bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unhealthy alcohol use and toxicity of concurrent chemoradiation for head and neck cancer.
Authors: Graf Solomon A. , Wheat Chelle L. , Frost Madeline C. , Sigel Keith , Zeliadt Steven B. , Williams Emily C. 
Published: May 2019

e17559 Background: Unhealthy alcohol use (UAU) is an important risk factor for development head and neck squamous cell carcinoma (HNSCC), but any effect on treatment outcomes is not well understood. The Veterans Health Administration (VHA) annually screens outpatients for UAU with the validated Alcohol Use Disorders Identification Test Consumption (AUDIT-C). Methods: Using national VHA data we retrospectively identified patients administered upfront radiation with concurrent systemic therapy (chemo- and/or immuno- therapy) for stage III-IVb HNSCC diagnosed 2008 –2017 and included males with a prior-year AUDIT-C. Regression models were fit to assess associations between AUDIT-C risk groups [low-level use (score 1-3), moderate UAU (4-7), severe UAU (≥ 8)] and treatment toxicity. Models were adjusted for a priori defined covariates including smoking and variables related to demographics, comorbidities, and cancer diagnosis and treatment. Results: Among 3,094 patients, 46.7% screened positive for UAU: 23.9% with moderate UAU and 22.9% with severe UAU. Compared to patients with low-level alcohol use, those with severe UAU were younger (mean age 65 vs 67 years) and more frequently active smokers (63.4% vs 36.2%) and underweight (11.2% vs 3.5%) ( p for all comparisons < 0.05). There was no significant difference between alcohol use groups in race/ethnicity, cancer stage, or systemic treatment agent used. In adjusted models, severe UAU was associated with lower risk of nausea [adjusted odds ratio (AOR) 0.63, 95% CI 0.47 – 0.84], ED visits (AOR 0.79, CI 0.63 – 0.99), and hospitalizations during treatment (AOR 0.78, CI 0.62 – 0.98). UAU was not associated with a composite measure of complications of infection or organ damage (AOR 0.94, CI 0.74 – 1.20), severe weight loss (AOR 0.83, CI 0.66 – 1.05), or mortality within 100 days of completing treatment (AOR 1.01, CI 0.62 – 1.66). Conclusions: In this large cohort of male patients in the VHA treated for locoregionally advanced HNSCC with concurrent chemoradiation, moderate and severe UAU is common. UAU is not associated with increased toxicity of treatment, and future research is required to define its place in treatment selection, supportive care, and counseling.
Impact of systemic treatment associated to radiotherapy on quality of life in locally advanced head and neck cancer patients in Brazil: Prospective real-world data study.
Authors: Santos Marcos Antonio , Oliveira e Silva Luis Felipe , Kohler Hugo Fontan , Curioni Otavio , Vilela Ricardo Alencar , Fang Marcel , Lima Carmen Silvia Passos , Gomes João Pedro Perez , Chaves Aline Lauda Freitas , Pulido Jose Zago , Trindade Karine , Araujo Mauricio C. , Obst Fernando , Brollo Janaina , Ferreira Ediane , Kowalski Luiz Paulo , Domenge Christian 
Published: May 2019

