bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advanced gastrointestinal cancer patients' perceptions of prognosis and goals of treatment.
Authors: El-Jawahri Areej , Traeger Lara , Park Elyse R. , Greer Joseph A. , Pirl William F. , Lennes Inga Tolin , Jackson Vicki A. , Gallagher Emily R. , Temel Jennifer S. 
Published: March 2020

6106 Background: Patients with advanced cancer require accurate perception of their illness in order to make informed decisions regarding their care. However, little is known about the accuracy of these patients’ illness and prognostic understanding. The objectives of this study are to 1) examine prognostic understanding in patients with advanced gastrointestinal (GI) cancers, 2) assess patient preferences for prognostic information, and 3) explore associations of perceptions with quality of life (QOL) and mood. Methods: Cross-sectional study of 50 patients within 6-12 weeks post diagnosis of advanced GI cancers (gastric, esophageal, pancreatic, and hepatobiliary). We assessed patients’ perceptions of prognosis with a 15-item questionnaire, the Perception of Treatment and Prognosis Questionnaire. QOL and mood were assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) and hospital anxiety and depression scales (HADS), respectively. Results: We enrolled 50/62 (80%) consecutive eligible patients within an 11-month period. 50% (25/50) of participants responded that the primary goal of their cancer treatment was to “cure their cancer.” Similarly, 54% (27/50) reported that they were “somewhat” to “extremely likely” to be cured from their cancer. Only 22% (10/49) reported having a discussion about their end-of-life care preferences with their oncologist. 76% (38/50) reported wanting to know as many details as possible about their cancer diagnosis and treatment and 64% (32/50) rated this information as “extremely important.” Patients who perceived knowing about their prognosis as “extremely helpful” reported a better QOL (p = 0.009), lower symptoms of anxiety (p = 0.02) and depression (p = 0.02). Conclusions: Although the majority of patients report that they desire detailed information about their prognosis, half incorrectly perceived their cancer as curable and the majority did not discuss their end-of-life care preferences with their oncologist. Patients who found learning about their prognosis to be extremely helpful reported better QOL and mood. Studies of interventions to increase advanced cancer patients’ knowledge of their prognosis and to encourage end-of-life discussions are warranted.
Association between baseline physical function and comorbidity status with patient-reported quality of life after prostate cancer treatments: Combined analysis of two prospective cohort studies.
Authors: Chen Ronald C. , Reeve Bryce B. , Deal Allison Mary , Moore Dominic T , Talcott James Austin 
Published: March 2020

6107 Background: Treatment-related bowel, urinary, and sexual dysfunction in prostate cancer patients varies by treatment type, baseline function and other patient factors. To better predict patient outcomes after treatment, we examined the impact of comorbidity on these quality of life (QOL) outcomes in a secondary data analysis of two pooled, prospective cohort studies. Methods: A total of 697 patients from 3 academic hospitals who received radical prostatectomy, external beam radiation, or brachytherapy were included. Using a validated instrument, patients reported bowel, urinary, and sexual symptoms pretreatment, and at 3, 12, 24, and 36 months after treatment. Baseline physical function was measured by the physical component summary score (PCS) of the SF-12 using patient report. Comorbidity as measured by the Index of Co-Existent Disease (ICED) was obtained from medical record review. Repeated QOL measurements were analyzed using a mixed modeling method, by random coefficient modeling. Separate models were built for each outcome using bowel, urinary, and sexual scale scores at each time point.Covariates in all models included baseline age, education, ICED, and PCS. Results: Approximately 70% of patients had one or more comorbid conditions at baseline. After adjusting for age and education in mixed-models, we found baseline comorbidity was independently associated with more sexual dysfunction (p<.001) and urinary incontinence (p=.03). Worse baseline physical functioning was independently associated with more bowel problems (p<.001) and sexual dysfunction (p<.001). There were no treatment by comorbidity or physical functioning interactions. Conclusions: Comorbidity and worse physical functioning at baseline are significantly associated with poorer bowel, urinary, and sexual function after treatment for prostate cancer, but the associations do not appear to differ by treatment. Patients with comorbidity recovered more slowly. This information may help patients and their physicians anticipate outcomes after surgical and radiation treatments.
