bluuebunny/crossref_metadata_2025_split huggingface dataset:
Locoregional therapy trends by frailty and life expectancy in older adults with T1N0 hormone receptor-positive breast cancer.
Authors: Minami Christina Ahn , Jin Ginger , Freedman Rachel A. , Schonberg Mara A. , King Tari A. , Mittendorf Elizabeth A. 
Published: June 2022

12047 Background: Women >70 years old with T1N0 hormone receptor-positive (HR+) breast cancer face complex locoregional therapy decisions, as breast surgery type, and omission of axillary surgery or radiation therapy (RT), do not impact overall survival. Although frailty status and life expectancy (LE) ideally factor into therapy decisions, their impact on decision-making is unclear. We sought to identify trends in, and factors associated with locoregional therapy type by frailty and LE, and to determine if therapy type was associated with cause of death. Methods: Women >70 years old with T1N0 HR+/HER2-negative breast cancer diagnosed 2010-2015 were identified in SEER-Medicare. Stratified by validated claims-based frailty (Kim et al) and LE (Tan et al) measures, trends in therapy (lumpectomy, lumpectomy + axillary surgery, lumpectomy + RT, mastectomy, lumpectomy + axillary surgery + RT, and mastectomy + axillary surgery, with the last two combinations deemed “more intense” therapy) were analyzed. Generalized linear mixed models were used to identify factors associated with therapy receipt (breast surgery type, axillary surgery, and RT) and, among the women who died in this cohort, to explore potential associations between local therapy received and cause of death. Results: Of the 16,188 women included, 21.8% were frail, 22.2% had a LE<5 years, but only 12.3% were both frail and had a LE<5 years. In frail women who had a LE < 5 years, more intense therapy regimens decreased significantly (lumpectomy + axillary surgery + RT: 27.5% to 17.3%, p<0.001; mastectomy + axillary surgery: 20.8% to 13.9%, p=0.02) over the study period. However, in 2015, 30% of frail women with a LE<5 years still underwent a more intense regimen. On multivariable analysis, frailty and LE<5 years were associated with a lower likelihood of axillary surgery (frailty: OR 0.65, 95% CI [0.57-0.73]; LE<5 years: OR 0.67, 95% CI [0.59-0.76]) and RT (frailty: OR 0.77, 95% CI [0.69-0.86]; LE<5 years: OR 0.73, 95% CI [0.65-0.83]), but not with breast surgery type. Of the 1868 women who died, 306 (16.4%) died of breast cancer and those undergoing more intense therapy were as likely to die of breast cancer vs other causes (Table). Conclusions: In older women with T1N0 HR+ disease, rates of more intense therapy are decreasing but 30% of frail women with a limited LE still underwent more intense therapy in the final study year. As therapy intensity does not affect breast cancer-specific mortality, appropriate de-escalation of locoregional therapy is needed. [Table: see text]
Remote geriatric assessment program for older patients starting new chemotherapy treatment in Brazil.
Authors: Bergerot Cristiane Decat , Bergerot Paulo Gustavo , Razavi Marianne , Lakhdari Sabri , Philip Errol James , Franca Marcos V S , Molina Lorena Nascimento Manrique , Freitas Alici Natalia de Sousa , Taveira Mariane Cunha , Azeredo Andressa Cardoso , Fuzita William Hiromi , Fernandes Cristiano Menezes , Pio Raquel Baptista , Filho Romildo De Araujo Periera , Couto Milena Macedo , Vasconcellos Vitor Fiorin de , Matos Neto Joao Nunes , Buso Marco Murilo , Soto Pérez de Celis Enrique , Dale William 
Published: June 2022

12052 Background: Older cancer patients in developing countries face considerable challenges in obtaining access to specialized medical attention, often due to a lack of human resources and healthcare infrastructure. This study sought to explore the benefit of a remote, validated geriatric assessment (GA) program for older patients starting chemotherapy in Brazil. Methods: Older adults (65+ years) beginning a new chemotherapy treatment regimen in Brazil were recruited. Through telehealth, patients were assessed with GA before starting chemotherapy treatment for any type of solid cancer and at a follow-up visit (3 months after enrollment). GA results were discussed by a multidisciplinary team (e.g., geriatrician, psychologist, nutritionist) and recommendations were determined. Outcome measures included chemo toxicity scores (CARG, scale 0-19), physical symptoms (FACT-G, scale 0-108) and activities of daily living (IADL, scale 0-5 for men and 0-8 for women, or scale 0-1 for IADL ratio). Descriptive statistics were generated, and paired t-tests were used to evaluate the change in these measures over time. Results: A total of 51 older patients from 5 different Brazilian states (Amazonas, Distrito Federal, Espirito Santo, Pernambuco and Rio Grande do Sul) have been enrolled to date. The mean distance from a patients’ home to their place of cancer treatment was 21 miles (range: 3-101 miles). Participants had a mean age of 76.5 years (SD = 7.6) and were predominantly female (57%), white (57%), married (61%), and had a high school degree or more (65%). Patients were mostly diagnosed with gastrointestinal (39%) or gynecological (20%) cancers; 55% of patients were diagnosed with a stage IV disease. The majority of patients (80%) were referred to appropriate remote services based on the GA; including geriatricians (41%), nutritionists (39%) and/or psychologist (16%). At the time of abstract submission, data from 34 complete cases were available for longitudinal analysis, in which we observed a decrease in chemo toxicity scores (M1= 6.65, M2= 5.88, p = 0.035) and an improvement in FACTG (M1= 92.94, M2= 98.53, p < 0.001). The improvement in IADL ratio was not significant (M1= 0.79, M2= 0.85, p = 0.069). Conclusions: This novel, ongoing study is, to our knowledge, the first to implement a remote GA program in Brazil. Our preliminary findings suggest that a remote GA program, with appropriate referrals to specialists, may increase the reach of supportive services and improve cancer care in developing countries.
