bluuebunny/crossref_metadata_2025_split huggingface dataset:
Competing causes of death in patients with neuroendocrine tumor.
Authors: Low Soon Khai , Hoang Trong Bao Long , Bahaie Nourelhoda Sami , Giannis Dimitrios , Tawfik Gehad Mohamed , Lee Shin Yin , Huy Nguyen Tien 
Published: May 2019

e23009 Background: Increasing survival of patients with neuroendocrine tumors (NETs) may be associated with higher risk of mortality due to causes other than the primary NET, namely the competing causes of death (CCD). Therefore, our study focused on comprehensively investigating the magnitude of the CCD on the overall NET mortality and the associated demographic, clinicopathologic and treatment factors using data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Patients with histologically confirmed primary NET diagnosed from 1973 through 2015 were identified using the SEER-9 registries for subsequent data collection and analysis. CCD were stratified and analyzed using standardized mortality ratios (SMRs) as measures of the relative risks of mortality for NET patients in comparison to the general population in the US adjusted by age, sex and race over the same time period. Competing risk regression analysis was performed using Fine and Gray multivariate regression model. Results: A total of 29,981 NET patients were included, 5481 (42.5%) of which deceased due to CCD. Overall SMR attributed to CCD was 2.50 [95% Confidence interval (CI): 2.43–2.56]. The SMR of non-cancer CCD was 2.65 (95% CI:2.58–2.73) and that of SPN was 1.91 (95% CI:1.79–2.04). Heart diseases and other cardiovascular diseases accounted for approximately half of all non-cancer CCD. SPN mortality accounted for 16.1% of CCD, with lung and bronchus cancer being the most prevalent. Stratification by the year of diagnosis revealed a drastic rise in CCD was observed in the last decade between 2005 and 2015, during which the SMR peaked. Advanced age, black race, small intestinal and gastric NETs, and cancer-directed surgery were significantly associated with an increased risk of CCD (p<0.001). Interestingly, female sex, pancreatic NETs, recto-anal NETs, NETs of unknown primary site, race other than white and black, distant and regional spread, chemotherapy and radiotherapy were significantly associated with a decrease in the incidence of CCD. Conclusions: CCD play an increasingly significant role in NET mortality in recent years, especially for those with higher risk of CCD. Further prospective studies are needed to evaluate the association of NETs with these CCD.
A prospective study of the impact of chemotherapy-related toxicities on the quality of life in elderly patients with cancer.
Authors: Kotne Sanketh , Ponnada Bharadwaj , Philip Arun , Keechilat Pavithran 
Published: May 2019

e23013 Background: Treatment of cancer in elderly is challenging. Majority of the elderly cancer patients are offered chemotherapy based on their performance scale and geriatric assessment tools are not routinely employed in clinical practice as they are time consuming and cumbersome. Aim: The primary objective was to estimate the incidence of chemotherapy related adverse events in newly diagnosed elderly cancer patients above 65 years of age treated at a tertiary cancer institute in southern India. The secondary objective was to predict and assess the factors associated with chemotherapy related toxicities in the elderly patients using the Cancer and Aging Research Group's (CARG) scoring tool and to study the quality of life and to assess the nutritional status and the mental status in elderly cancer patients above 65 years of age. Methods: A prospective cross-sectional study was done among 179 patients with age ≥ 65 years, a solid organ cancer (any type or stage) from February 2017 to August 2018. Prechemotherapy comprehensive geriatric assessment (CGA) with Older People’s Quality of Life Questionnaire (OPQOL-35), Mini Nutritional assessment (MNA) and Folstein’s Mini Mental status examination (MMSE) was done at baseline, 2 months and 6 months. CARG tool was used to predict the risk of chemotherapy toxicity with the standard and modified dose. Results: The mean age was 68.53 years. Majority of the patients had breast cancer 29.60%. The proportion of lung cancer, prostate cancer, stomach cancer, colorectal and ovarian cancers were 21.80%,10.60%, 9.50%, 14.5% and 7.30% respectively. Other cancers were seen in 5 patients (2.79%). 40 (22.30%) patients had received anthracycline based chemotherapy. 143 (79.90%) had received standard dosing chemotherapy.118 (65.90%) & 125 (69.80%) out of 179 patients had developed hematological toxicities and non- hematological toxicities respectively. According to the ROC curve for the CARG tool risk of toxicity with standard & modified dosing and hematological & non- hematological toxicities, the accuracy of the test is 60.89% indicating its poor predictive validity. There is a decline in the CGA at 2 months follow-up, but there was an improvement after assessment at 6 months. Conclusions: Comprehensive geriatric assessment at base line is required to adequately analyse patient’s risk of chemotherapy related toxicities. In our study, the patients have tolerated the chemotherapy well in spite of receiving standard dosing.
Neutrophil to lymphocyte ratio ≥4 correlates with 6-month postoperative mortality in cancer patients age >75.
Authors: Ali Imran Yousuf , Sarraf Saman , Downey Robert J. , Kim Soo Jung , Alexander Koshy , Korc-Grodzicki Beatriz , Shahrokni Armin 
Published: May 2019

