bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient attitudes toward oncofertility care in male cancer patients receiving targeted and immune therapies.
Authors: Tsai Katy K. , Kamal Puneet , Ramstein Joris , Algazi Alain Patrick , Daud Adil , Smith James F 
Published: September 2018

e21593 Background: Tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) have resulted in durable response for many cancer patients. The impact of these agents on future fertility are not well described, and patients are often committed to long-term treatment without adequate oncofertility counseling. We sought to better characterize patient attitudes toward oncofertility and challenges faced by male cancer patients undergoing treatment with TKI or ICI. Methods: Men receiving TKI/ICI at the UCSF Helen Diller Family Comprehensive Cancer Center were retrospectively identified. Eligible men had received at least one dose of TKI/ICI. Detailed questionnaires addressing cancer history, possible effects of treatment on fertility, and obstacles to fertility preservation were completed. Results: Between January 2013 to September 2016, 51 men with a mean age of 46 years (SD 12, range 21-72), 65% white, completed questionnaires. Most (61%) were CML patients, with 12% RCC, 10% GIST, 6% melanoma, and NET, oligodendroglioma, and HCC comprising remaining histologies. 96% were treated with TKI, and 4% with ICI. At the time of diagnosis, 35% of patients indicated a desire to father future children, and 53% believed that cancer treatment might affect their fertility. Despite this, 45% were not asked whether having children was important to them, and 47% did not receive information from any provider on their oncology care team about the possible risks of TKI/ICI to future fertility. The majority of patients felt there was inadequate discussion of how treatment might affect testosterone levels (73%) and their ability to father a child (53%), yet only 14% recalled adequate referrals to a fertility specialist. Conclusions: These data demonstrate that male cancer patients perceive treatment-related infertility risks as important, yet have few opportunities to discuss these concerns with providers. Care plans to address oncofertility needs, especially as TKI/ICI are increasingly used in multiple cancer types, are needed as part of the diagnosis, treatment, and follow up of these patients. Larger retrospective and prospective studies are ongoing to further characterize this patient cohort.
Survivor feedback on a late effects-oriented survivorship care plan for head and neck cancer.
Authors: Salz Talya , McCabe Mary S. , Oeffinger Kevin C. , Schnall Rebecca B , Corcoran Stacie , Vickers Andrew J. , Salner Andrew L. , Dornelas Ellen A , Raghunathan Nirupa Jaya , Fortier Elizabeth , Finitsis David , Baxi Shrujal S. 
Published: September 2018

e21596 Background: Survivorship care plans (SCPs) typically include generic advice for the management of late effects (LEs) that can occur, rather than addressing LEs that the survivor actually has. We developed a platform called HN-STAR that uses electronic patient-reported outcomes (ePROs) and evidence-based LE management to generate a personalized SCP for survivors of head and neck cancer (HNC), a population vulnerable to various LEs. We assessed HNC survivors’ experiences with HN-STAR to ensure its acceptability and usefulness. Methods: Disease-free HNC survivors at two cancer hospitals used HN-STAR in conjunction with a routine survivorship visit. Prior to the visit, survivors used a validated ePRO measure (PRO-CTCAE) to report up to 22 physical LEs. Based on clinic visit discussions, HN-STAR generated an SCP that included a treatment summary and LE management plans. Survivors indicated their level of agreement to statements regarding the ease of use of the ePROs, content of the SCP, and intentions to adhere to LE management recommendations. Results: 47 survivors completed surveys (mean 5.4 years from treatment completion). Most were white (89%), male (85%), had an oropharynx tumor (58%), and received multimodality therapy (81%). More than half (51%) experienced at least 9 of the 22 LEs in the last 30 days (mean 8.2 per person). Most survivors reported that completing ePROs improved the discussions with their provider (98%), the quality of their care (96%), and their communication with their provider (98%). 91% agreed the SCP was the right length, and 98% agreed it was easy to follow. 98% intended to follow at least some of the recommendations for LEs management, and 98% reported feeling confident that they could follow the recommendations. The majority agreed that the SCP accurately summarized the clinic visit (98%), they would refer back to the SCP (98%), they trust the SCP (100%), and they plan to share the SCP with a primary care provider (87%). Conclusions: Among HNC survivors, an automatically generated SCP that was tailored to their LEs was acceptable, was trusted, and provided recommendations they intended to follow. Patient-centered SCPs that focus on existing LEs hold promise as a means to help survivors manage LEs.
Long term peripheral neuropathy symptoms in breast cancer survivors.
Authors: Mustafa Ali Moaath Khader , Moeller Machelle , Rybicki Lisa A. , Moore Halle C. F. 
Published: September 2018

