bluuebunny/crossref_metadata_2025_split huggingface dataset:
An institutional evaluation of the safety and efficacy of same-day administration of pegfilgrastim in patients receiving chemotherapy for lung cancer.
Authors: Vraney Jamie , AlRawashdh Neda , Choi Briana , Abraham Ivo , McBride Ali 
Published: June 2021

e18591 Background: Pegfilgrastim is recommended to be administered 24 hours after myelosuppressive chemotherapy (CTX) as prophylaxis for chemotherapy-induced (febrile) neutropenia (CIN/FN). Recent studies have yielded equivocal data on same day versus next day administration of pegfilgrastim. There has been limited real world evidence addressing lung cancer (LC) patients and the use of same day pegfilgrastim. We evaluated our own institutional data on the safety of same day pegfilgrastim administration in LC patients. Methods: A retrospective chart review was performed by searching electronic health records using ICD-9 and ICD-10 codes corresponding with a lung cancer diagnosis between November 1, 2013 and August 31, 2018 at The University of Arizona Cancer Center (UACC). Patients included in the study were 18 years of age or older, diagnosed with biopsy-confirmed lung cancer, treated at UACC, and receiving chemotherapy and pegfilgrastim on the same day. The outcomes of interest included FN incidence after the first cycle and across all cycles of CTX, CIN grade 3/4 and CTX dose delays or hospitalizations due to CIN/FN after first cycle and across all cycles of CTX. Results: 1,181 patient records were reviewed and 114 patients met the inclusion criteria; 87 (76%) patients had non-small cell LC and 27 (24%) patients had small cell LC. The median age was 68 years, 52% of patients had cancer stage of 3 to 4, and 63% of patients had 0-1 ECOG status. The FN risk assessment was mild in 72% of patients. The mean (SD) of baseline absolute neutrophil count was 5.68 (3.09). In total 384 CTX cycles were received. The table shows the results of all intended outcomes. One patient experienced FN after the first cycle of CTX of irinotecan and 5 patients developed 6 FN episodes across all cycles; 2 patients were on carboplatin etoposide; 1 patient on cisplatin etoposide; 1 patient on vinorelbine and 1 patient was on pemetrexed and then on irinotecan CTX when the two FN episodes were developed. Conclusions: This study showing that same day administration of pegfilgrastim was as effective as next day administration in LC patients, without warranting any concerns for febrile neutropenia or delayed engraftment. Utilization of same day pegfilgrastim, in light of biosimilars and COVID, provides a unique opportunity for cancer care without concerns for FN as stated in previous studies.[Table: see text]
Association of systemic anticancer therapy with an increased risk of death in hospitalized COVID-19 positive oncology patients.
Authors: Hermel David Jacob , Spierling Bagsic Samantha R. , Bhangoo Munveer Singh , Bollin Kathryn Blount , Mason James R. , Saven Alan , Sigal Darren 
Published: June 2021

e18594 Background: Malignancy is thought to be an independent risk factor for increased COVID-19 morbidity and mortality. However, neoplastic diseases encompass a heterogenous group of pathologic processes, and further stratification of those patients prone to severe disease is necessary. We sought to identify predictors of poor COVID-19 outcomes among hospitalized patients with malignancy. Methods: We retrospectively reviewed all patients with a diagnosis of hematologic and solid tumor malignancy within the regional Scripps Health hospital system in San Diego County from March 1, 2020 to January 5, 2021 with a PCR confirmed diagnosis of COVID-19. Cancer diagnoses were confirmed via manual chart review; in situ non-melanoma skin cancers were excluded. Only hospitalizations greater than one day were included in the analysis and readmissions were excluded. Outcomes of interest included admission to the ICU, intubation during hospitalization, and death. Associations between outcomes of interest and tumor types, metastatic disease (with or without lung involvement) and those receiving active systemic anticancer therapy (treatment within 3 months of admission) were determined using univariable logistic regression analyses. The study was approved by the Scripps Health Institutional Review Board. Systemic anticancer therapy included cytotoxic chemotherapy, immunomodulators, immune checkpoint inhibitors, and other targeted therapies. Results: Among a total of 2,771 hospitalized patients, 204 (7.36%) met inclusion criteria. The average age was 72.7 years, 48.5% were male, 33.3% were Hispanic and the average BMI was 27.5. The majority of patients (82.8%) had solid tumors, with the most prevalent being breast carcinoma (17.6%) and prostate carcinoma (17.2%). Overall, 21.9% had metastatic disease and 16% had lung involvement. 17.2% had been receiving active cancer systemic treatment. On univariate analysis, patients who were actively receiving treatment had an increased rate of death (37.1% vs 18.9%, OR: 2.5 (1.1-5.5) p= .021). Among patients receiving systemic anticancer therapy, 48.6% received cytotoxic chemotherapy, 5.7% immune checkpoint inhibitors, 22.9% immunomodulators, 17.1% molecularly targeted agents and 2.7% other agents. Moreover, there was a trend towards increased mortality in those with lung involvement (33.3% vs 17.6%, OR: 2.3 (0.9-5.7) p= .067) and those with hematologic malignancy (31.4% vs 20.1%, OR: 0.5 (0.2-1.3) p = 0.146). Conclusions: Among patients hospitalized with a diagnosis of cancer, systemic anticancer therapy was associated with a significantly increased odds of death. Other factors potentially increasing risk of death include hematologic malignancy and solid tumors with lung involvement. Further validation of these findings in a larger sample could impact therapeutic decision making during the COVID-19 pandemic.
Uptake and effectiveness of checkpoint inhibitor therapy among trial-ineligible patients with advanced solid malignancies.
Authors: Parikh Ravi Bharat , Min Eun Jeong , Wileyto E. Paul , Riaz Fauzia , Gross Cary Philip , Cohen Roger B. , Hubbard Rebecca A. , Long Qi , Mamtani Ronac 
Published: June 2021

