tbuckley/cabot-search huggingface dataset:
The relationship between service quality measures and overall patient satisfaction in oncology.
Authors: J. F. Grutsch, C. G. Lis, M. Rodeghier, D. Gupta
Journal: Journal of Clinical Oncology (2010)

e16550 Background: Cancer patients usually undergo extensive and debilitating treatments, which makes patient satisfaction with care in oncology an important health care assessment measure. We evaluated the relationship between commonly used service quality measures and subsequent single top box “overall patient satisfaction” among oncology patients. Methods: 2,018 returning cancer patients treated at Cancer Treatment Centers of America responded to an internally developed service quality questionnaire, covering the following dimensions: operations and services, physicians and staff, and patient endorsements. Items were measured on a 7-point Likert scale ranging from “completely dissatisfied” to “completely satisfied.” Overall patient satisfaction “Considering everything, how satisfied are you with your overall experience with CTCA?” was also measured on a similar scale and was dichotomized into 2 categories: top box response (7) versus all others (1-6). The relationship between service quality and “overall patient satisfaction” was assessed via forward stepwise multiple logistic regression. Results: 959 patients were newly diagnosed while 1059 were previously treated. 902 were males and 1,116 females. Mean age was 54.7 years and the most frequent diagnoses were breast (412), lung (294), prostate (260), colorectal (179) and pancreas (169). 1,335 (66.2%) patients were “completely satisfied” with their overall experience with CTCA. Upon multivariate logistic regression, items that were significantly predictive of overall patient satisfaction in the final model, independent of age, gender and treatment history were timeliness of care delivered (OR = 2.1; 95% CI: 1.7 to 2.6), ease of care delivered (OR = 2.6; 95% CI: 1.9 to 3.5), staff caring for patient as an individual (OR = 1.7; 95% CI: 1.1 to 2.5), hospital providing with a sense of well-being (OR = 1.8; 95% CI: 1.3 to 2.7), whole person approach to patient care (OR = 1.5; 95% CI: 1.1 to 2.1) and team explaining treatment options (OR = 2.2; 95% CI: 1.8 to 2.8); p < 0.01 for all. Conclusions: We found several service quality drivers related to hospital operations & services as well as physicians and staff as independent predictors of overall patient satisfaction. No significant financial relationships to disclose.
Regional cancer treatment with high dose ifosfamide and hyperthermia for soft tissue sarcoma. An experimental model
Authors: H. Martínez-Saíd, J.-L. Aguilar-Ponce, X. Kon-Jara, P. García-López, J. G. De La Garza-Salazar
Journal: Journal of Clinical Oncology (2004)

9051 Background: The two most active single agents for advanced soft-tissue sarcomas (SST) are doxorubicin and ifosfamide with objective regression rates of 15% to 30% by systemic administration. Recent studies have evaluated the role of isolated limb perfusion (ILP) and hyperthermia in the management of extremity sarcoma. The agents most commonly employed for ILP have been melphalan and Tumor Necrosis Factor that increase significantly the response rate. Ifosfamide is a pro-drug with hepatic metabolism by CYP 450 that exclude its use in ILP. Some SST expressed CYP families (2a, 3a and 3b). With the hypothesis that is feasible the activation by tumor itself in ILP we conducted the in-vitro study. Methods: Cells lines cultures of synovial sarcoma HT1080 were artificially preserved in adequate environmental conditions and exposed to gradually incremented doses of ifosfamide (Group A) and ifosfamide plus hyperthermia (40° C) (group B). The baseline dose was calculated according to the Cmax of drug in serum (0.19 mmol) at regular systemic doses of ifosfamide (1.5 mg/m2). The escalating doses of ifosfamide was 0, 0.5, 1, 5, 10 y 50 mmol. The cellular viability after drug exposure was assessed in both groups. Results: The CI50 (medium inhibitory concentration) was 18 mmol and 10 mmol for ifosfamide alone and ifosfamide with mild hyperthermia respectively. Clearly, hyperthermia amplified the antineoplastic effects of the drug as it is demonstrated in the dose response curves comparing both groups. The 10 mmol concentration is equivalent to 68 gr/m2 when is systemically applied. Conclusion: While working to develop better systemic therapies for advanced STS the integrated use of our best chemotherapy regimens in combination with selected surgical efforts like ILP may provide patients with the best available therapy. According to our results Ifosfamide at doses 20 to 30 times above the normal systemic dose plus hyperthermia is active against STS cell lines. It seems reasonable to investigate the role of ifosfamide in the treatment of STS using ILP. No significant financial relationships to disclose.
Phase II study of bevacizumab in combination with docetaxel and radiation in locally advanced squamous cell cancer of the head and neck (SCCHN)
Authors: P. Savvides, J. Greskovich, J. Bokar, D. W. Stepnick, P. Fu, F. Johnson, C. Patel, J. Wasman, S. Remick, P. Lavertu
Journal: Journal of Clinical Oncology (2007)

