bluuebunny/crossref_metadata_2025_split huggingface dataset:
FIT: Functional and imaging testing for patients with metastatic cancer.
Authors: Roeland Eric , El-Jawahri Areej , Nelson Sandahl H , Gallivan Andrea , Nipp Ryan David , Horick Nora , Cohen-Arazi Yael , Hagmann Chelsea , Sera Chris , Friedman Sarah , Ma Joseph , Phull Hardeep , Baracos Vickie E 
Published: November 2018

208 Background: Despite multiple cancer cachexia (CC) trials evaluating novel agents, the FDA has not approved a single drug to date. One key challenge in CC trials is selection of endpoints. The aim of this study was to explore changes in body composition and associations with functional and patient-reported outcomes (PROs) to clarify CC trial endpoint selection. Methods: We identified metastatic solid tumor cancer patients receiving cancer-directed therapies at a single cancer center (2016-2018). Patients completed all assessments at study enrollment and 3 months from enrollment. We analyzed body composition utilizing cross-sectional computed tomography (CT) scans at the third lumbar vertebra. Functional assessments included the 6-minute walk test (6MWT), Timed Up-and-Go (TUG) test, and Short Physical Performance Battery (SPPB). PROs included the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) and Functional Assessment of Cancer Therapy Fatigue (FACT-F). We examined changes in body composition and functional assessments from enrollment to 3 months using paired t-tests. We utilized linear regression models to assess the relationship between changes in body composition and changes in functional assessment adjusting for age and sex. Results: A total of 57 patients completed baseline assessments; 19 patients did not complete 3-month assessments (5 died, 1 hospice, 13 withdrew). Of the 38 patients with complete data (mean age 61.8 years, 47% female, 71% GI malignancy), 50% received chemotherapy, 16% immunotherapy, and 34% combination therapy. From enrollment to 3 months, we observed an increase in total adipose tissue (16.9±52.4 cm2, 95% CI -33.79-0.63; p = 0.059), but not weight or skeletal muscle. Greater losses in skeletal muscle were associated with greater declines in 6MWT (B = 0.036, p = 0.014) and SBBP (B = 2.444, p = 0.002), but not the TUG. We observed no association with change in weight with all functional outcomes or PROs. Moreover, we found no association with body composition and PROs from enrollment to 3 months. Conclusions: In future CC trials, changes in longitudinal body composition rather than weight should be utilized. Furthermore, changes in skeletal muscle and the 6MWT and/or SBBP may be preferred endpoints.
Perceiving hope from oncologists and prognostic understanding and treatment planning.
Authors: George Login , Derry Heather M , Kurita Keiko , Maciejewski Paul K , Breitbart William , Prigerson Holly Gwen 
Published: November 2018

21 Background: Offering hope during prognostic discussions is widely considered essential to the delivery of humane medical care. However, clinicians always offering hope may undermine realism in patients' prognostic understanding and preparation for what lies ahead. We examine how patients’ perceptions of their oncologists as always offering hope, compared to a more tempered sense of hope, relate to prognostic understanding and treatment planning. Methods: Data came from post-scan baseline assessments of an NCI funded multi-site study on prognostic communication among metastatic cancer patients’ refractory to at least one chemotherapy regimen. The analytic sample consisted of 235 participants, who during structured interviews, rated the question, “how often does your oncologist offer hope,” as “always,” “most of the time” or “sometimes.” A binary variable was created comparing participants endorsing “always” to participants endorsing “most of the time” or “sometimes.” Patients also reported on elements of prognostic understanding, DNR order completion, and preference for either life-extending or comfort care. Results: Patients who rated their oncologists as “always” offering hope (62.1%), compared to those who rated “most of the time” or “sometimes” (37.9%), were more likely to have inaccurate prognostic understanding regarding life-expectancy ( OR = 0.40; 95% CI, 0.16, 0.97), and marginally more likely to have a treatment preference that favored life-extending care over comfort care ( OR = 0.61; 95% CI, 0.35, 1.07). A significant moderation effect was seen ( b = -1.43, p = .04) such that accurate understanding of the incurability of their cancer was associated with DNR completion only among patients who perceived more tempered hope from oncologists ( OR = 5.53; 95% CI, 1.80, 17.02), and not among patients who always perceived hope ( OR = 1.32; 95% CI, 0.63, 2.78). Conclusions: Results suggest that the tempering of hope may have benefits, as perceiving oncologists as always offering hope was associated with worse prognostic understanding and lower advance care planning. Future research examining in a more nuanced way the nature of hope offered (e.g., hope for cure vs. symptom management) in longitudinal designs is needed.
Risk of health-related quality-of-life events and pulmonary toxicities in patients with cancer treated with poly adenosine diphosphate ribose polymerase inhibitors: A meta-analysis of seven phase III trials.
Authors: Swarup Sriman , Sultan Anita , Zaw Myo , Yendala Rachana , Han Myat M. , Myat Yin Mon , Yu Nyein Htwe , Panigrahi Kalpana , Thein Kyaw Zin 
Published: November 2018

