bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of life and satisfaction with care in a contemporary cohort of pancreatic cancer patients.
Authors: Abdel-Rahman Omar , Renouf Daniel John , Schaeffer David F. , Cheung Winson Y. 
Published: September 2018

e21623 Background: Pancreatic cancer patients face significant disease- and treatment-related morbidity while management is frequently complex. With recent advances in radiation and surgery and the introduction of new systemic therapy regimens, understanding these patients’ quality of life (QOL) and their satisfaction with the care that they currently receive is essential to inform the design of future care delivery models. Methods: Pancreas Centre BC was established in British Columbia in 2012 to promote efficient triage, rapid access to multidisciplinary care, and early involvement of palliative care, if necessary. Consecutive pancreatic cancer patients who were referred to and seen at Pancreas Centre BC completed the EORTC-QLQ C30 and PAN26 questionnaires before and after surgery as well as surveys focused on the levels of satisfaction with their disease management. Using independent samples t-tests, we correlated clinical characteristics with QOL and satisfaction scores. Results: In total, 167 patients were included: median age was 63 years, 45% were men, and 70% were ECOG 0/1. The majority had early stage disease (78%), pancreatic head tumors (53%), adenocarcinoma histology (68%), and adjuvant gemcitabine (75%). Baseline mean QOL scores were 63, 90, 83, 58 and 92 (out of 100) in the overall, physical, emotional, cognitive and social domains, respectively. Advanced age ( > 70 years), weight loss ( > 10 kg), and poor ECOG were independently associated with lower overall QOL rating (all p > 0.05). Surgery had a positive impact on all functional domains where we observed a mean improvement in QOL scores ranging from 8 to 17 points (all p > 0.05). In terms of satisfaction, 94% of patients rated their overall care as good to excellent. Likewise, 80% of patients were very or mostly satisfied with the amount of information they received and 84% of patients rated the healthcare information they received as very or mostly helpful. Conclusions: Despite the morbidity of pancreatic cancer, patients referred to and seen at a tertiary pancreatic cancer center reported good QOL and satisfaction levels, suggesting that the centralization of pancreatic cancer care may be an effective model to address the high priority needs of this population
Feasibility of monitoring of body temperature for patients undergoing stem cell transplant or intensive chemotherapy.
Authors: Dambrosio Nina , Gannon John , Eager Jon , Sylvan David , De Lima Marcos J.G. , Levitan Nathan , Malek Ehsan 
Published: September 2018

e21630 Background: Early detection of fever and prompt use of broad-spectrum antibiotics is crucial in neutropenic patients (pts). Episodic monitoring of temperature serves as standard-of-care (SOC) method in inpatient settings may suffer from delay in fever detection, whereas self-reported fever can be less reliable in the outpatient setting. Therefore, a continuous real time method of body temperature measurement may serve as a clinical decision support tool to improve outcomes. In this study, we proposed to test a device that continuously monitors body temperature. Methods: Pts admitted for stem cell transplant or high dose chemotherapy for leukemia were included. Body temperature was measured every 4 hours as SOC throughout hospital stay. Temperature Rise (TR) was defined as spikes above 100.4 °F. We used TempTraq patch (Blue Spark, Ohio), a FDA class II device, to monitor body temperature in real time. It transmits the data to a receiver (iPad or Smartphone) via Bluetooth to display body temperature data with the ability to set alerts. A questionnaire was designed to capture patient’s adherence, compliance and satisfaction. Results: The patches were applied every 24 hours on 10 pts throughout hospital stay. Body temperature was recorded remotely with 10 minutes intervals (14, 342 temperature measurements). There were 23 episodes of TR among all pts by SOC method, 21 of them were detected by the patch with a median of 140.1 minutes (range: 30-180 minutes) sooner than SOC. The patch data was successfully transmitted and displayed on the study iPad invariably. Ten out of 10 pts were able to wear the patch daily through hospital admission and felt the patch was easy to apply. Nine out of 10 pts felt the patch was comfortable and did not irritate their skin. Eight out of 10 pts were interested in wearing the patch for temperature monitoring in future. Eight out of 10 pts were completely satisfied with the patch. Conclusions: Our data suggest that real time body temperature measurement by the patch sensor used in this study is feasible and convenient. Also, it is able to detect the rise in temperature earlier in majority of cases. Further studies to assess reliability of this device in outpatient setting are warranted.
Association of paclitaxel to lipid nanoparticles in the treatment of bone metastasis in patients with solid tumors.
Authors: Graziani Silvia Regina , Vital Carolina Graziani , Morikawa Aleksandra Tiemi , Fernandes Hezio Jadir , Naime Fauzia de Fátima , Fonseca Ricardo Oliveira Da , Dias Carla Andressa Rodrigues , Almeida Ligia Rabello De , Neto Raphael Francisco Azuaga , Yamada Karina Emi , De Abreu Maria Stella Sa Granja , Pontes Tatiana Caldeira , D'Alvia Thiago , Ferreira Rafael Sanches , Eyzaguirre Velasquez Arianne Renata , Orias Valéria Urresti , Vanderlinde Fabiano Garcia , de Almeida Leandro Maritan , Diniz Paula Calixto Batistela , Maranhão Raul Cavalcante 
Published: September 2018

