bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative concurrent chemoradiation (CCRT) for non-squamous cell carcinoma (NSCCA) of head and neck.
Authors: Thamlikitkul Lucksamon , Petsuksiri Janjira , Ithimakin Suthinee 
Published: September 2018

e17582 Background: Surgery is the mainstay of treatment for resectable non-metastatic NSCCA of head and neck. Postoperative radiation (RT) is delivered to patients (pt) with high risk for recurrence. Unlike the squamous cell counterpart where survival advantage from adding chemotherapy (CMT) as a radio-sensitizer is evident, the benefit of CCRT is uncertain in NSCCA pt. We hypothesized that CCRT would improve disease free survival (DFS), comparing to RT alone. Methods: NSCCA of head and neck pt who underwent curative surgery and RT at Siriraj hospital from 2006 to 2015 were included in this retrospective study. Patients with residual tumor after surgery or neuroendocrine histology were excluded. The primary outcome was DFS. The secondary outcome was overall survival (OS). Results: We included 139 pt, 99 (71.2%) had RT while 40 (28.8%) had CCRT. Baseline characteristics, including age, gender, primary site, histology and radiation dose were similar between 2 groups. Salivary gland was the most common primary site (67.6%). The most common histology was adenoid cystic carcinoma (35.3%), followed by mucoepidermoid carcinoma (25.9%). Patients who received RT alone had earlier stage (Stage I 29.3%, Stage IVa 14.1%), compared to CCRT group (Stage I 7.7%, Stage IVa 38.5%), p = 0.003. High risk features (positive margin, extranodal extension or ≥ 2 cervical lymph nodes metastasis) were found in 42% and 62% of pt with RT and CCRT, respectively (p = 0.03). In CCRT group, 92% of pt received cisplatin every 3 weeks during RT period. With the median follow-up time of 54.9 months, 3-year DFS was 79.4% and 79.5% in RT and CCRT groups, respectively (p = 0.22). There was no significant difference in 3-year OS between RT and CCRT groups (89.2% vs 89.9%, p = 0.76). Among pt with high-risk features (n = 67, 48.2%), 3-year DFS and OS were not significantly different between treatment groups. However, among pt without high-risk features, 3-year DFS in RT group was significantly higher than CCRT group (84.8% vs 79.0%, p = 0.04). Conclusions: This study demonstrates no survival benefit from adding concurrent CMT to RT following curative surgery in NSCCA of head and neck. Moreover, addition of CMT may be detrimental in pt without high-risk features.
Risk factors for central neck lymph node metastases in papillary thyroid microcarcinoma.
Authors: Zheng Weihui , Shang Jinbiao 
Published: September 2018

e17583 Background: Papillary thyroid microcarcinoma (PTMC) accounts for nearly half of all cases of thyroid papillary cancer. Although PTMC has a good prognosis, lymph node metastasis, especially central lymph node metastasis (CLNM), is the leading cause of local recurrence. The value of central lymph node dissection in PTMC remains controversial. Few studies have focused on the relationship between CLNM and multifocality in PTMC. This retrospective study of a large cohort of patients with PTMC aimed to identify assess the predictive value of multifocality for identifying patients at high risk of CLNM who may benefit from central lymph node dissection. Methods: Patients with PTMC who underwent total or hemi-thyroidectomy with effective unilateral or bilateral central lymph node dissection at Zhejiang Caner Hospital between January 2007 and December 2015 were enrolled ( n = 3543). Number and laterality of PTMC foci, extrathyroidal extension (ETE), tumor size, age, sex, positive/total number of central lymph nodes and other clinicopathological factors were recorded. The chi-square test was used for univariate analysis; logistic regression, for multivariate analysis. Results: Multifocality, age, sex, tumor size, ETE and nodular goiter were significantly associated with central lymph node metastasis (CLNM) in univariate analysis. Multifocality was an independent predictive factor for CLNM in multivariate analysis. Compared to unifocal disease, the odds ratio (OR) for CLNM was 1.447 for patients with ¡Ý 2 tumor foci ( P < 0.001) and 2.978 for patients with ¡Ý 3 tumor foci ( P < 0.001). Conclusions: Multifocality with ¡Ý 3 tumor foci was an independent predictive factor for CLNM in PTMC. Multifocality should be assessed when selecting patients for prophylactic central neck lymph node dissection, and we recommend patients with multifocality should undergo more radical treatment.
Radioiodine I-131 ablation therapy and impaired renal function: Possible impact on guidelines.
Authors: El-Zeftawy Hossam A , Zekri Jamal M , Farag Kamel , Al-Saadi Rawan , Bin Sadiq Bakr M , Miliebari Salman 
Published: September 2018

