bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of recurrence in patients with sinonasal undifferentiated carcinoma (SNUC) treated with multimodality therapy at a single center.
Authors: Rodriguez Cristina P. , Liao Jay Justin , Liu Andrew W. , Parvathaneni Upendra , Laramore George E , Humphreys Ian , Davis Greg , Martins Renato G. , Chamberlain Marc C. 
Published: September 2018

e17575 Background: SNUCs are rare and without established therapeutic standards. This is a retrospective review of therapeutic outcomes in pts with SNUCs treated at our center. Methods: Data was collected retrospectively on pts with a confirmed diagnosis of SNUC treated at the University of Washington Medical Center. Demographic data, tumor/treatment characteristics,and dates of recurrence/progression and death were recorded. The Kaplan Meier method was used to estimate survival outcomes; the log-rank and Wilcoxon tests were used to explore associations of clinical characteristics with outcome. Results: Between 5/1992 and 11/2016, 32 pts were treated, 1 was excluded due to incomplete data. The median age was 52 (range 22-82) years, 14(45%) were female, 26(83%) were white, 17(54%) reported current or former tobacco use. One presented with distant metastases, 1 had T2N0 disease, and all other pts had locally advanced disease. Six pts had nodal involvement on initial staging, and 25 patients had T4 disease. Eleven(35%) pts had no skull base/CNS invasion, 7(22%) had skull base extension up to the cribriform plate, 13(42%) had extension beyond the cribriform plate and into the CNS. Twenty-one(67%) pts underwent surgical resection, 29(93%) underwent radiation(XRT) with a median dose of 70 (range 54-72) Gy, and 28(90%) received cisplatin based chemotherapy, with 24 of these given concurrent with XRT, 19(60%) were treated with surgery followed by chemoradiation. With a median 61 months of follow up, 15 pts have recurred, 10 of these recurrences occurred in local sites, with 6 having intracranial progression, 2 of which were leptomeningeal. The median time to progression was 15 months and median overall survival was 58 months . Any vs no tobacco use (58 vs 35 mo p = 0.8), was not predictive of overall survival. The presence of nodal disease (87 vs 7 mo p = 0.005), and CNS invasion beyond the cribriform plate (NR vs 14 mo p = 0.04) was associated with inferior median overall survival. Conclusions: Local/CNS recurrence was the predominant failure pattern in our pts. CNS invasion beyond the cribriform plate and nodal disease were associated with significantly worse survival.
Multifocality and Hashimoto’s thyroiditis as independent predictors of structural recurrence in a cohort of low risk intrathyroidal papillary thyroid cancer.
Authors: Pezzullo Luciano , Marotta Vincenzo , Chiofalo Maria Grazia , Gambardella Claudio , Bellevicine Claudio , Grasso Marica , Conzo Giovanni , Docimo Giovanni , Troncone Giancarlo , Sciammarella Concetta , Colao Annamaria , Faggiano Antongiulio 
Published: September 2018

e17577 Background: Increasing incidence of thyroid malignancies is almost totally attributable to papillary thyroid cancer (PTC). Although all disease stages are involved, PTCs confined to the thyroid were those with the higher trend. The absence of dedicated randomized controlled trials makes challenging the management of these low risk PTC at different steps of the therapeutic process (extent of surgery, prophylactic central node dissection, and radio-iodine treatment). Thus, it is mandatory to set a prognostic system suitable for this clinical setting. We analyzed prognostic factors of structural recurrence in a large cohort of consecutive low-risk intra-thyroidal PTC. Methods: Multicenter retrospective study including pT1/2 PTC without any evidence of extra-thyroidal disease. The following parameters were considered: gender, age at diagnosis, histology, tumour size, multifocality, pathologically-proven Hashimoto’s thyroiditis (HT), and radiometabolic treatment (RAI). The parameters significantly associated with structural recurrence at the univariate analysis ( p < 0.05) were included in the multivariate analysis. Results: We included 284 patients (mean follow-up 6.3 yrs). At univariate analysis, parameters achieving significance were: age at diagnosis ≥ 45 yrs (p = 0.001, OR 0.04, 95% CI 0-0.72), microcarcinoma (p < 0.001, OR 0.02, 95% CI 0-0.39), multifocality (p < 0.001, OR 4.3, 95% CI 1.88-9.84), HT (p = 0.018, OR 0.33, 95% CI 0.13-0.86), and RAI (p = 0.002, OR 19.43, 95% CI 1.16-323.3). At multivariate analysis, only multifocality (p = 0.042, OR 2.52, 95% CI 1.03-6.16) and HT (p = 0.036, OR 0.34, 95% CI 0.12-0.93) revealed as independent prognosticators. Conclusions: Our data show that multifocality and HT should be considered as the main parameters for the decision-making of low risk PTC. Further studies are required. Note: We acknowledge Umberto Veronesi Foundation for granting Vincenzo Marotta with Post-doctoral Fellowship year-2017 Award.
Diagnostic performance of thyroid multimodal-imaging comprehensive risk stratification scoring (TMC-RSS) system in characterising thyroid nodules.
Authors: Mahajan Abhishek , Vaish Richa , Arya Supreeta , Sable Nilesh , Pande Shilpa , Paul Peter , Kane Shubhada , Chaukar Devendra , Chaturvedi Pankaj , Pai P. S. , Pantvaidya Gouri , Thakur Meenakshi , D'Cruz Anil 
Published: September 2018

