bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in use of advanced imaging at the time of breast cancer diagnosis in a statewide registry.
Authors: Henry Norah Lynn , Braun Thomas , Lusk Elizabeth , Munir Khan , Griggs Jennifer J. , Gorski David H. , Silver Samuel M. , Breslin Tara M. , Ali Haythem Y. ,   Michigan Breast Oncology Quality Initiative
Published: February 2017

287 Background: Advanced imaging for diagnosis of metastatic disease at the time of diagnosis of stage 0-II breast cancer is not recommended according to national guidelines. The purpose of this study was to examine the variation in ordering of CT chest, abdomen, and pelvis, PET, and bone scans across the state of Michigan, and to investigate clinical and non-clinical factors associated with test ordering. Methods: We prospectively collected data from all patients diagnosed with stage 0-II breast cancer from 2008-2014 in 25 health systems in the Michigan Breast Oncology Quality Initiative (MiBOQI), a Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored quality initiative. Demographic, imaging, and pathologic data were abstracted from the medical record. The primary endpoint was the percentage of patients with at least one advanced imaging test performed within 90 days after diagnosis of breast cancer. Analyses were performed using the chi-squared test of association. Results: Of the 27,011 patients, 4799 (17.8%) had at least one staging exam performed within 90 days of diagnosis. Imaging tests were primarily performed post-operatively. The average percentage of patients who had at least one staging exam performed varied by stage and by site (Table). The rate of testing decreased over time for stage 0-IIA cancers but not for stage IIB. On multivariate analysis, younger age, black race, hormone receptor negativity, HER2 positivity, and higher grade were associated with increased likelihood of undergoing imaging. Conclusions: There is considerable variability in ordering of staging scans at the time of diagnosis of early stage breast cancer across Michigan. Factors underlying use of imaging in stage IIB disease should be examined in order to develop interventions for rate reduction. [Table: see text]
Patterns of comorbidity among older U.S. patients with non-Hodgkin lymphoma.
Authors: Hester Laura , Park Steven I. , Lund Jennifer Leigh 
Published: February 2017

304 Background: Evidence suggests that the number and type ofcomorbidities at cancer diagnosis influences cancer treatment and mortality, especially among older patients.We sought to describe comorbidity patterns and identify how patterns predict all-cause mortality among older non-Hodgkin lymphoma (NHL) patients. Methods: Using the linked Surveillance, Epidemiologic, and End Results (SEER)-Medicare databases, we identified patients aged > 66 with a first diagnosis of stage I-IV NHL from 2007-2009. Codes for individual comorbidities in the Charlson Comorbidity Index (CCI) were identified in the 12 months before NHL diagnosis, during which patients were required to have continuous Medicare Parts A, B, and D enrollment and no managed care. The prevalence of single and concurrent comorbidities was calculated. Medicare enrollment files contained vital status. We used multivariable Cox proportional hazard models to estimate adjusted hazard ratios (aHR) for all-cause mortality in each comorbidity group versus no comorbidity controlling for age, sex, race/ethnicity, stage, tumor growth category, and other comorbidities. Results: Among 4901 older NHL patients, 52% had ≥ 1 comorbidity and 26% had a CCI > 2. The most prevalent comorbidities were diabetes (25%), chronic obstructive pulmonary disorder (COPD) (16%), and congestive heart failure (CHF) (12%). All-cause mortality was greater among patients with CHF (aHR = 1.44; 95%CI = 1.26, 1.65), diabetes (aHR = 1.16; 95%CI = 1.03,1.29), or dementia (aHR = 1.20; 95%CI = 1.03, 1.41) compared to those without each comorbidity. More than half of diabetes patients, two-thirds of COPD patients, and three-quarters of CHF patients had > 1 additional non-cancer comorbidity. All-cause mortality was higher among NHL patients with CHF who had co-occurring COPD (aHR = 1.56; 95%CI = 1.19, 2.05), diabetes (aHR = 1.66; 95%CI = 1.29, 2.14), or both COPD and diabetes (aHR = 2.61; 95%CI = 1.97, 3.46). Conclusions: Comorbidity is common among older, newly-diagnosed NHL patients and should be carefully considered when making treatment decisions. Given the known cardiotoxicity of the main NHL chemoimmunotherapy, providers should discuss comorbidity management, particularly for CHF, before initiating therapy.
Comparison of real-world acute care interventions (ACI) in patients (pts) with advanced non-small cell lung cancer (adv NSCLC) treated with chemotherapy versus targeted therapies.
Authors: Radtchenko Janna , Korytowsky Beata , Bhor Menaka , Tuell Ken , Feinberg Bruce A. 
Published: February 2017

