bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Edmonton Symptoms Assesment Scale (ESAS) symptoms improvement (SI) assessment as a prognostic factor for survival in advanced cancer patients (pts) undergoing palliative care (PC): An observational prospective study
Authors: Gamucci T. , Narducci F. , Sperduti I. , Mentuccia L. , Trapasso T. , Magnolfi E. , Grande R. , Cianci G. , Gemma D. , Trombetta G. 
Published: August 2020

9591 Background: ESAS is a validated tool for physical symptoms assessment in PC practice which evaluates symptoms through a numeric scale ( 0–10). The use of SI as a prognostic factor is controversial. To this purpose, an observational prospective study in advanced cancer pts previously treated with anti-cancer treatments and now undergoing only PC was conducted. Methods: Pts were considered eligible if no longer able to receive any anticancer treatment; they were scheduled to undergo ESAS assessment: 1) at the hospitalization time-point (TH); 2) at the hospital discharge time-point (TD). Symptoms’ scores were divided into 3 severity-classes (SC): mild (0–3, MI), moderate (4–6, MO) and severe (≥7, S). Differences across symptoms’ classes between TH and TD was analyzed with the paired-data McNemar-test, according to tumor types. KM method was used for survival calculation, according to ESAS score classes, and logrank test for curves comparison. Uni/multi-variate survival analysis including age, sex, tumour, symptoms number and score class, PaP (Palliative Prognostic)-score, KPS, were carried out using the Cox regression model. Results: ESAS was administered to 68 pts, gastrointesinal (GI)/lung (NSCLC): 39/29, median age: 69-yrs, KPS ≤50/>50: 27 (39.7 %)/ 41 (60.3%), PaP-score A/B/C: 26 (38.2%)/37 (54.4%)/C (7.4%). A statistically significant reduction of S-SC rates was observed, as shown in the Table . SI correlates with survival improvement: PaP score (HR 2.95, 95% CI 1.35–6.41, p=0.006) and anorexia (HR 3.21, 95% CI 1.33–7.72, p=0.009) appear to be prognostic factors for survival at the multivariate analaysis for GI pts; asthenia is the only significant variable (HR 5.11 CI 95% 1.86–14.03, p=.0.002) for NSCLC pts. Conclusions: SI according to ESAS after PC treatment represents an important prognostic factor for survival in pts no longer suitable to receive any anticancer active therapies. [Table: see text] No significant financial relationships to disclose.
Association between inflammatory markers, symptom burden, hypogonadism, and survival in cancer patients with cachexia
Authors: Del Fabbro E. , Hui D. , Nooruddin Z. , Dalal S. , Freer G. , Palmer L. , Bruera E. 
Published: August 2020

9594 Background: Cancer cachexia is characterized by muscle wasting, anorexia, and elevated inflammatory markers. Similarly, in patients without cancer, hypogonadism is associated with lower lean body mass, increased symptom burden and decreased survival. Hypogonadism in cancer cachexia could exacerbate symptom distress, facilitate a pro-inflammatory state and decrease survival. Currently, there are no guidelines for testosterone replacement therapy in cancer patients. We evaluated the relationship between hypogonadism, symptom severity, inflammation and survival in patients with cachexia. Methods: A retrospective chart review of 159 consecutive patients (61 females, 98 males) referred to a specialized cachexia clinic at a comprehensive cancer center. 98 patients (62%) had C-reactive protein (CRP) levels measured, and 68(69%) males had serum total testosterone evaluated. Testosterone levels were not evaluated in female patients. Symptoms were assessed by the Edmonton Symptom Assessment Scale (ESAS). Results: All patients reported weight loss of >5% within the preceding 6 months; Median age was 62, CRP 26mg/L and in males median total testosterone186ng/dL (normal level≥240 ng/dL). Spearman correlation revealed higher CRP levels (r=0.57, p<0.01) increased dyspnea (r=0.27, p<0.05) and poorer sleep scores (r=0.29, p<0.05) in males with low testosterone. In 46 males and females who underwent CRP testing within 30 days of their ESAS evaluation, pain (r=0.48, p<0.01), fatigue (r=0.39, p<0.01), poor appetite (r=0.49, p<0.01), insomnia (r=0.42, p<0.01), anxiety (r=0.29, p<0.05), and dyspnea (r=0.31, p<0.05) correlated with an elevated CRP. Survival of male patients with testosterone<186 ng/dL was decreased compared to those with levels ≥ 186ng/dL (13 vs.62 weeks, p=0.004). Patients with CRP>10 mg/L had decreased survival compared to those <10 mg/L (30 vs. 66 weeks, p=0.017). Conclusions: Elevated C-RP levels in cancer cachexia are associated with poorer survival and increased symptom burden. Low testosterone is strongly associated with decreased survival in cachectic male patients and correlates inversely with CRP levels, dyspnea and insomnia. No significant financial relationships to disclose.
Survival prediction in terminally ill cancer patients: Description and validation of a new predictive score
Authors: Jimenez Gordo A. M. , Feliu J. , Dominguez J. , Molina R. , Camara J. C. , Alonso A. , Madero R. , De Castro J. , Espinosa E. , Gonzalez-Baron M. 
Published: August 2020

