bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical characteristics and outcomes of advanced cancer patients referred to outpatient supportive care who missed their appointment.
Authors: Delgado-Guay Marvin Omar , Tanzi Silvia , San Miguel Arregui Maria Teresa , Chisholm Gary B. , Williams Janet L. , Allo Julio , Bruera Eduardo 
Published: February 2017

79 Background: Supportive Care Outpatient Clinics (SCOC) offer comprehensive care and symptom management to patients with advanced cancer (AdCa). Missed appointments (MA) are important source of problems to patient care and clinic operations. But there are no studies on the clinical outcomes of patients who fail to show for consultation. Methods: We determined the frequency of MA, including clinical and demographic data, and reviewed clinic appointment records for 218 consecutive kept (KA) and 218 MA for distinct patients referred to SCOC from January to December 2011. Results: 218/1,352(16%) AdCa who were referred to our SCOC, missed their appointment. Median age was 57 years (interquartile range 49-67). The mean(range) time between referral and appointment was 7.4 days(0-71) for KA vs. 9.1 days(0-89) for MA (p=0.0062). Age, gender, marital status, and cancer types or stages, and reasons for referral to SCOC were not significantly different between MA and KA patients. The reasons for MA were: admission to the hospital 17/218(8%), death 4/218(2%), appointment with primary oncologist 37/218(18%), other appointments 19/218(9%), visits to emergency room(ER) 9/218(9%), and unknown 111/218(54%). MA patients visited more the ER at 2 weeks 16/214(7%) vs. 5/217(2%), p=0.01, and 4 weeks 17/205(8%) vs. 8/217(4%), p=0.06. Median survival for MA patients was 177 days (range:127-215) vs. 253 days (range:192-347) for KA patients (p=0.013). Multivariate analysis showed that MA were associated to the time between referral and scheduled appointment (OR: 1.026/day, p=0.03), referral from targeted therapy services (OR:2.177, p=0.004), living at Texas/Louisiana regions (OR;2.345, p=0.002), having advanced directives (OR:0.154, P<0.0001), and being referred for symptom control(OR:0.024, p=0.0003). Conclusions: AdCa with MA have worse survival and increased ER utilization. We identified AdCa at higher risk for MA who should undergo more aggressive follow up. More research on MA prevention is needed.
Patient-specific quality assurance measurements for VMAT treatments: Do we really catch errors?
Authors: Laub Wolfram , Thomas Charles R. 
Published: February 2017

81 Background: Patient-specific quality assurance measurements are time consuming and Gamma pass/fail criteria are often picked based on typical criteria used for IMRT QA measurements in the past. The questions needs to be asked if with these criteria QA plans could still show clinically significant deviations from the treatment plan calculated and how we should be doing QA for treatment delivery of complex treatment plans. In our study DICOM files of clinical Rapidarc plans were modified with in-house developed software to mimic leaf alignment errors and gravitation shifts. The Octavius 2D-ARRAY (PTW-Freiburg) and the Delta4 device (Scandidos) were used to investigate the effect of the simulated errors on the passing rate of quality assurance results. The manipulated Rapidarc plans were recalculated on patient CT scans in Eclipse. Methods: Three different types of errors were simulated and applied to five prostate (two arcs), three 2-arc head and neck cases and three 3-arc head and neck cases. The MLC modifications were: (1) both MLC banks are opened by 0.25mm, 0.50mm and 1.00mm in opposing directions resulting in larger fields, (2) both MLC banks are closed by 0.10mm, 0.25mm and 0.50mm, (3) both MLC banks are shifted in the same direction for lateral gantry angles to simulate effects of gravitational forces onto the leaves by 1mm, 2mm and 3mm, (4) 25%, 50% 70% and 100% of all active leaves are shifted by 3mm as in (3). QA evaluations were performed according to a gamma-index criterion of 3mm and 3% as well as 2mm and 2%. Results: All unmodified plans and the majority of the plans with the smallest modification pass the gamma-index criterion of 2%/2mm with >90%. After that the passing rate drops below 90%. For the largest modifications passing rates were typically below 85%. The Delta4 is generally more sensitive and the passing rate for modified plans drops below 90% earlier and more drastically. With the standard criteria (3mm, 3%) even the largest modifications would satisfy a >90% passing rate. Conclusions: A stricter gamma-index (2mm, 2%) is necessary in order to detect MLC positional errors and a passing rate of >90% should be expected. Clinical pass/fail criteria need to be developed.
Pathways impact on chemotherapy administration before death.
Authors: Neubauer Marcus A. , Garey Jody S. , Turnwald Brian , Howell Josh , Harrell Robyn K. , Hayes Jad , Bhowmik Debajyoti , Hoverman J. Russell , Brooks Barry Don 
Published: February 2017

