bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term survival after distant metastasis in oropharyngeal carcinoma.
Authors: McBride Sean M , Busse Paul M. , Clark John Ross , Parambi Ron J. , Wirth Lori J. , Chan Annie W 
Published: March 2020

5594 Background: The possibility of cure after distant metastases (DM) in oropharyngeal carcinoma (OPC) is uncertain. We conducted a retrospective cohort study to determine outcome and factors predictive of survival after metastasis in patients with OPC. Methods: From 2003-2010, 24 patients definitively treated (96% with concurrent chemo-radiation) at the Massachusetts General Hospital for OPC subsequently developed DM. At initial diagnosis, HPV status was available in 13 patients, 12 of whom were positive; six patients had T4 and 12 N2c-3 disease. Imaging studies pertinent to the diagnosis of DM were re-reviewed; 83% of patients had DM pathologically confirmed. Overall survival (OS) was defined from 1st radiographic evidence of DM to either death or last follow-up. Cox regression was used to evaluate factors predictive of OS after DM. Results: Median time to DM after initial treatment was 8.25 months (range, 1.6-24). Twenty (83%) patients had isolated distant failure; of these, 6 had limited (1 lesion or 2 adjacent lesions) single-organ disease. Eighteen (75%) had treatment after DM (83% had chemotherapy, 61% radiation, and 33% surgery). Median survival after distant metastasis was 19.2 months. Median follow-up for survivors was 23.5 months (range, 7.9-60.3). In multivariate analysis, limited single-organ disease (HR=0.14, p=0.01, 95% CI 0.031, 0.67) was predictive of improved survival after DM; T4 disease at initial diagnosis predicted for decreased OS after DM (HR=3.9, p=0.01, 95% CI 1.31, 11.89). For patients with limited single-organ disease, the 2-year OS was 82% compared to 32% with extensive metastases (p = 0.006). Of the 6 patients with limited, single-organ metastatic disease, two remained alive at 59.4 and 60.5 months without evidence of disease; both had HPV-positive tumors. One patient had a solitary hepatic failure and received neoadjuvant chemotherapy followed by partial hepatectomy; the other had a solitary lung metastasis and received wedge resection followed by radiation. Conclusions: Limited, single-organ metastatic disease predicts improved survival after DM in OPC. Cure is possible in this group. Patients with limited, single-organ distant disease should be considered for aggressive, local salvage treatment.
Assessment of the prognostic and predictive utility of the breast cancer index (BCI): An NCIC CTG MA.14 study.
Authors: Sgroi Dennis , Goss Paul Edward , Chapman Judy-Anne W. , Richardson E. , Binns Shemeica N. , Zhang Yi , Schnabel Catherine A. , Erlander Mark G. , Pritchard Kathleen I. , Han Lei , Shepherd Lois E. , Pollak Michael N. 
Published: March 2020

561 Background: Breast Cancer Index (BCI), a continuous risk index, combines the ratio of HOXB13 to IL17BR (H/I) and the molecular grade index (MGI) (Jerevall et al., British J Cancer, 2011). Here, the prognostic and predictive performance of BCI for BC relapse in MA.14 trial was examined. Methods: MA.14 randomly assigned 667 hormone receptor positive (HR+) women to 5 years of tamoxifen (TAM) +/- 2 years of octreotide LAR (TAM-OCT). A representative subgroup of 299 patients was profiled by RT-PCR for BCI. The primary objective was to determine the prognostic performance of BCI based on relapse-free survival (RFS) with median 9.8 years follow-up. Association of BCI was assessed with step-wise forward stratified Cox regression. Pre-defined categories of low (L), intermediate (I) and high (H) BCI risk groups were used to provide adjusted 5- and 10-year RFS. Results: 292 of 299 patient samples passed internal analytical quality control. The 292 patients contained 49% LN+ patients and had 19.9% BC relapses. Both continuous and pre-specified BCI risk groups were significant multivariate factors (p<0.0001; p=0.007) with higher BCI associated with shorter RFS. Adjusted univariate hazard ratios and 95% CI were 2.53 (1.36 – 4.71) for BCI-H vs -L and 1.28 (0.65 – 2.52) for BCI-I vs -L. With both LN- and LN+ included, BCI-L had 5- and 10-year RFS of 94.0% and 87.5%; -I, 91.8% and 83.9%; and -H, 81.5% and 74.7%. No significant difference in BCI’s ability to stratify patients into 3 risk groups was observed between LN-/no chemotherapy subgroup vs balance of MA.14 patients (p=0.26). Higher pathologic T-stage was multivariately associated with shorter RFS (p=0.01). Interactions between trial therapy and BCI was not significant (p=0.40). Conclusions: This study confirmed the strong prognostic effect of BCI on breast cancer recurrence. BCI was prognostic in both LN- and LN+ patients. The lower 10-year RFS in the BCI-L group than in our previous studies reflected the mixed LN-/LN+ population examined. Like the parent MA.14 trial, BCI did not predict benefit of adding OCT to TAM therapy (Pritchard et al., J Clin Oncol, 2011). This retrospective study is an independent validation of the prognostic performance of BCI within a prospective trial.
Fertility preservation options and the young breast cancer patient: A survey.
Authors: Junqueira Manuela Jacobsen , Goldfarb Shari Beth , Oppong Bridget A. , Patil Sujata , Eaton Anne , Olcese Cristina , Morgan Jessica , Kelvin Joanne Frankel , Dickler Maura N. , Gemignani Mary 
Published: March 2020

