bluuebunny/crossref_metadata_2025_split huggingface dataset:
Large scale training of oncology providers and staff to improve care delivery.
Authors: Salama Monica , Steele Joseph Rodgers 
Published: September 2018

e18282 Background: UT MD Anderson Cancer Center began participating in the Press Ganey survey in 2014, and the initial feedback was disappointing. Imaging outpatient services scores were lower than expected, and a difference of opinion between providers and patients was believed to be a contributing factor. Imaging providers defined “care” as the technical quality of the study and the accuracy of the report, while patients associated the term “care” with their healthcare experience. Methods: To improve the patient and family experience and better equip the staff and providers, the Service Excellence Academy (SEA) was created. This ten-hour, three-module program was developed at UT MD Anderson Cancer Center in collaboration with UNLV and MGM Resorts. The program combined didactic and interactive education by leveraging clinical examples and role-playing. A train-the-trainer format was used, including Institutional and Departmental leaders to facilitate the classes. Over 800 participants completed the SEA over 9 months. Questionnaires were administered to the participants before and after the sessions. Results: Since launching the SEA June of 2015, the outpatient Press Ganey scores have improved, and continue their upward trend. All metrics show percentile improvement ranging from 9% to 34%. Additionally, participants felt a greater connection with the institutional mission, vision, and heritage, were more comfortable making decisions, felt more empowered, and had developed greater empathy and skills to meet the needs of others. Conclusions: Large scale training of oncology providers and staff is possible and effective. Implementation of a Service Excellence Academy demonstrated both objective and subjective improvement of patient and employee satisfaction.
The effect of aspirin and anticoagulation on tyrosine kinase inhibitors induced thrombotic events in chronic myeloid leukemia: A retrospective cohort.
Authors: Numan Yazan , Jamil Muhammad , Cortes Jorge E. 
Published: September 2018

e18550 Background: The newer Tyrosine Kinase Inhibitors (TKI) versus imatinib recently were called into question due to reported long-term toxic effects. These include cardiovascular adverse events, arterial and venous thrombosis. Our objective is to determine the effect of antiplatelet and anticoagulation on arterial and venous thrombotic events during the use of TKI for chronic myeloid leukemia (CML). Methods: Multi-center retrospective cohort based on the use of antiplatelet and anticoagulation medications. Chi square test was used and regression analysis for the recorded confounding variables applied. Results: a total of 968 patients were identified from 4 large cancer centers. Preliminary results on the first 168 entered are the following: Average age of the sample is 48 years. 41% were females and the rest were male patients. Average BMI was 29. Average duration of treatment on TKI was 66 months. 20 % of patients were using Aspirin and 11% were using anticoagulation with therapeutic INR. 8% were using dual therapy. 10% developed a thrombotic event during TKI use, namely: MI (2.4%), DVT (3.1%), PE (0.7%), Stroke (2.4%). Our results show that Aspirin or dual therapy decrease the thrombotic events excluding MI only in newer TKI (26% vs 11% P value = 0.002) Fig-1. Conclusions: This study is the first to investigate the effect of anticoagulation and antiplatelet medications on patients receiving TKI. Our main objective after completion of analysis of 968 patients is to answer the question whether patients receiving TKI should receive a prophylactic antiplatelet or anticoagulation therapy and if TKI mediated thrombotic event has “Vasculitis induced thrombosis” pathway that is resistant to anticoagulation/antiplatelet therapy.
PIK3CA mutations are distinctive genetic features in non-small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD): A comprehensive mutational analysis from multi-institutional cohort.
Authors: Sawa Kenji , Kawaguchi Tomoya , Koh Yasuhiro , Kambayashi Satoshi , Asai Kazuhisa , Mitsuoka Shigeki , Kimura Tatsuo , Yoshimura Naruo , Kubo Akihito , Saka Hideo , Matsumura Akihide , Nishiyama Noritoshi , Hirata Kazuto 
Published: September 2018

