bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of sarcopenia in patients with gastroesophageal and lung malignancies undergoing surgical resection and its impact on immediate postoperative outcomes: A prospective observational study.
Authors: Gunasekar Sudhakar , Deo SVS , Kumar Sunil , Dhamija Ekta , Bhoriwal Sandeep Kumar 
Published: June 2021

e18617 Background: The study evaluated the prevalence & impact of sarcopenia in gastroesophageal cancer (GC) & lung cancer (LC) patients undergoing resection. Methods: An observational prospective study was conducted in department of surgical oncology, AIIMS, New Delhi. All patients aged under 65 years with resectable GC & LC were included. Skeletal muscle index (SMI) using cross-sectional CT images at the level of L3 & Hand grip strength (dynamometer) were used to assess sarcopenia. Random benign patients with CT images were used as control group. Patients were categorized into sarcopenic and non-sarcopenic and outcome parameters were compared. Results: In the study population (n = 66), GC & LC constituted 44 (66.67%) & 22(33.33%) respectively. Mean age was 53.4 years. The prevalence of sarcopenia based on the combined method (CT imaging & handgrip strength) was 57.58%, CT based sarcopenia was 33.34% & handgrip strength-based sarcopenia was 43.93%. Mild and moderate sarcopenia was seen in 37.88% (n = 25) & 19.7 % (n = 13) respectively. Among patients with GC, prevalence of sarcopenia was 59.09% by combined method, 36.36% and 43.18% by CT based method alone & handgrip strength-based method alone respectively. Among LC prevalence of sarcopenia was 54.54% by combined method, 27.27% and 45.45% by CT based & handgrip-based method. The concordance between CT muscle mass & grip strength was 62.12%. Most female patients had weak handgrip strength despite having normal SMI. In control group (n = 44) mean age was 54.5 years, the prevalence of CT based sarcopenia was 34.09%. Weight loss history & BMI correlated with the degree of sarcopenia. Out of 66 patients 13% (n = 9) patients were unresectable. Moderate sarcopenia group had more statistically significant (P -0.02) unresectable disease compared to mild and non-sarcopenic groups. In postoperative period, sarcopenic group (64.51% vs 38.36 %) had more grade 2 complications though statistically insignificant. There was no difference in hospital stay between the two groups. In patients with GC , postoperative respiratory complication occurred in 11.53% (n = 3) of sarcopenic patients and 5.5%(n = 1) of non-sarcopenic patients, anastomotic leak occurred in 7.69% (n = 2) of sarcopenic patients and 5.5% (n = 1) of nonsarcopenic patients. Conclusions: The prevalence of sarcopenia is higher in patients with gastroesophageal cancer compared to lung cancer. The important factors that affect the sarcopenia include age and body mass index and weight loss history. The study has showed a trend towards increased post-operative complications and increased unresectable cases in patients with mild to moderate sarcopenia. Further larger studies are required to validate if sarcopenia can be used as an adjunct to predict resectability and post-operative outcomes.
Clinical outcomes in HER2-positive and triple-negative breast cancer: Assessing racial disparities.
