bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of virtual live education on the competence and knowledge of gynecologists caring for ovarian cancer patients.
Authors: Carranza Vanessa , Taylor Bryan Carson , Gitzinger Susan H. , Fowler Joan B. , Hall Jessica 
Published: June 2022

e23003 Background: About 35% of ovarian cancer patients in the US have geographic-related disparities in their access to gynecologic oncologists. This disparity becomes more apparent as advances in the treatment of ovarian cancer continues to improve, particularly in regard to maintenance therapy (e.g., PARP inhibitors). Thus, it is critical for gynecologists who are most likely to see these patients over the span of their lives, have an intimate understanding of the management of these patients. Methods: CEC Oncology developed an educational initiative presented at four American College of Obstetricians and Gynecologists District Meetings, targeting obstetricians, gynecologists, and other health professionals. Education focused on PARP inhibitors in ovarian cancer, identification of those eligible for genetic testing and counseling, and strategies to improve patient outcomes. Evaluations were collected from attendees attending the District Meetings to assess impact on practice, increased competency, and intent to make a change in practice. This was objectively assessed by analyzing pre-test, post-test, and follow-up survey data (sent 4-6 weeks post-activity). Chi-square analysis was conducted with a priori significance set at 0.05. Results: A total of 183 clinicians were educated, practicing in academic settings (44%), community hospital settings (24%), private practice (25%), and government (7%). Attendees were asked case questions at baseline, immediately after the activity, and 4-6 weeks after the activity to assess knowledge about the DNA damage response pathway, genetic testing guidelines, and management of therapy toxicities. Knowledge increased from pre- to post-test and from pre-test to follow-up for all topics, with the greatest increase in the management of adverse events (41% increase from pre- to post-test; 50% increase from pre-test to follow-up; P< 0.01). Additionally, there was a 22% and 24% increase in confidence in identifying patients eligible for germline genetic testing and in recognizing toxicities with PARP inhibitors from pre-test to six-week follow-up, respectively. 60% of participants stated that there was a lack of patient education regarding the importance of genetic testing and counseling. At follow-up, 100% stated that they had educated patients on genetic testing and counseling, highlighting the value of educating gynecologists on this topic. Conclusions: Attendees of this educational initiative were eager to take back the knowledge learned to their clinical practices. While there was a measurable increase in knowledge with regard to different ovarian cancer related topics, educational gaps remain. Collectively, this particular audience stated that they care for > 1,000 ovarian cancer patients, elucidating the need for OB/GYNs to feel more comfortable regarding PARP inhibitor toxicities, as they become more prevalent in practice.
Two oncologists, three opinions? Second opinions in oncology: Noise, bias, and disagreement.
Authors: Gil Deza Ernesto , Gil Deza Lourdes , Abal Mariana , Garcia Gerardi Carlos , Martin Reinas Gaston , Tognelli Flavio A , Dragosky Marta , Smolje Leonel , Marin Ordoñez Alba , Brandon Maximiliano , Montiel Monica , Gonzalez Cesar , Jaunarena María del Huerto , Rivarola Edgardo G. J. , Morgenfeld Eduardo L. , Gercovich Daniela ,   ECOE USAL 2021 Team
Published: June 2022

e23009 Background: Systematic reviews show that second opinion consultations in Oncology are frequent (1 – 35%) and differ from initial recommendations by up to 50% (BMJ Open 2021;11:e044033). This study evaluates the variability of second opinions of Oncology Fellows in a Virtual Observational Standard Clinical Examination (V-OSCE 2021) (J Clin Oncol 39, 2021, suppl 15; abstr 11005). Methods: One of the stations of the V-OSCE 2021 included a simulated patient’s relative requesting a second opinion. The patient was a 62-year-old male with advanced lung adenocarcinoma (Mts in lymph nodes, bone and liver) PDL1 3%. All other markers (EGFR, ALK, ROS1 and Her2) were negative. The tumor progressed at first line with standard chemoimmunotherapy (Carboplatin + Pemetrexed + Pembrolizumab). At the time of consultation, the patient had PS2, depression, hepatic progression without evidence of CNS lesions and all laboratory results were normal. Docetaxel had been recommended as a second line of treatment. The case was sent to each Fellow before the examination, and the evaluation consisted of ten standardized prognostic and therapeutic questions. Results: A total of 16 Oncology Fellows were evaluated. Sex Female/Male (11/5) Age: Mean 33 years (r= 30-35). We analyzed the answers to ten standardized questions (Table). Conclusions: A) The Oncology Fellows agreed on only two out of ten answers to the standardized questions (incurability and mental health referral); and in the remaining eight, disagreement is evident. B) Within the first seven questions, all Fellows differed among themselves in at least one answer. C) These findings coincide with our daily practice: It is highly likely that if a patient gets a second opinion, they will get divergent and even contradictory answers about their case. D) Are these findings a product of differing knowledge or physicians’ noises and biases? Further research could address how medical education and professional development can help with reflecting upon these issues.[Table: see text]
Adaptive expertise for medical oncology fellows: How to foster evidence-based medicine mastery.
Authors: Agarwal Parul , Regan Linda , Donehower Ross C. , Marrone Kristen 
Published: June 2022

