bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methylene blue for the treatment of oral mucositis related to radiation therapy of head and neck cancers: An uncontrolled cohort.
Authors: Roldan Carlos , Koyyalagunta Lakshmi , Rosenthal David Ira , Warner Keith , Feng Lei 
Published: September 2022

194 Background: Oral mucositis is a feared complication of radiation therapy of head and neck cancers, causing severe pain that affects oral functioning, nutrition, and quality of life, as well as therapy non-adherence or failure. Growing reports suggested that methylene blue (MB) oral-rinse was an effective and safe treatment for this oral pain. Methods: In order to evaluate the efficacy and safety of MB oral-rinse for the treatment of oral pain from mucositis in patients treated with radiation therapy of head/neck, we retrospectively evaluated patients who experienced refractory pain despite conventional therapy. Results: We identified 58 patients who received MB oral-rinse. Most were receiving treatment for squamous cell carcinoma of the tongue (n = 26, 44.83%) and squamous cell carcinoma of the tonsil (n = 14, 24.1%). The most common cancer therapy used was chemotherapy plus radiation (n = 23, 39.66%). The median duration of symptoms was 14 days. The mean NRS pain score before MB oral-rinse therapy was 7.59 (±1.68 standard deviation [SD]; median 8), and after therapy, 2.05 (±2.20 SD; median 2) ( P< 0.0001). The mean oral function scores (ability to talk, chew, and swallow) before MB oral-rinse therapy was 3.55 (±1.33 standard deviation [SD]; median 3.5), and after therapy, 0.52 (±0.86 SD; median 0) (P < 0.0001). Among 58 patients, n = 11; 18.92% had percutaneous feeding tubes placed before using MB oral rinse. Of those, four (36%) were soon removed after pain was controlled using MB. A few patients had PEG tubes inserted despite using MB oral rinse (n = 2; 3.44%), one for malnourishment and another for dehydration. Few adverse events were reported (n = 9, 15.48%) Three patients experienced oral burning sensation during the first-time use. One patient discontinued MB oral-rinse use due to cost of pharmacy compounding charge. Other discontinued it for unknown reason. Conclusions: MB oral-rinse is an effective and safe treatment for refractory pain from oral mucositis related to radiation therapy.
The PaCES (Palliative Care Early and Systematic) Project: Impact of individual components of a multi-faceted intervention on early referral to specialist palliative care.
Authors: Sinnarajah Aynharan , Earp Madalene , Biondo Patricia , Piquette Camille , Vandale Janet , Tang Patricia A. , Kerba Marc , Watanabe Sharon , Tan Amy , Simon Jessica 
Published: September 2022

199 Background: Early referral to specialist palliative care can improve, or maintain, symptom and quality of life outcomes that matter most to patients facing life-limiting illnesses. We tested a multifaceted oncologist-facing intervention (Palliative Care Early and Systematic) in the real-world setting of a busy outpatient cancer clinic for its ability to increase the proportion of patients who receive early specialist palliative care (defined as ≥ 90 days before death). Herein, we describe how each component of the multi-faceted intervention, intended to bridge cancer, primary, and palliative care, impacted early use of specialist palliative care among advanced colorectal cancer patients. Methods: Two intervention components were implemented in Calgary, Alberta, Canada’s tertiary cancer centre from January 2019 to June 2020: 1) Adult colorectal cancer patients were referred to a community-based Clinical Nurse Specialist if they failed, or could not receive, first-line chemotherapy, or had high symptom burden (indicated by an Edmonton Symptom Assessment System Revised score ≥ 7); 2) Medical oncologists sent templated ‘Shared Care’ letters to patients’ primary care providers to improve communication, collaboration and role clarity. Results: N = 209 eligible patients died during the intervention period, of whom 57% experienced early referral to specialist palliative care. The median days from referral to death was 130 (IQR: 53-359). Of the 209, 28 (13%) saw the Clinical Nurse Specialist and received Shared Care letters, and all (100%) had early specialist palliative care referral (median 240 days, IQR: 161-359). 21/209 (10%) saw the Clinical Nurse Specialist but had no Shared Care letter. Of these 21, 76% had early specialist palliative care referral (median 197 days, IQR: 96-251). 43/209 (21%) had a Shared Care letter but no interaction with the Clinical Nurse Specialist. Of these 43, 53% had early specialist palliative care referral (median 102 days, IQR: 53-257). 117/209 (56%) did not interact with the Clinical Nurse Specialist or have a Shared Care letter. Of these 117, 45% had early specialist palliative care referral (median 86 days, IQR: 40-204). Conclusions: The Clinical Nurse Specialist was associated with the greatest increase in early specialist palliative care referral; however, the Clinical Nurse Specialist and Shared Care letters combined were associated with even greater (100%) early specialist palliative care use.
Health-related quality of life among metastatic prostate cancer survivors: Comparisons to survivors originally diagnosed with localized disease and men without a cancer history in the United States.
Authors: Zheng Zhiyuan , Shi Kewei , Yabroff K. Robin Robin 
Published: September 2022