575 Background: Approximately 15% of breast cancers (BC) are diagnosed in reproductive aged women. Management of the disease in this age group frequently includes chemotherapy and hormonal therapy, which can both affect fertility. Considering that age at first delivery has been steadily increasing, young women may face BC before completion of childbearing. Methods: In this prospective study, women referred to our institution for surgical treatment of BC were asked, before their first visit, to fill out a questionnaire regarding their reproductive history and fertility preservation knowledge. Eligible patients included women between the ages of 18 and 45, with a newly diagnosed BC, who had not yet started treatment. Results: Sixty women were eligible with a median age of 40 (range 20-45). 98% of responders (59 out of 60) had been diagnosed within the previous 2 months. 78% (47/60) had a college or post-graduate degree. 80% (48/60) had been pregnant before, while 86.5% (45/52) reported having had children. 81% (47/58) were premenopausal, and only 3 patients reported not having had periods for more than 1 year. 50% of responders (30/60) declared no interest in future childbearing, 25% were definitely interested, and 25% were undecided. However, only 9% (5/57) reported having received information on fertility preservation options before the survey. Women who have been pregnant were significantly less likely to consider fertility preservation options prior to treatment (egg/embryo/ovarian tissue cryopreservation [6% vs. 50%, p=0.001]), or after treatment (egg/embryo donation, surrogacy or adoption [6% vs. 58%, p<0.0001]). Conclusions: This pilot study was designed to gather information on reproductive health of newly diagnosed young BC patients and to assess their willingness to consider various fertility preservation options before or after treatment. Our study population consisted of mostly women who had been pregnant and had children. We found that 50% of the women were unsure or wanted future children. Yet, only 9% had received information on fertility options at diagnosis. This pilot study highlights the need for education and/or intervention in fertility preservation options for young women with breast cancer.
A multicenter phase II trial of the LH-RH analogue and an aromatase inhibitor combination in premenopausal patients with advanced or recurrent breast cancer refractory to an LH-RH analogue with tamoxifen: JMTO BC08-01.
Authors: Nishimura Reiki , Anan Keisei , Yamamoto Yutaka , Higaki Kenji , Tanaka Maki , Shibuta Kenji , Sagara Yasuaki , Ohno Shinji , Tsuyuki Shigeru , Mase Takahiro , Teramukai Satoshi 
Published: March 2020

588 Background: The aim was to provide an endocrine therapy option against advanced (ABC) or recurrent breast cancer (RBC) in premenopausal women. We conducted an exploratory phase II trial in combination with an LH-RH analogue (LH-RHa) and an aromatase inhibitor (AI) to assess the efficacy and tolerability after failure of standard LH-RHa plus tamoxifen (TAM). Methods: Premenopausal patients (pts) with ER+ and/or PgR+ ABC or RBC refractory to LH-RHa + TAM were treated with LH-RHa (goserelin: GOS) and AI (anastrozole: ANA). The primary endpoint was an objective response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), clinical benefit rate (CBR) based on RECIST, and safety assessed using CTCAE ver. 3.0. Pts with only bone legions were assessed using the criteria by Japanese Breast Cancer Society (14th Ed.). Local assessment (CR, PR or long SD of 24 weeks or longer) was confirmed independently by two radiologists. Results: Between September 2008 and November 2010, 37 pts were enrolled at 10 clinical institutions in Japan. Eleven had recurrence either during, or within one year after the end of adjuvant GOS + TAM (including GOS + TAM followed by only TAM). The disease progressed in 26 women during GOS + TAM. Mean age and BMI were 43.5 years and 22.2 kg/m2, respectively. Thirty-five pts (94.6%) were ER+, and 36 pts (97.3%) were HER2- (one with unknown HER2 status). Non-endocrine treatment included chemotherapy (20 pts; 54%) and radiation therapy (13 pts; 35%). The viscera, soft tissue, and bones were treated in 17, 15 and 14 pts, respectively. Pts with both measurable lesions and bone metastasis, measurable lesions only, and only bone metastasis were 21 (57%), 15 (41%) and 1 (2%), respectively. ORR was 18.9% (95%CI: 8.0-35.2%, 1 CR and 6 PR cases), CBR 62.2% (23 pts, 95%CI: 44.8-77.5%), and median PFS was 7.2 months. Eight pts (21.6%) had adverse events, but none resulted in treatment discontinuation. GOS + ANA was well tolerated. Conclusions: LH-RHa (GOS) + ANA can be a subsequent endocrine treatment for premenopausal pts with ABC or RBC after failure of GOS + TAM.
Racial disparities in breast cancer survival.
Authors: Silber Jeffrey H. , Rosenbaum Paul R. , Clark Amy Sanders , Wang Min , Teng Yun , Ross Richard N. , Ludwig Justin , Niknam Bijan , Even-Shoshan Orit , Giantonio Bruce J. , Fox Kevin R. 
Published: March 2020