Pregnancy outcomes in women with cancer.
Authors: Milbourne Andrea , Sun Charlotte C. , Fanale Michelle A. , Theriault Richard L. , Rimes Sue A , Litton Jennifer Keating , Ramirez Mildred M. 
Published: March 2020

6116 Background: Parenthood after cancer is a critical concern for many cancer patients (pts). Pregnancy (prg) during cancer is an emotional time for about 1/1000 pregnant women. No randomized controlled studies exist examining the impact of cancer treatment (tx) on the developing fetus nor on the woman with cancer. Methods: From 2002-2011, women presenting for cancer tx during prg were approached for this IRB-approved prospective database study. All pts provided written consent. Results: To date 143 pts are evaluable. The median age at diagnosis was 32.1 years and median gestational age (GA) at enrollment was 18.2 weeks. 95/143 (66.4%) are White, 19 (13.3%) are African American, 17 (11.9%) are Hispanic and 12 (8.4%) are Asian/Other. Primary cancers included breast (n=59, 41.3%), hematologic (n=29, 20.3%), melanoma (n=13, 9%), GYN (n=11, 8%), GI (n=8, 5.6%), head/neck (n=7, 6%) and other (n=16, 11%) (brain=4, GU=1, thyroid=3, head/neck=7, thoracic=1, sarcoma=6, unknown primary=1). 111/143 (77.6%) of prgs resulted in live births. Median birth weight was 6.5 lbs. Median follow-up time for pts was 32.3 months. To date, 3/19 pts who terminated prgs have died (1.6%). Most terminations occurred in the 1st trimester. To date, 79 pts (55.2%) are NED and 23 pts have died; of these 19 (1.7%) had live births. No major malformations were observed in the 74/143 (52%) of pts who received chemotherapy (CTx) during pregnancy. 57% received FAC/FEC; other regimens included ABVD (n=5), cytarabine (n=5), CHOP/R-CHOP, and platinum-based regimens. Median GA at the start of CTx was 19.7 wks. Median number of CTx cycles during prg was 4. Other pts underwent surgery (n=32), no tx (n=14), deferred tx until after delivery (n=17), radiation (2), transplant (3), other (1). Conclusions: Cancer diagnosis during prg is compatible with successful tx and prg outcome. Cancer tx during the 2nd and 3rd trimester can be safely given and in our pts did not result in adverse prg outcomes. Tx during the 1st trimester is usually not recommended. Thus cancer pts in their 1st trimester need to be extensively counseled about their disease as well as about the risks to the prg. In our pts continuation or termination of prg were not associated with an increased risk of death.
Influence of hospital characteristics on immediate breast reconstruction following mastectomy.
Authors: Richards Catherine A. , Wright Jason Dennis , Neugut Alfred I. , Ascherman Jeffrey , Hershman Dawn L. 