e21599 Background: Peripheral neuropathy (PN) is a common complication from chemotherapy (CTX), associated with significant morbidity, and may improve with time. The prevalence of long-term PN symptoms in breast cancer survivors is not well known. We sought to explore PN symptoms and associated risk factors among breast cancer survivors at least 2 years out from diagnosis. Methods: We performed a cross-sectional retrospective study investigating the prevalence of patient-reported numbness/tingling symptoms as a surrogate for PN in breast cancer survivors at our institution. We included patients with stage 0-III breast cancer who completed a questionnaire about symptoms and life-style habits at a survivorship visit that occurred 2 or more years after initial diagnosis. We evaluated the prevalence of PN and associated risk factors using univariable and multivariable logistic regression analysis; results are shown as odds ratio (OR) and 95% confidence interval (CI). Results: 605 patients assessed between April 2009 and October 2016 met eligibility for analysis. Median age was 60 (31-93) years. Median number of years from diagnosis to assessment was 6.3 (2-21). All patients had surgery and 62% had CTX. Twenty-seven percent reported PN. On univariable analysis, obesity, stage II & III, mastectomy, PN before diagnosis, and receipt of taxane CTX were associated with PN (all p < 0.05). Patients who were older, exercised before diagnosis, had ER/PR-positive disease and who received endocrine therapy reported less PN (all p < 0.05). On multivariable analysis, only receipt of docetaxel (OR: 2.18, CI: 1.22- 3.88) or paclitaxel (OR: 4.07, CI: 2.54-6.50) and reporting PN symptoms before diagnosis (OR: 3.28, CI: 1.49-7.21) were associated with PN. Among patients without pre-existing PN symptoms, 15%, 19%, 28% and 43% reported long-term PN after no CTX, non-taxane CTX, docetaxel CTX and paclitaxel CTX respectively. Conclusions: At a median follow-up of 6.3 years from diagnosis, 28% of survivors in our cohort who had received docetaxel and 43% who had received paclitaxel report long-term PN symptoms compared with 15-19% in those who received no or non-taxane CTX. These data can help inform patients and clinicians regarding long-term PN risk following CTX.
Cancer survivorship in the rural U.S. Columbia Pacific: A pilot study.
Authors: Lycette Jennifer L. , Cockrum Paulina , Fromwiller Venus , Winters-Stone Kerri M. 
Published: September 2018

e21614 Background: We provide the only fully staffed cancer center in the rural Columbia Pacific, serving multiple counties in OR and WA. Rural areas can lack resources to provide comprehensive survivorship care. Higher rates of medical comorbidities and socioeconomic barriers add challenges to rural survivorship. We conducted a pilot study to 1) develop a program for lifestyle and behavior modifications to fit the needs of our patients in our rural community and 2) determine feasibility and preliminary efficacy of a survivorship program for breast cancer patients. Methods: 9 women with stage I-III breast cancer completed a 12-week program consisting of 1:1 meetings every 2 weeks with a physical therapist and registered dietician; health coach support; and access to a social worker. The following pre-post measures of physical health were taken: fasting lipids and glucose, HbA1C, waist circumference, blood pressure, BMI, 3-day physical activity log and food journal, joint range of motion, and muscle strength. Pre-post well-being was assessed by EORTC QLQC30 and focus groups. Results: Decreases in systolic BP, weight, waist circumference, fasting glucose, and HbA1c were seen in a majority of participants; however, only decreases in waist circumference reached statistical significance (p = .043). On post-program survey using a 0-10 rating scale, program acceptability was rated at an average of 7, and likelihood to continue at an average of 9.4; however, overall QOL rating had no change. Focus group feedback indicated participants valued dietician visits, but requested more social work support, exercise customization, and group support to foster mentoring, education, and sense of community. Conclusions: Developing a rural comprehensive survivorship care program locally is feasible. More work is needed to translate physical health goals into enhancement of well-being and improved QOL of rural cancer survivors.
Effect of hypoglycemic agents on survival outcomes of patients with lung cancer and diabetes mellitus: A systematic review and meta-analysis.
Authors: Huang Ping , Xin Wenxiu , Fang Luo , Ding Haiying , Zheng Xiaowei ,   Zhejiang Caner Hospital
Published: September 2018

