bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 10-item frailty index based on a comprehensive geriatric assessment (FI-CGA-10) in older adults with cancer: Development and construct validation.
Authors: Nishijima Tomohiro F. , Shimokawa Mototsugu , Esaki Taito , Morita Masaru , Toh Yasushi , Muss Hyman B. 
Published: June 2021

e24011 Background: A frailty index based on domain-level deficits in a comprehensive geriatric assessment (FI-CGA) has been previously developed and validated in general geriatric patients (Jones D, Aging Clin Exp Res 2005). Our objectives were to construct an FI-CGA and to assess its construct validity in geriatric oncology setting. Methods: Consecutive older adults with cancer who underwent a CGA on a geriatric oncology service were included. We developed a 10-item frailty index based on deficits in 10 domains (FI-CGA-10): cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem) and 1.0 (major problem). Scores were calculated by dividing the sum of the score of each domain by 10, and categorized as fit ( < 0.2), pre-frail (0.2–0.35), and frail ( > 0.35). Construct validity was tested by comparing the FI-CGA-10 with the following established frailty measures: the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS), CSHA rules-based frailty definition and CSHA Function Scale. To evaluate the ability to predict mortality, we tested association between the FI-CGA-10 and validated prognostic indices for mortality: the Lee index and Schonberg index (higher scores reflect a higher risk of mortality). We also examined associations between the FI-CGA-10 and several features commonly seen in frail older adults such as function (Timed Up & Go (TUG) test), cognitive impairment (Mini-Cog), and high comorbidity burden (Charlson Comorbidity Index (CCI)). Results: Of 540 patients (median age 80 years, range 66–96 years), common cancer types were gastrointestinal tract in 37%, hepatobiliary and pancreatic in 22%, and head and neck in 12%. 406 (75%) patients had ECOG PS 0 to 1. The FI-CGA-10 had a right-skewed distribution and was well approximated by the gamma distribution. Overall, 20% of patients were fit, 41% were pre-frail, and 39% were frail. The FI-CGA-10 was highly correlated with CSHA CFS (Pearson's r = 0.83), CSHA rules-based frailty definition (r = 0.67) and CSHA Function Score (r = 0.77). People who were more frail had higher scores on the Lee index (fit: 7.3, prefrail: 8.8, frail: 12.0; p < .0001) and Schonberg index (fit: 10.1, prefrail: 13.1, frail: 15.7; p < .0001), suggesting an increased probability of death. Increasing levels of frailty were significantly associated with a longer TUG (seconds), fit: 11.3, prefrail: 13.0, frail: 26.3; p < .0001, poorer cognitive function (Mini-Cog score, fit: 4.7, prefrail: 4.0, frail: 3.1; p < .0001), and higher comorbidity burden (CCI, fit: 0.8, prefrail: 1.4, frail: 1.9; p < .0001). Conclusions: The FI-CGA-10 is a clinically sensible and construct-validated measure of quantifying frailty from a CGA.
Use of the geriatric assessment in clinical practice in Mexico: A survey of cancer providers.
Authors: Verduzco-Aguirre Haydee Cristina , Bolano Guerra Laura Margarita , Martínez-Said Hector , Quintero Beulo Gregorio , Culakova Eva , Mohile Supriya Gupta , Soto Perez De Celis Enrique 
Published: June 2021