e17588 Background: A univocal ultrasound (US) classification system for characterising thyroid nodules is still lacking. The aim was to create an algorithm (TMC-RSS) using US features in combination with Color Doppler (CD), TIRADS, elastography (ES) and test its diagnostic performance. Methods: Analysis of prospectively collected data over 10 months. All studies were performed on single equipment using standard US protocol with TIRADS scoring. Gold standard was pathology. 340 nodules in 260 patients of which 316 nodules included for final analysis. 148 (46.8%) benign and 168 (53.2%) Malignant. TMC-RSS Multiple Logistic Regression Model. Malignant characteristics:Plus (+) 3 points for: ES score 3/4, malignant nodes. (+) 1 point for: Taller than wider, microcalcification, hypoechogenicity, solid composition, ill-defined margins, central +/- peripheral vascularity. (+) 0.5 point for: irregular halo, size > 1 cm. Benign characteristics:Minus (-) 3 points for: Purely cystic, ES score-1; (-) 1 point for: spongiform, comet tail artefact, complete halo. (-) 0.5 point for: peripheral vascularity. Final TMC-RSS Score calculated by addition of all the points. Results: Mean age was 47.3 yrs. Mean size was 2.3 +/- 1.5 cm. Diagnostic performance of combined US, ES, TIRADS and CD (sensitivity: 96%, specificity: 95%, PPV: 95%, NPV: 96%, kappa: 0.911) was significantly higher (p < .001) than either combination of US, TIRADS, ES, CD. On multivariate analysis all US features except taller than wider were independent predictor of malignancy (p < .01). TMC-RSS Model had 90% sensitivity, 89% specificity and 91% accuracy for characterising nodules. On the ROC curve the cut-off for best performance of TMC-RSS score was 5.75. The cumulative risk of malignancy based on TMC-RSS score was 2.4% for score < 3, 18% for score ≥ 3 - < 6 and 80% for score ≥ 6. Conclusions: The proposed TMC-RSS is easy-to-use, robust, reproducible and provides higher degree of confidence to a non-expert radiologist. It can be the first step in standardization of reporting lexicon to allow effective communication between the radiologists, pathologists, and clinicians; helping avoid unnecessary interventions.
Implementation of molecular testing for EGFR mutations and ALK rearrangement in lung adenocarcinoma in Brazil.
Authors: Palacio Sofia , Lopes Gilberto , Prado Edna 
Published: September 2018

