bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-reported priorities for survivorship care and experience discussing available services.
Authors: Rabin Julia , Quain Katharine , Horick Nora , Chinn Garrett , McDonough Allison , El-Jawahri Areej , Chen Yen-Lin , De Rooij Belle , Perez Giselle Katiria , Park Elyse , Peppercorn Jeffrey M. 
Published: November 2017

200 Background: Despite the recognized need for high quality survivorship care, barriers to identifying and addressing patients’ needs still remain. We sought to evaluate cancer survivor care priorities, awareness of available services, and factors associated with care and informational needs. Methods: A needs assessment survey was distributed to patients presenting for routine follow-up care in adult oncology clinics at the MGH Cancer Center between February and August of 2016. The survey assessed sociodemographic characteristics, and preferences for care and communication. Care priorities were selected from a list of options including open ended response. Discussion of supportive care services was assessed by the item “have any of your providers informed you about the types of supportive care services that are available to cancer patients" with response options of “yes,” “no” or “don’t know.” Results: Among 637 total respondents, 339 patients with early stage cancer completed the survey. The majority of participants were between 50-69 years old (54%), white (89%), female (64%), and college educated (80%). Breast (32%) and hematological malignancies (21%) were the most prevalent diagnoses. Commonly endorsed priorities for care included: emotional concerns related to cancer (40%), strategies to increase self-care (33%), and management of physical cancer symptoms (30%). Demographic and clinical factors associated with endorsing emotional concerns as a care priority included female gender, and moderate or greater levels of fatigue, depression, or anxiety (all p< 0.01). Factors associated with endorsing management of physical cancer symptoms as a care priority included younger age, and moderate or greater levels of fatigue or depression (all p≤0.01). Despite these priorities for care, only 41% of patients reported receiving information from providers about available supportive care services. Conclusions: Cancer survivors’ preferences for emotional support and symptom management are strongly associated with self-reported depression and fatigue. Routine screening for these issues and improvement in communication regarding available services should be prioritized in survivorship care.
Association between clinical and biochemical indices and survival in glioblastoma patients.
Authors: Liu Wenli , Qdaisat Aiham , Yeung Jason , Lopez Gabriel , Weinberg Jeffrey S , Cohen Lorenzo , Bruera Eduardo , Yeung Sai-Ching J. 
Published: November 2017

201 Background: Survival of glioblastoma remains grim. Identifying survival-associating factors may provide actionable targets for future research and clinical intervention to improve patient outcomes. Our study examined the association between multiple clinical and biochemical indices and survival in glioblastoma patients. Methods: 265 consecutive glioblastoma patients who received tumor resection between 1/1/2010 – 12/31/2014 were reviewed. Data about treatments (extent of tumor resection, radiation therapy, and use of temozolamide), medical history, vital signs, weight, and lab tests were collected. Charlson Comorbidity Index (CCI) was calculated with ICD-9 codes. Lab and vital signs data within 30 days of surgery were excluded from the analysis. Cox regression for survival analysis was performed. Results: The mean age of the population was 57.5 years, with 78% death rate. The median survival was 19.1 months. Systolic blood pressure, blood glucose, and serum albumin were significant factors for survival while adjusting for known predictors, such as age, Karnofsky Performance Status (KPS), extent of tumor resection, and treatments (See Table). Conclusions: Optimization of medical comorbidities and nutritional status may have significant impact on the survival of glioblastoma patients aside from cancer specific treatments. The target range of systolic blood pressure, blood glucose, and serum albumin will need to be determined in future research. [Table: see text]
Integration of palliative care into oncology: A curriculum development project.
Authors: Von Gunten Charles F. , Periyakoil Vj , Brown Ally , Yzaguirre Ben , Spiegel Sam , Paris Andrew , Bender Stephen , Von Roenn Jamie H. 
Published: November 2017

