tbuckley/cabot-search huggingface dataset:
Organizational barriers to receiving quality health care: A qualitative study among lung cancer patients and caregivers.
Authors: Satish Kedia, Kenneth Daniel Ward, Siri Alicia Digney, Bianca Michelle Jackson, Kristina S. Roark, Stephanie W. Boyd, Raymond U. Osarogiagbon
Journal: Journal of Clinical Oncology (2014)

76 Background: For lung cancer patients and caregivers, navigating the healthcare system while coping with the complexities of the illness is challenging. We explored organizational barriers to receiving quality healthcare from the perspectives of these stakeholders. Methods: A qualitative study involving 10 focus groups (5 of patients, 5 of caregivers) was conducted. Discussions were guided by a standardized script, recorded for transcription, and analyzed using Dedoose software. Results: 22 patients (10 Males/12 Females; 15 Caucasians and 7 African Americans) and 24 caregivers (6 Males /18 Females; 17 Caucasians and 7 African Americans) shared their experiences. Content analysis showed 5 recurring themes: (1) Insurance Issues: Delays in diagnosis or treatment were reported due to lack of insurance, lag time in insurance approvals and care processing, uncertainty about coverage, and caps for tests and/or office visits. (2) Appointment Scheduling: Participants reported appointment delays and rescheduling, long wait times, cancellations by providers, and inflexibility to accommodate schedules. (3) Provider Communication: Communication was lacking at times in initial diagnosis disclosure, prognosis and treatment preparation, willingness to answer questions in lay terms, and time dedicated to patients during appointments. (4) Patient Education: Participants had inadequate knowledge about lung cancer, treatment options and duration, prognosis, and relied on providers to educate and direct them to credible resources. Many felt confused, frustrated, anxious, or fatalistic. (5) Healthcare System Support: Participants found support within the healthcare system extremely beneficial, when available, for coping with lung cancer, expediting appointments, seeking information, connecting with physicians, and receiving timely diagnosis and treatments. Conclusions: These findings offer valuable insight into lung cancer patients’ and caregivers’ perspectives on organizational barriers to receiving quality care. By identifying these barriers for lung cancer patients and caregivers, better planning and management of effective cancer services can be developed.
Factors associated with the prescription of antidepressive medication in breast cancer patients: A rehabilitation perspective.
Authors: S. O. Dalton, N. P. Suppli, I. Deltour, L. H. Damkjær, A. B. Jensen, N. Kroman, C. Johansen
Journal: Journal of Clinical Oncology (2010)

e19646 Background: This study evaluated factors associated with use of antidepressant medication (AD) subsequent to a diagnosis of breast cancer (BC). Further, we evaluated the effect of participation in a cancer rehabilitation program on use of AD. Methods: A register-based cohort study included 1,247 women diagnosed with BC from 1998 until 2006 and who attended a week-long rehabilitation program as well as a matched comparison group of 2,903 women who did not attend the program. The associations between BC-related, treatment related and socio-demographic factors with use of AD were evaluated in multivariate Cox proportional hazard models separated on use of AD prior to diagnosis of BC. Results: In women who were not users of AD prior to BC, a relapse increased the hazard ratio (HR) of first use of AD to 2.53 (95% CI, 1.16-2.09) whereas a diagnosis of a new primary cancer increased the HR to 3.36 (95% CI 1.48 to 7.65). Further, number of tumor-positive axillary lymph nodes and unemployment was associated with significantly increased HRs for use of AD, whereas having children living at home, education and income was borderline associated with AD use. No effect of the rehabilitation program was observed on first use of AD after BC. Conclusions: Sociodemographic rather than disease and treatment characteristics at time of diagnosis were associated with first time use of AD following a breast cancer. No significant financial relationships to disclose.
Safety and activity of lenalidomide (LEN) in elderly patients (pts) with chemotherapy-naive, castration-resistant prostate cancer (CRPC).
