bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bevacizumab-induced bleeding in colorectal and noncolorectal cancer patients in a community oncology setting: An Abington Memorial Hospital experience.
Authors: Ali Naveed , Malik Faizan , Naglak Mary , Jafri Syed Imran Mustafa , Fidler Christian , Shahin Mark S. , Seidman Michael J. , Cohen Steven J. 
Published: September 2018

e18250 Background: Bevacizumab (Bev) can be associated with clinically significant bleeding. Patients (pts) in community practice have increased comorbidities, leading to some reluctance to use Bev with anticoagulation (AC) or antiplatelet therapy (APT). This study was conducted to determine the incidence of Bev induced bleeding in colorectal (CRC) and non-colorectal (non-CRC) cancer pts in a real-world setting. Methods: In this retrospective analysis, pts with Bev treated CRC and non-CRC from Jan 2010 to Jan 2017 at our hospital were identified. Bleeding was graded according to CTCAE v4.0. Chi-Square and ANOVA were used to calculate associations. Overall survival (OS) and progression free survival (PFS) were calculated using Kaplan-Meier and log rank methods. Results: 241 pts were evaluated (mean age = 63; 54% females), 112 with CRC and 129 with non-CRC (lung = 27%; gynecologic = 14%; CNS = 7%; other = 5%). Median duration of Bev therapy was 21 weeks. Overall bleeding was 22% (mucocutaneous = 14%; hematochezia = 4.5%; hematemesis = 1%; hematuria 2.5%; cerebral hemorrhage = 1%). Grade 3 bleeding occurred in 8 pts (epistaxis = 1; hematemesis = 2; hematochezia = 1; hematuria = 4), of whom 1 was on AC. There were no grade > 3 events. Concomitant AC (n = 35) increased bleeding risk ( p = 0.01) whereas APT (n = 43) did not ( p = 0.4). There was no association of bleeding and Bev dose ( p = 0.1); however, longer duration of therapy increased bleeding risk ( p = 0.01). In CRC pts, concomitant chemotherapy (oxaliplatin vs irinotecan), bleeding history, intact tumors and tumor side were not associated with increased risk ( p > 0.05). In CRC, pts with bleeding had longer estimated median OS (52 [95%CI, 35-66] vs 35 [95%CI, 22-48] months; p= 0.079) and PFS (80 [95%CI, 59-101] vs 72 [95%CI, 49-95] months; p= 0.048). Conclusions: We demonstrated in a modern community hospital practice that there is a 22% incidence of bleeding with Bev, although mostly mild even with concurrent AC, and only 3% grade 3. Concurrent AC but not APT was associated with increased bleeding risk and warrants careful discussion with pts. The observation of longer OS and PFS in pts with Bev induced bleeding warrants further investigation.
Role of nutrition in incidence and management of cancer therapy-induced diarrhea (CTID): HEAT (Health Eat and Toxicity) prospective interventional study and preliminary data.
Authors: Mirabile Aurora , Vecchio Erika , Falvella Stefania , Barbarini Lucia , Butti Chiara , Ciambelli Fabrizio , Bovio Antonella , Pauli Sergio , Ricci Isabella , Frigo Fiorenza , Del Grosso Elisabetta , Aloisio Enrica , Oliva Giovanna , Artale Salvatore Agatino 
Published: September 2018

e18251 Background: Metastatic colorectal cancer (mCRC) patients (pts) are at high risk of CTID influencing treatment outcome. The primary end-point of our study was the decrease of grade 3-4 (G3-4 from Common Terminology Criteria for Adverse Events 4.0) CTID incidence to 50% in respect to literature data. A predefined nutritional regimen was planned and administrated to each pts. In explorative analyses, we investigated the correlation between Vitamin D deficiency and CTID incidence and between dihydropyrimidine dehydrogenase (DpD) mutations and CTID. Methods: All mCRC pts undergoing chemotherapy (CT) with an expected G3-4 CTID incidence of about 17% were enrolled. During CT the nutritionist administered a predefined, slag free diet according to Italian Society of Human Nutrition indications and within World Cancer Research Found recommendations. Results: Fifty consecutive pts were enrolled within 11 months. Pts characteristics are summarized in the table. A significant decrease (p-value 0.00096; IC 95% 0.059) of G3-4 CTID incidence to 95% was obtained in respect to literature data. No CT modification or admissions/supportive care were needed. Due to strict diet adherence (96%) > 50% pts had no diarrhea and no one had G4 diarrhea. BMI improved in 35% over-weights and in 40% obese, no changes in normal-weights. The correlation analysis showed the decrease of CTID incidence with the increase of vitamin D levels, but did not reveal a relation between DpD mutations and diarrhea. Conclusions: The preliminary results suggest a possible role of the diet on CTID prevention and a correlation with vitamin D levels. [Table: see text]
Satisfaction among lung cancer (LCa) patients (pts) in multidisciplinary (MDC) vs. serial care (SC) settings.
Authors: Ward Kenneth Daniel , Boateng Nana , Rugless Stewart Fedoria Elaine , Smeltzer Matthew , Jackson Bianca , Foust Courtney , Faris Nicholas Ryan , Ray Meredith , Osarogiagbon Raymond U. 
Published: September 2018

