bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategies to embed palliative care into a culture of cancer care.
Authors: Taber Angela Marie , Korber Susan F. , Martin Edward , Mega Anthony E. 
Published: September 2018

e21678 Background: In 2012, the 3 hospital Lifespan Health System launched a palliative care initiative. The hospitals and medical oncologists knew this was critical for patient centered and value-based cancer care, but recognized many barriers: physician practice patterns, lack of dedicated resources and systems, patient and family education gaps, and limited return on investment in the current environment. A multi-level inpatient and outpatient strategy was implemented and tracked over four years. Methods: External benchmarking data from a Medicare claims analysis of Vizient (academic health system consortium) member organizations and from ASCO QOPI data were used in the analysis. Internal data analysis included a study on symptom management for lung cancer patients, hospital reports on palliative care service utilization, ED visits and hospital admission trends for cancer patients. Multi-level interventions were employed: hospital investment in staff and systems, partnership with a community-based hospice and palliative care provider, a medical oncology physician champion with Board certification in palliative care, a palliative care inpatient consult service and daily ICU rounds, an oncology medical home, medical oncologist Saturday hours, electronic prompts for consults, and a cancer call triage center. Results: A Medicare claims analysis for 2012 to 2014 on cancer decedents with ICU stays in the last 30 days in the Vizient national study of health systems showed that Lifespan was at the 11th percentile, making them the 4th lowest (days in ICU) in performance (pre/post data requested). QOPI data on appropriate referrals to hospice or palliative care prior to death improved from 58% in 2010, which was below the QOPI benchmark of 61%, to 94% in 2016 which is above the QOPI benchmark of 74%. Other QOPI and hospital data will be included in the presentation. Conclusions: Palliative care, a crucial tool for the delivery of future cancer care, is challenging to implement effectively. This study shows that a hospital/medical oncology partnership can drive change to embed palliative care into the culture of cancer care and these strategies offer a roadmap for others to follow as they strive to offer patient centered and value-based cancer care.
Disparities in supportive care needs among minority and non-minority patients with advanced lung cancer.
Authors: Seiden Danielle , Morillo Jose , Wisnivesky Juan P. , Smith Cardinale B. 
Published: September 2018

e21690 Background: Significant racial and ethnic disparities exist in lung cancer care. Thus, minorities are diagnosed with late stage cancer and have inferior outcomes likely leading to increased suffering. Little is known, however, about disparities in supportive care needs among patients with advanced lung cancer. Methods: We performed a prospective cohort study of patients newly diagnosed with advanced lung cancer (stage III and IV). At baseline (within 3 months of diagnosis), patients completed a validated survey assessing needs among seven domains: medical communication and information, psychological and emotional support, daily living, financial concerns, physical symptoms, spiritual needs, and social needs. Univariate and multivariate regression analyses compared differences in supportive care needs among minority (Black and Hispanic) and non-minority patients with advanced lung cancer. Results: We have enrolled 95/160 patients (60%). To date, baseline surveys have been completed on 55 patients. Of those, 37 (67%) are minorities and 18 (33%) non-minorities. Minorities were less likely to be married (p = 0.01), had a lower annual income (p < 0.001), lower education attainment (p = .02) and more likely to have Medicaid (p < 0.001). There were no differences in gender (p = 0.35) or performance status (p = 0.13). Overall, 39% of minorities report having higher supportive care needs across all domains compared with 25% of non-minorities (p < 0.001). Similarly, minorities reported having significantly higher needs among each domain except medical communication and information (p = 0.06). Multivariate analysis, controlling for patient characteristics, found minorities had increased odds of overall supportive care needs (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.03-1.16). Conclusions: Minority patients with advanced lung cancer are more likely to have increased supportive care needs than non-minority patients. Ensuring minority patients have adequate supportive care evaluation and treatment is necessary to mitigating health disparities among patients with lung cancer. Future studies will be performed to evaluate how these needs change throughout the trajectory of lung cancer.
Self-guided online cognitive behavioral strategies for chemotherapy-induced peripheral neuropathy (CIPN): A multicenter, single blind, randomized, wait-list controlled trial.
Authors: Knoerl Robert , Yang James , Barton Debra L. , Williams David A. , Holden Janean , Krauss John C. , Bridges Celia , Smith Ellen M. Lavoie 
Published: September 2018

