bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of early nutrition intervention on advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy.
Authors: Meng Lingbin , Xu Xiaochun , Jiang Xin , Mekhail Tarek 
Published: May 2019

e17504 Background: Patients with nasopharyngeal carcinoma (NPC) frequently developed the problem of malnutrition at the time of diagnosis. Chemoradiotherapy (CRT) can even worsen the situation. Therefore, nutritional intervention should be applied to prevent CRT-associated weight loss and interruption of CRT. However, it is still controversial if early nutritional intervention is beneficial to NPC patients with CRT. This study is to investigate the influence of early nutritional intervention on advanced NPC patients with CRT by evaluating the nutritional status and CRT treatment tolerance. Methods: A cohort of 78 stage III-IV nasopharyngeal carcinoma patients was divided into early (n = 46) and late (n = 32) nutrition intervention groups. The early group of patients received nutritional support at the beginning of CRT, whereas the late group received such a support until development of the side effects, like 50% required oral dietary intake or > 10% weight loss. The data were collected and statistically analyzed. Results: There was no significant difference in baseline clinical characteristics between these two groups, suggesting that no selection bias occurred. Both groups of patients had weight loss at the end of CRT and 3 months thereafter. However, at the later time point, the early group started to regain their weight, while the late group continued to lose weight. At both time points, the early group had a lower percentage of weight loss than the late group. Similar results were also obtained for BMI, albumin, and pre-albumin levels (All p< 0.05). Besides, the early group showed a lower rate of advanced mucositis, a lower percentage of patients with more than 3 days RT breaks, fewer days of RT delayed for toxicity, and a lower percentage of patients with unplanned hospitalizations (All p< 0.05). A linear correlation was also found between the percentage of weight loss and the number of days of RT delayed. Conclusions: Early nutritional intervention provides beneficial outcomes to NPC patients by maintaining their nutritional status and enhancing CRT treatment tolerance. Our results also indicated early nutrition intervention may reduce the hospital cost and improve patients’ life quality.
Long-term toxicity following radiation therapy for head and neck squamous cell carcinoma: A retrospective study analyzing the effect of concurrent chemotherapy and advanced t-stage on late treatment-induced toxicities.
Authors: Barrett William , Cassidy Christine 
Published: May 2019

e17560 Background: There are approximately 436,000 survivors of head and neck squamous cell carcinoma (HNSCC) in the U.S. Toxicities related to definitive chemoradiation or radiation therapy can persist for many years, with some toxicities not presenting clinically until five or more years after definitive treatment. Long-term management of late radiotherapy effects is thus warranted. Methods: This retrospective chart review has three aims: (1) comprehensively assess overall late effects of definitive radiation and chemoradiation; (2) compare treatment-related toxicities between definitive radiation and chemoradiation; and (3) compare treatment-related toxicities between patients with TNM stage T1/T2 tumors to T3/T4 tumors. Late term effects were assessed using 17 toxicity categories including xerostomia, dysphagia, and neck fibrosis. HNSCC patients included in the study were those seen by a single practitioner for follow-up of definitive radiation or chemoradiation, without a history of surgical intervention to the primary site, between June 2017 and June 2018 (N = 49). Results: The median time from the end of treatment to the most recent follow-up was 8.53 years (1.17-24.08 years). In the total cohort, the most common late effect was xerostomia (78%, N = 38), followed by dysphagia (43%, N = 21), and neck fibrosis (27%, N = 13). For the majority of toxicity categories (11 of 17), the cohort that received definitive chemoradiation had higher rates of toxicity than the cohort that received definitive radiation alone. Additionally, for the majority of toxicity categories (10 of 17), the cohort of T3/T4 tumors had higher rates of long-term toxicity than the cohort of T1/T2 tumors. Conclusions: Although the patient population in this study has excellent locoregional control after definitive radiation or chemoradiation, the majority of patients suffer from long-term treatment-related toxicities. Long-term follow up care is needed to manage the late effects of radiotherapy that can develop and persist for years after treatment completion.
Characteristics of the course of squamous cell carcinoma of the oral cavity depending on the HPV status.
Authors: Svetitskiy Pavel V. , Zykova Tatiana A. , Volkova Viktoriya L. , Aedinova Irina V. 
Published: May 2019

