bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of knowledge translation opportunities in the treatment of locally advanced breast cancer: Results of a national survey of physicians.
Authors: Rajmohan Yanchini , Leonard Robyn , Hogeveen Sophie , Ebrahim Jalal , Han Dolly , Wong Audrey , Boileau Jean-Francois , Gandhi Sonal , Lee Justin , Dinniwell Robert Edward , Brackstone Muriel , Simmons Christine E. 
Published: March 2020

6585 Background: Locally advanced breast cancer (LABC) accounts for only 10% of all breast cancers. While several guidelines and consensus statements exist, whether the current practice reflects these guidelines is unclear. We sought to survey the oncologists in Canada to assess current practice patterns and identify areas of targeted knowledge translation interventions (KTIs) in the treatment of LABC. Methods: 426 Canadian oncologists were surveyed with a 29 item survey-tool. They were subdivided into LABC experts (n=83) and non-experts (n=343). Physicians were removed from the survey if they identified that they were not involved in the treatment of breast cancer. The survey included demographic information as well as questions as to the current practice patterns utilized in the pathway of care for LABC patients. Level of discordance was calculated between the expert and non-expert responses using a z test. Results: 139 responses were obtained (48% response rate) from the non-experts and 51 responses were obtained from the experts (61% response rate). Areas of discordance in expert and non-expert survey included: frequency of clinical assessment during neoadjuvant therapy, methods for clinical assessment, radiographic re-evaluation post therapy, and assessment of receptor status (see Table). Conclusions: Several areas have been identified as targets for KTIs that may help to improve the quality and consistency of care of patients with LABC in Canada and may also have implications for improvements in resource utilization. [Table: see text]
Incidence of venous thromboembolism in patients with hematologic malignancies related to upper extremity peripherally inserted central venous catheters.
Authors: Giever Thomas A. , Richter Emily L. , Broge Kristine M. , Foy Patrick C. , Blust Linda S. , Palmer Jeanne M. , Fenske Timothy S. , Rilling William S. , Hari Parameswaran , Atallah Ehab L. 
Published: March 2020

6586 Background: Central venous catheters (CVCs) are an integral part of management in patients with hematological malignancies (HMs). CVCs are not without risk however, including DVT which adds significant morbidity. Peripherally inserted central venous catheters (PICCs) via the brachiocephalic veins were the most common CVCs utilized at the Medical College of Wisconsin for patients with HMs. Recent evidence has indicated an increased risk of DVT in patients with PICCs. Methods: We retrospectively reviewed patients admitted to our institution from 2009-2011 with a HM and a CVC placed based upon CPT codes. A chart review was performed and those with a radiologic-confirmed DVT were identified. Results: From 2009-2011, 487 patients with HMs had 1091 CVCs placed. Diagnoses included lymphoproliferative disorders (35.8%), acute leukemia excluding APL (23.8%), APL (1.6%), plasma cell dyscrasias (34.6%), MDS (1.7%), CML (1.6%), and other diagnoses (0.7%). Of the CVCs placed 51% were in patients undergoing stem cell transplantation (HCT) and 49% were placed in non-HCT patients. A total of 91 DVTs were documented and confirmed. DVTs occurred in 85 of 728 PICCs (11.7%), 3 of 104 implanted ports (2.9%), 3 of 249 tunneled CVCs (1.2%), and 0 of 10 other CVCs. DVT rates were similar between HCT (47 of 556, 8.4%) and non-HCT (44 of 535, 8.2%) patients. The highest number of DVTs were associated with plasma cell dyscrasias (29 of 378, 7.7%) followed by lymphoproliferative disorders (28 of 391, 7.2%), acute leukemia (26 of 260, 10%), APL (3 of 18, 16.6%), MDS (3 of 19, 15.8%), and CML (2 of 17, 11.7%). Two DVTs occurred in the setting of warfarin therapy, 5 while on prophylactic and 9 while on therapeutic LMWH. The mean duration from line placement to DVT was 21 days (range 1-169). Using standard chi-squared evaluation, PICC lines were significantly more likely to be associated with DVTs than tunneled or implanted CVCs (p<0.0001). Conclusions: Brachiocephalic PICC-lines are associated with a high incidence of DVT in patients with HMs compared to other CVCs. We have currently changed our practice to utilizing a tunneled internal jugular PICCs for central venous access.
Analysis of health-related quality of life during neoadjuvant endocrine therapy with letrozole in postmenopausal breast cancer patients: N-SAS BC06 trial.
Authors: Ohtani Shoichiro , Taira Naruto , Kihara Kiyohiro , Hasegawa Yoshie , Sakai Takehiko , Iwase Takuji , Masuda Norikazu , Fujisawa Tomomi , Yanagita Yasuhiro , Ohsumi Shozo , Higaki Kenji , Yamaguchi Takuhiro , Iwata Hiroji 
Published: March 2020

