bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the addition of bevacizumab (Bev) to chemotherapy on survival in metastatic colorectal cancer (MCRC): A real-world population-based analysis.
Authors: Kannappan Sunand Nageswaran , Arora Rahul Krishan , Cheung Winson Y. 
Published: May 2019

e18215 Background: The addition of bev to IFL chemotherapy in MCRC was shown to improve survival in clinical trials, but its benefit in the real-world where it is frequently used with other systemic therapy regimens has not been fully evaluated. We aimed to assess the impact of bev on MCRC outcomes in a population-based setting. Methods: We examined all patients diagnosed with MCRC from a large Canadian province between 2004 and 2016. We categorized cases based on receipt of bev. Predictors of bev use were examined with multivariate logistic regression models. We also determined correlates of overall survival (OS) and disease specific survival (DSS) using Kaplan-Meier methods and Cox regression models, adjusting for measured confounders. Results: In total, 1,324 MCRC patients received systemic therapy. Median age was 68 years and 728 (55.0%) were men. Among them, 310 (23.4%) received bev. Younger age and better Charlson comorbidity score were associated with a higher likelihood of bev treatment (all p < 0.05). In multivariate analysis, bevacizumab receipt did not correlate with OS or DSS for the entire cohort or for those who received bev with single agent chemotherapy (see Table). However, use of bev was correlated with improved outcomes for patients treated with oxaliplatin-based chemotherapy (HR for OS: 0.751 [0.571 – 0.987], p = 0.040; HR for DSS: 0.680 [0.502 – 0.920], p = 0.013), but worse outcomes for irinotecan-based chemotherapy (HR for OS: 1.327 [1.083 – 1.628], p = 0.006; HR for DSS: 1.309 [1.054 – 1.627], p = 0.015). Conclusions: Bev was only associated with improved survival when used with specific chemotherapy regimens. Table: Univariate and multivariate survival analysis for MCRC patients based on receipt of bevacizumab. m = median; (m) = months; HR = hazard ratio [Table: see text]
Current treatment patterns and associated outcomes in Waldenström macroglobulinemia (WM) and related hematologic malignancies: A systematic literature review (SLR).
Authors: Tang Boxiong , Yang H. Keri , Caver Tony E. , Karcher Rachel , Trautman Holly 
Published: May 2019

e18235 Background: The objectives are to review published literature and identify unmet needs for WM-related treatment and outcomes. Methods: A SLR using PubMed was performed to identify WM-related studies published Jan. 2013-Sept. 2018. Inclusion criteria included interventional or observational clinical studies with N > 40, non-case reports or editorial review, English abstracts available. Results: Of 1146 evaluable publications, 59 were included (40 real-world data [RWD], 4 clinical trials, 15 guidelines). Specific guideline recommendations varied due to limited comparative Phase III trials. RWD on safety and efficacy of WM treatment primarily included retrospective, single-center chart reviews or database analyses in mainly US and European populations. RWD showed heterogeneous WM treatment patterns and outcomes: (1) first-line chemoimmunotherapy use often did not follow guidelines; and (2) overall and progression-free survival (OS; PFS) with front-line regimens were lower than reported in trials. Reduced adherence, discontinuations (DC), and extended holds ( > 8-14 days) with kinase inhibitors (KI; ibrutinib or idelalisib) were common and associated with poorer outcomes (e.g. reduced OS or PFS) ( Table). Common reasons for KI DC/hold included toxicity, procedure/surgery, patient-request, and low/no disease activity. Conclusions: This SLR identified potential unmet needs in current WM treatment associated with poorer clinical outcomes, including KI DC, holds, and reduced adherence. Deviations from treatment guidelines were also reported. Future comparative clinical and RWE studies are needed.[Table: see text]
Is a delay in ALK inhibitor initiation associated with poorer survival? A retrospective analysis based on real-world data.
Authors: Sheinson Daniel , Wong William Bruce , Wu Ning , Mansfield Aaron Scott 
Published: May 2019

