bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malnutrition screening in cancer patients on chemotherapy.
Authors: Gudipally Sindusha R , Tayyem Ala'a , Venkatesan Rohit , Willis Maurice 
Published: June 2022

e18640 Background: Malnutrition occurs in 40-80% of cancer patients and has great impact on quality of life and treatment outcomes. The essential elements of malnutrition for patients with cancer are early identification of patients at greatest risk, nutrition assessment to determine the level of deficit, and appropriate nutrition intervention. Currently we don’t have a standard tool to identify patients who are malnourished on chemotherapy and nutrition referrals were placed based on provider's subjective assessment. Methods: From March 2020 to August 2020, 41 patients on chemotherapy were reviewed, of which 29% were referred to nutrition. To assess the patients at risk early on, a validated Malnutrition Screening Tool(MST) was implemented from September 2020 to February 2021 in the Medical Oncology fellow's clinic notes. Although the original MST was implemented mostly for inpatient elderly patient population, the idea of this study was to apply this tool to assess acute nutrition issues for patients receiving cancer therapy in the outpatient setting. This tool used two simple questions, Have you lost weight recently without trying? (If lost 1-6lbs = 1points, 7-13lbs = 2points and > 13 = 3points), and have you been eating poorly because of decreased appetite? (Yes = 1 point; No = 0 points).A smart phrase which included these questions was used in the notes and if patients scored greater than or equal to 2, were considered malnourished and qualified for nutrition referrals. Other variables included were age, sex, and type of cancer. Results: Of the 41 charts that implemented MST, 21 patients(49%) screened positive and all 100% of them were referred to nutrition. After implementing this tool, there was a 20% increase in identifying and referring the malnourished patients who were receiving cancer therapy during the clinic visits. Median age for patients who screened positive was 60 years, more males screened positive than females(60% vs 40%). Gastro-intestinal malignancies and head and neck cancers were the highest who screened positive in the MST group(14% each out of the 49%). Conclusions: Malnutrition is a major cause of morbidity and mortality in patients with any stage cancer and especially worse in advanced stage cancer. By simply using this two-step questionnaire, we were able to identify 20% more patients who were at risk for malnutrition. Older age, Males and Gastro-intestinal and Head and Neck cancer patients are more at risk and needs to be more closely screened. The study concludes that using a simple tool in the outpatient clinics can assess patient's at risk and provide early qualitative support throughout course of therapy.
Patient-reported distress at a cancer center during the COVID-19 pandemic.
Authors: Shah Manan P , Rosenthal Sarah , Roy Mohana , Khaki Ali Raza , Hernandez-Boussard Tina , Ramchandran Kavitha 
Published: June 2022

e18644 Background: Assessments of health-related quality of life (HRQOL) are conducted by health systems to analyze and improve patient-centered care. Numerous studies have shown that the COVID-19 pandemic poses unique stressors for patients with cancer. However, the impact of the pandemic on HRQOL in patients with cancer is unknown. This study investigates change in self-reported global health scores in patients with cancer before and during the COVID-19 pandemic. Methods: In this single-institution retrospective cohort study, patients who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) at a comprehensive cancer center before and during the COVID-19 pandemic were identified. Surveys were analyzed to assess change in the PROMIS global mental health (GMH) and global physical health (GPH) scores at different time periods (pre-COVID: 3/1/5/2019-3/15/2020, surge1: 6/17/2020-9/7/2020, valley1: 9/8/2020-11/16/2020, surge2: 11/17/2020-3/2/2021, and valley2: 3/3/2021-6/15/2021). Results: A total of 29,983 surveys among 7,209 patients were included in the study. Mean GMH scores for patients before the COVID-19 pandemic (50.57) were similar to that during various periods during the pandemic: surge1 (48.82), valley1 (48.93), surge2 (48.68), valley2 (49.19). Mean GPH score was significantly higher pre-COVID (42.46) than during surge1 (36.88), valley1 (36.90), surge2 (37.33) and valley2 (37.14) (Table). During the pandemic, mean GMH (49.00) and GPH (37.37) scores obtained through in-person were similar to mean GMH (48.53) and GPH (36.94) scores obtained through telehealth. Conclusions: In this single institution study, patients with cancer reported stable mental health and deteriorating physical health during the COVID-19 pandemic as indicated by the PROMIS survey. Modality of the survey (in-person versus telehealth) did not affect scores. [Table: see text]
Smoking cessation counseling in patients with active malignancy.