205 Background: Maximizing health-related quality of life (HRQOL) is an important therapeutic goal for metastatic prostate cancer patients. Moreover, HRQOL measures can inform clinicians about treatment sequelae and aide decision-making. To date, few studies have comprehensively compared HRQOL between metastatic prostate cancer survivors and survivors with localized diseases and men without a cancer history. Methods: The SEER-Medicare Health Outcomes Survey (MHOS) data linkage was used to identify prostate cancer survivors and individuals without a cancer history enrolled in Medicare Advantage plans. Prostate cancer survivors (diagnosed 1988-2017) who completed the MHOS baseline survey (1998-2019) after diagnosis but < 10 years post diagnosis were included, as were men without a cancer history who completed the MHOS in the same years. Survey records were clustered at person-level. 27,829 prostate cancer survivors with 42,277 survey records (metastatic n = 752 with 1040 records) and 784,305 Medicare Advantage enrollees in SEER regions without a cancer history with 1.15 million survey records were identified. Multilevel linear regressions were used to compare HRQOL outcomes, i.e. The Veterans RAND 12 Item Health Survey (VR-12 scores), between metastatic survivors and other survivors, and men without a cancer history. The VR-12 includes 8 health domains: general health, physical functioning, role limitations due to physical and emotional problems, bodily pain, energy-fatigue, social functioning and mental health. All analyses adjusted for age at survey, stage, comorbid conditions, body mass index, race/ethnicity, marital status, socioeconomic status, SEER region, and survey era. Results: Compared to men without a cancer history, prostate cancer survivors were older, had fewer comorbid conditions, were more likely to racial/ethnic minorities, married, and higher socioeconomic status. Compared to men without a cancer history, metastatic prostate cancer survivors were most likely to report worse general health (T-score difference: -6.26, 95% confidence internal [95CI]: -7.14 to -5.38; p <.001), and physical (T-score difference: -4.33, 95CI: -5.18 to -3.48; p <.001) and mental component summary (T-score difference: -2.64, 95CI: -3.40 to -1.88; p <.001), followed by survivors with early stage diseases in adjusted analyses. Results were similar for other HRQOL VR-12 measures. Conclusions: Metastatic prostate cancer survivors experience significantly worse HRQOL than men diagnosed with early-stage disease and men without a cancer history across all domains. Our findings suggest a need for better symptom management and palliative care for men diagnosed with metastatic prostate cancer.
Provider-led advance care planning in community oncology: A successful multidisciplinary quality improvement intervention.
Authors: Mudumbi Sandhya , Owens Leah , Schneider Christy L , Frailley Susan A , Arrowsmith John , Waddell Pam , Vanatta Kim , Bilbrey Larry Edward , Murphy Kathleen L , Blakely L. Johnetta , Schleicher Stephen Matthew , Dickson Natalie R. 
Published: September 2022

