bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term impact of head and neck cancer (HNC) and treatment on financial distress and employment of HNC survivors.
Authors: Wulff-Burchfield Elizabeth Marie , Schlundt David G , Bonnet Kemberlee , Castellanos Emily , Dietrich Mary S. , Murphy Barbara A. 
Published: September 2018

e21575 Background: Increasing HNC survival highlights the importance of understanding late biopsychosocial outcomes. Financial and occupational impacts of HNC remain unexplored, thus we undertook a qualitative analysis to identify themes and explore the impact of HNC/treatment on survivors’ financial health. Methods: Eligibility: Locally-advanced HNC who participated in an R0-1, NED, and > 1 year post treatment. Ten of 12 eligible patients were interviewed. Topics queried: financial issues related to HNC/treatment, financial/insurance matters affecting treatment, impact of treatment on fiscal responsibilities, financial counseling, and late impact of HNC/treatment on work. Frequency distributions were used to summarize patient characteristics. Interviews were transcribed verbatim, double-coded, and organized into themes and subthemes. Results: 50% male, 100% Caucasian, 60% married, median age 64 years, and median time since treatment of 64 months. Most denied ongoing financial strain from HNC/treatment, citing mitigating factors of preparedness (e.g. preexisting savings), health/disability insurance, and marital status. Those with financial distress noted an income limited by savings or disability. None reported financially-related delays in care. However, 2 patients used free healthcare. Most denied impact of HNC/treatment on financial obligations, but a minority reported subsequent delays in dental care, paying credit card bills, and travel. Financial counseling was used by 4 patients; benefits included decreased stress, access to financial programs, and education. Healthcare providers were considered an important source of financial counseling. Not all patients returned to work; late effects (fatigue, cognitive changes) impaired work capacity for those who did. Limitations: Population may have been skewed by loss to follow-up of patients with financial toxicity that precluded ongoing medical follow-up. Conclusions: Long-term financial distress was limited in this cohort of HNC survivors. Preparedness, adequate insurance, marital status, and financial counseling attenuated financial impacts of HNC. For those returning to work, late effects may affect capacity.
Evaluation of cardiovascular health in sarcoma survivors.
Authors: Baker Laurence H. , Murthy Venkatesh Locharla , Weinberg Richard Lawrence , Jalife Jose , Herron Todd 
Published: September 2018

e21579 Background: Heart disease is the most common and serious chronic illness observed in sarcoma survivors treated with doxorubicin. Now the commonest heart disease in theses survivors is coronary artery disease (CAD). We established a Sarcoma Survivorship Program to include patients at high risk of chronic illness including exposure to doxorubicin who are at least 2 years free of disease post treatment. Methods: Every 6 months patients electronically complete NIH’s PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaires (on Anxiety, Depression, Mobility, Pain Interference, Sleep Disturbance, and Physical Function). Detailed family history is documented. Chemotherapy doses are abstracted from original medical records. Data collected includes: blood pressure, lipid profile, high-sensitivity C-reactive protein (hs-CRP), basic metabolic panel, chemistries, renal and pulmonary function, expert echocardiography. All patients signed an IRB approved informed consent. Results: All patients had normal left ventricular ejection fractions (median = 60%) yet 8 (N = 24) patients had an elevated hs-CRP suggesting increased risk of early CAD. 10 patients had untreated hypertension. More than half of our patients have a BMI > 25 and self-declare that they do not exercise. Our high rate of family history of heart disease (58%) raises the issue of genetic predisposition both to heart disease and sarcoma. We compared standardized cardiac risk assessments with mediastinal calcification and epicardial fat on serial chest CT scans. A 39 y.o. man had a coronary calcium score > 400 Agatston units and scattered calcifications were found in 4 additional patients under the age of 40. Conclusions: This survivorship phase of oncologic care represents a unique opportunity to improve the health and quality of life for sarcoma survivors as well as a new focus for translational research to understand mechanisms driving premature aging and chronic heart disease. We assess cardiomyocyte function (cell viability, organization, fibrosis, electrical coupling and contractility) for survivors and matched sibling controls with cells from skin biopsy using 3D bioengineering techniques to culture and mature the phenotype from human stem cells.
Sexual health and quality of life in testicular cancer survivors (TCS) in a third level hospital of a middle-income country.
Authors: De La Mora Hector , Hinojosa Juan , Velazquez Hugo Eduardo , Castillejos-Molina Ricardo Alonso , Monjaras Victor , Bourlon Maria Teresa 
Published: September 2018

