bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk and protective factors for dementia in cancer survivors vary by cancer type.
Authors: Neth Bryan , Graff-Radford Jonathan , Alden Eva , Botha Hugo , Raghunathan Aditya , Johnson Derek R. , Lachance Daniel Honore , Petersen Ronald C. , Jack Clifford R. , Vemuri Prashanthi , Cerhan James Robert , Knopman David S. 
Published: June 2023

e24089 Background: Little is known about risk and protective factors for dementia in cancer survivors. With increasing longevity due to improved cancer therapy, it’s prudent to study factors contributing to cognitive impairment in this patient population. Methods: We performed multivariable cox regression analyses to assess established risk factors for all-cause dementia (age, education, APOE4-status, social and physical activity engagement) in breast and prostate cancer survivors. Patients 50+ years old with pathology-confirmed cancer diagnosis at Mayo Clinic were identified from a longitudinal, population-based cohort – Mayo Clinic Study of Aging. Analyses were controlled for age, APOE4-status, education, and cancer treatment. Results: We included a total of 209 patients with breast cancer (mean age 75.4 years, 24% APOE4-positive, median follow-up 6.8 years) and 352 with prostate cancer (mean age 77 years, 26% APOE4-positive, median follow-up 6.4 years). 31 patients with breast cancer (15%) and 66 patients with prostate cancer (20%) were diagnosed with dementia at last follow-up. Older age was associated with increased risk for dementia (5-year increase – breast: hazard ratio (HR) 1.9 [95%CI 1.3-2.7, p = 0.001]; prostate: HR 2.4 [95%CI 1.8-3.2, p < 0.0001]). APOE4-positivity was associated with increased dementia risk in breast (HR 3.6 [95%CI 1.6-7.8, p < 0.002]), but not prostate cancer (HR 1.2 [95%CI 0.7-2.0, p = 0.5]). More education was associated with lower dementia risk in prostate cancer (education year: HR 0.91 [95%CI 0.84-0.98, p < 0.02]; education years > 12: HR 0.26 [95%CI 0.1-0.6, p < 0.001]). Physical activity engagement in mid-life was associated with lower dementia risk (prostate: HR 0.56 [95%CI 0.4-0.8, p < 0.005]; breast: HR 0.48 [95%CI 0.3-0.9, p < 0.02]). Conclusions: In this longitudinal, population-based study we found that some risk and protective factors for dementia in cancer survivors vary by cancer type. While advanced age is an expected dementia risk factor, there were mixed results for APOE4-positivity (increased risk only in breast cancer) and education (only protective in prostate cancer). Our results support further study into factors influencing dementia risk by cancer type in hopes of identifying preventative strategies.
Delayed immune toxicities in patients with breast cancer receiving immune checkpoint inhibitors.
Authors: Jacob Saya , Quandt Zoe , Melisko Michelle E. , Majure Melanie , Chien Amy Jo , Blaes Anne Hudson , Heditsian Diane , Esserman Laura , Rugo Hope S. 
Published: June 2023

