bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment outcomes and prognostic factors of bowel function recovery after hyperthermic intraperitoneal chemotherapy and cytoreductive surgery for metastatic cancers of the abdomen and pelvis.
Authors: Naz Sidra , Dai Jianliang , Jeong-Ah Lee Irene , Sayed Ahmed F. , Helmink Beth A. , Shafi Mehnaz 
Published: June 2024

e23225 Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is combined with cytoreductive surgery (CRS) to treat metastatic tumors of the abdomen and pelvis. The risk factors of GI dysmotility after HIPEC and CRS are not well known. Methods: We performed a single-center, retrospective chart review including all patients who had undergone HIPEC and CRS for metastatic cancer of the abdomen and pelvis from 2016-2023 to assess the prognostic factors of bowel function after HIPEC and CRS treatment. Patients were classified into high or low peritoneal cancer burden by a peritoneal cancer index (PCI) score. Statistics: Categorical variables were summarized by count and percentage and continuous variables. Comparisons of categorical and continuous covariables were conducted using Fisher’s exact test and the Wilcoxon rank sum test. Results: 195 patients met the study criteria. Duration of bowel recovery time in the High PCI was significantly higher than in the Low PCI group (median 11.5 days vs 9 days, p = 0.027). Persistent bowel dysfunction at day 30 was (7.47 x) associated with malnutrition (p = 0.001) and (6.95 x) a venting G Tube (p = 0.032) and history of radiation (p = 0.019) and Pre-OP Opioid Use (p = 0.01). Metoclopramide, Erythromycin and Mu Antagonists were used in 32%, 4.7% and 1.2% respectively of patients with bowel dysfunction. Conclusions: Patients with a high PCI score had a statistically significant longer duration of bowel dysfunction. Malnutrition and a history of radiation were statistically higher in patients with prolonged bowel dysfunction. Use of prokinetics and mu receptor antagonists was uncommon. [Table: see text]
Cross-sectional and longitudinal associations between PG-SGA criteria with survival of cancer patients.
Authors: Min Yu , Dai Tingting , Li Xuemei , Cai Lei , Zhou Jitao , Peng Xingchen 
Published: June 2024

e23277 Background: Malnutrition is prevalent in cancer patients and is associated with treatment efficacy and clinical outcomes. Whether the available malnutrition assessment tools contain optimal survival prediction value for cancer patients, especially from developing countries, remains unclear. Methods: In this retrospective cohort study, cancer patients were selected from our center between Nov 2019 and Sep 2023. According to the PG-SGA criteria, PG-SGA scores < 4 referred to well-nourished, ≥ 4 PG-SGA scores < 9 referred to malnutrition, and ≥ 9 referred to severe malnutrition. Kaplan-Meier (KM) curves were used to estimate the survival patterns of cancer patients with varied levels of PG-SGA scores. The Cox proportional hazard model was used to evaluate the association between baseline and longitudinal changes of PG-SGA scores with the all-cause mortality of cancer patients. Subgroup analysis with interaction tests was used to determine the high-risk subgroups. A series of sensitive analyses were performed to validate the findings we determined. Results: There were 1,415 cancer patients included in our study, with a mean age of 46 years old. The mean PG-SGA score was 2.42 in non-malnourished patients, 10.10 in malnourished patients, and 12.65 in severely malnourished patients, respectively. The KM curves showed that cancer patients with severe malnourished status (PG-SGA ≥9) presented the lowest short- and long-term survival probability, compared with the other two subgroups. A linear trend was observed between the PG-SGA scores and cancer mortality (p for overall test < 0.001). The Cox regression analysis showed that baseline malnourished status was significantly associated with the survival of cancer patients [≥4 PG-SGA < 9: hazard ratio (HR): 1.46, 95% confidence interval (CI): 1.09 – 1.96, p = 0.012; PG-SGA ≥9: HR = 1.78, 95%CI: 1.34 – 2.37, p < 0.001]. Cancer patients with longitudinal increased PG-SGA scores ( > 2 points) were observed to have a high risk for mortality (HR = 1.69, 95%CI: 1.04 – 2.74, p = 0.033). Compared with longitudinal changes in PG-SGA scores, the baseline PG-SGA scores showed significantly higher predictive power in identifying the risk subgroup (concordance index: 0.646 vs. 0.586, p < 0.001). PG-SGA scores showed more pronounced predicting value among subgroups with features of younger age, normal and underweight body mass index, late cancer stage, without history of diabetes, smoking, radiotherapy, and immunotherapy. A series of sensitive analyses determined consistent correlations. . Conclusions: Our study validates the clinical value of baseline, as well as longitudinal changes of PG-SGA, scored status for predicting the survival of cancer patients. Our findings provide new insights into the identification and prevention strategies for malnourished conditions in cancer patients, resulting in improved cancer-related nursing in resource-limited regions.