e18002 Background: Lung cancer is the leading cause of cancer death worldwide. In Brazil, cancer is the second most common cause of death and there were an estimated 27,330 new cases of lung cancer in 2014. Targeted therapies have changed disease prognosis and current clinical guidelines advocate for EGFR/ALK molecular testing for all patients with advanced-stage lung adenocarcinoma. Access to this testing is often limited in the developing world. In the case of Brazil, there is limited data regarding the frequency of testing and the changes in patterns of testing overtime. Methods: De-identified data was obtained from a commercial database that surveys approximately 2,000 cancer physicians in Brazil regarding practice patterns. On average 300 physicians responded to the survey, which is conducted every 6 months, and provided information on about 18,000 patients. Subsequently, we identified patients with lung cancer and calculated the frequency of testing for EGFR mutations and ALK rearrangement from 2011 to 2016. Results: 11,684 patients with lung adenocarcinoma were analyzed from 2011 to 2016. The frequency of testing for EGFR mutations increased significantly: 12.8% (287/2,228) in 2011, 34.4% (738/2,142) in 2012, 39.2% in 2013 (822/2,092), 43.9% in 2014 (866/1,972), 53.3% (1165/2,184) in 2015, and 58% (626/1,066) for the first semester of 2016. Testing for ALK rearrangement also increased noticeably over the same period: 0% in 2011 (0/2,228) and 2012 (0/2,142), 0.9% (19/2,092) in 2013, 2.99% (59/1,972) in 2014, 5.5% (121/2,184) in 2015, and 4.8% (52/1,066) for the first semester of 2016. Conclusions: To our knowledge this is the largest data analysis regarding changing practice patterns of molecular testing for lung adenocarcinoma over time in Brazil and Latin America. The frequency of testing for EGFR mutations and ALK rearrangement has increased over the last 5 years but is still below the current guidelines recommending that all patients with advanced disease be tested. Further understanding of the barriers to testing, will hopefully lead to national strategies for universal implementation of molecular testing.
Correlates of cervical cancer screening from four Sub-Saharan African (SSA) countries: Results from the Demographic Health Survey (DHS)—2013-2015.
Authors: Menon Manoj , Krantz Elizabeth , Casper Corey 
Published: September 2018

e18006 Background: Widespread cervical cancer screening has led to a dramatic reduction in cervical-cancer related mortality in resource-rich regions. However, cervical cancer remains a leading cause of cancer-related death in SSA due in part to a lack of accessible screening and treatment options. Methods: The DHS is a nationally representative household survey designed by ICF International and typically implemented every 5 years. In addition to demographic characteristics, select surveys collect data on cervical cancer awareness and screening. We included women aged ≥21 years from Côte d'Ivoire, Kenya, Namibia, and Zimbabwe who participated in the DHS. After sample weights were applied, we used logistic regression to examine associations of demographics and national cervical cancer incidence (as per the International Agency on Research on Cancer) with cervical cancer screening. Factors with p < 0.20 in bivariate analyses were included in a multivariate model. Results: We analyzed data from 45,947 women aged 21 to 49 years (mean = 32.2); 69% were married with an average of 3 children. Nearly half had completed secondary education (47%), 73% were literate, and 48% belonged to the highest two wealth quintiles. Over 70% of women were aware of cervical cancer; 24% of all women reported a previous screening exam with variation by country. Namibia, with the highest rates of screening (46%), had the lowest incidence. In multivariate analyses, cervical cancer screening was associated with increasing age (OR = 1.06; CI = 1.05, 1.07), education (OR = 1.48; CI = 1.30, 1.69), literacy (OR = 1.80; CI = 1.53, 2.13), and wealth (OR = 1.14; CI = 1.09, 1.20). Higher cervical cancer incidence at the national level (OR = .980; CI = .976, .983) and rural residence (OR = .839; CI = .738, .953) were inversely associated with odds of cervical cancer screening. Conclusions: Based on DHS data from four SSA countries, awareness of cervical cancer is high, but receipt of cervical cancer screening is low and may be associated with reductions in cervical cancer incidence. Targeted efforts to increase utilization of cervical cancer screening in SSA are warranted to reduce the preventable burden of cervical cancer.
A demonstration project: Providing colon cancer screening to homeless people—Capitalizing on community partnerships.
Authors: Foreman Leslie , Green Donna Akerson , Thorpe Beverly , Haddock Malia , Burns William , Roberts M.Parker , Remick Scot C. 
Published: September 2018

e18009 Background: Homeless people encounter many barriers to healthcare and preventative services, while having an increased prevalence of most risk factors for cancer. A group of homeless adults (40) receiving services from Preble Street in Portland Maine were successfully provided access, support and coaching to participate in colon cancer screening using Fecal Immunochemical Test (FIT) over a period of six weeks. Maine Medical Center Cancer Institute (MMCCI) recruited a Physician champion, while Preble Street gathered multiple internal and external community partners and together help plan the project identify resources needed, plan for data collection and address potential barriers for participation. Methods: Community partners (MMCCI, Preble Street, Casco Bay Surgery, NorDx, MaineHealth Care Partners and Homeless Health Partners Case Managers, Me Health LRC, and Maine Medical Center Magnet Council) created a detailed protocol to be used to overcome barriers and facilitate screening. The combination of a simple screening tool and caseworker relationship proved to be an effective strategy. Community Partners were used to identify barriers in the process, monitor all test results and navigate patients testing positive to colonoscopy. Small incentives of $10 food cards were provided for those participating in the screening event. Results: Of the 40 participants who were screened 8 (20%) tested positive and are in colonoscopy follow-up, with ages ranging from 50-74 years. The majority of participants 28 (70%) reported never having a provider conversation about colon cancer screening. Conclusions: Providing cancer prevention education and access to screening can have a positive impact on early detection in the homeless population. Identifying practical barriers and solutions are essential to improving cancer screening participation for homeless people.
Impact of cancer therapy on oral care utilization.
Authors: Smith Derek , Castellanos Emily , Murphy Barbara A. 
Published: September 2018