e23015 Background: Adaptive expertise (AE) describes a physician’s ability to effectively apply pre-existing knowledge to unfamiliar clinical situations. This skill relies on understanding not just “how” solutions work, but instead developing a framework of “why” a specific decision is correct for a particular situation. Acquiring this skillset enables one to rely on foundational knowledge, while simultaneously reaching for novel information in order to make the best clinical decision. Given the expansion of primary literature and evolving treatment options in oncology, development of AE is critical for fellows to provide high level patient care. There is limited research focused on oncology trainee development of AE and evidence-based medicine (EBM) mastery. Methods: We designed an observational cohort study of ten first-year medical oncology fellows at Johns Hopkins during the 2021-2022 academic year (IRB00293232). Fellows were required to attend a case-based, faculty moderated EBM peer-teaching curriculum. A validated, ten question Likert scale AE questionnaire (Carbonell instrument) was administered to each fellow at baseline. Data collection from weekly questionnaires measuring efficiency and innovation in case preparation and presentation is ongoing. These data will be quantitatively summarized and correlated with the baseline AE instrument to evaluate change and development of AE over the academic year. Results: Ten learners have participated in the curriculum as of February 2022. All questions in the baseline AE instrument had a 100% response rate. Selected results are presented in Table.While all participants “strongly agree” that knowledge in their discipline keeps on developing, only 50% “strongly agree” that they are able to apply knowledge in new and unfamiliar situations with a degree of success, highlighting the need for a curriculum focused on AE for trainees. Conclusions: AE utilizing EBM in medical oncology is an essential skill for trainees to acquire. Next steps will include moderated focus groups at the 6 month and 10-month time point, followed by analysis of the weekly questionnaires, which will allow for formal assessment of this curriculum. Future directions will include expansion to include other institutions and adaption for different learner levels.[Table: see text]
A multicenter evaluation of treatment patterns and outcomes for Adamantinoma-like Ewing sarcoma.
Authors: Dorand Rodney Dixon , Wang Daniel Ying , Keedy Vicki Leigh , Davis Elizabeth J. 
Published: June 2022

e23500 Background: Sarcomas are a rare and heterogenous group of malignancies comprised of > 150 histologic subtypes. Adamantinoma-like Ewing sarcoma (ALES) is a rare, small round blue cell tumor that represents a variant of Ewing sarcoma (EWS). First described 20 years ago, ALES harbors a EWS subset defining EWS-related translocation; however, ALES has a complex epithelial differentiation component defining it as a distinct clinical entity. Most ALES cases arise in the head and neck, but it has also been reported in the extremities and thorax. Given the rarity of ALES, there is a paucity of literature to guide treatment and describe outcomes. Methods: We performed a retrospective review (January 1, 2010-January 1, 2022) at two sarcoma centers in the United States and identified 4 cases of ALES. Tumor and patient characteristics were described, and patient outcomes were assessed. Results: Four patients were identified. 3 (75%) were male. Median age at diagnosis was 37 years (range 23-57). Primary site of ALES was head and neck (50%) and thorax (50%). Median tumor size was 4 cm (2.7-5.5 cm). All patients underwent resection of their primary tumor, and two (50%)received adjuvant radiation therapy. All pts received/are receiving adjuvant chemotherapy. 75% of patients were treated with Vincristine, Doxorubicin, and Cyclophosphane (VDC) alternating with Ifosfamide & Etoposide (IE) for 12-14 cycles. One patient received 4 cycles of adjuvant carboplatin and etoposide and radiation after an initial diagnosis of basaloid carcinoma but recurred 47 months later and diagnosed at ALES at that time. That patient underwent re-resection followed by adjuvant chemotherapy with Vincristine, Doxorubicin, and Ifosfamide (VAI). Median follow-up from initial diagnosis was 25 months (3-39 months). All patients are alive with no evidence of disease. Conclusions: Similar to treatment of EWS, a multidisciplinary strategy is paramount. VDC/IE is a reasonable treatment strategy. Further multicenter collaboration is essential to define clinical characterization of this rare sarcoma subtype and to guide treatment particularly in the relapsed or refractory setting.[Table: see text]
Treatment facility: Effects on stage IV osteosarcoma survival.
Authors: Furtmann Amanda , Eaton Vincent , Silberstein Peter T. , Tupper Connor 
Published: June 2022