e18254 Background: Coordinated MDC, in which all key specialists concurrently provide early input, develop and execute a consensus plan of care in collaboration with pts and their caregivers, may improve satisfaction with care. We rigorously evaluated this premise. Methods: Prospective clinical cohort study comparing newly-diagnosed LCa pts receiving MDC (n=156) or SC (n=307) in the same healthcare system. Pts were enrolled before treatment onset. At baseline (study entry) and 3 months later, pts and caregivers completed treatment-related measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, including perceptions of quality of care, satisfaction with care, and extent of involvement in decision making. Satisfaction indices at 3 months will be compared in multiple linear regression models, adjusting for baseline scores and demographic and treatment-related characteristics. Results: Pt characteristics were similar, except for age and stage (Table). At baseline, MDC pts rated their care more positively than SC pts, but satisfaction with provider communication was similar. Three month data are currently being analyzed. Conclusions: MDC provided greater pt satisfaction in the diagnostic phase of LCa care. Further prospective analyses will test the hypothesis that MDC pts experience greater satisfaction with quality of care and provider communication compared to SC pts. Clinical trial information: NCT02123797. [Table: see text]
What do patients really want to know?
Authors: Ahamad Anesa Waheda , Wallner Paul E. , Salenius Sharon , Ross Rudi , Fernandez Eduardo 
Published: September 2018

e18261 Background: We describe and analyze the quantity, nature and spectrum of questions asked by patients at consultation for radiotherapy to clarify the volume of questions that patients have and to inform the extent to which pre-composed non-personalized educational material is sufficient. Methods: With IRB approval, we retrospectively reviewed records of consultations that were performed by a single radiation oncologist from 2012 to 2016. Patients had been asked to list all of their questions exhaustively, which were then documented. To define topics for data abstraction, questions were extracted from records of a pilot group from the initial six-month period. One hundred and seventy five questions were obtained and were condensed into 57 information topics that were further grouped in to 34 themes, nine subjects and 2 broad areas. Results: A total of 2,386 questions were posed by 396 patients. The median number of questions asked per patients was 6, range 0 to 16 and interquartile range 4. There were 878 disease-related questions (36.8% of all questions) and 1,358 radiation modality-related questions (56.9% of all questions). The frequency of questions on each of nine subjects is listed in the Table. Conclusions: It is important to elicit all patients’ questions and concerns during consultation. Since almost 40% of all questions were disease-related regarding the details of the individual’s tumor, pre-composed non-personalized educational material is not sufficient. The 3 most frequently asked subjects also cannot be adequately given as a set on non-personalized information: they require details of their individualized radiotherapy logistics, side effects and radiation technical details. Further study is needed to measure the amount of time and effort required to evaluate and manage the information needed and whether the practice of personalization of information merits additional reimbursement or coverage. [Table: see text]
Incidence of pregnancy events among women with a malignant disease diagnosis.
Authors: Rodriguez Maria Alma , Cheng Lee , DeJesus Alma Yvette , Milbourne Andrea 
Published: September 2018

