tbuckley/cabot-search huggingface dataset:
Follow-up of long-term young breast cancer survivors.
Authors: Corinne Daly, Elisabeth M. Del Giudice, Rinku Sutradhar, Lawrence Frank Paszat, Drew Wilton, Linda Rabeneck, Nancy N. Baxter
Journal: Journal of Clinical Oncology (2012)

8 Background: Evidence suggests breast cancer patients can be offered follow-up by family physician without concern of important recurrence–related serious clinical events occurring more frequently or quality of life being negatively affected. This study describes population-based patterns of follow-up care in 5-year recurrence-free young breast cancer survivors to determine factors influencing continued oncology follow-up in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study using cancer registry and administrative data. Women diagnosed with an incident breast cancer aged 20-44 between 1992 and 1999, survived for at least 5 years and recurrence-free for 5 years past diagnosis were identified in the Ontario Cancer Registry. Each survivor was matched to 5 control women with the same calendar year of birth and place of residence in Ontario. We determined outpatient physician visits with primary care, medical, radiation and surgical oncology physicians to investigate trends associated with increasing survivorship and compared visit rates to controls. We used negative binomial regression to investigate factors predicting high utilization of oncology services among survivors after 5-year recurrence survival. Results: We identified 4,581 survivors and 22,898 controls. By year 10, 51% breast cancer survivors were still being followed by an oncologist. In the survivors, fewer physician visits were observed among recurrence-free breast cancer survivors as time increased from diagnosis (Visit Rate Ratio [VRR] =0.95, 95% CI: 0.94, 0.96). Breast cancer survivors diagnosed from 1992-1995 had a higher rate of physician visits than those diagnosed from 1996-1999 (VRR = 1.16, 95% CI: 1.07, 1.25). More oncologist visits were associated with patients visiting a female oncologist (VRR = 1.20, 95% CI: 1.09, 1.33) and fewer visits were associated with patients visiting an oncologist who practiced outside of a regional cancer center (VRR = 0.67, 95% CI: 0.58, 0.77). Conclusions: Oncology visits of young breast cancer survivors after 5-year survival were associated with oncologist factors indicating that prolonged oncology follow-up in breast cancer survivors may be driven by practice patterns rather than patients’ needs.
The Know Your Tumor (KYT) initiative: A national program of multi-omic molecular profiling (MoP) for patients (Pts) with pancreatic cancer (PDA).
Authors: Anitra Engebretson, Jonathan Robert Brody, Lola Rahib, Lynn Matrisian, Andrew Eugene Hendifar, William Arthur Hoos, Sameh Mikhail, Vincent M. Chung, Vincent J. Picozzi, Craig Heartwell, Kimberly Mason, Katelyn Varieur, Subha Madhavan, Emanuel Petricoin, Michael J. Pishvaian
Journal: Journal of Clinical Oncology (2016)

279 Background: There has been a significant increase in the utilization of MoP to facilitate the selection of therapies for pts with advanced cancers. However, coordinated efforts to perform uniform MoP and collect clinical outcomes data have only successfully been executed in limited academic settings. In an effort to “democratize” the availability of MoP for PDA patients in a broad spectrum of clinical settings, The Pancreatic Cancer Action Network (PanCAN) and Perthera initiated the KYT initiative, an academic, industry, and advocacy group collaboration. Methods: PDA pts self-referred to the Patient Central call center at PanCAN. Pts interested in enrolling in an IRB-approved registry trial were then referred to Perthera to facilitate consent, tissue acquisition, and commercial MoP of the pt’s tumor. Test results were reviewed by a team of PDA specialists in the context of the pt’s treatment (tx) history. A report detailing tx options was delivered to the pt’s oncologist. Pts are being actively followed longitudinally to assess physician acceptance of the tx options and to track outcomes. Results: From 06/2014 to 09/2015, 382 pts were enrolled into KYT. Of these, 273 pts from 192 physicians (community and academic) in 38 states were enrolled. Reasons for non-enrollment were: pts no longer interested (67%); pts too ill or not appropriate for KYT (17%); the pt’s physician would not sanction MoP (16%). To date, 162 pt tumor samples have been obtained, and 117 reports delivered. 75% of samples had adequate tissue for genomic profiling (NGS), with 87% of samples harboring a KRAS mutation. Actionable findings (i.e. linked to a specific tx option) identified by NGS included mutations in BRCA2 (5%), PALB2 (1%), ATM (4%); BRAF (2%), PIK3C/PIK3R (7%), STK11 (5%), amplification of ERBB2 (3%), FGFR (2%), PDGFR (2%); and RET fusions (2%). Of the 117 profiles, 43% revealed actionable findings; 58% presented off-label therapy options; and 48% led towards high priority clinical trials. Conclusions: MoP of pts with PDA is feasible irrespective of their geographical location or access to an academic center. Updated information on tx selection and patient outcomes will be provided.
Carcinoid syndrome-related symptoms in pancreatic neuroendocrine tumors (pNETs) and impact on health care utilization.
Authors: Michael S. Broder, Eunice Chang, Sheila R. Reddy, Maureen Neary
Journal: Journal of Clinical Oncology (2016)