e21589 Background: TCS have long life expectancy, but struggle with numerous potential long-term sequelae, including sexual dysfunction (SD). They can suffer organic SD as a treatment side effect, and non-organic SD as a result of psychosexual changes related to the disease. The aim of this study is to determine the prevalence of SD in a cohort of TCS in a middle-income country, and to examine possible influences on health-related quality of life (HRQoL). Methods: An observational, cross-sectional, descriptive and analytic study was conducted. TCS in our cohort underwent IIEF-5 questionnaire, and sexual hormones measurement. HRQoL was examined using SF-36 questionnaire. Beck Depression Scale was used to assess psychological symptoms. Logistic regression analysis was used to evaluate the association among SD and disease characteristics and HRQoL. A Pearson correlation test was performed between SD and disease free survival interval. Results:The study population comprised 35 men whose and mean age was 32±8.3 years (21-54) and the median follow-up time since the end of treatment was 24 months, . Twelve TCS (34%) reported any level of impairment of erectile function (ED), 21 (60%) had loss of sexual desire, and 15 (42%) reported orgasmic dysfunction (OD). The presence of ED, loss of desire, or OD were not associated with worse scores in all SF36 domains, including both composite scores and the total SF-36 score. Treatment with adjuvant chemotherapy (CT) or CT plus retroperitoneal lymph node dissection were not associated with ED (p = 0.8). Fatigue (SF-36 vitality) was statistically significant higher among our cohort of TCS compared to an age-adjusted normative Mexican male population, independently of SD or depression level (0.001). Fatigue was independently associated with higher levels of gonadotropins and lower of testosterone (p = 0.05). Conclusions: The incidence of SD in Mexican TCS is similar (34%) to the rate reported in other populations. HRQoL is decreased particularly in the vitality section, when compared to age-adjusted normative controls. Nevertheless, we did not demonstrate a correlation between SD and worse HRQoL or depression level. Fatigue was associated with low level of tesosterone.
Illness understanding of oncology patients in a community-based cancer institute.
Authors: Sivendran Shanthi , Jenkins Sarah , Svetec Sarah , Horst Michael , Newport Kristina Braine , Yost Kathleen J. , Yang Manshu 
Published: September 2018

e21605 Background: Several studies have demonstrated patients have a poor understanding of prognosis, survival and effectiveness of chemotherapy, particularly in the setting of advanced cancer. This study examines oncology patients’ understanding of their illness based on accurate reporting of stage at diagnosis as well as knowledge of remission status. Methods: 208 cancer patients previously treated at our large community based cancer institute participated in The Consumer-Based Cancer Care Value Index (CCCVI) Field Survey. Electronic medical record (EMR) documentation of stage at diagnosis and remission status were compared to patients’ self-reported responses. Concordance of responses and variables influencing discordance were evaluated. Results: 51.0% of patients’ self-reported cancer stage matched the abstracted stage with the highest concordance in the advanced cancer patients (72%) versus stage I-III patients (36.4%-61.5%). Unexpectedly, discordance was lower among advanced cancer patients as compared to stage I-III patients (p = 0.0528) Those who were concordant for cancer stage at diagnosis were significantly more likely to be female (p = 0.001), under the age of 65 (p = 0.01), have an income greater than $60,000 (p = 0.03), and have more education (p = 0.02). 64.4% of patients’ self-reported remission status matched the abstracted status. Nearly 30% of patients were not sure about their status even when they were in remission. Conclusions: Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding, as well as highlights that an even greater number of patients with early stage I-III cancers have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.
Quality of life and cognitive functioning impairment associated with cisplatin-based chemotherapy in testicular cancer survivors.
Authors: Chovanec Michal , Vasilkova Lucia , Setteyova Lucia , Rejlekova Katarina , Obertova Jana , Sycova-Mila Zuzana , Palacka Patrik , Kalavska Katarina , Svetlovska Daniela , Mladosievicova Beata , Mardiak Jozef , Mego Michal 
Published: September 2018