e24013 Background: Despite the growing burden of cancer in older adults in Mexico, it is unknown how many cancer care providers in Mexico use information obtained through a geriatric assessment (GA) and/or geriatric oncology principles in their everyday clinical practice. Methods: We administered a cross-sectional survey to oncology providers in Mexico via the Mexican Society of Oncology mailing list (n = 1240). The survey included questions on demographics, awareness about geriatric oncology principles, and the use of the GA and other geriatric clinical tools. The primary outcome was to estimate the proportion of providers using GA tools through the question: “For your patients ≥65 years, do you perform a multidimensional geriatric assessment using validated tools?”. We hypothesized that ≤10% of respondents would give a positive answer. We used descriptive statistics and X2 tests to compare groups of respondents. Results: We obtained 196 answers (response rate 15.8%). 121 (62%) respondents were male; median age 42. 98 (50%) were surgical oncologists, 59 (30%) medical oncologists, and 38 (19%) radiation oncologists. Median time in practice was 8 years, with 39% practicing in Mexico City. A third had their practice at a public institution, 26% at a private institution, and 38% in both. The proportion of patients aged 65-79 and ≥80 seen on an average clinic day by the respondents was 30% and 10%, respectively. 121 (62%) reported having a geriatrician available at their practice site. 37 respondents (19%) reported using validated GA tools to evaluate older adults with cancer in their practice. The proportion of respondents who evaluated each GA domain is shown in Table 1. Male respondents (p=0.03), medical oncologists (p<0.01), and those with a less busy practice (≤10 patients/day) (p=0.01) were more likely to use validated tools to perform a GA. Regarding barriers for implementing GA, 37% reported lack of time, 49% lack of qualified personnel, 44% lack of knowledge of geriatric tools, 6% patient unwillingness to undergo a GA, and 8% prohibitive cost. Only 17 (9%) thought that information obtained through a GA would not lead to practice changes. Conclusions: According to our survey, the proportion of Mexican oncology providers using validated tools to perform a GA is 19%, which is higher than expected. Some GA domains, such as comorbidity and functional status, were commonly assessed, while others, such as fall history, were seldom evaluated. Common barriers for GA implementation were lack of qualified personnel and of knowledge about geriatric tools. We plan to further explore these barriers and potential facilitators through focused interviews in order to guide future interventions.[Table: see text]
Comparison of validated screening tools for the assessment of potentially inappropriate medications in older Indian patients with cancer.
Authors: Castelino Renita , Noronha Vanita , Ramaswamy Anant , Rane Pallavi , Gattani Shreya , Nair Vandhita , Gawit Kalpita , Dhekle Ratan , Nookala Manjunath , Patil Vijay Maruti , Banavali Shripad Dinanath , Prabash Kumar , Gota Vikram 
Published: June 2021

e24018 Background: The use of potentially inappropriate medication (PIM) and polypharmacy are highly prevalent in older cancer patients and are recognized as potential risk factors for adverse outcomes during cancer treatment. With geriatric cases increasing steadily in India, there is a need for comprehensive studies to identify a reliable screening tool for the assessment of PIMs. Methods: Retrospective analysis of patients ≥ 60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India between 2018-2021. Five tools (Beers-2015, STOPP and START-2014, PRISCUS-2010, FORTA-2018, and the EU (7)-PIM list-2015) were used to assess PIM. A standardized PIM value (SPV) was assigned for each patient for each scale which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all 5 scales for each patient was considered the reference standard. Agreement between each scale and the reference was carried out using Bland-Altman plots. The agreement was determined based on bias and the width of the limit of agreement. Association between categorical variables such as sex, comorbidities, and number of medications (above and below the median) and PIM use was determined using the chi-squared test. Results: 352 patients were included; median age - 70(range: 60-100) years, 287 (81.6%) were males. The bias and limit of agreement given by the Bland-Altman plot for each scale is shown in Table 1. The EU(7)-PIM list was found to have the least bias of 0.7% and the narrowest limits of agreement of 0.43 (-0.21 to 0.22). PIM use was observed to be significantly higher in patients with diabetes than without (83/281 versus 13/82, respectively, p = 0.013) and, patients prescribed with > 7 medications compared with ≤7 (137/281 versus 06/70, respectively, p < 0.001). Conclusions: The EU(7)-PIM list was found to have the least bias and thus considered the most reliable among all other scales in our study population. A high degree of discordance was observed between the tools, thus, we emphasize the need for future studies to identify the most reliable tool for the prediction of PIMs to aid clinical decision-making in geriatric practice.[Table: see text]
The prevalence of cognitive impairment in older Indian persons with cancer and brain metastases.
Authors: Dhanawat Aditya , Noronha Vanita , Ramaswamy Anant , Gattani Shreya , Castelino Renita , Dhekle Ratan , Mahajan Sarika , Patil Vijay Maruti , Menon Nandini , Daptardar Anuradha , Gota Vikram , Prabhash Kumar 
Published: June 2021

