bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidisciplinary PAIN management features of pediatric oncology patients in a pediatric cancer center in Turkiye: A developing country experience.
Authors: Tacyildiz Nurdan , Incesoy Ozdemir Sonay , Canakci CEM , Yigit hande Irem , Maharramova Vafa , Dincaslan Handan , Unal hanzade Aybüke , Asik Ibrahim , Ozgencil Enver , Unal Emel Cabi 
Published: June 2024

e22002 Background: Pain is one of the most important problems that affects more than half of cancer patients at any stage of the disease and disrupts the quality of life of patients. The aim should be to relieve pain as soon as possible and prevent its recurrence. In this study, we aimed to evaluate the clinical characteristics of our patients who were followed up with a diagnosis of cancer in our clinic and whose pain management was planned in a multidisciplinary manner with the department of Algology. The clinic where the study was conducted is the reference center of a middle income developing country. Therefore, the data obtained will represent the characteristics of developing countries. Methods: In this retrospective descriptive study, patients followed up with diagnosis of cancer at Ankara University Faculty of Medicine, Department of Pediatric Oncology between 2018 and 2023 and consulted to Department of Algology for pain management were included. Patients whose file information could not be accessed from the hospital information system were excluded from the study. Demographic and clinical parameters of the patients were recorded. The data were evaluated with descriptive statistical methods appropriate to distribution. Results: A total of 33 patients, 19 girls and 14 boys, aged between 2.2 and 23.5 (median 14.4) were evaluated in the study. For each case, a median of 2 (1-16) consultations were made. The most frequent cancer diagnosis was bone tumors with 42% (n:14). Nociceptive pain was present in 25 of the patients, nociceptive and neuropathic pain were present together in 8 patients. It was determined that the most commonly used treatment for pain management was paracetamol, which was used in all patients. Other agents used, in order of frequency: Fentanyl in 19 (57.6%) of the patients, NSAID in 13 (39.4%), gabapentin in 9 (27.3%), oxycodone in 12 (36.4%), 7 (3%) 21.2) were tramadol, 4 (12.5%) were morphine, and 1 (3%) was codeine-paracetamol. Intravenous patient-controlled analgesia (PCA) was used in one patient. Side effects were observed in 3 patients. Fentanyl-related constipation was observed in 1 patient, fentanyl-related globe vesicale was observed in 1 patient, and thrombocytopenia was observed in 1 patient due to gabapentin. Conclusions: Pain is an important factor affecting the quality of life and treatment compliance of children with cancer. Therefore, it is important to ensure effective treatment and to raise the awareness of physicians and care providers by keeping it constantly on the agenda especially in developing countries. Prospective studies will be most useful guide for clinicians.
Clinical and histological profiling of triple-negative breast cancer at Chihuahua´s state cancer center: An observational study.
Authors: Baylon Valdez Victor , Gonzalez-Gonzalez Luisa F , Zamudio Lozoya Enrique Jose , Ochoa-Elizondo Patricio , Mendoza-Muraira Paolo , Martinez-Garcia Lascurain Regina , Martinez-Sanciprian Rafael , Bates Rodriguez Valeria , Mares García América Susana , Reza Bravo Gustavo Gil , Gonzalez Mendoza Rene Lazaro 
Published: June 2024

