bluuebunny/crossref_metadata_2025_split huggingface dataset:
A qualitative study of the subjective experience of chemotherapy-induced nausea in cancer patients and survivors.
Authors: Olver Ian N. , Eliott Jaklin A. , Koczwara Bogda 
Published: March 2020

e19553 Background: Despite improvements in anti-emetics and reduction of chemotherapy-induced vomiting, nausea remains problematic. We hypothesize that a set of symptoms is identified by patients as nausea and these vary. Methods: Two groups of cancer patients (N = 42) with current or past experience of chemotherapy-induced nausea consented to semi-structured interviews about nausea, which were transcribed and analyzed. At interview, survivors were a median of 3.5 years (range 4 weeks – 15 y) post-treatment, median age 50 (range 25 – 80); current patients were being treated in an out-patient clinic, median age 54 (range 39 – 72). Both groups comprised 12 females and 9 males. Results: Across both groups, the nature, number, location, duration and intensity of experiences described as nausea varied; no single symptom was common to all descriptions. Physical and psychological symptoms sometimes but not always included dry-retching, vomiting, loss of appetite, indigestion, change of taste, dizziness, bloating, reflux, inability to concentrate, fatigue and physical restlessness. Location of nausea varied from head/neck, sternum, mid and lower abdomen and the whole body. Onset ranged from immediate to day 5 post-chemotherapy. Duration was from 1.5 hours to 6 months with conditioned stimuli continuing to trigger nausea 11 years post-treatment in one case. Intensity varied between and within, patients and successive treatments. For most, distinguishing features of chemotherapy-induced (as opposed to other) nausea were a constant presence over time, fatigue and emotional associations with the cancer diagnosis; for many, nausea negatively impacted on social and work interactions. Triggers also varied, and included food (smells), negative emotions including anxiety, movement, smells (e.g. hand-cream, cleaning products), treatment related events, tooth-brushing and mentioning nausea. Prescribed anti-emetics were consistently noted as reducing the intensity of, but for many, not completely alleviating, nausea; distraction and relaxation were preferred management techniques. Conclusions: Control of nausea will require personalized management of a range of physical and psychological symptoms.
Antiemetic effectiveness of palonosetron and first-generation serotonin inhibitors for high emetic risk chemotherapy in the post-aprepitant era.
Authors: Yun Jina , Jeon Young Woo , Kim Han Jo , Kim Kyoung Ha , Kim Se Hyung , Kim Hyun Jung , Lee Sang Cheol , Bae Sang Byung , Lee Namsu , Lee Kyu Taek , Park Sung Kyu , Won Jong-Ho , Hong Dae Sik , Park Hee Sook 
Published: March 2020

e19554 Background: Palonosetron(PAL) is a 5-HT3 antagonist with an approximately 100-fold higher binding affinity for the 5-HT3 receptor compared to the other serotonic antagonists(i.e., ondansetron, granisetron, and dolasetron). Several large phase III trials have demonstrated the superiority of palonosetron compared with other 5-HT3 antagonists in preventing emesis associated with both moderate and high emetic risk chemotherapy regimens. But, these studies carried out in the pre-aprepitant era. We assessed that PAL is still preferred over the other serotonin inhibitors for high emetic risk chemotherapy in the post-aprepitant era. Methods: A retrospective analysis was made of all patients who underwent serotonin inhibitor, aprepitant and dexamethaxone for high emetic risk chemotherapy between 2009 and 2011. Group A received PAL, aprepitant and dexamethaxone. Group B received first-generation serotonin inhibitors(ondansetron, granisetron or dolasetron), aprepitant and dexamethaxone. Results: Four hundred fourty patients were included in the analyses: 331 patients in the Group A and 109 patients in the Group B. No case of grade 3-4 nausea/vomiting was noted. There were no significant differences between Group A and Group B for both acute and delayed CINV. The proportion of patients with a emesis-free during the acute phase(0-24 h) was similar in both groups: 275 of 331 patients(83%) in the Group A vs 88 of 109 patients(81%) in the Group B. The proportion of patients with a emesis-free during the delayed phase(24-120h) was similar in both groups: 255 of 331(77%) vs 76 of 109 (70%). Conclusions: In aprepitant era, all of the serotonin inhibitors seems to be equally effective for high emetic risk chemotherapy.
Treatment of post-herpetic pain with scrambler therapy, a patient-specific neuro-cutaneous electrical stimulation device.
Authors: Smith Thomas J. , Marineo Giuseppe 
Published: March 2020