Using CT-based body composition metrics and frailty index in predicting survival among older adults with cancer.
Authors: Giri Smith , Feliciano Elizabeth , Harmon Christian , Kenzik Kelly , Al-Obaidi Mustafa , Anyene Ijeamaka , Beg Mirza Faisal , Chow Vincent Tze Yang , Popuri Karteek , Lenchik Leon , Caan Bette Jane , Williams Grant Richard 
Published: June 2022

12057 Background: Older adults with cancer are at an increased risk of treatment related toxicities and excess mortality during cancer treatment. While altered body composition and frailty are associated with worse survival among older adults with cancer, no prior study has examined their combined influence on survival prediction. Methods: Prospective study of older adults (≥60 years) undergoing geriatric assessment (GA) at initial visit with a medical oncologist at UAB from 9/2017-07/2021 with available abdominal computed tomography (CT) within 60 days of GA. Using multi-slice CT images from T12 to L5 level, volumetric skeletal muscle (SMV), visceral (VATV) and subcutaneous (SATV) adipose tissues, and skeletal muscle density (SMD), were derived. Sex-specific z-scores for each measure were determined. A 44-item frailty index was obtained, using the deficit accumulation model. Overall survival (OS) was defined as time from GA to death or last follow-up (11/8/2021). Kaplan-Meier estimates of survival rates were compared using log-rank statistics. Multivariable cox regression models were used to predict OS in a random sub-sample (1:1 split of training:validation set), sequentially adding frailty and each body composition measure and assessing improvement with likelihood ratio tests and Harrel’s C statistic. Results: 815 patients were included (median age 68 years, 61% men, and 75% non-Hispanic Whites. 73% had gastrointestinal malignancies (stage III, 25%, stage, IV 48%). 32% were frail, 31% pre-frail. There was a weak negative correlation between height-adjusted SMV and frailty (r = -0.16), particularly among men (r -0.24). Over a median follow-up of 25.7 months (range 0.3-49.6 months), 268 patients (33%) died. The 2-year survival rate was 75.9%, 68.5% and 52.2% among robust, pre-frail and frail (log-rank p <.001), respectively. In multivariable models adjusted for age, sex, race, cancer type and cancer stage, being frail (vs robust) (Hazards Ratio, HR = 2.32; 95%CI: 1.69-3.2; p <.001) and higher skeletal muscle volume (HR = 0.85; 95%CI: 0.72-0.99; p= 0.04, per SD increment) were independently associated with OS. Adding body composition and frailty to clinical variables led to significant improvement in prediction (Harrel’s C increased from 0.69 to 0.74). In the validation set, discrimination was similar (Harrel’s C = 0.72) and plots suggested good model calibration. Conclusions: CT-based body composition metrics and frailty are independent predictors of OS among older adults with cancer and improve survival prediction compared to routine clinical risk factors.
Complementary and alternative medicine use and recommendations for discontinuation of supplements in an integrative oncology clinic.
Authors: D'Andre Stacy D. , Bauer Brent D. , Hofmann Maggie D. , Burckhard Jenna D. , Montane Heather D. , Loprinzi Charles L. 
