bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which patients are at risk for poorer outcomes from testicular cancer (TC) and its treatment?
Authors: Jacobs Linda A. , Vaughn David J. , Blauch Abigail N. , Pucci Donna A. , Palmer Steven C 
Published: June 2022

e24060 Background: TC is a highly treatable disease with a 5-year combined relative survival rate of 95%. Survival, however, can come at a price, and longer-term negative physical and psychosocial sequelae have been described in the literature. We examined unmet needs and psychological and physical well-being in a sample of TC survivors attending a survivorship visit with the aim of describing the outcomes achieved and identifying characteristics of individuals most at risk of poor outcomes. Methods: Patients attending a survivorship clinic visit completed measures assessing 13 common physical and psychosocial needs, anxiety and depression (HADS), and QoL (SF-12V2). These data were described, subjected to hierarchical cluster analysis, and the resulting clusters were examined for disease, treatment, and demographic differences. Results: Participants (N = 312) from the same institution were primarily white (94%), non-Hispanic (98%), middle-aged (M = 42.8, SD = 11.1), married (74%), college graduates (79%), making more than $80,000/year (72%). On average, participants were diagnosed 9.8 (SD = 6.5) years earlier, though that ranged from 2-44 years, with Stage I or II TC (80%) that required surgery (99%) including RPLND (22%), chemotherapy (50%), and/or radiation (12%). Unmet needs were generally low (M = 0.91, SD = 2.1, R = 0-13) with 72% reporting no unmet need, and no unmet need was endorsed at a rate higher than 10%. Depressive symptoms were uncommon (HADS-D M = 2.3 SD = 2.6) with 95% classified as having no depressive symptoms. Symptoms of anxiety were more common (HADS-A M = 4.9; SD = 3.7) although 78% were classified as having no symptoms. QoL was similar to population norm values (M = 50) for both mental (M = 51.8) and physical (M = 51.7) well-being. Hierarchical cluster analysis of unmet needs, anxiety and depressive symptoms, and QoL revealed 2 distinct groups, one (86%) experiencing more positive outcomes than the other (14%). These groups differed significantly in unmet needs (M's 0.5 vs. 3.3), anxiety (M's 3.9 vs. 10.6) and depressive symptoms (M's 1.6 vs. 6.3), and mental QoL (M's 54.4 vs. 34.3; all p's < 0.001). Groups did not differ with respect to physical well-being (M's 51.4 vs. 53.2, ns). Individuals in the less well-functioning group were more likely to have been diagnosed with Stage 3 disease, be unmarried, and have a lower income (all p < 0.05). Treatment intensity, educational attainment, age, and time from diagnosis were not significantly associated with group membership. Conclusions: Most TC survivors report good functioning with few unmet needs and low levels of anxiety and depression during survivorship. A minority of TC survivors, however, experience substantially greater psychosocial but not physical difficulties, and these individuals are likely to be unmarried, have lower income, and been initially diagnosed with more advanced disease.
Elucidation of the mechanisms of trastuzumab-induced severe cardiotoxicity using patient-derived iPSCs cardiomyocyte model.
Authors: Sasaki Ritsuko , Kurebayashi Nagomi , Eguchi Hidetaka , Horimoto Yoshiya , Shiga Takahiro , Miyazaki Sakiko , Kashiyama Taku , Akamatsu Wado , Saito Mitsue ,   Department of Breast Oncology, Juntendo University Graduate School of Medicine
Published: June 2022

e24065 Background: Trastuzumab (Tmab) is a highly effective anticancer drug, but it is associated with unpredictable and non-accumulative cardiotoxicity, which can interfere with continuous treatment. In order to elucidate the mechanism of Tmab-induced cardiotoxicity, we attempted to reproduce the cardiotoxicity using disease-specific iPS cells from patients who had suffered myocardial dysfunction after Tmab administration. Methods: From 468 breast cancer patients treated with Tmab at our hospital, we selected three patients exhibiting severe cardiotoxicity (SP) with left ventricular ejection fraction reduced by more than 30% from baseline, and three non-cardiotoxic patients (NP)matched with the SP group on various clinical factors. Patient-specific iPSCs established from peripheral blood samples were differentiated to cardiomyocytes (iPSC-CMs). We evaluated contractility and intracellular metabolic function. Results: Treatment of iPSC-CMs with Tmab for 7 days reduced contraction and relaxation velocity, which were more evident in SP than in NP ( p= .032, .044, respectively). In addition, SP-iPSC-CMs showed a significant decrease in ATP ( p= .048), increase in reactive oxygen species production ( p= .046), and increase in autophagy activity ( p= .030) compared to NP-iPSC-CMs. In contrast, there was no significant difference in the suppression of mitochondrial maximal respiratory rate by Tmab between the two groups. Conclusions: We demonstrated that iPSC-CMs well recapitulate the individual differences in contractile and intracellular metabolic dysfunction caused by Tmab.
Association between palliative care consultation, hospital length of stay, and in-hospital costs in women with metastatic breast cancer in United States.
Authors: Subramaniam Divya S. , Al-Hammadi Noor , Jenkins Alexandria , Hinyard Leslie J. 
Published: June 2022

