bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analyzing immunotherapy adverse events in elderly cancer patients.
Authors: Puskoor Sujith , Calderon Jonathan , Surapaneni Rakesh , Raiyani Chandni 
Published: June 2022

e24009 Background: Immunotherapy (IT) has cemented itself as a mainstay in cancer treatment, especially in those with late stage malignancies. Generally, these agents are well tolerated, but there is a known association with immune-related adverse events (iRAE). Due to an underrepresentation of elderly patients in clinical trial data, it is valuable to understand the tolerance of these agents. The primary objective of our study was to evaluate for an association between older age, defined as age 75 and above, and increased risk for iRAE in a real-world population. Methods: We performed a retrospective study utilizing data from elderly patients (pts) who had first received IT (specifically Pembrolizumab, Nivolumab, Atezolizumab, Avelumab, and Durvalumab) from 01/01/2015 through 12/31/2019. This subset of pts were followed until 12/31/2021. Descriptive analyses were performed to identify iRAE patterns. A chi-square test or a Fisher’s exact test was used to test for associations in bivariate comparisons while a two-sample t-test was used to test for differences in continuous variables between age groups > 75 to 79 years (Group 1) and > 80 years (Group 2). Statistical significance was determined by p < 0.05 unless otherwise noted. Results: 103 pts qualified for assessment over the study period. Group 1 had a total of 48 pts with a median age of 77. Group 2 had a total of 55 pts with a median age of 84. The study had 57 males and 46 females. 96 pts were Stage IV and 7 pts were Stage III. The most prevalent malignancies in the study were lung, skin, and renal cancer. Treatment intent was palliative for 96 pts, adjuvant for 6 pts, and neo-adjuvant for 1 pt. Overall, there were 72 pts with reported iRAE and 31 pts without reported iRAE. Of the pts with iRAE: 7 pts required outpatient observation without intervention, 38 pts required outpatient intervention(s), 19 pts were hospitalized, and 8 pts required ICU level of care. There was one death due to complications from encephalitis associated with hypophysitis and hyperthyroidism. Regarding discontinuation of IT for pts: 42 pts transitioned to hospice, 35 pts had progression of disease, 8 pts finished their treatment regimen, 5 pts developed an alternative diagnosis, and 9 pts discontinued due to iRAE. Nine pts in the study required corticosteroids for their iRAE. There was no statistically significant difference in incidence of any iRAE (regardless of type) between the two age groups 75-79 and over 80 years (p-value = 0.3703). Similarly, there was no difference for sub-categories including stage of cancer, type of cancer, treatment intent, and severity of iRAE. Conclusions: Elderly pts over age 75 that received the aforementioned IT were shown to have relatively tolerable safety profiles regardless of their age group and the majority continued with IT despite iRAE. This study reinforces the notion that IT could be used in geriatric pts without fear of exposing this vulnerable age group to substantial rates of negative outcomes.
Correlates of common concerns in older cancer survivors of leukemia and lymphoma: Results from the WHI-LILAC study.
Authors: Loh Kah Poh , McLaughlin Eric , Krok-Schoen Jessica L. , Johnson Lisa , Odejide Oreofe Olukemi , El-Jawahri Areej , Qi Lihong , Shadyab Aladdin H. , Paskett Electra D. 