e21631 Background: Bone metastasis occurs in more than 65-90% patients with hormone-dependent solid tumors, as breast and prostate cancer, with slow evolution, being not responsive to standard chemotherapeutic agents, which restricts treatment options. Previously, we have shown that lipid nanoparticles resembling LDL-cholesterol-like are uptake in malignant tissues and capable of delivery anti-cancer drugs, after intravenous injection. The delivery of drug drastically reduced toxicity. The objective of this study was to evaluate the clinical responses to treatment with paclitaxel associated to nanoparticles, laboratory toxicity and pain scale in patients with breast and prostate carcinoma, previously treated with conventional schemes chemotherapy and not eligible for subsequent treatment. Methods: We included six patients with prostate carcinoma, and ten patients with breast carcinoma (age 68 ± 4 and 55 ± 7 years, respectively). All patients had advanced clinical staging IV at diagnosis (TNM-UICC classification). Treatment consisted in the combination of paclitaxel to lipid nanoparticles (dose: 175 mg/m2 body surface), intravenous, every 21 days, without premedications. Biochemistry determinations were performed before onset and every three weeks during treatment. To assess pain, we used the Verbal Analogue Scale (from zero to 10) and the use of opioids in the treatment period. Results: Total of 64 cycles were performed without clinical or laboratory toxicity. At the beginning of treatment the pain score was 8 (range 6-9), after six weeks it reduced to a mean of 6 (range 4-8) and after 18 weeks reduced to 4 (range 2-8). Six patients required 180 mg/day of morphine, but after 12 weeks the dose was reduced to 60 mg/day. Six patients progressed after three cycles requiring use of potent analgesic. Conclusions: The notable absence of toxicity and significant improvement in pain indicate paclitaxel associated to lipid nanoparticles as a promising option in chemotherapy regimens.
Neurotoxicity associated with anti-PD1 therapy: A multi-center case series.
Authors: Smith Jess Louise , Menzies Alexander M. , Cohen Justine Vanessa , Lioret Margarida Mut , Ozgun Alpaslan , Spain Lavinia , Park John J. , Johnson Douglas Buckner , McQuade Jennifer Leigh , Feng Sophie , Sandhu Shahneen Kaur , Atkinson Victoria , Tsai Katy K. , Long Georgina V. , Larkin James M. G. , Eroglu Zeynep , Sullivan Ryan J. , Henderson Andrew , Carlino Matteo S. 
Published: September 2018

e21641 Background: The anti-PD1 antibodies (PD1) pembrolizumab and nivolumab are now FDA-approved in multiple malignancies. With increased use, rarer immune-related adverse events (irAEs) not well characterized in clinical trials are being identified, including neurotoxicities. Methods: Patients (Pts) who developed neurotoxicites while being treated with PD1 (alone or in combination) were retrospectively identified from 10 cancer centers. Data regarding treatment, toxicity and outcome were examined. Results: 40 pts (38 melanoma and 2 non-small cell lung cancer pts) developed neurotoxicity; 14 on anti-PD1 monotherapy, 23 in combination or sequence with ipilimumab, and 3 on blinded trials or in combination with interferon. The overall response rate was 90% and median progression free survival was not reached. The median time from treatment initiation to development of neurotoxicity was 7 weeks (range 1-86.5 weeks). 8 pts had died, 5 from disease progression and, 2 from neurotoxicity. 26 pts (65%) developed other irAEs. 27 (67.5%) pts developed toxicities affecting the peripheral nervous system including motor sensory neuropathies (6), sensory neuropathies (4), and Myasthenia Gravis (3). 13 (32.5%) pts developed central nervous system toxicities including aseptic meningitis (6) and encephalitis (4). 24 (60%) pts were treated with steroids alone. 9 pts required further immunomodulation including IVIG (7), plasmapheresis (3), MMF (1) and rituximab (1). 17 (43%) had complete resolution of symptoms, 5 (13%) had stable or worsening neurological disease, and 22 ( 55%) were improving at the time of datacut . 10 pts were retreated with PD1, of which 2 developed exacerbation of prior neurological symptoms. Conclusions: While rare, a variety of neurotoxicities can occur with PD1 treatment. Management may require immunomodulation beyond corticosteroids. Given the high response rate observed in this cohort, such toxicities and their management do not appear to negatively impact treatment response.
A pilot study of lactoferrin in patients with self-reported, chemotherapy-induced taste and smell abnormalities.
Authors: Lesser Glenn Jay , Case Doug , Wang Aili , Dietrich Andrea , Duncan Susan 
Published: September 2018