Tolerability, dose intensity, and prescribing patterns of capecitabine by race.
Authors: Dower Joshua , Salei Yana , Koethe Benjamin , Julian Alex , Schwartz Jake , Dumas Brett , Elkon Jacob Matt , Buchsbaum Rachel J. , Schlam Ilana 
Published: June 2024

e23278 Background: Capecitabine (cap) is approved for the treatment of breast and colorectal cancer and is used off-label to treat other solid malignancies. Approved dosing varies by indication and concurrent therapies, and the initial dose of cap may be modified empirically based on different patient characteristics. Race/ethnicity have been used by some providers as factors in prescribing patterns. However, the tolerability of cap among patients of different racial/ethnic backgrounds is unknown. Here, we present an updated analysis outlining the tolerability of cap among patients of different racial/ethnic groups. Methods: We performed a retrospective, multicenter study that included patients treated with cap monotherapy, concurrent with other chemotherapy, or concurrent with radiation at three sites in Massachusetts between 2017-2021. Patients were excluded if race/ethnicity data were not available. Data on cap dose, required dose reductions/treatment discontinuation, and adverse events (AE) were collected. Dose Intensity (DI) was calculated (Total administered cap dose during the treatment period (mg)/Recommended cap dose (mg/m2)*BSA (m2)). DI was compared across groups using non-parametric Kruskal-Wallis tests. The frequency of AE leading to dose reduction/discontinuation was compared across groups using chi-square tests. Results: 239 patients were included as outlined in Table 1. Median DI (IQR) for White patients was 0.95 (0.77,1.00), for Asian patients 1.00 (0.86,1.00), for Black/African American patients 0.88 (0.67,1.00), and for patients of other race 1.00 (0.79,1.00). There was no statistically significant difference across racial groups (p = 0.233). Median DI (IQR) for Hispanic/Latino patients was 0.84 (0.73,1.00) and for non-Hispanic/Latino patients 0.96 (0.77,1.00). There was no statistically significant difference between ethnicity groups (p = 0.562). The most commonly experienced AE included Hand Foot Syndrome, Fatigue, Diarrhea, and Nausea/Vomiting (Table 1). There was no statistically significant difference in AE frequency between groups. Conclusions: Our study shows no significant difference in the tolerability of cap between patients of different racial/ethnic groups, nor did we find any difference in the predominant AE. While this study is limited by the fact that it is retrospective and small, the results reinforce the importance of considering the entire clinical context when selecting a treatment dose and avoiding empiric dose reductions based on factors such as race/ethnicity. [Table: see text]
Gender disparities in incidence of psychological disorder among patients with breast cancer: A national cohort study.
