bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acceptability and effects of values-based outpatient advanced care planning (ACP) in gastrointestinal (GI) cancers.
Authors: Epstein Andrew S. , O'Reilly Eileen Mary , Volandes Angelo E. , Li Yuelin , Shuk Elyse , Breitbart William 
Published: September 2018

e21571 Background: We developed and validated the values questions for the Person-Centered Oncologic Care and Choices (P-COCC) ACP intervention, which combines an informational care goals video with a brief patient values interview. Herein, we studied (primarily) the acceptability of P-COCC, and (secondarily) its effects on wellbeing and decisional conflict. Methods: Patients (pts): English-speaking with GI cancer, ≤ monthly followup in MSK medical oncology clinics and believed by their oncologist able to complete study measures and to survive 1-12 months. Consented pts randomized 2:2:1 to P-COCC vs. video alone (V) vs. usual care (UC). Questionnaires: administered baseline and at next follow-up visit on validated measures of wellbeing, and on follow-up only, decisional conflict. P-COCC arm pts also completed 3 Likert scales (was the intervention helpful, comfortable and recommended to others?); a positive score on ≥1 of 3 indicated acceptability for that pt. Results: During screening from 9/2014-11/2016, 202 potentially eligible pts were approached. 51 (25%) declined participation (most common reason, N = 31 = not wanting to discuss the topic). 151 consented and were randomized; 99 (66% of the 151) completed study measures (most common attrition reason, N = 34 = disease progression or death). Of the 99, 63% male; mean age 61 years; mean ECOG PS 1; most common cancer types colorectal, gastroesophageal, and pancreatic; most white race, Christian religion and married. The primary aim was met: Among 33 pts, 32 (97%, 95%CI: 0.84-0.99, p < 0.001) rated P-COCC acceptable. Mean distress scores (0-10) increased (0.43) in the P-COCC arm but decreased in the V (-0.04) and UC (-0.21) arms (p = 0.03 and 0.04, P-COCC vs V and UC, respectively). There were no significant pre-post change scores on other measures of wellbeing (anxiety, depression, stress, acceptance, QOL), or intergroup differences in decisional conflict. Conclusions: Our values-based ACP paradigm is acceptable but may increase distress in GI cancer outpatients. Further studies will investigate underpinnings and follow-up duration of these observations, and ways to best support cancer patients (with any cancers, and regardless of prognosis) in ACP. Clinical trial information: NCT01912131.
Comparison of myocardial strain in cancer patients undergoing chemotherapy with and without anthracycline.
Authors: Zheng Haoyi , Reichek Nathaniel , Way Ann , Toole Rena , Verma Sajal , Mehrotra Bhoomi 
Published: September 2018

e21600 Background: Cardiotoxicity has been reported in cancer patients treated with anthracycline- and non-anthracycline-based chemotherapy. Myocardial strain assessed by speckle-tracking echocardiography enables early detection of subclinical chemotherapy-induced cardiotoxicity. However, comparisons of strain indices in patients undergoing chemotherapy with and without anthracyclines have not been reported. The prupose of this study was to compare myocardial strain in patients treated with these two chemotherapy regimens. Methods: This study was approved by the institutional review board at Saint Francis Hospital. 43 adult cancer patients (30 with solid tumors, 6 with lymphomas, 6 with leukemias and 1 with multiple myeloma) treated with anthracyline-based or non-anthracycline-based chemotherapy, were studied with conventional 2D and 3D echocardiography, 2D speckle-tracking imaging, and cardiac biomarkers. Results: Of the 43 patients, 22 received anthracycline-based chemotherapy, with an average cumulative anthracycline dose of 235 mg/m2. The other 21 patients received non-anthracycline-based chemotherapy including VEGF inhibitors and HER-2 receptor antagonists. There was no difference in 2D or 3D left ventricular ejection fraction (LVEF) (60.9 ± 4.5% vs 62.0 ± 4.9% by 2D; 60.5 ± 5.4 % vs 62.1± 5.2% by 3D, p = 0.35 for both 2D and 3D), troponin or NT-proBNP between anthracyline-treated patients and non-anthracycline treated patients. However, global longitudinal strain (GLS) and global circumferential strain (GCS) were decreased in patients treated with anthracycline-based chemotherapy compared with patients treated with non-anthracycline-based chemotherapy (-17.8 ± 2.8 vs 19.9 ± 2.9, p = 0.018 for GLS; -21.6 ± 4.8 vs 24.8 ± 4.8, p = 0.041 for GCS). Conclusions: In contrast with patients treated with non-anthracyline-based chemotherapy, patients treated with anthracyclines had reduced myocardial systolic strain even at low cumulative doses. This occurred in the absence of detectable reductions in LVEF. Thus early assessement of myocardial strain abnormality and early intervention with cardioprotective agents may be considered for these patients.
Room to move: Physical activity and exercise barriers in the cancer clinic.
Authors: Quain Katharine , O'Donnell Elizabeth , Perez Giselle Katiria , Rabin Julia , Park Elyse R. , Peppercorn Jeffrey M. 
Published: September 2018

