tbuckley/cabot-search huggingface dataset:
Evaluating survivorship cancer care through quality improvement programs.
Authors: Guadalupe R. Palos, Fran Zandstra, Ludivine Russell, Jacklyn J. Flores, Katherine R. Gilmore, Maria Alma Rodriguez
Journal: Journal of Clinical Oncology (2012)

112 Background: The Institute of Medicine noted cancer survivors’ care may be improved by providing each with a cancer survivorship care plan (CSCP). Recently, numerous versions of CSCPs have emerged; however, evidence-based processes to evaluate their use and quality in providing personalized survivorship care have yet to be implemented. Here, we describe our efforts to use the approach recommended by the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) to track and report the compliance rate for using electronic CSCPs in our survivorship clinics. Methods: The criteria used to conduct our audit evolved from the QOPI template, which included selection of survivors seen in 7 different out-patient survivorship clinics within a specific 6-month period, identification of denominators and numerators unique to each clinic, and determination of the number of records to audit based on the number of full-time providers in each clinic. Next, we established the target condition, method(s) used for data collection, appropriate measures, and other criteria used in the QOPI. All data were obtained from our CSCPs’ mined data, institutional electronic medical records, and scheduling systems. Results: From December 1, 2011, to May 31, 2012, we conducted an electronic medical records audit to determine the compliance rate for issuing survivorship care plans in 7 clinics. The survivorship clinics included breast, colorectal, endocrine (thyroid), genitourinary, gynecology, head/neck, and melanoma. A total of 3,274 electronic medical records were reviewed. 40 providers issued a total of 2,761 electronic CSCPs within 30 days of the arrived appointment. The compliance rate per clinic ranged from 64.5% to 94.7% (X=84.5%). Conclusions: We found the QOPI process to be user-friendly and applicable to our compliance monitoring effort. All data were extracted from electronic tools, thus ensuring the processes used were reliable, reproducible, and reasonably consistent across clinics. Further examination is warranted to determine characteristics of clinics with high- vs. low-compliance rates and their impact on survivors’ outcomes as related to specific CSCP recommendations.
Renal nephrometry score and predictors of complications in partial nephrectomies.
Authors: Deepak K. Pruthi, Darrel E Drachenberg, Thomas B McGregor
Journal: Journal of Clinical Oncology (2014)

512 Background: Feasibility of partial nephrectomy for small renal masses extends beyond standard clinical tumor size. We analyze patient characteristics and anatomic tumor factors to determine variables associated with surgical complications after partial nephrectomy. Methods: Retrospective review of all patients who underwent partial nephrectomy at our institution between January 1, 2012 and Aug 31, 2013. Follow-up extended to 8 week post-operative outpatient clinic visit. The R.E.N.AL. Nephrometry score is a tumor descriptive (the maximum radius, exophytic/endophytic, nearness to collecting system/sinus, anterior/posterior position, location relative to polar line) that was applied to each pre-operative scan. Standardized grading systems and statistical analysis were applied. Results: Of the 83 patients who underwent partial nephrectomy 72 had a laparoscopic approach. Seventeen (20%) patients had complications and seven were Clavien-Dindo grade 3 to 4. Two patients had laparoscopic partial nephrectomies converted intra-operatively to radical nephrectomies; two other laparoscopic partial nephrectomies were converted to open partial nephrectomies. Forty-three (52%) of operated patients were either obese, morbidly obese, or super obese. Fifteen (18%) of patients had pathologic oncocytomas or angiomyelipomas. In univariate analysis Charlson comorbidity score (&gt;6 p=0.0027), diabetes (42% p=0.0195), age (&gt;70 p=0.02034), and total R.E.N.A.L. Nephrometry score (10-12, 67%, p=0.0254) were associated with complications. Nephrometry score also correlated with warm ischemic time (WIT) in laparoscopic cases (low 26 min [SD +/- 11.71], intermediate 31 min [SD +/- 7], high 34 min [SD +/- 14]). Conclusions: Categorizing renal masses according to the R.E.N.A.L. Nephrometry score may help us council patients towards expected WITs, complication rates, and predicted renal function outcomes. This is increasingly important as the majority of our patients are either obese, elderly, or have significant comorbidities; all of which have been shown to be associated with increased complication rates.
Efficacy of prophylactic minocycline treatment for skin toxicities induced by erlotinib plus gemcitabine in advanced pancreatic cancer patients.
Authors: Akira Shinohara, Hiroyuki Okuyama, Akiko Kuwahara, Misaki Kobayashi, Hideaki Takahashi, Izumi Ohno, Satoshi Shimizu, Shuichi Mitsunaga, Shinichiro Saitoh, Masafumi Ikeda
Journal: Journal of Clinical Oncology (2014)

