bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of cholesterolemia and body mass index on outcome of metastatic non small cell lung cancer treated with immunotherapy.
Authors: Galli Giulia , Corsetto Paola , Ferrara Roberto , Prelaj Arsela , Proto Claudia , Signorelli Diego , Zilembo Nicoletta , De Toma Alessandro , Pagani Filippo , Randon Giovanni , Ganzinelli Monica , Sica Antonio , De Braud Filippo G. , Garassino Marina Chiara , Lo Russo Giuseppe 
Published: May 2019

e20691 Background: Immunotherapy (IO) is effective against metastatic Non Small Cell Lung Cancer (mNSCLC). Nonetheless, a minority of patients (pts) gains a benefit from IO and predictive variables of response are scarcely understood. Previous retrospective studies have showed a superior outcome for obese pts and preclinical data suggest a role of lipid profile. We aimed at investigating these topics in a cohort of pts with mNSCLC. Methods: We retrospectively collected data about all consecutive pts with mNSCLC treated with IO at our Institution between 12/2017 and 12/2018. Body Mass Index (BMI) was calculated as weight/height2; pts were classified as overweight if having a BMI≥25 kg/m2. Basal Cholesterolemia (BC) was dosed between one month (mo) before and one mo after the beginning of IO, with a cut-off for normality of 200 mg/dL. Survival was estimated with Kaplan-Meier method. Cox model was used for multivariate analyses. Results: We identified 55 pts. Thirty-three had a normal baseline BMI, the remaining were overweighted. Median BC was 171.5 mg/dL (range 15-313); 14 pts had hypercholesterolemia. No correlation was evident between BMI and BC ( p .1772). Neither BMI nor BC were associated to first and best response to IO. Median Progression Free Survival (PFS) was 3.75 mos; median Overall Survival (OS) was 6.78 mos. Hypercholesterolemia was related to longer PFS (9.44 vs 3.71 mos, p .0484), confirmed at multivariate analysis ( p.0392). Both hypercholesterolemia and BMI≥25 kg/m2 were associated to longer OS (15.56 vs 5.13 mos, p.0411, and 16.67 vs 4.97 mos, p.0222, respectively), but only BMI retained significance at multivariate analysis ( p .0279). Conclusions: Hypercholesterolemia shows a positive impact on outcome of mNSCLC treated with IO. The independence of this correlation from BMI suggests the existence of a true different metabolic pathways. Moreover, overweight patients have a longer OS than those with normal BMI. This result confirms previous data on obese patients, extending the range of BMI values that are linked to a better prognosis. In conclusion, the role of metabolism and body composition in defining the benefit from IO in mNSCLC is likely multifaceted, warranting further investigation.
A survey of healthcare professionals and oncology patients at the McGill University Health Centre reveals enthusiasm towards establishing a post-mortem rapid tissue donation program.
Authors: Dankner Matthew , Senecal Julien , Neubarth Noah , Bertos Nicholas , Park Morag , Issa-Chergui Badia , Asselah Jamil , Siegel Peter , Bouganim Nathaniel 
Published: May 2019

e23005 Background: In the early developmental phase of a post-mortem Rapid Tissue Donation (RTD) program for metastatic cancer patients, we surveyed health care professionals (HCPs) and oncology patients at the McGill University Health Centre (MUHC) to assess their knowledge and attitudes pertaining to RTD from metastatic cancer patients for research purposes. Methods: A 23-item survey was developed and distributed to HCPs at tumour board meetings, and a related 26-item survey was developed and distributed to oncology patients at the MUHC Cedars Cancer Centre. Results: 73 HCPs, including 37 attending physicians, and 102 oncology patients participated in the study. Despite the fact that 88% of HCPs rated their knowledge of RTD as none or limited, 42% indicated that they would feel comfortable discussing RTD with their cancer patients. 67% of HCPs indicated that their current knowledge of RTD would impact their decision to discuss such a program with patients, implying the importance of educating HCPs to facilitate enrolment of patients into an RTD program. 78% of patients indicated that they would not be uncomfortable if their doctor discussed RTD with them, and 61% indicated that they would like for their doctor to discuss RTD with them. HCPs and patients felt that the best time for patients to be approached about consenting to an RTD program is in the transition to palliative care when there are no treatment options remaining. Conclusions: HCPs and patients at the MUHC are generally enthusiastic about adopting an RTD program for metastatic cancer patients. Education of HCPs and patients will be an important determinant of the program’s success.
A retrospective analysis of elderly population with metastatic colorectal cancer treated with raltitrexed in the target therapy era.
Authors: Ugidos Lisardo , Rodriguez-Pascual Jesus , Alvarez-Gallego Rafael , Munoz Cesar , Sanz Enrique , Ceniceros Lucia , Cubillo Antonio 
Published: May 2019

