tbuckley/cabot-search huggingface dataset:
Challenging conversations in oncology: A workshop for fellows.
Authors: Kavitha Ramchandran, Lidia Schapira, David Spiegel, Stephanie Harman, Joshua Fronk, Manuela Kogon, Kay Kostopoulos, Erika L Tribett, Jonathan S. Berek
Journal: Journal of Clinical Oncology (2014)

60 Background: Compassionate communication is critical to patient-centered cancer care. Conversations about sensitive topics are necessary to help patients make well-informed decisions. Still, many oncologists feel ill-equipped during these conversations and thus avoid them or approach them with a purely clinical perspective. Fortunately, empathic communication skills can be learned. This project, Challenging Conversations in Oncology (CCO), involves the development of an experiential workshop to help build skill and confidence communicating with cancer patients. The workshop is part of a movement to reimagine cancer care at Stanford. Methods: The first iteration of CCO was multi-day event with didactic lectures, self-awareness exercises and small group role-play. The faculty was multi-disciplinary, including clinicians in various subspecialties, communications experts and patients themselves. Activities were designed to build skills in interviewing, cultural humility, adapting communications, and dealing with patient and provider emotions. A post-workshop evaluation survey assessed overall effectiveness as well as self-reported learning and perceived enhancement of patient care as a result of participation. Results: The CCO workshop was implemented in Fall 2013. Participants included 17 physicians from various oncology subspecialties. Participants reported that the workshop was very valuable (rating at least 4 on a 5-point scale of overall effectiveness). Common themes included learning to “slow down” and do “less talking, more listening,” taking time to “let patients express themselves…cry, be silent.” Faculty reported enthusiasm watching trainee communication skills “evolve along with…the patient’s story.” Conclusions: This workshop was a significant educational opportunity for junior faculty at Stanford. Feedback suggests the experience was rewarding and influential. It encouraged cultivation of communication skills that will likely benefit doctors and their patients. This fall (Year 2), we will extend this workshop to senior faculty, staff, and administration. The course will continue to evolve to meet the needs of providers and align with comprehensive institutional enhancements in cancer care.
Nutritional Factors, Long-Term DDT Intake, and Chloroleukemia in Rats
Authors: R KIMBROUGH, T B GAINES, J D SHERMAN
Journal: JNCI Journal of the National Cancer Institute (1964)

The influence of diet and 1,1,1-trichloro-2,2-bis (p-chlorophenyl)-ethane (DDT) on the development of chloroleukemia in 135 Sherman strain randombred rats was investigated. Seven animals, all less than 16 months old, developed chloroleukemia; 4 animals of this group were on a purified high-fat diet, 2 were on a purified high-fat diet and DDT, and 1 was on a purified “normal-fat” diet and DDT. In 13 years of study of DDT and other pesticides, leukemia was not observed in our rats other than in the two experiments discussed in this paper. It was concluded that animals on purified diets develop leukemia, addition of DDT to the diet has no bearing on the development of leukemia, and the promoting factor may be a nutritional imbalance. The leukemia was successfully transplanted and its viral origin is presently under investigation. Tissue alterations caused by DDT in the diet were not observed. The only indication of DDT poisoning was the occurrence of slight-to-moderate tremors in 11 animals on purified “normal-fat” diets beginning 107 days after onset of exposure to DDT. Fatty metamorphosis of the liver and a higher incidence of pneumonia were attributable to the purified high-fat diets. The lifespan was shorter and the mortality rate higher among the animals on purified diets, and the addition of DDT to the diet did not influence these factors.
Criteria defining the duration of chemoreduction with focal treatment in retinoblastoma: A retrospective analysis.
Authors: M. Beck Popovic, H. Abouzeid, M. Gaillard, M. Faouzi, A. Pica, A. Balmer, F. Munier
Journal: Journal of Clinical Oncology (2010)