6588 Background: The impact of neoadjuvant endocrine therapy (NET) on health-related QOL (HRQOL) has not been clarified yet. N-SAS BC 06 is a multicenter study in postmenopausal patients with hormone-sensitive primary breast cancer, two-staged (preoperative and postoperative) enrollment, and intervention. It includes a randomized controlled study of patients responding to NET, which is designed to compare chemotherapy followed by endocrine therapy, with endocrine therapy alone, as postoperative adjuvant therapy. The primary endpoint is DFS, and the secondary endpoints include adverse events, HRQOL and health economic evaluation. This report presents the planned analysis of HRQOL during 6 months of NET. Methods: The target sample size was 850 patients of whom the first 500 enrolled patients were included in HRQOL evaluation. Subjects were assessed at enrollment, and at 1 and 4 months after starting NET, using FACT-G (General), B (Breast), ES (Endocrine Symptoms) and HADS (Hospital Anxiety and Depression Scale). Results: Mean age was 63 years, mean BMI was 23.9. Results of clinical efficacy were as follows: CR: 2%; PR: 44.3%; SD: 48%; and PD: 5.7%. The questionnaire response rates at enrollment, and at 1 and 4 months were 93%, 90% and 82%, respectively, quite a high response rate. The mean scores at enrollment, and at 1 and 4 months were as follows: FACT-G: 82.9; 83.4; 82.7, FACT-B TOI (Trail outcome index): 68.3; 69.5; 68.9; ES subscale: 61.2; 60.1; 59.7 and HADS score: 10.4; 8.9; 8.8 respectively. There were no significant changes in the FACT-G or B-TOI over time, while the social domain score, ES subscale, decreased significantly (worse social well-being and ES). In the ES analysis by item, symptoms such as hot flash showed a greater decrease. HADS scores deceased significantly (improved anxiety and depression), and emotional domain scores increased significantly (better emotional well-being) at 1 month and 4 months after NET. Conclusions: NET had no impact on the overall HRQOL scores, but the anxiety and depression observed at enrollment had improved by 1 month after therapy. To our best knowledge, this is the first report of HRQOL during NET. Clinical trial information: 000001090.
Hepatitis B reactivation in HBsAg-/cAb+ patients receiving rituximab: A meta-analysis.
Authors: Mozessohn Lee , Chan Kelvin K. , Feld Jordan J. , Hicks Lisa K 
Published: March 2020

6592 Background: Patients with hepatitis B virus (HBV) who are HBsAg+ are recognized to be at risk of HBV reactivation if rituximab is administered in the absence of antiviral treatment. Recently, it has been reported that patients with so-called “resolved HBV infection”(HBsAg-/cAb+) may also be at risk; however, the degree of risk is not known. Methods: We performed a systematic review of the English and Chinese language literature in Medline (1996 to July week 2 2012) and Embase (1996 to 2012 week 29) using the MeSH terms “lymphoma” and “hepatitis B”. Eligible studies were limited to those reporting primary data on HBV reactivation rates in HBsAg-/cAb+ patients receiving rituximab. We excluded case series with less than 5 patients. Pooled estimates were calculated for HBV reactivation and the impact of HBsAb status on HBV reactivation rate was explored. Results: Data from 445 patients in 12 studies were included. Using a standardized definition of HBV reactivation, (ALT >3 x upper limit of normal AND either an increase in HBV DNA from baseline OR HBsAg seroreversion), the pooled estimate for the risk of HBV reactivation in HBsAg-/cAb+ patients was 5.4% (I2 = 63%, P = 0.009). Significant heterogeneity was apparent. Exploratory analyses suggested that patients were less likely to reactivate if they were HBsAb+ (OR = 0.32; 95% CI 0.12-0.85, P = 0.0285). Conclusions: Our meta-analysis confirms that there is a measurable risk of HBV reactivation in HBsAg-/cAb+ patients exposed to rituximab HBsAb+ patients may be at lower risk than those who are HBsAb-. However, heterogeneity in the risk estimates limits their generalizability. Large prospective studies are needed to clarify the risk of HBV reactivation in HBsAg-/cAb+ patients and to inform decisions about best practice.
Effect on patient care of repeat pathologic review for breast cancer.
Authors: Shaw Andrew Cota , Sanoff Hanna Kelly , Smolkin Mark E 
Published: March 2020