e22529 Background: Triple-negative breast cancer (TNBC) is an aggressive subtype characterized by the absence of estrogen receptor, progesterone receptor, and HER2 expression. This subtype is associated with a poorer prognosis and higher recurrence rates compared to other breast cancer subtypes. Understanding the histopathological and clinical characteristics of TNBC is crucial for improving early detection, clinical management, and treatment outcomes. In this context, a descriptive analysis was conducted to explore the association between TNBC and histological grade, histopathological type, and clinical stage at the State Cancer Center. Methods: A retrospective, single-center study was conducted at Chihuahua's State Cancer Center, where medical records of patients aged ≥ 18 years old diagnosed with TNBC between January 2018 and December 2022 were retrospectively reviewed. Data related to weight, histological grade, histopathological type, and clinical stage at TNBC diagnosis were collected. Frequency analysis was performed to determine the distribution of these characteristics in the TNBC patient population. Additionally, the association between histological grade and clinical stage at diagnosis was examined using appropriate statistical tests. Results: During the study period, 753 patients were diagnosed with breast cancer. Of these, 84 (11%) were diagnosed with triple-negative breast cancer and were included in the study. The mean age was 49 ± 13 years, with a mean BMI of 28 ± 5. The most common histologic subtype in this group was invasive ductal carcinoma, accounting for 78 (93%) of the TNBC cases. At the time of diagnosis, 19 (23%) were diagnosed with stage IIA, 17 (20%) with stage IIIA, 9 (11%) with stage IV, and 4 (5%) were detected in situ. Overall, the majority were identified as grade 3 tumors (44; 52%). Finally, within the stage IIA group, the majority were grade 3 tumors (58%). Conclusions: As seen in other cohorts, we found a similar frequency of TNBC among patients with breast cancer in our facility in the northwest of Mexico. The distribution of clinical stages highlights the varying degrees of disease progression at the time of diagnosis, with a considerable portion presenting at advanced stages. Moreover, these insights underscore the urgent need for improved screening strategies and early detection methods.
Pathogenic germline variants among Thai patients with colorectal cancer: A study in Genomics Thailand Project.
Authors: Roila Nutdanai , Pithukpakorn Manop , Thuwajit Chanitra , Trakarnsanga Atthaphorn , Chantharasamee Jomjit 
Published: June 2024

e22534 Background: Germline variant testing in colorectal cancer (CRC) patients (pts) has been applied in many countries. Limited data is known regarding germline CRC prevalence in Thailand and other low to middle-income countries in Southeast Asia. Identifying the variants in different ethnicities may show the variety in frequency of the pathogenic germline variants (PGVs) and their relationship with clinical characteristics. Our study reports on the distribution of PGVs and their clinical findings in Thai CRC pts. Methods: We use the germline testing results from the Genomics Thailand Project during 2020-2023, which performed next-generation sequencing on 50,000 pts in 5 disease groups. CRC pts in our institution with a potential risk of carrying PGVs were sent to a geneticist to obtain a family history prior to undergoing germline testing with 25-96 cancer-predisposing genes. Pts with complete pedigree data and germline testing results were enrolled in our retrospective cohort to analyze the variants and clinical findings from chart reviews. Descriptive statistics, the Cox proportion hazards model, and the Kaplan-Meier method were used to evaluate the results. Results: We included 137 CRC pts with a mean age of 47 years at diagnosis, and 58.4% were male. Of these, 38/137 (27.8%) pts were identified as pathogenic/likely pathogenic(P/LP). 26/38 (68.4%) were pathogenic Lynch syndrome (LS), 16 (42.1%) MLH1, 6 (15.8%) MSH2, 2 (5.3%) MSH6, and 2 (5.3%) PMS2. Among pathogenic non-LS, the most frequent variant was 4 (10.5%) APC, followed by 3 (7.9%) ATM, 2 (5.3%) BRCA2, 1 (2.6%) PTEN, 1 (2.6%) BARD1, and 1 (2.6%) monoallelic MUTYH. The LS group was significantly associated with a family history of CRC (p < 0.001), endometrial cancer (p = 0.001), and a synchronous/metachronous CRC (p = 0.003) compared to the non-PGVs group. Likewise, the presence of CRC in a first-degree relative (p = 0.025), more than one CRC pts in the family (p = 0.027), or early onset CRC (p = 0.012) in a first-degree relative was also significantly higher in the pathogenic non-LS group compared to the non-PGVs group. CRC pts who had more than one primary cancer in a lifetime were not significant in the LS or non-LS group compared to the non-PGVs group. At a median follow-up time of 60 (range 7-453) months, Pts in the PGVs group tended to have a shorter median time from the first CRC diagnosis to a second event defined as any of metachronous/synchronous CRC, recurrent CRC, or second cancer in a different organ compared to the non-PGVs group (135 vs. 228 months, p = 0.11). Conclusions: 27.8% pts in our cohort carried P/LP germline variants. The PGVs group was associated with a shorter time to the second event and a higher rate of familial cancer. Our study supports the benefits of genetic cancer screening. [Table: see text]
Defeating cancer through education, prevention, and youth athletics.
Authors: Barrett William , Anderson Sherwin , Frankart Andrew , Thompson Samuel , Mackey William 
Published: June 2024