e19564^ Background: Post herpetic neuropathy (PHN) is common in cancer and hematologic malignancy patients. It can be debilitating and difficulty to treat effectively. Scrambler therapy, a patient-specific neurocutaneous stimulation device, can be effective in treating chemotherapy induced neuropathy (JPSM 2010) and other neuropathic pain (JPSM 2012). Methods: We treated ten patients, 2 with cancer as their primary diagnosis, with refractory PHN Scrambler therapy at two institutions. Scrambler therapy was given as 30 minute sessions daily for 10 days. Pain was recorded before and after treatment. Results: The patient mean age was 54 ± SD 13 years, 6 men and 4 women, with a mean duration of PHN for 15.6 months (range 2.5 to 48 months) without satisfactory relief despite conventional drugs. The average pain score rapidly diminished from 7.64 ± 1.46 at baseline to 0.42 ± 0.89 at one month, a 95% reduction, with continued relief at 2 and 3 months. Patients achieved maximum pain relief with less than 5 treatments. Conclusions: Scrambler therapy appears to have a promising effect on PHN, with prompt and continued relief and no side effects. Further research is warranted. [Table: see text]
External validation of the simple prognostic score in a palliative care clinic at a comprehensive cancer center.
Authors: Vij Brinder , Stabler Stacy Marie , Thaler Howard T. , Glare Paul A. 
Published: March 2020

e19566 Background: Accurate survival predictions are essential for the optimal delivery of palliative care (PC). Clinical predictions of survival are notoriously inaccurate. Tools for making objective survival estimates in ambulatory cancer patients, who have months or years to live, are lacking. The Simple Prognostic Score (SPS) separated Canadian palliative radiotherapy patients into three groups with 12, 6 and 3 months median survivals, respectively. The aim of this study was to test the SPS in an outpatient PC clinic at a U.S. comprehensive cancer center. Methods: Retrospective chart review of 300 consecutive patients referred to one PC clinic at Memorial Sloan-Kettering Cancer Center (MSKCC). Cancer type, metastatic sites and Karnofsky performance status (KPS) score were used to calculate SPS (1 point each for non-breast cancer; non-osseous metastases; KPS score <70%). Outcome was date of death, obtained from the MSKCC institutional data base. Survival analysis was performed. Discrimination (non-overlap between groups) and calibration (percentage difference between estimated and observed survival) were measures of accuracy. Results: 79% (236 of 300) patients had advanced disease. Of them, 90% had cancers other than breast; 76% had metastases in sites other than bone; 27% had a low KPS score. The SPS score was 2 or 3 in 80%. By 10/31/11, 85% had died (median survival 4.9 months). SPS categorized the sample into four prognostic subgroups (see Table), with median survivals of 15, 9, 5 and 2 months respectively (log rank test χ2=38.71, d.f .3, p<0.0001). SPS was not very accurate, with poor discrimination (extensive intergroup overlap) but reasonable calibration (6-15% for the different groups). Conclusions: The SPS is user-friendly and helpful at the group level, but inaccurate at the individual level. Additional variables may narrow the prediction intervals, but will make the tool more complex. [Table: see text]
Intra-and inter-patient variability of baseline pain intensity scores during breakthrough pain in cancer.
Authors: Burton Allen W, , Filbet Marilene , Tayi Ravi , Perelman Michael Sidney , Knight Alastair D. 
Published: March 2020