e18595 Background: Immune checkpoint inhibitors (ICIs) are part of standard of care in many advanced solid malignancies. Patients (pts) with poor performance status or organ dysfunction have been usually ineligible in pivotal clinical trials of ICIs. Methods: In this retrospective cohort study, we assessed ICI uptake and effectiveness among 34,131 pts diagnosed with advanced non-targetable non-small cell lung (NSCLC), urothelial cell (UCC), renal cell (RCC), or hepatocellular (HCC) carcinoma between January 1, 2014 and December 31, 2019. Pts were identified from the Flatiron Health electronic health record-derived database, consisting of pts receiving care in 280 mostly community oncology practices in the US. 9,318 (27.3%) pts were trial-ineligible based on ECOG performance status ≥ 2 or liver (total bilirubin ≥ 3 mg/dL) or kidney (eGFR < 30 ml/min/1.73m2) dysfunction. The association between trial-ineligibility and ICI monotherapy uptake was assessed using inverse probability weighted logistic regression. We hypothesized that there would be no differences in overall survival between ICI and non-ICI therapies in the trial-ineligible cohort. To test this hypothesis, we used inverse probability of treatment weighted survival analyses. Because we observed non-proportional hazards, we report 12- and 36-month restricted mean survival times (RMSTs) and time-varying hazard ratios < and ≥ 6 months. Results: Between 2014-2019, the proportion of pts who received ICI monotherapy rose from 0% to 30.2% among trial-ineligible pts and from 0.1% to 19.4% among trial-eligible pts. Trial-ineligible pts received ICI monotherapy more frequently than trial-eligible pts (22.5% vs 12.7%, adjusted odds ratio [aOR] relative to non-ICI therapy 1.8, 95% CI 1.7-1.9). Among trial-ineligible pts, there were no OS differences between ICI monotherapy, ICI combination therapy, and non-ICI therapy at 12 months (RMST 7.8 vs. 7.7 vs. 8.1 mos) or 36 months (15.0 vs. 13.9 vs. 14.4 mos). Relative to non-ICI therapy, ICI monotherapy was associated with early mortality (adjusted hazard ratio [aHR] within 6 months 1.19) but late benefit (aHR after 6 months 0.80) in trial-ineligible pts (Table). Conclusions: Trial-ineligible pts with advanced malignancies preferentially receive first-line ICI, despite the lack of a survival benefit and possible early mortality associated with ICI use. Positive results for ICI in phase III trials may not translate to this vulnerable population. [Table: see text]
Thirty-day readmission after percutaneous coronary intervention with drug eluting stent in patients with active malignancy.
Authors: Macchi Hugo , Salazar Miguel , Del Cid Fratti Juan , Upadhyay Shristi , Baral Binav , Shrivastava Trilok , Gauto Estefania , Cattoni Juan Adolfo 
Published: June 2021