e23022 Background: Raltitrexed is a antifolate chemotherapy agent with activity against metastatic colorectal cancer (mCRC). Most clinical trials with raltitrexed were performed before approval of anti-EGFR and anti-VEGF therapies. Its toxity profile suggests that might be a useful drug to treat elder patients, but there are no specific data in this population group. Methods: A retrospective review of elderly patients (70 years or older) with mCRC treated with raltitrexed monotherapy in our hospital between 2008 and 2017 was conducted. All of them had received previously oxaliplatin, irinotecan, fluoropyrimidines, and bevacizumab as standard therapy. All RAS native patients had received also anti-EGFR drugs. Results: Eighteen elder patients were reviewed, 11 (61%) male. Age ranged 70-85 years (median 78). All patients had ECOG PS 0 or 1. Locations were rectum (4), right colon (8), and left colon (6). Number of treatment lines ranged 2-5 (median 3). Three pts (16%) had received regorafenib previously. KRAS and BRAF were mutated in 61% and 5% respectively. Median number of cycles was 3 (1-13). Response rate was 11% (2 partial responses). Stable disease was achieved in 33%. Median progression-free and global survival were 2.8 (95% CI 1.2-10) and 5.9 (95% CI 1.6-18) months respectively. Grade 3-4 hematologic and non-hematologic toxicities were present in 22% and 5.5% respectively. Dose reduction was needed only in 11%. Sex, location, RAS status were not related to response or survival. Conclusions: Raltitrexed is a well tolerated option por elderly patients after standard treatment of mCRC.
The comprehensive geriatric assessment in malignancies and prognostic factors: Description of a prospective cohort of 889 Brazilian elderly cancer patients.
Authors: Telles O Lima Jurema , Viana Raissa , Rebello Mirella , Mello Maria Julia Gonçalves , Sales Letícia telles , Bergmann Anke , Cavalcanti Zilda , Thuler Luiz Claudio Santos 
Published: May 2019

e23035 Background: According to the World Health Organization (WHO), the definition of "elderly" varies according to the degree of development of the country. In Low and Medium Development Countries (LMDC), a person aged 60 or older is considered elder, opposed to developed countries (65 or older). It is in LMDC that is occurring the largest relative increase in the incidence of cancer, specially those related to aging. The Comprehensive Geriatric Assessment (CGA) is still underutilized in oncological clinical practice, especially in LMDC. Objectives: To determine predictive factors for the occurrence of early death (in the first six months of surveillance) and to perform the development and temporal validation of a practical prognostic score based on the CGA to predict early death (up to 180 days) in elderly cancer patients. Methods: A prospective cohort enrolled elderly patients ≥ 60 years with a recent cancer diagnosis admitted between 2015-2017. The CGA performed at the time of admission included the following instruments: CCI; KPS; MMSE; TUG test; IPAQ; ADL; MNA; MNA-SF; GDS15; PPS and Polypharmacy. The studied outcome was early death, defined as the one that occurred within the first six months after the diagnosis. Survival analysis (Kaplan-Meier) and Cox proportional hazard regression was performed. Results: 889 patients were included in the study, performed at a referral center in cancer of a teaching hospital in Northeastern Brazil. The independent risk factors for death identified by CGA were: Mini exam of mental state (MMSE) as a continuous variable (HR 1.04 95% CI 1.00-1.07), Geriatric depression scale (GDS-15) ≥ 10 (HR 1 , 50 IC95% 1.10-2.07), Karnofsky Functional Performance Scale (KPS) < 50 (HR 1.57 IC95% 1.02-2.42), Katz Index ≤4 (HR 2.58 IC95% 1.68-3.97) and the Mininutrition assessment (MAN-SF) < 12 (HR 2.96 IC95% 2.00-4.39), with higher risk for early death amongst patients with abnormalities detected by the scales performed at admission (log rank < 0.001). Conclusions: Comprehensive geriatric assessment is an important tool to identify fragility in elderly cancer patients. Some of its scales should be incorporated into clinical practice, as they are simple and significant prognostic markers and identify patients with a higher risk of death in the first twelve months.
Chemotherapy and trastuzumab-induced cardiotoxicity in geriatric breast cancer patients.
Authors: Agbisit Christian , Johnson Alexander , Robinson Kathy , Delfino Kristin , Desai Meghna R. 
Published: May 2019

