tbuckley/cabot-search huggingface dataset:
Optimizing patient scheduling for ambulatory chemotherapy.
Authors: Ben de Mendonca, Kirsty Wield, Angela Boudreau, Simron Singh, Matthew C. Cheung, Sherrol Palmer
Journal: Journal of Clinical Oncology (2013)

199 Background: The Odette Cancer Centre (OCC) manages more than 24,000 chemotherapy visits annually. The delivery process is complex and patients have significant wait times for treatment. The OCC was faced with improving this process with no data infrastructure to support continuous quality improvement. Methods: An electronic scheduling manager, Chemotherapy Appointment Reservation Manager (CHARM) was built in house to improve scheduling logic and optimize bed and chair utilization. The chemotherapy unit has recently undergone renovations to change the staff-to-patient ratio and chair distribution. At baseline, a nurse is assigned to 4 chairs in a “pod” without adjustment for patient and chemotherapy intensity variation. An interprofessional team participated in a Kaizen event to create a Value Stream Map of the scheduling process. Scheduling logic considerations were identified to better match nursing and chair resources to patient appointment times. An analysis was performed to evaluate the distribution of patients throughout the chemotherapy unit by time of day, and day of week to identify opportunities to align the schedule with nursing and pharmacy resources. Results: The mean number of patients seen per day was 85 with a range of 65 to 105. 80% of patients are scheduled before 11:30 (the unit operations 08:30 to 18:00). The mean number of patients assigned to a pod was 8 with a range of 3 to 15. Unit performance on days of &gt;95 patients was observed to be poorest. Load levelling techniques were established to reduce the range of patients booked per day throughout the week. New considerations for scheduling are: maximum 12 patients per nurse per pod per day, maximum 3 new patients per nurse per pod per day, maximum 10 clinical trials per day, and maximum 50% of patients scheduled before 11:30 per day. Conclusions: Matching the patient schedule to the nursing and pharmacy resources of the unit is critical to efficient and safe chemotherapy delivery. A Plan-Do-Study-Act is scheduled for September 2013 to implement the scheduling changes and evaluate the impact of the new logic on unit operations. Further work to improve the delivery process and pharmacy medication processing is ongoing.
Efficacy of FOLFOX4 in patients with hypoalbuminemia or immune impairment
Authors: M. Shibata, N. Yumiko, T. Hirano, S. Matsuo, H. Abe, Y. Yajima
Journal: Journal of Clinical Oncology (2009)

e15141 Background: The effects of chemotherapeutic agents are understood to be regulated by many factors including tumor factors such as sensitivity to drugs and host factors. Among these host factors, nutritional conditions and immune function of cancer-bearing host has been told to relate the effects of chemotherapy, however, it has not been clarified yet. Methods: We have analysed the relationships between the effects of FOLFOX4 and nutritional markers such as serum albumin concentrations and immunology markers including counts of lymphocytes and neutrophils, the ratios of these counts G/L: granulocytes/lymphocytes) and serum concentrations of immunosuppressive acidic protein (IAP) in the patients with disseminated colorectal cancer who have received FOLFOX4. All these blood examinations were performed before the first administration of FOLFOX4 as a first line chemotherapy in 18 patients with disseminated colorectal cancer. Results: Firstly serum albumin levels have shown significant correlation to lymphocyte counts and did inverse correlation to neutrophil counts and G/L ratios. The albumin levels in the patients with PD of FOLFOX outcome was significantly lower than in the patients with PR(p&lt;0.05) and SD (p&lt;0.05). The lymphocytes counts in the patients with PD were significantly lower than in those with PR (p&lt;0.05) and SD (p&lt;0.05). Neutrophil counts, on the other hand, was significantly higher in the patients with PD than in those with PR (p&lt;0.01) and SD (p&lt;0.05). IAP, have been recognized as a marker of immune-suppression in patients with cancer was higher in the patients with PD. Conclusions: Thus the nutritional status is closely related to the immune status in patients with cancer, and the markers of these conditions may present important informations in prediction of results of cancer chemotherapy. No significant financial relationships to disclose.
Indirect comparison of the cost-effectiveness of letrozole plus lapatinib (LET+LAP) versus anastrozole plus trastuzumab (ANA+TZ) as first-line treatment for postmenopausal women with HER2+ and HR+ metastatic breast cancer (MBC) from the U.K. National Health Service (NHS) perspective.
Authors: V. Hastings, T. E. Delea, M. Amonkar, K. Lykopoulos, J. Diaz, S. R. Johnston
Journal: Journal of Clinical Oncology (2010)