e18262 Background: Pregnancy concurrent with cancer is rare, but adds additional complexity to cancer management and treatment. Little information is available about incidence of pregnancy events among women with malignant diseases. We aimed to describe the incidence of pregnancy and the clinical characteristics of pregnant women with cancer who have received care at MD Anderson Cancer Center. Methods: This was an IRB-approved retrospective cohort study. We searched our electronic health records for women aged 12-50 years, with a cancer diagnosis, treated from January 1, 2011, to December 31, 2015. Results: Over 5 years, out of 30,670 unique female patients (pts), 315 (1.02%) had pregnancy events documented. The distribution of events by malignant disease site is shown in Table 1. When pregnancy was documented or diagnosed, the pts’ mean age was 31.3 years (range: 16.5-50.1) and mean gestational age was 17.8 weeks (range: 1.0-38.0). There were 18 documented terminations of pregnancy events (16 = 1st trimester; 2 = 2nd trimester). Of these pts, 83% (15/18) had received chemotherapeutic agents during 1st trimester = 11 cases; 2nd trimester = 2 cases; 12 weeks pre-conception = 2 cases. Conclusions: Most pregnant cancer pts can be safely treated. Most pregnancy terminations were associated with chemotherapy administration, prior to and within the first trimester of pregnancy. Thus, it is important to conduct pretreatment pregnancy screening and effective contraception when women of reproductive age are treated with a potentially teratogenic agent. In addition, urine pregnancy tests, recommended contraceptive methods, and menstrual history need to be documented during cancer-related therapy. [Table: see text]
The quality of life (QoL) assessment of oxaliplatin-based preoperative chemotherapy for locally advanced gastric cancer: An integration analysis of two prospective phase I study.
Authors: Satake Hironaga , Miki Akira , Yasui Hisateru , Tsuji Akihito 
Published: September 2018

e18263 Background: Surgery with lymph node dissection is the primary treatment for patients with localized resectable gastric cancer. However, the prognosis of locally advanced gastric cancer is poor. One promising approach is neoadjuvant chemotherapy, however, the use of neoadjuvant chemotherapy consisting of oxaliplatin-based regimen for locally advanced gastric cancer has not been reported. Oxaliplatin-induced neurotoxicity may continue after the chemotherapy and interfere with patients’ daily activities. We conducted two prospective phase I study of oxaliplatin-based neoadjuvant chemotherapy for locally advanced gastric cancer and assessed the oxaliplatin-induced neuropathy using the FACT-Ga and FACT-GOG-Ntx assessments. Methods: We planned two cycles of oxaliplatin administration and evaluated oxaliplatin-induced neuropathy using the FACT-Ga and FACT-GOG-Ntx assessments. Patients with locally advanced gastric cancer received two cycles of neoadjuvant chemotherapy with oxaliplatin (100 or 130 mg/m2) on day 1, as well as S-1 (80 mg/m2/day, b.i.d.) or capecitabine (2000 mg/m2/day, b.i.d.) for 14 days, repeated every 3 weeks. They then underwent gastrectomy with curative D2/3 lymph-node dissection followed by adjuvant S-1 (80 mg/m2/day, b.i.d.) for one year. QoL was assessed at baseline and during treatment. Results: Twelve patients were enrolled and fully assessed the QoL. All patients were chmo-naïve and had a good performance status: median age 70y, 67% male. The mean dose intensity of delivered during the neoadjuvant chemotherapy was 96.0% for oxaliplatin. Peripheral neuropathy was observed in all patients but with no functional disorders. Median time to QoL deterioration in FACT-G and FACT-GOG-NTx was 3 weeks. There were correlation between oxaliplatin administration and QoL deterioration by the repeated-measures ANOVA. Conclusions: FACT-GOG-Ntx showed that sensory neuropathy caused a deterioration in QoL immediately after the initiation of preoperative oxaliplatin-based chemotherapy, but that QoL recovered after the neo-adjuvant chemotherapy. Clinical trial information: UMIN000015950,UMIN000015181.
Effect of nivolumab therapy on pulmonary artery.
Authors: Fournel Ludovic , ARRONDEAU Jennifer , Boudou-Rouquette Pascaline , Girault Frederique , Revel Marie-Pierre , Mansuet-Lupo Audrey , Roche Nicolas , Damotte Diane , Goldwasser Francois , Alifano Marco 
Published: September 2018