37 Background: This analysis compared the frequency of ACI for any cause (emergency room [ER] visits, hospitalizations, and readmissions) to better understand the burden of treatment in adv NSCLC pts treated with chemotherapy (chemo) vs targeted therapy (TT). Methods: Using Inovalon’s MORE2 Registry claims data, adv NSCLC pts treated with antineoplastics identified by ICD-9 codes from July 2013-2014 were selected. Inclusion: pts >18 y who received first-line (1L) systemic therapy within 6 mo of diagnosis. Exclusion: pts with small cell lung cancer or secondary malignancies and pts in clinical trials. TT was defined as erlotinib, ceritinib, afatinib, crizotinib, ramucirumab, or bevacizumab monotherapy. Analysis included frequency distributions, chi-square, and t-tests. Results: Of 5319 pts included, 1304 (25%) received 1821 total lines of TT. Overall, median age was 66 y, 48% were male, 56% were on Medicare, and 41% received ≥ 2 L of therapy. Mean Charlson Comorbidity Index (CCI) was 2.2 (lower in pts on TT [2.1 vs. 2.2, P<.0001]). Pts on TT were older, more likely to be female, and less likely to have Medicare (Table). Overall, 45% of pts were hospitalized, of whom 50% were readmitted (43% while on the same line); 62% of pts had an ER visit, of whom 62% were readmitted (56% while on the same line). Pts on TT were less likely to be hospitalized, have ER visits, and be readmitted (hospital or ER). Conclusions: Pts with adv NSCLC had considerable ACI. Readmission was common for both hospitalizations and ER visits, with many pts readmitted while on the same line. Pts on TT had fewer ACI and readmissions vs pts on chemo; however, nearly half of pts in this study required hospitalization, highlighting the need for novel therapies with improved safety and efficacy. [Table: see text]
Real-world treatment patterns and outcomes in HER2 positive MBC patients with brain metastasis in the U.S. community oncology setting.
Authors: Patt Debra A. , Fonseca Eileen , Yoo Bongin , Wilson Thomas , Goertz Hans-Peter , Lai Catherine 
Published: February 2017

92 Background: Patients (pts) with HER2 positive (HER2+) metastatic breast cancer (MBC) have different patterns of disease and treatment (tx) from HER2 negative MBC. Brain metastasis (BM) frequently occurs and txs vary. Methods: This retrospective study included adult HER2+ MBC pts from a community oncology network electronic health record (EHR) database and diagnosed between 2009-2011, with follow-up until 11/2014. Pts with other primary tumors were excluded. Two cohorts were defined: pts diagnosed with BM and pts with no evidence of BM (NBM), and were initially matched on age and performance status at MBC diagnosis (dx) and stage. Eligibility and txs were examined in electronic chart review. Overall survival (OS) from MBC dx was estimated using a weighted Kaplan-Meier method. Results: The final sample consisted of 86 BM and 101 NBM pts. All baseline MBC demographics were similar across cohorts. Median age was 54 and 52 years for BM and NBM, respectively. The cohorts (BM:NBM) included 57%:75% Caucasians, 12%:6% Blacks, and 31%:19% other/unknown. There were fewer estrogen receptor positive pts in the BM cohort (58%:74%; p = 0.02). Except for bone (p = 0.01), both cohorts had similar prevalence of metastatic sites: liver 35%:35%; lung 31%:30%; bone 41%:62. Of all the BM pts, 54% had first CNS imaging after symptoms, 37% were first imaged for other known reasons. After BM dx, 20% had surgical resection, 67% whole brain radiation (XRT), 37% stereotactic XRT, and 22% palliative XRT (not mutually exclusive). 25% of pts had both XRT and surgery while 72% had only XRT. Among pts receiving systemic therapy after BM dx, the first regimen contained trastuzumab in 55% of pts and lapatinib in 41% of pts. Among pts changing txs after BM dx, 1/3 switched to a trastuzumab but not lapatinib-based regimen; 1/3 to a lapatinib but not trastuzumab-based regimen; 17% to a lapatinib + trastuzumab-based regimen; and 17% to non-HER2-based therapy. Weighted median OS from MBC dx for BM vs. NBM pts was 30.2 and 46.1 months (p = 0.01). Conclusions: For HER2+ MBC pts, survival was shorter for pts with BM vs. NBM and a high degree of tx variability for BM existed. Understanding how detection and tx impacts outcomes will improve care of BM pts.
E1308: Phase II Trial of Induction Chemotherapy Followed by Reduced-Dose Radiation and Weekly Cetuximab in Patients With HPV-Associated Resectable Squamous Cell Carcinoma of the Oropharynx— ECOG-ACRIN Cancer Research Group
Authors: Marur Shanthi , Li Shuli , Cmelak Anthony J. , Gillison Maura L. , Zhao Weiqiang J. , Ferris Robert L. , Westra William H. , Gilbert Jill , Bauman Julie E. , Wagner Lynne I. , Trevarthen David R. , Balkrishna Jahagirdar , Murphy Barbara A. , Agrawal Nishant , Colevas A. Dimitrios , Chung Christine H. , Burtness Barbara 
Published: February 2017