e21710 Background: Four in 10 individuals receiving neurotoxic chemotherapy develop chronic painful CIPN, symptoms which negatively influence quality of life and physical function, and may require the withdrawal of effective chemotherapy. However, few recommended pharmacological and no effective non-pharmacological treatments for chronic painful CIPN exist. The purpose of the study was to examine the efficacy of an online cognitive behavioral pain management intervention, the PROactive Self-Management Program for Effects of Cancer Treatment ( PROSPECT), to reduce worst pain intensity in individuals with chronic painful CIPN. The secondary outcomes were average pain intensity, non-painful CIPN symptoms, and impaired function. Methods: Sixty patients with chronic painful CIPN were randomized (1:1 ratio) to receive either 8 weeks of PROSPECT or usual care. A 7-day electronic worst CIPN pain intensity diary was completed at the baseline and eight week time points. At the same time points, participants completed electronic standardized measures of functional impairment, non-painful CIPN symptom severity, and average CIPN pain intensity. Mean change scores from baseline and eight week surveys were compared between groups using ANCOVA adjusting for baseline. Results: Individuals who received the PROSPECT intervention had a mean change in worst pain intensity of -0.94 ( SD = 1.36, Range = -3.29 – 1.29). Those in the control group had a mean change score of 0 ( SD = 1.31, Range = -3.43 – 2.86) ( p = 0.046; d = 0.53) ( n = 38). For the secondary outcomes, no significant mean change score differences were found between groups. Conclusions: PROSPECT use significantly improved worst pain intensity, but not secondary outcomes, in individuals with chronic painful CIPN. A larger study testing PROSPECT is needed to determine if improvements in worst pain intensity may be sustained, to evaluate the effect of the intervention on the secondary outcomes, and to identify mediators of pain-related improvement. If shown to be efficacious with further testing, PROSPECT may be added to pharmacological modalities for the treatment of chronic painful CIPN. Clinical trial information: NCT02760654.
Tocilizumab for the management of immune mediated adverse events secondary to PD-1 blockade.
Authors: Stroud Chipman Robert Geoffrey , Cherry Cynthia R. , Naqash Abdul Rafeh , Sharma Nitika , Cherukuri Sulochana Devi , Parent Teresa , Hardin Jessica , Walker Paul R. 
Published: September 2018

e21712 Background: Immune checkpoint inhibitors are poised to revolutionize the management of a growing number of malignancies. Unfortunately, the management of steroid-refractory immune mediated adverse events (irAEs) is based on a paucity of randomized data and limited to single center experiences. Our initial experience with the IL-6 receptor antagonist tocilizumab showed clinical improvement in a wide variety of irAEs. As a result, we adopted the use of tocilizumab for the management of steroid-refractory irAEs. Methods:The character and clinical course of irAEs were abstracted from the medical record and analyzed. The dose of tocilizumab was 4 mg/kg given IV over 1 hour. C-reactive protein was drawn at first nivolumab infusion and at q 2 weeks (and with irAEs) thereafter. Clinical improvement was defined as either: documentation of resolution of symptoms or hospital d/c within 7 days. Results:Of the initial 87 patients that were treated with nivolumab, 34 required tocilizumab (39.1%). All pts were on corticosteroids. The majority (88.2%) were lung cancer patients. The index grade 3/4 irAE was pneumonitis in 35.3%, cytokine release syndrome/SIRS in 35.3%, cerebritis in 14.7% and one case each of hypophysitis, colitis, pancreatitis, hepatitis and immune mediated coagulopathy. Median time between first nivolumab and initiation of tocilizumab was 76 days (range 1-429). Median CRP at initial tocilizumab dose was 100.5 mg/L (2.0 -350.4). Clinical improvement was noted in 27/34 pts (79.4%). 52.9% of pts required a single dose, while 35.3% required two, 8.8% required three and 1 pt required 4 doses. Twenty seven doses were given in the inpatient setting (49.1%). Median time to discharge was 4 days (range 1-27). Seventy four percent of pts were discharged home. For the 55 doses of tocilizumab that were delivered there was a cost savings of $147,174.94 (WAC) during the 18 month period versus infliximab 5 mg/kg IV dose. Conclusions: Tocilizumab is a therapeutic option for the management of steroid refractory irAEs secondary to immune checkpoint blockade. However, randomized trials are needed to better elucidate the relative efficacy and safety of these agents.
Characterizing social worker and chaplain interactions with parents of critically ill children with cancer.
Authors: Lentini Nicole , Martinez Elizabeth , Michelson Kelly 
Published: September 2018