Authors: Sarma Maithreyi , Ronghe Ashwini , Nasir Samar , Kapoor Ankita , Attwood Kristopher , Gandhi Shipra 
Published: June 2021

e18624 Background: Triple negative breast cancer (TNBC) & HER2 positive breast cancer (Her2BC), are aggressive breast cancer subtypes. Both are associated with higher mortality in Non-Hispanic Black (NHB) compared to Non-Hispanic White women (NHW). Factors attributed to this racial disparity include socioeconomic status, insurance status, diagnosis(dx)/ treatment delays & comorbidities. We examined the association between race & clinical outcomes (pathological complete response, pCR; recurrence free survival, RFS & overall survival, OS) in patients (pts) dxed with TNBC/Her2BC treated with neoadjuvant chemotherapy (NAC) at Roswell Park Comprehensive Cancer Center. Methods: Pts dxed with Stage I-III TNBC/Her2BC who received NAC from 2000-2018 were included. pCR was defined as absence of residual invasive cancer in the breast & lymph nodes after NAC. Association of race with pCR & survival outcomes was evaluated using logistic & Cox regression models, respectively. Multivariate (MV) models were used to evaluate the association between race & pCR or survival while controlling for relevant confounders including age, BMI, insurance, comorbidities, clinical stage, grade & time from dx to chemotherapy(chemo)/surgery. Analysis was conducted using SAS v9.4 at a significance level of 0.05. Results: 174 TNBC (49 NHB, 125 NHW) & 80 Her2BC (13 NHB, 67 NHW) pts were analyzed. Among TNBC pts, NHB pts had higher baseline BMI(34.3 vs 28.6 kg/m2; p<0.001), higher incidence of hypertension (HTN) (45% vs. 24%; p<0.01), diabetes mellitus (20% vs 8%; p<0.05) & higher Medicare/Medicaid use (M/M) (55% vs. 28%; p<0.01). Among Her2BC pts, NHB pts had higher incidence of HTN (54% vs 25%; p<0.05). There was no statistically significant difference in mean chemo relative dose intensity by race. Among TNBC pts, those with pCR were younger (47 vs 53 yrs; p=0.002) & had more grade 3 tumors (96% vs 80.5%; p<0.05) at dx compared to pts without pCR. Similarly, among Her2BC pts, those with pCR had more grade 3 tumors (64% vs 36%; p<0.05) at dx compared to pts without pCR. Among TNBC pts, advanced age, higher clinical stage & longer time from dx to surgery were associated with worse RFS & OS (p<0.05). Among Her2BC pts, M/M use & advanced clinical stage were associated with worse RFS & OS (p<0.05). There were no significant associations between race & pCR/RFS/OS on MV analysis (table below). Conclusions: Similar outcomes were noted between races for TNBC/Her2BC pts treated at a single academic center in Buffalo, NY. Given the known genetic diversity of African American ancestry in the US, further studies investigating the interplay between race, geography & clinical outcomes are warranted.[Table: see text]
Differences in transitions of care among cancer patients with and without venous thromboembolism (VTE) events.
Authors: Nathan Cinduja 
Published: June 2021

e18636 Background: Transitions of care are an important part of medical care, as they provide opportunities to address patient concerns, refine goals to match current needs and prevent unforeseen complications and comorbidities. One such common and prevalent comorbidity amongst cancer patients is venous thromboembolism (VTE) events. Common VTE events include the occurrence of pulmonary embolism (PE), deep vein thrombosis (DVT) or both at the time of diagnosis or any time thereafter. It is estimated that approximately 4–20% of cancer patients will experience a VTE. Cancer patients developing VTE is a serious concern as it can adversely affect the patients’ quality of life and reduce overall survival rates and prognosis. Methods: This study is designed as a case control study. The subject group consists of 87 cancer patients who had one or several VTE events after their cancer diagnosis. Patients were selected from the UVM Medical Center electronic health record database. The goal of this project was to quantify and compare the average number of transitions of care in cancer patients with and without venous thromboembolism (VTE) events. This was achieved by reviewing the patients charts three months following a VTE event and evaluating whether these patients had a greater number of transitions compared to the three months prior to their VTE event. Transitions of care in our study were defined as office visits, ED visits, and inpatient admissions related to their VTE. Results: Initial evaluation of the results showed that there were more transitions of care amongst cancer patients with a VTE than without. Preliminary data of the 87 patients shows that patients who developed a VTE event after their cancer diagnosis had on average 1.3 more transitions of care within the three months following their VTE event compared to cancer patients without a VTE event. A t test will be used to determine whether the difference between the means (number of transitions of care) of the two groups (cancer patients with VTE and those without VTE) is significant. Conclusions: The implications of having greater transitions of care amongst cancer patients with VTE events are profound. Having more transitions of care exemplifies better implementation, patient care and involvement of health care teams given a history of VTE. Furthermore, the results of this study will provide further insight on ways to improve clinical outcomes and oncology patient care given a history of VTE.