e23501 Background: Osteosarcoma is a malignant, bone-forming tumor that makes up approximately 20% of bone cancers. Osteosarcoma has an overall 5-year survival of 68%, so to see significant changes in survival, this study looks only at Stage IV osteosarcoma. Osteosarcoma is most commonly treated with a combination of chemotherapy and surgery, but no studies have been conducted to investigate the facility type at which treatment is received and its effect on survival outcomes. The goal of this study is to investigate the survival of patients with stage IV osteosarcoma based on treatment facility type. Methods: There were 1,634 patients with stage IV osteosarcoma identified in the National Cancer Database (NCDB), with 657 including data on facility type. SPSS version 27 was used to generate both descriptive statistics regarding demographics and Kaplan-Meier curves to determine the impact treatment facility type has on overall survival. Results: Stage IV osteosarcoma was more common in males (59.5%) and white race (77%) with 55.4% receiving treatment at academic centers, 22.5% at comprehensive community programs, 16.9% at integrated cancer programs, and 5.2% at community cancer programs. Patients on Medicare also demonstrated a decreased overall survival when compared to all other insurance types (p < 0.001). In stage IV osteosarcoma patients, there were statistically significant differences in survival outcomes when comparing each facility type to each other (with p values all < 0.05), except for the comparison between comprehensive community cancer programs and integrated network cancer programs. Patients who received treatment at academic/research programs demonstrated the best overall survival with a median of 7.29 months when compared to community center programs, comprehensive community cancer programs, and integrated network programs (with p values of < 0.001, 0.046, and 0.03, respectively). Patients treated at academic research programs were more likely to be white males with private insurance or Medicare. Conclusions: Patients treated at academic centers for stage IV osteosarcoma had better survival outcomes compared to those treated at nonacademic facilities. These patients were more likely to be white, insured individuals. African Americans and Medicare patients were associated with increased risk of mortality from stage IV osteosarcoma. Future studies can be done with multivariate analyses to determine other variables that may affect outcomes in this patient population.[Table: see text]
Pazopanib in metastatic soft tissue sarcoma (STS): Results of a multi-institutional observational study.
Authors: Bilici Ahmet , Koca Sinan , Karaagac Mustafa , Eraslan Emrah , Ocak Birol , Goktas Aydin Sabin , Sezgin Goksu Sema , Paydas Semra , Derin Sumeyye , Ergun Yakup , Yekegunduz Emre , Erol Cihan , Tataroglu Ozyukseler Deniz , Demiray Atike Gokcen , Karaca Mustafa , Guc Zeynep Gulsum , Menekse Serkan , Yesil Cinkir Havva , Gumusay Ozge , Sakin Abdullah ,   Turkish Oncology Group
Published: June 2022

