bluuebunny/crossref_metadata_2025_split huggingface dataset:
Receipt of recommended surveillance with imaging in survivors of early stage non-small cell lung cancer.
Authors: Malhotra Jyoti , Rotter David , Jabbour Salma , Aisner Joseph , Lin Yong , Manne Sharon , Demissie Kitaw 
Published: September 2018

10017 Background: Lung cancer survivors have a high risk for recurrence and second cancers and a 5-year survival of only 50%. Imaging surveillance for early cancer detection in this group is recommended for life. We measured the rates and determinants of regular surveillance imaging in non-small cell lung cancer (NSCLC) survivors. Methods: Using the Surveillance Epidemiology and End Results (SEER)-Medicare linked database, we identified 10680 patients with stage I and II NSCLC, age ≥ 66 years diagnosed from 2001-2011 and treated with surgery. Patients were censored at the time of recurrence/second cancer, loss of insurance or 3 months before death. Receipt of a CT and/or PET scan during the surveillance periods of 7 to 18, 19 to 30, 31 to 42 and 43 to 60 months from the date of surgery was assessed. Percentage of patients’ receiving regular imaging up to 18, 30 and 60 months of follow-up was determined. Adjusted cox regression was used to measure the effect of receiving recommended imaging on survival. Results: Overall, 79% and 40% survivors had follow-up information till the end of 30-month and 60-month surveillance periods respectively. Forty nine percent survivors were male and 86% were white. With a median follow-up of 7.6 years, 71% of the survivors received imaging in the first 18 months after surgery, but only 56% and 44% of survivors continued to receive regular imaging by 30-month and 60-month of follow-up periods respectively. Survivors were less likely to receive imaging if they were older (≥80 years), black, not married, had rural residence, did not receive adjuvant therapy, had stage I disease (compared to stage II) and were diagnosed in 2006 or earlier. In adjusted analysis, survivors receiving recommended imaging up to 18 months from surgery had improved survival compared to survivors who did not (HR 0.86; 95% CI 0.81-0.92). Survival benefit was also observed in survivors who had regular imaging up to 5 years from surgery (HR 0.68; 95% CI 0.60-0.76). Conclusions: More than half the lung cancer survivors did not receive recommended long-term surveillance imaging especially if older, black or with rural residence. Adherence to regular surveillance even at 5 years from initial surgery is associated with improved survival.
Mitochondrial DNA content in peripheral blood as a biomarker for cancer-related fatigue in early-stage breast cancer patients: A prospective cohort study.
Authors: Chae Jung-Woo , Chua Peh Siang , NG Terence , Yeo Hui Ling Angie , Shwe Maung , Gan Yan Xiang , Dorajoo Sreemanee Raaj , Foo Koon Mian , Loh Kiley Wei Jen , Koo Si-Lin , Chay Wen Yee , Tan Tira Jing Ying , Beh Sok Yuen , Lim Hsuen Elaine , Lee Guek Eng , Dent Rebecca Alexandra , Yap Yoon Sim , Ng Raymond C.H. , Ho Han Kiat , Chan Alexandre 
Published: September 2018

10018 Background: Cancer-related fatigue (CRF) is reported to be associated with mitochondrial dysfunction. Hence, mitochondrial DNA (mtDNA) content, a biomarker of mitochondrial dysfunction, is hypothesized to correlate with the onset of CRF. This study aimed to evaluate the association between peripheral blood mtDNA content and CRF in patients receiving chemotherapy. Methods: This was a prospective cohort study. Early-stage breast cancer patients (Stages I to III) receiving anthracycline or taxane-based chemotherapy were recruited. CRF was assessed using the validated Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) at two time points: baseline (T1; prior to treatment) and 6 weeks after initiation of treatment (T2). Worsening of CRF was defined as ≥10% increase in the overall MFSI-SF score at T2. Peripheral blood mtDNA content was measured at both time points using real-time quantitative polymerase chain reaction. Multiple logistic regression was utilized to evaluate the association between mtDNA reduction and worsening of CRF, adjusting for age, anxiety, insomnia and other clinically important covariates. Results: A total of 91 patients [mean age (±SD): 51.3 (9.2) years; 81.3% Chinese; 63.3% receiving anthracycline-based chemotherapy] were recruited. Proportions of patients with worsening of CRF increased from the lower to the upper quartiles of mtDNA reduction (26.1%, 30.4%, 52.2%, and 59.1% in quartiles 1, 2, 3, and 4, respectively, P = 0.010 for trend). Reduction of mtDNA content was significantly greater among those with worsening of CRF compared to those without CRF [mean reduction (±SD): 16.3 (23.5) vs 6.0 (17.3), P = 0.018]. After adjusting for covariates, every 1-unit reduction of the mtDNA content was associated with a 4% increase risk for worsening of CRF (95% CI, 1%-8%; P = 0.016). Conclusions: This is the first study to show that reduction of mtDNA content in peripheral blood is associated with onset of CRF in patients receiving chemotherapy. Further validation studies are required to confirm the findings.
Agreement about end-of-life (EOL) care among advanced cancer patients and their caregivers: Associations with care received.
Authors: Kamen Charles Stewart , Duberstein Paul , Prigerson Holly Gwen , Mohile Supriya Gupta , Asare Matthew , Janelsins Michelle Christine , Mustian Karen Michelle , Peppone Luke Joseph , Epstein Ronald M. 
Published: September 2018

