tbuckley/cabot-search huggingface dataset:
A breast cancer nomogram for prediction of non–sentinel-node metastasis in patients with sentinel node metastasis and validations of the 14 models.
Authors: Bekir Kuru, Bulent Koca, Necati Ozen, Savas Yuruker, Yuksel Bek
Journal: Journal of Clinical Oncology (2013)

93 Background: To avoid performing axillary lymph node dissection (ALND) for non-sentinel lymph node (SLN)-negative patients with SLN-positive axilla, nomograms for predicting the status of the axillary non-SLNs have been developed in many centers. We created a new nomogram predicting non-SLN metastasis in SLN positive patients with invasive breast cancer and evaluated 14 existing breast cancer models in our patient group. Methods: Two hundred and thirty seven invasive breast cancer patients with SLN metastases who underwent ALND were included in the present study. Based on the independent predictive factors for non-SLN metastasis identified by logistic regression analysis, we developed a new nomogram. Receiver operating characteristics (ROC) curves for the models were created, and the areas under the curves (AUC) were computed. Results: In a multivariate analysis, tumor size, presence of lymphovascular invasion, extranodal extension of SLN, large size of metastatic SLN in mm, the number of negative SLNs, and the multifocality were found to be independent predictive factors for non-SLN metastasis. The AUC was found to be 0.87 which is the highest value reported to date for previous models, and calibration was good for the present Ondokuz Mayis nomogram. Among the 14 validated models, the MSKCC, Stanford, Turkish, MD Anderson, MOU (Masaryk), Ljubljana, and 9 Eylul models yielded excellent AUC values of &gt; 0.80. Conclusions: We present a new model (the Ondokuz Mayis nomogram) to predict the likelihood of non-SLN metastasis. Each clinic should determine and use the most suitable nomogram or should create their own nomograms for the prediction of non-SLN metastasis. [Table: see text]
Transitions in care and reduction in discharge errors.
Authors: Mary Anne Fenton, Tara Szyamnski, Megan Begnoche, Carol Chase, Michelle Moreau, Jessica Barnett
Journal: Journal of Clinical Oncology (2016)

77 Background: Patients are often overwhelmed at the time of hospital discharge and focus on home rather than the discharge process. Fragmented communication and lack of planning between the hospital team, patient, family and primary oncologist can lead to frustration and delays in implementation of palliative or curative therapies and potential hospital readmission when the plan of care is not followed in a timely manner. Our goal is to avoid medication errors, delays in implementation of a care plan and reemergence of symptoms or new symptoms as a result of a suboptimal discharge transition. Methods: A multidisciplinary care transition team including phone nurses, social workers, pharmacists, physicians, nursing leadership and a palliative care practitioner meet monthly to review and refine discharge transitions. Our intervention is a proactive phone call, by specially trained ambulatory oncology nurses, to patients within 1-2 business days after discharge from the inpatient Hematology Oncology service. The nurse asks consistent questions to address common issues in the discharge transition including review of symptoms, understanding of discharge medications, confirmation of new medication initiation, side effects, coping, and next appointment with the oncologist. The nurse reinforces the ambulatory nurse phone line and availability of same day sick visits. Results: Preliminary discharge phone call results from the nurses’ interventions include clarification of discharge medications, interventions when a patient had not obtained the ordered medication including antibiotics, referrals for same day sick visits, referrals to social work for emotional and financial distress, education on medications or side effect management, and follow-up appointments. The average time for the post discharge call is 13 minutes. Conclusions: Our follow up discharge intervention by the oncology nurse has shown many patients are uncertain of medications and follow-up even when provided with detailed discharge paperwork and medication reconciliation. A proactive discharge phone call may help resolve these issues and prevent future readmissions. A six month summary of our intervention will be presented.
Prognostic role of integrin β<sub>1</sub>, E-cadherin, and rac1 expression in small cell lung cancer.
Authors: M. H. Chang, K. Lee, y. S. Kim, J. Kang
Journal: Journal of Clinical Oncology (2011)