e23014 Background: We assessed the correlation between elevated neutrophil to lymphocyte ratio (NLR), a pro-inflammatory biomarker, with patient frailty and post-operative 6-month mortality. Methods: Patients aged ≥75 evaluated preoperatively by the Memorial Hospital Geriatrics Service completed a geriatric assessment (GA). NLR was determined from preoperative blood work. Patients were included if they underwent elective surgery between 2015-2018 with hospital length of stay (LOS) ≥ 1 day and had ≥ 6 month follow up. Univariate analysis was used to determine correlation between GA domains and NLR. Multivariable regression (MVR) analysis was used to assess the relationship of frailty and NLR with postoperative 6-month mortality. Results: 1028 patients (median age 80) were included. 323 patients (31.4%) had NLR ≥ 4. By univariate analysis, patients with NLR ≥4 were often male ( 57% vs. 45%), had Karnofsky Performance Status (KPS) < 90 (44% vs. 37%), were dependent for instrumental activities of daily living (iADL) (53% vs. 44%), had social activity limitation (57% vs. 49%) (all p < 0.05) and Timed Up and Go test (TUG) > 10 seconds (40% vs. 33%, p = 0.06). Other conditions, particularly cognitive function, weight loss, polypharmacy did not differ between groups, nor did operative time and blood loss. Patients with NLR ≥4 experienced more major adverse surgical events (8% vs. 5% , p = 0.03) and had longer LOS (9 vs. 6.3, p < 0.001). After six months, 12% and 5% of the NLR≥4 and NLR < 4 groups respectively had died. By MVR analysis, patients with NLR≥4 were at higher risk for 6-month mortality (OR = 1.91, p = 0.01) after adjustment for gender, KPS, iADL, TUG, social activity, major adverse surgical events, LOS, and metastatic disease status. Conclusions: NLR ≥4 was associated with components of the GA but correlated with risk for major adverse surgical events and 6-month postoperative mortality. Ongoing work directed at clarifying the relationship between NLR and risk of specific complications to help plan interventions is needed.
Endocrine therapy discontinuation rates in older women with early stage breast cancer who are candidates for omission of radiation.
Authors: Egloff Heidi , Swartz Leigh Klaus , Fang Fang , Kidwell Kelley M. , Schott Anne F. 
Published: May 2019

e23018 Background: As the treatment for early-stage breast cancer continually evolves, there has been a pragmatic shift with regard to standard treatment placing a high-value on multidisciplinary management. Recent studies have shown that sentinel lymph node biopsy (SLNB) and adjuvant radiation (RT) can be omitted in a subset of older women with early-stage hormone receptor positive breast cancer who plan to take adjuvant endocrine therapy (ET). Prior analyses estimate a wide range of discontinuation rates, with studies citing 31-73%. The primary aim of this analysis is to estimate the discontinuation rate of endocrine therapy in women ages 70 and older with early stage breast cancer who omit radiation therapy at our institution. Methods: We performed a retrospective review of institutional cancer registry and EMR data to identify all women with breast cancer, ages 70 or older, AJCC 7 stage I or II, hormone receptor positive, HER2 negative, who underwent lumpectomy at the University of Michigan inclusive of years 2014 through 2017. Multiple variables of interest were collected and analyzed. Results: 174 women met initial inclusion criteria for ER/PR positive, HER2 negative, Stage I/II disease, who underwent lumpectomy. Of these, N = 10 pursued adjuvant radiation therapy with omission of ET, and N = 19 declined both ET and RT upfront. The remaining 145 women chose to pursue ET alone (N = 78) or ET+RT (N = 67). 30/145 (21%) discontinued endocrine therapy, 22% (N = 15) in the ET+RT, 19% (N = 15) in the ET alone groups. There was no statistically significant difference between groups with regard to the discontinuation of ET upon comparison, log-rank p-value 0.4. The primary reason for ET discontinuation, N = 27 (90%) was secondary to side effects. Conclusions: This review demonstrated that a significant number (54%) of older women opt to omit radiation in favor of ET alone after multidisciplinary discussion, in accordance with NCCN guidelines. Endocrine therapy discontinuation rates among older women at our institution were comparable to rates in the literature for women of all ages, and the reason for discontinuation was attributed to side effects. The pivotal clinical trials (PRIME II and CALGB 9343) exploring ET alone versus ET+RT did not report on ET discontinuation rates. In our analysis, almost 20% of women receiving ET alone discontinued ET therapy, calling into question a missed radiation treatment opportunity in a curative setting.
Comprehensive geriatric assessment prior to autologous stem cell transplant as a predictor of patient outcomes: A retrospective review.
Authors: Sokol Kelsey , Rhoades Ruben , Leiby Benjamin E. , Binder Adam , Chapman Andrew E. , Porcu Pierluigi , Flomenberg Neal , Grosso Dolores , Palmisiano Neil David 
Published: May 2019