e22024 Background: Parents of children with cancer admitted to the pediatric intensive care unit (PICU) often obtain support from social workers and/or chaplains (SWs/Cs). Yet, empirical work describing the roles and activities of SWs/Cs caring for patients in the PICU is lacking. This study examined the roles of SWs/Cs caring for critically ill children with cancer and their families. Methods: Parents of patients with cancer expected to have a PICU stay > 72 hours, ongoing involvement with palliative care, or a pediatric index of mortality score > 4 were invited to participate. These criteria were meant to identify patients with more complicated PICU admissions. The SWs/Cs caring for these families in the PICU were also invited to participate. SWs/Cs audio recorded information about their encounters with parents and patients, specifically, who was present, the kinds of supports provided, and the discussion topics. These recordings were analyzed using content analysis resulting in broad categories describing support provided to the families by SWs/Cs. Results: In total, 3 SWs and 3 Cs submitted recordings about 34 encounters with families of 9 patients. Categories of activities and supports identified from these recordings included: discussing the child’s condition, assessing parent or child coping, assessing the role of faith, discussing communication between parents and the medical team or advocating for the family with the medical team, providing emotional support to patients and families, discussing concerns outside of the hospital (family, financial, work), and providing legal and/or logistical support. SWs/Cs, in general, provided very similar services to families. Conclusions: SWs and Cs caring for PICU patients with cancer and their families have overlapping roles in providing emotional, communication, and logistical support. Future work will identify barriers and facilitators to SWs and Cs providing support to critically ill children with cancer.
Risk factors associated with ifosfamide (IFOS)-induced encephalopathy in patients (pts) with metastatic (Met) sarcoma (Sarc).
Authors: Ogunniyi Adebayo , Desai Anjali Varma , Horvat Troy Z , Qin Li-Xuan , Chi Ping , Dickson Mark Andrew , Gounder Mrinal M. , Keohan Mary Louise , Tap William D. , D'Angelo Sandra P. 
Published: September 2018

e22518 Background: IFOS is commonly used in the treatment of met sarc. IFOS has been reported to cause encephalopathy in 5 - 30% of pts. Potential risk factors for IFOS-induced encephalopathy (IIE) include female gender, older age, route of administration of IFOS, low serum albumin, existence of pelvic disease and renal failure. Unfortunately, the majority of the data surrounding potential risk factors is from heterogeneous cohorts. Methods: The purpose of this single-center retrospective analysis was to identify risk factors for developing IIE in a homogenous cohort of met sarc pts treated at MSKCC between 1/2010 and 5/2015. Logistic regression was used to examine the univariate effect of baseline and treatment variables. Variables significant at the 0.05 level were entered into a multivariate model. Results: A total of 328 met sarc pts with a median age of 51 years were analyzed. Thirty-four pts (10%) developed IIE. Of those 34 pts, 88% developed encephalopathy with the first or second cycle of IFOS. Age at the time of treatment (p = 0.0037), low serum albumin (p < 0.0001), increased serum alkaline phosphatase (p = 0.0022), liver met disease (p = 0.0011) and more than 3 met sites at time of IFOS dose (p = 0.0008) were all identified as risk factors by univariate analysis. Only low serum albumin (p < 0.0001, odds ratio = 0.33) and more than 3 met sites at time of IFOS dose (p = 0.0068, odds ratio = 2.47) maintained statistical significance after multivariate analysis. Conclusions: To our knowledge, this is the largest retrospective analysis of risk factors for IIE in the met sarc population. This analysis identified low serum albumin and more than 3 met sites at time of IFOS as predictors of IIE. Our data would suggest that clinicians considering the option of IFOS in met sarc pts should give particular attention to these predictive risk factors when making their treatment decisions.
The role of endomyocardial biopsy in cardiac tumors diagnosis.
Authors: Ionescu Dana , Stone Danielle , Stone James , Durand Jean-Bernard , Banchs Jose , Iliescu Cezar 
Published: September 2018