e24019 Background: Normal aging is associated with a decline in neurocognitive abilities. Regardless of age, 42% to 91% of persons with cancer and brain metastases are reported to have neurocognitive impairment. There are no data regarding the prevalence of cognitive impairment in older persons with cancer and brain metastasis. Methods: This retrospective analysis was performed on a prospectively collected dataset of patients who attended the geriatric oncology clinic at the Tata Memorial Hospital, a tertiary-care comprehensive cancer center in India from June 2018 to February 2021. Patient aged 60 years and over with malignancy were included. Cognition was assessed with the mini-mental status examination (MMSE); the Hindi MMSE was used for illiterate patients. A score of < 23 on the MMSE was considered abnormal. Correlation between the presence of cognitive impairment and brain metastases was tested using the chi-square test. Results: A total of 401 patients were included, of which 318 (79.3%) were males. The median age was 70 years (range: 60-100 years). All patients had solid tumors; 162 (40.4%) had lung, 139 (34.7%) had gastrointestinal and 48 (12%) had head and neck malignancies. Twenty-five (6.2%) patients had brain metastases, of which 5 (20%) had solitary, 19 (76%) had multiple lesions, and 1 (4%) had leptomeningeal metastases. Cognitive impairment was noted in 4 (16%) of the 25 patients with brain metastases and 61 (16.2%) out of 376 patients without brain metastases. There was no significant correlation between the presence of brain metastases and cognitive impairment, p = 0.57. Conclusions: Older persons with cancer and brain metastases do not have a higher incidence of cognitive impairment than those without brain metastases. The next step is to understand whether older persons with brain metastases are more at risk for cognitive decline as a result of therapeutic interventions such as cranial radiotherapy and chemotherapy.
Preliminary efficacy of a community-based, group-mediated cognitive behavioral lifestyle intervention among breast cancer survivors.
Authors: Haynam Marcy , Fairman Ciaran , Bowman Jessica , DeScenza Victoria , Chaplow Zachary , Kilar Megan , Dispennette Kathryn , Hohn Stephanie , Zhang Xiaochen , Lustberg Maryam B. , Focht Brian 
Published: June 2021

e24035 Background: Post-treatment weight gain places breast cancer (BCa) survivors at heightened risk for cardiovascular disease, metabolic syndrome, and functional decline. Lifestyle weight management (LWM) interventions combining exercise and dietary weight loss represents an effective approach to mitigating the adverse cardiometabolic and functional effects frequently observed in BCa survivors. Unfortunately, community access to cost-effective, sustainable, LWM interventions among BCa survivors remains limited. The purpose of this study is to determine the preliminary efficacy of a community-based LWM intervention in BCa survivors on select body composition (BC), physical function, and social cognitive outcomes of the first wave of participants in the Healthy New Albany Breast Cancer (HNABC) pilot trial. Methods: The 24-week, community-based pilot trial promotes lifestyle behavior changes through a group-mediated cognitive behavioral (GMCB) approach driven by Social Cognitive Theory. The measures analyzed were BC done via Dual-energy X-ray Absorptiometry, physical function via the 400m walk test, and social cognitive outcomes via satisfaction with function and appearance and perceived competence with exercise and diet at 6-months via effect size calculations using Cohen’s d. Results: Meaningful changes were observed in fat mass ( d= -0.46), percent lean mass ( d= 0.33), lean mass ( d= -0.45), and physical function ( d= -0.59), some of which reached clinical relevance. Select self-reported outcomes also saw meaningful improvements from this LWM intervention. Conclusions: Findings from this study demonstrate the preliminary efficacy of implementing a GMCB-based LWM intervention among overweight or obese BCa survivors. Given the meaningful impact that successful weight management has on reducing risk for chronic diseases, these results highlight the utility of implementing a LWM intervention in the community for BCa survivors in an effort to extend the access, reach, and scalability of supportive care approaches during BCa survivorship.
Parotid sparing adaptive radiotherapy in head and neck cancer patients: A study evaluating resource intensiveness and impact on quality of life.
Authors: Maulik Shaurav , Mallick Indranil , Arunsingh Moses , Prasath Sriram , Arun B , Chatterjee Sanjoy 
Published: June 2021

