bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unscheduled hospitalization in advanced cancer patients: Time to rethink about the illness.
Authors: Ostios-García Lorena , Miranda Poma Jesus , Sánchez Cabrero Darío , Gutiérrez Sainz Laura , Villamayor Sánchez Julia , Alonso-Babarro Alberto , Feliu Batlle Jaime 
Published: May 2019

e23007 Background: The aim of our study was to determine if an unscheduled hospitalization in advanced cancer patients is a good time for palliative care referrals, and if this indicator could be improved with some other prognostic score. Methods: We conducted a retrospective study, which included all patients with unscheduled hospitalization in the medical oncology service from January 2011 to December 2013. In order to improve the accuracy of the analysis we considered only first admissions of each patient. We excluded patients with scheduled and unindicated hospitalization. The main variable was survival after an unscheduled hospitalization. We collected the following variables: demographic (age, sex, date of birth, date of death and place of death), tumor type, clinical variables (reason for admission, date of hospitalization, assessment by the palliative care unit during hospitalization, date of last chemotherapy and ECOG), analytical variables (albumin, lymphocytes and lactate dehydrogenase) and a prognostic nomogram developed by our team. Results: Inclusion criteria were met by 1,180 patients. Table summarizes the main sociodemographic characteristics, the type of tumor, and the functional status of patients according to the ECOG scale. After two years of follow-up, 816 (69%) patients had died. The median overall survival was 188 days (161-214). Patients with breast and gynecological cancer had the longest survival, while patients with melanoma, gastric cancer, lung cancer, and pancreatic cancer had the poorest survival. 676 patients (58%) were readmitted during the following year. Readmissions meant a significant decrease of survival. The stage of the oncological disease and performance status measured by ECOG had a clear relationship with survival time. Prognostic nomogram showed high accuracy to predict the probability of survival. Median survival for different quartile was respectively: 348, 139, 68 and 31 days (p < 0´000). Conclusions: The median survival of patients after an unscheduled hospitalization was around 6 months. Been admitted seems a good indicator to introduce specific palliative care. The use of other prognostic scores, as a prognostic nomogram, could help to select patient’ groups with poorer survivals. [Table: see text]
Perceptions of medical status and treatment goal in older adults with advanced cancer.
Authors: Thompson Leah L. , Temel Brandon , Fuh Charn-Xin , Server Christine , Kay Paul , Landay Sophia , Lage Daniel E , Traeger Lara , Scott Erin , Jackson Vicki A. , Greer Joseph , El-Jawahri Areej , Temel Jennifer S. , Nipp Ryan David 
Published: May 2019

e23016 Background: Perceptions of medical status and treatment goal are often used to assess prognostic awareness, but whether these items fully capture patients’ understanding of their prognosis remains unclear. We sought to better understand these measures by investigating their relationship with quality of life (QOL), symptom burden, functional impairment, hospitalizations, and overall survival (OS). Methods: We enrolled patients age ≥70 years within 8 weeks of a diagnosis of incurable gastrointestinal cancer. We surveyed patients to assess perceptions of medical status [terminally ill vs not], treatment goal [curative vs non-curative], QOL (EORTC - Elderly Cancer Patients), symptom burden (Edmonton Symptom Assessment System [ESAS]), and functional impairment (activities of daily living [ADLs]). We used regression models adjusted for age, sex, and education to explore relationships between these items and patients’ QOL, symptom burden, functional impairment, risk of hospitalizations, and OS. Results: Of 132 patients approached, 103 (78.0%) enrolled (mean age 77.62 years, 47.6% female). Half (49.5%) reported a terminally ill medical status and nearly two-thirds (64.0%) reported a non-curative treatment goal, with 42.0% reporting discordant responses to these items. Patient report of a terminally ill status was associated with worse QOL (EORTC illness burden: 53.59 vs 35.26, p = .001), higher symptom burden (ESAS score: 28.15 vs 16.79, p = .002), more functional impairment (number of ADLs: 3.63 vs 5.24, p = .006), greater risk of hospitalizations (HR = 2.41, p = .020), and worse OS (HR = 1.93, p = .010). We found no associations between these outcomes and patient-reported treatment goal. Conclusions: In older adults with advanced cancer, half reported a terminally ill medical status and nearly two-thirds reported a non-curative treatment goal. Patient report of a terminally ill status was associated with worse QOL, symptom burden, functional impairment, risk of hospitalizations, and OS. We did not find associations between these outcomes and patient report of their treatment goal. Our findings suggest that these questions measure different constructs and more nuanced tools for assessing prognostic awareness are needed.
Delirium incidence, risk factors, and treatment in older adults receiving chemotherapy: A scoping review.
Authors: Alibhai Shabbir M.H. , Jung Patrick , Alam Zuhair , Yeung Lily , Malik Uzair , Syed Ali Taqi , Rosario Carla , Yokom Daniel , Rowbottom Leigha , Ayala Ana Patricia , Reka Roger , Puts Martine 
Published: May 2019

