bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer-related fatigue and functional impairment: Retrospective study in patients with newly diagnosed solid-tumor cancer.
Authors: Beeler Dori Michelle , Boselli Danielle , Meadors Patrick L. , Walsh Declan 
Published: June 2023

e24143 Background: Functional impairment (FI) and debilitating cancer-related fatigue (CRF) occur across all cancers with negative impact on quality of life (QoL). The nature of the association between CRF and FIs is unknown. We conducted a retrospective, single institutional study to investigate the association between CRF and FIs prior to treatment in newly diagnosed solid tumors within Levine Cancer Institute (LCI), a regional, multi-site cancer system. Methods: Electronic Distress Screening (EDS) and Cancer Registry databases from Jan 2017 to Jan 2022 were sourced. CRF was defined as fatigue (0-10 scale) ≥4. FIs were assessed using three EDS questions with a two-week recall: (1) how well have you been able to manage your day-to-day life? (PM); (2) has your physical health kept you from doing things like household chores or climbing stairs? (PHL); and (3) do you have limited movement (LM) in any of the following [body parts]? These are proxies for activities of daily living and instrumental activities of daily living. LCI patients aged ≥18 years with one cancer diagnosis within 10 years, completed EDS ±2 weeks of diagnosis, and before treatment were included. Proportions were compared using Fisher’s Exact test; multivariable logistic regression models evaluated the prognostic value of FIs on CRF. Results: 3439 unique patients were identified with strong associations between CRF and FIs. Median age was 62 years (18 to 97); 68% female and 78% White. The largest diagnostic groups were breast (30%), upper GI (17%), and gynecologic (16%); and 21% had stage IV disease. High CRF was reported by 57% (N = 1946) patients. FIs included: poor PM of day-to-day life, PHL, and ≥1 one body area of LM which were reported by 18% (N = 613), 19% (N = 648), and 29% (N = 982) respectively. More patients with FIs indicated CRF: PM 92% v. no PM 49% (P < .01), PHL 92% v. no PHL 48% (P < .01), and LM 75% v. no LM 49% (P < .01). In multivariable modeling, all FIs were significantly associated with CRF. The Table outlines that all lower bounds of estimated 95% confidence intervals ratios associated with odds ratios were greater than 1.66 when adjusted for age at diagnosis, sex, race, diagnostic group, and advanced disease, highlighting that all are independently associated with CRF. Conclusions: FIs are highly associated with CRF prior to treatment for solid tumors in a large cohort of patients. Pre-diagnosis FI screening identifies patients at risk for significant CRF. Early CRF management is essential to reduce negative QoL impacts.[Table: see text]
Factors affecting administration of palliative care in primary central nervous system tumors: An NCDB analysis.
Authors: Spalinski Daniel , Nguyen Daniel , Hoenack Michael , Memon Ali , Zineldine Sherif , Silberstein Peter T. 
Published: June 2023

e24146 Background: Primary central nervous system (CNS) tumors are a diverse group of neoplasms that can vary greatly in terms of their cellular origin, histological features, clinical behavior, and prognosis. Many diagnoses leave patients with a poor prognosis and an impaired quality of life. Palliative care (PC) has long been used as a means to improve quality of life and symptoms associated with debilitating malignancies; however, its use in CNS tumors is not well characterized. Yet, the plethora of life-altering symptoms such as gait impairment, cognitive decline, motor deficits, and seizures provide a need for further multidisciplinary approaches to integrating PC with primary CNS tumor diagnoses. We aim to assess factors that influence the receipt of PC in the current data on central nervous system tumor patients and assess differences in overall survival. Methods: This study retrospectively evaluated the use of PC in patients with single primary malignant central nervous system tumors (gliomas, neuroepitheliomatous neoplasms, and meningiomas) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2020. Patients were identified by ICD-O-3 coding and patients with other malignancies were excluded. Multivariable logistic regression was performed to evaluate associations between patient characteristics and the use of PC, and Kaplan-Meier curves with log-rank analysis were used to determine survival for each group. Results: After excluding patients without information on utilization of PC, a total of 9295 patients with primary CNS tumors were considered in the final analysis. Overall, 1.31% received palliative care. From patients receiving palliative care, 81.1-93.4% received non-curative treatment with surgery, radiation, chemotherapy, or a combination of one or more of these modalities with additional pain management. Odds of receiving palliative care were decreased in black patients, patients who received non-palliative surgical treatment, patients with a primary tumor site at the optic chiasm, patients with unilateral tumors, and patients with private, medicaid, other government, or unknown insurance status. Odds of receiving palliative care were increased with increased Charlson-Deyo Score, in patients receiving non-palliative systemic or radiation treatment, and patients with a primary site at the spinal dura. Utilization of PC was associated with a decreased 1-year and 5-year overall survival. Conclusions: PC use in CNS tumors was influenced by tumor location, treatment type, insurance status, patient race, and comorbidity index. This study demonstrates the areas in which use of PC utilization is still lacking across a diverse set of CNS tumors and patients. Further exploration is needed into the integration of palliative care broadly across these malignancies as it still remains low despite the abundance of quality-of-life altering symptoms.
