bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics and predictors of pain in patients with newly diagnosed and relapsed acute leukemia (AL).
Authors: Shaulov Adir , Rodin Gary , Rydall Anne , Popovic Gordana , Schimmer Aaron David , Le Lisa W , Zimmermann Camilla 
Published: September 2018

e21633 Background: AL is a hematopoietic stem cell malignancy associated with substantial morbidity and mortality. The prevalence, correlates and causes for pain in this population have not been well studied. We present the results of a large cross-sectional study of pain in individuals with AL. Methods: Patients with newly-diagnosed or recently-relapsed AL admitted to a large tertiary cancer center completed the Memorial Symptom Assessment Scale (MSAS, which has subscales of prevalence, severity, frequency and distress, with ratings of 0 = none, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe). Demographic information, and disease and treatment variables were recorded. Two raters completed chart reviews in duplicate (with discussion of discordant results) for patients with severe pain (MSAS severity ≥3/4) to assess the site of pain. Results: A total of 362 patients were recruited from January 2008 to October 2013: 249 (68.8%) with AML, 80 (22.1%) ALL and 33 (9.1%) APL. Of these, 326 (90.1%) were newly diagnosed and 36 (9.9%) had relapsed disease; 346 (95.6%) were treated with (re)induction chemotherapy. Of 360 who completed the MSAS, pain was reported in 174 (48.3%), of whom 34.4% scored ≥3/4 on severity, 43.1% on frequency, and 44.3% on distress related to the pain. On multivariable analysis, patients reporting pain were more likely to be younger (OR 0.98 old vs young, p < 0.001), and to have ALL (OR 0.57 AML vs ALL, p < 0.05); duration of illness, gender, education, income and treatment intensity were not associated with pain. Pain was correlated with difficulty sleeping, worrying, difficulty concentrating, and feeling sad, nervous or irritable (all p < 0.001). Of the 60 patients reporting severe pain (≥3/4), its site was identified in 53 (88.3%). The most common sites were oropharynx (29.7%), head (18.9%), abdomen (14.9%) and musculoskeletal (12.2%). Only 1.1% (4/362) of the cohort was referred to the palliative care/symptom control team over the month prior to or following assessment. Conclusions: Pain is a frequent and distressing symptom in patients with newly diagnosed or relapsed AL. Further research is needed to assess the efficacy of supportive care interventions in this population.
A comparison of liver cancer and lung cancer patients at two Veteran Affairs Medical Centers.
Authors: Kothadia Sejal , Wang Zhen , Lee Sarah , Chang Victor Tsu-Shih , Wang Yucai , Park Yeun-Hee Anna , Olson Ellen , Klein David , Leaf Andrea Nadine , Hwa Stephanie , Zhong Fengming 
Published: September 2018

e21642 Background: Little is known about palliative care for liver cancer. In this study, we examined palliative care for liver cancer and lung cancer patients. Methods: In an IRB approved protocol, we reviewed medical records of patients diagnosed with liver cancer who were seen by the palliative care service between 2006 and 2012 at 2 VA medical centers, and matched them to patients with lung cancer by year, KPS, and stage. Veterans were compared by symptom prevalence with the CMSAS and by palliative care interventions. Statistical analyses were performed with SAS Studio Version 3.5. Results: We analyzed a total of 138 male patients at 2 VA centers; 69 with lung cancer and 69 with liver cancer. The mean age in both groups was 65 years and 60% of patients self-identified as a minority. There was a high prevalence of symptoms in both groups. Symptom prevalence differed significantly between liver and lung cancer pts for weight loss and dyspnea at one site, and for feeling drowsy, constipation, at the other site. These differences disappeared in a pooled analysis. During palliative care evaluation, more lung cancer patients received treatment for constipation (n = 44 in lung, 29 in liver, p = 0.0107) and dyspnea treatment (n = 37 in lung, 22 in liver, p = 0.0167). More patients with lung cancer were evaluated by physical therapy (n = 41 in lung, n = 28 in liver, p = 0.0276) and psychiatry (n = 31 in lung, n = 20 in liver, p = 0.032). Conclusions: Differences between lung and liver cancer patients’ symptom prevalence and treatment by palliative care can vary by site. This reinforces the importance of local surveys of symptom prevalence . Further studies should be replicated in other sites.
Cancer related insomnia and wireless technology: A pilot study.
Authors: O'Connor Brenda , Ui Dhuibhir Pauline , Walsh Declan 
Published: September 2018

