bluuebunny/crossref_metadata_2025_split huggingface dataset:
A retrospective analysis of gender disparities in clinical outcomes of patients diagnosed with non-uterine leiomyosarcoma.
Authors: Hana Caroline , Nano Olger , Samuels Shenae , Hussein Atif Mahmoud , Wadhawan Ashna 
Published: June 2022

e23547 Background: The effect of gender in sarcoma patients in various organ systems has been the subject of several studies, many of which show no overall survival (OS) difference between male and female genders. Tumor size and grade have been noted to be independent predictors of local recurrence and disease specific survival in a prospective study of patients with non-uterine leiomyosarcoma by Gaddy et. al. however, gender had no effect on OS. Methods: The 2004-2016 National Cancer Database (NCDB) was queried for males with leiomyosarcoma (LMS) and females with extrauterine leiomyosarcoma (EULMS) using topographical codes C490-C496, and C498-C499. Data included: patient’s age, race, year at diagnosis, tumor grade, size and stage, lymph node involvement, receipt of surgical treatment, chemotherapy or palliative care treatment, surgical margins, time to treatment in days, OS (months between the date of diagnosis and date of death or censored at last contact), and long-term survival defined as survival for 60 months or more. Univariate analysis was used to determine significant predictors of binary survival status (i.e. alive or dead), significant factors were then included in a multivariate analysis. Using Stata/SE 15.1, Kaplan-Meier (KM) method with log-rank test was used to compare and estimate OS rates between the 2 groups. Results: The total number of patients was 13537, with 6311 males (46.6%) and 7226 females (53.4%). The OS in females was 57.2 months compared to 72.0 months in males (P < 0.001). Men were also more likely to achieve long-term survival (36.1%) compared to females (34.4%, P < 0.001). Men with LMS had a lower percentage of chemotherapy use compared to females (18.7% vs 25% respectively, P < 0.001) and palliative care use (3.0% vs 3.5%; P = 0.013). Lower likelihood of survival among both groups was noted in older age (OR = 0.96; P < 0.001 in males; OR = 0.97, P < 0.001 in females), tumor stage > I (OR = 0.64, P = 0.005 in males; OR = 0.56, P < 0.001 in females) and positive surgical margins (OR = 0.76, P = 0.013 in males; OR = 0.87, P = 0.009 in females). Contrarily, increasing year of diagnosis was associated with an increased likelihood of survival (OR = 1.51, P < 0.001 in males; OR = 1.27, P < 0.001 in females). Larger tumor size was also associated with decreased likelihood of survival, but only in the female group (OR = 0.39, P = 0.001). Conclusions: Our analysis shows that males with LMS had a higher OS and higher percentage of long-term survival compared to females. The only factor affecting survival that was different between the 2 groups was the tumor size, which was associated with significantly decreased likelihood of survival in females. No clear explanation for this different survival could be extrapolated from the clinical data collected. Further studies are recommended to investigate the genetic, epigenetic, and possibly hormonal factors that may affect survival in LMS.
Surgical treatment of locally advanced retroperitoneal sarcomas.
Authors: Gevorkyan Yuriy A. , Katelnitskaya Oksana V. , Kit Oleg I. , Maslov Andrey A. , Soldatkina Natalya V. , Petrov Dmitriy S. , Kolesnikov Vladimir E. , Savchenko Dmitriy A. , Tolmakh Roman E. , Dashkov Andrey V. , Ilchenko Sergei A. , Vashchenko Larisa N. , Kasyanenko Vladimir N. 
Published: June 2022

e23552 Background: Surgery with negative resection margins is now considered the main treatment for retroperitoneal sarcomas improving the survival and quality of life of patients. The most common obstacle to surgery with R0 resection in locally advanced tumors is the involvement of the great vessels. The purpose of this study was to analyze the results of surgical treatment in patients with locally advanced retroperitoneal sarcomas involving the inferior vena cava or iliac veins. Methods: The study included 34 cancer patients who underwent tumor resection with major vessel resection in 2015-2021. The mean tumor size was 15.5 cm (from 6 to 41 cm). The most common tumors were moderately differentiated liposarcoma (38%) and pleomorphic liposarcoma (26%). Results: Resection of the inferior vena cava was performed in 19 cases, resection of the iliac segment - 15. Circular vein resection without reconstruction was performed in 5 patients, wedge resection - 7, segmental resection with end-to-end anastomosis - 1, replacement of the venous segment with a prosthesis - 25. Resection of adjacent organs was required in 26.5% of surgical interventions. According to the final pathoanatomical examination, the rate of complete tumor resections (R0-1) was 88.2%. During the 30-day postoperative period, mortality and complication rates were acceptable, 29% and 0%, respectively. During the follow-up period, the median disease-free survival was 13 months, and the median overall survival was not reached. Conclusions: Surgical interventions expanded due to resection of the major veins in locally advanced retroperitoneal sarcomas allow achieving a high rate of radical tumor resection and improving relapse-free and overall survival rates.
Metastasectomy in synovial sarcoma: A systematic review.
Authors: Alshamsan Bader , Delisle Megan , Smith Denise , Wang Ying , Srikanthan Amirrtha 
Published: June 2022