e17563 Background: the purpose of this study was to compare quality of life (QoL) and overall survival (OS) in patients with locally advanced head and neck cancer treated with radiotherapy only (RT), chemoradiotherapy with cisplatin (CT-RT) or RT with cetuximab (CET-RT). Methods: in this real-world, multi-institutional and prospective study, QoL outcomes were assessed using EORTC QLQ-C30 and QLQ-H&N43 questionnaires. Patients were treated according to each participating institution’s protocol. The Item Response Theory was used to generate a global QoL score, based on the 71 questions of both forms. Questionnaires were completed before treatment and every three months, thereafter. Survival was calculated using the Kaplan-Meyer method, and groups were compared by the log-rank test. The impact of the treatment modalities on QoL was analyzed using multivariate regression analyses. Results: Six hundred and twenty-six patients, with tumors located at the oral cavity (36%), oropharynx (30%), larynx (21%), hypopharynx (9%) and nasopharynx (4%) were included. Median follow up was 10.2 months. RT was delivered to 39% of the patients while 58% received CT-RT and 3% received CET-RT. Patients submitted to surgery were not included. OS was higher when systemic treatment was added to RT (median OS CET-RT: 21.9 months and CT-RT: 24.3 months, versus 14.2 months with RT, p < 0.05). A decrease in QoL during treatment was observed in all patients’ groups, but CT-RT had a statistically significant negative impact on QoL when compared to CET-RT (p = 0.02). An important limitation of the study is the low number of patients that received this last treatment modality, what is, probably, a result of local policies on reimbursement. Other factors that influenced QoL were alcohol consumption (better QoL for patients with no history of chronic alcohol consumption, p = 0.007) and radiotherapy technique (better QoL for patients treated with intensity-modulated RT, when compared to conformal RT, p < 0.001). Conclusions: We observed, as expected, better OS with systemic therapy, when associated to RT. A decrease in QoL was detected, as well, during treatment, but a less pronounced decrease was seen in patients receiving CET-RT, when compared to CT-RT. More studies are needed to confirm the QoL improvement in patients submitted to this last treatment approach.
Single institution preliminary analysis of geriatric head and neck squamous carcinomas treated with modulated radiotherapy.
Authors: Basu Trinanjan , Karpe Ashay , Kendre Pradip , Bhaskar Pradeep , Sharnanghat Vijay , Gawde Sachin , Kasat Amrita , Raina Priyanka , Behera Neelam 
Published: May 2019

e17566 Background: Geriatric head and neck squamous carcinomas (GHNC) treatment remains challenging due to multiple patient and treatment related factors. We analysed preliminary data for fifty HNC patients beyond 70 years of age treated by modulated radiotherapy (MRT). Methods: There were 50 patients (M:46,F:4) with median age of 78 years (70-96) treated by MRT at our centre. They were analysed for efficacy and acute side effects. Besides demographic and disease related parameters compliance to treatment, rate of hospitalisation, dependency of WHO ladder 3 analgesia and early clinico-radiological outcomes were analysed. Results: The median follow up was 10 months. 65% patients were locally advanced stage and 65% received radical MRT. For radical MRT the dose ranged between 66-70 Gy in 30-33 fractions and 5 patients received palliative MRT. 83% completed intended treatment with 30% had MRT interruptions. 48% patients required hospitalisation. 60% had comorbidities with 35% two or more types. 3 patients had concurrent chemotherapy and 48% had hospitalisation and 60% had feeding tubes.65% and 30% had post MRT endoscopic evaluation and imaging respectively. Among them 80% are loco-regionally controlled. 30% patients are long term (more than 3 months) tube dependent and morphine dependent. There were 5 deaths while on MRT both due to associated cardiac and pulmonary comorbidities. 40% and 65% of palliative and radical MRT patients respectively had complete response post MRT. All patients underwent psychological counselling and dietician evaluation. The median G8 screening score was 15. Conclusions: GHNC are a unique group with its own challenge. In specialised setting and with MRT treatment compliance and effective outcome is highly promising. Non disease related concerns like alteration in daily quality of life (QOL), social engagement related issues, age related dementia and end of life care emerged as prominent issues beyond disease control.
Factors associated with non-completion of radiation therapy (RT) or radiochemotherapy (RTCT) in head and neck squamous cell carcinoma (HNSCC): A prospective study.
Authors: Clatot Florian , Lebret Lucie , Rigal Olivier , Lefebvre Laureline , Dandoy Simon , Cabourg Marine , Moldovan Cristian , Veresezan Ovidiu , Thery Jean Christophe , Petrau Camille , Lebreton Mathilde , Guérault Fanny , Ebran Mélanie , Gouley-Toutain Céline , Bon-Mardion Nicolas , Bastit Vianney , Di Fiore Frédéric , Dubray Bernard M. , Lequesne Justine , Thureau Sébastien 
Published: May 2019

