bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the risk of relapse of patients with stage III cutaneous melanoma at event-free survival time points.
Authors: Weppler Alison M. , Lee Derrick G , van Niekerk Dirk , Savage Kerry J. 
Published: September 2018

e21074 Background: The prognosis of patients (pts) with stage III cutaneous melanoma is typically estimated at the time of diagnosis. Recent studies in other malignancies have reported the utility of estimating outcome using a conditional survival approach. Herein, we evaluated the risk of melanoma relapse at event-free survival (EFS) time points in pts with stage III cutaneous melanoma in British Columbia (BC). Methods: The Cancer Surveillance & Outcomes Database and Co Path Database were screened to identify pts diagnosed between 1998 and 2013 in BC with completely resected stage III cutaneous melanoma. A competing risk model was used to estimate 5-year (y) risk of recurrence at pre-specified EFS time points, with non-melanoma related deaths considered competing risks. Results: In total, 513 patients were identified: 329 males (64%); median age at diagnosis 58 y (16-99); median follow-up 5.6 y (0.2-17.5) for living pts. In total, 330 pts (64%) had a melanoma recurrence and most were distant metastases (n=194, 59% v regional n=79, 24% v local n= 57, 17%). The median time to first recurrence of any type was 11.6 months. The 5-y risk of any relapse was 63.8% at EFS 0, which decreased to 11.4% by EFS 5 y (Table 1). Full staging information was available for 423 pts (83%); the risk of relapse was lower for stage IIIA compared to IIIB and IIIC at EFS 0 (48%, 68% and 77%, respectively, p<0.001). By EFS 2 y, there was no difference between the groups; however, the 5-y risk of relapse was still moderate (IIIA 40%, IIIB 41%, IIIC 36%, p=0.46). Conclusions: While the risk of melanoma relapse decreases over time, it remains moderate up until 5 y, with distant recurrence as the most frequent event. This data can help inform surveillance guidelines and serves as a benchmark to compare the impact of novel therapies in the adjuvant setting. [Table: see text]
The stability of treatment preferences of advanced cancer patients over time.
Authors: Jabbarian Lea Jasmina , Maciejewski Renee , Maciejewski Paul K , Prigerson Holly Gwen 
Published: September 2018

e21501 Background: The stability of patient treatment preferences has important implications for the optimal timing of advance care planning. Nevertheless, longitudinal data on cancer patients in real-life settings have not examined stability of treatment preferences over time. This study examines the stability of treatment preferences of advanced cancer patients over time and the potential influence of changes in physical functioning. Methods: The patient sample (N = 104) was drawn from a multi-institutional, longitudinal cohort study of patients recruited between 2010 and 2015. Patients with metastatic solid tumor cancer that had progressed on prior chemotherapy regimens were interviewed after an initial clinic meeting in which their most recent scan results were discussed (baseline) and, subsequently, completed monthly follow-ups. Patients reported their treatment preferences (i.e., comfort versus life-extending care) and physical functioning at each assessment. Results: The treatment preferences of the majority of patients (80.8%) remained stable within the first month of follow-up. Patient characteristics, such as age or type of cancer, were not significantly associated with treatment preference stability. The proportion of patients whose preferences changed in favor of comfort care (10.6%) was only slightly higher than the proportion of patients whose preferences changed in favor of life-extending care (8.7%). The same pattern held for the two- and three-month follow-up assessments. Improvement in physical functioning was significantly associated with change in treatment preferences. However, the vast majority of patients (72.2%) had stable or declining physical functioning. Conclusions: Most advanced cancer patients have stable treatment preferences regarding comfort versus life-extending care in the months leading up to their death. Thus, advance care planning earlier in the course of illness may not be premature for the vast majority of patients. As physical functioning changes, treatment preferences should be re-evaluated.
Documenting goals of care (GOC) and prognosis of patients with advanced cancer: A tertiary cancer centre review of internal and external correspondence.
Authors: Hamid Anis , Ha Francis , Das Oindrila , Weickhardt Andrew 
Published: September 2018