Improving end of life care with advance care planning in a rural cancer center.
Authors: Barnhart Jacquelyn , Wells Stacy , Harris Tasha , Symington Banu 
Published: June 2021

e18637 Background: We discovered four out of five Medical Oncology patients admitted to the hospital December 2019 and January 2020 were discharged to hospice and died within a week. None of those patients had advance directives. In November and December 2019, all oncology patient charts were reviewed and only 7% (12/174) had advance directives. We believe an established advance directive could have helped avoid unnecessary hospitalization, improved end of life care and reduced wasteful health care costs. This led to the question: Would process changes in a rural cancer center lead to an increase in completion and documentation of Advance Directives, thereby providing more patient goal congruent care? Methods: Data collection and process mapping was performed revealing current processes and overall barriers. This was analyzed and countermeasures were developed leading to process changes and interventions. The interventions included assigning dedicated staff to “own” the advance directives education, follow up and completion, training and certification of staff, and education of the entire Cancer Center on the new process and interventions. The new process included a standardized order set to cue a referral to the dedicated staff, standardized patient education and follow up and documentation consistencies. Results: The initial data collection revealed an advance directive completion rate of 7% in new oncology patients. Process inconsistencies and communication deficiencies, with redundant screening and no follow up, created significant barriers to advance directives. Repeat data collection after creating a position for dedicated staff to educate patients and help with advance directive completion revealed a completion and documentation rate of 6% and thus, was insufficient to lead to change. When a consistent process with formal communication to the dedicated staff was implemented, improvements were noted. Our most recent data collection revealed a 36% completion and documentation rate in advance directives. Conclusions: Lack of effective advance directive programs potentially lead to end of life care incongruent with patients’ wishes and wasteful of health care resources. An advance directive ensures that if a patient is unable to clearly communicate their wishes, these wishes are still honored. In addition, the advance directive can help avoid unnecessary hospitalizations, improve end of life care and reduce wasteful health care costs. As a rural cancer center with a limited service area, we are challenged with a small sample size. Practice will be needed to ensure consistency and efficacy of the current interventions in order to support continued improvement in completion and documentation rates of advance directives. This project will be expanded to address advance directives for all patients.
Descriptive study of the therapeutic aggressiveness in oncology patients in the hospital area of Huelva.
Authors: Amor Urbano María , Sánchez Escudero Laura , Palomo Rodríguez Rocío , Inoriza Angel , Camacho Pizarro Tomás , Bayo Juan L. 
Published: June 2021

e18645 Background: The therapeutic aggressiveness (TA) criteria or Earle criteria (EC) (Table) explore indicators that reflect the quality of end-of-life cancer patients (pts). They are considered the gold standard to evaluate TA. The aim of our study is to analyze TA by applying EC in deceased cancer patients (pts) in the hospital area of Huelva. Methods: Observational and descriptive study of deceased cancer pts in the area of Juan Ramón Jiménez (HJRJ) and Vázquez Díaz (HVD) hospitals (2017– 2019). We used the IBM SPSS Statistics 22 program to analyze the overuse of oncology therapies (OT) and invasive therapies near death, as well as underutilization of hospice services (HS). Results: 922 pts were classified according to the type of tumor. The most prevalent was lung-pleural cancer (LC) 27%, followed by colorectal cancer (CRC) 17.7%. 25.3% died in an acute care unit of the HJRJ, 48.7% in the hospice care unit (HCU) of the HVD and 26% at home with follow-up by HCU. 70.3% received OT in the last month of life. 11% started a new treatment and 17% received it in the last 14 days of life. 75.8% of the pts were included in the HCU before death. Of these, 4.3% were included in the 72 hours before death. 18.5% of pts went to the Emergency Service more than once in the last month of life. We also analyzed the previous data according to the type of tumor (Table). Conclusions: Our study reflects an overuse of oncology therapies near death. This produces a greater use of resources, such as assistance to the Emergency Service or aggressive actions to alleviate the adverse effects secondary to the treatments. There is a greater TA in pts with head and neck cancer (HNC). These pts usually initially show malnutrition, comorbidities (heart disease, liver disease) and a borderline performance status before starting the treatment. Our data show that the rise of new therapeutic options in LC and breast cancer generated an overuse of treatment near the end-of-life.[Table: see text]
Insomnia in cancer patients.
