bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 10-year age-related survival analysis on cytoreductive surgery in stage IIIC-IV ovarian cancer: Elderly versus younger women.
Authors: Ruscito Ilary , Gasparri Maria Luisa , Crispino Stefania , La Russa Chiara , Marchetti Claudia , Di Donato Violante , Palaia Innocenza , Perniola Giorgia , Musella Angela , Muzii Ludovico , Benedetti Panici Pierluigi 
Published: February 2017

123 Background: Approximately half of women diagnosed with advanced ovarian cancer (AOC) is over 65 years old. According to WHO,65 years is the cut-off age for distinguishing elderly individuals from younger people. Aim of the study was to analyze, in a 10-year retrospective series, the age-related differences in perioperative outcome of cytoreductive surgery for stage IIIC-IV ovarian cancer, identifying in ≥ 65y and < 65y patients(pts)the clinicopathological factors associated with poor prognosis. Methods: 167pts with primary epithelial AOC FIGO stage IIIC-IV underwent cytoreduction and platinum-based chemotherapy from 2005 to 2015 at “Sapienza” University of Rome. Pts ≥ 65 and < 65 years were compared regarding surgical outcome, clinicopathological variables and prognosis. Results: Median age was 56 years(19-87);50 pts (29.9%) were ≥ 65y, whereas 117 pts(70.1%) were younger.42%(21/50) of pts in elderly group and 39%(46/117) in younger group received neoadjuvant chemotherapy followed by interval debulking surgery. No residual tumor was achieved in 82% of elderly pts and in 82.9% of younger pts (p > 0.05).No differences between the two groups were found in terms of mean operative time, mean number of blood units transfused, mean postoperative stay and number of pts requiring intensive care unit stay. The perioperative complications rate was 16% in elderly group and 10.2% in younger pts(p > 0.05).The 60-day postoperative mortality was 2%for elderly and 0.8%for younger pts(p > 0.05).The 10y-PFS was 11.6% vs 15.2%(p = 0.84) and the 10y-OS was 16.9% vs 21.4%(p = 0.60) in elderly and younger pts, respectively. Multivariate analysis showed that age itself was not a prognostic factor for OS but in < 65y pts BMI had an independent prognostic significance (HR:4.97;CI 95%:2.09-11.83),together with residual tumor, which was confirmed to be an independent prognostic factor also in elderly pts(HR = 7.33;CI 95% = 1.30-41.33). Conclusions: Elderly pts with AOC showed a similar perioperative outcome compared to younger pts. In ≥ 65y pts, residual tumor was the only variable impacting significantly survival, while in pts < 65y, BMI was also found to be an independent prognostic factor for OS.
A comparison of chemotherapy-induced peripheral neuropathy assessment tools in patients receiving neurotoxic chemotherapy.
Authors: Ramnarine Sabrina , Williams Linda J , Dougherty Patrick M. , Fallon Marie T 
Published: February 2017

132 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a challenging toxicity with significant sequelae impacting prognosis and quality of life. Clinical presentation although predominantly sensory can include motor and autonomic dysfunction. As there is no standardised approach to the diagnosis and assessment of CIPN, characterisation of symptoms can be problematic. This study aims to investigate the relationship between various CIPN assessment tools in gynaecological, colorectal and lung cancer patients receiving neurotoxic chemotherapy. Methods: Patients with the above cancers receiving chemotherapy (platinum and/or taxanes) were assessed prospectively every 3 weeks for a cumulative total of 159 cycles. Prior to each cycle the following tools were utilised: European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 questionnaire, MD Anderson Symptom Inventory (MDASI) and associated descriptors of sensory disturbance/pain. Spearman’s correlation coefficients were used to compare these tools with the most commonly measured CIPN diagnostic tool, the National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI-CTCAE). Results: The EORTC sensory, motor subscales and total scores were highly correlated as expected. MDASI, question 13 (severity of numbness or tingling at its worst) was most correlated with the EORTC sensory subscale (ρ = 0.76). The correlation between the descriptors and EORTC sensory improved (ρ = 0.64 to ρ = 0.71) when the analysis focused on only numbness or tingling. CTCAE grade was more highly correlated with EORTC sensory (ρ = 0.61) and descriptors (ρ = 0.76) compared with EORTC motor (ρ = 0.46). All correlations were statistically significant (p < 0.001). Conclusions: In this mixed cohort of patients, comparison of the various CIPN assessment tools during chemotherapy cycles revealed significant correlations. This suggests the tools are useful in capturing the predominance of sensory symptoms and characterising the sensation of numbness and tingling. Further evaluation of this cohort along with additional studies may provide insight regarding the optimum choice of assessment tool(s).
New conditions identified through a comprehensive geriatric assessment in cancer patients.
Authors: Edwards Beatrice Jara-Almonte , Holmes Holly Michelle , Valladarez Heather , Sun Ming , Khalil Peter , Nguyen Vu , Song Juhee 
Published: February 2017

