bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late mortality and chronic health conditions in long-term survivors of nasopharyngeal cancers: The 20-year follow-up of territory-wide Hong Kong Nasopharyngeal Cancer Survivor Study (HKNPCSS).
Authors: Chiang Chi Leung , Cheung Ching Lung , Chan Sik-Kwan , Au Philip Chun Ming , Fong Ka Shun , Sing Chor Wing , Wong Charlene Hoi Lam , Chow James Chung Hang , Cheung Ken Ka Man , Tin Winnie Wing Yan , Wong Edwin Chun Yin , Lau Tracy Tsz Shan , Wong Kenneth Chun Wai , Chan Ann Sum Yin , Lee Victor Ho-Fun , Lee Anne Wing Mui , Ng Wai Tong , Wong Ian Chi Kei 
Published: June 2024

12045 Background: The survival rate of patients with nasopharyngeal cancer (NPC) has significantly improved in the last decade. However, there are only a few studies that have quantified the long-term morbidity and mortality that follow NPC treatment. This study aims to analyze the chronic health conditions, all-cause mortality, and cause-specific mortality among NPC survivors. Methods: The Hong Kong NPC Survivor Study (HKNPCSS) is a retrospective cohort study conducted across all six oncology centers in Hong Kong. It included longitudinal follow-up of 5-year survivors diagnosed with NPC between 1997 to 2015. We compared the standardized mortality ratio (SMRs) of 7893 survivors to a matched population in terms of age, sex, and calendar year. We also calculated the frequencies of chronic conditions of 7893 survivors and 23679 healthy individuals with matched age, sex, and date of cohort entry. Chronic health conditions were classified using the Common Terminology Criteria for Adverse Events. Cox proportional hazard models were used to estimate hazard ratios (HRs) for chronic health conditions. Results: The mean age of NPC survivors was 49.1 years, while healthy individuals had a mean age of 50.5 years. Among the 7893 NPC survivors, the 20-year cumulative all-cause mortality was 34.0% (95% CI, 29.1%-38.9%), with 1668 (59.9%) of 2785 deaths attributed to health-related causes. The SMR for NPC survivors compared to the general population was 3.81 (95% CI, 3.67-3.95), with the highest SMRs observed for pulmonary (SMR: 6.18, 95% CI, 5.73-6.64) and cardiovascular (SMR: 2.12, 95% CI, 1.90-2.36) causes. Among the survivors, 59.2% (n=4674) had severe, life-threatening, or fatal (grade 3-5) health conditions, with a 20-year cumulative incidence of 59.0% (95% CI, 56.4%-61.5%). The adjusted hazard ratio (HR) of grade 3-5 chronic condition in NPC survivors, compared to healthy cohorts, was 7.02 (95% CI, 6.64-7.42). Gastrointestinal (HR: 20.7), hearing, visual, and nasal (HR: 15.4), and neurological (HR: 8.39) conditions had the highest risks. Intensity modulated radiotherapy (IMRT), compared to non-IMRT, was associated with reduced risks of all-cause mortality (HR: 0.83, 95% CI, 0.74-0.91) and a trend towards reduced grade 3-5 chronic health conditions (HR: 0.89, 95% CI, 0.75-1.05). Conclusions: Even 20 years after diagnosis, NPC survivors still face increased risks of late mortality and morbidity. The findings emphasize the need for a comprehensive survivorship program to improve outcomes for NPC survivors.
Efficacy of treatment with traditional Chinese patent medicine (Fufang E'jiao Syrup) for cancer-related fatigue in patients with advanced cancer: A randomized, double-blinded, placebo-controlled, multicenter trial.