e21512 Background: Patients with advanced cancer require clear communication and documentation of GOC and prognosis to inform optimal care planning between the patient, family, specialist and primary healthcare providers. Such documentation may be lacking despite multiple inpatient and outpatient (OP) interactions prior to death. We aimed to review the frequency, content and timing of GOC/prognosis documentation during the last year of life of advanced cancer patients. Methods: All patients who died during palliative care admission at our tertiary centre in 2015 were identified. Patients with incurable solid cancer and reviewed ≥1 times in oncology OP clinic were included. We reviewed all oncology OP consultation notes and letters, oncology discharge summaries and advanced care plans (ACP) over a 12 month period before death. Both internal (OP notes) and external documents (OP letters; discharge summaries) were reviewed in detail for documentation of GOC and prognosis (qualitative/quantitative description). Results: 147 patients were included in the analysis. There was a median of 6 OP consultations and 6 hospital encounters (including admissions) per patient. Median time from first OP consultation to death was 7.7 months. Most patients had documentation of GOC in OP notes (61%) however only 24% had prognosis documented. 63% of OP visits resulted in a letter to external doctors. 58% of patients had ≥1 OP letter documenting GOC (median time before death, 3.9 months) and 16% had a letter documenting prognosis (median time before death, 2.8 months). 73% of patients had a ward admission yet 5% of discharge summaries specified prognosis. Only 15% of patients had an accessible ACP on record. Conclusions: We observed a lack of documentation of GOC and particularly prognosis in internal and external hospital correspondence despite multiple interactions prior to patient death. Although discussion of GOC and prognosis may occur within a consultation, lack of documentation in correspondence reduces insight into patient clinical trajectory and may result in differing care between providers. There is a need for improved communication and documentation in advanced cancer care.
Association of multidimensional comorbidities with survival in elderly patients with metastatic colorectal cancer treated with chemotherapy.
Authors: Kim Ki Hyang , Lee Jae Jin , Kim Jongphil , Morgado Gomes Fabio Renato , Sehovic Marina , Extermann Martine 
Published: September 2018

e21530 Background: In geriatric assessments, comorbidity is often assessed with tools such as the Charlson comorbidity index (CCI) and the Cumulative Illness Rating Scale-Geriatrics (CIRS-G). In studies of older patients with colorectal cancer (CRC), comorbidity was mainly measured using the CCI, and inconsistent results about the correlation comorbidity with overall survival (OS) were found. In order to refine our understanding of the impact of comorbidity, we evaluated its correlation with OS using the CIRS-G and heat maps to elicit the subgroups with the highest impact. Methods: We retrospectively reviewed 153 consecutive patients from the Total Cancer Care database, aged ≥65 with stage 4 CRC, who underwent chemotherapy at Moffitt Cancer Center from 2000 to 2015. The association between CIRS-G scores and OS was examined by the Cox proportional hazards regression model. Results: Median age at diagnosis was 71 years. Forty-eight % of patients had an ECOG PS of 0. Median MAX2 score of chemotherapies was 0.119. Median total score of CIRS-G was 8 (1-20) and median severity index was 0.57 (0.07-1.43). The most common comorbidities were vascular, EENT and larynx, and respiratory diseases. Eleven patients had 1 comorbidity and 1 patient had 2 comorbidities at level 4 severity. Median OS of all patients was 25.1 months (95% CI 21.2-27.6). In univariate analysis, the number of CIRS-G level 4 comorbidities was a significant worse prognostic factor for OS (0 vs 1 or 2, HR 2.16, p = 0.017). In multivariate analysis, ECOG PS ≥2, poorly differentiated histology, age at diagnosis and numbers of CIRS-G level 4 comorbidities were significant worse prognostic factors for OS. ECOG PS ≥2 and age at diagnosis were significant worse prognostic factors for unplanned hospitalization. Conclusions: The OS in the elderly metastatic CRC patients was good and similar to the general population with this disease. The number of CIRS-G level 4 comorbidities was associated with worse OS but no specific CIRS-G category was individually associated with OS.
Development of 3-item questionnaire for preoperative evaluation of older cancer patients.
Authors: Shahrokni Armin , Tin Amy , Aiken William N. , Vickers Andrew J. , Korc-Grodzicki Beatriz 
Published: September 2018

