tbuckley/cabot-search huggingface dataset:
Rethinking the Harvard scale of breast cosmesis: An analysis of patients treated with breast-conserving therapy on a phase II clinical trial.
Authors: Allison M. Hunter, Anthony E. Dragun
Journal: Journal of Clinical Oncology (2013)

88 Background: The Harvard Scale of cosmetic outcome is frequently used to assess quality of life (QOL) outcomes and late toxicity in patients who have undergone breast conservation treatment. Our purpose is to evaluate its objectivity and reproducibility in the modern era of digital photography in a prospective phase II protocol. Methods: This assessment included at total of 68 digital photographs taken atfourpredetermined post-lumpectomy time points for seventeen (17) patients enrolled on a phase II protocol of once-weekly hypofractionated whole-breast radiotherapy for early stage breast cancer. Each time point assessment was completed by the principal investigator (PI) using the four-tier Harvard Scale (Excellent, Good, Fair, Poor) to compare the treated breast to the control breast. A computer-based survey including the same de-identified images was then distributed to forty-four (44) medical students and residents to determine congruence with the assessment of the PI. Results: Of the 44 respondents, there was equal distribution between male (23) and female (21), with the majority of whom were single (82%), Caucasian (70%), and less than twenty-nine (29) years of age (89%). The respondent assessment of cosmetic outcome differed somewhat from the PI averages: Excellent (43% vs. 27%), Good (34% vs. 34%), Fair (20% vs. 28%) and Poor (3% vs. 11%). PI-respondent congruence for the same four categories was 49%, 37%, 44%, and 86%, respectively. Combining the categories into a bimodal representation of Excellent/Good (70%) and Fair/Poor (72%), produced significantly better congruence (70% and 72%, respectively). Conclusions: Pysician-assessed cosmetic outcome using the traditional four-point Harvard Scale is highly variable and influenced by evaluator factors. A two point scale increases congruence among evaluators and may be a more reproducible and pragmatic approach for results reporting in cosmesis studies.
Endoscopic transduodenal cholecystolithotomy and cholecystolithotripsy
Authors: Guoxin Wang, Xiang Liu, Sheng Wang, Nan Ge, Jintao Guo, Siyu Sun
Journal: Endoscopy (2017)

Laparoscopic cholecystectomy is generally accepted as the gold standard treatment for symptomatic gallstones [1] [2]. For patients who are not suitable operative candidates, endoscopic ultrasound (EUS)-guided cholecystoduodenostomy or cholecystogastrostomy can be performed using a double-flanged, fully covered, metal stent as a bridge to further transduodenal or transgastric cholecystolithotomy [3] [4]. Given that the diameter of the stent is limited, it was previously believed that only gallstones of less than 1 cm in diameter should be removed by this novel technique. Here, we report a patient with a symptomatic gallstone larger than 1 cm who successfully underwent endoscopic transduodenal cholecystolithotripsy via a double-flanged, fully covered, metal stent.
Investigating rates of CINV across settings of care in Medicare: A retrospective claims-based analysis.
Authors: Barnabie C Agatep, Claudio Faria, Russell L. Knoth, Richard H. Chapman, Timothy J Inocencio, Michael Johnsrud, Annette Powers
Journal: Journal of Clinical Oncology (2014)