9581 Background: Chemoreduction combined with focal treatment (CT) has become a standard approach for most patients with retinoblastoma to avoid external beam radiotherapy and/or enucleation (= second line treatment, SLT). However, the type of agents used and the number of cycles applied vary. We report on our criteria used to define individually the minimal duration of CT to control disease. Methods: Retrospective analysis of 120 eyes in 83 patients staged Group A-E according to the International Classification, treated with etoposide/carboplatin × 3 days, 1 to maximally 5 courses according to following ophthalmological response and stopping criteria: maximal tumor width reduction, retraction from optic nerve/macula, reapplication of retinal detachment, resorption of vitreous seeds. In addition, best response to CT was evaluated in 76 eyes by measuring tumor width reduction after each course. CT was considered as ineffective when SLT was needed. Results: Response to CT by tumor width reduction was significant only after the first and second course (p<0.001 by sign test). In 43/120 (35.8%) eyes SLT was needed: none in Group A, 5/32 Group B (15.6%), 8/36 Group C (22.2%), 24/38 Group D (66.7%), 6/6 Group E (100%). Mean time to SLT was 6.3 ± 8.6 months, mean follow-up 88 ± 36.9 months. SLT concerned 15/44 (34%) eyes with measurable tumor width reduction after 2.8±0.9 courses, 5/33 (15%) eyes with optic nerve/macula retraction after 2.6±1 courses, 8/15 (53.3%) eyes with important retinal detachment after 4.3±0.6 courses and 10/15 (67%) eyes with important vitreous seeds after 3±1.5 courses. In 5 more eyes SLT was needed after 3.8±1.5 courses. Multivariate regression analysis confirmed the higher risk of SLT in Group D and E eyes compared to Group A-C (p<0.001) and in those eyes that received 3 or more CT courses (p 0.001). Conclusions: Best tumor control was obtained in eyes that responded rapidly to 2-3 courses of CT.These were mainly eyes with measurable tumor width and rapid retraction from optic nerve/macula. In eyes with important retinal detachment and/or vitreous seeds, increased numbers of CT cycles did not reduce the need for SLT. For these patients, other treatment strategies have to be developed. No significant financial relationships to disclose.
Long-term outcomes with concurrent carboplatin, paclitaxel, and radiation therapy in locally advanced, inoperable head and neck cancer
Authors: R. L. Ferris, S. S. Agarwala, E. Cano, D. E. Heron, J. Johnson, E. Myers, V. Sandulache, Y. Wang, S. Bahri, A. Argiris
Journal: Journal of Clinical Oncology (2007)

6032 Background: Our goal was to evaluate long-term outcomes of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with carboplatin, paclitaxel, and radiotherapy. Methods: We conducted a phase II trial in inoperable patients with locally advanced SCCHN. Carboplatin 100 mg/m 2 and paclitaxel 40 mg/m 2 were administered intravenously once a week during external beam radiotherapy (once daily, 180 cGy/fraction) for 6–7 weeks. Interstitial brachytherapy was used as a boost in selected patients with primary malignancies of the oral cavity and the oropharynx. Results: 55 patients were enrolled. 52 patients (95%) had stage IV and 51 (93%) had technically unresectable disease; 62% had an oropharyngeal primary site. 21 patients underwent brachytherapy boost. Grade 3 or 4 mucositis occurred in 30% of patients. One death occurred during treatment; it was related to complications of gastrostomy tube (G-tube) placement. Forty of 50 evaluable patients (80%) had an objective response, with a complete response rate of 52%. With a median follow-up of 69 months years for surviving patients, the 5-year progression-free survival (PFS) was 36% and the 5-year overall survival (OS) was 35%. Two of the 18 long-term survivors of &gt;50 months were G-tube feeding dependent. Patients undergoing brachytherapy boost (n=21) had similar outcomes compared with the rest of the patients. In multivariate analysis, baseline hemoglobin levels and N stage were predictive of survival. Conclusion: Treatment with concurrent carboplatin, paclitaxel and radiation is safe and offers curative potential for poor prognosis patients with locally advanced SCCHN. No significant financial relationships to disclose.
Underweight and breast cancer recurrence and death
Authors: H. Moon, W. Han, J. Lee, E. Ko, E. Kim, E. Kim, J. Yu, D. Noh
Journal: Journal of Clinical Oncology (2009)

e22054 Background: The association of body mass index or body weight and breast cancer outcome is controversial. Furthermore, the impact of underweight on breast cancer recurrence and death has not been adequately addressed. Methods: We investigated this issue in a large nation-wide database of 14,039 Korean breast cancer patients (Korean Breast Cancer Registry). Furthermore, to test whether the association was due to more frequent non-cancer death in underweight women, we used breast cancer recurrence data of 4,345 women from single institution (Seoul National University Hospital). Results: The results from Korean Breast Cancer Registry data showed significantly lower overall survival in underweight patients compared to normal weight after adjusting known prognostic factors [hazard ratio=1.36 (95% CI 1.08–1.72)], which was not observed in obese patients. The association between body mass index and breast cancer recurrence was further investigated in Seoul National University Hospital data. Underweight women had significantly higher risk of distant metastasis and local recurrence of breast cancer [hazard ratio=1.86 (95% CI 1.25–2.76) and 2.62 (95% CI 1.55–4.41), respectively]. Conclusions: These findings suggest that underweight could be considered as high risk factor of death and recurrence after breast cancer surgery. No significant financial relationships to disclose.
Age as prognostic factor in osteosarcoma
Authors: M. Hagleitner, P. Hoogerbrugge, U. Flucke, H. Schreuder, A. van de Luijtgaarden, W. van der Graaf, M. te Loo
Journal: Journal of Clinical Oncology (2009)