e17579 Background: HPV infection has a positive prognostic value in the treatment of patients with oropharyngeal squamous cell carcinoma. The purpose of the study was to evaluate the effect of HPV status on the course of oral cavity cancer. Methods: Formalin-fixed paraffin-embedded tumor tissues were studied in 34 patients with cancer of the floor of the mouth aged 47-85 years, 3 (8.8%) women and 31 (91.2%) men. All patients had histologically verified squamous cell carcinoma: stage (st) I in 1 (2.9%), II st - 8 (23.5%), III st - 12 (35.3%), IV st - 13 (38.3%); G1 in 15 (44.1%), G2 - 19 (55.9%). HPV DNAs were detected by Real-time PCR. Results: HPV DNAs were found in 12 (35.3%) samples of tumor tissues, including type 6 in 1 (2.9%), 11 in 3 (8.8%), 16 in 6 (17.6%), 35 in 1 (2.9%), 16+35 in 1 (2.9%). HPV+ tumors were more often in women (66.7% vs 32.3% in men), but high-risk HPV types were detected in men only - 8 (25.8%). Among patients aged 47-55 years, HPV+ tumor status was detected in 4 (33.3%), 56-65 years in 7 (53.8%), 66 years and older - in 1 (11.1%). In st I, no HPV+ tumors were observed; st II - 3 (37.5%) HPV+ tumors, low-risk in all; st III - 3 (25%) HPV+ patients, including high-risk in 2 (16.7%); st IV - 6 (46.2%) HPV+ samples, high-risk in all. G1 tumors: HPV+ in 7 (46.7%), HPV- in 8 (53.3%) patients; G2 tumors: HPV+ in 5 (26.3%), HPV- in 14 (73.7%) patients. Among patients with HPV+ tumors, metastases were observed in 5 (41.7%), no metastases - in 7 (58.3%); for patients with HPV- tumors, the values were 12 (54.5%) and 10 (45.5%) respectively. 4 (33.3%) patients with HPV+ tumors died, while 8 (66.7%) survived; for patients with HPV- tumors, the values were 12 (54.5%) and 10 (45.5%) respectively. Conclusions: The development of squamous cell carcinoma of the oral cavity was multidirectional and depended on the HPV status. HPV+ tumors, especially high-risk ones, were more often registered in stages III and IV. HPV+ tumors were more often lower-grade ones and less often metastasized; the mortality rate among patients with HPV+ tumors was lower than with HPV- ones.
Anaplastic thyroid cancer: A report of six consecutive cases treated successfully with nab-paclitaxel.
Authors: Travers Nicholas , Cronin Eleanor , Marinova Mira , Smith Peter , Dean Andrew Peter 
Published: May 2019

e17586 Background: Advanced anaplastic thyroid cancer is a disease with very few treatment options. Poor response rates have been reported with cisplatin / doxorubicin and modest response noted in a single phase 2 trial with 24 hour paclitaxel infusion. The 50% response rate has not been reproduced by other investigators but raises questions about the possible utility of taxanes. Although paclitaxel is not approved for this indication in Australia, nab-Paclitaxel is available on a compassionate access scheme. We report 6 consecutive cases treated with nab-paclitaxel (as an alternative to paclitaxel infusion) who all exhibited a response to treatment. Methods: 6 consecutive patients with histologically proven advanced anaplastic thyroid cancer were assessed and imaged to document extent of disease. They were all treated with nab-paclitaxel 100mg/M2 given weekly either continuously or for 3 weeks out of every 4. Clinical and radiological response to treatment was documented. Results: The number of cycles given ranged from 3 to 8. Two patients required dose reductions due to neuropathy. Of the 6 patients; 5 had measurable metastatic disease and 5 had measurable local disease. Four patients showed clinical response to treatment with shrinkage of measurable local disease. One patient showed response to treatment with shrinkage of the primary tumour. Three patients with stridor developed considerable relief from this distressing symptom. Three patients with inoperable disease subsequently became operable and were resected to obtain local disease control. One patient with no evaluable disease after resection (Stage 4B) who received adjuvant nab-paclitaxel remains free of recurrence at 4 years. Conclusions: Anaplastic thyroid cancer is generally regarded as malignancy untreatable by chemotherapy. Our pilot series suggests nab-Paclitaxel warrants further evaluation and should be considered as a chemotherapy backline for combination with targeted agents.
Potential length of stay reduction with outpatient management of low risk febrile neutropenia in a regional cancer centre.
Authors: Nguyen Mike , Jacobson Tate , Tamjid Babak , Torres Javier , Sahu Arvind , Wann Alysson 
Published: May 2019