1035 Background: The EGF30008 trial assessed the efficacy of the combination of the anti-HER2 tyrosine kinase inhibitor LAP and the aromatase inhibitor (LET) compared with LET plus placebo in postmenopausal women with HER2+ and HR+ MBC. The TAnDEM study evaluated the benefits of adding TZ to the AI ANA in postmenopausal women with advanced HER2+ and HR+ MBC. Both studies demonstrated statistically significant improvements in progression-free survival (PFS) with the addition of anti-HER2 therapy. Methods: An economic model was used to evaluate the incremental cost per quality-adjusted life year (QALY) gained with LET+LAP versus ANA+TZ as first-line treatment in postmenopausal women with HR+ and HER2+ MBC from the U.K. NHS perspective. Expected PFS and overall survival (OS) with LET+LAP and ANA+TZ were based on adjusted indirect comparison using data from the TAnDEM and EGF30008 trials as well as the P025 trial of LET versus tamoxifen (TAM) and the TARGET and North American trials of ANA versus TAM. Costs and utility values were obtained from the literature. Results: Shown in the Table (all results are discounted). LET+LAP yields more progression-free life years (PFLYs), life years (LYs), and QALYs than ANA+TZ. Medication costs are greater with LET+LAP, partly due to longer PFS. These higher costs are offset by savings in costs of drug administration. LAP+LET is therefore dominant (less costly and more QALYs) versus ANA+TZ. Conclusions: Letrozole plus lapatinib has greater effectiveness and lower cost from the U.K. NHS perspective when indirectly compared with anastrozole plus trastuzumab. Measure LET+LAP ANA+TZ Difference Effectiveness PFLY 1.181 1.042 0.139 LY 3.399 3.021 0.378 QALYs 2.434 2.162 0.272 Costs (in £) Medication 29,568 21,031 8,537 Drug administration 520 13,753 -13,232 Other preprogression 8,285 7,307 978 Other postprogression 20,105 17,943 2,162 Total 58,479 60,033 -1,554 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration GlaxoSmithKline GlaxoSmithKline GlaxoSmithKline GlaxoSmithKline GlaxoSmithKline, Royal Marsden NHS Foundation Trust & Institute of Cancer Research Research Fund
TV: Shock to stop?
Authors: J. Worden and Brian Flynn
Journal: BMJ (1999)

Massachusetts' antismoking campaign 

Pam Laffin, a 29year old mother of two, is the latest weapon in the US health sector's war on the tobacco industry. Mrs Laffin's struggle to survive emphysema is being shown on prime time television in Massachusetts in a series of 30second antismoking advertisements.

Paid for by the state's Department of Public Health, the media campaign reveals that she is waiting for a second lung transplant, her body having rejected the first. It also features a comparison of a healthy lung and a tobacco ravaged lung, and displays the woman's transplant scar. Costing $1.5m ($0.9m), these advertisements are intended to grab the attention of smokers who need more urging to quit and young people who are just starting to smoke.

The Massachusetts adverts reflect a trend started by an Australian campaign in 1997that used scare tactics to target …
Burden of illness analysis of renal cell carcinoma
Authors: K. Lang, N. Danchenko, K. Gondek, B. Schwartz, D. Thompson
Journal: Journal of Clinical Oncology (2006)

14548 Background: There were over 36,000 new cases of kidney cancer reported in the US in 2004, the most common being renal cell carcinoma (RCC). RCC patients have limited treatment options and low survival rates, particularly for advanced-staged patients. Despite the growing importance of RCC, data on its economic burden are limited. Methods: A prevalence-based approach was used to estimate the aggregate annual cost burden from a societal perspective, including costs of medical treatment and lost productivity, due to RCC in the U.S. Key relationships represented in the model include the annual number of patients treated for RCC by age group and cancer stage; utilization of cancer specific treatments; unit costs of these treatments; work-days missed by these patients, and wage rates. Data sources included the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the Bureau of Labor Statistics, and the published literature. Results: The annual prevalence of RCC in the US was estimated to be 109,500 cases. The associated annual burden of RCC (US $2005) was approximately $4.8 billion ($43,749 per patient). Healthcare costs and lost productivity accounted for 84.9% ($4.1 billion) and 15.1% ($726 million) of the total, respectively. Reflecting its higher prevalence, the total cost associated with localized RCC accounted for the greatest share (78.2%) followed by regional, distant and unstaged RCC, which accounted for 18.3%, 2.8% and 0.7%, respectively. Sensitivity analyses resulted in a range in the estimated annual burden from $3.9 to $5.2 billion. Focusing only on newly diagnosed RCC cases (approximately 25,000 per year), the annual burden was estimated at $1.5 billion, with a per-patient cost of $62,340. Conclusions: The economic burden of RCC in the US is substantial. New therapies for RCC have the potential to yield considerable economic and societal benefits. [Table: see text]
Gene expression profile of advanced squamous and transitional cell carcinoma of the bladder.
Authors: H. M. Khaled, F. Abu-Taleb, A. Zekri, R. Haggag
Journal: Journal of Clinical Oncology (2010)