266 Background: Erlotinib has been reported to be associated with a high incidence of skin toxicities, such as acneiform rash, paronychia and xerosis. The aim of this study was to evaluate the efficacy of prophylactic minocycline treatment for the skin toxicities induced by erlotinib, as compared to deferred minocycline treatment. Methods: The study subjects were patients with advanced pancreatic cancer receiving treatment with erlotinib plus gemcitabine. In the prophylactic minocycline group, oral minocycline was administered at the dose of 200 mg/daily during the chemotherapy prior to the emergence of any skin toxicities, while in the deferred minocycline group, oral minocycline treatment at 200mg/daily was initiated after the emergence of grade 2-3 of skin toxicities. In both groups, heparinoids were administered during the chemotherapy and topical steroid therapy was initiated after the emergence of the skin toxicities. Results: A total of 96 patients were enrolled, of which 44 received prophylactic minocycline treatment and 52 received deferred minocycline treatment. The incidence rate of acneiform rash and xerosis of any grade during the first 6 weeks of chemotherapy was significantly reduced in the prophylactic minocycline treatment group as compared with that in the deferred minocycline treatment group (47.7% vs. 80.8%; p&lt;0.001; 2.3% vs. 19.2%; p=0.01); on the other hand, no significant difference in the incidence rate of paronychia of any grade was observed between the two groups. Univariate and multivariate analyses identified prophylactic minocycline treatment and female gender as significant independent factors associated with the incidence of acneiform rash of any grade (odds ratio [OR], 0.20; 95%CI, 0.08 to 0.49; p&lt;0.001; OR, 0.30; 95% CI, 0.11 to 0.87; p=0.03). Conclusions: Prophylactic minocycline treatment significantly reduced the incidence of acneiform rash and xerosis, but not that of paronychia, induced by erlotinib in advanced pancreatic cancer patients. Prophylactic minocycline treatment is recommended for the management of erlotinib-related acneiform rash and xerosis.
Systemic therapy for advanced appendiceal adenocarcinoma: An analysis from the National Comprehensive Cancer Network (NCCN) database.
Authors: Mohamedtaki Abdulaziz Tejani, Anna ter Veer, Dana Milne, Rebecca Ottsesen, Tanios S. Bekaii-Saab, Al Bowen Benson, Deborah Schrag, Stephen Shibata, John Michael Skibber, Martin R. Weiser, Neal W. Wilkinson, Steven J. Cohen
Journal: Journal of Clinical Oncology (2012)

562 Background: Appendiceal neoplasms are rare and represent 1% of intestinal tumors in the United States. The role and efficacy of modern systemic therapy in advanced appendiceal adenocarcinoma has not been established. Methods: Patients with recurrent or metastatic appendiceal adenocarcinoma in the NCCN Colorectal Database (2005-2010) were analyzed. Study objectives were to describe and evaluate the efficacy of systemic therapy and investigate relationships with clinicopathologic features. Cox regression analysis was performed to identify predictors of PFS and OS. The hazard ratio and 95% CI from Cox models and median PFS and OS from Kaplan-Meier curves were reported. Results: Of 177 patients with advanced appendiceal carcinoma, 81 (46%) received systemic therapy for measurable disease and are the focus of this report (patients undergoing IP chemotherapy excluded). Patient/tumor characteristics: median age 50 (range 20-82), ECOG PS 0/1 (67%/22%), mucinous/non-mucinous (44 %/ 51%), 91% peritoneal and 15% liver metastases. 70% of patients had primary surgical debulking. Common chemotherapy regimens included FOLFOX with or without bevacizumab (n=30 and n=28), FOLFIRI (n=11), and single-agent fluoropyrimidine (n=7). Among 70 patients with a recorded best response, the response rate (RR) was 46% with 31% stable disease. Median PFS was 1.0 year (95% CI: 0.7-1.9) and OS was 2.1 years (95% CI: 1.7-2.6). Patients with non-mucinous histology, high grade tumors and non-debulking surgery had worse PFS and OS (Table). Conclusions: Treatment of advanced appendiceal adenocarcinoma at NCCN centers commonly incorporates agents utilized for colorectal cancer. RR, PFS and OS are comparable to those achieved in the treatment of metastatic CRC and support routine use of these regimens in clinical practice. Poor prognostic factors include non-mucinous histology, high grade and not undergoing debulking surgery. [Table: see text]
An analysis of vitamin D (Vit D) and serum estrogens in postmenopausal (PM) breast cancer (BC) patients receiving aromatase inhibitors (AIs).
Authors: D. W. Cescon, M. Ennis, P. A. Ganz, S. Beddows, F. Z. Stanczyk, S. S. Sridhar, P. J. Goodwin
Journal: Journal of Clinical Oncology (2011)