10537 Background: Osteosarcoma may occur at all ages but has a distinct age distribution from 10 to 20 years old. Several retrospective studies of osteosarcoma suggest a favourable outcome for children compared to adults. To evaluate whether age is indeed related to outcome, we retrospectively analyzed patients with osteosarcoma under the age of forty. Furthermore, we retrospectively analyzed whether outcome of osteosarcoma in young adult patients is different when treatment took place in a pediatric or an adult oncology department. Methods: Patients with primary osteosarcoma treated in our hospital between 1978 and 2008 were included in this study. To evaluate the role of age, patients were divided in two groups: less than 20 and 20 - 40 years of age. Prognostic factors including histological response after neoadjuvant chemotherapy, were analyzed using Cox regression multivariate analysis. Results: In total, 102 patients with primary osteosarcoma were included. Overall survival (OS) of the whole population was 50.7% with a 5-years event-free survival of 47.1%. Age markedly affected survival with an OS of 61.1% in patients below 20 years of age and 38.6% in the patient group between twenty and forty years (p=0.014). There was no significant difference in prognostic factors, such as presence of metastasis at diagnosis. Pediatric patients under the age of 10 had a superior OS of 71.4% (p =0.02) compared to patients older than 10 years. Overall survival of patients aged 14–20 years was not significant different when treated in a pediatric oncology department as compared to treatment in an adult department (57.9% vs. 47.4%, p= 0.705) . Osteosarcoma patients older than 20 years, showed a worse histologic response to pre-operative chemotherapy and experienced more toxicity. Dose reduction due to toxicity was applied in 20.8% of adults vs. in 1.9% (p=0.002) of the children. Conclusions: Based on the results found in this study, we conclude that age is an independent prognostic factor for outcome of patients with primary osteosarcoma. No significant financial relationships to disclose.
Treatment patterns and clinical outcomes of patients with advanced breast cancer after failure of an anthracycline and a taxane in Taiwan.
Authors: Y. Lu, L. Tseng, M. Hou, C. Lin, H. Li, S. Chen
Journal: Journal of Clinical Oncology (2010)

e11504 Background: Whilst there are many options of chemotherapeutic agents as salvage chemotherapy for patients after failure of anthracycline and a taxane, few compounds are currently licensed specifically for this patient population. This chart-review study aimed to evaluate the treatment pattern and clinical outcomes for this patient group in Taiwan. Methods: Medical charts from 4 medical centers in Taiwan were reviewed to construct a cohort of patients with metastatic or locally advanced breast cancer, who had failed treatment with anthracyclines and taxanes between January 2001 and December 2007. Data from the medical chart were extracted retrospectively from the date of diagnosis of breast cancer and the patient outcomes were followed until June 30, 2009. Time to treatment failure (TTF) was defined as as time to death, time to disease progression, or time to other anticancer treatments, whichever occurs first. Results: To date, 745 eligible patients have been enrolled in this study. In total, 70% subjects completed first salvage chemotherapy regimens. The major first salvage regiments included capecitabine (C), vinorelbine (V), taxane (T), and fluorouracil (F), either in monotherapy or combination setting. The median TTF of these options (with 95% confidence interval) were C: 3.5 (3.0∼4.6) months, V: 4.4 (3.1∼5.1) months, T: 3.8 (3.0∼4.4) months and F: 4.2 (3.0∼5.1) months respectively. The overall survival (OS) of these treatment options from starting these salvage treatment were C: 16.3 (13.3-21.0) months, V: 19.3 (14.7-24.2) months, T: 21.0 (14.0-26.6) months and F: 19.5 (12.9-22.5) months respectively. Combination chemotherapy had a significantly better OS (median: 21.6 months) compared to single agent chemotherapy (median: 17.5 months) in subjects who received first salvage chemotherapy (p=0.0426). Conclusions: This study indicated that there does not appear to be a difference in TTF or OS among the current treatment regimens available for patients with advanced breast cancer who failed anthracycline and taxane. However, combination chemotherapy had better clinical outcomes compared with those treated with monotherapy in this cohort. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bristol-Myers Squibb Bristol-Myers Squibb Bristol-Myers Squibb
Abstract 15035: Effects on Lipids and Safety Following Cessation of Treatment with Cholesteryl Ester Transfer Protein Inhibitor Anacetrapib in Patients with or at High Risk for Coronary Heart Disease
Authors: Antonio M Gotto, Christopher P Cannon, Sukrut Shah, Sherry Liu, Susie Li, Michael Stepanavage, Eliot Brinton, Michael Davidson, Hayes Dansky, Yale Mitchel, Philip Barter
Journal: Circulation (2011)