e17591 Background: Sodium iodide (I-131) is eliminated predominantly through renal clearance. There is no consensus on the ideal dose of I-131 to be administered for patients with impaired kidney function. We aim to compare the rate of I-131 clearance in patients with impaired to those with normal renal functions. Methods: 27 cases (34 treatments) of differentiated thyroid cancer and eGFR 15-59 ml/min/1.73 m2 received I-131 (mean dose of 150 mCi) for remnant ablation between 2010 and 2016. Another 34 patients matched for age, gender, weight and I-131 dose with eGFR ≥ 60 ml/min/1.73 m2 were selected as controls. Endpoints of interest were (a) Length of hospital stay (LOHS) until the patient’s I-131 activity declines to < 30 mCi (b) Exposure rate measured by Geiger counter 0 to 48 hours after treatments (ER 48). Paired t-test was used to compare both groups. Results: Mean LOHS for cases vs. controls was 2.47 vs. 2 days respectively (P = 0.007). Results of ER 48 were available and matched in 18 cases and controls. Mean ER 48 for cases vs. controls was 3.74 vs. 1.8 mR/h respectively (P = 0.002). The mean proportional reduction of exposure rate after 48 hours compared to hour 0 for cases and controls was (-88% vs. -92.6%, P = 0.008), (-93.5% vs. -94.5%, P = 0.5) and (-67.2% vs. 94.3%, P = 0.04) for eGFR 46-59 (n = 13), 30-45 (n = 3) and 15-29 ml/min/1.73m2 (n = 2) respectively. Conclusions: Patients with impaired renal function are subject to longer hospital stay and delayed renal clearance of the tracer with consequent increased radiation exposure. Guidelines should consider adjusting the dose of I-131 in these patients to avoid possible harmful effects of excess I-131 on vital organs.
Barriers in time to initiation of therapy for newly prescribed novel oral oncolytics.
Authors: Tapia Christopher , Wang Ann Andee , Bhanji Yasin , Campbell Christopher , Larsen Daniel , Ganatra Seema , Gross Derick , Stein Regina Michelle , Tellez Claudia , Jain Shikha 
Published: September 2018

e18005 Background: Novel oral oncolytics have been incorporated into standard of care for many malignancies. With increasing utility of these medications, accessibility issues have emerged. The purpose of this study is to examine the time-to-therapy initiation of novel oral oncolytics and to identify barriers that result in delays and access issues. Methods: A retrospective review of our electronic data warehouse was performed of adults newly prescribed a novel oral oncolytic for FDA approved indications from 04/01/16 to 12/31/16. Exclusion criteria: traditional chemotherapy or previous treatment with the same agent. Primary outcome: time from date prescribed to date filled. Record of pharmacy transfer, manufacturer assistance, and delays in treatment were also extracted. Kruskall-Wallis and Mann Whitney U tests of association were performed to identify whether pharmacy transfers or manufacturer assistance were associated with delays in time to treatment filled. Fisher’s Exact tests were performed to identify drug or insurance related associations with delays. Results: Of our interim analysis of 92 patients who met inclusion criteria, 9 (9.8%) were insured by Medicaid, 32 (34.8%) by Medicare, 51 (55.0%) by private insurance or other. The median time between date prescribed and date filled was 6 days (range 0-109 days). The most frequently prescribed drug was palbociclib (n = 22, 23.9%). 25 (27.2%) of patients had a pharmacy transfer prior to receiving their drug, 15 (16.3%) patients received manufacturer assistance, and 17 (19%) of patients’ records indicated a delay. Transfers, manufacturer assistance, and delays each had a statistically significant relation with time-to-fill (p < 0.05), though none were significantly associated with drug or insurance type. Time-to-fill was not significantly associated with a particular drug or insurance type. Conclusions: As the landscape of oncology changes, barriers to treatment will be discovered as new novel agents are approved. Our study shows that potential exists to prevent treatment delays and improve access to care. By studying the factors affecting time-to-treatment, quality improvement initiatives can be developed to better streamline the process.
Oncologic patients attitudes and participation in clinical trials.
Authors: Asher Nethanel , Wolf Ido , Pelles Sharon , Geva Ravit 
Published: September 2018