e21601 Background: Exercise can improve outcomes and quality of life following cancer diagnosis. The American College of Sports Medicine (ACSM) recommends 150 minutes of moderate aerobic activity for patients with cancer. We sought to evaluate exercise patterns and barriers to exercise among patients presenting for follow-up care. Methods: Patients were recruited from the outpatient cancer clinic and completed a self-administered survey focused on symptoms, lifestyle and needs. Participants reported height, weight, weekly time performing moderate-to-vigorous aerobic activity, time spent strength training and perceived barriers to exercise. Descriptive statistics characterized the sample and patterns of exercise. An independent-samples t-test examined differences in strength training between patients currently on and off treatment; Chi-square examined differences among those meeting or not meeting ACSM activity guidelines. Results: Of 637 patients surveyed, 590 (93%) completed exercise questions (55% female; median age 60-69). The most common cancer diagnoses were breast (26%), hematologic (18%) and gastrointestinal (12%). Over half (57%; n = 352) were overweight (BMI ≥ 25) and 26% (n = 161) were obese (BMI ≥ 30). Patients engaged in moderate-to-vigorous aerobic exercise an average of 110 min/week and in strength training for 30 min/week. 71% did not meet ACSM aerobic exercise guidelines; 62% reported no strength training and 29% reported no exercise. 76% of respondents reported at least one barrier to exercise. Common barriers included other illness (35%), lack of free time (21%), fatigue (8%) and boredom with exercise (8%). Most participants (60%; n = 351) decreased exercise after cancer diagnosis. Participants currently on therapy were significantly less likely to meet ACSM aerobic activity guidelines (p = 0.04) and reported doing less strength training (p < 0.001) than those not on therapy. Over half of participants (53%) expressed interest in receiving more information about exercise and physical activity services. Conclusions: There is potential to improve activity, fitness and cancer outcomes through increasing exercise among patients with cancer. Accessible, engaging exercise interventions are needed.
The relationship between statins and breast cancer prognosis varies by statin type and exposure time: A meta-analysis.
Authors: Liu Binliang , Yi Zongbi , Guan Xiuwen , Ma Fei , Zeng Yi-Xin 
Published: September 2018

e21606 Background:Breast cancer is the most common cancer in females. The effects of statins on breast cancer prognosis have long been controversial, so it is important to investigate the relationship between statin type, exposure time, and breast cancer prognosis. This study sought to explore the effect of statins on breast cancer prognosis. Methods:We searched the MEDLINE, EMBASE, Cochrane Library between October 15, 2016 and January 20, 2017. Searches combined the terms “breast neoplasms[MeSH]”, “statins”, “prognosis” or “survival” or “mortality” with no limit on publication date. Data were analyzed using Stata/SE 11.0. Results: 7 studies finally met the selection criteria and 197,048 included women. Overall statin use was associated with lower cancer-specific mortality and all-cause mortality (HR 0.73, 95% CI 0.59-0.92, P = 0.000 and HR 0.72, 95% CI 0.58-0.89, P = 0.000). Lipophilic statins were associated with decreased breast cancer-specific and all-cause mortality (HR 0.57, 95% CI 0.46-0.70, P = 0.000 and HR 0.57, 95% CI 0.48-0.69, P = 0.000); however, hydrophilic statins were weakly protective against only all-cause mortality (HR 0.79, 95% CI 0.65-0.97, P = 0.132) and not breast cancer-specific mortality (HR 0.94, 95% CI 0.76-1.17, P = 0.174). Of note, more than four years of follow-up did not show a significant correlation between statin use and cancer-specific mortality or all-cause mortality (HR 0.84, 95% CI 0.71-1.00, P = 0.616 and HR 0.95, 95% CI 0.75-1.19, P = 0.181), while groups with less than four years of follow-up still showed the protective effect of statins against cancer-specific mortality and all-cause mortality (HR 0.62, 95% CI 0.44-0.87, P = 0.000 and HR 0.61, 95% CI 0.45-0.80, P = 0.000). Conclusions:Although statins can reduce breast cancer patient mortality, the benefit appears to be constrained by statin type and follow-up time. Lipophilic statins showed a strong protective function in breast cancer patients, while hydrophilic statins only slightly improved all-cause mortality. Finally, the protective effect of statins could only be observed in groups with less than four years of follow-up.
L-carnitine for pegylated-l-asparaginase induced hepatotoxicity.
Authors: Wieduwilt Matthew Joseph , Goodman Aaron , Jonas Brian Andrew , Cassaday Ryan Daniel , Castro Januario E. , Mulroney Carolyn M. , Tzachanis Dimitrios , Ball Edward David 
Published: September 2018

