tbuckley/cabot-search huggingface dataset:
Hypertension monitoring as a tool to predict congestive heart failure (CHF) during sunitinib (SU) therapy in GIST and renal cell carcinoma (RCC).
Authors: D. Galizia, C. Ortega, E. Palesandro, V. Prati, S. Gallo, L. D'Ambrosio, A. Bonzano, D. Rota Scalabrini, S. Aliberti, G. Grignani, M. Aglietta
Journal: Journal of Clinical Oncology (2011)

10061 Background: Cardiovascular events (CVE), i.e. CHF and coronary artery disease (CAD), may occur in up to 10% of patients (pts) affected by GIST and RCC treated with SU. CVE recognition, SU interruption and appropriate therapy based on ACE inhibitors and/or β blockers, are the only effective treatment for this severe complication. As of today, CVE known predictors are a history of hypertensive disease (HD) and/or CAD (Chu, Lancet 2007). Aim of this project was to enhance our ability to identify patients at risk to develop CHF. Methods: Between July 2007 and September 2010, 39 consecutive pts, median age 68 yrs (46-82) affected by either GIST (21) or RCC (18) were treated with SU at the approved dose of 50 mg/day, 4 weeks on and 2 weeks off. In all pts, two expert cardiologists longitudinally studied left ventricular ejection fraction (LVEF) at baseline, after 3 months, and every 6 months until progression or permanent SU discontinuation. We prospectively recorded the following pts features: cardiovascular history, blood pressure, NYHA class, renal function, antihypertensive therapy. We searched correlations between CVE/CHF and patients features. Results were assessed with paired Student’s t-test and Chi-square test. Predictors of CVE/CHF were searched by means of logistic regression analysis. Results: At baseline, we found 20 pts (51%) with HD and 1 (3%) pts affected by CAD. On SU, 20 (51%) pts developed HD or worsened a preexisting one. We observed 7 (17%) CVE (3 CHF and 4 CAD). History of HD or CAD predicted CVE (p=0.03). In 17 pts (43%) we prospectively showed a median ≥ 10% LVEF reduction compared to baseline value (p = 0.001). Predictors of ≥ 10% LVEF reduction was the development or worsening of preexisting HD (p=0.03). Conclusions: Since only an early identification and treatment of pts at risk to develop CHF may reduce this dreadful event, we suggest that worsening or development of HD should be closely monitored and regarded as the most relevant risk factor. Therefore, a worsening hypertension deserves close serial echocardiograms with prompt reduction or interruption of SU in case of LVEF reduction. A prospective study is undergoing to validate our results in a different series.
The Association of Cancer Physicians responds to “Cancer drugs, survival, and ethics”
Authors: Adam Dangoor, Johnathan Joffe, Adam Januszewski, Janine Mansi, David Cunningham, Peter Selby
Journal: BMJ (2016)

As UK health professionals specialising in the drug treatment of cancer, we think that Wise’s analysis strays into the territory of unbalanced opinion.1 We welcome discussion of topics that we debate ourselves; his article is a useful counterpoint to the hyperbole we often see in the media around incremental improvements in treatment. But he conflates problems from different …
Controlled Interventions to Reduce Burnout in Physicians
Authors: Maria Panagioti, Efharis Panagopoulou, Peter Bower, George Lewith, Evangelos Kontopantelis, Carolyn Chew-Graham, Shoba Dawson, Harm van Marwijk, Keith Geraghty, Aneez Esmail
Journal: JAMA Internal Medicine (2016)