e23043 Background: Cardiotoxicity is a known side effect of anthracyclines & trastuzumab. Dilated cardiomyopathy is the most common form of cardiotoxicity associated with this treatment. Cardiovascular disease & cancer are common conditions in the geriatric populations. These comorbidities complicate the treatment of geriatric breast cancer patients. The purpose of this study was to determine the cardiotoxic effects of chemotherapy & trastuzumab in a geriatric population of breast cancer patients. Methods: An institutional database of a total of 269 patients with histologically confirmed invasive or in-situ breast cancer with age 65 years or older at the time of diagnosis was reviewed in an IRB approved fashion. Patients were divided in groups depending on the therapy (AC/TAC, CMF, TC and Trastuzumab) they received. Fisher’s exact test was used to calculate overall survival (OS). Results: Of the 269 patients, 72 (26.8%) were offered chemotherapy & 197 (73.2%) were not. Of the patients offered chemotherapy, 58 (21.6%) accepted treatment & 14 (5.2%) declined. 17 (6.7%) had an early termination, AC n = 11,( 4.1%), TAC n = 13, (4.8%), CMF n = 0, (0%), Trastuzumab n = 12, (4.5%), TC n = 11, (4.1%). Cardiovascular risk factors taken into consideration were, CAD n = 30, (13.8%), HLD n = 23, (10.6%), HTN n = 98, (45.2%), HTN/HLD n = 66, (30.4%), DM (N = 45, (16.7%), Smoking n = 121, (46.4%) & BMI > 30, n = 116,( 48.1%). Patients completing chemotherapy had higher OS than patients who had early termination (P = 0.017). Of the 24 patients who received Anthracycline containing regimen, 1 experienced cardiotoxicity. There was no statistically significant difference in OS between AC, TAC & Trastuzumab (P = 0.570, P = 0.547, P = 0.614). A decrease in OS was seen for patient who received TC (P = 0.002). Of the 12 who received trastuzumab, 1 experienced cardiotoxicity. There was a significant association between patients with a high BMI ( > 30) & increased cardiovascular comorbidities (P = 0.0009) but had no impact early on termination of chemotherapy or OS, NS (P = 0.7). Conclusions: The cardiotoxic effect of anthracyclines and trastuzumab are well known, however in our study, only 2 elderly breast cancer patients who received chemotherapy experienced cardiotoxicity. As would be expected, those who completed chemotherapy had improved OS. There were no difference in OS between AC, TAC and Trastuzumab, however TC treatment was associated with a decrease in OS.BMI had an impact on cardiovascular comorbidities but not on early termination of chemotherapy or OS.
Lactate response during acute exercise in cancer survivors undergoing exercise rehabilitation.
Authors: Harman Nicholas , Ramani Arjun , George Benjamin Jacob , Hayward Reid 
Published: May 2019

e23047 Background: Cancerous cells express a markedly different metabolic profile characterized by lactate production even when oxygen is plentiful. Lactate accumulation is a common marker for energy production and utilization, yet it is currently unclear how blood lactate responds during acute exercise to volitional fatigue in individuals with cancer and how this response is modified with exercise-based rehabilitation. The purpose of the current study is to assess the effect of an acute exercise bout to volitional fatigue on lactate accumulation before and after an exercise-based rehabilitation program for cancer survivors. Methods: 33 cancer survivors (female, n = 18; male, n = 15) were recruited to participate in a 12-week exercise-based rehabilitation program. All participants performed an initial assessment of physiological parameters, including blood lactate accumulation (LA) during a progressive treadmill protocol to volitional fatigue. LA was quantified every 2 minutes during treadmill testing via finger stick. The exercise intervention consisted of one hour sessions, three days per week, and included cardiovascular endurance, muscular strength, balance, and flexibility exercises. After 12 weeks of rehabilitation, participants completed a follow-up evaluation of physiological parameters. Results: There was a significant increase in LA at volitional fatigue after 12 weeks of training (Initial: 6.17 ± 2.61 mM, Post 12 Weeks: 7.26 ± 2.10 mM; p = 0.04), with no significant difference in resting blood lactate. The workload at which anaerobic lactate threshold presented was significantly increased after 12 weeks (Initial: 5.87 ± 1.59 METs, Post 12 weeks: 7.35 ± 1.85 METs; p = 0.02). Conclusions: Cancer survivors respond to acute exercise to volitional fatigue in a manner similar to healthy controls. Furthermore, similar to the response observed in healthy populations, cancer survivors exhibited an increase in lactate threshold and an increase in peak lactate accumulation at volitional fatigue after completing an exercise-based rehabilitation program. Thus, although many cancerous cells have a unique glycolytic profile, this does not appear to influence training-induced adaptations in blood lactate.
Mobile text messaging to improve adjuvant hormone therapy and side effect management among breast cancer patients: A pilot RCT.
Authors: Wen Kuang-Yi , Goldstein Lori J. , Smith Rita , Miller Suzanne M. 
Published: May 2019