e21645 Background: Cancer related insomnia (CRI) includes difficulty with sleep onset, maintenance or non-restorative sleep. CRI is common with prevalence up to 95%. Consequences include cognitive dysfunction, fatigue, increased hospitalisation and lost work productivity. Early detection may help. CRI remains under-investigated as objective assessment has needed specialised laboratories. Mobile technology may provide a solution. This study aimed to determine the feasibility and acceptability of a wireless bedside monitor (SleepMinder [ResMed Sensor Technologies Ltd, Dublin]) to evaluate CRI. Methods: A prospective observational study recruited 10 consecutive hospice inpatients (IP) and 20 consecutive community participants (CP) with cancer. Participants used a wireless non-contact bedside sleep monitor for 3 consecutive nights. Three insomnia features were examined (sleep onset, maintenance, early awakening). Computerised algorithm-generated metrics were compared to visual inspection of the monitor sleep/activity report. Acceptability questionnaires were completed by patient, nurse and family. Results: The device successfully recorded sleep patterns in all 30 participants. No technical difficulties were experienced. IP: Mean age was 63 +/- 9 years. 7/10 had one or more insomnia features with delayed sleep onset most common. The monitor over-estimated Sleep Latency (77% nights), Duration (77% nights) and Final Awakening (63% nights). CP: Mean age was 64 +/- 10 years. 15/20 had one or more insomnia features with poor sleep maintenance most common. The monitor overestimated Sleep Duration (62% nights) and Final Awakening (45% nights). Lower levels were noted in CP as they spent less time in bed. Patients, nurses and family members reported high (100%) device acceptability. Conclusions: A wireless bedside monitor effectively measured sleep in seriously ill cancer patients in both inpatient and outpatient settings without the use of a sleep laboratory High reliability and acceptability supports routine clinical use Sensitivity of wakefulness detection was reduced as the device incorrectly identified sleep during awake but motionless periods Concurrent use of sleep diary and a monitor is recommended for comprehensive assessment
Olanzapine versus aprepitant in the prevention of chemotherapy induced nausea and vomiting (CINV) in breast cancer patients.
Authors: Mukesh S , M Sathya , Jk Akshay 
Published: September 2018

e21670 Background: Olanzapine has been shown to be a safe and effective agent for the prevention of CINV. This study aims to compare olanzapine with aprepitant in the prevention of CINV. Methods: This study included breast cancer patients receiving doxorubicin 60mg/m2 and cyclophosphamide 600mg/m2 chemotherapy. Female patient; age, ≥ 18; chemotherapy naïve; no nausea/ vomiting in the past 24 hours were included. Patients with seizure disorder, brain metastasis, prior use of antipsychotic agents and hypersensitivity to olanzapine were excluded. Patients were randomized into two groups. Olanzapine group received tab olanzapine 10 mg on day 1 to 3. Aprepitant group received tab.aprepitant 125mg on day 1 and 80mg on days 2-3. Both groups received inj palnosteron 0.25mg, inj dexamethasone 8mg on day 1. Use of rescue therapy for nausea or vomiting was permitted. The primary end point of the study was complete response (CR) for nausea that is no nausea in the acute (within 24 hours), delayed (days 2-5), and overall periods (0-120 hours). Secondary endpoint was CR for vomiting and no use of rescue drugs in all periods. Beginning with the first day of chemotherapy and daily through day 5, patients were asked to record daily episodes of nausea using a visual analogue scale from 0 to 10, with 0 indicating no nausea and 10 indicating a maximal level of nausea. They were asked to record daily episodes of vomiting (number and time) and the utilization of rescue therapy. Results: A total of 84 patients (42 in each arm) were evaluated and consented for the study. The median age 48 years; range 29-80; ECOG PS - 0, 1. CR for nausea was 84% for the acute period , 58% for the delayed period and 56% for the overall period for the olanzapine group. CR for nausea in aprepitant group was 69% acute period, 55% delayed period, and 55% for the overall period. CR for vomiting was 91% acute; 74% delayed; 70% overall period for olanzapine group. CR for vomiting in aprepitant group was 91% acute; 83% delayed; 83% overall period. There were no Grade 3 /4 toxicities. Conclusions: Olanzapine is better in the prevention of nausea. However aprepitant is better in the prevention of vomiting. Combination of these two agents needs to be studied in future studies.
Use of granulocyte colony stimulating factor (GCSF) in patients receiving highly myelosuppressive chemotherapy for breast cancer.
Authors: Kornelsen Emily , Cheung Winson Y. 
Published: September 2018