7071 Background: Integrin β1 mediates cellular adhesion to the extracellular matrix and is correlated with highly invasive and metastatic behavior in small cell lung cancer (SCLC). E-cadherin (ECAD) is a calcium-dependent cell-cell adhesion receptor that restricts invasion of cells and reduces metastasis. Rac1 is involved in the regulation of the actin cytoskeleton, adhesion, migration, invasion, and tumor metastasis. The aim of this study was to examine integrin β1, ECAD and rac1 expression in SCLC and analyze the prognostic value in patients with SCLC. Methods: We analyzed integrin β1, ECAD and rac1 expression in 112 patients by immunohistochemical staining. Correlative analyses between integrin β1, ECAD and rac1 expression and cliniopathological factors were performed. Results: A total of 65 patients had extensive disease (ED) (58%), and 47 had limited disease (LD) (42%). The median follow-up duration was 61 months (range: 14-117), and the median progression free survival (PFS) and overall survival (OS) were 6.1 months (range: 4.8-7.4), and 9.7 months (range: 8.1-11.3), respectively. The expression of integrin β1, ECAD and rac1 protein was observed in 64, 73 and 99 of patient, respectively. The correlative analyses between integrin β1, ECAD, or rac1 expression and various clinical parameters did not show any statistical significance. However, the ECAD expression was associated with OS in the entire cohort. In contrast, the expression of integrin β1 and rac1 was not associated with PFS or OS. In a subgroup analysis, patients with less than two metastasis had significantly longer OS (P=0.047) if their tumors expressed integrin β1 compared to those without integrin β1 expression. OS was longer for patients with ECAD positive tumors compared to those whose tumors did not express ECAD in males (P=0.032) and patients who never smoked (P<0.001). Multivariate analysis showed that LD (P=0.004), overall response rate (ORR) (P=0.003), and expression of ECAD (P=0.015) were the independent good prognostic factors for OS. LD (P=0.024), ORR (P< 0.001) and less than two metastasis (P=0.003) were prognostic factors for longer PFS. Conclusions: These results suggest that ECAD may be useful as a prognostic indicator in patients with SCLC.
Docetaxel, carboplatin, and trastuzumab (TCH) preoperative induction treatment (IRx) in patients (pts) with HER2-positive breast cancer (BC).
Authors: C. F. Kelleher, F. Sclafani, M. Zuradelli, D. Collins, T. Lyons, J. Ballot, A. O'Meara, H. Reid, T. Mahgoub, A. M. M. Ibrahim, J. M. Walshe, E. McDermott, D. Evoy, C. Collins, D. Fennelly, J. P. Crown, G. Gullo
Journal: Journal of Clinical Oncology (2011)

e11065 Background: In randomised trials IRx consisting of chemotherapy (cRx) + H produced pathological complete responses (pCR, defined variously as absence of invasive cancer, or, absence of invasive and in-situ cancer) in 29-40% of pts with HER2+ BC. Most of the regimens which have been studied include an anthracycline (A), raising concerns about cardiac toxicity from H +A. Our unit adopted the non-A based TCH regimen which was developed by the BCIRG, as our standard for both IRx and adjuvant Rx of HER+BC in 2006, following the presentation of the data from the BCIRG 006 trial, in which TCH produced similar levels of activity to a more aggressive A+H containing regimen, but with substantially less cardiac toxicity. In preparation for a random assignment trial in which TCH will be compared to TC+/- Lapatinib (L) +/- H we studied the efficacy of the TCH regimen in producing pCR. Methods: We reviewed the records of all patients that received IRx TCH. The TCH regimen consisted of T 75mg/m2, C AUC 6 and H 6mg/kg administered q 3 weeks x 6 cycles. All patients proceeded to definitive surgery post IRx. Post surgical therapy was at clinician discretion. Results: 37 patients were treated. All were HER+ (66% 3+ immunohistochemistry, and 34% were fluorescent in-situ hybridisation showing amplification of the Her 2 gene). Clinical and radiographic assessment pre-treatment determined that 36% of tumours were T2, 48% were T3-4 and 15% were inflammatory BC. Pre-Irx, 38% of pts had cN1 or cN2 BC. Efficacy data: 27% (n=10) had a pCR (no invasive BC or DCIS), and a further 10.8% (n=4) has no invasive cancer but had residual DCIS. Post-treatment the mean tumour size was 10.6 mm and 58% had histologically negative axillary lymph nodes. Breast conservation surgery was performed in 43% of cases. Conclusions: In this series of T2-4 breast cancer, Irx TCH produced a pCR rate (defined as absence of residual loco-regional invasive cancer) of 37%. These data are similar to those reported for most A+H-containing regimens. Accrual to the ICORG TCH v TCHL v TCL study, a study with mandatory tissue collection for biomarker analysis, has commenced.
Preclinical study of MEK1/2 inhibitor AZD6244 combined with gemcitabine for treatment of biliary cancer.
Authors: Junyao Xu, Jennifer J. Knox, Ming Sound Tsao, Eric Xueyu Chen, Pinjiang Cao, Chow Sue, Stefano Serra, David W Hedley
Journal: Journal of Clinical Oncology (2012)