Published: March 2020

6118 Background: Immediate breast reconstruction (IBR) following mastectomy is underutilized in the U.S. Racial, economic and geographic factors are associated with lower rates of IBR. Prior research has explored the association of individual and surgeon-level factors with the use of IBR, with little attention paid to hospital characteristics. Methods: We analyzed data from the 2008 Nationwide Inpatient Sample (NIS), a 20% random sample of academic, public and private U.S. hospitals. We used ICD-9 codes to identify women diagnosed with invasive breast cancer or DCIS who underwent mastectomy, and IBR (natural or expander/implant). If a hospital performed at least one IBR during 2008, they were classified as performing reconstruction. Relative risk regression was used to assess the hospital factors associated with a hospital performing IBR. Results: Of the 3,518 hospitals that performed mastectomy in 2008 only 50.4% performed at least one IBR. For hospitals that did not perform IBR, the average number of mastectomies was 5, compared to 35 at hospitals that did perform IBR (p<0.01). Among hospitals that did perform IBR, the mean proportion of mastectomy patients that had IBR was 34% (SD=20). In a multivariable adjusted model, urban/teaching (RR=3.47) and urban/non-teaching (RR=2.86) hospitals were significantly more likely to perform IBR compared to rural hospitals. Hospitals with a high proportion of privately insured patients (RR=1.10) were significantly more likely to perform IBR compared to hospitals with a low proportion of privately insured patients. In contrast, hospitals with a high proportion of publically insured patients (RR=0.24) and hospitals with a high proportion of female patients ≥ 70 years old (RR=0.75) were significantly less likely to perform IBR. Hospital region, hospital ownership status and the proportion of nonwhite patients were not significantly associated with IBR. Conclusions: Almost half of all U.S. hospitals where mastectomies are performed do not have any patients who have undergone IBR. The likelihood a hospital will perform IBR varies significantly by hospital characteristics.
Why do cancer patients die in the emergency department (ED)? Analysis of 283 deaths in North Carolina EDs in 2008.
Authors: Leak Ashley Nicole , Mayer Deborah K. , Travers Debbie , Wyss Annah , Waller Anna 
Published: March 2020

6119 Background: Emergency departments (ED) in the US are utilized by cancer patients for symptom management, treatment side effects, oncologic emergencies, and/or end of life care. EDs have become a place where acute care needs are addressed and there are discussions about end of life care. The purpose of this study was to describe characteristics of cancer patients who died in the ED, highlighting lung cancer patients and their ED visit characteristics. Methods: A secondary data analysis of ED visit data fromthe North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a population database of 110 of the 112 EDs in NC in 2008. This was a descriptive, retrospective analysis providing descriptive statistics of patient demographics including: sex, age at death, insurance, cancer type, and visit categories (hour, day, month). Free text chief complaints, as recorded by the health care provider, were cleaned and categorized. Results: There were37,760 ED visits by 27,644 patients associated with cancer; 283 (1%) of these visits resulted in death in the ED. The most common chief complaints of those who died were respiratory distress (17.3%), neurological changes (13.4%), and pain (5.7%). Of all cancer deaths, 63% were male with a mean age of 66 (SD 14.2). Over a third (N= 104, 36.7%) of cancer ED visits resulting in death had a code for lung cancer listed. Medicare was the insurance provided for almost half (47.3%) of these patients. Majority of deaths occurred on a patient’s first ED visit (70.9%). Although a third (34.7%) of deaths occurred during weekends, over a third (37.5%) occurred during weekday clinic hours. Conclusions: Even though deaths in the ED were infrequent, this study provides insight into reasons patients visit the ED. Some patients were enrolled in Hospice and/or had a DNR documented. This study can inform future research associated with precipitating factors leading up to the ED visit (e.g. worsening shortness of breath, location of care prior to ED visit). This study illustrates the importance of research on discussion of end of life care needs (advanced directives, code status, use of Hospice services) with cancer patients and their family before they reach the final stage of their disease.
Survival outcomes in HER2-positive invasive lobular breast carcinoma.
Authors: Barcenas Carlos Hernando , Hess Kenneth R. , Delpech Yann , Pusztai Lajos , Hortobagyi Gabriel N. , Giordano Sharon Hermes , Esteva Francisco J. 