297 Background: Clinical practice may differ according to settings of care and may impact both the quality of care delivered and, ultimately, patient outcomes. This study describes the differences in chemotherapy-induced nausea and vomiting (CINV) rates between chemotherapy (CT) naïve Medicare cancer patients starting CT in a hospital outpatient (HOP) or community outpatient (COP) setting. Methods: Using the 5% Medicare Fee-for-Service standard analytic files, patients with a new claim of CT and ≥1 outpatient cancer diagnosis claim between 1/1/10 – 6/30/11 were identified. Patients with a previous inpatient cancer diagnosis, multi-day CT cycles or who switched CT relevant to emetogenic potential were excluded. CINV was defined using relevant claims-based ICD-9-CM diagnosis and procedure codes within days 2-7 of the first 8 single-day CT cycles or the first 6 months following the index CT claim. CINV events were evaluated descriptively and using regression models. Results: Medicare patients receiving CT in HOP (n=1,007) vs. COP (n=1,080) were similar in demographics such as age, race, and baseline healthcare costs. However, Medicare patients receiving CT in COP compared to those in HOP settings were more likely to be female (57.0% vs. 44.7%), breast cancer patients (27.6% vs. 16.0%), live in the South region (37.7% vs. 32.3%), have higher Charlson Comorbidity Index scores (mean 5.2 vs. 4.8) and receive moderately to highly emetogenic CT (44.1% vs. 36.0%) (all p&lt;0.05). Overall, 13.9% had any CINV in the evaluation period. More CINV events per patient were reported among those in COP compared to those in HOP settings (0.43 vs 0.27, p &lt;0.05). However, differences between settings of care were not shown to be significantly different in adjusted regression analyses (p=0.177). Conclusions: We found the population characteristics between Medicare patients treated with CT in HOP and COP to vary on a number of factors. However, after controlling for these differences, our results suggest the number of CINV events was similar across settings of care. Future research should further clarify how differences in quality of care for antiemesis between COP and HOP settings may impact the incidence of CINV events in this population.
The University of Pittsburgh CancerCenter Primary Care Provider Workforce Integration Initiative: An institutional model—Design, process, status, and implications.
Authors: G J. Van Londen, Jill Weiskopf Brufsky, Ira Russell Parker
Journal: Journal of Clinical Oncology (2016)

41 Background: Due to increasing numbers of individuals diagnosed with cancer, a burgeoning cohort of cancer survivors with significant medical co-morbidities, and oncology workforce “supply-demand” challenges, the optimal integration of Primary Care Providers (PCPs) into the comprehensive cancer care paradigm is of timely importance. The objective is to describe those specific planning and implementation issues impacting the establishment of a cancer care delivery model targeting the interface between Oncology and Primary Care. Methods: The University of Pittsburgh CancerCenter PCP Workforce Integration Initiative received authorization to proceed in December of 2014. Immediate actions were then undertaken: 1) Establishment of an “Advisory/Working Group” [Fifteen stakeholders representing the interests of Oncology, Patient Advocacy, Nursing, Primary Care (Family Medicine, Geriatric Medicine, Internal Medicine, and Gynecology); Administration, Information Technology, and Research]; 2) Conduct of focus groups and individual, fact-finding conversations; 3) Programmatic planning of a “pilot” intervention; and 4) Planning of a full-day, continuing medical/nursing education symposium focusing upon the specific training and empowerment needs of PCPs with regard to their evolving roles in the comprehensive cancer care paradigm (November/2015). Results: Focus groups demonstrated an overall acknowledgement of the importance of the issue and a willingness to participate. Specific identification of those unique provider roles and competencies necessary to address a patient’s individual “survivorship” risk profile and the development of a system to best enhance communication and information exchange among the providers and patients were made evident. The results of a survey (knowledge, attitudes, beliefs, and practices) conducted to the attendees of the Symposium will be discussed. Conclusions: To best optimize the interface between Oncologists and PCPs with regard to best practices cancer care, well-planned competency training and “system development” will be necessary.
Validation of a claims-based predicted performance status measure in SEER-Medicare.
Authors: F. Hendrick, I. H. Zuckerman, N. B. Pandya, X. Ke, M. J. Edelman, A. J. Davidoff
Journal: Journal of Clinical Oncology (2011)