209 Background: Advanced care planning (ACP) is an important aspect of shared decision making in cancer treatment. Due to its importance, in 2016, Medicare expanded coverage and reimbursement for advance care planning (ACP) services (CPT codes 99497 and 99498). Despite this, ACP has been underutilized in practice. Methods: Tennessee Oncology aimed to increase knowledge and utilization of this service by medical oncologists and advance practice providers and corresponding CPT codes through an educational and quality improvement project. We formed a multidisciplinary team with individuals representing medical oncology providers, palliative care team, billing and accounting, information technology and informatics, nursing, navigation team, and operations. This team created an educational video, incorporating the “PAUSE” framework for addressing advance care planning and its role in community oncology, and details of documentation and billing. We also built in documentation templates into the medical oncology note and created a process to automate the charge capture to avoid additional steps for oncology providers. Results: Prior to this initiative, there was no baseline method to measure ACP and corresponding documentation. After two months of launching our educational video and new documentation templates, 120 documented ACP discussions were completed. ACP documentation was performed by 61 total providers practicing across 16 clinics. Providers completing documentation included both medical oncology (n = 53, 86%) and palliative care (n = 8). Of medical oncology providers, 39 (73%) were physicians and 14 (27%) were advanced practice providers. The three most common cancer diagnoses in ACP encounters were lung (20%), breast (13%), and prostate (8%). Conclusions: This combination of education and automation with multidisciplinary team input helped establish a baseline for ACP measurement that will help identify gaps and improve ACP discussions and documentation in our practice going forward.
Association of pain catastrophizing longitudinally with pain severity and interference in patients with chronic pain and cancer: A CHOIR study.
Authors: Azizoddin Desiree Rachel , Wilson Jenna , Mackey Sean , Flowers Kelsey Mikayla , Darnall Beth , Edwards Robert , Schreiber Kristin L. 
Published: September 2022

213 Background: Understanding how psychosocial factors change during cancer and affect chronic pain outcomes may help identify potential interventional targets. This longitudinal cohort study of cancer patients investigated the relationship between changes in psychosocial factors and worsened pain severity and interference over time using the Collaborative Health Outcomes Information Registry (CHOIR) dataset. Methods: Data from patients with cancer and chronic pain (n = 316) treated at a tertiary pain clinic were prospectively collected. At their initial visit (baseline; Time 1), patients provided demographic and clinical information, and completed validated psychosocial and pain assessments. Psychosocial and pain assessments were repeated at Time 2, on average 4.9 months later. Change scores (Time 2-Time 1) were computed for psychosocial and pain variables. Multivariable hierarchical linear regressions assessed the associations between changes in psychosocial factors with changes in pain outcomes over time. Results: Participants had an average age of 59, were 61% female, and 69% White. Overall, a decrease in pain severity ( p≤.001), but not pain interference, was observed among the group from T1 to T2. Increased pain catastrophizing was significantly associated with increased pain severity over time (b= 0.24, p≤.001). Similarly, increased pain catastrophizing (b= 0.21, p≤.001) and increased depression (b= 0.20, p≤.003) were significantly associated with increased pain interference over time. Demographic and clinical characteristics were not significantly related to changes in pain outcomes. Conclusions: Increased catastrophizing was uniquely associated with increased chronic pain severity and interference. Future interventional studies investigating the utility of nonpharmacological approaches that address psychological processes, like catastrophizing, for patients with cancer and chronic pain are needed.
A pilot intervention to improve health insurance literacy and financial toxicity among recently diagnosed adolescents and young adults with cancer.
Authors: Kirchhoff Anne C. , Mann Karely , Waters Austin R. , Kaddas Heydon K. , Perez Giselle K. , Warner Echo L. , Vaca Lopez Perla L. , Ray Nicole , Chevrier Amy , Allen Karlie , Fair Douglas Beaty , Tsukamoto Tomoko , Lewis Mark Andrew , Haaland Ben , Park Elyse R. 
Published: September 2022