10021 Background: Patients with advanced cancer and their caregivers often have different preferences regarding patients’ EOL care. Disagreement in a patient-caregiver dyad can increase stress and result in suboptimal care. Understanding factors that promote agreement, as well as the effect of agreement on care received at EOL, can inform interventions to improve communication and EOL decision-making for patients and caregivers. Methods: 205 patients (Stage III or IV cancer plus limited prognosis) and their caregivers were recruited to a randomized controlled trial of a communication intervention for patients, caregivers, and providers (Cancer Communication Study, PI: Epstein). Before intervention, patients completed the Preferences for Life-Extending Treatment questionnaire, which asked their preference regarding experimental treatment, life support, and palliative care; caregivers were asked about patients’ preferences. Binomial logistic regressions analyses modeled agreement in preferences as a function of patient and caregiver demographic characteristics and EOL care received as a function of patient-caregiver agreement. Results: The majority of patient-caregiver dyads agreed about experimental treatment (60.3%), life support (63.4%), and palliative care (70.7%). Dyads were more likely to agree about palliative care when patients were female (OR = 1.94, p = .03) and non-Hispanic white (OR = 2.10, p = .07) and when caregivers were college educated (OR = 2.04, p = .03). Of the 82 patients who died during study follow-up, 57 (69.5%) received EOL care congruent with their preferences. In 19 of the 38 (50%) cases where patient-caregiver dyads disagreed, caregivers’ preferences predicted EOL care received. Dyadic agreement about life support was associated with increased odds of patients receiving/not receiving life support congruent with their preference (OR = 3.02, p = .02). Conclusions: Facilitating agreement between patients and caregivers could improve receipt of patient-centered care. A communication intervention designed to increase dyadic agreement by helping patients and caregivers discuss challenging EOL decisions might improve EOL care delivery. Clinical trial information: NCT01485627.
Latino ethnicity, immigrant status, and preference for life-extending end-of-life cancer care.
Authors: Tergas Ana Isabel , Prigerson Holly Gwen , Shen Megan Johnson , Maciejewski Paul K 
Published: September 2018