Purpose Human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC) is treatment-responsive. Definitive chemoradiation results in high cure rates but causes long-term toxicity and may represent overtreatment of some patients. This phase II trial evaluated whether complete clinical response (cCR) to induction chemotherapy (IC) could select patients with HPV-associated OPSCC for reduced radiation dose as a means of sparing late sequelae. Methods Patients with HPV16 and/or p16-positive, stage III-IV OPSCC received three cycles of IC with cisplatin, paclitaxel, and cetuximab. Patients with primary-site cCR to IC received intensity-modulated radiation therapy (IMRT) 54 Gy with weekly cetuximab; those with less than cCR to IC at the primary site or nodes received 69.3 Gy and cetuximab to those regions. The primary end point was 2-year progression-free survival. Results Of the 90 patients enrolled, 80 were evaluable. Their median age was 57 years (range, 35 to 73 years), with the majority having stage T1-3N0-N2b OPSCC and a history of ≤ 10 pack-years of cigarette smoking. Three cycles of IC were delivered to 77 of the 80 patients. Fifty-six patients (70%) achieved a primary-site cCR to IC and 51 patients continued to cetuximab with IMRT 54 Gy. After median follow-up of 35.4 months, 2-year progression-free survival and overall survival rates were 80% and 94%, respectively, for patients with primary-site cCR treated with 54 Gy of radiation (n = 51); 96% and 96%, respectively, for patients with < T4, < N2c, and ≤ 10 pack-year smoking history who were treated with ≤ 54 Gy of radiation (n = 27). At 12 months, significantly fewer patients treated with a radiation dose ≤ 54 Gy had difficulty swallowing solids (40% v 89%; P = .011) or had impaired nutrition (10% v 44%; P = .025). Conclusion For IC responders, reduced-dose IMRT with concurrent cetuximab is worthy of further study in favorable-risk patients with HPV-associated OPSCC. Radiation dose reduction resulted in significantly improved swallowing and nutritional status.
Results From the Phase III Randomized Trial of Onartuzumab Plus Erlotinib Versus Erlotinib in Previously Treated Stage IIIB or IV Non–Small-Cell Lung Cancer: METLung
Authors: Spigel David R. , Edelman Martin J. , O’Byrne Kenneth , Paz-Ares Luis , Mocci Simonetta , Phan See , Shames David S. , Smith Dustin , Yu Wei , Paton Virginia E. , Mok Tony 
Published: February 2017