9595 Background: Determining an accurate prognosis for terminally ill cancer patients is one of the biggest challenges that confronts a physician. Correct predictions can be done in only 20–40% of all cases. Although the current prognostic scales are helpful, they have significant limitations. Our objective consists of determining the potential indicators that influence the survival of these patients and develop and validate a new predictive model. Methods: A prospective, multicentric and observational study was conducted in 880 terminally ill cancer patients. At first, 40 clinical, demographic and laboratory variables were recorded in 406 patients. A forward stepwise regression method was applied for the multivariate survival analysis. Hence, a predictive model was constructed. Subsequent validation was performed in 474 patients. Results: Median age was 66.4 years (range 18–95). The median overall survival was 21 days in the first 406 patients studied and 19 days in the validation group. A prognostic model with 9 variables was constructed (age, ECOG, the amount of time between initial diagnosis up to being considered terminal phase, nauseas, anorexia, cognitive impairment, lymphocytes, LDH and albumin). Afterwards, to simplify the model, 4 variables that were considered more objective and with greater Odds ratio were selected and assigned one point per each prognostically poor category. We obtained a survival model that discriminates 3 prognostic categories: Good prognoses (score 0) with a median survival of 95 days (44–146), intermediate prognoses (score 1–2) with a median survival of 33 days (26.8–39.2) and bad prognoses (score 3–4) with a median survival of 15 days (11.1–18.9). In the validation group, median survival times were 60 (47.1–72.8), 27 (22.8–31.1) and 11 days (9.2–12.7) respectively. Conclusions: We propose a predictive score model that is objective and easy to use to help in accurately predicting life expectancy in terminally ill cancer patients. Its effectiveness has been validated in a group of independent centers. No significant financial relationships to disclose.
Factors for choosing prostate cancer treatment and resulting impact on health related quality of life
Authors: Rice K. , Peay K. , Hudak J. , Elsamanoudi S. , Travis J. , Lockhart R. , Jennifer C. , Black L. , Hogue S. , Brassell S. 
Published: August 2020

9601 Background: The equivalence of surgery (RP), external beam radiation (EBRT), and expectant management (EM) on overall survival of prostate cancer (PCa) patients and their respective impact on health-related quality of life (HRQoL) is controversial. Thus, the benefit of screening has been raised. There is a scarcity of information on demographic factors that influence patient treatment choice and the resulting impact treatment has on HRQoL. Methods: Patients presenting to an equal access military multi-disciplinary PCa clinic are enrolled in a HRQoL database after informed consent. Surveys are administered prior to treatment and at 3, 6, 9, and 12 months. The instruments are the EPIC, EPIC Demographic, and the MOS Short-Form 36. Chi-square analysis compared frequency of race, income, and education level by treatment choice. Multivariate analysis was used to predict changes in HRQoL outcomes over time. Results: The study consisted of 538 patients. Caucasians chose EM twice as frequently as African Americans (AA) (p=0.0033). Caucasians were 3 times more likely to choose RP over EBRT, whereas AA were more evenly divided. Patients who earned over $100,000 annually disproportionately chose RP while the other treatment groups were disproportionately represented by those earning less than $100,000 (p<0.0001). Those having a graduate school degree disproportionately chose RP while the other treatment options were disproportionately represented in those with college education or less (p<0.0001). Mean age for RP, EBRT, and EM was 58, 67, and 69 respectively. Patients undergoing RP had significantly worse HRQoL outcomes in the following domains: urinary function, sexual function, and sexual bother at 12 months despite having the highest baseline scores (p<0.0001). The only domain that differed between patients undergoing EBRT and EM was bowel bother (p<0.0001). Conclusions: Patients choosing RP tend to be younger Caucasians with higher income and educational levels. This cohort chose the option with the greatest impact on HRQoL, which gives evidence that patients with certain demographics may emphasize other factors in their treatment decisions. HRQoL between EBRT and EM differed in only one domain. EBRT may be offered to older patients with minimal HRQoL impact. No significant financial relationships to disclose.
Is a diagnosis of invasive breast cancer an effective motivational factor for lifestyle change?
Authors: Ellsworth R. , Sann N. J. , Kvecher L. , Ellsworth D. L. , Shriver C. D. 
Published: August 2020