e17568 Background: Although numerous factors have been reported to increase RT/RTCT toxicity, identification of patients with high risk of toxicities is lacking. Methods: The monocentric NutriNeck study (NCT02900963) recruited all HNSCC patients between 2014 and 2018 treated by RT or RTCT. Patients fed by enteral nutrition before RT initiation were excluded. All clinical and biological, planned RT or RTCT parameters were collected at baseline. A daily monitoring of the weight and a weekly evaluation of clinical, biological and food intake during RT/RTCT were performed. A nutritional intervention by enteral feeding was systematically proposed in case of 2 kg weight loss under treatment. Complete treatment was defined as full planned RT doses without more than 3 days interruption, and full planned doses of cisplatin and cetuximab if indicated. Primary endpoint assessed factors associated with non-completion of the planned treatment. Secondary endpoint assessed factors associated with use of enteral nutrition during treatment. A p value < 0.01 was considered significant. Results: Among the 249 HNSCC patients included, 118 (47%) were treated by RT and 131 (53%) by RTCT. 63 patients (25%) did not complete treatment: 3/118 (2.5%) in the RT group compared to 60/131 (45.8%) the RTCT group, p < 0.0001. Median weight lost during treatment (7 vs 3.8 kg, p < 0.0001) and grade 3 toxicities (53 vs 33%, p = 0.006) were more frequent in patients with incomplete RT/RTCT. Nutritional intervention was performed in 111 patients: 28 (23.7%) with RT and 83 (62.6%) with RTCT (p < 0.0001). Week 4 was associated with the higher rate of enteral nutrition initiation in both RT and RTCT groups. Among RTCT group, weight loss during treatment (OR 1.2 for each kg, p < 0.0001) and use of enteral feeding (OR 2.7, p = 0.005) were associated with incomplete treatment in multivariate analysis. Of note, 48 patients refused enteral nutrition while indicated, they had comparable grade 3 toxicities and weight loss during treatment compared to the 111 patients who accepted enteral nutrition. Conclusions: Incomplete treatment is overwhelmingly associated with RTCT rather than RT. Baseline clinical, biological features or treatment volume/dose are not associated with incomplete treatment. Enteral nutrition initiated during treatment is poorly efficient.
Incidence of severe late toxicities of head and neck squamous cell cancer (HNSCC) treatment in the era of intensity modulated radiotherapy (IMRT).
Authors: Eziokwu Akaolisa Samuel , Koyfman Shlomo A. , Reddy Chandana A. , Matia Brian , Woody Neil McIver , Joshi Nikhil Purushottam , Burkey Brian B. , Scharpf Joseph , Lamarre Eric , Prendes Brandon , Lorenz Robert , Ku Jamie , Adelstein David J. , Geiger Jessica Lyn 
Published: May 2019

e17570 Background: IMRT for HNSCC limits exposure to critical nearby structures thereby reducing toxicities. Real world data on toxicities after long term follow-up post IMRT for HNSCC are lacking. This study assessed the incidence of late toxicities in patients with HNSCC within 5 years post-treatment with definitive IMRT (d-IMRT). Methods: This is a retrospective, IRB approved, single-institution review of patients (pts) with stage I-IVB HNSCC treated with d-IMRT +/- chemotherapy between 2009 and 2013. The primary outcomes were incidence of severe late toxicities (dysphagia requiring esophageal stricture dilation, physician-reported grade 2 or worse neck fibrosis and xerostomia) occurring 3 months or more after completion of IMRT; feeding tube (FT) dependence within 1st year of IMRT completion, and FT dependence beyond 1st year post IMRT. Toxicities were deemed acute if they occurred during IMRT and up to 90 days post IMRT. Results: 274 pts, median age 59 years (38 – 82.9), were identified. 67.6% were HPV positive, 10.5% HPV negative and HPV status was unknown in 21.9%. Site of disease was oropharynx in 70%, larynx in 25% and hypopharynx in 4%. 206 pts (75.2%) received d-IMRT alone, 37 (13.5%) had definitive concurrent chemoradiation – mostly with cisplatin (58%), and 31 (11.3%) received adjuvant IMRT. Of the 243 pts treated with d-IMRT +/- chemotherapy, 80 (32.9%) required FT during RT due to grade 2 or worse acute dysphagia. Excluding 11 pts with disease recurrence or new HNSCC diagnosis, FT dependence at any time from 3 months to one year post IMRT occurred in 22 of 232 pts (9.48%), while FT dependence beyond 1st year post IMRT occurred in 8 pts (3.4%). 11 pts (4.7%) required stricture dilation for late dysphagia. Late grade 2 or worse fibrosis and xerostomia occurred in 7 (3.0%) and 89 (38.4%) pts, respectively. Conclusions: Our study suggests that except for xerostomia, severe late toxicities after definitive IMRT for HNSCC is likely uncommon. Prospective studies with late IMRT toxicities and their impact on quality of life (QoL) as endpoints are warranted.
Satisfaction survey from an innovative cancer care delivery model (Pendharkar model), creating access at scale: An outcome research.
Authors: Tripathi Chandramauli , Pendharkar Dinesh , Saitya Bhure Singh 
Published: May 2019