Purpose The phase III OAM4971g study (METLung) examined the efficacy and safety of onartuzumab plus erlotinib in patients with locally advanced or metastatic non–small-cell lung cancer selected by MET immunohistochemistry whose disease had progressed after treatment with a platinum-based chemotherapy regimen. Patients and Methods Patients were randomly assigned at a one-to-one ratio to receive onartuzumab (15 mg/kg intravenously on day 1 of each 21-day cycle) plus daily oral erlotinib 150 mg or intravenous placebo plus daily oral erlotinib 150 mg. The primary end point was overall survival (OS) in the intent-to-treat population. Secondary end points included median progression-free survival, overall response rate, biomarker analysis, and safety. Results A total of 499 patients were enrolled (onartuzumab, n = 250; placebo, n = 249). Median OS was 6.8 versus 9.1 months for onartuzumab versus placebo (stratified hazard ratio [HR], 1.27; 95% CI, 0.98 to 1.65; P = .067), with a greater number of deaths in the onartuzumab arm (130 [52%] v 114 [46%]). Median progression-free survival was 2.7 versus 2.6 months (stratified HR, 0.99; 95% CI, 0.81 to 1.20; P = .92), and overall response rate was 8.4% and 9.6% for onartuzumab versus placebo, respectively. Exploratory analyses using MET fluorescence in situ hybridization status and gene expression showed no benefit for onartuzumab; patients with EGFR mutations showed a trend toward shorter OS with onartuzumab treatment (HR, 4.68; 95% CI, 0.97 to 22.63). Grade 3 to 5 adverse events were reported by 56.0% and 51.2% of patients, with serious AEs in 33.9% and 30.7%, for experimental versus control arms, respectively. Conclusion Onartuzumab plus erlotinib did not improve clinical outcomes, with shorter OS in the onartuzumab arm, compared with erlotinib in patients with MET-positive non–small-cell lung cancer.
When, What, and Why of Perioperative Treatment of Potentially Curable Pancreatic Adenocarcinoma
Authors: Perez Kimberly , Clancy Thomas E. , Mancias Joseph D. , Rosenthal Michael H. , Wolpin Brian M. 
Published: February 2017

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 64-year-old woman with a history of hypertension and type 2 diabetes had been in her usual state of health until she developed symptoms of diarrhea, abdominal bloating, and discomfort in the midepigastrium. Evaluation with a contrast-enhanced abdominopelvic computed tomography (CT) scan demonstrated a mass in the pancreatic body that was approximately 3.1 cm × 2 cm × 2.1 cm in size with abutment of the portal vein–superior mesenteric vein confluence for less than 180°. The confluence was narrowed but without thrombosis. No tumor–vessel interface was noted at the superior mesenteric artery, celiac artery, or common hepatic artery. Several peripancreatic lymph nodes were observed that measured up to 11 mm × 5 mm. No evidence for distant spread of disease was identified. An upper endoscopy with endoscopic ultrasound was performed and fine-needle aspirates of the pancreas mass were positive for malignant cells that were consistent with adenocarcinoma. Chest CT scan without intravenous contrast demonstrated no evidence of metastatic disease. The patient came to the clinic to discuss management of her newly diagnosed malignancy.
Radiation Therapy for Glioblastoma: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Guideline
Authors: Sulman Erik P. , Ismaila Nofisat , Armstrong Terri S. , Tsien Christina , Batchelor Tracy T. , Cloughesy Tim , Galanis Evanthia , Gilbert Mark , Gondi Vinai , Lovely Mary , Mehta Minesh , Mumber Matthew P. , Sloan Andrew , Chang Susan M. 
Published: February 2017

Purpose The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on radiation therapy for glioblastoma. Because of its relevance to the ASCO membership, ASCO reviewed the guideline and applied a set of procedures and policies used to critically examine guidelines developed by other organizations. Methods The ASTRO guideline on radiation therapy for glioblastoma was reviewed for developmental rigor by methodologists. An ASCO endorsement panel updated the literature search and reviewed the content and recommendations. Results The ASCO endorsement panel determined that the recommendations from the ASTRO guideline, published in 2016, are clear, thorough, and based on current scientific evidence. ASCO endorsed the ASTRO guideline on radiation therapy for glioblastoma and added qualifying statements. Recommendations Partial-brain fractionated radiotherapy with concurrent and adjuvant temozolomide is the standard of care after biopsy or resection of newly diagnosed glioblastoma in patients up to 70 years of age. Hypofractionated radiotherapy for elderly patients with fair to good performance status is appropriate. The addition of concurrent and adjuvant temozolomide to hypofractionated radiotherapy seems to be safe and efficacious without impairing quality of life for elderly patients with good performance status. Reasonable options for patients with poor performance status include hypofractionated radiotherapy alone, temozolomide alone, or best supportive care. Focal reirradiation represents an option for select patients with recurrent glioblastoma, although this is not supported by prospective randomized evidence. Additional information is available at www.asco.org/glioblastoma-radiotherapy-endorsement and www.asco.org/guidelineswiki .
Racial Comparison of Outcomes and Costs for Inpatient Neutropenic Patients: A Multicenter Evaluation
Authors: Motl Susannah E. , Suda Katie J. , Kuth John C. , Gladney Thomas J. 
Published: February 2017