e24091 Background: Immune checkpoint inhibitors (ICI) have improved outcomes in patients with breast cancer, however management of immune-related adverse events (irAE) remains a challenge. Delayed irAE after cessation of ICI have been observed. We sought to characterize delayed irAE occurring at our center. Methods: We identified patients with breast cancer who received ICI at UCSF using ICD codes specific to ICI administration between 2012-2018. After IRB approval, charts were reviewed for delayed irAE. Delayed irAE were defined as occurring >60 days after the last ICI dose; events were counted as irAE if provider notes indicated that the toxicity was/possibly was related to ICI. Data were securely stored using RedCap. Results: We reviewed 100 consecutive patients who underwent ICI (56 metastatic, 44 localized) of which 11 (2 (4%) with metastatic disease, 9 (20.5%) with localized disease) developed delayed irAE. Median age was 42. 3 patients had HR+ disease, 8 patients had triple negative disease. 10 patients received ICI on a clinical trial, including 9 on the neoadjuvant ISPY2 trial. 10 patients received pembrolizumab; 1 received durvalumab. Median number of ICI doses was 4, median follow-up time after last ICI infusion was 46 months. 14 incidences of delayed irAEs were identified (Table). 9 patients experienced both delayed and early irAE. 7 patients experienced 2 irAEs: 1) three dermatitis & delayed hypophysitis/adrenal insufficiency (AI) 2) one AI & delayed thyroiditis 3) one dermatitis and delayed colitis 4) one elevated transaminases & delayed colitis 5) one delayed elevated transaminases and delayed thyroiditis. One patient had 3 irAEs (thyroiditis, delayed AI & delayed arthralgia) and one patient had 4 irAE (colitis, dermatitis, delayed elevated transaminases & delayed neutropenia). Of the 9 patients with > 1 irAE, 3 experienced > 1 delayed irAE (thyroiditis + elevated transaminases; arthralgia + AI; elevated transaminases + neutropenia). All irAE either self-resolved, resolved with systemic steroids or indefinite hormone replacement. 6 irAEs required systemic steroids, not including hydrocortisone replacement for AI. Conclusions: Delayed irAE may occur months after ICI cessation and require awareness for identification. Patients who experience irAE may be more likely to develop additional irAE at either a delayed or earlier time point. Most patients with delayed irAE experienced an irAE at an early time point. Future directions include identifying risk factors for early and delayed irAEs to inform treatment decisions. [Table: see text]
Toxicities associated with sacituzumab govitecan: Data from clinical trials and real-word pharmacovigilance database.
Authors: Mei Xiangping , Tan Qiaoyun , Yao Jing 
Published: June 2023

e24093 Background: This study aimed to analyze the adverse effect of sacituzumab govitecan (SG) with multiple source data, to provide reference for clinical medication safety management. Methods: Clinical trials of SG with available safety data were searched and included in the pooled analysis (up to January 5th, 2023). The adverse drug reaction (ADR) signals of SG were collected from the FDA Adverse Event Reporting System (FAERS) database up to January 1st, 2023. The ADR signals were presented and sorted by incidence frequency and reporting odds ratio (ROR) strength, respectively. We also searched and summarized drug interactions with SG in DDInter database. Results: A total of 6 clinical trials enrolled 1737 patients were included in pooled analysis, the most common adverse events of ≥3 grade were neutropenia (51.55%), leukopenia (14.50%), anemia (10.69%), diarrhea (7.30%), fatigue and asthenia (4.23%). In pharmacovigilance study, 1024 AE reports were extracted, the most common toxicities of SG are hematologic and gastrointestinal. AEs not included in the instructions also showed high signals, such as meningitis, colitis and lymphedema. A total of 40 drugs identified can induce drug-drug interaction when concomitant administration with SG. Conclusions: This study provides a comprehensive profile of SG based on clinical trial, FRAES and DDInter database, attention should be paid not only to the common ADRs, but also to the ADRs not reported in the drug instructions and potential drugs that induce drug-drug interactions. [Table: see text]
Non-hematopoietic cell transplant-related veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) in solid tumor and hematologic malignancies: A systematic review.
Authors: Stewart Fiona , Ruiz Kimberly , Gill Malia , Devani Darsh , Fusco Nicole , Fan Lin , Amber Vian , Hanvesakul Raj , Gangi Alexandra 
Published: June 2023

e24094 Background: VOD/SOS is a serious liver injury caused by toxic damage to sinusoidal endothelial cells. It has been linked to conditioning regimens preceding hematopoietic cell transplant (HCT) but little is known about its epidemiology and characteristics outside the HCT setting. We conducted a systematic review to examine the incidence, burden of illness, and management of non-HCT VOD/SOS. Methods: We searched MEDLINE, Embase (2002–2022), and relevant congress proceedings (2019–2022) for studies reporting incidence, diagnosis, clinical and patient characteristics, humanistic and economic burden, and treatments in non-HCT VOD/SOS. All study designs were eligible except case series of < 5 patients. Pyrrolizidine alkaloid-induced VOD/SOS was excluded. Results: We identified 3,544 records and included 80 studies; 58% were retrospective cohort studies. Sample sizes ranged from 5 to 12,941; 38% of the studies included > 100 patients. The highest incidences of non-HCT VOD/SOS were in patients with colorectal liver metastases (CLM) (median 41%) and Wilms tumor (median 14%) (table). Diagnostic criteria were heterogenous. Rubbia-Brandt histological criteria were used in CLM. In other disease settings, diagnosis varied and was based on clinical criteria (eg, McDonald, Seattle, or Baltimore). Management of VOD/SOS included defibrotide, supportive therapy (eg, fluid restriction, blood products) and switching/pausing chemotherapy. No usable data were found on humanistic/economic burden. Conclusions: Non-HCT VOD/SOS occurs in diverse disease areas, including hematologic and solid tumor cancers. Lack of consensus regarding diagnosis of non-HCT VOD/SOS may indicate underdiagnosis. Clinicians should be vigilant for VOD/SOS even in non-HCT patients. Defibrotide is approved for post-HCT VOD/SOS but there is no approved therapy for non-HCT VOD/SOS; future trials should focus on diagnosis and treatment outside the HCT setting, which represents a significant unmet need. A limitation of the current work is the suboptimal reporting and low methodological quality in some primary studies.[Table: see text]
Trends and factors related to pregnancy after breast cancer treatment in young patients.
Authors: Lee Young-Jin , Lee Young Joo , Yoo Tae-Kyung , Lee Sae Byul , Kim Jisun , Chung Il Yong , Ko Beom Seok , Lee jong Won , Sohn Byung Ho , Kim hee Jeong 
Published: June 2023

