bluuebunny/crossref_metadata_2025_split huggingface dataset:
A rules-based algorithm to identify patients who would benefit from re-addressing advanced care planning.
Authors: Bestvina Christine M. , Daly Robert Michael , Wroblewski Kristen , Huber Michael , Malec Monica , Chow Selina Lai-ming , Hantel Andrew , Beach Brittany , Polite Blase N. 
Published: September 2018

e21510 Background: Advance care planning (ACP) should be initiated early and readdressed often for cancer patients. We hypothesize that a rules-based algorithm based on occurrence of high-risk events can predict decreased overall survival, and can be used to target patients who would benefit from readdressing ACP. Methods: We performed a retrospective analysis of 221 patients receiving palliative chemotherapy with a diagnosis of leukemia, cholangiocarcinoma, esophageal, gastric, pancreatic, lung or urothelial cancer at the University of Chicago Medicine. Patients were included if they had an index outpatient oncology visit from April 1, 2015 through June 30, 2015. Starting at the date of index visit, we examined a three-month window for a “high-risk event,” defined as: 1. change in chemotherapy 2. emergency department visit 3. hospitalization. Patients were followed from index visit until date of death or last clinical encounter as of January 31, 2017. Each “high-risk event” was treated as a time-varying covariate in a Cox proportional hazards regression model to calculate a hazard ratio of death compared to those without an event. Results: Sixty-six percent of patients (146/221) experienced at least one high-risk event over the 3 month time frame. A change in chemotherapy regimen, an ED visit, and a hospitalization occurred in 53% (118/221), 10% (22/221) and 26% (57/221) of patients respectively. The hazard ratio of death for patients with at least one high-risk event when compared to those without was 1.86 (95% CI: 1.26-2.74, p = 0.002), when adjusted for age, gender, and race. Inpatient admission had the highest hazard of death among the high-risk events (HR 2.52: 95% CI: 1.69-3.76, p < 0.001). Conclusions: The rules-based algorithm identified patients with a greater risk of death. Implementation of this algorithm in the electronic medical record can identify patients with increased urgency to readdress goals of care.
Hospitalizations in elderly glioblastoma patients.
Authors: Moroney Claire Elizabeth , Perry James R. , Tsang Derek S , Bilodeau Denise , Mueller Christina , Soliman Hany , Myrehaug Sten , Sahgal Arjun , Tseng Chia-Lin , Tsao May 
Published: September 2018

e21529 Background: Elderly glioblastoma (GB) patients are at risk of hospitalizations due to the morbidity of the disease and possible treatment toxicity. Methods: In this observational cohort study, 255 newly diagnosed GB patients age 65 years and older were included. Survival, emergency room visits and admissions to an acute care hospital were determined. Mean and median total health care costs were calculated. Risk factors for Emergency room visits and acute care hospital admissions were determined. Results: Median overall survival was 6 months. The majority of patients (68%) had at least one visit to the emergency department and 77% had at least one admission to acute care. The mean and median length of hospital stay per patient was 20.5 days and 14 days respectively. Forty-three percent of patients spent 0-4% of their survival as an inpatient. Only 3% spent 70% or more of their survival as an acute care inpatient. There was a mean of 79.7 days and a median of 43 days from the last emergency department visit to death. The mean and median total costs (hospital, ambulatory, physician billing, other health care costs) per patient were $162 479.78 (CAN) and $125 511.00 (CAN), respectively. Treatment with radiation or treatment with radio-chemotherapy was associated with a relative risk (RR) of 2.31 (95% CI 1.44, 3.7; p = 0.0005) and 2.19 (95% CI 1.28, 3.74; p = 0.0 04), respectively for emergency department visits as compared to patients who were managed with comfort measures only. Patients with a baseline ECOG 0 had a RR of 1.71 (95% CI 1.06, 2.77; p = 0.0289) and patients with baseline ECOG 1 had a RR of 1.49 (0.98, 2.26; p = 0.0623) for hospital admission as compared to patients with ECOG 4. Conclusions: A large proportion of elderly GB patients (particularly those with good baseline performance status who underwent active treatment) presented to the emergency department and had at least one admission to acute care.
Longitudinal trajectory of frailty and related factors in 376 breast cancer patients aged 50+ compared to controls.
Authors: Magnuson Allison , Mohile Supriya Gupta , Lei Lianlian , Gilmore Nikesha , Esparaz Benjamin , Giguere Jeffrey K. , Misleh Jamal Ghazi , Janelsins Michelle Christine 
Published: September 2018