e24068 Background: Regardless of detailed advantages of palliative care for cancer patients, there is limited research about the utilization of palliative care services for women with metastatic breast cancer, particularly at the end-of-life. The purpose of this study was to determine the incidence of inpatient palliative care consultations (PCC) in women with metastatic breast cancer and to examine the association between palliative care consultation and hospital length of stay (LOS) and in-hospital costs in a nationally representative sample. Methods: Women, 18 years and older, with a metastatic breast cancer related hospitalization in the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS) 1998-2017 were included in the study. Multivariable logistic and linear regression analyses were used to examine the effects of patient and hospital characteristics on the receipt inpatient palliative care, length of stay and total hospital charges. SAS software survey procedures (version 9.4, SAS Institute Inc, Cary, NC) were used for all analyses to account for the sampling design of NIS. Results: Older women were associated with higher odds of getting PCC [aOR, 95% CI (60-69 yrs: 1.08 (1.01, 1.16); ≥70 yrs: 1.25 (1.17, 1.34))]. Women of races other than White [Blacks: 1.12 (1.07, 1.16); Other races 1.08 (1.04, 1.13)], and patients from Zip codes of with lower household income levels were more likely to receive a palliative care consult [0-25th percentile: 1.17 (1.12, 1.21); 26-50th percentile 1.05 (1.01, 1.09); 51-75th percentile 1.06 (1.02, 1.20)]. Women receiving governmental insurance had slightly lower odds of receiving palliative care compared to women receiving commercial types of insurance [0.94 (0.91, 0.98)]. Small and medium-sized hospitals were less likely to offer the service to admitted women [0.87 (0.84, 0.91)]. Hospitals located in the Northeast, Midwest, South were associated with lower odds of offering inpatient PCC when compared to hospitals in the West. A woman with any comorbidity had higher odds of receiving a PCC during their hospital admission. Hospitals were likely to charge patients receiving palliative care services less compared to patients who did not have a PCC encounter (Estimate: -5450; 95% CI: -5968, -4936) despite being associated with higher odds of a longer hospital stay (> 4 days) [1.17 (1.14, 1.20)]. Conclusions: Our study found that inpatient PCC for women with metastatic breast cancer increased LOS and hospital costs. We also found that inpatient palliative care consultation was provided to sicker patients; patients who would likely have longer length of stay, and in return, higher hospital costs compared to those without multiple acute comorbidities. Hence, targeted interventions must be implemented to increase PCC for metastatic breast cancer patients in the United States.
Effect of traditional Chinese medicine on pyrotinib-associated diarrhea in patients with HER2-positive breast cancer.
Authors: Jiang Zhansheng , Yang Yanfang , Wang Hao , Tong Zhongsheng , Pan Zhanyu 
Published: June 2022