4572 Background: Bladder carcinoma is the foremost oncological problem in Egypt, being the most common malignant tumor among Egyptian males. The gene expression profile in Egyptian bladder cancer may be a potential predictor to treatment response. Methods: We compared the expression profiles of 30 cases of advanced bladder tumors (20 TCC,7 SCC, and 3 undifferentiated tumors) using cDNA microarrays containing 15.620 known genes and expressed sequence tags. Written informed consent was obtained prior to the study. Results: The application of bootstrapping techniques to hierarchical clustering segregated our cases into four main clusters. Multidimensional analysis confirmed these clusters. Of the 516 genes differentially expressed, 128 showed up-regulation, 44 are involved in biological processes, 48 in molecular function, and 53 in cellular components. Ten genes (SOS1, HDAC2, PLXNC1, GTSE1, ULK2, IRS2, ABCA12, TOP3A, HES1, and SRP68) are involved in 33 different pathways. The most frequently detected genes are: SOS1, in 20 different pathways, HDAC2 in 5 different pathways, and IRS2 in 3 different pathways. Down-regulation of 388 genes was detected, 109 are involved in biological processes, 124 in molecular function, 131 in cellular components and 21 are involved in 36 different pathways. These include PLCB2 in 11 pathways, MDM2 in 9 pathways, FZD4 in 5 pathways, p15 in 4 pathways, POLE2 3 pathways, and MCM4 in 2 pathways. Out of these 516 genes, which were differentially expressed, only 30 showed significant differences between TCC and SCC. One of them is SOS10, which is involved in the FGF-β signaling pathway. In addition 26 genes showed significant differences between low and high stages of them is fragile histidine triad gene, Ras and sialyltransferase 8 (alpha), while 16 showed significant differences between low and high grades of them is methionine adenosyltransferase II, beta. Conclusions: The present study has identified molecular biomarkers of potential clinical significance and critical molecular targets associated advanced Egyptian bladder cancer progression. No significant financial relationships to disclose.
Soluble epidermal growth factor receptor (EGFR) and HER-2 monitoring in a Phase II combination of gefitinib (ZD1839) and docetaxel for non-small-cell lung cancer (NSCLC)
Authors: M. P. Gatineau, E. Dansin, F. Chomy, E. Lemarie, P. Nouyrigat, S. Oudard, R. Mouawad, S. Kalla, D. Khayat, O. Rixe
Journal: Journal of Clinical Oncology (2004)

7090 Background: We previously reported the preliminary activity and tolerability of the combination of the EGFR tyrosine kinase inhibitor gefitinib ('Iressa', ZD1839) and docetaxel in patients with advanced NSCLC who have failed (Group A) or are unsuitable (Group B) for platinum-based chemotherapy (Proc Am Soc Clin Oncol 2003; 22: 661, abs 2659). In this analysis, we aimed to determine the predictive biologic factors of response to this combination by measuring the soluble EGFR and HER-2 levels before initiation of treatment. Methods: Daily oral gefitinib (250 mg/day) was combined with docetaxel (75 mg/m2) every 3 weeks starting on day 1. Updated clinical analysis is as follows: 43 patients were included between 07/2002 and 10/2003; male/female: 28/15; median (range) age: 57 (21–84) years; WHO PS 0/1/2: 17/22/4; Group A: 30 patients, Group B: 13 patients; 37 stage IV, 6 stage IIIb, median (range) number of involved organs: 2 (1–4). Results: To date, efficacy data according to RECIST are available for 37 patients; 8 partial response (PR) and 15 stable disease were documented (all PR were in Group A). Biologic monitoring by ELISA test (soluble active EGFR and HER-2) was done before and during treatment. There was no statistically significant difference between responding and non-responding patients at baseline for mean soluble EGFR levels (64 ± 62 vs 118 ± 217 pmol/mL, p=0.03) and HER-2 (1.278 ± 0.59 vs 1.520 ± 0.35 pmol/mL, p=0.1). However, responding patients exhibited a stable level of soluble EGFR during therapy while this level increased significantly in non-responders (p=0.03 at Cycle 3). Median progression-free and overall survival, as well as EGFR and HER-2 expression analyzed by immunohistochemistry on primitive tumor cells, will be presented at the meeting. Conclusion: Initial soluble EGFR and HER-2 determinations do not predict response to gefitinib-docetaxel combination in this cohort. 'Iressa' is a trademark of the AstraZeneca group of companies Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration AstraZeneca
Outcomes for hematologic malignancies in the Nurses’ Health Study (NHS) as compared to the Surveillance, Epidemiology, and End Results (SEER) program
Authors: G. A. Abel, K. A. Bertrand, C. C. Earle, F. Laden
Journal: Journal of Clinical Oncology (2007)