133 Background: Chronologic age cannot be used to predict the degree of comorbidity and of functional deterioration of older adults. Assessment of older adults includes health, functional status, nutrition, cognition, socio-economic and mood disorders evaluations. This multidisciplinary assessment is referred to as comprehensive geriatric assessment (CGA). The risk of comorbid conditions increases with age and may result in under diagnosis: in older patients, new symptoms may not be clearly recognized by the patient and may be dismissed by practitioners as manifestations of preexisting conditions. Methods: We conducted a retrospective cohort analysis, of older adult patients (aged 70 years of age and older) evaluated at the Program for Healthy Aging at MD Anderson from January 1, 2013 through December 31, 2014. Assessment was conducted using Katz’ ADLs, Lawton’s IADLs, PHQ-9, the short physical performance battery, the Montreal cognitive assessment, mini nutritional assessment and Charlson co-morbidity index. Medication review and social assessment were also included. Analysis: cross tabulations were performed in SAS 9.4 (SAS Institute INC, Cary, NC) Results: We evaluated 198 patients, (n = 99, 51.6% females). Most common malignancies evaluated included hematologic malignancies (n = 62, 33%), breast cancer (n = 32, 13.2 %), prostate cancer (n = 19, 10 %) and other solid malignancies (n = 85, 43%). The comprehensive geriatric assessment identified a mean of 3 new conditions (range 1-10). The most commonly identified conditions included cognitive impairment and dementia (n = 148, 77%), low bone mass and osteoporosis (n = 67, 34%), malnutrition (n = 65, 34%), frailty (n = 58, 30.2%), and polypharmacy (n = 64, 33%). These conditions are relevant in the management of such patients and could lead to recurring admissions if left unaddressed. Conclusions: A CGA program in a cancer center allows for the identification of medical conditions that directly contribute to clinical outcomes. A CGA allows for the development of a comprehensive plan of care that addresses such issues preventing adverse consequences.
Long-term health outcomes of germ cell tumor survivors.
Authors: Miller Trent James , Einhorn Lawrence H. , Hanna Nasser H. , Champion Victoria , Monahan Patrick , Stump Timothy E. , Brames Mary J. , Case-Eads Somer 
Published: February 2017

135 Background: Survivors of germ cell tumors (GCT) may face long-term health risks We have previously reported the high incidence of hypogonadism (HG) in survivors of GCT. These patients also may be at risk for other chronic health and psychosocial problems. Methods: Patients treated with chemotherapy (Group 1) or with orchiectomy and/or other surgery or radiotherapy for GCT (Group 2), were 18-50 yrs of age, and not receiving supplemental testosterone at baseline were eligible. Total testosterone was measured at baseline. For patients receiving supplemental testosterone while on study, total testosterone was also measured at 3 and 6 months. Cancer diagnosis and treatment variables were obtained from medical records. Patients completed a validated quality of life (QOL) questionnaire at baseline, 3, and 6 mos. Measures included the Aging Males’ Symptoms (AMS) scale and NIH Patient Reported Outcome Management Information Systems (PROMIS) measures. Results: The rate of HG ( < 300 testosterone) at baseline did not differ between Group 1 and Group 2 (p = 0.45). Compared to non-HG, patients with HG measured at baseline were significantly more likely to have a BMI in the obese ( > 30; 57% vs 19%) range (p < 0.001). Improvements in testosterone during treatment from baseline to follow-up were strongly correlated with improvements in AMS (r = 0.51, p = 0.001) and moderately correlated with improvements in general health (r = 0.32, p = .049). Multivariable models using baseline variables demonstrated that baseline HG was significantly associated with worse baseline quality of life in the areas of general health, sleep quality, and fatigue. BMI in the obesity range was significantly associated with worse general health. Conclusions: Patients who were treated for GCT are at higher risk of HG. This subsequently increases the risk of having a BMI in the obese range, which in turn is associated with worse QOL. Treating HG is associated with improvements in AMS scale.
Recovery of chemotherapy-induced left ventricular dysfunction in cancer survivors.
Authors: Fadol Anecita P. , Banchs Jose , Hassan Saamir , Durand Jean-Bernard , Shelton Valerie , Smith Lisa A. , Fellman Bryan , Zhuang Amy , Yeh Edward T.H. 
Published: February 2017