10028 Background: Latino advanced cancer patients are less likely to engage in advance care planning, use hospice services, and receive end-of-life (EOL) care in line with their preferences compared to non-Latino advanced cancer patients. Little is known about how immigration status influences preference for life-extending care (LEC) at the EOL. Methods: Data were derived from two sequential multi-institutional, longitudinal cohort studies of patients with advanced cancer recruited from 2002 – 2008 (Coping with Cancer I [CwC-1]) and 2010 – 2015 (Coping with Cancer II [CwC-2]). Multiple logistic regression analysis was used to estimate effects of immigrant status and CwC cohort among Latinos, and effects of ethnicity and CwC cohort among US-born Latinos and non-Latino whites, on preference for LEC at the EOL. Results: Of the 760 studied cancer patients, 661 were US-born non-Latino (US non-L), 34 were US-born Latino (USL) and 65 were Latino immigrants (LI). LI were less educated (mean years of education: 7.8 years) than USL (11.1 years), who were in turn less educated than US non-L (13.7 years). Far fewer LI had insurance compared to USL (18.5% vs. 64.7%, respectively; p < 0.001), and fewer USL had insurance compared to US non-L (64.7% vs. 81.4%, respectively; p = 0.017). Within CwC-2, LI had higher odds of preferring LEC over comfort care compared to USL (adjusted odds ratio [AOR] = 9.4; 95% CI: 1.2, 72.4), and USL had lower odds of preferring LEC compared to US non-L (AOR = 0.3; 95% CI: 0.1, 1.0). LI from CwC-2 had higher odds of preferring LEC compared to LI from CwC-1 (AOR = 11.4; 95% CI: 2.7, 48.4), but there was no difference between USL from CwC-2 and USL from CwC-1. US non-L from CwC-2 had higher odds of preferring LEC compared to US non-L from CwC-1 (AOR = 3.9; 95% CI: 2.6, 5.9). Within CwC-1, there was no difference in LEC preference between LI and USL, nor between USL and US non-L. Conclusions: Immigrant status has a strong effect on preference for life-extending care among the more recent cohort of Latino cancer patients. Preference for life-extending care appears to have increased significantly over time for Latino immigrants, but remained unchanged for US-born Latinos. Latino immigrants may increasingly want life-extending care near death.
Accrual of older adults to Canadian Cancer Trials Group (CCTG) led trials: A retrospective analysis from 1990 to 2015.
Authors: Hernandez Torres Catalina , Cheung Winson Y. , O'Callaghan Christopher J. , Hsu Tina 
Published: September 2018

10031 Background: Older adults (OA) age 65+ make up to 60% of all newly diagnosed cancers. However, only 22-32% of patients accrued in cooperative group studies in the 1990s were age 65+. In 2003, several studies suggested that clinical trial design, in particular the presence of strict exclusion criteria, was a major barrier to accrual of OA. The objective of this study was to determine: 1) whether there has been an improvement in accrual of OA to clinical trials led by the Canadian Cancer Trials Group (CCTG) over time; 2) clinical trial features associated with accrual of OA to clinical trials 3) whether exclusion criteria in trials initiated 2003 or after have been relaxed. Methods: All completed randomized Phase II and III CCTG-led clinical trials initiated between 1990 or later were included. Trial characteristics including tumor type, stage, treatment type, and exclusion/inclusion criteria, as well as percentage of OA age 65+ accrued were recorded. Association between percentage of OA accrued and trial characteristics were compared using the Wilcoxin rank sum test. Assessment of exclusion criteria before and after 2003 was compared using the Chi Square test or Fisher exact test. Results: A total of 68 trials were included. Most trials were phase III (73%), chemotherapy trials (48%), opened before 2003 (70.6%), advanced disease (73%) and lung cancer was the most common tumour site (17.6%). OA accrual remains low compared to OA diagnosed with cancer in Canada (41% vs. 56%, p < 0.001). There was an improvement in accrual of OA after 2003 (47.1% vs. 34.9%, p = 0.02). Tumour site, early stage disease, more restrictive performance status, requiring a new biopsy, and having a longer consent form, were associated with lower accrual of OA (p < 0.05). There was no significant loosening of exclusion with time though patients with pulmonary comorbidities were more likely to be excluded in studies initiated in 2003 or later (p = 0.006). Conclusions: OA remain under-represented in clinical trials. There has been no relaxing of exclusion criteria; however, exclusion based on comorbidities was not significantly associated with under accrual of OA in our study.
Patient-reported comorbidity and survival in older adults with cancer.
Authors: Williams Grant Richard , Deal Allison Mary , Lund Jennifer Leigh , Chang YunKyung , Muss Hyman B. , Pergolotti Mackenzi , Guerard Emily Jean , Shachar Shlomit S. , Sanoff Hanna Kelly 
Published: September 2018

