bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival trends in elderly patients with malignant mesothelioma: An analysis utilizing Surveillance, Epidemiology, and End Results database.
Authors: Arjyal Lubina , Vallatharasu Yazhini , Bista Amir , Ojelabi Michael Olayiwola 
Published: May 2019

e18164 Background: Malignant mesothelioma is a highly aggressive tumor arising from the mesothelial surface. Treatment for malignant mesothelioma has not changed significantly in recent years. Better patient care may have improved survival in malignant mesothelioma patients. We conducted this study to evaluate the relative survival rates in elderly patients with malignant mesothelioma over the last one and half decades in the United States. Methods: Elderly patients (age≥65 years) diagnosed with malignant mesothelioma were selected from the Surveillance, Epidemiology, and End Results (SEER-18) database. We used Z-test to compare 1- year relative survival rates (RS) between the two time frames: 2000-2009 and 2010-2014. Several cohorts categorized by race (Caucasians and African-Americans) and gender were stratified. The survival rates were accompanied by standard errors. Results: In total, the SEER-18 database identified 6,346 patients (4,210 from 2000-2009 and 2,136 from 2010-2014; 78.3% were males, 92.6% were Caucasians). Overall, there was no improvement in survival in recent years (1-year RS: 35.4 ± 0.8 vs 36.5 ± 1.2, Z score = 1.910 on 2000-2009 & 2010-2014 respectively). This was true for most of the cohort including those for males: 1-year RS: 35.0±0.9 vs 36.1±1.3, Z score = 1.569; females: 1-year RS: 37.0±1.7 vs 37.8±2.5, Z score = 1.116 and Caucasians: 1-year RS: 35.8± 0.8 vs 36.6.± 1.2, Z score = 1.512 on 2000-2009 & 2010-2014 respectively. There was significant improvement in relative survival among African Americans: 1-year RS: 25.3±3.6 vs 38.6±5.6, Z score = 2.362. Conclusions: Our analysis of real-world data showed an improvement in relative survival rates for African American patients with malignant mesothelioma in recent years. This is likely related to improved delivery of care. Overall prognosis continues to remain poor and there is a strong need for novel therapeutic agents.
Liver cancer systemic treatment patterns in the largely rural state of New Mexico.
Authors: Cadavid Natalia , Anselmo Lisa M. , Maestas Erika , Soares Heloisa P. 
Published: May 2019

e18166 Background: New Mexico (NM) has one of the highest rates for hepatocellular carcinoma (HCC) in the US. Systemic therapy (ST) for HCC is typically reserved for patients with unresectable or metastatic disease. Sorafenib has been commonly used as the first-line (1L) systemic agent for HCC after its FDA-approval in 2007. Since 2017, several other agents have been FDA-approved for HCC including lenvatinib as 1L therapy and regorafenib, cabozantinib, ramucirumab and checkpoint inhibitors (nivolumab and pembrolizumab) as second-line (2L) treatment options. This retrospective study describes the HCC treatment patterns of patients seen at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Following approval by the institutional review board, a retrospective chart review of all consecutive HCC patients at the UNMCCC between January 1, 2012 and August 30, 2018 was performed. Patients were identified accessing the UNMCCC tumor registry database. Data on patients’ characteristics, treatments and outcomes were collected. Descriptive statistics were conducted for this initial analysis. Results: A total of 99 of the 380 patients seen at the UNMCCC within the study period were considered for systemic therapy. Most patients were males (82.8%) and of Hispanic/Latino (57.6%) ethnicity. The majority of patients had one or more risk factors for HCC including a history of hepatitis (70.7%), cirrhosis (70.7%), and history of alcohol use (72.7%). Child Pugh class A and B were seen in 30.3% and 44.4% of patients, respectively. Ninety-six patients were prescribed sorafenib initially; however, only 67 patients (70%) successfully initiated treatment. The median time between sorafenib prescription and treatment initiation was 15 days. Only fifty percent of patients started sorafenib with the FDA-recommended dose of 400mg PO BID. Commonly reported adverse events were fatigue, diarrhea, hand and foot syndrome and LFT elevation. After 2017, when 2L options became available, 11 of 27 patients that started on sorafenib continued on to 2L (9 patients received nivolumab and 2 patients received regorafenib). Outcome data are currently being analyzed and will be reported. Conclusions: Although systemic options are available for the treatment of HCC, a significant number of patients are still not accessing and receiving treatment. A detailed analysis of factors affecting treatment patterns in New Mexico is warranted.
Arabic and Assyrian immigrants’ knowledge of hepatitis and liver cancer in Sydney, Australia. Findings of a community consultation process.
Authors: Robotin Monica Cristina , Gallego Gisselle , Mansour Zeinab , Masgoret Ximena , Wallace Jack , George Jacob 
Published: May 2019