Authors: Avigan Zachary M , Boussi Leora S , Mukamal Kenneth J. 
Published: June 2022

e18655 Background: Tobacco smoking increases risk of multiple malignancies, most notably lung cancer, and is a leading cause of premature morbidity and mortality. Tobacco cessation counseling is effective in assisting patients to quit smoking and improving health outcomes, but over one third of smokers report receiving no counseling by healthcare providers. In this study, we investigated rates of tobacco cessation education at ambulatory visits among patients with active malignancy. Methods: We identified ambulatory visits among current smokers with a diagnosis of malignancy using the National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of ambulatory visits in the US, from 2008 to 2018. We first determined weighted rates of documented smoking cessation counseling. We next evaluated sociodemographic characteristics, provider and visit type, and chronic conditions as determinants of counseling in this population using logistic regression. Results: We identified 2,437 total visits during the study period, representing an estimated 48.9 million such visits in the US. In this cohort, smoking cessation counseling was provided at 14.2% (95% confidence interval [CI] 12.1-16.7%) of visits. Patients were significantly less likely to receive counseling with older age (adjusted OR 0.97 per year of age; 95% CI 0.96-0.98) and less likely in surgical (OR 0.49; 95% CI 0.32-0.75) or medical subspecialties (OR 0.60; 95% CI 0.36-0.99) compared to primary care visits. Sex, race, year of visit, insurance type, and previous visit to the same provider were not significantly related to receipt of counseling. Patients with concomitant COPD were substantially more likely to receive counseling (OR 3.50; 95% CI 2.21-5.53), with 28.4% (95% CI 21.5-36.4%) of such visits including tobacco cessation education. Conclusions: Tobacco smoking is a modifiable risk factor associated with multiple malignancies and substantial non-neoplastic morbidity and mortality. Nonetheless, smokers with current malignancy receive smoking cessation counseling at only about one in seven outpatient visits, with lower frequency with advanced age and at subspecialty visits. As more effective treatments improve survival for cancer patients, further work is needed to improve tobacco cessation efforts that could improve survival and quality of life.[Table: see text]
Insomnia in cancer patients.
Authors: Mensah-Osman Edith J. 
Published: June 2022

e18657 Background: As new treatments extend patient survival, the quality of their lives (QoL) grows in importance. QoL may differentiate alternative treatments, and QoL assessment has become a standard component of treatment evaluations. Sleep is a key component of QoL. Insomnia can worsen pain, fatigue, depression and cognitive impairments in cancer patients. Inappropriate treatments for insomnia can further worsen these and interact with chemotherapy medications. Recognizing this, in 2019 the American Society of Clinical Oncology identified Insomnia as a key patient-reported outcome performance measure (PRO-PM) for the National Quality Forum to consider. Methods: Through review of the scientific literature the project identified specific cancers and their treatments where treating Insomnia can have a significant impact on patient QoL. PubMed, Pharmapendium, and Science Direct databases were used. Search terms included “insomnia demographics, epidemiology of insomnia in cancer, insomnia in tumor types, cancer insomnia, insomnia associated hormonal treatment, insomnia in patients awaiting cancer diagnosis; insomnia in cancer care-givers, insomnia in cancer survivors, cancers treated with corticosteriods”. Original research articles in English that used human subjects between January 1, 1993 and January 31, 2020 were included. Results: Insomnia is associated with specific tumor types: brain tumors, breast cancer, gastrointestinal cancer, leukemia, lymphoma, multiple myelomaand terminal cancer. Autoimmune causes of insomnia in paraneoplastic syndromes. Insomnia is prevalent in oncology patients being evaluated, awaiting diagnosis and treatment. Age and gender are demographic factors associated with oncology insomnia. Insomnia is associated with specific antineoplastic agents. Corticosteroid use is associated with insomnia, before, during and after cancer treatment. Insomnia in cancer survivors starts during their treatment and may persist for years. Conclusions: Specific demographics, cancers and treatments are associated with insomnia. Insomnia often occurs in patients undergoing evaluations for cancer. Insomnia is often not recognized and not treated in oncology patients. Insomnia that is not addressed during cancer treatment often persists in cancer survivors. There is the need to investigate whether treating insomnia early in cancer patients during their course of treatment can reduce symptoms such as fatigue and improve their QOL.