e19578 Background: Breakthrough pain in cancer (BTPc) can be assessed using a patient-reported 11-pt pain intensity (PI) scale (0=no pain; 10=worst possible pain). Little information has been reported about variation of PI between episodes and between individuals. This analysis examined intra- and inter-patient variation in baseline PI scores among patients participating in BTPc clinical trials. Methods: This was a pooled analysis of data from 2 randomized, double-blind, crossover studies that treated BTPc with fentanyl pectin nasal spray (Lazanda®, PecFent®) compared with placebo or with morphine sulfate immediate release. Patients were adults with ECOG score ≤2 who experienced BTPc despite background pain that was adequately controlled with ≥60mg morphine (or equivalent). Each study included dose titration prior to the double-blind treatment phase of 10 episodes of BTPc. Inter- and intra-patient variability of baseline pain scores for each episode were analyzed by ANCOVA using a mixed-effect model. Influence of covariables including demographics and ECOG score at study entry was assessed. Results: A total of 152 patients had 1399 BTPc episodes assessed. Mean (SD) age was 54.2 (12.0) yr; 81 patients (53%) were men. The mean ± SD episode baseline PI score was 7.3 ± 1.76 (range 2-10). Inter-patient variability of baseline PI scores was 75.9% and between-study variability, 3.5%; intra-patient variability among the 152 patients was 20.6%. Fixed terms for demographics and ECOG score were not significant factors influencing baseline PI scores at or below the 5% level. Conclusions: This analysis demonstrates that BTPc episodes have large variations in baseline PI scores between patients and that these scores are not influenced by demographics or ECOG score (0-2). However, individual patients show comparatively low variability in baseline PI scores between BTPc episodes. This supports the use of a consistent maintenance dose of an analgesic agent once it has been titrated to an effective dose.
The effect on patients with pulmonary fibrosis (PF) and advanced non small cell lung cancer (NSCLC): A prospective, feasibility study of S-1 and carboplatin.
Authors: Kato Terufumi , Yamaguchi Ou , Yoshida Masahiro , Fukushima Hiroki , Ogata Ryo , Nakazawa Atsuhito , Oda Tsuneyuki , Okuda Ryo , Ikeda Satoshi , Takasa Akiyuki , Tsuchiya Noriko , Enomoto Takahiro , Baba Tomohisa , Kitamura Hideya , Shinohara Takeshi , Nishihira Ryuichi , Komatsu Shigeru , Hagiwara Eri , Ogura Takashi 
Published: March 2020

e19583 Background: PF is commonly concomitant disorder with lung cancer. Because PF sometimes deteriorates and results unfavorable clinical course, patients with PF are excluded from most cancer clinical trials. S-1 is a novel active oral fluoropyrimidine anticancer agent consisting of tegafur, gimeracil and oteracil potassium. Although most anti-cancer agent have pulmonary toxicity, post marketing surveillance reported S-1 has lower pulmonary toxicity incidence. We have conducted feasibility study of S-1 and carboplatin combination for patients with advanced or ineligible for other treatment modality of NSCLC patients. Methods: Patients with histologically or cytologically confirmed NSCLC, clinically diagnosed pulmonary fibrosis, aged 80 years old or younger, performance status 0-2 and chemo naive were eligible for the study. Carboplatin (AUC 5) was administered on day 1 and S-1 (80mg/m2/day) on day 1 to 14 for four to six cycles. Endpoints were response rate, common safety profiles and effect to PF. Results: From March 2009 to December 2011, 21 pts (19 males/ 2 females, median age 67 years old, ranged 55 to 77, 10 adenocarcinoma, 10 squamous, 1 adenosquamous, stage IIA: 1, IIIA: 3, IIIB: 9, IV: 4, recurrence: 4) were enrolled. All patients had moderate or severe PF. Treatment delivery; 1 cycle: 3pts, 2: 3pts, 3: 3pts, 4: 10pts, 5; 1pts, 6: 1pts. Partial responses were observed in 7 patients (RR; 33%). The median progression free survival duration was 4.0 months and the median overall survival duration in 10.4 months. During the treatment, 2 patient experienced moderate deterioration of pulmonary fibrosis, 1 experienced infectious pneumonia, all three patients recovered from the event. There was no treatment related death. Besides pulmonary toxicity, most common adverse events were myelotoxicities. Conclusions: This is the first trial of S-1 and carboplatin combination for patients with PF and NSCLC. The study revealed S-1 and carboplatin combination was feasible and active even in patients with PF and NSCLC who are usually excluded from cancer clinical trials.
Temporal versus probabilistic approach to survival estimation: Physician’s accuracy over time.
Authors: Perez-Cruz Pedro Emilio , Hui David , dos Santos Renata , Kilgore Kelly L. , Buosi Silva Thiago , Chisholm Gary B. , de Almeida Leite Raphael , Souza Crovador Camila , Del Fabbro Egidio , de Angelis Nascimento Maria Salete , Zhukovsky Donna S. , GonÃƒÂµaves de Freitas Seriaco Fabiola de Lourdes , Reddy Suresh K. , Machado Frascari Luciana , Dalal Shalini , Paiva Carlos Eduardo , Dev Rony , Hall Stacy , Fajardo Julieta , Bruera Eduardo 
Published: March 2020

