results: Oncologists in the cancer center referred 197 patients for consultation about the integration of complementary medicine to their care. The majority of the participants were female (n=121), mean age was 56, range 21–90. Patients had been using a large range of CIM therapies including nutritional supplements (n=144), dietary changes (n=36), and acupuncture (n=33). The leading diagnosis was breast cancer followed by prostate cancer, but all major cancer diagnoses were represented. The leading concerns were related to “What else can I do?” and “How can I better cope?” From pre to post there was a reduction in severity of the concerns scores in 79% of patients, no change for 8%, and an increase for 13% (mean pre = 4.6; mean post = 2.6). For the question of Well being there was a reduction for 49%, no change for 32%, and an increase for 18% of the patients (mean pre = 2.5; mean post = 1.82). Conclusions: Integrative medicine consultations for cancer patients appear to be a valuable service that addresses patients’ main concerns and improves well being. No significant financial relationships to disclose.
Zoledronic acid and atrial fibrillation in cancer patients with bone metastases
Authors: Aksoy S. , Dizdar Ö. , Turgut D. , Sener Dede D. , Arslan Ç. , Harputluoglu H. , Altundag K. 
Published: August 2020

e20591 Background: Treatment with a bisphosphonate was linked with a significantly increased risk for atrial fibrillation (AF) in a few studies. Once-yearly infusions of intravenous zoledronic acid (ZA) was also significantly increased serious AF in postmenopausal women with osteoporosis. This study was conducted to determine the frequency of atrial fibrillation among cancer patients receiving the standard treatment of ZA. Methods: One hundred and twenty-four cancer patients who had bone metastasis receiving ZA were included in this study. All patients have been receiving 4 mg ZA at 4-week intervals; with each dose administered over 15 minutes. Patients who presented outpatient clinic for any reason (routine control, chemotherapy, ZA administration) a short survey completed and standard 12-lead ECG recordings were obtained. Results: One hundred and twenty-four cancer patients with documented bone metastases were evaluated. Mean age of the patients was 55 ± 13.0 years, 60% of the patients were female. Forty-one percent of the patients had breast cancer and 17% non-small cell lung cancer and the remainder had other solid tumors. Mean duration of ZA administration was 13.4 ± 15.0 months/patients. Mean total cumulative dose was 54 ± 15.0 mg per patients. 60 (48%) of the patients were treated with antracycline including regimens, and 37 (30%) were treated with mediastinal radiotherapy that might effect the heart. Twenty-three percent of the patients had hypertension, 10% diabetes mellitus, 7% currently smoker and 32% exsmoker, 3.7% myocardial infarction history, 1.9% congestive heart failure, and 1% valvular disease. On ECG evaluation; we observed sinus rhythm in 58%, sinus tachycardia in 15%, sinus bradicardia in 3.2%, ventricular exracystole in 5.7% of the patients. There were no AF. Conclusions: Although most of the patients were also having potentially cardiotoxic treatment, there was no increase in AF frequency in cancer patients who were treated with intravenous ZA. We believe that the risk of AF is small and may increase with age and comorbidity. No significant financial relationships to disclose.
Predictive value for thrombosis of pre-chemotherapy D-Dimer in ambulatory cancer patients
Authors: Vicente E. , Gonzalez-Billalabeitia E. , Zafra M. , García-Martinez E. , Roldan V. , García T. , Lopez-Oliva J. , Macias J. , Vicente V. , Ayala F. 
Published: August 2020

e20601 Background: Elevated D-Dimer (DD) is related with activated coagulation system. We pretended to assess if high DD is predictive of thrombosis in ambulatory cancer patients. Methods: We prospectively determined DD in plasma specimens from ambulatory cancer patients, without previous thromboembolic events (TE), before chemotherapy initiation. DD was determined with an immunological test in an automated coagulometer (IL D-Dimer test, Instrumentations laboratory). The selected cut-off point for DD was 1.5 x UNL, as it was the nearest point to the median DD. All thromboembolic events were recorded. Results: Between June 2007 and December 2008 eighty four patients were included, 66% with advanced and 34% with early disease. The most frequent tumours were colorectal 31%, breast 27% and genitourinary cancers 30% (12% HR prostate and 28% non prostate cancers). Antiangiogenic drugs were included in 24% of treatments (16% Bevacizumab and 8% Sunitinib). Median ECOG was 1. With a median follow-up of 6.5 months, 12 thromboembolic events were observed (5 PE, 3 DVT and 4 Arterial thrombosis). The following variables were included in the univariate analysis: high DD (>1.5 x UNL), low haemoglobin (Hb <10 mg/dL), high leukocyte, high platelet, high BMI and tumour location. High DD (HR = 6,25, 95% CI: 1,34–29,25; p= 0,02) and low Hb (HR= 6,17, 95% CI: 1,77- 21,53; p=0,004) were associated with increased TE. The high risk group in the Khorana index was also significant (p=0.02). In multivariate analysis both high DD (HR= 5,06, 95%CI: 1,05–24,48; p=0,044) and low Hb (HR=3,77, 95%CI: 1,02–13,97; p=0,047) remained significant. Conclusions: High pre-chemotherapy DD is associated with increased risk of thrombosis in ambulatory cancer patients. No significant financial relationships to disclose.