bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do future innovations in development influence oncologists’ treatment recommendations today? A survey of U.S. oncologists.
Authors: Li Meng , Elsisi Zizi , Wong William Bruce , Kowal Stacey , Veenstra David L , Garrison Louis P. 
Published: June 2023

e24004 Background: Survival benefit from current anticancer treatments, even if modest, improves a patient’s chances of accessing and benefiting from future innovations currently in clinical development. No studies to date have evaluated the potential impact of future innovations on oncologists’ treatment recommendations. Methods: We conducted a national survey of medical and hematologic oncologists (n = 200) on how expectations about future innovations may influence their treatment recommendations today. The survey described a hypothetical patient with metastatic cancer, whose median overall survival (OS) was approximately 6 months with most dying within 2 years. We presented four alternative hypothetical scenarios of new innovations in the clinical development pipeline with varying (a) expected efficacy—“modest” (improvement in median OS of 2 months} or “breakthrough” (improvement in median OS of 6 months) and (b) time of arrival (in 6 months or 1 year). We asked the oncologists about the likelihood (using a 5-point Likert scale) (1) that they would discuss these new innovations with the hypothetical metastatic patient, and (2) that these new innovations would influence their recommended treatment for the patient today. We descriptively summarized percentages of oncologists who responded “likely” or “very likely” and examined their associations (using multivariate logistic regression) with the expected efficacy and time of arrival of future innovations as well as the characteristics of oncologists and their practice. Results: When future innovations were expected to have modest efficacy and arrive in 6 months, 61% of oncologists reported that they would be likely or very likely discuss them with their patients, and 52% reported new innovations would influence their treatment recommendations today. With modest efficacy and time of arrival in 1 year, percentages dropped to 49% and 41%, respectively. With breakthrough efficacy and arrival in 6 months, 76% would discuss and 68% would consider new innovations. With breakthrough efficacy and arrival in 1 year, percentages dropped to 62% and 55%, respectively. Greater expected efficacy and shorter time to arrival were associated with a significantly greater likelihood of discussing a future innovations with patients across oncologist and practice characteristics (adjusted odds ratios: breakthrough vs. modest = 1.75; 6 month vs. 1 year = 1.72). Conclusions: Future treatment innovations in clinical development are relevant for decision-making today even when anticipated time to arrival is two times the current median OS. results indicate that it is important to include future innovations in shared decision-making in addition to the benefit-risk balance of current treatments.
One way to provide effective healthcare services for patients with advanced cancer to improve their quality of life and survival: Prediction modeling using machine learning techniques and causal relationship between self-management strategy, health-related quality of life, and survival.
Authors: Jung Juyoun , Jung Kyung Hae , Koh Su-Jin , Yun Young Ho 
Published: June 2023

e24005 Background: In healthcare services, self-management strategies can play a crucial role in enhancing the health-related quality of life (HRQoL) or survival of cancer patients, regardless of their stage or treatment plan. However, there needs to be more research addressing the relationship between the strategies, HRQoL, and survival. To address this gap, we investigated the relationship between the strategies, HRQoL, and survival using machine learning techniques (MLT) and path analysis with structural equation modeling (SEM). Methods: This study was a secondary analysis of a randomized controlled trial (RCT) to provide early palliative care to individuals with advanced cancer (ClinicalTrials.gov, ID NCT03181854). We employed dimensional multiple Cox proportional hazard regression analyses to identify the crucial predictors of 1-year survival. By integrating the critical predictors extracted from the Cox regression models, we established a final survival prediction model using the eXtreme Gradient Boost (XGBoost) and the BorutaSHAP in MLT. Furthermore, we used path analysis to investigate the causal relationship between the strategies, HRQoL, and survival. Results: The univariate dimensional Cox models indicated that factors such as worse ECOG performance status (hazard ratio (HR) = 2.18), living alone (HR = 1.74), male (HR = 1.65), low global QoL (HR = 1.81), high dyspnea (HR = 2.30), high pain (HR = 1.75), high appetite loss (HR = 1.94), high constipation (HR = 2.11), high depression (HR = 2.79) at baseline, and no significant positive changes in emotional functioning (HR = 1.88) negatively impacted survival. The final XGBoost model for survival prediction using repeated K-fold methods (K = 5, repeats = 20, area under the receiver operating characteristic curve (AUROC) = 0.76, area under the precision-recall curve (AUPRC) = 0.87) and bootstrapping (n = 300, AUROC = 0.81, AUPRC = 0.91) showed high survival prediction performance. Additionally, the path analysis revealed a causal relationship between self-management strategies, HRQoL, and survival in patients with advanced cancer ( p-value = 0.005). HRQoL was found to have a complete mediating relationship between the strategies and survival. Self-management strategies did not directly correlate with survival but showed an impact on survival through HRQoL. Conclusions: To the best of our knowledge, this is the first study to uncover the connection between self-management strategies, HRQoL, and survival in patients with advanced cancer using MLT and path analysis. These findings have the potential to deepen our understanding of self-management strategies and aid healthcare providers in providing improved cancer care for patients with advanced cancer. Clinical trial information: NCT03181854 .
The financial toxicity of chemotherapy in Belize.
Authors: Wong Wayne , Dickerson James , Lattin John , Ohanian Alec , Habet Marta , Bernard Margaret , Huang Franklin W. , Yacab Ramoncito Argenes 
Published: June 2023