e24096 Background: Pyrotinib, an irreversible pan-HER tyrosine kinase inhibitor, has been a salvage regimen for metastatic HER2+ breast cancer failed to trastuzumab in Chinese guidelines. However, the incidence of pyrotinib induced diarrhea is more than 80% as neratinib. TCM-padia001 (clinicaltrials.gov: NCT04988165) is an open-label, phase II study investigating the effectiveness of Traditional Chinese Medicine (TCM) in treating diarrhea and improving tolerability of pyrotinib. Methods: All patients in the group had diarrhea after taking pyrotinib, and they could not be controlled after previous use of other antidiarrheal drugs (loperamide, Bifidobacterium, montmorillonite powder). All patients were treated with oral TCM (a Chinese herbal formula, one dose per day divided in two times) for 3 weeks. Diarrhea assessment was graded according to NCI-CTCAE v5.0 and quality of life was graded according to EORTC QLQ-C30. The primary endpoint was incidence of grade ≥3 diarrhea. Results: A total of 28 patients were enrolled, and 23 patients completed 3 weeks of TCM treatment and were followed up. The median number of diarrheas was 7 times (4-13), and 15 cases in these 23 patients were ≥grade 3 before treatment with TCM. After treatment with TCM, none of patients had grade 3 diarrhea, and the rate of grade 2 diarrhea was 17.4% (4/23). The scores of global health status/quality-of-life assed with EORTC QLQ-C30 in patients were dramatically improved (40.90+7.68 vs. 62.88+7.15) after treatment with TCM. Most importantly, in the symptom domains scores, we found that TCM treatment did not increase the incidence of constipation, but also significantly improved the fatigue, pain, nausea, vomiting and anorexia of patients. Conclusions: TCM is very effective in the treatment of Pyrotinib related diarrhea, and compared with Western antidiarrheal drugs, it will not produce secondary painful symptoms such as constipation. Clinical trial information: NCT04988165.
Patient and caregiver-reported acceptability of an automatic phone call offering supportive and palliative care referral for advanced non-small cell lung cancer patients.
Authors: Pabani Aliyah , King Seema , Ahmed Sadia , Shirt Lisa , Slobogian Vanessa , Vig Chandra , Hao Desiree , Barbera Lisa Catherine , Kurien Elizabeth , Santana Maria , Biondo Patricia , Sinnarajah Aynharan , Simon Jessica 
Published: June 2022

e24097 Background: Timely palliative care interventions can help to alleviate the distress people experience after a diagnosis of an incurable, life-threatening cancer. However, referrals to palliative care continue to be late due to various provider and patient barriers. The Palliative Care Early and Systematic (PaCES)-Automatic study was co-designed with patients and providers and implemented an early palliative care intervention for newly diagnosed stage IV non-small lung cancer (NSCLC). The objective of this study was to determine patient/caregiver-reported acceptability of a phone call from a supportive and palliative care (SPC) nurse offering consultation, automatically (without referral) after first oncologist appointment. Methods: Two SPC specialist nurses screened out-patient clinic lists at a tertiary cancer center weekly and called all eligible patients offering an in-home consultation. Eligibility: > 18 years, newly diagnosed/suspected Stage IV NSCLC and had first medical/radiation oncologist visit. Patients/caregivers were surveyed about the acceptability (5-point Likert scale) of the automatic phone call offering a palliative care consult, using Sekhon’s Framework of Acceptability domains. Results: Among the 113 patients screened, 81 patients/caregivers were contacted and offered SPC consultation and 72% accepted the in-home consult. Of 70 patients/caregivers that agreed to be contacted for the survey: 4 did not recall the call offering SPC, 3 declined participating in the survey, and 15 were not reached. Of 48 respondents, 93.6% rated overall acceptability of the automatic call offering SPC consultation somewhat/completely acceptable, with the other 6.4% rating it as neither acceptable nor unacceptable. Of 35 patients/caregivers that completed the full survey: 31% caregivers, 63% female, 57% ≤65 years, 29% ≤high school education, 67% (n = 27) < $60,000 household income, 80% spoke only English/French, and 71% Caucasian. Within the domains of acceptability, 94.7% were comfortable receiving the call, 91.9% understood why they received it; 86.5% thought the call was a valuable; 69.5% thought the call helped them; 65.7% learned about SPC from the call; no one expressed concern that the SPC nurse had access to their contact/health information; 97.2% thought the call didn’t take much physical/emotional effort and were confident in their ability to participate (ask questions/make decisions). Conclusions: Nearly all patients/caregivers found the automatic SPC call offering consultation to be acceptable. Most patients agreed to the consultation offer. Routine calls offering SPC consultation may be a timely alternative to awaiting conventional referral by oncologists.
Cost-utility of apixaban and rivaroxaban in the thromboprophylaxis of cancer patients treated with chemotherapy in Spain.
Authors: Ortega Laura , Muñoz Martín Andrés J. , Rubio-Terres Carlos , Rubio-Rodriguez Dario , Soria Jose Manuel 
Published: June 2022