e20060 Background: A mutual developmental mechanism has been proposed between NSCLC and COPD; however, the association is not fully understood. We previously reported that the mutations in PI3K/AKT/mTOR pathway and NFE2L2 were frequently observed and co-existed in NSCLC patients with COPD (Kawaguchi T, J Clin Oncol 34, 2016 [suppl; abstr 8526]). To further validate this finding, a new cohort was added and merged into the original cohort’s study. Methods: A total of 197 surgical specimens of early stage NSCLC including 90 newly added from Osaka City University hospital were collected between 2010 and 2013. Extracted DNAs were deep-sequenced using NGS technologies for somatic mutations in 72 cancer-associated genes for a molecular profiling in NSCLC patients with COPD. We defined COPD as presence of FEV1/FEV < 0.7 and classified the severity based on the Global Initiative for Chronic Obstructive Lung Disease. Results: The COPD group (N = 77) including 56 mild, 21 moderate/severe diseases, had 58 squamous cell carcinoma (SQ) and 19 adenocarcinoma (AD), with 70 smokers. The non-COPD group (N = 120) had 53 SQ, 64 AD and three others, with 78 smokers. The frequency of PIK3CA mutations was higher in COPD (10.4 %) than non-COPD (1.7 %), while in AD KRAS mutations were more frequent in COPD (21.1%) than non-COPD (9.4%). Notably, the frequency of PIK3CA mutations increased parallel to the COPD severity (p < 0.001). Meanwhile, NFE2L2 mutations were observed only in SQ, and no difference in the frequency was observed between the two groups (17.2% vs. 17.0%) unlike our previous analysis. In the multivariate logistic regression model, significantly more PIK3CA mutations were observed in the presence of COPD (Odds ratio = 5.47, 95%CI: 1.04-28.85, p = 0.045) with consideration of age, smoking dose, histology and pathological stage. The most frequent base substitution pattern in PIK3CA mutations was C > T change, suggesting the association with APOBEC-mediated mutagenesis. Conclusions: PIK3CA mutations are distinctive genetic features in NSCLC with COPD, regardless of age, smoking dose, histology and pathological stage.
Expanding the search for significant EGFR mutations in NSCLC outside of the tyrosine kinase domain (TKD) with next-generation sequencing (NGS).
Authors: Stein Matthew K , Morris Lindsay Kaye , Sullivan Jennifer , Fenton Moon Jung , Vanderwalde Ari M. , Schwartzberg Lee Steven , Martin Michael Gary 
Published: September 2018

e20506 Background: While conventional organization of EGFR mutations in NSCLC includes classic lesions sensitive to tyrosine kinase inhibitors (TKI) and variants localized to TKD in exons 18-21, NGS raises the prospect of identifying clinically relevant variants in extra-TKD regulatory regions. Methods: Patients (pts) with lung cancer who received tumor profiling with NGS from 2013-2015 via Caris were identified. EGFR mutations were arranged based upon their known distribution relative to the TKD. In silico analysis was performed with PolyPhen-2 (Harvard) to predict nsSNPs’ pathogenicity. Results: 259 pts (248 NSCLC, 11 SC) had median age 65 years (26-85); 50% female; 64% white, 34% black; 73% with ≥20 pack-years (py), 12% non-smokers; 53% of samples were metastases. 65% NSCLC were adenocarcinoma (A), 21% squamous (S), 8% large-cell; 87% stage IV, 12% III. 44 EGFR variants were seen in 40 pts (15%; 39 NSCLC, 1 SC). While 32 pts had TKD lesions demonstrable through standard testing, 8 had extra-TKD mutations (8/44), of which 5 were extracellular domain (ECD), 1 juxtamembrane (JM) and 2 carboxy terminal (CT). Aside from pathogenic ECD mutation G598V, 5/7 extra-TKD nsSNPs were predicted-damaging (pnsSNP) with in silico (Table 1). 7/7 extra-TKD nsSNP+ pts smoked (6/7 ≥20 py) and all 6 NSCLC pts were stage IV; 50% A, 17% S; 83% male. The pt with JM R675Q had erlotinib, 150 mg daily, added following progression of stage IV NSCLC on carboplatin and paclitaxel and had a partial response for 4 months. No other pt received EGFR-directed therapy. Conclusions: 2% NSCLC cases in our cohort had EGFR pnsSNPs located outside of the TKD, representing >18% of all EGFR mutations. Extra-TKD variants should be characterized collaboratively to determine TKI sensitivity and additional therapeutic targets. [Table: see text]
Monitoring response of PDL-1 directed immunotherapy in patients with advanced NSCLC using serum CEA levels.
Authors: Roy Rajasree , Chan Wallace , Patel Dilip , Nissel-Horowitz Sandy , Caramalis Angela , Diaz Melanie , Thomas Adrienne , Durban Lawrence H , Mehrotra Bhoomi 
Published: September 2018

