bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ratio of some fibrinolytic system components and biological aggressiveness of melanoma.
Authors: Bandovkina Valeria , Frantsiyants Elena Mikhaylovna , Kaplieva Irina V. , Trepitaki Lidia K. , Pogorelova Yulia A. , Cheryarina Natalia D. , Neskubina Irina Valerevna , Sustretov Vyacheslav A. , Maksimova Maria I. , Rozenko Ludmila , Kit Oleg I. 
Published: September 2018

e21069 Background: Melanomas of early stages in a horizontal growth phase can masquerade as a melanocytic nevus or other benign skin lesions. Activation of plasmin/plasminogen system is typical of both physiologic and pathologic processes. Cell remodeling and neoangiogenesis play critical role in melanoma invasion and metastasis. The purpose of the study was comparative analysis of plasmin/plasminogen system in tissues of nevi and melanomas of different sizes and extension. Methods: Activity of plasmin and plasminogen was studied and antigen and activity assays (ELISA) were performed for uPA, tPA and PAI-1 in tissues of nevi (n = 30) and melanomas pТ1-2N0M0 (n = 17) and pТ3-4N0-1M0 (n = 23). Intact tissue (n = 15) obtained in surgical treatment of patients without cancer was used for the control. Results: Plasminogen levels were decreased by 2 times in tissues of nevi and pТ1-2N0M0 melanoma, while plasmin was unchanged. pТ1-2N0M0 melanoma significantly differed from nevi by a marked activation of uPA without PAI-1 increase. Activation of plasminogen system in both рТ1-2N0M0 melanoma and in nevi was not accompanied by plasmin accumulation. The main difference between tissues of nevi and pТ1-2N0M0 melanoma was the uPA/PAI-1 ratio reduction by more than 40 times in nevi. pТ3-4N0-1M0 melanoma was characterized by plasmin level increase by more than 19 times and uPA activity and content increase by 2.5 times, compared to pТ1-2N0M0, without an increase in PAI-1 activity. The uPA/PAI-1 ratio almost doubled. Conclusions: Normal plasmin levels in nevi and melanomas in a horizontal growth phase are probably the result of its inhibitors activity. Increased activity of fibrinolytic system, plasmin accumulation and uPA/PAI-1 increase in a vertical growth phase determine proliferative, invasive and metastatic potential of tumors.
Mohs micrographic surgery volume and payment patterns among dermatologists in the Medicare population, 2013.
Authors: Johnstone Cameron , Joiner Keith M , Krouse Robert S. 
Published: September 2018

e21078 Background: Mohs Micrographic Surgery (MSS) has expanded markedly in recent years but there is limited information on volume, practice patterns, compensation or comparative effectiveness data to support preferential use. This study examines patterns of MSS utilization in the Medicare population. Methods: We obtained the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File Calendar Year 2013dataset from CMS.gov. This contains comprehensive payment and utilization data for physician/supplier Medicare Part B Fee For Service final-action non-institutional claims in 2013. For dermatologists as a whole and the subset of dermatologist MSS surgeons, we analyzed provider service volume and reimbursement for all services as well as for malignant skin cancer procedures (destructions, excisions or MSS) in SAS 9.3. Results: Total Medicare funded MSS procedures increased 25 percent from 2009 (558,447) to 2013 (700,262). Dermatologists who performed MSS had significantly more average services per provider (5,419.4 vs. 3,627.1, r = 0.16, p < 0.0001), earned significantly more in average total procedure-related compensation ($475,883.64 vs. $144,564.74, r = 0.49, p < 0.0001) than dermatologists who did not perform MSS, and made up 71.3 percent of the top decile of dermatologists ranked by total payment received from Medicare. Total MSS service volume and compensation was concentrated among a subset of providers: the top quintile in this group (513 – 3,759 procedures) in annual procedure volume performed over 50 percent of total MSS surgeries. MSS providers with higher annual service volumes performed a greater percentage of their total MMS procedure annual totals on lesions located on the trunk, arms or legs versus the head, neck, hands, feet or genitals (r = 0.27, p < 0.001). Conclusions: Mohs Micrographic Surgery is expanding among Medicare beneficiaries. A subset of dermatologists performing MSS accounts for most services and earnings, and performs surgeries more frequently on the trunk or extremities. Further studies are needed incorporating clinical data not available in Medicare billing information to explore implications of these findings for clinical practice.
Effect of gene expression profile (GEP) testing on clinical management in 19% of consecutively treated patients with stage IB/IIA melanoma at a single institution.
Authors: Dengel Lynn Thacher , Hickman Alexandra W. , Slingluff Craig L. 
Published: September 2018