e24102 Background: Apixaban and rivaroxaban are two direct-acting oral anticoagulants (DOACs) recommended for thromboprophylaxis in cancer patients treated with chemotherapy. The objective was to assess the cost-utility of thromboprophylaxis with apixaban and rivaroxaban vs no thromboprophylaxis in ambulatory cancer patients starting chemotherapy with an intermediate-to-high risk of venous thromboembolism (VTE), Khorana score ≥ 2 points. Methods: A cost-utility analysis was performed from the perspective of Spain´s National Health System (NHS) using an analytical decision model in the short term (180 days) and a Markov model in the long term (5 years). Transition probabilities were obtained from randomized, double-blind, placebo-controlled clinical trials of apixaban and rivaroxaban in adult ambulatory patients with cancer at risk for VTE, treated with chemotherapy (AVERT and CASSINI trials). The costs (€ 2021) were taken from Spanish sources. The utilities of the model were obtained through the EQ-5D questionnaire. Deterministic (base case) and probabilistic (second-order Monte Carlo simulation) analyses were conducted. Results: In the base case, apixaban was dominant (with a gain of 0.005 QALY, quality-adjusted life years, and a saving of €59.49 per patient) compared to no prophylaxis. Rivaroxaban would be cost-effective (with a gain of 0.006 QALY and an additional expense of €116.23 per patient) with a cost per QALY gained of €18,747 compared to no prophylaxis. For an willingness to pay of €25,000 per QALY gained, the probability that apixaban or rivaroxaban will be cost-effective would be 62.6% and 51.9%, respectively. Conclusions: VTE thromboprophylaxis with apixaban generates savings and with rivaroxaban it generates an additional cost vs. no prophylaxis. With both DOACs, a modest QALY gain would be obtained. The probability that prophylaxis with apixaban would be cost-effective is 10.7% higher than with rivaroxaban.
Hypokalemia, hypomagnesemia, and hyponatremia are associated with acute kidney injury in patients treated with cisplatin.
Authors: Pinard Louis , Adam Jean-Philippe , Chagnon Miguel , Bollée Guillaume , Soulieres Denis 
Published: June 2022

e24105 Background: Cisplatin-associated acute kidney injury (C-AKI) is common. Predictive factors of C-AKI include age > 60 years, hypertension, cisplatin dose, diabetes, and serum albumin < 3.5g/L. The association between C-AKI and hypokalemia, hypomagnesemia or hyponatremia has not been well characterized to date. Methods: Data from a previous retrospective observational study was obtained. Patients who received at least one dose of cisplatin between September 2010 and December 2016 at the Centre Hospitalier de l’Université de Montréal were included. Patients were separated into 3 groups with similar cisplatin doses and schedules. Group A received cisplatin 60-100 mg/m2 q 3 weeks with laboratories before day 1, group B received cisplatin 60-75 mg/m2 q 3 weeks with laboratories before days 1 and 8 of each cycle and group C had weekly cisplatin 40 mg/m2 and laboratories. Association between hypomagnesemia, hypokalemia, hyponatremia, and risk of AKI, as defined by KDIGO criteria, was determined using a counting process specification of Cox’s regression models. These were used to estimate hazard ratio (HR) of AKI incidence with 95% confidence intervals (CI) of patients with and without cisplatin-induced electrolyte disorders. Estimates were adjusted for confounding factors such as volume of hydration (3 or 4 L), fluids (D5/0.45 NS or NS), age, sex, presence of furosemide and mannitol. Results: A total of 1305 patients were separated in group A (714 pts), B (205 pts) and C (386 pts). The proportion of patients with at least one event of hypokalemia, hypomagnesemia or hyponatremia was lower in group A (29.1%, 57.7% and 36.3%) compared to group B (43.4%, 66.8%, 60.0%) and group C (48.7%, 78.6%, 50.8%). The incidence of all grade C-AKI was 35.7% (group A), 46.8% (group B), 18.2% (group C). The HR of C-AKI based on each electrolyte disorder per group is presented in table I. Conclusions: The presence of one event of hypokalemia, hypomagnesemia, or hyponatremia was significatively associated with increased risk of C-AKI only in group A. This could be related to the higher average dose per cycle in this group. Other studies are needed to characterize the presence of an electrolyte disorder as a risk factor that can predict the risk of C-AKI in this subpopulation. [Table: see text]
A whole-food, plant-based (WFPB) dietary intervention to improve cancer-related and cardiometabolic outcomes in metastatic breast cancer patients.
Authors: Campbell Thomas , Campbell Erin , Culakova Eva , Janelsins Michelle Christine , Mustian Karen Michelle , Kamen Charles Stewart , Lin Po-Ju , Guido Joseph John , Peppone Luke Joseph 
Published: June 2022

