bluuebunny/crossref_metadata_2025_split huggingface dataset:
What do doctors value about attending multi-disciplinary cancer case discussions?
Authors: Mitchell Paul , Soon Jennifer , Kenny Joanne , Simons Katherine 
Published: May 2019

e18324 Background: Discussion of cancer cases at multi-disciplinary meetings (MDMs) for treatment planning is expected standard care in Australia. There has been rapid uptake of MDMs in the last 10 - 15 years and in the state of Victoria approximately 70% of cancer cases are discussed. MDMs have strong support from medical staff and we investigated their motivation in attending MDMs. Methods: Over 12 months, Austin Health in Melbourne, Victoria, hosted 452 cancer MDMs discussing 5943 patients. MDMs covered 15 tumour areas: 11 solid tumour, one lymphoma and three haematological. Over a 4-week period, medical staff attending MDMs were surveyed and asked to rank what they valued most about cancer MDMs, over and above the benefits for patients. Results: Responses were received from 84% of the 285 medical staff surveyed, which included consultants as well as trainees (registrars and fellows). For 75% of respondents the highest ranking was given to multi-disciplinary communication, 9% gave the highest ranking to quality assurance and governance, 5% ongoing learning for consultants, 5% collegiate relationships, 2% learning and teaching for non-consultant staff, 2% peer support 1% job satisfaction and 1% clinical trials engagement. Similar results were obtained for consultant staff and for registrars / fellows. For consultant medical staff, if multidisciplinary communication was excluded, 44% of respondents gave the highest ranking to quality assurance and governance, 23% to collegiate relationships, 20% ongoing learning for consultants, 10% peer support and 3% clinical trials engagement. Conclusions: When we asked doctors what they valued most about attending cancer MDMs, besides the benefits for patients, communication between disciplines was clearly the most valued aspect. The benefits for quality and governance was the next most valued, then collegiate relationships and peer support, and ongoing learning.
Diagnostic utility of tele-cystoscopy for bladder cancer surveillance.
Authors: Beller Haerin Lee , Mills James , Mason Jennifer , Horton Bethany J. , Jones Randy A. , Corey Thomas , Sims Terran , Schenkman Noah S. , Krupski Tracey Lynn 
Published: May 2019

e18335 Background: Urology workforce shortage in rural areas limits access to surveillance cystoscopy for bladder cancer. Tele-cystoscopy is a novel solution whereby an advanced practice provider (APP) performs cystoscopy at a satellite location with real-time interpretation and guidance by an off-site urologist via transmitted video. We hypothesized that tele-cystoscopy videos would be comparable to traditional cystoscopy videos in diagnostic utility. Methods: Our IRB approved tele-cystoscopy protocol utilizes a dual-cystoscopy model. Two sequential cystoscopies are performed first by an APP with off-site urologist guidance (tele-cystoscopy) then by a urologist onsite (traditional cystoscopy) without removal of the cystoscope from the urethra. Both cystoscopies are video-captured. Twelve de-identified videos were reviewed via electronic survey (Qualtrics) by board-certified urologists who were blinded as to whom performed the cystoscopy. Survey questions centered on completeness of exam and diagnostic level of suspicion. A random effects logistic regression model was used to account for multiple reviews of the same video. Results: Diagnostic utility, defined as visibility sufficient for diagnosis, was 83% for both tele-cystoscopy and traditional cystoscopy. There were no statistically significant differences in completeness of exam between the two techniques (tele 83.3%, traditional 91.7%, p = 0.308). When asked about action taken based on cystoscopic findings, reviewers recommended action other than planned surveillance (i.e., biopsy, operative resection, etc.) for 58.3% of tele-cystoscopy videos vs. 66.7% for traditional cystoscopy videos (p = 0.300). Conclusions: Tele-cystoscopy provides high quality bladder surveillance with diagnostic capacity comparable to that of traditional cystoscopy. These results support continued expansion of the tele-cystoscopy platform as a means to amplify the care provided by a single urologist. [Table: see text]
Fear of receiving less effective care: A barrier to effective cancer care cost communication.
Authors: Kang Sokbom , Yu Yelee 
Published: May 2019

