bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a comprehensive prognostic model of lymphedema risk for breast cancer survivors.
Authors: Kwan Jennifer , Famiyeh Petra , Su Jie , Xu Wei , Yip Kenneth , Liu Fei Fei 
Published: May 2019

e23083 Background: Lymphedema is a side-effect of cancer treatment affecting up to 1 in 5 cancer survivors. It is associated with life-threatening medical complications and higher medical costs. To facilitate early detection and treatment of lymphedema in high-risk patients, improved prognostic modeling is required. Methods: The study cohort comprised of female breast cancer survivors at the Princess Margaret Cancer Centre during 2016-18. Using lymphedema diagnosis as the end-point, the Cox proportional-hazards model was applied to patient, disease, and treatment-related parameters to assess performance of established and putative novel prognostic factors for lymphedema. Concordance index (C-index) and Kaplan-Meier analyses were used to evaluate prognostic performance. Results: A total of 176 breast cancer survivors were included in the preliminary analysis. On univariable analysis, traditional treatment-related risk factors for lymphedema (e.g. axillary lymph node dissection, number of lymph nodes dissected, use of radiotherapy) were significant (p < 0.05). Additionally, other treatment-related factors (e.g. radiation boost, supraclavicular radiation), disease factors (e.g. tumor size, number of positive lymph nodes, cancer stage), and patient/biological factors (e.g. developing a surgical seroma) were significant (p < 0.05). Multivariable analysis revealed one traditional treatment-related factor (i.e. number of lymph nodes dissected) and other treatment details (e.g. radiation boost, axillary/supraclavicular radiation) to be the most significant factors. Combining radiation treatment details with traditional treatment-related lymphedema risk factors improved the C-index from 0.609 to 0.710 and separated patients into high- and low-risk groups with 2-year lymphedema-free survivals of 26% (15-44%) and 85% (74-97%) respectively (p < 0.001). Conclusions: Prognostication of lymphedema risk can be improved by considering radiation treatment details, including use of radiation boost and site of radiotherapy. Biological factors, such as developing a surgical seroma, may reveal predisposition towards edema. Validation on an independent data set is being completed. Prospective validation is also required.
Long-term neurotoxicity in women with breast cancer.
Authors: Faruqi Fahad Ahmed , Loprinzi Charles L. , Ruddy Kathryn Jean , Couch Fergus , Staff Nathan , Olson Janet E. 
Published: May 2019

e23089 Background: Taxanes (paclitaxel and docetaxel) are commonly administered as part of chemotherapy for breast cancer, but long-term data on chemotherapy-induced peripheral neuropathy (CIPN) are limited in this population. We aimed to assess CIPN approximately three years after an initial exposure to paclitaxel or docetaxel. Methods: In a cross-sectional observation study, which surveyed consented enrollees annually after receipt of care at Mayo Clinic for a new breast cancer diagnosis over age 18, we collected patient-reported EORTC CIPN20 data by mailed questionnaire at baseline and three years after a breast cancer diagnosis. We then confirmed patient-reported chemotherapy data by chart abstraction and only included those who had received a standard course of docetaxel-based or paclitaxel-based chemotherapy, but had not had other neurotoxic treatment for cancer. CIPN20 overall and sensory scale raw scores were converted to a 0-100 linear scale with lower scores indicating more severe symptoms. Results: 84 women who received a taxane for breast cancer completed the survey. 82 were treated in the adjuvant or neo-adjuvant setting, while 2 received a taxane for metastatic breast cancer. 67 women received paclitaxel, while 17 received docetaxel. The median age at diagnosis was 51.5 years (range 31-86). 37 had estrogen receptor (ER) and/or progesterone receptor (PR) positive and human epidermal growth factor receptor-2 (Her2) negative, 31 Her2 positive, and 16 triple negative breast cancer. The median CIPN20 score was 92.98 (range 33.33-100). The median sensory CIPN score was 92.59 (range 25.94-100). 81% of women had an overall CIPN20 score of less than 100, and 68% had a sensory score of less than 100. Conclusions: The majority of women who received a taxane based chemotherapy regimen for breast cancer reported at least mild neuropathic symptoms three years out from treatment. Additional research is needed to help tailor chemotherapy decisions to toxicity risks and to reduce the likelihood of long-term CIPN, which can impair quality of life.
Pilot study investigating an oncofertility program in adults with breast or sarcoma cancers.
Authors: Bhave Manali A. , Fang Fang , Kidwell Kelley M. , Smith Gloria Lola , Chugh Rashmi , Burness Monika Leigh 
Published: May 2019