e21677 Background:We hypothesized that GCSF use may be suboptimal in the real world despite prior research that shows prophylaxis with GCSF can reduce neutropenic fevers and hospitalizations. Our aims were to characterize patterns of GCSF use in a population-based cohort of breast cancer patients receiving highly myelosuppressive chemotherapy and to describe outcomes and predictors associated with appropriate GCSF prophylaxis. Methods:Patients diagnosed with breast cancer from 2008 to 2012, seen at any 1 of 5 comprehensive cancer centers in a Canadian province, and treated with chemotherapy that posed > 20% risk of neutropenic fever were reviewed. Associations between GCSF use and 1) patient and physician factors and 2) treatment outcomes, including rate of neutropenic fevers, were analyzed using regression models. Results:We included 805 women: median age was 52 (IQR 44 to 61) years, 40% reported smoking, 52% used alcohol regularly, 64% were ECOG 0, and 24% had private health insurance. In this cohort, 330 (41%) patients were given GCSF. Among those treated with GCSF, 132 (40%) and 198 (60%) individuals received GCSF as primary and secondary prophylaxis, respectively. Overall, neutropenia was noted in 467 (58%) cases while neutropenic fever was experienced by 161 (20%) patients. When compared to those who did not use GCSF, patients who used GCSF experienced a lower rate of neutropenia (14% vs. 61%, p < 0.01) and a decreased incidence of neutropenic fever (8% vs. 23%, p < 0.01). In regression models, patients lacking extended medical coverage (32% vs. 49%, p = 0.02), poor performance status (30% vs. 55%, p = 0.03), and those who were evaluated at non-teaching institutions (25% vs. 69% p < 0.01) were less likely to receive GCSF. Patients seen at non-teaching institutions were also given primary GCSF prophylaxis less frequently (16% vs 59%, p < 0.01) than those at teaching centers. Conclusions:GCSF prophylaxis was associated with improved neutropenia-related outcomes in the real world. Despite evidence-based recommendations, use of GCSF remains suboptimal in this population-based cohort of breast cancer patients receiving highly myelosuppressive chemotherapy.
Association of risk of febrile neutropenia (FN) with docetaxel in prostate cancer (PC) patients: A meta-analysis of published phase II-III trials.
Authors: Maria Blazquez Arroyo , Merida Garcia Antonio , Lora David , Bernard Brandon David , David Lorente , Manneh Kopp Ray , Sepúlveda Juan Manuel , Castellano Daniel , Sweeney Christopher , De Velasco Guillermo 
Published: September 2018

e21683 Background: Reported rates of FN with docetaxel (DTX) in PC patients are variable. This creates uncertainty regard the use of granulocyte colony-stimulating factor primary prophylaxis (G-CSF) in this setting. We conducted a meta-analysis of randomized clinical trials to determine the relative risk (RR) of FN in patients receiving DTX. Methods: To perform this analysis we systematically searched in PUBMED and MEDLINE database the following terms: “DTX”, “randomized clinical trial” and “prostate cancer” only for articles published between January 1996 and August 2016. Phase II-III clinical studies comparing DTX to non-DTX control arms (best supportive care [BSC] including non-cytotoxic therapy or mitoxantrone) for PC were included. The meta-analyses were performed by computing RRs with 95% confidence intervals (CI) using fixed-effects model with the Mantel-Haenszel method. Results: Seven studies (N = 5088 patients) were included. The global incidence of FN in patients treated with DTX was 10.7%. The RR of FN was higher in patients receiving DTX compared to patients did not receive DTX (RR 16.8 [95% CI 10.7; 26.4] p < 0.0001). 6.6% of patients with metastatic castration resistant prostate cancer (CRPC) treated with DTX developed FN, the RR of FN with DTX compared to mitoxantrone was 28.6 (95% CI 5.6; 145.1). 12.4% of patients with hormone-sensitive prostate cancer (HSPC) treated with DTX developed FN, the RR of FN was 15.3 (95% CI 9.6; 24.6) compared to BSC. There was no statistically significant differences in the rate of FN according to the hormone sensitivity (HSPC vs CRPC) (p = 0.7). In most studies the use of G-CSF was at the discretion of the investigator. Conclusions: This meta-analysis shows that DTX is associated with a significant increase in the relative risk of FN in patients with PC. The effectiveness of primary prophylactic G-CSF in this setting has not been fully established. The incidence reported here does not meet the threshold recommended by ESMO and ASCO guidelines for the use of prophylactic G-CSF. Special attention should be given to high risk groups for FN, including elderly patients and those with bone marrow involvement or previous radiotherapy/chemotherapy.
Prevalence of critical malnutrition (CMN) in patients enrolling on phase I/II (P1/2) clinical trials.
Authors: Jain Rishi , Handorf Elizabeth , Khare Vipin , Chertock Yana , Hall Michael J. 
Published: September 2018