e21643 Background: Taste and smell abnormalities (TSA) are common in patients receiving chemotherapy and may lead to food avoidance, altered nutritional intake, treatment delay or withdrawal, diminished socialization and impaired overall quality of life. Lipid peroxidation of mucosal cell membranes in the oral cavity is one cause of TSA and lactoferrin (LFN), an iron-binding protein normally present in saliva, is an effective scavenger of lipid byproducts that can decrease metallic flavor in healthy volunteers. Methods: Eligible patients with colorectal or pancreatic adenocarcinoma and self-reported TSA while on an oxaliplatin-containing chemotherapy regimen were treated with LFN 250mg three times daily for 4 weeks and then followed for an additional 4 weeks off study drug. A second identical IRB-approved pilot trial enrolled patients with solid tumors, lymphoma or myeloma with self-reported TSA while receiving chemotherapy. The primary outcome was the change in self-reported TSA following 4 weeks of LFN as measured by a validated taste and smell questionnaire (TSQ) consisting of taste (score 0-10) and smell (score 0-6) subscales, which are combined to yield a total composite score (0-16, 0 = no TSA). The TSQ was assessed at 0, 4 and 8 weeks along with the FAACT (FACT–G + anorexia subscale), salivary protein and metals analyses, and the Brief Smell Identification test (B-SIT). Results: 26 total pts were enrolled (14 Males; mean age 60.5 years; range 32-79), and 19 and 17 pts remained on study with analyzable data at 4 and 8 weeks. Baseline mean taste, smell and composite TSQ scores for the 26 enrolled patients were 6.5, 3.1 and 9.6 units. After 4 weeks of LFN treatment, the mean overall TSQ score improved by 1.7 units (p = .018) while the taste and smell subscales improved by 0.6 (p = .062) and 1.1 units (p = .042) respectively. At 8 weeks, the mean TSQ score improved from baseline by 3.8 units (p < .0001) while the taste and smell subscales improved by 1.9 (p = .001) and 1.8 (p = .003) units. No significant change from baseline was recorded in the FAACT or the B-SIT at 4 or 8 weeks. Conclusions: These pilot data suggest that further evaluation of LFN in patients with self-reported TSA is warranted. A randomized trial is in development. Clinical trial information: NCT01941810, NCT01596634.
Effect of maintenance of normal circadian function while undergoing chemotherapy on advanced cancer patient outcomes.
Authors: Block Keith I. , Carome Edward , Blask David E , Huff Dinah Faith , Kaslausky Thomas , Gyllenhaal Charlotte , Block Penny B. , Reynolds Justin , Grutsch James F. , Hrushesky William J. 
Published: September 2018

e21650 Background: Cancer patients develop symptoms that are pathognomonic of a failing circadian organization [CO]. Our concurrent study of 84 advanced cancer patients on randomly timed chemotherapy revealed that each suffered more disrupted circadian rhythms, sleep disorders, anxiety/depression, and quality of life scores compared to healthy age-adjusted controls, as well as poor survival. Herein, we report relationships between CO of advanced cancer patients and their functioning, symptoms, mood, and quality of life during chemotherapy in a clinic that uses comprehensive integrative therapies to maintain patient CO. Methods: 30 patients with advanced cancer participated in a randomized single-blind crossover trial of whether nightly use of blue-light blocking eyeglasses improved circadian organization during chemotherapy. Chemotherapy was applied at or near times of day known to be least toxic and most effective. CO was measured serially using actigraphy and patients provided data on their sleep quality [PSQI], mood [HADS], fatigue [Piper], and quality of life [EORTC QLQ-C30 and Ferrans/Powers QLI]. Kruskal-Wallis tests were used to detect the differences between groups [p < 0.05]. Results: These cancer patients’ actigraphy data were indistinguishable from a convenience control of healthy individuals. Sleep quality, Piper Fatigue, and HADS scores were in the non-symptomatic range; and all functional and symptomatic parameters of the EORTC QLQ-C30 and three of four QLI subscales were within population-based norms. Only the EORTC health-related quality of life and the QLI health/function parameters were lower than non-cancer controls. Median overall survival was 38.4 months. Conclusions: Actigraphy-measured COs of advanced cancer patients are damped, disorganized and accompanied by a heavy symptom burden. These cancer patients reported good quality sleep, normal function, good mood, low intensity of cancer-related symptoms and extended survival while undergoing circadian timed cancer chemotherapy and integrative support. This CO maintenance among such cancer patients is unprecedented and requires attention especially as it is achievable entirely without risk. Clinical trial information: ISRCTN16219928.
Feasibility of incorporating patient reported outcomes (PROs) into routine care for oropharyngeal carcinoma (OPC).
Authors: Baxi Shrujal S. , Cracchiolo Jennifer R , Patel Snehal G. , McBride Sean Matthew , Migliacci Jocelyn , Lee Nancy Y. , Kurtzman Rachel , Pfister David G. , Wong Richard J. 
Published: September 2018