6068 Background: VEGF expression has been shown to be up regulated in SCCHN, representing a promising therapeutic target. Bevacizumab is an anti-VEGF monoclonal antibody that may potentiate the efficacy of concurrent radiation and docetaxel. This trial represents the first attempt, to the best of our knowledge, to establish the efficacy and toxicities of the addition of bevacizumab to concurrent radiation with docetaxel in patients with locally advanced SCCHN. Methods: Patients with previously untreated stage III-IVb SCCHN receive standard once-daily radiation (70.2Gy, 1.8Gy/day), weekly docetaxel (20 mg/m 2 /week for the duration of radiation) and biweekly bevacizumab (5 mg/kg/two weeks) during and for up to one year following radiation. A total of 30 patients will be enrolled in this study. Results: Twelve of 30 planned patients (11 males), mean age 58 years (range 49–66), all with stage IV disease have been enrolled. Primary site: pharynx (n=8) and larynx (n=4). 10 patients have completed concurrent chemoradiation. After a median followup of 9 months (range: 0 –13), 9 patients remain in complete response, 1 patient developed metastatic disease. 6/10 patients underwent planned neck dissection and they all had a pathologic complete response. 6/9 patients, in complete response, are currently receiving adjuvant bevacizumab. The remaining 3 patients are currently off adjuvant bevacizumab treatment for area of radiation necrosis of larynx (n=1), pharyngoesophageal stenosis (n=1), status post cholecystectomy with pathology revealing acute hemorrhagic cholecystitis with transmural gangrenous necrosis (n=1). Conclusions: For patients with locally advanced SCCHN, preliminary data suggest that the addition of bevacizumab to concurrent radiation with docetaxel is feasible, safe and active. Supported in part by Genentech, NIH grants P30 CA43703 and M01 RR-000080 Clinicaltrials.gov identifier: NCT00281840 [Table: see text]
Surgical treatment for early cervical cancer: Experience at a cancer hospital in Nepal
Authors: G. Dangal
Journal: Journal of Clinical Oncology (2009)

e16575 Background: The purpose of this study was to find out the clinocopathologic characteristics, post-operative findings and complications of patients with early (up to stage IIA) cervical carcinoma who underwent radical hysterectomy. This study concentrates on the evaluation of our early experience in radical hysterectomy for cervical cancer in Nepal. Methods: This was a retrospective analysis of 48 patients who had radical hysterectomy with bilateral pelvic lymphadenectomy for early cervical cancer at the BP Koirala Memorial Cancer Hospital (BPKMCH) from September 2002 through September 2005. Characteristics such as chief complaint, disease staging and duration, intraoperative and postoperative complications, histopathological findings, need for blood transfusion, and duration of hospital stay were considered for analysis. Results: Patients’ age ranged from 28–67 years. Age group of 40–49 had highest number of patients (58.3%). Majority (62.5%) were premenopausal women who presented with abnormal vaginal bleeding (73%) as the chief complaint. More than half of them (56%) had FIGO stage IIA disease. Thirty-three percent had intraoperative and postoperative complications such as urinary problems, wound infection and vessel injury/ureteric injury. All needed blood transfusion, 42% needing four pints. The average duration of hospital stay was 11 days. Forty-four had squamous cell carcinoma and four had adenocarcinoma. Pelvic lymph node metastasis was found in 10 patients. Resected margins were adequate in 42 patients. Majority (62.5%) of the women were premenopausal and 56% of them had stage IIA disease. Conclusions: Although the primary treatment of early-stage cervical carcinoma involves either surgery or radiation therapy with or without chemotherapy, surgery (radical hysterectomy) was used for lower-stage disease and smaller lesions in fit and young patients in our resource-poor set-up. The complication rate seems to be higher in Nepal; however, it will decrease as more experience is gained. No significant financial relationships to disclose.
Male breast cancer at the Veterans Affairs hospital of Manhattan: A ten-year experience
Authors: N. Seetharamu, E. Bendaly, H. Ballard
Journal: Journal of Clinical Oncology (2008)