e18339 Background: Increasing financial burden in cancer care promoted cost communication as an intervention to the problem. We explored patients’ attitudes and concerns for the physician-patient communication of the costs of cancer care. Methods: From an oncology outpatient clinic, patients were recruited and interviewed using a 29-item questionnaire. The questionnaire includes basic and financial characteristics, attitudes toward cost-communication, and experience of cost-communication with oncologists. Results: Among 292 patients with gynecologic cancer, 68% were found to have an income below the nation’s average households income. Although the majority (81%) of patients have a positive attitude toward patient-physician cancer care cost-communication, however, only 19% of them wanted to discuss the cost with their physicians - 33% of them did not want to disclose their financial status to health care providers and 48% wanted to discuss the cost with other providers than their physicians. In addition, while 87% preferred to be informed about costs for various treatment options, 86% of them did not want to receive cost-effective treatment and preferred to receive the most effective treatment regardless of their financial status. Compared with non-cancer patients (n = 83), significantly more patients had a negative attitude to disclosing their financial status especially to their physician (22% vs. 11%, P = 0.024). Conclusions: A considerable proportion of cancer patients had concerns that cost communication with their physician may interfere with their opportunity to access the best care options. To facilitate cost communication, oncologists should understand such concerns and making a thoughtful effort to relieve the concern during cost communication.
Treatment patterns, survival rate, and Parts A and B costs by line of therapy for FDA-approved/NCCN Category 1 treatments for patients with metastatic pancreatic cancer.
Authors: Muldoon L. Daniel , Hirsch Jared , Dieguez Gabriela , Cockrum Paul 
Published: May 2019

e18357 Background: There is currently limited real-world evidence regarding metastatic pancreatic cancer (m-PANC) FDA-approved/NCCN Category 1 treatment patterns, resource utilization, and survival rate. We analyzed these outcomes in the Medicare fee-for-service (FFS) population by chemotherapy regimen and line of therapy (LOT). Methods: We identified patients with m-PANC using ICD-9/10 diagnosis codes in the 2013-2017 Medicare 100% Limited Data Set claims, which include all Medicare paid FFS claims, except professional services, for 45 million Medicare FFS beneficiaries. We studied mean costs and survival rate by regimen and LOT. Patients in our study had two or more claims with a pancreatic cancer (PANC) diagnosis more than 30 days apart and one or more claims with a secondary malignancy (metastasis) diagnosis on or after the first PANC diagnosis date. We defined index date as the earliest metastasis diagnosis date. We excluded patients with pre-index non-PANC malignancies and those without six months pre-index and three months (or until death, if earlier) post-index Medicare FFS enrollment. LOTs were assigned based on therapies used. LOTs ended the day before a new chemotherapy began, 28 days after the last chemotherapy (if no new chemotherapy), or upon death. Results: Gemcitabine monotherapy, gemcitabine/nab-paclitaxel, and FOLFIRINOX were most commonly used as first line (1L) therapy (91%, 80%, and 80%, respectively). Mean total Parts A and B (excluding professional) cost for 1L gemcitabine monotherapy was lower than gemcitabine/nab-paclitaxel or FOLFIRINOX ($14,601, $32,447, and $33,628, respectively), but FOLFIRINOX had a higher 90-day survival rate (86%) than gemcitabine-based regimens (76-79%). Liposomal irinotecan was most commonly used in second and third lines (2L, 3L) (54% and 28%, respectively); 97% of these patients previously received gemcitabine, consistent with approved labeling. Despite disease progression, 2L and 3L liposomal irinotecan had similar costs ($36,350 and $35,010, respectively) to 1L gemcitabine/nab-paclitaxel and FOLFIRINOX. As expected, 2L and 3L liposomal irinotecan 90-day survival rates were lower (68% and 73%, respectively). Conclusions: Mean total Parts A and B (excluding professional) costs for common 1L-3L regimens varied from less than $15,000 to greater than $30,000. 90-day survival rates for common regimens varied between 1L (86%) to 3L (68%).
Predictors of financial toxicity among head and neck cancer patients: A prospective cohort study.
Authors: de Almeida John R. , Hueniken Katrina , Eng Lawson , Giuliani Meredith , Ringash Jolie , Hansen Aaron Richard , Liu Geoffrey , Xu Wei , Li Madeline , Goldstein David Paul 
Published: May 2019

