bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of rates of referral and systemic therapy on 1-year outcomes in metastatic NSCLC: A real-world population based study.
Authors: Fundytus Adam Michael , Fu Yunting , Shack Lorraine , Pham Truong-Minh , Cheung Winson Y. 
Published: May 2019

e18238 Background: EGFR/ALK inhibitors and immunotherapy represent promising treatments for metastatic NSCLC, but patients must be referred to a cancer center (CC) to be considered for these treatments. Local referral rates to a CC for advanced pancreatic cancer are only 51%. We hypothesized that rates of referral for stage IV NSCLC are also low, thereby affecting survival. Methods: Using linked data from the provincial cancer registry, oncology specific EMR, administrative claims and vital statistics, we identified all patients diagnosed with stage IV NSCLC from 2009 to 2016 in Alberta, Canada. Demographics, Charlson Comorbidity Index (CCI), method of diagnosis, year of diagnosis and site of metastasis were compared between patients referred vs not referred (NR) to a CC and between those who received systemic therapy (ST) vs those who did not. A multivariable piecewise constant hazard model was constructed to estimate the hazard ratio (HR) of death in the 1st year. Results: We identified 9717 stage IV NSCLC patients among whom 65.8% and 34.2% were diagnosed pre and post 2012. In this cohort, 6907 (71%) were seen at a CC. Factors which predict referral to a cancer center are: dx by cytology (OR 6.81, 95% CI: 5.99-7.75; p < 0.001) or histology (OR 6.29, 95% CI: 5.40-7.34; p < 0.001) vs radiologic dx; Age < 70 (OR 1.87, 95% CI: 1.69-2.07; p < 0.001); dx after 2012 (OR 1.52, 95% Cl 1.36-1.70; p < 0.001) and CCI≤1 (OR 1.50, 95% Cl 1.34-1.68; p < 0.001). ST was administered to 2057(21.2%). Factors that predict ST are: dx by cytology (OR 6.48, 95% CI: 5.18-8.11; p < 0.001) or histology (OR 6.35.18 , 95% CI: 5.02-8.04; p < 0.001); Age < 70 (OR 2.55, 95% Cl 2.33-2.82; p < 0.001); CCI≤1 (OR 1.56, 95% Cl 1.39-1.76; p < 0.001); dx after 2012 (OR 1.28, 95% CI: 1.16-1.41 and female gender (OR 1.18 , 95% CI: 1.07-1.29; p < 0.001; p < 0.001). Within the 1st year post dx, HR for mortality was lower both in patients referred to a CC vs NR (HR 0.3, 95%CI .28-0.31, p < 0.0001) and patients receiving ST vs no ST (HR 0.3, 95% CI .28-0.32, p < 0.0001). Conclusions: Close to 1 in 3 patients with stage IV NSCLC were not referred to a CC even though referral and receipt of ST were associated with a significantly lower risk of death in the 1st year following diagnosis. Clear delineation and wide dissemination of appropriate referral pathways are needed to improve outcomes, especially among older patients.
Meta-analysis of effect of hormone therapies on lipid levels in breast cancer patients.
Authors: Huang Hsin-Hui , Bertolet Marnie , Barinas-Mitchell Emma , Diergaarde Brenda , Chang Chung-Chou 
Published: May 2019

e18243 Background: Breast cancer (BC) patients with hormone-sensitive tumors often receive adjuvant hormone therapy for an extended period. How this affects lipid levels is not known. This study evaluated the relationship between dyslipidemia, a cardiovascular disease risk factor, and use of adjuvant hormone therapy among breast cancer patients. Methods: Randomized clinical trials for adjuvant hormone treatment in post-menopausal BC patients without residual cancer after primary treatment that reported lipid levels were identified in PubMed and EMBASE (N = 13). Bayesian network meta-analysis for longitudinal data was used to evaluate each drug’s effect on the mean changes in lipid levels from baseline. Key covariates were examined to determine heterogeneity of treatment effects; consistency of estimates was assessed using the arm-based method. Results: Toremifene improved all lipids more than any other hormone drug studied (see Table). Most aromatase inhibitors (AIs) did not significantly impact lipids. Age, baseline lipid value, and prior usage of Tamoxifen modified the drug effects on most lipids. However, these modifications do not change the overall conclusion. Conclusions: Selective estrogen receptor modulators (SERMs) are beneficial to most lipid profiles, but AIs do not have consistent impacts on lipids. Tailoring hormone drug prescriptions based on medical conditions of BC patients is recommended. [Table: see text]
Online education about lung cancer immunotherapy: Outcomes over time.
Authors: Pender Lori Keys , Kadkhoda Haleh , Lucero Katie S. , Repetto Patti , Gearhart Jacqueline 
Published: May 2019