e23555 Background: Synovial sarcoma (SS) is a malignancy with high metastatic potential. The role of metastasectomy in SS is unclear, with limited data on prognostic factors and clinical outcomes. In this systematic review, we evaluate the survival outcomes post-metastasectomy for patients with SS. Methods: A systematic review was undertaken following PRISMA guidelines. English studies reporting survival outcomes among adults and children with SS undergoing metastasectomy were evaluated. Databases were searched from inception to May 31, 2021, and included Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Two reviewers independently undertook literature evaluation and screening, data extraction and grading of studies. Risk of bias assessments utilized the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies and the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Qualitative data was summarized in descriptive format, and survival outcome data were assessed for meta-analysis. Results: Thirteen retrospective studies, published between 1993 to 2017, were included, six were cohort studies, and seven were case series. A total of 598 patients with SS were included, of whom 462 had metastatic pulmonary disease, and 309 underwent metastasectomy. The median ages of the study cohorts ranged from 14 to 51 years. The median survival period after metastasectomy ranged from 21 to 80 months. The most common prognostic factors associated with survival included a disease-free interval (DFI) of greater than 12 months and complete resection of the metastases. Conclusions: The current literature has demonstrated that metastasectomy, particularly pulmonary, is a reasonable treatment option for appropriately selected patients with metastatic SS. Individuals with a DFI of greater than one year and who can safely undergo a complete resection appear the derive the greatest benefit. Registration: This protocol has been registered within the international prospective register of systematic reviews (PROSPERO) database (registration ID: CRD42019126906).
Resource utilization and futile management in terminally ill cancer patients: A perspective from hospital-based palliative care program in Saudi Arabia.
Authors: Saeed Mohammed 
Published: June 2022

e24006 Background: The palliative care needs for cancer patients are on the rise across MENA region (Middle East and North Africa) with economical and quality of health-care implications. We believe this is the first reported study in the Saudi Arabia about resource utilization and futile management from a hospital-based palliative care program for terminally ill cancer patients. Methods: The data was collected retrospectively, the data collection took palace in the year 2018. The data collection tool consisted of seven parts, 1- Patient’s information, 2- Initial diagnostic procedures, 3- Imaging procedures 4- Pathology and laboratories workup, 5- Treatment modalities (if any), 6-Healthcare facility and resources utilization, 7- Palliative care utilization. Results: A total of 103 patients were included, their median age 66 years (20-94), and (58%) were females, the majority of the cases had stage IV cancer 99 (96.1%), half of them with gastrointestinal cancer 44 (42.7%). During their stay under PCU, 59 (57.3%) had chest X-rays, 21.4% ECG and 14.6% Abdominal ultrasound, various types of Computed Topographies (CT) were done for 18 patients (17.4%). Daily multiple times glucose checking was done for all patients, and complete blood count was done for 81.6%. Only 31 patients (30%) visited the Emergency Department ED after being transferred to PCU, 83 patients (80.6%) had no outpatient clinic visit at all. The median duration for palliative care was 17 days, while the median duration for oncology service is 193 days. The majority of the patients (n = 68) died within 30 days from transfer to palliative care, among them 4 patients (4 %) died on the same day of transfer. No statistically significant differences were found between males and females regarding the days from diagnosis to palliative transfer, days from diagnosis to palliative referral, the number of visits to ED, and the number of non- ICU admissions. Conclusions: Many patients were exposed to unnecessary procedures with no clinical implications, e.g. CT scans, EKGs, daily multiple labs. There is a significant delay in transferring the patients to palliative care service, policies and regulations are needed for timely transfer to palliative care services for cancer patients. Early complex advance care planning is an essential tool to combat futile management. 100% deaths in palliative care unit may reflect limitations for palliative care providers for alternate placements. Predominant use of palliative care unit for the end of life care would drive health care cost to higher level from direct and indirect expenses.
Development of memorial Sloan Kettering (MSK) surgery stress score for older adults with cancer.
Authors: Shahrokni Armin , Tin Amy L. , Downey Robert J. , Bochner Bernard H. , Nash Garrett Michael , Kim Soo Jung , Afonso Anoushka , Korc-Grodzicki Beatriz , Vickers Andrew 
Published: June 2022