240 Background: MEK1/2 is an integral component of the Ras/Raf/MEK/ERK signaling pathway, implicated in uncontrolled cell proliferation and cell survival, a key hallmark of cancer. AZD6244, a novel inhibitor of MEK1/2, is currently completing Phase II clinical trials in biliary cancer, with modest antitumor activity observed as monotherapy. Gemcitabine is a cytotoxic drug commonly used in biliary cancer therapy but many patients showed early resistance. In this preclinical study, we investigated the sequence-dependent antitumor effects of AZD6244 combined with gemcitabine in biliary cancer models. Methods: Two biliary cancer cell lines (EGI-1 and TFK-1) were used. In vitro the effects of single drug or three combination protocols(concurrently; AZD6244 followed by GEM or Gem followed by AZD6244) on cell proliferation, DNA synthesis, and cell cycle distribution were evaluated by MTS, clonogenic assay, EdU uptake and flow cytometry. Drug interactions were analyzed by Chou-Talaly method. In vivo, 4 tumor models subcutaneously xenografted in SCID mice from the two cell lines and 2 human patients were set up to compare the therapeutic effects of different sequence-scheduled combinations. Results: AZD6244 caused G 1 -S cell cycle arrest in biliary cancer cells in vitro and in vivo, and this effect is correlated with the MEK/ERK signaling pathway blocking. Synchronized progression of the population through S phase were observed in 15h after removal of AZD6244 in cell culture or 48h after final dose of acute AZD6244 treatment in vivo. Antagonistic or additive effects was observed in vitro when combination were given as concurrently(CI=2.03~2.46) or Gem followed by AZD6244(CI=1.34~1.78). In contrast, a synergistic antiproliferative activity was obtained when AZD6244 was given first followed by a drug-free interval before Gem treatment (CI=0.53~0.69). In vivo, the best therapeutic effects were obtained with the sequence of AZD6244 followed by Gem, compared with concurrent or reverse sequence. Conclusions: This study provides a sound rationale for a Phase II trial of a potentially synergistic sequence of MEK inhibitor AZD6244 followed by gemcitabine in patients with advanced biliary cancer.
Survivorship care patterns and late effects after cancers of the pancreas and biliary tract.
Authors: Christine E. Hill-Kayser, Carolyn Vachani, Margaret K. Hampshire, Gloria A. Di Lullo, James M. Metz
Journal: Journal of Clinical Oncology (2013)

296 Background: Pancreas and biliary (PBT) cancers are generally associated with poor prognosis, despite aggressive, multimodality therapy. The population of cancer survivors after these diagnoses may be largely ignored, despite risk of late effects. This Internet-based study seeks to evaluate patient-reported toxicities and survivorship care patterns after treatment of PBT cancers. Methods: Patient-reported data were gathered via convenience sample from PBT survivors voluntarily utilizing a publically available Internet-based tool for creation of survivorship care plans. Available at www.livestrongcareplan.com and the OncoLink website, the tool asks survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. During use of the tool, PBT survivors are queried regarding late effects associated with specific treatments. Results: 89 PBT survivors utilized the tool from 2010-2012, 66% with pancreas cancer, 20% biliary, and 13% liver. Of the entire group, 59% were female and 81% Caucasian. Median diagnosis age was 59 and median current age 61. Average time since diagnosis was 2 years (range &lt;1-8). Most reported having had multimodality therapy - 71% surgery, 78% chemotherapy, and 46% radiation – although only 30% report continued care from an oncologist and 8% having received previous survivorship information. Of 17 patients queried, 3 had metastatic disease and 3 had recurrent disease. When the entire group was queried regarding possible side effects of treatment, 44% report persistent neuropathy, 24% chronic diarrhea, 21% bowel stricture or obstruction, and 15% chronic skin changes in the radiation portal. Conclusions: Although the prognosis after PBT cancers remains relatively poor, a small population of long-term survivors exists. Survivors using this tool have generally not received survivorship information and most are no longer followed by an oncologist despite having received multimodality treatment. Neuropathy and gastrointestinal side effects appear to be the most bothersome to this group. This tool represents a potential way to provide information to underrepresented survivorship groups such as PBT survivors in the future.
Utility of [18F] flourodeoxyglucose positron emission tomography (FDG-PET) to predict resectability after neoadjuvant therapy in patients with unresectable pancreatic cancer on CT scans.
Authors: Mohamad Osama Khawandanah, Carla Kurkjian, Shyla Penaroza, Charles Arnold, Terence S. Herman, Michael Talbert, Russell Postier, Shubham Pant
Journal: Journal of Clinical Oncology (2014)