10033 Background: Our ability to optimize the care of older adults with cancer and comorbid illnesses is insufficient as most clinical trials lack systematic measurement of comorbidities. The primary purpose of this study was to evaluate the prevalence and impact of patient-reported comorbidity on survival using various comorbidity scoring algorithms. Methods: We utilized a unique linkage of the Carolina Senior Registry, an institutional registry (NCT01137825) that contains geriatric assessment data, with the North Carolina Central Cancer Registry to obtain mortality data. Comorbidity was assessed using a patient-reported version of the Older Americans Resources and Services Questionnaire (OARS) Physical Health subscale that includes information regarding 13 specific comorbid conditions and the degree to which each impairs function (“not at all” to “a great deal”). Multivariable Cox proportional hazard regression models were used to evaluate the association between comorbidities and all-cause mortality. Results: 539 patients were successfully linked to mortality data. Median age 72, 72% female, 85% Caucasian, 47% breast cancer, and 12% lung cancer. 92% of participants reported at least one comorbid condition, mean of 2.7 conditions (range 0-10), with arthritis and hypertension the most common (52 and 50%, respectively). 62% of patients with a comorbid illness reported a functional limitation related to comorbidity. Both the presence of 3 or more total comorbidities (hazard ratio (HR) 1.44, CI 1.08-1.92) and 2 or more comorbidities impacting function (HR 1.46, CI 1.09-1.95) increased mortality. After adjusting for age, cancer type, and stage, the risk of death increased 12% for each comorbid condition impacting function (HR 1.12, CI 1.02-1.24), but did not significantly increase for the number of comorbid conditions alone (HR 1.07, CI 0.99-1.15). Conclusions: Comorbid conditions in older adults with cancer are highly prevalent, frequently impair function, and impact survival. Comorbid conditions that impair function have a greater impact on survival than the presence of comorbidity alone. Comorbidity assessment should be incorporated in clinical trials and can be measured via a simple one-page patient-reported questionnaire.
Immuno-oncology and the elderly: A comparative analysis of participation and toxicities of senior adults aged 65 years and above vs mid age and adolescent/young adult patients on immunotherapy-based phase I clinical trials.
Authors: Subbiah Ishwaria Mohan , Hess Kenneth R. , Fujii Takeo , Alshawa Anas , Lui Anna , Roy Sarath , Khanji Rahil , Subbiah Vivek , Naing Aung , Hong David S. 
Published: September 2018

10034 Background: Senior adults ≥ 65 yrs remain underrepresented in early phase clinical trials in particular trials with novel immunotherapies. One general limitation to enrollment is the concern for immune-related toxicities in the context of older age and comorbidities. We analyzed the enrollment and incidence of toxicities of seniors in comparison to mid age and adolescent/young adult (AYA) pts enrolled in phase 1 immunotherapy trials. Methods: We identified 422 consecutive pts w advanced cancer treated on immunotherapy-based phase I trials bw 04/2009-09/2015. We divided pts into 3 cohorts based on age at start of trial (AYA 15-39y, mid age 40-64y, seniors 65y+) and collected pt/disease characteristics and immune-related adverse events (irAE) including endocrinopathies, diarrhea/colitis, pneumonitis, constitutional (eg fatigue, fever, anorexia), myalgia, and dermatitis. Results: Of 422 patients treated, 116 were seniors (27%, median 70y), 50 AYA (12%, median 30y), 256 mid age (61%, median 56y). Most common cancers were GI (n = 108, 26%), thoracic/head/neck (n = 84, 20%), GU (n = 54, 13%), and GYN (n = 47, 11%). Median PFS was comparable in all 3 cohorts (2.4m seniors, 2.1m AYA, 2.1m mid age). The incidence of irAE was higher in elderly than mid age or AYA (low grade [G1/2] 49% vs 34% vs 34%, p 0.02; high grade [G3/4] 19% vs 11% vs 12%. p 0.14). When comparing irAE rates of seniors to AYA and mid age pts, the odds ratio of high grade events was 1.81 (95% CI 1.01, 3.24; p 0.05) and low grade events was 1.85 (95% CI 1.20, 2.85; p 0.0055). Most common G1/2 irAE among all cohorts was fatigue (n = 76, 18%), dermatitis (n = 59, 14%), fever (n = 29, 7%) and anorexia (n = 28, 7%) with seniors having a greater incidence of low grade fatigue (25% vs 15%, OR 1.84, 95% CI 1.09, 3.10, p 0.025). Conclusions: Senior adults accounted for < 1/3 of pts on immunotherapy-based phase I trials. When compared to mid age and AYA pts, seniors had a higher likelihood of experiencing a toxicity. Early phase immunotherapy trials may be an option for older adults but with a particular vigilance for adverse events in this population.
The emotional toll of caregiving for older patients with advanced cancer: Baseline data from a multicenter geriatric assessment (GA) intervention study in the University of Rochester NCI Community Oncology Research Program (UR NCORP).
Authors: Mohile Supriya Gupta , Xu Huiwen , Canin Beverly E. , Plumb Sandy , Wells Megan , Flannery Marie Anne , Hoerger Michael , Kamen Charles Stewart , Hurria Arti , Dale William , Heckler Charles E. , Culakova Eva , Bautista Javier , Hopkins Judith O. , Liu Jijun , Peri Srihari , Geer Jodi , Mustian Karen Michelle , Morrow Gary R. , Duberstein Paul 
Published: September 2018