Authors: T. M. Lestingi, K. Tolzien, S. K. Kelby, C. Nabhan
Journal: Journal of Clinical Oncology (2010)

e15125 Background: Pts with CRPC have limited therapeutic options. Proliferation, angiogenesis and evasion of immune surveillance are important pathways by which CRPC progresses. Based on LEN's immunomodulatory mechanism of activity, we investigated its efficacy and toxicity in chemotherapy-naïve CRPC. Preliminary activity was reported (ASCO/GU 2010). Here we present results for the subset of pts over the age of 75. Methods: Eligible pts received LEN 25 mg daily on days 1–21 of a 28-day cycle until disease progression. Responses were assessed every 2 cycles and toxicity every cycle. Primary endpoint was overall clinical benefit (sum of complete response, partial response, and stable disease (SD)). PSA responses were assessed using the working group criteria and radiographic disease using RECIST. Secondary endpoints were toxicity and impact on quality of life (QOL). Results: For20 pts enrolled, median age is 78 yrs (58–89); 12 pts were >75 years. Median time on hormone therapy was 60 months, and median time from diagnosis to LEN was 106 months. Median PSA is 64 (3–690). 7 pts had bone and visceral involvement. 19 pts are evaluable for toxicity and 16 for response. Serum PSA declined in 6 pts (38%), in 3 pts (18%) by > 50%. Radiographically, 10 pts (62%) had SD lasting a median of 8 months (3-14). A decline in PSA occurred in 4/12 pts (33%) over 75. Of remaining 8 pts, 1 had SD, 4 progressed, and 3 are not evaluable (2 withdrew consent; 1 discontinued due to atrial fibrillation). At a median 13-month follow-up, 90% of pts are alive; only 2 pts have died. For pts over 75, 2/12 (16%) required dose reduction due to neutropenia, and 4/12 (33%) developed grade 3/4 toxicity (dehydration in 2, atrial fibrillation in 1, and sepsis in 1). QOL was not impacted adversely with LEN. One pt showed a decline in PSA despite scans indicating progression suggesting that change in PSA may not accurately assess responses to LEN. Conclusions: LEN is well-tolerated by elderly pts with CRPC with reversible neutropenia being the most common toxicity. Objective PSA responses and risk benefit ratio were sufficiently encouraging to warrant further investigation in elderly pts with CRPC. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Celgene Celgene
Tumor regression in patients with metastatic renal cancer treated with a monoclonal antibody to CTLA4 (MDX-010)
Authors: J. C. Yang, K. E. Beck, J. A. Blansfield, K. Q. Tran, I. Lowy, S. A. Rosenberg
Journal: Journal of Clinical Oncology (2005)

2501 Background: T-lymphocytes express both co-stimulatory (CD28) and inhibitory (CTLA4) receptors that are engaged by the B7 family of ligands. One strategy to unbalance this antagonistic network in favor of lymphocyte activation is to block CTLA4 engagement using a monoclonal antibody to this receptor. Methods: In a phase II protocol, patients with advanced renal cancer were given MDX-010, a human IgG1 antibody to CTLA4 every 3 weeks. One cohort (cohort A, N=21) received 3 mg/kg once, followed by 1 mg/kg. A second cohort (B, N=20) received all doses at 3 mg/kg. Response rate was the primary endpoint. Results: Toxicities were primarily autoimmune with 3 patients in cohort A and 9 patients in cohort B experiencing significant autoimmune toxicity. This included enteritis (n=9), hypophysitis (N=2) and meningitis (N=1). Brief oral or parenteral steroids were used to treat symptomatic autoimmune enteritis, and one patient underwent colectomy for perforation while the others resolved. One patient in cohort A had an objective response (RR=5%) while 5 of 20 patients in cohort B responded (RR=20%). All responses were partial and durations are 18, 8, 8+, 8+, 6+ and 4+ months. Three of the 6 responding patients had had previous IL-2, although the impact of this factor is still under analysis. All 6 responding patients were among the 12 patients showing autoimmune manifestations with no responses in the other 29 patients (p=0.0002). Conclusions: CTLA4 blockade using the MDX-010 antibody can induce the regression of metastatic renal cancer and these regressions are associated with clinical autoimmune breakthrough events. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Medarex Medarex
Characteristics and outcomes of psychology referrals in palliative care.