e23023 Background: While autologous stem cell transplant (ASCT) has been shown to be safe and effective in the geriatric population, age alone is not a sufficient predictor of outcomes. Minimal data exists regarding the use of a comprehensive geriatric assessment (CGA) tool prior to ASCT as a predictor of patient outcomes. This study aims to assess our institution’s pre-ASCT CGA on its ability to predict transplant-related outcomes in the elderly. Methods: We retrospectively analyzed all patients age 65 years of age and older (n = 68) who received ASCT at Thomas Jefferson University Hospital between 2012 and 2018 for multiple myeloma (MM) (n = 52), AL amyloidosis (n = 1), combined MM/amyloidosis (n = 2), B-NHL (n = 11), T cell lymphoma (n = 2), and Hodgkin lymphoma (n = 1). The CGA consists of 13 components, culminating in an overall frailty status. Kaplan-Meier survival estimates were used to assess overall survival (OS) and progression free survival (PFS), and multivariable logistic regression and Cox proportional hazard regression were used to determine associations between CGA variables and relevant post-ASCT outcomes. Results: Among the 68 patients (43 males, 25 females) who received ASCT, the median age was 68 years (range 65-78). Fifty-one patients (75%) underwent pre-transplant CGA. Among the entire cohort, 2-year OS and PFS were 95.4% and 79.6%, respectively. Median OS was not reached, and median PFS was 48.5 months. There was no difference in OS between patients who underwent CGA and those who did not (P = 0.937). Multivariate analysis revealed that none of the variables in the CGA were predictive of patient outcomes, such as OS, length of stay on ASCT admission, 30-day readmissions, and falls. Conclusions: This single-institution data suggests that ASCT is safe and highly effective in geriatric patients. Undergoing a CGA was not associated with improved outcomes, and none of the CGA components including frailty status were predictive of outcomes in this preliminary data set. Our data suggest that further refinement of the CGA may improve its predictive ability. Future studies examining additional outcomes, including patient-reported quality-of-life outcomes, are warranted.
Effect of fractures on overall survival in cancer patients: The NHANES database.
Authors: Edwards Beatrice Jara-Almonte , Zhang Xiaotao 
Published: May 2019

e23024 Background: Fractures are a significant cause of morbidity, institutionalization and mortality in older adults who are cancer-free. We evaluated the effect of fractures on overall survival in older patients with cancer. Methods: The National Health and Nutrition Study (NHANES) assessed the health and nutritional status of the U.S. The NHANES database is publicly available, and this study was exempt from approval by an institutional review board. All participants provided informed consents both before the interview and examination stages. A total of 62,160 individuals participated in NHANES during 1999-2010. We restricted our analyses to older adults (65 years of age and older) with self-reported cancer diagnosis, with a follow-up till 2011. Results: In total, 1,718 older adults with cancer and with available follow up were included for final analysis. There were 303 participants with fractures (17.6%) and 581 deaths (33.8%) that occurred over a median follow up 4.3 years (range 0.1-12.8 years). Mean age was 74.8 ± 0.2, with females 49.6%. Cancer types included solid tumors and hematologic malignancies. Among solid tumors, colorectal 9.0%, breast cancer 17.4%, prostate cancer 17.7%, lung 3.0%. Among hematologic malignancies, lymphoma 1.6%, myeloma 7.2%, CLL 1.2%. Hip fractures were associated with advanced age, obesity, diabetes, stroke, functional impairment, and mortality. Spine fractures were associated with advanced age, cardiovascular disease, functional impairment and mortality. Univariate analysis for factors associated with overall survival in older adults in NHANES revealed an increased risk with spine fractures H.R. = 1.89, (95% CI 1.11, 3.2, p = 0.02) and hip fractures H.R. = 2.66, (95% CI 1.41, 5.02, p < 0.01). Conclusions: In older cancer patients vertebral and hip fractures were associated with an increased risk for mortality.
Propensity score matching analysis of the survival outcome and toxicity of different treatment modalities for the elderly nasopharyngeal carcinoma patients.
Authors: Tan Mingyu , Feng Mei , Huang Yecai , Xu Peng , Xu Ke , Yin Jun , Li Lu , Qi Yunxiang , Lang Jinyi 
Published: May 2019