Published: March 2020

612 Background: HER2-positive (HER2+) invasive lobular breast carcinoma (ILC) is a rare entity and survival outcomes are not well characterized. Methods: We retrospectively searched for breast cancer patients treated at MD Anderson Cancer Center between 1992 and 2010 with a diagnosis of early stage (I-III) HER2+ILC or with HER2+ invasive mixed ductal/lobular carcinoma (MIX). With the purpose of comparing survival outcomes, we looked for patients with a diagnosis of HER2-negative [HER2(-)] ILC, HER2(-)MIX, and HER2+ invasive ductal carcinomas (IDC). We obtained data on demographics, estrogen (ER) and progesterone (PR) receptor status, tumor grade, chemotherapy received and survival status. A multivariate analysis using a Cox proportional hazards regression was performed to compare disease-free survival (DFS) and overall survival (OS) between the following groups: 1) HER2+ILC vs. HER2(-)ILC; 2) HER2+MIX vs. HER2(-)MIX; 3) HER2+ILC vs. HER2+MIX; 4) HER2+ILC vs. HER2+IDC; 5) HER2+MIX vs. HER2+IDC. Results: The number of patients identified for each group was: HER2+ILC (N= 67), HER2(-)ILC (N= 1260), HER2+MIX (N= 92), HER2(-)MIX (N= 932), HER2+IDC (N= 3080). Specifically for both the HER2+ILC and HER2+MIX groups, 24% patients were stage I, 43% stage II and 33% stage III. The median age at diagnosis was 53 years (y) in HER2+ILC, and 49 y in HER2+MIX. The ER/PR were both negative in 16% of HER2+ILC patients, and in 25% of HER2+MIX. While 80% of patients in these two groups received chemotherapy, 36% of HER2+ILC patients received trastuzumab compared to 50% of HER2+MIX. The median follow up was 60 months in the HER2+ILC group and 53 months in the HER2+MIX group. DFS and OS were not statistically different between all groups compared. However, the subgroup of ER/PR negative HER2+MIX patients had a better OS compared to ER/PR/HER2 negative (triple negative) MIX patients (Hazard ratio = 0.4, 0.2 – 0.9, p= 0.026). Conclusions: HER2+ILC and HER2+MIX are rare clinical entities and their survival outcomes may not differ from the more common HER2(-)ILC, HER2(-)MIX and HER2+IDC. ER/PR negative HER2+MIX may have an OS advantage over triple negative MIX tumors.
Do patient tracking, follow-up, and referral practices contribute to breast cancer disparities in a large urban area?
Authors: Weldon Christine B. , Trosman Julia R. , Dupuy Danielle , Roggenkamp Betty , Schink Julian C. , Orsi Jennifer M. , Murphy Anne Marie 
Published: March 2020

6120 Background: Chicago Black women are 62% more likely to die from breast (BC) cancer than White women. Previous data from 39 Chicago hospitals suggested significant quality deficits in breast cancer screening and treatment (Chicago Breast Cancer Quality Consortium, 2010). Patient tracking, follow up and referral practices may influence quality of care for minority women (Mojica et al, Cancer Control, 2007). Our goal is to evaluate tracking, follow up and referral practices during screening, diagnosis and treatment of BC at Chicago hospitals servicing Black women. Methods: Using the framework approach of qualitative research, we conducted interviews with providers of BC screening and care from 20 Chicago institutions with Black patients averaging 50% of patient base (15 community, 3 academic and 2 public hospitals). Informants included surgeons, medical oncologists, radiologists, mammography technicians, internists, nurses, administrators, and patient navigators. Interviews were transcribed, and thematic and statistical analyses were performed (simple frequencies and Fisher's exact test). Results: Six of the 20 sites (30%) follow up with patients who did not show for a scheduled mammography visit. Five of these sites (83%, 5/6) have a low “no-show” rate (below 20%), compared to 4 sites (29%, 4/14) with low “no-show” rates among the 14 sites without follow-up (p=0.05). Seven of the 20 sites (25%) direct diagnosed patients to their next step in care by providing referrals and guidance, while other 13 sites rely on a primary care physician or leave the patient without a clear care plan. BC patients at 6 of the 7 sites directing care (83%, 5/6) are referred to a mid- or high-volume surgeon (3+ BC surgeries / month), compared to patients from only 1 of the 13 sites not directing care (p=0.001). Nine of the 20 sites track diagnosed BC patients through their care. Five of them (56%, 5/9) also track survivors, compared to none (0%, 0/11) of the 11 sites who do not track patients (p=0.008). Conclusions: Poor tracking, follow up and referral practices for breast cancer screening and treatment are associated with suboptimal care and may contribute to outcome disparities for Black women in Chicago.