213 Background: Poly adenosine diphosphate ribose polymerase (PARP) enzymes aide in the repair of DNA damage. PARP inhibitors showed synthetic lethality in cancer cells and were utilized in many solid tumors with notable toxicities. Fatigue and pain are the major determinants of health-related quality of life (HRQOL) in cancer patients undergoing chemotherapy. We undertook a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of HRQOL events and pulmonary toxicities. Methods: MEDLINE, EMBASE databases and meeting abstracts from inception through June 2018 were queried. Phase III RCTs that mention HRQOL events and pulmonary toxicities as adverse effects were included. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Random effects model was applied. Results: 3188 patients from 7 phase III RCTs with breast, ovarian, and gastric cancer were eligible. Studies compared olaparib or niraparib or rucaparib versus placebo, olaparib vs single agent chemotherapy, iniparib + gemcitabine / carboplatin (GC) versus GC, veliparib + C versus C and olaparib + paclitaxel versus paclitaxel. The RR of all-grade side effects were as follows: fatigue, 1.26 (95% CI: 1.07 – 1.49, P = 0.006); decreased appetite, 1.42 (95% CI: 1.18 – 1.71, P < 0.001); arthralgia, 1.05 (95% CI: 0.83 – 1.34, P = 0.65); headache, 1.35 (95% CI: 0.99 – 1.84, P = 0.05); cough, 1.75 (95% CI: 1.17 – 2.62, P = 0.006); dyspnea, 1.40 (95% CI: 0.90 – 2.18, P = 0.12); and upper respiratory infections, 1.70 (95% CI: 0.97 – 3.00, P = 0.06). The RR of high-grade side effects were as follows: fatigue, 1.94 (95% CI: 1.24 – 3.04, P = 0.004); arthralgia, 1.37 (95% CI: 0.29 – 6.51, P = 0.68); headache, 1.09 (95% CI: 0.47 – 2.55, P = 0.83); and dyspnea, 1.02 (95% CI: 0.44 – 2.36, P = 0.95). Conclusions: The risk of developing all grades of fatigue as well as any-grade cough and decreased appetite was high in PARP inhibitors group, compared to control arm. Recognizing these toxicities and providing good supportive care is vital in enhancing patients’ quality of life.
A systematic review and meta- analysis of randomized controlled trials to evaluate the risk of hematological toxicities in patients with cancer treated with poly adenosine diphosphate ribose polymerase (PARP) inhibitors.
Authors: Sultan Anita , Swarup Sriman , Zaw Myo , Han Myat M. , Myat Yin Mon , Aung Htay Htay , Zin Myet Mon Mon , Panigrahi Kalpana , Thein Kyaw Zin 
Published: November 2018

217 Background: Poly adenosine diphosphate ribose polymerase (PARP) inhibitors have shown to benefit in DNA repair-deficient tumors by enhancing synthetic lethality in cancer cells and are currently employed in many solid tumors. Nevertheless, the risk of hematological toxicities remains significant. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of hematological toxicities. Methods: We conducted a comprehensive literature search using MEDLINE, EMBASE databases and meeting abstracts from inception through June 2018. Phase III RCTs that mention hematological toxicities as adverse effects were incorporated in the analysis. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Random effects model was applied. Results: Seven phase III RCTs with a total of 3,188 patients with breast, ovarian and gastric cancer were eligible. Studies compared olaparib or niraparib or rucaparib versus placebo, olaparib vs single agent chemotherapy, iniparib + gemcitabine / carboplatin (GC) versus GC, veliparib + C versus C and olaparib + paclitaxel vs paclitaxel. The RR of all-grade side effects were as follows: anemia, 2.38 (95% CI: 1.42 – 4.00, p = 0.001); thrombocytopenia, 2.96 (95% CI: 1.37 – 6.40, p = 0.006); neutropenia, 1.47 (95% CI: 1.06 – 2.05, p = 0.02); and leukopenia, 1.08 (95% CI: 0.77 – 1.50, p = 0.63). The RR of high-grade adverse effects were as follows: anemia, 3.63 (95% CI: 1.53 – 8.57, p = 0.003); thrombocytopenia, 2.65 (95% CI: 0.89 – 7.85, p = 0.07); neutropenia, 1.27 (95% CI: 0.87 – 1.86, p = 0.21); and leukopenia, 1.20 (95% CI: 0.90 – 1.58, p = 0.19). Conclusions: Our meta-analysis demonstrated that patients on PARP inhibitors experienced a significant increase in the risk of all grades of anemia with a relative risk of 3.63 for grade 3 and 4 anemia, along with any-grade thrombocytopenia and neutropenia. Proper supportive care is essential, and it will ultimately reduce drug dosing inconsistencies and financial burden among patients undergoing treatment.
The antidiarrheal efficacy of a proprietary amino acid mixture in neuroendocrine tumor (NET) patients.
Authors: Luque Laura , Chauhan Aman , Yu Qian , Miller Rachel C , Weiss Heidi , Siddiqui Fariha , Tarter Zackary , Anthony Lowell Brian 
Published: November 2018

