bluuebunny/crossref_metadata_2025_split huggingface dataset:
End-of-life outcomes of patients with advanced cancer enrolled in palliative care.
Authors: Lynch Andrew , Lyon Liisa , Ramalingam Nirmala D. , Whitehead Hannah , Chang Mina , Liu Raymond 
Published: June 2023

12030 Background: Palliative Care (PC) integration improves end-of-life (EOL) outcomes for patients with advanced cancer. However, there is limited evidence in real world settings of the impact of PC enrollment on EOL outcomes and the presence of racial disparities in PC enrollment. We sought to understand how PC enrollment differs between certain patient demographics and whether enrollment affects EOL outcomes in a large integrated health system. Methods: This retrospective cross-sectional study included adults 18 years and older diagnosed with Stage IV solid cancers who died within 1 year of diagnosis at 21 cancer centers within Kaiser Permanente Northern California between 2018-2020. Demographics, clinical variables and EOL outcomes were compared by PC enrollment status. Categorical and continuous comparisons were made using Chi-squared and t-tests, respectively. Results: Among 3,575 patients diagnosed with stage IV solid cancers who died within 1 year of diagnosis (mean age 73.2), 52.8% were male; 8.2% were Black, 11.0% Hispanic, 12.3% Asian, and 67.7% non-Hispanic White. Most patients (93.0%) selected English as their preferred language. The most common cancer subtypes were thoracic (33.2%), upper GI (32.4%), and lower GI (10.6%). Overall, 1613 patients (45.1%) were enrolled in PC. Baseline demographics were similar between the PC and no-PC groups including gender (p = 0.58), race (p = 0.32), and preferred language (p = 0.23). There was a difference in mean age between groups (72.0 vs. 74.2, p < 0.01). Patients enrolled in PC were more likely to enroll in hospice (42.9% vs. 25.7%, p < 0.01, Table) and less likely to be hospitalized in the last 30 days of life (35.5% vs. 45.7%, p < 0.01, Table). Short hospice stays (< 3 days) were uncommon in both groups, and there was no statistically significant difference between groups (4.5% vs. 5.4%, p = 0.49, Table). There was no significant difference in the proportion of patients with multiple ED visits in the last 30 days of life between groups (21.0% vs. 21.8%, p = 0.56, Table). Conclusions: PC enrollment is associated with significant improvement in some EOL outcomes with higher rates of hospice enrollment and lower rates of hospitalization at the EOL. These outcomes were seen without racial disparities in PC enrollment. Future studies are needed to assess other outcomes related to goal-concordant care and to determine which patients benefit most from PC enrollment. [Table: see text]
Risk of malnutrition and predisposing factors among Mexican patients with advanced cancer.
Authors: Contreras Sergio , Covarrubias-Gómez Alfredo , Ramos-Lopez Wendy Alicia , Carrillo-Bedoya Araceli , Gonzalez Salazar Roberto , De la Puente-Tawil Ilana , Morales Alfaro Andrea , Amaya Caballero Montserrat , Lagarde-Santillán Laura Kay , Ramos-Ruelas Gloria Lizbeth , Acevedo-Silva Jaziel Simón , Milke Garcia Maria del Pilar , Esparza-Orozco María Fernanda , Soto Pérez de Celis Enrique , Chavarri Guerra Yanin 
Published: June 2023

12033 Background: Malnutrition is a predictor of cancer survival independent of cancer site. However, routine screening for malnutrition is underutilized. Advanced cancer accounts for 60% of cancer cases in developing countries of which approximately 52 % have malnutrition. This study aimed to describe factors associated with risk of malnutrition among patients with advanced cancer. Methods: We conducted a cross-sectional analysis of baseline data from patients with recently diagnosed advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). At the time of enrollment in the program, patients completed a series of questionnaires including assessments of quality of life (FACT-G), various symptoms and the validated malnutrition screening tool (MST). Clinic and demographic characteristics were obtained from the patient chart. Descriptive statistics were used for analysis and factors associated with risk of malnutrition were analyzed by bivariate testing. Results: Between August 2017 and December 2022, a total of 601 patients were included. Mean age was 62 years (range 18-94), 57.2% were women, 56% had gastrointestinal and 28% gynecological malignancies. 72 % screened positive for malnutrition on the MST and 49 % reported nausea on FACT-G. Patients with an ECOG performance status ≥3 were more likely to screen positive for malnutrition (OR 5.9 95%CI 2.5- 13) as well as those with baseline nausea (OR 2.99; 95%CI 1.9-4.7). On the other hand, patients with active chemotherapy (OR 1.4 95%CI, 1.016-1.95) and those receiving antiemetic treatment with a single medication (OR 1.63 95%CI, 1.1-2.4) were more likely to have nausea. No other clinical or demographic characteristics were significantly associated with screening positive for malnutrition or reporting nausea, including gender, age, history of smoking or alcohol abuse, type of neoplasia, or oncologic treatment. Conclusions: Our results show that a high proportion of patients with advanced cancer are at increased risk for malnutrition and report nausea. Poor functional status and nausea were strongly associated with a higher risk of malnutrition, while receiving insufficient antiemetic medication was associated with increased odds of nausea. This suggests that appropriate treatment of nausea and nutritional interventions should be prioritized early in the management of patients with advanced cancer regardless of the type of cancer treatment in order to avoid malnutrition and improve patient well-being.