e23061 Background: Substantial evidence reports that adjuvant hormone therapy (AHT) decrease breast cancer (BCa) recurrence and mortality, however, many patients are nonadherent due to troublesome side effects. The goal of this pilot study is to test a novel mobile text messaging-based intervention ( TXT2Adhere) that delivers adherence-promoting and side effect coping tips messages. Methods: 58 BCa patients who were within 1 month of AHT initiation were randomized into the TXT2Adhere group (n = 29) or usual care control group (UC, n = 29). Intervention participants received a daily reminder prompt for medication uptake and two messages addressing the importance of AHT adherence and management for potential side effects for 3 months. Assessments were conducted at baseline, 1-month, 2-month, and 3-month. Results: Participants in the TXT2Adhere group reported higher AHT adherence at 2 months (93% vs. 54%, p < 0.05) but this difference between groups disappeared at 3-month as adherence rate in the TXT2Adhere group greatly declined at month 3. Increase in symptom distress at 3-month was found substantially smaller in the TXT2Adhere group than the UC group, although this difference was not statistically significant. Conclusions: Daily text messages promoting adherence and side-effect management demonstrated feasibility with better short-term adherence. Potential intervention improvement to facilitate greater participant engagement and adherence behaviors as the onset of symptoms (e.g. during month 3) needs to be considered.
Patient-reported outcomes for dental health, shoulder-neck dysfunction, and overall quality of life after treatment with radiation for head and neck cancer.
Authors: Verma Neha , Tan Xianming , Knowles Mary , Bernard Stephen A. , Chera Bhishamjit S. 
Published: May 2019

e23064 Background: The current exploratory cross-sectional study was designed to better characterize survivorship issues among patients treated with radiation for head and neck cancer with regard to dental health, shoulder-neck dysfunction, and overall quality of life. Methods: Patients (n = 58) being seen for follow-up at a radiation oncology clinic at least one year beyond the end of treatment completed three survey questionnaires: the EORTC Core Quality of Life Questionnaire (EORTC QLQ-C30), the EORTC Head and Neck module (EORTC QLQ-H&N35), and an original 18-item Dental Health and Shoulder Function questionnaire. The questionnaires were scored and univariate analyses were performed using the variables of age, radiation dosage, definitive radiation + neck dissection vs. definitive surgery + postoperative radiation, and chemotherapy. Results: Median follow-up was 2.5 years. Of patients surveyed, 35% reported having more problems with their general dental health as compared to before treatment and 38% reported having pain at night in the neck and shoulder; 79% of patients reported being counseled about their dental health prior to treatment while 31% reported being counseled about possible shoulder-neck dysfunction. Patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation reported a higher burden of functional and symptomatic issues. Conclusions: Patients treated with radiation for head and neck cancer face a number of survivorship issues, including problems with dental health and shoulder-neck dysfunction, and many do not feel that they are adequately counseled about these issues prior to treatment. Subsets of patients who may experience a higher burden of functional and symptomatic issues include patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation. Increasing pre-treatment counseling for all patients and placing a particular emphasis on supportive care for these subsets of patients may allow us to better support this growing population of cancer survivors.
Implementation of a brief screening tool to identify needs of cancer survivors.
Authors: McDonough Allison L. , Lei Yvonne Y. , Haggett Dana , Jimenez Rachel , Johnston Katherine T. , Moy Beverly , Spring Laura , Peppercorn Jeffrey M. 
Published: May 2019