e21617 Background: Although hypoglycemic agents (metformin, insulin, sulfonylureas [SUs] and thiazolidinediones [TZDs]) may influent prognosis of cancer at several sites, very little is known about their effects on clinical outcomes of lung cancer patients with diabetes mellitus (DM) and results from clinical trials are often inconsistent. Methods: To assess the association between hypoglycemic agents and clinical outcomes of lung cancer, we performed a systematic review of published studies from PubMed, EMBASE, Web of Science and The Cochrane Library up to January, 2016. Meta-analysis was performed to calculate the pooled hazard ratio (HR) and 95% confidence interval (95% CI). Results: The pooled HRs favoring metformin users was 0.77 for overall survival (OS) (n = 12, 95% CI: 0.66-0.89) and 0.59 for disease-free survival (DFS) (n = 6, 95% CI: 0.47-0.72). Only one study assessed the relation between metformin and cancer-specific survival (CSS) in lung cancer patients, reporting no statistically significant results. No significant association between insulin use and OS (n = 2, HR: 0.95, 95% CI: 0.79-1.13) or CSS (n = 2, HR: 1.03, 95% CI: 0.76-1.41) was noted. Only one study evaluated the effect of SUs in patients with lung cancer and reported no statistically clinical benefit (HR: 1.10; 95% CI: 0.87-1.40). Likewise, one study evaluated the effect of TZDs on OS in patients of lung cancer and reported no significant difference between TZDs and non-TZDs groups (HR: 1.04, 95% CI: 0.65-1.66). Conclusions: This meta-analysis demonstrated that metformin could improve survival outcomes of patients with lung cancer and DM. No association between insulin, TZDs or SUs and lung cancer outcomes was found.
Antiangiogenetic-induced hypertension and improved outcome in cancer patients.
Authors: Barni Sandro , Dognini Giuseppina Patrizia , Petrelli Fausto , Borgonovo Karen , Ghilardi Mara , Cabiddu Mary , Destro Maurizio 
Published: September 2018

e21651 Background: Hypertension (HTN) is one of the most common adverse events observed during treatment with antiangiogenetic drugs (AAG) inhibiting the Vascular Endothelial Growth Factor Pathway. It may rise few days after anti-AAG starting, is dose dependent and reversible after its withdrawal. Some reports seem to suggest an improved outcome in patients (pts) developing HTN after AAG initiation (AAG-HTN). The aim of this study was to evaluate the impact of AAG-HTN on ORR, OS and EFS in pts receiving AAG, particularly tyrosine kinase inhibitors. Methods: All consecutive pts referred to ASST Bergamo Ovest between March 2012 and January 2017, and receiving sunitinib, sorafenib, regorafenib, pazopanib or axitinib, were evaluated. AAG- HTN was defined either as ex novo HTN or worsening of a pre-existing and pharmacologically controlled HTN, arising after AAG starting, and graded according to the NCI CTCAE 4.03. Overall survival was estimated using the Kaplan-Meyer method and hazard ratio with 95% CI was calculated, the primary endpoint was analyzed with a stratified log-rank test. Overall response rates were compared applying the chi-square test. Results: Overall 43 pts (male/female = 30/13, median age = 65yrs, range: 49-84) were evaluated. The AAG used were: sunitinib (n = 20), sorafenib (14), regorafenib (4), axitinib (3), pazopanib (2). Hypertension was present and pharmacologically controlled before AAG in 35 pts. Antiangiogenetic-related hypertension was developed in 27 pts (62.8%). Thirty-four pts were evaluable for ORR, which was observed in 44% of pts developing AAG-HTN versus 9% of those not developing AAG-HTN (p = 0.045). A trend to improved OS (hazard ratio [HR] 0.71 95%CI 0.33-1.5; P = 0.33) and EFS (HR 0.7, 95%CI 0.33-1.49; P = 0.29) in pts developing HTN was observed too. Conclusions: the development of AAG-HTN is related to an increased ORR. An improvement in OS and EFS has been postulated too, but the small number of this series did not allow to find a statistical correlation. For its potential impact on pts’ prognosis, further studies to better explore this issue should be performed and, importantly, AAG-HTN should be early recognized and properly managed.
Characteristics and outcomes of oncology patients requiring admission to an Australian intensive care unit.
Authors: Tan Aaron , Freyberg Sarah , Oatley Meredith , Guminski Alexander David 
Published: September 2018

