bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of denosumab in patients with refractory differentiated thyroid cancer and advanced medullary thyroid cancer.
Authors: Wassermann Johanna , Mathy Elise , Lescaille Geraldine , Slim Marine , Buffet Camille , Saie Clotilde , Braik-Djellas Yasmin , Simon Jean-Marc , Ménégaux Fabrice , Tresallet Christophe , Chami Linda , Lussey-Lepoutre Charlotte , Hervé Geneviève , Bernier Marie-Odile , Spano Jean-Philippe , Leenhardt Laurence 
Published: May 2019

e17578 Background: Few data exist regarding the use of denosumab in patients with bone metastases from radioactive iodine (RAI) refractory differentiated thyroid cancer (DTC) and advanced medullary thyroid cancer (MTC). We aimed to describe adverse events of specific interest - osteonecrosis of the jaw (ONJ) and severe hypocalcemia - in this rare setting. Methods: We retrospectively reviewed the charts of all the patients treated with denosumab for bone metastases from RAI-refractory DTC and advanced MTC in our institution. All patients had a calcium measurement and a clinical and radiological dental screening before denosumab initiation. All patients without hypercalcemia received a calcium supplementation. We assessed associations between ONJ or severe hypocalcemia ( < 1.75mmol/L) and suspected risk factors by Fisher exact tests. Results: Between 2014 and 2018, 23 patients were treated with denosumab. Two-thirds of patients were male (n = 16), median age was 69 years (range 43-87). Histology was DTC and MTC in 19 (83%) and 4 (17%) patients, respectively. DTC patients had received a median cumulated dose (CD) of 300 mCi of RAI (range 100-700). Ten patients (43%) had at least one cervical surgery for recurrence or persistence, and 6 (26%) had cervical radiotherapy. Four patients had hypoparathyroidism before denosumab initiation. Two-thirds of patients ( n =15) received a tyrosine kinase inhibitor (TKI) in association with denosumab. The median duration of denosumab was 20 months (range 1-47). ONJ occurred in 6 patients (26%) and severe hypocalcemia in 3 patients (13%). Conclusions: Patients with RAI-refractory DTC and advanced MTC are at high risk of ONJ and severe hypocalcemia under denosumab treatment. Benefit/risk ratio should be highly weighted particularly when treatment is prolonged. Patients should be closely monitored for the risk of ONJ and hypocalcemia. [Table: see text]
Analysis of trends in mortality in patients with lymphoepithelial carcinoma of the head and neck.
Authors: Weldon Marcus Kyle , Komiya Takefumi , Guddati Achuta Kumar 
Published: May 2019

e17583 Background: Squamous cell carcinoma is the most common subtype of malignancy found in patients with Head and Neck malignancy. There are other rare subtypes which are not adequately reported in medical literature. Lymphoepithelial carcinoma consists of lymphocytic infiltration in a background of undifferentiated carcinoma cells and has a high malignant potential. They are most often seen in salivary glands but can also be found in other structures of the head and neck region. This analysis reports the nation-wide mortality of patients diagnosed with lymphoepithelial carcinoma of the Head and Neck. Methods: Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) Database from the years 2000 to 2014. Incidence-based mortality for all stages was queried and results were grouped by gender and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). Paired T-test was used to determine statistically significance difference between various subgroups. Results: Incidence-based mortality has been improving for African American/Black patients and has been worsening for Caucasian/White, American Indian/Alaskan native and Asian/Pacific Islander for the period of 2000 to 2014. The differences in mortality trends were statistically different (P < 0.05). The highest mortality rate per 1000 patients was seen in Asian/Pacific Islander population, followed by African American/Black, American Indian/Alaskan native and the least mortality was noted in Caucasian/White patients. When a similar analysis with linearized trend lines on gender was conducted, only African American/Black males and Asian/Pacific Islander females showed an improving trend in mortality. The sample size was a major limitation of this study (Caucasian/White - 134, African American/Black - 30, American Indian/Alaskan native - 5 and Asian/Pacific Islander – 87). Conclusions: Lymphoepithelial carcinoma is a rare subtype of Head and Neck malignancies whose incidence-based mortality showed a worsening trend. This study showed significant race and gender disparity amongst patients with lymphoepithelial carcinoma. Due to its rarity, this subtype warrants further study; especially with regards to its etiology, clinical course and cure rates.
Rising thyroid cancer incidence in Kerala: Is it real or over diagnosis?
Authors: Raghuram Saadvik , Ponnada Bharadwaj , Keechilat Pavithran 
Published: May 2019