218 Background: Gastroenteropancreatic neuroendocrine tumor (GEPNET) incidence has risen 6-fold over past 3 decades. North American Neuroendocrine Tumor Society estimates that over 100,000 GEPNET patients are currently living in the United States. One of the common quality of life limiting symptom seen in GEPNET patient is diarrhea. Diarrhea in these patients could be due to excessive serotonin production, secondary to post-operative short gut syndrome, steatorrhea from somatostatin analogs, bile acid colitis or intestinal bacterial overgrowth. A novel amino acid based oral rehydration solution (enterade) is currently being evaluated in a Phase II clinical trial for antidiarrheal effects in post bone marrow transplant patients (NCT02919670). We conducted a pilot study of enterade in neuroendocrine tumor (NET's) patients with quality of life limiting diarrhea. Methods: Medical records of all the NET patients given enterade to alleviate symptomatic diarrhea were evaluated. Patients were treated at Markey Cancer Center between May 2017-June 2018. Results: Total 69 NETs patients were treated with enterade. Enterade was administered as 8 Oz bottle BID for 1 a week. Antidiarrheal efficacy data was available on 41 patients at the time of abstract submission. 15 patients had small bowel NETs, 5 had bronchial NETs, 1 had colorectal NETs, 3 had NETs of unknown primary, 3 had gastric NETS, 3 had pancreatic NETs and one had high grade neuroendocrine carcinoma of the prostate. Data regarding primary site was unavailable in 10/41 patients. 21 patients had history of prior bowel resection either for primary neuroendocrine tumor resection or debulking. 25 patients were on somatostatin analogs at the time of initiation of enterade. 31 out of 41 patients reported some reduction in diarrhea frequency. 21 out of these 41 patients reported at least a 50% reduction in diarrhea frequency. Conclusions: 75.6% (31/41) neuroendocrine tumor patients reported improvement in diarrhea frequency with enterade. 51.2% (21/41) reported more than 50% reduction in diarrhea frequency. A prospective Phase II study of enterade in neuroendocrine tumor patients with quality of life limiting diarrhea is currently planned.
Risk of gastrointestinal and hepatic toxicities in patients with cancer treated with poly adenosine diphosphate ribose polymerase inhibitors: A meta-analysis of seven phase III trials.
Authors: Zaw Myo , Sultan Anita , Swarup Sriman , Han Myat M. , Myat Yin Mon , Htwe Khaing Khaing , Hein Aung Myo , Yang Tsujung , Thein Kyaw Zin 
Published: November 2018