450 Background: PNETs, rare neoplasms originating from secretory neuroendocrine cells, produce peptides and neuroamines causing hormonal syndromes, including carcinoid syndrome (CS). Somatostatin analogues (SSAs) are usual 1 st -line treatment; everolimus and sunitinib are targeted therapies (TT) approved for progressive disease. Carcinoid or hormonal symptoms associated with CS may occur in pNET and are treated with SSAs. Information is limited on impact of these symptoms on health resource use in pNET. Methods: This retrospective cohort study merged 2 large HIPAA-compliant claims databases and identified pNET patients (ICD-9-CM 157.4) initiating treatment with TT or cytotoxic chemo (CC) from 2009-2012. Patients had no prior TT or CC for pNET for 1 year preindex and were continuously enrolled 1 year postindex. Descriptive statistics were reported for comorbidities and health care use, overall and by presence of symptoms defined to include: diarrhea, nausea/vomiting, flushing, cardiac palpitations, asthma, wheezing, fatigue, hypotension, or dizziness. Chi-square and t-tests were used for analyses of categorical and continuous variables, respectively. Results: This study included 338 newly treated pNET patients with 1 year followup; 237 1 st -line CC and 101 TT (64 everolimus, 37 sunitinib). Mean age was 54.5; 46% female. Patients had mean of 5 (SD 2.0) chronic conditions and Charlson Index of 10.1 (SD 2.9). Utilization included 43.5% hospitalizations, 48.8% ED visits, and mean of 25.5 (SD 24.8) office visits. 212 (62.7%) patients had symptoms. Other conditions were infection (34.9%) and anemia (29.9%). PNET patients with symptoms had considerably higher rates of hospitalization, ED visits, and office visits than those without: 57.5% vs. 19.8%, 64.2% vs. 23.0%, mean 29.2 vs. 19.3, all P &lt; 0.001. Conclusions: In this study, nearly 2/3 of treated pNET patients had carcinoid or hormonal symptoms; about 1/3 had infection and anemia. Symptoms may influence drug treatment patterns. PNET patients with symptoms were high utilizers of health resources; over half were treated as inpatients and more sought ED care. This increased use may result from a high burden of symptoms and comorbid conditions.
Quality of systemic cancer therapy in routine care: What are we measuring?
Authors: Shixin (Cindy) Shen, Monika K. Krzyzanowska
Journal: Journal of Clinical Oncology (2012)