e21607 Background: Testicular cancer (GCT) survivors are at risk for different types of late treatment sequelae. This study aimed to evaluate long-term quality of life (QOL), sexual (SexF) and cognitive functioning (CogF) issues resulting from cisplatin-based chemotherapy. Methods: QoL, SexF and CogF data were prospectively collected in 83 GCT survivors with median 9 year follow-up (range 5-32). The chemotherapy group (CTG) consisted of 53 and 18 patients receiving a cisplatin cumulative dose of ≤ 400mg/m2 (LCD) and > 400mg/m2 (HCD), respectively. The control group (CG) included 12 patients treated with orchiectomy (6 pts) and adjuvant radiotherapy (6 pts). Data were collected using EORTC QLQ-C30, QLQ-TC26, FACT-Cog and sexual functioning questionnaires and analyzed according to the scoring guidelines. Results:The CTG survivors had significantly (all p < 0.05) more limitations while working or doing daily activities (37% vs 8%), needed to rest more often (61% vs 33%) and feared the disease relapse more often (73% vs 50%) compared to the CG. A subscale for family problems within QLQ-TC26 have shown higher impairment in the CTG vs. CG (mean score ± SEM: 54.2 ± 26.7 vs. 38.8. ± 7.3, P < 0.05). Cognitive abilities were perceived better in CG vs. CTG (mean score 24.5 ± 1.8 vs. 20.5 ± 0.7, P < 0.05). The CG surivors had higher education level and fathered more children compared to the CTG. The CTG felt more unsettled than the CG (all P < 0.05), however the impact of perceived cognitive impairment on their lives did not significantly differ ( P = 0.4). Patients who received HCD have suffered from dyspnea more often than patients treated with LCD (mean dyspnea subscale score ± SEM: 22.2 ± 4.4 vs 8.9 ± 2.6, P < 0.05). The HCD group also reported more difficulties to concentrate while watching television/reading newspaper and struggled to name things during conversation compared with the LCD group ( P < 0.05 for both). No impairment in sexual functioning was reported. Conclusions: Our study shows thatGCT survivors cured with cisplatin-based chemotherapy suffered from QoL issues and their perception of cognitive abilities was altered. The HCD of cisplatin further impaired several QoL and cognitive aspects.
A web-based tool to predict chemotherapy-associated cognitive impairment during survivorship.
Authors: Dorajoo Sreemanee Raaj , NG Terence , Chae Jung-Woo , Yeo Hui Ling Angie , Shwe Maung , Gan Yan Xiang , Foo Koon Mian , Loh Wei-Jen Kiley , Koo Si-Lin , Chay Wen Yee , Tan Tira Jing Ying , Beh Sok Yuen , Lim Elaine H. , Lee Guek Eng , Dent Rebecca Alexandra , Yap Yoon Sim , Ng Raymond C.H. , Chan Alexandre 
Published: September 2018

e21609 Background: Chemotherapy-associated cognitive impairment (CACI) experienced during survivorship can dramatically impair quality of life, particularly among patients receiving treatment with curative intent. We construct a web-based tool to predict the risk of self-perceived CACI at 15 months post-chemotherapy initiation among early stage breast cancer patients, to facilitate screening and early intervention. Methods: We recruited patients receiving chemotherapy for early-stage breast cancer between 2011 and 2014. Subjective cognitive function was assessed using FACT-Cog before, during and at 15 months after initiating chemotherapy. Based on a previously established minimal clinically important difference, an 11-point reduction in FACT-Cog score relative to that at baseline was considered as clinically significant CACI. Factors evaluated as potential predictors of CACI included clinical, laboratory and demographic factors, behavioural symptom and quality of life assessments (EORTC-QLQ-C30). Logistic regression was used to construct a model predicting CACI. Validation was performed on an external cohort recruited between 2015 and 2016. Model discrimination and calibration were evaluated using the receiver operating curve (ROC) and Hosmer-Lemeshow goodness-of-fit, respectively. The model was implemented as a web-based tool. Results: A total of 131 patients were recruited for model development. The model consisted of baseline EORTC-QLQ-C30 fatigue subscale percentage [effect size (95% confidence interval), 5.0% (2.0% to 7.0%), p < 0.001] and the change in FACT-Cog score after 2 cycles of chemotherapy, relative to baseline [-4.0% (-7.0% to -1.0%), p = 0.007]. The model was validated on an external cohort of 33 patients, with an ROC of 0.60, Hosmer-Lemeshow goodness-of-fit statistic of 5.86 (p = 0.44), sensitivity of 57.1% and specificity of 76.9%. The web application is accessible at http://bit.ly/CognitiveRisk Conclusions: A web application to predict CACI risk has been developed and externally validated. The tool facilitates early screening for patients at high risk for CACI and allows timely interventions to prevent or minimize the impact of CACI during survivorship.
Fear of progression in patients with low-risk malignant melanoma.
Authors: Kaehler Katharina C. , Wagner Tobias , Blome Christine , Forschner Andrea , Garbe Claus , Gutzmer Ralf , Hauschild Axel , Heinzerling Lucie , Livingstone Elisabeth , Lang Berenice M. , Loquai Carmen , Schadendorf Dirk , Terheyden Patrick , Augustin Matthias 
Published: September 2018