219 Background: Inhibition of poly adenosine diphosphate ribose polymerase (PARP) enzymes terminates an alternative DNA repair pathway, resulting in synthetic lethality in homologous recombination deficient tumors. Many PARP inhibitors have shown to improve survival in many solid tumors with noteworthy safety concerns. We undertook a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of gastrointestinal (GI) and hepatic toxicities. Methods: We conducted a comprehensive literature search using MEDLINE, EMBASE databases and meeting abstracts from inception through June 2018. Phase III RCTs that mention GI toxicities and elevation of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) as adverse effects were incorporated in the analysis. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Random effects model was applied. Results: 3188 patients from 7 phase III RCTs with breast, ovarian and gastric cancer were eligible. Studies compared olaparib or niraparib or rucaparib versus placebo, olaparib versus single agent chemotherapy, iniparib + gemcitabine / carboplatin (GC) versus GC, veliparib + C versus C and olaparib + paclitaxel versus paclitaxel. The RR of all-grade side effects were as follows: diarrhea, 1.24 (95% CI: 1.08 – 1.42, P = 0.002); nausea, 1.53 (95% CI: 1.16 – 2.02, P = 0.002); vomiting, 1.46 (95% CI: 1.02 – 2.08, P = 0.03); elevated AST, 1.25 (95% CI: 0.58 – 2.67, P = 0.55); and elevated ALT, 1.61 (95% CI: 0.81 – 3.20, P = 0.16). The RR of high-grade side effects were as follows: diarrhea, 1.08 (95% CI: 0.52 – 2.24, P = 0.82); nausea, 1.81 (95% CI: 0.79 – 4.12, P = 0.15); vomiting, 1.99 (95% CI: 1.06 – 3.73, P = 0.03); elevated AST, 1.86 (95% CI: 0.45 – 7.55, P = 0.38); and elevated ALT, 1.33 (95% CI: 0.42 – 4.18, P = 0.62). Conclusions: Our study showed that the risk of developing all grades of vomiting as well as any-grade nausea and diarrhea was high in PARP inhibitors arm, compared to control group. Timely recognition and prompt intervention with good supportive care are entailed.
Nurses’ beliefs and practices regarding intravenous opioid use for breakthrough cancer pain.
Authors: Arthur Joseph Anthony , Reddy Akhila Sunkepally , Smith Uniqua , Hui David , Liu Diane D. , Park Minjeong , Bruera Eduardo 
Published: November 2018

222 Background: Faster intravenous (IV) opioid administration speed is associated with increased adverse effects and subsequent increased opioid intake. Infusion rates ≥ 2 minutes are recommended. Data on nurse practices regarding IV opioid administration are limited. We assessed the frequency of nurse-reported speeds of IV opioid bolus infusion in the inpatient oncology units, and nurses’ beliefs and perceptions about opioids in cancer pain management. Methods: A cross-sectional survey among inpatient nurses working in the medical, surgical, intensive care unit (ICU), and emergency department (ED) work areas was conduceted. We defined fast IV opioid bolus infusion speed as < 120 seconds(s). Results: The participant response rate was 60% (731/1234).57%, 55%, and 58% of all nurses administered morphine, hydromorphone, and fentanyl in < 120s.Overall median (IQR) infusion speed of IV morphine, hydromorphone, and fentanyl were 60s (40-120), 90s (45-120), and 60s (30-120) respectively. Correlation between morphine, hydromorphone, and fentanyl infusion speeds were 0.93, 0.90, and 0.90 respectively (p <0 .0001). Median infusion speed of morphine was 55s for ICU nurses, 60s for both surgical unit and emergency department nurses, and 85s for medical unit nurses (p=0.0002). The odds ratio for fast IV opioid infusion was 2.22 for ED nurses (p= 0.027), 2.67 for ICU nurses (p= 0.001), 0.27 and 0.18 for frequent (p=0.003) and very frequent(p=0.001) use a timing device respectively, and 0.86 for hydromorphone infusion compared with morphine (< 0.0001). Fast infusion was also independently associated with perception that suboptimal pain control as the reason for increased patient opioid requests(p=0.009), clinician reluctance to prescribe opioids(p=0.008), lack of psychosocial support services (p= 0.03), and patient’s reluctance to take opiates (p=0.015). Conclusions: More than half the nurses working in the inpatient setting reported administering IV opioids at a faster speed than recommended. Nurses who frequently use a timing device are more likely to infuse at a more optimal speed. Further research is needed to standardize and improve safe intermittent infusion of parenteral opioids.
Outcomes after empiric radiation therapy for leukemic infiltrates of the lung: A single institution experience.
Authors: Byun John , Jabbour Salma , Patel Vimal D. , Parikh Rahul 
Published: November 2018