e18002 Background: With the aim of empowering alternate oncology workforce, to resolve the issue of access, a unique cancer care delivery model (Pendharkar model) was launched in 4 states of India, spread across 125 districts with population coverage of around 210 million. The model has established nodal cancer units in every government run district hospital and created a point of contact for cancer- a physician-medical officer. Hundreds of patients have been seen by these hospital in last four years. The aim of this analysis was to survey the patient population attending and their satisfaction level. Methods: An elaborate survey was conducted amongst patients coming to district hospital. It sought information on satisfaction, choices. The written responses were sought, and data analysed. Results: Overall.186 patients were surveyed. Nearly 62 % of the patients had visited hospital multiple times before. Referral pattern showed that about 7 % of the patients were referred by other patients who were treated here, 62 % of the patients were referred by other medical professional, including nearby cancer hospitals and specialists. More than half of the patients (54.1) had taken cancer treatment outside district hospital, at some point of time. On question of comparison of service 65 % felt services to be better in government run setup, the time to start of therapy was much faster (74%).The time given by the doctor to the patient was satisfactory, highly appreciated by 97% of the respondents. Ease of accessibility of the staff was positively accepted by 100 %. All were happy with the level of communication by the doctors and nursing staff. Chemotherapy experience was better in district hospital set up for 58 % of the patients. More than 95% rated nursing services of high quality and all were happy with the behaviour of nurses. 80% were interested in continuing chemotherapy in same government hospital. Majority said that they are happy with their decision of taking chemotherapy in district hospital and would definitely refer other patients here. Conclusions: The survey strongly favours the model of empowerment of alternate oncology workforce in government run district hospital, and achieves high level of satisfaction amongst cancer patients.
Patients’ perspectives and outcomes on an oral chemotherapy education and electronic monitoring program.
Authors: Tocci Noah Xavier , Doolin Jim , Roberts Daniel Aaron , Cibotti Christina , Hartwell Rebekah A , Espiritu Jennifer , Devlin Scott M , Dowling Holly , Trillo Kelsey , Yenulevich Mary , Zerillo Jessica A. , Shea Meghan 
Published: May 2019

e18007 Background: Patients on oral chemotherapy (OC) often lack consistent education and monitoring, risking toxicity and poor adherence. We developed an OC management program including education and an online tool for active outreach. Methods: In November 2017, we initiated pharmacist-led education for patients newly prescribed OC at a community practice and in the gastrointestinal oncology group at an academic medical center (AMC). An online tool assessing adherence, symptoms, and financial toxicity was emailed to patients three days after starting OC. Non-responders were contacted for phone interviews. A random sample of 28 patients newly started on OC at both sites before the intervention in 2017 was analyzed at baseline. A retrospective chart analysis was done to collect time to symptom assessment, identification and action. A report generated date of first emergency department (ED) visit or hospitalization within the AMC. We conducted a Mann Whitney U-Test, using a one-sided p value of 0.025 with Bonferroni correction. Results: Sixty-nine of 106 eligible patients (66%) received education, of whom 36 (52.1%) received the online tool, and 13 (36.1%) responded. There was a significant difference between the intervention and baseline median times to first new/worsening symptoms (p = 0.0105) but otherwise there were no outcome improvements. Eight of 23 patients who did not respond to the electronic tool were interviewed and indicated that their illness impeded their ability to check email (n = 2), and that they never check email (n = 2). Conclusions: This OC management program improved time to detect new/worsening symptoms and could potentially improve outcomes after further patient accrual. Future investigation should examine ways to improve patient responsiveness to electronic patient-reported symptom tools. [Table: see text]
Association between the variation in hospital beds and inpatient chemo/radiotherapy for breast cancer: A retrospective study using the Japanese Diagnosis Procedure Combination database of over 500K records.
Authors: Ogiya Rin , Matsumoto Haruki , Matsuda Shinya 
Published: May 2019