e23025 Background: Older adults with cancer are at increased risk of delirium given their advanced age, multiple comorbidities and medications, prevalence of cognitive impairment, and possibly cancer treatment. Awareness of such risks and interventions to prevent or treat delirium is important to clinicians and to provide high quality care. However, there is scant published information on the risks of delirium with chemotherapy or evidence-based approaches to prevent or treat it. We performed a scoping review to summarize the available evidence. Methods: We conducted a scoping review using the framework of Arksey and O’Malley. We systematically searched peer-reviewed journal articles in English, French, and German from Medline, Embase, PsychINFO, CINAHL Plus, and Cochrane Central from inception until January 2017 to identify studies that examined delirium in patients receiving chemotherapy. We also attempted to identify any studies that reported on multivariable delirium risk prediction models and any clinical trials that examined prevention or treatment of delirium. Article titles and abstracts as well as full text articles were reviewed using Covidence software by two or more reviewers independently. Similarly, data extraction was performed by two independent reviewers. Results: A total of 21,678 titles and abstracts were screened, and 1,166 full-text articles were reviewed. Nineteen articles with varying study designs (retrospective administrative databases to clinical trials) reported on delirium using an acceptable diagnostic standard. Sample sizes varied from 15 to over 21,000. No one tumour site or treatment protocol constituted the majority of studies. The incidence of delirium ranged from 0 to 51% (mean 13.5%). The time course of delirium relative to the cycle of chemotherapy was inconsistently reported. No studies reported on risk prediction models for delirium, and no intervention studies to prevent or treat delirium were identified. An additional 109 studies reported on outcomes that could be part of the delirium syndrome but did not meet even our broad inclusion criteria (e.g. cognitive disturbance). Conclusions: Delirium may occur in over 1 in 8 older adults receiving chemotherapy, although there were substantial limitations in reported studies. This scoping review highlights the dearth of knowledge in the area, particularly for risk factors, prevention, and treatment, and emphasizes the need for high-quality studies examining these important outcomes in the oncology setting.
Comparison of mortality trends in geriatric and nongeriatric patients with salivary gland tumors.
Authors: Nawaz muhammad Sarfraz , Parikh Jigarkumar R. , Guddati Achuta Kumar 
Published: May 2019

e23026 Background: The treatment of salivary gland tumors has not changed significantly in the past two decades. However, its increased incidence in the geriatric population poses new challenges for their management. This study explores the incidence-based mortality (IBM) trends in the geriatric and non-geriatric population for the time period of 2000 to 2014 and compares the trends between races. Methods: Mortality data was extracted from the Surveillance, Epidemiology, and End Results (SEER) Database for the years 2000 to 2014. IBM for all stages of salivary gland tumors was queried and the results were grouped by age (geriatric vs. non-geriatric) and race (Caucasian/White, African American (AA)/Black, American Indian/Alaskan native and Asian/Pacific Islander). All stages and both genders were included in the analysis. T-test was used to determine statistically significance difference between various subgroups. Linearized trend lines were used to visualize the mortality trends between various subgroups (Geriatric vs. Non- geriatric and Caucasian vs. African American). Results: IBM for salivary gland tumors has worsened since 2000 to 2014 for both geriatric and non-geriatric patients (P < 0.05), There was a statistically significant difference between these two groups in both Caucasian/White and AA/Black patients. Notably, the worst IBM rates were noted in non-geriatric AA/Black patients followed by non-geriatric Caucasian/White patients. However, there was no statistical difference in IBM between geriatric patients of Caucasian/White and AA/Black descent. Conclusions: The similarity in IBM for geriatric patients with salivary gland tumors in both Caucasian/White and AA/Black groups suggest that the effects of race may not be pronounced in the elderly population. The high rate of IBM in non-geriatric AA/Black patients may suggest environmental influence and warrants further study.
Treatment approaches and survival outcomes of older patients with locally advanced esophageal cancer (LAEC) in Ireland.
Authors: Martin Petra , o'Leary Eamonn , Deady Sandra , Horgan Anne M. 
Published: May 2019