Purpose Racial disparities have been reported in the care and outcome of cancer patients. We evaluated whether race would influence the cost and outcomes of inpatient neutropenic cancer patients in a multicenter study from a large health care system in the southern United States. Methods Data was collected on all cancer inpatients with a diagnosis code for neutropenia in a 16-hospital system between October 1, 2002, and September 30, 2003. Demographics, treatment outcomes, and costs were compared between white and minority patients. A P value less than .05 was considered statistically significant. Results Two hundred seventy-nine cancer patients (0.29% of all admits) had a diagnosis of neutropenia. Demographics were similar between white and minority patients. However, minorities were more likely to be younger than whites (P = .002). With regards to outcomes, length of stay (LOS), LOS in the intensive care unit, and discharge status were not statistically different. Total hospital, medication, laboratory, radiation, surgery, and respiratory costs were also similar (P > .05), although minorities were less likely to receive myeloid colony-stimulating factors (P = .032) and more likely to have higher nursing care costs (P = .048). Conclusion In light of the escalating reports of racial disparities in cancer care, these minimal differences are encouraging.
Study of Medication Errors on a Community Hospital Oncology Ward
Authors: Ford Clyde D. , Killebrew Julie , Fugitt Penelope , Jacobsen Janet , Prystas Elizabeth M. 
Published: February 2017

Purpose Medication errors (MEs) have been a significant problem resulting in excessive patient morbidity and cost, especially for cancer chemotherapeutic agents. Although some progress has been made, ME measurement methods and prevention strategies remain important areas of research. Methods During a 2-year period (2003-2004), we conducted a prospective study on the oncology ward of a large community hospital, with the goals of (1) complete nurse reporting of observed medication administration errors (MAEs), (2) classifying observed MAEs, and (3) formulating improvement strategies. We also conducted a retrospective review of a randomly chosen sample of 200 chemotherapy orders to assess the appropriateness of ordering, dispensing, and administration. Results Our nurses reported 141 MAEs during the study period, for a reported rate of 0.04% of medication administrations. Twenty-one percent of these were order writing and transcribing errors, 38% were nurse or pharmacy dispensing errors, and 41% were nurse administration errors. Only three MAEs resulted in adverse drug events. Nurses were less likely to report MAEs that they felt were innocuous, especially late-arriving medications from the pharmacy. A retrospective review of 200 chemotherapy administrations found only one clear MAE, a miscalculated dose that should have been intercepted. Conclusions Significant reported MAE rates on our ward (0.04% of drug administrations and 0.03 MAEs/patient admission) appear to be relatively low due to application of current safety guidelines. An emphasis on studying MAEs at individual institutions is likely to result in meaningful process changes, improved efficiency of MAE reporting, and other benefits.
Mean Platelet Volume (MPV) as an indicator of disease activity and severity in lupus
Authors: Khan Abidullah , Haider Iqbal , Ayub Maimoona , Khan Salman 
Published: February 2017

Background: Amongst the different clinical and laboratory parameters used to monitor disease activity in systemic lupus erythematosus (SLE), mean platelet volume (MPV) is a novel biomarker. Although MPV has been studied in other rheumatological conditions like rheumatoid arthritis, its role in adult SLE needs to be defined, especially in Pakistan. Methods: The aim of this study was to evaluate the role of MPV as a biomarker of disease activity in SLE. Fifty patients were recruited through a consecutive non-probability sampling technique for this cross-sectional study. On the basis of their SLE disease activity index (SLEDAI) score of greater or lesser than 5, these 50 participants were divided into two equal groups respectively;25 patients with active SLE, and another 25 participants with stable, inactive lupus. MPV was measured in each group and compared using SPSS version 16. MPV was also correlated with SLEDAI and erythrocyte sedimentation rate (ESR). Independent sample t-test and Pearson’s correlation tests were applied. Sensitivity and specificity of MPV were checked through ROC analysis. Results: The MPV of patients with active SLE (n=25, mean [M]=7.12, SD=1.01) was numerically lower than those in the inactive-SLE group (n=25, M= 10.12, SD=0.97), and this was statistically significant (P<0.001). MPV had an inverse relationship with both ESR (r=-0.93, P<0.001) and SLEDAI (r= -0.94, P<0.001). However, there was a strong positive correlation between ESR and SLEDAI (r=0.95, P<0.001). For MPV, a cutoff value of less than 8.5fl had a sensitivity of 92% and a specificity of 100% (P< 0.001). Conclusions: Higher disease activity in SLE is associated with a correspondingly low MPV.