e21653 Background: Patients with advanced malignancies have historically been considered poor candidates for the intensive care unit (ICU), however survival and prognosis is continually improving and requirements for use of intensive care services is increasing. This study aimed to understand the characteristics and outcomes of oncology patients admitted to an Australian ICU and identify potential prognostic factors. Methods: A single-centre, retrospective, cohort study was conducted at Royal North Shore Hospital, a tertiary public hospital in Sydney, Australia with a 58-bed quaternary ICU. All patients aged > 18 years, admitted under the medical oncology team requiring ICU admission between June 2014 and June 2016 were evaluated. Data collected included basic demographics, cancer type and status, performance status (ECOG) and co-morbidities (ACE-27 score). Clinical outcomes were determined including ICU and hospital mortality, requirements (ventilation, dialysis, vasopressors, infection) and APACHE II scores. Results: There were 96 patients admitted to the ICU during the study period. Mean age was 61 years, 58% were male and 76% had metastatic disease. Most patients were receiving palliative treatment (89%), with recent chemotherapy (43%), immunotherapy (10%) and other therapies (5%). Of the 10 patients with recent immunotherapy, three (all melanoma) required ICU admission due to immunotoxicity with all three alive at time of data collection (mean 222 days follow-up). 13% were admitted due to an oncological emergency. Most common primary tumour site was thoracic (20%), genitourinary (11%), breast (10%) and melanoma (10%). Mean APACHE II score was 17 (SD 5.33), mean SOFA score was 4 (SD 2.70), ICU mortality was 5% and hospital mortality was 22%. For the 75 patients (78%) discharged from hospital, 42 (56%) were still alive at time of data collection (mean 321 days follow-up). Conclusions: Our patient population had good short-term outcomes for survival despite most receiving palliative treatment, although prognostic scores were also favourable. This suggests cancer patients can achieve positive outcomes after ICU admission with appropriate selection of patients crucial.
Effect of a combined diet plus exercise intervention on weight loss, physical fitness, and cancer-related fatigue among Japanese women with breast cancer.
Authors: Okumatsu Koki , Tsujimoto Takehiko , Seki Akina , Yamauchi Teruo , Yamauchi Hideko , Tanaka Kiyoji 
Published: September 2018

e21658 Background: Weight gain, deterioration of physical fitness, and cancer-related fatigue often occur in the breast cancer patients mainly due to endocrine therapy. A number of previous studies have reported that obesity increases the risk of breast cancer recurrence and death, while exercise habituation improves physical fitness and fatigue among breast cancer patients. However, almost all studies have been conducted in the Western community and there are few studies focused on Asian women who may have lower BMI compared with the Western ones. Therefore, we investigated whether a combined diet plus exercise program affects weight loss, physical fitness and fatigue indices among Japanese breast cancer patients undergoing endocrine therapies. Methods: Thirty-two Japanese women with breast cancer undergoing endocrine therapy (age; 50±6 years, body weight; 57±10 kg) were voluntarily assigned to either intervention group (n = 21) or control group (n = 11). The intervention group completed a 12-week combined diet plus exercise program, consisting of weekly diet instruction classes aimed at maintaining a nutritionally well-balanced 1,200 kcal/d diet and a weekly 90-min exercise session. Anthropometric indices, physical fitness, blood sample and cancer-related fatigue were measured at baseline and after the 12-week program. Results: All of the 21 women completed the 12-week program. Mean weight loss was 8.7% of the initial weight in the intervention group and 0.1% in the control group ( P < . 001). Significant improvements were observed in cardiorespiratory fitness ( P < .01), flexibility ( P < .01) and agility ( P < .01) in the intervention group. Cancer related-fatigue scores decreased by 7.9 points (39%) among the intervention group ( P < .001), while it remained essentially unchanged among the control group. No adverse events were reported in the intervention group. Conclusions: A combined diet plus exercise program may contribute to a decrease in body weight and improvement in physical fitness and cancer-related fatigue. Further study is needed to help reduce side effects due to endocrine therapy and enhance quality of life among Asian breast cancer patients. Clinical trial information: UMIN000025890.
Prognostic factors of mortality and recurrence of malignant pleural effusion in high-risk tumors according to the LENT Score.
Authors: Abrao Fernando , de Oliveira Mariana Campello , Abreu Igor , Garcia Geisa , D'Alpino Renata D'Alpino , Marciano Carolina , Toledo Mariana Belaunde , Younes Riad N. 
Published: September 2018