e17589 Background: There has been an increase in the incidence of thyroid cancer in India and in high income countries. One of the reasons for this has been attributed to the large number of screening programs. Kerala state ranks second highest in the incidence of thyroid cancer in India. Screening provides the advantage of early detection of cancer and successful treatment but also tends to over diagnose. Methods: To study the trend of incidence of primary thyroid cancer among newly diagnosed cancer patients and its association with the mode of detection, we retrospectively reviewed hospital based cancer registry data of patients with thyroid cancer who were treated at AIMS (Amrita Institute of Medical Sciences), Kochi between 2004-2014. All patients who were newly diagnosed with primary thyroid cancer at our center or referred to us after initial surgery were included in this analysis. Patients with recurrent cancer/metastases were excluded. Results: We analyzed the records of 2,315 newly diagnosed thyroid cancer patients. Median age was 44.1yrs (range 13-90yrs). There were 619 males and 1696 females. Papillary type was the most common 85.8% followed by follicular type 7.4%. 1235 cases were operated at AIMS. 74 cases (3.2%) were diagnosed incidentally by Ultrasonography/PET scan/CT scan. All others (97% n = 2,245) presented with neck swelling. It was seen that the proportion of new cases of thyroid cancer among all new cancer cases was increasing serially from 4.6 % (n = 106, 95% 2004) to 7.4% (n = 195) to13.7% (n = 317, 2014). There was a significant increase in the number of cases of T1a and T1b at the time of diagnosis during the study period (n = 1235, p value < 0.001 and p value for trend < 0.001 respectively) which indicates that there was early diagnosis. 97% of the cases presented with thyroid related symptoms indicating that clinical presentation has still been the main mode of detection in our series. Conclusions: Our data shows that there may be a true increase in the number of cases of thyroid cancer as majority presented with clinical symptoms, except few detected incidentally. As it is a single institution based data we need further studies to see if over use of USG based imaging for any thyroid swelling is responsible for an apparent increase in the number of thyroid cancer cases.
Learnings from a pragmatic study to evaluate benefit of performing reflex clinical trial matching and providing clinical decision support to physicians.
Authors: Jain Neha M , Culley Alison , Osterman Travis John , Levy Mia Alyce 
Published: May 2019

e18006 Background: Clinical trial enrollment is an assiduous process and requires active initiation and maintenance efforts by providers, patients, trial investigators, or other clinical staff. Setting up automated process triggers to perform a reflex clinical trial matching can kick-start the process without requiring human intervention. Methods: Using a clinical trial matching service developed in collaboration with GenomOncology, we used the receipt of sequencing test results as a process trigger to perform reflex clinical trial matching on oncology patients. A research nurse performed additional refinements to these results using multi-faceted filtering and an initial manual prescreening. In this pragmatic study, providers were randomized to receive results of prescreening events. EMR messages were sent to the intervention cohort of providers with recommendations for clinical trials for their patients and suggested next steps. Provider responses and prescreening outcomes were recorded in a REDCap project. To iteratively refine the trial results, matching algorithm updates were deployed throughout the study. Results: In the pilot deployment of this trial, we performed prescreening on 60 patients. At the time of prescreening vital status of 17% of the patients was outdated. We observed that trial cohort related recruiting statuses were the highest contributors to false matches (44%) and provider response rate was 94%. Conclusions: It is not possible to make substantial improvements to the outcome of clinical trial enrollment events without investing in reliable publicly available resources that host updated recruiting status for trials at the arm/cohort level. Uptake of such efforts by NCI or NLM has the potential to radically change the accuracy of clinical trial matching services and thereby improve enrollment efficiencies.[Table: see text]
Triple blinded prospective study assessing the impact of genomics: EndoPredict and artificial intelligence Watson for Oncology (WFO) on MDT’s decision of adjuvant systemic therapy for hormone receptor positive early breast carcinoma.
Authors: Somashekhar S.P. , Yethadka Ramya , C Rohit Kumar , Rajgopal Ashwin K , Rauthan Amit , Patil Poonam 
Published: May 2019

