bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endobronchial ultrasound-guided transbronchial needle aspiration samples for multiple molecular analysis.
Authors: Chen Kezhong , Yang Fan , Zhao Hui , Wang Jun 
Published: February 2017

75 Background: We assessed the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to detect EGFR, K-ras, ALK mutations from malignant mediastinal nodes of patients with NSCLC. Methods: From February 2010 to April 2012, 81 specimens diagnosed with lung adenocarcinoma by EBUS were used for molecular analysis. Needle puncture site for the EBUS was standard 22G needle, once cytology pathology diagnosed adenocarcinoma, at the same site with the conventional needle puncture method to obtain adequate biopsy specimen for further analysis. The tissue was fixed in 10% formalin. When histologic diagnosis confirmed adenocarcinoma, the FFPE tissue was extracted DNA to detect EGFR mutation by both amplification refractory mutation system (ARMS) and direct sequencing. Partial specimens also extracted DNA or RNA to detect K-ras and ALK mutation. Results: 80/81 specimens were successfully extracted DNA, 52 were male and 28 were female, mean age of 62.9 years (34 to 82 years). Somatic mutations of the EGFR gene were detected in 37 of 80 cases (46.3%), 22 cases of exon 19 mutation,14 cases of exon 21 mutation, and 1 of T790M mutation in ARMS. The result have some difference in direct sequening. In the patients who requested other biomarkers analysis, 6 had K-ras mutations and 2 had ALK mutations.7 patients with EGFR mutations had a radical surgery after neoadjuvant chemotherapy, tumor specimens were tested again with EGFR gene mutation, the same result as the preoperative test results. Conclusions: EBUS-TBNA mediastinal lymph node biopsy in the detection of EGFR, K-ras, and ALK mutations in tissue samples was feasible, through the highly sensitive methods, higher detection rate was available, the result can be used as evidence of personalized treatment of lung cancer.
High-throughput glycomics for discovery of cancer biomarkers.
Authors: Nakahara Taku , McCarthy Diane , Miura Yoshiaki , Asada Hidehisa 
Published: February 2017

9 Background: While the importance of glycosylation in many cancers is well established, the use of glycomics in biomarker research has lagged behind genomics and proteomics. This is due, in part, to the lack of practical platforms capable of analyzing clinically relevant sample numbers. To address these challenges, we have developed a novel glycomics technology (the GlycanMap platform) that combines a high-throughput assay with custom bioinformatics and rapidly provides both biomarker candidates and information on the underlying biology. Methods: N-glycans were enzymatically released from their parent glycoproteins and captured on chemoselective beads. After washing to remove non-glycan components, purified glycans were derivatized to stabilize labile sialic acids and released from the beads. The steps described above were automated on a 96-well format robotics system to maximize throughput and reduce variability and can be performed in less than 24 hours. Released glycans were analyzed by MALDI-TOF MS using internal standards to facilitate quantitation. In addition to comparing individual glycans between groups, glycan changes were also analyzed with respect to known glycan biosynthetic pathways. Results: The automated assay was compatible with multiple biological sample types, including serum/plasma, tissue, and cell lysates. Human serum was used to assess assay performance and yielded 50-60 glycans with CVs of 10-15% and good linearity. The lower limit of detection was approximately 100 nM. The assay was applied to drug-treated colon cancer cells (HCT116) and revealed significant (> 2-fold) changes in 17 glycans. Projection of these glycan changes on the known N-glycan pathway showed that the most significant changes occurred in the medial-Golgi. Conclusions: We have developed and optimized a high-throughput glycomics platform to facilitate large-scale biomarker studies and assured its practical performance in terms of sensitivity, repeatability, and linearity. Application of this assay to drug-treated colon cancer cells demonstrated that projection of individual glycan changes against known glycan pathways provided additional information about biological mechanism and relevance.
MDR1 gene expression in peripheral blood as a marker of treatment response in lung cancer.
Authors: Luque Raquel , Gonzalez Flores Encarnacion , Delgado Juan Ramon , Melguizo Consolación , Prados Jose Carlos , Gonzalez Astorga Beatriz , Ortiz Raul , Sánchez Toro Carmen , Valdivia Javier , Aránega Antonia 
Published: February 2017