e18361 Background: Treatment of Head and Neck Cancer (HNC) is associated with significant costs and treatment morbidity. The impact of treatment on financial well-being has not been investigated. Methods: Patients with HNC treated at Princess Margaret Cancer Centre, Canada between 2014 and 2018 were enrolled in a longitudinal study from treatment up to 24 months of follow up. Participants completed questionnaires for demographics, out-of-pocket cost during treatment and at 3, 6, 12, 24 months, and the Financial Toxicity Index (FTI) at 12 and 24 months. The FTI is a 14 item, Likert response scale, with summary score out of 14, and higher scores indicating greater toxicity. Preliminary reliability, validity, and responsiveness for the FTI are very good and ongoing. Uni- and multi-variable analyses (UVA, MVA) were performed to identify predictors for FTI score. Results: Among 363 patients enrolled, average age was 61, 76% male, 81% Caucasian, 72% married, 84% living with others, 53% at least college educated, 57% currently unemployed and 59% had stage IV disease. Median pre-treatment household income was $85K, median lost household income was $15K over 12 months following treatment. At least some difficulty paying for food (14%), housing (17%), or medications (11%) was experienced; 13% had to borrow money and 5% had to relocate housing due to financial pressures. Predictors of greater FTI scores on MVA were younger age (p < 0.001), living alone (p = 0.009), and lower baseline household income (p < 0.001). In subgroup analysis of patients with available information, lost household income (p < 0.001) but not out of pocket costs (p = 0.58) was associated with higher FTI score. Conclusions: Financial toxicity is not uncommon in patients with HNC. Younger age, lower baseline income, living alone, and loss of household income are associated with financial toxicity. This should be a priority population for research into improved supportive care and return to work strategies.
Economic impact of post-progression treatment in gastroenteropancreatic neuroendocrine tumor (GEP-NET) patients previously treated with octreotide monotherapy.
Authors: Ray David , Zivkovic Marko , Gargano Michael , Soares Heloisa P. 
Published: May 2019

e18366 Background: For unresectable, well-differentiated, advanced GEP-NET patients somatostatin analogs octreotide LAR (OCT) and lanreotide depot (LAN) are recommended as first-line systemic therapy. Recent evidence suggests that GEP-NET patients may benefit from LAN after OCT prior to modifying treatment class. The goal of this analysis is to quantify treatment escalation costs among patients who progress on OCT. Methods: A decision-tree model was used to assess the cost of treating GEP-NET patients over a 6-month time horizon after they progress on OCT. Drug acquisition (Wholesale Acquisition Costs), administration, grade 3/4 adverse event (AE) management, and patient monitoring costs were considered. Patients could utilize either OCT escalation (30 mg every 3 weeks or 40 or 60 mg every 4 weeks), OCT + peptide receptor radionuclide therapy (PRRT), OCT + liver directed therapy (e.g. transarterial chemoembolization (TACE)), everolimus, or LAN 120mg every 4 weeks. Administration and monitoring test costs were based on CMS physician and laboratory fee schedules, respectively. AE management costs were determined from the CMS Inpatient prospective payment system based on reimbursements corresponding to the associated DRG codes. Results: LAN ($44,462) was found to be cost-saving versus alternatives when used post-OCT. OCT escalations to 30mg every 3 weeks, 40mg every 4 weeks, and its use with liver directed therapy were 2nd, 3rd, and 4th lowest cost treatment options ($52,873, $53,041, and $72,152, respectively); all three had higher drug acquisition and AE management costs. Drug acquisition costs for everolimus were more than twice those of LAN and for PRRT + OCT nearly 4 times that amount. GA-68 Dotatate PET/CT imaging greatly increased the monitoring costs of PRRT + OCT, which were $3,682 higher than the nearest alternative. Conclusions: LAN was the lowest cost treatment option over a 6-month interval for GEP-NET patients who progressed on OCT, however clinical appropriateness must be considered when transitioning patients. Evidence for the appropriate clinical strategy of sequencing of patients is still needed.
A novel algorithm to redefine blood-based tumor mutational burden for optimized prediction of clinical benefits from immunotherapy.
Authors: Wang Zhijie , Wang Guoqiang , Duan Jianchun , Zhao Jing , Zhao Zhengyi , Bai Hua , Wang Shuhang , Cai Shangli , Wang Jie 
Published: May 2019