e24037 Background: Anatomical changes during the course of parotid sparing IMRT for head and neck cancer can lead to an increase in the actual dose absorbed by the parotid glands, which may be controlled with the use of interval adaptive replanning. In this prospective assessment of adaptive replanning for parotid dose changes, we explored the feasibility of carrying out adaptive replanning based on predefined objective dosimetric criteria at specified time points. We sought to assess the impact of this measure using a clinically meaningful endpoint of patient reported quality of life outcomes. Methods: 90 patients with head and neck radiotherapy indicated for definitive management or adjuvant therapy who had at least one parotid gland receiving a mean dose (MD) of between 25-30Gy were accrued in the study. The index parotid was delineated on the images acquired on 14th and 19th day and the MD was determined by overlaying the verification image on the planned CT. If the MD had increased by 2% of the initial intended dose, an adaptive plan was attempted with an aim to reduce MD by 2% without compromising PTV coverage; this plan was then used to deliver the remaining treatment. Patients were invited to complete QoL questionnaires: EORTC-QLQC30 with HN35 module, and XeQoL score at baseline, at 3 and 9 months after completion of treatment. Results: 46 out of 90 patients met the threshold for adaptive replanning and were switched to the new plan during treatment. Adaptive replanning was triggered at D14 for 31 patients and D19 for the remaining 15. Need for adaptive replanning was associated with receipt of concurrent chemotherapy and weight loss in the first two weeks of RT. QoL was evaluable for 50 patients at 3 months post treatment. In patients who required adaptive replanning per protocol, Mean XeQoL scores at 3 months showed significantly worse scores for overall scores (1.1 vs 2.3, p 0.001) and for the component individual physical, pain, psychological, and social domains. EORTC QLQ-C30 and HN35 questionnaires at 3 months also demonstrated significantly worse mean symptom scores of the relevant domains of mouth dryness (39 vs 60), stickiness (32 vs 54) and swallowing (39 vs 60) in patients who required adaptive replanning versus those who did not. No significant QoL trends were observable in the 31 patients who were evaluable at 9 months post treatment. The average time required for each step in the planning process was comparable for both the initial planning workflow and adaptive replanning process. Conclusions: The trigger criteria for replanning identified a population of patients who have significantly worsened quality of life due to radiation induced xerostomia. The benefits of adaptive replanning strategies based on weekly evaluation, binary thresholds and standard planning procedures is doubtful Clinical trial information: CTRI/2017/11/010683.
The impact of chemotherapy on subjective cognitive complaints in breast cancer: Evidence from pooled analyses with longitudinal studies.
Authors: Kim Heeju , Jung Sun-Ok , Kim Esther , Abraham Ivo 
Published: June 2021

e24050 Background: Subjective cognitive impairment (SCI) is one of the most commonly occurring symptoms in breast cancer patients. Chemotherapy (CTX) may be an important contributing factor to SCI, yet its association with SCI has been inconclusive. The meta-analysis with longitudinal data can provide more conclusive evidence as to the impact of CTX on SCI. This meta-analysis aimed to (a) determine whether CTX is associated with time-dependent SCI outcomes in breast cancer patients with pooled longitudinal data and (b) identify at the time point with the highest impact of CTX on SCI. Methods: Data were collected from Pubmed, EMBASE, CINAHL, PsychInfo, and the Cochrane library in November 2020. Effect sizes (Hedges’ g) were calculated for the mean differences of the SCI level between the CTX treated patients and controls. Data were analyzed by and across clinical time periods; during CTX, within 1-month-post CTX, within 1-year-post CTX, and 1-year or longer post-CTX. Results: The longitudinal data were pooled with 9 data sets from 13 studies, including 857 patients treated by CTX, 410 patients not treated by CTX, and 517 healthy subjects. At baseline, CTX patients showed significantly better SCI compared to the non-CTX patient controls (ES=0.17, p=.031) and did not differ from healthy controls (ES = -0.04, p = .77). The CTX-treated patients had significantly worse SCI compared to both type of controls after initiating CTX. The effect sizes for the group differences were larger for the group comparison with healthy controls than the non-CTX control (- 0.16 for the comparison with non-CTX control, -0.51 for comparison with the healthy control). The largest time effect was found at the time point of within 1-month-post CTX in comparison with the healthy control (- 0.81). Conclusions: Our analysis indicated the association of CTX with SCI. Yet, more studies are needed to confirm the impact of CTX as (a) the effect size for the comparison with non-CTX control is very small and (b) limited data on the comparison with controls at the time point during active CTX and immediately after CTX. [Table: see text]
Corrected QT prolongation among chemotherapy: Treated patients, a study of a Romanian center.
Authors: Crisan Cristina 
Published: June 2021