e18000 Background: Febrile neutropenia is a serious complication of chemotherapy. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score can reliably identify patients with febrile neutropenia at low risk of serious complications. Outpatient management programs utilising protocol based risk stratification, daily ambulatory nursing visits, telephone follow up and early outpatient review have been successfully piloted in other Australian cancer treatment centres. Methods: We performed a retrospective review of medical records for all patients admitted at our institution with febrile neutropenia between January 1 2016 and December 31 2018. We collected information regarding patient characteristics, cancer diagnosis and treatment, determined the MASCC risk index score, and if low risk, we determined the potential eligibility for outpatient care and potential reduction in length of stay. Results: A total of 98 hospital admissions with febrile neutropenia were analysed. Of these, 66 were determined to have a MASCC low risk index score. 58 patients met the eligibility criteria for outpatient management. The median age was 67 years. 71% were female. The most common tumour type was breast cancer. 52% were treated with palliative intent. The median length of stay was 3 days. The median potential reduction in length of stay for each admission was 2 days. The total potential reduction in length of stay was 198 days. No admission resulted in serious complications indicating the safety of outpatient care. Conclusions: Febrile neutropenia is a common complication of chemotherapy and a leading cause of hospital admission. This review demonstrates a significant number of hospital admission days can be avoided with outpatient care. We intend to conduct a prospective pilot study at our centre to institute an outpatient febrile neutropenia program for such low risk groups with potential reduction in hospital bed length of stay. This has significant implications on health resource usage, service provision planning and patient quality of life.
Patient attendance at molecular tumor board: A new means of shared decision making?
Authors: Cannon Timothy Lewis , Trump Donald L. , Knopp Laura , Wang Hongkun , DeMarco Tiffani , Jessup John Milburn 
Published: May 2019

e18001 Background: Patient engagement in medical decision-making improves patient related outcomes through compliance and patient satisfaction. The Inova Schar Cancer Institute (ISCI) has a weekly molecular tumor board (MTB) to match comprehensive genomic sequencing results with targeted therapies for patients. The ISCI MTB invites patients to attend and engage in the MTB discussion. We performed a pilot study to investigate the feasibility and satisfaction in patients who attended MTB. Methods: During the time of this study, August 2017 through October 2018, 139 patients were presented and all 20 who were able to attend MTB completed pre-and post- MTB surveys. Patients who did not attend were either not invited by their primary oncologist, unable to attend, or chose not to attend. The survey included six questions related to comprehension, engagement, and satisfaction with the treatment team. Results: There was a statistically significant change for the question “I am satisfied with how well informed I am about targeted therapy” with p = 0.016. All 20 patients answered positively that it was beneficial for them to attend. Many patients expressed concerns about their difficulty understanding the technical aspects of the meeting. Conclusions: Patients who attended MTB reported a higher level of satisfaction after MTB attendance as compared to before MTB. This may reflect a sense of engagement in shared decision making rather than comprehension of genomic information. A more holistic method of studying this practice would include sampling a larger patient population and a formal evaluation of the physicians’ experience with patients attending. Supported by philanthropic funds from the Inova Schar Cancer Institute.
Patient factors that drive unplanned acute care utilization in oncology care.
Authors: Kaufmann Tara L. , Aakhus Erin , Bilger Andrea , Gabriel Peter Edward , Nimgaonkar Vivek , Rendle Katharine A. , Shah Arnav , Trotta Rebecca , Bekelman Justin E. , Barg Frances 
Published: May 2019

