bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of plasma fibrinogen on the curative effect and prognosis of locally advanced oropharyngeal cancer after induction chemotherapy.
Authors: JIN feng Li yuan-yuan Wu wei-li 
Published: June 2022

e18062 Background: To investigate the effect of plasma fibrinogen on the curative effect and prognosis of locally advanced oropharyngeal cancer after induction chemotherapy. Methods: Data from 52 patients with locally advanced oropharyngeal cancer who received sequential chemoradiotherapy with induction chemotherapy were retrospectively analyzed. Univariate and multivariate analyses were performed based on logistic regression models to identify clinicopathological factors associated with the efficacy of induction chemotherapy. Cox regression model was used to determine the correlation between clinical or pathological parameters and overall survival (OS) and progression-free survival (PFS). Kaplan-meier test and log-rank test were used for survival analysis. Results: ROC curve was used to determine the optimal threshold of response after induction chemotherapy. Patients were divided into low Fib group and high Fib group (Fib≤4.01g/L and ＞4.01g/L).The proportion of stage IVb and P16 negative in the high Fib group was higher than that in the low Fib group (55.6% vs 29.4%, P= 0.027; 72.2% vs 47.1%, P = 0.082) .Regarding overall response, 42(80.8%)patients responded to IC and 10(19.2%)patients did not respond.The proportion of stage IVb and p16 negative in the non-responding group was higher than that in the responding group (80% vs 28.6%, χ2= 9.026, P= 0.003; 90% vs 47.6%, χ2= 5.881, P= 0.015).In logistic regression model, high Fib level was significantly correlated with no response to induction chemotherapy (OR = 6.946, 95% CI 1.015̃47.516, P = 0.048). Multivariate analysis showed that total stage, P16 status and plasma Fib level before treatment were independent influencing factors of OS and PFS. The 3-year OS and PFS in pre-treatment high Fib group was significantly lower than that of the low Fib group ( P< 0.001, P = 0.005) .Responding to induction chemotherapy was independent influencing factors of PFS. The 3-year OS and PFS in the responding group was significantly higher than that in the non-responding group (65.2% vs 12.7%, P< 0.001; 64.5% vs 12.2%, P= 0.015). Conclusions: Responding to induction chemotherapy was independent influencing factors of PFS.High plasma Fib(Fib＞4.01g/L) was significantly associated with no response to locally advanced oropharyngeal cancer after induction chemotherapy. In addition, patients with pre-treatment high Fib level had significantly lower OS and PFS than those with low Fib level.
Gender distribution of speakers and moderators at the Russian cancer congresses in 2016-2021.
Authors: Abdullaeva Sheyda , Shamrikova Valentina , Gushchin Vadim , Shilo Polina 
Published: June 2022

e18516 Background: Gender equity in world medicine has recently received widespread attention. There is evidence that men and women may practice medicine differently, and better women representation in the oncology workforce and leadership may improve patient outcomes. Nevertheless, women continue to be under-represented in the big academic events, also in oncology. Methods: A retrospective analysis of the programs of major annual Russian oncological congresses: Russian Oncology Congress and White Nights was carried out. The gender of speakers and moderators was collected from 2016 to 2021. Participation of the same person in several sessions or in different roles in one session was considered as a separate case. Data are presented by descriptive statistics, and differences between groups were assessed using the Сhi-square test. P-values below 0.05 were considered statistically significant. Results: The data of 1350 sessions, 796 moderators and 1756 speakers were available for analysis. For the analyzed period of time (2016-2021), the total percentage of female speakers was 42.2% (n = 3120), the percentage of female moderators was 34.8% (n = 1196). There were more male speakers than female speakers in surgical sessions (87.9% and 12.1% p < 0.001). There were more male moderators than women in surgical sessions (92.4% and 7.6% p < 0.001). There were more male speakers than female speakers in chemotherapy sessions (55.2% and 44.8% p < 0.001). There were more male moderators than women in chemotherapy sessions (58.9% and 41.1% p < 0.001). Conclusions: The gender inequality in oncology is more pronounced in the leadership positions in male-dominated specialties such as surgical oncology. Better women representation in the oncology leadership may be an effective strategy to improve oncology care in Russia
Variations in Ewing sarcoma and rhabdomyosarcoma patient outcomes based on treatment center volume.