e18249 Background: The indications and use of immune checkpoint inhibitors (ICIs) in the treatment of advanced and metastatic lung cancer have grown dramatically since the first lung cancer drug approval in 2015. The rapid pace of change can make it difficult for oncologists to stay up to date with how best to integrate these news agents into treatment paradigms. The objective of this study was to assess trends over time in oncologists’ knowledge, competence, and confidence using ICIs in the treatment of lung cancer. Methods: A series of online continuing medical education (CME) activities about the role of ICIs in lung cancer treatment was launched in April 2014; 28 included multiple-choice knowledge/competence questions and a confidence question assessed on a 5-point Likert-type scale before and immediately after the activity. Activities that had at least 30 oncologists participate pre/post are included in this analysis. A pre-/post-assessment study design was used, and educational effect was assessed with Chi-square tests. Analyses were conducted to examine trends in knowledge, competence, and confidence over four years on a quarterly basis. Weighted averages in each of the outcomes were calculated by quarter. Results: A total of 132,370 learners participated from April 2014-March 2018, including 61,761 physicians, of whom 19,439 were oncologists. The average increases pre- to post-test for knowledge- (25 activities), competence- (18 activities), and confidence-based (9 activities) questions were 16%, 12%, and 7%, respectively (P < 0.001 for all comparisons). The absolute increase in knowledge from pre-test in 2014 (41%) to post-test in 2018 (56%) was 14 percentage points; and for competence, 25% (from 28% in 2014 to 52% in 2018). The mean confidence rating pre-test in 2016 was 2.85 versus 3.16 post-test in 2018. Conclusions: Online CME improves oncologists’ knowledge, competence, and confidence using ICIs in the treatment of lung cancer at any given point in time; however, gaps remain, and given the wealth of new data that continue to emerge, on-going education is needed to reinforce and build upon existing knowledge, close persistent gaps, and increase oncologists’ confidence with this new therapeutic class.
The burden of hyponatremia and hypercalcemia on hospitalizations and mortality in lung cancer patients in the United States: An analysis of nationwide inpatient database.
Authors: Kamboj Sukriti , Kumar Varun , Mazurkivich Stephen , Acker Warren 
Published: May 2019