Authors: Gu Shan Shan , Xu Yun , Mao Jun J. , Sun Lingyun , Cui Ning , Wang Feiye , Dong Jing , Guo Xingyu , Fu Li , Wang Jinghui , Shi Jiyan , Zeng Yumei , Hu Yidan , Zhang Zipei 
Published: June 2024

12053 Background: There is ongoing interest in finding effective drugs for cancer-related fatigue (CRF) in advanced cancer patients, although studies have had mixed results. Fufang E'jiao Syrup (FFEJS), a traditional Chinese patent medicine, has shown promise in alleviating CRF. This trial aims to investigate whether FFEJS could reduce fatigue and improve quality of life in advanced cancer patients. Methods: This prospective, multicenter, double-blinded, placebo-controlled trial was implemented at 29 hospitals in China, enrolling 611 advanced non-small cell lung cancer, colorectal cancer, and gastric cancer patients with Visual Analogue Scale for Fatigue ≥ 4 points. The study was conducted between September 23, 2019 and April 7, 2022, with a final follow-up on May 25, 2022. Participants were randomized to receive FFEJS (20 ml, 3 times per day) or a matching placebo orally for six weeks. The safety assessments were extended until the fourth week after the trial ended. The primary outcome was the change in total mean score (range: 0 [no fatigue] to 10 [extreme fatigue] points) on the Revised Piper Fatigue Scale-Chinese Version (RPFS-CV) from baseline to week 6. Secondary outcomes include quality of life (Functional Assessment of Chronic Illness Therapy-Fatigue, FACIT-F) and adverse events. FFEJS were compared with the placebo group using a linear mixed model. Results: Among 611 patients randomized (FFEJS: 303 and placebo: 308; 210 non-small cell lung cancer [34.4%], 201 colorectal cancer [32.9%], 200 gastric cancer [32.7%]; mean [SD] age, 62.8 [9.3] years; 413 [68.3%] man; mean [SD] baseline RPFS-CV total mean score, 4.86 [1.30] points), 503 (82.3%) completed the primary end point. By the end of week 6, the FFEJS group achieved normal fatigue levels (RPFS-CV < 4) compared to the placebo group (FFEJS: 3.78 vs Placebo: 4.39, adjusted mean difference 0.59 points [95% CI, 0.45 to 0.76 points]; P < .001). The adjusted mean difference for a favorable shift to a higher FACIT-F total score at week 6 comparing FFEJS with placebo was 2.77 points (97.36 vs 94.23 points; [95% CI, 0.56-4.96 points]; P = .02). There was no difference in adverse events occurrence between FFEJS and the placebo groups (110 [20%] vs 122 [18%], P = .38). Conclusions: In this randomized clinical trial among advanced cancer patients with CRF, FFEJS reducedfatigue severity and improved quality of life compared to placebo. Research is needed to assess the mechanism, clinical effect, and long-term safety of FFEJS for CRF in advanced cancer patients. Clinical trial information: NCT04147312 .
Attitudes and beliefs regarding sexual dysfunction among patients with advanced cancer receiving palliative care.
Authors: Bramati Patricia , Admane Sonal , Chen Minxing , Rozman de moraes Aline , Padilla Guadalupe , Erck McKenna , Delgado-Guay Marvin Omar , Bruera Eduardo 
Published: June 2024

12054 Background: Sexual dysfunction (SD) is highly prevalent among patients with advanced cancer, but it is not regularly assessed by palliative care (PC) specialists. This study aims to investigate the frequency of SD, and its impact in PC patients with cancer, as well as the barriers they face to have an open communication with PC providers. Methods: AdultPC patients with cancer seen at the outpatient Supportive Care Clinic were invited to participate in a 25-item questionnaire about SD. The survey was voluntary and anonymous. Results: A total of 100 patients (54 women and 46 men) completed the survey. The mean age was 55 (range 24-78), 90% were Caucasians, 16% Hispanics and 77% were married or lived with a partner. In the month and within six months before the survey, the patients received treatment with chemotherapy (44 and 37%), radiation (14 and 13%), or surgery (4 and 20%), respectively. Only 29 patients (29%) would like to discuss their SD with a provider -this was consistent across gender ( p= 0.827) and age groups ( p= 0.194)-, even though 81% had experienced SD in the previous year and merely 45% were satisfied with their sexual function. Only 20 (20%) reported that their clinician had ever asked them about SD. Most of the patients (79%) responded that it was appropriate for the clinician to inquire about SD but only 32% thought that clinicians should always ask. Patients "strongly agreed or agreed" that the SD worsened their depression (39%), anxiety (28%), pain (14%), fatigue (13%), and wellbeing (39%). Factors that worsened the current sexual desire included medications in 33/59 participants, treatments (chemotherapy, radiation or surgery) in 61/80, miscommunication with the partner in 31/66, urinary incontinence in 17/24, weigh loss in 18/36, body image in 45/64, tube/lines (nephrostomy, colostomy, urinary catheter, etc) in 12/18, and oxygen in 4/12. When asked why they did not discuss SD, 64% said that discussing other symptoms was more important, 35% said that they wanted to keep it private, 29% because a family member was present, and 17% because of lack of time. Conclusions: SD is very common among PC patients with cancer and it worsens their emotional and physical symptoms as well as their overall wellbeing. About only a third of the respondents said they would want to discuss it with their provider, and almost two-thirds said that talking about other symptoms was more important. Our findings do not support the notion that PC specialists should always initiate a discussion about SD with their PC patients with cancer. Future studies should try to better identify which PC patients are open to talk about SD and exploring its therapies.