e21532 Background: Frailty, a clinical syndrome of vulnerability, is associated with adverse outcomes; however, the trajectory of frailty in cancer patients is not well understood. This longitudinal analysis evaluates frailty, and related factors, over the course of chemotherapy in breast cancer patients (BCa pts) aged 50+. Methods: BCa pts aged 50+ scheduled to receive adjuvant/neoadjuvant chemotherapy (n = 376) and age matched controls without cancer (n = 234) were recruited from the University of Rochester NCI Community Oncology Research Program as part of an observational study. Frailty was assessed by a modified Fried frailty score (range 0-4) using self-reported weakness, exhaustion, physical activity, and walk speed. Cognition was assessed objectively (Controlled Oral Word Association [COWA]) and subjectively (FACT-Cog). Frailty and cognition were measured pre- and post-chemotherapy (similar time lapse for controls). Linear regression models evaluated associations between cognition and frailty, controlling for age, race, marital status, education, performance status and baseline frailty score. Results: Average age was 59 (50-64: 77%; 65-79: 23%). At baseline, the cancer group had more people aged 65+ (24% vs 20%, p = 0.002), a higher mean frailty score (1.2 vs 0.73, p < 0.001), and lower mean FACT-Cog score (158.5 vs 167.4, p < 0.001) compared to controls. In unadjusted analysis, BCa pts had greater increase in frailty and cognitive problems than controls over time (mean change frailty score: cancer 0.87 vs control 0.05; mean change FACT-Cog: cancer 12.78 vs control 1.58; mean change COWA: cancer -0.41 vs control 0.43; p < 0.001 for all). In adjusted analysis, cancer (p < 0.001) and lower baseline FACT-Cog score (p = 0.01) were associated with an increase in frailty score over time. In a separate model, a decline in subjective and objective cognition was associated with increased frailty score (COWA p = 0.03, FACT-Cog p = 0.07). Conclusions: Frailty is prevalent in BCa pts prior to chemotherapy and increases during treatment. Lower baseline cognition and decline in cognition were associated with increased frailty. Frailty and cognition are important survivorship factors for BCa pts aged 50+.
Predicting cumulative incidence of chemotherapy toxicity in older patients with cancer: Korean Cancer Study Group prospective cohort study (KCSG) PC 13-09.
Authors: Kim Jee Hyun , Kim Jin Won , Kim Se Hyun , Lee Yun-Gyoo , Hwang In Gyu , Song Hong-Suk , Koh Su-Jin , Ko Yoon Ho , Shin SeongHoon , Woo In Sook , Hong Soojung , Kim Tae Yong , Kim Sun Young , Nam Byung-Ho , Kim Hyun Jung , Kim Hyo Jung , Lee Myung Ah , Kwon Jung Hye , Hong Yong Sang , Ryoo Hun-Mo ,   Korean Cancer Study Group Geriatric Oncology Working Party
Published: September 2018

e21539 Background: Older adults have increased risk of developing chemotherapy toxicity. Currently available prediction tools do not provide information on cumulative risk and none are from Asia. Methods: Patients with histologically confirmed solid cancer aged ≥70 years were prospectively enrolled from 17 centers and underwent geriatric assessment before starting their 1st line chemotherapy. Chemotherapy toxicity prediction model was built for adverse events (AEs) ≥G3, among geriatric assessment, laboratory and clinical variables. Model discrimination values were evaluated using c-statistics compared with actual cumulative incidence of AE ≥G3 in each cycle. Results: 301 patients were enrolled with a median age of 75 years (range 70-93). Primary site included colorectal (28.9%), lung (24.6%), hepato-biliary-pancreatic (22.3%), stomach (10.6%) and others (13.6%). Median chemotherapy cycle was 4 (2-7 cycles). During first line chemotherapy, 53.8% of patients experienced AEs ≥G3. Six variables significantly associated with occurrence of AEs ≥ G3 were serum protein < 6.7 g/dL, no dose reduction at first cycle, suffering from psychological stress or acute disease in the past 3 months, water consumption of less than 3 cups per day, not being able to obey command of 'Grab a piece of paper in your hand', and self-perception of ‘not in good health’. Model with all six variables was selected with the highest mean value of c statistics (0.646) and prediction tool indicated score ranging from 0 to 8 points. Patients were classified to 4 risk groups; 61 (21.0%), 143 (49.3%), 66 (22.8%), and 20 (6.9%) in low (0, 1 point), medium-low (2, 3), medium-high (4, 5), and high risk group (6, 7, 8). Predicted cumulative incidence of AEs ≥G3 was discriminated according to risk groups; low risk group: 13%, 19%, 27%, 30%, 30% in cycle 1, cycle 2, cycle 3, cycle 4, cycle 5, medium-low risk: 17%, 37%, 48%, 56%, 60%, medium-high risk: 26%, 44%, 50%, 68%, 75%, and high risk: 45%, 62%, 87%, 94%, 94%. Conclusions: Novel prediction tool could identify those at high risk of developing AEs ≥G3 after chemotherapy, which provided information on cumulative incidence in each cycle.
Efficacy of PD-1 and PD-L1 inhibitors in older adults: A meta-analysis.
Authors: Elias Rawad , Giobbie-Hurder Anita , Rahma Osama E. 
Published: September 2018