Does perceived stigma or shame affect stage of presentation in Iraqi Kurdish women diagnosed with breast cancer?
Authors: Chagpar Anees B. , Qader Suzann , Baqri Mehdi , Khoshnood Kaveh , Ahmed Hamdia 
Published: June 2022

e18680 Background: The concept of breast cancer related stigma and its effect on stage at presentation has been understudied in the Iraqi context. We sought to determine the extent to which perceived stigma or shame affected stage at presentation in Iraqi women diagnosed with breast cancer. Methods: A survey was conducted of 100 cancer patients seen at the Breast Center in Erbil, Kurdistan. Patients were asked subjectively whether they felt a sense of shame with the diagnosis of breast cancer and whether this delayed them in being diagnosed. In addition, a breast cancer stigma scale (BCSS) that has been validated in Arab women was fielded, and objective data regarding stage at presentation was collected. The BCSS has a possible score of 12-60, with lower scores indicating higher levels of stigma. Results: : Of the 100 women surveyed; only 7% were diagnosed at stage 1. While only 6% of women stated that they felt shame when diagnosed with breast cancer, 48% felt that some sense of shame delayed them getting diagnosed. The median BCSS score was 43 (range; 16-60). While marital status (p = 0.360), rural vs. urban setting (p = 0.380), working outside the home (p = 0.669), educational level (p = 0.203) and monthly household income (p = 0.642) were not associated with whether women presented with stage 1 breast cancer at diagnosis, there was a trend towards higher BCSS among those with stage 1 disease (p = 0.076). Further, patients who reported that feelings of shame either “somewhat” or “very much” delayed them being diagnosed were more likely to present with higher stage disease than those who felt this did “not at all” cause a delay (100% vs. 87.8%, p = 0.016). Indeed, all six patients diagnosed with stage 1 disease reported that feelings of shame did “not at all” delay them from being diagnosed. Conclusions: Most patients in the Iraqi Kurdistan context are diagnosed with later stage disease. Feelings of stigma or shame may contribute to later diagnosis in this context.
Clinical effectiveness of SARS-CoV-2 vaccines and booster doses in patients with cancer: An analysis from the European OnCovid registry.