6085 Background: Observational studies analyzing cancer treatment and outcomes in datasets such as Surveillance, Epidemiology and End Results (SEER)-Medicare are unable to capture performance status (PS), a key determinant of treatment. In prior work we developed a multivariate regression model to predict poor PS (ECOG 3-4 versus 0-2) as a function of claims-based service use indicators. We report on initial predictive validation of our model by examining chemotherapy treatment in a cohort of metastatic breast cancer (MBC) patients. Methods: 1,519 female estrogen receptor negative MBC patients aged ≥66 were identified in 1999-2005 SEER registry data linked to Medicare Part A and B claims. We generated the predicted probability of poor PS (PredPS) by creating the set of service use indicators from Medicare Part B claims one year before diagnosis and applying coefficients from the prediction model. We examined the relationship of PredPS to age, race, socioeconomic status, and the Charlson Comorbidity Index (CCI). We also included PredPS as either a discrete (Good/ Poor) or continuous variable in multivariate logistic regressions to predict receipt of chemotherapy within 6 months following diagnosis, obtained from Medicare claims. Results: 258 (17%) had poor PredPS; 494 women (33%) received chemotherapy. Poor PredPS patients were less likely to receive chemotherapy (17% versus 36%; p<0.01); poor PredPS was more prevalent among non whites (31% versus 14% for whites; p<0.01), and the oldest (29% among 85+ versus 14% among patients aged 66-74 years). After adjusting for sociodemographics and CCI, MBC women with poor PredPS were 56% less likely to receive chemotherapy (OR 0.44, 95% CI 0.25, 0.77). Models with continuous PredPS showed that a 1% increase in poor predPS resulted in a 3% decrease in odds of receiving chemotherapy (OR 0.97, 95% CI 0.96, 0.99). Results were similar with alternative PredPS developed from models that included interactions with region and with Medicaid enrollment. Conclusions: A predicted PS measure derived from Medicare claims was associated with receipt of chemotherapy and this effect appears to be independent of sociodemographics and CCI. Ongoing analyses will validate predPS in cancer survival models.
Ex Vivo Modulation of Donor Cells Results in Enhanced Survival and Reduced Gvhd Mortality
Authors: Lisa Guerrettaz, Newsha Sahaf, Leah Mitchell, Chris Lynn, Sarah Raynel, Thuy Le, Heater Foster, Chris Truong, Betsy Rezner, David Robbins, Wendy J. Levin, Daniel Shoemaker
Journal: Blood (2015)
Developing and evaluating composite measures of cancer care quality.
Authors: Cleo A Samuel, Mary Beth Landrum, Alan M Zaslavsky, Karl A. Lorenz, Nancy Lynn Keating
Journal: Journal of Clinical Oncology (2014)

187 Background: Composite measures are useful for distilling quality data into summary scores; yet, there has been limited use of composite measures for cancer care quality measurement. We compared multiple approaches for generating composite measures of cancer care quality and evaluated how well composite measures summarize dimensions of cancer care and predict survival. Methods: We computed hospital-level rates for 13 colorectal, lung, and prostate cancer process measures for care delivered in 59 Veterans Affairs (VA) hospitals between 2001-2004. We generated 3 sets of composite measures: 3 cancer-specific composites (colorectal, lung, prostate), 3 care-modality-specific composites (diagnosis, surgery, non-surgical treatment), and 4 empirical-factor domain composites based on an exploratory factor analysis. We assessed correlations among all composite measures and estimated separate Cox proportional hazards models predicting all-cause survival for colon, rectal, non-small cell lung, and small cell lung cancers as a function of composite scores, controlling for patient clinical and demographic characteristics. Results: Four factors emerged from the factor analysis and accounted for 68.7% of the total variation in the cancer care measures. The factor domains included a combination of cancer-specific factors for "colorectal early diagnosis" and "prostate treatment" and care-modality-specific factors for "surgical treatment" and "non-surgical treatment.” We observed strong correlations (r) among composite measures comprised of similar process measures (r=.58 to 1.00, p&lt;.0001), but not among composite measures reflecting different care dimensions. Across the different approaches, few composite measures were associated with survival. Conclusions: Each of the composite measure approaches examined reflected different aspects of cancer care quality, with the empirical-factor domains reflecting a combination of cancer-specific and modality-specific care domains. However, there was little evidence pointing to a single best approach for cancer care composite measurement. Weak associations across different care domains suggest that low- and high-quality cancer care delivery may coexist within VA hospitals.
Expression of MICA by Granulocytes in Neutropenia Due to Large Granular Lymphocyte Leukemia Points towards Cytotoxicity Exerted Via NKG2D on Clonal Cytotoxic T Cells.
Authors: Aaron D. Viny, Michael Clemente, Monika Jasek, Courtney Prince, Jaroslaw P. Maciejewski
Journal: Blood (2008)
Circulating tumor cells fluctuations in colorectal cancer patients.
Authors: D. Ernst, A. de Albuquerque, I. Kubisch, J. Boese-Landgraf, S. Kaul, N. Fersis
Journal: Journal of Clinical Oncology (2011)