e21544 Background: Immune checkpoint inhibitors (ICIs) have a promising activity in variety of malignancies however little is known regarding their efficacy and toxicity profile in older adults (≥65 yo). Accordingly, we performed a meta-analysis of published trials using anti-PD-1 or PD-L1 to define the activity of these agents in this subset of patients. Methods: We conducted a search using PubMed and Web of Science databases for randomized controlled trials (RCTs) of PD-1 and PD-L1 inhibitors including nivolumab (N), pembrolizumab (P), and atezolizumab (A). We then identified the studies that reported a subgroup analysis of overall survival (OS) based on an age cutoff. Results: We identified a total of 17 RCTs that compared N, P and A to chemotherapy or targeted therapy. Out of those trials only 9 reported hazard ratio (HR) based on age and were included in this meta-analysis. These trials treated a total of 5033 patients including 2315 patient ≥65 yo (46%). The overall estimated, random-effects hazard ratio (HR) for death was 0.69 with 95% CI of 0.63 -0.74 (p < 0.0001) in the general population favoring ICIs. Based on the selected trials, there was evidence of a 31% reduction in the hazard of death with PD1/PDL1 inhibitors compared with chemo/targeted therapy. This OS benefit persisted when the analysis was done based on disease type (NSCLC or others) or the drug target (PD-1 or PD-L1). Analysis based on age cutoff of 65 yo showed that the efficacy of PD-1 and PD-L1 inhibitors did not vary for older or younger patients. The overall estimated random-effects HR was 0.64 with 95% CI of 0.54 -0.76 in patients ≥65 yo vs. 0.68 with 95% CI of 0.61-0.75 in patients < 65 yo. Data regarding toxicity based on age was available only for 3 trials. The rate of grade 3-4 toxicities was comparable between the 2 groups (45-50% in patients ≥ 65 compared to 37.1-50% in patients < 65). Conclusions: PD-1 and PD-L1 inhibitors efficacy using N, P or A is comparable in older and younger adults when using an age cutoff of 65 years. Future ICIs trials should report efficacy and toxicity based on age.
Supportive care needs among Mexican young women with breast cancer.
Authors: Galvez C. Lizette , Villarreal-Garza Cynthia , Mohar Alejandro 
Published: September 2018

e21552 Background: Despite high rates of breast cancer (BC) in young Mexican women, information about their particular needs and concerns is largely unknown. Understanding the patients individual needs in a population with unique socio-cultural features is essential to guide supportive care and improve their quality of life. We aim to describe the unmet needs of Mexican young women with breast cancer (YWBC). Methods: A cross-sectional study including women with stage I-III BC aged 40 years or younger at diagnosis was conducted at the National Cancer Institute in Mexico City. YWBC were invited to complete the Supportive Care Needs Survey, Short Form-34 (SCNS-SF34), a comprehensive tool that measures the perceived unmet needs of cancer patients. The survey was previously adapted and validated in our population for its use. Results: 81 consecutive patients with median age at diagnosis of 35.09 (SD 3.9) years were included. 45.7% were married and 29.2% completed secondary school. 92.6% had stage II-III BC. 70.4% were undergoing active treatment and 29.6% were either on hormonal therapy or surveillance. From a total standardized score of 100, the health systems and information domain had the highest mean score (39.3), followed by the psychological domain (36.3). The sexuality domain had the lowest mean score (27). The highest ranked items of unmet needs (by mean crude score) were: to be informed about cancer is under control or diminishing (2.9), to be informed about things you can do to help yourself get well (2.8), lack of energy and fatigue (2.7), and fear about the cancer spreading (2.7). Perceived needs among patients undergoing active treatment were greater compared to those in follow-up (z = -2.390 p = 0.017), predominantly in the sexuality domain (z = -2.084 p = 0.037). Conclusions: Mexican YWBC have specific needs that are currently not systematically addressed. The predominant unmet need regarding health systems and information should be a priority. Further research to understand the needs and concerns of this unique and understudied patient population will aid tailor clinical interventions and supportive care.
A prognostic index to stratify survival benefit in patients of solid tumor metastases treated with stereotactic body radiotherapy.
Authors: Lu Yi , Tang Chad 
Published: September 2018