e24053 Background: Chemotherapy cardiotoxicity sometimes occurs as QTc prolongation, which may lead to ventricular arrhythmia. We assessed incidence of QTc prolongation among chemotherapy-treated patients. Methods: We enrolled 396 consecutive patients receiving chemotherapy in the Oncology Institute of Cluj-Napoca, Romania. 870 ECGs were performed at baseline and every 2 months, for 5 assessments, during 2016. Results: Most patients were diagnosed with gastro-intestinal tumors and received regimens containing more than one drug. Maximum QTc was recorded after 4 months, when we also found the maximum incidence of increased QTc (>470msec), of 3,73% and of increased ΔQTc (>60msec), of 4%. Female gender was associated with a higher baseline QTc=421 msec, ± 26,9 (p=0.02). No particular chemotherapy regimen was proved to significantly increase QTc. Age was associated with higher QTc and is also an independent variable predicting QTc prolongation (for QTc >480msec, p=0.02), as well as increase of ΔQTc (p<0.001). The number of prior chemotherapy lines correlates with baseline QTc (p<0.0001), with QTc prolongation after 2 months (p=0.01) and predicts higher ΔQTc after 2 months (p=0.01), although within normal range. There was no additive effect during all the 5 assessments. Conclusions: Our results confirm QTc prolongation with chemotherapy and a special attention should be paid to previously treated patients and to elderly patients. Key words: chemotherapy, cardiotoxicity, QTc prolongation.
Long-term follow-up outcomes and treatment among patients previously treated with Zizao Yangrong granules (ZYG) for egfris–related skin xerosis.
Authors: Xue Chongxiang , Li Jia , Lu Xingyu , Cui Huijuan 
Published: June 2021

e24054 Background: Traditional Chinese medicine (TCM) has broad prospects in the treatment of targeted drugs–related dermatologic toxicity. In our previous study (ChiCTRIOR-17013498), Zizao Yangrong granules (ZYG) made effect on EGFRIs-related xerosis and improve the quality of life. However, some people still doubt that TCM could affect therapeutic benefit for patients treated with EGFRIs. Methods: Patients with EGFRIs related xerosis who underwent ZYG and vitamin E ointment from May 2016 to January 2018 were retrospectively reviewed. Survival data and quality of life data analysis were performed. Besides, patients who used ZYG for more than 8 weeks were also summarized, followed by telephone follow-up and questionnaire survey. Results: Of 68 participates randomly assigned, 54 patients were successfully followed up. Median PFS in Vitamin E Ointment plus ZYG group was 41.6 months, and that in Vitamin E Ointment group was 40.9 months, with no statistical difference (HR 0.85, 95% CI 0.48 to 1.51, P = 0.586). Subsequently, 19 patients who used ZYG for longer than 8 weeks were also included. 2 patients reported complete response, 14 patients reported partial response, and 3 patients reported no response. The overall effective rate was 84.2%. The total DLQI score of patients with long-term intervention of ZYG was 4.47±3.10. Compared with baseline DLQI score (7.00±2.91), the DLQI of patients after ZYG intervention has been significantly improved (P = 0.000). During the continuous use of ZYG treatment, incidence of adverse effects was 57.9%. Treatment-related adverse reactions were mostly mild, with no grade 3/4 adverse events. Conclusions: ZYG did not affect progression free survival of patients treated with EGFRIs. And long time-scale ZYG intervention could continuously relieve EGFRI-related xerosis and significantly improve the quality of life of patients without serious adverse effects. Clinical trial information: ChiCTRIOR-17013498.