The impact of patient age on palliative care utilization and end-of-life outcomes among patients with metastatic breast cancer.
Authors: Mitchell Carley , Stabellini Nickolas , Chen Zhengyi , Fu Pingfu , Montero Alberto J. 
Published: June 2023

12034 Background: Among patients with advanced cancer, palliative care (PC) utilization is frequently associated with improved quality of life, less aggressive end of life (EOL) measures, and hospice enrollment at the time of death. While older age is often associated with less PC utilization. The interplay between patient age, site and timing of PC with resultant EOL trends is not well understood. We aimed to assess these variations within a single institution’s metastatic breast cancer (mBC) population. Methods: An IRB approved retrospective study was conducted. All adult, decedent, mBC patients from 2011-2022 were analyzed. Manual chart review extracted demographic and clinical data related to diagnosis, treatment, PC utilization and death. The relationship of patient age with PC utilization (including setting and timing), aggressive EOL measures, hospice care at the time of death, and hospice duration were evaluated. Univariate analyses were conducted and factors with a significance level p < 0.15 were further evaluated on multivariable logistic regression. Results: 278 decedent mBC patients met inclusion criteria. Any form of PC interaction from date of metastatic diagnosis to date of death, and utilizing outpatient (OP) PC (i.e., only OP or OP + inpatient (IP)) during the last year of life were significantly associated with hospice enrollment at the time of death. Similarly, utilizing only OP PC (i.e., no IP) was significantly associated with a longer time on hospice care. There was a trend toward shorter hospice durations in mBC patients who received only IP PC, and patients who received any IP PC or had their first PC interaction < 4 months prior to the time of death were more likely to experience ≥ 1 aggressive EOL measure. Young adults (< 40) were significantly more likely to receive some form of PC throughout their disease course, with a trend toward receiving only IP PC. While no significant relationships were identified between age and EOL factors, there were trends toward young and middle-aged adults (40-64) receiving ≥ 1 aggressive EOL measure and less time on hospice compared to older adults (≥ 65). Conclusions: This study gives important insight into a breast cancer-specific female population. Results highlight the importance of PC, especially in the OP setting, and its effect on hospice enrollment prior to death. However, there appears to be an interesting dichotomy between young adults receiving more PC and worse EOL experiences compared to older adults receiving less PC and better EOL experiences. These results should guide and promote, early OP focused PC specifically for young and middle-aged adults to help improve challenging EOL transitions. [Table: see text]
The association of the comorbidity polypharmacy score (CPS) with functional limitations, frailty, and mortality in older adults with gastrointestinal malignancies.