6599 Background: Many cancer centers routinely re-review outside pathologic specimens. We hypothesized re-review rarely changes patient treatment plans. Methods: Of 1495 patients seen at the University of Virginia with a diagnosis of breast cancer from 2006-2011, the 276 cases with both internal and outside pathology reports comprised the study cohort. Interobserver agreement (kappa coefficient, K) between internal and outside diagnoses were calculated for histopathology, lymph node, margin, ER/PR, and HER2 status. We then evaluated if the change would result in a change in therapy or surveillance per the National Comprehensive Cancer Network (NCCN) guidelines. The effect of region and teaching affiliation of outside institutions was explored. Results: For the 276 cases with re-reviewed pathology at UVA there was absolute agreement for ER/PR and surgical margins, and excellent agreement for lymph node, K= 0.93, and histopathology, K=0.93. Agreement was good for HER2, K=0.83. 3 cases were changed from HER2 positive to negative (2) or intermediate (1). Of 9 changes in histopathology, 2 had a major upgrade: 1 ADH to DCIS; 1 DCIS to carcinoma. 3 had a major downgrade: 2 from DCIS to ADH; 1 from carcinoma to DCIS. 2 cases changed from ALH to LCIS. Lymph node status was changed from positive to negative in one out of 31 reviewed cases. Treatment plan would have changed for all 13, 4.7% of all patients. Changes were made almost exclusively (11/13) if referred from a hospital with no or minor teaching affiliation, including all major histopathology changes and changes in lymph node and HER2 status. Conclusions: Interobserver agreement for breast pathology between pathologists at an NCI designated cancer center and outside institutions was good. However, 4.7% of women had discordant results that would lead to a change in their care. Changes were most common for noninvasive carcinoma and benign atypia. In order to best utilize resources, referral centers may want to consider limiting re-review to the pathology from centers with high risk for discordance.
Continuing to work while receiving cancer treatment: A financial or a symbolic issue?
Authors: Ganem Gerard , Naman Herve L. , Dohollou Nadine , Facchini Thomas , Coscas Yvan , Antoine Eric-Charles , Lortholary Alain , Catala Stephanie , Jacquot Stephane , Lhomel Christine , Eisinger François 
Published: March 2020

6603 Background: As improved cure rates lead to longer life expectancy, occupational concerns during and after cancer treatment become important. The advent of new drugs with fewer side effects will increase the profile of this issue. We carried out a field survey to explore the question. Methods: We questioned 97 oncologists, and a subgroup of 216 patients treated for breast cancer who were working at the time of diagnosis and who wanted to continue to do so during at least part of the treatment period. Results: Data Collected from Patients: In total, 208 patients (96%) were satisfied or very satisfied with their jobs. Only 68 (31%) were able to achieve the goal of working without interruption while being treated (physicians estimated that figure at only 11%). For the remaining women, who did stop working (69%), the median number of days off work was 59. Data Collected from Physicians: A total of 87 physicians (89%) stated that having information regarding working conditions is very important when counseling patients about whether they could continue to work. Comparison of the answers given by patients and physicians: 36% of physicians thought that the initiative in addressing the work/job issue was taken primarily by themselves, while 53% felt it came from the patient. The patient perspective was different: 61% of patients thought they took the initiative themselves and only 13% of them thought the physician took the lead. The main reason behind the desire to continue working is thought by 56% of physicians to be “Financial gain”; while for patients it is “To feel the same” (42%). A total of 90 (92%) physicians feared that those patients continuing to work would face at least one type of medical difficulty; only 143 (66%) patients shared this fear. Lastly, although 94% of the physicians have access to psychological or psychiatric support workers at the health care center, only 62% have access to a social worker. Conclusions: Of the patients who really wanted to work while being treated for breast cancer, only 31% could achieve that goal without any interruption. There is also a difference of perception regarding patient motivation, with physicians believing that the reasons are mainly financial while the patients see it as more of a symbolic issue.
Shared decision making in radiation oncology: Implications for patient satisfaction.
Authors: Shabason Jacob Ezra , Mao Jun J , Frankel Eitan S. , Vapiwala Neha 
Published: March 2020