Authors: Sujin Ann-Yi, Eduardo Bruera, Monica T. Agosta, Diana Guzman, John M. Najera, Monica Raznahan, Janet L. Williams, Cindy L. Carmack
Journal: Journal of Clinical Oncology (2016)

230 Background: Despite high distress, a small percentage of cancer patients are referred for psychological care. MD Anderson’s interdisciplinary Palliative Care team recruited 2 clinical psychologists in 9/2013. The demand for services exceeded capacity; thus a 3rd psychologist and 3 counselors were added in 6/2015. Methods: Retrospective review of 2827 unique patients (6451 total contacts) from 9/1/2013 to 2/29/2016, including billable (psychologists) and non-billable (counselors) services. Results: Psychologists saw 1958 unique patients (4987 contacts): 1662 (85%) inpatients and 296 (15%) outpatients. Mean inpatient and outpatient session length was 37 (SD = 15) and 51 (SD = 19) minutes, respectively. 865 (44%) patients had 1 session, 507 (26%) had 2, and 585 (30%) had 3 or more. At first visit, DSM-5 diagnoses were: 1681 (86%) adjustment disorders and 226 (12%) major mood or anxiety disorders. Most first visits included assessment (N = 1666; 85%); other services were also provided: 1545 (79%) supportive expressive counseling; 300 (15%) family counseling; 114 (6%) cognitive-behavioral therapy (CBT); and 40 (2%) relaxation skills. From 6/2015-2/2016, counselors saw 869 unique patients (1464 contacts): 759 (87%) outpatients, 99 (11%) inpatients, and 11 (1%) outreach through web-based video or phone. Mean session length for outpatient, inpatient, and outreach was respectively, 37 (SD = 17), 34 (SD = 18), and 17 (SD = 8) minutes. 560 (64%) patients had 1 session, 166 (19%) had 2, and 143 (17%) had 3 or more. Services at first visit included: 994 (93%) supportive expressive counseling; 654 (61%) assessment; 139 (13%) relaxation skills; 99 (9%) CBT; and 73 (7%) acceptance and commitment therapy (ACT). Conclusions: The 128% increase in psychology services after expanding providers underscores the value placed by the Palliative Care team. With the majority receiving only 1 session, results indicate the need to improve screening for earlier referral, allowing for more sophisticated services such as CBT and ACT, which are most effective for major mood or anxiety disorders and may prevent adjustment disorders from progressing to greater clinical distress. Our new efforts at outreach could also enhance access and types of services provided.