e23034 Background: Neo+/- adjuvant treatment data in older patients with cancer is sparse due to exclusion of this population from clinical trials. We evaluated the management of locally advanced esophagogastric cancer (LAEC) in older Irish patients to determine treatment modalities utilized and identify factors associated with survival. Methods: Patients diagnosed with LAEC (stage II or III) over a 5 year period (2007-2011)were identified from the National Cancer Registry of Ireland. Follow-up was till end 2014.Demographic characteristicswere assessed. Treatment was classified as “best supportive care (BSC)”, “surgery only”, “neo/adjuvant treatment” and “chemo/radiation alone” (ie chemo, radiotherapy or chemoradiotherapy alone in the absence of surgery).Survival was estimated by Kaplan-Meier estimates and Cox models. Clinicopathologic factors and treatment type found to be significant in univariate analysis were included in a multivariate analysis (MVA). Results: 46%(n = 580) of the 1,251 patients were ≥70yrs, 62% had stage III disease and 51% had gastric cancer. 11% (n = 134) received BSC, 23% (n = 288) had surgery only, 31%(n = 390) had chemo/radiation alone, 35% (n = 439) had neo/adjuvant treatment. 20% (n = 39) of patients ≥75yrs had neoadjuvant treatment compared to 46% < 75 yrs. No patient ≥80yrs received neo/adjuvant treatment. With increasing age patients were less likely to receive neo/adjuvant treatment (p < 0.001), less likely to receive surgery (p < 0.001) and less likely to receive any treatment (p < 0.001).Median survival(OS) decreased with age (< 70yrs: 23months; 70-74: 19months; 75-79:13months; ≥80 years:10 months). In MVA, older age, smoking, later stage, higher grade were significantly associated with a higher risk of death.Including an interaction between treatment and age, patients receiving adjuvant or neoadjuvant treatment had lower risk of death than any other treatment group regardless of age. Conclusions: Older patients were less likely to receive any treatment for LAEC than younger patients. Patients ≥70 years benefit from neo/adjuvant treatment, however,these patients are often excluded based on age. Prospective clinical trials focusing on elderly patients and incorporating life expectancy, comorbidities and geriatric assessment are needed to best guide treatment.
Validation of G8 and its acuracy as a predictor of object in oncological patients with age of ≥ 60 YEARS. prospective cohort of 889 brazilian elderly cancer patients.
Authors: Telles O Lima Jurema , Viana Raissa , Sales Letícia telles , Rebello Mirella , Figueiroa José Natal , Bergmann Anke , Cavalcanti Zilda , Mello Amanda L LINS , Mello Maria Julia Gonçalves , Thuler Luiz Claudio Santos ,   BROG- Brazilian Research Oncologic Geriatric Group
Published: May 2019