e18013 Background: : Decision on adjuvant systemic therapy in hormone positive early breast carcinoma is the only grey area in breast carcinoma management. This study was done to investigate the concordance between the results of genomic test, artificial intelligence and tumor board decision and implications of the same in clinical practice. Methods: This was a triple blinded, prospective study. Decision regarding the adjuvant systemic therapy was done by the multidisciplinary tumor board (MDT)after reviewing the pathology reports & the results correlated with Endopredict test reports & artificial intelligence(Watson for Oncology). Results: Total of 42 patients included. Mean age was 58.3 years, 71.4% were post-menopausal. Breast conservation was done in 47.6%. 64.2% were T1-2N0 stage. Infiltrating ducal carcinoma was major type (83.3%). Decision by MDT to give adjuvant chemotherapy was for 25 patients (59.5%) & hormonal therapy for rest. Recommendation by Watson for oncology was to give adjuvant chemotherapy in 50%. Endopredict score (EPclin) resulted in a low-risk group of 22 patients (52.3%), while 15(47.6%) had a high risk EPclin score. Discordance between the endopredict test, Watson & tumor board was for 11 patients (26.1%): 3 patients had high risk score, but the tumor board decision was to give hormonal therapy due to the age factor. 8 patients had low risk score, but tumor board decision was to give adjuvant chemotherapy. Extremes of age, premenopausal status, intermediate grade & high Ki 67% values were the factors associated with discordance. The treatment decision changed for 4 patients (4/11, 36%) after reviewing the endopredict test and Watson recommendation. Conclusions: Tumor board decision can be more scientific & evidence based with the help of genomics & a learnt colleague in the form of Watson for Oncology. Even though the clinical experience is the important determinant of adjuvant therapy, genomic test with artificial intelligence, which includes the scientific evidence, will guide in decision making. Long term follow up is needed for the validation in our clinical setting.
The impact of a digital solution on tumor board preparation time for nurse navigators.
Authors: Fowler Donna , Sheets Lincoln R , Prime Matthew S , Siadimas Athanasios , Levy Yariv Z , Hammer Richard D 
Published: May 2019

e18020 Background: A multidisciplinary tumor board (MTB) provides an interdisciplinary approach for decision-making in cancer care. Oncology nurse navigators (NN) have been introduced to facilitate patient access to services and resources, and to improve continuity and coordination of care. Little is known about how digital technologies support this role. Methods: A prospective IRB approved cohort study was undertaken to evaluate NN time preparation for MTBs before and after the implementation of the NAVIFY Tumor Board (NTB) solution at University of Missouri Health Care (MU). Data was collected using a digital time-tracking application. The NTB manual version was implemented via a phased roll-out (Hematology – Apr 9, 2018; Breast May 18, 2018; Gastrointestinal Jul 11, 2018). Subsequently, the integrated version was introduced (Oct 4, 2018). Results: Time preparation for 101 MTBs (828 cases) were evaluated throughout 2018 (35 Breast; 213 cases / 32 GI; 302 cases / 34 Hematology; 313 cases). Data showed NN meeting preparation time decreased for each MTB after the introduction of NTB; further time saving was achieved with NTB integrated version (Table 1). For the Breast MTB there was statistical significance between time preparation pre- & post-NTB (p-value = 0.011) but not between the manual and integrated versions (p-value = 0.118). For the Gastrointestinal MTB, there was no statistical significance between pre- & post-NTB (p-value = 0.214). For Hematology MTB there was statistical significance between the change from the NTB manual version vs. integration (p-value = 0.004). Note before NTB implementation Hematology MTB was not supported by NN. Conclusions: Introduction of the NTB reduced time spent by NNs preparing for 3 different MTBs, EMR integration delivered further time-savings. No discernable learning curve was observed suggesting user-training was sufficient and NTB was easy to learn. A reduction in variance (SD & IQR) for time preparation across all MTBs was seen. This suggests the NTB solution standardized the process for MTB preparation. Less time spent preparing for MTBs gives NNs more time to support patients.
Bone marrow donation perceptions among healthcare workers: A follow-up study at University of Cincinnati Medical Center.
Authors: Roof Logan , Chaudhary Rekha T. 
Published: May 2019