6599 Background: Health literacy, often defined as the degree to which an individual can obtain and understand information needed to make appropriate health decisions, may lead to a decreased incidence and improved mortality for some cancers by promoting risk factor modification and adherence to treatment. As a result, nurses, who presumably possess a higher level of health literacy and access to care than the general population, might be expected to manifest a lower incidence of and better survival for the hematologic malignancies. Methods: We assessed the incidence, all-cause, and cause-specific mortality for Hodgkin's disease (HD), non-Hodgkin's lymphoma (NHL), multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) in the NHS, an ongoing cohort study of 121,700 female registered nurses aged 30–55 years at entry who have been followed for 30 years. We compared these outcomes to those in the SEER program of the National Cancer Institute, matching for age and race. Results: In over 2.5 million person-years, the incidence of HD in the NHS was the same as in SEER. The incidence of NHL, CLL and MM was slightly increased. All-cause mortality was better in the NHS when compared to SEER for HD (HR= 0.62, 95% CI: [0.38, 1.0]) and NHL (HR= 0.81, 95% CI: [0.71, 0.91]). There were no differences in cause-specific mortality, except for MM, which was worse in the NHS (HR= 1.27, 95% CI: [1.07, 1.52]). Conclusion: The incidence of hematologic malignancy is not reduced in nurses, possibly because preventable risk factors for these cancers have yet to be elucidated. To the contrary, the slight increase in incidence for NHL, MM and CLL may be due to higher levels of overall health vigilance and/or occupational exposures. The fact that cancer-related mortality is similar for nurses as compared to age and race-matched SEER controls casts doubt on the roles of health literacy and access to care in improving survival for these disorders. No significant financial relationships to disclose. [Table: see text]
Microsatellite instability and oral fluoropyrimidine adjuvant chemotherapy in stage II and III colorectal cancer
Authors: Y. Kakeji, E. Oki, K. Ohgaki, K. Shibahara, S. Shiotani, N. Sadanaga, M. Morita, Y. Maehara
Journal: Journal of Clinical Oncology (2008)

15059 Background: Microsatellite instability (MSI) occurs in about 15% of sporadic colorectal cancers, and many studies have reported a better survival with MSI. However, conflicting data exist regarding the relevance of MSI for predicting the prognosis and benefits of 5- fluorouracil (5-FU) based chemotherapy in colon cancer patients. In Japan, oral fluoropyrimidine drugs have been used for adjuvant chemotherapy for gastrointestinal tract malignancies. We therefore investigated the usefulness of MSI as a predictor of distinct clinical attributes influencing the overall survival (OS) based on the use of adjuvant chemotherapy with oral fluoropyrimidine drugs in stage II and III colorectal cancer. Methods: We collected data and tumor specimens from 171 consecutive stage II and III colorectal cancer patients from 1994 to 2006. Five Microsatellite loci were analyzed using a high intensity micorosatellite analysis we reported previously. The Cox proportional hazard model was used to compare the clinical data and survival as well as any associations for MSI and the oral fluoropyrimidine treatment status of patients with MSI or microsatellite stability (MSS) colorectal cancers. Results: We identified 18 high microsatellite instability (MSI-H, 10.5%), 26 low microsatellite instability (MSI-L, 15.2%) and 127 MSS (74.3%) tumors. In an analysis that did not take into account the use of chemotherapy, univariate and multivariate analyses failed to show any difference between the MSI-H/L and MSS groups with respect to the overall survival. Furthermore, the survival after the administration of oral fluoropyrimidine did not correlate with the MSI status. Conclusions: The results of this study showed that the MSI status has no clear influence on the overall survival and response to oral fluoropyrimidine in stage II and III colorectal cancer. No significant financial relationships to disclose.
Concomitant chemo-radiotherapy with continuous infusion cisplatin and 5-fluoruracil in locally advanced cervical carcinoma (LACC): A single institution experience
Authors: A. Savarese, A. Felici, A. Micheli, L. Mariani, E. Magnani, M. Carosi, S. Gasparro, G. Arcangeli, C. Sbiroli, F. Cognetti
Journal: Journal of Clinical Oncology (2004)