e23029 Background: With the aging society was coming, more elderly nasopharyngeal carcinoma NPC patients should be pay attention. However, no guideline is proposed for them due to lack of prospective clinical trials. We aimed to use propensity score matching method to evaluate the survival outcome and toxicity of the different treatment modalities for them. Methods: II-IV(UICC 8th) elderly NPC patients (≥65 years) were retrospectively enrolled between 2004 to 2016 in our center. All the patients received definitive IMRT, and were allocated into radiotherapy only (RT), concurrent chemoradiotherapy (CCRT) and neoadjuvant chemotherapy followed with CCRT (NACT). Cisplatin-based chemotherapy was used. Survival outcomes and toxicity were analyzed using propensity score-matching method. Results: There were 142 patients included, and the median age was 68 years. The median follow-up time was 47 months. 23 patients received RT only, 61 patients received CCRT and 58 patients received NACT. After matching for gender, age, T and N stage, chemotherapy and non-chemotherapy patients (22 pairs) were analyzed and shown the chemotherapy group had a better OS (86% vs 68%, p= 0.031). The 3-years LRFS, DMFS and DFS of chemotherapy and non-chemotherapy was 95% and 85% ( p= 0.251), 95% and 86% ( p= 0.307), 86% and 73% ( p= 0.309). Furthermore, 41 pairs who underwent chemotherapy were sub-analyzed according to different modalities. CCRT group showed a comparable 3-years LRFS (100% vs 94%, p= 0.143), DMFS (87% vs 89%, p= 0.608), DFS (81% vs 84%, p= 0.892) and OS (79% vs 66%, p= 0.080) with NACT. For acute toxicity, the incidence of G3-5 bone marrow suppression in non-chemotherapy was significantly lower than chemotherapy group (8.7% vs 36.4%, p= 0.31), and the incidence of G3-5 mucositis was similar ( p= 0.517). Besides that, there was no significant difference in the incidence of G3-5 bone marrow suppression and mucositis between CCRT and NACT group ( p= 0.824, p= 0.618). Conclusions: Chemoradiotherapy could improve the survival rate of the elderly NPC patients compared with radiotherapy only. The acute toxicity of CCRT and NACT was similar and acceptable. CCRT was still the standard treatment modality for them. As for the elderly NPC patients who are in good performance status and comorbidity conditions, NACT might be also worthy of recommendation.
Analysis of proportion of geriatric patients in phase III cancer clinical trials.
Authors: Gopishetty Swathi , Kota Vamsi , Guddati Achuta Kumar 
Published: May 2019

e23032 Background: Geriatric patients are often under-represented in cancer clinical trials. The presence of multiple comorbidities makes geriatric patients ineligible for most clinical trials. However, the increase in cancer incidence in geriatric patients raises the question of applicability of the results is such clinical trials. Methods: Data about Phase 3 trials was extracted from the clinical trials.gov for 3 common solid organs and 3 hematological malignancies [breast, colon, lung, diffuse large B-cell lymphoma (DLBCL), acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL)]. The time period studied was for the past 10 years and included only adult patients (≥ 18 years). The age distribution of the patient population in these trials were extracted and analyzed. Results: Geriatric patients are heavily under-represented in all phase 3 cancer clinical trials. Table shows the proportion of patients below 65 years, above 65 years and older in clinical trials for each organ specific malignancy. The range of the proportion of geriatric patients varied from 10% to 40%. Conclusions: The results of phase 3 clinical trials that are currently conducted on non-geriatric patient population may not meaningfully be applicable to geriatric patients. This study highlights the disparity of age for patients enrolled in clinical trials as against the patients seen in the real world.[Table: see text]
Baseline laboratory tests as predictors of early death risk in 746 elderly oncologic patients: A prospective cohort study.
Authors: Telles Sales Letícia , Telles O Lima Jurema , Mello Maria Julia Gonçalves , Torres Leuridan , Pires maria Luiza lemos , Rebello Mirella , d'Almeida Carolina Vanderley Menezes , Orange Flavia , Bergmann Anke , Thuler Luiz Claudio Santos , Orange Flavia 
Published: May 2019