e18240 Background: The time between a patient’s positive biomarker test result and initiation of targeted therapy may vary due to a number of factors, including the use of chemotherapy prior to or after the biomarker test result. The objective of this study was two-fold: first, to investigate the impact of delayed ALK inhibitor (ALKi) therapy on overall survival (OS) and second, to examine the association between the use of chemotherapy prior to or after biomarker testing and OS. Methods: The Flatiron Health EHR-derived database was used to identify patients with ALK-positive (ALK+) advanced NSCLC diagnosed between 1/1/2011 - 9/30/2018. The median time from ALK+ test result to ALKi start was used to separate patients into early versus delayed treatment cohorts. To account for potential immortal time bias, times from ALK+ test result to ALKi start from the delayed cohort were sampled with replacement and used to create modified index dates among the early cohort. Cox proportional hazards models adjusting for baseline characteristics (i.e. ECOG) were used to assess the association between delayed ALKi start and OS and the use of chemotherapy with OS. Results: 422 patients with ALK+ aNSCLC were included in this analysis with a median time from test result to ALKi start of 3 weeks. 88 patients (20.9%) received chemotherapy prior to starting their ALKi. Delayed ALKi use was associated with a 2.3 fold increase in risk of mortality (HR [95% CI]: 2.30 [1.28, 4.15], p < 0.01). There was no difference in survival observed between those who had received chemotherapy prior to initiating their ALKi and those who did not receive chemotherapy (HR [95% CI]: 0.99 [0.62, 1.58]). Among those who initiated chemotherapy prior to their ALK+ test result, the continued use of chemotherapy prior to initiating an ALKi did not result in differences in OS compared to those who switched to an ALKi without continuing chemotherapy (HR [95% CI]: 1.03 [0.44, 2.41]). Conclusions: Delayed initiation of ALKi may result in poor outcomes in patients with ALK+ NSCLC. Receipt of chemotherapy prior to ALKi or the duration of chemotherapy did not impact survival. Future strategies to improve the time to therapy initiation may be useful in improving patient outcomes.
Employment outcomes and quality of life in patients with early breast cancer and their support persons: A dyadic study.
Authors: Veenstra Christine M , Wittmann Daniela , McLeod Chandler , Braun Thomas , Hawley Sarah T. 
Published: May 2019

e18241 Background: Many women with breast cancer face job loss related to their diagnosis, but little is known about employment outcomes among their partners and other supporters. Moreover, virtually nothing is known about associations between patients’ quality of life and supporters’ employment status. Methods: Breast cancer patients reported to Georgia and LA SEER registries in 2014-15 (N = 2,502, 68% RR) and their key decision support person (DSP) were surveyed separately. 1234 DSPs responded (71% RR). Patients and DSPs were asked about employment impacts of the patient’s breast cancer. Patients’ quality of life (QOL) was measured with the PROMIS scale for global health. Descriptive analyses of employment outcomes (job loss, missed days due to cancer) were generated for patients and DSPs. Associations between patients’ QOL and employment status of patients and their DSPs were assessed using linear mixed model regression analyses stratified by dyad type (partner vs. non-partner DSP). Results: Among DSPs, 43% were partners. 57% were non-partners (daughters, other family, friends). 67% were employed at time of patient’s diagnosis. Among these, 11% were no longer employed at survey completion. 39% missed > 30 days work. Non-partner DSPs were as likely as partners to lose their job or miss work because of the patient’s cancer. 65% patients were employed at diagnosis. Compared to patients whose DSP was a partner, patients with non-partner DSP were more likely to lose their job (39% vs. 24%; p < 0.01) or miss > 30 days work (55% vs. 45%; p < 0.01). For patients with a partner DSP, both patient and DSP employment at diagnosis were associated with improved patient QOL (each associated with a QOL score 24% of 1 standard deviation higher; each p < 0.05). For patients with non-partner DSPs, only patient employment at diagnosis was associated with improved patient QOL (QOL score 51% of 1 standard deviation higher; p < 0.01). Conclusions: Both non-partner and partner DSPs faced negative employment impacts related to patients’ breast cancer. Job loss and > 30 days of missed work were more likely among patients with non-partner DSPs. Only the employment of partner DSPs at diagnosis positively contributed to patients’ QOL.
Population kinetics of progression free survival (PFS).
Authors: Stewart David J. , Bossé Dominick , Robinson Andrew George , Ong Michael , Brule Stephanie Yasmin , Fung-Kee-Fung Michael , Hilton John Frederick , Clemons Mark J. , Ocana Alberto 
Published: May 2019