218 Background: Adolescents and young adults (AYAs; ages 18-39) with cancer report worries about costs and feeling uninformed about their insurance, which may impair their ability to navigate the health care system, use their insurance, and manage costs. We conducted a pilot randomized controlled trial (RCT) to assess a virtually delivered health insurance navigation intervention (“CHAT”) to improve health insurance literacy (HIL) and knowledge, increase awareness of insurance protections in the Affordable Care Act (ACA), and reduce financial toxicity and stress. Methods: CHAT is a 4-session program delivered by a patient navigator. Session content included learning about insurance, navigating your plan, insurance-related laws, & managing care costs. Eligible participants had access to a wireless device, were within their first year of cancer diagnosis, and were treated at oncology sites from the University of Utah Healthcare and Intermountain Healthcare systems. We assessed feasibility and preliminary efficacy of CHAT compared to usual navigation care, including HIL (9 items on confidence using insurance), insurance knowledge (13 items on terms such as deductible & copay), ACA protections (8 items), Perceived Stress Scale (PSS; 4 items), and COmprehensive Score for financial Toxicity (COST; 11 items) using t-tests. Results: From November 2020 to January 2022, 86 AYAs enrolled (46.2% approached consented); 68.6% were female, 72.1% white, 18.6% Hispanic, 34.9% age 18-25, 65.1% age 26-39, 83.7% had private insurance, and 10.5% public. Mean baseline HIL scores were 22.6 (range = 9-33, SD = 5.5). At baseline, 65.1% of participants were unaware of the ACA provision allowing appeals for coverage denials. 64.4% of intervention participants completed all 4 sessions; 86.0% completed the 5-month follow-up survey with data collection ongoing (74/86). At follow-up, compared to usual navigation care, CHAT participants had improvements in HIL, knowledge of insurance, and knowledge of ACA provisions (Table). While PSS improved more for CHAT than usual care, COST did not differ. Conclusions: Results support the feasibility and preliminary efficacy of CHAT with related improvements in HIL and knowledge of the ACA. Clinical trial information: NCT04448678. [Table: see text]
Impact of the Cancer and Aging Research Group (CARG) chemotherapy toxicity (tox) risk score on the benefit of a geriatric assessment–driven intervention (GAIN) among older adults with cancer.
Authors: Crook Christiana , Sun Can-Lan , Kim Heeyoung , Soto Pérez de Celis Enrique , Chung Vincent , Koczywas Marianna , Fakih Marwan , Chao Joseph , Cabrera Chien Leana , Charles Kemeberly , Katheria Vani , Trent Monica , Roberts Elsa , Jayani Reena , Moreno Jeanine , Sedrak Mina S. , Dale William , Li Daneng 
Published: September 2022

235 Background: The CARG tox score can predict risk of chemotherapy-related tox in older adults with cancer. GAIN can reduce tox vs standard of care (SOC) among these patients (pts); GAIN’s impact across CARG risk groups is unknown. Methods: A secondary analysis of the GAIN randomized clinical trial (NCT02517034) of pts aged ≥65 (solid tumor diagnosis, starting a new chemotherapy) was performed. Pts were randomized 2:1 to receive GAIN vs SOC and were categorized into low (0-5), medium (6-9), and high (10-20) risk groups according to CARG score. The primary outcome was incidence of grade 3-5 tox. Chi-square/Fisher’s exact tests were used to compare outcomes (GAIN vs SOC, stratified by risk groups). Log-rank tests were used to compare 1-year survival across risk groups. Results: This analysis included 600 pts: 26.5% low risk, 45.2% medium risk, 28.3% high risk. Table shows pt/treatment characteristics. For pts with low/medium risk scores, GAIN demonstrated a 14.0% (95% CI 4.1%-23.9%) reduction in tox vs SOC (p = 0.006). No significant reduction in tox was observed among pts with high risk scores (p = 0.86). One-year survival (GAIN vs SOC) for each risk group was 73.6% vs 67.4% (low risk), 68.5% vs 64.5% (medium risk), and 57.3% vs 61.7% (high risk), respectively (log-rank p = 0.10). Conclusions: Older adults with low/medium, but not high, CARG risk scores benefit from GAIN. Additional strategies may be needed to improve outcomes for pts with high CARG risk scores. Clinical trial information: NCT02517034. [Table: see text]
Bone mineral density testing and the risk of fractures in men initiating androgen-deprivation therapy: Population-based study.
Authors: Hu Jason , Aprikian Armen G. , Dragomir Alice 
Published: September 2022