e18266 Background: Nivolumab, a human antibody targeting programmed death 1 receptor, is part of the armamentarium of lung cancer. Serious treatment-related adverse effects have been reported, including pneumonitis, whose mechanism is unclear. The aim of this study was to evaluate the occurrence of subclinical or patent pulmonary hypertension in patients receiving Nivolumab for advanced lung carcinoma. Methods: Clinical and morphometric data of patients receiving Nivolumab for treatment of advanced lung carcinoma are prospectively collected in our Institution and reviewed monthly by a multidisciplinary panel. For the purposes of the study, a blinded analysis of computed tomography (CT)-scans was performed, by two radiologists, to measure pulmonary artery (PA) and ascending aorta (Ao) diameters at the level of the bifurcation. Pre- and post-treatment PA/Ao ratios were calculated. Results: There were 62 patients with mean age and body mass index of 62.3 years and 24.3 kg/m2, all current or former smokers. Main histological type of carcinomas (stage IV in all cases) was adenocarcinoma (58.1%). Mean PA (+SD) diameters (before and after 4 cycles of Nivolumab [3mg/Kg]) were 26.3 (+/-2.8) mm and 28.0 (+3.0) mm, respectively (p = 4.9*10-7). Mean Pre- and post-treatment by Nivolumab PA/Ao ratios were 0.82 (+0.09) and 0.87 (+0.11), respectively (p < 0.001). There was no significant change in CT-scan aspect of lung parenchyma. Two patients experienced acute respiratory failure at day 52 and 58 after starting of Nivolumab therapy. CT-scan ruled out pulmonary embolism, but we observed PA/Ao ratio > 1 suggesting acute pulmonary hypertension, confirmed by echocardiography. They both died despite intensive care. Even excluding these 2 patients from comparative analysis, PA diameters and PA/Ao ratios remain significantly higher after Nivolumab treatment (both p < 0.001). Conclusions: Nivolumabcan induce subclinical or symptomatic acute pulmonary hypertensionpossibly leading to fatal adverse events.
Comparative evaluation of the safety and effectiveness of rivaroxaban (riva) and enoxaparin (enox) for treatment of venous thromboembolism (VTE) in cancer patients.
Authors: Hummert Shelly E , Gilreath Jeffrey , Rodgers George M , Wilson Nathan , Stenehjem David D. 
Published: September 2018

e18268 Background: The current standard for VTE management in patients with active malignancy is low molecular weight heparin (LMWH). Direct oral anticoagulants (DOACs) are convenient options, but comparative data is lacking in cancer patients. Methods: An observational cohort study was conducted to identify patients with cancer treated with either enox or riva (institutional preferences) from December 2012 to April 2015. Patients were excluded if they received prophylactic dosing of enox, prior anticoagulation, transitioned to warfarin, or received anticoagulation for less than 15 days unless they had a bleeding event. Results: A total of 182 patients were included: enox (n = 97) and riva (n = 85). Median age was 65 years at initiation for riva vs 57 years for enox, p = 0.0007. Gender was similar between groups (54% male). Fifty-three percent (n = 97) had metastatic disease and 54% (n = 99) were actively receiving chemotherapy when diagnosed with initial VTE. Sixty-five percent (n = 119) were treated for deep venous thrombosis (DVT), 19 percent (n = 35) had pulmonary embolism (PE), and 11 percent (n = 20) had both DVT and PE. More patients initiated riva for extensive VTE’s 48% vs 29% (p = 0.02). Median duration of anticoagulation was 3.1 months in the enox group and 7.1 months in the riva group (p < 0.0001). Recurrent VTE occurred in 3 patients (one on riva). Ten percent of patients (n = 10) had a bleeding event on enox compared to 15 percent on riva (n = 13, p = 0.3). Major bleeds occurred in seven percent (n = 7) in the enox group and 8 percent (n = 7) in the riva group (p = 0.4). One fatal bleed occurred with each anticoagulant. Pharmacodynamic interactions with antiplatelet agents may have contributed to 3 major bleeds (two with riva). Three percent of patients (n = 3) experienced minor symptomatic bleeds on enox compared to six (7%) on riva. Mean time to bleeding will be presented. Conclusions: Riva is a safe and effective alternative to enox for VTE management in cancer patients. Concomitant medications must be reviewed before initiation and during anticoagulant therapy to minimize drug interactions. Randomized trials are needed to directly compare LMWH to DOACs in this population.
Reliability of administrative data for evaluating quality of systemic cancer treatment.
Authors: Krzyzanowska Monika K. , Powis Melanie Lynn , Taback Nathan , Diong Christina , Enright Katherine , Booth Christopher M. , Trudeau Maureen E. 
Published: September 2018