e23542 Background: Soft tissue sarcomas (STS) are a heterogenous group of tumors which have limited therapeutic options and poor prognosis in advanced/metastatic settings. Herein, we present the clinical outcomes of metastatic STS patients treated with pazopanib (PAZ) in real-life. Methods: We retrospectively collected data about adult patients treated with PAZ for metastatic STS in Turkey. We described the clinical characteristics and tumor responses, and estimated the progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method. The Cox proportional hazards regression model (HR, 95%CI) was used for evaluation of prognostic factors for PFS. Results: 507 patients (median age: 52 [range: 18-87]; 56.8% female) were included in the analysis. Extremities were the most common primary tumor sites (n:202; 39.8%) followed by abdomen (n:116; 22.9%) and pelvic cavity (n:102;20.1%) where 98% of STSs arose in uterus (n:100). The leading histologic subtypes were leiomyosarcoma (n:192; 37.9%), synovial sarcoma (n:58; 11.4%) and undifferentiated pleomorphic sarcoma (n:48; 9.5%). Of the reported tumor grades (n = 350), 61.4% (n:215) were grade 3. The most common metastatic sites were lungs (52.7%) and liver (20.3%). Doxorubicin plus ifosfamide (45.9%) was the preferred front-line regimen and PAZ was the treatment of choice in second (59.8%) and third-line (61.8%) settings. The median follow-up under PAZ treatment was 5.03 (0.10-84.67) months. Objective response and disease control rates were 31.4% and 42.2%, respectively. Overall, 183 (36.1%) patients were alive at last follow up, 123 of which (67.2%) did not show progression. The median PFS and OS for the study group and the most commonly observed types of STS are shown in Table. Favorable prognostic factors for PFS were low-intermediate tumor grade (HR[95% CI] for grade I and 2 vs 3:1.371[1.016-1.849]; p = 0.039) and ECOG (Eastern Cooperative Oncology Group) score (HR[95% CI] for ECOG score < 2 vs ≥2: 2.698[1.923-3.787]; p = 0.0001). Weakness/asthenia (10.8%), impaired liver function tests (4.7%) and diarrhea (3.6%) were the most common adverse events, no grade 4 or 5 events were observed. Conclusions: This large scale real-life study confirms that PAZ, with its positive impact on clinical outcomes and acceptable tolerability and safety profile is a valuable treatment option for metastatic STS.[Table: see text]
Characteristics and outcomes of soft tissue sarcoma in Saudi Arabia.
Authors: Alshamsan Bader , Alrifai Omar , Atayeb Mohammad , AlAboud Mohammed , Alshomrani Aiman , Alsadoun Nouf , Bin Khidhr Rashed , Pant Rajeev , Shaheen Mahmood , Atallah Jean Paul 
Published: June 2022

e23544 Background: Soft tissue sarcomas (STS) are a rare heterogeneous group of neoplasms that count for less than one percent of all solid cancers in adults. There is limited data from Saudi Arabia (SA). We aimed to describe the disease characteristics and clinical outcome of STS from a specialized referral center in STS management in SA. Methods: All adult patients treated at King Faisal Specialist Hospital and Research Center between January 2010 and December 2019 were reviewed. Continuous variables are described in median and interquartile range, and categorical variables are described in frequency and compared by the Chi-square test. Survival analysis was estimated by the Kaplan-Meier method and compared by the Log-Rank test. Results: Two hundred fourteen patients diagnosed with soft tissue sarcoma were eligible for the study. The median age at diagnosis was 38 years old (IQR: 26-50.5), and males were (56.1%). The most common histology subtypes were synovial sarcoma (19.6%), liposarcoma (13.5%), undifferentiated pleomorphic sarcoma (11.6%), leiomyosarcoma (9.8%). The most common presentation was painless swelling (49.1%), and the median duration of symptoms was 8 (IQR: 4–13) months. The majority (131 patients, 61.2%) were localized diseases, and the most common primary site was the lower limb (62.1%). The median tumor size was 10 (IQR: 6.8-15) cm, and the tumors were deep to fascia in 144 (67.3%) patients. Eighty-three patients (38.8%) presented with de novo metastasis, and lung (81.9%) was the most common site. The local therapy was as follows; surgery (45.3%), radiation (7.5%), both (41.6%), and none (5.6%). Eighty-five patients received chemotherapy as follows; anthracycline (51%), ifosfamide (28%), and both (23.5%). Seventy-nine patients (36.9%) achieved complete response, 56 (26.2%) developed distant metastasis, and 11 (5.1%) local relapse. Thirty-one patients received salvage chemotherapy, and 30 patients received second-line chemotherapy. The best response of first-line chemotherapy in metastatic patients was CR (3%), PR (14%), SD (8%), and PD (63%). The median follow-up was 37 (IQR: 12-76.75) months. The median OS for the localized disease was not reached, and three years OS was 88.2%. There was a statistical difference in OS between extremities vs. trunk (90.9% vs. 66.7%), (p = 0.01), histological subtypes (p = 0.006), nodal involvement (p < 0.001), T stage (p = 0.03), and complete response 96.9 vs. 68.5% (p < 0.001). The median OS for metastatic disease was 26 (95% CI: 16–35.5) months. The median OS for patients who underwent surgery, radiation, both or none were 26, 23, 31, and 9 months, respectively (p = 0.004). Conclusions: STS in SA is diagnosed at a younger age, with a longer median time for diagnosis and a more advanced stage. Histological subtypes and the advantage of local disease control and metastasectomy are consistent with other figures.
Outcomes in pleomorphic liposarcoma of the extremity and trunk: Is multimodality therapy indicated?
Authors: Tseng William W. , Barretta Francesco , Radaelli Stefano , Colombo Chiara , Callegaro Dario , Barisella Marta , Morosi Carlo , Sanfilippo Roberta , Fabbroni Chiara , Stacchiotti Silvia , Fiore Marco , Gronchi Alessandro 
Published: June 2022