Quantitative HER2 measurement and PI3K mutation profile in matched primary and metastatic breast cancer tissues.
Authors: Huang Weidong , Lara Jonathan F. , Michaelson Richard , Sun Xiu , Conte Pierfranco , Guarneri Valentina , Barbieri Elena , Ali Suhail M. , Leitzel Kim , Weidler Jodi Marie , Lie Yolanda , Haddad Mojgan , Paquet Agnes , Sperinde Jeff , Howitt John , Eisenberg Marcia , Hurley Laura , Petropoulos Christos J. , Lipton Allan 
Published: March 2020

614 Background: HER2 status of primary breast cancer (PBC) is routinely used to determine systemic treatment for metastatic breast cancer (MBC) patients. Discordance rates of HER2 status between PBC and MBC range from 5.5% to 29% based on published meta-analyses. The clinical benefit of re-assessing HER2 in MBC tissues remains controversial. In this study, we measured quantitative HER2 expression in matched PBC and MBC tissues and correlated changes of HER2 with mutations in the catalytic domain of PI3 kinase(PIK3CA). Methods: Total HER2 protein expression (H2T) was quantified by the HERmark assay in 41 matched PBC and MBC formalin-fixed, paraffin-embedded specimens. PIK3CA mutation status in exons 9 (E545K and E542K) and 20 (H1047R) was determined using a validated pyrosequencing assay. Results: MBC samples included 5 lymph node, 13 viscera, 6 brain, and 17 soft tissue lesions (N=41). 27 (66%) cases showed higher H2T in MBC than in matched PBC; and 14 (34%) cases had higher H2T in PBC than in matched MBC, indicating an overall increase of H2T in matched MBC lesions (fold change 0.25-17.57; p=0.005, paired Wilcoxon rank sum test). HER2 positive conversion (HERmark negative/equivocal in PBC, but positive in matched MBC) was found in 6 (15%) cases, while HER2 negative conversion (HERmark positive in PBC, but negative/equivocal in matched MBC) was seen in 2 (5%) cases. HER2 status was unchanged in 33 (80%) cases. PIK3CA mutations were detected in 13 (32%) of PBC and 19 (46%) of MBC samples. Among the HER2 positive conversion cases, PIK3CA mutation was identified in 50% (3/6) PBC and 67% (4/6) MBC, compared to 0% (0/2, PBC or MBC) in the HER2 negative conversion cases. Among cases with unchanged HER2 status, PIK3CA mutation was observed in 30% (10/33) PBC and 42% (14/33) MBC. Conclusions: Quantitative HER2 assessment revealed a 20% discordance in HER2 status between matched PBC and MBC tissues, with more frequent conversion from low HER2 in PBC to high HER2 in MBC. PIK3CA mutation was observed more frequently in patients who converted from HER2 negative PBC to HER2 positive MBC. These results suggest that re-assessment of biomarkers in MBC tissues may better inform the selection of therapeutic options for patients with MBC.
Use of the PRO Onc Assay (Prometheus) to measure HER2 overexpression/activation in circulating tumor cells (CTCs) in women with HER2-negative metastatic breast cancer (MBC): A Sarah Cannon Research Institute (SCRI) trial.