238 Background: Androgen deprivation therapy (ADT) is a staple of advanced prostate cancer (PCa) treatment, however several side-effects are associated with its long-term use. Notably, loss of bone mineral density (BMD) is accelerated which increases fracture risk. Although guidelines recommend BMD testing when initiating ADT to properly assess baseline fracture risk, there is limited data to support this recommendation in the PCa patient population. The objective was to examine the association between baseline BMD testing (bBMDT) and the risk of fractures in men initiating ADT for PCa. Methods: A retrospective observational cohort study using data from Quebec public healthcare insurance administrative databases was conducted. The cohort included PCa patients who initiated ADT from 2004-2015 and who received at least one year of ADT treatment. Baseline BMD testing was defined as a BMD test performed from 6 months prior to ADT initiation and up to 3 months after. Patients were categorized as either having received bBMDT or not received bBMDT when initiating ADT. The primary study outcomes were incidence of any fracture and incidence of fractures resulting in hospitalization. Inverse probability of treatment weighting was used to adjust for measured baseline characteristics which included patient demographic variables, comorbidities, risk factors for fractures, and use of other medications affecting bone density. Results: We identified 13,532 patients who initiated ADT, of which 2,070 (15.3%) underwent bBMDT. The unadjusted 5-year incidence of any fracture was 15.1% for patients not receiving bBMDT and 14.0% for patients receiving bBMDT. In adjusted analyses, bBMDT (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.76-1.12) was not associated with the risk of any fracture. For fractures requiring hospitalization, bBMDT was associated with a lower risk (HR 0.71, 95%CI 0.52-0.98). Furthermore, bBMDT was associated with increased odds of bisphosphonate use within 1 year of ADT initiation among patients who were bisphosphonate-naïve at baseline (odds ratio [OR] 2.03, 95%CI 1.74-2.36). Conclusions: In our study population, bBMDT was associated with a lower risk of fractures resulting in hospitalization. Given the low uptake of bBMDT, additional efforts emphasizing the importance of BMD testing in guidelines may be needed.
Investigating keratinocyte growth factor hair serum for the prevention of chemotherapy-induced alopecia.
Authors: Potluri Preethika , Paul Emma Elizabeth , Segar Jennifer Margaret , Ehsani Sima , Jiralerspong Sao , Roe Denise , Chalasani Pavani 
Published: September 2022

240 Background: Chemotherapy induced alopecia (CIA) is known to have a significant psychological and quality of life impact, mainly in women. While cold caps have been shown to decrease CIA, expense, availability, and extension of treatment durations are barriers for routine clinical use. Keratinocyte Growth Factor (KGF) has been shown to have cytoprotective effects on human keratinocytes in vitro and reduce apoptosis in human hair follicles. Based on this data, we hypothesized that KGF-Hair serum (KGF-HS) will prevent CIA in women undergoing chemotherapy as treatment for breast cancer. Methods: We designed a Simon 2-stage prospective study to test our hypothesis. Study was approved by our institutional review board and registered on clinicaltrials.gov (NCT04554732). In part 1 we planned to enroll 20 patients into a single arm. If ≥ 4 responses are noted, we proposed to initiate part 2: randomized double-blind placebo-controlled study. Patients with early-stage breast cancer (ESBC) who were scheduled to get at least 4 cycles of anthracycline or taxane based chemotherapy were included. Patients with inflammatory scalp conditions, hair loss disorder, scalp disorders were excluded. The primary endpoint was successful hair preservation using the Common Terminology Criteria for Adverse Events 4.0 scale at the end of 4 cycles of chemotherapy. Secondary end points included wig use and scores on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30, Hospital Anxiety and Depression Scale, and a summary scale of the Body Image Scale. Results: Twenty patients completed part 1 of the study and were evaluable for primary endpoint. Mean age was 60 years and 70% were treated with taxane based chemotherapy. Successful hair preservation was noted in 0 of 20 women. Mean duration of treatment with KGF-HS was 4.6wks (range 2-10 weeks) before women came off study due to grade 2 hair loss. There were no statistically significant differences in changes in any of the scales of quality of life from baseline to end of treatment. There were only 2 grade 1 events (1 rash and 1 itching) reported which resolved after coming off the KGF-HS. There were no serious adverse device events. Conclusions: Among women with early-stage breast cancer receiving chemotherapy with a taxane, anthracycline, or both, using KGF-HS did not prevent CIA. Further research is needed to investigated other novel topical options to prevent CIA. Clinical trial information: NCT04554732.