METASNCore: A new tool for palliative whole brain radiotherapy (WBRT) assessment in the era of targeted therapies.
Authors: Flores Paco Pablo , Vargas Alicia , Guevara Maria Geraldina , Lopera Ignacio , Rodríguez Ruiz Lucía , María López-Herrero , Camús Juan Adrián , López-González Javier , Inga-Saavedra Elizabeth , Montero Marina , Barneto Isidoro , Gomez Maria Auxiliadora , Ruiz Estela , Ruza Marta , Tudela María Luz , Palacios Amalia , De La Haba Juan , Aranda Enrique 
Published: June 2023

e24154 Background: Palliative WBRT has been the main treatment for multiple brain metastases (BM). Recent studies report no benefit in survival or quality of life of WBRT compared to palliative supportive care in patients (pts) with poor prognosis. Several scores have been developed to support decision-making for selection of patients; despite this, the scales implemented so far do not consider the substantial impact of new developments in recent years. The purpose of this study was to develop and statistically validate a prognostic score in palliative pts with BMs who underwent WBRT. Methods: 239 pts with BM who received palliative WBRT between 2013-2022 in our center were analyzed retrospectively. Relevant clinicopathological features and their association with overall survival (OS) were measured using univariate and multivariate Cox regression models. The score was designed according to the value of the β coefficient of each variable with statistical significance (p < 0.05) in the multivariate model. Extra 0.5 points were added to all variables with a statistical significance of p < 0.001. Once the score was established, a comparison was performed according to Kaplan-Meier and the survival curves were analyzed with the log-rank test. Results: 149 pts (62.3%) were male and median age was 60 years. 139 (58,2%) were lung cancer (22,8% small cells), 35 (14,6%) breast cancer (53% luminal). 124 pts had ECOG 0-1 (52,1%) and 114 (47,9%) ECOG 2-3, 169 (70,7%) had extracranial disease and the most common symptom was headache (24,3%). All patients received 30Gys in 10 sessions. 37 pts (15,5%) had a specific target mutation and 15 (6,3%) received targeted therapy after WBRT. Median OS was 3,74 months (95% CI 3,28-4,20). After the multivariate analysis: ECOG, gastrointestinal (GI) or urothelial cancer, previous RT, protein C reactive (PCR), target drug treatment and chemotherapy after WBRT were shown to have independent prognostic value for the OS. Our score found 16% to 33% higher risk of the event taking place before per each point in the score. (HR (CI 95%): 1.243 (1.164 - 1.329). p < 0.001) (table 1). We found that 48 pts were in group 0-4 points with mOS 6,89ms (CI 95% 3,18-10,62), 80 in group 4-7 points with mOS 4,01ms (CI 95% 3,40-4,62) and 90 pts in group > 7 points with mOS 2,72ms (CI 95% 1,93-3,52). Conclusions: Some items in our cohort like ECOG, primary tumor site, PCR or post-WBRT systemic treatment (specially target treatment) are associated with OS and they could be useful in a score to select palliative pts to receive WBRT. More prospective and multicenter studies are necessary to corroborate our findings.[Table: see text]
Extracranial palliative radiotherapy for metastatic renal cell carcinoma.