Authors: Yeo Sarah , Xu Ying Hui , Yu Min Lee Ursula Joan , Simmons Christine E. , Smrke Alannah , Wang Ying 
Published: June 2022

e18530 Background: Due to their rarity and requirement for multi-modality care, evidence suggests (and guidelines recommend) patients (pts) with Ewing Sarcoma (ES) and rhabdomyosarcoma (RMS) treated at high volume centres (HVC) with multidisciplinary tumour board discussions (MTDs) have improved outcomes. However, access to care at HVC is challenging for pts who live remotely, such as many pts in British Columbia (BC), Canada. Our study explores the difference in outcomes of patients with ES and RMS based on location of diagnosis and treatment in BC. Methods: A multi-center retrospective chart review of adults diagnosed with ES and RMS Jan 1st 2000 to Dec 31st 2020 was performed for pts undergoing curative intent therapy at one of six provincial cancer centers. All pts underwent expert pathology review. Descriptive statistics were performed. Fisher’s exact and chi-squared tests were used to evaluate associations. Cox proportional hazards model was used to assess for predictors of better survival outcomes by treatment centre. HVCs was defined as those that saw ≥15 patients. Results: 77 patients were included in this analysis; 46 (60%) and 31 (40%) were treated at HVC and LVC respectively. By HVC and LVC respectively, mean age was 36 and 35, 14 (45%) and 20 (43%) were female, 23 (74%) and 26 (57%) had ES, and 11 (35%) and nine (20%) had localized disease. Pts treated at HVCs were more likely to: receive curative intent radiation (p = 0.006), be presented at MTDs (p = 0.042), and less likely to experience disease progression on fist line therapy (p = 0.04) (Table). Time from biopsy to start of chemotherapy (chemo) was 13 days sooner at HVCs vs LVCs (34 vs 47 days, p = 0.12). Initial chemo regimen (p = 0.25) and surgical treatment (p = 0.75) were not significantly different between HVCs vs LVCs. Age, ECOG, stage, and Charlson Comorbidities Index (CCI) were all significant contributors to overall survival (OS). There was no statistically significant difference in OS by treatment center (HR 0.68, 95% CI 0.36 – 1.29). Conclusions: Variations in care exist for both treatment and outcomes amongst ES and RMS pts treated at HVC vs LVC in BC. Pts treated at HVCs were more likely to be presented at MTDs, to receive curative intent radiation, and less likely to experience disease progression. This may reflect differences in access to resources, sarcoma-specific clinician specialists, and familiarity with upfront aggressive treatment protocols. This study can be used to better inform decisions regarding triaging and centralization of curable ES and RMS patients.[Table: see text]
Medical oncologists' perspectives of end-of-life care communication with racial/ethnic minority and limited English proficiency patients.
Authors: Garcia-Jimenez Maria De Lourdes , Glaspy John A. , Anand Sidharth , Walling Anne M. 