e21626 Background: Pegylated-L-asparaginase (PEG-Asp) treatment causes severe hepatoxicity in about 25% of adults. Two case reports suggest that L-carnitine may rapidly reverse PEG-Asp-induced hepatotoxicity. Methods: We retrospectively analyzed data from 11 consecutive patients from 3 centers receiving L-carnitine for PEG-Asp-related hepatotoxicity from 4/2014 to 4/2016. Eligible adults received L-carnitine for hepatotoxicity probably or definitely related to PEG-Asp. Total bilirubin (Tbili), ALT, or AST stabilization was defined as a variation within 10% from baseline maintained for 3 days. Improvement was defined as a decrease of ≥10% the prior day maintained for 3 days. Liver imaging included CT scans or ultrasounds. Results: The majority of patients were male, 91% (Table 1). Imaging on 7 patients showed hepatic steatosis in 2 (29%) prior to PEG-Asp and 5 (71%) after PEG-Asp. Median peak Tbili, ALT, and AST were 15.4 mg/dL (2.3-27.58), 194 IU/L (120-1491), and 119 IU/L (52-1064), respectively. Median days from hyperbilirubinemia to L-carnitine initiation was 4 (1-13). Median L-carnitine dose was 2,000 mg/day (1,880-4,450). Median days until Tbili, AST, and ALT improvement were 6.5 (4-14), 4 (2-19), and 3.5 (1-8), respectively. Median days until Tbili normalization was 34 (4-52). Improvement in Tbili, ALT, and AST within 8 days of L-carnitine was seen in 5, 19, and 11 patients, respectively. No adverse events were attributable to L-carnitine. Conclusions: L-carnitine for PEG-Asp-induced hepatotoxicity was safe and associated with stabilization and improvement in transaminitis and, to a lesser extent, hyperbilirubinemia. See table. [Table: see text]
Preliminary results from CAMEO-PRO study: Complementary and alternative medicine in oncology—Physicians inform oncological patients.
Authors: Bozza Claudia , Gerratana Lorenzo , Basile Debora , Vitale Maria Grazia , Bartoletti Michele , Agostinetto Elisa , Russo Stefania , Bonotto Marta , Cinausero Marika , Fanotto Valentina , Pelizzari Giacomo , Lisanti Camilla , Minisini Alessandro Marco , Andreetta Claudia , Mansutti Mauro , Poletto Elena , Iacono Donatella , Sottile Roberta , Fasola Gianpiero , Puglisi Fabio 
Published: September 2018

e21632 Background: It is estimated that about half of cancer patients (pts) use at least one form of (CAM) Complementary and Alternative Medicine in their life but there is a strong reticence of pts in talking about CAM with their oncologist. Aim of this study is to inform pts about CAM. Methods:From April to December 2016, the observational pilot trial “CAMEO-PRO” prospectively enrolled 200 cancer pts that were invited to attend a tutorial about CAM at the Department of Oncology, University Hospital of Udine (Italy). Before and after the seminar, pts were asked to fill a questionnaire reporting their knowledge and opinion about CAM . Results:Median age was 61 years, 141 (72%) women and 53 (28%) men. At study entry, 139 (72%) pts declared they have never been interested in this topic before; 22 pts (12%) revealed the use of a type of alternative therapy and 53 (31%) revealed the use of complementary therapy. Overall, 111 (55.5%) pts participated to the tutorial. Table 1 shows the percentage of response and the opinion’s change about CAM before and after the tutorial. Conclusions:Informative seminars seem to have an impact on patients’ perceptions and opinions about CAM. [Table: see text]
Early palliative care interventions in patients with hematologic malignancies prior to hematopoietic cell transplantation.
Authors: Alamgir M.Ahsan , Wen Sijin , Craig Michael D. , Pedraza Sandra L. 
Published: September 2018