e19584 Background: Physicians are inaccurate in estimating survival. Both Temporal and Probabilistic approaches have been used for prediction. Serial prognostication might improve accuracy. In this study we compare these two approaches and assess whether serial prognostication improves accuracy. Methods: Physicians prognosticated survival daily for cancer patients admitted to palliative care units in two hospitals until death/discharge, using two prognostic tools: Temporal (What is the approximate survival of this patient in days?) and Probabilistic (What is the probability that this patient will be alive in 24 hrs?, 0% to 100%) (Hui et al. Oncologist 2011). Temporal prognosis was accurate if it fell within ± 33% of the actual survival. Probabilistic prognosis was accurate if the clinician selected a survival probability ≥70% and the patient survived in ≤24 hours or the clinician endorsed a survival probability ≤30% and the patient died. We compared physicians’ accuracy with each method at specific time points using Mc Nemar’s test. We assessed accuracy for each method over time comparing the accuracy at each time point with day -14 using a test of proportions. Results: Baseline characteristics of 306 patients included mean age 58 (18-88), female 69%, Caucasian 76%. Physicians were significantly more accurate in prognosticating survival with the Probabilistic v/s Temporal approach (p<.001 at each time point). The accuracy of Temporal approach was stable over time (Table). The accuracy of Probabilistic approach decreased close to death (Table). Conclusions: Physicians were more accurate at estimating probability of survival at 24 hrs than at estimating days to death. The accuracy of the probabilistic approach decreases as patient approaches death. Serial prognostication does not improve accuracy of survival estimation. [Table: see text]
Effect of enobosarm on physical function in cancer patients with < or ≥ 5% weight loss in a phase IIb trial.
Authors: Dodson Shontelle , Johnston Mary Ann , Hancock Michael L. , Steiner Mitchell S. 
Published: March 2020

e19585 Background: Although cachexia has been defined as >5% weight loss, limited data exists on the prevention and treatment of muscle wasting prior to a patient becoming cachectic. Cancer induced muscle wasting can begin early in the course of a patient’s malignancy resulting in decline in physical function and other detrimental clinical consequences including less tolerability to chemotherapy, worse outcomes, and shorter survival - underscoring the importance of diagnosing and treating this condition at an early stage. Methods: We conducted a randomized, double blind, placebo controlled, multi-center study to evaluate the effect of enobosarm on physical function and muscle wasting in cancer patients. Subjects (n=159) were randomized to oral enobosarm or placebo for 16 weeks. Subjects were males >45y and postmenopausal females, with ≥2% weight loss in the 6 months prior to randomization and diagnosed with NSCLC, colorectal cancer, non-Hodgkin’s lymphoma, chronic lymphocytic leukemia or breast cancer. We report on changes in physical function based on weight loss of < or ≥5%in the 6 months prior to randomization. Results: 103 subjects (MITT) had physical function assessed by stair climb at baseline and week 16 with 24% losing <5% weight in the previous 6 months. Distribution of weight loss was similar across genders, however subjects with <5% weight loss were more likely to be ECOG=0 (<5% loss: 46.2%; ≥5% loss: 35.8%). Subjects with ≥5% weight loss had worse physical function at baseline compared to those with <5% loss (p=0.048). A significant improvement in physical function was observed in subjects that received enobosarm regardless of baseline weight loss (<5% loss, p=0.041, ≥5% loss, p<0.001) while subjects that received placebo failed to improve. Conclusions: Enobosarm was generally well tolerated and showed a statistically significant improvement in physical function in cancer subjects regardless of baseline weight loss. These data provide evidence that enobosarm may play an important role in the management of cancer patients by not only treating, but also preventing further decline in physical function and muscle wasting before a patient becomes cachectic.
Comparison of pain and efficacy between large-bore and small-bore chest tube drainage for malignant pleural effusion in Songklanagarind Hospital: A randomized controlled trial.
Authors: Porntepkasemson Apirudee , Geater Sarayut Lucien 
Published: March 2020