e21615 Fear of progression in patients with low-risk malignant melanoma Fear of cancer progression (FoP) is one of the problems most commonly reported by cancer patients and is among the most prevalent cancer-related worries in cancer survivors. FCR is highly variable in different cancer entities. Background: This study aimed to elicit the prevalence and significance of FCR in melanoma patients with low risk tumors and further to assess psychosocial and demographic factors predicting severity of FoP as well as to determine the impact of FoP on quality of life (QoL). Methods: In total, 133 patients with low-risk melanoma (pT1a) completed the short version of the Fear of Progression Questionnaire (FoP-Q-SF), the Hospital Anxiety and Depression Scale (HADS), and the EQ-5D questionnaire, as well as self-constructed questions on the socio-demographic background. Results: MeanFoP-Q-SF sum score was 30.1 points (± 8.4 points SD) and the median 29 points. Two thirds of patients deviated not more than 1 SD from the mean. Risk factors for elevated FoP were female gender (p < 0.01), young age (p = 0.04) and working (p = 0.02) patients and patients with severe comorbidities (p = 0.03). Cancer in closely related persons predicted higher FoP (p < 0.01). HADS anxiety scale (r = 0.49, p < 0.01) and depression scale (r = 0.26, p < 0.01) correlated with FoP. A negative correlation with the EQ-5D index was found (r = -0.34, p < 0.01). Conclusions: As in many other malignancies,FoP is prevalent in low-risk melanoma patients and is associated with reduced QoL. Severe comorbidities, cancer in related persons, gender and income could be identified as predictors of FoP. Considerable high levels of FoP even in patients with low-risk malignancies underline the need of psychosocial support and intervention for special subgroups of melanoma patients to enable the patient to manage FoP more successfully.
Comparison of palliative care for lung cancer patients (pts) at two Veteran Affairs Medical Centers.
Authors: Kothadia Sejal , Wang Zhen , Lee Sarah , Chang Victor Tsu-Shih , Park Yeun-Hee Anna , Olson Ellen , Klein David , Leaf Andrea Nadine , Hwa Stephanie , Zhong Fengming 
Published: September 2018

e21621 Background: Palliative and end of life care is essential for lung cancer pts. We examined palliative care delivery for lung cancer pts at 2 VA medical centers. Methods: In an IRB approved protocol, we reviewed medical records of matched pts diagnosed with liver or lung cancer between 2006 and 2012 who were seen by palliative care at 2 VA medical centers (S1, S2). Veterans were compared by 1) demographics, 2) palliative interventions, and 3) outcomes: ED visit within 1 month (mo) of death, ED visit within 6 mo of death, and ICU within 30 days of death. Analyses were performed with SAS Studio Version 3.5. Results: We analyzed 69 male pts (29 at S1and 40 at S2), with a mean age of 63 and 66 years respectively. Thirty (43%) pts were Caucasian and 39 (56.5%) African American. Cancer stages were I (1%), Stage II (3%), Stage III0 (29%), Stage IV (58%), and unknown (8%). Median Karnofsky performance status was 60%. By site, differences were seen in DNR/DNI (S1, S2) [ 21 (72%), 12 (30%) p = 0.0007). For palliative care interventions, significant differences were seen in treatments for pain (S1, S2) [17 (59%), 37 (93%) p = 0.0011], constipation (S1, S2) [10 (34%), 35 (88%) p < 0.0001], and dyspnea (S1, S2) [8 (28%), 29 (73%) p = 0.0003], but not for holding goals of care discussions. We observed differences between sites in evaluations by palliative social work (S1, S2) [15 (51%), 39 (98%) p < 0.0001], mental health (S1, S2) [21 (88%), 10 (25%) p < 0.0001], and chaplain visits (S1, S2) [ 19 (66%), 36 (90%) p = 0.0167]. Finally with outcome, there was a difference between consultations by other medical specialties (S1, S2) [ 19 (66%), 39 (98), p = 0.0005] but not for ED visits, admissions, procedures or ICU stays at the end of life . Conclusions: There are site specific differences between VA medical centers and may reflect local practice patterns, Additional sites should be studied.
Reno-vascular toxicities associated with carfilzomib: Systematic review and meta-analysis.
Authors: Shah Chintan , Bejjanki Harini , Bishnoi Rohit , Jain Ankur , Samal Subhankar , Moreb Jan 
Published: September 2018

