bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discontinuing chronic medications: Perceptions of patients with life-limiting illness.
Authors: Kutner Jean , Ritchie Christine , Furuno Jon , Prince-Paul Maryjo , Tjia Jennifer , McPherson Mary Lynn , Sloan Jeff A. , Somers Tamara , Abernethy Amy Pickar , Blatchford Patrick Jud 
Published: February 2017

97 Background: Optimal management of chronic medications is uncertain in life-limiting illness. To inform shared decision making, we assessed patient perceptions in a trial on the safety of discontinuing statins in life-limiting illness. Methods: Eligible adults (life expectancy 1–12 months, on statin for ≥ 3 months for primary/secondary prevention, recent functional decline, no active cardiovascular disease) were randomized to discontinue or continue statins and were followed monthly for up to 1 year. Cognitively intact participants were asked 9 questions regarding discontinuing statins prior to randomization. We used Pearson chi-square to compare responses between study groups and between those with and without cancer. Of 381 participants, 297 (78%) were cognitively intact (138 discontinued, 159 continued statins). Mean age was 72 years (SD 11) and mean number of medications used was 11.5 (SD 5.0); 58% (N = 173) had cancer. Results: There were no statistically significant differences between the study groups in responses to the medication perception questions. Aggregate findings are presented (Table). Patients with cancer were less likely to think that they may be able to stop other medications (28% vs. 42%, p=0.007) and that statin discontinuation means that the doctor is giving up on them (1% vs. 7%, p=0.013). Conclusions: Few participants expressed concerns about discontinuing statins; many perceived potential benefits. Cancer patients may perceive less impact from stopping statins. Clinicians should inquire about patient concerns when engaging in shared decision making about discontinuing chronic medications in the setting of advanced cancer. Clinical trial information: NCT01415934. [Table: see text]
The effect of perioperative transfusion on recurrence and survival following gastric cancer resection: A seven-institution analysis of 765 patients from the U.S. Gastric Cancer Collaborative.
Authors: Squires Malcolm Hart , Kooby David A. , Poultsides George A. , Weber Sharon M. , Bloomston Mark , Fields Ryan C. , Pawlik Timothy M. , Votanopoulos Konstantinos I. , Schmidt Carl Richard , Ejaz Aslam , Acher Alexandra W. , Worhunsky David J. , Saunders Neil , Swords Doug S. , Jin Linda X. , Cho Clifford Suhyun , Winslow Emily , Russell Maria C. , Staley Charles A. , Maithel Shishir K. 
Published: February 2017

100 Background: Whether perioperative blood transfusion has a negative prognostic effect on recurrence and survival in patients undergoing resection of gastric adenocarcinoma (GAC) is unknown. Methods: All patients who underwent resection for GAC from 2000-2012 at 7 institutions were identified. The effect of transfusion on recurrence-free (RFS) and overall survival (OS) in the context of adverse clinicopathologic variables was examined by univariate (UV) and multivariate (MV) regression analyses. Results: Out of 965 pts, 765 underwent curative intent, R0 resection. Median FU for survivors was 44 mos; 30-day deaths were excluded. Median estimated blood loss (EBL) was 250cc and 166 pts (22%) received perioperative RBC transfusions. 5-yr RFS was 51% in transfused and 61% in non-transfused patients (p=0.01). Median OS was decreased in patients receiving transfusions (19 vs 50 mos, p<0.001). On MV analysis, transfusion remained an independent risk factor for decreased RFS (HR 2.8; 95% CI: 1.2-6.5; p=0.01) and decreased OS (Table), regardless of EBL or need for splenectomy. Timing (intraop vs postop) and volume (# of units) did not alter the effect of transfusion on survival. Non-transfused pts were more likely to receive adjuvant therapy (56% vs 44%; p=0.01). Conclusions: Perioperative blood transfusion is associated with decreased recurrence-free and overall survival following resection of gastric cancer, independent of adverse clinicopathologic factors. This supports the judicious use of perioperative transfusion during resection of gastric cancer. [Table: see text]
Acid-suppressive medications and risk of esophageal adenocarcinoma in patients with Barrett’s esophagus: A systematic review and meta-analysis.
Authors: Singh Preet Paul , Singh Siddharth , Garg Sushil Kumar , Iyer Prasad G. , El-Serag Hashem 
Published: February 2017