e20514 Background: The previous reported predictive biomarker, blood-based tumor mutational burden (bTMB) can only predict progression-free survival (PFS) while failed to predict overall survival (OS) from atezolizumab over docetaxel, or to predict PFS or OS in the atezolizumab arm. Here we aimed to explore the underlying mechanism and develop an algorithm to redefine bTMB as a predictor of both PFS and OS from immunotherapy. Methods: Data from POPLAR (N = 211) and OAK (N = 642) trials was used for algorithm development in bTMB redefinition. The derived algorithm was validated in two independent NSCLC cohorts (cohort 1 N = 64; cohort 2 N = 184). Results: In POPLAR and OAK cohorts, bTMB-H was not associated with favorable OS (P = 0.68, HR 1.06; 95% CI, 0.81-1.38) from immunotherapy at the reported cut-point of 16, which was validated in our independent cohort 1 (P = 0.86, HR 0.39; 95% CI, 0.39-1.89). Further analysis showed that blood TMB was associated with maximum somatic allele frequency (Pearson r = 0.47 in POPLAR and OAK cohorts, Pearson r = 0.36 in the independent cohort 2), which was a negative prognostic factor and may impede the predictive value of bTMB. The bTMB was thus redefined (referred to as bTMB*) with mutations with allele frequency > 5% filtered out, when the correlation between bTMB and MSAF became less correlated (Pearson r = 0.09 and 0.07, respectively). Both better PFS and OS benefits from atezolizumab over docetaxel was observed in the redefined bTMB-H group as tested in POPLAR (PFS HR = 0.41, 95% CI, 0.21-0.80; OS HR = 0.34, 95% CI, 0.16-0.71) and validated in OAK (PFS HR = 0.49, 95% CI, 0.33-0.71; OS HR = 0.47, 95% CI, 0.29-0.77) with the cut-point of 12, while there was no significant association in redefined bTMB-L group (P interaction = 0.01 and 0.04 for PFS and OS in POPALR, < 0.001 and 0.06 for OAK PFS and OS in OAK). The results was further validated in our independent cohort 1 treated with anti-PD-1/PD-L1, where the redefined bTMB-H was also associated with favorable PFS compared with bTMB-L (Logrank P = 0.005, HR = 0.34, 95% CI, 0.26-0.75) and OS (Logrank P = 0.08, HR 0.35, 95% CI, 0.11-1.18). Conclusions: The allele frequency needs to be taken into consideration in the algorithm of bTMB. The redefined bTMB may serve as a predictor of both PFS and OS of immunotherapy.
The efficacy and safety of extended use of endostatin plus platinum-based doublet chemotherapy in patients with advanced non-small cell lung cancer: An analysis of a 10-year retrospective study.
Authors: Zhao Jing , Wang Jianhua , Zhao Xueqi , Cheng Yi , Xi Qingsong , Mei Qi , Hu Guangyuan 
Published: May 2019

e20523 Background: Endostatin is a potent inhibitor of angiogenesis developed and approved in China. We aimed to evaluated the efficacy and safety of extended use of endostatin with platinum-based chemotherapy for advanced non-small cell lung cancer (NSCLC) in this study. Methods: We performed a retrospective analysis of chemotherapy-naïve patient with stage IIIB-IV or recurrent NSCLC who had been treated with first-line chemotherapy plus endostatin between January 2008 and June 2018. The primary endpoints were progression-free survival (PFS) and overall survival (OS). The Cox proportional hazards regression model was used to assess the prognostic importance of risk factors (age, gender, smoking status, ECOG performance status, stage, histology, EGFR gene status and endostatin cycles). Results: A total of 105 patients were eligible for analysis. The median (range) cycles of chemotherapy with endostatin were 4 (2-19). The objective response rate and disease control rate were 45.1% and 87.3%, respectively. Under multivariate analysis, non-smoking status and extended use of endostatin (≥4 cycles) were significantly correlated with better PFS, and squamous cell cancer and extended use of endostatin (≥4 cycles) were significantly correlated with better OS. The median (95% CI) PFS and OS for patients with extended use of endostatin (≥4 cycles) or not were 8.2 (5.6-12.7) vs. 5.3 (2.8-7.3) months, HR = 0.63, p= 0.014, and 21.2 (6.8-37.7) vs. 11.9 (4.1-23.9) months, HR = 0.77, p= 0.028, respectively. Patients with squamous cell cancers significantly benefited from the extended use of endostatin (≥4 cycles) (n = 55, p= 0.043) but not adenocarcinoma (n = 46, p= 0.089). Hematologic and gastrointestinal toxicities occurred more frequently in patients who received extended use of endostatin (≥4 cycles), but no statistically significant difference was detected in those who did not. Conclusions: In patients with advanced/recurrent NSCLC, extended use of endostatin (≥4 cycles) could provide additional survival benefits and satisfactory toxicity profiles, especially for those with squamous cell cancer, which merits further evaluation in a larger prospective study.
Rebiopsy in patients with or without prior TKIs revealed complicated histology of lung cancer.
Authors: Zhu Kuikui , Li Qianwen , Zhang Sheng , Wu Gang , Xiang Qun , Fang Zhili , Meng Rui 
Published: May 2019