Published: June 2022

12058 Background: It is well established that many patients with cancer are taking dietary supplements (DS) and alternative medicines and often do not disclose such to their care teams. There is potential for harm in several ways: 1) interactions with their medications that may increase side effects, 2) interactions with their treatment that may lead to decreased efficacy, 3) direct toxicity from the supplement 4) financial toxicity. We have recently started a new Integrative Oncology service to help counsel patients about improving lifestyle factors and assist patients with safe and evidence-based integrative treatments and supplements. Methods: Patient data (N=100) were collected prospectively from an Integrative Oncology Clinic. The number and type of DS were documented. Using the Natural Medicines Database (NMD), we determined whether supplements interacted with the patients’ other medications or cancer therapies. We calculated the percentage of patients in which a recommendation for discontinuation of DS was recommended, along with the supporting reasons. We calculated the most common DS being taken and other alternative therapies beyond supplements. Results: Ninety-one percent of patients took DS, with an average of 5.5 per patient (range 0-20). The most common DS patients reported taking (%): Vit D (52), Vit C (41), Multivitamin (34), probiotic (27), B Vitamins (26), Ca (20), zinc (20), fish oil (18), cannabis (18), mushrooms (18), turmeric (17), magnesium (15), melatonin (14), biotin (11), coq10 (7), iron (8), VIT E (5), and glucosamine (5). Eighty-nine percent of patients using DS were on active cancer therapy. In thirty-five percent of patients, we recommended stopping some of their DS or other therapies. Number of patients using alternative therapies beyond DS: IV Vitamin C (5), Rick Simpson oil (high dose THC) (4), extreme diets (4), mistletoe (2), re-purposed meds (2); and one each was using hyperbaric O2, ozone, homeopathic, ayurvedic, insulin-potentiated chemo, miracle mineral cure, chelation, low dose naltrexone Conclusions: Cancer patients both on and off active treatment are using large numbers of DS with potential for adverse effects and/or decreasing efficacy of treatments. This study highlights the prevalence of DS and alternative medicine usage in cancer patients referred to an integrative oncology clinic and demonstrates the need for counseling about safe supplement use; in 35% of patients, discontinuation of DS was recommended. [Table: see text]
Symptom monitoring with patient-reported outcomes using a web app with alerting algorithms among patients with lung cancer (SYMPRO-Lung).
Authors: Becker-Commissaris Annemarie , Billingy Nicole Erica , Hoek Rianne , Tromp Vashti , van den Hurk Corina , Walraven Iris 
Published: June 2022

12060 Background: The use of patient reported outcomes (PROs) to monitor symptoms during and after cancer treatment can improve symptom management, health-related quality of life (HRQoL), and overall survival, especially when linked to an alert system. Previous studies used alerts to the health care provider (HCP), but will this also work when patients receive the alerts? The aim is to compare a reactive (patient receives alert) and an active (HCP receives alert) method of PRO symptom monitoring on symptom incidence and management during the first 15 weeks of treatment. Methods: SYMPRO-Lung is a Dutch multicenter stepped wedge RCT performed among lung cancer (LC) patients to monitor symptoms, using a PRO-CTCAE LC subset. The NCI scoring algorithm assessed the symptom severity. If symptoms exceeded a predefined threshold an alert was sent by email to the HCP (active arm) or to the patient (reactive arm). Differences between both study arms in baseline characteristics, symptom incidence and management, were assessed using chi-square tests. Results: In total, 244 patients (active arm n = 155, 64%, reactive arm n = 89, 37%) completed 2412 symptom checklists during the first 15 weeks of treatment, with a mean of 10 per patient (pp) (SD 4.3). A total of 673 alerts (28%) were triggered, with a mean of 3 (SD 2.1) pp in both arms. The top 3 symptoms that caused the app to send an alert were fatigue (n = 231, 19%), pain (n = 188, 16%), and constipation (n = 144, 12%). Decreased appetite, diarrhea, and nausea were significantly higher in the reactive arm compared to the active arm (see table). For 313 alerts (74%), telephone contact with a HCP was the only intervention needed. 57 Alerts (13%) were discussed during a planned outpatient’s consultation in the week of the alert. For 39 alerts (9%) the patients were referred to another specialty (see table). However, ‘no need to follow-up’ (FU) was requested after 237 alerts (35%). For all symptoms, the no FU request was significantly higher in the reactive arm (n = 135, 32% vs n = 102, 40%), compared to the active arm (p-values between 0.02 and < 0.001). Conclusions: In both arms an average of 3 alerts pp were triggered. In the reactive arm, significantly more patients chose not to contact their HCP compared to the active arm. Future research needs to unravel the underlying mechanisms and the potential consequences of this observed difference between study arms. Clinical trial information: Trial NL7897. [Table: see text]
Evaluation of social connectedness, loneliness, and anxiety among cancer survivors during the 2020-2021 winter surge of COVID-19 pandemic.