e18011 Background: There is a critical need to develop oncology care delivery models that help cancer patients avoid preventable acute hospital care. We are conducting a mixed methods study to assess patient- provider- and system-level factors that drive unplanned acute care utilization in order to implement evidence-based practices (EBPs) at a large health system. Here we present data from patient perspectives on the factors that influence their decision to seek acute care. Methods: We used a purposive sampling approach to identify cancer patients with solid tumors on active treatment with unplanned acute care events at an academic cancer center or its two affiliated community practices from August 2018-January 2019. We conducted semi-structured interviews designed to elicit patient factors that drive unplanned acute care utilization and to understand strategies patients use to manage unexpected symptoms at home. Interviews were analyzed using the constant comparative method to identify key themes. Results: Forty-three patients participated in this study. We identify several patient factors that intersect with the decision to seek care: self-management behaviors, guilt, negative ED perception, safety concerns, and trust. Patients attempt self-management prior to contacting their oncology team, which introduces variability in the duration and severity of reported symptoms. Delay is related to patients’ sense of guilt for burdening their oncology team and to differences in provider accessibility. Patients describe a high symptom threshold to seek care that is often coupled with a negative perception of the ED. However, due to safety concerns, patients do prefer in-person evaluation for new and distressing symptoms. They also express a high level of trust in the oncology team and relative distrust of non-oncology providers. Conclusions: Our data suggest a conceptual model for patient factors that drive unplanned acute care and identify the following targets for implementation of EBPs: 1) symptom management 2) provider accessibility 3) alternate triage pathways for in-person evaluation. Strategies to target these needs should address patients’ emotional concerns and be well integrated within the oncology team.
Barriers to accessing healthcare services: A multidisciplinary approach towards improving pancreatic cancer survival in a Canadian province.
Authors: Faour Elizabeth , Colwell Bruce , Lamond Nathan William Dana , Snow Stephanie Leann , Jeyakumar Alwin S. , Patil Nikhilesh Gajanan , Costa Andreu F. , Walsh Mark , Gala-Lopez Boris , Livingstone Scott M , Peltekian Kevork , Stueck Ashley , Huang Weei-Yuarn , Arnason Thomas , Ramjeesingh Ravi 
Published: May 2019

e18018 Background: Pancreatic cancer (PC) is associated with the highest death rate among common malignancies and is the fourth leading cause of cancer-related death in North America. Despite similar access to treatment options across Canada, the province of Nova Scotia (NS) has the lowest 5-year survival rate for PC. To investigate reasons behind the poor PC outcomes in NS, a multidisciplinary team was created to investigate barriers to care and streamline patient flow. In 2016, initial data informed the reorganization of the hepatopancreaticobiliary (HPB) multidisciplinary team towards the goal of identifying and reducing barriers to care and, ultimately, improving survival. Methods: This quality improvement project included a retrospective chart review of PC patient data from a single institution (The NS Cancer Center), where over 80% of PC patients from this province are seen. A review of PC diagnosis, referrals patterns, and wait time data was undertaken. Results: Data was extracted on 365 patients with a diagnosis of PC between 2011 and 2014. During that period, only 40.4% of patients diagnosed with PC had a tissue diagnosis and just over 71% had a baseline CA19-9. Referral rate to Medical Oncology (MO) was 53%, mean wait time to see MO was 37.2 days and only 23% of patients received systemic treatment. Initiatives to improve access to care included standardization of diagnostic procedures, early triaging of referrals, transfer of port-a-cath (PAC) insertions from interventional radiology to the HPB surgeons, and the creation of provincial guidelines, which were implemented in 2016. Positive Improvements were observed in all identified barriers to care. Conclusions: Barriers to accessing care for PC patients in NS were identified, and a multidisciplinary team proposed provincial guidelines were implemented to expedite care. Preliminary results show improvement in all aspects of healthcare delivery. Survival data will be available in late 2019. [Table: see text]
Oncology leadership development using decentralization, task shifting, techno-mentoring and creation of alternate oncology workforce.
Authors: Pendharkar Dinesh 
Published: May 2019

