bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment costs of breast cancer among younger women aged 19 to 44 years enrolled in Medicaid.
Authors: Ekwueme Donatus U. , Allaire Benjamin T. , Guy Gery , Arnold Sarah , Trogdon Justin G 
Published: February 2017

74 Background: Breast cancer is the most common malignant tumor among women in the United States, accounting for about 30% of incident cancers. It is one of the most costly medical conditions to treat. Younger women aged 18-44 years account for 11% of new cases. These women tend to experience more aggressive types of breast cancer, requiring intensive and expensive treatment. In recent years, a few studies have examined the costs of breast cancer treatment in a Medicaid population at the state level. However, no study has estimated medical costs for breast cancer treatment at the national level for women aged 19-44 years enrolled in Medicaid. Methods: A sample of 5,542 younger women aged 19-44 years, fee-for-service Medicaid enrollees, and diagnosed with breast cancer in 2007 were compared with 4.3 million women aged 19-44 years, fee-for-service Medicaid enrollees, but without breast cancer. The study used linear and nonlinear regression methods to estimate treatment costs for younger women with breast cancer compared with those without breast cancer. Individual medical costs were estimated by race/ethnicity and by type of services. All medical treatment costs were adjusted to 2010 dollars. Results: The estimated annual direct medical costs for breast cancer treatment among younger women enrolled in Medicaid ranged from nearly $25,000 to $42,000 per woman. Non-Hispanic black women had the highest annual total medical costs, followed by Hispanic women, while non-Hispanic women of other race had the lowest. The cost estimates ranged from $14,600 to $18,800 for outpatient service, $4,600 to $5,700 for inpatient service, and $3,500 to $4,800 for prescription drugs. Conclusions: The cost estimates demonstrate the substantial medical costs associated with breast cancer treatment for younger Medicaid beneficiaries. As the Medicaid program continues to evolve, the treatment cost estimates could serve as important inputs in decision-making regarding planning for treatment of invasive breast cancer in this population.
Impact of dosing schedule of doxorubicin and cyclophosphamide (AC) chemotherapy on rates of hospitalization and resource utilization.
Authors: O Donovan Helen , Murphy Kate , Bird Brian Richard , Murphy Conleth G. 
Published: February 2017

78 Background: 4 cycles ofAC chemotherapy are given as a component of several important and widely used chemotherapy regimens in the adjuvant treatment of breast cancer. We queried whether the use of dose-dense (every 2 week) AC chemotherapy is associated with a lower rate of hospitalization and resource utilization in clinical practice. Methods: We identified patients with early stage breast cancer treated with 3-weekly AC chemotherapy in a single institution. Cases were matched to controls by year of diagnosis and age. Rates of hospitalization during AC chemotherapy as well as duration of hospitalization, associated costs and use of pegfilgrastim were compared between the two groups. Fisher's exact test was used to compare categorical variables, and paired t-test was used to compare continuous variables. Results: 26 patients were included in the analysis. The mean age was 56 in both groups. As expected, rates of growth factor support with pegfilgrastim were higher in the dose dense versus 3-weekly group (52 versus 23 cycles, 2-tailed p = 0.0003). There was no difference in the likelihood of hospitalization among patients treated with dose dense versus 3-weekly AC (Fisher's exact test, p-value = 1.00). There was no difference in the mean duration of hospitalization between groups (mean 2.31 versus 1.23 days, 2-tailed p = 0.3352).Costs pertaining to pegfilgrastim use and hospitalization will be compared. Conclusions: In this clinical setting, dose dense administration of AC was not associated with lower rates or mean duration of hospitalization.
Patient-reported distress screening outcomes in breast cancer.
Authors: Smart Bridget , Vallow Laura , Hollant Laeticia , Single Megan , Gaines Katherine , Habboush Jacob , Biers Heather , Day Atiya , Tzou Katherine S. , Miller Robert Clell 
Published: February 2017