e22548 Background: Barriers to effective scientific learning exists for elementary students, particularly in socially and financially disadvantaged settings. Maintaining interest, concentration and focus can be difficult for children, particularly when confronted with complex material and multiple distractions. Methods: We implemented a scientific educational program for children attending an urban community center after-school program entailing tutoring stations conducted during a basketball practice. Five tutoring stations included human physiology, astronomy, geography, geology and cancer. Five children spend 3 minutes with tutors who are medical students or residents while five other children are on the basketball court going through drills with a coach. After 3 minutes the kids on the court and the kids being tutored switch places. The sequence is repeated until each child has rotated through each of the 5 tutoring stations and through each of the 5 basketball drills. After this, each child rotates through each tutoring station for one minute where they are quizzed on what they were taught and the end of practice scrimmage begins with a score based upon each team of fives’ performance on the quiz. Results: The method proved to be highly effective in the children’s ability to understand and retain scientific concepts. Within weeks nearly every child could list the planets of the solar system in order, calculate their pulse and explain its importance, list the most common symptoms of the most prevalent cancers, correctly identify continents, oceans, countries and states on maps and explain the origin of volcanos, earthquakes, hurricanes and tsunamis. Conclusions: This novel teaching method proved highly effective with children being able to maintain interest, focus and concentration in a setting where physical exertion is rapidly alternated with educational instruction. Parents and teachers commented that the kids learned more in 45 minutes with this method than in 2 weeks of conventional classroom teaching. The approach is widely applicable to students from diverse backgrounds.
Associations between prognosis and primary endpoint selection in phase III oncology trials in the United States.
Authors: Uemura Nariaki , Ono Shunsuke 
Published: June 2024

e23022 Background: Overall survival (OS) is commonly used as a primary endpoint in phase III oncology trials in the United States, serving as direct evidence of clinical benefit and as an objective outcome measure. Other endpoints such as progression-free survival (PFS) and objective response rate (ORR) are also utilized. Factors such as a cancer type and treatment line are considered important for primary endpoint selection, however, the fundamental factor influencing primary endpoint selection across various cancer types or treatment lines remains unclear. I hypothesize that the prognosis of the target patient population is one of the key fundamental factors across any groups in primary endpoint selection. This study aims to investigate the associations between the prognosis and the type of primary endpoint. Methods: All phase 3 clinical trials conducted in the US, focusing on drug therapies for cancer, between January 1, 2015 and Dec 31, 2022 were included. Multinomial logistic regression was utilized to assess the relationships between prognosis, indicated by the median overall survival of the control arm, and the type primary endpoint among OS, non-OS time-to-event endpoints (Other TTE), and response or remission rate (RR). Models were adjusted for cancer type, treatment line, the primary endpoint of the previous clinical study for the same target patient population, monotherapy, mechanism of action (MOA), biomarker for the drug, orphan drug designation (ODD), and accelerated approval (AA) before regulatory approval. Results: Out of 5,877 phase 3 clinical trials, 151 studies and 167 evaluation sets were included in the analysis. When the prognosis and the type of primary endpoint were tested, this factor demonstrated a statistically significant difference with a positive coefficient for Other TTE, RR, and a co-primary endpoint of OS and Other TTE compared to OS. The prognosis, the median OS of the control arm, was 10.5 months (95% CI 5.00-16.6) for OS, 18.5 months (95% CI 7.50-34.3) for Other TTE, 32.9 months for RR, and 13.6 months (95% CI 8.7-46.6) for the co-primary endpoint of OS and Other TTE respectively. No effect modification was observed for Other TTE and the co-primary endpoint of OS and Other TTE. Conclusions: A better prognosis is associated with the selection of surrogate endpoints in phase 3 oncology trials among many factors. The associations between the prognosis and the type of primary endpoint were observed for Other TTE and a co-primary endpoint of OS and Other TTE. These findings elucidate one of the fundamental factors for primary endpoint selection and emphasize the importance of prognosis in selecting a primary endpoint in phase 3 clinical trial in oncology in the US. However, further study is required to comprehensively understand the impact of RR on primary endpoint selection, as this analysis was limited by the lack of median OS data for RR.
Impact of frailty on hospitalized patients with prostate cancer: A retrospective analysis.
Authors: Patel Rushin , Patel Mrunal , Chitkara Akshit , Patel Zalak , Patel Darshil , Anamika Fnu , Onyechi Afoma 
Published: June 2024