Authors: Yoon Chang Ik , Kim Dooreh , Oh Jooyoung , Jeon Soyoung , Lee Hye Sun , Lee Jinah , Park Woo-Chan 
Published: June 2024

e23285 Background: Male breast cancer (MBC) is rare. The features of MBC shares similar characteristics with female breast cancer, often resembling postmenopausal breast cancer. However, there are notable differences between male and female breast cancer, especially regarding gender and age, which can have distinct psychological impacts on male patients. In this study, we investigated whether the psychological distress experienced upon a diagnosis of breast cancer differs according to gender. Methods: Data were obtained from the National Health Insurance claims database of the Health Insurance Review and Assessment Service in South Korea. This study focused on the three most common psychological disorders: sleep disorders, anxiety disorders, and depression. Diagnosis confirmation relied on diagnostic codes based on the International Code of Disease, 10th revision, alongside breast cancer diagnoses. Propensity score matching was used in a 1:5 ratio, and adjustment variables included age, endocrine therapy, chemotherapy, HER2-targeted treatment, and Charlson Comorbidity Index score. Results: After excluding patients with previous psychological disorder, there were a total of 75,936 patients, and 281 (0.4%) male patients. Male patients were diagnosed at an older age, had a higher prevalence of hormone receptor-positive status, higher comorbidities, and lower rates of anxiety disorders, while sleep disorders and depressive disorders showed similar incidences. The Cox proportional hazard regression model exhibited that being female was a risk factor for anxiety disorder (after matching, multivariable, HR 1.498, 95% CI 1.057-2.123, p = 0.023). However, gender did not significantly influence the development of sleep or depressive disorders, despite these conditions typically having a higher incidence in females. During the acute phase shortly after diagnosis, women tend to have more distress, as seen on the cumulative incidence curves. Conclusions: MBC patients experienced similar levels of psychological distress related to sleep and depression disorders as female patients. These results suggested that both genders require an equal support system and psychological care to maintain mental well-being after a breast cancer diagnosis.
Analyzing megestrol prescribing patterns in the Medicare cancer population in a community oncology network.
Authors: Sharma Gunjan , Feinberg Erica , Garey Jody S. , Indurlal Puneeth 
Published: June 2024

e23288 Background: Megestrol Acetate (Megestrol) used for appetite stimulation in cachexic cancer patients is listed as a potentially inappropriate medication to be avoided in patients 65 years and older per the American Geriatrics Society (AGS) Beers Criteria. It is also classified as a high-risk medication for elderly people by the Pharmacy Quality Alliance. However, due to the complexity of medication prescribing in geriatric cancer patients, some medications on the Beers Criteria may be used more often. We aim to review the use, and weight gain benefits of Megestrol in elderly patients with cancer. Methods: We obtained prescription data for Megestrol for episodes with patients 65 years and older for 15 practices in The US Oncology Network (The Network) participating in the Oncology Care Model (July 2016- June 2022). We evaluated the trends and patterns of Megestrol prescribing in The Network. We compared the documented weights before the initial prescription date (Pre-weight) within an episode to the weights immediately after a 12-week period (12-week weight) as documented in the Electronic Health Record (EHR) system. Results: Of 249,944 episodes, 4,957 (2%) episodes had Megestrol prescribed. Of the episodes with Megestrol, 3,464 (70%) had weight documented within the duration of a 6-month episode of care, with a mean weight of 67.3 kgs. The mean difference (0.8 kgs) between Pre-weights (mean = 67.6 kgs, std dev = 16.3 kgs, n = 2,112) and 12-week weights (mean = 66.8 kgs, std dev = 16.0 kgs, n = 2,112) was found to be significant (paired, one tail T-Test, p-value < 0.0001, significance level = 0.01). Patients who received Megestrol showed weight loss instead of weight gain in the 12-week follow-up period. Summary statistics for the two cohorts are provided in Table 1. Table 1: Summary statistics for the two patient cohorts. Conclusions: Oncology providers generally follow Beer’s criteria with limiting Megestrol use in older age patients. Megestrol use did not appear to contribute to weight gain in older age cancer patients. We aim to look at Megestrol use and thromboembolic adverse events in cancer populations in future studies. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.[Table: see text]
A single institution review of immunotherapy use, adverse events, and outcomes in early-onset cancer.