e21634 Background: Early palliative care (EPC) interventions have been endorsed by multiple medical societies, mostly for solid tumors but not for hematological malignancies. Patients undergoing hematopoietic stem cell transplantation (HSCT) suffer significant physical and emotional distress affecting negatively their quality of life (QOL). They also receive more aggressive end-of-life interventions than other cancer patients. Few studies have shown the impact of EPC in the pre-transplant phase on post transplant morbidity and mortality. Methods: 53 patients undergoing HSCT were evaluated on the supportive care clinic for symptom and needs assessment using the Edmonton symptom assessment scale (ESAS) to evaluate symptom burden prior to transplant. Consecutive palliative care visits were offered to patients. We also evaluated whether the supportive care clinic (SCC) visits made a difference on hospitalization rate and mortality comparing this group with 108 patient who did not undergo evaluation. Kaplan-Meier method and log-rank test were used in the survival analysis and Fisher’s exact test was used in the data analysis for categorical variables. Results: The most common symptoms reported by patients included: fatigue (4.4), sleep problems (3.7), pain (2.8), anxiety (2.8), well-being (2.7), and drowsiness (2.3). 26% (14) of the patients were followed in the SCC at 3 months. The most common symptoms at that time included fatigue (5.1), pain (4), drowsiness (3.6), sleep problems (3.1), well-being (2.9), and appetite (2.4). Overall mortality for the whole group was 24%. 28% for the palliative care group and 21% for the control group. Odds Ratio for mortality at 3 and 6 months were not significantly different between groups. Differences in hospital admissions were also not statistically significant. Conclusions: EPC in HSCT patients is feasible and may help with symptom detection and control. No effect on mortality or hospital admission rates was found on this study on patients referred for EPC interventions. Prospective studies are needed to clearly define the role of EPC in HSCT patients.
Implementation of a distress/supportive care screening tool in lung and head and neck cancer clinic.
Authors: Pasquinelli Mary , Obilade Sandra , Rosenberg David , Deliu Zane , Shah Aakash , Knightly Eileen , Feldman Lawrence Eric 
Published: September 2018

e21646 Background: Identifying and addressing depression, anxiety, and supportive care needs in cancer patients is an emerging standard of care. The Coleman Foundation “Patient Screening Questions for Supportive Care” tool was used with demographic and diagnostic data to investigate the relationships between screening scores. Methods: Lung/head/neck cancer patients at the University of Illinois Cancer Center were screened using the Coleman Foundation tool. This screening tool identified needs in several categories including Patient Health Questionnaire 4 (PHQ-4) scores; practical, family/caregiver, nutritional, treatment, physical, and spiritual/faith/religious concerns; levels of pain, fatigue, physical activity to quantitatively assess patient distress/supportive care needs. Scores were compared with age, sex, race/ethnicity, insurance, cancer type, and cancer stage. Linear regression was used for statistical analysis. Results: We performed initial screening on 164 lung/head/neck patients ages 36-88 (mean 61), with stages IA to IVC (May 2016 to Jan. 2017). Our findings are summarized in below. We found a 1oeffect that racial/ethnic minority status was significantly correlated with higher scores. We found that lung cancer was correlated with higher screening scores than head & neck on initial screen. Medicare insurance was correlated with significantly lower screening scores. Conclusions: Patients with lung/head/neck cancer have significant needs and concerns that go beyond merely treating their cancer. Our findings show that certain demographic groups have especially high burdens in some specific dimensions and that these specific concerns may be predicted based on diagnostic and demographic information. Thus, these findings serve to inform providers as to where and how to focus supportive care for these patient populations. [Table: see text]
Evaluation of safety, efficacy, and other clinical endpoints of delta-9-tetrahydrocannabinol in older patients with hem/onc malignancies.
Authors: Hansra Damien Mikael 
Published: September 2018