e18029 Background: Clinical trials are an essential part of the oncological care. However, literature indicates low accrual of only 2-4% of the oncologic population. One of the leading known barriers is the patient's hesitant attitude toward participation. This study aimed to evaluate the patients' population treated in the Tel Aviv Sourasky Medical Center (TASMC) oncology division and their understanding of clinical research in order to improve local recruitment strategies. Methods: An observatory, questionnaire based research was conducted. Patients receiving active oncology treatment in the TASMC oncologic day care unit were asked to complete an anonymous questionnaire, which was comprised of two main parts: the first evaluate demographic information and past experience in clinical research. The second investigated basic knowledge true/false test regarding clinical trials. The questionnaire was validated by both external and internal validity tests (α-Cronbach validity test) and was approved by the local ethics committee. Results: Two hundred patients completed the questionnaires. Median age was 60. 64% would consider participating in a clinical study. 23% (N = 46) had past experience in research, and compared to those with no experience they were found to have higher academic education (67.4% vs 36.9%, p < 0.0001), be more secular (76.1% vs 58.3, p = 0.037) and to have a better understanding of medical research (84.4%, vs 36.5%, p < 0.0001). They were also more inclined to participate in a future research (73% vs 44.9%, p = 0.01). Of those who would decline to participate and had failed the knowledge test (score less than 60%), the most frequent concern was related to the placebo arm (p = 0.055), ability to reject consent, and to trust issues with the treating oncologist. Conclusions: Despite a noteworthy readiness to enroll in clinical trials among the TASMC oncologic population, there were found significant knowledge and basic understanding gaps regarding clinical trials. Further efforts are needed to better understand specific accrual barriers and to develop an adapted information system.
Patterns of unavoidable and potentially avoidable hospitalizations among cancer patients.
Authors: Lau Sally C , Samawi Haider , Bae Steven , Cheung Winson Y. 
Published: September 2018

e18030 Background: Hospitalizations can be distressing to patients and caregivers as well as costly to the healthcare system. Prior research in the non-oncology setting indicates that up to 50% of admissions are potentially avoidable. Our aims were to characterize the patterns of hospitalizations in cancer patients within a universal healthcare system and describe factors associated with potentially avoidable admissions. Methods: We reviewed all patients admitted to the British Columbia Cancer Agency over an 18 month period from 2013 to 2014. Pre-planned hospitalizations for inpatient treatments were excluded. Eligible hospitalizations were divided into 2 groups: unavoidable (UH) and potentially avoidable hospitalizations (PAH) based on pre-defined criteria, with discrepancies resolved via a consensus of clinicians. A multivariate analysis was conducted to test the associations of patient, disease, and treatment factors with UH and PAH. Results: Of 701 hospitalizations reviewed, 350 were eligible for inclusion. Among them, 286 (82%) and 64 (18%) were UH and PAH, respectively. Comparing between the UH and PAH groups, median ages at admission were 64 and 63 years, 48% and 45% were men, 67% and 66% were receiving palliative therapy, and median lengths of stay were 5 and 7 days, respectively (all p > 0.05). Patients with PAH were more likely to have a non-hematologic malignancy (92% vs 76% p < 0.01) and undergo a palliative care discussion while in hospital (14% vs 9% p = 0.03). The 30-day mortality rate after discharge was higher in the PAH subset (34% vs 13% p < 0.01). In multivariate analysis, significant factors associated with PAH included presence of cancer-related symptoms (OR 4.7 95% CI 1.7-13.3 p < 0.01), treatment toxicities (OR 3.9 95% CI 1.2-12 p = 0.02) and admissions in the preceding year (OR 3.4 95% CI 1.7-6.8 p < 0.01). In the 64 patients with PAH, admissions may be prevented with intensive follow-up (52%), better coordination of community supports (25%) and early palliative care discussions (20%). Conclusions: In our cohort, PAH were frequent in cancer patients and associated with poor short term outcomes. Optimization of outpatient care and better utilization of community and palliative care resources may reduce PAH.
Current status of availability of radiotherapy machines in Nepal.
Authors: Karn Ambuj 
Published: September 2018