Trichology to predict efficacy of scalp cooling: New pathologic insights besides encouraging clinical results.
Authors: Schaffrin-Nabe Dorthe , Josten-Nabe Anke , Tannapfel Andrea , Heinze Adrian , Schaffrin Merle , Voigtmann Rudolf 
Published: June 2024

12093 Background: Chemotherapy continues to be an essential element of tumour-specific systemic therapy. The associated hair loss impacts patients ‘quality of life in addition. Sensor-controlled scalp cooling has proven itself as a method of preventing alopecia. This study evaluates the grade of hair preservation as well as predictive factors, including (ultra)structural changes of the hair follicle during treatment, offering potential for enhanced therapeutic strategies. Methods: Scalp cooling, was evaluated in 81 patients (79 women, 2 men, median age 56 years) undergoing breast carcinoma treatment (4x EC 90/600 mg/m² BSA followed by 12x PAC w). Key outcomes included hair preservation (Hair Mass Index = HMI), avoidance of visible hair loss (HMI ≥ 50), and prevention of severe hair loss (all measured by Cross Section Trichometer). Parameters such as hair density (HMI), trichologic parameters like hair shaft and bulb diameter, anagen rate, shaft surface damage and melanosomes changes were measured through (ultrastructural) microscopy. Results: Over the half (53%) of patients avoided successfully noticeable hair loss (HMI post ≥ 50). Most important predictors of successful hair preservation in different analyses included lower post-therapeutic shaft surface damage (via scanning electron microscopy) (β = -.30, p = .034), larger pre-treatment shaft diameter (via light microscopy) (OR = 1.11, p = .011), and stable melanosome density (via transmission electron microscopy) (β = .35, p = .013). Higher anagen ratio (β = .30, p = 0.009) and larger hair shaft diameter (β = .29, p=0,023) plays a crucial role in hair prevention, considering only light-microspcopic parameters. Comorbidity (OR = 0.12, p = .024) and alopecia causing medication (e.g. antihypertensiva) (β = -.31, p = .017) led to increased hair loss. Patients with fewer hair loss over the course reported higher quality of life (r = .25, p = .042) and lower psychological burden (r = -.42, p < .001). Data indicate that optimal pre-therapeutic hair density (HMI =/> 69), coupled with the absence of comorbidities and alopecia-inducing medications, substantially enhances the efficacy of scalp cooling, elevating the probability of preventing severe hair loss (HMI ≥ 50) by nearly sevenfold (OR = 6.98, CI95% [1.01;48.33]. Conclusions: Scalp cooling proves effective in preventing visible hair loss in 53% of patients, with mini-organ (hair follicle) characteristics influencing outcomes. It does not only prevent hair loss but also enhances quality of life, underscoring the need for personalized approaches in managing chemotherapy-induced alopecia. The study confirms the method's safety and effectiveness without increasing scalp metastasis risk.
Cognitive symptoms in patients with cancer receiving PD-1/PD-L1 checkpoint inhibitors: Insights from a cross-sectional pilot study.
Authors: Yang GeeSu , Hegde Upendra P. 