e18251 Background: We assessed drug type impact on whether PFS curves could be fit by 2 phase decay models on nonlinear regression analysis (NLRA). Methods: We digitized 894 published PFS curves for incurable cancers. We used GraphPad Prism 7 for 1 phase and 2 phase decay NLRA, with constraints Y0 = 100 and plateau = 0. We defined curves as fitting 2 phase models if each subpopulation was ≥1% of the entire population and if subpopulation half-lives differed by a factor of ≥2, or if log-linear plots demonstrated unequivocal 2 phase decay. Results: PFS curves for single agents showed either high (≥75%) or low ( < 30%) probability of 2 phase decay, depending on drug type (p < 0.0001, Table). 11/11 PD1/ipilimumab combinations had 2 phase decay vs 36/209 curves (17%) for all other combinations. Conclusions: Drugs have either high or low probability of PFS curve 2 phase decay. Clinical trial methods or some mechanisms of acquired resistance might contribute to 2 phase decay, but 2 phase decay also could indicate a dichotomous factor (eg gene mutation/deletion or complete pathway silencing) producing 2 distinct subpopulations with differing progression rates. Drugs with high 2 phase decay could be prime candidates for RNA & whole genome sequencing, pathway expression studies etc to identify dichotomous predictive factors. Further assessment is needed to better understand why some drugs behave differently when given in combinations vs as single agents. [Table: see text]
The Quality Oncology Practice Initiative Program: Experience in Spain.
Authors: Lopez Rafael , Anton Antonio , Aranda Enrique , Carrato Alfredo , Constenla Manuel , Cruz Juan Jesús , Díaz-Rubio Eduardo , Feyjoo Margarita , García Foncillas Jesús , Gascon Pedro , Guillem Vicente , Lugo Ilse , Camps Carlos 
Published: May 2019

e18267 Background: Patient care quality is a discipline with enormous relevance in today’s healthcare. Quality Oncology Practice Initiative (QOPI) is a referral worldwide in quality for oncology practices. The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. ECO reached an agreement with QOPI to involve Spanish hospitals in the QOPI program. Methods: 7 rounds of data collection have taken place (Fall 2015 to Round 2 2018). Practices had to register online and submit data into the QOPI platform, and the ECO Foundation offered them the necessary support. 18 Spanish hospitals have participated in the 7 rounds, and 12 of them have repeated participation. Core, Lung Cancer and Breast Cancer modules were completed. Results: During the 7 rounds, 2341 charts were submitted by the Spanish practices. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75%, 100% in the three following rounds and 88% in the last round. For the 12 hospitals that repeated participation, 8 reported improvements at different degrees of their global scores. These hospitals specifically show an improvement in the QOPI measures related to the signed patient consent for chemotherapy and the documentation of the patient consent in the practitioner note, the chemotherapy intent documentation, the appropriate completion of the chemotherapy planning, the documentation of the number of chemotherapy cycles and the development and documentation of the pain assessment. On the other hand, regarding QOPI Certification, three Spanish hospitals have received this accreditation in September 2017 and one in June 2018. Conclusions: These preliminary results are a good starting point for the continued implementation of the QOPI program in Spain, thus providing a well-structured approach to analyze cancer care. The ECO Foundation will continue pursuing excellence and quality with further activities like the QOPI Certification program and Quality Training Program, with these performed for the first time in Spain in 2017 and 2018 respectively.
Lack of clinician knowledge of human papillomavirus (HPV) vaccination to prevent HPV-related cancers in men: An interview study.
Authors: Varga Stefan , May Suepattra Grace , Morais Edith , Shrestha Anshu , Huber Caroline , Tantri Anupama , Roach Meaghan , Phillips Matthew , Jena Anupam B. 
Published: May 2019