e21622 Background: Carfilzomib (Carf) is a novel proteasome inhibitor that is approved for patients with relapsed multiple myeloma (RMM) who have failed ≥ 1 prior lines of therapy. The incidence and seriousness of Carf associated reno-vascular toxicities (RVT) is not well known. We performed systematic review of Carf literature with meta-analysis to determine its incidence and overall risk. Methods: Initial search of literature led to a total of 175 Carf related articles. However, we used a total of 29 publications; phase I/II, phase II and phase III clinical trials (n = 3) which used Carf as monotherapy or in combination. We excluded phase I studies. Incidence rates and odds ratios (OR) were calculated with either fixed effect or random effect model based on the heterogeneity of included studies. Toxicity such as hypertension (HTN), renal failure (RF) and venous thromboembolism (VTE) were reported according to CTCAE v4.0. Results: A total of 4560 patients with various hematological and solid malignancies were included. Incidences of toxicities were: 15.9% and 4.7 % for HTN, 11.2% and 3.44% for RF, 6.47% and 2.22% for VTE, respectively for all grades and high grades in each category. When compared to control group taken from phase III clinical trials, the risk of HTN and RF due to Carf was significantly higher [OR = 2.91 and 3.32 in HTN (P < 0.001)], [OR = 1.71 and 1.79 (P < 0.05) for RF], respectively for all grade and high grade in each category. Moreover, incidence of HTN with higher than standard dose of carf (27 mg/m2 twice weekly) was significantly higher (P < 0.001). RF and VTE did not have the dose effect. Concomitant use of immunomodulator (IMiD) significantly increased, as expected, the incidence of VTE (P < 0.001). There was no variation in the incidence of RVT among newly diagnosed versus RMM (P = 0.4). Conclusions: Overall incidence and risk of hypertension and renal toxicities seems to be high when using Carf. Higher doses of Carf seem to lead to higher incidence of HTN, while the risk of VTE is higher with concomitant IMiD use. The pathophysiology for these complications is poorly understood, however it could be secondary to endothelial effect of carf. Physician should be vigilant about these effects as it can lead to poor overall outcomes.
Result of the feasibility study of lidocaine (LDC) for peripheral venous pain induced by oxaliplatin (L-OHP).
Authors: Sakai Daisuke , Uemori Miwako , Sugiura Takashi , Kudo Toshihiro , Boku Miwa , Tanizaki Keiko , Kato Aya , Mizushima Tsunekazu , Doki Yuichiro , Mori Masaki , Satoh Taroh , Hayashi Taro 
Published: September 2018

e21624 Background: For the patients with colorectal cancer, CapeOx or SOX, combination of L-OHP with oral fluoropyrimidines Capecitabine or S-1, is commonly used in clinical practice. These regimens, different from FOLFOX, do not necessarily require central venous port placement and can be administered via peripheral vein. However, peripheral vascular pain induced by administration of L-OHP was discussed. Methods: LDC was concomitantly administered through the lateral duct of drip route from 30 minutes before to end of L-OHP administration, to patients with colorectal cancer who are to be administered L-OHP (100 mg/m2 or more) via the peripheral vein for the first time. LDC dose was set at two levels of 0.5 (Level 1) and 1.5 (Level 2) mg / kg / Hr. Safety, symptoms of pain and pharmacokinetics of LDC were evaluated. The DLT criteria were (1) an allergic reaction of Grade 2 or higher, (2) non-hematological toxicity of Grade 3 or more related to LDC, (3) cessation of administration of L-OHP or LDC, (4) higher than 5 mcg / mL of blood concentration of LDC. Results: A total of nine patients were enrolled (Level 1: 3, Level 2: 6). No DLTs were observed. The average Cmax of LDC was 0.4 (range: 0.3 - 0.5) mcg/ml at Level 1 and 1.3 (0.5 - 2.3) mcg / ml at Level 2. In the pain assessment (VAS score), in Level 1, 2 cases did not feel pain, 1 case was 3/10. In Level 2, there were no pain in 4 cases and 2/10 in the remaining 2 cases. Conclusions: To alleviate vascular pain caused by peripheral intravenous administration of L-OHP, concomitant administration of LDC could be safe and effective. Clinical trial information: UMIN000011393.