Authors: Westbrook Brian , Giri Smith , Harmon Christian , Jin Jing , Al-Obaidi Mustafa , Williams Grant Richard , Outlaw Darryl Alan 
Published: June 2023

12036 Background: Older adults share a growing burden of cancer morbidity and mortality. The presence of comorbid medical conditions and polypharmacy may present significant challenges to cancer management for older adults. Although geriatric assessment (GA) is recommended to personalize treatment for older adults with cancer, it remains underutilized in routine oncology practice, and how best to measure comorbidity and polypharmacy remain unknown. The Comorbidity Polypharmacy Score (CPS), which is the sum of the number of comorbid medical conditions and medications for a patient, has been validated in other medical fields. Here we review the association of CPS with key outcomes among older adults with gastrointestinal (GI) malignancy. Methods: The Cancer and Aging Resilience Evaluation (CARE) tool is a brief, patient-completed GA developed for older adults with cancer at the University of Alabama at Birmingham (UAB). For patients enrolled in the CARE registry, diagnosed with a new GI malignancy between September 2017 and April 2021, we calculated a CPS based upon the number of patient-reported medical comorbid conditions and daily medications. Patients were separated into two groups, those with CPS ≥ 15, or high-risk, and those with CPS < 15. Multivariable analyses were adjusted for age, sex, race, cancer type, and cancer stage, and were performed to examine the potential association between high-risk CPS and falls, functional limitations, frailty, and mortality. Results: 548 patients were included in this study with a mean age of 69.7 years; 44.9% female and 23.9% Black. Common GI malignancies included colorectal (30.8%), pancreatic (25.5%), hepatobiliary (17.7%), and gastroesophageal (10.8%). Patients with CPS ≥ 15 were more likely to report falls (adjusted odds ratio [aOR] 3.39, 95% CI 1.91-6.02), dependence in activities of daily living (ADL) (aOR 3.07, 95% CI 1.67-5.66) and instrumental ADL (aOR 3.81, 95% CI 2.02-7.20), and have frailty (aOR 5.17, 95% CI 2.84-9.39). There was not a statistically significant association with either six-month or twelve-month survival. Conclusions: CPS was associated with falls, functional limitations, and frailty, but not survival, among older adults with GI malignancies. This association highlights the potential role of CPS as an efficient screening tool for older adults with cancer who would benefit from more comprehensive comorbidity and medication review.
Racial differences in muscle measures and survival among older adults with GI malignancies.
Authors: Aleixo Gabriel , Hess Daniel L. , Giri Smith , Williams Grant Richard 
Published: June 2023

12044 Background: Sarcopenia (low muscle mass) and myosteatosis (fat infiltration of muscle) can be assessed from routinely obtained Computed tomography (CT) images and are independent predictors of chemotherapy toxicities and survival among patients with gastrointestinal (GI) malignancies. However, most studies to date have consisted of predominantly white populations. Therefore, the role of sarcopenia and myosteatosis among racial minority populations is unknown. Our objective was to examine racial differences in muscle measures and their association with survival among older adults with GI malignancies. Methods: This is a prospective cohort study of older adults with GI cancers from the University of Alabama at Birmingham. Single slices of axial CT images from L3 segments were analyzed using Slice-O-Matic software. Skeletal muscle area (cm2) was divided by height to obtain the skeletal muscle index (SMI, cm2/m2). Skeletal muscle radiodensity (SMD) in Hounsfield units (HU) was used to approximate muscle composition. Sarcopenia (low SMI) and myosteatosis (low SMD) were defined based on standard cut-offs developed in a cohort of GI malignancies (Martin et al., JCO 2013). We compared differences in muscle measures between non-Hispanic (NH) White and NH Black participants. We utilized Cox models, separated by race, to examine the impact of muscle measures on survival. We adjusted for age, sex, education, cancer type, cancer stage, lines of therapy, and comorbidities. Results: Six hundred sixty patients were included, 76% NH White and 24% NH Black. The median age was 69.4 years, 35% had colorectal cancer, and 42% had stage IV disease. NH Black patients had higher SMD (41.7 vs. 38.3 HU; p < 0.001) and lower rates of myosteatosis (40% vs. 27%; p = 0.04) but similar SMI (42.3 vs. 41.1 cm2/m2) and rates of sarcopenia (58% vs. 55%). In stratified Cox models, each 5 HU unit increase in SMD was associated with reduced risk of all-cause mortality of NH black patients (HR 0.88; 95% CI 0.80-0.98 p = 0.02) and not in NH White patients (HR 0.95; 95% CI-0.88-1.01; p = 0.14). Meanwhile, each 5-unit increase in SMI was associated with improved survival in NH White patients (HR 0.91; CI 0.85-0.98; p = 0.03) but not in NH Black patients (HR 0.89 CI0.78-1.03 p = 0.13). When using existing cut points for sarcopenia and myosteatosis, NH White patients with sarcopenia had worse survival (HR 1.42; CI 1.04-1.92; p = 0.02), but sarcopenia among NH black patients was not associated with worse survival (HR 1.16 95% CI 0.62-2.16 p = 0.64). Myosteatosis was not associated with worse survival in either NH white (HR 95%CI 0.95-1.68 p = 0.10) or NH black patients (HR 1.61 95%CI 0.88-2.95 p = 0.12). Conclusions: Muscle measures may differ by race and have different associations with survival by racial group. Therefore, it is essential to develop cut points for muscle measures incorporating race.