79 Background: A significant percentage of cancer patients experience psychosocial distress with the highest prevalence observed in breast cancer patients. The importance of psychosocial distress screening and assessment in women with breast cancer has clearly been established. Patients in our clinic are screened for distress. The results were reviewed in an attempt to better understand the psychosocial distress of breast cancer patients undergoing radiotherapy. Methods: Patients treated curatively for breast cancer prospectively completed the 30 question patient reported distress (PRD) survey that also included a linear analog measure of overall distress. The recorded clinical results of the PRD survey were retrospectively assessed in patients receiving breast radiotherapy from June 1, 2013 to February 2, 2015. Results: Completed PRD questionnaires were available on 179 female patients. 21 (12%) were treated for ductal carcinoma in situ and 91 (51%), 35 (20%), and 32 (18%) were treated for invasive carcinoma Stages I, II, and III. 85 (47%) received chemotherapy. Overall distress ranged from 0 to 10, with a median value of 5. Mean distress scores per category ranged from a low of 1.25 to a high of 2.52. Top concerns in descending order of importance were: “How will I feel during treatment” (2.52), “Fatigue” (2.46), “Sleep difficulties” (2.32), “How will I feel about appearance related to treatment” (2.23), & “Pain that affects daily functioning” (2.19). Least distressing symptoms “Spirituality” (1.25), “Housing during treatment” (1.26), “Control of anger” (1.28), “End of life concerns” (1.32), & “Transportation” (1.34). Conclusions: Distress over tumor related issues ranked low among women’s concerns in comparison to distress related to the side effects of therapy concerning treatment related discomfort, fatigue, and changes in appearance, and anxiety. Pain was a significant concern, although in this group of patients receiving definitive, adjuvant or neoadjuvant therapy, this was likely related to treatment associated discomfort rather than from disease progression. These findings highlight the importance of careful patient education and communication of the expected symptoms and effects of therapy.
The prevalence and pattern of chemotherapy-induced peripheral neuropathy (CIPN) among women with breast cancer receiving care in a large community oncology practice.
Authors: Simon Natalie Brooke , Danso Michael A. , Alberico Thomas , Basch Ethan M. , Bennett Antonia Vickery 
Published: February 2017

80 Background: CIPN is a common side effect of taxane-based chemotherapy agents. This study examined the prevalence, severity, and risk factors of CIPN and its impact on quality of life (QOL) among women treated for breast cancer in a large U.S. community oncology practice. Methods: In this cross-sectional survey study, women previously treated with taxane-based chemotherapy for early stage breast cancer completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), breast cancer module (QLQ-BR23) and CIPN module (QLQ-CIPN20). Each subscale is scored 0-100 where higher scores indicate better function or greater symptom severity. Clinical data were abstracted from the medical record. Bivariate analyses were conducted to test pre- specified hypotheses. Results: 126 women with mean age 56.7 years (SD = 11.8) were stage I-II (79.4%) or stage III (20.6%) at the time of the survey; 65.1% were White and 27.8% were Black or African American. 73.0% of women reported they had CIPN. The mean time since last taxane chemotherapy cycle was 144.9 weeks (SD = 112.9). The mean (SD) score of QLQ-C30 global health status/QOL was 77.0 (20.3) and physical function was 85.7 (17.1). QLQ-CIPN20 mean scores for the sensory, motor, and autonomic subscales were 18.9 (23.1), 18.6 (18.7), and 17.1 (21.8), respectively. Presence of CIPN was associated with patient referral and visitation to a neurologist or pain specialist (p < 0.05). CIPN symptom severity was negatively correlated with global health status/QOL and physical and role functioning (range of r= -0.46 to -0.72). Further, it was not associated with age, body mass index, diabetes, or cumulative taxane dosage, but was greater for Black or African American patients versus White patients (e.g., sensory: 28.6 vs 14.5, p < 0.002). CIPN sensory impairment was marginally greater for patients treated with paclitaxel compared to docetaxel (23.3 vs 15.6, p < 0.06). Conclusions: CIPN was prevalent in this community oncology practice and significantly impacts function and QOL. These data highlight the importance of developing methods to mitigate CIPN.
Comparison of prognosis and specific features according to tumor size in small-sized breast cancer with extensive lymph node involvement.
Authors: Han Hong-Seok , Paik Hyun-June , Ryu Jai Min , Park Sungmin , Yi Ha Woo , Bae Suyeon , Lee Sekyung , Kil Won Ho , Lee Jeong Eon , Nam Seok Jin , Kim Seok Won 
Published: February 2017