e18042 Background: Nepal is a developing country with about 29 million populations. The incidence of cancer is 100-120 per 100 thousand populations and the number is increasing. The most common cancers in Nepal are of lung (13.2%), cervix (9.5%) and breast (8.6%). More than 80% of cancer patients present in advanced or metastatic stage where palliation can only be the goal of treatment. Radiotherapy is one of the essential treatment modalities for cancer, for both curative and palliative intent. This study aims to find the availability of radiotherapy machines throughout the country. Methods: Data regarding Radiotherapy machines in the country were collected by on site visit and by telephone conversations. Results: There are only seven centers having radiotherapy machines. Bir hospital was the first to start radiotherapy with telecobalt machine. At present there are 4 Tele-Cobalt machines, 5 Linear Accelerators and 5 High Dose Rate (HDR) Brachytherapy machines in the country. Most of the centers do only conventional 2-dimensional radiotherapy treatment. Newer centers which are non-government centers have high end linear accelerators with IMRT and IGRT facilities. HDR brachytherapy are used for intracavitory radiotherapy for endometrial and cervical cancers only. Conclusions: Nepal is far below the World Health Organization (WHO) recommendation of one megavoltage machine per million populations which means that Nepal should have at least 29 megavoltage machines. Combined efforts of public, government and international agencies are required to upgrade the situation.[Table: see text]
A population-based analysis of urban-rural disparities in advanced pancreatic cancer (APC) management and outcomes.
Authors: Canale Thomas , Cheung Winson Y. 
Published: September 2018

e18049 Background: The high morbidity burden associated with APC means that its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Methods: Patients diagnosed with APC (locally advanced or metastatic disease) from 2008 to 2015 and received gemcitabine (gem), gem plus nabpaclitaxel (gem/nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers were reviewed. Using postal codes, the Google Maps Distance Matrix determined the distance from each patient’s residence to the closest cancer center. Rural and urban status were defined as patients living > / = 100 km and < 100 km to the closest treatment site, respectively. Different cut points were used in sensitivity analyses. Patients were also stratified according to Canadian census population sizes. Univariate and Cox regression analyses were applied to examine whether rurality resulted in variations in management and outcomes. Results: In total, we identified 659 patients: median age 68 years, 54.3% men, and 45.7% metastatic disease. Among them, 19.3% lived rurally. For treatment, 67.7%, 9.2%, and 23.1% received gem, gem/nab, and FOLFIRINOX, respectively. There were no differences in baseline clinical characteristics between rural and urban patients (all p > 0.05). Time from diagnosis to oncology appointment and time from appointment to treatment were 31.5 and 29.5 days for rural patients and 28.6 and 40.1 days for urban patients, respectively (all p > 0.05). In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 0.864, 95% CI 0.619-1.206, p = 0.390). Furthermore, regression analysis found that population size did not pose a signficiant impact on APC outcomes (all p > 0.05). Conclusions: There was no correlation between rurality and outcomes in APC. The strategic and geographic allocation of cancer care delivery across 6 comprehensive treatment centers in British Columbia may serve as a model for other jurisdictions, particularly those that currently face outcome disparities in cancers that often require complex multidisciplinary care
Impact of socioeconomic status on anal cancer survival.
Authors: Lin Daniel , Gold Heather Taffet , Schreiber David , Leichman Lawrence P. , Sherman Scott , Becker Daniel Jacob 
Published: September 2018