22129 Background: Male Breast Cancer (MBC) accounts for 1% of all breast cancers. In contrast to women with breast cancer, MBC patients (pts) are older, and more often have advanced disease at diagnosis. Because of the relative rarity of the disease, most data available is from retrospective analyses and case series. We report a series of MBC pts from the Veterans Affairs Hospital of Manhattan (MVA). Methods: A chart review of MBC pts diagnosed at the MVA from January 1996 to December 2006 was performed. Data included demographics, medical history (hx), tumor histology and stage, receptor status (ER, PR, Her2neu), local and systemic therapy, and response to treatment. Results: Eighteen men (10 Caucasian, 8 African American) were identified. Mean age at diagnosis (dx) was 70.8 years (range: 44–93 years). Seven had a family hx of cancer (2 for breast, 2 for prostate), and 8 (44.4%) had a second malignancy (4 prostate, 1 bladder, 1 melanoma, 1 lung, 1 thyroid). Six pts (33.3%) were overweight (BMI: 25–29) and 4 (22.2%) were obese (BMI 30 and above). A mass was felt by the pt in 67% of cases. Mean time from mass detection by pt until dx was 6.9 months. A diagnostic mammogram was performed in 28% of cases. Stage at dx: DCIS (11%), I (22%), II (22%), III (28%), IV (11%). Of those without metastatic disease, all but 3 underwent modified radical mastectomy. Thirty nine percent had axillary node involvement. Intraductal carcinoma was the most common histology (66%). All tumors had positive ER status, with 78% also being positive for PR. Her2neu was positive in 19%, and not tested in 56%. Seventy eight percent received adjuvant tamoxifen, either alone (58%) or in addition to chemotherapy (42%). Sixty two percent had no evidence of disease after initial treatment (2 stage I, 4 stage II, 3 stage III). With a mean follow up of 48 months, there were 6 deaths, 3 of which were from causes related to breast cancer (2 stage IV, 1 stage III). Conclusions: Our series showed an older population, with late presentation, more advanced disease at diagnosis, and significant underlying risk factors. However, we noted lower rates of recurrence which could be explained by a more aggressive local approach to treatment and a positive ER status in all the pts. No significant financial relationships to disclose.
Predictive model for mediastinal lymph node status at the time of mediastinoscopy
Authors: L. Gainor, A. M. Parsons, L. A. Parker, F. C. Detterbeck, T. Stinchcombe, D. N. Hayes
Journal: Journal of Clinical Oncology (2007)

18004 Background: Mediastinal lymph node (N2) positivity in non-small cell lung cancer (NSCLC) patients is suspected based on imaging such as CT or PET scan, with confirmation by mediastinoscopy. However, the most accurate clinical information in predicting N2 status is controversial. Methods: We reviewed 147 candidates for NSCLC resection (2000–2005) who had clinical database information available and had undergone mediastinoscopy. Using suspected clinical predictors of mediastinal metastasis available prior to mediastinoscopy, we constructed a predictive model of N2 status. Results: The largest N2 node short-axis diameter on CT was by far the most influential factor in the model. Three other predictors for N2 node positivity were significant (p&lt;0.05) in univariate analysis: indistinct tumor borders and mediastinal invasion on CT, and mediastinal PET scan positivity. However, all were less influential than N2 size on CT. Using logistic regression, these factors can be used to predict probability of positive N2 biopsy in an individual patient. The resulting diagnostic test had a ROC (receiver operator characteristic) area of 0.80 and optimal sensitivity-specificity pairing of 75% and 73%. 35% (51/147) of patients analyzed had at least one N2 node positive at mediastinoscopy. 39% (57/147) of patients had PET scan data available, and 82% (120/147) had CT data available. Conclusions: Of available data in early-stage NSCLC patients, mediastinal lymph node size on CT scan was more important than PET scan or other CT scan findings in predicting probability of positive mediastinoscopy. A predictive model is useful in more accurately determining need for invasive staging by mediastinoscopy. No significant financial relationships to disclose.
Molecular predictors of treatment response in colon and gastric cancer.
Authors: John P. Shen, Eric Roeland, Michael Hwang, Kelly Anne Shimabukuro, Jason Keith Sicklick, Sonia Ramamoorthy, Elisabeth C. McLemore, Tony R. Reid, Andrew M. Lowy, Paul Timothy Fanta
Journal: Journal of Clinical Oncology (2012)