e23075 Background: Innovation in health care delivery is needed to improve care for cancer survivors. We report a pragmatic study intended to evaluate our experience with adopting screening guidelines from the National Comprehensive Cancer Network (NCCN) to the routine care of breast cancer survivors in primary care and oncology follow up. Methods: We adapted the NCCN recommended screening questions into a plain language self-administered 1 page intake questionnaire. The tool was administered to a convenience sample of female breast cancer survivors in routine follow-up at an oncology or primary care clinic from September through December 2018. Domains included symptoms, lifestyle concerns, and financial issues. Frequency of concerns was assessed as “never”, “rarely”, “sometimes”, “very frequently” and “always”. We dichotomized results and evaluated feasibility of administration, prevalence of reported symptoms and qualitative assessment of burden as well as utility of the tool among participating clinicians. Results: 165 out of 169 patients offered the questionnaire participated (98%). Office staff provided the questionnaire at routine visits without notable impact on clinic flow. Most commonly endorsed concerns (sometimes or more) were: desire to improve fitness or nutrition (80%), worry about cancer recurrence (72%), and problems with sleep (57%). A majority also reported feeling nervous or worried (55%) and aches or pains in limbs or joints (55%). Several issues known to be underreported in clinic visits were endorsed including lack of satisfaction with sexual function (30% sometimes or more, 12% very often or always) and difficulty remembering things (47% sometimes or more, 13% very often or always). Among 7 participating clinicians, the tool was deemed useful and not burdensome. Several noted that it led to discussing issues that may not otherwise have been addressed. Suggestions included systematically identifying resources and strategies to address common issues and incorporating the tool into the electronic health record to increase utility. Conclusions: Screening for individual needs among survivors is feasible and efficient and may identify prevalent issues that otherwise can be missed in routine survivorship care.
Effect of temozolomide on neurogenesis and anxiety in the adult mouse brain.
Authors: Hussaini Syed , Jang Mihyeon 
Published: May 2019

e23082 Background: The hippocampus is one of two regions in the adult brain where new neurons are generated well into adulthood. Newborn neurons develop from neural stem cells, and are consequently integrated into the hippocampal circuitry to function in learning and memory. Temozolomide (TMZ) is a commonly used alkylating agent for treatment of malignant gliomas. In this study, we examine the effects of TMZ on adult neurogenesis and cognitive function in the murine model. Methods: Adult male mice (8-week-old) were injected daily with TMZ (25 mg/kg, i.p.) for 2, 2.5 and 3.5 weeks to estimate progenitor proliferation, neuronal maturation and animal behavior respectively. For progenitor proliferation, a single dose of BrdU (50mg/kg, i.p.) was injected at 2 weeks and the mice sacrificed 2 hours later. For maturation analysis, five separate doses of EdU (41.1 mg/kg, i.p.) were injected over five days starting at 2 weeks. Three weeks after first EdU injection mice were sacrificed. Both BrdU and EdU are novel thymidine analogues that label dividing cells. Immunostaining was performed on hippocampal brain slices to label progenitors at different stages of development. For behavioral analysis, daily tests measuring anxiety, memory and motor activity were started at 2 weeks into TMZ administration. Results: TMZ significantly reduced the resident radial glia-like and non-radial glia-like population (MCM2+Nestin+), as well as the overall proliferating progenitor pool (n = 2, p < 0.05). In addition, it significantly reduced the population of Type-3 neuroblasts (EdU+DCX+NeuN-) (n = 4, p < 0.05). During neuronal maturation, immature new neurons (EdU+DCX+NeuN+) and mature new neurons (EdU+DCX-NeuN+) were also reduced by TMZ (n = 4, p < 0.05). These effects of TMZ coincided with specific behavioral deficits. While TMZ had no effect on working memory and locomotor activity, mice that underwent TMZ administration showed significantly increased anxiety on the open field test (n = 7, p < 0.05). Conclusions: Our findings demonstrate TMZ significantly impairs cellular proliferation of neural stem cells and fate-committed neuroblasts, and increases anxiety with sparing of non-hippocampal-dependent memory. TMZ may thus be associated with specific deficits in hippocampal function in the adult brain, providing mechanistic insight into adverse effects that may be observed with TMZ treatment.