e18601 Background: Reducing the 30-day readmission is one of the quality performance measures upon which hospitals are being evaluated. Readmissions represent a significant economic burden to the patients and the health care system. Index admission for myocardial infarctions requiring PCI with a concurrent diagnosis of malignancy represents a critical part of the population due to the association between cancer and the pro-thrombotic state that renders them at high risk of readmission. By harnessing the power of large datasets such as the NRD (National Readmission Database), we sought to find associations that, together, could aid in the development of better public and private policies that would make patient care more efficient. Methods: We conducted a retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for myocardial infarction requiring PCI with a concurrent diagnosis of malignancy. We aimed to identify the 30-day readmission rate, mortality, healthcare-related utilization resources, and independent readmission predictors. Results: A total of 8,350 patients with malignancy underwent PCI. The 30-day readmission rate was 17.8%. The main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI. Compared to initial admissions, readmitted patients were less likely to require mechanical ventilation (7.3% vs. 5.2%; P = 0.05), intra-aortic balloon pump placement (4.1 vs 0.4; P < 0.01), IMPELLA device use (4.0 vs 0.3; P < 0.01), less had private insurance (16.2% vs 12.9%; P = 0.02), less developed shock (7.7% vs 3.2%; P < 0.01), & less had major bleeding (2.0% vs 0.1%; P < 0.01). Readmission was associated with lower in-hospital mortality rate (1.5% vs. 0.1%; P < 0.01), but more likely to require hemodialysis (4.3% vs 6.6%; P < 0.01), & have venous thromboembolism (VTE) (1.9% vs 3.2%; P < 0.01). The total health care in-hospital economic burden of readmission was $937 million in total charges for patients and $224 million in total costs for hospitals. Independent predictors of readmission were female gender, the disposition to a short-term hospital or skilled nursing facility, prolonged length of stay, inpatient hemodialysis, and VTE episodes. Conclusions: Readmissions after PCI in patients with malignancy are associated with a lower in-hospital mortality rate but pose a high health care burden. We identified potential risk factors that, if targeted, could lead to a reduction in readmissions after PCI in cancer patients, & therefore decrease health care costs.
Association of Memorial Sloan Kettering-Frailty Index with the postoperative intensive and specialized advanced care units admission among older adults with cancer.
Authors: Donoghue Timothy J , Tin Amy L. , Shahrokni Armin 
Published: June 2021

e18606 Background: Understanding factors associated with poor surgical outcomes of older adults with cancer is necessary in identifying high risk patients and finding ways to mitigate poor outcomes following surgery. In this study, we evaluated whether frailty is associated with intensive postoperative healthcare utilization for this vulnerable population. Methods: This was a single hospital, retrospective cohort study, using the Memorial Sloan Kettering Frailty Index (MSK-FI) to define frailty, with higher MSK-FI corresponding to increased frailty. Multivariable logistic regression with random intercept models were used to assess the association between frailty and 30-day postoperative Intensive Care Unit (ICU) admission, and Specialized Advanced Care Unit (SACU) admission, separately. Covariates included surgical department, age, sex, surgical stress score, preoperative albumin level, and whether patients took a Beers criteria medication prior to surgery. Results: We identified 4417 patients over the age of 65 undergoing elective surgery between January 2015 and December 2018 at our institution and had a length of stay of at least one day. A quarter of patients had an MSK-FI score of 3 or greater. Among our patients, 3.8% (95% CI 3.2%, 4.4%), and 5.4% (95% CI 4.8%, 6.1%) were admitted to the ICU, and the SACU, respectively. We found evidence of an association between greater frailty and increased risk of ICU admission (OR per one-point increase in MSK-FI 1.44; 95% CI 1.31, 1.59; p-value < 0.001), and SACU admission (OR per one point increase in MSK-FI 1.46; 95% CI 1.33, 1.60; p-value < 0.001). For example, for a patient with an MSK-FI score of 2, the predicted risk of ICU admission is 2.2% and SACU admission is 1.1%, compared to 4.5% and 2.2%, respectively, for a patient with an MSK-FI score of 4, when all continuous covariates are set to the mean and the categorical covariates are set to the mode. Conclusions: Frailty based on the MSK-FI is associated with intensive postoperative care utilization in this population of older adults with cancer. Future studies should assess the impact of this information on surgery decision making for this vulnerable population.
Mortality in adult patients with solid or hematological cancers and SARS-CoV-2 infection with a specific focus on lung and breast malignancies: A systematic review and meta-analysis.
Authors: Tagliamento Marco , Agostinetto Elisa , Bruzzone Marco , Ceppi Marcello , Saini Kamal S. , de Azambuja Evandro , Punie Kevin , Westphalen Benedikt , Morgan Gilberto , Pronzato Paolo , Del Mastro Lucia , Poggio Francesca , Lambertini Matteo 
Published: June 2021