202 Background: Program Directors of Oncology Fellowships cite lack of adequate faculty to teach communication skills, prognostication and symptom management to oncology fellows as a barrier to ensuring oncologists integrate palliative care into their own practice. We partnered with ASCO and its Training Program directors to develop, evaluate and disseminate a PC curriculum using an innovative format. Methods: All of the fellows in a program were randomized as a single group to one of 3 cohorts: digital education, digital education plus a 4-week palliative care rotation or delayed digital education (control). In the intervention, each fellow received 2 MCQs (on their phones or other device) focused on a particular teaching point, every other day. If answered incorrectly, focused education material was forwarded to the learner and the testing point was retested at a later date. Fellows in cohort 2 also participated in a clinical rotation at an ACGME approved PC program. Cohort 3 received the same training as cohort one, but beginning fellowship year 2, as a delayed control. Fellows’ PC knowledge was assessed during the in-training exam pre- and post-intervention. Opioid prescribing behavior was tracked after graduation and compared with a control group( group 4). Results: 283 fellows from 71 programs were quasi-randomized. The average ITE score of PC MCQs ranged from 70-73% correct across all groups and all years, for pre- and post-test scores. All fellows randomized to the PC rotation, completed it. Prescribing data was based on NPI numbers and available for all providers. 72% of cohort 1 prescribed opioids appropriately, 57% cohort 2, 72% cohort 3, 46% in a group 4 (1 vs 4, p=.0008; 2 vs 4, p=.2231; 3 vs l, p=.0011). Conclusions: Spaced education via a hand held device is acceptable, efficient and cost-effective. All groups showed acceptable knowledge on the in-training examination. Yet, opioid prescribing behavior improved as a result of the education intervention. The favorable impact on opioid-prescribing behavior was extinguished by the PC rotation, raising the question about the role of a PC clinical rotation.
Risk of gastrointestinal and hepatic toxicities in patients with metastatic solid tumors treated with cabozantinib: A systematic review and meta-analysis of randomized controlled trials.
Authors: Zaw Myo , Thein Kyaw Zin , Han Myat M. , Igid Henry Palangdao , Hardwicke Fred L. , Tijani Lukman 
Published: November 2017

208 Background: The vascular endothelial growth factor (VEGF) signaling pathways and the proto-oncogenes MET, KIT and RET were implied in cancer development and progression. Cabozantinib is an oral inhibitor of multiple tyrosine kinases and hence employed in many solid tumors. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of gastrointestinal (GI) and hepatic toxicities among patients with metastatic solid tumors treated with cabozantinib. Methods: MEDLINE, EMBASE databases and meeting abstracts from inception to March 2017 were queried. Phase 3 RCTs that mention GI and elevation of liver enzymes as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% confidence interval (CI). Random effects model was applied. Results: We included 3 RCTs with a total of 1999 patients treated with cabozantinib for various solid tumors. The study arm used cabozantinib while the control arm utilized everolimus, placebo or prednisone. The relative risks (RR) of all-grade side effects were as follows: diarrhea, 2.39 (95% CI: 2.01 – 2.85, P < 0.0001); nausea, 1.86 (95% CI: 1.64 – 2.10, P < 0.0001); vomiting, 2.53 (95% CI: 1.60 – 3.99, P < 0.0001); stomatitis, 4.08 (95% CI: 0.55 – 30.01, P = 0.16); dysgeusia, 4.23 (95% CI: 2.30 – 7.76, P < 0.0001); elevated AST, 2.04 (95% CI: 1.12 – 3.73, P = 0.02); and elevated ALT, 1.61 (95% CI: 0.67 – 3.88, P = 0.28). The RR of high-grade side effects were as follows: diarrhea, 5.93 (95% CI: 3.43 – 10.25, P < 0.0001); nausea, 4.05 (95% CI: 1.99 – 8.23, P < 0.0001); vomiting, 2.37 (95% CI: 1.26 – 4.44, P = 0.007); stomatitis, 3.36 (95% CI: 0.45 – 24.98, P = 0.23); dysgeusia, 1.52 (95% CI: 0.15 – 14.57, P = 0.71); elevated AST, 1.70 (95% CI: 0.72 – 4.01, P = 0.22); and elevated ALT, 3.00 (95% CI: 0.60 – 14.93, P = 0.17). Conclusions: The risk of developing all-grade and high-grade diarrhea, nausea and vomiting with cabozantinib is high. Moreover, it is associated with all-grade elevated AST and dysgeusia. Timely recognition and providing good supportive care will enhance patients’ quality of life.
A systematic review and meta-analysis of randomized controlled trials to evaluate the risk of gastrointestinal and hepatic toxicities in patients with hormone receptor-positive HER2-negative metastatic breast cancer treated with CDK 4/6 inhibitors.
Authors: Zaw Myo , Thein Kyaw Zin , Tun Aung , Han Myat M. , Thar Yu Yu , Nayak Asha , Guevara Elizabeth 
Published: November 2017