e14042 Background: The role of circulating tumor cells (CTCs) in peripheral blood of cancer patients as an indicator of tumor recurrence has not been clearly established. This study aims to evaluate the use a multimarker panel for detection and characterization of CTCs in colorectal cancer patients and its utility in predicting clinical outcome. Methods: CTCs were isolated with immunomagnetic separation in a training set of 430 peripheral blood samples from 103 colorectal cancer patients, using the high affinity antibodies BM7 (MUC1) and VU1D9 (EpCAM) and subsequently analyzed by RT-qPCR for the expression of CK19, MUC1, EpCAM, CEA and Survivin. Results: Overall positivity of the training set was 55.9% while specificity was 100%. Positivity rates for each individual marker were as follows: 19.5% for CK19, 24.7% for MUC1, 28.1% for EpCAM, 17.9% for CEA and 17.8% for Survivin. Detection of CTCs in patients before starting therapy could not be associated with disease free survival (median PFS; 195.9 v 207.3 days in patients with positive CTCs detection and negative CTCs detection, respectively; P = 0.619). Follow-up of these patients has shown that in some cases CTCs can be present at a constant level with patients presenting stable disease, while an increase in CTCs during therapy was often indicator of disease progression. Conclusions: Our results indicate that the detection of CTCs before therapy could not predict the clinical outcome in colorectal patients. We hypothesise that it is rather the fluctuations of CTC-levels during the course of therapy and the individual phenotypic pattern of CTCs that might prove helpful as an independent predictor of disease free survival. To verify this hypothesis further research is required.
The role of surgical management of locally recurrent rectal cancer(LRRC)
Authors: M. Yasui, M. Ikeda, Y. Fujie, T. Shingai, T. Hata, I. Takemasa, H. Yamamoto, M. Ikenaga, M. Ohue, M. Sekimoto, M. Monden
Journal: Journal of Clinical Oncology (2005)

3712
Racial/ethnic differences in use of surgery and adjuvant chemotherapy for nonmetastatic colon cancer: Where's the rub?
Authors: J. Yang, P. Mauldin, M. Ebeling, T. Hulsey, M. B. Thomas, N. F. Esnaola
Journal: Journal of Clinical Oncology (2011)

529 Background: Disparities in receipt of recommended medical therapy for colon cancer have been reported. The objective of this study was to determine the independent effect of black race and Hispanic ethnicity on use of surgery/adjuvant therapy in patients (pts) with nonmetastatic colon cancer, controlling for surgical/medical oncology consultation Methods: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified 26,946 pts aged 66 and older with resected stage I-III colon cancer diagnosed between 1999-2004. Surgical/medical oncology consultation and receipt of chemotherapy were ascertained from Medicare claims. The relationships between patient/tumor characteristics, surgical/medical oncology consultation, and use of surgery/adjuvant therapy were analyzed using chi square tests. Odds ratios (OR) of receipt of surgery/chemotherapy were calculated using logistic regression analysis. Results: We identified 23,834 white, 2,022 black, and 1,090 Hispanic pts with stage I (7,088 pts), stage II (9,510 pts), and stage III (7,236 pts) colon cancer. Blacks and Hispanics were more likely to be younger, less educated, of lower income, and have greater comorbidity compared to whites. Rates of surgical resection were lower among blacks than Hispanics (86.6% vs. 88.8% vs. 92.0% in whites, all p &lt; 0.001). Blacks with stage III colon cancer (but not Hispanics) were also less likely to receive adjuvant chemotherapy (48.2% vs. 54.7% in whites, p &lt; 0.001). After controlling for socioeconomic status, comorbidity, and surgical/medical oncology consultation, black race (but not Hispanic ethnicity) was independently associated with underuse of surgery (adjusted OR, 0.68; 95% confidence interval [CI], 0.51-0.89) and adjuvant chemotherapy (adjusted OR, 0.71; 95% CI, 0.60-0.85). Conclusions: Black race, but not Hispanic ethnicity, is a powerful, independent predictor of underuse of surgery and adjuvant chemotherapy in pts with nonmetastatic colon cancer. Qualitative studies are needed to determine whether patient misperceptions about colon cancer surgery/chemotherapy or suboptimal physician-patient interactions may underlie these observations. No significant financial relationships to disclose.
In vitro comparative efficacy of ON01910.Na and cisplatin with radiation on cervical carcinoma cells
Authors: L. Agoni, I. Basu, A. Danish, E. P. Reddy, A. Alfieri, C. Guha, G. L. Goldberg
Journal: Journal of Clinical Oncology (2008)