e21080 Background: A 31-GEP test is predictive of metastasis in cutaneous melanoma. We hypothesized that GEP testing would “upgrade” surveillance to routine imaging in at least 16% of stage IB/IIA patients, similar to the upgrade rate from sentinel node biopsy. Methods: A GEP score was obtained for consecutive patients with Stage IB/IIA melanoma treated between 6/2014-6/2016. A retrospective review of a prospectively collected database was performed. Results: 67 patients with Stage IB/IIA melanoma met inclusion criteria. In four cases, a GEP result was not available. Of the 63 tested cases, 68% were Stage IB (N = 43), and 32% were Stage IIA (N = 20). A high-risk result was seen in 12% of stage IB (5/43) and 42% of stage IIA (8/19) patients. Insurance denied coverage of scans in 1/13 patients with a high-risk GEP result. The remaining 12 Stage IB/IIA patients with high-risk scores were “upgraded” to high-intensity surveillance. With a median follow-up of 14 months, 1/13 patients with a high-risk GEP result developed distant metastases 21 months after diagnosis of a Stage IIA melanoma. Conclusions: Results from this retrospective single institution study show that GEP testing altered patient management in 19% of Stage IB/IIA patients. Early detection in 1/13 patients with high-risk scores in this series supports further investigation into stratifying traditionally low-risk patients by GEP testing.
The use of anticoagulants in terminal cancer patients admitted in hospice center.
Authors: Shim Hyun Jeong , Kim Ka-rham , Hwang Jun Eul , Bae Woo Kyun , Cho Sang-Hee , Chung Ik-Joo 
Published: September 2018

e21503 Background: Venous thromboembolism (VTE) is common in patients with cancer and the risk increases with advanced disease. However, no management guidelines exist specific to terminal cancer patients in hospice. We conducted a retrospective analysis to determine the patterns of anticoagulant use in hospice setting. Methods: We identified patients who were prescribed anticoagulants in the Hospice and Palliative Care Clinic at Jeonnam Regional Cancer Center from August 2008 to September 2016 in this study. Patient characteristics included age, gender, cancer diagnosis, length of hospice stay, type and duration of anticoagulation. Results: Of 1,494 consecutive patients who received hospice care in our center, 57 (3.8%) were prescribed ≥ 1 anticoagulants. Types of anticoagulants prescribed were; LMWH only (n = 44, 77.2%), warfarin only (n = 7, 12.3%), rivaroxaban (n = 2, 3.5%) and both LMWH and warfarin (n = 4, 7%). Indications for anticoagulation were DVT (n = 17, 29.8%), PTE (11 = 19.3%), clinical suspicion of DVT with leg swelling (n = 23, 40.4%) and atrial fibrillation (n = 6, 10.5%), respectively. The mean age was 65 years (range 28-84) and 37 (52.6%) were male. The mean age was 63.5 years in LMWH treated patients and 67 years in warfarin treated patients (p < 0.95). The median duration of hospice stay and anticoagulation use were 18.5 days and 11.2 days. The reasons for discontinuation of anticoagulants were bleeding (n = 8, 14%), no palliative benefit (n = 10, 17.5%) and clinical signs of impending death (n = 39, 68.4%). Conclusions: In this retrospective study, anticoagulants were used in highly selected patients. In the absence of specific evidence, decisions are difficult for clinicians to initiate and stop anticoagulation treatment in hospice patients with terminal cancer. Further research is needed to determine the impact of anticoagulation on outcomes, especially cost, quality of life and complications for cancer patients in hospice.
How to better help cancer patients face their coming death?
Authors: Goudot Francois-Xavier , Maglio Milena , Bretonniere Sandrine 
Published: September 2018