e21578 Background: To investigate the clinical factors related to the prognosis of solid tumor metastases treated with SBRT and to create a scoring system that stratifies survival benefit. Methods: The clinical factors and follow-up data of 404 patients with metastases from solid primary (127 liver metastases, 205 lung metastases and 72 adrenal gland metastases), treated with SBRT from 2005 to 2016, were analyzed retrospectively. The prognostic index (PI) of patients was calculated based on the results of multivariate cox regression model from liver metastases cohort and pretreatment variables included were race, gender, age, KPS, primary tumor and histology, number of metastases, status of disease outside, previous treatment at SBRT site, and interval time from diagnosis to metastases. This model then was used in lung and adrenal gland metastases cohorts. Results: Median follow-upwas 24 months for liver metastases cohort. The median survival time of liver metastases was 21.8 months. Three variables were selected from liver cohort-database training as independent prognostic index for survival benefit: age (HR =1.81, p =0.03), KPS (HR =0.72, p =0.03), number of organs with active disease outside (HR =1.68, p<0.01). Patients were classified into three hazard groups with significant difference. The median survival of group 1(poor) was 8.1 months, group 2 (intermediate) reached 25 months, and group 3 (excellent) reached 39.1 months (p< 0.001). This prognostic index model was also been approved effectively in lung and adrenal gland metastases cohorts, which identified patient subgroups into poor and excellent prognosis. Conclusions: The prognostic index model allows solid tumor metastases patient to stratify survival benefit based on the three predictive factors. Table 1 Survival score and groupings [Table: see text]
Longitudinal physical activity assessment in post-surgical gynecologic cancer patients.
Authors: Gorzelitz-Liebhauser Jessica , Costanzo Erin S. , Spencer Ryan J. , Rumble Meredith E. , Rose Stephen L. , Cadmus-Bertram Lisa 
Published: September 2018

e21582 Background: Physical activity is a key determinant of health, and exercise can be effective for decreasing anxiety and depression and improving quality of life in cancer survivors. The primary aim of this study was to report the trajectory of physical activity over time for post-operative gynecologic cancer patients. The secondary aim was to identify correlates of total physical activity over time. Methods: The study population included patients who underwent surgery for endometrial (n = 80) or ovarian (n = 43) cancer and wore an accelerometer for a 3-day period at 1 week, 1 month and 4 months after surgery. Accelerometer data were captured during all waking hours and were transformed into categories of light, moderate and vigorous intensity physical activity. The outcome of interest was total minutes of moderate to vigorous intensity physical activity (MVPA) collected over the three day period at each time point, analyzed using a linear mixed effect model approach, assessing the correlates of age, body mass index (BMI), self-rated health, laparotomy vs. laparoscopic (endometrial only) and neoadjuvant chemotherapy yes/no (ovarian only). Results: Mean age was 58.8 ± 10.1 years with mean BMI of 35.5±10.3 kg/m2. Over each three-day period, patients performed 7 ± 12 minutes of total accumulated MVPA at 1 week, 20 ± 41 minutes of total MVPA at 1 month, and 25 ± 36 minutes at 4-months post-surgery (p = 0.01). Federal guidelines recommend approximately 70 minutes of moderate intensity activity over a three-day period to collect 150 minutes of moderate activity a week. Better self-rated health at baseline was associated with increased activity over time (p = 0.02). BMI, age, type of surgery or use of neoadjuvant chemotherapy did not predict physical activity in patients of either disease site. Conclusions: Physical activity increased over time for endometrial and ovarian cancer patients. Self-reported health at baseline was also positively associated with increased moderate-vigorous physical activity over time. There is insufficient evidence to show that BMI significantly contributes to changes in moderate-to-vigorous physical activity over time. Future research should address barriers to activity and novel interventions.
Impact of fertility preservation by ovarian stimulation on breast cancer outcomes.
Authors: Wang Ying , Lee Shaina , Camateros Pierre , Perdrizet Kirstin Ann , Yokom Daniel , Warner Ellen , Roberts Jeffrey , Lohrisch Caroline A. 
Published: September 2018