e24007 Background: In low- and middle-income countries (LMICs) such as Belize, large fractions of healthcare costs are borne directly by patients. In these settings of minimal insurance coverage and a fragmented healthcare system, evaluating the extent of financial toxicity is paramount to understanding direct barriers to care delivery. We surveyed Belizean cancer patients in 2022 who were receiving chemotherapy at the only public oncology clinic in the country, established at the Karl Heusner Memorial Hospital (KHMH) in 2018, to quantify financial toxicity. Methods: A convenience sample of patients at the KHMH oncology clinic were surveyed between February and March 2022. Patients who consented during their infusion appointment were given a tablet with a 21-question survey (English or Spanish). This survey was developed from the FACT-G and COST tools adapted specifically for LMIC settings. Answers were on a 5-point Likert scale. We provide descriptive statistics of the population and survey responses. Results: Median age of survey participants (n = 32) was 51 (IQR 43 – 62), 84% were female and 53% unemployed. 71% were uninsured. Those insured were covered by the Belizean government’s National Health Insurance which does not include oncologic care. Most patients (72%) had traveled from another district for treatment at the clinic in Belize City. Cancer types represented were breast (42%), gastrointestinal (27%), gynecologic (27%), and lymphoma (4%); 75% of patients had either stage 3 or 4 disease. 56% agreed with the statement “I am having financial problems with cancer treatment,” 31% disagreed, and 13% neither agreed nor disagreed. Patients were allowed to indicate multiple contributors to financial hardship during treatment, with costs of chemotherapy cited most often (50% of patients), followed by transportation costs (38%), hospital fees (22%), food (12%), and housing (9%). 25% of respondents agreed with the prompt “It is difficult to come to all of my appointments,” with transportation being the most cited reason (88%). Conclusions: In our survey, more than half of Belizean cancer patients on chemotherapy reported financial hardship with their treatment. Drivers of toxicity were the cost of chemotherapy and travel. Our sample, predominately female, unemployed, uninsured, and from less wealthy districts, had sociodemographic factors that suggest a high risk for financial toxicity during cancer treatment. Though limited by the small sample size, this study prompts further investigation and more precise quantification of financial toxicity in Belize. These preliminary data have begun conversations within the Ministry of Health for inclusion of chemotherapy under the covered medications list by public health institutions.
Clinical benefit (rate) of geriatric assessment in a Veterans Affairs (VA)-based oncology clinic according to the Geriatric 5Ms framework.
Authors: Gregorio Dave , Shaker Sarah , Powers Becky , Arora Sukeshi Patel , Banwait Ranjit Singh , Datta Paromita 
Published: June 2023