e18608 Background: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and a diagnosis of cancer are at high risk of severe symptomatic disease (COVID-19) and death. We performed a systematic review and meta-analysis of published studies, to estimate the case-fatality rate (CFR) of patients with solid or hematological tumors and SARS-CoV-2 infection. Methods: A systematic search of PubMed library up to 31 January, 2021, was performed in order to identify publications reporting the CFR among adult patients with solid or hematological tumors and SARS-CoV-2 infection. CFR was defined as the rate of deaths among SARS-CoV-2-positive cancer patients. Moreover, we separately assessed the CFR among patients with lung and breast cancer. Studies with at least 10 patients were included. The CFR was assessed through a random effect model, and 95% confidence intervals (CI) were calculated. The Higgins I2 index was computed to assess the heterogeneity between studies. Results: The systematic search of the literaturereturned 1,727studies. 1,551 were excluded on the basis of the title, 29 based on the abstract, and 3 were duplicates. A total of 144 studies were selected, including 35,725 patients with solid or hematological tumors and SARS-CoV-2 infection. In total, 46 and 32 studies reported the CFR among COVID-19 patients with lung (total N = 1,555) and breast (total N = 1.398) cancer, respectively. Overall, the CFR was 25.5% (95% CI 23.1%-28.1%, Egger test p < 0.001). A sensitivity analysis, after excluding studies with less than 100 patients, showed a CFR of 22.1% (95% CI 19.4%-25.2%). The CFR among patients with lung cancer and SARS-CoV2 infection was 33.4% (95% CI 28.1%-39.6%) when including all studies and 26.3% (95% CI 17.6%-39.2%) at the sensitivity analysis after excluding studies with less than 100 patients. The CFR among patients with breast cancer and SARS-CoV2 infection was 13.7% (95% CI 9.1%-20.7%) when including all studies and 13.0% (95% CI 7.6%-22.1%) at the sensitivity analysis after excluding studies with less than 100 patients. Conclusions: One year after the outbreak of the pandemic, this large meta-analysis reports the impact of SARS-CoV-2 infection in patients with cancer. This population experienced a high probability of mortality, with a comparatively higher CFR in patients with lung cancer, and a comparatively lower CFR in patients with breast cancer. Patients with an underlying diagnosis of cancer require special attention with aggressive preventive measures that also include early access to COVID-19 vaccination.
Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.
Authors: Parikh Divya Ahuja , Ragavan Meera Vimala , Srinivas Sandy , Garrigues Sarah , Rosenthal Eben Lloyd , Patel Manali I. 
Published: June 2021

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.
Neoadjuvant chemotherapy and disease recurrence after curative-intent surgery in patients with pancreatic adenocarcinoma: A single-center retrospective review.
Authors: Alhamad Khaled , Alrifai Nada , Attah Abraham Attah , Shankar Karthik , Alnimer Lynna , Samhouri Yazan , Jayakrishnan Thejus Thayyil , Srinivasamaharaj Srividya , Monga Dulabh K. 
Published: June 2021

e18610 Background: Early stage pancreatic ductal adenocarcinoma (PDAC) account for up to 30% of newly diagnosed patients. Until recently, the mainstay of treatment remained curative-intent surgery followed by adjuvant chemotherapy. More recently, the incorporation of neoadjuvant therapy (NAT) has demonstrated clinical benefit. The two commonly used regimens are 5-Fluorouracil, Leucovorin, Oxaliplatin and Irinotecan (FOLFIRINOX), or Gemcitabine and nab-Paclitaxel. Limited data is available to differentiate outcomes between the 2 common NAT regimens. We conducted a retrospective review to assess the rates of disease recurrence and progression after neoadjuvant chemotherapy and to identify any associations that may predict early recurrence. Methods: A retrospective review was conducted of all patients diagnosed with PDAC from 2017-2019 at Allegheny General Hospital. Data analysis was completed using IBM SPSS v23. Disease recurrence or progression was assessed radiologically, and time to progression was calculated as time (months) since diagnosis to evidence of radiological progression. Results: Out of 171 patients reviewed, 56 were deemed resectable or borderline resectable and underwent curative-intent surgery and were included in the analysis. Median age was 68, and 12 (41%) were male. Majority of the patients were white (90%). 29 (52%) patients received neoadjuvant chemotherapy: 16 (55%) received FOLFIRINOX, 12 (41%) received Gemcitabine with nab-Paclitaxel, and 1 received another regimen. 9 patients out of 16 (56%) that received FOLFIRINOX progressed, and 5 out of 12 patients (42%) who received Gemcitabine with nab-Paclitaxel progressed. Patterns of progression in those that received FOLFIRINOX: 1 (11%) within 6 months, 4 (44%) between 6-12 months, and 4 (44%) after 12 months. Of those that received Gemcitabine with nab-Paclitaxel, 2 (40%) progressed within 6 months, 1 (20%) progressed between 6-12 months, and 2 (40%) progressed after 12 months. On multivariate analysis, no association was identified to predict progression. Conclusions: There was no significant difference in disease progression rates among patients that received neoadjuvant FOLFIRINOX versus Gemcitabine and nab-Paclitaxel (42% vs. 56%; p = 0.46). No predictive associations were identified in patients with disease recurrence. Study limitations include a low sample size and retrospective analysis. Further, larger scale studies are warranted to better assess the difference in rates of progression after neoadjuvant FOLFIRINOX versus Gemcitabine and nab-Paclitaxel.[Table: see text]