596 Background: Vit D supplementation is common in BC. Given reports that Vit D modulates aromatase activity, we examined the relationship between Vit D and estrogen levels in PM BC. Methods: 125 PM women within 2 years of diagnosis of T1-3, N0-3, M0 BC were recruited in Toronto and Los Angeles between Mar 2009 and Jan 2010. Data included: anthropometrics (measured); medications and Vit D supplementation (structured interview); and tumor/treatment variables (clinical records). Serum was analyzed for 25(OH)D by radioimmunoassay (RIA) and estradiol (E2) and estrone (E1) by extraction-column chromatography-RIA. Statistical analyses used t-tests, Pearson correlation (r) and regression models after suitable transformation of variables. Results: Hormone therapies included AIs (n=56), tamoxifen (n=30) and none (n=39). The tamoxifen and no hormone groups did not differ for important variables, and were combined (non-AI, n=69). Mean age was 62 years, BMI 27 kg/m2, Vit D supplementation 1244 IU/day, 25(OH)D 98 nmol/L; these attributes were similar in AI users and non-users. Mean E2 and E1 levels (pmol/L) were significantly lower in AI users (19.9 and 26.2) than non-users (39.6 and 123.7), both p<0.0001. The relationship between 25(OH)D and E2 differed qualitatively in AI users vs non-users (interaction p = 0.002): in AI users, 25(OH)D was positively correlated with E2 (r = + 0.31, p=0.02); in non-AI users this correlation was negative (r = − 0.26, p=0.03). 25(OH)D was not associated with E1 in either group. BMI was not associated with either E1 or E2 in AI-users (r = +0.09, p=0.52; r = − 0.03, p=0.84), but was univariably associated with E1 but not E2 in non-AI users (r = +0.44, p=0.0001, and r = +0.22, p=0.07). In multivariable analyses [age, BMI, 25(OH)D], 25(OH)D was positively associated with E2 in AI users (p=0.04) and negatively in non-AI users (p=0.05). BMI was associated with E1 in non-AI users (p=0.002). Measurement of AI levels is underway. Conclusions: In PM BC survivors, serum 25(OH)D was associated with higher E2 among AI users but not non-AI users. If replicated, this finding has implications for BC survivors receiving AIs. Funded by the Breast Cancer Research Foundation.
Genomic landscape of pancreatic adenocarcinoma: Does age matter?
Authors: Irit Ben-Aharon, Moshe Elkabets, Raphael Pelossof, Kenneth H. Yu, Peter J. Allen, Christine A Iacobuzio-Donahue, Steven D. Leach, Maeve Aine Lowery, Karyn A. Goodman, Eileen Mary O'Reilly
Journal: Journal of Clinical Oncology (2016)