249 Background: While clinical trials provide efficacy and early safety information regarding systemic cancer therapy (ST), most cancer patients who receive ST are treated outside clinical trials. We performed a systematic review of studies that have evaluated the quality of ST in routine practice to summarize the literature and define knowledge gaps across five quality domains – access, treatment delivery, toxicity, safety and outcome. Methods: We searched MEDLINE using a combination of terms pertaining to ST, such as “chemotherapy” with keywords related to healthcare quality for articles published in English from January 1, 2000 to December 31, 2010. Articles were included if they were based on original studies that examined quality of ST among adult patients from a population perspective (defined as multiple institutions). Study information was abstracted using a standardized form. Summary statistics were used to describe the results. Results: Our search identified 179 articles. The number of studies published each year increased over time from nine studies in 2000 to 30 in 2010. Most studies were conducted in the United States (58%) in either colorectal (31%) or breast cancers (27%) and focused on adjuvant intent cytotoxic chemotherapy (81%). Majority of the studies retrospectively (92%) identified patients from cancer registries (83%) and used either billing data (64%) or information in the registry itself (27%) for treatment identification. 66% of the studies evaluated a single quality domain, whereas the remaining articles assessed two or more domains. No study was found that examined safety from a population perspective. Access was the most frequently evaluated domain (77%) whereas treatment delivery was the least examined (12%). Treatment toxicity and outcome were evaluated in 21% and 31% of studies, respectively. Among studies that assessed outcome of ST, most evaluated patient specific outcomes such as survival (93%) although a few (13%) examined system level outcomes such as cost. Conclusions: Majority of studies evaluating quality of ST have focused on access to cytotoxic chemotherapy in early stage disease. Further studies focusing on other aspects of quality and in different clinical settings are needed.
A prospective comparison of the FACT-e and EORTC-QLQC30 and OG25 questionnaires for evaluating changes in health-related quality of life in patients with esophageal cancer.
Authors: Gail Darling
Journal: Journal of Clinical Oncology (2013)

130 Background: The FACT-E (Functional Assessment of Cancer Therapy– Esophageal) and the EORTC QLQ-C30 (European Organization for Research on Treatment of Cancer Quality of Life Questionnaire) and its cancer-specific module (OG25) are two validated instruments used to assess quality-of-life (QOL) in patients with esophageal cancer. This study investigates the differences between these two instruments. Methods: This is a prospective study of 22 consecutive patients treated with chemoradiation followed by surgery. Questionnaires were self-administered at each of the following: baseline (prior to treatment), 6-8 weeks and 12-14 weeks following start of chemoradiation, and 1, 3, 6, 9, 12, and 18 months following esophagectomy. Mixed model regression was applied to model the repeated measures of the two questionnaires to compare slopes. Results: Of the 22 patients, 20 proceeded to surgery. Overall survival and disease-free survival at 18 months were 59% and 55% respectively. Comparison of the QOL domains over time showed good correlation for physical and functional well-being, with an apparent variation in the magnitude of the changes over time for the latter. The questionnaires were discordant with respect to social and total well-being. Social well-being showed a return to baseline by 1 month post-op using the FACT, but never recovered to baseline for the EORTC. FACT Total well-being recovered to baseline by 9 months, while the EORTC only approached baseline values by 18 months. The disease-specific modules showed post-operative symptom improvement with the FACT and a deterioration with the EORTC. There was also discordance in emotional well being. Conclusions: Domain comparisons of the EORTC and FACT questionnaires showed differing results. Discordance was seen for emotional, social and overall QOL, as well as symptomatology. The EORTC total and physical well-being domains showed a similar pattern of change over time. These findings might result from the overall tendency of the EORTC to emphasize physical aspects of QOL. Thus these two instruments appear to measure different aspects of QOL, which may affect their clinical utility.
Tracking viewership of survivorship topics from an online educational resource for breast cancer survivors: Findings from the Pink Ribbon Survivors Network Curriculum for Recovery Library.
Authors: Robert E. Fisher, Kelly Ann Adams
Journal: Journal of Clinical Oncology (2013)