6000 Background: Reducing racial disparities in breast cancer survival has been a federal priority since the early 1990’s. We present a new method to assess disparities using sequential multivariate matching. We ask if racial disparities have increased or decreased over time and if so, what were potential reasons for such changes. Methods: We studied all women over 65 years of age in the Medicare fee for service system diagnosed with breast cancer between 1991 and 2005 who were treated in one of 12 SEER sites (the sites in SEER since 1991). There were 5,251 black patients (74% early stage (I-III), 9% late stage (IV) and 17% missing stage) and 72,695 white patients (81% early stage, 5% late stage and 14% missing stage). All black cases represented the focal group for all matches. Using multivariate matching and the propensity score, white controls were matched to blacks in steps: (1) White controls matched to black cases on age and year of diagnosis; (2) Age, year of diagnosis, and stage; (3): Age, year, stage, estrogen receptor status, grade, and 30 comorbidities. We then compare 5-year survival in the Pre and Post-Taxane periods (1991-1998, 1999-2005). Results: When whites were matched to blacks on age and diagnosis year, 5-year Kaplan-Meier survival was 69.2% vs. 56.7%, P < 0.0001. Matching additionally on stage, differences = 64.1% vs. 56.7%, P < 0.0001; Matching further on tumor characteristics and 30 comorbidities, the disparity reduced to 61.6% vs. 56.7%, P < 0.0001. Comparing trends over time, white-black differences in survival matched for age and year were 67.6% vs. 55.2% (P < 0.0001) in the pre-Taxane era (difference = 12.4%) and 71.2% vs. 58.7% (P < 0.0001) in the post Taxane era (difference = 12.5%); age and year matched paired racial differences were not different across eras (P = 0.389). Conclusions: While there may have been some improvements in overall survival, racial disparities in breast cancer survival have not improved, despite important policy initiatives and treatment advances. Adjusting for presentation at diagnosis does reduce differences in survival, but even these differences remain large and significant, suggesting that differences in both presentation and treatment given presentation are contributing to this disparity.
Competing causes of mortality in long-term survivors of head and neck cancer.
Authors: Baxi Shrujal S. , Pinheiro Laura C , Patil Sujata , Pfister David G. , Oeffinger Kevin C. , Elkin Elena B. 
Published: March 2020

6001 Background: Most head and neck cancers (HNC) recur within the first 3 yrs of diagnosis. Patients who live beyond this time point continue to have an excess risk of mortality. We investigated the causes of mortality in 3-yr survivors of HNC. Methods: We completed a retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database. We identified patients with a diagnosis of non-metastatic HNC between 1992 and 2005 who survived 3 yrs from diagnosis. The primary outcome was death from all-causes, HNC, non-HNC malignancy, cardiovascular disease (CVD), and pulmonary disease (PD). We estimated the age-adjusted standardized mortality ratio (SMR; observed-to-expected (O/E)) and the absolute excess risk (AER; O-E), for all-cause and cause-specific mortality compared to US population data. Results: 31,772 long-term survivors were identified with disease arising in the larynx (40%), oral cavity (29%), oropharynx (26%), nasopharynx (3%) and hypopharynx (1%). In this cohort, 8191 (26%) were female, 3021 (10%) were black and 15,321 (48%) were younger than 60 yrs. In this cohort, 16,697 (53%) had locally-advanced disease and 8353 (26%), 8721(27%) and 13,919 (44%) received radiation alone, surgery alone or both. With a median follow-up of 6.4 years (3-17 years), there were 10,757 deaths due to: HNC (24%), non-HNC malignancy (31%), CVD (21%), PD (6%), and other causes (19%). Compared to the US population, the all-cause SMR was 5.4 (95% CI 5.3-5.6) with an AER of 336 deaths per 10,000 person-years (py). The greatest excess risk was attributable to non-HNC malignancies (956 per 10,000 py), CVD (533 per 10,000 py) and pulmonary disease (136 per 10,000 py). Conclusions: HNC survivors experience excess mortality compared to the general population. Competing causes of mortality challenge long-term survival. Additional analytic studies with detailed data on tobacco history, treatment characteristics and co-morbidities are required to further evaluate associations with specific causes of death and individualize risk in this heterogenous population of survivors.
Patient-centered medical homes may improve breast cancer surveillance among survivors.
Authors: Wheeler Stephanie B. , Kohler Racquel Elizabeth , Goyal Ravi K. , Reeder-Hayes Katherine Elizabeth , Lich Kristen Hassmiller , Smith Timothy , Melvin Cathy , Moore Alexis , Domino Marisa E 
Published: March 2020