Importance Burnout is prevalent in physicians and can have a negative influence on performance, career continuation, and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. Objective To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects. Data Sources MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials were searched from inception to May 31, 2016. The reference lists of eligible studies and other relevant systematic reviews were hand searched. Study Selection Randomized clinical trials and controlled before-after studies of interventions targeting burnout in physicians. Data Extraction and Synthesis Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of prespecified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified. Main Outcomes and Measures The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals. Results Twenty independent comparisons from 19 studies were included in the meta-analysis (n = 1550 physicians; mean [SD] age, 40.3 [9.5] years; 49% male). Interventions were associated with small significant reductions in burnout (standardized mean difference [SMD] = −0.29; 95% CI, −0.42 to −0.16; equal to a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-directed interventions (SMD = −0.45; 95% CI, −0.62 to −0.28) compared with physician-directed interventions (SMD = −0.18; 95% CI, −0.32 to −0.03). Interventions delivered in experienced physicians and in primary care were associated with higher effects compared with interventions delivered in inexperienced physicians and in secondary care, but these differences were not significant. The results were not influenced by the risk of bias ratings. Conclusions and Relevance Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals.
A Multicenter Randomized Placebo Controlled Trial of Compression Stockings to Prevent the Post-Thrombotic Syndrome After Proximal Deep Venous Thrombosis: The S.O.X. Trial
Authors: Susan R. Kahn, Stan Shapiro, Phil S Wells, Marc A. Rodger, Michael J. Kovacs, David Anderson R, Vicky Tagalakis, Mira Johri, Adrielle H Houweling, Christina Holcroft, Susan Solymoss, Marie-José Miron, Erik Yeo, Reginald Smith, Sam Schulman, Jeannine Kassis, Clive Kearon, Isabelle Chagnon, Turnly Wong, Christine Demers, Rajendar Hanmiah, Scott Kaatz, Rita Selby, Suman Rathbun, Sylvie Desmarais, Lucie Opatrny, Thomas Ortel, Jeffrey S. Ginsberg
Journal: Blood (2012)
Updated Results of the Phase II Study of Pegylated Liposomal Doxorubicin (PLD), Low Dose Dexamethasone (DEX) and Lenalidomide (LEN) In Patients with Newly Diagnosed (ND) Multiple Myeloma (MM)
Authors: Rachid Baz, Mohamad A Hussein, Daniel Sullivan, Jose-Leonel Ochoa-Bayona, Monique A Hartley, Kenneth Shain, Taiga Nishihori, Jennifer Paleveda, Kara Kosakowski, William S. Dalton, Melissa Alsina
Journal: Blood (2010)
The Effect of a Nonabsorbed Oral Antibiotic (Rifaximin) on the Symptoms of the Irritable Bowel Syndrome
Authors: Mark Pimentel, Sandy Park, James Mirocha, Sunanda V. Kane, Yuthana Kong
Journal: Annals of Internal Medicine (2006)

In this double-blind trial, 87 patients with the irritable bowel syndrome were randomly assigned to either rifaximin (400 mg 3 times daily) or placebo for 10 days. Over a 10-week follow-up period, ...
Diabetes and cancer risk in the REDUCE trial.
Authors: C. Wu, D. M. Moreira, L. Gerber, R. S. Rittmaster, G. L. Andriole, S. J. Freedland
Journal: Journal of Clinical Oncology (2011)

194 Background: Men with diabetes mellitus (DM) are less likely to be diagnosed with prostate cancer (PC). As diabetic men have lower PSA values, it is unclear if this is due to reduced PC incidence or lower biopsy rates from the lower PSA. To account for differential biopsy rates, we explored the link between DM and risk of PC and high-grade PC in the REDUCE trial. We also explored if these associations differed by body mass index (BMI) as a prior study suggested BMI may modify the effect of DM on PC aggressiveness. Methods: The 4-year REDUCE study tested the effect of dutasteride 0.5 mg daily on PC risk reduction in men with PSA of 2.5-10.0 ng/mL and a negative prostate biopsy. Men underwent study-mandated biopsies at 2 and 4 years regardless of PSA. DM was determined by self report at baseline. BMI (kg/m 2 ) was calculated from height and weight measured at baseline. The risk of PC and high-grade PC (Gleason 7-10) was determined using multivariate logistic regression adjusting for age, race, BMI, PSA, and treatment arm. Effect modification by BMI (&lt;25, 25-29.9, and &gt;30 kg/m 2 ) was tested via interactions. Results: Of 8,122 men in the REDUCE trial, 499 (6.1%) had DM. Diabetic men were older (63.8 vs. 62.7 yrs, p=0.001) with a higher BMI (median BMI 27.8 vs. 26.8, p&lt;0.0001). After adjusting for age and BMI, diabetic men had lower PSA values (p=0.04). On multivariate analysis, DM was not associated with PC risk (OR 0.96, 95% CI 0.75-1.22, p=0.74). When stratified by BMI, DM was not associated with PC risk in any group (all p&gt;0.23) and the results did not vary by BMI category (p-interaction=0.13). DM was not associated with high-grade PC on multivariate analysis (OR 0.88, 95% CI 0.58-1.33, p=0.55). When stratified by BMI, though DM was not associated with high-grade PC risk in any single group (all p&gt;0.14), there was a suggestion of effect modification by BMI (p-interaction=0.056) with a positive association between DM and high-grade PC in obese men (OR 1.32) and an inverse association in normal weight men (OR 0.35). Conclusions: In the REDUCE trial, when all men undergo biopsy regardless of PSA, DM is not associated with lower PC risk, but rather equal PC risk and equal risk of high-grade PC. These results suggest the lower rate of PC among diabetic men in prior studies may be driven by lower biopsy rates from lower PSA. [Table: see text]
Clinical outcomes in adult and childhood rhabdomyosarcoma (RMS) treated with vincristine, dactinomycin, and cyclophosphamide (VAC)/VAC-like chemotherapy.
Authors: K. Harano, Y. Kojima, K. Hashimoto, M. Ando, A. Hirakawa, K. Yonemori, M. Kodaira, M. Yunokawa, C. Shimizu, K. Tamura, N. Katsumata, A. Makimoto, Y. Fujiwara
Journal: Journal of Clinical Oncology (2011)