81 Background: As known, larger tumor size and more extensive lymph node (LN) involvement have been considered an independent factor for poor prognosis of breast cancer. We evaluated if very small tumor size may be a factor of worse prognosis compared to larger tumor in small sized breast cancer with LN involvement. Methods: A retrospective analysis was made in a single center of all 1400 patients with small (below 2cm, T1) sized and LN involved (N1~N3) breast cancer without metastasis diagnosed between 2004 and 2014. Their ages ranged from 23 to 88 years (mean age 49.1 ± 9.9 years) and mean follow-up was 31 months. All patients were performed with surgery including axillary LN dissection without neo-adjuvant chemotherapy. We subdivided their tumor size to 4 group (T1m, T1a, T1b and T1c) grading by 7th AJCC cancer staging. The number of patients in each group is as follows: T1m = 17, T1a = 63, T1b = 214, T1c = 1106. The specific features related to mortality were analyzed according to the minor groups and they were compared with one another by Chi-square test and Kaplan-Meier analysis. Results: Total expired patients were 39 (2.8%) and the number (the rate in each group) of the minor groups is as follows: T1m = 1 (5.9%), T1a = 1 (1.6%), T1b = 7 (3.3%), T1c = 22 (2.0%). Overall survival of smaller sized tumor groups ( ≤ 1cm, T1m+T1a+T1b) are significantly decreased than the other larger sized group T1c in T1N1 staged patients (p = 0.004). There are significant differences in estrogen receptor, progesterone receptor, nuclear grade, recurrence among the 4 minor groups in whole patients group. In the analysis of nuclear grade, the results show higher grade in T1m than T1a, T1m than T1b, T1b than T1c. Especially, recurrence of T1m is significantly more frequent than T1a (17.6% vs 3.2%, P = 0.03) or T1b (17.6% vs 4.2%, p = 0.016). Conclusions: In conclusion, this study indicates smaller sized tumor with LN involvement can progress worse compared to larger tumor. This result supports very small size can be another predictive factor for prognosis in small sized breast cancer with LN involvement.
Voice of Cancer Patients: Analysis of patient concerns regarding cognitive deficits associated with treatment for breast cancer.
Authors: Aggarwal Sangeeta , Liu Mingfeng , Sharma Rishi , Yang Fred , Gupta Ankit , Singh Divjot , Sharma Rahul , Basak Anirban , Aggarwal Alok 
Published: February 2017

82 Background: Patients undergoing breast cancer treatment often report Symptoms of Cognitive Deficit (SCD). Many of them share their experiences on online forums, which contain millions of freely shared messages that can be used to analyze these SCD. Unfortunately, this data is unstructured, making it difficult to analyze. In this project we organize this data using methods from Big Data Science (BDS) and analyze it by creating a Decision Support System (DSS): an interface that can be used by patients and providers to understand how SCD are associated with specific types – hormonal only (HT), chemo only (CT), or both (CT/HT) – of breast cancer therapies. Methods: We collected 3.5 million unique messages from 20 unrestricted breast cancer forums that provide clinically relevant information. We next built custom ontologies for breast cancer treatments, SCD, and supportive therapies. Then, we created a DSS using methods from BDS, including topic modeling, information retrieval, and natural language processing to extract the relevant data from these messages. We also used token windows and co-occurrence-based algorithms to associate treatment with SCD and supportive therapies. To use this system, a user provides disease-related parameters and the treatment. The DSS then gives the percentage of messages discussing SCD for a similar cohort of patients and the percentage of messages that discuss supportive therapies for each of these SCD. Results: We found 15719 messages that had strong association of SCD with treatments. 3355 messages were from HT patients, 5740 messages were from CT patients, and 9095 messages were from CT/HT patients. Among HT, 28.18% patients taking aromatase inhibitors and 19.20% taking tamoxifen associated SCD to HT. Among CT, 35.26% patient receiving taxane containing chemo associated SCD to CT. SCD worsened during HT for CT/HT patients. Suggestive therapy: 80 messages found Vitamin B12 and B6 useful, 65 suggested Acetyle-L-Carnitine, and 50 suggested playing word games. Conclusions: Using methods from BDS, our DSS reliably associates SCD with HT, CT and CT/CT, and suggests supportive therapies. More research is needed to evaluate the role of supportive therapy for SCD.
Bio-identical hormones replacement therapy and the quality of life for breast cancer patients.
Authors: Wiley TS 
Published: February 2017