Preventive care for breast cancer survivors versus controls: Changes between 1998 and 2002
Authors: C. F. Snyder, K. D. Frick, M. E. Kantsiper, K. S. Peairs, R. J. Herbert, A. L. Blackford, A. C. Wolff, C. C. Earle
Journal: Journal of Clinical Oncology (2008)

6501 Background: Whether the recent focus on appropriate preventive care for cancer survivors has led to improvements is unclear. Methods: We used the SEER-Medicare database to examine 5 cohorts of stage 1–3 breast cancer survivors aged 65+ diagnosed between 1998 and 2002 and in fee-for-service Medicare. For each cohort (defined by diagnosis year), we calculated the mean number of visits to oncology specialists, primary care providers (PCPs), and other physicians and the percentage receiving flu shots, cholesterol screening, colorectal cancer (CRC) screening, and bone densitometry during survivorship Year 1 (days 366–730 post-diagnosis). Survivors' patterns of physician visits and preventive care were compared to 5 non-cancer control cohorts matched on age, sex, race, and region. We assessed trends over time in physician visits and preventive care using Poisson and logistic regression, respectively, adjusting for subject characteristics. Results: 23,731 survivors were matched with 23,731 controls. Over time, survivor visits to all provider types increased, but only PCP visits increased for controls (all p<.0001) (Table). Between 1998 and 2002, survivors had increases in flu shots (51.7% to 55.4%), cholesterol screening (31.0% to 38.6%), and bone densitometry (14.1% to 18.2%) (all p<.0001) but a decrease in CRC screening (29.3% to 26.9%; p=.03). Controls had increases in flu shots (61.0% to 62.7%) and cholesterol screening (38.6% to 43.7%) but a decrease in CRC screening (35.4% to 28.4%) (all p<.001). The increase over time in cholesterol screening and bone densitometry was significantly greater for survivors vs. controls (p=.02 and p<.0001, respectively). The decrease over time in CRC screening was significantly greater for controls vs. survivors (p=.003). With one exception, fewer survivors received each preventive service than controls each year. Conclusions: While rates of several preventive services have improved for survivors, they still lag behind controls in receipt of appropriate preventive care. Observed Mean (SD) Number of Physician Visits 1998 Cohort (n=2526) 1999 Cohort (n=2695) 2000 Cohort (n=5663) 2001 Cohort (n=6226) 2002 Cohort (n=6621) Adjusted P-Value for Trend over Time Adjusted P-Value for Difference in Trend over Time Between Groups Oncology Specialist Survivors 2.2 (2.5) 2.2 (2.4) 2.5 (2.6) 2.5 (2.6) 2.5 (2.8) <.0001 NA Primary Care Provider Survivors 4.2 (4.6) 4.3 (4.3) 4.2 (4.4) 4.2 (4.4) 4.3 (4.6) <.0001 0.17 Controls 3.8 (4.0) 4.0 (4.5) 3.7 (4.2) 3.6 (4.1) 3.9 (4.4) <.0001 Other Physician Survivors 3.2 (4.5) 3.4 (4.5) 3.7 (4.7) 3.6 (4.7) 3.8 (4.8) <.0001 0.002 Controls 3.6 (4.9) 3.5 (4.5) 4.0 (5.1) 3.8 (5.0) 3.7 (4.9) 0.99 Sample sizes equal for survivors and controls; Adjusted for age, race, comorbidity, region (and stage for survivors) No significant financial relationships to disclose.
The accumulation and prognosis value of tumor-infiltrating IL-17-producing cells in esophageal squamous cell carcinoma.
Authors: J. Xia
Journal: Journal of Clinical Oncology (2011)

e21000 Background: The role of IL-17 producing cells in tumor is controversial. In the present study, we investigate the prognostic value of measuring tumor-infiltrating IL-17 producing cell levels in human esophageal squamous cell carcinoma (ESCC). Methods: Immunohistochemical staining was performed to investigate the levels of IL-17+ tumor infiltrating lymphocytes (TILs), as well as CD8+ cytotoxic T lymphocytes (CTLs) and CD57+ natural killer (NK) cells from 181 ESCC patients. The prognostic value of measuring the densities of IL-17+TILs and the correlation with CTLs and NK was evaluated. Results: IL-17 producing cells were detected in esophageal squamous cell carcinoma tissues. The median level of IL-17+TILs was 3.90 cells/ high power microscopic field (HPF). The density of IL-17 producing cells correlated negatively with T stage (P = 0.042). The higher densities of tumor infiltrating IL-17+ lymphocytes were associated with better overall survival (P = 0.031). Furthermore, we found that there were positive correlations between levels of IL-17 producing cells and the densities of CD8+cells, as well as CD57+cells (r = 0.198, P = 0.008 for CD8+ cells and r = 0.261, P < 0.001 for CD57+ cells, respectively). The prognosis analysis also showed that the higher levels of CD8+ CTLs and CD57+ NK cells correlated with better overall survival of ESCC patients. Conclusions: Our study suggests that tumor infiltrating IL-17 producing cells may mediate anti-tumor immunity by strengthening the responses of CTLs and NK cells in the tumor microenvironment and may be treated as a prognostic marker for ESCC patients.
