bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of mortality trends in patients with non-salivary gland and salivary gland adenoid cystic carcinoma in the United States population.
Authors: Raval Girindra Ghanshyam , Ajebo Germame Hailegiorgis , Bryan Locke Johnson , Guddati Achuta Kumar 
Published: May 2019

e17584 Background: Adenoid cystic carcinoma is the most common histological subtype of malignancy seen in major and minor salivary glands. Although indolent they tend to recur and progress. Adenoid cystic carcinoma also arises from other structures such as lacrimal glands and trachea. This study compares the incidence-based mortality between patients who have salivary and no-salivary origin adenoid cystic carcinomas of the head and neck region over the period of 2000 to 2014. Methods: A nation-wide analysis was conducted utilizing the Surveillance, Epidemiology, and End Results (SEER) Database from the years 2000 to 2014. Incidence-based mortality for all stages of adenoid cystic carcinoma was queried and the results were grouped by race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander) and gender. All stages were included in the analysis. T-test was used to determine statistically significance difference between various subgroups. Linearized trend lines were used to visualize the mortality trends of all sub groups. Results: Incidence-based mortality for salivary gland adenoid cystic carcinomas in African American/Black patients is comparable to Caucasian/White patients despite a higher incidence in Caucasian/White patients (no statistically significant difference was noted). Also, the incidence-based mortality for non-salivary gland adenoid cystic carcinomas of the head and neck region in African American/Black patients was similar to Caucasian/White patients. Essentially no racial difference in mortality was noted between salivary and non-salivary gland tumors. Comparison of mortality between genders in both races in salivary and non-salivary gland tumors also did not show any statistically significant difference. Conclusions: This study showed that adenoid cystic carcinoma of non-salivary gland origin have the same mortality trends as that from salivary gland origin in both Caucasian/White and American/Black patients and in both genders. Given such uniformity, genetic and environmental factors may not play significant role in the progression and outcomes of this disease. Hence, adenoid cystic carcinoma may be treated with similar therapeutic approaches regardless of the origin, gender and race of the patient.
Efficacy and prognostic factors of systemic therapies for metastatic adenoid cystic carcinoma.
Authors: Roussel-Simonin Cyril , Riet Francois , Hervé Geneviève , Bertolus Chloe , Maingon Philippe , Spano Jean-Philippe , Gobert Aurelien 
Published: May 2019

e17587 Background: Metastatic cystic adenoid carcinoma (mCCA) is a rare entity of cancer associated with a poor prognostic. Only limited efficacy data based on case-reports and retrospective analysis are available and there is currently no standard for treatment. The aim of our study is to evaluate the efficacy and prognostic factors in recently diagnosed mCCA. Methods: We retrospectively collected demographic and efficacy data from patients treated for mCCA between September 2012 and January 2019 at the Pitié-Salpêtrière Hospital. Univariate analysis of prognostic factors was performed using the Cox model. Survival was estimated using the Kaplan-Meier method and long rank analysis. Results: Fifteen patients were included: 8 women and 7 men with a median age at diagnosis of 57 years (range 32-71). The primitive sites were accessory salivary glands in 9 patients, major salivary glands in 3 patients, lung, cervix and lacrimal glands in each of the 3 other patients. Histology of the primary tumor was available for 7 patients with 4 cribriform and 3 solid types respectively, an intermediate grade in 5 patients, a high in 2 patients, and a median of Ki67 at 35% (range 8.5-40%). Thirteen patients received a first line therapy, including 10 with platinum – LV5FU2, 2 with cisplatine anthracycline and cyclophosphamide association (CAP) and 1 with sunitinib. A stable disease was found in 7 patients (54%), a partial response in 4 patients (31%) and 2 patients had progression at first evaluation. The median 1st line PFS was 5.8 months (range 2.0-12.7). With a median time of follow-up at 12.9 months (range 4.0-61.3), 5 patients (33%) were dead, 8 patients (53%) were still receiving systemic therapy and 4 patients (27%) received 4 lines. A patient with partial response after 6 CAP cycles,received a liposomal anthracycline combined with carboplatin for 8 cycles with a response time of 12.7 months. In univariate analysis, no statistically significant prognostic factors were found. Conclusions: In our retrospective study, 1st line of systemic therapy is efficient in mACC with a 31% response rate. Furthermore, here we report the first patient treated with liposomal anthracycline associated with duration of response for 12.7 months. These preliminary results should be confirmed before becoming a new option for treatment in mACC.
External validation of the COMPASS-Cancer Associated Thrombosis Study: A predictive score to identify patients with solid tumors on treatment who are at risk for venous thromboembolism.
Authors: Anand Lalitha N , Spyropoulos Alex C , Eldredge Joanna B , Nourabadi Soheila , Zhang Meng , Qiu Michael , Rosenberg David 
Published: May 2019