5073 Background: The primary aim of this analysis was to evaluate the resecability of LACC (stage IIA-IIIB) and the relationship between downstaging, progression-free-survival (PFS) and overall survival (OS) after neoadjuvant concomitant chemo-radiotherapy (CT-RT). Secondary aim was the assessment of activity and tolerability of such approach. Methods: Pts affected by LACC were planned to receive 50.4 Gy external beam RT (EBRT, boost included) plus concomitant CT with cisplatin (DDP) 5 mg/m2/day i.v. and 5-fluorouracil (5FU) 200 mg/m2/day i.v., day 1–5, for scheduled 5 weeks. After restaging, patients not suitable for curative resection were treated with additional 25 Gy EBRT. Scheduled surgical procedures were radical hysterectomy plus pelvic lymphadenectomy (PIVER II/III), according to clinical response. Results: Forty-nine pts with LACC referred to our Institution; pts characteristics: median age 55 (range 32–78); stage IIA/IIB/IIIA/IIIB 3pts/34pts/2pts/9pts; squamous cell LACC/adenocarcinoma 45/4. Thirty-two pts (65.3%) received 4–5 weeks of concurrent CT-RT (median RT dose 50.4 Gy, range 46–57.6) and underwent surgical resection. Twelve pts obtained CR (37.4%, 95% CI 20.7–54.3), 14 pts PR (43.8%, 95% CI 26.6–60.9), and 6 pts NC (18.8%, 95% CI 5.2–32.3). Seventeen pts (34.7%) received additional 2–3 weeks of concurrent CT-RT (median RT dose 25 Gy) without surgery. Of these, 3 pts had RC (17.6%, 95% CI 0–35.8), 6 pts PR (35.3%, 95% CI 12.6–58), 4 pts NC (23.5%, 95% CI 3.4–43.7), 3 pts PD (17.6%, 95% CI 0–35.7), and 1 pts NV. No CTC Grade 4 toxicity was observed; only 3 pts had G3 diarrhea. At a median follow-up of 18 months (range 3–84), 5-yrs-PFS in all pts was 60.5%, and 5 yrs-OS 56.9%. Five-yrs PFS and survival rate were significantly greater in pts undergone surgery (respectively p=0.03 and p=0.0001). Conclusions: Neoadjuvant concurrent CT-RT is tolerable, active and affect resecability owing to tumor shrinking. Moreover, the data seems to indicate that curative surgery improves 5-yrs OS. No significant financial relationships to disclose.
Predictors of quality of life among breast cancer survivors
Authors: G. Matthews, J. Alton, L. A. Jacobs, S. Palmer, A. T. Meadows, A. Demichele
Journal: Journal of Clinical Oncology (2004)

8128 Background: Breast cancer (BC) has the greatest one-year incidence of any cancer among women, and women diagnosed with BC constitute the largest group of female cancer survivors at five years and beyond. Yet, data concerning predictors of the long-term adaptation achieved by these women is lacking. The Rowan Breast Center of the Abramson Cancer Center has begun a prospective study to determine factors related to outcomes among survivors. We have gathered initial data on more than 1200 patients and report on a subset of long-term survivors. Methods: Using mailback questionnaires and telephone interviews, disease, treatment, physical symptom and City of Hope Quality of Life (QOL) data were gathered from 60 BC disease-free survivors who were two years from diagnosis. Results: Mean age at diagnosis was 51.5 years. 98% were Stage I or II; 90% ER positive; 73% PR positive. Chemotherapy was received by 73%. 43% were post-menopausal prior to treatment, and 67% of the pre-menopausal survivors experienced premature ovarian failure (POF). The most commonly reported physical symptoms for both groups were hot flashes (72%), night sweats (62%), and decreased desire for sex (55%). Symptom occurrence did not differ by ovarian failure status with the exception of women with POF reporting less urinary frequency (p < .05). QOL was high and unrelated to disease stage, receptor status, or receipt of chemotherapy (p > .05). Women who were older at diagnosis reported better QOL overall, and in physical, social, and psychological domains (ps < .05). QOL did not differ by ovarian failure status (all p > .07). Conclusions: Long-term survivors of BC in the Rowan database report high levels of adaptation on the City of Hope QOL measure, and QOL appears to be related primarily to age at diagnosis, rather than disease or treatment-related variables. Given the relatively high levels of psychological adjustment and low levels of physical complaints, large prospective samples will be required for predicting difficulties in QOL. No significant financial relationships to disclose.