96 Background: Non-small cell lung cancer (NSCLC) is sometimes chemoresistant and does not respond to treatment; several factors are involved in the development of chemoresistance, such as multidrug resistance (MDR) phenotype, mainly. Methods: We studied MDR1 gene expression in peripheral blood PMN of 23 patients with NSCLC, advanced stages in most of the cases, who had not received treatment previously, before (hour 0) and after (hour 6) paclitaxel-carboplatin treatment. RNA was obtained from PMN pellet by means of the protocol of trizol. RNA was checked with agarose gels, and later RT-PCR technique was carried out using specific primers. Expression levels were randomly distributed, so that overexpression under 3 was considered low level of expression, and overexpression above 4 was considered high level of expression. Results: After treatment, we found overexpression of MDR1 in 22 patients. High levels were found in 11 patients, and low levels were observed in the other 11 patients. No relation was found between this fact and the treatment response or survival rate. No significant differences in expression were found in the other variables: gender, tobacco habit, weight loss at the diagnosis, tumour staging, and tumor histology. Conclusions: We can conclude that MDR1 expression in peripheral blood is not a predictive factor for treatment response nor a prognostic factor of the disease. Despite these results, further studies are necessary on molecular biology of NSCLC in order to try to establish subgroups of patients based on genetic profiles, in which the use of microarrays could be very useful.
Utilization of intensive care resources due to better communication of end-of-life issues.
Authors: Chen Allen Ray Sing , Kane Joyce M. , Kasecamp Barbara , Cottrell Candace , Apostol Colleen C. , Billing Lynn , List Donald C. , Jones Richard J. , Fetting John H. 
Published: February 2017

1 Background: Advanced life support resources are required for optimal care of patients undergoing curative therapy, but their use in patients with terminal disease does not improve patient outcomes. In 2007, our cancer center established the Duffey Pain and Palliative Care team, and one important goal was to help our physicians improve at discussing end-of-life issues with patients. We hypothesized that if this effort was effective, it would result in less utilization of intensive care unit (ICU) management among patients who die in the center. Methods: All inpatient deaths were systematically tabulated and code status displayed at the multidisciplinary Morbidity and Mortality review twice per quarter, beginning in July 2006. Utilization of ICU care, defined as ventilator or dialysis support, was identified from billing data and confirmed by chart review. Survival to discharge among patients who received ICU care was monitored as a component of our patient safety dashboard. Results: From 2008 through 2011, 525 oncology patients died while hospitalized in the cancer center. During this period, among patients who died, there was a gradual increase in no-code status, election of comfort care, or withdrawal of ICU support, from 81% to 95% (OR 1.14 per quarter, p<0.0001). Although the proportion of patients who received any ICU care during their terminal hospitalization did not change, the duration of such care decreased: the proportion with mechanical ventilation for over 14 days decreased from 10% to 5% (OR 0.93 per quarter, p<0.05). There was no decrease in the survival-to-discharge of patients who received ICU care. Conclusions: A multidisciplinary team approach to improve discussion of end-of-life issues, combined with regular feedback to cancer center staff regarding code status at death, resulted in significant changes in patient and family decisions about management at the end of life over a four-year interval. These changes have reduced utilization of ICU care during terminal hospitalizations with no reduction in the survival-to-discharge of all patients who receive ICU care. We propose appropriate establishment of code status and survival-to-discharge of ICU patients as measures of quality oncology care.
Changes in adjuvant endocrine therapy over one year among postmenopausal women with early-stage breast cancer initiating aromatase inhibitors.
Authors: LaMorte Danielle Lindsay , Hartmann Katherine E. , Abramson Vandana Gupta , Mayer Ingrid A. , Peacock Nancy Walker , Cella David , Castel Liana Desharnais 
Published: February 2017

11 Background: Aromatase inhibitors (AIs) are standard of care for adjuvant endocrine therapy (AET) to prevent recurrence of early stage breast cancer in postmenopausal women. Previous AET adherence research has focused on the 25-96% adherence observed with, but more information is needed about AI adherence, especially regarding the role of arthralgia (joint pain or stiffness) in AET changes. Our objective was to understand AET changes within a year of AI initiation. Methods: We examined AET switching (either to another AI or to tamoxifen), overall changes in AET (including switching and temporary or permanent discontinuation), and physician- and patient-reported arthralgia, using data abstracted from medical records and self-administered surveys among 93 patients initiating AI. We conducted Chi-square and Wilcoxon univariate analyses. Results: Anastrazole was initially prescribed to 64 patients (69%), letrozole to 28 patients (30%), and exemestane to 1 patient. A year after AI initiation, 64 patients (69%) had no change in AET. Among the 29 patients (31%) who had an AET change, 14 switched to at least one other AI, 11 switched to tamoxifen, 9 temporarily discontinued AET, and 7 entirely discontinued AET (categories not mutually exclusive). Average time to first AET switch was 182.7 days. Average number of AET switches was 1.4. Arthralgia was the most common reason for AET changes, noted in the records of 19 patients (66% of those who changed AET). Patients who changed AET reported more severe arthralgia (median pain from 0-10 among 8 joint groups =1.4, interquartile range [IQR]=0.3-2.6) at week 12 than those who did not (median=0.3, IQR=0-1.1), p=0.03. A higher proportion (46%) of the 28 patients who initiated with letrozole changed AET due to arthralgia, compared with 20% of the 64 patients who initiated with anastrazole (p=0.01). Conclusions: A substantial proportion of women initiating AI change AET over one year. Arthralgia appears to play a key role in AET changes, particularly for letrozole as compared with anastrazole. More longitudinal patient-reported arthralgia data are needed to guide clinical decision making about AI initiation and AET changes.
Evaluating survivorship cancer care through quality improvement programs.
Authors: Palos Guadalupe R. , Zandstra Fran , Russell Ludivine , Flores Jacklyn J. , Gilmore Katherine R. , Rodriguez Maria Alma 
Published: February 2017