9602 Background: While survival rates for patients diagnosed with invasive breast cancer have increased dramatically, survivors often face a host of adverse health effects. Factors such as obesity, physical activity and tobacco may contribute to decreased survival and quality of life. Here, we evaluated behavioral risk factors in patients with and without breast cancer to determine whether a diagnosis of invasive disease was sufficient motivation to modify lifestyle choices. Methods: The dataset included patients undergoing surgical procedures between 2001 and 2006 and diagnosed with malignant (n=299) or benign (n=130) breast disease and who had baseline and 1-year follow-up information available. Changes in BMI, fat intake, exercise frequency, alcohol and tobacco use, caffeine consumption and frequency of breast self exam (BSE) were assessed. Results: At baseline (diagnosis), significantly more (P<0.005) invasive patients (70%) were menopausal compared to benign patients (48%), no other patient characteristics were significantly different between malignant and benign groups at baseline; a majority in both groups were overweight, non (current) smokers, and consumed high fat diets, ∼40% reported exercising >3 times/week, >60% had high (>500 mg/day) levels of caffeine and consumed low (<1 drink/month) levels of alcohol. The only modifiable behavior that showed a significant change (P<0.05) between baseline and 1-year from diagnosis was compliance with recommended BSE frequency in invasive patients, improving from 61% of patients at baseline to 72% one year later; a concomitant change was not seen in benign patients. No other behaviors changed either from baseline to 1-year or between invasive and benign patients. Conclusions: The paucity of behavioral changes after a diagnosis of breast cancer suggests that a diagnosis of breast cancer is not sufficient motivation to promote healthier lifestyles. Our data suggest a need for increased health-related behavioral counseling and support systems to successfully modify personal behaviors. Development and implementation of lifestyle recommendations have the potential to improve the health and quality of life of breast cancer survivors. No significant financial relationships to disclose.
Health-related quality of life (HRQOL) in non-small cell lung cancer (NSCLC): An update of a systematic review on methodological issues in randomized controlled trials (RCTs)
Authors: Claassens L. , van Meerbeeck J. , Coens C. , Quinten C. , Wang X. S. , Velikova G. , Bottomley A. 
Published: August 2020

9604 Background: NSCLC is a prevalent cancer site and RCTs frequently assess patient HRQOL, given the modest survival gains. This study is an update of a systematic review (JCO, 2003) on the HRQOL methodology in NSCLC RCTs. The objective was gaining insight into the evolution of HRQOL methodology over the last decades to help understand if the quality of reporting—and its benefit for clinical-decision making—has improved. Methods: A systematic literature review was undertaken through Medline. RCTs including newly diagnosed NSCLC patients with age ≥ 18, who underwent chemotherapy and/or radiotherapy; comprising patient-reported HRQOL endpoints; and published in English from 2002 to end 2008 were eligible. Two independent reviewers evaluated demographics, trial design, HRQOL measurements and statistical analysis. Results: Forty-five RCTs including 16,382 patients were selected, versus 29 trials between 1980 and 2002. Overall, the quality of HRQOL methodology reported was adequate, although no improvement over time was noticed. Comparisons to the former review led to similar results (p > .05): Of the 45 RCTs, HRQOL end points were primary objectives in 20%. Significant HRQOL between-treatment differences were found in 60% of the RCTs. Adequacy of result presentation was found for a majority (71%). Few studies paid attention to clinically meaningful differences (36%). The EORTC and FACIT tools and the LCSS were most commonly applied in 56%, 18% and 13% respectively. There was sufficient detailing on domains, time points and patient compliance (> 70%), but little on instrument administration methods (18%). However, HRQOL hypothesis (9%); instrument rationale (11%); verification of the cultural validity (29%); and impact of missing data (31%) were addressed to a significantly less extent than before 2002 (p < .05). Conclusions: The number of RCTs incorporating HRQOL assessments in the NSCLC population has increased considerably. Despite the acceptable quality of the HRQOL methodology reporting, certain aspects remain poorly addressed. Our findings suggest the need for international standardization of HRQOL reporting, similar to the CONSORT guidelines for clinical findings. No significant financial relationships to disclose.
Prevalence and correlates of fatigue among patients at a comprehensive cancer center
Authors: Bharne A. A. , Shimabukuro K. A. , Vu P. H. , White M. M. , Mills P. J. , Bardwell W. A. , Messer K. , Bazhenova L. 
Published: August 2020