Published: June 2022

e24031 Background: Older survivors of leukemia and lymphoma often experience long-term and late effects of chemotherapy, worsened by aging-related conditions such as functional and cognitive impairment, which may be inadequately addressed. In this study, we described common concerns in older survivors of leukemia and lymphoma, and assessed demographic and clinical factors associated with these concerns. Methods: We utilized data from the WHI LILAC study that recruited post-menopausal women aged 50 and 79 years. Participants who were diagnosed with leukemia and lymphoma after enrollment in WHI and answered at least half of the questions on current concerns in LILAC were included (n = 420). Participants were asked about 14 areas of current concerns common in cancer survivorship and to rate each from 0 (no concern) to 2 (major concern), with total score ranging 0-28. Linear regression was used to assess demographic and clinical factors associated with the concern score, and logistic regression for factors associated with the three most common concerns, with backward variable selection methods. Results: Mean age at assessment was 81 years (range 69-99) and 73% had non-Hodgkin lymphomas. Median time since diagnosis was 8.8 years (range 2.5-20.8 years). Seventy-two percent reported any concern; median concern score among these survivors was 3.5 (Q1-Q3, 2-5) (Table). Factors significantly correlated with the concern score were sadness, pain, loneliness, worse quality of life (QoL), lower physical functioning, more comorbidities, and greater prior symptom count (all p < 0.05). Significant factors correlated with common concerns were: 1) Fatigue/sleep: leukemia diagnosis, greater prior symptom count, feeling sad or depressed, reported distress, lower physical functioning; 2) Physical functioning/activity: public health insurance, older age, greater prior symptom count, reported pain, worse QoL, higher BMI; 3) Memory/concentration: prior chemotherapy or radiation, loneliness, worse QoL, greater prior symptom count (all p < 0.05). Conclusions: Almost three-quarter of survivors of leukemia and lymphoma reported at least one concern, with common concerns being fatigue/sleep, physical functioning/activity, and memory/concentration. A multicomponent intervention is needed to address these common concerns in older cancer survivors.[Table: see text]
Let our patients shine: Survivorship and health interventions in nutrition and exercise program for breast cancer survivors.
Authors: Teplinsky Eleonora , Cording Jessica , Horowitz Elizabeth , Fishman Elena I , Podolski Amanda , Christoudias Moira Katherine , Tomaszewski Donald , Angner Robert , Klein Laura 
Published: June 2022

e24032 Background: Nutrition and lifestyle interventions are instrumental in modifying cancer risk. These changes are often challenging for patients to make due to residual side effects from active treatment and/or ongoing toxicities from current treatment. The SHINE (Survivorship and Health Interventions in Nutrition and Exercise) Program is a wellness program for patients with breast cancer focusing on three pillars of nutrition, exercise and community in order to improve overall health outcomes and decrease the risk of cancer recurrence. Methods: Participants in SHINE have either been diagnosed with ductal carcinoma in situ (DCIS) and/or stage I-IV breast cancer. They are referred to the program at the three-month breast surgery post-operative follow-up appointment or any time after that. All patients are referred to meet with a registered dietitian (RD) and integrative health coach, who provides counseling and education on how to reduce risk through diet and lifestyle, using evidence-based recommendations. Patients are provided with support and accountability. A collaborative program, the Physician Referred Exercise Program (PREP), was established with our health system’s medical fitness center, Valley Health LifeStyles. Patients undergo a fitness assessment that focuses on aerobic fitness, muscle strength and endurance, flexibility, & functional activity. Each patient then receives an exercise prescription developed by a degreed exercise specialist, taking into account both the physician’s & patient’s recommendations & goals. Results: Each component of the SHINE Program has been developed in various stages due to the COVID-19 pandemic. 336 patients with either DCIS or stage I-IV breast cancer have been seen by the RD from December 2020 through January 2022. Mean number of visits/patient: 1.89 (range 1-8). N = 48 were participants in a 12-week study on the feasibility of nutrition counseling and impact on quality of life (QOL) which is still in progress. 76 patient referrals have been placed to the PREP program from August 2021-February 2022. Multiple community programs (Table) have been created for patients to help them develop shared experiences & camaraderie with each other so that they can better integrate new ideas and lifestyle modifications. Conclusions: The SHINE Program addresses care for the whole person, empowering individuals to live their healthiest lifestyle. Future work will focus on clinical trials to evaluate the benefits of these individual and collective interventions on overall QOL, QOL subscales (physical, psychological, social & spiritual well-being), & survivorship symptoms.[Table: see text]
Cardiotoxicity in patients on anthracyclines and traztuzumab: Identifying risk factors and echocardiographic parameters.