e24095 Background: In women of reproductive age who have been treated for breast cancer (BC), interest in fertility preservation (FP) is as important as treatment. Although methods for FP are already well known, sufficient information is not provided about the pregnancy results at specified BC stage or treatment. This study was designed to retrospectively analyze and provide information on fertility preservation attempts and actual pregnancy in women of childbearing age who had been diagnosed with BC for the past 10 years. Methods: We retrospectively reviewed women of childbearing age (18-40 years) with treated at single tertiary medical center from December 2010 to September 2020. The relationship between the tumor characteristics and treatments and actual pregnancy was analyzed. Time from diagnosis to pregnancy was analyzed according to tumor characteristics and treatments. During the period, intensive education on FP was offered to the patients from 2014, and whether there were any changes in the results before and after this was also analyzed. Results: A total of 1033 patients were included, representing 115 patients who were pregnant during the observation period. Overall, 519 (50.2%) patients were offered fertility counseling, 81 (7.8%) patients get oocytes or embryos preservation and 456 (44.1%) patients underwent Gonadotrophin hormone receptor analogue (GnRHa) for FP. Our analysis showed differences in pregnancy rates for age at diagnosis ( P= .002), HR (Hormone receptor) status ( P=.015), and hormonal therapy ( P= .004), among them, there was a significant difference in pregnancy timing only for HR (2.53 vs 3.42 years, P= .009) and hormonal therapy (2.39 vs 3.56 years, P<.001). There were 93 patients who stopped taking tamoxifen for preparing pregnancy, and 53 patients succeeded in becoming pregnant. In this cohort there were no significant difference in pregnancy rate for age, tumor characteristics, stage and treatments. Conclusions: Tumor characteristics which required endocrine therapy was related to the pregnancy rate and time to conception. However, more than half of the women who actively consulted with their doctor for pregnancy and interrupted endocrine therapy within first five years had a successful pregnancy and also were not inferior in disease free survival. Most of FP was still predominantly underwent with concurrent GnRHa use. In young women who want to preserve fertility, it is important to provide such information and make mutual decisions for active FP.[Table: see text]
Quality of life in patients diagnosed and treated for breast cancer in Uruguay.
Authors: Camejo Natalia , Amarillo Dahiana , Castillo Cecilia , Guerrina Maria , Savio Florencia , Carrasco Mariana , Strazzarino Noelia , Hernandez Ana Laura , Herrera Guadalupe , Krygier Gabriel David 
Published: June 2023