e20509 Background: Immunotherapy (IT) response measurements in advanced NSCLC management are evolving. We describe here our retrospective single institutional experience in measuring serum CEA levels as an early response determinant and correlation with radiographic assesment. Methods: Retrospective chart review was performed after obtaining IRB approval. Demographic information, stage, histology, prior treatment, IT agent used, radiographic response assesment and serum CEA levels were recorded. Patients were evaluable if they had elevated baseline serum CEA levels (normal range non smokers: 0-3 ng/ml, smokers 0-5 ng/ml), had recieved at least two cycles of IT and had radiographic response assessment performed. Results: Six eligible patients were identified. Median age 60 yrs; M:F1:5, SCC n=1, Adeno: n=5; Smoking history positive n=4; Stage IV n=6, EGFR mut+ n=2; IT agent used: nivolumab: n=5; atezolizumab: n=1. IT as 1st line of Rx n=1; 2nd line n=3, 3rd line: n=2. On first radiographic assesment: three patients had progressive disease (PD), Two patients had PR, one patient (#1) had an intial PR and subsequently PD with subsequent rise in CEA level to 16.1 corelating with PD on radiographs. Conclusions: Serum CEA levels appear to correlate well with response assesment in patients with advanced NSCLC while being treated with immunotherapy. This small study is hypothesis generating and is currently being evaluated in a larger series. [Table: see text]
Some immunohistochemical markers of angiogenesis in melanocytic skin neoplasms.
Authors: Novikova Inna Arnoldovna , Maksimova Natalia A. , Ulianova Elena Petrovna , Maksimova Maria I. , Shulgina Oksana G. , Grankina Anastasia , Pozdnyakova Victoria V. , Ilchenko Maria G. 
Published: September 2018

e21067 Background: The purpose of the study was to analyze the expression of angiogenesis-controlling markers (CD31, VEGF) in tissues of melanocytic skin lesions. Methods: The study included 20 patients with benign pigmented lesions and 15 patients with superficial spreading and nodular melanoma. Immunohistochemical study was performed on sections of paraffin blocks for standard morphological studies using murine monoclonal CD31 and VEGF antibodies. UltraVision Quanto Detection System HRP DAB was used for visualization. Angiogenesis in tumors was assessed by intratumoral microvessel density (iMVD) index. Microvessels were stained with anti-CD31 antibody. The number of vessels was determined in each area of sight using objective lens with 40x magnification and AxioVs40 v-4.8.1.0 program. The tumor was considered VEGF-positive if more than 25% of tumor cells showed positive staining, and percentages of these tumor cells were calculated in each case (in %). Results: Quantitative evaluation of iMVD showed that the median number of microvessels in an area of sight in melanoma and nevi was 10.0±0.9 and 4.1±0.4, respectively, results of CD31 expression were statistically significant (р˂0.05). The numbers of CD31-stained vessels in melanoma ranged from 4 to 18 in one area of sight. 14 nevus cases (70%) showed 4 and less vessels, and only giant-cell nevi (6-30%) demonstrated up to 15 vessels in one area of sight. VEGF expression was found in the cytoplasm of melanoma cells in 100% of cases (15), in nevi – in 65% (13). The expression was not found in nevi cells in 35% (7). The number of VEGF-positive cells varied greatly in both melanomas and in nevi – from less than 5% to 50%. The maximal VEGF expression was observed in melanomas – 32.5±2.9%, while in nevi 23.8±2.1% (р˂0.05). Conclusions: The immunohistochemical study demonstrated a high angiogenic potential of melanoma that can be used as an additional criterion for tumor progression and malignant transformation of melanocytic skin neoplasms and thus contribute to the development of novel approaches to the diagnosis of the disease.
Development and validation of a Medicare health outcomes survey (MHOS) frailty index in multiple myeloma (MM).
Authors: Fiala Mark A , Guerard Emily Jean , Schroeder Mark A. , Stockerl-Goldstein Keith , Vij Ravi , Wildes Tanya Marya 
Published: September 2018