Authors: Hainsworth John D. , Burris Howard A. , Murphy Patrick Brian , Lamar Ruth E. , Shastry Mythili , Finney Lindsey H. , Yardley Denise Aysel 
Published: March 2020

618 Background: HER2- targeted therapy has markedly improved the treatment of women with HER2- positive breast cancer. FISH testing for HER2 overexpression is the most reliable assay method; treatment decisions are usually based on HER2 expression of the breast primary tumor. Accurate determination of HER2 status by testing CTCs may improve patient management by allowing ongoing assessment of HER2 status during treatment and/or identifying additional patients (pts) for HER2- targeted therapy. Methods: The PRO Onc assay uses a multiplexed immunoassay format to provide expression and activation profiling of HER2 and other signal transduction molecules. The assay can detect overexpression and activation (phosphorylation) of HER2, with sensitivity at a single CTC level. We obtained blood specimens from 57 women with metastatic HER2- negative breast cancer who were receiving standard chemotherapy. In these women, HER2 status had previously been determined by FISH (32) or 0 – 1+ IHC testing (25). All specimens were tested for the presence of CTCs; the PRO Onc assay was performed when CTCs were identified. The HER2 overexpression cutoff (>3.0 CU) was based on the reference value (average + 4SD) determined by analyzing normal blood obtained from 42 healthy donors. Results: 31 of 57 pts (54%) had CTCs identified. 6 of 31 pts (19%) had HER2 overexpressed, and 4 pts (13%) had HER2 activation without overexpression. 7 of 10 pts with HER2 overexpression/activation by PRO Onc Assay were FISH- negative; 3 were IHC- negative. Since initial HER2 determination, these 10 pts had received a median of 3 chemotherapy regimens (range 1 - 5). Conclusions: When CTCs were present, the PRO Onc assay identified HER2 overexpression or activation in 31% of women with HER2- negative MBC. The therapeutic significance of this finding is unknown. Since the predetermined threshold of ≥10% HER2- positive assay results was exceeded, this trial will proceed to a planned second portion, in which women with HER2- negative MBC (by FISH testing) and HER2 overexpression or activation in CTCs will receive a trial of HER2- targeted therapy.
Nilotinib versus imatinib in patients (pts) with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP): ENESTnd 3-year (yr) follow-up (f/u).
Authors: Kantarjian Hagop , Flinn Ian W. , Goldberg Stuart , Bunworasate Udomsak , Zanichelli Maria Aparecida , Nakamae Hirohisa , Hughes Timothy P. , Hochhaus Andreas , Saglio Giuseppe , Woodman Richard Charles , Blakesley Rick E. , Kemp Charisse N. , Kalaycio Matt E. , Larson Richard A. 
Published: March 2020

6509^ Background: In ENESTnd, nilotinib significantly reduced progression to AP/BC and demonstrated superior rates of MMR, MR4, and MR4.5 vs imatinib with f/u of 2 yrs. Methods: 846 pts with Ph+ CML-CP were randomized to nilotinib 300 mg BID (n = 282), nilotinib 400 mg BID (n = 281), or imatinib 400 mg QD (n = 283). Here, we report 3-yr f/u data. Results: Both nilotinib doses continued to demonstrate significantly higher rates of MMR, MR4, and MR4.5 vs imatinib. In a landmark analysis, pts with BCR-ABL transcript levels ≤ 10% at 3 months (mo) had a higher probability of achieving MMR by 1 and 2 yrs vs pts with transcript levels > 10%. No new progressions occurred on treatment since the 2-yr analysis; rates of progression to AP/BC including events on treatment (n = 2, 3, 12) and those occurring both on treatment and after discontinuation (n = 9, 6, 19) were significantly lower for nilotinib 300 mg BID and nilotinib 400 mg BID vs imatinib, respectively. At 3 yrs, OS considering only CML-related deaths was significantly higher for nilotinib vs imatinib. The safety profiles of nilotinib and imatinib were similar to those at 2 yrs. Conclusions: 3-yr f/u confirms the superiority of nilotinib vs imatinib and an acceptable tolerability profile for the treatment of pts with newly diagnosed Ph+ CML-CP. [Table: see text]