e18043 Background: Access to cancer care remains the greatest challenge world over. One of the solutions include task shifting , decentralization and empowerment of alternate oncology workforce, with health system strengthening. “Pendharkar model “ of cancer care delivery is widely being followed across four states in India and is expanding to two more. It has sustainably created alternate oncology workforce with community oncology leaders. Methods: The model involved creating nodal cancer units in government run district hospitals and creating a physician point of contact for cancer in every unit. The method involved training these general physicians over one month and giving them techno-mentoring backup over every cancer patient they see. They were supposed to play multiple roles including early diagnosis, patient care including chemotherapy, palliative care. One of their role being advocacy and public education. Results: The model led to training of more than 140 physicians and starting of cancer units in about 125 hospitals, with population coverage of more than 200 million population across five states of India. Through their training and mentorship backup they were encouraged to take leading role in the society s cancer advocates, besides care of the cancer patients. In 2018 alone thousands of patients benefited from the services including thousands of courses of chemotherapy. They took up the role of community leaders in oncology. The list of activities performed by them varied from-oncology education and training of the paramedical staff, education of the physicians, cancer counselling camps, designing educational material, public educational meeting, rallies , leaflet distributions, multiple press and TV – mass media presentations on cancer, organizing cancer related painting exhibitions, slogan campaigns and so on. World cancer activities were simultaneously observed in more than 100 districts in last two consecutive years. Conclusions: The model as by product led to the creation of an huge army oncology leaders in the community. The general physicians from periphery turned in to powerful cancer advocates.
Social media for oncology clinical trial recruitment: Oncologists’ attitudes and perceptions.
Authors: Sedrak Mina S. , Hurria Arti , Sun Virginia , Li Daneng , Liu Jennifer , George Kevin , Wong Andrew R. , Padam Simran , Katheria Vani , Mohile Supriya Gupta , Waisman James Ross , Dale William , Mortimer Joanne E. , Dizon Don S. 
Published: May 2019

e18066 Background: Social media may be an effective strategy to improve public awareness of oncology clinical trials and increase accrual. How oncologists perceive the role of social media in clinical trials now and in the future remains unknown. We explored oncologists’ attitudes and perceptions related to social media and clinical trial recruitment. Methods: Semi-structured interviews were conducted with 44 medical oncologists at City of Hope from March to June 2018. Primary measures were oncologists’ self-reported benefits, concerns, and future interventions to leverage social media for trial recruitment. Secondary measures were facilitators and barriers to social media use for professional purposes. Responses were recorded digitally, transcribed, and de-identified. Data was managed using NVivo v12. Two analysts coded interview data using thematic content analysis (kappa = 0.7). Results: Of the 44 participants, 55% were academic and 45% were community oncologists, 36% were women, and 68% had > 10 years of experience. The most commonly cited benefit was increased awareness and visibility (63%). The most commonly cited concerns were: lack of time or support (31%), misinformation or oversimplification (31%), and lack of guidance (regulatory/ethical oversight) (28%). Oncologists reported a desire for an institutional-level intervention (e.g., personnel support with social media expertise) to facilitate trial recruitment using social media (50%). Oncologists’ perceptions of the facilitators to social media use for professional purposes were centered on networking (40%) and staying up to date in the field (33%). Perceived barriers were clustered around lack of comfort, training, time (38%), and lack of evidence of benefit (25%). No differences were identified between academic and community oncologists. Conclusions: Oncologists are hopeful that social media can increase awareness and visibility of cancer clinical trials. However, they have numerous concerns about the application of social media in clinical trials due to lack of time, support, and risk of misinformation. Further research is needed to examine whether social media can facilitate recruitment to oncology clinical trials.