9608 Background: Cancer-related fatigue is a widely reported distressing symptom. We examined patterns and clinical correlates of fatigue among a series of patients with and without cancer at Moores UCSD Comprehensive Cancer Center (MCCC). Methods: All patients who come for initial consultation to MCCC complete a 39-question screen assessing problems including fatigue, sleep, and mood disturbance on a 5-point scale (0 = not a problem, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe). We report prevalence of fatigue from 1,880 consecutive patients; the charts of 515 of these were reviewed for further data. Results: Overall 1,137 of 1,880 (61%) patients reported problems with fatigue. Of the 515, there were 321 cancer and 194 non-cancer patients. 40 patients not responding to the fatigue question were excluded. There was no significant difference in the proportion of cancer (189 of 296; 64%) and non-cancer patients (104 of 179; 58%) reporting fatigue. Prevalence was similar between genders. 126 of 208 (61%) chemotherapy-naïve cancer patients reported fatigue compared to 63 of 88 (72%) patients who received any chemotherapy (p=0.07). In comparison to the chemotherapy-naïve, 37 of 48 (77%) with ongoing or recent (< 6 mo) chemotherapy reported fatigue as a problem (p=0.03); but among patients who underwent chemotherapy > 6 mo prior to the questionnaire, fatigue was not significantly different (26 of 40; 65%). 51 of 189 (27%) cancer patients married or living with a partner reported moderate to severe fatigue compared to 39 of 104 (38%) with no partner (p=0.06). Among cancer patients without sleep or mood problems, 19 of 71 (27%) reported fatigue as a problem compared to 166 of 221 (75%) with sleep and/or mood problems (p < 0.001). Conclusions: Fatigue is prevalent among cancer and non-cancer patients. Although more cancer patients with ongoing/recent chemotherapy reported fatigue compared to the chemotherapy-naïve, after 6 mo there was no significant difference, suggesting that fatigue may only be partly explained by chemotherapy. Social support from a spouse/partner may also help reduce problems with fatigue. Sleep and mood disturbance are associated with fatigue, but many cancer patients reported fatigue in its absence, consistent with previous data and suggestive of other etiologies. No significant financial relationships to disclose.
Longitudinal assessment of cognitive impairment among lung cancer survivors
Authors: Kohli S. , Szydlo D. W. , Novotny P. J. , Yang P. , Brown P. D. , Buckner J. C. , Sloan J. A. 
Published: August 2020

9609 Background: Patients undergoing treatment for cancer often report problems with their cognitive function (CF), which is an essential component in maintaining Quality of Life (QoL). We conducted a longitudinal study of lung cancer (LC) patients to systematically evaluate changes in QOL including changes in CF, over time. Methods: Between 2005–2008, we followed 1757 primary LC patients who responded to CF questions at least once within 8 years of diagnosis. Overall QoL measured by LCSS and LASA (scores 0–100 from worst to best) were assessed among 1,604 of 1,757 (91%) who completed the questionnaire at one or both of two time periods: short-term (T1-within 3 years of diagnosis) and long-term follow-up (T2-beyond 5 years of diagnosis). Questions rated overall CF and problems in thinking clearly. Results: The median age at the time of LC diagnosis was 68 years in men (n=834) and 65 years in women (n=770), p<0.0001. At T1, the mean score of patients reporting problems with CF was 63.2 (±22.45) vs 74.4 (±20.38) who reported no problems (p<0.0001). At T2, the mean score was 62.2 (±24.18) for patients who reported CF problems and 78.1 (±18.28) who reported no changes with their CF (p<0.0001). At T1, the mean score of patients reporting problems thinking clearly was 66.1 (±21.65) vs 75.6 (±20.21) reporting no problems with their thinking (p<0.0001). At T2, the mean score was 70.4 (±20.95) for patients reporting problems thinking clearly vs 82.6 (±17.76) who reported no problems (p<0.0001). Conclusions: Self-reported QoL of lung cancer survivors showed substantial deficits with their cognitive function. Prospective and objective assessments are needed to determine if cancer treatments are positively associated with cognitive decline, to identify the patients at risk, and to test appropriate interventions. Funding Source: NIH grants: CA 115857, CA 84354, CA 80127 and CA 77118. No significant financial relationships to disclose.
Relationships among health-related quality of life indicators in cancer patients: A pooled study of baseline EORTC QLQ-C30 data from 6,739 patients
Authors: Martinelli F. , Quinten C. , Coens C. , Flechtner H. , Gotay C. , Mendoza T. , Osoba D. , Reeve B. , Wang X. , Bottomley A. 
Published: August 2020