e21652 Background: We assessed the feasibility of using PROs as part of routine care to better understand the trajectory in quality of life (QOL) following treatment of OPC. Methods: The Memorial Sloan Kettering Cancer Center (MSK) head and neck disease management team (DMT) assembled a parsimonious paper survey composed of validated PRO measures (EORTC QLQ 30 and HN-35, Neck Dissection Impairment Index, Skindex-16, and COST-FACT) to assess QOL at baseline, immediately and 3 months post treatment. From Jan-May 2016, a DMT PRO coordinator identified patients with non-metastatic OPC and notified clinical teams to print the surveys to be completed in the waiting room. We assessed the feasibility of incorporating PROs into routine care across the DMT using this process by examining response rates (RR) and identifying potential barriers (i.e., regional site of treatment, number of treatment modalities, hospitalizations, demographic variables) to completing PROs. Results: Of 54 patients with non-metastatic OPC, 3 non-English speakers and 5 protocol patients were excluded. Median age was 61.3 years (43.8-78.4). Patients were mostly male (89%), married (74%) and presented with locally-advanced OPC (89%) due to HPV (89%). 89% received multimodality therapy (89%), of which 36 (88%) received chemoradiation, and nearly half (48%) were treated at MSK regional sites. The RR decreased substantially over time (Table 1). 2 patients died* and 17 patients were hospitalized within these 3 months. In bivariate analyses, no prespecified demographic or clinical barriers to completion of PROs were identified. On deeper investigation, decline in RR overtime resulted from not capturing change in scheduling, which occurs more frequently after treatment completion. Conclusions: Implementation of longitudinal PROs into routine care is feasible and generally acceptable by the patients, but requires a coordinated effort to sustain an acceptable RR. For future efforts, the project coordinator will use a portal messaging system to communicate directly with patients and use an electronic PRO format. [Table: see text]
Weight changes at diagnosis in solid tumours.
Authors: O'Donoghue Niamh , Shrotriya Shiva , Aktas Aynur , Hullihen Barbara , Ayvaz Serkan , Walsh Declan 
Published: September 2018

e21655 Background: Unintentional weight loss is common in cancer and associated with increased morbidity and mortality. Most research to date has examined weight loss in advanced disease. The clinical significance of any weight change (WC) (loss/gain) before/at cancer diagnosis remains unclear. This study aimed to determine the prevalence and clinical significance of WC at diagnosis in out-patients with solid tumours presenting to a tertiary academic medical centre. Methods: A retrospective study of the electronic medical record (EMR) was conducted (n=6477). Those with a pre-diagnosis weight, T0, (recorded within 6 months of cancer diagnosis) and 2 subsequent weights (diagnosis, T1; final visit, T2) were identified (n=4258). Logistic regression and survival analysis identified WC predictors and overall survival respectively. The significance threshold was p < 0.05. Results: Mean age was 61 ±12.5 years. 54% (n=2315) were male. Common tumour sites were breast (17%; n=725), prostate (16%; n=664), lung (14%; n=599) and upper GI (11%; n=470). Known metastatic disease present at T1=15% (n=652). 68% (n=2908) were overweight or obese (WHO BMI Classification) at T1. 98% (n=4159) had WC from T0-T1(loss: 58%; n=2454; gain: 40%; n=1705). Primary tumour sites significantly associated with weight loss (WL) included colon, head & neck, kidney, lung and upper GI. 8% (n=320) were cachectic (>5% WL in previous 6 months) and 50% (n=2134) were pre-cachectic (≤ 5% WL) at T1; 3% had “Abnormal Weight Loss” (ICD 9 Code). Survival was worst with WL >5% and weight gain (WG) ≥ 10% from T0-T1 (p<0.05). However, those with 2.5-5% WL from T0-T1 were also at risk (p<0.05); 0.1-2.4% WG was protective. Primary tumour site (lung, upper GI) and normal/underweight BMI at T1 predicted poor prognosis. Conclusions: Weight changes were highly prevalent, but WL typically was undiagnosed. Most were overweight or obese at diagnosis. Nevertheless 58% (n=2454) of those reviewed at T1 met current criteria for cachexia or pre-cachexia. Those with WL > 5% or WG ≥ 10% had worst survival. The majority had evidence of significant, yet frequently undiagnosed, WC abnormalities at diagnosis.
Does chemotherapy work in reversal of malignant obstruction due to gastric cancer?
Authors: Santos Vanessa Montes , Azevedo Renata Gondim Meira Velame , Lopez Rossana Veronica Mendoza , Hoff Paulo Marcelo , Sabbaga Jorge , Glasberg Joao 
Published: September 2018