11 Background: Acid-suppressive medications, particularly proton pump inhibitors (PPI), may modify risk of esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE). We performed a systematic review and meta-analysis of studies evaluating the association between PPIs and histamine receptor antagonists (H2RA) and risk of EAC or high-grade dysplasia (BE-HGD) in patients with BE. Methods: Through a systematic search up to June 2013, we identified 7 observational studies (5 cohort studies and 2 case-control studies; 2,813 patients with BE, 317 cases of EAC and/or BE-HGD, 84.4% PPI users) reporting the association between PPIs or H2RA and EAC in patients with BE. Summary odds ratio (OR) with 95% confidence intervals (CI) was estimated using random effects model, and heterogeneity was measured using the inconsistency index (I2). Results: On meta-analysis, PPI use was associated with 71% reduction in EAC risk in patients with BE (adjusted OR, 0.29; 95% CI, 0.12-0.71). There was a trend toward a dose-response relationship with PPI use for >2 years protective against EAC [3 studies; PPI use >2 years vs. <2 years (as compared to no use): OR, 0.45 (0.19-1.06) vs. 1.09 (0.47-2.56)]. Considerable heterogeneity was observed in the overall analysis (I2=81%). On restricting analysis to 5 cohort studies, use of PPIs was consistently associated with a lower risk of EAC and/or BE-HGD (adjusted OR, 0.33; 95% CI, 0.19-0.58; I2=9%). H2RA use was not associated with decreased risk of EAC in patients with BE based on 2 studies (adjusted OR, 1.15; 95% CI, 0.77-1.72). Using a 67% summary risk reduction (derived from cohort studies) of EAC and/or BE-HGD with PPI use in patients with BE, and observed cumulative incidence rates of EAC and/or BE-HGD in patients with BE overall as 10.2 per 1,000 patient years, we estimate the number needed to treat with PPIs to prevent 1 case of EAC or BE-HGD in BE patients at 147. Conclusions: Based on meta-analysis of observational studies, the use of PPI, but not H2RA appears to be associated with a decreased risk of EAC and/or BE-HGD in patients with BE. PPI use should be considered in BE, and chemopreventive trials of PPIs in patients with BE are warranted.
Evaluation of the effects of postoperative oral nutrition support on body weight in gastric cancer patients by using an elemental diet: A randomized study.
Authors: Nishikawa Kazuhiro , Kishi Kentaro , Inoue Kentaro , Matsuyama Jin , Akamaru Yusuke , Kimura Yutaka , Tamura Shigeyuki , Kawabata Ryohei , Kawada Junji , Fujiwara Yoshiyuki , Kawase Tomono , Fukui Junichi , Takagi Mari , Takeno Atsushi , Shimokawa Toshio , Imamura Hiroshi 
Published: February 2017

110 Background: Postoperative weight loss causes deterioration in the patient’s quality of life and influences long-term prognosis in gastric cancer patients who have undergone gastrectomy. Moreover, recent retrospective studies indicated postoperative weight loss as a risk factor for premature interruption of S-1 adjuvant chemotherapy. We conducted a prospective randomized controlled study to examine whether the early institution of nutritional support comprising an oral elemental diet (ED) prepared for post-gastrectomy patients with depressed digestive/absorptive function would help prevent postoperative weight loss. Methods: After surgery, patients were randomly assigned to the ED or control groups. The groups were divided according to the surgical methods used (total/distal gastrectomy), clinical stage (≤Ia/>Ia), and patients’ body mass index (<18.5/>18.5). In patients assigned to the ED group (Elental, 300 kcal) was provided in addition to the regular diet from the day starting soft rice diet or equivalent diet to 6–8 weeks after surgery. The primary endpoint was the percentage of body weight change from the pre-surgical body weight to that at 6–8 weeks after surgery. The secondary endpoints were ED adherence, nutrition-related blood parameter changes, and adverse effects. Results: The study included 112 patients from eight hospitals. There was a significant difference in the percentage of body weight loss (%BWL) between the ED and control groups (4.88±3.41% and 6.91±5.06%; P=0.015). Sub-group analysis showed a significant difference in the %BWL in patients who underwent total gastrectomy (5.31±3.43% and 9.11±5.57%; P=0.016). Multivariate analysis demonstrated ED treatment and surgery type as independent factors that affect body weight changes. The mean treatment compliance rate in the 58 ED-group patients was 72.9±33.1%, with a favorable median value of 90.8%. No significant differences were observed in any parameter analyzed, including hematological and non-hematological adverse events, between the two groups. Conclusions: The ED product can prevent postoperative weight loss in gastric cancer patients undergoing gastrectomy. Clinical trial information: 000008056.
Effect of a multidisciplinary cancer conference for thoracic malignancies on patient care management.
Authors: Schmidt Henner M. , Roberts John M. , Bodnar Artur M. , Kirtland Steven H. , Kunz Sonia H. , Markar Sheraz , Low Donald E. 
Published: February 2017