Published: June 2024

12094 Background: Cancer-related cognitive impairment is common with traditional therapeutic modalities, affecting memory, psychomotor speed, attention, and executive function of up to 75% of adults with cancer. Over the past decade, immune checkpoint inhibitors (ICIs) have emerged as novel and efficacious treatments due to their ability to penetrate the blood-brain barrier and improve survival rates. However, they come with significant short- and long-term complications, including neurological toxicities. Despite their benefits, the impact of ICIs on cognitive function is not well understood. This study aims to examine the frequency and severity of cognitive impairment and the factors correlated among adults with cancer receiving ICIs. Methods: We collected questionnaire data on cognitive function using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and other concurrent symptoms, as well as saliva samples of a subset of inflammatory cytokines from patients treated with PD-1/PD-L1 checkpoint inhibitors between 2022 and 2023. Sample characteristics were described using mean, frequency, and percentage. To analyze the relationship among symptoms and demographics, we used Pearson’s correlation and the Mann-Whitney U test. Saliva cytokines were analyzed using ELISA assays. This study is IRB approved. Results: Twenty-three patients (male: n=11, female: n=12) have received ICIs for an average of eight months, with a mean age of 70.87±11.63 years. 78.3% had melanoma/skin cancer, 8.7% had head and neck cancer, and 13% had other malignancies. Pembrolizumab was administered to 47.8%, and Nivolumab to 26.1%. The mean scores of FACT-Cog for perceived cognitive impairment (PCI) and perceived cognitive abilities (PCA) were 60.87±13.06 (maximum: 72) and 22.30±6.70 (maximum: 28), respectively. 26.1% of participants (n=6) reported lower scores than the cut-off in both PCI (cut-off: ≤55.1) and PCA (cut-off: ≤19.5). Lower FACT-Cog PCI scores were significantly correlated with older age ( r=-.511, p<.05), greater fatigue ( r=-.483, p<.05) and pain ( r=-.558, p<.01). Participants with PCA and PCI scores below the cut-off showed higher mean concentrations of IL-1β (mean±SE: 188.22±133.72 vs. 80.99±14.73pg/mL), CRP (6659.47±3027.58 vs. 3910.71±1022.41pg/mL), and IL-6 (109.24±56.07 vs. 30.22±6.26pg/mL) compared to those with scores above the cut-off, although the results were not significant. This suggests that increased inflammatory cytokines may be associated with cognitive impairment. Conclusions: This preliminary study suggests that some patients may experience cognitive impairment during ICI treatment. As cancer patients are more at risk for cognitive impairment before treatment, a longitudinal study is warranted to confirm cognitive function both pre- and post-immunotherapy, along with objective measures of cognitive performance.
Patient navigation as an effective way to increase breast, cervical, and colorectal cancer screening among immigrants in the US: A systematic review.
Authors: Mann Katherine , Sun Kennedy , Jang Jeffrey , Khilnani Aneka , Barrett Emmalee , Harrod Thomas , Phillips Serena 
Published: June 2024

e22501 Background: Immigrants undergo recommended cervical, breast, and colorectal cancer screening at a lower frequency than U.S.-born patients and face unique language, educational, and cultural barriers. The delay or lack of screening has known implications in the presentation of breast, cervical, and colorectal malignancies, including worse staging at diagnosis. To address the disparity in cancer screening that immigrants experience, various interventions have been studied, including patient navigation (PN) programs. This systematic review aims to determine whether PN increases cervical, breast, and colorectal cancer screening in immigrant populations. Methods: A systematic literature search was conducted using PubMed, Scopus, and Web of Science to identify English-language articles published from January 2000 to November 2023 examining the role of patient navigators in encouraging routine breast, colorectal, and cervical cancer screening among immigrant populations in the United States. For the articles that met the inclusion criteria, details of patient navigation programs and uptake or change in cancer screening behaviors were extracted. Results: We screened 2196 articles, 53 of which met criteria for review, and 18 articles were ultimately included in the analysis. PN programs increased breast, cervical, or colorectal screening within immigrant populations compared to the control or alternative intervention in all 18 studies. In 7 out of 18 (38.9%) studies, the PN intervention group achieved screening rates similar to or above Non-Hispanic White national average screening rates. Two of those studies occurred in the outpatient setting, which resulted in higher screening rates than community-based settings. Two of those 7 studies that matched the Non-Hispanic White screening rates also had a longer duration of over 4 years. The majority of PN programs included educational sessions or materials and screening appointment scheduling assistance delivered from members of the same cultural group. Other services included identification and assistance with overcoming barriers, insurance assistance, reminders, transportation, and accompaniment to screening appointments. Of the 18 studies included, rural areas were underrepresented, and the training of patient navigators was not always described. Conclusions: Our review suggests that PN programs are effective at increasing cancer screening rates among immigrant populations, and certain aspects of PN programs, including outpatient settings and longer navigation duration, may help to further increase screening rates.
Analysis of diagnosis patterns and implications on cancer stage in patients with lung cancer: A single-institution experience.