e18167 Background: In Australia over 50% of hepatocellular cancers (HCC) are diagnosed in immigrants born in viral hepatitis endemic areas. Therefore, increasing community awareness of viral hepatitis as a preventable and treatable cause of liver cancer is critical in designing community-based cancer prevention programs. Although 7% of Australians living with chronic hepatitis B (CHB) were born in Africa or the Middle East, limited information exists about these communities’ knowledge and beliefs around hepatitis and cancer. To assist the design of effective strategies for screening and treatment, we conducted a community consultation process among Arabic and Assyrian-speaking communities in Sydney, Australia. Methods: The consultation involved semi-structured interviews with key opinion leaders in the Arabic and Assyrian communities and focus group discussions (FGD) conducted in Arabic, Assyrian and English with community members. Interviews and discussion were digitally recorded, translated and transcribed. Framework analysis was employed for data analysis. Results: Twelve face to face semi-structured interviews were conducted with Arabic and Assyrian community leaders. Sixty-six participants, aged from 22 to 71 years took part in seven FGDs. Findings were highly confluent and highlighted a limited knowledge and understanding of hepatitis and of links to liver cancer. Hepatitis and cancer are stigmatising diseases and kept within the family. To mitigate the distress brought about by cancer, euphemisms and protective language are used and a cancer diagnosis is not disclosed to family members. Communities’ ability to engage with the health system is limited. Fear and past medical interactions influence decision about accessing care and education levels, health literacy and English proficiency are significant barriers to navigating the health system. The internet, doctors, television and radio are the communities’ main sources of health information. Conclusions: Reluctance to talk openly about hepatitis and cancer and widespread ‘cancer fatalism’ need to be considered in clinical interactions. Health information messages need to be tailored to patients’ cultural beliefs, couched in accessible terms and delivered through a range of communication channels.
Incidence patterns of early onset colon cancer by race and stage in the US.
Authors: Shah Nishi , Acuna-Villaorduna Ana , Goel Sanjay 
Published: May 2019

e18168 Background: Several studies show that incidence of colorectal cancer is increasing among young individuals. However, information on incidence of early onset colon cancer by race and stage is lacking. Methods: We analyzed incidence of colon cancer using National Program of Cancer Registries database which covers 99% of the US population. We identified colon cancer using ICD-O-3 code 8000-9049, 9056-9139, 9141-9589, along with the variable for site from cecum to sigmoid colon for years 2001 to 2015. SEER*Stat was used to calculate age-adjusted rates, trends and annual percent change. Results: Age adjusted incidence rate for colon is 31.2 cases per 100,000 among the entire population. Incidence in the age group of 15-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, 80+ years is 2.4, 14.3, 39.8, 86, 165.8, 232.3 per 100,000 respectively. The distribution of colon cancer by race for age groups is listed in table. When evaluating the incidence trend in each race for early onset colon cancer, the trend shows a rise in whites for both age groups (Annual Percent Change [APC] 3.4%, 1.5% for 15-39 years, 40-49 years of age respectively, p < 0.05). The trend in blacks on the other hand shows a rise of 1.2% (p < 0.05) in 15-39 years of age and a small but statistically significant decrease in incidence in 40-49 years of 0.5% (p < 0.05). In Asian Pacific Islanders (API) and American-Indians or Alaskan Natives (AI), the trend is not significant for either age groups. In the age groups above 50 years, the trend shows a decrease in incidence of colon cancer in all races. The rise in incidence for colon cancer in 15-39 years age group appears higher in localized disease as compared to metastatic disease (6.5% vs 2.8% for localized vs distant site of disease). Conclusions: This study highlights differences in incidence of early onset colon cancer among young patients by race and stage. Although there have been more cases of early onset colon cancers in blacks, the rise in incidence is higher in whites. With colonoscopy, there has been decrease in incidence of colon cancer for patients > 50 years for all races and stages. [Table: see text]
Time matters: A retrospective study of cancer care in a Brazilian public university hospital.
Authors: Souza Camila Brambilla , Neto José Tristão , Padua Tiago Costa de , Tadokoro Hakaru , Almeida Michelle , Ribas Christian 
Published: May 2019