141 Background: The Pink Ribbon Survivors Network created a virtual library, The Curriculum for Recovery Library, as part of its online resources for breast cancer survivors and the health care providers who care for them. The website's library became available on July 11, 2012. 199 articles are organized into 19 categories within the library. Within each category, article titles are directly linked to their online text. The library is hosted on the organization's website: www.PinkRibbonSurvivorsNetwork.org. Methods: Through the website's administrative site, we tracked and reviewed the number of visits to each of the 19 categories's content in The Curriculum for Recovery Library between July 11, 2012 and April 21, 2013. Results: The five following categories were most were accessed by our viewership, in descending order: " Fatigue," "Doubt and Hope," "Your Survivorship Document," "Diet/Exercise/Selfcare," and "Leaving a Legacy." The tally has been determined by review of the first 2,800 viewings of the website, during this 9 month period. Conclusions: When given free access to 19 categories relevant to survivorship, our data reveals that treatment related fatigue and doubt about a breast cancer survivor's future are the most sought after categories among our viewership population. This data will help to prioritize research and resources for breast cancer survivors in the future.
90Y Liver Radioembolization Imaging Using Amplitude-Based Gated PET/CT
Authors: Dustin R. Osborne, Shelley Acuff, Melissa Neveu, Austin Kaman, Mumtaz Syed, Yitong Fu
Journal: Clinical Nuclear Medicine (2017)

The usage of PET/CT to monitor patients with hepatocellular carcinoma following Y radioembolization has increased; however, image quality is often poor because of low count efficiency and respiratory motion. Motion can be corrected using gating techniques but at the expense of additional image noise. Amplitude-based gating has been shown to improve quantification in FDG PET, but few have used this technique in Y liver imaging. The patients shown in this work indicate that amplitude-based gating can be used in Y PET/CT liver imaging to provide motion-corrected images with higher estimates of activity concentration that may improve posttherapy dosimetry.
Choosing Wisely in oncology: Are we ready for value-based care?
Authors: Gabrielle Betty Rocque, Doug Blayney, Mohammad Jahanzeb, Pamela Kadlubek, August Knape, Merry Jennifer Markham, Trang Pham, Tracey L. Evans
Journal: Journal of Clinical Oncology (2016)

275 Background: The Choosing Wisely (CW) Campaign challenges patients, healthcare providers, and specialty disease societies to make better decisions about healthcare delivery. In 2012, Schnipper et al. published ASCO’s Top Five List targeting overuse of medications, tests, and procedures that are costly and lack evidence. 1.) Do not use cancer-directed therapy for patients with low performance status (undocumented, 3 or 4). 2.) Do not use PET, CT and radionuclide bone scans in the staging of early prostate cancer. 3.) Do not use PET, CT and radionuclide bone scans in the staging of early breast cancer. 4.) Blood tests for biomarkers and advanced imaging tests should not be used to screen for cancer recurrences in early breast cancer. 5.) Avoid administering colony stimulating factors (CSFs) to patients undergoing chemotherapy who have less than a 20 percent risk for febrile neutropenia. These recommendations are an opportunity to provide a tool to identify the gaps in care and enhance the value of care. Methods: We evaluated results from the ASCO Quality Oncology Practice Initiative (QOPI) CW “test” measures. We analyzed four QOPI collection periods for which measures were available to all participants (Spring ‘13, Fall ‘13, Spring ‘14, Spring ‘15). Results: 361 unique oncology practices (155, 160, 161, and 187 participants in the Spring ‘13, Fall ‘13, Spring ‘14, and Spring ‘15 cycles, respectively) collected data on CW measures within QOPI. Trends for performance varied for specific recommendations and marked variability was noted between practices in performance (range 0% to 100% adherent for any measure). Measure 2 was reported by only one practice in 3 out of the 4 cycles. Using linear regression, adherence decreased over time between rounds for measures 1 and 5 (-2.05; p&lt;0.01 and 1.37; p=0.05), while adherence to measures 3 and 4 increased (0.26; p=0.60 and 2.63; p=0.04). Conclusions: This is the first examination of cancer-related CW measures among oncology practices reporting their performance in QOPI. Although significant variability exists, concordance with CW guidelines remains low across the United States. Opportunity exists for further research into the causes of this low compliance and to share best practices.
Cost-effectiveness of partial breast irradiation versus whole breast irradiation for early-stage breast cancer
Authors: D. J. Sher, R. S. Punglia
Journal: Journal of Clinical Oncology (2008)