e19608 Background: Malignant pleural effusion is one of the most common presenting symptoms in lung cancer. There has been no large RCT comparing large-bore and small-bore chest tubes in terms of pain and efficacy of management. Methods: A randomized controlled trial was conducted in 2011. Patients with malignant pleural effusion were randomly allocated to receive either a large-bore or small-bore chest tube. The primary objective was to compare pain using the Numeric Rating Scale. Other objectives included the efficacy of the drainage and pleurodesis and any complications were recorded. Results: Each arm comprised 21 patients. Median age was 61.2 years. Thirty-eight patients (90.5%) had adenocarcinoma; 14(33.3%) had received systemic chemotherapy. Pain score did not differ significantly between the groups from the time of tube insertion to removal. However, pain rose from day 4 until day 9 in the small-bore group. The proportion of patients requiring a second chest tube was higher in the small-bore group (small-bore = 7, 33.3 %; large-bore = 1, 4.8%; p 0.052). Complications were higher in the small-bore group. Five patients were complicated by tube occlusion which occurred only in the small-bore group (23.8 %, p 0.048). Times from tube insertion to lung expansion, to pleurodesis and to chest tube removal did not differ significantly between groups. Pleurodesis was effective in 70-80 % in both groups at the 28-day follow-up. Conclusions: No differences between large-bore and small-bore chest tubes were seen in pain, efficacy of drainage or success of pleurodesis. However, small-bore chest tubes had a higher rate of occlusion and more frequently required additional tube insertion.
Clinical outcome of recombinant human soluble thrombomodulin (rTM) for patients with disseminated intravascular coagulation (DIC) complicating advanced solid cancer: Retrospective analysis.
Authors: Takahashi Shin , Ohuchi Kohta , Kato Shunsuke , Shimodaira Hideki , Kakudo Yuichi , Akiyama Shoko , Yoshida Kozue , Shiono Masatoshi , Okada Yoshinari , Sugiyama Shunsuke , Saito Naoko , Lee Jin , Oishi Takayuki , Takahashi Hidekazu , Yoshino Yuki , Ishioka Chikashi 
Published: March 2020

e19611 Background: Disseminated intravascular coagulation (DIC) is a syndrome characterized by the activation of coagulation leading to systemic microvascular thrombosis. DIC is frequently observed in patients with hematologic malignancy and often in patients with advanced cancer. Recombinant human soluble thrombomodulin (rTM) has been introduced as a new type of anti-DIC agent for clinical use in patients with hematological cancer or infectious disease. However, the efficacy for advanced solid cancer has not been elucidated. Methods: All patients with DIC complicating advanced solid cancer who were treated by rTM in Tohoku university hospital from December 2009 to November 2011 were enrolled in this retrospective study. DIC was diagnosed and scored according to the diagnostic criteria established by the Japanese Ministry of Health and Welfare (JMHW DIC criteria). Change in DIC score and period of overall survival (OS) after treatment of rTM (380U/kg/day) were evaluated. The Kaplan-Meier method was used to calculate OS. Results: Twenty-two patients (32% female) were enrolled. The median age was 61.5 (r: 32-82). The primary organs were 7 stomach, 3 colorectal, 2 esophageal and 10 other cancers. DIC score (63.6%), FDP (54.5%), PT-INR (45.4%), FBG (36.4%) were kept or improved in these patients between day 1 and day 5 in rTM treatment. Median OS (mOS) was 30 days (r: 2–301). Subgroup analyses revealed that mOS was longer in patients who underwent chemotherapy following rTM treatment than in patients who did not (114 days vs. 10 days, p = 0.0083). Patients with better ECOG PS (<2 vs. >3; 114 days vs. 15 day, p = 0.018), smaller number of chemotherapy treated before DIC (<2 vs. >3; 69 days vs. 6 days, p = 0.0008) also showed better mOS. No critical complication was observed. Conclusions: This study showed that rTM was effective and safe for patients with DIC complicating advanced solid cancer. PS and number of chemotherapy regimens could be predictive factor of rTM. We considered that rTM yield the chance of chemotherapy to advanced cancer patients with DIC by preventing deterioration of DIC.