e22536 Background: Pathologic examination is essential for definite diagnosis of both primary and secondary (metastatic) cardiac tumors. Limited data exists on the risks and benefits of catheterization with endomyocardial biopsy (EMB) of cardiac tumors. The present study aims to assess the safety of EBM in diagnosing cardiac tumors. Methods: We retrospectively reviewed therecords of cancer patients who presented with cardiac masses at MD Anderson Cancer Center between 2011 and 2016. Clinical presentation, transthoracic/transesophageal echocardiogram and pathology laboratory results for patients who underwent cardiac catheterization & EMB were reviewed. Results: Out of 8 patients with cardiac tumors (4 females, 4 men, average age of 59.7 y.o.), 5 patients had cardiac catheterization with EMB (5.4 French with Jaw Volume of 2.2, specimens are typically 5 to 20 mg per sample). Clinical presentation included shortness of breath and dyspnea (3 patients), syncope and palpitations (1 patient), and fatigue and slurred speech, as result of a hemispheric stroke (1 patient). Diameter of the cardiac tumors ranged between 4 – 6.5 cm, with no wall abnormalities or hemodynamic compromise as identified by echocardiography. Right atrium (RA) was the most common location (4 patients). One patient had extension of bronchus squamous cell tumor extending into a coronary artery bypass graft (LIMA). Review of the pathological specimens obtained from EMB performed under TEE and fluoroscopic guidance identified 2 patients with cardiac sarcomas in the RA, 1 patient with atrial metastatic melanoma (RA) and 1 patient with lymphoma (right ventricle). EMB was performed with minimal blood loss in all patients. During procedure, one patient developed rapid accumulation of fluid in the pericardial space requiring emergent echo-guided pericardiocentesis. Conclusions: EMB is suggested for the diagnosis of selected cardiac tumors, if the potential benefits from the procedure outweighs the risks. A more invasive approach for rapid histological diagnosis allows appropriate therapy to be promptly initiated. To ensure the safety, EMB should be performed by an experienced operator with fluoroscopy and with transthoracic, transesophageal or intra-cardiac echocardiography guidance.
Association between microRNAs expression in primary breast cancer and presence of circulating tumor cells (CTC) in peripheral blood.
Authors: Mego Michal , Hajduk Matus , Karaba Marian , Minarik Gabriel , Benca Juraj , Sedlackova Tatiana , Repiska Gabriela , Krasnicanova Lucia , Manasova Denisa , Jurisova Silvia , Sufliarsky Jozef , Pindak Daniel , Klucar Lubos , Reuben James M. , Mardiak Jozef 
Published: September 2018

e23022 Background: CTCs play major role in tumor dissemination and progression and represent one of the key component of metastatic cascade. MicroRNAs (miRs) are involved in regulation in several biological processes in cancer including invasion, epithelial-mesenchymal transition (EMT) and disease progression. The aim of this study was to identify miRs in primary tumor associated with presence of CTCs in peripheral blood (PB) in non-metastatic breast cancer patients. Methods: This translational study included 79 patients with primary breast cancer for whom fresh frozen tumor tissue and status of CTCs in peripheral blood were available. CTCs were detected before surgery by qRT-PCR assay for expression of epithelial (CK19) or epithelial-mesenchymal transition (EMT) genes (TWIST1, SNAIL1, SLUG, ZEB1). Total RNA was extracted from fresh frozen primary tumor and the expression profiles were obtained using Human microRNA Microarray v21.0 (Agilent Technologies). Results: We analyzed 48 (60.8%) tumor samples from patients with presence of CTCs in PB and 31 (39.2%) tumors with non-detectable CTCs. From CTCs positive patients, in 20 (41.7%) of them epithelial CTCs (EP_CTC) were detected while in 28 (38.3%) CTCs with EMT (CTC_EMT) phenotype were present. We identified 178 miRs that were expressed at significantly different levels (FDR < 0.05) in tumors with presence of any type of CTCs in PB compared to tumors with non-detectable CTCs. We also identified 174 and 137 miRs (33 overlapping) that were expressed at significantly different levels in tumors with EP_CTCs and CTC_EMT, respectively, compared to tumors with non-detectable CTCs. Overlapping miRs with highest different levels in expression (FDR < 0.01) were miR-3137, miR-3138, miR-3168, miR-605-5p, miR-6165 and miR-6790-5p. Conclusions: We identified for the first time miRs expressed in primary tumor associated with CTCs in peripheral blood in breast cancer patients. Moreover, we identified miRs specifically associated with various subpopulations of CTCs. We suppose, that these miRs could be involved in tumor dissemination and might lead to identification of new therapeutic targets. Study was supported by APVV-14-0327.
Concordance of mutations identified using circulating tumor DNA (ctDNA) compared to tissue based next generation sequencing (NGS) in gastrointestinal malignancies: A single institution experience.
Authors: Kamath Suneel Deepak , Kalyan Aparna , Taxter Timothy J. , Wehbe Firas , Kircher Sheetal Mehta , Nimeiri Halla Sayed , Mulcahy Mary Frances , Benson Al Bowen , Cristofanilli Massimo , Giles Francis J. 
Published: September 2018