136 Background: Chemotherapy-induced left ventricular dysfunction (CILVD) leading to heart failure (HF) is a clinical problem of emerging importance particularly with the 14.5 million cancer survivors who are alive in the United States today, and projected to increase to almost 19 million in 2024. Many of these survivors have received cardiotoxic anticancer agents such as anthracycline and trastuzumab. Research showed that those exposed to anthracyclines are expected to have some degree of cardiac dysfunction 10 to 20 years after treatment and 5% of those patients will develop overt HF. This pilot study investigated whether cancer survivors with CILVD who achieved recovery of cardiac function will maintain their left ventricular ejection fraction (LVEF) if HF medications were discontinued. Methods: We conducted a prospective pilot study on 20 cancer survivors with history of CILVD with recovered cardiac function. HF medications were weaned off in a stepwise process per protocol. Cardiac function was monitored with LVEF measurement per echocardiography and cardiac biomarkers performed at baseline, 2, 4 and 6 months. Patients monitor their heart rate, blood pressure, and symptoms and reported changes based on set parameters. Results: Cancer survivors who maintained their LVEF after discontinuation of HF medications were younger (mean age 47.9 years SD+12.0), 65% female, 55% breast cancer survivors, with no history ofischemic heart disease, hypertension, diabetes mellitus and cardiac dysrhythmias. Chemotherapeutic agents (mean dose) used in the treatment of these patients include doxorubicin (363 mg/m2), epirubicin (527mg /m2), cyclophosphamide (5062 mg), and trastuzumab (6317 mg). There was no significant change from baseline measurements of LVEF and global longitudinal strain (GLS) of 55.1% (± 3.7) GLS of -18.3% (± 2.7) prior to weaning the HF medication to 56% (± 1.6) GLS of -18.2% (± 2.3). after complete withdrawal of HF medications. Conclusions: With the increasing number of young cancer survivors, CILVD may become a frequent clinical issue. Clearly, there is a need to examine the safety of withdrawing HF medications in cancer survivors with CILVD and if lifelong therapy with HF medications is necessary.
Cognitive rehabilitation for brain tumor survivors: A pilot study.
Authors: Richard Nadine M. , Bernstein Lori J. , Mason Warren P. , Laperriere Normand , Chung Caroline , Millar Barbara Ann , Maurice Catherine , Edelstein Kim 
Published: February 2017

140 Background: Brain tumor survivors often face unique challenges from chronic cognitive deficits such as memory problems or executive dysfunction. Cognitive rehabilitation is a relatively new field. With few well-controlled studies in cancer patients, oncology and supportive care teams lack accessible, reliable tools to address cognitive dysfunction. This pilot study evaluated the feasibility and potential efficacy of two behavioral interventions for brain tumor survivors. Methods: We compared two programs, each with 8 individual treatment sessions and daily homework. Goal Management Training (GMT) is a neuroscience-based integration of mindfulness and strategy training. The Brain Health Workshop (BHW) offers supportive psychoeducation about living with a brain tumor. Using a prospective randomized design, 6 brain tumor patients (with chronic cognitive dysfunction, ≥ 3 months post-radiation or surgery) were enrolled in GMT or BHW and completed a battery of measures at baseline and post-training. Composite scores were calculated by domain, with objective tests of attention, processing speed, memory, and executive functioning, and subjective measures of coping, mood, behavioral regulation and cognitive symptoms. Patient feedback was obtained in post-training qualitative interviews. Results: All patients (Table 1) completed all study activities. Analyses of group differences in composite change scores showed greater improvement in executive functions and greater attainment of pre-training functional goals in the GMT group (p's < .05). The BHW group showed a trend toward greater improvement in mood and behavioral regulation that did not reach statistical significance. Patients in both groups reported satisfaction with their program and continued, frequent (daily to every other day) use of their new knowledge following training. Conclusions: This pilot study demonstrated the feasibility of cognitive rehabilitation for brain tumor survivors between 1 and 8 years post-diagnosis. Results suggest unique benefits of each intervention that will be further explored in a larger clinical trial. [Table: see text]
Patient- versus physician-reported toxicities among survivors of head and neck cancer after chemoradiation: Prospective evaluation of screening methodologies.
Authors: Chen Allen M. , Felix Carol , Hsu Sophia 
Published: February 2017