e18171 Background: The perception of symptoms, diagnosys, access to a cancer care institute and the first-line of therapy are milestones of cancer care. The success of an oncological treatment is directly relatable to these key-points and the time gaps between them. Growing research in developing countries points out the challenges of offering quality of care in this setting as social, cultural, economic and political factors are deeply intertwined. The objective of this study is to identify the key-points of cancer care, the time gaps between them and the time-related end-points of patients refered to a medical oncology department of a public university hospital in São Paulo, Brazil, in the period of one year. Methods: This is a observational retrospective study based on review of medical records of all cancer patients refered to the medical oncology department of a public university hospital in São Paulo, Brazil, from 01/01/17 to 12/31/17. The analysis was performed in January 2019. The data collected comprises the age at diagnosys, gender, primary tumor site, stage (AJCC 7th ed. staging system), onset of symptons, date of hystopathological diagnosys, the first therapeutic modality and when it was offered, intention of care (curative or palliative), outcomes and the following time-relations: symptoms-dyagnosis (SD), dyagnosis-treatment (DT) and symptoms-treatment (ST). Results: From 358 profiles, 275 were included. The average age at diagnosys was 58,7 years (15-88 years). Men were 147 (53,4%) and 128 (46,5%) were women. The most common primary tumor sites were gastrointestinal tract 22,9%, head and neck 20,3%, cutaneous melanoma 17,8% and genitourinary tract 16%. 160 (58,1%) patients were diagnosed at advanced/metastatic stages (III/IV). The median time-relations were: 5,5 months for SD; 2 months for DT and 8 months for ST. The first treatment offered was surgery at 63,2% of cases, radiotherapy 17,8%, systemic therapy 16,7% (endocrine therapy, targeted therapy or chemotherapy) or palliative care 1,8%. The intention of the initial treatment: 76,3% were curative and 23,2% palliative. At time of analysis, 63,6% of patients were alive, 19,2% deceased and 16,7% of unknown outcome. Conclusions: Our data endorses prevalent findings of developing countries epidemiological studies: late diagnosys, non-curative treatments and poor outcomes. Known causes are desfavorable social-economic conditions, symptom neglection, ineffective cancer screening and deficiency of public cancer care networks. We emphasize time goals as important quality indexes to guide new solutions.
Evaluation of selective outcome reporting bias in efficacy endpoints in print and television advertisements for oncology drugs.
Authors: Wayant Cole , Aran Greg , Vassar Matt 
Published: May 2019

e18179 Background: Drug advertisements marketed to consumers and healthcare providers have been the subject of recent debate, and the efficacy endpoints that underpin these advertisements may sway perceptions of drug efficacy. Methods: Using the AdPharm database we extracted data for oncology drug advertisements printed or aired between March 1, 2017 and September 1, 2018. Our primary objective was to evaluate endpoints from television and print advertisements and endpoints from the corresponding published papers. A secondary objective is to identify the frequency of drug advertisements that are aired or printed while overall survival data is immature. Results: We included 74 advertisements for 34 unique oncology drugs and 22 unique indications. Print ads were most common (n = 66) and most print ads were targeted to healthcare providers (n = 55, 83.3%). The 74 advertisements were underpinned by 48 published clinical trials. The primary endpoint of the 48 underpinning trials was most often PFS (n = 25), followed by OS (n = 11) and ORR (n = 7). Primary endpoints of underpinning trials were not reported in 8 (8/74, 10.8%) advertisements. Statistically significant endpoints were reported more often than nonsignificant endpoints (RR 1.42; 95% CI, 1.26 - 1.60). Thirty advertisements (42.3%) ran while OS data was immature. When OS and PFS were statistically significant, they were reported at a significantly higher rate than when not reported (each P < .001). ORR was not preferentially reported based on its statistical significance (RR 1.33; 95% CI, .94 - 1.87). Conclusions: Oncology drug advertisements appear to preferentially report statistically significant endpoints, which is highly suggestive of selective outcome reporting bias. By reporting only endpoints that achieve statistical significance, advertisers may encourage misconceived notions about a drug’s efficacy profile.
A nationwide study for patterns of immune thrombocytopenia treatment in patients with chronic lymphocytic leukemia.
Authors: Atallah-Yunes Suheil Albert , Haddadin Faris , Kadado Anis , Clark Jackson , Ready Audrey Anne , Ali Syed S. 
Published: May 2019