10042 Background: Depression is common in caregivers (cgs) of patients (pts) with cancer. However, little is known about the association of health status of older pts with cancer with cg emotional health. Methods: Baseline data from a GA intervention study conducted at 68 oncology practices in the UR NCORP were analyzed. Pts aged ≥ 70 with an advanced solid tumor cancer or lymphoma with ≥ 1 GA impairment were enrolled; pts could enroll with 1 cg. Relationships between pt GA impairments (using 12 validated measures) and cg (spouses or live-in partners) emotional health including anxiety ( ≥ 5 on Generalized Anxiety Disorder-7 (GAD-7)), depression ( ≥ 2 on Patient Health Questionnaire-2), and distress ( ≥ 4 on distress thermometer) were evaluated in separate multivariate logistic models adjusted for pt (cancer type, treatment status) and cg (age, sex, race, education, income, comorbidity) characteristics. Results: Among 213 pts (mean age 76, 70-89), >50% had ≥ 5 impaired GA measures. Of the 213 cg (mean age 73, 52-91), 23% screened positive for anxiety, 16% for depression, and 40% for distress. In bivariate analyses, number of GA impairments, ≥ 1 fall, pt anxiety ( ≥ 5 on GAD-7) and depression ( ≥ 5 on Geriatric Depression Scale (GDS)) were associated with all 3 cg outcomes; pt activities of daily living (ADL) deficits were associated with cg depression and distress. In multivariate analysis, number of GA impairments was associated with cg distress. In separate models, pt ADL deficit and depression were associated with cg distress, and pt ADL deficit was associated with cg depression. GA variables were not associated with cg anxiety in multivariate analysis. Conclusions: A high proportion of cg of older pts with cancer report distress. GA can help identify cg at risk for poor emotional health. Interventions for cgs should address the health status of older pts with cancer. [Table: see text]
Evaluation of adolescents and young adults (AYA) attitudes towards participation in cancer clinical trials.
Authors: Gupta Abha A. , Bell Jennifer A.H , Wang Kate , Forcina Victoria , Tam Seline , Lin Yu-Chung , Taback Nathan , Mitchell Laura , Lewin Jeremy Howard 
Published: September 2018

10047 Background: Participation in clinical trials (CT) for AYA ( < 39 years) remain the lowest of any patient group with cancer. Little is known about the personal barriers to AYA accrual. The aim of this study was to explore AYA attitudes that influence CT participation. Methods: A mixed methods approach included 1) qualitative: interpretive descriptive methodology guided individual semi-structured interviews with 21 AYA for factors influencing CT enrollment and 2) quantitative: AYA and non-AYA (≥40) matched for histology completed Cancer Treatment subscale of Attitudes toward Cancer Trials Scales (ACTS-CT) (Schuber, 2008) and 9 supplementary questions formed from interview analysis. Differences between AYA and non-AYA cohorts were analyzed using the Mann-Whitney U test and ordered logistic regression models were constructed for prediction of the effect of baseline demographics. Results: The major themes influencing CT participation were: (1) family/peer group opinion (2) CT impact on daily/future life (e.g. school; starting a family) and (3) illness severity/psychological readiness for CT information. Surveys were distributed to 61 AYA (median age: 29 years (17-39)); 74 non-AYA (55 (40-88)). Compared with non-AYA, AYA perceived CT to be unsafe/more difficult (Personal Barrier/Safety domain; p = 0.01). AYA were also more concerned with CT interference in their long term goals (p = 0.04). Logistic regression identified participants who had previously been offered a CT (p = 0.01) or who spoke English as their first language (80% of cohort)(p = 0.01) reported less barriers to CT. There were no differences based on age in other domains (Personal Benefits; Personal/Social Value; Trust in CT). In all participants, differences were seen in the Personal Benefits domain if respondents had children (p = 0.05) or were currently working (p = 0.04). Conclusions: Age-related differences in attitudes towards CT suggest that tailored approaches to CT accrual of different patient groups may be warranted. Patient-centered delivery of information regarding CT, particularly for those in whom English is a second language and who are trial-naïve, may improve accrual and warrants further prospective, randomized study.