e21588 Background: Chemotherapy and hormone therapy results in potential ovarian toxicity and delay in child-bearing among women of reproductive age with breast cancer. Whether short term ovarian stimulation is safe is not well studied. We examined the effects of short-term ovarian stimulation on patients’ breast cancer recurrence rates. Methods: Women diagnosed with localized breast cancer between 2005 and 2011 at any one of five cancer centres and referred to a reproductive endocrinologist in British Columbia, Canada, were identified from a central database. Clinical, pathological, treatment, and outcome characteristics were compared for patients who did and did not undergo ovarian stimulation prior to systemic cancer treatment. Results: Seventy-seven patients were included: median age was 33, all were ECOG 0/1, 31 (40%) had lymph node involvement, 62 (81%) had estrogen receptor (ER) positive disease, and 18 (23%) had HER2 positive disease. Thirty-four (44%) women underwent ovarian stimulation: they were more likely to receive chemotherapy than patients who declined ovarian stimulation (p = 0.001). Age, number of existing children, radiation, and hormonal treatments were not significantly associated with decision to undergo ovarian stimulation (p > 0.05). After a median follow-up of 3.7 years, 7 (21%) patients who pursued ovarian stimulation and 9 (21%) patients who did not experienced disease recurrence. There was no association between ovarian stimulation and rate of local or distant breast cancer recurrence (p = 0.658). Conclusions: We did not find a harmful effect of short term ovarian stimulation on breast cancer recurrence rates. Limitations include short follow-up, a small sample size, and few relapses. Patients who received chemotherapy were more likely to pursue ovarian stimulation, suggesting that patients were well informed about the negative impact on fertility of chemotherapy and of the importance of fertility preservation prior to potentially gonado-toxic treatments.
A longitudinal, multimodal approach to characterizing chemotherapy-induced peripheral neuropathy.
Authors: Ramnarine Sabrina , Dougherty Patrick M. , Williams Linda J , Gourley Charlie , Fallon Marie T 
Published: September 2018

e21595 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a complex, dose-limiting toxicity impacting prognosis and quality of life. The optimal approach to identification and assessment remains unclear. This study aims to prospectively characterize the development and trajectory of CIPN using a combination of patient-reported outcomes (PROs) and objective Quantitative Sensory Testing (QST) measures in gynaecological, colorectal and lung cancer patients receiving neurotoxic platinum and/or taxane-based chemotherapy. Methods: Patients (n = 33, mean age 60.8) were evaluated at baseline prior to chemotherapy, during (every 3 weeks) and post-treatment every 3 months up to 1 year. Assessments at each time point included: PRO (EORTC QLQ-CIPN20 questionnaire) and QST measures (thermal and mechanical detection and grooved pegboard test). Statistical modelling using repeated measures analysis by patient was conducted. Results: Significant and parallel changes were observed in PROs and QST measures over time. Total EORTC score (sensory, motor and autonomic) increased in severity from baseline at all time points, peaking at 3 months post-treatment (34.8% increase; p < 0.0001) and persisting at 1 year (17.9% increase; p = 0.01). Every increase by one point in EORTC sensory score over time corresponded with an elevation in QST parameters: warm detection threshold (upper limb; p = 0.02 and lower limb; p = 0.03) and mechanical detection threshold, MDT (upper limb; p = 0.04 and lower limb; p = 0.02). Equally, rising total EORTC and motor score were related to increasing MDT in the upper limb p = 0.02 and p = 0.003 respectively. A delay of one second taken to complete the grooved pegboard test (dominant hand) was linked to a proportional increase in EORTC motor score (p = 0.01). Conclusions: Associations are shown here amongst PROs and QST parameters providing an opportunity to quantify and synthesize objective with subjective measures of neuropathy in CIPN patients. This may have potentially informative implications to underlying mechanisms of CIPN symptom burden, contributing to a more comprehensive clinical picture and allow stratification of patients by phenotype severity. Additional studies are warranted.