Authors: Poghosyan Hermine , Yu James B. 
Published: June 2022

12061 Background: Limited research is available about cancer survivors’ level of stress, social connectedness and loneliness during the COVID-19 that can put them at increased risk for poor physical and mental health. We estimated relative decreased rate of social connectedness and increased rates of loneliness/sadness and stress/anxiety among cancer survivors during the 2020-2021 winter surge of COVID-19 and investigated whether decreased social connectedness is associated with increased feelings of loneliness/sadness and stress/anxiety. Methods: This cross-sectional study used data from Medicare Current Beneficiary Survey COVID-19 Winter 2021 Supplement, nationally representative phone survey of Medicare beneficiaries living in community, conducted in March-April 2021. We included 1,836 respondents who self-reported cancer history (other than skin cancer). Outcomes were self-reported feelings of loneliness/sadness and stress/anxiety over the past 4 months. The independent variable was social connectedness defined as feeling less socially connected to family/friends over the past 4 months. We used weighted descriptive statistics and multivariable logistic regression adjusting for self-reported socio-demographics (age, sex, race, income), region, metropolitan residency, Medicaid eligibility, living alone, depression, having access to internet and health care. We applied sample weights to account for complex survey design with results generalizable to 9.5 million cancer survivors. Results: Out of 9505626 cancer survivors, 6.8% self-reported as Black, 7.1% Hispanic, 80.4% White, 59% women, 42.7% reported decreased social connectedness, 20.3% increased feeling of loneliness/sadness, and 40.0% increased feeling of stress/anxiety in the past 4 months. Women had higher rates of reporting increased feelings of loneliness/sadness (12.0% vs. 26.1%, P = <.001), stress/anxiety (30.0% vs. 46.6%, P = <.001), and decreased social connectedness (38.7% vs. 45.5% P =.028) than men in the past 4 months. Among self-reported racial and ethnic groups, Hispanics had the highest rates of reporting increased feelings of loneliness/sadness (31.2% vs. 20.5% of Whites vs. 10.2% of Blacks, P =.008) and stress/anxiety (54.0% vs. 39.4% of Whites vs. 31.2% of Blacks, P =.034). No statistically significant difference was found in social connectedness by self-reported race and ethnicity. Survivors who reported decreased social connectedness had higher odds of feeling more lonely/sad (adjusted OR = 3.67, 95%CI 2.85-4.72, P = <.001) and more stressed/anxious (adjusted OR = 2.63, 95%CI 2.1- 3.26, p = <.001) over the past 4 months. Conclusions: Increased feelings of loneliness/sadness and anxiety/stress in the past 4 months were prevalent among cancer survivors. Also, almost half of them reported decreased social connectedness at the end of the second year of COVID-19.
Prevalence of pain symptoms among U.S. adult cancer survivors.
Authors: Hu Xinwen , Cao Chao , Han Yunan , Jiang Shu , Yang Lin , Colditz Graham A. 
Published: June 2022

12062 Background: Pain symptoms are common in cancer survivors. The life expectancy of US cancer survivors continues to raise. To date, the comprehensive pattern of pain symptoms in US cancer survivors by cancer history remains unknown. Methods: Data on pain symptoms and correlates were derived from a nationally representative sample of cancer survivors (n = 55,716, weighted population = 17,352,886) in the 1997-2018 National Health Interview Survey. Individuals who answered “yes” to the questions “During the past three months, did you have headache/facial/neck/low back pain/low back pain radiating to the leg” were considered as having pain symptoms at respective anatomical regions. The US national prevalence of pain overall and by anatomical regions were estimated. Correlates of pain symptoms were examined using multivariable logistic regression. Results: The prevalence of overall pain symptoms was persistently high (48.5%, 95% CI: 48.0-49.0) in cancer survivors from 1997-2018 ( P for trend =.58), driven by low back (37.6%, 95% CI: 37.1-38.0) and neck pain (20.9%, 95% CI: 20.5-21.3), and was leading in survivors of bone (63.1%, 95% CI: 57.9-68.4), soft tissue (58.1%, 95% CI: 50.6-65.6), and brain (58.2%, 95% CI: 52.3-64.0) cancers. Considerable pain symptoms were reported by survivors of commonly diagnosed cancers: lung (48.5%), breast (46.7%), colon (52.2%) and prostate (38.4%) cancers. The prevalence of pain is higher in females (52.9%) than