10092 Background: The outcomes for the patients (pts) with adult RMS have remained poor, with approximately 30% at 5-year survival. The purpose of the current study is to compare the clinical outcomes of adult RMS to childhood RMS by local or metastatic disease, to examine the impact of local therapy, and the optimal timing of local therapy in metastatic disease. Methods: We collected the data of the pts with RMS between 1981 and 2010 at our institution. The chart review was performed for all identified pts to obtain the following information; age, stage, group, disease site, histopathology, chemotherapy regimen, tumor response, and radiotherapy schedule. We defined adult as the pts aged greater than or equal to 21 years. The induction phase was defined as in the first 6cycles of VAC and the maintenance phase was defined as after the first 6 cycles of VAC. The progression free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method and the Cox hazard model. Results: We identified 98 pts. Of 36 pts were adult (median age, 29; range, 21 to 72) and of 62 pts were childhood (median age, 11; range, 0.6 to 20). The median PFS of localized and metastatic disease for childhood and adult RMS were as follows, localized disease, 166.9 vs. 22.4 months (p = 0.005) and metastatic disease, 13.3 vs. 13.3 months (p = 0.949), respectively. Multivariate regression analysis demonstrated that age (< 21 vs. ≥ 21) was negatively correlated with PFS (p = 0.044) and the tumor response (PD / SD vs. PR / CR) was positively correlated with PFS (p = 0.005) in the localized disease. In 20 pts with metastatic disease, only the local therapy (surgery and / or radiotherapy) significantly improved the PFS and OS while age did not relate to survival. We further examined the optimal timing of local therapy in 53 patients who received local therapy during the induction phase or the maintenance phase. The differences of PFS and OS were not statistically significant among the patients. Conclusions: The age was a negative prognostic factor of PFS in RMS with localized disease. For metastatic disease, local therapy may be effective on survival but the timing of local therapy can be varied depending on pts.
Systemic Mastocytosis with Eosinophilia: A Novel Diagnostic Approach To Distinguish Imatinib-Resistant Kit D816V-Associated Mast Cell Disease from Imatinib-Sensitive FIP1L1/PDGFRA-Associated Hypereosinophilic Syndrome.
Authors: Todd M. Wilson, Irina Maric, Amy D. Klion, Cem Akin, Melody Carter, Weiming Fu, Jennifer Stoddard, Linda Scott, Arnold Kirshenbaum, Michael Fay, Thomas B. Nutman, Pierre Noel, Dean D. Metcalfe, Jamie Robyn
Journal: Blood (2006)
Antecedents of New-Onset Major Depressive Disorder in Children and Adolescents at High Familial Risk
Authors: Frances Rice, Ruth Sellers, Gemma Hammerton, Olga Eyre, Rhys Bevan-Jones, Ajay K. Thapar, Stephan Collishaw, Gordon T. Harold, Anita Thapar
Journal: JAMA Psychiatry (2016)