e24010 Background: The geriatric assessment (GA) is a validated, multi-system assessment tool that can detect vulnerabilities often not captured with standard oncology assessments in older adult patients with cancer. The Geriatric 5Ms is a novel communication framework used to describe core competencies in geriatrics. Prior studies have shown GA integration in oncology practice can significantly reduce grade 3 or higher chemotherapy-related toxicities, falls, polypharmacy, hospital length of stay (LOS), increase completion of advanced directives, and improve quality of life measures. Despite these benefits, implementation into clinical practice has remained low. This study aimed to utilize telemedicine to integrate GA into a busy VA oncology practice. Methods: In this quality improvement study design, we enrolled adult patients aged 70 years and older with solid tumors or hematologic malignancy, either newly established or receiving active systemic treatment through an urban, academic VA oncology clinic. Patients were assigned to the intervention (GA conducted via telemedicine by a geriatric specialist) if they scored ≤14 on G8, a validated screening tool. Outcomes were compared with a historical control cohort who received usual care (no virtual GA). Reported here are the clinical benefits measured qualitatively according to the geriatric 5Ms framework. Results: Between January 1, 2022 and March 30, 2022, we enrolled 116 patients (n = 57 intervention, 59 control) from a US VA-based population. Patients had a mean age of 76.8 (SD 6.2) between both cohorts and all patients were male (100%). Among patients in the intervention cohort, all patients (100%) derived benefit in at least one element of the 5M’s framework (Mind, Mobility, Medications, Multicomplexity, and Matters Most) from GA. Based on findings from the GA, services were provided in each of the 5M’s categories in the following frequencies: multicomplexity (88%), matters most (71%), medication (58%), mentation (50%), and mobility (46%). Conclusions: Incorporating GA via telemedicine into routine oncologic care was feasible within this VA-based population of older adult patients with cancer. Further, this project led to clinic recognition as an Age Friendly Health System by the Institute for Healthcare Improvement (IHI). When routinely performed, geriatric assessment led to clinical benefit among all patients receiving the intervention according to the 5M’s framework. Future studies will compare the clinical benefits of this intervention to clinical outcomes measures such as hospital length of stay, emergency room utilization, therapy toxicity, and survival among this patient population.
The role of Chinese acupuncture plus herbal decoction for chemotherapy induced cognitive impairment in elderly cancer patients.
Authors: Lv Guangmei , Hu Meng , Liang Wei , Wan Haijun Wan , Zhao Sunyan , Ha Wentao , Gong Yongling 
Published: June 2023

e24018 Background: Elderly cancer patients would suffer cognitive impairment due to chemotherapy, and a series of neurocognitive symptoms, known as "chemobrain". Chinese acupuncture plus herbal decoction is an emerging therapeutic option for chemotherapy-induced cognitive impairment in elderly cancer patients, despite limited supporting evidence. By evaluating this novel Chinese medicine mode in elderly cancer patients at our institution, we aimed to contribute to the existing knowledge in this area while establishing a basis for further research. Methods: We performed a retrospective review of all cases of “chemobrain” related elderly cancer patients treated with Chinese acupuncture plus herbal decoction between 2019 and 2022. We identified 168 elderly cancer patients with clinically confirmed chemobrain; 83 were treated with electroacupuncture (2 sessions per week over 8 weeks) plus herbal decoction(Chines herbal medicine); 85 received either conventional drug therapy, or palliative-intent therapy. The Montreal Cognitive Assessment(MoCA) served as the primary outcome. Digit span test was the secondary outcome for attentional function and working memory. The quality of life and multiple functional assessments were also evaluated. Results: Those with Chinese acupuncture plus herbal decoction had much better performance than the remainder(as control), reverse digit span test at Week2 and Week8, with medium eﬀect size of 0.53 and 0.48, respectively, the difference in MoCA score and prevalence of chemobrain between cohorts was underpowered and not statistically significant. Higher baseline ECOG and comorbidity was noted in the latter cohort. Conclusions: These results suggest that Chinese electroacupuncture plus herbal decoction might have particular beneﬁts in reducing chemotherapy-induced working memory impairment and could markedly reduce various side effects caused by cytotoxic chemotherapy drugs.
Thyroid dysfunction and immune checkpoint inhibitors: Effect on survival in elderly patients.
Authors: Donisi Clelia , Pretta Andrea , Lai Eleonora , Liscia Nicole , Cadoni Andrea , Persano Mara , Mariani Stefano , Pinna Giovanna , Spanu Dario , Saba Giorgio , Migliari Marco , Dubois Marco , Atzori Francesco , Dessì Mariele , Puzzoni Marco , Pusceddu Valeria , Ziranu Pina , Madeddu Clelia , Massa Elena , Scartozzi Mario 
Published: June 2023