Authors: Pinato David J. James , Aguilar-Company Juan , Ferrante Daniela , Hanbury Georgina Helen , Bower Mark , Salazar Ramon , Lambertini Matteo , Pedrazzoli Paolo , Lee Alvin Jun Xing , Sinclair Alasdair , Townsed Sarah , Plaja Andrea , Tucci Marco , Sita-Lumsden Ailsa , Mukherjee Uma , Mazzoni Francesca , Aujayeb Avinash , Gennari Alessandra , Tabernero Josep , Cortellini Alessio 
Published: June 2022

e18725 Background: Immunogenicity and safety of SARS-CoV-2 vaccines have been widely investigated in patients (pts) with cancer. However, their effectiveness against Coronavirus disease 2019 (COVID-19) and the additional protective effect of a booster dose in this population are yet to be defined. Methods: Using OnCovid study data (NCT04393974), a European registry enrolling consecutive pts with cancer and COVID-19, we evaluated morbidity and 14 days case fatality rates (CFR14) from COVID-19 in pts who were unvaccinated, vaccinated (either partially/full vaccinated but not boosted) and those who had received a third dose. Analyses were restricted to pts diagnosed between 17/11/2021 (first breakthrough infection in a boosted pt) and the 31/01/2022. Pts with unknown vaccination status were excluded. Results: By the data lock of 22/02/2022, out of 3820 consecutive pts from 36 institutions, 415 pts from 3 countries (UK, Spain, Italy) were eligible for analysis. Among them, 51 (12.3%) were unvaccinated, 178 (42.9%) were vaccinated and 186 (44.8%) were boosted. Among vaccinated pts, 26 (14.6%) were partially vaccinated (1 dose). Pts with haematological malignancies had more likely received a booster dose prior to infection (25.4% vs 13.6% and 11.8%, p = 0.02). We found no other associations between vaccination status and pts’ characteristics including sex, age, comorbidities, smoking history, tumour stage, tumour status and receipt of systemic anticancer therapy. Compared to unvaccinated pts, boosted and vaccinated pts achieved improved CFR14 (6.8% and 7.0% vs 22.4%, p = 0.01), COVID-19-related hospitalization rates (26.1% and 20.6% vs 41.2%, p = 0.01) and COVID-19-related complications rates (14.5% and 15.7% vs 31.4%). Using multivariable Inverse Probability of Treatment Weighting (IPTW) models adjusted for sex, comorbidities, tumour status and country of origin we confirmed that boosted (OR 0.21, 95%CI: 0.05-0.89) and vaccinated pts (OR 0.19, 95%CI: 0.04-0.81) achieved improved CFR14 compared to unvaccinated pts, whilst a significantly reduced risk of COVID-19 complications (OR 0.26, 95%CI: 0.07-0.93) was reported for vaccinated pts only. Conclusions: SARS-CoV-2 vaccines protect from COVID-19 morbidity and mortality in pts with cancer. Accounting for the enrichment of haematologic pts in the boosted group, the observation of comparable mortality outcomes between boosted and vaccinated pts is reassuring and suggests boosting to be associated with reduced mortality in more vulnerable subjects, despite evidence of adverse features in this group.
Real-world biomarker testing trends in metastatic non-small cell lung cancer (NSCLC).
Authors: Clinton Natasha , Patel Manish R. , Ayars Michael 
Published: June 2022

e18728 Background: NSCLC is now recognized as not one disease, but many—differentiated by an increasing number of molecular targets. About 50% of patients with advanced nonsquamous NSCLC have a targetable driver mutation. We retrospectively assessed biomarker testing trends in a large community oncology practice to identify evolving real-world testing rates and patterns in the areas of methodology, specimen types, and vendors. Methods: Natural-language processing queries were used to extract data from biomarker testing reports of patients diagnosed with stage IV NSCLC in 2015-2019. Tests were included if done within 1 year of diagnosis and were classified as NGS panels (20+ genes) or targeted single-gene tests. Results: Records of 587 patients were included. Over the 5-year study window, testing rates increased for all 6 mutations analyzed (Table). In 2015, only ALK, ROS1, and EGFR were profiled in our data (n = 20 patients), all using targeted single-gene tests. The use of multigene panels increased steadily over time, constituting the majority by 2019. MET, RET, and NTRK were tested almost exclusively using NGS panels (data beginning in 2016). Tissue-only specimens were used for 93.8% of patients diagnosed in 2015, while tissue plus blood were used in 6.3%. Blood-only samples began appearing in our data in 2016, making up 7% of patients. By 2019, the use of blood tests had increased substantially, to 47% of patients, although tissue-only remained the most common type (54%). While blood testing has become more popular, it is often still performed with tissue tests. The primary testing methods used in 2015-2017 were FISH for ALK and ROS1; NGS for MET, NTRK, and RET; and Sanger or NGS for EGFR. By 2018, NGS had become the predominant test method across all 6 biomarkers. During 2015-2016, several vendors were used for testing, with a very segmented market for ALK and EGFR tests. By 2019, the market had aligned to a few key vendors for the majority of tests. In 2016, the top 5 vendors did 76% of 180 total tests, which increased to 93% of 1880 tests in 2019. Almost all blood testing in our data was performed by a single vendor. Conclusions: Testing rates for ALK, ROS1, and EGFR were more consistent than those for MET, RET, and NTRK throughout the study window, possibly because of earlier availability of tests and treatments for these biomarkers. NGS was more available by the time MET, RET, and NTRK became established as actionable biomarkers, explaining the earlier use of panels. A limitation is that nearly 75% of the data are from the final 2 years. These results, however, represent notable testing trends from a large practice and illustrate the expanding application of molecular testing in community oncology.[Table: see text]
Outpatient cancer rehabilitation services for gynecologic cancer survivors: Who participates, and do they benefit?