e21543 Background: Our study aims at developing a very short screening questionnaire for the preoperative evaluation of older cancer patients in the surgical clinics. Methods: Our study was based on 47-item electronic Rapid Fitness Assessment (eRFA) data presented last year (Shahrokni, et al. (J Clin Oncol 34, 2016 (suppl; abstr 10011). Frail patients were defined as having any of these criteria: Cognitive impairment (Mini-Cog < 3), basic or instrumental activities of daily living dependency, Karnofsky Performance Score ≤80, occurrence of fall in the past year, high level of distress (distress thermometer score ≥7), or Timed Up and Go test ≥ 10 seconds. The dataset was split 2/3 for training set and 1/3 for validation set. The sets were matched based on age and gender. Decision Curve Analysis (DCA) was preformed to assess the clinical utility of different models. Results: Based on a dataset of 1076 older cancer patients who completed the eRFA for preoperative evaluation in the geriatrics clinic, five models of 3 or 4-items showed to have the highest accuracy ( > 78%). For example, one 3-item questionnaire (difficulty with bladder and bowel control, fall in the past year, limitation of walking outside home) was able to identify 100% of non-frail patients and 73% of frail patients. If we use this model in the surgical clinic with a presumed 36% incidence of frailty among 1000 potential patients, the model can correctly indentify 266 out of 363 frail patients and all 637 fit patients who may and may not benefit from referral to geriatrics clinic, respectively. Using the validation set, the sensitivity and specificity of the model remained high and we confirmed the utility of the 3-item questionnaire on decision analysis. Conclusions: We identified a 3-item questionnaire to be used as a screening tool to identify frail and fit older cancer patients. Implementation of the tool is needed to evaluate whether it is useful in distinguishing older cancer patient in surgical clinic for geriatric referral. If effective, further studies should look into correlation between this questionnaire and surgical outcomes.
Comparative nocebo effects in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort—NCCTG 97-24-51 and ACOSOG Z9001 (Alliance A151602).
Authors: Le-Rademacher Jennifer , Foster Jared C. , Feliciano Josephine Louella , Gajra Ajeet , Seisler Drew K. , DeMatteo Ronald P. , Lafky Jacqueline M. , Hurria Arti , Muss Hyman B. , Cohen Harvey Jay , Jatoi Aminah 
Published: September 2018

e21545 Background: A nocebo is an inert substance that causes adverse events. Although previous studies have examined the favorably positive (placebo) effects of an inert substance, few studies have examined negative (nocebo) effects, particularly in older patients who sometimes experience frequent and severe adverse events from cancer therapy. Methods: This study focused on placebo/nocebo-exposed patients who participated in two double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Treatment Group (NCCTG) 97-24-51 and American College of Surgeons Oncology Group (ACOSOG) Z9001, with the goal of reporting comparative, age-based adverse event rates. Results: Among the 446 patients who received placebo/nocebo exclusively, 161 were 65 years of age or older at the time of respective trial entry; 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients 65 years of age or older and those younger: rate ratio (99% confidence intervals (CI): 1.01 (0.47, 2.02) with similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and trial resulted in no significant age-based rate differences in adverse event rates. Similar findings were observed with an age threshold of 70. Conclusions: A nocebo effect appears to occur irrespective of age. This observation suggests that adverse events should be taken no less seriously in older than in younger cancer patients and that education to manage patients’ expectations from cancer therapy might improve tolerability. [Table: see text]
The importance of evaluation and taking care of the patient and caregiver in the oncological disease experience: A multicentre study.
Authors: Ratti Maria monica , Portaluppi Alessandra , Bertin Federica , Franchini Eleonora , Verusio Claudio 
Published: September 2018