Authors: Ashraf Sara , Jafri Mohammad Ali Syed , Alsharedi Mohamed Farouq 
Published: June 2021

e18651 Background: Insomnia is a prevalent, debilitating problem that is faced by a growing number of patients with cancer. These patients are at higher risk of excessive fatigue, anxiety, depression, less immunity and poor adherence to treatment. A recommendation by the National Comprehensive Cancer Network (NCCN) Guidelines is to routinely screen patients for sleeps issues. We sought to analyze the screening for insomnia and its management at a cancer center in Appalachia. We also evaluated referrals for cognitive behavioral therapy, which is recommended as first line therapy in patients with chronic insomnia by the American College of Physicians (ACP). Methods: We performed an anonymous survey related to sleep at our cancer center which included 312 patients diagnosed with a solid tumor malignancy divided into early stage (stage I or II) or advanced stage (stage III or IV). Three questions were directly from NCCN guidelines screening for sleep disturbances in patients with cancer. We also added questions regarding if the patients’ medical oncologists ever asked about or addressed their sleep difficulties and if any treatment was offered. The institutional review board of the cancer center approved this study. Results: Our results showed that 67.9% (212 patients) reported either having difficulty falling asleep, staying asleep, or waking up too early. 14.7% (46 patients) reported excessive sleepiness, while 64.7% (202 patients) reported that someone else told them that they snore frequently or stop breathing while sleeping. Of the patients who reported difficulty with sleep, only 4.7% (10 patients) reported that their medical oncologist ever addressed it, with 7 patients being started on medication. No patients were referred for cognitive behavioral therapy. Patients with advanced stage disease were four times more likely to report disturbances with sleep than early stage disease. Conclusions: Patients with cancer have difficulty with sleep, which profoundly affects their quality of life and may negatively impact their response to treatment. We wanted to use this survey to see how we can improve efforts to routinely screen patients and identify those in need of assistance and therapy. Routine screening and initiation of treatment must be implemented nationwide in all cancer centers. We aim to start referrals for cognitive behavioral therapy and continue to address patients’ sleep disturbances on a routine basis.
Availability, reading level, quality, and accessibility of online cancer center smoking cessation materials.