225 Background: Acute leukemias (AL) may present with variable clinical findings, from incidental discovery to respiratory distress or obtundation. However, patients may progress rapidly, requiring emergent treatments including leukophoresis, chemotherapy or radiation. There is little to no data supporting the use of radiation therapy in the setting of presumed lung infiltration. We present the first known case series on the treatment of presumed leukemic lung infiltration with empiric radiation therapy (eRT). Methods: Eleven patients with AL from 2008 – 2018 were identified who were treated with eRT at our center. All patients were on empiric antibiotics, and all were noted to have at least one chest plain film with suspicious infiltrates. The median age was 66 years old (29-77), and five of eleven patients were febrile at the start of radiation. One patient had been intubated prior to radiation delivery. Three of seven patients underwent leukophoresis and six of ten patients received any chemotherapy prior to eRT. Results: The median treatment regimen was 450cGy (range 50 – 1050) in 3 fractions (1 – 7). The median white blood cell (WBC) count prior to radiation therapy was 119.0 x 103 /μL (highest recorded, 1.9 – 317.6), with median blast percentage on manual differential, 88% (3 – 98). All eleven patients had a large reduction in WBC count within the first day of eRT, with median response 48.2% decrease in WBC count (31.7 –99.8; average 57.3%). Ten of ten patients reported subjective improvement in breathing. Conclusions: Empiric radiation therapy is a safe and effective means for rapidly decreasing leukocyte counts and for symptomatic palliation in patients with AL and radiographic chest infiltrates.
An association between tobacco smoking, daily opioid use, pain response and the risk for aberrant opioid use behaviors.
Authors: Yennu Sriram J. , Edwards Tonya , Lu Zhanni , Williams Janet L. , Arthur Joseph Anthony , Reddy Suresh , Bruera Eduardo 
Published: November 2018

226 Background: Opioid misuse is a growing crisis. Cancer patients at risk of aberrant drug behaviors are frequently underdiagnosed. Primary aim was to determine the association between current tobacco smoking, daily opioid use, pain response, and risk for aberrant opioid use behaviors (AOB) among patients receiving outpatient supportive care consultation at a comprehensive cancer center. Methods: 1,501 consecutive cancer patients referred to a supportive care clinic from March 1, 2016 to June 6, 2018 were reviewed. Patients were eligible if they had diagnosis of cancer, and were on opioids for pain for at least a week. All patients were assessed using Edmonton Symptom Assessment Scale (ESAS), SOAPP-14 (validated questionnaire for assessment of risk for aberrant opioid use behaviors), and CAGE-AID. Patients with AOB (SOAPP+) were defined by SOAPP score ≥7. Results: Median age was 61yrs. Median ESAS pain item score on consultation was 5. Median ECOG was 2. Never smokers, previous smokers, and current smokers were 54%, 40%, and 6.6% respectively. 16.8% were AOB+ and 10.1% were CAGE-AID+. There was no significant difference in ESAS pain response at first follow-up between AOB+ versus AOB negative. Morphine Equivalent Daily Dose (MEDD) in AOB+ never smokers versus previous smokers versus current smokers was 45 mg versus 60 mg versus 75mg respectively (P=0.03). Table 1 shows that male pts and those with current or previous smoking history, anxiety, and prior alcoholism/illicit drug use are at increased risk of AOB. Conclusions: Male patients and those with history of current or previous smoking history, anxiety, and prior alcoholism/illicit drug use are at increased risk of AOB. [Table: see text]
Family perspectives on prognostic communication in the palliative oncology clinic: "Someone was kind enough to just tell me".
Authors: Craig Kevin , Washington Karla T. 
Published: November 2018

24 Background: Talking with patients with cancer and their families about the likely course of a disease is commonly cited as one of the most difficult aspects of healthcare delivery, yet palliative care providers routinely engage in such discussions. As such, attention to communication about prognosis in palliative oncology care has increased in recent years. Research and practice wisdom alike have provided important insights into the experiences of providers, patients, and family members who have taken part in discussions about prognosis and, relatedly, goals of care. As a result, we now have a number of highly effective tools at our disposal to enhance prognostic communication in palliative care. Methods: We sought to build on this existing expertise, applying a social ecological perspective to the study of prognostic communication from the family caregiver’s point of view. In this session, we present the findings of an inductive thematic analysis of qualitative data collected as part of randomized clinical trial of a family caregiver intervention in palliative oncology (R21CA191165; Principal Investigator: Author). Results: Findings illustrate how family caregivers ( N = 63) experience discussions about prognosis as one part of a much larger experience with the healthcare system. Themes describe how family caregivers attempt to make sense of seemingly contradictory information, incorporate information from non-provider sources, elicit prognostic information when it is not forthcoming, make their information needs known when they conflict with the patient’s, and use information to plan their future lives. Conclusions: Evidence-informed strategies to improve communication with family caregivers as vital partners in the delivery of palliative oncology care are sorely needed. Clinical trial information: NCT02427490.