87 Background: Many treatments for breast cancer block the estrogen receptor or the androgen conversion of estrogen to reduce the risk of relapse. This results in a change in the hormonal milieu. Although most women tolerate the change in hormonal status, problems can arise from this change. Without estrogen, clinical symptoms include hot flashes, sleeplessness, insulin sensitivity, and mood changes. Here, it is examined that the use of estrogen and progesterone bio-identical hormone replacement therapy (BHRT) for women in the normal physiological pattern of reproductive women is expected to coincide with increased well-being and better quality of life for women with breast cancer. Methods: This BHRT approach uses bio-identical estrogen and progesterone to restore the woman’s body to normal serum levels through twice daily transdermal application. Using real “bio-identical” or plant-derived human molecular hormones compounded via a standard formula, concentration, and packaging of transdermal creams (Estradiol E2) of 1 mg/0.1ml and progesterone P4 of 20 mg/0.1 ml). Furthermore, through an understanding of hormonal mechanisms, this BHRT mimics the female reproductive cycle by following a 28 day cycle. Results: Throughout the study, women were asked to how gauge their general well-being and quality of life. Most women reported resolution of menopausal symptoms, better sleep, decreased migraines and incontinence, increased focus, and increased libido. Most patients were pleased to be on the treatment and showed general improvement in the quality of life. Conclusions: We present the general mechanisms of action for BHRT and explain clinical trials conducted over the past decade have been examining the impact on the overall well-being and quality of life for 112 patients, as well as the impact on various cancers as well as other chronic conditions. Patients reported increased energy and overall well-being. BHRT provided resolution of most all of the patients subjective anti-estrogenic complaints. It is also observed that the recurrence rate of various breast cancers was no higher than national averages. Therefore, BHRT and rhythmic dosing seems to greatly improve well-being with no increase of cancer risk.
Emotional experiences of oncologists treating women with metastatic breast cancer (MBC).
Authors: Brufsky Adam , Mayer Musa , Bell Dickson Robyn , Citron Marc L. 
Published: February 2017

97 Background: Research on the psychological status of medical oncologists (MO) is limited. The Make Your Dialogue Count survey explored emotional experiences of licensed US MOs who treat ≥ 5 women with MBC/month as well as women ( ≥ 21 y) with MBC. Methods: A survey was conducted (June-Aug 2014) online, by paper and telephone; MOs responded online only. Patient (pt) data were unweighted. MO data were weighted by geographic region and years in practice by sex to match actual proportions in the population. Statistically significant differences between groups were determined by standard t-test of column proportions and means at the 95% confidence level (marked by *). Results: 359 pts (median age 53 y) and 252 MOs (median age 49 y; median 15 y in practice) completed surveys. At initial MBC diagnosis, more MOs than pts felt that showing care and compassion (81% vs 72%) and helping pts cope with the diagnosis (63% vs 51%) were very important, and fewer felt that referring pts to support services (24% vs 38%) was very important. More MOs practicing < 15 y vs ≥ 15 y said it was very important to refer pts to support services at first diagnosis (30% vs 19%*). Slightly more MOs with more experience perceived emotions like anxiety, commitment, hopefulness, and determination in their pts at initial diagnosis. Many MOs (42%) reported that treating women with MBC had a lot/a great deal of negative emotional impact; 81% strongly/somewhat agreed that it is unprofessional to let emotions impact treatment recommendations; and 23% reported that emotions kept them from providing some information to pts. Less experienced MOs said their emotions kept them from providing some information to their pts than their more experienced counterparts (29% vs 17%*). Most MOs (93%) did not want to give their pts false hope; yet 27% reported that in certain situations, they do not discuss with pts that MBC is incurable. Conclusions: MOs empathize with pts and feel responsible for providing them emotional/psychological support. MOs revealed the negative emotional weight of their work. MOs with less experience were more impacted by their emotions than MOs with more experience. Acknowledging MOs’ emotions is important and underscores their own need for psychological/emotional support.
Association between daytime activity, sleep, and symptom burden in patients with advanced cancer: A preliminary report.
Authors: Yennu Sriram , Tayjasanant Supakarn , Balachandran Dave , Padhye Nikhil S , Williams Janet L. , Liu Diane D , Bruera Eduardo 
Published: February 2017