e23096 Background: Cancer survival is at an all-time high; however, patients often face long-term consequences including infertility. Loss of fertility can be devastating and lead to long-lasting emotional distress. Despite consensus guidelines encouraging providers to discuss infertility risk and refer for fertility preservation (FP) consultations, fertility counseling and FP occur in only 10-29% of patients of childbearing age. A few identified barriers include lack of provider knowledge on FP, constraints on time and lack of available resources. Methods: This is a prospective pilot study evaluating the efficacy of an oncofertility program in increasing discussions on infertility risk and FP between providers and patients. The oncofertility program includes medical provider education, an electronic medical record (EMR)-based best practice alert with smart order set, patient education pamphlets and a patient navigator through Reproductive Endocrinology and Infertility (REI). Our primary objective was to increase documentation on fertility in the EMR, while our secondary objective was to increase referrals to REI for females and orders for semen cryopreservation for males. Provider and patient-reported outcomes were also obtained. Results: 19 patients with a new diagnosis of breast or sarcoma (7 pre-intervention and 12 post-intervention) were enrolled and 17 providers participated in the study at the University of Michigan. There was no change in documentation on fertility in the EMR and no increase in fertility referrals placed. However, patients reported a statistically significant change in amount of information provided on infertility risk and FP from "too little" to "the right amount." Providers also reported increased confidence in initiating a conversation about FP and a trend towards increased comfort documenting their conversations on FP in the EMR. Conclusions: With an increase in cancers diagnosed in young adults, there is a need to improve counseling on the risk of infertility with cancer treatment and FP options. Through an easily implemented oncofertility program, we were able to improve medical provider confidence in initiating this important conversation, provide patients with education on infertility risk and FP and streamline the process for FP referrals utilizing the EMR.
Medical cannabis in cancer patients: Prevalence, efficacy, and safety.
Authors: Macari David , Gbadamosi, MD. Bolanle , Ezekwudo Daniel , Khoury John , Jaiyesimi Ishmael A. , Gaikazian Susanna S. 
Published: May 2019

e23099 Background: Cancer patients are using medical cannabis (MC) to address symptoms, however, little data exists to guide clinicians when counseling patients regarding use. We seek to define the patterns of MC use among oncology patients as well as efficacy and safety of MC. Methods: Cancer patients attending oncology office visits at Beaumont Hospital, Michigan from July – Dec 2018 were anonymously surveyed. The survey included data regarding demographics, diagnosis, treatment, symptom burden, and MC use. Patients who reported MC since their cancer diagnosis completed a section on patterns of use, efficacy, and safety. Results: Response rate was 188 of 327 (57.1%). Ages ranged from 18 to > 71, 59% were 61 or older. Early stage solid malignancy was 38%, metastatic was 41%, and hematologic malignancy was 21%. Cancer treatment was active in 80%. MC use was reported in 46 of 188 (24.5%). Median composite baseline symptom score ranging from 8 (best) to 32 (worst) was higher in patients using MC vs non-users; 17.5 vs 14.4 (p < 0.001). Pain was the symptom with the highest frequency of improvement 34/42 (81%), followed by appetite 34/44 (77%), and anxiety 32/44 (73%). MC improved ability to tolerate treatment in 24/44 (54%). The most frequent adverse effects were cloudy thinking 7/42 (17%), and decreased energy 4/41 (10%) Use of cannabis prior to cancer had no impact on median composite efficacy score (p = 0.43). Age > 61 was not associated with higher toxicity (p = 0.077). Conclusions: This data confirms MC is being utilized by a significant portion of cancer patients, across age, diagnosis, stage, and treatment. Patients with a higher severity of baseline symptoms are more likely to use MC, and report a favorable efficacy profile of MC with no increased risk of adverse effects in older population and similar efficacy in novel MC users. Minimal toxicity was reported in this cohort. Prospective studies are needed to define the efficacy and safety of MC. [Table: see text]
Randomized phase II study comparing mannitol with furosemide for the prevention of cisplatin-induced renal toxicity in advanced non-small cell lung cancer: The OLCSG1406 trial.
Authors: Makimoto Go , Hotta Katsuyuki , Oze Isao , Ninomiya Kiichiro , Ninomiya Takashi , Kubo Toshio , Ohashi Kadoaki , Ichihara Eiki , Rai Kammei , Tabata Masahiro , Maeda Yoshinobu , Kiura Katsuyuki 
Published: May 2019