A retrospective comparison between regorafenib and TAS-102 for refractory metastatic colorectal cancer.
Authors: Toshiki Masuishi, Hiroya Taniguchi, Satoshi Hamauchi, Azusa Komori, Yosuke Kito, Seiichiro Mitani, Hiroko Hasegawa, Yukiya Narita, Shigenori Kadowaki, Takashi Ura, Masashi Ando, Keita Mori, Masahiro Tajika, Hirofumi Yasui, Kei Muro, Kentaro Yamazaki
Journal: Journal of Clinical Oncology (2016)

723 Background: Regorafenib (R) and TAS-102 (T) prolonged survival for patients (pts) with refractory metastatic colorectal cancer (mCRC) in phase 3 trials. However, little is known regarding optimal sequence of administration of R and T, because of lack of head-to-head trials. Methods: We retrospectively evaluated pts who had been treated with R or T in two institutions from May 2013 to March 2015. Inclusion criteria were ECOG PS 0–2, refractory or intolerant to fluoropyrimidines, oxaliplatin, irinotecan, angiogenesis inhibitors, and anti-EGFR antibodies (if KRAS wild type), and no previous treatment with R or T. Results: A total of 182 pts (R/T: 138/44) were eligible for the study. The baseline characteristics were similar for the two groups as follows (R/T): median age, 64/63.5; male, 61%/52%; and KRAS wild type, 52%/59%. However, the proportion of pts with ECOG PS 2 (8%/18%) and who had not received irinotecan (1%/14%) was lower in R than in T. Efficacies were as follows (R/T): response rate, 0.8%/0%; disease control rate, 34%/33%; median time to treatment failure, 1.8/1.9 months (m) (median duration of follow-up, 5.6/5.0 m); median progression-free survival (PFS), 2.1/2.0 m (HR 1.09, p= 0.62, adjusted HR 0.97, p= 0.89 [11 covariates such as age, PS, and KRAS status]); median survival time (MST), 5.9/5.8 m (HR 0.92, p= 0.70); and MST for 74 eligible pts (R/T: 30/44) after the approval of T in Japan, 6.4/5.8 m (HR 0.94, p= 0.84, median duration of follow-up 4.7/5.0 m). Subgroup analysis suggested that pts with higher age and poor PS had shorter PFS in R than in T. The frequency (R/T) of grade 3 or 4 hand–foot syndrome and increased ALT were higher in R than in T (21%/0% and 10%/0%). Conversely, the frequencies of grade 3 or 4 neutropenia, anemia, and febrile neutropenia were lower in R than in T (2%/34%, 8%/27%, and 0%/7%, respectively). The main reason for discontinuation was disease progression (R/T: 85%/82%). Subsequent chemotherapies were received in 53%/46% (R/T). Conclusions: Our retrospective analysis suggested that regorafenib and TAS-102 had similar efficacy in patients with refractory mCRC. Our study results indicate that different toxicity profiles should be considered when selecting a drug treatment.
Metformin reduces cell migration and down-regulates epithelial to mesenchymal transition by AMPK / Foxo3a pathway in human intrahepatic cholangiocarcinoma
Authors: S. Di Matteo, A. Lustri, D. Costantini, L. Nevi, E. Manzi, C. Napoletano, J. Faccioli, F. Giulitti, A.M. DeRose, M.C. Bragazzi, G. Grazi, P.B. Berloco, F. Giuliante, V. Cardinale, G. Carpino, D. Alvaro
Journal: Journal of Hepatology (2017)
Sequential use of new agents (NAs) after docetaxel (DOC) first line in metastatic castration-resistant prostate cancer (mCRPC) patients (pts): A pooled-analysis of the published studies.