e23023 Background: The role of the ctDNA in the management of solid organ malignancies is an area of active research. A potential application of this technology is for monitoring disease progression in patients who had sequencing of their tumor tissue at time of diagnosis. This approach relies on concordance between tumor tissue NGS and the ctDNA, which can vary due to biology and technology. Biologic variability can be due to tumor heterogeneity, ctDNA concentration fluctuations and genomic alterations in clonal non-malignant hematopoietic cells. Methods: We retrospectively evaluated 41 patients who had NGS with Foundation Medicine’s FM1 panel performed on tumor tissue from diagnosis and follow up ctDNA NGS using the Guardant 360 panel(G360). Only genes shared by both panels with the same level of gene coverage were evaluated. This eliminated several genes and alterations, particularly amplifications and splice site alterations. Results: Patient demographics are in Table 1. 148 alterations were identified by G360, of which 42 (28%) alterations were also seen on FM1 testing. When these alterations were restricted to KRAS, APC and TP53, the most common genes altered in GI cancers, 53 alterations were identified and 32 (60%) were also identified by FM1 testing. These results demonstrate that concordance between ctDNA and tissue NGS can be improved if restricted to driver mutations. This restriction eliminates potential passenger mutations acquired by subclones of the original tumor and controls for clonal hematopoiesis. Conclusions: It is difficult to base treatment decisions on the overall concordance seen here between ctDNA and tissue NGS. However, quantification of driver mutations using ctDNA may offer another monitoring tool for disease progression beyond tumor markers, which sometimes can be non-specific or absent.
Prognostic value of neutrophil-to-lymphocyte ratio in advanced EGFR-mutated non-small cell lung cancer (NSCLC) treated with a tyrosine-kinase inhibitors: A retrospective analysis in a series of western patients.
Authors: Meriggi Fausto , Codignola Claudio , Beretta Giordano D. , Ceresoli Giovanni Luca , Caprioli Alberto , Scartozzi Mario , Fraccon Anna Paola , Prochilo Tiziana , Ogliosi Chiara , Noventa Silvia , Libertini Michela , Zaniboni Alberto 
Published: September 2018

e23045 Background: Several studies demonstrated that an elevated neutrophil-to-lymphocyte ratio (NLR) correlate with a poor prognosis both in early and advanced stage of NSCLC. The aim of this retrospective analysis was to investigate the correlation between NLR and prognosis in caucasian patients diagnosed with advanced EGFR-mutated NSCLC and treated with tyrosine kinase inhibitors (TKIs). Methods: A retrospective database was used to identify consecutive patients diagnosed with advanced EGFR-mutated NSCLC and treated with TKIs. From January 2011 to December 2015, 63 patients from five Institutions were enclosed in our series. NLR was derived from the absolute neutrophil and the absolute lymphocyte counts of a full blood count.Survival curves were calculated with Kaplan-Meier method and data were compared by log-rank test. Prognostic significance of NLR were assessed using a Cox regression analysis. Results: Sixty-three eligible patients were stratified according to the mean pretreatment NLR value (3.57 ± 2.42). The chosen cut-off for NLR was 3.5. Forty patients had NLR < 3.5 while 23 patients had a value of NLR > 3.5.A statistical significant difference, both in PFS and OS, was found in the NLR < 3.5 group compared with the higher NLR group (PFS: p < 0.01, OS: p < 0.05). According to univariate analysis, histological type (adenocarcinoma vs non-adenocarcinoma) and NLR value correlate significantly with PFS and OS. In Cox multivariate analysis, only NLR ³ 3.5 resulted significantly associated as independent prognostic factor for worse PFS (HR 2.275, 95% CI 1.257-4.116, p < 0.01) and OS (HR 2.699, 95% CI 1.187-6.137, p < 0.05). Conclusions: Pre-treatment NLR seems to represent a reliable, simple, and easy to reproduce, laboratory tool to predict survival and outcome to therapies in western caucasian EGFR-mutated NSCLC patients. Further prospective trials are needed to definitively confirm its prognostic and predictive role.