112 Background: The Institute of Medicine noted cancer survivors’ care may be improved by providing each with a cancer survivorship care plan (CSCP). Recently, numerous versions of CSCPs have emerged; however, evidence-based processes to evaluate their use and quality in providing personalized survivorship care have yet to be implemented. Here, we describe our efforts to use the approach recommended by the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) to track and report the compliance rate for using electronic CSCPs in our survivorship clinics. Methods: The criteria used to conduct our audit evolved from the QOPI template, which included selection of survivors seen in 7 different out-patient survivorship clinics within a specific 6-month period, identification of denominators and numerators unique to each clinic, and determination of the number of records to audit based on the number of full-time providers in each clinic. Next, we established the target condition, method(s) used for data collection, appropriate measures, and other criteria used in the QOPI. All data were obtained from our CSCPs’ mined data, institutional electronic medical records, and scheduling systems. Results: From December 1, 2011, to May 31, 2012, we conducted an electronic medical records audit to determine the compliance rate for issuing survivorship care plans in 7 clinics. The survivorship clinics included breast, colorectal, endocrine (thyroid), genitourinary, gynecology, head/neck, and melanoma. A total of 3,274 electronic medical records were reviewed. 40 providers issued a total of 2,761 electronic CSCPs within 30 days of the arrived appointment. The compliance rate per clinic ranged from 64.5% to 94.7% (X=84.5%). Conclusions: We found the QOPI process to be user-friendly and applicable to our compliance monitoring effort. All data were extracted from electronic tools, thus ensuring the processes used were reliable, reproducible, and reasonably consistent across clinics. Further examination is warranted to determine characteristics of clinics with high- vs. low-compliance rates and their impact on survivors’ outcomes as related to specific CSCP recommendations.
Implementation and evaluation of a tobacco cessation program in an outpatient oncology center.
Authors: Hensing Thomas A. , Brockstein Bruce , Carro George W. , Gavin Shannon Maureen 
Published: February 2017

117 Background: Tobacco use is the leading preventable cause of premature death in the United States and has a causal link to various cancer types. Continued tobacco use after a cancer diagnosis may decrease survival, reduce treatment efficacy, prolong/increase treatment toxicity, and increase the risk for recurrence. The combination of support from trained professionals and appropriate medications increases the chances of quitting successfully. In the literature, the advice of a physician improves quit rates to about 10% and the combination of tobacco cessation medication and behavioral support can increase the rate to 20-35%. There is a lack of data on the impact of a tobacco cessation program integrated into a cancer center. The objective of this project is to implement and prospectively evaluate a tobacco cessation program in a hospital-based outpatient cancer center across three treatment sites. Methods: A multidisciplinary group at the cancer center was established to oversee the development and implementation of the program including: pharmacist training to become a certified Tobacco Treatment Specialist, electronic medical record documentation tool establishment, and development of patient education tools. The pharmacist provided one-on-one counseling for each referred patient. Assessment of the 3, 6, and 12 month quit rates was performed. Results: The tobacco cessation program at the cancer center has been available for approximately one year to all patients and their family members. Of the 67 patients referred to the tobacco cessation program, 27 (40%) patients followed through with the referral and met with the tobacco treatment specialist. The 3, 6, and 12 month quit rates are 68%, 50%, and 50%, respectively. Conclusions: The tobacco cessation program at the cancer center is evolving into a successful program. The quit rates of the program have exceeded those reported in the literature. The accessibility of the tobacco cessation program has enhanced the comprehensive care provided to the patients at the cancer center.
Breast imaging boot camp: A mammography quality improvement initiative.
Authors: Dupuy Danielle , Miller Louise , Weldon Christine B. , Orsi Jennifer M. , Macarol Terry , Murphy Anne Marie , Trosman Julia R. 
Published: February 2017