250 Background: State-of the art genomic analyses of pancreatic adenocarcinoma (PDAC) has yielded insights into signaling pathways underlying carcinogenesis. PDAC is characterized by substantial genomic heterogeneity. We aimed to determine if early-onset PDAC ( ≤ 55 yrs) displays a distinctive molecular landscape from average-age onset PDAC ( ≥ 70 yrs). Methods: Three distinct datasets of PDAC in age groups ≤ 55 and ≥ 70 years old were analyzed. In the first, patients undergoing treatment at MSKCC were consented for MSK-IMPACT (Integrated Mutation Profiling of Actionable Cancer Targets) next generation sequencing. The second cohort analyzed was The Cancer Genome Atlas (TCGA) dataset for differences in somatic mutations, gene expression and protein expression. The third dataset was the Australian cohort of PDAC (Waddell et al, Nature, 2015). Clinical data were correlated with genomic analyses. Results: One hundred and eighty-three samples were analyzed, yielding N = 56 patients (pts) aged ≤ 55 years and N = 127 pts aged ≥ 70 years. Several genes known to be associated with carcinogenesis differed in mutation frequency across age groups: SMAD4, MYC and PIK3CA displayed higher mutation rates in younger patients (p &lt; 0.05, table below). Comprehensive analysis by cellular pathways indicated that the PI3Kpathway is further altered in the younger population. Protein expression had different patterns in younger versus older patients. Smoking was more prevalent in the early-onset group in all three cohorts (59% vs. 47%). Survival outcomes revealed no differences between the age groups. Conclusions: This exploratory analysis suggests that there may be somatic gene alterations within the population of early onset PDAC patients that involve unique cellular pathways compared with average onset PDAC. Former studies imply these cellular pathways may play a role in smoking-related PDAC carcinogenesis. Larger genomic datasets are warranted for future analysis to support this observation. [Table: see text]
Ductal carcinoma in situ (DCIS) of the breast in Israeli women treated by radiation therapy following breast-conserving surgery
Authors: I. Jiveliouk, B. Corn, M. J. Inbar, O. Merimsky
Journal: Journal of Clinical Oncology (2008)

11564 Background: Lumpectomy followed by radiation therapy (RT) has become an accepted local management strategy for patients with small, mammographically detected ductal carcinoma in situ (DCIS) of the breast. The aim of this analysis is to describe control rates and patterns of relapse in a cohort of Israeli women with mammographically detected DCIS treated at a single medical center. Methods: The files of 107 consecutive patients with DCIS were retrieved from the cancer registry of the unit of radiation therapy. All women underwent lumpectomy followed by definitive RT, administered in conventional dose-fractionation regimens. Results: Within a median follow-up time of 52 months no local recurrence of any breast tumor was found. There was no correlation between event free survival and tumor size, focality, grading, hormone receptor status, administration of adjuvant hormonal therapy, timing of RT, and RT boost delivery. The 8-year overall survival, disease-free survival, and event-free survival were 100%, 92%, and 87%, respectively. Conclusions: The results reported herein are consistent with short-term and intermediate-term outcomes that are better than the reported benchmarks from prospective randomized trials. Although this could reflect selection factors at a single institution it is also plausible that a genetically distinct disease is present in this local population. No significant financial relationships to disclose.
Timeliness of care delivery for lung cancer patients in a vertically integrated health care system.
Authors: Robert Michael Cooper, Erin Elizabeth Hahn
Journal: Journal of Clinical Oncology (2016)

127 Background: A Kaiser Permanente Southern California (KPSC) organizational goal is to achieve optimal timeliness of cancer care delivery. The purpose of this report is to present a process used for a multi-disciplinary physician led performance improvement exercise at the at the Los Angeles Medical Center and share initial learnings. Methods: A CME approved Performance Improvement (PI) program to examine timeliness of care delivery for newly diagnosed patients with lung cancer was created for physicians. The multi-disciplinary core group met for 6 three hour blocks of time to process map the patient centered flow. The physicians evaluated current practice, developed a future state and made structural changes. The group focused on two time intervals: time from suspicion of malignancy until pathology resulted, and time from pathology until the start of treatment. Results: Initial learnings included, that the work was meaningful as shown by physicians using their dedicated education time and consistency of participation; an electronic medical record was useful for the initial process mapping and ongoing monitoring; patient flow is complex and patients followed many different paths to diagnosis and treatment. Participating in this project benefitted team building, improved understanding of the challenges throughout the system, enhanced empathy for their colleagues and patients, and educated physicians about performance improvement methodology. Preliminary review of timeliness of care delivery shows improvements in timeliness at the two time points both during the year of instituting a PI program and with the first interventions. Conclusions: A physician led multi-disciplinary approach to review of timeliness of care delivery is feasible and productive.
Partnering to build a statewide cancer disparities program.
Authors: Betty C. Murray, Lucinda H. Hogarty, Devon Latney, Andrew L. Salner
Journal: Journal of Clinical Oncology (2013)