e24116 Background: Obesity rates in the US have increased dramatically in recent years. Breast cancer treatment is associated with additional weight gain, and among patients with breast cancer, obesity and weight gain are associated with negative outcomes such as reduced progression-free and overall survival due to cardiometabolic co-morbidities. New evidence suggests that cardiometabolic comorbidities themselves can further accelerate breast cancer progression. We used a WFPB dietary intervention because it results in significant weight loss and larger improvements in cardiometabolic outcomes than a traditional, calorie-restricted omnivore diet. Methods: Patients with stage 4 breast cancer receiving treatment were randomized 2:1 into: 1) a WFPB dietary intervention (N = 19) or 2) usual care (N = 9) for 8 weeks with assessments at baseline, 4, and 8 weeks. Our WFPB diet consisted of education and an ad libitum whole-food, plant-based diet; 3 prepared meals a day were provided to WFPB subjects for the duration of the trial. The diet included fruits, vegetables, whole grains, legumes, nuts/seeds and excluded meat, dairy, and eggs. Outcomes include compliance, weight, cardiometabolic outcomes, and cancer progression markers. Effects of the WFPB on the outcomes were assessed by comparing marginal means by arm estimated at 8 weeks from the analysis of covariance model controlling for baseline. Results: Dietary compliance was high, with 95% of WFPB subjects consuming ≥80% of their calories from on plan foods. The WFPB group (mean baseline BMI = 31.6 kg/m2), on average, lost 6.7% (p < 0.01) of their total body weight. Adjusting for baseline weight, the WFPB group lost 8.9 lbs. more (p < 0.01) and 5.8% more of their total body weight (p < 0.01) than the control group. Conclusions: Our WFPB dietary intervention resulted in clinically meaningful and statistically significant improvements in weight and cardiometabolic outcomes, with a trend towards improving a clinically used cancer progression marker. Larger studies with longer interventions are needed to confirm these findings and investigate the sustainability of the benefits. Clinical trial information: NCT03045289. [Table: see text]
The COVID-19 in oncological settings: The buffering role of the physician’s empathic communication protects from the impact of fear on hopelessness.
Authors: Rossi Alessandro , Marconi Maria , Taccini Federica , Mannarini Stefania , Verusio Claudio 
Published: June 2022

e24126 Background: During the lockdown related to the recent COVID-19 pandemic, many oncological patients, in addition to the fear of the COVID-19, have also experienced a sense of hopelessness related to the difficult management of their medical and oncological care. However, several studies showed that the physician’s empathic communication about medical care management may act as a buffer against this negative relationship. Thus, the study aimed to test a model in which the physician’s empathic communication mediates the relationship between fear of COVID-19 and hopelessness related to aforementioned difficulties. Methods: A sample of 70 oncological outpatients [36 females (51.4%), aged from 40 to 81 years ( mean = 65.94, SD = 11.13)] were recruited at the Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona. An ad hoc structured interview was developed to assess: (A) fear of COVID-19 (KR20: 0.86); (B) feelings of hopelessness related to the COVID-19 (KR20: 0.80); and (C) the patient's perception of empathy shown by the physician in communicating care management during the pandemic (KR20: 0.71). The factor score of each dimension was used as the total score. A mediation analysis (10,000 bootstrap resampling) was performed. Results: The mediation model showed statistical significance: F = 31.852, p < 0.001; R2 = 0.487. The relationship between ‘fear of COVID-19’ and ‘hopelessness’ was partially mediated by physician’s empathic communication ( path c’: β = 0.369, se = 0.096, 95%CI[0.177; 0.561], p < 0.001) – revealing its buffering role; path a: β = -0.488, se = 0.073, 95%CI[-0.634; -0.342], p < 0.001; path b: β = -0.375, se = 0.124, 95%CI[-0.623; -0.128], p = 0.003. Conclusions: These results highlight the protective role (buffer) of the physician’s empathic communication in the process that leads to hopelessness from the fear of COVID-19. Results suggest how physicians as well as psycho-oncologists should structure stronger interventions – based on the improvement of communication strategies – that may lead to an improvement of patients’ quality of life.