e18273 Background: Human papillomavirus (HPV) has a well-established link to cervical cancer and anogenital and oropharyngeal malignancies. Recognition of the HPV-caused cancer burden in males has led to expansions of female-only HPV vaccination programs to all genders. This study explored drivers of and barriers to gender-neutral HPV vaccination (GNV) program adoption, implementation, and potential impacts on the HPV-caused cancer burden. Methods: We conducted in-depth interviews with academic oncologists as well as advocacy, public health, infectious disease, and policy experts in six countries (Argentina, Australia, Austria, Brazil, Canada and Italy) from April-August 2018. Using a semi-structured discussion guide, we sought to elicit expert perceptions on factors affecting uptake of HPV vaccination in males and subsequent effects on the incidence of HPV-associated cancer. Data were analyzed for key themes. Results: Eighteen experts participated in the study, including three academic oncologists and two doctoral level oncology researchers. A key theme from the analysis was the critical need to promote education and awareness about GNV across all healthcare providers to facilitate vaccine uptake and high GNV coverage rates. Participants reported a lack of awareness among segments of practitioners about the effectiveness of the HPV vaccine in preventing HPV infection and associated cancers in all genders. They also described strategies to overcome knowledge gaps, such as partnerships with oncologists, cancer advocacy organizations, and professional medical societies, emphasizing the key role that all health care providers can play in raising awareness of the importance of HPV vaccination for all genders. Conclusions: Findings from this study suggest the need to enhance healthcare provider education about GNV, and the importance of a multi-specialty approach to promoting HPV vaccination to prevent infection and HPV associated morbidity and mortality in all genders.
Initial breast cancer consult: Improving satisfaction and impact on distress.
Authors: Decker Veronica B. , Ivanov Olga 
Published: May 2019

e18284 Background: Goals of this performance improvement project were to: (1) determine the impact of initial breast cancer consultation on distress and number of reported problems as measured by the NCCN Distress Thermometer and Problem List (DT and PL) questionnaire and to: (2) explore the relationship between pre-consult DT and PL scores and patients’ satisfaction with information received during the consult as measured by the EORTC QLQ-INFO25. Methods: (1) Immediately prior to, and after, initial consult with the breast cancer surgeon, 59 convenience-sampled women completed NCCN DT and PL questionnaires. (2) They then completed an EORTC QLQ-INFO25 questionnaire designed to measure information satisfaction. Participants were placed in quartile groups based on DT score and, likewise, grouped based on number of reported problems on the PL. Quartile groups were then analyzed to determine scale satisfaction with the information provided. Results: (1) Both DT and PL pre-post changes were significantly positive (DT: M = 5.4, SD = 3.0 versus M = 3.6, SD = 2.8; t-test p< .000); (PL: M = 5.3, SD = 4.4 versus M = 3.7, SD = 4.3; t-test p< .000). Except for the INFO25 RECLESS scale (less information desired), lower scores are better. (2a.) Generally, high distress and problems reported (i.e., scores increase), guarantees lower information satisfaction. (2b.) With one exception, the quartile range for each scale was consistently small. (2c.) Score trajectories for both DT and PL quartiles over the scales were similar. Conclusions: Although data suggests current consultation processes are significantly effective, there is room for satisfaction improvement. (2a.) Providers who continue to give the DT and PL prior to a consult, must ensure information satisfaction to pre-consult DT and PL high scorers. (2b.) Similar quartile scores for each scale suggests that individually tailoring the consultation based on pre-consult DT or PL scores alone (without satisfaction improvement efforts) may have minimal benefits. (2c.) Consult satisfaction improvement efforts should focus on the following scales: INFOCD (information on CD/tape/video); RECMORE (more information wanted); INFOTHSE (other services); INFOHELP (things you can do to help yourself get well); INFODIFP (different places of care); INFOTREAT (treatments), and; INFODIS (the disease).
Metabolites as mediator for alleviating adverse effects in chemotherapy: A new finding from a recent study of Japanese traditional Kampo medicine, rikkunshito (RKT).
Authors: Suzuki Hiroyuki , Inoue Takuya , Takagi Hironori , Watanabe Masayuki , Ozaki Yuki , Muto Satoshi , Okabe Naoyuki , Hasegawa Takeo , Shio Yutaka , Minemura Hiroyuki , Kanazawa Kenya , Ohbuchi Katsuya , Fukushima Takahisa 
Published: May 2019