6029 Background: Community Care of North Carolina (CCNC) initiated a medical home (MH) program in the early 1990s focused on improving care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular disease outcomes, but has not been examined in the context of cancer care. We sought to determine whether CCNC enrollment was associated with improved cancer surveillance among breast cancer survivors. Methods: Using state cancer registry records linked to Medicaid claims, we identified women ages 18-64 diagnosed with stage 0, I, or II breast cancer from 2003-2007. We included only cases insured by Medicaid for at least 12 of 15 months following the index cancer diagnosis. Reflecting ASCO guidelines for breast cancer surveillance for survivors (2006), we defined outcomes as time to first surveillance mammogram post-diagnosis and overall receipt of mammogram by 15-months post-diagnosis. Our primary independent variable was enrollment in CCNC, categorized as never enrolled, enrolled up to 6 months, and enrolled 7 months or more. We used multivariate Cox proportional hazards stratified by receipt of radiation therapy (RT) and logistic regressions. Results: 840 women were included in our sample. Approximately half were enrolled in CCNC for at least some time during the study period, 38% for more than 7 months post-diagnosis. Among women who received RT, being in a MH for at least 7 months corresponded to earlier follow-up mammogram (Hazard Ratio: 1.34; p=0.028), controlling for all other factors. Enrollment in a MH for at least 7 months post-diagnosis also was associated with overall receipt of mammogram by 15 months (p<0.01). Interaction terms indicated that women enrolled in MHs and living in a rural area had a statistically significant higher likelihood of receiving mammography. Conclusions: Results suggest that MH enrollment is associated with improved cancer surveillance among breast cancer survivors insured by Medicaid. Given the growing population of cancer survivors and increased emphasis on MHs in the Affordable Care Act, more research is needed to explore how patient-centered medical homes can be enhanced to improve the transition from cancer patient to cancer survivor.
How radiation oncologist accessibility influences treatment choice and quality in early-stage breast cancer: A SEER database analysis.
Authors: Churilla Thomas M. , Donnelly Patrick E. , Peters Christopher A. 
Published: March 2020

6031 Background: Mastectomy and breast conserving therapy (BCT, partial mastectomy and adjuvant radiotherapy) are equivalent in survival for treatment of early stage breast cancer. This study evaluated the impact of radiation oncologist accessibility on choice of mastectomy versus BCT, and the receipt of radiotherapy after BCT. Methods: In the NCI SEER database, breast cancer cases from 2004-2008 were selected with the following criteria: T2N1M0 or less, lobular or ductal histology, and treatment with simple mastectomy or partial mastectomy (+/-) adjuvant radiation. The HRSA Area Resource File was combined to define average radiation oncologist density (ROD, number of radiation oncologists/100K people) by county over the same time period. Tumor characteristics, demographic information, and ROD were evaluated with respect to mastectomy rates and receipt of radiation therapy after BCT in univariate and multivariate analyses. Results: In the 118,961 cases analyzed, mastectomy was performed 33.3% of the time relative to BCT. After adjustment for demographic and tumor variables, the odds of having mastectomy versus BCT were inversely associated with ROD (OR [95% CI] = 0.94 [0.93-0.96]; p<0.001). Adjuvant radiation therapy was not administered in 23.4% of BCT cases. Likewise, the odds of having BCT without adjuvant radiation were inversely associated with ROD (0.96 [0.95-0.98]; p<0.001, table). Conclusions: There was a significant, inverse and linear relationship between ROD and mastectomy rates independent of demographic and tumor variables. An inverse trend was also observed for the omission of radiotherapy after BCT. Access to radiation oncologists was a factor in surgical choice and receiving appropriate BCT in early stage breast cancer. [Table: see text]
Unintended consequences of health information technology: Evidence from Veterans Affairs Colorectal Cancer Oncology Watch Intervention.
Authors: Bian John , Bennett Charles L. , Fisher Deborah , Ribeiro Maria Leonor , Lipscomb Joseph 
Published: March 2020