e14069 Background: With the exception of KRAS mutational status, there is limited use of tumor-derived biomarkers in the clinical management of GI malignancies. High ERCC1 expression is associated with inferior outcomes in platinum-exposed patients with non-small cell lung, esophageal, and head and neck cancers. Previous studies have concluded ERCC-1 gene expression levels may identify patients unlikely to benefit from oxaliplatin-based chemotherapy in metastatic colon cancer and in the adjuvant therapy of esophageal/gastric cancer. Methods: Biomarkers were obtained from formalin fixed paraffin embedded tumor samples from 69 colorectal and 22 gastric cancer subjects. Each tumor was dissected using laser-captured microdissection and analyzed mRNA expression using a quantitative RT-PCR. A retrospective chart review was performed to evaluate clinical response. The primary objective was todetermine the prevalence of select tumor biomarkers including ERCC1, TS, VEGFR2a, Her2, KRAS, BRAF, and EGFR mutation status and and correlate these with overall survival. Results: Colon: Subjects with high ERCC1 expression had significantly worse OS survival compared to those with lower ERCC1 expression (26.0 vs 71.1 mo, p=0.0077). There was a trend towards decreased OS with high TS expression, but this was not statistically significant (71 vs 56 mo, p=0.49). Subjects with the V600E BRAF mutation had significantly worse OS compared to wild-type tumors (48.5 vs 61.3 mo, p=0.03). Gastric: Median OS was not reached due to a limited number of gastric subjects and only 9 of 22 had died at time of analysis. Updated analysis is planned. Conclusions: Even in this small population it is possible to detect survival differences using biomarker analysis of biopsy and resection specimens. Virtually all tumor samples yielded sufficient material for analyses. We suspect that the decreased OS in high ERCC1 expressing tumors is a result of platinum resistance. These results suggest that the use of biomarkers may identify patients unlikely to respond to conventional therapy, and warrant further investigation in a prospective clinical trial.
Final results of a phase II study of sorafenib in combination with carboplatin and paclitaxel in patients with metastatic or recurrent squamous cell cancer of the head and neck (SCCHN).
Authors: George R. Blumenschein, Bonnie S. Glisson, Charles Lu, Anita Lyn Sabichi, Lawrence E. Ginsberg, Claudia I. Bartos, Lei Feng, Hai T. Tran, Adel K. El-Naggar, Scott Michael Lippman, Merrill S. Kies
Journal: Journal of Clinical Oncology (2012)

5592 Background: Cytotoxic chemotherapy (CT) is the current standard treatment for metastatic/recurrent SCCHN. The prognosis for these patients (PTS) is poor with a median progression free survival (PFS) of 4 months with CT. Survival in PTS with SCCHN may correlate inversely with the number of angiogenic growth factors secreted. Sorafenib is a potent inhibitor of c-Raf, b-Raf, VEGFR-1/2/3 and PDGFR-β. To investigate the hypothesis that a multi-targeted TKI added to chemotherapy would improve outcomes in patients with metastatic/recurrent SCCHN, we performed a phase II trial of paclitaxel and carboplatin and sorafenib (PCS). Methods: PTS were required to have ECOG PS 0-1, measurable disease, controlled blood pressure, and may have received one regimen of induction, concomitant or adjuvant CT, but not CT for recurrent/metastatic disease. Sites of primary disease excluded nasopharynx and paranasal sinus. Treatment consisted P 200mg/m 2 and C AUC 6 intravenously on day 1 followed by S 400 mg orally bid (days 2-19) in every 3-week cycles. Primary endpoint was PFS, targeting median PFS of 6 months (M). Secondary endpoints include overall survival (OS), response rate (RR), exploratory biomarkers, and toxicity. Results: Forty-eight PTS with SCCHN were enrolled with 44 PTS evaluable for PFS and response using RECIST. Median age: 56 years (22-79 years), 89% male, median ECOG PS 1. Median follow-up was 24.1 M. RR was 55% (n=24), disease control rate was 84% (n=37), median PFS was 8.51 M (95% CI: 5.98 ~ 13 months), and median OS was 22.6 M (95% CI: 13.1 - NA months). Grade ³3 treatment related toxicities included hand-foot syndrome (n=10), neutropenia (n=5), pain (n=6), elevated lipase (n=4), elevated amylase (n=3), anemia (n=3), fatigue (n=2), hypertension (n=2), neuropathy (n=2), febrile neutropenia (n=2), and thrombocytopenia (n=2). Conclusions: The combination of PCS was well tolerated and had encouraging activity in recurrent/metastatic SCCHN. Blood-based and tissue biomarkers are being analyzed. Final outcomes, toxicity, and correlative biomarker data will be reported.
Current status and future directions of research on the American Indian child
Authors: A Yates
Journal: American Journal of Psychiatry (1987)