e18005 Background: A predictive model to identify patients on active treatment for solid tumors at risk for venous thromboembolism (VTE) remains an important clinical need. The COMPASS-CAT Risk Assessment Model (RAM) for VTE in a Eurasian patient population with solid tumors undergoing active treatment displayed good discrimination to identify patients into low/intermediate versus high VTE risk groups. We sought to externally validate this RAM in a North American cancer population. Methods: Patients age > 17 years who presented to the Monter Cancer Center between 1/12014 to 12/31/2016 with breast, ovarian, lung, or colorectal cancers were included. The COMPASS CAT RAM included 8 scored variables that were identified by ICD-9 and -10 codes and chart review. The primary endpoint at 6-month study follow-up was symptomatic VTE. Area under the ROC Curve (AUC) was calculated. We calculated a binary cut off to define VTE risk groups into low/intermediate and high VTE risk categories and calculated sensitivity, specificity, and negative and positive predictive values (NPV, PPV). Results: 3814 patients were included with a mean age of 64, of whom 49%, 5%, 29%, and 17% had breast, ovarian, lung, and colorectal cancer, and 52% had localized and 48% had advanced stage disease. In 94% of patients, cancer was diagnosed within the last 6 months prior to inclusion and 46% of patients were on active therapy when evaluated. Symptomatic VTE at 6-month follow-up occurred in 5.85% of patients. The AUC was 0.62. Using model cut-offs of 0-6 or > 7 points, patients stratified into low/intermediate and high-risk groups had VTE rates of 2.27% and 6.31%, respectively. The sensitivity, specificity, NPV, and PPV of the RAM were 95%,12%, 97.73%, and 6.31%, respectively. Conclusions: In this large retrospective external validation study of the COMPASS-CAT RAM for VTE in cancer patients undergoing active treatment, model discrimination and calibration was fair. Further prospective validation studies are needed before the model can be implemented into routine clinical practice for primary thromboprophylaxis of high VTE risk cancer patients with solid tumors.
Contemporary use of inpatient antineoplastic (IP) treatment (Rx): Who is getting care and why?
Authors: Hachem Hilal , Levitz David , Dima Danai , Dower Joshua R. , Fresco Rabiah B. , Weidner Ruth Ann , Buchsbaum Rachel J. , Erban John Kalil , Parsons Susan K. 
Published: May 2019