209 Background: Hormonal therapies function through CDK4/CDK6/E2F axis which is essential in luminal estrogen receptor positive breast cancer. Reactivation of these CDK4 and CDK6 kinases has been implicated in endocrine resistance. Many CDK 4/6 inhibitors were employed in studies with noteworthy safety concerns. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the risk of gastrointestinal (GI) and hepatic toxicities. Methods: MEDLINE, EMBASE databases and meeting abstracts from inception through June 2017 were queried. RCTs that mention GI symptoms and elevation of liver enzymes as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% confidence interval (CI). Results: We included five RCTs with a total of 2671 patients treated with CDK 4/6 inhibitors. The study arm used palbociclib-letrozole, palbociclib-fulvestrant, ribociclib-letrozole and abemaciclib-fulvestrant while the control arm used placebo in combination with letrozole or fulvestrant. The relative risks (RR) of all-grade side effects were as follows: diarrhea, 1.72 (95% CI: 1.08 – 2.74, p = 0.02); stomatitis, 2.62 (95% CI: 1.43 – 4.79, p = 0.002); nausea, 1.59 (95% CI: 1.30–1.94; p < 0.0001); vomiting, 1.65 (95% CI: 1.06–2.56; p = 0.02); elevated AST, 2.30 (95% CI: 1.34–3.93; p = 0.002); and elevated ALT, 2.78 (95% CI: 1.90–4.08; p < 0.0001). The RR of high-grade side effects were as follows: diarrhea, 2.26 (95% CI: 0.39 – 13.09, p = 0.36); stomatitis, 2.14 (95% CI: 0.36 – 12.72, p = 0.40); nausea, 1.13 (95% CI: 0.28 –4.47; p = 0.86); vomiting, 0.79 (95% CI: 0.24 – 2.54; p = 0.69); elevated AST, 1.85 (95% CI: 0.74 – 4.64; p = 0.18); and elevated ALT, 4.33 (95% CI: 2.15 – 8.71; p < 0.0001). Conclusions: The risk of developing any-grade diarrhea, stomatitis, nausea, vomiting and elevated AST and ALT, was high in CDK 4/6 inhibitors based regimen. Moreover, it increased the risk of high-grade elevated ALT.
Opioid epidemic or pain crisis? Exploring prescription opioid medication utilization for patients with cancer in rural Southwest Virginia.
Authors: LeBaron Virginia T. , Camacho Tareq Fabian , Russell Kyle , Beare Marianne , Gilson Aaron M. 
Published: November 2017

210 Background: The U.S. is in the throes of two concurrent epidemics: too many people die from opioid-related fatalities, but too many people continue to suffer in pain. In certain regions this dilemma is particularly pronounced. For example, Southwest (SW) Virginia is a rural area with disproportionately high cancer mortality rates and high rates of opioid fatalities. Little is known about how to most effectively and safely manage pain in a region where there exists both a high cancer burden and significant opioid misuse. Purpose: Describe prescription opioid medication (POM) use for patients with cancer in SW Virginia and potential harms. Methods: This is a longitudinal, exploratory, secondary data analysis using the Virginia All Payers Claims Database (APCD), which includes paid medical and pharmacy claims data on 4 million individuals in the Commonwealth of Virginia. Patients with a diagnosis of cancer who lived in far, rural SW Virginia between 2011–2015 were included. Outpatient prescription data were linked to hospitalization admission claims data to explore potential opioid-related harms. Analysis was conducted at the patient, prescription and prescriber level (SAS 9.4, STATA 13.1) to identify predictors of POM use and opioid-related substance use admissions. Results: Within the APCD, POMs represent 7.23% of all medications prescribed for patients with cancer, with hydrocodone- and oxycodone-combinations, oxycodone, fentanyl transdermal patch and morphine sulfate being the most common. Over 50% of patients were prescribed a POM at least once during the study period. Multi-level logistic regressions suggest age, payer source, cancer type, gender, prescriber type and specialty were all significant (p < .001) predictors of being prescribed POMs. Preliminary analyses of hospitalized cancer patients found no association between POM use and opioid-related substance use hospitalization. Conclusions: A clearer view of geographic patterns and predictors of both POM use and potential harms can inform targeted clinical interventions and policy initiatives that achieve a balanced approach to POMs – ensuring access for patients in need, while reducing risk.
Validity and reliability of Korean version of simplified nutritional appetite questionnaire in patients with advanced cancer: A multicenter, longitudinal study.
Authors: Koh Su-Jin , Oh So Yeon , Baek Ji Yeon , Kwon Kyung A. , Jeung Hei-Cheul , Lee Kyung Hee , Won Young-Woong , Lee Hyun Jung 
Published: November 2017