6044 Background: Although health information technology (HIT) has been hypothesized to help achieve greater adherence to recommended clinical guidelines and increase use of preventive care, well-conducted empirical studies evaluating this hypothesis are lacking. This study evaluated the ongoing Colorectal Cancer (CRC) Oncology Watch intervention, a clinical reminder system, implemented in 8 Veterans Affairs (VA) hospitals in 2008 for improving CRC (1) screening adherence among average- or higher-risk veterans, and (2) surveillance. Methods: VA administrative data were used to construct 4 cross-sectional groups of average-risk age 50-64 veterans, one for each of 2006, 2007, 2009, and 2010. We applied a linear probability model with hospital fixed-effects for estimation, using a natural experiment in which the 8 hospitals served as the intervention and other 121 hospitals as a control and with 2006-2007 designated as the pre-intervention period and 2009-2010 as the post-intervention period. Results: The sample included 4,352,082 veteran-years in 4 years. The proportions adherent to screening were 37.6%, 31.6%, 34.4%, and 33.2% in the intervention in 2006, 2007, 2009, and 2010, respectively, and the corresponding proportions in the control were 31.0%, 30.3%, 32.3%, and 30.9%. Regression analysis showed that among those eligible for screening, the intervention was associated with a 2.2-percentage-point decrease in likelihood of adherence (P-value<0.0001). Additional analyses showed that the intervention was associated with a 5.6-percentage-point decrease in likelihood of screening by colonoscopy among the adherent, but with increased total colonoscopies (any indication) of 3.6 per 100 veterans age 50-64. Conclusions: The intervention may have slightly reduced CRC screening rates for the studied population. This consequence may have been caused by an unintentional shift of limited VA colonoscopy capacity from average-risk screening to higher-risk screening and to CRC surveillance, or by physicians’ fatigue due to the large number of clinical reminders implemented in the VA.
Positron emission tomography/computed tomography (PET/CT) for the diagnosis of recurrent cancer (PETREC): A multicenter, prospective cohort study.
Authors: You John J. , Inculet Richard I. , Dhesy-Thind Sukhbinder K. , Chan Adrien M. , Freeman Marc , Cline Kathryn J. , Pritchard Kathleen I. , Dayes Ian S. , Gu Chu-Shu , Julian Jim A , Gulenchyn Karen Y. , Evans William K. , Levine Mark Norman 
Published: March 2020

6049 Background: The clinical utility of PET/CT in patients with suspected cancer recurrence remains unclear. The aim of this multi-center, prospective, comparative effectiveness study is to assess the impact of PET/CT on clinical management of patients with suspected cancer recurrence. Methods: Patients were eligible if cancer recurrence (non-small cell lung, breast, head and neck, ovarian, esophageal, Hodgkin’s or non-Hodgkin’s lymphoma) was clinically suspected, and if conventional imaging (e.g. X-ray, ultrasound, CT, or MRI) was non-diagnostic. As a pre-requisite to PET/CT booking, clinicians were asked at enrolment to indicate their planned management if PET/CT were not available. Patients then underwent 18FDG-PET/CT. Clinicians were then asked to indicate their management plan based on PET/CT findings. Patients were followed up once at 3 months. The primary outcome was change in planned management after PET/CT and was assessed independently and in duplicate by external outcome adjudicators using all available source documents. Results: 101 patients (mean age 64 y, 45% male, median 1.3 y since last treatment) were enrolled from 4 centers in Ontario, Canada between April 2009 and June 2011. Distribution of tumor types was: non-small cell lung (55%), breast (19%), ovarian (10%), esophageal (6%), lymphoma (6%), head and neck (4%). 8 patients did not complete the study (non-adherence to protocol, 2; death, 5; disease progression prior to PET/CT, 1), of whom 2 did not receive PET/CT. PET/CT changed planned management in 52 (53%) patients (Table). At 3 months, planned management was carried out in 46/52 (88%) patients. Conclusions: In patients with suspected cancer recurrence, PET/CT changes planned management from non-treatment to treatment for approximately 1 in every 3 patients (“number needed to scan” = 3) and contributes importantly to clinical management. [Table: see text]