e21671 Background: Dronabinol, synthetic delta-9-tetrahydrocannabinol (Δ-9-thc), is the active compound & natural occuring component of Cannabis Sativa L(Marijuana). Dronabinol is used as an appetite stimulant & treatment of chemo induced nausea/vomiting in cancer patients (pts). Here we evaluate the efficacy, safety, & other clinical endpoints in older cancer pts. Methods: Survey study administered to cancer pts prescribed Dronabinol w/ 7 questions (yes/no/n/a): Did Dronabinol increase appetitie? decrease nausea/vomiting? improve mood? decrease insomnia? decrease anxiety? have any side effects? improve quality of life (QOL)? Also pts were asked if they preferred sythetic meds vs natural plant based meds (oil, capsule, liquid, etc). Inclusion: age > 60, hem/onc malignancy, prescribed Dronabinol. Exclusion: death, altered mental status, not taking Dronabinol, off label use. Unpaired t-test w/ two sided P value used to compare differences. Results: N = 28 pts enrolled, 12 pts excluded, 16 pts meeting study criteria. Mean age 70 (range 61-78). 100% white pts w/ 94% Latin 6% non-Latin. 50% male 50% female. 81% Onc vs 19% Heme malignancy. Dose given: 2.5 mg QD (25%), 2.5 mg BID (62.5%), 5mg BID (12.5%). Significant improvements in appetite (87.5% vs 12.5% p = < 0.0001), anxiety (75% vs 25% p = 0.0128), QOL (81.3% vs 18.7% p = 0.0001) observed. No side effects seen in 87.5 % vs 12.5% (dizziness) p = < 0.0001 of pts. 100% vs 0%, p = < 0.0001 of pts preferred natural plant based meds vs synthetics. Non significant improvements in mood (61.5% vs 38.5% p = 0.2567), insomnia (61.5% vs 38.5% p = 0.2567), nausea/vomiting (71.4% vs 28.6% p = 0.1263) observed. Conclusions: This unique study shows Dronabinol significantly improved appetite, anxiety, & QOL in older cancer pts w/ most pts having no side effects. Also non significant improvements in mood, nausea/vomiting, insomnia observed. 100% of pts preferred natural plant based meds vs. synthetics. Further investigations examining the clinical benefits & safety of Dronabinol & Cannabis Sativa L are warranted in older cancer patients.
Cardiotoxicity associated with carfilzomib: Systematic review and meta-analysis.
Authors: Shah Chintan , Bishnoi Rohit , Bejjanki Harini , Jain Ankur , Samal Subhankar , Moreb Jan 
Published: September 2018

e21674 Background: Carfilzomib (Carf)is a novel proteasome inhibitor (PI) 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 cardiotoxicity (CT) is not well defined. We hypothesize that CT is more frequent than that seen with other PIs. 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 29 publicatons; phase I/II, phase II and phase III (n = 3) clinical trials in which Carf was used as monotherapy or in combination with other chemo agents. We excluded phase I studies and studies without CT data. Incidence rates and odds ratios (OR) were calculated with either fixed effect or random effect model based on the heterogeneity of included studies. Toxicity was reported according to CTCAE v4.0. Results: A total of 4560 patients with various hematological and solid malignancies were included. Incidence of all grades and high grades (≥ 3) CT (including arrhythmias, CHF with LVEF drop, and coronary syndrome) were 7.8% and 4.72%, respectively. When compared to control group taken from phase III clinical trials, the risk of developing CT due to Carf was significantly higher with OR of 1.90 and 2.03 (P < 0.01) for all grades and high grades, respectively. Moreover, incidence of CT was significantly higher in Carf combination therapy (9.85%) compared to Carf monotherapy (5.40%) (P = 0.01). Furthermore, incidence of high grade CT was 7.5% and 5% with and without concomitant immunomodulatory agent (IMiD), respectively (P = 0.004). There was no variation in the incidence of CT among newly diagnosed versus RMM (P = 0.6), and no Carf dose effect. Mortality rate associated with cardiotoxicity was 1.5%. Conclusions: Overall incidence of Carf related CT seems to be higher than that reported with other PIs. Although, the pathophysiology is poorly understood, this trend could potentially be secondary to irreversible nature of proteasome inhibition by Carf. There seems to be a significant increase in CT with combination of Carf and an IMiD. Prior therapies and higher Carf doses have no effect on CT incidence.