e23105 Background: Although cisplatin-based chemotherapy has been the mainstay in the treatment of advanced non-small cell lung cancer (NSCLC), it is still controversial as to whether furosemide (FUR) or mannitol (MAN) is better as a forced diuresis for avoiding cisplatin-induced nephrotoxicity. We conducted a randomized phase II trial to clarify this issue in candidates. Methods: Those with advanced NSCLC, suitable for receiving cisplatin-based chemotherapy with an adequate renal function were randomly assigned either to the FUR arm or the MAN arm. Either of forced diuretics was administered with an appropriate hydration in cisplatin administration. The primary endpoint of the study was a proportion of ≥ grade 1 serum Creatinine (Cr) elevation in the first cycle, defined by the CTCAE v4.0. Results: The trial was terminated early with 44 (FUR arm; 22 and MAN arm; 22) of the planned 66 patients because of slow accrual. The patient demographics are listed in Table1. In the first cycle, 2 (9%) and 4 patients (18%) developed grade 1 Cr elevation, respectively (P = 0.33), despite no ≥ grade 2 toxicity. The median time to develop the worst Cr score was 29 (range: 26-31) and 12 (range: 8-28) days, respectively. All patients recovered within 3 to 330 days, respectively. Cisplatin induced grade 3 emesis was observed in 3 patients (14%) in MAN arm, whilst none developed in FUR arm. No treatment related deaths were observed. Conclusions: In this setting, the preventive effect of the two types of forced diuretics on cisplatin-induced renal toxicity was not significantly different. Clinical trial information: UMIN000015293. [Table: see text]
Impact of high-dose vitamin d supplementation on short physical performance battery and bioelectrical impedance analysis in older patients with prostate cancer on ADT.
Authors: Inglis Julia Ellen , Culakova Eva , Dunne Richard Francis , Janelsins Michelle Christine , Lin Po-Ju , Mustian Karen Michelle , Peppone Luke Joseph 
Published: May 2019

e23106 Background: Androgen deprivation therapy (ADT) is standard treatment for prostate cancer but may cause changes in body composition that lead to decreased physical function. Low vitamin D status is also associated with decreased functionality. The Short Physical Performance Battery (SPPB) is an objective assessment tool for evaluating functionality. The bioelectrical impedance analysis (BIA) is a portable tool for assessing lean mass and phase angle, a measure of nutrition status and frailty in chronic disease. Methods: This was a secondary analysis of a randomized controlled trial to assess the impact of high dose vitamin D in older patients (≥60 yrs) with prostate cancer on ADT. Patients with prostate cancer (N = 59, age 67.6 ± 5.4) with vitamin D insufficiency ( < 32 ng/ml) were randomized to high-dose vitamin D (n = 29, 600 IU/daily plus 50,000 IU/weekly) or low-dose vitamin D (n = 30, 600 IU/daily plus placebo weekly) for 24 weeks. SPPB tests and BIA were assessed at baseline, 12 weeks and 24 weeks. Phase angle values were calculated using atan(reactance/resistance) x (180°/π). A phase angle value < 5.7° is a valid cutoff for frailty in older men. Results: Serum analyses showed compliance with vitamin D intake (25-OH vitamin D change: high vitamin D = +32.0 ng/ml vs low dose RDA vitamin D = +4.3 ng/ml; p < .01). There were no difference at all three assessments for SPPB or lean mass between arms. The high-dose vitamin D group had wider phase angle values at 12 weeks (5.81º vs. 5.32º; p = .018) and 24 weeks (5.89º vs. 5.40º; p = .030). The low-dose group had phase angle values < 5.7º over the course of the study. At baseline, over 18% of patients had phase angle values below the 10th percentile of the general population matched on age and BMI. As vitamin D levels increased throughout the study, fewer patients fell below the 10th percentile. Conclusions: The high-dose vitamin D group maintained wider phase angle values over 24 weeks, while phase angle for the low-dose group decreased from baseline. High-dose vitamin D supplementation may impact factors related to phase angle and frailty in patients receiving ADT. Funding: NCI UGCA189961, R21CA175793, K07CA168911, and GR501293.
Ondansetron versus palonosetron as a marker of non-adherence to antiemetic prophylaxis guidelines in highly emetogenic chemotherapy.
Authors: Roeland Eric , Ruddy Kathryn Jean , LeBlanc Thomas William , Clark-Snow Rebecca Anne , Wickham Rita S. , Binder Gary , Sebastiani Silvia , Potluri Ravi C. , Papademetriou Eros , Schmerold Luke M. , Navari Rudolph M. 
Published: May 2019