e21666 Background: The aim of this study was to identify predictors of overall survival (OS) and recurrence after palliative pleural procedures in patients with malignant pleural effusion (MPE) and high-risk tumors according to the LENT Score. Methods: Data was collected from our database between January 2013 and December 2015 of patients with MPE and high-risk tumors according to the LENT Score. All patients were followed-up for at least 30 days after the pleural procedure. We evaluated radiological aspects, biochemical and hematologic parameters as well as clinical features. For OS analysis, patients were divided into two groups. Group I included OS < 30 days and group II included OS > 30 days. Prognostic factors for pleural recurrence and OS were identified by univariate analysis, using Fisher's exact and Student's t-test. Subsequently, significant variables were entered into a multivariate logistic regression analysis ( p < 0.05). Results: A total of 134 patients were included. Median follow-up time for surviving patients was 56 (range: 2-623) days. High-risk primary tumors included lung (66.4%), gastrointestinal (24.6%) , sarcoma (3.7%), urologic (3.7%) and others (1.5%). Forty-four patients in Group I had OS < 30 days while 22 patients had MPE recurrence. Factors affecting OS in univariate analysis were: type of procedure, ECOG, albumin, leukocytes, neutrophil to lymphocyte ratio( NRL) and hemoglobin. Factors affecting recurrence were: type of procedure, chemotherapy line (CT), albumin and platelets. In multivariate analysis for Group I, type of procedure (therapeutic pleural aspiration – TPA) ( p= 0.011), ECOG 3/4 ( p= 0.004), NLR > 5 ( p= 0.037) and leukocytes > 8000 ( p= 0.042) were identified as independent predictors of OS. In terms of recurrence, only CT beyond first line ( p = 0.042) was identified as an independent prognostic factor. Conclusions: Patients with MPE who underwent TPA, had ECOG 3/4, leukocytes > 8000, and NLR > 5 were significantly associated with shorter OS,. CT beyond first line was associated with recurrence. The identification of these prognostic factors may assist physicians in choosing the optimal palliative technique.
Developing and piloting an electronic telephone triage application.
Authors: Ellis Peter G. , Carlisle Christine , Ford Colleen F. , Nikolajski Peggy , Reidmiller Carol , Stewart Leslie , Rushford Justin S. , Barry Amanda , Krebs Melinda 
Published: September 2018

e21680 Background: With the shift of cancer care to the outpatient setting, telephone triage is a vital part of today’s oncology practice. UPMC CancerCenter (UPMC) desires to streamline the current telephone triage process across its 31 outpatient clinics. UPMC and Via Oncology collaborated to develop and pilot a prototype of an electronic telephone triage application. The key components of the prototype were defined as decision support, EHR integration, reporting, and workflow management. Methods: A prototype application, Symptom Manager (SM), was developed and piloted with 4 nurses at 3 outpatient clinics. Front office staff registered inbound calls in SM, which populated a phone triage queue. The nurse was prompted to enter information about the call. Decision support materials were displayed for reference, including algorithms for symptom assessment, adjudication, and treatment. The output was a structured summary of the encounter that was copied to the patient’s chart. From the queue, the nurse was also prompted to make outbound calls for symptom reassessment. A feedback session with the nurse users and institution leadership was held following the pilot. Results: A total of 235 inbound calls were captured in the application, of which 74 (31.5%) were symptom-related. Additional data fields collected during the pilot included symptom, adjudication, time elapsed for callback, and symptom status at follow up. The ability to extract and report on data of this type was viewed as valuable for quality and process improvement. The nurse users praised SM’s ease of use, but prototype performance issues shortened the pilot. They indicated that the standardized documentation increased efficiency. Requests for future enhancements included deeper EHR integration and additional fields for data capture. Conclusions: This pilot provided the feedback necessary to develop the latest version of SM which begins roll out across UPMC in November 2016 and includes EMR integration. An update on the software and additional data captured during the pilot will be provided at presentation.