The cholesteryl ester transfer protein inhibitor anacetrapib was shown to raise high-density lipoprotein (HDL) cholesterol and reduce low-density lipoprotein (LDL) cholesterol, with an acceptable s...
Determinants of recovery from amenorrhea in premenopausal breast cancer patients receiving adjuvant chemotherapy in the taxane era
Authors: A. M. Minisini, J. Menis, C. Andreetta, B. Alessi, G. Pascoletti, P. Driol, F. Valent, A. Piga, G. Fasola, F. Puglisi
Journal: Journal of Clinical Oncology (2008)

631 Background: Chemotherapy (CT)-induced amenorrhea occurs in about 20–70% of premenopausal breast cancer (BC) patients (pts) and its incidence could depend on several factors. Iatrogenic amenorrhea can affect choice of hormone therapy (tamoxifen vs aromatase inhibitors), fertility, and quality of life of BC survivors. A benefit from the ovarian failure in hormone receptor positive BC pts is estimated since the estrogen production is suppressed. Methods: We retrospectively analyzed the incidence of amenorrhea after adjuvant CT and the subsequent recovery of the menses in 145 BC pts. Age, smoke, BMI, number of CT courses, CT regimen, number of childbearing were analyzed as potential predictive factors of ovarian function recovery. Results: Mean age was 43 years (range 23–58) at the beginning of adjuvant CT with a 30% of pts younger than 40 years. The mean value of BMI was 24.6 even though a 34% of pts presented with BMI>25. The majority (87.6%) of pts received an anthracycline-based CT, 35.2% of pts received a CMF regimen and 42.8% a taxane. In 77% of cases, pts had endocrine-responsive disease and the most used adjuvant hormone treatment after CT was tamoxifen (64% versus 11% of aromatase inhibitors). The incidence of CT-induced amenorrhea was 84% and 32% of these pts resumed menses after a mean of 9.5 months. Younger age (< 40 years) and taxane-based CT were associated with increased probability of recovery of menses after CT-induced amenorrhea (p=0.005 and p= 0.02, respectively). On the contrary CMF-based CT was associated with an increased probability of permanent amenorrhea (p=0.06). Multivariate analysis confirmed that younger age is associated with higher chance of ovarian function recovery after CT-induced amenorrhea (HR= 4.2, p= <0.0001). Moreover, childbearing (HR=0.4, p= 0.01) and smoke (HR=0.9, p=0.06) were associated with reduced probability of menses recovery. Conclusions: Recovery of menses after CT-induced amenorrhea occurs more probably in younger women with no pregnancies. Physicians should consider the risk of ovarian function recovery in these patients, especially when prescribing aromatase inhibitors. No significant financial relationships to disclose.
Abstract 12803: Abnormal P-wave Terminal Force in Lead V1 Is Associated with Cardiac Death or Hospitalization for Heart Failure in Prior Myocardial Infarction
Authors: Akira Tamura, Kumie Torigoe, Yoshiyuki Kawano, Munenori Kotoku, Junichi Kadota
Journal: Circulation (2012)

The prognostic significance of P-wave terminal force in lead V 1  (PTFV 1 ), a marker of left atrial overload, has not been fully investigated in patients with myocardial infarction (MI). Accordingly, we sought to clarify the prognostic significance of PTFV 1  in patients with prior MI. We retrospectively examined 185 patients with prior (> 6 months) MI. Patients with atrail fibrillation or flutter were excluded. The primary end point was cardiac death or hospitalization for heart failure. Abnormal PTFV 1  was defined as PTFV 1  ≥40 mm × msec. During a follow-up period of 6.4 ± 2.9 years, 39 patients developed the primary end point. A Kaplan-Meier analysis showed a lower primary event-free rate in 79 patients with abnormal PTFV 1  than in 106 with normal PTFV 1  (p  1 , loop diuretic use, and spironolactone use were significantly associated with the primary end point. A multivariate Cox regression analysis selected age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.04 - 1.14, p  1  (HR 2.72, 95% CI 1.24 - 5.99, p = 0.01) as independent predictors of the primary end point. In conclusion, abnormal PTFV 1  is an independent predictor of cardiac death or hospitalization for heart failure in patients with prior MI. The analysis of P waves in lead V 1  would provide useful prognostic information in patients with prior MI.
Phase II trial of pegylated interferon (Peg-Intron) and thalidomide (Thal) in pretreated metastatic malignant melanoma
Authors: L. E. Flaherty, L. Heilbrun, C. Marsack, U. N. Vaishampayan
Journal: Journal of Clinical Oncology (2005)