138 Background: In mammography, compression, and positioning are key quality factors. ACR standards suggest that compression should ensure that a breast is taut (drawn tight with no slack). In environmental scans, semi-structured interviews with cross discipline providers from Chicago mammography facilities, we found wide variation in radiology technologist’s understanding of standard compression and views. Optimal compression was reported from 12-45 lbs and some sites reported that four views are taken regardless of breast size. This discovery led to a mammography technologist training program as a quality improvement intervention. Methods: The Chicago Breast Cancer Quality Consortium contracted with Louise Miller, AART, CRT, and RTRM to lead a Breast Imaging Boot Camp and partnered with 4 hospitals to carry out the training. There were three components of the boot camp: a 1-day seminar for all mammography technologists, 1 day of hands on training for a limited number of techs and a train the trainer component where selected techs went through a 3-day intensive program with the goal of preparing them to provide ongoing education to the Chicago mam-tech community. A preliminary tool was developed and used randomly by radiologists during the training to examine the amount of tissue in the image from one year to the next, the presence or absence of an Inter-mammary fold and cleavage. Results: More than 120 radiology technologists attended a day-long seminar, 10 received hands on training, 4 of the 10 were trained to be future trainers. Participants rated their overall impression of the day-long seminar between 4 and 5 on a 5-point scale. During the hands-on training, radiologists assessing the images commented on significant improvements in image quality from the previous year’s mammogram. A quantitative evaluation process has been developed to examine the efficacy of the training and measure impact on mammography quality. This evaluation involves a 3 month and 1-year assessment that will take place in September of 2012 and again in May of 2013. Results of first evaluation will be available for presentation. Conclusions: Results from the evaluation will help review effectiveness of technologists post-training techniques and identify areas to improve.
Increasing hand hygiene compliance using a solution session.
Authors: Rohe Duke , Perego Cheryl , Williams Polly , Zabka Cindy , Foster Julie , McLemore Lisa , Yao David 
Published: February 2017

147 Background: Few would argue that proper hand hygiene (HH) is vital for preventing nosocomial infection, yet compliance rates remain low and capturing its data is difficult. Methods: A homegrown "design" methodology called Solution Session which combines creative problem solving, GE WorkOut and an accountability maturity model was used to define problems, formulate ideas to increase HH compliance. From the session five subteams (addressing Compliance, Patient Education, Staff Education, Process and Automation) were enlisted to develop a holistic set of solutions to address HH compliance. Infection Control paid special attention to developing custom observation plans for each unit. One of the solutions, a homegrown web-based observation collection system, was created to collect and report compliance by individual and department level. The system of solutions were piloted on a unit that was already doing well (with a baseline compliance of 92%) and two struggling high acuity units (with baseline compliance at 54% and 50%). Results: The pilot unit that was doing well to begin with has averaged HH compliance rate 99% for over a 15 month period (n=105/month). The two struggling units have averaged 84% and 80% respectively (n= 60/month and n=24/month) over the same period. The operating room is the next candidate in line to employ this system. Conclusions: 1) Solutions are best designed by those affected. 2) People respond to data.Weekly reportsdisplay number of observations taken, compliance down to the department and individual level: powerful tools to start the self correction process. 3) Compliance is a marathon, not a sprint.
Cost of cancer care: The impact of disclosure on willingness to pay and treatment preferences.
Authors: Howe Rebecca , Hassett Michael J. , Wheelock Alyse , Thorsen Cristina M. , Kaplan Celia , Ozanne Elissa 
Published: February 2017

15 Background: Little is known about patients’ views regarding the costs of cancer care and its effect on treatment selection. Even less is known about how patients view information about conflicts of interest, such as disclosure of a clinic’s profit from cancer therapy. In the setting of health care reform and rising costs, we sought to understand how out-of-pocket costs and disclosure of profit impact patient treatment preferences. Methods: Previous breast cancer patients were invited to complete a web-based survey that presented four scenarios outlining cancer care treatment benefits and risks (MRI, pegfilgrastim, cold cap, and chemotherapy drugs). Initially, respondents were asked their preference for each treatment over a standard of care alternative and their out-of-pocket willingness to pay. After providing information about first, the total cost per treatment and second, the profit to the clinic, respondents were asked if their preference changed. Results: 40 women responded, all whom had previous diagnoses of breast cancer. In each of the four scenarios, respondents were less interested in the treatment option after being informed about cost or disclosure of a clinic profit. While 45.5% of respondents said they consider costs all or most of the time, only 9.1% considered clinic profit. However, 66.7% of respondents said they would be less interested in a treatment if they knew their provider received a profit from the treatment. Conclusions: Patients are less likely to prefer treatments after disclosure of total cost and clinic profit data. Communication about the costs and profits associated with cancer care may be an essential component of informed decision making in an era of growing patient involvement and escalating health care costs. [Table: see text]