9612 Background: Cancer patients frequently experience multiple and co-occuring problems due to their illness and therapies. Clusters are defined as groups of two or more Health-Related Quality of Life (HRQoL) indicators that occur concurrently and may or may not have a common related cause. The objective of this meta-analysis was to identify how HRQoL indicators cluster among cancer patients. Methods: Retrospective pooling of 29 European Organisation for Research and Treatment of Cancer (EORTC) randomized clinical trials, among 10 cancer sites, yielded baseline EORTC QLQ-C30 HRQoL data for a total of 6739 patients. A cluster analysis was performed to identify clusters among the 15 HRQoL scales, via Ward's method. Cronbach's alpha coefficient (α) was used to measure internal consistency. Dendrograms of the HRQoL indicators were plotted for the overall data and for each cancer site. Results: Three main clusters emerged from the pooled dataset: a physical function-related cluster, consisting of physical and role functioning, fatigue and pain (α = 0.83); a psychological function-related cluster, consisting of emotional and cognitive functioning and insomnia (α = 0.64); and a gastrointestinal cluster, consisting of nausea and vomiting and appetite loss (α = 0.68). The same clusters were found in patients with metastatic and non-metastatic disease. The gastrointestinal cluster was reproduced in all 10 cancer sites. We found that pain was not correlated with the other variables of the physical function cluster for patients with brain, colorectal or pancreatic cancer. For the psychological component cluster, cognitive functioning was not correlated with the other variables of the cluster for breast or pancreatic cancer patients, while insomnia was found not to be correlated with the other variables of the cluster for prostate cancer patients. Conclusions: This study shows that relationships among HRQoL indicators exist and that three major constructs can be found: a physical, a psychological and a gastrointestinal component. Understanding these relationships may aid diagnostic criteria, and assessment, management, and prioritization of symptom care. No significant financial relationships to disclose.
The management of dysphagia in esophageal cancer patients undergoing neoadjuvant chemotherapy: Is invasive tube feeding required?
Authors: Rousseau M. , Guevremont P. , Chasen M. , Spicer J. , Eckert E. , Alcindor T. , Ades S. , Ferri L. E. 
Published: August 2020

9613 Background: The dysphagia commonly associated with esophageal cancer often interferes with patient tolerance of neo-adjuvant chemotherapy. Surgical or endoscopic invasive tube feeding (ITF - gastroscopy/jejunostomy/stent) is a commonly employed strategy to maintain nutritional support however it can cause significant morbidity in its own right. We sought to determine if a strategy of careful dietary counseling and appropriately-timed neoadjuvant chemotherapy can obviate the need for ITF. Methods: Pts undergoing neoadjuvant chemotherapy (TAX/CDDP/5FU Q3 weeks x3) for esophageal or GEJ adenocarcinoma at a single institution from 3/07–7/08 were identified from a prospective database. All received dietary counseling and were closely monitored for signs/ symptoms of malnutrition with serial (baseline, after 1st cycle, pre-surgery) Body Mass Index (BMI), albumin, dysphagia scores (0 best - 4 worse), and quality of life (FACT-E). We assessed the response of dysphagia and nutritional status to neoadjuvant treatment and the need for ITF. Data presented as median (range) or mean (±SD), paired t-test or Wilcoxon signed ranks test determined significance. Results: 25 pts received neoadjuvant chemotherapy and significant dysphagia (score 2–4) was found in 14. Dysphagia scores improved in all 14 (all results in Table 1 ), and 10/13 improved after the first cycle. No patient required ITF. QoL as assessed by the FACT-E improved in 13/14 patients. A small decrease in BMI was noted, however serum albumin did not significantly decrease. Conclusions: Appropriately timed neoadjuvant chemotherapy with a highly effective regimen rapidly restores normal swallowing, maintains nutritional status, and obviates the need for ITF in patients with significant dysphagia from esophageal adenocarcinoma. [Table: see text] No significant financial relationships to disclose.