Published: June 2022

e18585 Background: Racial/ethnic minority (REM) and limited English proficiency (LEP) patients with cancer receive more intensive treatment at the end-of-life (EOL) compared to non-Hispanic whites. Various factors at the health system, patient, and provider level contribute to this disparity. While some data exists on the role of provider communication, little is known about medical oncologists' knowledge and attitudes regarding EOL care communication with REM and LEP patients with cancer. Methods: We conducted a cross-sectional, anonymous, pilot survey of medical oncology attendings and fellows at one academic center. Over 3 months, 57 individuals were invited to participate. The survey addressed 6 domains about EOL care communication with REM and LEP patients (role of language, barriers, facilitators, provider beliefs, provider communication skills, and cultural competency training). Questions used Likert scales and were modified from previously validated items when possible. Results: Of 35 individual respondents (61% response rate) 21 (60%) were male, 14 (40%) were female, and 29 (83%) were attendings. Average participant age was 42 years (range 31-60 years) and average years in practice was 9 (range 2-25 years). Twenty-three (66%) self-identified as non-Hispanic white, 11 (31%) as Asian, and 1 (3%) as other. Thirty-three (94%) reported their primary language as English and 23 (66%) reported speaking a second language. A majority (77%) strongly agreed discussing EOL care is part of an oncologist’s job and 69% strongly agreed patients with cancer, regardless of race/ethnicity or English language ability, should be engaged in EOL care discussions. Among several facilitators identified, two most highly rated as “Very Important” were eliciting patient belief systems about their disease (71%) and about death/dying (69%). However, only 14% strongly agreed they ask patients their beliefs about death/dying, and a minority strongly agreed they feel comfortable having EOL care discussions with REM (34%) and LEP (29%) patients. Importantly, 77% rated themselves at 6 or 7 (on a scale from 0 to 10, with 10 being the best) in how well they currently communicate about EOL care with REM and LEP patients, 74% reported wanting to be at 8 or 9 in 6 months, and 89% completely or somewhat agreed with wanting help to improve. Conclusions: Our results suggest there is conceptual understanding among academic medical oncologists of the need to engage all patients in EOL care discussions and elicit patient belief systems on the topic. Though there is lack of comfort in having EOL care discussions with REM and LEP patients, and infrequent inquiry about patient belief systems, there is also motivation to improve communication skills in this area. Interventions that foster medical oncologists' comfort and skills in cross-cultural, language non-congruent communication about EOL care are needed.
Association between control group therapy and magnitude of clinical benefit of cancer drugs.
Authors: Molto Consolacion , Tibau Ariadna , Bujosa Aida , Tapia Jose Carlos , Mittal Abhenil , Tamimi Faris , Amir Eitan 
Published: June 2022

e18604 Background: Oncology societies have developed tools to quantify the magnitude of clinical benefit. These include the American Society of Clinical Oncology Value Framework (ASCO-VF) version 2, the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) version 1.1, the National Comprehensive Cancer Network (NCCN) Evidence Blocks and the ASCO Cancer Research Committee criteria (ASCO-CRC). Associations between the characteristics of approved drugs and magnitude of clinical benefit have been explored in depth. Here, we assess the association between characteristics of control group therapy and magnitude of clinical benefit. Methods: We searched Drugs@FDA to identify new solid tumor cancer drugs approved based on randomized trials (RCTs) between January 2012 and December 2021. Substantial clinical benefit was defined as: overall survival gain ≥ 2.5 months and progression-free survival gain ≥ 3 months for the ASCO-CRC (palliative setting only); ASCO-VF threshold score ≥45 (palliative and curative setting); NCCN Evidence Blocks threshold score ≥16 (palliative and curative setting); and grade A or B for trials of curative intent and 4 or 5 for those of non-curative intent using ESMO-MCBS. Associations between characteristics of control group therapy (e.g. type of active therapy, use of matched placebo and overlap between experimental and control therapy) and substantial clinical benefit scores were explored using logistic regression. Results: We identified 174 RCTs supporting the approval of 76 drugs for 164 indications. Of these, 47% (82/174) were placebo-controlled trials among which 42% (34/82) comprised active treatment with a matched placebo. Substantial clinical benefit was observed in 45%, 46%, 72% and 73% using the ESMO-MCBS, ASCO-VF, NCCN Evidence Blocks and ASCO-CRC, respectively. These low proportions resulted in an inability to fit multivariable models adequately. RCTs with a control group comprising of active treatment with a matched placebo were associated with significantly lower odds of substantial benefit with ESMO-MCBS (OR 0.27, P = .003) and ASCO-VF (OR 0.30, P = .008) but not with NCCN Evidence Blocks (OR 0.74, P = .55) or ASCO-CRC criteria (OR 1.36, P = .54). Similar results were observed when excluding trials in the curative setting. There was a non-significant association with higher odds of substantial benefit with ESMO-MCBS with trials in which the control group was chemotherapy (OR 1.97, P = .07). For ASCO-CRC a non-significant association in the opposite direction was observed (OR 0.40, P = .06). Conclusions: Clinical benefit scales can be sensitive to the type of control group therapy. RCTs with an active treatment and matched placebo in the control group were less likely to be scored as providing substantial clinical benefit using the ESMO-MCBS and the ASCO-VF scales. Control group therapy did not influence NCCN Evidence Blocks or ASCO-CRC scores.