e23054 Background: The impact of Hospital frailty risk score on outcomes in hospitalized patients with prostate cancer has not been previously studied. This research aimed to examine the association between frailty and prostate cancer outcomes. Methods: This retrospective study utilized hospitalization data from the National Inpatient Sample (NIS) between January 1, 2020, and December 31, 2020. Data of patients with a primary or secondary discharge diagnosis of prostate cancer (ICD10-CM codes C61.0, D07.5, and Z85.46) were obtained. The objective was to evaluate the correlation between frailty and prostate cancer. Multivariate analysis was performed, stratified by race, age, Charlson index, median annual income in the patient's zip code, hospital bed size, teaching status, and census division of the hospital. Results: A total of 51,980 hospitalizations for prostate cancer were identified, with 72.7% in the intermediate to high frailty score (IHFS) group and 27.3% in the low frailty score (LFS) group. The IHFS group had a higher unadjusted in-hospital mortality rate than the LFS group (5.85% vs. 1.2%). Patients with IHFS had increased odds of adjusted mortality compared to those with LFS (adjusted odds ratio [aOR] = 4.45, 95% Cl [3.80-5.22], P < 0.01). Hispanic and Black race patients also had increased odds of adjusted mortality compared to Caucasian race patients (aOR = 1.42, 95%CI [1.19-1.70], P < 0.01); aOR = 1.16, 95%CI [1.00-1.32], P = 0.037, respectively). Additionally, the IHFS group had longer lengths of stay (5.65 ± 0.038 vs. 3.26 ± 0.28 days) and higher adjusted total costs ($66,107 ± 850 vs. $64,308 ± 1066) compared to the LFS group. Conclusions: Patients with prostate cancer and a high hospital frailty risk score exhibited significantly higher mortality rates, longer lengths of stay, and increased total adjusted costs. Frailty assessment plays a crucial role in predicting outcomes in patients with prostate cancer. Physicians can use frailty assessment to stratify patients based on risk and improve their ability to anticipate consequences.
Factors linked to patient rehabilitation disposition following surgical treatment of bone-related complications.
Authors: Corabi Jagger , Yan Vivian , Mallick Atrayee B. , Binder Adam F. 
Published: June 2024

e23061 Background: Cancer in the skeletal system, whether primary or metastatic, can cause fractures or impending fractures needing stabilization. Patients with pathologic fractures or impending fractures needing prophylactic fixation have lower home discharge rates than non-malignant hip fracture cases, a recognized quality metric. We initiated a single-center retrospective study to identify modifiable risk factors for improving home discharge rates in this population. Methods: We reviewed orthopedic surgery patients at Thomas Jefferson University Hospital (TJUH) from July 2020 to April 2023. We assessed demographics, living situation, admission-to-surgery time, surgery-to-physical therapy time, in-hospital complications, pathological fracture site, and weight-bearing status. Patients were stratified into discharge groups: home, subacute rehabilitation, and acute rehabilitation. Differences in rehabilitation facility versus home discharges were analyzed using pairwise two-sample t-tests and Fisher exact tests. Results: In this study, 102 cancer patients underwent orthopedic intervention at TJUH. The cohort comprised 57 women (55.9%), 67 non-Hispanic white individuals (63.7%), with median age of 66.6 (52.4-80.8). Living alone increased the likelihood of discharge to an acute rehabilitation facility compared to home (13 vs. 5, p<.001). Lower median age correlated with home discharge compared to subacute and acute discharge (age 62.4 vs. 74.7, p<0.001; 62.4 vs. 66.9, p<0.05). Higher in-hospital complications, like sepsis, were associated with acute rehabilitation discharge versus home (24 vs. 17, p<.05). Conclusions: These results link living alone, older age, and in-hospital complications to rehabilitation facility discharge. No modifiable risk factors for home discharge were identified. This study reinforces the importance of caregiver support for patient outcomes and high-quality care. In the future, we intend to investigate if the in-hospital complications were avoidable and, thus, modifiable. A larger patient cohort may be required to reveal potential areas for improvement. [Table: see text]
The real-world impact of next-generation sequencing in advanced stages of solid tumor malignancies.
Authors: Shaw Brian S. , Shaw Ryan , Truong Rachel , Ploucher Shelby , Makani Neeharika Srivastava 
Published: June 2024