e21676 Background: Malignant obstruction (MO) is a common complication in patients with gastric cancer. Although palliative chemotherapy has already shown beneficial for overall survival in advanced cases, its value for MO reversal is still unknown. Methods: Inthis retrospective study we analyzed all consecutive patients with metastatic gastric cancer admitted with MO at the Instituto do Câncer do Estado de São Paulo (ICESP) from 2008 to 2016. The primary and secondary endpoints were overall survival and obstruction reversal rate respectively. Clinical measures other than chemotherapy and alimentary pause included the use of octreotide 0.1 mg, 3 times a day, steroids, antiemetics and anticholinergic drugs. Survival curves were calculated by Kaplan-Meier and log-rank test was used to compare them. The Cox regression model was used to evaluate risk factors for overall survival and the hazard ratio (HR) was calculated with its respective 95% confidence intervals. The analysis was performed in SPSS v.18 for Windows statistical software, and the significance level was 5%. Results: One hundred and eighteen(118)patients were included. Median overall survival was 11.2 months and survival time after the MO was 3.6 months for the whole group. Median time of use of octreotide was 3 days. Reversal of obstruction was seen in 16 of 36 patients (38.4%) in which chemotherapy was used and only in 22 of the 92 patients (24%) treated with exclusive clinical measures. In spite of these figures a significant better overall survival (p 0.002) was achieved in the group of patients that reached obstruction reversal without chemotherapy (13.6 months vs. 11.6 months for the clinical treatment group). Conclusions: This study suggests that chemotherapy even when reversing MO, has no impact in patients overall survival. These finding is particularly relevant for cost contingency in settings with limited resources. .
Efficacy of olanzapine for prevention of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis.
Authors: Kumar Rohit , Singh Naina , Thekkekara Romy Jose , Singh Sunny R K , Harrington Sarah Elizabeth , Shah Mousami 
Published: September 2018

e21692 Background: Olanzapine is an atypical antipsychotic medication which has shown efficacy in prevention of chemotherapy-induced nausea and vomiting (CINV) in multiple trials. This study aims to investigate the efficacy of Olanzapine to prevent CINV with an up-to-date systematic review and meta-analysis. Methods: A literature search of Ovid MEDLINE, Embase and Cochrane library was performed to identify randomized controlled trials of olanzapine compared to other antiemetic therapy (5HT3 and/or NK1 antagonist with or without steroids) for prevention of CINV in patients age >=18 years up until December 2016. The primary endpoint was no emesis or nausea episodes in acute (0-24hrs), delayed (24-120hrs) and overall (0-120hrs) period in patients receiving highly or moderately emetogenic chemotherapy (HEC or MEC). Statistical analysis was performed using Review Manager (RevMan 5.3). The Mantel–Haenszel method was applied and random effect analysis model was used to calculate risk ratios. Results: From the literature, 12 RCTs met the inclusion criteria. The age range of patients was 18-89 years. Seven trials included only patients who received HEC while 5 trials included patients receiving either HEC or MEC in various proportions. Olanzapine was statistically superior for 5 primary endpoints except for no nausea in acute period (Table 1). In the non-steroids cohort, olanzapine was superior for no emesis in all 3 periods but statistically significant only for delayed period. Conclusions: Olanzapine is superior to other antiemetic therapy for prevention of CINV. It is less expensive and can improve patient’s quality of life and chemotherapy adherence. [Table: see text]