Early-onset major depressive disorder (MDD) is common in individuals at high familial risk of depression and is associated with poor long-term mental health, social, and educational outcomes.To examine the developmental pathways that lead to first-episode adolescent-onset MDD (incident cases) in those at high familial risk and to postulate a theoretically informed model that enables simultaneous testing of different pathways to incident adolescent-onset MDD composed of contributions from familial/genetic and social risk factors, as well as effects via specific clinical antecedents.This investigation was a 4-year longitudinal study (April 2007 to March 2011) among offspring of depressed parents in the general community. Analyses were conducted between September 1, 2015, and May 27, 2016. Participants were 337 families in whom the index parent (315 mothers and 22 fathers) had experienced at least 2 episodes of MDD (recruited through primary care) and among whom there was a biologically related child in the age range of 9 to 17 years living with the index parent (197 girls and 140 boys with a mean [SD] age of 12.4 [2.0] years) at baseline. Offspring with MDD before the study or at baseline (n = 27), offspring with an episode of MDD that had remitted by follow-up (n = 4), and offspring with missing baseline MDD data (n = 2) were excluded. Ninety-two percent (279 of 304) of families completed the follow-up.The primary outcome was new-onset offspring MDD, and the secondary outcome was the total DSM-IV MDD symptom score.On average, children and adolescents had a mean (SD) of 1.85 (1.74) (range, 0-8.5) DSM-IV symptoms of MDD at follow-up. Twenty (6 males and 14 females) had new-onset MDD, with a mean (SD) age at onset of 14.4 (2.0) years (range, 10-18 years). Irritability (β = 0.12, P = .03) and fear and/or anxiety (β = 0.38, P < .001) were significant independent clinical antecedents of new adolescent-onset MDD, but disruptive behavior (β = -0.08, P = .14) and low mood (β = -0.03, P = .65) were not. The results were similar for the DSM-IV symptom count at follow-up. All the measured familial/genetic and social risk indicators directly influenced risk for new-onset MDD rather than indirectly through acting on dimensional clinical antecedents.There are multiple pathways to first-onset adolescent depression in individuals at familial risk. Irritability and fear/anxiety may be additional clinical phenomena to be included as targets in primary preventive interventions focusing on the child. In addition to targeting these phenomena in parents and children, depression prevention methods in high-risk groups may need to take into consideration social risks, such as poverty and psychosocial adversity.
Maternal deaths from suicide must be tackled, say experts
Authors: Gareth Iacobucci
Journal: BMJ (2016)

Maternal deaths by suicide have remained unchanged since 2003 and are now the leading cause of direct maternal deaths within a year of childbirth, says a report from researchers at the University of Oxford.1

The latest confidential inquiry into maternal deaths from MBRRACE-UK, the national collaborative programme studying maternal and infant deaths, concluded that more must be done to identify “red flag” signs of severe maternal illness that require urgent senior psychiatric assessment.

It said that admission to mother and baby units should always be considered when a woman displays a …
The impact of ethnicity and insurance status on stage of cancer at diagnosis and overall survival of breast cancer.
Authors: M. Omaira, M. Mozayen, R. Mushtaq, K. Katato
Journal: Journal of Clinical Oncology (2011)

154 Background: Major advances in early diagnosis and treatment of breast cancer (BC) have been achieved with significant declines in mortality. However, not all segments of the United States population have experienced equal benefits from this progress. Though ethnic disparities in BC outcome have been attributed to lack of adequate health insurance, the differences in outcome when insurance and socioeconomic status are similar still exist. We elected to examine the effect of insurance status at diagnosis, and whether race is an independent risk of poor outcome in a population from a community-based cancer database. Methods: A retrospective study on BC among patients aged 18 to 64 years were identified, between 1993 and 2005, using data from the Tumor Registry at Hurley Medical Center in Flint, Michigan. Patient’s characteristics included age, race, stage at diagnosis, and primary payer. Insurance status was classified as uninsured/Medicaid, private insurance, and Medicare disability (Medicare under age 65). The 5-year overall survival (OS) was calculated, in respect to patient ethnicity, and compared between the three insurance groups using Fisher’s exact test. Results: A total of 779 patients have been identified with diagnosis of BC. 147 patients were excluded due to incomplete data. 632 patients were analyzed. African Americans were 228 (36%), Caucasians 391 (62%), and other ethnicities 13 (2%). Mean age at diagnosis was (49.21) for African Americans versus (51.35) for Caucasians (p = 0.002). African Americans were more likely to present at advanced stage (III, IV) than Caucasians (17% versus 10%, p = 0.017). However, this difference was not statistically significant when adjusting for insurance status. Although both ethnicities had similar OS in respect of their insurance group, patients with Medicaid/uninsured had significantly lower OS compared to patients with Medicare disability (p = 0.006) and private insurance (p &lt; 0.0001) respectively. Conclusions: Uninsured/Medicaid patients with breast cancer have worse outcome when compared to patients with Medicare or private insurance. Ethnicity is not an independent risk factor of advanced stage at diagnosis and poorer outcome.
Lymphedema and arm symptoms following three-dimensional conformal radiation therapy (3DCRT) for node-positive breast cancer (BC) patients.
Authors: I. Sparks, P. Prior, Q. Xiang, X. A. Li, T. W. Yen, J. R. White
Journal: Journal of Clinical Oncology (2011)