Authors: Zafar Maha , Arnous Muhammad , Nwankwo Nkolika , Reddy Aswanth 
Published: June 2024

e22508 Background: Lung cancer is the most common cause of cancer-related death in the US. Patients are often diagnosed at advanced stages, challenging treatment and improving life expectancy. There has been tremendous progress in developing newer treatments; however, it is crucial to emphasize low-dose CT (LDCT) screening as it may improve earlier diagnosis and ultimately lead to better outcomes. Research Question What is the utilization of LDCT for lung cancer screening in newly diagnosed lung cancer patients? Do patients with lung cancer diagnosed after LDCT have earlier-stage disease when compared to patients who did not have LDCT? Methods: We conducted an observational cohort study on all new lung cancer patients seen in our clinic from January 2022 to July 2023 (18 months). Data collected included the age, type of lung cancer (NSCLC/SCLC), reason and method of initial identification of lung mass/nodule, methodology of biopsy, cancer stage, and if the patient was eligible for LDCT. Results: Over the study duration, 143 newly diagnosed lung cancer patients were seen in our oncology clinic. Of these, only 12% (18) patients had LDCT before diagnosis. Amongst these 18 patients, 44% (8) were diagnosed with stage I, two patients were diagnosed with stage II, and 44% (4+4) were diagnosed with stages III and IV. A total of 56% of patients (combined stage I/II) were eligible for curative treatment in this group. The remaining 82% of patients were diagnosed with lung cancer after imaging for other reasons (non-LDCT group). In this group, the most common stage at diagnosis was stage IV, constituting 39% (56) of the patients, followed by patients diagnosed at stage III with 24% (34). Only 37% (combined stage I/II) were eligible for curative treatment in this group. Conclusions: The USPSTF recommends annual lung cancer screening with LDCT for adults aged 50 to 80 years who have a 20-pack-year smoking history and are current smokers or have quit within the past 15 years. In an observational study conducted in 2021 from our institution, we identified a lower utilization of LDCT in eligible patients. We improved the screening rates by more than 50% from baseline with lung navigation intervention. In this study, we show that patients are getting diagnosed with lung cancer from X-rays and CTs performed for reasons including but not limited to chest pain, shortness of breath, workup for pulmonary embolism, and preoperative X-rays. Most patients diagnosed after LDCT (44%) had stage I disease compared to only 18% of patients in the non-LDCT group. We also observed that a significantly higher percentage (56% vs 37%) of patients are eligible for curative treatment (stage I/II) when diagnosed with LDCT. We highlight the importance of LDCT screening potentially offering a curable treatment in patients with lung cancer.
Recruitment strategies in a lung cancer screening program for Asian women with no smoking history.
Authors: Li Wenyuan , Bell Jaimie , Shum Elaine 
Published: June 2024

e22514 Background: The Female Asian Nonsmoker Screening Study (FANSS) is a pilot study for eligible Asian women with no smoking history to provide low-dose CT (LDCT) Chest scans for lung cancer screening annually for 3 years. To recruit for the study, we took into consideration several factors including potential language barriers, low awareness of lung cancer incidence in non-smoking populations, and participant (pt) availability. Here we describe the use of various recruitment strategies to support enrollment to the FANSS study. Methods: Multimodal recruitment strategies for enrollment into FANSS were used. A dedicated phone line answered by receptionists able to speak English and several Chinese dialects was created. Research staff are bilingual or utilized telephonic interpretation services in all pt interactions. Informational flyers available in both English and Chinese were mailed to primary care physicians serving primarily Asian communities and posted in pharmacies and storefronts in NYC Chinatown. A website was developed for interested individuals to submit their contact information for further information. Working with our institutional Epic EMR, a list of all pts with active MyChart accounts was created with criteria “Asian,” “female,” “OK to contact for Research recruitment,” “age 40-74,” and excluded anyone with a smoking history and “Cancer” in the past 5 years. From this list, pts then were sent an IRB-approved recruitment message through MyChart from 3/2023-6/2023. Interested pts who reached out through the above methods were contacted by research staff to determine eligibility. All eligible pts who agreed to participate were consented either in-person or virtually to allow for schedule flexibility to review the consent. Results: From 3/5/21 to 1/27/24, 1518 women inquired about FANSS through our website, dedicated phone line or MyChart messages and were directly contacted by our team. After determination of eligibility, 760 pts had an informed consent discussion either virtually or in-person. From 3/5/21 to 3/2023, 247 pts underwent the consent process and 229 pts had a baseline LDCT. Following the intervention of directed MyChart messaging in 3/2023, 568 pts responded to the MyChart message indicating interest, however 102 pts were not eligible due to inaccurate info in their Epic medical record (i.e. ethnicity or smoking history). Overall, from 3/2023 to 1/27/24, 513 pts underwent the consent process. Among these, 90 subjects (18%) were recruited via MyChart. Conclusions: Recruitment to a lung cancer screening program in non-smokers is feasible, and specific considerations tailored to engage minority populations can improve enrollment such as bilingual staff and translated materials. The use of directed messaging through the Epic EMR is an important tool to identify potential pts which may be applied to aid in recruitment to other clinical trials or lung cancer screening programs.