e18032 Background: It has been well-documented that there is a severe lack of participants enrolled in the National Bone Marrow Donor registry. Even those who are registered often decline to donate at a critical juncture in the donation process due to a wide variety of misconceptions. Health care professionals should be among the most educated about the bone marrow donation process as they will often be giving advice to potential donors. Methods: We conducted an anonymous online survey of medical students, residents, fellows, and attending physicians at the University of Cincinnati Medical Center to determine the common misconceptions surrounding bone marrow donation. Results: There were a total of 187 participants (73% medical students, 23% residents/fellows, 4% attending physicians). Fifty-one percent were already bone marrow donors, while 49% were not. Forty percent of respondents believe bone marrow biopsy is necessary for donation and 10% believe CT scans are done prior to donation. Twenty-eight percent responded that bone marrow is extracted under general anesthesia, 43% responded that it is extracted not under general anesthesia, 5% responded that it is extracted via central intravenous line, and 24% responded that it is extracted via peripheral intravenous line. Thirty percent responded that they are not bone marrow donors because bone marrow donation is painful, 12% because it involves surgery, 2% because it weakens the donor, 13% because it involves a lengthy recovery process, 3% because donors have to pay for donation, 1% because of ethnic/religious/cultural beliefs, while 39% have not had the opportunity to donate but would or are planning on it. Conclusions: The majority of allogeneic transplants are performed with peripherally collected bone marrow stem cells, however, most potential donors including health care professionals do not know this. We conclude that a great deal of education surrounding bone marrow donation is still needed among healthcare workers today. Educating health care workers is of the utmost importance as they will impart this knowledge to those considering donation. Future aims of this project are to develop an educational curriculum to address the most common misconceptions, particularly in medical students, as they are in the age group most targeted in bone marrow donation and they will be the future generation of physicians to educate patients on the process.
Characterization of temporal relationships of comorbidities developed following cancer diagnoses in veterans.
Authors: Hong Julian C. , Hauser Elizabeth R. , Redding Thomas S. , Sims Kellie J. , Gellad Ziad F , O'Leary Meghan , Madison Ashton , Qin Xuejun , Weiss David G. , Bullard A Jasmine , Williams Christina D. , Sullivan Brian , Lieberman David A. , Provenzale Dawn T. 
Published: May 2019

e18049 Background: Understanding patient trajectories and common sequences of comorbidity accrual among those newly diagnosed with cancer is critical for precision approaches to care and prevention. The Veterans Affairs (VA) Cooperative Studies Program (CSP) #380 cohort includes 3,121 healthy asymptomatic veterans who underwent screening colonoscopy and were followed for at least ten years. The current analysis leverages computational approaches to characterize the temporal relationships of diagnoses in CSP #380 participants following diagnosis of colorectal or other cancers. Methods: Patients enrolled in CSP #380 with at least 5 years of linked electronic health record data from the VA Corporate Data Warehouse (October 1999-December 2015) were included. Cancer diagnoses and their most common subsequent new diagnoses were identified per patient by the first instance of each three-digit ICD-9 diagnosis affecting at least 50 patients. Pairwise chronological relative risks (RR) between subsequent diagnoses were represented as a directed network graph, which maps the probability of developing a diagnosis following a prior diagnosis. Results: A total of 2,210 patients were included. The most common cancer diagnoses were prostate (436), thoracic (169), bladder (120), colon (72), and kidney cancers (65). Most first diagnoses following a cancer diagnosis were related to progressive cancer or acute/subacute treatment toxicity. For prostate cancer, comorbidities with greatest RR were carcinoma in situ (RR 6.85), unspecified (NOS) metastases (2.75), and urethral stricture (2.53). For lung cancer, they were metastases of respiratory and digestive sites (12.24), lymph nodes (6.47), and NOS (5.68), pneumothorax and air leak (4.16), and convalescence and palliative care (3.07). In bladder cancer, they were carcinoma in situ (9.00), cystitis (6.78), kidney or other urinary cancer (6.19), attention to artificial openings (3.40), and urethral stricture (2.78). These and other results were visualized with network graphs. Conclusions: Computational techniques can identify and visualize future health concerns following cancer diagnoses. In this cohort of initially healthy and asymptomatic veterans on a prospective screening colonoscopy study, most subsequent diagnoses were related to cancer or toxicities of therapy, as might be expected in an aging cohort. Future work may focus on streamlining in-clinic identification of potential high likelihood comorbidities.
Target versus non-target lesions in determining disease progression: Analysis of 581 patients.
Authors: Raskin Stephen , Klang Eyal , Kharizman Tehila , Konen Eli , Berger Raanan , Amitai Michal 
Published: May 2019