Peaceful acceptance of illness among older adults with cancer.
Authors: Gilbride Elizabeth , Hryniv Sofiia , Consagra William , Mohile Supriya Gupta , Yilmaz Sule , Culakova Eva , Canin Beverly , Malhotra Arul , Dib Elie G. , Onitilo Adedayo A. , Berenberg Jeffrey L. , LoCastro Marissa , Anand Maya , Magnuson Allison , Loh Kah Poh 
Published: June 2023

12045 Background: Greater illness acceptance is associated with lower levels of psychological distress and higher rates of completion of advance care planning in adults with advanced cancer. However, studies on factors associated with illness acceptance among older adults with advanced cancer are limited and historically have not explored its relationship with caregiver or physician characteristics, despite the important role caregivers and oncologists play in patient illness acceptance. We aimed to evaluate the associations of patient, caregiver, and physician-related factors with illness acceptance among older adults with cancer. Methods: We utilized data from a national geriatric assessment cluster-randomized trial (NCT 02054741; PI: Mohile; funding NCI UG1CA189961). We recruited patients aged 70 years or over with stage III or IV incurable solid tumors or lymphoma and at least one geriatric assessment domain impairment as well as their caregivers. Illness acceptance was assessed using the 5-item Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) questionnaire (range 5-20). Higher PEACE score indicates greater illness acceptance. Multiple linear regression was used to assess the associations of patient, caregiver, and physician-related variables with PEACE. Variables included patient sociodemographic factors, geriatric assessment variables, and estimated life expectancy; caregiver sociodemographic variables, anxiety, depression, and physical function; and oncologist years in practice and comfort with geriatrics. Results: We included 333 patient-caregiver dyads; mean age (SD) of patients and caregivers, respectively, were 76.8 (5.4) and 66.6 (12.1). Approximately 27%, 26%, and 16% of patients had lung, gastrointestinal, and genitourinary cancers, respectively. Mean PEACE score was 17.4 (2.5), indicating relatively high illness acceptance (Table). On regression analysis, patient psychological impairment domain (including both anxiety and depression) (B=-0.89; p>0.01), patient’s lower estimated life expectancy (≤1 vs. >5 years, B=-1.19, p=0.02), and lower caregiver education attainment (≤high school vs. college; B=-0.86; p<0.01) were associated with a lower illness acceptance. No physician variables were associated with PEACE. Conclusions: A better understanding of illness acceptance and its associated factors can facilitate patient-caregiver dyadic interventions to improve illness acceptance. [Table: see text]
Association between food insecurity and frailty among older adults with gastrointestinal malignancies: The CARE Registry.