Improving advanced directive completion rates on an inpatient oncology unit using internal medicine resident participation: A quality improvement study.
Authors: Bloom Matthew Doran , Pan Kelsey , De Leo Edward , Altshuler Ellery 
Published: June 2022

e18636 Background: A written advanced directive (AD) allows patients to indicate their preferences for medical care should they ever lose the ability to make their wishes known. This may take the form of a living will or designation of a healthcare surrogate. AD completion rates remain poor on inpatient oncology units, with only 20-40% of patients having an AD. This is despite the fact nearly all cancer patients (95%) believe discussing ADs is an important issue. It has recently been shown that nearly 87% of cancer patients would support a policy in which admitting physicians offered to have a conversation regarding ADs. The goal of our project was to increase the percentage of patients with documented ADs on our inpatient oncology unit from 30% to 50% using the participation of internal medicine residents. Our secondary objective was to initially assess resident knowledge, confidence and skills with AD discussions. Methods: We carried out a prospective QI project in which we first calculated the percentage of consecutive patients on our inpatient oncology unit with documented ADs. After providing educational materials and delivering AD forms to the resident workroom to increase accessibility, we again calculated the percentage of consecutive patients with documented ADs. We also initially surveyed residents about their knowledge, comfort levels, and barriers to having AD discussions with patients. Results: Pre-intervention, 15 out of 50 (30%) consecutive patients on our inpatient oncology unit had documented ADs. Post-intervention, 13 of 27 (48%) consecutive patients in our oncology unit had documented ADs. Most residents felt their knowledge of ADs was average (46.88%, n = 15) or good (28.13%. n = 9). When asked about comfort in filling out ADs with patients, most responded as average (28.13%, n = 9) or poor (28.13%, n = 9). The main barrier to completing ADs was lack of time (25%, n = 20) followed by lack of knowledge (25%, n = 8) and not feeling the responsibility (12.5%, n = 4). Most residents were interested (65.53%, n = 21) or maybe interested (28.13%, n = 9) in further teaching on ADs. Conclusions: Our study showed that AD completion rates on an inpatient oncology unit can be improved using the participation of internal medicine residents. This was done through a standardized approach of housestaff offering to discuss ADs on admission after they had received short small group teaching sessions on AD discussions. Furthermore, we identified that most internal medicine residents had average or poor comfort in initiating advanced care discussions, but were interested in obtaining further knowledge to help discuss ADs with patients.
A randomized, open-label, crossover study assessing the pharmacokinetic and pharmacodynamic bioequivalence of pegfilgrastim-cbqv via on-body injector vs prefilled syringe.
Authors: Tang Hong , Civoli Francesca , Tatarewicz Suzanna , Miyasaki Lisa , O'Kelly Hillary , Young Alasdair , Finck Barbara 
Published: June 2022

e18637 Background: Pegfilgrastim-cbqv, a pegfilgrastim biosimilar, is administered 24-72 h after myelosuppressive chemotherapy to prevent febrile neutropenia. Pegfilgrastim delivery via an on-body injector (OBI) applied on the day of chemotherapy eliminates the need for a second healthcare visit. This study evaluated the pharmacokinetic (PK), pharmacodynamic (PD) bioequivalence (BE), and the safety of pegfilgrastim-cbqv administered via OBI vs prefilled syringe. Methods: In this open-label, 2-period crossover study, healthy adult male participants were randomized 1:1 to 2 treatment sequences to receive a 6-mg subcutaneous (SC) injection of pegfilgrastim-cbqv via OBI or prefilled syringe in period 1 and an injection via the other method in period 2 (after a 6- to 8-wk washout). Primary endpoints (PK) were area under the concentration-time curve from time 0 to infinity (AUC0-inf), the AUC from time 0 to the last quantifiable concentration (AUC0-last), and the maximum plasma concentration (Cmax). Secondary endpoints (PD) were area under the absolute neutrophil count (ANC)-time curve from time 0 to the last quantifiable ANC (ANC