e23108 Background: ASCO antiemetic guidelines recommend upfront triple prophylaxis (NK1 receptor antagonist (RA) + 5HT3 RA + dexamethasone) for patients receiving highly emetogenic chemotherapy (HEC). Physicians exhibit high variation in HEC guideline adherence, principally involving inclusion of NK1 RA. Whether adherence is associated with selection of the specific 5HT3 RA agent remains inadequately studied. Methods: In the IBM Explorys electronic health record database, we used procedure and diagnosis codes to identify HEC courses and related nausea/vomiting (NV) from 2012 to 2018. We defined HEC guideline adherence as triple prophylaxis at chemotherapy initiation. We assigned HEC courses for ≥ 7 day cycles of cisplatin or anthracycline + cyclophosphamide (AC), or carboplatin (≥ 14 day cycles as a proxy for AUC ≥ 4) to prescribing oncologists based on encounter frequency. We categorized 5HT3 RA use of each physician treating ≥ 5 HEC courses based on their most commonly used 5HT3 and performed descriptive statistics. Results: Of 12,262 HEC courses, 57% involved physicians having greater use of ondansetron (OND) (mean OND to palonosetron (PALO) ratio of 3.9:1). These courses had lower guideline adherence (due to NK1 RA omission) and higher rates of NV for combined HEC, AC, and carboplatin. NV rates for cisplatin did not vary by 5HT3 agent used. Courses involving physicians with greater PALO use (mean OND:PALO ratio of 0.2:1) had superior adherence and NV rates, despite involving a slightly higher risk population (younger and/or female). Conclusions: According to HEC antiemetic guidelines, NK1 RA use should occur independent of 5HT3 RA agent selection. However, we observed less NK1 RA use where OND was preferred, which may have caused the observed higher rates of NV with OND. Further evaluation should assess whether pharmacy cost minimization is a driver of both OND preference and NK1 omission in HEC. [Table: see text]
Knowledge, attitude and practices regarding use of medical cannabis: A national survey among israeli oncologists.
Authors: Mirelman Dan , Waissengrin Barliz , Goldway Noam , Wolf Ido 
Published: May 2019

e23110 Background: Despite lack of clinical trials reporting on beneficial effects of the cannabis plant for cancer-associated symptoms, its use is increasing worldwide. Approximately 10,000 Israeli cancer patients receive permits for the use of medical cannabis, making cannabis one of the most commonly prescribed oncology treatments in Israel and making the Israeli oncologists highly experienced with its use. The experience gained by the Israeli oncologists is therefore highly valuable. Materials and Methods: We conducted a web-based survey among all 238 Israeli oncologists, addressing personal experience; knowledge and attitudes toward the use of cannabis in oncology. Results: Response rate was 54% (n = 126), with the vast majority (87%) regularly prescribing cannabis to their patients. Anorexia, pain and nausea were the most common indications for cannabis use. While 90% of responders stated lack of sufficient knowledge regarding cannabis, its use was perceived as effective and safe. Interestingly, while most oncologists stated that opioids should be used as a first line treatment for cancer pain, most would prefer cannabis for pain relief if needed by a close relative. Oncologists who support cannabis legalization were more likely to prescribe it. Conclusions: Our findings indicate extensive use and perception of efficacy despite lack of knowledge, and indicate unique role for moral attitudes affecting clinical decisions. These data call for the implementation of an educational program and practical guidelines enabling more consistent and rational approach toward cannabis role in oncology.
Use of remote symptom monitoring with breast cancer survivors using patient-reported outcome (PRO) measures in MyChart.
Authors: Terstriep Shelby A. , Wacker James , Quinlan Charissa , Pochardt Kiara , Basch Ethan M. 
Published: May 2019