Authors: Kwon Young Suk , Hsu Eric , Stein Maggie , Christie Alana , Garant Aurelie , Wang Andrew Zhuang , Yang Daniel X. , Yen Allen , Miljanic Mihailo , Courtney Kevin Dale , Hammers Hans J. , Zhang Tian , Arafat Waddah , Qin Qian , Cole Suzanne , Brugarolas James , Timmerman Robert D. , Hannan Raquibul 
Published: June 2023

e24156 Background: Radiation therapy (RT) is routinely used for the palliation of metastatic renal cell carcinoma (mRCC) symptoms despite a paucity of literature on RT’s efficacy. Since RCC is considered radioresistant to conventionally fractionated RT, we retrospectively evaluated factors influencing effective symptom palliation with RT for mRCC. Methods: A retrospective review of patients with mRCC between 2011 and 2022 at a high-volume academic radiation center was performed to identify patients with symptomatic extracranial metastatic sites managed with RT. Radiation therapy techniques included three-dimensional conformal RT, intensity-modulated RT, and stereotactic body RT. Symptomatic indications for RT were categorized as pain, neurologic (weakness and numbness), respiratory (hemoptysis and cough), gastrointestinal/genitourinary (GI/GU) bleeding, or multiple. Symptom relief was evaluated from chart reviews at subsequent on-treatment visits or follow-up encounters. Time to symptom alleviation (days) was measured from the RT start date. Descriptive analyses were performed. Results: Of 243 patients included in the study cohort, there were 617 irradiated sites. 560 out of 617 (91.0%) patients were treated for pain, and the other symptoms included neurologic (6.8%), respiratory (3.9%), and GI/GU bleeding (1.5%). The most common RT regimen was 20Gy in 5 fractions (122 lesions; 19.8%) followed by 30Gy in 10 fractions (35 lesions; 5.7%). Symptom relief was observed in 84.9% (95%CI 81.4, 88.1) of patients for pain, 90.8% (95%CI 78.2, 97.6) for neurologic, and 69.9% (95%CI 49.3, 88.0) for respiratory symptoms. The overall proportion of symptom relief was 103/131 (79%) for 20 Gy in 5 fractions versus 27/38 (71%) for 30 Gy in 10 fractions (chi-square P = 0.3). Conclusions: RT is effective for symptom palliation of mRCC. Further studies are required to fully delineate the impact of dose-fractionation and RT modality. [Table: see text]
Introduction and validation of the RONIN open assessment framework: A modular system for assessing patient-reported outcomes (PRO) in clinical practice and research.
Authors: Sidey-Gibbons Chris , Brown Grace , Elrick Ashley , Tang Yiqing , Williams Melanie , Harrison Conrad , Swisher Christine 
Published: June 2023

e24158 Background: Despite their potential to improve patient quality of life and survival, PRO-based symptom assessments are not routinely used in clinical cancer care. Barriers to use include cost, availability to for-profit users, and data sharing mandates as well as restrictions to any modification or translation to mobile devices. A trustworthy, open, and flexible approach to PRO-based symptom assessment may create new opportunities to reduce patient burden, increase clinical insight, and maximize measurement quality. Methods: We conducted expert interviews with oncology care staff, patients, and psychometricians to develop a flexible framework for symptom assessment that could be used to provide clinical insight and, uniquely, provide unidimensional measurements supported by item response theory. We developed a scalable framework to create symptom assessments using four interchangeable components, recall period, construct (e.g., severity, frequency, control), symptom (e.g., nausea, fatigue, pain), and an optional qualifier (e.g., at its worst, on average, in your lower back) In its first iteration, we tested 18 questions measuring presence as well as the severity, frequency, and impairment related to 9 symptoms occurring over the previous 7 days. We assessed construct validity by comparing scores to the PRO-CTCAE and assessed scalability and dimensionality using Mokken analysis. We recruited cancer patients receiving therapy in the United States to complete the nascent assessment alongside the PRO-CTCAE. Results: We recruited 10 patients and 13 clinical and psychometric domain experts for the expert interviews to develop the framework. For validation, we recruited 251 patients. Fatigue (65%) was the most common symptom and vomiting (32%) the least. All items correlated with the PRO-CTCAE equivalents (r = 0.46 - 0.72, all P < 0.05). Mokken analysis confirmed the scalability and dimensionality of all symptom scales with multiple items ( Ho = 0.59 - 0.72) as well as their constituent items ( Ho = 0.49 - 0.66). Conclusions: We created a flexible framework using exemplar PRO-based symptom assessments that can flexibly provide clinical insights and robust research measurements depending on stakeholder need. In the future, we plan to share access and encourage its use and expansion. Further work is planned to increase the number of symptoms and number of questions per symptom available within the framework.