e23066 Background: Next-generation sequencing (NGS) is a revolutionary technology that allows for DNA and RNA genomic analysis of malignant tumors via tissue or blood sample to aid in diagnosis and treatment while providing predictive and prognostic data about cancer patients. 75.6% of US oncologists use NGS in advanced cancer patients. As there are now site-agnostic approvals of certain targeted therapies, ASCO published a provisional clinical opinion stating that there is a rationale for genomic testing of all solid tumors. This retrospective study evaluates the impact of NGS testing in advanced solid tumor patients in a community based cancer center in Florida. Methods: Patients were diagnosed with stage 3 or 4 solid malignancy between January 1st, 2019 - December 31st, 2022. 496 patients were reviewed of which 269 patients were included in the study as they underwent NGS testing with either tissue (70.6%), blood (25.3%) or both (4.1%). Results: Median age of the study population was 71% with 87% of patients being insured with Medicare. 52.4% of patients were male. Overall, 67.7% of patients had biomarkers identified, 47.2% had FDA approved targeted therapies, and 77.3% had clinical trials identified. NGS testing impacted first line therapy in only 10% of patients where a matched therapy was initiated as first line treatment. Median time from initial diagnosis to NGS result was 53 days while the median time from diagnosis to initiation of first line of therapy was 47.5 days. In the entire study population, 14.1% never received therapy and 40.9% of patients passed. Of the 110 patients who passed, median overall survival in patients who had a biomarker identified through NGS testing was 6 months compared to 7 months in patients without a biomarker. Rates of biomarker identification and availability of FDA approved therapy were similar between deceased patients (67.3% and 45.5%) and those who were alive at time of analysis (63.1% and 48.4%). Conclusions: NGS testing has become part of routine oncologic care in patients with advanced solid malignancies, however in only 10% of cases did it impact first line therapy. Though currently NGS testing has a limited role in the initial management of advanced solid tumors, it is imperative that this technology continues to be used and developed as it leads to hypothesis generating and clinically relevant questions in discovery of oncogenic drivers, targets for novel therapeutics, and mechanisms of resistance to therapies. [Table: see text]
Innovative performance-based remuneration model for oncologists: Balancing productivity with quality of care in a Brazilian healthcare setting.
Authors: Sasse Andre Deeke , do Carmo Rafael Luis Moura Lima , de Jorge Juliana Limeira 
Published: June 2024

e23089 Background: Traditional fee-for-service (FFS) models in oncology often lead to biased healthcare delivery, prioritizing quantity over quality of care. Our objective was to develop and implement a comprehensive remuneration model for oncologists in Brazil that emphasizes both productivity and quality in patient care. Methods: The '4E' model forms the basis of our remuneration strategy. 'Effectiveness' measures clinical productivity through patient consultations, treatments, and participation in multidisciplinary activities. 'Structure' evaluates academic credentials and scientific contributions, 'Efficiency' examines adherence to clinical and administrative protocols, and 'Excellence' assesses quality interactions with patients and healthcare systems. These elements provide nuanced bonus adjustments to the effectiveness score, facilitating a balanced and comprehensive compensation approach. Adapted to various healthcare settings, the model accommodates different budgeting methodologies. Results: Implemented in February 2020, the model has led to significant improvements in service delivery. Between May 2020 and August 2023, consultations in private services increased by 36.8%, and patient numbers grew by 42.2%. The financial impact was notable, with more than a doubling of revenue, reflecting the model's success in enhancing both the volume and quality of healthcare provision. Conclusions: This multi-level remuneration model offers a comprehensive, ethical approach, aligning physician compensation with a broad range of professional activities and responsibilities. It demonstrates potential for enhancing healthcare delivery quality while ensuring financial sustainability. However, a limitation of our study is the lack of longitudinal quality measurement, an aspect we aim to address in future research. This suggests the model's replicability in diverse global oncology settings and underscores its relevance in the current healthcare landscape.