e18256 Background: In 2018, there were over 234,030 patients diagnosed with lung cancer in the US with over 154,050 deaths. While the incidence continues to fall (mostly due to reduced tobacco consumption ), the mortality continues to be high with an overall median five year survival rate of only 19%. It is important to identify factors which are associated with worse outcomes in these patients. We aim to note the trends in patients hospitalized with lung cancer who have hyponatremia and hypercalcemia. Methods: We used the Nationwide Inpatient Sample (2002-2013) to identify lung cancer hospitalizations with hyponatremia and hypercalcemia. We analyzed trends in incidence, in-hospital mortality, length of stay (LOS) and cost. We calculated adjusted odds ratios (aOR) for outcomes including in-hospital mortality. Results: A total of 1,404,228 patients were studied with lung cancer were hospitalized from 2005-2014. A number of admissions has been progressively declining from 159,568 in 2005 to 123,305 in 2014 with a relative decline of 21.8%. The overall incidence of hyponatremia in these patients was 8.62%, and it has been trending up from 6.79% to 10.48% (p < 0.001) from 2005-2014 with a relative increase of 57%. Hypercalcemia was reported in 2.59 % of patients admitted with lung cancer. The number of hospitalizations in lung cancer patients with hypercalcemia has increased from 2.19% to 3.17% (p < 0.001) with a relative increase of 49.3%. Hospitalizations for hyponatremia and hypercalcemia were more frequent in age 50-64 years, males and smokers. Lung cancer patients with hyponatremia have in-hospital mortality of 12.9 % (OR 1.43, p < 0.001). Patients who have hypercalcemia have in hospital mortality of 17.1%( OR 1.15, p < 0.001). Conclusions: This study studies trends in hospitalizations in patient with lung cancer and incidence of hyponatremia and hypercalcemia. It is noted that hyponatremia and hypercalcemia are associated with increase the risk of in hospital mortality and increase cost of care in lung cancer patients. Utilization of these findings in guiding management may lead to decreased hospitalizations, hospital stays, and improve outcomes for these patients.
Anticancer therapy within the last 30 days of life: Results of an audit and re-audit cycle from a regional cancer center.
Authors: Nguyen Mike , Wann Alysson , Tamjid Babak , Sahu Arvind , Torres Javier 
Published: May 2019

e18260 Background: The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. Methods: A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to a hospital meeting and a quality improvement intervention program instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. Results: The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. Conclusions: This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and perceived better tolerability.
Non-clinical needs of cancer patients in Spain under different perspectives: A comparative study.
Authors: Cruz-Hernández Juan J. , Ruiz Isabel , Fernandez-Marcos Ana , Martin Rosana , Aranda Enrique , Carrato Alfredo , Díaz-Rubio Eduardo , Guillem Vicente , Lopez Rafael , Feyjoo Margarita , Ferrer Ramon , Gonzalez-Garcia Nerea , Nieto-Librero Ana , Gonzalo-Gomez Alicia , Camps Carlos 
Published: May 2019

e18266 Background: Patients with cancer and their caregivers express unmet needs beyond the clinical approach to cancer. The ECO Foundation (Quality and Excellence in Oncology) and the Spanish Association Against Cancer (AECC) have promoted a qualitative research study with the objective to compare the perceptions of newly diagnosed and 2-3 years after diagnosis cancer patients, caregivers, oncologists, nurses and social workers in relation to a set of non-clinical needs expressed by cancer patients and caregivers, and to obtain concrete and feasible proposals for improvement aimed at satisfying these needs. Methods: A multidisciplinary group of experts developed a questionnaire containing information processes for cancer patients and caregivers, shared decision-making, healthcare circuits, the architecture of consultations, psychological support, support of associations and hospital social workers. Fourteen Medical Oncology Services of Spanish hospitals have participated in this study collecting 310 forms. Data were statistically analyzed using Fisher's exact test. Results: Information processes. The opportunity to have a second opinion is positively valuated for 72.6% of patients and 70.2% of caregivers. However, although 62.5% of oncologists referred to offer this option to their patients, only 10.9% of patients reported having received it. Shared decision-making. For 58% of oncologists, patients are sufficiently trained to share decision-making, but only 24.6% of newly diagnosed patients consider being prepared. In addition, although 95.8% of oncologists report offering the participation of their patients in decision-making, only 45.8% of newly diagnosed patients and 64.4% of 2-3 years after diagnosis patients, consider having received this opportunity. Psychological support. Psychological assistance was considered positive for 94.2% of the patients, 97.4% of the caregivers, 85.4% of the oncologists and 97.1% of the nurses. However, only 21.3% of oncologists and 31.4% of nurses recognize offering such proffessional care given by psychologists to patients. Conclusions: Knowing the non-clinical needs, not only of patients and caregivers, but also from the health care professionals, is essential when designing health strategies that should align the perceptions of patients and health care professionals.
Medication-related osteonecrosis of the jaw: Evidence for infection versus oversuppression.
Authors: Fleisher Kenneth Evan , Muggia Franco , Glickman Robert S 
Published: May 2019