e21551 Background: Caregiver and patient are a dyad in which the hardship of one inevitably results in a worsening of the other’s condition. Supporting caregivers so they can deal with their relatives’ cancerous condition is useful to improve both patient care and collaboration with medical teams (Zavagli et al., 2012). Burden of caregivers has psychological and physical negative impact on patients (Gritti et al., 2011). This research matches the effects of the oncological disease on the patients and the caregivers, to find similarities and differences in order to better understand their specific needs and optimizing the support provided to them in hospital setting. Methods: Two different sets of tests are composed of a particular registry paper, SF-36, MAC, BDI-II, STAI-Y, addressed to patients, and SF-36, ZBI, COPE, addressed to caregivers. The samples are made up of 250 patients (M = 107; W = 143) and 143 caregivers (M = 54; W = 89). 34% of the sample had changes in job life due the illness process (C1), while 69% of caregivers had changes in their social, working or familiar life due taking care patients (CC1). 40% of patients in sample of caregivers had received the diagnosis since less than 3 months (CD3), 23% from 3 to 6 months (CD3-6), 14% from 6 to 12 months (CD6-12) and 22% over 12 months (CD12). Results:C1 reported worse levels of “Mental Health Index” (t = 2,016; p = ,045), depression (t = -3,949; p = ,000) and anxiety (t = -3,363; p = ,001) than patients had not changes in job. CC1 had worse levels of “Mental Health Index” (t = 4,276; p = ,045) and burden (t = -6,402; p = ,000) than caregivers without changes in life. Patients who received the diagnosis since less than 3 months reported less “Fighting Spirit” coping style (F(210;8) = 2,76; p = ,006) and worse levels of “Role Limitations due to Emotional Problems” (F(211;8) = 2,346; p = ,020) than in other periods. CD12 reported worse levels of burden than CD3, CD3-6 and CD6-12 (F(136;3) = 3,67; p = ,014). Conclusions:The results suggest that patients and caregivers share a similar suffering related to life changes, but underscore a difference in the adaptation to the disease condition with increasing time from diagnosis.
Cancer clinical trials education: Insights from patient experiences and preferences.
Authors: Saxton Claire 
Published: September 2018

e21554 Background: Clinical trials offer cancer patients access to innovative treatments, quality care, and hope for a better future. Yet, participation rates across adult cancers remain low. Education is a target intervention. The following research examines patient experiences, beliefs, and preferences related to cancer clinical trial participation. Methods: In 2015-16, the Cancer Support Community conducted an online survey with the goal of developing an educational program that would increase clinical trial awareness and participation. Survey responses from 506 cancer patients were collected. Most respondents were female (85.5%) and Caucasian (84.8%). The average age was 58.7 years old. Nearly half (47.2%) were diagnosed with breast cancer. Of the respondents, 48.3% were currently receiving treatment. Results: Most (81.4%) had heard of clinical trials prior to diagnosis. While 36.3% had participated in trials, 52.5% never considered it. Results found that 56.7% had discussed clinical trials with their healthcare team during treatment, but only 20.2% felt that their goals and concerns were meaningfully addressed. Additionally, 93.1% reported that more time with their doctors to discuss clinical trials would be “somewhat” or “very” helpful. Websites with clinical trial information were shared with just 34.4% of respondents. Survey results indicated that 91.9% felt that a website including clinical trial information would be “somewhat” or “very” helpful. Specifically, 60.2% of respondents reported that a website with patient narratives would be “very” helpful. While, 60.9% felt that tools to help locate clinical trials would be “very” helpful. Most had not been offered or couldn’t independently locate videos (80.7%) or illustrations/images (73.8%) explaining clinical trials. Of the respondents, 94.0% reported that speaking directly with a clinical trial participant would be helpful. Yet, this was only offered to 10.3% of patients. Conclusions: Findings were used to develop content for educational products and programs delivered by CSC for those potentially eligible for clinical trials. Survey data highlight the importance of providing information relevant to eligible participants across multiple formats.
Incidence of permanent alopecia following adjuvant chemotherapy in women with early stage breast cancer.
Authors: Crown John P , Sills Emer , Ballot Jo , McDonnell Deirdre , Walshe Janice Maria , Fennelly David , Kearney Susan , Long Jessica Claire , Collison Deirdre , Gullo Giuseppe 
Published: September 2018