e23036 Background: The G8, a questionnaire with 8 questions, has been specifically developed as a screening tool for vulnerability in older patients (70+) with cancer, with results suggesting 14 points as a threshold (equivalent to 90% sensitivity and 60% specificity). Its prognostic value for early death was not evaluated in Brazilian population. Methods: Cancer patients (60 years or older) with solid organ malignancies were included in a prospective cohort in a Brazilian Geriatric Oncology Clinic, between 2015 and 2017. Before the start of any oncologic therapy, a Comprehensive Geriatric Assessment (CGA) with 12 questionnaires was performed. For this study, we analyzed the G8 (Figure 1) considering items from Mini Nutritional Assessment (MNA), polypharmacy ( > 3 medications per day), self reported health status and the age of patient. G8 score was considered abnormal if ≤14, and early death (within six months of surveillance) was the gold standard for the study accuracy. Cox proportional hazard risk and Kaplan-Meier survival curves were performed. Results: 889 patients were enrolled and there were 145 (16.3 %) early deaths. Overall, 52% were male, the extremes of age were from 60 to 97 (mean 72.5 ± 0.24), and 38% were < 70 years old. The most common cancers were prostate (31.2%), digestive tract (21.9%) and breast (16.0%); 30.4% were metastatic. 470 (52,9%) from all patients had abnormal (≤ 14) G8 score; 128 (27.2%) who had abnormal G8 score died within the first 6 months, versus 17 (4.1%) with normal score (Table 1). At cut point 14, the G8 sensitivity was 88.3% (CI95% 81.9 - 93.0); specificity 54.0% (CI95% 50.4 - 57.7); positive predictive value 27.2% (CI95% 23.3 - 31.5); negative predictive value 95.9% (CI95% 93.6 - 97.5); area under ROC curve was 0.819 (Figure 2). For those older than 70, the G8 sensitivity was 91% (CI95% 83.4 - 96.1). Abnormal scores showed significant differences in survival probability (Figure 3). Conclusions: G8 score is a strong and consistent predictor of overall 6-month survival, regardless of age, metastatic status or tumor site in Brazilian older (60 or older) oncologic patients. This finding strengthens the clinical utility of this instrument in the Geriatric Oncology and may be an option to extend the practice of Geriatric Assessment in countries with medium-low economic development, even in the younger elderly population.
Evaluation of the diagnostic and prognostic performance of the modified G8 screening instrument in oncological patients with age of 60 YEARS or age: Prospective cohort of 889 Brazilian elderly cancer patients.
Authors: Telles Sales Letícia , Telles O Lima Jurema , Rebello Mirella , Figueiroa José Natal , Thuler Luiz Claudio Santos , Bergmann Anke , Orange Flavia , Mello Maria Julia Gonçalves , Camara Davi de brito 
Published: May 2019

e23040 Background: Elderly oncology patients are not often included in studies of new therapeutic guidelines. The modified-G8 is easy to use, has satisfactory accuracy and does not require additional tools. Its value for predicting early death has not been evaluated. Objective: To evaluate accuracy of the modified G8 instrument for prediction of early death (up to 6 months) in elderly Brazilian patients (≥ 60 years). Methods: We used data from a prospective cohort with participants aged 60 years or older and a recent diagnosis of a solid neoplasm, followed in a geriatric oncology outpatient clinic between 2015 and 2017. Sociodemographic, clinical and laboratory data were obtained, along with CGA. From the primary data, we developed a modified-G8 score using 6 as the cut-off point, normal being < 6 and abnormal being ≥ 6. The primary outcome was early death (occurring within up to 6 months) considered the gold standard for the accuracy study of modified-G8 as a predictor of early death. Through bivariate and Cox multivariate analysis, the risk for early death (Hazard Ratio - HR crude and adjusted) was determined. Overall survival was estimated using the Kaplan-Meier method, and the log-Rank test was used for comparisons according to the categorization of the scores. Results: Of the 889 participants included, 537 (60%) had modified G8 scores ≥ 6 (abnormal). The overall mean score was 9.9 ± 8.4; mean age was 72,5 years (range, 60–97 years), 38% were 60 and 70 years of age. Fifty-two percent of the participants were male. The most common tumor sites were prostate (31%) and breast (16%), followed by digestive and gynecological (both with 11%). On analysis of accuracy, we found sensitivity 91.7% (95% CI 86–95.7), specificity 45.7% (95% CI 42.1–49.4), positive predictive value 24.8% (95% CI 21.2–28.6) and negative predictive value 96.6% (95% CI 94.1–98.2), area under the ROC curve 81.7% (95% CI 77.9–85.4). The crude HR for early death among those who had abnormal scores was 8.3 (95% CI 4.6–14.9) and the age-adjusted HR, tumor site and metastatic disease at diagnosis was 4.5 (95% CI 2.5–8.3) times greater and survival was lower (log-rank p 0.001). Conclusions: The modified G8 predicted early death in an elderly population (≥ 60 years) with cancer in a northeastern Brazilian institution. Satisfactory prognostic accuracy was obtained. This instrument could reduce the number of patients who would follow-up with CGA, saving time and resources, and accelerating individualized treatment.
Tobacco cessation practices among primary care physicians in northern Illinois.
Authors: Nocon Cheryl , Bhayani Mihir , Karcioglu Amanda 
Published: May 2019