e18193 Background: Steroids and Intravenous immunoglobulin (IVIG) are considered as the first line of therapy in immune thrombocytopenia (ITP) when treatment is indicated. Approximately 5% of patients with untreated CLL and 25-30% of patients with previously treated CLL have thrombocytopenia. There is limited data about ITP treatment patterns and therapeutic responses in patients with CLL. Methods: This is a retrospective cohort study using the 2016 National Inpatient Sample of adults ( > 18 years) hospitalized for ITP as the admitting diagnosis and CLL as a secondary diagnosis based on ICD-10 codes. Primary outcomes were rate of administration of IVIG, splenectomy, platelet transfusion and packed red blood cell transfusion during same admission. Length of hospitalization was a secondary outcome. Multivariate linear regression was used to adjust for cofounders of age, gender, race and Charlson comorbidity Index. STATA 15 was used for analysis. Results: 14,490 patients were admitted for ITP (56% females, mean age 46), of which 255 had CLL (95 females, mean age was 72.4). On multivariate linear regression there was a significant increase in the use of IVIG among ITP patients with CLL (OR: 2.11; 95%-CI 1.05-4.23, P = 0.03). While there was no difference in terms of splenectomy rate ( OR: 0.35, 95% CI 0.05 to 2.52, p = 0.28 ) or rate of platelet transfusion (Odds ratio 1.15, 95% CI 0.63 to 2.08, p = 0.65) and packed red blood cell transfusion (Odds ratio 1.03, 95% CI 0.44 to 2.39, p = 0.94) between patients who have ITP with CLL and patients admitted with ITP without CLL. No statistical difference was found in hospitalization length. Conclusions: Patients hospitalized for ITP with CLL were more likely to require IVIGs. This could be explained by several theories including the need for a more rapid increase in platelet count as thrombocytopenia may be more severe due to bone marrow infiltration by CLL, immune dysfunction and/or treatment induced thrombocytopenia. Additionally, CLL patients can have hypogammaglobinemia making them more likely to get IVIG as a treatment of choice for ITP and as an immune replacement. Also ITP patients with CLL may have less response to steroids, as was noted in a previous study. Fear of atypical infections due to steroids in CLL patients may result in increased IVIG use. Further research of the microenvironment of ITP in CLL patients might explain the difference in treatment pattern and therapeutic response in this population.
Re-evaluating the neutrophil-to-lymphocyte ratio: Machine learning-based variable selection for predicting survival at twelve months in late-stage cancer patients receiving immunotherapy.
Authors: Spakowicz Daniel , Li Mingjia , Hoyd Rebecca , Burkart Jarred Thomas , Patel Sandip H. , Husain Marium , He Kai , Presley Carolyn J , Bertino Erin Marie , Shields Peter G. , Carbone David Paul , Shah Hiral A. , Tinoco Gabriel , Folefac Edmund , Bhateja Priyanka , Verschraegen Claire F. , Otterson Gregory Alan , Li Lang , Kendra Kari Lynn , Owen Dwight Hall 
Published: May 2019

e18201 Background: Neutrophil to Lymphocyte Ratio (NLR) is prognostic for cancer patients treated with immune checkpoint inhibitors (ICI). We showed the change in NLR early during treatment to be a stronger, curvilinear predictor, i.e. patients with an intermediate change in NLR performed better than those with large decreases or increases. This led us to re-examine whether NLR is an optimal predictor of overall survival (OS). Methods: A retrospective review of 467 patients with advanced cancer who received ICIs from 2011 to 2017 at the Ohio State University was performed with IRB approval. NLR was collected at the initiation of ICI and on-treatment (median 21, IQR 8 days) and calculated as ratio of absolute neutrophil to lymphocyte counts. Variable selection machine-learning algorithms included fast and frugal decision trees and random forest, performed in R. Results: The machine-learning algorithm fast and frugal decision trees identified the ratio of NLR on treatment to baseline NLR, the NLR on treatment, the change in NLR and the cubic change in NLR to be the most informative predictors of survival at 12 months. A random forest algorithm identified the same four variables as the most important for prediction accuracy. Age, sex and cancer type were the least informative predictors in the model, suggesting the on-treatment NLR variables are of value across wide range of demographics. Conclusions: NLR measured during treatment, and its derivative values of the ratio to baseline, change from baseline, and the cubic change from baseline, hold more predictive value than NLR measured at baseline. Common control variables such as age, and sex showed little effect on the model, suggesting on-treatment NLR is useful across wide demographic space. [Table: see text]
Diabetes mellitus: An adverse prognosis in cancer patients—Study of a cohort treated at Instituto Oncológico Henry Moore (IOHM).
Authors: Gil Deza Ernesto , Bragagnolo Julio Cesar , Morgenfeld Eduardo L. , Dragosky Marta , Gercovich Natasha , Montiel Monica , Niewiadomski Dario , Perez Pamela , Musini Silvina Laura , Rivarola Edgardo G. J. , Gercovich Felipe G. 
Published: May 2019