Authors: Francesca Maines, Orazio Caffo, Antonello Veccia, Emilio Bria
Journal: Journal of Clinical Oncology (2015)

258 Background: NAs have recently demonstrated a survival advantage in mCRPC pts progressing after DOC: two hormonal NAs (HNA), abiraterone and enzalutamide, and one chemotherapeutic agent, cabazitaxel (CAB). Recent evidences of possible cross-resistance has opened a debate about the best strategy when these drugs are used sequentially. We performed a pooled analysis of the published studies in order to assess if one of the following sequence strategy was potentially better than the others: a) HNA→ HNA, b) HNA → CAB or c) CAB → HNA. Methods: We evaluated the studies reporting clinical outcomes of a single NA administered after sequential treatment with docetaxel followed by another NA in mCRPC pts. All studies reporting monthly overall survival (OS) rates were considered eligible for the analysis; data were extracted, cumulated and weighted by taking into account each trial sample. We also evaluated possible differences in terms of factors able to produce potential patient-selection biases (age, Performance Status, visceral metastases and Gleason score). Results: Ten retrospective studies met the selection criteria of our analysis. They reported the outcomes of 735 pts who have received HNA → HNA (320 pts), HNA→ CAB (249 pts), and CAB → HNA (166 pts). No statistically significant differences were observed in terms of selection factors. Cumulative OS rates (with CIs), according to treatment sequence, are summarized in the Table. Conclusions: Our data seems to confirm a potential cumulative survival benefit of sequential use of NAs without a clear superiority of a single strategy over the others after DOC first-line in mCRPC patients. This conclusion is tempered by the retrospective nature and the potential selection biases. Nevertheless, a possible OS advantage could be observed when a CAB-based sequence is adopted. [Table: see text]
Evaluation of ADAM28 as a serological and histochemical marker for non-small cell lung cancers.
Authors: H. Kuroda, M. Shimoda, M. Kawamura, H. Nomori, Y. Okada
Journal: Journal of Clinical Oncology (2010)

10599 Background: ADAMs (a disintegrin and metalloproteinases) are a gene family, which exhibit both proteolytic and adhesive properties. ADAM28 is over-expressed in non-small cell lung cancer (NSCLC) with correlation to cancer cell proliferation, tumor size and lymph node metastasis. This study was aimed to develop an enzyme-linked immunosorbent assay (ELISA) system for serological and histochemical marker of NSCLC. Methods: AnELISA system by using two monoclonal antibodies against ADAM28. Serum levels of ADAM28 in 102 NSCLC and 20 controls were measured. ADAM28 was also examined in urine samples. ADAM28 production levels in the resected specimens were compared with the degree of immunoreactivity. The patients were classified to three groups (high-, middle- and the low-expressing) according to the immunostaining and analyzed by the Kaplan-Meier. Results: Our ELISA specifically measured ADAM28, showing negligible cross-reactivity with other metalloproteinases. The ADAM28 level in the NSCLC tissue was remarkably 36.9-fold higher than that in the non-neoplastic lung tissue (p < 0.001). The serum level was significantly 4.6-fold higher in NSCLC patients (5.41 ± 8.62 ng/mL) than in controls (1.17 ± 0.93 ng/mL) (p < 0.001), and increased with progress of stage. The level was also significantly higher in the patients with recurrence than controls (p < 0.001) and in the patients with lymph node metastasis than those without metastasis (p < 0.001). The sensitivity, false-negative rate and AUC for ADAM28 were better than those for CEA. The detection rate in urine was increased with progress of stage, and significant correlated with serum subjects (n = 45; p < 0.001). There was a positive correlation between the ADAM28 level and the degree of immunostaining in the lung adenocarcinomas with a size of ≤ 20 mm in diameter. The patients showing the high immunohistochemical reaction exhibited a poorer disease-free survival (n = 102; p < 0.05). Conclusions: Our data demonstrate that our ELISA is specific and sensitive to monitor the levels of ADAM28 in NSCLC and suggest that ADAM28 is a useful serological and histochemical marker for NSCLC. No significant financial relationships to disclose.