86 Background: Continuing IV chemotherapy (chemo) in patients (pts) with advanced cancer near death does not extend survival or improve quality, but does increase costs. Pathways (PW) programs have compared treatment (tx) costs but have not evaluated the impact on chemo given near death. The primary goal is to evaluate IV chemo administered in the last 14 and 30 days of life in pts treated On vs. Off-PW. Methods: Eligibility: in US Oncology’s (USO) iKnowMed (iKM) EHR 7/1/09-6/30/12; diagnosis (dx) of breast, colon, NSCLC, SCLC or pancreas cancer; >/=3 visits to a USO clinic; assessed for Level I PW compliance in the last 12 mths of life; and a date of death. IV chemo received in the last year of life was assessed. Pts were defined On-PW if all tx was On-PW or if pts did not receive IV chemo 12 mths before death (best supportive care). Pts were Off-PW if any tx received was Off-PW. PW-status, age, sex, dx, and last line of therapy (LOT) received were assessed. Multivariate logistic regression analysis was used to assess if PW status predicted likelihood of chemo within 14 and 30 days of death. Results: 12,551 pts met inclusion criteria. PW status was independently associated with chemo 14 and 30 days before death. Pts treated Off-PW had 2-fold higher odds of receiving IV chemo within 14, 30 days of death vs. pts treated On-PW (OR: 2; 95% CI: 1.8-2.3, OR: 2.2, 95% CI: 2-2.4), see Table. Findings were similar for each dx. Tx for pts On-PW vs Off-PW showed lower mean last LOT overall (1 vs. 2) and by dx. Conclusions: Pts On-PW were less likely to receive IV chemo within 14 and 30 days of death and had fewer LOT. This suggests adherence to Level I PWs is associated with improved quality metrics. [Table: see text]
Assessing patient values first: Creating a platform for advance care planning (ACP) in the adult oncology population.
Authors: Mikan Sabrina Q. , Taniguchi Cynthia , Hoverman J. Russell , Ash-Lee Susan , Harrison Deb , Olson Kevin Donald , Arlen Aimee 
Published: February 2017

99 Background: Patients, families and healthcare providers can be apprehensive about having end-of-life (EOL) conversations. However, asking patients about personal values regarding their healthcare goals may create a platform for more in depth conversations. A quantitative instrument to assess patient values and ACP readiness was developed and validated to complement a process for identifying patients appropriate for ACP. Methods: Recruitment was conducted at seven cancer center sites in The US Oncology Network over a 90-day pilot study period. Of 871 identified patients, 301 Texas Oncology patients engaged in ACP. A cross-sectional descriptive design was used in 301 metastatic cancer patients. Sixty-three participants completed the questionnaire. The 13-item instrument was created after an extensive literature review regarding EOL choices and interventions using a 5-point Likert scale. Descriptive statistics were examined, in addition to analysis of the relationships between items using Pearson’s r correlations. Results: Participants were primarily female (59%) and Caucasian (95%); with a mean age of 66 years. Sixty-eight percent reported it "Very Important" to be told they were dying. There was a significant association between willingness to discuss feelings about dying and being told by their physician when dying, (r= 0.373, p<0.01). Sixty-two percent reported it "Very Important" to be able to choose their EOL care location. EOL care location and level of burden for caregivers were significantly associated (r= 0.315, p<0.05). Also, 76% reported being able to select the person who makes EOL decisions for them as "Very Important." Conclusions: Recent studies have shown the importance of assessment of patient healthcare values in the metastatic oncology population. The values and readiness instrument allows healthcare providers to understand the patient’s wishes early in the course of care. ACP can be guided through review of the validated instrument in the adult metastatic population. This provides appropriate weight to both sides of the care equation and is a major step toward creating patient-centered care. Further development of the instrument is needed in this population.
Is computed tomography necessary for clinical T1 gastric cancer?
Authors: Fujikawa Hirohito , Yoshikawa Takaki , Shirai Junya , Iwasaki Kenichi , Hasegawa Shinichi , Hayashi Tsutomu , Aoyama Toru , Ogata Takashi , Cho Haruhiko , Oshima Takashi , Rino Yasushi , Masuda Munetaka , Tsuburaya Akira 
Published: February 2017