e24014 Background: The stress from oncologic surgeries for older adults may lead to poor surgical outcomes. In this study, we aim to develop a MSK Surgery Stress Score to measure the complexity of surgery for these patients. The score could then be used for future analyses using datasets where patients undergoing a variety of procedures. Methods: This is a retrospective analysis of adults aged 75 and older who underwent elective cancer surgery in our institution with hospital length of stay of at least one day in 2015 to 2020. Based on surgery stress score developed by Haga et al., we explored various models including at least one or some of these variables as linear or non-linear terms: operation time, weight (kg), blood loss (cc), type of surgery, body mass index, and incision score. The primary outcome of interest evaluated was defined as the composite outcome of death within 90-day of surgery, readmission or emergency room visit or major complications (grade 3-5) within 30 days of surgery. We additionally explored models for a secondary outcome, where minor complications (grade 1-2) were included in the definition, and lastly, we looked at major complications alone as a tertiary outcome. For each of the model and outcomes, we used a logistic regression. We then used the logit transformation of the predicted probability to represent the proposed surgery stress score. Using this score, we evaluated the area under the curve (AUC) for each outcome. Results: In total, 1573 patients were included in the study. The median age was 80 (quartiles 77, 83) and just under half (49%) were male. The median (quartile) operation time was 181 minutes (115, 259), weight was 71 kg (62, 84), blood loss was 100 mL (50, 300), and just over (51%) of patient underwent an abdominopelvic procedure. The rate of 90-day mortality was 3.8%, while the rate of 30-day major complication, readmission and emergency room visit was 7.4%, 10% and 13%, respectively Furthermore, 21%, and 35% experienced primary, and secondary outcomes, respectively. Overall, 18 predictive models for each of the outcomes were developed and assessed. AUC for our different models ranged from 0.59 to 0.73 for the different definitions of our outcomes. Among the various models, the one defined using whether patients underwent an abdominopelvic procedure, incision score, operation time, weight, and blood loss (the latter two both included as non-linear terms) appeared to the front runner. Conclusions: We explored potential models to be used as the MSK Surgery Stress Score. Currently the model is being optimized by additional work. Following optimization of the model, future studies should validate this score in other cohorts of older surgical patients with cancer.
Integration of geriatric assessment in cancer care for senior adults during COVID-19 pandemic.
Authors: Al-Jumayli Mohammed , Vonnes Cassandra , Sehovic Marina , Extermann Martine 
Published: June 2022

e24027 Background: Older patients with cancer are particularly vulnerable, and the risk of mortality and morbidity during this pandemic is high. Comprehensive geriatric assessment (CGA) helps in predicating toxicity and improve outcomes. SAOP3 is validated geriatric screening tool that can efficiently identify deficits in different GA domains. It was developed to determine when a multidisciplinary team consultation with GA-intervention is required. Methods: We performed a retrospective review of institutional cancer registry. We compared 2 groups of cancer patients ≥ 70 years old who completed SAOP3 questionnaire in the pre-COVID (9/1/2019- 3/10/2020) and during the pandemic period (3/11/2020-12/31/2020). Fisher’s exact test was used to statistical analysis. Analytical models were adjusted for age, cancer histology, stage, therapy type, and GA variables. Results: 951 patients were included (499 prepandemic,452 during pandemic). Median age was 76.6 yrs. (range = 71-86). A 50.7% male, 48.3% female and 34% (323) have metastatic disease. The capture and completion rate of SAOP3 were 82% (779) and 86% (817) respectively. There was a significant psychosocial impairment during the pandemic. More patients were feeling depressed 26% (118) during Vs. 3% (15) prior pandemic (P < 0.001). The caregiver availability was different with 47% (212) during pandemic compared to 52% (259) in pre-pandemic (P = 0.0013). There was a statistically significant difference in the fall history with 4% (20) in pre-, in contrast to 10% (45) during pandemic (P = 0.003). There was a numerical difference in the cognitive impairment during the pandemic in compared to the pre-COVID [34% (171), 52% (235) respectively], but it was not statistically significant (P = 0.154). There was no difference observed in nutritional domains between the two groups. Conclusions: Data regarding patients’ domains of a CGA are crucial for optimal care. Screening with the SAOP3 questionnaire captured significant changes in CGA domains associated with the pandemic. These findings also suggest that Integration of high-yield brief geriatric screening tools such as SAOP3 is feasible in busy practice during the pandemic. It can help identify specific impairment of older cancer patients and trigger appropriate interventions to improve the quality of life and clinical outcomes.
Development of a remote Mediterranean Diet intervention during chemotherapy treatment: A qualitative analysis.
Authors: Kleckner Amber , Reschke Jennifer E , Cherubin Lisadine , Youngblood Shari , Peppone Luke Joseph 
Published: June 2022