e24020 Background: Aging inevitably leads to an accumulation of senescent cells, and immune system cells aren't an exception. They can contribute to a pro-inflammatory state and be involved in the immune escape of cancer cells through a boosted PD-L1 expression. Immunocheckpoint inhibitors (ICIs) represent the standard of care in several cancer histotypes, and immune-related adverse events (irAEs) seem to be associated with better outcomes. ICIs represent a valid therapeutic agent in elderly patients too. However, there is a lack of data on irAEs and outcomes correlation in this subgroup of patients. This retrospective-prospective study aims to evaluate the relationship between thyroid dysfunction and progression-free survival (PFS) and overall survival (OS) in elderly patients undergoing ICIs. Methods: From January 2019 to January 2023, we retrospectively collected data from 65 elderly patients under treatment with ICIs at the Medical Oncology Unit of the University Hospital and University of Cagliari, Italy. All patients were affected by stage IV disease. The primary endpoint was PFS and the secondary endpoint was overall survival OS. Statistical analyses were performed using the MedCalc Statistical Software Version 20.216. Results: The median age was 76 (± 5,5); 15.38% were female, whereas 84.62% were male. The histologies were: melanoma (26.9%), lung cancer (48.0%), kidney cancer (15.3%), and colorectal cancer (9.8%). Compared to those without thyroid dysfunction during immunotherapy treatment, individuals with thyroid irAE had, at univariate analysis, longer median PFS (68 versus 26 months, p = 0.02, CI 95% 18.0-68.0, HR 0.29 0.10-0.83) and longer median OS (59 versus 39 months, p = 0.04, CI 95% 25.0-90.0 HR 0.50 0.25-0.99). Conclusions: In an era where biomarkers for immunotherapeutic agents are lacking, thyroid dysfunction irAE could be a predictive factor of better PFS and OS in elderly patients affected by cancer of various histology.
Validation of the distress thermometer score in a geriatric oncology population.
Authors: Zuber Charlotte , Swartz Kristine , Chapman Andrew E. , Rhodes Lora , Zhan Ting Ting , Wen Kuang-Yi 
Published: June 2023

e24030 Background: The geriatric oncology population is uniquely vulnerable to increased levels of psychological distress due to age related challenges such as social isolation, change in lifestyle, and comorbid conditions. In the general population, higher levels of psychological distress have been shown to impact treatment course, quality of life, and survival. The NCCN Distress Thermometer (DT) is a validated fast and effective screening tool for psychological distress, with a cutoff score of 4 yielding optimal sensitivity and specificity in a general cancer population. However, the best cutoff for detecting psychological morbidity in older cancer patients is unclear. In this study, we aim to compare the sensitivity and specificity of various cutoff values for the Distress Thermometer score to predict Geriatric Depression Scale (GDS) score. Methods: Data is derived from 242 geriatric oncology patients from the Senior Adult Oncology Center at Jefferson Health. Using a cutoff of 5 for the GDS as the clinical standard guideline, we use receiver operating characteristic (ROC) curve analysis of the univariable logistic regression model to predict clinical depression. Results: A cutoff DT score of 3.5 was found to be most sensitive and specific (0.66,0.68) for predicting clinical depression (Area Under the ROC Curve (AUC) = 0.70). Multivariable logistic regression including age improved the predictive ability of the DT score to an AUC of 0.75. Conclusions: The increase in AUC with the addition of age indicates the potential use of a composite value of age and DT score to best determine at-risk patients in a clinical setting. While these results indicate the utility of the Distress Thermometer as an effective screening tool in the geriatric oncology population, our findings also suggest that a lower threshold score is advised for clinicians who are hoping to identify older cancer patients who are distressed. Patients who meet the threshold criteria would then be assessed further for triage into appropriate levels of geriatric supportive services.
Risk factors for falls and fear of falling among older patients with cancer.
Authors: Gomaa Sameh , Swartz Kristine , Chapman Andrew E. , Zhan Tingting , Wen Kuang-Yi 
Published: June 2023