1 Background: Initial diagnosis of gastric cancer is based on upper gastrointestinal tract endoscopy (GF) and/or upper gastrointestinal series (UGI) which also determines invasion depth of T1 or Non-T1. Subsequently, TNM is evaluated by Multi Detector-row Computed Tomography (MDCT). TNM is indispensable to decide treatment of gastric cancer, however, T1 disease has low metastatic potential and is almost curable only by local treatment. It remained unclear whether MDCT is necessary for clinical T1 (cT1). Methods: Patients were selected from the prospective database of Kanagawa Cancer Center between Oct 2000 and Oct 2007 based on the following criteria; (1) histologically proven adenocarcinoma of the stomach, confirmed by endoscopic biopsy (2) patients were diagnosed with cT1 by GF/UGI, (3) patients received MDCT, (4) patients received no prior treatment before the examination, and (5) patients received endoscopic mucosal dissection (ESD) or radical surgery with D1 or more lymphadenectomy as a primary treatment. Efficacy of MDCT was evaluated by incidence of cM1 in all patients with cT1 disease and by accuracy to diagnose pathological N+ in patients who received surgery. Regional lymph nodes were considered to be involved by metastases if they were larger than 8 mm in the short-axis diameter. Results: A total of 761 patients were entered into this study. Of these, 236 patients received ESD while 525 underwent surgery. No cM1 disease was found in 761 patients. Among 525 patients who underwent surgery, 484 were pathologically diagnosed with T1 (pT1, 92.2%), 31 with pT2 (5.9%), 5 with pT3 (0.9%), and 5 with pT4 (0.9%). Clinical N+ was observed in 8 patients (1.5%), while pathological N+ in 45 (8.6%). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value was 90.3%, 4.3%, 98.7%, 25%, and 91.3%, respectively. Conclusions: The present study suggested that MDCT was unnecessary for cT1 gastric cancer because cM1 was extremely rare and diagnosis of N+ was unreliable in cT1 disease.
Result of HER2 status in Japanese metastatic gastric cancer: Prospective cohort study (JFMC44-1101).
Authors: Nishikawa Kazuhiro , Chin Keisho , Nashimoto Atsushi , Miki Akira , Miwa Hiroto , Tsuburaya Akira , Miyanaga Tamon , Hara Takuo , Fukushima Ryoji , Gamoh Makio , Fukushima Norimasa , Sano Takeshi , Kodera Yasuhiro , Kakeji Yoshihiro , Morita Satoshi , Sakamoto Junichi , Saji Shigetoyo , Yoshida Kazuhiro 
Published: February 2017

10 Background: Randomized phase III (ToGA trial) has demonstrated that the addition of trastuzumab to standard chemotherapy improved overall survival in patients (pts) with HER2-positive metastatic gastric cancer (mGC). In screening of the ToGA trial, HER2 positivity rate was 22.1 % in total, but the rates varies between countries. Therefore, to determine the HER2 incidence rate in Japanese mGC, we planned prospective cohort study JFMC44-1101. Methods: JFMC44-1101 is a multicenter epidemiological trial assessing HER2 status in Japan. Patients with histologically confirmed gastric adenocarcinoma, not suitable for curative resection were eligible. HER2 status was centrally assessed both immunohistochemistry (IHC) and fluorescence in-situ hybridization (FISH) using formalin fixed paraffin embedded (FFPE) tissues from tumor. HER2 positive is defined as either IHC3+ or FISH+ in accordance with ToGA trial. Overall and subgroup estimates calculated with 95%CI. Results: Between September 2011 to June 2012, 1466 pts were registered from 157 sites. Patients characteristics were; gender (M/F):1044/422, median age (min-max): 68 (25-99), advance / recurrence: 1068 / 398. Samples are 768 from biopsy and 698 from excision. In August 2012, 1427/1466 pts were assessed. Overall, HER2 positivity was 20.5% (293 pts). Each IHC status (0/1+/2+/3+) with FISH+ was 3.0% / 11.3% / 46.9% / 97.2%, respectively. The frequency of IHC 0/1+ with FISH+ was almost as high as IHC 2+ with FISH+ (5.6%/4.2%). HER2 positivity rate of background factors were; male/female:23.6%/14.3%, biopsy/ excision: 22.7%/19.0%, advance / recurrence: 21.6%/17.6%. Conclusions: JFMC44-1101 confirmed the incidence of HER2 positivity in Japanese mGC. HER2-positivity rate and HER2 status were similar to the ToGA screening population. Clinical trial information: UMIN000006190.
Prognostic impact of postoperative radiation in patients with radical esophagectomy and pathologic lymph nodes positive esophageal cancer.
Authors: Xu Yaping , Sun Xiaojiang , Zheng Yuanda 
Published: February 2017