e21700 Background: Cancer therapies undergo evaluation in P1/2 trials, frequently in patients (pts) with disrupted caloric intake, weight loss, and other adverse effects of cancer on physical and psychological functioning. CMN and sarcopenia may increase treatment related toxicity (TRT) due to acquired pharmacokinetic variability and altered drug metabolism. Little is known about the prevalence of CMN among pts enrolling on P1/2 trials, its association with abnormal physical and psychological functioning, and its role in mediating TRT. Methods: Pts initiating a P1/2 trial were recruited. Study acceptance rate was > 95%. Pts had a comprehensive nutritional assessment using the validated PG-SGA, a short, 3-5 minute tool that evaluates multiple nutritional domains [symptom burden, functional status, metabolic stress and physical exam (muscle/fat status)]. CMN is defined as a PG-SGA score of ≥ 9. Distress, anxiety, depression and physical activity were also measured. BMI and albumin were extracted from the chart. Statistical significance was determined by Fisher’s exact test. Results: 54 pts (85% P1) were enrolled. CMN was identified in 39%. Pts with gastrointestinal (GI) cancers were more likely to have CMN than non-GI cancers (75% vs 24%, p = 0.001); otherwise, CMN rates were not different by age ( < 60 vs 60+), gender, race, or trial phase (1 vs 2). CMN was also associated with number of lines of therapy, but was surprisingly less common among patients with > 2 therapies compared to those with 0-2 (29% vs 57%, p = 0.051). Strong associations of CMN to distress (p = 0.028), depression (p = 0.020) and sedentary lifestyle (p = 0.012) were also seen. Clinical “red flags” of MN such as low BMI ( < 25) and low albumin ( < 3.5) had poor sensitivity (66.7% and 33.3%) and specificity (57.6% and 78.8%) for CMN. Correlation of CMN to TRT is underway. Conclusions: CMN is prevalent among P1/2 trial pts, notably in those with GI cancers and with fewer lines of therapy, and is associated with physical inactivity, distress and depression. BMI and albumin are poorly predictive of CMN. Undiagnosed CMN may, through multiple pathways, increase the vulnerability of pts on P1/2 studies to TRT. Comprehensive nutritional assessment of P1/2 pts should be considered.
Trajectories of anxiety among breast cancer patients treated with chemotherapy pre- and post-chemotherapy compared to healthy controls: A nationwide multicenter study.
Authors: Paterson Carly Lynn , O'Mara Ann M. , Heckler Charles E. , Kipnis Victor , Kamen Charles Stewart , Ontko Mary , Schmidt Karen , Mitchell Jerry W. , Janelsins Michelle Christine 
Published: September 2018

e21711 Background: A diagnosis of breast cancer (BC) elicits a myriad of concerns for women. Treatments are complex, often with multiple components, including chemotherapy. This study describes the trajectory of anxiety among BC patients treated with chemotherapy compared to healthy controls. Methods: This prospective observational study of breast cancer and lymphoma patients is being conducted through the National Cancer Institute Community Oncology Research Program (NCORP). For this analysis, women diagnosed with stage I-III BC and age-matched healthy controls were assessed using the State Trait Anxiety Inventory (STAI) at baseline prior to chemotherapy, 1-month and 6-months post-treatment. Baseline characteristics were compared using Welch’s t-test and chi-squared tests, and proportions of participants reporting anxiety between groups were examined at each time point. Linear mixed models (LMM) were used to compare anxiety trajectories over time, accounting for relevant baseline clinical, medical and demographic factors. Results: Among 945 participants, including 581 BC patients and 364 controls, the average age was 53 years, 91% were White, and 98% were non-Hispanic. Compared to controls, more BC patients reported anxiety scores > 40 at baseline (35% vs. 13%), 1-month (31% vs. 16%), and 6-months (30% vs. 19%), indicating potentially clinically significant anxiety. While BC patients’ anxiety decreased after an apex at baseline, it remained significantly higher than controls’ anxiety at each time point (all p < 0.001), and LMM analysis identified group and group by time interactions for each follow-up (all p < 0.001). Among all participants, predictors of increased anxiety included younger age, post-menopausal status, lower baseline cognitive function and higher baseline depressive symptoms. Conclusions: BC patients reported higher anxiety than controls at all time points, providing further insight into the trajectory of anxiety pre- and post-chemotherapy. Research into optimal timing of assessment and appropriate interventions to minimize anxiety burden in this population is warranted. Clinical trial information: NCT01382082.
Efficacy of treatments in children with relapsed/refractory acute lymphocytic leukemia (r/r ALL).
Authors: Martin Amber L , Thomas Simu K. , Cota Mariana , Hao Yanni , Zhang Younan , Turner Monica 
Published: September 2018