150 Background: This study sought to compare the incidence of late toxicities among survivors of head and neck cancer treated by definitive chemoradiation using patient-reported versus physician-reported methodologies. Methods: Two validated quality of life instruments, the University of Washington Quality of Life questionnaire (UW-QOL) and the Functional Assessment of Cancer Therapy for Head and Neck questionnaire (FACT-H&N) were administered to patients returning for follow-up after chemoradiation for head and neck cancer. Only patients who had been clinically without evidence of disease for greater than 6 months were sampled. Scores were compared to physician-reported toxicities, which were recorded blindly and independently after each patient visit, using the National Cancer Institute’s Common Toxicity Criteria (version 4.0). Two by two contingency tables were constructed to assess differences between patient- and physician-reported responses using Fisher’s exact test. Results: Fifty patients (35 male; 15 females) completed both instruments. While 78% of patients reported an inability “to swallow certain solid foods” and 70% reported difficulty to “swallow naturally and easily” using the self-reported UW-QOL and FACT-H&N surveys, respectively, the incidence of grade 2+ esophageal dysfunction as reported by physicians was only 48% (p < 0.001). While 60% of patients reported “too little saliva” and 50% acknowledged having problems with "voice quality and strength" using the UW-QOL and FACT-H&N surveys, only 20% and 30%, respectively, were scored as having grade 2+ xerostomia and laryngeal toxicity. Significant discordance was also observed between patient- and physician-reported toxicities with respect to the domains of appearance (p = 0.02), pain (p = 0.01), activity/energy (p < 0.001), and mood (p = 0.001). Conclusions: Late toxicities are frequently under-reported by physicians after chemoradiation for head and neck cancer. The true incidence and severity of these treatment-related toxicities, with respect to both functional and psychosocial impairment, among survivors may be better evaluated by patient-reported methods.
Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management.
Authors: Samuel Cleo A. , Turner Kea , Donovan Heidi AS , Van Londen G J. 
Published: February 2017

155 Background: Adjuvant endocrine therapy (AET)-related symptom management (SM) among breast cancer survivors (BCS) typically involves a multidisciplinary team of health care providers; yet few studies have examined provider perspectives on AET-related SM. The purpose of this study was to examine provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. Methods: We conducted 3 focus groups (FGs) with a multidisciplinary group of health care providers (n = [6] physician; n = [7] non-physician) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM and its barriers and facilitators as well as recommendations for improvement. All FGs were held at the University of Pittsburgh, audiotaped, and transcribed. We analyzed FG transcripts using qualitative software to identify key themes. Results: Providers described patient-, provider-, and system- level facilitators and barriers to AET-related SM. At the patient-level, facilitators included social support and provider communication about symptoms while cancer-related distress, misinformation and misinterpretation of online information were identified as barriers. Provider-level facilitators included strong relationships with other providers and ongoing communication with patients; however, lack of time, insufficient resources, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Finally, at the system-level, electronic health records were described as both a facilitator and barrier to SM. Moreover, poor care coordination among different providers and lack of clear guidelines on which provider “owns” AET-related SM emerged as key system-level barriers. Conclusions: Findings suggest that efforts to improve AET-related SM should span multiple levels, in order to address patient-, provider-, and system-level barriers to SM. Recommendations include increased education for patients, greater access to clinical decision support tools for providers, and improved coordination of survivorship resources within hospitals.
Management of aromatase inhibitor-associated musculoskeletal symptoms: A systematic review.
Authors: Roberts Kate , Rickett Kirsty , Woodward Natasha E. 
Published: February 2017