6610 Background: Shared decision making (SDM) has been linked to healthcare quality outcomes, including patient satisfaction. However, the importance of SDM has not been evaluated in radiation oncology. This study aims to determine the association between patient-perceived SDM and patient satisfaction during radiation therapy (RT). We also explore patient desire for and perception of control during RT and its relationship to patient satisfaction. Methods: We conducted a cross-sectional survey of 305 patients undergoing RT at an urban academic cancer center. Patients self-reported measures of satisfaction and control during the last week of RT. SDM was measured using a 3-item validated instrument. The relationships between SDM, control over treatment decisions, and satisfaction were evaluated using chi-2 analyses. Results: The 305 participants had a mean age of 59.8 (range 18-87) and were 47.5% female. Ethnicities included white (75.7%), black (19.7%), Asian (2.6%), and Hispanic (0.7%). Tumor types represented were breast (19.7%), prostate (17.7%), head and neck (18%), gastrointestinal (15.1%), lung (13.4%), and other cancers (16.1%). Ninety (31.3%) patients reported experiencing SDM and 227 (76.2%) reported feeling very satisfied with their treatments. There were no significant differences in these outcomes based on demographic or clinical characteristics. Patients who experienced SDM were more likely to be satisfied with the care provided by their radiation oncologist (84.4% vs. 71.4%, p <0.02). Furthermore, the perception of having control in treatment decisions was associated with increased satisfaction regardless of whether the patient preferred control or not (Table). Conclusions: These findings emphasize the value of SDM in radiation oncology. Regardless of a patient's desire for control, it is important for physicians to engage patients in the decision making process. Both physician- and patient-targeted interventions may aid in improving SDM and, in turn, overall satisfaction among radiation oncology patients. [Table: see text]
A retrospective cohort study of inpatient chemotherapy utilization in hospitalized advanced lung cancer patients in the United States.
Authors: Kang Hyunseok , Kim Sungjin , Chen Zhengjia , El-Rayes Bassel F. , Brandes Johann Christoph , Saba Nabil F. , Khuri Fadlo Raja , Ramalingam Suresh S. , Owonikoko Taofeek Kunle 
Published: March 2020

6611 Background: The administration of chemotherapy to patients with limited performance status and within 6 weeks of death is considered an indicator of poor quality care. We assessed predictors of inpatient chemotherapy use and the risk of death in hospitalized lung cancer patients treated with chemotherapy in the US. Methods: Data were obtained from all US states that contributed to the Nationwide Inpatient Sample (NIS) by Agency for Health Care Research and Quality (AHRQ) in 2006 and 2010. Lung cancer diagnoses and inpatient chemotherapy were identified using Clinical Classification Software (CCS) code which is based on ICD9 and CPT codes. Univariate and multivariate analyses were performed to compare patients based on chemotherapy administration using ANOVA, chi-square test, and logistic regression. Initial analysis in the 2006 NIS data was validated in the 2010 NIS data. Results: 24,025 and 24,323 eligible hospitalized lung cancer patients including 1,005 (4.2 %) and 869 (3.6 %) patients treated with chemotherapy were identified in 2006 and 2010 respectively. Female gender, radiation use, urban location and longer length of stay (LOS) were significantly associated with receipt of chemotherapy. Chemotherapy administration was associated with prolonged hospital stay (14.1 ± 9.8 vs. 8.8 ± 8.1 days, p<.001) and increased odds of death in unadjusted analyses. Adjusted analysis showed significant increased odds of death in chemotherapy-treated patients with metastatic disease (vs. no metastasis); poor performance status indicated by severe loss of function (vs. minor/moderate loss of function) and increased LOS (Table). Conclusions: Inpatient administration of chemotherapy to hospitalized US lung cancer patients is associated with higher mortality and can be explained by treatment given to patients with high co-morbidity and disease burden. [Table: see text]
Desire for and use of genetic testing in a population-based sample of breast cancer patients.
Authors: Hawley Sarah T. , Hamilton Ann S. , Graff John , Katz Steven J. , Jagsi Reshma 
Published: March 2020