7562 Background: Pegylated interferon and thalidomide each possess immunomodulatory and anti-angiogenic activity with some clinical efficacy in melanoma. The combination was hence evaluated in a phase II trial. Methods: Eligibility included biopsy confirmed progressive metastatic malignant melanoma, maximum of two prior therapies allowed, performance status of 0–2, and adequate hepatic, bone marrow, and renal function. Pegylated interferon was administered at a dose of 0.5microgram/kg subcutaneously weekly and thalidomide 200mg orally daily. Toxicity was evaluated every two weeks and response every eight weeks. Results: 17 patients; 10 males and 7 females have been enrolled in the first stage of the study. The median age is 55 years (range 29–80 years). 15 patients had visceral metastases and 2 patients had brain metastases. 12 patients had failed prior immunotherapy regimens. Performance status was 0, 1 and 2 in 11, 5 and 2 patients, respectively. 7 of 17 patients had an elevated lactate dehydrogenase level. (range- 121-3553 units/L). Severe (Grade 3 or 4) toxicities observed were: fatigue and anemia in 2 patients each and constipation and nausea in 1 patient each. No treatment related deaths occurred. Dose escalation of thalidomide to 300mg daily was feasible in 4 patients. Three patients required dose reduction: 2 due to constitutional symptoms (myalgias, fevers, flu-like symptoms) and 1 due to bradycardia. One therapy related hospitalization for nausea and dehydration occurred. There were no objective responses noted; three patients demonstrated disease stabilization. Conclusions: The regimen of pegylated interferon and thalidomide had predominantly constitutional side effects and minimal myelosuppressive effects. However the combination failed to demonstrate clinical efficacy in pretreated metastatic malignant melanoma. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Celgene Celgene Celgene, Schering
Determination of a score to predict life-expectancy in terminally ill cancer patients
Authors: J. Durand, V. Montheil, J. Alexandre, S. Ropert, S. Pourchet, F. Goldwasser
Journal: Journal of Clinical Oncology (2008)

20545 Background: Life expectancy is a crucial parameter for the decision-making in advanced cancer patients (pts). The Karnofsky Performance Status is the best known clinical parameter but associated with low predictive value and large inter-observer variations. The purpose of this study was to develop a validated score to predict survival in terminally ill cancer pts. Methods: From January 2004 to September 2007, a prospective study enrolled 454consecutive pts entering in a palliative care unit. The sample was divided into a two-thirds randomly selected derivation set used to construct the prognostic score and a one-third validation set used to evaluate its performance. A multiple logistic regression analysis was applied to the derivation set to assess the association between 18 biological parameters at admission and fatal outcome within 2 weeks. Results: 389 pts were evaluable. 204 men, median age: 62 years (range:19–93). Primary tumor was gynecological (18.8%), gastro-intestinal (16.5%), pulmonary (15.2%), hepatic or biliary (13.9%), urological (10.3%), head and neck (9.3%) or others (16.2%). In the derivation set (259 pts), independent predictive factors were LEUCOCYTES > 15.0 G/L (Odds Ratio (OR) = 4.05, 95%Confidence Interval (CI) = [1.84;8.94], p<.001), PLATELETS > 400 G/L (OR=.34, 95%CI=[0.16;0.71], p=.004), UREA > 12 mmol/L (OR=4.52, 95%CI = [2.04;10.01], p<.001), ALBUMIN < 25 g/L (OR=3.16, 95%CI=[1.39;7.15], p=.006). A score based on these parameters was tested on the validation set (130 pts). The area under the receiver operating characteristic curve was 0.718 (95%CI=[0.690;0.836]). A discrimination threshold of 65% was associated with a positive predictive value of 76%, a specificity of 45% and sensitivity of 80%. Conclusions: We defined a score predicting short-term survival in the palliative setting. The same study is ongoing in less advanced disease. No significant financial relationships to disclose.