American Indians are the most severely disadvantaged of any population within the United States. By adolescence, Indian children show higher rates of suicide, alcoholism, drug abuse, delinquency, and out-of-home placement. School achievement is severely compromised, and many youths drop out before graduation from high school. The Indian child understands the environment through intuitive, visual, and pictorial means, but success in the Anglo school is largely dependent on auditory processing, abstract conceptualization, and language skills. This difference compounds existing problems of poverty, dislocation, alienation, depression and intergenerational conflict and can partially account for the higher rate of emotional and behavioral problems among Indian adolescents.
Correlations between efficacy and early changes in biomarkers in a metastatic breast cancer (mBC) clinical trial with sunitinib malate.
Authors: K. Keyvanjah, W. Carley
Journal: Journal of Clinical Oncology (2010)

1055 Background: Prognostic and predictive biomarkers have been sought to improve therapies in mBC. Burstein et al. previously showed plasma concentration of sKIT (CD117), vascular endothelial growth factor (VEGF), VEGF Receptor 2 (R2) and Receptor 3 (R3) change with sunitinib malate treatment (J Clin Oncol. 2008 Apr 10;26[11]:1810-6.). Final trial data were further evaluated for correlations between efficacy and early plasma biomarker change during treatment cycles to identify early predictive markers in mBC. Methods: Plasma samples from 64 patients with mBC (anthracycline and a taxane pretreatment) from a phase II clinical trial for sunitinib were analyzed for sKIT, VEGF, R2, and R3 concentrations at start and end of cycles, and cycle 1 day 14. During each cycle patients received sunitinib 50mg qdx28 days, followed by 14 days off treatment. Efficacy endpoints evaluated: time to progression (TTP), progression-free survival (PFS), and overall survival (OS). Biomarker stratification was by median baseline concentration and median %change during first two cycles. Survival analysis was by Kaplan Meier and log-rank methods. Hazard ratios were computed. Results: Median % concentration change of sKIT, VEGF, R2, and R3 were 48.6, 89.4, 55.8, and 52.8%, respectively. Patients with ≥48.6% sKIT change had significantly longer PFS, TTP, and OS (Table). Patients with ≥89.4% VEGF change survived 2-fold longer. Conclusions: Early changes in R2, R3, or baseline concentration did not correlate with survival. Changes in sKIT and VEGF may serve as early predicitve markers in mBC. TTP/PFS sKITΔ- Survival VEGFΔ+ Survival R2Δ- Survival R3Δ- Survival <48.6% (30) 7.86 <89.4% (30) 9.86 <55.8% (30) 10.14 <52.8% (27) 10.14 >48.6% (31) 21.71 >89.4% (31) 10.29 >55.8% (31) 10.21 >52.8% (28) 11.00 P <0.0001 0.0541 0.8101 0.2673 HR 6.00 1.75 1.07 1.40 OS <48.6% (30) 25.71 <89.4% (30) 32.29 <55.8% (30) 36 <52.8% (27) 51.57 >48.6% (31) 53.71 >89.4% (31) 62.57 >55.8% (31) 53.71 >52.8 (28) 52.71 P 0.018 0.0325 0.235 0.1466 HR 2.33 2.12 1.52 1.52 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Pfizer Pfizer