e18212 Background: Numerous studies have evaluated the unfavorable impact of diabetes mellitus (DM) on cancer evolution. The objective of this paper is to study the coexistence of DM and cancer diagnosis; and its influence on the evolution of a cohort followed at IOHM. Methods: Between 9/26/2012 and 11/28/2018 all new patients (Pt) admitted to IOHM filled out a Past Medical History Form (PMHF) (ASCO 2013 ABST. e17539) with their preexisting clinical conditions.The database was locked and anonymized. Those with a history of DM or who were taking insulin and/ or oral antidiabetics were selected (Group A). The stage and evolution of their tumors were compared with those of non-diabetic patients (Group B). Results: Out of 15,617 Pt, 1,829 Pt (11,7%) had DM (Group A); 1,087 Pt were being treated with oral hypoglycemics (59%); 178 Pt with insulin (10%) and 564 Pt (31%) were not on antidiabetics drugs. They were compared to 13,788 Pt without DM (Group B). Oncological treatment was similar in both groups. Mortality was greaterin DM Patients adjusted by sex, age, PS, BMI, Dx and stage; Multivariate Cox Regression (p = 0.0001). The results are presented in the chart below. Conclusions: 1) In a cohort of 15,617 cancer Pt, 11,7% had DM. 2) DM Pt's tumors were more advanced. 3) Under similar treatments, DM Pt presented higher mortality. 4) Based on this, we advocate for DM in oncological Pt to be considered as an independent adverse factor.[Table: see text]
Inclusion of patient-reported outcomes (PROs) in randomized controlled trials (RCTs) with elderly cancer patients: A systematic review.
Authors: Sparano Francesco , Aaronson Neil K , Sprangers Mirjam A.G. , Fayers Peter , Pusic Andrea , Kieffer Jacobien M , Rees Jonathan , Wan Chonghua , Pezold Mike , Fuzesi Sarah , Isharwal Sumit , Anota Amelie , Charton Emilie , Vignetti Marco , Cottone Francesco , Blazeby Jane M. , Efficace Fabio 
Published: May 2019

e18217 Background: Inclusion of PROs in RCTs involving elderly cancer patients may be particularly important, as the elderly are often frail and vulnerable, and treatment decisions need to carefully balance potential burden against benefit. We aimed to determine how many RCTs involving elderly patients have included a PRO endpoint, and identified the most relevant PRO information available in this area. Methods: A systematic review in PubMed/Medline and Cochrane Library identified RCTs with PRO endpoint that enrolled a cancer sample (breast, colorectal, lung, prostate, gynaecological and bladder cancer) with a mean/ median age ≥70 years, published from January 2004 to June 2018. The quality of PRO reporting was evaluated using the ISOQOL-PRO recommended criteria. Two reviewers independently performed data extraction. RCTs meeting at least two-thirds of the recommended criteria were considered as “probably-robust” and therefore most likely to be able to inform patient care. Results: Out of the 610 RCTs with PRO endpoint identified, only 67 RCTs (11%) enrolled a sample that met the above criteria. In 19 RCTs (28.4%) PROs were the primary endpoint and 35 RCTs (52.2%) were conducted in a metastatic population. Less than one-third of these trials (n = 21) were considered as probably-robust. In 10 (47.6%) out of the 21 probably-robust RCTs, PROs favored the experimental arm and in 8 (38.1%) the arms did not differ. Overall survival (OS) was an endpoint in 13 of the probably-robust RCTs. In only 3 of these RCTs (23.1%) did OS improve in the experimental arm and in 10 (76.9%) there was no difference in OS between arms. In about half of the probably-robust trials evaluating OS (n = 7, 53.8%), PROs provided information that contrasted with survival findings. In two RCTs, OS improved in the experimental arm, while PROs either did not change between arms (n = 1) or favoured the control arm (n = 1). Conversely, in 5 RCTs (38.5%), OS did not differ between arms whereas PROs favoured the experimental arm. Conclusions: Among cancer RCTs including PROs, the proportion of those conducted in the elderly is low. However, PRO data may provide useful information for these type of patients and their clinicians.