101 Background: There is limited research in advanced cancer patients (ACP) regarding association between objective daytime activity, sleep variables and symptom burden. Our primary aim was to determine the association between mean daytime activity (MDTA) and objective sleep variables, cancer related fatigue (FACIT-F), symptom burden (ESAS), Anxiety and Depression (HADS), Sleep Quality (PSQI) and overall survival (OS). Methods: Secondary analysis of a recent clinical trial of cancer related fatigue in advanced cancer (NCT00424099). Association between MDTA and sleep variables (measured by actigraphy) during the first week of the study and patient characteristics, symptoms (FACIT-F, ESAS, HADS, and PSQI) and OS were analyzed using Spearman correlation, multivariate analysis and survival analysis. Results: 79 eligible patients were evaluable. The median age was 57 years. Median MDTA was 248.43 counts/min. MDTA was significantly associated with (r, p-value) age (-.379, ≤ .001), serum albumin (.328, .006), FACT-Functional well-being (FWB) (.248, .028), ESAS dyspnea (-.300, .008), HADS-Anxiety (.262, P = .019) and total sleep time (-.323, .004). MDTA was not associated with FACIT-F subscale (p = .997) and OS (p = .18). PSQI was significantly associated with FACIT-F, HADS, ESAS anxiety and depression, but none of these variables were associated with sleep measured by actigraphy. Conclusions: In ACP, lower MDTA was not correlated with patient reported fatigue, and sleep measured by actigraphy was not associated with patient reported sleep disturbance. Both fatigue and sleep disturbance were strongly associated with depression and anxiety. More research is needed to characterize the association between objective and patient reported daytime activity, fatigue and sleep. Clinical trial information: NCT00424099.
A palliative radiation oncology consult service’s impact on care of advanced cancer patients with symptomatic bone metastases.
Authors: Chang Sanders , Smith Cardinale B. , Morrison R. Sean , Rosenzweig Kenneth , Dharmarajan Kavita Vyas 
Published: February 2017

110 Background: Single-fraction and ≤ 5 fraction radiation treatment (SF-RT and Hypo-RT, respectively) is underutilized despite strong evidence regarding its efficacy in symptom management. Established in 2013, the Palliative Radiation Oncology Consult Service (PROC) is a specialty service designed to provide individualized, efficient treatment for advanced cancer patients by a radiation oncology team with a dedicated palliative care focus. We assessed the impact of this new model of care on use of SF-RT, hypo-RT, pain improvement, palliative care utilization, and hospitalization among patients treated with palliative radiation (PRT) for painful bone metastases. Methods: We searched electronic charts of advanced cancer patients who had PRT for symptomatic bone mets from Dec 2010 to April 2015, extracting PRT details, demographics, cancer type, pain pre- and 1 month post-PRT, comorbidities (summarized using Charlson comorbidity index [CCI]), palliative care consults, and hospitalization. Comparisons were made before and after PROC using chi-square or t-tests. Multivariable logistic regression estimated the likelihood of SF-RT or hypo-RT, controlling for age, gender, cancer type, treatment site, and CCI. Results: We identified 334 patients, described in the table below. Patients were more likely to have SF-RT (OR 2.2, 95% CI [1.2-3.8], p = 0.007), or hypo-RT (OR 3.0, 95% CI [1.8-4.7], p < 0.001) after establishment of PROC. Conclusions: Establishment of a PROC service nearly doubled utilization of SF-RT and hypo-RT while maintaining pain improvement, and was associated with an increased use of palliative care consult services, decreased inpatient PRT use, and decreased length of stay. A dedicated service combining palliative care principles and radiation oncology improved quality of palliative cancer care. [Table: see text]