e24032 Background: Cancer is a disease of the elderly with more than 60% of all cancers diagnosed in adults age 60 or older. Falls pose a substantial risk for older cancer patients leading to hip fractures, traumatic brain injury, and are the leading cause of injury-related hospitalizations in persons aged 60 and older. This risk is due to aging changes compounded by the effect of cancer and cancer therapy. This report aims at understanding risk factors for falls and the perception of fear of falling (FOF) among older patients with cancer. Methods: As a single-site, retrospective cohort study, data was derived from 249 geriatric oncology patients from Senior Adult Oncology Center at Jefferson Health. The primary endpoints are the number of falls in the preceding 12 months and FOF as part of a self-reported fall screening. Multivariate logistic regression model was used to identify the independent risks factors by including patients’ age, sex, race/ethnicity, BMI, polypharmacy, cancer types, ECOG scores, Timed up and go (TUG) test, CARG toxicity scores, Mini-Cog, frailty status and depressive symptom for each endpoint separately. Results: Majorities were White (62.1%) and female (57.2%) with a mean ages of 78.1 (SD = 8.7). The most common cancers diagnosed were hematologic malignancy (34.1%), gastrointestinal (23.4 %) and breast cancer (16.1%). 26.1% experienced one or more falls in the past 12 months and 28.9% were worried about falling. Average CARG score is 10.1 (SD = 3.8). 50.4% had an abnormal TUG tests and 23.6% had an abnormal Mini-Cog. In the multivariate logistic regression, CARG score (OR = 1.46 95% CI = 1.30 - 1.65, p = 0.000) was associated with falls in the past 12 months after adjusting for confounders. Further, both abnormal TUG (OR = 4.63 95% CI = 2.12-10.13 p = 0.000) and increased CARG score (OR = 1.17 95% CI = 1.05-1.31 p = 0.005) were associated with FOF. Conclusions: Falls and FOF are common among older cancer patients in our cohort. As the CARG toxicity score found as a major predictor for prior falls, our findings suggest the importance of future toxicity risk-tailored interventions which could potentially lead to the prevention of further falls. We also found that the TUG test and CARG were associated with FOF, which might diminish older cancer patient’s confidence in participating in daily activities. Future research is needed to investigate causal relationship among comprehensive risk factors and the efficacy of tailored interventions.
Is Karnofsky performance scale a proxy measure of frailty phenotype in older adults with cancer?
Authors: Parala-Metz Armida , Lasheen Wael , Haggstrom Daniel Ernest , Induru Raghava Reddy , Caprio Anthony James , Walsh Declan 
Published: June 2023

e24035 Background: The use of performance status (PS) assessments in patients with cancer is a common practice to determine their suitability for treatment, clinical trial enrollment, and prognosis. The Karnofsky Performance Scale (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG PS) score are widely used clinical instruments for this purpose. However, these tools are subjective and unidimensional, with potential for bias, and were validated in younger patients. KPS has demonstrated greater specificity than ECOG in evaluating PS. Frailty, a dynamic medical syndrome characterized by diminished strength, endurance, and reduced physiological function, is recognized as a predictor of vulnerability to adverse outcomes, especially in older adults with cancer. The Fried Frailty Phenotype (FP) is a widely validated tool that uses both objective and subjective measures to identify frailty based on presence of 3 or more criteria: unintentional weight loss, self-report of exhaustion (fatigue), weakness (measured by grip strength), slow walking speed, and low physical activity. Our study compares physician-rated KPS with FP (fit, prefrail, frail) and looks at correlation of both tools in older adults with cancer. Methods: Data from older adults with solid tumor malignancies referred to the geriatric oncology clinic for geriatric assessment (GA) from January 2015–August 2019 were abstracted. Physician-rated KPS (0-100) were categorized into 3 groups: normal activity, high functioning (80–100); intermediate, capable of self-care but unable to do active work (70); and poor PS, requires considerable assistance (<60). These were compared to FP which classified patients based on the number of frailty criteria present: fit (0), prefrail (1-2), and frail (>3). Frequency data calculation and bivariate analysis were done. Results: 241 older adults with cancer completed a GA, median age of 80 years, 52% female. 57% were frail, 37% prefrail, and 6% fit. 90% of patients with KPS 80-100, had prefrail and frail phenotypes. Patients with KPS 70 had 24% prefrail and 76% frail phenotypes and those with KPS < 60 had 10% prefrail and 90% frail phenotypes. Conclusions: Majority of older patients with prefrail and frail phenotypes were assessed as high functioning (KPS 80-100). KPS is an inadequate substitute for FP and should not be used alone in assessing functional status of older adults with cancer.