Authors: Daunov Michael , Domb Chaim , Mirsky Matthew M. , Murphy Jennifer Elizabeth , Perez Jamie Abraham , Cullen Jennifer , Daunov Kate , Lumish Melissa Amy 
Published: June 2024

e23320 Background: A significant portion of cancer patients are treated with immune checkpoint inhibitors (ICI) and many experience immune related adverse events (irAE) which impact treatment and outcomes. A paucity of data exists related to use of ICIs in Early Onset Cancers (EOC), their irAE, and its correlation to outcomes. Methods: A single institution database of immunotherapy use from an NCI-designated cancer center (NCI-CC) was reviewed with patients treated from 2010-2019. Two cohorts were examined: EOC (age ≤50 at diagnosis), and age > 50. Clinically significant irAEs were defined as those requiring hospitalization (≥grade 3). Pearson's Chi-squared test and Fisher's exact test were used for analysis. Significance was defined as p < 0.05. Results: A total of 1067 patients were identified, 173 were EOC. Race and ethnicity were similar between groups, the EOC group had significantly higher proportion of females, private insurance, working, single, treated at main campus, and ECOG 0. Main cancer types in EOCs were skin cancers (38.2%), lung (16.2%), and heme malignancies (11.6%); those > 50 were lung (46.6%), skin cancer (21.6%), and GU malignancies (11.2%). Stages of cancer were not statistically different nor was type or doses of ICI. EOCs were more likely to get a greater number of ICIs. IrAE requiring hospitalization were similar between groups; 20 (11.6%) in EOC vs 95 (10.6%) in > 50. There was no difference in the incidence of specific irAEs. Further stratification of EOC cohort by age group 13-30, 31-40, and 41-50 demonstrated no difference in experience of an irAE. Ipilimumab had the highest incidence of irAE in EOC; 12 (75.0%) vs 52 (33.1%), as did receiving 2+ ICIs: 11 (68.8%). The number of doses of a specific ICI was not correlated to irAE in EOC. EOC patients without an irAE were more likely to have a disease response; either stable disease, partial response, or a complete response: 21 (70.0%) vs 1 (12.5%); there was no difference in mortality. Conclusions: In a single NCI-CC review of ICI use, EOC had no difference in ≥grade 3 irAEs or in specific irAEs relative to older adults. Within EOCs, those who experienced a significant irAE were more likely to have received Ipilimumab or 2+ ICIs and were less likely to obtain a response to treatment, although mortality was not different. [Table: see text]
Small cell osteosarcoma: An NCDB analysis of demographic and socioeconomic factors of diagnosed patients.
Authors: Nowlen Frances , Tade Yanick , Puvvadi Suraj , Zaki Roya , Silberstein Peter T. , Heise Craig , Hsia Beau 
Published: June 2024

e23504 Background: Small cell osteosarcoma (SCOS) is a rare subtype of osteosarcoma accounting for roughly 1.5% of all osteosarcomas. Its prognosis is slightly worse than conventional osteosarcoma. Exploring demographic trends in patients with a confirmed SCOS diagnosis may provide insight into its epidemiology and allow for earlier diagnosis. The National Cancer Database (NCDB) was analyzed to research the demographic factors in patients diagnosed with SCOS. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included patients with a histologically-confirmed diagnosis of SCOS (ICD-O-3 9185). Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles-Deyo score) were analyzed via descriptive statistics. Incidence trends were interpreted in regression analysis. The mean survival was compared using the Log Rank (Mantel-Cox) test. Results: A cohort of 102 cases of SCOS were retrieved from the NCDB between 2004–2020. The primary sites for SCOS were the long bones of the lower limb (41%). Most patients were male (69%), White (63%), non-Hispanic (84%) with a mean age for diagnosis of 28 (SD = 18). The mean survival for males was 117 months (95% CI [93,141]), more than twice as long as females with 58 months (95% CI [31,85]). The Log Rank (Mantel-Cox) test reported a chi-square (χ²) value of 6.434, indicating a statistically significant difference between survival curves of males and females (p = 0.01). Residence in a metropolitan area (86%) was more common