211 Background: Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. Nutrition risk screening aims to increase awareness and allow early recognition and treatment of cancer cachexia. Therefore, screenings should be brief, inexpensive, highly sensitive, and have good specificity. SNAQ is a simple screening tool including 4 questions, and validated to predict weight loss within 6 months in community-dwelling adults and nursing home residents. Our study aimed to translate the SNAQ into Korean, and to assess the validity and reliability of the translated screening tool in advanced cancer patients. Methods: The SNAQ was translated into Korean according to linguistic validation. The internal consistency of the SNAQ was evaluated by Cronbach’s alpha coefficient. Test–retest reliability was evaluated using the intraclass correlation coefficient. Concurrent validity was evaluated by measuring the Pearson’s correlation coefficient between the SNAQ and Mini-Nutritional Assessment (MNA) and Patient-Generated Subjective Global Assessment (PG-SGA). Results: In the 194 patients included in full analysis set, cancer stage was predominantly (98.5%) metastatic, the mean age was 60 years, and the mean BMI was 24 kg/m2. According to MNA score ≤11, 57 patients (29.3%) were malnourished. The mean score of the Korean version of the SNAQ was 13.8 (SD = 2.5) with a range of 6–19. Cronbach’s alpha coefficient was 0.74, and intraclass correlation coefficient was 0.87. The SNAQ was moderately correlated with MNA(r = 0.4043, p < 0.0001) and PG-SGA(r = -0.5297, p < 0.0001). A significant weight loss of 5% of the original body weight within 6 months occurred in 46 (24.7%) of the 186 patients. SNAQ score ≤14 predicted 5% weight loss with a sensitivity of 56.5% and a specificity of 44.3%. Conclusions: The Korean version of the SNAQ had high validity and reliability. SNAQ is useful for the screening tool for advanced cancer patients. The SNAQ had a limitation to predict impending weight loss in advanced cancer patients.
Modeling of quality of life in older adults with advanced cancer: Data from a URCC NCORP multisite trial.
Authors: Flannery Marie Anne , Culakova Eva , Xu Huiwen , Loh Kah Poh , Kamen Charles Stewart , Wells Megan , Geer Jodi , O'Rourke Mark Allen , Vogelzang Nicholas , Dale William , Duberstein Paul , Mohile Supriya Gupta 
Published: November 2017

218 Background: While the importance of symptom assessment is well recognized in Palliative Care (PC), limited evidence is available on the growing population of older adults with advanced cancer. Increasingly geriatric assessment (GA), which incorporates validated tools to assess health status, is advocated as a component of the care for older patients with cancer, but is not routinely incorporated into PC evaluations. We tested the hypothesis that variability in QoL for older adults with advanced cancer would be predicted by both symptoms and GA. Methods: Data from an ongoing cluster RCT conducted at 68 oncology practices were analyzed. Inclusion criteria were: > 70 years old, advanced solid tumor diagnosis, impairment in at least 1 GA domain (e.g., function). Multiple reliable and valid objective assessments and self-report measures for each GA domain were completed. Symptoms were assessed by MD Anderson Symptom Inventory (MDASI). Hierarchical regression modeling was conducted. The dependent variable was FACT score at Time 2 (4-6 weeks). The independent (Time 1) variables were entered in 3 steps: 1) gender, race, educational level( < or > high school), cancer type ( GI / Lung or other), receiving chemotherapy; 2) MDASI, 3) GA measures: Polypharmacy, Blessed Orientation and Memory Concentration Test, % weight loss, Short Physical Performance Battery, Instrumental Activities of Daily Living (IADL), Older Adult Resource Survey (OARS) Comorbidity, OARS Medical Social Support, and Generalized Anxiety Disorder-7. Results: N = 342 at time 1 (Mean age 77 years, 43% female, 90% white, 51% high school graduates, 49% GI or Lung cancer, 68% on chemotherapy). N = 303 at time 2(11% attrition due to death or withdrawal). Overall, 46% of variance in QoL was explained (demographic and disease characteristics: 4% [p = .05], symptoms: 32% [p < .0001], GA measures: 10% [p < .0001]). Significant individual GA predictors of worse QoL were lower social support, higher anxiety, impairment in IADLs, and poorer physical performance. Conclusions: Findings suggest that GA explains variance in quality of life scores for older adults with advanced cancer and reinforce the importance of symptom assessment and management in this population. Clinical trial information: NCT02107443.
Nasal vestibulitis as an under-recognized and undertreated side effect of cancer treatment.
Authors: Cathcart-Rake Elizabeth Jane , Smith DeAnne R. , Loprinzi Charles L. 
Published: November 2017