216 Background: People of color die from cancer in disproportionately higher rates than Caucasians. As an NCI Community Cancer Centers Program (NCCCP) network member, we utilized American Recovery and Reinvestment Act (ARRA) funding to develop a unique partnership. Hartford Hospital’s Helen and Harry Gray Cancer Center (GCC) has worked closely with our statewide comprehensive cancer control coalition, the Connecticut Cancer Partnership (CCP), to address racial and ethnic health disparities across the state of Connecticut. Methods: We provided a Disparities Project Coordinator (DPC) to work for the CCP as a loaned executive. In this role, the DPC leveraged GCC resources, shared best practices, convened and coordinated statewide activities, and provided oversight for statewide implementation of evidence-based disparities- related cancer projects. This project has been funded in whole or in part with Federal Funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. Results: The DPC worked within the CCP structure to inform decision-making, initiate educational activities, and spearhead innovative projects such as a disparities internship with local universities and the evidence-based Body and Soul program in churches. Beyond CCP integration, the DPC represents CCP and the GCC on key statewide bodies to influence and inform policy affecting racial and ethnic minorities. Conclusions: This unique partnership is an example of a successful private-public partnership that has resulted in increased minority involvement in the state coalition and creation of multiple key partnerships with private, non-profit and state agencies. The accomplishments of the DPC have resulted in sustainability for this position and the establishment of an effective partnership model to address cancer disparities in the state.
Increasing the interval between neoadjuvant chemoradiotherapy and surgery in esophageal cancer: A meta-analysis of published studies.
Authors: Gang Lin, Shuiyun Han, Weimin Mao, Yaping Xu
Journal: Journal of Clinical Oncology (2015)

e15044 Background: Neoadjuvant chemordiotherapy followed by surgery was the most common approach for patients with resectable esophageal cancer. Operation was performed within 2 to 8 weeks after nCRT were completed. The aim of this meta-analysis was to clarify whether a longer interval between the end of neoadjuvant chemoradiotherapy (nCRT) and surgery was associated with a better overall survival in esophageal cancer. Methods: We performed a systematic literature search in MEDLINE, EMBASE, Cochrane Central Register of Contralled Trials (CENTRAL/CCTR), Clinical Trials from January 2000 to December 2014. Eligible studies were prospective or retrospective studies of esophageal cancer that assessed the effects of intervals longer or shorter than 7 to 8 weeks between the end of nCRT and surgery. The primary endpoint was the overall survival (OS) and pathologic complete response (pCR). Secondary endpoints were anastomotic leak, R0 resection and postoperative mortality rate. A meta-analysis was performed to estimate odds ratios (ORs) , using the fixed- or random-effects model, with review manager 5.2. Results: Five studies met the eligibility requirements, including 1016 patients, with 520 in the shorter interval group (≦7~8 weeks) and 496 in the longer interval group (＞7～8 weeks). The results of our meta-analysis showed that the longer interval between nCRT and surgery may be at a disadvantage in 2-year overall survival (OR = 1.40 ,95% CI: 1.09–1.80, P = 0.010) and R0 resection rate (OR = 1.71, 95%CI:1.14-2.22, P = 0.009 ). The pCR, anastomotic leak rate and postoperative morbidity were similar in the two groups. Conclusions: A longer waiting interval (more than the classical 6–8 weeks) from the end of preoperative CRT is not an increases the rate of pCR in esophageal cancer, with similar anastomotic leak rate and postoperative mortality rates. However, the longer interval between nCRT and surgery may be at a disadvantage in the long-term overall survival, thus it may be reasonable to perform surgery for patients at the esrliest opportunity after adequate recovery form nCRT, especially, who have clinical pCR. These results should be validated prospectively in a randomized trial.