than other rural or urban areas. The greatest proportion of patients lived in the Middle or South Atlantic region of the United States (68%). The majority of patients were insured (86%), with the most covered by private insurance (64%) or Medicaid (22%). The median household income for each patient was most commonly in the highest quartile of over $74,063 (29%). Patients were diagnosed with SCOS at a steady rate between 2004 to 2020 (R² = 0.0956). Using the AJCC Cancer Staging System, most patients were Stage II (40%) or Stage IV (21%) at diagnosis. As a primary treatment, 87% of patients received chemotherapy. Most patients (91%) had no comorbidities with a Charlson-Deyo score of 0. Conclusions: This is the first time that demographic and socioeconomic factors of SCOS patients have been analyzed from the NCDB, revealing that the mean survival time of patients after receiving a diagnosis was more than double for males than females. SCOS patients are also more likely to live in metropolitan areas, particularly within the Middle or South Atlantic United States. Consistent with earlier reports, SCOS is typically diagnosed in young adults in the long bones of lower limbs. To better understand the impact of demographic factors on the diagnosis, treatment, and overall survival of patients with SCOS, further research is recommended.
Mixed liposarcoma: A study of socioeconomic and demographic factors.
Authors: Loken Delaney , Tade Yanick , Moroz Mark , Tandon Nikhita , Silberstein Peter T. , Heise Craig , Hsia Beau 
Published: June 2024

e23527 Background: Mixed Liposarcoma (LS) is an extremely rare subtype of LS, with characteristics often spanning 2 or more of the other LS subtypes such as myxoid, round cell, or well-differentiated LS. To date, the cytologic features of this uncommon tumor has yet to be described. Analyzing trends in diagnoses may produce valuable information about its epidemiology. The National Cancer Database (NCDB) was analyzed to uncover the demographic factors in patients diagnosed with mixed LS. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 199 patients were found with a histologically confirmed diagnosis of mixed LS (ICD-8855-3). Race, gender, Hispanic origin, type of treatment facility, insurance coverage, and distance from patient residence to treatment facility were analyzed via descriptive statistics, and trends in incidence were interpreted using regression analysis. Results: The majority of patients were white (89%) and non-Hispanic (83%) with a relatively equal split of males (56%) and females (44%). The most common primary site of mixed LS was the retroperitoneum (72%), and the frequency of diagnosis decreased from 2004 to 2020 (R2 = 0.4568). Patients were treated at academic/research programs (45%), comprehensive community cancer programs (25%) and integrated network cancer programs (18%) that were generally located in the Middle Atlantic (19%), South Atlantic (18%), and East North Central (16%). The two primary payers at diagnosis include private insurance/managed care (45%) and Medicare (43%). Most patients were from counties in metro areas with a population of at least 1 million (57%) followed by metro counties with a population of 250,000 to 1 million (18%). The largest median household income quartile was $74,063 or more (38%), followed by $46,227 - $57,856 (22%). Most patients had a Charlson-Deyo Score of 0 (83%) with a NCDB analytic stage of either I (28%), III (26%), or not applicable (21%). Conclusions: To the best of our knowledge this NCDB analysis on mixed LS is the first of its kind and therefore addresses a significant knowledge gap. Most patients tend to be white and non-Hispanic. Mixed LS most commonly is found in the retroperitoneum, which is similar to case reports. We found that mixed LS patients have a relatively high household income, most often live in high populated metro areas, and are most frequently treated at academic/research programs. These findings are significant because these socioeconomic factors have not been noted before in literature. Further examination of these demographic and socioeconomic factors is required to understand how they impact treatment, diagnosis of, and survival of patients with mixed LS.