e18053 Background: RECIST, among methodologies designed to provide an objective assessment of tumor response to therapy, is based on the measurement of Target Lesions (TLs) and classification of response according to an objective scale of beneficial response or progressive disease (PD). The “PD point” (the time-point at which RECIST 1.1 first classifies the trial as PD) is a common end-point in clinical trials and is defined as that point when the objective response rate is > 20%. However, RECIST also allows for the subjective assessment of non-TL lesions (NTLs) and new lesions (NLs) to determine the PD point. We sought to determine which of these parameters was most influential in determining PD. Methods: We evaluated the formal RECIST 1.1 assessments for consecutive patient enrollments in randomized clinical trials prepared by two senior radiologists at our institution from 2013 through 2018. Data was evaluated at the “PD point.” Results: There were 1260 patients, with 4499 CT or MRI scans. Of these, 581 trials concluded with PD. There were seven groups (+/-/-, -/+/-, -/-/+ . . . +/+/+) according to the status of TLs, NTLs, and NLs at the PD point. In 538 patients (92.6%), TLs were unnecessary in determining the PD point. Two-thirds of these had objective response rates of < 40%. Measurable and non-measurable NTLs were equally responsible for PD, and the strongest determinant of PD was the unequivocal appearance of new lesions. Conclusions: In this study, subjective parameters, as defined by RECIST 1.1, were far more likely to result in a determination of PD than objective ones. These findings may have relevance for considering the value of RECIST 1.1 as a scientific standard for therapeutic efficacy as well as in the design of new methodologies for the assessment of tumor response.
Real-world efficacy of bone modifying agents (BMAs) in patients with breast cancer (BC) treated in an academic health system: Use of the “green button.
Authors: Karimi Yasmin , Gombar Saurabh , Dean Latanya , Hansen Jennifer , Callahan Alison , Jung Ken , Divi Vasu , Blayney Douglas W. 
Published: May 2019

e18054 Background: BC patients (pts) have a high incidence of bone metastases (mets) and associated morbidity. BMAs – zoledronic acid (ZA) and denosumab (Den) – reduce bone met related skeletal related events (SREs). ASCO guidelines do not recommend one over another, and survival and real-world outcome data to guide point-of-care decision-making is lacking. We used the previously developed “Green Button” informatics consult service, designed to rapidly test hypotheses when no applicable published data is available to guide treatment choices (Longhurst et al Health Affairs 2014), to compare BMA efficacy in BC patients. Methods: Patients treated for BC at Stanford HealthCare between 2009 - 2018, receiving standard of care cancer and BMA therapy, as determined by their oncologists, were identified who had > 2 electronic health records (EHRs) documenting BMA administration, and had either ICD9 174 or ICD10 C50 diagnostic codes. Pts were grouped into Den only, ZA only, or both. Two outcomes were analyzed: 1) SREs as a composite outcome of pathologic fracture (1st ICD10 M84.5); spinal cord compression (1st ICD10 M47.1 or G95.2), radiation therapy (1st CPT 77300) or hypercalcemia (calcium ≥10.5); and 2) death. Effects were compared relative to baseline treatment with ZA; we show results of log rank tests for differences in survival outcomes. Three analyses were performed: 1) Unadjusted analysis; 2) Basic matching analysis accounting for length of medical record, age, sex and year of treatment; 3) Propensity score matching using all available data; all prior to index treatment with either Den or ZA. Results: 802 patients had ≥ 2 records of BMA administration. Comparison of Den only and ZA only pts is shown in the table below. Median ages and length of medical record were balanced in all groups. Conclusions: This preliminary retrospective analysis of unsupervised BMA use suggests that Den is superior to ZA for the outcomes of interest; confirmatory analyses are underway.[Table: see text]