112 Background: Treatment of thoracic cancers frequently involve multiple subspecialties thus treatment decisions are typically best facilitated in multidisciplinary tumor boards (MTB). This approach should facilitate and improve treatment decision making, standardize staging and therapeutic decisions and improve outcomes. In this study we analyze the evolution in staging and treatment decision making associated with presentation at MTB. Methods: Retrospective review of all patients with lung or esophageal cancer presented at our weekly MTB from June 1, 2010 to September 30, 2012. All providers submitting patients to tumor board recorded their current treatment plan prior to presentation. The physician’s plan was then compared to the tumor board’s final recommendation. Changes made were graded according to degree of magnitude as minor, moderate or major change. Minor changes included changes in diagnostic imaging. Moderate changes involved modifications in the type of invasive staging or biopsy procedures. Major changes were defined as changes to final therapeutic plans such as surgery, chemotherapy, or radiation therapy. Results: 435 patients with esophageal or lung cancer were discussed in the MTB. 86 patients having no prior treatment plan available were excluded. In the remaining 347 patients there were 163 patients with esophageal cancer (47%) and 184 patients with lung cancer (53%). In the esophageal cancer patients a change to the physician’s prior treatment plan was recommended in 33 cases (21%). For lung cancer patients a change in the treatment plan was recommended in 50 cases (27%). Overall a recommendation for change in treatment occurred in 83 cases (24 %). Changes were major 13%, moderate 6% and minor 5%. Follow-up in 249 patients confirmed that MTB recommendations were followed in 97% of cases. Conclusions: MTB recommendations frequently differs from the physician’s primary treatment plan. MTB reviews have previously been documented to improve patient’s outcome. The study demonstrates that in one quarter of patients MTB recommendation will be different from the primary treatment plan. Complex cancer patients should be considered for presentation at MTB whenever feasible.
Assessment and management of the risk of recurrence of resected gastrointestinal stromal tumors.
Authors: Conley Anthony Paul , Sasane Medha , Pelletier Corey L. , Guérin Annie , Macalalad Alexander R. , Huang Qing , Wu Eric Q. 
Published: February 2017

119 Background: For patients with KIT+ gastrointestinal stromal tumors (GIST), several algorithms can evaluate the risk of recurrence and initiation of adjuvant therapy following primary GIST resection. With a variety of risk assessment tools and no standardized approach for assessing risk, it is unclear how physicians estimate the risk of recurrence in real-world clinical practice, and how they use the level of risk when considering adjuvant therapy. Methods: We conducted a cross-sectional survey of US oncologists on August 2013. From an existing panel of US physicians, oncologists were randomly asked to participate in an online survey of their assessment and management of GIST recurrence risk after resection of primary resectable disease. Oncologists’ feedback included rated responses by Likert scale and ranked responses by priority. Results: Of 109 participating oncologists, 69 (63%) were in private practice and 61 (56%) were in practice for >10 years. Mitotic count and primary tumor size were the most influential factors chosen for assessing risk of recurrence, followed by presence of tumor rupture during surgery, tumor location, and presence of genetic mutations. A majority of oncologists (56%) reported the revised NIH criteria as the preferred risk classification tool, mainly because it was easy to use and remember. Initial level of risk assessed after GIST resection was the key factor influencing initiation, dosage, and duration of adjuvant therapy with imatinib. 98% of physicians would treat high risk patients with adjuvant imatinib, whereas 79% would consider adjuvant treatment for intermediate risk patients, and 28% for low risk patients. The percentage who would prescribe at least 3 years of adjuvant therapy varied from 26% for low-risk patients to 52% for intermediate-risk patients and 76% for high-risk patients. Conclusions: Level of risk of recurrence is a key factor when considering adjuvant therapy after resection of resectable GIST. However, significant variability exists in the perception physicians have regarding the initiation of adjuvant therapy among intermediate to high risk patients. This may be attributed to the variability in the different risk assessment tools and criteria.
Chemoradiotherapy for highly advanced gastric cancer.
Authors: Tsutsui Mai , Takahashi Tsunehiro , Saikawa Yoshiro , Kawakubo Hirofumi , Wada Norihito , Takeuchi Hiroya , Kitagawa Yuko 
Published: February 2017