e18010 Background: Cancer therapy can result in lifelong detrimental changes to oral function. These changes often result in negative effects on patients' quality of life. The primary objective of this study is to evaluate attendance at dental visits among patients receiving a cancer diagnosis, and how attendance may change as patients move through pre-diagnosis, diagnosis and into survivorship. Methods: The Health and Retirement Study is a publically available dataset containing longitudinal survey data detailing financial and health information on 4195 patients, over 51 years old who received a new cancer diagnosis during the study. The odds of reporting a dental visit were examined as patients proceed through various phases of cancer therapy using a mixed-effects logistic regression model. A propensity score weighted analysis of the association between dental attendance in the survey wave in which the cancer was diagnosed and survival was also undertaken. Results: The odds of attending a dental visit were substantially lower in the diagnosis wave OR = 0.784 (0.700, 0.876) and the post-diagnosis waves OR = 0.734 (0.655, 0.823) compared to pre-diagnosis waves. This effect persisted in patients who survived for at least two years indicating that the decline in oral health visits was not due to extremely low expected survival. The decrease in oral health visits was not affected by age, race, gender, income, insurance coverage or education. After propensity score weighting, patients who attended a dental visit in their diagnosis wave demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance. Conclusions: Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy despite indications for dental referral existing for many types of cancer therapy. Attendance at dental appointments during cancer therapy is associated with improved survival, which is likely due to a combination of direct and indirect effects. The fact that the decreases in care were not modified by socioeconomic factors suggests that it is not driven by strictly financial concerns and more research is necessary to identify barriers to adequate care.
Comprehensively assessing the clinical trial landscape in oncology over the last 10 years.
Authors: Crowther Jonathan , Cocker David john 
Published: September 2018

e18023 Background: Since the establishment of clinical trial registries such as ClinicalTrials.gov the number of such registries and the volume of data within the registries has quadrupled. Many studies have assessed the clinical trial landscape within their research field and have been hindered by inadequate search queries. Several approaches within these studies have implemented descriptive statistical analysis by examining specific indications or by searching for trials often using vague search terms such as “neoplasms”. This type of analysis permits the integration of potentially non-relevant noisy data which, impairs the overall analysis quality, Methods: In this study, we developed a semantic ontology linking algorithm to comprehensively merge 16 trial registries, 198,000 clinical trials, 10,000 molecules from multiple drug databases and PubMed, thus rendering and identifying indications, treatment, sites and investigators into one resource. The method allowed for a semantically cleaned and collapsed database to be queried more effectively with higher reliability in results. Results: The second proponent of our study was to assess the international oncology trial landscape over the last 10 years. The last major analysis in 2009 identified a significant preference for United States clinical sites in large cancer trials. Since this study, oncology has evolved toward a precision therapy approach and adaptive design model. This 2017 analysis shows an increasing concentration of US based clinical activity. For lung cancer trials with a US component, the top 100 US clinical research sites in the US are involved in 86% of the phase 1 trials, representing 55% of the total enrolment. When analyzing site usage for phase 3, this share drops to 67% of trials, representing just 8,5% of the total patient enrolment targets. Conclusions: The semantic ontology and algorithms and exploiting real-world data to mapped out and re-evaluate the status of cancer trials globally and gave insights into how cancer trials are progressing in the future. Understanding this evolution is of high importance for clinical trial planning and global trial country and site optimization.
Utilization of advanced molecular analyses in lung cancer: A country perspective—Young Research Group.
Authors: Petekkaya H. Ibrahim , Abali Huseyin 
Published: September 2018