101 Background: Though postoperative radiation for esophageal cancer is offered in selected cases, there is conﬂicting evidence as to whether it improves overall survival (OS). We performed a retrospective investigation to analyze the prognosis impact of adjuvant radiation in a large cohort of patients. Methods: From 2002 to 2008, 545 patients underwent radical esophagectomy (R0) with or without postoperative radiation were eligible for retrospectively analysis. Patients were grouped to surgery only (n=346) and surgery plus postoperative radiation therapy (PORT) (n=199). Radiation dose was 50 Gy in 25 fractions. Kaplan-Meier and Cox regression analysis were used to compare OS. Results: The use of PORT was associated with signiﬁcantly improved OS ( p =0.006). The median OS was 31 months in the group receiving PORT and 21 months in the group undergoing surgery alone. The addition of PORT improved OS at 3 years from 38.3 to 45.8% compared with surgery alone. For American Joint Committee on Cancer (AJCC) stage III esophageal cancer (T1-2N2M0, T3N1-2M0, T4N1-3M0), there was signiﬁcant improvement on OS ( p < 0.001) in PORT group, for not only metastatic lymph-node ratio <0.25 ( p = 0.047), but also metastatic lymph-node ratio >0.25 ( p = 0.013). However, for stages IIB disease (T1-2N1M0) there was no signiﬁcant differences. Conclusions: This large population-based analysis supports the use of PORT for pathologic lymph nodes positive stage III esophageal cancer. Our results suggest that a subset of such patients may benefit from aggressive local therapy.
Significance of accurate HER2 testing as a new biomarker in advanced gastric cancer.
Authors: Kusumoto Tetsuya , Ohtsu Hajime , Kawano Hiroyuki , Ando Koji , Ida Satoshi , Kimura Yasue , Saeki Hiroshi , Oki Eiji , Morita Masaru , Maehara Yoshihiko 
Published: February 2017

106 Background: The Trastuzumab for Gastric Cancer (ToGA) study is the first international trial to include Japanese patients with human epidermal growth factor 2 (HER2)-positive advanced or recurrent gastric or gastroesophageal junction cancer, which demonstrated that trastuzumab plus chemotherapy improved overall survival in the overall population (hazard ratio 0.74). HER2 testing in gastric cancer differs from testing in breast cancer due to inherent differences in tumor biology; gastric cancer more frequently shows HER2 heterogeneity and incomplete membrane staining. The aim of the present study was to evaluate the frequency of HER2-positive cases by application of the standard criteria in Japanese patients with advanced gastric cancer (AGC) and to investigate the relationships between HER2 expression and therapeutic responses. Methods: A total of 199 tumor samples were assessed for HER2 expression both by immunohistochemistry (IHC) and HER2 amplification by fluorescence in situ hybridization (FISH). HER2-positive status was defined as IHC2+ and FISH-positive or IHC3+. Objective responses were evaluated in the patients with AGC who were treated with chemotherapy plus trastuzumab or chemotherapy alone based on the HER2 expression status. Results: HER2-positive tumors were identified in 12 patients (5.5%), less than 28.1% in the Japanese subgroup analyses of ToGA study. The positive rates varied with histological type; 14%, 5.3% and 0.95% in the well, moderately and poorly differentiated adenocarcinoma, respectively. Although high concordance between the results of IHC and FISH in all samples was found, IHC2+ samples retested here showed FISH-negative. Of all 10 patients with AGC, 3 patients with HER2-positive tumor were treated with capecitabine/cisplatin plus trastuzumab, and partial response was found in 2 cases; response rates were 67%. Conclusions: Specific consideration and scoring modification are required before embarking on HER2 testing in gastric cancer. Accurate and reliable HER2 testing and scoring will allow appropriate selection of patients eligible for treatment with trastuzumab.
PCF chemotherapy combined with surgical treatment of advanced gastric cancer.
Authors: Xiangdong Cheng 
Published: February 2017