121 Background: Although the prognosis of early gastric cancer is favorable, the treatment for advanced cases still have difficulty in achieving satisfactory results. Thus, more effective multimodality treatment should be established. Chemoradiotherapy has become a standard treatment for gastric cancer especially as an adjuvant therapy while radiotherapy has been expected as one of the modalities against highly advanced gastric cancer. Methods: Patients with advanced gastric cancer who were treated with chemotherapy of S-1 and cisplatin plus radiation were analyzed retrospectively. Concurrent radiation therapy (5 days/week) at 2 Gy/day was started with chemotherapy and repeated daily on days 1–5, 8–12, 15–19 and 22–26. Irradiation was planned using a computed tomography (CT) simulator for two rectangular portals with a pair of 45-degree wedge filters and was targeted at the primary tumor and surrounding lesions, including lymph nodes. Results: A total 109 patients were treated with chemoradiotherapy between 2002 and 2013 at our institute. The median age was 64 years. Histological type included 45 differentiated and undifferentiated 64 subtypes. The TNM stage before the treatment was diagnosed as IIIA: 11; IIIB: 10; IIIC: 14; IV: 74. Of the 98 evaluable patients, 69 patients had partial responses while no patients had a complete response, resulting in an overall response rate of 70%. Progressive disease (PD) occurred in 2 patients (4%). The most frequent adverse events more than grade 3 were hematologic toxicities, including leukocytopenia (47%), neutropenia (25%), and thrombocytopenia (24%). Non-hematologic toxicities such as general fatigue, renal-related events, and gastrointestinal toxicities were manageable with no treatment-related death. The median survival time was 537 days. Conclusions: While there were disadvantages of radiotherapy including the difficulty of confirming the area of irradiation due to peristaltic movement, risk of perforation and ulceration, recent technological advancement of radiation therapy has enabled pinpoint accuracy in treatment of primary gastric lesions and regional lymph nodes. There has been much anticipation that chemoradiotherapy will be a part of multidisciplinary treatment for advanced cancer.
Trastuzumab (T-mab) in combination with docetaxel/cisplatin/S-1 (DCS) for patients with HER2-positive metastatic gastric cancer: Feasibility and preliminary efficacy.
Authors: Sato Yasushi , Takayama Tetsuji , Ohnuma Hiroyuki , Hirakawa Masahiro , Osuga Takahiro , Miyamoto Hiroshi , Sagawa Tamotsu , Sato Yasuhiro , Takahashi Yasuo , Katsuki Shinich , Okuda Tokunori , Takada Kohichi , Hayashi Tsuyoshi , Sato Tsutomu , Miyanishi Koji , Takimoto Rishu , Kobune Masayoshi , Nobuoka Takayuki , Hirata Koichi , Kato Junji 
Published: February 2017