e18015 Background: The steady trend towards outpatient antineoplastic medication delivery has been spurred by improvements in supportive care, innovations in drug delivery, and financial considerations. Despite these trends, a significant number of patients (pts) continue to receive IP Rx for both hematological (HM) and solid cancers (ST). The purpose of this study is to describe a single center’s experience with IP Rx between 01/01/2015 and 12/31/2017. Methods: All pts ( > 18yo) who received IP Rx for a cancer diagnosis, exclusive of stem cell transplantation, were identified from hospital pharmacy records. Patient and disease characteristics were collected at the index (initial) admission. All pts were followed for 1 year after index admission for 30-day readmission and subsequent admissions for IP Rx. Reasons for IP Rx included: urgent/emergent initiation of Rx; high acuity inpatient management for ST (e.g., intraperitoneal, intra-arterial, intravesical therapy) or complex HM regimen; ongoing Rx; palliation. Results: A total of 266 index admissions were identified with 66.2% of pts having a HM (n = 176) and 33.8% having a ST (n = 90). IP Rx was classified as urgent for 48.1% of pts (n = 128); 70.3% (n = 90) of these admissions were new diagnoses of which 91.4% (n = 86) were HM. High acuity IP management was required for 37.5% of pts (n = 100) (47% for ST (n = 47) and 53% for HM (n = 53)). The remaining index admissions were classified as ongoing Rx for 4.5% of pts (n = 12) and palliation for 9.8% (n = 26). Pts with ST required intensive care significantly more often than pts with HM (57.8% vs. 15.9%, p < 0.001) but with no difference in inpatient mortality (4.4% vs. 5.7%, p = 0.891). The 30-day readmission rate was 32.2% for ST and 25.6% for HM (p = 0.515). After the index admission, 10% of ST pts and 60.2% of HM pts had at least 1 subsequent admission for IP Rx (p < 0.001). Conclusions: In this 3-year retrospective review, the vast majority of pts receiving IP Rx required either urgent initiation of care or high acuity care, currently only available in the inpatient setting. While there is little evidence of routine IP Rx or opportunity, at present, to transition further care to the outpatient setting, the high rates of 30-day readmission warrant further evaluation.
The Children’s Oncology Group (COG) Adolescent and Young Adult (AYA) Responsible Investigator (RI) Network: An initiative for advancing AYA cancer research in the National Clinical Trials Network (NCTN).
Authors: Mittal Nupur , Saha Aniket , Freyer David Robert , Roth Michael 
Published: May 2019

e18016 Background: The COG has previously developed a successful model in which institutional RIs are identified to champion site-level research activities and trial enrollment. In response to low participation of AYAs in COG clinical trials, the COG AYA RI Network was developed. Methods: In January 2018, the COG AYA Committee solicited nominations of AYA RIs by site Principal Investigators. The AYA RI role is focused on the following site-level activities: 1. Working with the local IRB to prioritize AYA relevant studies; 2. Developing systems for screening AYAs for enrollment; 3. Serving as a liaison with medical oncology; 4. Educating staff on disparities in AYA outcomes. Increased site-level interaction with adult NCTN groups is a goal of this initiative. Results: The network was launched in February 2018. Subsequently, 144 RIs (physicians, research staff, psychologists, administrators) from 118 demographically and geographically diverse sites have joined the initiative. To date, there have been 9 interactive webinars, with 18 presenters from diverse institutions, each attended by 60-90 RIs. Two symposia on addressing barriers to enrollment were held at COG meetings. Shared site-level barriers and facilitators to enrollment have been identified. The most common recommendations for improving AYA accrual are: 1. Increase the number and diversity of AYA trials; 2. Increase collaboration between pediatric and medical oncology; 3. Increase support and resources from institutional leadership; and 4. Overcome logistical constraints to accruing AYAs to COG trials. Recently, the COG AYA RI Network joined with the SWOG AYA Committee to identify site-level dyads involving an AYA RI representing each group. Conclusions: To our knowledge, the COG AYA RI network is a novel model for enhancing AYA-focused cooperative group research at the site level, including enrollment on clinical trials. Next steps include conducting a formal survey to gather site-level data and establishing metrics to assess impact of this initiative, as well as continuing to work closely with SWOG to improve cross-group trial enrollment of AYAs.
Using a video to introduce fertility preservation to women with cancer.
Authors: Gupta Abha A. , Lenton-Brym Talia , Charow Rebecca , Paulo Chelsea , Samadi Mahsa , Forcina Victoria , Chen Shian Li , Thavaratnam Adrian , Mitchell Laura , Lorenzo Armando J. , Papadakos Janet 
Published: May 2019