6530 Background: Partial breast irradiation (PBI) is a new treatment paradigm for early-stage breast cancer. Although PBI may lead to higher local recurrence rates, it may be cost-effective because of better tolerability and lower cost. We aimed to determine the incremental cost-effectiveness of PBI compared to whole breast radiation therapy (WBRT) for estrogen-receptor positive postmenopausal women treated for early-stage breast cancer. Methods: We developed a Markov model to describe health states in the 15 years following radiotherapy (RT) for early-stage breast cancer. Ipsilateral breast tumor recurrences (IBTR) were separated into local recurrences (LR) and elsewhere failures. External beam (EB) and MammoSite (MS) PBI were considered and assumed to be equally effective but carried different costs. Patients received tamoxifen but not chemotherapy. Utilities, recurrence risks, and costs were adapted from the literature; the baseline utility for no disease after RT was set at 0.92. Probabilistic sensitivity analysis (PSA) assumed a normal distribution of PBI hazard ratios (HR, the ratio of LR after PBI compared to WBRT) centered at 1.25, and normal distributions of early (i.e. years 0–5) and late NED-PBI utilities centered at 0.93 and 0.92, respectively. Costs (in 2004 $US) and QALYs were discounted at 3%/year. Results: The discounted quality adjusted life expectancy was 9.810 after PBI and 9.815 after WBRT. The incremental cost-effectiveness ratio for WBRT compared to EB-PBI was $630,000/QALY; WBRT strongly dominated MS-PBI. One-way sensitivity analysis found the results were sensitive to PBI HR, fraction of IBTRs that were local, baseline IBTR risk, and NED-PBI utility values. The PSA is shown in the Table. Conclusions: EB-PBI was the most cost-effective strategy for postmenopausal women with early-stage breast cancer. Unless the quality-of-life after MS-PBI proves to be superior, it will not be cost-effective. Probability that PBI is cost-effective given varying WTP. Modality Willingness-to-Pay $25k/QALY $50k/QALY $100k/QALY $250k/QALY $500k/QALY EB-PBI 97% 88% 78% 71% 68% MS-PBI 0.02% 4.4% 26% 49% 57% No significant financial relationships to disclose.
The feasibility, safety, and technique of endoscopic ultrasound (EUS)-guided fiducial marker placement for stereotactic body radiation therapy (SBRT) in borderline resectable pancreatic cancer.
Authors: S. Vignesh, S. E. Hoffe, R. Shridhar, J. Klapman, J. S. Barthel
Journal: Journal of Clinical Oncology (2011)

327 Background: Fiducial markers implanted into tumors that move with respiration facilitate planning for SBRT. To date, there is little evidence regarding the safety and utility of EUS implanted markers for “borderline resectable” pancreatic cancer. Methods: This is a retrospective review of 13 patients (7 men and 6 women) with “borderline resectable” pancreatic cancer as per NCCN guidelines. EUS-guided fiducial placement for stereotactic body radiation therapy was performed between January 2009 and September 2010. Gold cylindrical fiducials (0.35mmx 10mm or 0.75 mm X 10 mm; VISICOIL) were loaded into a 22g or 19 g EUS needle. With the needle in the target, the fiducial was deployed by retracting the needle and advancing the stylet. EUS confirmed fiducial position after deployment. A mean of 3 fiducials were placed (range 1-6) per patient. Fiducial position was analyzed at 4D CT simulation and daily cone beam imaging prior to SBRT. Results: Fiducial placement was successful in all. Technical difficulty was encountered in 2 patients secondary to retained food in stomach and uncinate tumors. Smaller (10x0.35mm) fiducials were successfully placed in these 2 patients. 3 patients had abdominal pain lasting &lt; 12 hours after fiducial placement but none had any acute complications. In 2 patients, change in fiducial position was noted on follow-up cone beam CT. This apparent change in position was related to biliary drainage, gastric distension and a pre-existing pseudocyst. Though this is not indicative of fiducial migration, it impacts radiation planning and delivery. No complications were noted at the end of a mean follow-up period of 6 months. Conclusions: EUS fiducial placement to assist with stereotactic body radiation for “borderline resectable” pancreatic cancer is safe, feasible, and technically successful in most cases. True migration did not occur but other factors may cause an apparent change in fiducial position. Further studies are planned to optimize the best configuration of fiducial placement by virtue of tumor location for SBRT planning and treatment. No significant financial relationships to disclose.