e23545 Background: In comparison to the more common histologic subtypes of liposarcoma (e.g., well differentiated/dedifferentiated; myxoid round cell), pleomorphic liposarcoma (PLPS) is poorly understood but generally regarded as more aggressive, with a high risk of distant metastasis. In this study, we sought to 1) assess outcomes after surgery for primary, non-metastatic PLPS and 2) explore indications for multimodality therapy (e.g., perioperative chemotherapy, radiation therapy) in this ultra-rare malignancy. Methods: Clinicopathologic data were retrospectively collected for eligible adult patients treated from 2002-2019 at our sarcoma referral center. Descriptive data was summarized and Kaplan-Meier plots were constructed for overall survival (OS) and crude cumulative incidences (CCI) of disease-specific death (DSD), local recurrence (LR) and distant metastasis (DM). Univariable models were performed to assess the association of specific variables of interest (e.g., tumor size) on outcome. Results: In total, 51 PLPS patients were included in this study. Mean tumor size was 9.7 cm. Tumors originated mostly in the extremity (67%), were deep in location (73%), and high grade (FNCLCC 3/3, 78%). All patients underwent complete (R0/R1) resection. Chemotherapy was given in 33% of patients and radiation therapy in 69%. With a median follow-up of 62 months, OS was 76% at 5 years. CCI of DSD, LR and DM at 5 years was 16%, 2% and 26%. Greater tumor size was observed to be strongly associated with worse OS (p = 0.002) and DSD (p = 0.006). Survival did not seem to be affected by pre-referral inadequate excision once patients (n = 18) underwent re-excision at our center. A separate subgroup of patients (n = 14) was identified with smaller (mean: 5.4 cm), superficial, lower grade tumors who underwent surgery alone without any DSD. Conclusions: In primary, non-metastatic PLPS, adequate surgery combined with perioperative chemotherapy and radiation therapy, when appropriate, is associated with favorable outcomes. Subgroups with potentially better clinical outcomes likely exist suggesting heterogeneity within PLPS. Multidisciplinary collaborative efforts across sarcoma centers are needed to better characterize these subgroups and determine the optimal strategies for management.
Compartment-specific clinical outcomes in patients with soft tissue sarcomas of the thigh.
Authors: Morinaga Sei , Yamamoto Norio , Hayashi Katsuhiro , Takeuchi Akihiko , Miwa Shinji , Igarashi Kentaro , Yonezawa Hirotaka , Asano Yohei , Saito Shiro , Tsuchiya Hiroyuki 
Published: June 2022

e23549 Background: Approximately one-third of all soft tissue sarcomas develop in the thigh, and the risk factors for developing a complication after soft tissue sarcoma resection include the tumour’s location in the lower extremity. This study analysed the relationship between various factors, particularly tumour location and clinical outcome, in patients with primary soft tissue sarcoma of the thigh. Methods: Patients who underwent wide excision of soft tissue sarcomas of the thigh without metastasis at the time of the initial visit between January 2006 and March 2018 were included in the study. Seventy-four patients were included in this retrospective study. The relationships between variables and prognosis were statistically analysed. Results: The mean patient age was 58.7 years (10–86 years), the mean follow-up period was 75 months (24–173 months). A total of 37 tumours were predominantly located in the anterior compartment of the thigh, 17 in the medial compartment, and 20 in the posterior compartment. Multivariate analysis of the patient clinical data demonstrated that seromas developed more often in the medial compartment tumours and postoperative complications excluding seroma occurred more frequently in patients with two or more muscles resected or stage III tumours. A low Musculoskeletal Tumor Society score was associated with a long operative time (more than 120 min), anterior compartment tumours, and more than two muscle resections. In addition, soft tissue sarcomas in the medial compartment and stage III sarcomas were associated with a low 5-year metastasis-free survival. Conclusions: Soft tissue sarcomas in the medial compartment were associated with postoperative seroma and metastasis, whereas sarcomas in the anterior compartment correlated with low postoperative function. Surgeons should be aware of compartment-specific clinical outcomes in patients with soft tissue sarcomas of the thigh.[Table: see text]