e18021 Background: Women with cancer risk premature ovarian insufficiency with implications for future fertility due to chemotherapy and radiotherapy. Still, infertility discussions are inconsistently provided. Options for egg cryopreservation exist for females, but discussing these topics can be overwhelming for patients and families. This paper aims to assess the understandability, actionability, and readability of a fertility preservation (FP) educational video, as well as patient (pt) and caregiver pre- and post-video perceptions and knowledge. Methods: A video was created by the institution's Adolescent and Young Adult Program to explain relevant anatomy, pathophysiology of ovulation and process of cryopreservation. Understandability and actionability were evaluated using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) and readability using the SMOG and Flesch-Kincaid indices. Pt perceptions and knowledge growth were captured using pre-post questionnaires. Female pts (n = 108) were recruited in oncology clinics over 2 months, using a convenience sample. Questionnaire responses were analyzed using SPSS to calculate descriptive statistics to conduct correlation analyses. Results: The median age of the participants was 28 (range 14-39 yrs). The average PEMAT-A/V score was 79% (±11.3%) for understandability and 72% (±13.1%) for actionability. A score of 70% is regarded as acceptable. The readability assessment determined that the video script was, on average, at a grade 8 reading level. Pts’ interest in learning about FP increased, with 14% of those initially uninterested or unsure wanting to learn more after viewing the video. Pts’ general knowledge on FP increased from the pre- to post-video questionnaire, from a mean score of 75% initially (±17.9%), to a mean score of 84% (±14.5%) after watching the video (t = -5.972, p = 0.000). On average, overall satisfaction with the video was 85% (±8.5%). Conclusions: Women commonly use online tools for researching health questions. This study demonstrates that the video is understandable and provides guidance for future discussion. It shows that videos can spark interest in sensitive discussions and can improve fertility knowledge. This video may encourage providers to more consistently initiate discussions about infertility. Furthermore, the video can be translated for related topics to help provide accurate information in a patient-friendly medium.
Follow-up of cancer patients at the Colorectal Multidisciplinary Clinic: The University of the Philippines - Philippine General Hospital (UP-PGH) experience.
Authors: Ting Frederic Ivan Leong , Sacdalan Danielle Benedict Leoncio , Sacdalan Josephine Anne Lucero , Sacdalan Dennis Lee 
Published: May 2019

e18022 Background: The University of the Philippines - Philippine General Hospital (UP-PGH) Colorectal Multidisciplinary Team is composed of colorectal surgeons, radiation oncologists, and medical oncologists tasked with the care of patients with colon and rectal cancers in a multidisciplinary clinic. Patients that have been lost to follow-up after initial work-up and treatment return later with more advanced disease if at all they come back for treatment. This is a concern because cancers of the colon and rectum are potentially curable if addressed in a timely manner by patient and physician. Moreover, aggressive follow-up of potentially curable colon and rectal cancers has been shown to improve patient outcomes. Identifying factors that contribute to poor patient follow-up will allow the team to design strategies that will lead to more patients completing treatment. This study aimed to identify the different factors that influence follow-up among Filipino cancer patients presenting at the UP-PGH Colorectal multidisciplinary clinic. Methods: This is a 6 month prospective cross-sectional pilot study where a questionnaire was designed to evaluate patient views regarding factors that contribute to continued follow-up as well as factors associated with poor follow-up at the colorectal multidisciplinary clinic. Patients were allowed to state multiple factors as they see fit. Descriptive statistics were employed in the analysis of data. Results: Of the 97 responders, 39 (40%) patients identified belief in the effectiveness of the treatment and trust in their physicians, 33 (34%) stated adequacy of family support , and 31 (32%) noted affordability of treatment as factors contributing to patient follow-up. In contrast, 44 (45%) patients identified financial constraints, and 7 (7%) stated the far distance of their home to the treatment center as potential causes of poor follow-up. Other potential causes of poor follow-up identified were fear and anxiety about treatment, intolerable side-effects, and long lines at the clinic -all with 2 (2%) responses each. Conclusions: Healthcare decisions in the Philippines are affected by an interplay of factors. This study has identified belief in treatment efficacy, trust in their attending physician, financial factors, and clinic accessibility as influencing continued patient follow-up. Future endeavors may be directed towards these factors to improve follow-up and care at the colorectal multidisciplinary clinic.
The impact of a digital solution on case discussion time at tumor boards.
Authors: Fowler Donna , Sheets Lincoln R , Prime Matthew S , Siadimas Athanasios , Levy Yariv Z , Hammer Richard D 
Published: May 2019