e21505 Background: According to literature and medical experience, the doctor-patient relationship becomes strained when oncologists tell their patients that they have no more curative treatments to offer them. Patients often resist when they are told that it is in their best interest to meet with the palliative teams. Little is known about how to meet patients’ expectations at this advanced stage. Methods: We conducted a multicenter qualitative research in an oncology department, a hospital at home service and in an inpatient hospice care center. We met 47 patients (M = 21, F = 27, mean age = 65 yrs, mean disease duration = 5 yrs) for in-depth face to face interviews performed by a multi-disciplinary ethics team. Interviews were carried out between 1 and 3 months before death. Results: Qualitative analysis revealed 4 main results. 1/ For respondents, palliative care introduction meant impending death. 2/ Palliative care introduction meant loss of hope. Without hope, the cancer trajectory is impossible to sustain, they said. 3/ Hope was intricately interwoven with the request for more chemotherapy, even if doctors had clearly refused to provide it. 4/ The oncologist remained the referent physician, even for patients in hospice care. Patients for which the mean duration between cancer diagnosis and interview was 5 years or more, were more willing to talk about death and better accepted palliative care than patients for which the mean duration of cancer was inferior to 3 yrs. For patients with fast progressing cancer (n = 11), 10 were not willing to talk about death and 7 strongly resisted palliative care introduction. There was no difference between patients according to age, sex, type of cancer or center of inclusion. Conclusions: In the terminal phase of cancer, patients are unwilling to talk about death and are reluctant to meet with palliative care teams. Short disease duration strongly reinforces this attitude. If patients resist discussions about their impending death, should physicians continue to consider it good practice to introduce such discussions? Is it beneficent for patients?
Preference of end-of-life discussion at diagnosis in patients with advanced/recurrent cancer.
Authors: Maejima Aiko , Yoshida Saran , Kudo Shun , Bando Hiroko , Aogi Kenjiro , Tokunaga Eriko , Furukawa Masayuki , Otani Hiroyuki , Shimizu Ken , Sakamoto Yasunari , Okusaka Takuji , Morita Tatsuya , Shimizu Chikako 
Published: September 2018

e21511 Background: End-of-life discussion (EOLd) including information about incurability, prognosis, the site of death, and do-not-resuscitate (DNR) status is considered indispensable for advanced care planning (ACP). However, the preference for EOLd in cancer patients has not been elucidated. Objective: To clarify the preferences of EOLd in Japanese patients with newly diagnosed advanced or recurrent cancer. Methods: A multi-center questionnaire survey was conducted on Japanese adult patients with breast cancer, pancreatic cancer, or sarcoma, who were diagnosed as incurable within the past three months. We asked patients whether they would like to have EOLd with their physician at the time of survey. Factors related to preferences of EOLd were analyzed using chi-square or Mann-Whitney U-test. Results: For 1 year from August 2015, we distributed the questionnaire to 251 patients at five centers. Responses were obtained from 159 patients (45 males, 113 females) (response rate: 63%). The median age was 65 years (range: 29-86). 93 patients (59%) answered they would like to have EOLd, while 60 patients (38%) answered they would not. In univariate analyses, elderly patients (odds ratio [OR]: 1.03; p = 0.027), patients having worse performance status (OR: 1.988; p = 0.03), and with any physical symptoms (OR: 1.533; p = 0.044) preferred to have EOLd. On the other hand, patients who perceived “being able to sufficiently fight the disease” ( p = 0.021) and “living without being aware of the disease” ( p = 0.004) as important were reluctant to have EOLd. 114 patients (72%) answered they wanted to know their life-time prognosis. Employed patients preferred to know their prognosis (OR: 8.919; p = 0.004) while patients who had received chemotherapy did not (OR: 0.313; p = 0.009). Conclusions: Even just after the diagnosis as an incurable disease, more than half of patients with advanced cancer were willing to have EOLd with their treating physician. Patients’ preference of knowing about life-time prognosis was affected by their social and medical experience.
Chemotherapy in the ICU: Association between palliative care consultation and care goal documentation.
Authors: Brown Audrey , Bensch Kenneth G , Rdesinski Rebecca , Fromme Erik K 
Published: September 2018