e24033 Background: The Mediterranean Diet (MedDiet) has emerged as an effective health-promoting dietary pattern. It is high in fruit, vegetables, whole grains, fiber, antioxidants, and anti-inflammatory compounds. A cancer diagnosis is often seen as a “window of opportunity” for behavior change, yet there are few structured nutritional programs available for patients undergoing active treatment. Herein, we developed a remote MedDiet intervention and identified barriers and facilitators to adherence. Methods: This was a qualitative analysis of the intervention arm of a clinical trial (NCT04534738). Participants had at least 6 weeks of chemotherapy scheduled. The MedDiet intervention was 8 weeks and included home food delivery (frozen meals and fresh ingredients weekly for the first 4 weeks), education, goal-setting, a cookbook, and weekly phone calls with a nutritionist. MedDiet adherence was measured using the MedDiet Adherence questionnaire at baseline, 4 weeks, and 8 weeks; change was assessed using paired t-tests between baseline and 4 and 8 weeks. After the study, participants underwent a semi-structured interview to provide feedback on the intervention. Interviews were transcribed and emergent coding was used to identify themes. Results: Patients (n = 23) were 52.5±13.6 years old, 2 were male, 83% were White, and 87% had breast cancer. MedDiet adherence was 4.0±2.7 at baseline. It increased 2.1±3.2 points from baseline to 4 weeks and 2.5±3.0 from baseline to 8 weeks (both p < 0.001). Interviews were conducted with 21 patients (example quotes in Table). Although most participants (n = 15, 71%) did not seek nutritional information at the time of their diagnosis, most (n = 19, 90%) were highly engaged with the program. In response to an open-ended question, many (n = 11) expressed a sense of empowerment. Facilitators to adherence included structure, accountability, food provision, palatability, and easy procurement of ingredients. Barriers included chemotherapy-induced taste changes and mouth sores, cooking for family members’ preferences, others preparing food for the patient, and higher priority areas for mental energy expenditure. The majority (n = 13, 62%) preferred a program during vs. after cancer treatment. All (21/21) indicated they would continue to follow at least some aspects of the diet. Conclusions: A remote MedDiet intervention was effective and well received by patients undergoing chemotherapy. Future research should investigate how a MedDiet intervention affects clinical outcomes and symptom burden. Clinical trial information: NCT04534738. [Table: see text]
Smoking cessation after cancer diagnosis: Relationships matter.
Authors: Neumann Melissa Francoise , Murphy Neal J , Seetharamu Nagashree 
Published: June 2022

e24039 Background: Continued smoking after a cancer diagnosis leads to worse morbidity and mortality. Unfortunately, smoking prevalence remains high amongst cancer patients and survivors. Few studies have been conducted to evaluate and target patients’ social networks that may contribute to a patient continuing to smoke. We developed a questionnaire intended to assess patients’ smoking status, motivation to quit, patient/family dynamics, and interest in enrolling in a smoking cessation program that includes the patient and the person closest to them in their social network that may be contributing to their continued smoking. Methods: We designed a three-page questionnaire to gain more information about a patient’s past and current smoking history, level of nicotine dependence, assessment of their motivation to quit smoking, their social network and family/friends who may be smoking, and willingness of the patient and close family to quit. Inclusion criteria included patients who have been diagnosed with any solid tumor malignancy and had a history of smoking or recently quit. Non-smokers were excluded. IRB approval was obtained and questionnaires were distributed to patients when checking in at the front desk of the Monter Cancer Center. 32 questionnaires were collected from July 2021 - January 2022. Results: Of the questionnaires completed, 59% quit smoking after their cancer diagnosis, 34% tried and were unable, and 7% did not try or declined to answer. Of the 59% who quit, 52% were married, compared to 45% of the 34% who tried and were unable to quit. The odds of quitting among people who were married was 1.56 (95% CI 0.36 - 6.69; p-value 0.55) times the odds of quitting among people who were not married. In the quit group, 53% lived with a smoker at some point compared with 75% of those in the quit but unable to group. The odds of quitting among people who lived with a smoker was 0.42 (95% CI 0.08 - 2.07; p-value 0.28) times the odds of quitting among people who did not live with a smoker. Five social network members quit after their relatives’ cancer diagnosis. No patients were currently enrolled in a tobacco cessation program. Two people answered they would be interested in being enrolled in a tobacco cessation program with a close family member that also smokes. Conclusions: Our study highlights high rates of continued smoking amongst cancer patients. Being diagnosed with cancer can serve as a teachable moment and motivate patients to quit smoking. Social network plays an important role in tobacco cessation. Our study showed that the odds of quitting was lower in patients who lived with smokers than those who did not, though not statistically significant likely due to small sample size. None of the active smokers were enrolled in a smoking cessation program highlighting the imminent need for innovative smoking cessation platforms that are engaging and effective in improving quit rates amongst cancer patients.