e22001 Background: Pediatric ALL is the most common childhood leukemia, 20% of children relapse after initial complete response (CR) to first-line treatment and the 5-year overall survival (OS) of pediatric r/r ALL patients is only 30%. A systematic literature review (SLR) and meta-analysis (MA) were conducted to determine the effects of treatments for pediatric r/r ALL. Methods: EMBASE, MEDLINE, and CENTRAL databases were searched from 01/01/2000-12/31/2016 using keywords for r/r ALL paired with terms for pediatric patients and relevant treatments to identify studies reporting efficacy and safety data. Proceedings from 2015-2016 oncology conferences were also searched. Statistical analysis was limited to studies with comparable patient populations and treatment regimens. Random-effects MA of single-arm data were performed to determine the OS rate at 6 and 12 months, median OS, and the rate of CR (timepoint not reported) for pediatric r/r ALL patients treated with clofarabine + cyclophosphamide + etoposide (CCE). Results: The studies included in the review were heterogeneous and just five of the 46 studies identified by the SLR were similar enough for MA in terms of outcomes and populations (median age 8-14 years, median 2 prior lines of therapy). All five studies were single-arm studies evaluating CCE, a treatment with a pooled 6-month OS of 43.5% (95% CI: 32.6% - 55.1%), 1-year OS of 26.7% (95% CI: 17.5% - 38.3%), and pooled median OS of 5.2 (95% CI: 3.2 – 8.6) months. The CR rate was 43.2% (33.7% - 53.3%) across the five studies (timepoint not reported), and the rate was comparatively higher when analysis was limited to those with B-cell immunophenotype (56.3% [95% CI: 22.5% - 85.1%]). Conclusions: This is the first SLR and MA to be conducted on pediatric r/r ALL to date. Available evidence was heterogeneous and MA were only possible for single-arm trials examining CCE. Survival is poor in this population, as just over a quarter of patients receiving CCE were alive at 12 months, with median OS less than 6 months. CR rates were more promising but the lack of data on timepoint of assessment make the results difficult to interpret. New treatments are needed to better manage patients in this r/r population.
Advances in the approach to treatment of bilateral retinoblastoma: 26-year experience.
Authors: Kebudi Rejin , Tuncer Samuray , Bay Buyukkapu Sema , Sencer Serra , Gorgun Omer , Yaman Agaoglu Fulya , Ayan Inci , Darendeliler M. Emin 
Published: September 2018

e22009 Background: Bilateral retinoblastomas (BRBS) comprise 25 % of all RBS. Treatment decision depends on tumor burden, potential for vision, status of the contralateral eye. As the survival rate in retinoblastoma has increased, ocular salvage and late effects has become an important issue. The aim of the study is to evaluate the demographic features, treatment modalities, and late effects in BRBS. Methods: BRBS treated in Istanbul University, Oncology Institute and Opthalmology Department between 1990-2016 were retrospectively evaluated. All patients were multidisciplinarily evaluated for chemotherapy (chemoreduction /adjuvant), local opthalmologic therapies (transpupillary thermotherapy, cryotherapy, plaque), radiotherapy, enucleation. The chemotherapy (CT) protocol used had vincristine, cisplatin, etoposide, cyclophosphamide until 2009, and vincristine, etoposide, carboplatin since then. Since 2011, intraarterial, intravitreal CT was also used. Results: 114 BRBS (228 eyes) (56 male, 58 female) with a median age of 9 months (20days-42 mo.) were evaluated. Three had extraocular disease, two trilateral RBS. Seventeen had history of retinoblastoma in their families. According to ICRB classification, there were 67 eyes in group E, 43 group D, 27 group C, 45 group B, and 19 group A. Enucleation was done in 68 (30%) eyes, mostly group E. During 1990-2000, 23/26 patients underwent enucleation, whereas 45/88 underwent enucleation after 2000. Radiotherapy was used for 30 eyes, most before 2000. Bone and soft tissue deformities and cataracts were observed in irradiated patients. Five patients had a second cancer (4 sarcomas, 1 meningioma) at a median of 11 years, four in irradiated sites. The 5 yr survival was 93.5%, 9 patients died, 4 due to second cancer. Conclusions: As the survival rate in intraocular BRBS has increased, ocular salvage and late effects have gained importance. Chemoreduction (systemic, intraarterial) and local ophtalmic therapies enable preservation of vision in most group A, B, C tumors and some D tumors. Most group E tumors require enucleation. Radiotherapy is not used in most RBS in the last decade. Intra-arterial chemotherapy is promising in maintaining ocular salvage.