e21519 Background: Increasing age is associated with poorer outcomes in MM. However, biological aging (BA) is heterogeneous and does not correlate perfectly with chronological age (CA). A recently developed frailty of CA, functional status, and comorbidities is more predictive of toxicity, progression-free and overall survival (OS) than CA alone (Palumbo et al Blood 2015). We sought to apply the Rockwood Accumulation of Deficits approach to develop and validate a frailty index (FI) for older adults with MM. Methods: MHOS, a random survey of HRQOL (health related quality of life) in Medicare Advantage HMO enrollees, data were obtained from 1,747,042 non-cancer patients (pts) and 340 with newly diagnosed MM 1997-2011 from the SEER-MHOS linked dataset. In creating the FI, we considered only variables available throughout all 4 survey versions used since its initiation in 1998. We identified 34 variables including items related to function/mobility, comorbidities, and mental health. The FI was calculated as the number of deficits present, divided by the number total number of possible deficits, with possible scores ranging from 0 to 1 and higher values indicating more frail. Missing data points were excluded from the FI calculation. Cox regression analysis was performed to determine the association of the FI with OS, controlling for CA, gender, and race. The FI was first derived in the non-cancer cohort then applied in the MM cohort. Results: The median age was 72 for non-cancer pts and 75 for pts with MM; the median FI was 0.308 and 0.368, respectively. Among non-cancer pts, each 10% increase in FI (~3-4 more deficits) was associated with a 35% increased risk for death (aHR 1.352, 95% CI 1.350-1.354, p < 0.001); among pts with MM it was associated with a 15% increased risk (aHR 1.147, 1.065-1.236, p < 0 .001). Median OS for pts with MM in the lowest tertile of FI was 48 months (95% CI 42-56) compared to 23 months (17-33) for the highest tertile. Conclusions: Here we present a MHOS-based FI. The FI was more prognostic among non-cancer pts than among pts with MM, presumably because stage and tumor characteristics also contribute to OS in MM pts. Further exploration of the MHOS-FI in MM and other cancers is warranted.
Ability of individual patient health parameters to predict malnutrition among elderly stem cell transplant patients.
Authors: Bhulani Nizar , Holmes Holly Michelle , Morgan Robert 
Published: September 2018

e21521 Background: Increasing number of geriatric patients are now being considered as suitable candidates for allogeneic hematopoietic cell transplantation (HCT). Malnutrition being a common comorbidity in older cancer patients with no gold standard in malnutrition screening tools, it warrants for a better understanding of the health of geriatric cancer patients from a nutrition stand point. This study was pursued to evaluate individual patient parameters to predict malnutrition among elderly stem cell transplant patients. Methods: A retrospective cohort analysis was conducted on patients eligible for allogeneic HCT at the MD Anderson Cancer Center. Nutrition was assessed using the Mini Nutritional Assessment tool. Individual parameters to predict malnutrition included body mass index of less than 24 and weight loss of more than 3 kgs in the past 3 months. Statistical analysis was conducted using SPSS, version 23. Results: Mean age of the study participants was 65 years. Majority of the study population had the diagnosis of acute myelogenous leukemia (AML) at the time evaluation. The mean BMI of the study participants was 28.91 +- 4.77 while the mean MNA score was 24.95 +- 3.39. There was no association found between patient characteristics and history of weight loss or abnormal BMI. There was a significant association (p < 0.001) found between loss of more than 3 kg weight and an abnormal MNA score. There was no association found between any of the patient characteristics and abnormal BMI with abnormal MNA. The sensitivity of weight loss in comparison with MNA score was 62.5% and the specificity was 91%, thus, having a positive and negative predictive value of 77% and 84% respectively. Given that 86% of our patients were either overweight or obese at the time of evaluation, from those who were under weight, 100% had an abnormal MNA and 50% of normal weight patients had an abnormal MNA. Conclusions: The significant association between weight loss and poor MNA status shows that we are moving in the right direction to provide answers to nutrition status using individual patient health parameters.
Hair loss associated with aromatase inhibitor treatment among breast cancer patients.
Authors: Gallicchio Lisa , Calhoun Carla , Helzlsouer Kathy J. 
Published: September 2018