e18008 Background: Chemo/radiotherapy for breast cancer patients does not require hospitalization in most cases. We investigated the relationship between the proportion of hospitalization for chemo/radiotherapy over total hospitalization among breast cancer cases (inpatient chemo/radiotherapy rate) and the number of hospital beds per capita using the national database in Japan. Methods: We conducted a retrospective observational study using Diagnosis Procedure Combination (DPC) database and National survey database from April 2012 to March 2016. We aggregated hospital-level data into prefecture-level data and classified the 47 prefectures into quintiles based on the number of hospital beds per capita (9-10 prefectures per quintile). Generalized estimating equations (GEE) were used for examining the relationship between the number of hospital beds and inpatient chemo/radiotherapy rate (discretionary setting) or the number of surgical operations (imperative setting). Results: Over the five-year study period, there were 561,165 records for hospitalization for breast cancer cases. The inpatient chemo/radiotherapy rate at each prefecture varied, ranging from 2.6% to 61.8% in 2016. The inpatient chemo/radiotherapy rate was significantly higher in the second highest and the highest quintile by 11.7% (95% CI 4.0-19.5%, P = 0.003) and 9.6% (95% CI 1.8-17.4%, P = 0.015), respectively, compared with the middle quintile. There was no significant difference between the lowest, second lowest and middle quintile. On the contrary, there was no significant difference in the number of surgical operations for breast cancer per capita between each quintile and middle quintile. Conclusions: We found that higher hospital beds associated with more chemo/radiotherapy in the inpatient setting. This study is a starting point for the discussion on the employment support for people with cancer and the economical utilization of the limited medical resource in the oncology field. The further studies evaluating the association between health resource and the other type of procedures are warranted.
Feasibility of mobile-deployed care management based on standardized ePRO and computer-interpretable-guideline engine for lymphoma patients.
Authors: Zhang Tingting , Song Yuqin , Ying Zhi Tao , Ping Lingyan , Zhang Chen , Xie Yan , Liu Weiping , Lin Ningjing , Tu Meifeng , Deng Lijuan , Hong Lingling , Zhu Jun 
Published: May 2019

e18010 Background: To effectively assist lymphoma patients and their care-givers after their hospital discharge, a standard follow-up guideline for lymphoma patients was designed and encoded through a computer-interpret-able-guideline (CiG) engine and deployed through mobile-Web and mobile-Apps to ensure continuous care throughout the treatment and recovery processes. Methods: Scheduled tasks including ePRO questionnaires and requests for test results were sent for completion, and a virtual care management team was assigned to ensure compliance and respond to automatic triggered alerts. Attending oncologists also were given mobile-Apps to access the patients’ securely uploaded records and consult remotely to manage side-effects manifested after discharge. The out-of-hospital record management and care coordination enabled the adjustment of individual treatment plans and the optimization of clinical resources utilization. Results: During 2018, 1012 patients or their caregivers interacted with our team through the mobile platform after discharge. Out of these, 856 individual patients uploaded enough information to be initiated in the mobile follow-up program. Approximately 30% of these patients were Beijing residents while the rest came from all over China. Close to half of these patients had follow-up tests done in other 387 hospitals or 52 clinics. Based on ePRO questionnaires submitted, 218 patients had 616 side-effect-symptom alerts triggered and followed up, in addition to patient-initiated mobile consultation with their attending oncologists. Lab results especially white blood cell counts, platelet counts, and neutrophil counts, contributed to the majority of test alerts managed by our team. Analysis of the thousands anonymized questions identified clinical processes in need of optimization. A new patient education manual addressing frequently asked questions, and new processes such as chemo-regime scheduling were put in place. Conclusions: We have demonstrated the feasibility of a mobile-deployed care management process after discharge for lymphoma patients and their caregivers. We have initiated retrospective studies of impacts on our patients’ treatment compliance and quality of life. A randomized clinical trial in six cancer types assessing the value of such an approach is also under planning.