e24096 Background: Breast cancer (BC) and its treatment can impair patient quality of life (QoL), and those undergoing more aggressive treatments may be more severely impacted. Objective: Assess the level of perception of the QoL of patients treated for BC at the Hospital de Clínicas and the Departmental Hospital of Soriano. Methods: A questionnaire for cancer patients (EORTC, QLQ-C30) and one specific for BC (EORTC QLQ-BR23) were used. Results: A total of 158 patients who had completed chemotherapy treatment at least one year prior to the evaluation were enrolled. The average age was 61 years old. QLQ-C30 questionnaire: the global QoL score (GQOL) was high: 70.9. Patients undergoing breast-conservation surgery (BCS) had better scores in physical and emotional functioning (p < 0.005) and presented less frequently with: pain, constipation and financial difficulties (p < 0.005). Those undergoing sentinel lymph node biopsy (SLNB) had higher scores for GQOL and for physical, role and social functioning scales (p < 0.001) and had less fatigue, pain, insomnia and financial difficulties (p < 0.005). Questionnaire QLQ-BR23: sexual functioning and sexual enjoyment scales were relatively low. Patients undergoing BCS had better scores on the functional scales: body image and future outlook; and fewer breast symptoms (p < 0.005). Those undergoing SLNB also had better scores on the functional scales for body image and future outlook future and presented less frequently with symptoms (p < 0.005). Conclusions: Patients had high values on the GQOL scale, those undergoing BCS and SLNB had better scores on most functional and problem/symptom scales. The implementation of intervention strategies aimed at improving the quality of life and the physical and emotional care of patients is recommended. Uruguayan BC patients experience high values on the GQOL scale, those undergoing BCS and SLNB had better scores on most functional and problem/symptom scales. Patients undergoing BCS had better scores in physical and emotional functioning and presented less frequently with: pain, constipation and financial difficulties. With respect to the type of axillary surgery received, patients who underwent SLNB had higher scores on the GQOL scale and on the physical, role and social functional scales. The implementation of intervention strategies aimed at improving the quality of life and the physical and emotional care of patients is recommended.
Obesity and toxic habits as avoidable determinants of chronic peripheral neuropathy induced by chemotherapy (NPCIQ): NeuroPredict project.
Authors: Vargas Alicia , Contreras María José , De la Haba María , Cano Maria Teresa , Morales-Estevez Cristina , Porras Ignacio , Pulido Gema , Flores Paco Pablo , De La Haba Juan , Aranda Enrique 
Published: June 2023

e24097 Background: Anti-tumor therapy is the most frequent cause of toxic neuropathy in the Western population. Unlike its acute presentation (AN), chronic neuropathy appears during treatment and persists for more than six months after the end of chemotherapy, significantly limiting the quality of life of many patients. Although it is a drug-dependent toxicity, there is scarce evidence about its frequency and the factors that are determinant in its development. The main objetive is to know the incidence of NPCIQ as well as to identify factors that predispose to its appearance. Methods: We retrospectively selected 98 patients treated with adjuvant chemotherapy with paclitaxel (P) (80mg/m2/weekly) or oxaliplatin (O) (130 mg/m2/every 3 weeks), establishing three groups: Group A and B: Patients treated with P or O and who have developed NPCIQ and Group C patients treated with P or O and who have not developed NPCIQ.Group A P+ NPCIQ: 34 (33,3 %), Group B O+NPCIQ: 27 (26,5 %) and Group C non-NPCIQ: 37 (36,2%). Results: Of the 79 patients who developed AN, 61 (77,2%) developed NPCIQ, of these 34 due to paclitaxel and 27 due to oxaliplatin. Those patients with a body mass index > 30 or toxic habits developed NPCIQ more frequently: 24% vs 36% and 24% vs 42% (p: 0.054) respectively (Table 1).The obesity impact on NPCIQ is statistically significative for paclitaxel group (p: 0,027). Conclusions: NPCIQ is a frequent toxicity, there are avoidable factors such as obesity, smoking and alcohol that can influence its development. Recommendations aimed at avoiding overweight or the consumption of alcohol and tobacco may be useful to reduce the incidence of NPCIQ. [Table: see text]
Relative and functioning sleep disturbance and fatigue: Impact on patients with ovarian cancer.
Authors: Andac-Jones Elif , Newell Abigail , Szamreta Elizabeth A. , Gonzalo Maria Belen , Hoffman Juliette , Monberg Matthew 
Published: June 2023