e18060 Background: Despite an increase in incidence of anal cancer over recent decades, improvements in awareness and therapy have improved survival outcomes. We hypothesized that the gains in outcomes were not shared equally by patients of disparate socioeconomic status (SES). We investigated whether area-based median household income (MHI) predicts survival of patients with anal cancer, after controlling for known predictors. Methods: Patients diagnosed with squamous cell carcinoma of the anus (SCCA) as the first primary malignancy from 2004 to 2013 in the Surveillance Epidemiology and End Results (SEER) registry were included. SES was defined by census-tract MHI, and divided into quintiles. Multivariable Cox Proportional Hazards models were used to evaluate the effect of (MHI) on cancer-specific (CSS) and overall survival (OS). A multivariable logistic regression was used to assess whether these same measures predicted receipt of radiation. Results: A total of 9,550 cases of SCCA were included; median age was 58 years, 63% were female, 85% were white, and 38% were married. In multivariable analyses, patients living in areas with lower MHI had worse OS and CSS compared to those in the highest income areas. Mortality HR’s in order of lowest to highest income were 1.32 (95%CI 1.18-1.49), 1.31 (95%CI 1.16-1.48), 1.19 (95%CI 1.06-1.34), 1.16 (95%CI 1.03-1.30); CSS HR similarly range from 1.34-1.22 from lowest to highest income. Other significant predictors of increased cancer specific mortality included older age, black race (HR 1.44, 95%CI 1.26-1.64), male gender, un-married, earlier year of diagnosis, higher grade, and later stage. Income level, however, was not associated with odds of initiating radiation in multivariable analysis (OR 0.87 for lowest to highest income level, 95%CI 0.63-1.20). Conclusions: SES measured by area-based MHI independently predicts cancer-specific and overall survival outcomes in patients with anal cancer, despite similar rates of initiating radiation therapy. Black race remains a predictor of anal cancer outcomes despite controlling for income. Further investigation is warranted to understand the mechanisms in which socioeconomic inequalities affect cancer care and outcomes.
Disparities in treatment-related financial burden and recurrence in a diverse sample of colorectal cancer survivors.
Authors: McDougall Jean A. , Banegas Matthew P. , Wiggins Charles , Rajput Ashwani , Chiu Vi Kien , Flores Kristina , Kinney Anita 
Published: September 2018

e18067 Background: The high cost of cancer care creates adverse financial consequences for cancer patients, impacting adherence to treatment, clinical outcomes, and quality of life. Prior studies estimate that 40% of colorectal cancer (CRC) patients experience treatment-related financial burden. This study aims to identify factors associated with financial burden and evaluate its relationship with cancer recurrence. Methods: This cross-sectional study identified individuals diagnosed with stages I-III CRC between 2001 and 2012 through the statewide New Mexico Tumor Registry. A comprehensive survey was administered in 2014. Participants were considered to have experienced financial burden if they reported any treatment-related debt accumulation, bankruptcy filing, other financial sacrifices, or inability to pay medical bills. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Among the 277 CRC survivors who participated in this study, 40% identified as Hispanic and 39% lived in a rural area. Financial burden was reported by 43% of CRC survivors. In a model adjusted for age at diagnosis, sex, race, ethnicity, education, and years since diagnosis, participants who spoke a mixture of English and Spanish (OR: 3.5, 95% CI: 1.3-9.5), those with low health literacy (OR: 2.4, 95% CI: 1.2-4.7), and those with public insurance (OR: 2.2, 95% CI: 1.2-4.4) were more likely to report financial burden. Ethnicity and rural status were not independently associated with financial burden. Six percent (n = 16) of participants experienced a CRC recurrence. Survivors who reported financial burden were 4-times as likely to experience a recurrence (OR: 4.3, 95% CI 1.1-17.7) as those who did not report financial burden. Conclusions: Language, low health literacy, and public insurance may increase the likelihood that CRC survivors experience financial burden. These disparities are alarming given the observed association between financial burden and CRC recurrence. Larger, prospective studies are needed to confirm the association between financial burden and recurrence and to identify potential intervention targets.