113 Background: Local advanced gastric cancer that could not receive R0 resection or gastric cancer with distant metastasis usually received palliative chemotherapy or entered into a number of clinical trials, and surgery usually roled as a symptomatic treatment. This study is to investigate the efficacy and safety of PCF chemotherapy combined with surgery in the treatment of these patients. Methods: From July 2008 to February 2011, 72 cases of local advanced gastric cancer that cannot be treated with R0 resection (T4N2~3M0) or gastric cancer with single organ metastases (M1) were prospectively analysed. Patients received 2-4 cycles of PCF chemotherapy (PTX 150mg/m2, d1, CDDP 25mg/m2, d1-3, CF 250 mg/m2, d1-3,5-FU 750 mg/m2, d1-3, repeated every 3 weeks), then the primary and metastatic tumor were treated with cytoreductive surgery: mainly treated with radical resection of gastric tumor, combined with D3 and D4 lymph node dissection, pancreaticoduodenal resection, colon resection, ovariectomy, peritoneal resection, liver resection, and tumor radio frequency, followed with another 2-4 cycles of PCF chemotherapy. The treatment completion rate, patients’ tolerance, and overall survival (OS) time were analyzed. Results: 50 patients (69.4%) accomplished chemotherapy and surgical resection as planned. 42 cases had R0 resection (58.3%). The postoperative complication rate was 6.0%. Grade 3/4 toxic effects included bone marrow suppression (30.6%) and gastrointestinal reaction (40.3%), the overall response rate (CR+PR) was 72.2%. Survival analysis: the median survival time was 23.5 months. 1-year and 2-year survival rate was 67.0% and 47.0%. The OS of patients with surgical resection was much longer than that of the non-surgery group. (30.2 vs. 8.9 months) (p <0.01). The OS of local advanced group was 30.3 months, and was significantly longer than 17.6 months of the distant metastasis group (p <0.01); however, it had no significant difference compared to 28.2 months of the distant metastasis group with R0 resection. Conclusions: PCF chemotherapy combined with surgical resection were safe and effective, and can make survival benefits for patients with local advanced gastric cancer or gastric cancer with single organ metastasis.
Prognostic significance of HER2 expression and associated clinical characteristics in esophageal adenocarcinoma.
Authors: Chan Ellie , Alkhasawneh Ahmad , Duckworth Lizette Vila , Zuluaga Toro Tania , Hou Wei , Yan Hui , Hughes Steven J. , George Thomas J. 
Published: February 2017

114 Background: The incidence of adenocarcinoma of the esophagus (EA) and gastroesophageal junction (GEJ) is on the rise. Her2Neu (HER2) is overexpressed in 20-25% of gastric cancers and is associated with poor prognosis. However, the prognostic significance of HER2 in EA/GEJ is less clear. Methods: This retrospective analysis included all sequential patients (pts) with EA or GEJ who underwent primary resection at the University of Florida from 2001 to 2011without neoadjuvant therapy or HER2 inhibition. Demographics, risk factors, tumor features, and outcome data were analyzed. Central blinded immunohistochemistry (IHC) was performed on paraffin embedded tumor specimens with HER2 expression scored as negative (-) (0 or 1+), indeterminate (2+) or positive (+) (3+). Results: 56 pts were eligible for analysis (45 M/11 F) with median age 67 years (37-83). Mean BMI was 29.6±6.6 and 43 pts (92%) had underlying Barrett’s esophagus. Most tumors (60%) were stage I (T1N0). Overall testing revealed tumors to be HER2 + (38%), indeterminate (21%) or - (41%). 50% of Stage I, 18% of stage IIA, 33% of stage IIB, and 14% of stage III tumors were HER2 + (p=0.035 for stage I compared to other stages). Underlying Barrett’s esophagus was associated with HER2 + (60 vs. 0%; p=0.045). The median follow up of the entire cohort was 2.9 years. Overall survival (OS) at 3 years was 80% for stage I, 50% for stage IA, 40% for stage IIB and 50% for stage III (p= 0.153). 3 year OS for HER2+ pts was 64% vs. 70% for HER2- (p=0.63). Univariate analysis did not show significant correlation among tobacco use, BMI, disease progression, survival and HER2 expression. Conclusions: This data suggests that HER2 overexpression is more frequent in early stage disease with underlying Barrett’s esophagus. Our data do not support HER2 as a prognostic factor in EA/GEJ. The relationship of HER2 overexpression in the development of early stage GEJ, particularly in the setting of Barrett’s, is of clinical interest. Further investigation is warranted.