e18268 Background: Antiresorptive medications are important in maintaining bone health for patients with osteoporosis, metastatic cancer and multiple myeloma. Medication-related osteonecrosis of the jaw (MRONJ) may compromise quality of life and treatment of the underlying disease. There are many controversies regarding the pathogenesis, risk and management of MRONJ. Evidence-based data that suggest osteonecrosis of the jaw (ONJ) is triggered by infection and reports of ONJ unrelated to antiresorptive therapy (ART) have confounded previous hypotheses that pathogenesis is directly attributed to ART by oversuppression of bone remodeling. The aim of this study is to determine the outcome for management of MRONJ based on eradication of infection. Methods: The investigators designed a retrospective cohort study for patients who underwent surgical management of MRONJ. Identification of infected and necrotic bone was achieved via nuclear imaging (i.e., technetium bone scan, positron emission tomography), computed tomography and/or cone beam computed tomography. Surgical techniques included bone resection (i.e., marginal, segmental), local flap, reconstruction with microvascular free flap, and/or autogenous platelet graft. Perioperative modalities included hyperbaric oxygen therapy and culture-guided antibiotic administration. We recorded medical history, location of the MRONJ lesion, type of antiresorptive therapy and duration of perioperative antiresorptive therapy. The outcome variable was postoperative healing defined by mucosal closure without signs of infection or exposed bone at the time of follow-up including cases with complications related to subsequent dental infection or treatment. Descriptive statistics were calculated for successful management, medical history and duration of perioperative antiresorptive therapy. We excluded cases treated by palliative intent, when surgery was limited or contraindicated, and/or inadequate follow-up. Results: A total of 54 patients with 59 MRONJ lesions were evaluated (40 with cancer and 14 with osteoporosis). All patients were successfully treated with 13 patients continuing ART after surgery (average follow-up 10 months) and 8 patients requiring more than 1 surgery for lesions associated with osteosclerosis. Conclusions: This study suggests that MRONJ is an infection-driven process that can be managed with various modalities to control diseased bone and facilitate healing. Patients may resume ART following successful management of MRONJ.
Delay in diagnosis and treatment of gastrointestinal cancer in Nepal.
Authors: Dulal Soniya , Paudel Bishnu D. , Shah Aarati , Acharya Bibek , Acharya Sandhya Chapagain , Thapa Rameej Revanta , Wood Lori 
Published: May 2019

e18269 Background: Gastrointestinal (GI) cancers represent a major health challenge worldwide including Nepal where patients (pts) often present with advanced disease. The purpose of this study was to determine the time delay in diagnosis and treatment by evaluating time from first symptoms to diagnosis and treatment and to identify contributing factors from both pts and the health system in Nepal. Methods: An IRB approved cross sectional study was performed in pts with GI cancers. 50 newly diagnosed pts were enrolled and interviewed with a standardized questionnaire during the last 6 months of 2018. Diagnosis delay was defined as time from first symptoms to histopathological diagnosis. Treatment delay was defined as time from diagnosis to surgery and/or treatment by medical/ radiation oncologist. Results: The median age at diagnosis was 52.5 years. 52% had gastroesophageal cancer and 48% had colorectal cancer. 84% presented with Stage III/ IV disease. The median diagnosis delay was 217 days and the median treatment delay was 37 days. The median patient delay (time from first symptoms to first medical consultation) was 150 days. 64% were illiterate, 94% had a history of self medication prior to first medical consultation, 68% were from rural areas with limited healthcare facilities and 72% were unaware of causes of GI cancers. Reasons for diagnostic delay appear to be self diagnosis, self medication and lack of a prompt referral system. Reasons for treatment delay included financial constraint, prolonged wait times for procedures and treatment due to limited skilled manpower. Conclusions: Our data shows there is a significant delay in diagnosis and treatment especially in the time from first symptoms to first medical consultation. We found many preventable reasons for this that, if addressed appropriately, could have a significant impact on reducing the morbidity and mortality of GI cancers. There is an urgent need for intensive and comprehensive cancer education in Nepal and other developing countries.
A physician-led team approach to improve advance directive completion rates in an inpatient oncology unit.
Authors: Konda Manojna , Ananthula Aneesha , Baltz Alan , Pandey Yadav , Atwal Dinesh , Makhoul Issam , Moore Heather C 
Published: May 2019