e18028 Background: A multidisciplinary tumor board (MTB) provides an interdisciplinary approach for decision-making in cancer care. Information factors such as, multiple data sources, incomplete or missing information and teleconferencing failures, have been identified as issues contributing to variability in MTB conduction and impact. Little is known about how digital tumor board solutions can optimize MTB meeting conduction. Methods: A prospective IRB approved cohort study was undertaken to evaluate the time for patient case discussions,before and after the implementation of the NAVIFY Tumor Board (NTB) solution, at University of Missouri Health Care. Data was collected using a digital time-tracking application. The NTB manual version was implemented via a phased roll-out (Breast May 18, 2018; Gastrointestinal (GI) Jul 11, 2018; ENT Oct 30, 2018 – no manual version phase). Subsequently, the integrated version was introduced (Oct 4, 2018) whereby automated electronic medical record (EMR) data extraction was enabled. Results: Patient case discussion time was recorded at 138 MTBs (1109 patient cases) during 2018 (Breast 40 MTB; 236cases / GI 49 MTB; 389 cases / ENT 49 MTBs; 484 cases). Case discussion time significantly reduced at the Breast MTB (6.6mins to 5.3 mins; p-value = 0.01). Case discussion time at ENT MTB and GI MTB showed no significant change (Table 1). Time variance in case discussions significantly decreased post-NTB implementation at the Breast MTB (p-value = 0.008). For the GI & ENT MTBs, there was no significant difference post-NTB implementation (GI p-value =0.199; ENT p-value = 0.511), however, variance was already sma Conclusions: Introduction of the NTB reduced the time spent discussing cases for the Breast MTB, but showed no change forGI MTB and ENT MTB. Interestingly, case discussion times converged to between 5.5 - 6.5 minutesirrespective of the MTB type. Furthermore, variance decreased or was already small, for all MTB types. Both observations suggest that NTB standardized the case discussion process, perhaps because it created a common format for case presentation. A common workflow tool for MTB meeting conduction could ensure availability of all required data, increase efficiency of therapy decision-making, and lead to higher throughput of cases resulting in shorter time-to-treatment.
A systematic analysis of off-label drug use in real-world data (RWD) across more than 145,000 cancer patients.
Authors: McCafferty Jonathan , Grover Kartikey , Li Li , Li Zhiqiang , Fink Marc Y. , Goldsweig Howard , Ma Meng , Zhou Xiang , Mullaney Tommy , Redfern Arielle , Jappe Whitney , Zimmerman Michelle , Prentice Tony , Pan Qi , Oh William K. , Schadt Eric , Li Dan , Chen Rong 
Published: May 2019

e18031 Background: Off-label drug use is common in cancer treatment (tx) due to limited approved tx options. Systematic analysis of RWD for off-label drug use facilitates hypothesis generation and design of clinical studies for new indications. Methods: We analyzed systemic tx data of > 145,000 cancer patients at Mount Sinai hospitals for 60 chemotherapy, 80 targeted, 16 hormonal therapy drugs, and 6 immune checkpoint inhibitors (CPIs). Off-label use was determined when patients received a drug for cancer indications that had not received regulatory approval, and the tx was not in a clinical trial setting. Clinical response to off-label tx was assessed using time to treatment discontinuation (TTD) as a surrogate endpoint. Results: Chemotherapy drugs were used off-label more frequently than targeted and hormonal agents. Across all cancer tx regimens involving a chemotherapy drug , 31% were off-label. In contrast, for tx regimens involving targeted and hormonal therapy drugs, only 11% and 6.7%, respectively, were used off-label. Further investigation revealed that chemotherapy often combines multiple drugs, where the combinations may include one or more drugs not approved for the disease. For example, cisplatin is approved only for bladder, ovarian and testicular cancers, but is widely used in combination to treat other cancers. Consequently, we observed an 84% off-label use of cisplatin. Several targeted drugs and CPIs were used off-label at high frequencies. 53% of nivolumab tx was off-label, primarily for treating hepatocellular carcinoma (before FDA approval) and relapsed/refractory multiple myelomas (RRMM). Trametinib targeting MEK and venetoclax targeting Bcl-2 were used off-label at a frequency of 84% and 89%, respectively, mainly in RRMM. In MM patients treated with trametinib (n = 91) and venetoclax (n = 121), 14 (15%) and 42 (35%), respectively, had TTD > 120 days. Conclusions: Off-label uses of novel targeted and immunotherapy drugs are likely based on disease mechanisms and when clinical trials deliver early, encouraging results. A thorough chart review would help us better understand clinical response as well as adverse events in these patients and potentially guide future clinical studies.