219 Background: Dryness, crusting, and bleeding of the nares due to inflammation, termed nasal vestibulitis (NV), is infrequently reported as a side effect of cancer treatments. However, one study described 115 patients who developed NV while undergoing targeted therapies; many were treated with bacitracin ointment (Ruiz et al Sup Care Cancer 2015). Methods: This study surveyed 94 patients regarding the presence of nasal symptoms during cancer treatments. Participants were consented for the study if they had undergone at least 6 weeks of cancer-directed therapy in the Mayo Clinic Chemotherapy Unit. They were asked about types of nasal symptoms, severity, and symptom treatments. A chart review was then conducted to determine documentation of symptoms, the presence of concurrent illnesses, and cancer treatment regimens. Results: Ninety-four patients completed questionnaires, with 41% reporting unpleasant nasal symptoms that they attributed to cancer treatments. Of the symptomatic patients, 46% had dryness, 33% had discomfort, 54% had bleeding, and 46% had scabbing. Average severity was 1.9 on a scale from 1 to 3 (1 = mild, 3 = severe). Symptoms were noted in patients undergoing a variety of cancer treatment regimens, with the highest frequency in patients undergoing a taxane-containing regimen (46%). 62% of patients with symptoms said they reported them to their provider, but only 41% of chart notes (for 16 patients) contained documentation of such, most frequently described as “allergies” or “epistaxis.” Only 10% of symptomatic patients had nasal swabs; all of which were obtained during respiratory illness or pre-op. 49% of patients with nasal symptoms reported treating their symptoms. Antihistamines (7 patients), nasal saline (6 patients), or nasal lubricants (i.e. Vaseline; 7 patients) were used; 2 patients applied bacitracin. 18% of symptomatic patients had providers who recommended treatments, including 2 patients who were thought to have concurrent infection and were treated with antibiotics. Conclusions: NV symptoms are prevalent among oncology patients, but infrequently recorded or treated by providers.
Caregiver stress: Clinical evaluation and intervention strategies for caregiver burden prevention.
Authors: Velutti Laura , Pavesi Carlotta , Poggio Chiara , Carettoni Beatrice , Saetta Annalisa , Arcanà Concetta , De Maio Ana Paula , Lopane Diego , Speciale Tatiana , Mazzieri Stefania , Rimassa Lorenza , Santoro Armando 
Published: November 2017

22 Background: Caregivers (CGs) of advanced cancer patients (pts/ACPs) experience a higher incidence of medical and psychological conditions compared to general population. Methods: We conducted a prospective assessment of the caregiver burden (CGB) - a term describing the physical, psychological, emotional, social, and financial problems often experienced by CGs - to identify potential risk management strategies. We used the Caregiver Burden Inventory (CBI), a multi-dimensional questionnaire with 5 subscales: Time Dependent, Developmental, Physical, Social, Emotional CGB, as a quantitative tool to investigate the level of stress of our pts CGs. Also, we used a semi-structured interview with 5 questions as a qualitative tool. Results: From Dec 2016 to Feb 2017 we administered the CBI and the interview to 37 CGs (F/M 31/6) of ACPs in 3 different settings: inpatient (9 CGs), outpatient (15 CGs), home-based (13 CGs). The quantitative data analysis showed that CGs had a variable emotional load, mostly of moderate level. In particular, the level of stress of our pts CGs of outpatients and inpatients was higher in the physical dimension, while was higher in the time dimension for CGs of home-based pts. Semi-structured interviews showed that CGs of home-based pts did not feel adequate to provide assistance to their relatives, and had partial or poor knowledge of basic care, especially of in-bed mobilization and hygiene techniques. In the other 2 settings, CGs showed a higher level of stress due to the lack of a professional contact person throughout the care pathway, and experienced the need of psychological support. Overall, the qualitative assessment showed that CGs lives were strongly affected by caregiving. Conclusions: Our results confirm published data showing that assisting ACPs is a particularly difficult task for the CGs. Therefore, we implemented potential improvement strategies: in the home setting, specific attention to the educational aspects of basic care; in the inpatient setting, a weekly meeting for physicians, nurses, and psychologists, to discuss the most difficult cases; in the outpatient setting, a 25% increase in the number of visits for pain and supportive therapy to offer a better continuity of care.