Authors: Fowler Mackenzie Elisha , Harmon Christian , Sharafeldin Noha , Giri Smith , Williams Grant Richard 
Published: June 2023

12046 Background: Food insecurity is associated with higher gastrointestinal (GI) cancer mortality, but its association with frailty, a known predictor of premature mortality among older adults with cancer, is less understood. Our objective was to evaluate the association between food insecurity and frailty among older adults with GI malignancies. Methods: In this cross-sectional analysis, we included 424 older adults ≥60y recently diagnosed with GI cancer undergoing self-reported geriatric assessment (GA) at their first pre-chemotherapy visit to the University of Alabama at Birmingham oncology clinic. Food insecurity was the exposure of interest, defined using the 2019 United States Department of Agriculture Economic Research Service (USDA ERS) Low-Income, Low-Access (LILA) measure, which classifies census tracts based on income and/or access to food stores at various distances by urban-rural status. The primary outcome was frailty measured via the CARE Frailty Index, a composite measure based on the proportion of deficits across several GA measures (44 items in total). Frailty was dichotomized as frail or robust/pre-frail. We examined the association between LILA and frailty with modified Poisson regression accounting for census tract clustering. Results: Median age at study participation was 69 (IQR: 64, 76), 56.6% were male, 27.2% were non-Hispanic black, 31.4% had colorectal, 28.1% had pancreatic cancer, and 71.7% presented with stage III/IV disease. LILA versus non-LILA had a higher proportion of participants who were non-Hispanic Black (52.1% vs. 11.0%, p: < 0.001) and lower educated (high school or less: 50.6% vs. 35.0%, p: 0.020). After adjustment for age, race, sex, cancer type and stage, LILA was associated with 37% higher risk of frailty (RR: 1.37, 95% CI: 1.05, 1.80) versus non-LILA. Analysis of LILA sub-categories revealed that the overall effect may be driven by low income + low access at 1 mile for urban/10 miles for rural areas (RR: 1.47, 95% CI: 1.12, 1.94) and low income + low access at 0.5 mile for urban/10 miles for rural areas (RR: 1.39, 95% CI: 1.05, 1.85). Low income + low access at 1 mile for urban/20 miles for rural areas, low income + low access with a vehicle or at 20 miles, low income only, or low access only did not demonstrate a significant difference. Conclusions: Low income and low access to food stores is associated with higher risk of frailty among newly diagnosed older adults with GI cancers prior to systemic treatment. Intervening on food insecurity at the local level, particularly in areas with low income and low access, may be a target for improving rates of frailty among older adults with GI cancers. Future studies are needed to determine causality.
Overall survival outcomes in older patients with metastatic breast cancer: A National Cancer Database analysis.
Authors: Patel Rima , Kwon Deukwoo , Tiersten Amy 
Published: June 2023

12049 Background: Over the last few decades, improvements in healthcare have increased life expectancy by nearly 10 years resulting in a rise in America’s older population. As age is one of the most significant risk factors for the development of cancer, there is a projected increase in the incidence of cancer in the elderly population, with the largest absolute and relative increases in breast cancer (BC). Although treatment advances have improved outcomes for patients with metastatic breast cancer (MBC), patients in clinical trials are often younger and there is limited data for the older population. The goals of this study were to use the National Cancer Database (NCDB) to assess overall survival (OS) in older patients over 75 years of age with MBC and evaluate the impact of tumor features and demographic factors. Methods: Women with a diagnosis of BC at age ≥75 years and with metastases at time of initial diagnosis from 2010 to 2019 were identified from the NCDB. Patients were stratified into age subgroups of 75-79, 80-84, and ≥85 years. Chi-square tests were used to compare categorical variables. Kaplan Meier curves were used to determine OS distributions for patients by age, BC subtype and year of diagnosis. Log-rank tests and multivariable cox proportional hazards modeling was performed to assess the difference in OS by BC subtype. Results: Of 17,325 eligible women included in the final analysis, 39.4% were 75-79, 30.1% 80-84, and 30.4% ≥85 years of age. We observed an improvement in OS over time, with 5-year OS rates improving from 13.7% in 2010 to 15.2% in 2015, p = 0.017. Three-year OS rates were higher in patients aged 75-79 (34.2%) compared with patients aged 80-84 (28.7%) and ≥85 years (18.6%), p < 0.001. Outcomes varied by BC subtype with better prognosis in patients with hormone receptor (HR)+, HER2-negative BC (3-year OS 35.1%), followed by HR+, HER2+ (32.8%), HER2+, HR-negative (20.6%) and lastly, HR-negative, HER2-negative BC (9.7%), p < 0.001. Based on multivariable analyses, a higher comorbidity index was associated with worse outcomes (HR 1.654 [1.48-1.849], p < 0.0001). Higher income (≥$63,000) was associated with decreased mortality (HR 0.859 [0.784-0.941], p = 0.0011) compared with lower income ( < $38,000). While the type of cancer facility (academic, community, etc) did not impact mortality, older patients living in metropolitan areas ( > 1 million) had improved outcomes (HR 0.829 [0.689-0.996], p = 0.046), compared to those in rural areas. Conclusions: We observed a modest though significant improvement in survival outcomes over time in older patients with MBC. Prognosis was better in patients with HR+ BC compared with HR-negative, HER2+, and HR-negative, HER2-negative subtypes. However, outcomes in patients ≥85 years remain poor. Given the lack of clinical trial data in older patients with cancer, future studies should specifically focus on improving outcomes in this population.