16565 Background: A synthetic benzyl styryl sulfone (ON019010.Na) has been shown to have anti-tumor activity, alone and in combination with other chemotherapeutic agents as a Chk2 inhibitor and anti-mitotic agent that induces selective G2/M arrest followed by apoptosis in several cancer cell lines. It is now undergoing phase 1–2 clinical trials. Cisplatin is the preferred primary chemotherapy for cervical malignancies. Studies were initiated to test if ON01910.Na may be used on checkpoint-compromised tumor to enhance the cytotoxic effects of radiation therapy. The primary objective of this study was to evaluate whether ON01910.Na has a more effective radiosensitizing capacity than Cisplatin. Methods: Clonogenic survival assay on HeLa cells incubated for 24 hours with ON01910.Na (1uM) or Cisplatin (1uM), prior to irradiation (2–8 Gy). FACScan cytometry was used for cell cycle analysis. Results: IC50 values for ON01910.Na and Cisplatin were 0.1 and 1uM respectively. FACS analysis demonstrated G2/M blocked cells at the concentrations used for this clonogenic assay for ON01910.Na. Survival curve comparison revealed a survival fraction of 30% for Cisplatin and 10% for ON01910.Na, and a radiosensitization effect of 1.1 for Cisplatin and 2.0 for ON01910.Na. Two-ways ANOVA analysis for each radiation dose subset showed that survivals among treatment groups were significally different (p<0.0001). Conclusions: Our data suggest that ON01910.Na appears to be more effective than Cisplatin when combined with radiation. The low toxicity on normal cells in culture and this reported data supports the need for clinical trials with ON01910.Na for patients with cervical carcinoma. No significant financial relationships to disclose.
Effects of weekly bevacizumab and paclitaxel/carboplatin with or without sorafenib on heavily pretreated patients with recurrent or persistent cervical cancer.
Authors: Y. Kikuchi, M. Takano, T. Goto, H. Kouta, R. Kikuchi, K. Kudoh, T. Kita, K. Furuya, K. Umayahara, K. Takizawa
Journal: Journal of Clinical Oncology (2011)

5085 Background: Prognoses of patients with recurrent and metastatic cervical cancer (CC) who received treatment including radiotherapy are commonly dismal. In such clinical settings effective treatment modalities are waited. Thus, we attempted to explore effects of weekly bevacizumab (B) and paclitaxel (P)/carboplatin (C) with or without sorafenib (S). Methods: Twelve cases with recurrent and metastatic CC after intensive treatment including radiotherapy were treated by weekly B (2mg/kg) and P (80mg/m2)/C (AUC 2) with or without S (200mg/day; 3 weeks, one week rest) with written informed consents. The treatment was continued until development of progressive disease (PD) or unmanageable adverse effects. Adverse effects were analyzed according to NCI-CTCAE v3. The responses were evaluated by RECIST criteria. Results: In RECIST evaluation, 2 (16.7%) of 12 patients had complete remission (CR) and 5 (42%) had partial remission (PR). Four (57%) of 7 cases combined with S showed PR, and 3 (60%) of 5 patients without S obtained PR. Response was observed in 3 (50%) of 6 adenocarcinoma patients, and in 4 (67%) of 6 cases with squamous cell carcinoma. It is noteworthy that 4 (67%) of 6 patients pretreated with chemotherapy plus radiotherapy showed response to weekly B and P/C, including two cases with CR. Median progression-free survival (PFS) and overall survival (OS) were 6 months and 13 months, respectively. Hematological adverse effects more than grade 1 were not observed. Hypertension and nasal bleeding due to B were frequently observed, but they were manageable. Although hand-foot syndrome was observed in half cases that received S, any treatment was not required. Conclusions: The present study demonstrated weekly B and P/C was effective in heavily pretreated cervical cancer patients with tolerable toxicities. The effects were observed in cases with irradiated squamous cell carcinoma and adenocarcinoma. These results warrant further study in such clinical settings.
Reduced Toxicity Condition, Mixed Chimerism and Donor Stem Cells Infusion — A More Effective and Safely Model of Nonmyeloablative Allogeneic Stem Cell Transplantation (Seventy-Two Cases Report).
Authors: Hui-Sheng Ai, Mei Guo, Chang-Lin Yu, Dan-Hong Wang, Jian-Hui Qiao, Qi-Yun Sun, Wan-Jun Sun, Zhang Shi
Journal: Blood (2005)