e23054 Background: Tobacco cessation is an acknowledged key component of cancer survivorship programs, but significant barriers to program implementation exist. In a 2012 ASCO member survey, 86% of respondents agreed that tobacco cessation should be a routine part of clinical care. However, only 29% reported adequate training. A 2013 survey of physicians at NCI Cancer Centers also showed high levels of support for such programs, but only 1% of oncologists personally engaged themselves. This view is in line with ASCO guidelines that recommend cessation interventions by primary care (PCPs). There is a disconnect between the oncologist’s desire to provide high quality tobacco cessation support for cancer patients and the delegation and delivery of such support. The goal of our study is to evaluate current tobacco cessation practices of PCPs in a large integrated healthcare system. Methods: An electronic survey was sent to all PCPs (n = 165) of the NorthShore Medical Group (Northern Illinois) with questions about their views and practices regarding tobacco cessation. Results: 53 PCPs responded to the survey (response rate of 32%). 94% of respondents believe that PCPs are primarily responsible for addressing tobacco cessation with general patients. 89% believe that PCPs are also responsible for cancer patients, although 34% believe the responsibility should be shared with oncologists. 100% believe that tobacco use affects cancer outcomes in their patients, and 98% report sufficient training in providing cessation support. 90% always ask their patients about tobacco status at the initial visit; this drops to 21% at follow-up visits. For current smokers, 57% of PCPs recommend tobacco cessation all the time and 36% recommend services most of the time. Lack of patient willingness was the most frequently cited barrier to tobacco cessation efforts (74%), followed by lack of time (46%) and lack of resources (42%). Conclusions: PCPs view themselves as primarily responsible for addressing tobacco cessation with their patients but are limited by multiple factors. This primary care-based approach is endorsed by ASCO and other clinical guidelines. More financial and clinical support should be allocated for successful efforts against tobacco dependency.
Real-time detection of patient-reported outcomes (PRO) through an app: A Brazilian experience.
Authors: Morelle Alessandra Menezes , Lima Geraldine Eltz de , D'Agustini Nathalia , Venero Fernando Castilho , Barrios Carlos H. 
Published: May 2019

e23059 Background: patient-reported outcomes (PRO) data are critical for informing patient-centered care and have been shown to enhance our ability to communicate with patients and to control their symptoms. Evidence suggests that patient active participation in symptom reporting and prompt attention to management may have a positive and measurable impact in survival. However, PRO data are not commonly collected in routine cancer care due to challenges – cost, technological rigidity of existing electronic health records and misalignment of stakeholders’ incentives. Methods: in an effort to bridge the unmet needs of PRO collection and integration into routine cancer care, we developed a symptom monitoring and management system that was launched as a free mobile app in August, 2018. Tummi app is designed for reporting 28 symptoms based on the National Cancer Institute’s Common Terminology Criteria for Adverse Events. Symptoms are reported in a 3-point scale (mild, moderate, severe) and patient reported an overall well-being scale represented by emojis. Tummi has the ability to record symptoms, summarize the reporting in physical printout, and automatically store and analyze the input symptoms into graphical interpretations. Results: since august 2018, 1292 patients downloaded and enjoyed the app. Of these, 240 recorded spontaneously their diagnosis. The most common side effect registered was fatigue followed by back pain. Regarding general well-being reports, male patients (25.68%) and female patients (74.32%) totaled 3771 records. Of these, on 50.22% of the time the patients were well, while in 40.17% they were average and in 9.59% they felt bad when made the report. Conclusions: there is an opportunity to better deliver our care for cancer patients, empowering them through collecting their own data. Tummi proved to be doable and understandable for patients’ language in Brazil.