e23125 Background: Electronic patient-reported outcome monitoring has been found to improve quality of life and overall survival when used with metastatic cancer patients during treatment (Basch, et al., 2017). There has been limited data on using PROs to enhance clinical outcomes in cancer survivorship. This pilot study of breast cancer survivors assessed utilization and satisfaction of electronic proactive symptom and adherence monitoring. Methods: Eighty breast cancer survivors who had completed surgery, chemotherapy, and/or radiation and had received their survivorship care plan were randomized to either usual care or to the PRO monitoring group. The PRO group received questions from the NIH PROMIS toolkit through their patient portal (EPIC) monthly for 6 months. The triage nurse received an alert if the survivor reported on the questionnaire that they had moderate to severe symptoms, had not taken their medication, or would like to speak to a nurse. Participants in the control arm were assessed for sadness, anxiety and satisfaction with provider communication at their usual follow-up visits. Results: Response rates for surveys ranged from 47to 75%. Patients in the PRO monitoring group exhibited no difference in satisfaction at 3 months but had significantly higher scores at 6 months for communication (P=0.005) and monitoring (P= 0.002). Anxiety scores were not significantly different among the usual care group versus the frequent remote monitoring group. Conclusions: Electronic PROs monitoring between clinic visits improved satisfaction with communication and follow-up without increasing anxiety in breast cancer survivors. The pilot data indicate continued development of efficient PROs monitoring can be an important tool to transform the survivorship care plan from a document to an active process of proactively monitoring symptoms and adherence. Support: UG1CA189823. Reference: Basch, E., Deal, A. M., Dueck, A.C., et al. (2017). Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. Jama, 318 (2), 197. Study Number: A23_Pilot2
Assessing quality of life (QoL) of patients and their caregivers on phase I clinical trials.
Authors: Chan Gloria HJ , Fransiska Diana , Chee Cheng Ean 
Published: May 2019

e23130 Background: Patients on Phase I trials help advance science through their participation but there is a paucity of data regarding QoL of patients and their caregivers. Methods: Phase I trial patients from a single Asian centre were assessed at baseline and at 3 time intervals after treatment initiation with EORTC-core (QLQ-C30) and Comprehensive Score for Financial Toxicity (COST) questionnaires. Caregivers’ QoL were assessed with Zarit-Burden Interview (ZBI). Paired-sample t-tests were used to test for QoL differences at different time intervals. Results: 35 patients have been recruited with 70 individual visits so far. 60% of patients were female, 74% were Chinese. The most common cancer types were gastrointestinal (51.5%) and gynaecological (25.7%). Patients had a median of 3 lines of prior treatment (range: 0-9). QLQ-C30 scores range from 0 to 100, higher scores represent a high level of QoL/functioning. At baseline, the mean global QoL score was 51.9 (range: 16.7-100). The mean physical, role, cognitive, emotional and social functioning scores (FS) were 74.1 64.7, 86.6, 78.8 and 69.5 respectively. Patients were most bothered by fatigue and pain. 65.7% experienced grade 1 or 2 financial toxicities based on COST. There were significant improvements in physical (14.5 +/- 16.7, p < 0.001), cognitive (18.1 +/- 25.0, p = 0.002) and emotional (10.5 +/- 18.4, p = 0.012) FS at baseline and 1-month post treatment. Patients experienced a reduction in fatigue, but no change in pain or financial concerns. Only 28.6% of patients were referred to palliative care medicine. Of 19 caregivers surveyed with ZBI, 10 experienced little/no burden, 8 had mild-moderate levels of burden and 1 reported severe burden. Conclusions: This is the first Asian study reporting QoL of cancer patients and their caregivers in Phase I clinical trials. In this group of heavily pre-treated patients, Phase I options can result in QoL improvement. Two-thirds of caregivers had minimal burden. Identifying QoL issues of patients and their caregivers will improve supportive care rendered to them.