e21516 Background: Patients receiving chemotherapy in the intensive care unit (ICU) are at high risk of morbidity and mortality. A growing consensus supports proactively addressing goals of care (GOC) - prognosis, goals, fears, and treatment preferences - rather than waiting until treatment options are exhausted. Palliative care consultations frequently address GOC but most often occur late in cancer care. We hypothesized that palliative care consultation is associated with an increased likelihood of GOC documentation. Methods: We reviewed electronic medical records of all patients who received chemotherapy for a cancer diagnosis in OHSU ICUs from 2010-2015, collecting patient demographics, cancer diagnoses and comorbidities, timing of palliative care consultation, chemotherapy administration, GOC documentation, and survival at 30 and 180 days following ICU discharge. Survival and diagnosis were also checked against the OHSU Tumor Registry. Results: 214 patients met our inclusion criteria. Demographics reflect the Oregon population, but with a male predominance (64.5% male, N = 138). A majority of ICU patients receiving chemotherapy had a hematologic malignancy (80%, N = 172), and acute respiratory failure as the reason for ICU admission (42%, N = 90). The majority (84%, N = 179) survived their ICU stay and 67% (N = 143) survived 30 days post-ICU discharge, whereas 50% (N = 108) died by 180 days post-ICU discharge. Documentation of GOC discussions was found for 95 patients (44%) and was more likely in patients receiving palliative care consult (71/72 = 99%) compared to those who did not (24/142 = 17%), p < 0.0001, Fisher’s exact test. 63% of conversations occurred after chemotherapy had already been given (60.6% when palliative care was consulted, 70.8% when not, p = 0.4656). Conclusions: Chemotherapy in the ICU was associated with a 16% chance of dying in the ICU and a 50% 6 month mortality overall. Despite this, only 44% had documented GOC conversations and 63% of the conversations occurred after chemotherapy was initiated. Palliative care consultation was not associated with earlier GOC conversations. We recommend routine GOC conversations be initiated by oncologists prior to giving chemotherapy in the ICU setting.
Systematic reviews and meta-analyses in geriatric oncology.
Authors: Poniewierski Marek S. , Lyman Gary H. 
Published: September 2018

e21517 Background: Cancer incidence for most malignancies increases with age with the majority diagnosed after age 65. Aging is also associated with an increasing number of major comorbidities and greater risk and consequences of treatment-related complications. Geriatric Oncology has emerged as a subdiscipline within oncology focused on clinical management and research related to the elderly. Methods: A comprehensive search of the English language literature between 1990-2016 was undertaken for systematic reviews or meta-analyses (SRMAs) related to geriatric oncology. Titles, abstracts and full text manuscripts when needed were reviewed. 1,088 potentially eligible records were identified including 703 not limited to elderly patients, 89 not cancer studies and 236 not SRMAs. Results:More than half of 61 eligible studies were published in the last five years including systematic reviews in 42 (69%), meta-analyses in 42 (69%) and both in 23 (40%). Studies came from Europe (30), US (14), Canada (9), Asia (7) and South America (1) with elderly age cutoffs ranging from > 60 to > 80. While 17 reviews included multiple cancer types, 44 were limited to lung cancer (9), colorectal cancer (8), breast cancer (7), multiple myeloma (5) and lymphoma (4). Research focus was survivorship or end-of-life (41), treatment (24), geriatric assessment (11) and supportive care (8). Studies were limited to randomized controlled trials (37), non-RCTs (9) and both (16). The primary outcome was overall survival (39), progression free or relapse-free survival (15), response or recurrence (11), treatment-related toxicity (21) and geriatric assessment or frailty (9). More than half of SRMAs included < 10 studies while 20% included > 30 with the number of subjects in included trials ranging from 153 to > 15,000. Conclusions: The development of Geriatric Oncology has spanned nearly three decades. While a strong evidence base of published research including rigorous SRMAs in Geriatric Oncology has only emerged over the past decade, steady growth across a range of topics and outcomes relevant to cancer in the elderly is apparent.
Adjuvant chemotherapy related toxicities and their impact on treatment cessation in elderly patients with breast cancer.
Authors: Iqbal Muhammad , Manthri Sukesh , Robinson Kathy , Mocharnuk Robert S. , Desai Meghna R. 
Published: September 2018