A whole-food, plant-based dietary intervention and cognitive function in women with metastatic breast cancer.
Authors: McGuire Jeremy , Campbell Thomas , Gilmore Nikesha , Culakova Eva , Mattick Lindsey Jean , Janelsins Michelle Christine , Peppone Luke Joseph , Campbell Erin 
Published: June 2023

e24160 Background: Disease-specific quality of life (QOL) is consistently regarded as one of the most important outcomes by women with metastatic breast cancer (mBC), and it predicts survival. Treatment-related symptoms such as cognitive impairment greatly impact QOL in women with mBC. Patients undergoing treatment for breast cancer are highly interested in diet and nutrition, but despite this high level of interest, very few trials have tested dietary interventions in women receiving systemic breast cancer therapy and; the majority of research has been conducted in survivors who have completed primary treatment. Given the limited treatment options for cognitive impairment we evaluated whether our results show a whole food plant based (WFPB) dietary intervention might improve perceived cognitive function (CF) in women undergoing treatment for metastatic breast cancer. Methods: Patients with stage 4 breast cancer receiving treatment were randomized 2:1 into 2 arms: 1) WFPB diet (n = 20) or 2) usual care (n = 10) for 8 weeks with assessments at baseline, and 8 weeks. Our WFPB diet consisted of an ad libitum whole-food, plant-based diet; 3 meals/day were provided, which included fruits, vegetables, whole grains, nuts/seeds and excluded meat, dairy, eggs, added oils, solid fats and most sugars. Patient reported outcomes for perceived CF were collected using FACT- COG and EORTC-QLQ-C30. Paired t-tests were used to assess within group changes from baseline to week 8. The between group difference (WFPB diet vs control) was assessed by ANCOVA model. Results: Patients on the WFPB diet began with a mean baseline score of 140.8 on the FACT-COG which significantly improved to 156.6 (p = 0.005) at 8-weeks post intervention. The reported minimally important difference (MID) between groups is (9.6) and we observed a clinically significant difference of 17.1 (p = 0.03). Similar results in CF were observed for EORTC-QLQ-C30. The baseline mean score of 73.3 was improved to 84.7 (p = 0.004) at 8-weeks post intervention. The reported MID between groups is (4) and we observed a clinically significant difference of 12.6 (p = 0.07), with no significant changes in perceived CF for the control group. Conclusions: Our 8-week WFPB diet resulted in clinically meaningful and statistically significant improvements in perceived cognitive function in women with metastatic breast cancer. A phase 3 clinical trial is needed to confirm the results of this novel intervention. Funding: 3UG1CA189961. Clinical trial information: NCT03045289 .[Table: see text]
Recruitment lessons learned from a cross-sectional study of quality of life experienced by people receiving treatments for hepatocellular carcinoma.