AUC0-last) and maximum ANC (ANCmax). PK/PD BE was established if the 90% CI for the geometric mean ratios (GMRs) fell within 80-125%. Safety and immunogenicity were also assessed. Results: The 90% CIs of the GMRs for PK and PD endpoints in healthy participants fell within the predetermined range (Table). Treatment-emergent adverse events (TEAEs) occurred in 87.8% (OBI) vs 75.8% (prefilled syringe) of participants. Most TEAEs were musculoskeletal effects and mild in severity. The most common injection siterelated TEAE was erythema (OBI 34.1%; prefilled syringe 2.5%). The injection site erythema reactions were mild in severity and self-limiting. The incidence of treatment-emergent antidrug antibodies (ADAs) in period 1 was similar with OBI (40.0%) vs prefilled syringe (36.6%); ADA titers were low, transient, and primarily directed to the polyethylene glycol (PEG) moiety of pegfilgrastim-cbqv. The ADAs had no apparent impact on PK, PD, or safety. Neutralizing antibodies were not detected in any participant. Conclusions: This study demonstrated PK and PD BE of pegfilgrastim-cbqv administered via OBI vs prefilled syringe in healthy adult males. OBI and prefilled syringe administration had similar safety and immunogenicity profiles. No unexpected safety signals were identified.[Table: see text]
Impact of weekend effect on neutropenic fever admissions associated with malignancy.
Authors: Kannayiram Sandhya Shri , Mariappan Aathi Lakshmi , Desai Palak 
Published: June 2022

e18658 Background: The impact of the “weekend effect” (increased mortality rate during Saturday and/or Sunday admissions) on hospitalizations for various medical emergencies has been studied with results often showing adverse patient outcomes. Febrile neutropenia in cancer patients is an acute oncological emergency with significant mortality and morbidity. Here, we attempt to explore if the day of admission impacts outcomes and healthcare utilization in cancer patients admitted for neutropenic fever. Methods: We performed a retrospective analysis using the National Inpatient Sample (NIS) database from 2019, and identified all adult admissions with cancer (hematological and solid cancers) and a concomitant primary or secondary diagnosis of Febrile Neutropenia using ICD 10 codes. These patients were divided based on the day of admission (group 1: weekday vs. group 2: weekend). The groups were compared for demographic differences, inpatient mortality, length of stay (LOS), and hospital charges (TCHG). Secondary outcomes studied were complications like sepsis, septic shock (SS), and mechanical ventilation (MV). Statistics were performed using the t-test, chi-square test, multivariate logistic analysis. Results: A total of 136,895 cancer patients were admitted with febrile neutropenia, and of those, 28,559 patients were admitted during the weekend. Both groups had similar demographics (p = > 0.05) with a mean age of 61 years, more males (52% vs. 51%), admitted in large-sized and urban teaching hospitals, and a majority had Medicare insurance (48% vs. 50%). 4.6% of weekday and 4.7 % of the weekend admissions died during hospitalization. Weekend admissions were likely to have a slightly lower mortality, although not statistically significant(aOR = 0.96,95% CI = 0.81-1.1, p = 0.72). The mean LOS was 9 days for group 1 and 8 days for group 2 (p < 0.001*). TCHG was lower for the weekend by $ 15,770 per admission (p < 0.001*). The rates and odds of having sepsis, SS, MV were similar between both groups (p > 0.05). In addition, increasing age, Hispanic race, and comorbid chronic kidney disease, diabetes, congestive heart failure, acute kidney injury, acute respiratory failure resulted in higher mortality, LOS, and all complications (p = < 0.001*) regardless of the day of the admission. Conclusions: The mortality rate and other outcomes in neutropenic fever did not statistically change between weekday and weekend admissions. Interestingly, the healthcare resource utilization (LOS and TCHG) was higher on weekdays. It is encouraging to note that the “weekend effect” has not impacted the in-hospital outcomes. However, patients admitted with febrile neutropenia have a high mortality rate and increased risk of serious complications. Therefore, utmost vigilance and close follow-up are necessary when treating these patients. *p = < 0.05 was considered significant; aOR = Adjusted Odds Ratio.