e21619 Background: Hair loss and thinning have been reported by breast cancer patients treated with aromatase inhibitors (AIs); these side effects are documented to be reasons that patients discontinue their AI therapy and have been shown to be associated with a decrease in quality of life. Despite this knowledge, there is a paucity of detailed data on hair changes over the course of AI therapy. The purpose of this study was to examine hair changes and risk factors for hair loss among breast cancer patients initiating aromatase inhibitor therapy and followed for one year. Methods: Data were analyzed from a cohort of 146 breast cancer patients initiating AI therapy and followed over the first year of their AI treatment. At baseline (prior to AI therapy) and at 1-year, a questionnaire was administered that ascertained data on demographics, health behaviors, and symptoms. Detailed hair loss questions, including those pertaining to family history and specific location of hair loss, were added during the study period when study staff noticed that hair loss and thinning were commonly being reported on the symptom checklist after initiation of AI therapy. Multivariable logistic regression analysis was conducted to examine factors related to AI-attributed hair loss. Results: Among the 86 breast cancer patients who completed the detailed hair loss survey at 1-year (mean age = 63y), 43% reported experiencing hair loss after the initiation of AI therapy. The most frequently reported time period of onset of the AI-attributed hair loss was between 3 and 6 months post-AI initiation (43.2%), with 67.6% of patients noting hair loss in the mid-scalp (top of head). Factors significantly associated with AI-related hair loss at 1-year were: hair loss prior to AI therapy, having a BMI > 30 kg/m2(odds ratio (OR) = 6.5), being a current smoker (OR = 7.8), and maternal history of hair loss or hair thinning (OR = 9.1). ORs were similar when patients with prior chemotherapy were excluded. Conclusions: Hair loss is a common side effect of AI therapy that can negatively affect a patient’s quality of life and potentially lead to treatment discontinuation. Treatment options for this AI-related side effect should be explored, especially for patients who are at increased risk.
Prognostic factors for mortality in malignant pleural effusion: Is it possible to predict survival?
Authors: Abrao Fernando , de Oliveira Mariana Campello , Garcia Geisa , Abreu Igor , D'Alpino Renata D'Alpino , Sardenberg Rodrigo Afonso , Marciano Carolina , Toledo Mariana Belaunde , Younes Riad N. 
Published: September 2018

e21638 Background: The aim of this study was to identify predictors of overall survival (OS) following palliative pleural procedures in patients with malignant pleural effusion (MPE). Methods: Data was collected from our database between January 2012 and December 2016 including all patients with MPE. 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 OS were identified by univariate analysis, using Fisher's exact for the categorical variables and Student's t-test for the quantitative ones. The cutoff points for any significant continuous variables were determined by the ROC curve. Subsequently, significant variables were entered into a multivariate logistic regression analysis ( p < 0.05). Results: A total of 238 patients were included in the analysis (37,6% males). Median age was 62 year-old (range 24-965) and median follow-up time for surviving patients was 127 days. Median OS was 83 days for therapeutic pleural aspiration (TPA), 353 days for pleurodesis, 135 days for VAT drainages without pleurodesis due to trapped lung and 39 days for indwelling pleural catheter. Regarding primary site, median OS was 170 days for lung (n = 91), 253 days for breast (n = 70), 90 days for gynecological (n = 18), 33 for gastrointestinal (n = 34) and 305 days for others (n = 26). Factors affecting OS in univariate analysis with p < 0.0001 were ECOG, procedure, protein, albumin, neutrophil to lymphocyte ratio(NLR) and hemoglobin, pulmonary infiltrate (p < 0.0438), hematocrit (p < 0.0002), and chemotherapy line (p < 0.0229). In multivariate analysis the following variables were identified as independent prognostic factor: ECOG 3/4 (p < 0.0095), pulmonary infiltrate (p < 0.0011), albumin < 2.5 (p < 0.0325), and hematocrit < 35 (p < 0.0055). Conclusions: Patients with MPE who presented with ECOG 3/4, pulmonary infiltrate, albumin < 2.5 and hematocrit < 35 had shorter OS. The identification of these prognostic factors may assist physicians in choosing the optimal palliative technique.