e24102 Background: Sleep disturbance and fatigue are prevalent among ovarian cancer patients and are associated with poor mental health and Health-related quality of life (HRQoL) outcomes; while this has been well-documented, we know less about the factors that may contribute, what cancer patients perceive as contributing to their issues, and how they describe and manage these issues across their treatment trajectory. Methods: In this qualitative study, data were collected via semi-structured interviews with 20 stage III/IV ovarian cancer patients diagnosed within three years with varied treatment trajectory, race/ethnicity, and location. A screener included PROMIS Sleep Disturbance and Fatigue measures, sociodemographics, and cancer history. Transcripts were analyzed using deductive codes of sleep and fatigue and inductive codes based on emergent themes. We identify two novel concepts of patients’ sleep and fatigue experiences: relative and functioning. Relative fatigue and sleep issues capture how patients self-report relative to different points in their treatment. Functioning concept shows how patients reinterpret and self-censor the severity and impact of their sleep and fatigue by emphasizing their ability to overcome exhaustion or insomnia. Results: All twenty patients reported persistent, debilitating fatigue, difficulty falling and staying asleep through the course of their disease, which negatively impacted their HRQoL and activities of daily living. The majority of patients struggled to complete daily chores (17/20), keep up with paid work (9/10), and maintain relationships(16/20). Although patients experience fatigue across their trajectories, the majority of patients described their fatigue as more intense during chemotherapy than maintenance therapy. Patients struggled to evaluate their current fatigue and sleep without reflecting on previous treatment experiences (relative), and continuously reinterpreted their levels of fatigue and sleep based on how much of their daily functions they could complete (functioning). Patients self-censor in reporting to meet their perceived expectations of their care provider/data collector . Although fatigue and sleep disturbance significantly impaired their HRQoL, patients framed their experiences positively and minimized their struggles. Conclusions: We conclude that PROMIS measures are important in evaluating baseline sleep disturbance and fatigue in patients with ovarian cancer. However, patients’ reporting is informed by their previous treatment experiences, subject to continued reinterpretation. Therefore 1) more nuanced and repeated measures including patients’ narratives are needed to understand the complexity of patients’ experiences; and 2) Patients’ self-censorship and filtering need to be considered. Future research will test these new concepts with a 200 patient survey.
Hypertriglyceridemia associated with the use of capecitabine in a Mexican cohort.
Authors: Luna Palencia Rosa Luz Luna , Macedo Perez Eleazar Omar 
Published: June 2023

e24107 Background: Capecitabine is a prodrug activated to its cytotoxic form 5-fluorouracil by thymidine phosphorylase whose active metabolites inhibit DNA synthesis by reducing thymidine production and also inhibits RNA and protein synthesis by competing with uridine triphosphate. Capecitabine is used in many types of tumors and its main reported side effects are diarrhea, hand-foot syndrome and hematologic toxicity. Methods: Retrospective analysis of a cohort of patients visited in a private hospital in Mexico City, that has a basal triglyceride profile and at least two determinations during treatment with capecitabine with or without oxaliplatin. Results: We analyzed 14 patients with a mean age of 55 years (IQR 40-73), 12 patients with colorectal cancer, 78.5% in the adjuvant setting, a half of patients with capecitabine monotherapy and the other half in combination with oxaliplatin. Comorbidities as overweight/obesity were seen in a half of the patients, diabetes in 21.4% and hypertriglyceridemia at baseline in 57.1% of patients all of them G1. The mean baseline glucose was 99.5 mg/dl (IQR 74-174), the mean baseline cholesterol was 180.8 mg/dl (IQR 85-243), the mean baseline triglycerides was 153.3 mg/dl (IQR 85-243). During capecitabine treatment a total of 85.7% of patients developed hypertriglyceridemia: G3/4 of 21.4%, G2 of 28.5%, G1 of 35.7%. No patient developed a serious complication associated with hypertriglyceridemia such as pancreatitis. There was no association between monotherapy or combination treatment with oxaliplatin, of patients with grade ≥2 hypertriglyceridemia, five received capecitabine monotherapy and two in combination with oxaliplatin. Also, no association was found among the highest levels of cholesterol, glucose, disease stage, age or body mass index. All of the 6 patients with normal baseline triglycerides developed hypertriglyceridemia 66.6% G1 and 33.3% G2. All the patients who present with hypertriglyceridemia G3/4 had baseline hypertriglyceridemia and 66.6% also diabetes. Conclusions: This analysis shows the high prevalence of hypertriglyceridemia associated with the use of capecitabine as monotherapy or combined with oxaliplatin in a Mexican cohort, with an incidence of 21.4% of hypertriglyceridemia G3/4 having the pre-existing hypertriglyceridemia and diabetes as risk factors. The cause of the worsening of the lipid profile requires more research but justify lipid profile at baseline and during the treatment with capecitabine. Due to the small size of the sample, the findings need to be confirmed with a prospective study with a larger number of patients.