Authors: Parmar Kanak , Jones Andrew , Appiah Duke , Jones Catherine , Quirch Miguel , Pawar Dushyant , Del Rio Pertuz Gaspar , Nguyen Tung , Morataya Cristina , Sethi Pooja 
Published: June 2022

e24052 Background: Anthracyclines and human epidermal growth factor receptor 2(HER-2) directed therapy are widely used as chemotherapy in various cancers. Up to 10% of patients treated with anthracyclines will develop reduction in left ventricle ejection fraction (LVEF), and cardiotoxicity by HER-2 directed therapy can be as high as 35%. The drop in EF is often late and changes may not be reversed at that point. Strain imaging using global longitudinal strain (GLS) has potential for detecting cardiotoxicity earlier however guidelines remain to be standardized. The objective of this study is to study variations in GLS over time as well as evaluate the relation of patient characteristics with various echocardiographic parameters. Methods: Linear mixed effects models with random intercepts were used to evaluate trends in EF and GLS over time and model the association of cancer therapy and patient characteristics with repeated measures of GLS and EF. Patients were enrolled in the study from 2018-2021 who received anthracycline, or HER-2 targeted treatment for any cancer and had serial echocardiography. Results: In the overall cohort there were more females (61%) than males (20%) in the study. Most patients had breast cancer (67%), followed by leukemia (14%) and lymphoma (13%).35% patients were in the younger age group (< 65 years) and 46% patients were in the older age (≥65 years). There was a significant change in GLS in older patients at 7-9 months (-15 SE 0.6) and 10-12 months (-14 SE 1) (P 0.006; P 0.001). Only 13 patients out of 81 patients developed cardiotoxicity as defined by the current consensus guidelines based on LVEF. Further analysis was then performed between these two groups at various time intervals. LV end diastolic volume (LVEDV) at baseline was significantly higher in the cardiotoxic group (P 0.016). GLS at baseline in both groups had no statistical difference. However, GLS began to show significant differences in the initial 1-3 months in the cardiotoxic group (-14; SE 0.9) as compared to the non-cardiotoxic group (-17.03; SE 0.3) (P 0.003). This difference persisted over various time points from 4 months till 1 year (P < 0.0001 at all points). Conclusions: Our data suggests that GLS may be used as a measure to identify patients who will develop cardiotoxicity by obtaining it at baseline and early during treatment. Higher baseline LVEDV was associated with development of cardiotoxicity. Older patients tend to have more drop in GLS and frequent measures will help to detect cardiotoxicity in this group.
Identifying common concerns and predicting vulnerable populations among breast cancer survivors.
Authors: Roy Pooja , Kovalenko Iuliia , Chan Gomez Janet , Rudge Beth , Wert Yijin , Torp Lisa , Wert Yijin 
Published: June 2022

e24064 Background: Long-term survival is common after breast cancer treatment with 5-year survival reaching almost 90%. Breast cancer survivors (BCS) face varying degrees of quality of life (QOL) issues depending on their age of diagnosis, disease severity, and treatment. We present a retrospective analysis aimed to describe demographics of BCS, recognize common concerns and identify the vulnerable patients. Methods: This is a retrospective analysis of BCS seen at our Breast Cancer Survivorship Program from October 2016 to May 2021. Patients were given a survey to assess self-reported symptoms following treatment. The descriptive analysis of patient characteristics included age, cancer stage, and treatment type. The bivariate analysis included the relationship between the patient characteristics and their outcomes. Chi-square test was used to analyze group differences. Fisher exact test was employed when any of the expected frequencies was five or less. Logistic regression models were developed to identify significant predictors for outcomes. Results: 902 patients (age 26-94; median 64) were seen. Patient's characteristics studied included cancer stage, age group, and treatment modality. Most common self-reported concerns affecting BCS were fatigue (34%), insomnia (33%), hot flashes (26%), night sweats (23%), pain (22%), trouble concentrating (19%) and neuropathy (21%). Majority of patients (91%) reported having a happy outlook and felt a sense of purpose (89%), but 13% of BCS felt isolated at least 50% of the time. Young survivors (age ≤45) (p = 0.028), higher stage BCS (Stage 2-3) (p = 0.0061) and those who had chemotherapy either alone or as part of their multi-modality treatment (p < 0.0001) were significantly less likely to return back to at least 50% of their pre-treatment baseline (Table). Conclusions: Our study showed that younger BCS, patients with higher cancer stage, and those who underwent chemotherapy are the most vulnerable groups in terms of severity of QOL issues. Identifying vulnerable populations and evaluating common concerns after treatments are important in delivering quality care. Optimizing interventions under standardized approach would help to increase QOL in BCS.[Table: see text]
Identifying patient characteristics associated with chemotherapy-induced peripheral neuropathy (CIPN) severity in a phase II clinical trial: A retrospective analysis.