124 Background: Recently the efficacy of trastuzumab (T-mab) for HER2-positive gastric cancer has been reported. We have developed a triplet-drug combination regimen consisting of docetaxel, CDDP, and S-1 (DCS) and reported that the regimen provides very high response rates (BJC 2007; CCP 2009 and 2013). To increase the efficacy of DCS in patients (pts) with HER2-positive unresectable gastric cancer, we carried out a feasibility study for the DCS-T-mab (DCS-T) regimen. Methods: Eligibility criteria included the following: age between 20 and 80 years; unresectable HER2-positive metastatic gastric cancer; normal cardiac function. Pts received oral S-1 (40 mg/m2 b.i.d.) on days 1-14, intravenous cisplatin (60 mg/m2), docetaxel (50 mg/m2) and T-mab (8 mg/kg in the first cycle and 6 mg/kg in the second cycle and thereafter) on day 8 every 3 weeks. Results: This study included 16 pts: median age, 60 years (34 – 76 years), 11 males and 5 females. PS 0/1/2, 10/4/2; differentiated/undifferentiated-type histology, 11/5; U/M/L, 7/8/1; HER2 3+, 13; HER2 2+/FISH+, 3; T3/T4a/T4b, 11/4/1; N0/N1/N2/N3, 2/0/4/10; and distant lymph nodes/liver/peritoneum/lungs/bone/ovaries, 11/7/4/2/1/1. The completion rate until the third cycle was 100%. According to the RECIST criteria, the objective response rate was 93.3%, and the median cycle to response was 1 (1–3 cycles). Adverse events of grade 3 or greater severity were: leukopenia/neutropenia, 68.8/81.3%; FN, 12.5%; anorexia, 25%; and diarrhea, 25%. All of these side effects were well controlled. Non-curative factors disappeared in 7 of 16 cases and R0 resection was carried out in 6 cases (37.5%) including 2 pts with liver metastases. A pathological response was found in 83 % of 6 resected cases. At a median follow-up of 9.8 months (2.3 – 23 months), median PFS was 12.8 months and median OS was not yet reached. Conclusions: T-mab in combination with DCS is a feasible regimen in pts with unresectable HER2-positive gastric cancer. The observed response rate is very promising and warrants further investigation. Clinical trial information: UMIN000005603.
A phase 2 study of trastuzumab in combination with S-1 and cisplatin in first-line human epidermal growth factor receptor (HER)-2-positive advanced gastric cancer.
Authors: Choo Su Pin , Chua Clarinda Wei Ling , Yamada Yasuhide , Rha Sun Young , Yong Wei Peng , Tham Chee Kian , Ng Matthew , Tai Wai Meng David , Lim Hwee Yong , Tan Iain B. 
Published: February 2017

127 Background: The addition of trastuzumab to cisplatin and 5-fluorouracil or capecitabine has been shown to have superior survival benefit. In this study, the addition of trastuzumab to chemotherapy combination, S-1 (tegafur, gimeracil, oteracil potassium; TS-ONER) and cisplatin, a standard first line therapy for advanced gastric cancer in Japan, was evaluated for efficacy and safety. Methods: This was a single-arm, phase II trial recruiting patients with advanced HER-2 positive (IHC 3+ or FISH +) gastric adenocarcinoma who had not had prior systemic therapy. Patients included had measurable disease, ECOG 0-2, creatinine clearance >60ml/min, LVEF at least 50%. Patients accrued received cisplatin at 60mg/m2 on day 1 of each cycle, trastuzumab at 8mg/kg as loading dose followed by 6mg/kg on day 1 of each cycle and oral S-1 for 14 days ( dosing based on BSA), every 3 weeks. Treatment continued till progressive disease or unbearable toxicity. Primary endpoint was response rate (ORR) and secondary endpoints were PFS, OS, CBR and safety. The study was designed to distinguish a favorable ORR of 55% from a null rate of 30% at 5% significance level and 80% power. Results: A total of 30 patients were recruited. Median age was 61.9 years, 73% were males and 90% had no prior resection of primary tumor. 56.7% were Chinese, 23.3% Japanese and 20% Korean. One patient achieved complete response, 16 had partial response and 2 had stable disease >24 weeks (ORR 63%; CBR 70.4%). Three patients did not have evaluable disease. With a median follow-up of 7.2 months, the median PFS was 7.4 months with 67.7% free of disease progression at the 6-month mark. Median OS was 14.6 months. The most common AEs were anorexia (50%), fatigue (47%), diarrhea ( 47%), nausea (37%), neutropenia (33%), anemia (27%) and mucositis ( 27%). LVEF decreased <50% in 14 patients and none led to treatment discontinuation nor death. Two patients had fatal SAEs that were deemed related to study drug ( neutropenic sepsis and hypotensive shock). Correlative studies will be reported later. Conclusions: The combination of trastuzumab with S-1 and cisplatin in advanced gastric cancer is active and tolerable. Clinical trial information: NCT01736410.