e18269 Background: There is ongoing interest in leveraging administrative data to examine quality but methodological concerns persist. We evaluated the reliability of a previously established panel of administrative data derived quality measures for systemic treatment. Methods: The cohort consisted of women diagnosed with early stage (stage I-III) breast cancer (ESBC) in Ontario, Canada, in 2010. Performance on 11 quality indicators evaluated using deterministically linked healthcare administrative databases has been reported previously. Sensitivity and specificity were examined using the chart as the gold standard. Results: The administrative cohort consisted of 6,795 women with ESBC from which a validation cohort of 705 patients was randomly selected from among patients who underwent cancer surgery at one of five hospitals chosen to balance feasibility and institutional characteristics.Sensitivity and specificity varied by indicator (Table 1). Reliability of some indicators may have been affected by suboptimal chart documentation in instances where care spanned multiple settings or the medical record was fragmented, or where the number of eligible patients for that indicator was low. Conclusions: Administrative data can be used to evaluate quality of systemic cancer therapy but understanding the reliability characteristics of individual indicators is essential to inform their appropriate use and interpretation. [Table: see text]
Factors influencing the use of thromboprophylaxis in cancer outpatients: CAT AXIS, a case-vignette study on clinical practice.
Authors: Scotte Florian , Elalamy Ismail , Mayeur Didier , Meyer Guy 
Published: September 2018

e18276 Background: Data on long-term venous thromboembolism (VTE) prophylaxis in cancer outpatients remain scarce. Our objective was to describe clinical practice and to identify factors influencing the use of thromboprophylaxis. Methods: CAT AXIS was a multicenter cross-sectional study based on the completion of physician-profile questionnaires and the assessment of 10 e-mailed credible clinical scenarios of lung, colon and breast cancer by each of participants using the case-vignettes validated method. Results: A total of 224 physicians participated allowing the completion and the analysis of 2,085 reviewed case vignettes corresponding to 765, 703 and 617 fictive clinical scenarios on lung, colon and breast cancers, respectively. The overall rate of thromboprophylaxis was 680/2085 (32.6%) among participants with a comparable proportion for the three types of cancer. Low-molecular-weight heparin (LMWH) was the most frequently used, by 92.7%, 93.8% and 83.9% of participants for lung, colon and breast cancer, respectively; treatment duration of ≥ 3 months was prescribed by 74.4% of participants. Multivariate analysis of factors influencing thromboprophylaxis based on patient’s characteristics is summarized in the table. Conclusions: In the absence of clear guidance, the use of thromboprophylaxis remains low and rather empiric even though the selection of LMWH by the majority of participants and treatment duration seems appropriate based on available data to date. ECOG index, metastatic malignancy, chemotherapy and history of thrombosis were significantly associated with the decision to use thromboprophylaxis in most situations. [Table: see text]
Incidence of peripheral neuropathy in patients with colorectal cancer receiving oxaliplatin alone vs. radiation therapy and oxaliplatin.
Authors: Lockwood Matthew Blake , Joshi Krishna Prasad , Mobley James , Sampath Suneetha , Siegel Eric R , Govindarajan Rangaswamy 
Published: September 2018

e18281 Background: Peripheral sensory neuropathy (PN) is a known dose limiting toxicity of oxaliplatin, used to treat patients with colorectal cancer. Patients with rectal cancer receive radiation therapy (RT) in addition to oxaliplatin in adjuvant setting. Pelvic radiation causes plexopathy due to demyelination, ischemia due to blood-vessel injury, and nerve fibrosis. To assess if RT increases the incidence of peripheral neuropathy, we conducted an analysis of patients with colorectal cancer treated with oxaliplatin alone vs. oxaliplatin and radiation. Methods: A retrospective analysis of subjects with stages II, III, and IV rectal (R) and colon (C) cancer from 2005 to 2014 was conducted. Only subjects receiving O with or without RT were included. The incidence of PN was compared for increase in subjects receiving both O and RT compared to O alone via one-sided chi-square tests at 5% alpha, both overall and after subgrouping by stage. Results: Out of 261 subjects analyzed, 158 met the study’s criteria. There were 97 C (all received only O) and 61 R (10 received only O; 51 received O+RT). PN occurred in 37% (19/51) of subjects receiving O+RT compared to 22% (24/107) receiving only O ( P= 0.025). In Stage II-III disease, PN occurred at nearly equal rates of 36% (14/39) in subjects receiving O+RT and 33% (16/46) in subjects receiving O only ( P= 0.457). However, in Stage IV disease, PN occurred in 42% (5/12) of subjects receiving O+RT compared to 13% (8/61) of subjects receiving only O ( P= 0.009). Conclusions: In our study, the incidence of PN was higher in subjects receiving both RT and O compared to O alone. Although our study did not show higher PN in stages II and III disease, patients with rectal cancer may have residual neurotoxicity from previous radiation and the subsequent exposure to oxaliplatin may be contributing to the cumulative toxicity. [Table: see text]