Authors: Zhi Wanqing Iris , Dreyfus Nechama , Dooley Andee , Piulson Lauren , Li Qing Susan , Bao Ting 
Published: June 2022

e24067 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of chemotherapy agents such as platinum, taxanes, vinca alkaloids, and bortezomib. Currently, as no effective prevention strategy is available, chemotherapy delay, reduction, and discontinuation are often necessary due to worsening CIPN. Our retrospective study aimed to identify patient characteristics associated with CIPN during neoadjuvant or adjuvant weekly paclitaxel chemotherapy in patients with early-stage breast cancer. Methods: We retrospectively collected baseline data from the screening phase in a phase IIA trial of weekly acupuncture intervention in women with early-stage breast cancer (ClinicalTrial.gov NCT02364726); the primary outcome was reported previously. Baseline data including age; body mass index (BMI); gender; race; CIPN severity; hemoglobin; hemoglobin A1c; TSH; vitamins B6, B12, and D levels; and anxiety and depression were retrospectively extracted from the electronic medical record (EMR) on the first day of treatment or up to four months prior to chemotherapy initiation. CIPN severity was measured by the Common Terminology Criteria for Adverse Events v4.0. Chemotherapy relative dose density (RDI) was calculated by total chemotherapy dose received divided by the total chemotherapy dose planned; disease recurrence and mortality rate were collected at the time of analysis. Logistic regression was used for statistical analysis. Results: A total of 105 patients’ baseline characteristics were extracted from the EMR. Baseline BMI was associated with CIPN severity (odds ratio [OR] 1.08; 95% confidence interval [CI] 1.01-1.16, p= 0.04). No significant correlations were observed in other covariates. At the median follow-up of 61 months, there were 12 (11.4%) breast cancer recurrences and 8 (7.6%) breast cancer-related deaths. Chemotherapy RDI was associated with disease-free survival (DFS, OR 1.026; 95% CI 1.00-1.05; p= 0.028). Conclusions: In this retrospective analysis, increased BMI was associated with worsening CIPN severity. Chemotherapy RDI was associated with improved DFS. Our findings suggest that baseline BMI may be a risk factor for CIPN. Additionally, suboptimal chemotherapy delivery due to CIPN maybe negatively impact DFS in patients with breast cancer. Further study is warranted to identify risks for CIPN.
Pain management in oncology-dedicated and general emergency departments.