e20525 Background: The important of rebiopsy is well known in lung adenocarcinomas (ADs) after acquiring resistant to TKIs, for they may transform to SCLC. But histology transformation in non-ADs or ADs without TKIs seems infrequent. Methods: We performed a retrospective collection of cases with changed histology after rebiopsy in patients presenting from January 2015 to April 2018 in a single center. Results: Among 188 patients who conducted rebiopsy, there were 20 cases presenting changed histologic type, which can be divided into two groups based on if TKIs were used before histology change. Group1 (TKIs used, N = 14) including ADs changing to SCLC (N = 9), squamous cell carcinoma (SQ) (N = 2), carcinosarcoma combined with few AD component (N = 1), SCLC combined AD (N = 1), and adenosquamous carcinoma changing to SCLC (N = 1). Four cases in group 1 went through surgery, and one of them who never smoke was diagnosed as AD (pT2N0M1a, EGFR exon 19del), with no small cell carcinoma (SCC) component found, but rebiopsy of metastasis revealed SCC without any AD component after 3 months of gefitinib. The disease continued to progress during the following chemotherapy (CT), and biopsies with other two metastases also presented SCC without AD component. Group 2 were 6 cases without TKIs before the rebiopsy (Table). Case 2, 4, 6 were all heavy smokers. Rebiopsy of case 2 was ALK+, so the patient took 4 months crizotinib and then 2 months alectinib, the disease was still stable on January 6, 2019. Case 5 was a classic extensive-stage SCLC with fast response to EP therapy, but fast relapse and resistance to the following CT, and the primary lesion at right upper lobe showed AD-like imaging, so rebiopsy was performed and carcinoma favor AD was found. EGFR exon 19del was detected in the plasma, and the lesion gain PR after one month of icotinib. The third biopsy of the progress lesion came back to SCC after resistance to TKI. Conclusions: Rebiopsy of lung cancers with or without TKIs therapy revealed diversity histology changes. This reminded us the important of rebiopsy, not only for TKIs resistant lung ADs. [Table: see text]
Myeloid immunosuppressive state as a predictor of rapidly progressive phenotype and poor survival in advanced non-small cell lung cancer (NSCLC) patients treated with PD-1/PD-L1 inhibitors.
Authors: Lau Sally CM , Le Lisa W , Chan Sze Wah Samuel , Smith Elliot Charles , Ryan Malcolm , Brown M. Catherine , Hueniken Katrina , Eng Lawson , Patel Devalben , Chen RuiQi , Zer Alona , Sung Mike Ru , Bradbury Penelope Ann , Ohashi Pamela S , Shepherd Frances A. , Tsao Ming Sound , Leighl Natasha B. , Liu Geoffrey , Sacher Adrian G. 
Published: May 2019

e20594 Background: Immune subpopulations within the tumor microenvironment (TME) play a central role in determining response to checkpoint inhibitors. Myeloid derived suppressor cells, a heterogeneous population of immature myeloid cells, have a predominantly immunosuppressive role by stimulating T regulatory cells. We hypothesize that elevated myeloid-to-lymphocyte measures in the peripheral blood predict for greater numbers of myeloid derived suppressor cells in the TME and worse outcomes. Methods: In advanced NSCLC patients who received immunotherapy between 2010-2018, baseline characteristics collected retrospectively included age, sex, histology, stage, smoking status, ethnicity, PD-L1 expression and tumor genotype. Pre-treatment neutrophil/lymphocyte (NLR) and monocyte/lymphocyte ratios (MLR) were log transformed and analyzed using cox and logistic regression models. Results: Among 219 eligible patients, a high NLR was associated with shorter time-to-treatment-failure (HR 1.38, 95%CI 1.09-1.75, p = 0.008) and poorer OS (HR 1.62, 95%CI 1.23-2.14, p < 0.001), independent of PD-L1 levels. Disproportionate increases in NLR and MLR were highly correlated (Spearman’s rho = 0.78). Further, higher NLR (p = 0.09) or MLR (p = 0.06) tended to associate with best overall response (BOR) to immunotherapy, with higher rates of progressive disease (PD) and lower rates of clinical response. A high NLR (p = 0.01) and MLR (p = 0.02) were associated with a rapidly progressive phenotype defined by PD as the BOR and duration of therapy ≤2 months. This remained significant after adjusting for confounders in a multivariate model (p = 0.03 for NLR and p = 0.03 for MLR). No associations were observed between high myeloid counts and other clinical prognostic factors such as liver metastases. Conclusions: A myeloid immunosuppressive state characterized by a disproportionate increase in peripheral immune myeloid populations is significantly associated with primary refractory disease, rapidly progressive phenotype, and poorer survival. Further investigation into myeloid mediated mechanisms of resistance is warranted.