e23039 Background: The elderly population is the thoroughly affected by new cases of cancer, as well as by its complications. The occurrence of early death (in the first six months after diagnosis) is one of the most important outcomes to be studied in this population. This study aims to identify if simple baseline laboratory tests can be used as predictive factors for early death in older cancer patients. Methods: Prospective cohort enrolled elderly patients ≥ 60 years with a recent cancer diagnosis admitted between 2015 -2017. Sociodemographic, tumor-related and laboratorial (leukocytes, creatinine, platelets and hemoglobin) variables were collected at admission and analyzed. Survival analysis (Kaplan-Meier) and Cox proportional hazard regression was performed. The outcome was a six-month death. Descriptive, univariate and multivariate analysis of Cox proportional hazards and Kaplan-Meier global survival were performed. Results: A total of 746 patients with an average of 71 (± 7.4) years were eligible. 16.5% died in the first six months after diagnosis. Risk factors for early death were controlled by age. Leukocytes < 4,000 / mm3 or > 12,000 / mm3 (HR 2.51 IC95% 1.68-3.75), Creatinine > 1.7mg / dL (HR 2.14 95% CI 1.37-3.36), Platelets < 150,000 / mm3 or > 300,000 / mm3 (HR 1.92 CI 95% 1.31-2.80) and Hemoglobin < 12 g / dL if female, or < 13 g / dL, if male (HR 1.89 95% CI 1.27-2.83) were all associated with greater risk of dying in the first six months after diagnosis (log rank < 0.001). Conclusions: Baseline laboratory tests performed at the hospital admission of the elderly cancer patient may be a simple way to help the clinician to identify patients at higher risk of early death.
The effects of wheatgrass juice administration in colon cancer patients during adjuvant chemotherapy and the treatment reflection on the extracellular vesicles.
Authors: Bar-Sela Gil , Avisar Adva , Shentzer Kutiel Talia , Cohen Miri , Aharon Anat 
Published: May 2019

e23045 Background: Adjuvant chemotherapy is recommended in stage II-III colorectal cancer (CC). Wheatgrass juice (WGJ), has high nutritional values may attenuate chemotherapy adverse events (AE). Extracellular vehicles (EVs) are subcellular membrane blebs that provide information on cellular processes. Aim: To evaluate the incidence of chemotherapy AE and to elucidate the effects of supportive treatment of WGJ on CC patients’ EVs characteristics. Methods: In a prospective trial between 3/2014- 7/2017, 99 patients stage II-III CC, treated with standard adjuvant chemotherapy were enrolled. According to patient preference, they were divided into: control group of 50 (CC-C) patients and intervention group of 49 patients who received chemotherapy plus consumption of daily 60cc frozen WGJ (CC-W). EVs were isolated from the blood samples of 15 healthy controls (HC) and 25 patients from each study group. Blood samples were taken before, during and at the end of chemotherapy, EVs characterized by membrane antigens/cytokine content Results: Study groups were well balanced. Median follow-up time was 15 months. Eleven patients had died at the time of analysis, 3 in the WGJ and 8 in the control ( p= 0.142). 11/50 (22%) and 8/49 (16.3%) had severe diarrhea in the control and WGJ groups, respectively ( p= 0.47). There was no difference between the groups in RFS (HR = 1.19 , p= 0.69). Higher levels of endothelial EVs (CD34+41, CD144), indicating vascular injury, were found in CC-C patients- compared to CC-W during and at the end of treatment. Increased EVs thrombogenicity in patients was documented, while EVs thrombogenicity was lowered in CC-W compared to CC-C during or at the end of treatment (TF, P = 0.029; TF/TF-pathway inhibitor (TFPI) ratio, p = 0.008; endothelial protein C receptor 0.005 and annexin-V 0.05). Following treatment, the majority of growth-factors/pro-inflammatory cytokines were found to be lower in CC-W than in CC-C. Conclusions: Daily consumption of WGJ during chemotherapy may reduce vascular damage and thrombogenicity. There was no statistical difference in overall survival. However, the large difference in death rate may relate to other long-standing effects of daily WGJ consumption. Clinical trial information: NCT01991080.