6615 Background: Prior research suggests that receipt of genetic testing to assess risk of disease in patients or their families is not limited to those who meet high-risk criteria (i.e., diagnosed at young age &/or with strong family history). There is little research from large population-based samples describing patterns and correlates of genetic testing receipt or reasons why patients undergo testing. Methods: We surveyed 2290 women newly diagnosed with breast cancer reported to the Detroit & Los Angeles SEER registries from 6/05-2/07. We merged these data to SEER and re-surveyed them again approximately 4 years later (n=1536). The primary outcomes were patient reports of a strong desire for genetic testing, participation in a discussion about genetic testing, and receipt of genetic testing. We also evaluated patient reports of reasons for getting tested. We compared dependent and independent factors using chi-square tests and used logistic regression to evaluate correlates of each outcome. Results: One third (33.9%) reported a strong desire to be tested, of whom 54% discussed testing with a health professional, & 46% were tested. A strong desire to be tested was associated with younger age (F=32.03, P<0.001), minority race (F=62.5, P<0.001), family history of breast &/or ovarian cancer (F=18.5, P<0.001) and worry about recurrence (OR: 1.8; 95% CI: 1.3-2.6). Overall, 19.3% were tested. Test receipt was significantly associated with younger age (F=26.8, P<0.001), higher education (OR: 1.8; 95% CI:1.13-2.71), and family history (F=25.1, P<0.001). Of those tested, reasons included: physician recommendation (61.8%), wanting more information about one’s own health (51.8%), wanting more information for family (54.2%), and family desire (13.6%). 7.8% of those not tested indicated it was because of the expense. Conclusions: Many women have a strong desire for genetic testing after diagnosis of breast cancer but often do not discuss testing with professionals. Desire for testing was correlated with pertinent clinical factors but also non-clinical factors such as minority race and worry about recurrence. Results suggest the continued need to address patient desire for testing and selection of appropriate patients for testing.
Predictors of early mortality and validation of novel prognostic models in Asian patients on phase I trials (PIT): A single-center experience.
Authors: Ahmad Aziah , Ong Whee Sze , Lim Wan-Teck , Tai Wai Meng David , Lim Cindy , Tan Eng-Huat , Choo Su Pin , Tan Daniel Shao-Weng 
Published: March 2020

6618 Background: Despite the growing number of clinical trials conducted in Asia and the unique pt demographic and molecular profile of endemic cancers, there is still lacking of studies examining the outcomes of pts on PIT. We examined the characteristics and outcomes of pts enrolled in phase I trials in National Cancer Center Singapore (NCCS). Methods: We reviewed 296 pts enrolled in PIT from 2004-2012 to identify factors that predicted for 90-day mortality and OS. Logistic regression model and Cox proportional hazard model assessed factors associated with 90DM and OS, respectively. The discriminative ability of the RMH prognostic score (LDH, no of met sites, albumin) and the final multivariate Cox model derived in Asian pts was evaluated using Harrell’s concordance index (c-index), and that for the logistic model was based on area under ROC curve (AUC). Internal validation was performed based on simulated data via bootstrapping. Results: Median age 60 (23-85), M:F (65/35%). The commonest cancer type thoracic (56%), GI (24%), head and neck (12%). 57% pt had comorbidities, commonest diabetes (16.6%) and hepatitis B (11.1%). Median no of lines of treatment 2. 20% of pts had known mut status. 15% pts survived less than 90 days from start of trial. Median OS was 9.6 m (95CI 7.8-11.2 m). Based on the RMH prognostic model, pts with score of 0 to 1 had a superior OS (median OS = 12.9 m) compared to those with score of 2 to 3 (OS = 5.7 m) (p < 0.001). The c-index for the RMH prognostic score was 0.64. On univariate analysis, alb<35,LDH>ULN, ≥3 met sites, low BMI, ECOG>0, Na<135,plt>440, Hb<12 and ≥3 lines of chemo were negative prognostic factors. On multivariate analysis, reduced model selection techniques identified alb<35, LDH>ULN, ≥3 met sites, and ≥ 3 prior lines of chemo as independent negative predictors of OS with a bias-corrected of 0.69. For 90DM, we developed a risk normogram based on ECOG, WBC, Na and Hb as continuous predictors with bias-corrected AUC 0.78. Conclusions: We have developed a novel NCCS normogram to predict for 90DM for PIT. The RMH prognostic score can be improved upon with the addition of number of prior lines of chemotherapy, underscoring the importance of early access to phase I trials.