e18292 Background: In Japan, RKT is used for chemotherapy-induced anorexia. There is considerable variation in the therapeutic response to RKT. We assessed the efficacy of RKT on anorexia induced by cisplatin (CDDP) therapy in lung cancer patients (pts) from the clinical and the plasma metabolomics perspectives. Methods: The study was a double-blind, randomized trial evaluating pts with age ≥20 y with lung cancer assigned to receive regimen including CDDP, ECOG PS 0 to 1. Pts were administered RKT or placebo from the beginning of 1st course of chemotherapy (Day1) until just before starting the 2nd course (21 or 28 consecutive days). The clinical endpoints were the change in mean dietary intake in hospital (MDIH), QOL and nutritional indices. Plasma samples were collected at Day1, Day7 and Day22 (22nd or 29th day) for metabolome analyses. Results: 60 pts were enrolled between Nov 2014 and Aug 2017. 29 were allocated to RKT and 31 to placebo. The ANCOVA estimate of treatment effect in MDIH (baseline adjusted RKT-Placebo difference) was not significant (-6.7; 95% C.I. -61.1 to 47.8). Regarding QOL, there was no significant results in changes of QLQ-C30 Global Health Status. Among the related subscales, Pain in Day22 in PPS analysis was the only significant item (-17.0; -29.7 to -4.2). Regarding QLQ-LC13 , Alopecia in Day22 was the only significant item (-21.3; -36.9 to -5.8). The changes in nutritional indices did not show any significant difference, either. In metabolome analysis, CDDP drastically influenced metabolites, such as essential amino acids. RKT did not significantly change them compared to the placebo. In contrast, the changes of acetylglycine and arabinose in plasma strongly correlated with those in dietary intake and pain only in the RKT. Conclusions: In this exploratory study, no significant difference was observed in the MDIH. Although, pain and alopecia observed in QOL were significantly improved in the RKT. Some plasma metabolites were found to correlate with improvement in dietary intake or QOL. This is the first suggestive evidence that the efficacy of RKT would be variable depend on the metabolic profile. Clinical trial information: JAPIC CTI-142747.
Evaluation of inpatient cancer rehabilitation by routine electronic patient-reported outcome measures (ePROM): Improvement of quality of life (QoL) and psychological distress.
Authors: Licht Thomas , Nickels Alain , Riedl David , Rumpold Gerhard , Holzner Bernhard 
Published: May 2019

e18294 Background: Many cancer survivors suffer from psychological distress and poor QoL. Cancer rehabilitation is aimed at improving their condition but the benefit remains controversial, we have thus investigated the outcome. Methods: ePROM were routinely integrated into the inpatient program of a cancer rehabilitation center in Austria. Hospital Anxiety and Depression Scale (HADS) was used to assess distress, and EORTC QLQ-C30 questionnaire for analysis of cancer-related symptoms and functions. Patients answered questions via internet prior to admission (T0). This allowed for allocation of physical therapies and 4-8 psychological counseling sessions according to their needs. Following informed consent, the outcome was investigated likewise by the time of discharge after 3 weeks (T1). Data were analyzed with SPSS software using ANOVA repeated measures. Results: 4198 patients (age 59.2±11.7 yr; range 18-91 years; 61.5% female) participated between January 2015, and August 2018. HADS identified a marked reduction of anxiety and depression, with distress levels similar to the normal population by T1. QLQ-C30 revealed significant increases for global QoL; physical, social, emotional and role functions. All recorded symptoms were improved, in particular fatigue, pain and insomnia. Moreover, subgroup analyses confirmed improvement for 11 investigated entities. Of notice, decrease of anxiety was most prominent in survivors of breast, head/neck and lung cancer patients (p < 0.001). No significant differences were observed between a subgroup of 1122 elderly ( > 70 yr), and younger patients except for the physical function, which improved significantly in older patients (p = 0.003). Conclusions: Our study shows that inclusion of ePROM into inpatient cancer rehabilitation helps allocate therapies according to individual needs. This large series demonstrates significant reduction of psychological distress and improvement of all parameters of QoL. [Table: see text]