males (42.6%) across all anatomical regions (OR, 1.50 [95% CI, 1.38-1.63]), particularly headache (19.8% vs. 8.6%) and facial pain (8.6% vs. 3.9%). Of note, females with reproductive system cancers, cervical (66.3%), uterine (60.0%) and ovarian (59.4%) cancers, have a higher prevalence in all types of pain than those with other cancers. Cancer survivors aged ≥65 years were less likely to report pain symptoms than younger survivors (OR, 0.71 [95% CI, 0.64-0.79]). Despite no racial disparity in the prevalence of overall pain, Non-Hispanic Blacks (18.6%, 95% CI: 17.2-20.0) and Hispanics (21.2%, 95% CI: 19.5-22.9) were more likely to report headache than Non-Hispanic Whites (14.4%, 95% CI: 14.0-14.8). A higher prevalence of pain symptoms was consistently observed in cancer survivors with low income, smoking history, low physical activity levels, diabetes, and cardiovascular diseases (all P <.05). Age at cancer diagnosis ( P for trend <.001), but not the time since, affected pain symptoms. Cancer survivors diagnosed at age 0-14 (53.0%, 95% CI: 49.1-56.9) and 15-39 years (58.6%, 95% CI: 57.5-59.7) had a significantly higher prevalence of pain across all anatomical regions than those at ≥40 years (45.5%, 95% CI: 44.9-46.1). Conclusions: Half of US cancer survivors experienced pain symptoms, driven by low back and neck pain. Higher prevalence of pain was noted in cancer survivors with younger age, female sex, low income and suboptimal lifestyle behaviors, calling for adequate pain management in cancer survivorship.
Analysis of incidence/mortality/cost for thrombotic events in hospitalized patients with lung cancer using the National Inpatient Sample database.
Authors: Atodaria Kuldeepsinh , Fidler Christian 
Published: June 2022

12073 Background: Thrombotic events are a common complication of lung cancer. We performed a retrospective analysis of an inpatient adult population (age ≥18) using the National Inpatient Sample (NIS) database from the years 2003-2014. Methods: The analysis was performed on the NIS database, using IBM SPSS Statistics 28.0.0.0 software. The cases for lung cancer were selected based on ICD-9(International Classification of Disease) codes for lung cancer. The cases were weighted by Weight to discharges in the universe. These cases were checked for a diagnosis of acute lower extremity Deep Vein thrombosis (DVT) and acute Pulmonary Embolism (PE) again using ICD-9 codes. Chi square tests were utilized to check the significance of association between mortality and DVT/PE. Independent T-tests were utilized to check the association of cost of hospitalization and length of stay with DVT/PE. Results: There were a total of 4,940,262 cases (53.0% male) of lung cancer from the years 2003-2014. 112,569 (2.3%) cases had a diagnosis of acute lower extremity DVT, and 164,208 (3.3%) cases had a diagnosis of acute PE. Overall, death for lung cancer cases was 516,070(10.5%). Death rate in patients with DVT was 12.4%(frequency = 13,943). DVT and death during hospitalization were positively associated, X 2 (1, N = 4,936,702) = 578.792, p <.001. Rate of death for PE was 15.5% (25,360). PE and death during hospitalization were positively associated as well, X 2 (1, N = 4,936,702) = 4540.012, p.000. DVT was associated with a prolonged length of stay ( M = 8.66 days, SD = 8.8.624), compared to cases without DVT ( M = 6.42 days, SD = 6.42), t(4,940,122) = 115.02, p =.000. DVT was also associated with increased total charges of hospitalization ( M = $ 62,950, SD = 85,105), compared to cases without DVT ( M = $ 41,764, SD = 55,410), t(4,864,517) = 124.09, p =.000. PE was associated with a prolonged length of stay ( M = 8.01 days, SD = 8.13), compared to cases without PE ( M = 6.42 days, SD = 6.41), t(4,940,122) = 97.89, p =.000. PE was also associated with increased total charges of hospitalization ( M = $ 56,161, SD = 76,585), compared to cases without PE ( M = $ 41,772, SD = 55,468), t(4,864,517) = 100.85, p =.000. Conclusions: DVT and PE are common complications of Lung Cancer. They are associated with increased mortality in these patients. DVT increases the mean LOS by 2.24 days, and mean charges by $21,186. PE increases the mean LOS by 1.59 days, and the mean charges by $14,389. Prevention of DVT and PE could help bring down the mortality, LOS and charges of hospitalization. This data provides support to the usage of prophylactic anticoagulation in patients with lung cancer as shown in recent trails with Direct Acting Oral Anticoagulants(DOACs), and further study of DVT/PE in Lung cancer patients would be warranted.