Authors: Pergolotti Mackenzi , Wood Kelley C , Bertram Jessica , Kendig Tiffany , Hidde Mary , Leiser Aliza L. , Buckley De Meritens Alexandre 
Published: June 2022

e18793 Background: Women with gynecologic cancers are likely to experience acute, late, or lasting functional impairments that impact ability to complete activities of daily living and quality of life. While cancer rehabilitation interventions (physical or occupational therapy, PT/OT) treat functional impairment, the use, impact, and acceptability of these services in community-based settings is unknown. We describe outpatient PT/OT services used by gynecologic cancer survivors and evaluate the impact and acceptability of these services using patient-reported outcome measures (PROM). Methods: This retrospective study included women with history of gynecologic cancer (via ICD-10 code) who: (1) received community-based outpatient cancer PT/OT services provided by a single institution in 5 geographic regions of the United States in 2019, and (2) completed a PROM at evaluation and discharge. Data was extracted from PT/OT medical charts. We calculated descriptive statistics for all available patient and rehabilitation characteristics (including age, cancer type, complexity-level of rehabilitation, interventions provided and number of visits). To evaluate pre-post rehabilitation change for each PROM, we used paired samples t-tests, then calculated pre-post effect size (Hedge’s g) and the proportion who achieved the minimal detectable change (MDC). We calculated median Net Promotor Score (NPS, 0-10) to determine acceptability. Results: Women who received rehabilitation (N = 84) were 64.63 ± 11.04 (range = 40.82 – 90.82) years old with predominant diagnoses of ovarian (n = 35, 41.7%) or endometrial (n = 27, 32.1%) cancer. Most attended PT (vs. OT) and completed 13 sessions ( IQR= 8.0 – 19.0). Seventeen different PROM were used. From pre- to post- rehabilitation, a significant improvement was seen in four PROM: Lower Extremity Functional Scale (LEFS; n= 20, M∆ = 12.88 ± 12.31, t(19) = 4.68, p = .00), Modified Fatigue Impact Scale (MFIS; n= 14, M∆ = 6.55 ± 9.69, t(13) = 2.53, p = .03), Patient-Specific Functional Scale (PSFS; n= 14, M∆ = 2.93 ± 2.31, t(13) = 4.72, p = .00), and Lymphedema Life Impact Scale (LLIS; n= 12, M∆ = 20.50 ± 20.61, t(11) = 3.45, p = .01). A large pre-post effect size (g ≥ 0.80) was observed for three PROM (17.6%), including: The PSFS ( n= 14, g = 1.47), LLIS, ( n= 12, g = 1.18), and Activities-specific Balance Confidence (ABC6; n= 3, g = 1.77). Overall, 54.8% (n = 46) patients achieved the PROM MDC. Median acceptability was 10.0 out of 10.0 ( n= 64, IQR = 9.75 – 10.0). Conclusions: For women with gynecologic cancers and functional impairment, cancer rehabilitation improved patient-reported function and was highly acceptable. Future research is needed to understand diagnosis-specific considerations and to optimize timing of rehabilitation.