e21527 Background: Data from the National Cancer Institute’s Surveillance Epidemiology and End Results program show that the incidence of breast cancer is 243.1 per 100,000 in women 65 years of age and older. Guidelines regarding the management of older breast cancer patients are lacking due to their underrepresentation in adjuvant therapy trials and conflicting evidence regarding the benefits of therapy. The objective of this study was to investigate the frequency of adjuvant chemotherapy related side effects and their correlation with early termination of therapy in elderly breast cancer. Methods: We collected retrospective data in patients with in situ or invasive breast cancer diagnosed after the age of 65.Docetaxel & cyclophosphamide, doxorubicin & cyclophosphamide, tratuzumab in combination and other regimens were studied. Fisher’s exact test was used to determine an association between grade 3 or 4 toxicities and therapy termination. Binary logistic regression was used to assess whether a specific toxic effect could predict for early discontinuation of therapy. Treatment termination was defined as inability to tolerate the proposed number of chemotherapy treatment cycles. Results: Among 269 eligible cases, 72 (26.76%) patients were offered adjuvant chemotherapy. Most patients (n = 58, 80.55%) accepted chemotherapy but 14 (19.44%) refused. Nausea (n = 16, 27.6%), vomiting (n = 8, 13.8%), diarrhea (n = 12, 20.7%), stomatitis (n = 3, 5.2%), hypersensitivity (n = 3, 5.2%), rash (n = 10, 17.2%), hepatotoxicity (n = 1, 1.7%), neuropathy (n = 12, 20.7%), cognitive changes (n = 3, 5.2%), bone pain (n = 5, 8.6%), anemia (n = 15, 25.9%), thrombocytopenia (n = 7, 12.1%), neutropenia (n = 16, 27.6%), cardiotoxicity (n = 1, 1.7%), hospitalization due to neutropenic fever (n = 5, 8.6%) and pneumonia (n = 2, 3.4%) were observed. Among 17 patients who discontinued chemotherapy, 23.5% reported bone pain (OR = 12, 95%CI:1.22-117.2, p = 0.024) and 47.1% developed neutropenia (OR = 3.55, 95%CI:1.04-12.13, p = 0.054). Other toxicities were not significantly associated with therapy discontinuation. Conclusions: The odds of terminating chemotherapy early increases for those who experience grade 3 or 4 bone pain and neutropenia.
Impact of adjuvant endocrine therapy related toxicities on treatment cessation in elderly breast cancer.
Authors: Iqbal Muhammad , Manthri Sukesh , Robinson Kathy , Mocharnuk Robert S. , Desai Meghna R. 
Published: September 2018

e21528 Background: According to American Cancer Society estimates, 252,710 new cases of invasive breast cancer will be diagnosed in women in the U.S. in 2017. Elderly breast cancer patients tend to be undertreated due to age, potential toxicities of adjuvant therapies and intrinsic ageist biases. The purpose of this study was to investigate the incidence of adjuvant endocrine therapy related side effects and their impact on discontinuation of therapy in geriatric breast cancer population. Methods: Data were collected by retrospective medical record review at our institution among breast cancer patients diagnosed after age 65. Adjuvant endocrine therapy included tamoxifen, letrozole, anstrozole and fulvestrant. Grade 3 and 4 toxicities were analyzed by Fisher’s exact test to determine an association with therapy discontinuation. Binary logistic regression was used to assess whether a specific toxic effect could predict for early therapy termination. Treatment termination was defined as inability to complete the proposed duration of endocrine therapy. Results: Out of 269 eligible cases, 221 (82.15%) patients were offered endocrine therapy based on their tumor’s ER and PR receptor status. A total of 216 (97.73%) patients received endocrine therapy while 5 (2.26%) declined treatment. Frequencies of osteopenia (n = 22, 10.2%), osteoporosis (n = 18, 8.3%), arthralgia (n = 35, 16.2%), hot flashes (n = 49, 22.7%), vaginal dryness (n = 3, 1.4%), weight gain (n = 7, 3.2%), fluid retention (n = 4, 1.9%), mood swings (n = 3, 1.4%), deep venous thrombosis (DVT, n = 3, 1.4%), pulmonary embolism (PE, n = 3, 1.4%) and stroke (n = 2, 0.9%) were reported by patients who received endocrine therapy. Among the 44 patients who terminated endocrine therapy early, 38.6% listed arthralgia as the chief cause (OR = 5.37, 95%CI:2.33-12.39, p = 0.0001). We detected no significant correlation between endocrine therapy cessation and other side effects. Conclusions: Arthralgia and hot flashes were the most common side effects observed in elderly breast cancer patients receiving adjunct endocrine therapy. We found that the elderly patients tend to discontinue treatment more often if they develop endocrine therapy related arthralgia.