e21576 Background: Alopecia is one of the most distressing toxicities of adjuvant chemotherapy for patients with breast cancer. Historically, oncologists have reassured patients (pts) that chemotherapy-induced alopecia is temporary, and followed by full hair recovery. More recently there have been troubling reports of permanent alopecia following adjuvant taxanes (Tax). We studied the incidence of long-term hair loss in patients treated on adjuvant trials in our institution. Patients who were enrolled on clinical trials involving Tax (D-Docetaxel, P-Paclitaxel) and/or Anthracyclines (A) were included. Methods: We conducted a telephone interview survey of pts who had completed adjuvant or neo adjuvant A and/or T chemotherapy on clinical trials more than one year before. Ongoing alopecia was graded as 0 (full hair recovery), 1 (mild hair loss) or 2(severe/total). The study was approved by the hospital audit committee. Results: We studied 295 pts who has been treated on 12 studies. Drug exposure: D-260 pts (D nonA-185, D+A-75); A-nonTax-12 pts ; A+P 23 pts. The overall incidence of alopecia was 15% (11% grade 1 and 4% grade 2). For all D the incidence was 15% (12% Grade 1 and 3% Grade 2). For D+A-24% (19% Grade 1 and 5% Grade 2). For D non A the incidence was 13% ( 8% grade 1 and 5% grade 2). For A non T 8% (Grade 2-8%). For PA-13% ( 4% grade 1 and 9% grade 2). For patients receiving D non-A regimens, there were two levels of D exposure, 300mg/m2 (90 pts) or 450 mg/m 2 (95 pts). The incidence of alopecia was significantly D dose dependent: D300- 7% (all grade 1) and D 450-19% (14% grade 1, 5% grade 2) (p = .02 chi2 ). Among the higher dose D group, the companion drug choices carboplatin for HER2 positive, (55 pts) or cyclophosphamide (40 pts) were associated with similar incidences of permanent alopecia (22% v 16%). Conclusions: Permanent alopecia is a common complication of adjuvant chemotherapy. The risk appears to be highest in regimens which contain A and Tax, but it is also seen in AP and in A non-Tax. For patients receiving D non A, the risk is dose-dependent. Our data set contains few P pts, and does not contain any pts undergoing low dose weekly P. Oncologists should warn all patients undergoing adjuvant therapy of the risk of permanent alopecia.
Feasibility intervention to increase exercise outcome expectations among breast cancer survivors.
Authors: Hirschey Rachel , Pan Wei , Kimmick Gretchen Genevieve , Hockenberry Marilyn , Shaw Ryan , Lipkus Isaac 
Published: September 2018

e21584 Background: Exercise is associated with decreased mortality and recurrence risk and improved quality of life for breast cancer survivors (BCS). Roughly 1/3 of BCS exercise enough to experience these benefits. A promising strategy to increase exercise among BCS is to target outcome expectations (OEs), or what one expects to obtain or avoid from a behavior. OE dimensions include 1) importance – value placed on the outcome(s); 2) certainty - perceived probability outcome(s) will occur; and 3) accessibility – the frequency with which outcome(s) are considered. Methods: This RCT tested the feasbility and effects of a self-directed booklet designed to increase OEs and exercise. It was created in collaboration with BCS who successfully use exercise to manage long term side effects. OEs were measured through online surveys and exercise was measure with a Fitbit accelerometer. Data was collected at baseline, 4, 8 and 12 weeks post intervention. Feasibility was defined as the extent to which participants made use of intervention materials and was assessed through 9 researcher related questions. Results: The sample is mean age of 58, 74% white, 26% black, an average 2.5 years post treatment and about 1/3 take an AI or SERM. The booklet “somewhat” (mean = 3.24, SD = 1.8 on 1-5 Likert scale) made use of the booklet, as intended. OEs increased 0.01 points over time in the intervention arm, compared to the control arm ( p = 0.3555); 0.4 points more for black participants compared to white ( p = 0.0003); 0.2 points per every unit of increased exercise self-efficacy ( p < 0.0001), and 0.01 points per month participants were closer to their time of cancer surgery ( p = 0.0037). Intervention arm participants increased their weekly steps by 970, every 4 weeks, compared to participants in the control arm ( p = 0.0283). Conclusions: Overall the intervention was well received by participants, had positive effects on OEs and exercise and can easily be translated into practice with need for minimal resources. Significant differences were noted for black compared to white participants, thus it is necessary to understand racial differences in exercise beliefs when designing future exercise interventions. Clinical trial information: NCT02348710.