Authors: Littman Dalia , Chino Fumiko 
Published: June 2021

e18662 Background: Smoking cessation after a cancer diagnosis improves cancer outcomes. Therefore, it is important for cancer centers to provide educational resources to encourage patients to quit smoking. The NIH recommends that patient reading materials be written at a grade 6-7 reading level to maximize comprehension. As smokers on average have lower educational attainment than the general population, they may have particular difficulty comprehending smoking cessation materials written at advanced grade levels. Methods: This study evaluated the reading level of online resources via textual analysis of smoking cessation webpages associated with 63 NCI-Designated Cancer Centers or their affiliated medical centers or universities. Reading level was assessed using the WebFx Readability Test Tool. Differences in grade level were calculated by Mood’s Median Test. Content was evaluated for the quality of information, including textual analysis of print-out pamphlets. Non-English content and ease of navigation to webpages was documented. Results: Availability: Of 63 cancer centers, 42 (67%) had smoking cessation webpages. Among centers that did not have their own webpages, 14 had smoking cessation webpages hosted by affiliated medical centers and the remaining 7 had webpages hosted by affiliated universities. Reading Level: The median grade level for online smoking cessation materials was 9 (interquartile range IQR 8-10). There was no significant difference in grade level based on cancer center region, ranking, or whether the webpage was hosted by the cancer center, medical center or university. 17 webpages (27%) had print out pamphlets available, which had a median reading level of 8.5 (IQR 7-10). Information Quality: 27 webpages (43%) explicitly stated that smoking cessation improves cancer outcomes, 15 (24%) included details about smoking cessation medications, 16 (25%) provided information on behavioral counseling, and 14 (22%) described the risks/benefits of e-cigarette use. Only 4 (6%) had information on all four topics, while 21 (33%) did not have information on any of these four topics. Accessibility: Only 3 webpages (5%) were available in multiple languages. 12 webpages (19%) were inaccessible by search from the homepage with common terms (i.e. smoking, quit smoking, tobacco, etc). 38 webpages (60%) required 3 or more clicks to reach from the center homepage. Conclusions: Online smoking cessation materials at leading cancer centers exceed recommended reading levels, which can inhibit comprehension for patients trying to quit smoking. These webpages do not routinely include information on cancer outcomes or on evidence-based medications and behavioral change interventions to assist patients in quitting. Given the survival benefit found in cancer patients who quit smoking, it is imperative that educational materials from cancer centers maximize comprehension and accessibility.
Mobile and comprehensive assessment of patient-reported outcomes (PRO) in routine inpatient cancer care: A three-arm randomized controlled feasibility study.
Authors: Salm Hanna , Hentschel Leopold , Kramer Michael , Pink Daniel , Schuler Markus K 
Published: June 2021

e18664 Background: Most of the work on PRO has been done in outpatient setting. However, cancer patients might even suffer from more severe problems when admitted to hospital for anticancer therapy. The question whether and how patients’ well-being changes during the course of the hospital stay and if electronically assessed PRO (ePRO) will bring benefit to patients and physicians remains unanswered. Implementing such a tool into routine clinical care can be considered as an additional challenge.The objectives of this study were to implement a multidimensional ePRO system to improve patient-physician interaction in inpatient cancer care and test its feasibility. A comprehensive set of PRO measures that would broadly assess the patient’s situation was developed by a multidisciplinary expert team. Before study initiation, semi-structured interviews with patients were carried out to optimize visualization and user experience. The tool included a rapid response ePRO system with a patient-tailored graphical feedback for physicians. The effect of the mobile tool on quality of life (QoL), symptom burden and patients’ satisfaction with care were explored. Methods: The study is an interventional, three-arm and multicenter inpatient trial. A self-administered questionnaire based on validated PRO-measures was applied and completed at admission, one week after and at discharge. Group A (intervention arm) and B received tablet versions while group C (control) completed the questionnaire on paper. Additional to the mere assessment of electronic patient reported outcome, results from group A were presented graphically to the treating physicians. Standardized instruments included measures of QoL (EORTC QLQ-C30), patients’ satisfaction with care (IN-PATSAT32) and adverse events (PRO-CTCAE). A feasibility questionnaire was administered to arm A and B. Results: N = 185 patients (mean age 63.5, 44.3% female) were recruited in oncology wards. 62% of patients were treated for oncological disease (33% with stage IV disease) and 37% for hematological disease. Feasibility questions revealed that the majority of patients preferred the electronic tool and believed that the tool was of high value for individualized patient care. Among others, symptom burden and global QoL did not significantly change during hospital stay. Satisfaction with care was significantly lower ( p = 0.047) in the intervention group (mean 3.55) versus the control group (mean 3.77) with scores ranging from 0-5. Conclusions: Results indicate that the intervention is feasible. Some of the results are counterintuitive and could possibly be influenced by a lack of physician compliance due to a busy daily routine. Moreover, the optimal interval and composition of questionnaires has yet to be determined in inpatient setting.