e18271 Background: Advance care planning (ACP) ensures that patients receive care which is consistent with their beliefs and preferences. Advance directive (AD) completion is an important part of this process, but there is much room for improvement as the AD completion rates in oncology patients have been reported to be as low as 10%. We sought to improve the AD completion rates in the inpatient oncology unit in our institution by undertaking an 8-week quality improvement project. Methods: Using a Plan-Do-Study-Act (PDSA) methodology, a multidisciplinary team lead by residents was created to review the process. 2 cycles of PDSA were conducted over a period of 8 weeks. Electronic medical record (EMR) was reviewed each morning, new patients admitted to oncology unit were identified, and those without AD on file were educated by a designated resident about the importance of completing AD. Based on the patients’ willingness, the case manager was alerted with daily communication to follow-up, provide more information and assistance to file the AD. The AD completion rates were tracked daily and communicated to the team through an e-mail. Results: Only 8.3% of hospitalized oncology patients had completed AD prior to our intervention. PDSA cycle 1 resulted in improving the AD completion rates to 28.9%. Barriers were identified after cycle 1 and were overcome by clarifying the role of each team member, addressing inconsistencies in AD filing, uploading into EMR and making the scanned AD easily accessible. After implementation of the above measures, PDSA cycle 2 resulted in improving the AD completion rates to 40.9%. Conclusions: Designating a person to take lead of a multi-disciplinary team, addressing the inconsistencies in the process and keeping a daily track through EMR can lead to an improvement in AD completion rates. Sustainability of this projects remains to be tested. However, there is a room for further improvement.
Detection of the burnout syndrome, empathy, and psychosocial profile of the health team of the oncology service, UANL University Center Against Cancer (CUCC).
Authors: Alcorta-Garza Adelina 
Published: May 2019

e18274 Background: The Burnout Syndrome, a set of somatic and behavioral signs given by the physical and mental exhaustion that arises from the workings of a person. In particular, health personnel in the oncology area have been exposed to this syndrome. Occupational exhaustion can affect the quality of life of individuals, in a way that also affects their performance at work. Also the staff burnout damages the attention given to the patient, so that the latter can also perceive it. Therefore, it is a priority in our center to determine the frequency and severity of exhaustion among the staff of the Oncology Service and its association with the quality of self-reported empathy towards patients. Methods: It is an observational, cross-sectional and correlation study. With the informed consent of the subjects, questionnaires were applied to assess the subjet´s psychosocial profile, the presence or absence of work exhaustion (Maslach), and empathy. A database was collected with the results obtained from validated questionnaires. The instruments were applied to 1060 staff members working in the Oncology Service of the CUCC, including physicians, students, nurses and administrative health personnel. Results: Among the sample, 413 (38.96%) Burnout cases were found. The age range was from 18 to 61 years. The most prevalent subscale was personal fulfillment with 247 cases, followed by depersonalization with 199 cases, and finally, emotional fatigue with 94 cases. When analyzing the Burnout cases according to their severity, 313 (29.52%) presented a subscale, 73 (6.88%) presented two and 27 (2.54%) presented three (% based on the total of n). The most affected age group was between 20 and 51 years old and, in general, had a higher level of Burnout than women (56.65 vs 43.35%). Regarding the type of personnel, the students showed a higher prevalence (402/1001, 40.15%) than the workers (11/59, 18.64%). As a group, there is a greater loss of empathy in association with burnout. For men and students, the severity and presentation of exhaustion are greater than for workers and non-workers. Conclusions: Among the other variables, the most correlated with the Burnout syndrome were empathy, the general health questionnaire and family malfunction. among others. We suggest starting a special program to help vulnerable staff for their own quality of life and a better service for patients.