Authors: Turgeman Ilit , Campisi-Pinto Salvatore , Habiballah Maher , Bar-Sela Gil 
Published: June 2022

e24076 Background: Cancer-related pain constitutes a dominant reason for admission to emergency services, and a significant patient and healthcare challenge. Evidence points to the rising prevalence of opioid misuse in this patient group. We sought to compare drug delivery in an oncology-dedicated emergency department (OED) and a general emergency department (GED) within the same hospital. Methods: Electronic files of patients with cancer seeking emergency services in a three-month period were obtained from the hospital registry. Data on patient demographics and drug-related characteristics were determined. Drug administration was compared between groups and thereafter according to admission types, using Fisher’s exact test, chi-square test and Mann-Whitney test. Results: In total, 584 patients had 922 visits to emergency services (OED n = 479; GED n = 443), and were administered 1815 drugs (OED n = 825; GED n = 990). Patient demographics and admission types were balanced between groups. Pain was the most common chief complaint (17% OED; 21% GED). In the OED, 12.5% of drugs were direct analgesics, compared with 19% in the GED. Opioids were prescribed more often in the GED than the OED (p = 0.008), significant for both pain related and non-pain related admissions, notably gastrointestinal and infectious conditions. Treatment in the GED was associated with delivery of three times as many intravenous opioids (p < 0.001), a narrower spectrum in selection of oral and intravenous opioids (p = 0.003) and non-opioid analgesics, lower usage of pain adjuvants and rapid-acting opioids (p = 0.003), and finally, the administration of agents not recommended for cancer pain treatment, such as meperidine and benzodiazepines (p = 0.003). Similar utilization of resuscitative fluids, gastrointestinal agents and antiemetics was observed between groups, with larger variation in drug choice in the OED (p = 0.001). The OED showed greater usage of bisphosphonates and growth factors; conversely, antibiotics, blood products, clotting agents, antihypertensive and diabetic drugs, predominated in the GED. Conclusions: Compared to the GED, management of cancer-related pain in the OED is characterized by fewer opioids, enhanced diversity in drug type, route and method of delivery. Emergency services should be incorporated in cancer programs to promote safe and effective urgent care.
Disparities in palliative care utilization in cholangiocarcinoma patients: A National Cancer Database (NCDB) study.
Authors: Chun Bennet , Lee Chang , Eaton Vincent , Silberstein Peter T. 
Published: June 2022

e24077 Background: Cholangiocarcinoma is an adenocarcinoma of the intra- and extrahepatic bile duct epithelial cells. Although cases of cholangiocarcinoma in the US are rare, there is a low 5-year survival rate for these patients. The preferred treatment option for all subtypes is surgical resection. Alternative options include palliative care (PC) treatments such as chemotherapy, radiotherapy and locoregional treatments. There are many obstacles in accurately diagnosing cholangiocarcinoma, including obtaining adequate tumor samples for histology and determining what is malignant vs. benign in patients with primary sclerosing cholangitis (an important risk factor of cholangiocarcinoma). Such delays in diagnosis can lead to delays in treatment, which in turn results in a poor prognosis and worse outcome for patients. To the authors’ knowledge, there is no current study assessing PC disparities in patients with cholangiocarcinoma. Methods: A total of 46,751 patients who had a diagnosis with cholangiocarcinoma were identified utilizing the National Cancer Database (NCDB) ICD-O-3 histology code 8160. The 5-year survival of PC use was analyzed via a Kaplan-Meier curve. Demographic factors (race, biological sex, income, facility type, insurance, geographic location, and Charlson-Deyo co-morbidity score) were studied in relation to the receipt of PC. Results: Approximately 15.16% of our cohort received PC (7,089/46,751). There was a statistically significant difference in the staging of those patients that received palliative care, with 52% of our cohort being stage IV (p < 0.001). The sex of patients who received PC was equally distributed between men and women (51.0% to 49.0%). The majority of PC recipients were white (83.6%) individuals making under $63,000 (69.6%) with a reported Charlson-Deyo score of 0 (64.9%). Many patients who received PC had Medicare (57.6%) and were treated at either an academic/research program (45.4%) or at a comprehensive community cancer program (33.6%). Facility locations were predominantly located in the Mid-South Atlantic and East North Central regions, compared to the Pacific regions (56.3% vs 8.4%), and patients who received PC lived mainly in urban areas (98.2%). The median survival for PC patients was shorter compared to patients that did not receive PC (5.32 months vs 9.23 months). Conclusions: This is one of the most comprehensive studies that identifies the demographic disparities of patients who received PC for cholangiocarcinoma. The typical PC patient is a white individual with Medicare, living in an urban area in the Mid-South Atlantic and East North Central region making under $63,000. By highlighting the disparities that exist, our study can aid clinicians in addressing PC under-utilization in specific demographics to help provide more comprehensive care.