e18027 Background: Molecular and genetic analyses in cancer treatment are continuously evolving, and taking part in patient management. This study evaluated the clinical practices of medical oncologists in Turkey for utilization of these methods in lung cancer patients. Methods: All medical oncologists registered to Turkish M.Oncology Society were called to participate an online survey about their practice patterns of using molecular and genetic analyses for the management of lung cancer patients. Survey included 19 questions for demographic data, work environment, knowledge about the molecular and genetic analyses, and barriers to use these methods. Results: A total of 188 medical oncologists (M/F: 117/71; mean age 39.3±6.7) were participated. The key findings: Work environment: Academia 49%; others 51% Checking mutations in adenocancer: 88.4% Molecular analyses available at home institution: 61.4% Checking EGFR, EML-ALK, ROS-1 in NSCLC: 75.7% Non-specifically checking markers: 58.2% Checking markers only for locally advanced/metastatic disease at diagnose: 75.1% Obtaining analyze results in: 8-14 days 45%; 15-21 days 31.2% Obtaining a positive EGFR/ALK report after initiating chemo: re-evaluate patient after 2/3 cycles 68.3%; stop chemo and shift to targeted therapy 20.6%; continue full-regimen 12.2% Maintenance therapy after response regardless of mutation: 36% If targeted therapy initiated regardless of mutation, the preferred 1st step cytotoxic chemo regimen in metastatic adenocancer: cisplatin+pemetrexed 50.2% Analyzing mutation from primary lung biopsy: 95.8% Re-biopsy if sample was inadequate: 91.5% Secondary biopsy for: EGFR/ALK discordance 38.1%; progression under treatment 46%; young patient 22.2%; never-smoker 34.9%; test-negative but presumed to be clinically-positive patient 46.6% Conclusions: Majority of the medical oncologists in Turkey use molecular and genetic analyses in clinical practice. But, the limited availability and the lags in obtaining results lead oncologists to initiate treatment primarily based on clinical findings. Once these methods become more available, targeted therapies and consequent favorable outcomes will increase in oncology practice.
Changes in clinical trial participation among adolescent and young adult (AYA) cancer patients from 2006 to 2013 in the United States.
Authors: Keegan Theresa , Penn Dolly , Li Qian , Pollock Brad , Malogolowkin Marcio H. , Wun Theodore , Parsons Helen M. 
Published: September 2018

e18037 Background: Stagnant outcomes for AYAs (15 to 39 years) with cancer are partly attributed to poor enrollment onto clinical trials. Initiatives have focused on increasing accrual, but changes at the population-level are unknown. We examined patterns of clinical trial participation over time in AYA cancer patients. Methods: We utilized medical record data from AYAs in two National Cancer Institute Patterns of Care Studies identified through the Surveillance, Epidemiology and End Results (SEER) Program. Among 1,358 AYAs diagnosed with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), acute lymphoblastic leukemia (ALL), germ cell cancer, and sarcoma in 2006 and 3,560 AYAs diagnosed with NHL, HL, ALL, sarcoma, and breast cancer in 2012/2013, we used unconditional logistic regression to evaluate patient and provider characteristics associated with enrollment by year of diagnosis. Analyses were weighted to reflect the SEER populations and associations are summarized as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results: From 2006 to 2012/2013, clinical trial participation increased from 14.8% to 17.9% among AYAs diagnosed with NHL, HL, ALL and sarcoma (p < 0.0001), primarily due to increased participation among ALL patients (2006: 37.4%; 2012/2013: 42.3%). In 2012/2013, participation varied by type of cancer, with the highest among those with ALL and sarcoma (31.2%), followed by HL (9.4%), NHL (6.9%) and breast cancer (4.3%). In both study years, multivariate analyses demonstrated that younger patients and those treated by pediatric oncologists (OR = 3.5; CI: 2.6-4.7) were more likely to enroll onto clinical trials. Uninsured AYAs were less likely to enroll in 2006 but no association was observed in 2012/2013. Hispanic (OR = 0.5; CI: 0.4-0.6), Black (OR = 0.6; CI: 0.5-0.9) and Asian (OR = 0.4; CI: 0.3-0.6) AYAs were less likely to enroll in 2012/2013 but not 2006. Conclusions: Our study identified increasing overall clinical trial participation over time. Disparities in likelihood of participating for racial/ethnic minority groups increased suggesting the need to improve access to clinical trials for all racial/ethnic groups to improve care and outcomes.