157 Background: Aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) are experienced by a significant number of women on adjuvant aromatase inhibitors for breast cancer. These symptoms can result in therapy noncompliance and there is no accepted standardised treatment. We believe that this is the first systematic review to consider the evidence for all pharmacological and non-pharmacological interventions in the treatment of AIMSS. Methods: We conducted a systematic search in PubMed, EMBASE, CINAHL and CENTRAL. Clinical trials and observational studies for all potential pharmacological and non-pharmacological interventions were included. Two reviewers screened the results and extracted the relevant data. Risk of bias for the full papers were assessed using JADAD or a modified Newcastle Ottawa score, with conference abstracts and letters to the editor excluded from this process. Results: Of 1260 records being identified, 887 unique citations were screened with 93 full text papers retrieved for assessment, and 37 selected for inclusion. We identified 9 pharmacological interventions (RCT = 3, pre-post = 4, cohort = 2) and 28 non-pharmacological interventions (RCT/CCT = 16, pre-post = 8, cohort = 3). The largest number of studies were for various exercise interventions (n = 7) with the largest trial showing a 29% decrease in worst joint pain scores compared to the control (2%, p < 0.001). The highest number of RCTs was for acupuncture (n = 5), the majority of which showed a significant benefit with both real and sham acupuncture. Other single RCTs showing benefit include the use of testosterone, calcitonin and etoricoxib. No study adequately controlled for contamination bias from extraneous variables of both pharmacological and non-pharmacological interventions. Conclusions: Given that pharmacological treatment is often recommended for AIMSS, it is surprising that there is limited published evidence for its use. Although the interventions being used appear tolerable with minimal adverse effects, the current level of evidence is low, and additional large RCTs with more rigorous controlling for contamination from other interventions are required to confirm some of the reported promising results.
Crossover from one aromatase inhibitor (AI) to another in the Exemestane and Letrozole Pharmacogenetics (ELPh) trial.
Authors: Kadakia Kunal C. , Kidwell Kelley M , Seewald Nicholas J. , Snyder Claire Frances , Flockhart David A. , Carpenter Janet S , Otte Julie L. , Hayes Daniel F. , Storniolo Anna Maria , Stearns Vered , Henry Norah Lynn 
Published: February 2017

158 Background: Tolerance of AI therapy can be poor due to treatment-emergent toxicities and can lead to early discontinuation (non-persistence). Patients often switch from one AI to another when toxicities develop; however, limited prospective data exist on patients who switch AI. Here we describe the effect of switching from E to L or L to E on tolerance of and persistence with therapy. Methods: Postmenopausal women initiating AI therapy were enrolled on the ELPh trial and randomized to E or L. Those that stopped their AI for self-reported intolerance were offered crossover to alternate AI after a 2-6 week washout. Kaplan-Meier estimates of proportions on AI after 1, 3, and 6 months were assessed during 1st and 2nd AI. Associations between time on 2ndAI and clinicopathologic factors were analyzed using univariable Cox proportional hazards model. To evaluate effect of crossover on patient-reported outcomes, multiple questionnaires, including a pain visual analog scale (VAS), were assessed serially. Results: 83 women, mean age 60 years, 45% prior chemotherapy, and 31% with prior tamoxifen use, participated in the crossover protocol. 71% reported improvement in symptoms a mean 4.72 weeks after discontinuing 1st AI therapy. Median time on 1st AI was 6.8 months (95% CI 5.8-9 months), and on 2nd AI was 11.5 months (6.9-24.2). The probability of persistence at 1, 3, and 6 months for the 1st AI was 94%, 76%, and 55% and for the 2nd AI was 89%, 73%, and 62%, respectively. There was no significant association between duration on 2nd AI and 1st AI (L vs. E), duration on 1st AI, age, body mass index, or prior therapies. The change in pain VAS from baseline to 1 or 3 months was not significantly different during treatment with the 1st or 2ndAI. Conclusions: Although all AI medications have similar mechanisms of activity, nearly two-thirds of patients who are intolerant of one AI are able to maintain therapy for at least 6 months following switch to 2nd AI. Switching is a reasonable approach for women who cannot tolerate 1st AI that may improve persistence with therapy. The mechanisms for intrapatient variation in tolerance warrant further study. Clinical trial information: NCT00228956.