Authors: Woodrell Christopher D. , Watman Deborah , Perez Sasha , Lubetsky Sara , Chen Yingtong 
Published: June 2023

e24162 Background: People with advanced-stage hepatocellular carcinoma (HCC) are living longer given improved treatment effectiveness, yet we know little of their unmet palliative and supportive care needs. Previous studies of palliative care in populations of people facing liver diseases and liver cancer have cited difficulty with recruitment. Methods: This is a cross-sectional study at a single academic medical center. Participants are recruited from a multi-specialty liver cancer practice that includes surgery, interventional radiology, and medical and radiation oncology. Treating physicians identify appropriate participants from a list of pre-screened eligible individuals generated by the study team. Once enrolled validated survey instruments are used to collect data at two time points separated by one month and a qualitative interview is conducted that focuses on the experience of living with HCC. PDSA framework was used to improve recruitment procedures to a rate of 3-4 per month. Results: During the first four months we identified 19 potential participants. Of these, ten were ineligible: four did not meet timing criteria (enrollment before treatment initiation); three lacked English proficiency; and three were identified by their physician as not appropriate for the study. Of the remaining nine potential participants, four were unable to be contacted by phone, two were uninterested (including one who specifically ended the call after hearing the term palliative care), one was lost to follow-up, and two were consented and enrolled. In response, the following modifications were made to the protocol: (1) Medical eligibility criteria were liberalized so that enrollment could occur at any time during treatment; (2) a protocol to involve trained interpreters (in-person when possible) was implemented and a study team member who can conduct qualitative interviews in Spanish was added; (3) the title of the study was changed to more accurately focus on understanding quality of life (from “Palliative Care for People Facing HCC”) to address patient and physician concern; and (4) recruitment efforts are now focused on in-person introduction of the study to develop rapport. Since implementation of these changes, enrollment doubled in just one month. Conclusions: We identified actionable protocol modifications to increase study enrollment. Liberalized inclusion criteria, language inclusivity, and careful attention to stigma around palliative care may be generalizable to similar studies about supportive care, palliative care, and hospice in the population of people facing liver cancer. Additionally, avoiding language-based exclusions for lack of resources (rather than scientific ones) increases inclusivity in research and will allow for a more meaningful and accurate description of all our participants’ needs.
Racial disparities in utilization of palliative care among inpatients admitted for lung cancer.
Authors: Bharathidasan Kavya , Ajitkumar Ashika , Mohan Gaurav , Rehman Shabnam 
Published: June 2023

e24166 Background: Multiple national database-based studies have shown that Black and Hispanic patients are less likely to receive palliative care options at end-of-life (EOL) inpatient care leading to higher costs and poorer quality of life. To the best of our knowledge, there is no reported data specifically considering lung and pleural malignancies. Methods: We analyzed hospitalizations across the United States in 2019 from the National Inpatient Sample dataset, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We identified adult non-emergent hospitalizations with ‘malignant neoplasm of the lung and bronchus’ (including mesothelioma) listed as the principal reason for hospitalization using the International Classification of Diseases, 10th revision, clinical modification codes C34.0, C34.1, C34.2, C34.3, C34.8, C34.9, and their sub-branches. StataCorp Stata software was used to extract data and compute mortality and palliative care consult utilization among various demographic factors such as sex, age, race, and payer status. Results: Of 67,425 total hospitalizations, 9.4% resulted in mortality. Of these 6338 patients that died, 73.1% were White, 13% Black, 5.8% Hispanic, 3.9% Asians/Pacific Islanders, 0.6% Native Americans, and 3.3% were other races. Palliative care was consulted in 63% of the patients whose admission resulted in death. 64.9% of the White patients, 58.6% of the Black patients, 62.6% of Hispanic patients, 67.7% of Asians/Pacific Islanders, 60% Native Americans, and 59.6% of other races were offered palliative care prior to their death. The average age among the admissions which resulted in death was 69.03 years. Conclusions: While most admissions resulting in mortality were among the White population, there was still a clear discrepancy in the number of Black patients on whom palliative care was consulted. Possible reasons include poor healthcare literacy, physician mistrust, and cultural preferences. Clinicians should consider and suggest early palliative care consultation in the care of Black patients and other minority racial groups to improve the quality of EOL care.