130 Background: Regional nodal irradiation for lymph node (LN) positive BC after lumpectomy/mastectomy can be subject to controversy due to the potential for treatment morbidity particularly lymphedema. Little is known about lymphedema and other arm morbidity rates after 3DCRT approaches. Methods: 172 LN positive BC cases treated from 2000 to 2007 using 3-DCRT and Dose Volume Histogram analyses were studied. All cases underwent axillary node dissection (AND). Axillary target volumes (ATV) were delineated on all treatment planning CT scans. Field arrangement and beam modifications were selected to deliver a min of 45 Gy to 90% of the ATV. Post-treatment bilateral arm circumference measurements (96%) and patient reported ipsilateral arm symptoms (thickness, heaviness, tingling, numbness) were recorded. Results: Median follow-up was 83.7 months. Median (med) patient age was 50. 52% were premenopausal. 76/66% had positive estrogen/progesterone receptors and 16% were HER2+. 52% underwent lumpectomy and 46% mastectomy. Median number of LN removed was 17 (1-46), number +LN was 3 (1-29), and tumor size was 3.7 cm. For 79 patients with separate AND the mean resected axillary volume was 157.8 cc (med 171 cc, range 25-472 ). The mean contoured ATV was 69 cc (med 58cc, range 16-608). On average 95% of the ATV was covered by a med of 44.7 Gy. Local control was achieved in 94.7% regional LN control in 99.4%. 16.7% met criteria for lymphedema (&gt; 2 cm difference in circumference). Arm symptoms were reported by 51 (30%) of these 20 (39%) had measured circumference change &gt; 2 cm. Referral to physical therapy was documented for 15% for reduced ROM but at last follow-up noted in 2.3%. The measured lymphedema rate was higher in patients who had mastectomy – 22 v. 11% (p=0.042) and worse with increasing resected axillary dissection volumes (p=0.032), ATV volume (p=0.883), and RT dose inhomgeneity coefficient (p = 0.049). Conclusions: Measured lymphedema rates following AND and 3-DCRT in this study were similar to those reported for AND in randomized studies compared to sentinel node. Careful attention to 3DCRT methods may help optimize lymphedema rates.
Barriers to chemoprevention of breast cancer with tamoxifen
Authors: D. Rouch, I. Mayer, C. Truica
Journal: Journal of Clinical Oncology (2005)

1010 Background: Tamoxifen (T) is the only drug FDA approved for chemoprevention (CP) of breast cancer (BC). Over two million women in the US may have a net benefit from CP with T. OB/GYN and primary care physicians (PCP) are the most likely physicians to first encounter women at high risk for BC. There are no data on whether these physicians’ communicate a woman’s objective risk of BC and discuss CP with those at high risk. The goal of this study was to ascertain if OB/GYN and PCP discuss CP with women they determine to be at high risk for BC, and if they prescibe T for these women. Methods: Data were obtained via a survey sent to 152 PCP (internal medicine, medicine/pediatrics, family practice) and 101 OB/GYN physicians selected from the Nashville, TN phonebook. Information was collected about respondents’ demographics, use of an objective tool to quantify BC risk, practice style regarding discussing CP with T, reasons they may not discuss CP, and if they prescribe T for high risk patients. The survey also contained two clinical vignettes regarding women at high risk for breast cancer. The responses were tallied and analyzed using decriptive statistics, and Chi sqare was used to compare responses between PCP and OB/GYN. Results: Sixty-three surveys were returned for a total response rate of 25%. 27/101(27%) were OB/GYN, and 36/152 (24%) were PCP. The responses to key questions are summarized in the table below. 17/36 (47%) of PCP vs 19/27 (70%) of OB/GYN were familiar with the STAR trial (p=.066), while 10/36(28%) of PCP and 9/27 (33%) of OB/GYN referred patients to CP studies. Conclusions: CP of BC with T is a complex topic. While OB/GYN are more likely than PCP to objectively quantify a woman’s risk for BC and discuss CP with patients, neither group is likely to prescribe T for CP. Many women who are eligible for CP or referral to CP trials may not have these options prestented to them. Efforts at patient education, either by physicans or patient decision aids, need to be explored. No significant financial relationships to disclose.