357 Background: The standard imaging approach in patients with pancreatic cancer is contrast enhanced computed tomography (CT), however, Response Evaluation Criteria in Solid Tumors (RECIST) may not be adequate in evaluating response to neoadjuvant therapy. A growing body of evidence exists to suggest that there is additional useful information to be gained from the use of FDG-PET scans in this setting. Methods: We conducted an IRB approved retrospective chart review of patients with locally advanced or borderline resectable pancreatic adenocarcinoma who underwent neoadjuvant therapy at the University of Oklahoma and who had PET/CT imaging before and/or after neoadjuvant therapy between September 2006 and September 2013. Complete remission (CR) was defined as decrease in SUV to ≤ 3.0 or background, and partial response (PR) was defined as decrease in SUV from baseline, but &gt; 3.0. Results: A total of 13 patients underwent Whipple surgery after neoadjuvant therapy at our institution. Four patients (31%) had persistent unresectable disease on CT scans post-neoadjuvant therapy, but demonstrated CR (three patients) or PR (one patient; Pre-treatment SUV: 10.1, Post Treatment: 4.6) on the PET scan. These patients underwent Whipple surgery based on PET response. All four (100%) patients underwent R0 resection. Two patients (50%) received neoadjuvant chemo-radiation in addition to chemotherapy. Conclusions: Response on FDG-PET/CT can be a predictor of R0 resection in cases with evidence of unresectable disease on conventional CT scan. A protocol to study larger number of patients prospectively is being designed.
From PRO screening to improved wellness: A nurse-led intervention.
Authors: Alison Morris, Erika L Tribett, Sandy Tun, Marcy Winget, Douglas W. Blayney, Kavitha Ramchandran
Journal: Journal of Clinical Oncology (2015)

72 Background: Emotional and physical distress in cancer patients is underreported and undertreated. In effort to address this, the Quality Oncology Practice Initiative (QOPI) requires patients to be screened for emotional well-being and pain by their second oncology visit. This project details one cancer center’s quality improvement initiative to: (1) utilize patient reported outcomes (PRO) screening to identify patient distress, (2) develop adaptive nurse-led algorithms to assess and intervene for unmet needs. Methods: In June 2015, we launched electronic collection of PROs using the Patient Reported Outcome Measurement Instrument System (PROMIS) global screen. Screening is completed via EMR patient portal prior to first return visit and 30-day intervals thereafter. A nurse-led algorithm categorizing distress was developed with evidence-based clinical pathways for care. Pathways optimize primary palliative care and referrals to specialist palliative services when appropriate. In August 2015, we will randomize four nurse navigators in gynecologic oncology to test the algorithm and make adaptations for scaling cancer center wide. We will assess the percent of patients screening positive for distress and the rate of primary palliative care interventions (e.g., symptom management and psychosocial support). We will also assess rate of referral to specialist palliative teams. Finally, we will interview a subset of patients to compare self-reported need, clinical management of needs, and whether needs were managed to the patient’s satisfaction. Results: We expect to report on adoption and adaptation of the algorithm for disease-specific groups. We will also report rates of primary palliative care interventions, referrals to specialist palliative care and PROs. Conclusions: Standard screening using PROs and clinical care pathways may foster early identification and management of patient’s psychosocial and physical needs. Support for oncology nurses to lead assessment and connect patients with resources is an opportunity to incorporate primary palliative care into oncology practice. The use of structured, adaptive, novel algorithms is a promising approach to meet patient needs and improve access to supportive resources.
Improving patient safety by minimizing chemotherapy dosing errors.
Authors: Daniel McCrone, Cecilia Tran, Nelly Stone
Journal: Journal of Clinical Oncology (2012)

99 Background: Medication dosing errors in adult outpatient settings continues to be a significant source of morbidity. One recent study reported that approximately 7% of adult patients receiving chemotherapy experience medication errors (Kathleen E. Walsh, et al. Medication Errors Among Adults and Children with Cancer in the Outpatient Setting, Journal of Clinical Oncology, 2009). In 2011, New Century Health implemented a quality improvement project focused on minimizing chemotherapy medication errors. This study describes the oncology quality management program used with the Midwestern oncology providers of a large health plan. Methods: An analysis determined the overall medication dosing error rate and the number of oncologist-to-oncologist interventions. In addition, the root cause of each medication error was identified. Results: During the course of the year, 2,395 chemotherapy treatment plans were reviewed for compendia alignment. In 235 cases, the plans did not align with compendia, were identified for peer-to-peer consultation and were voluntarily withdrawn by the prescriber. Evidence-based plans were subsequently resubmitted for approval. Of the original treatment plans, 68 contained dosing errors. The most common dosing errors included: frequency (60.3%); sub-therapeutic (13.1%); super-therapeutic (14.7%); and loading dose for continuation (10.3%). The full year 2011 medication error rate was 2.8%. Conclusions: The integration of clinical decision support tools for dosing verification with oncologist-to-oncologist clinical review improved patient safety by identifying serious errors prior to treatment. These findings underscore the issue that many chemotherapy medication errors are preventable and arguably the medication error rate should be zero. [Table: see text]
Breast cancer: Does where you get treated affect survival?
Authors: Nina A. Bickell, Jenny J Lin, Rebeca Franco, Natalia Egorova
Journal: Journal of Clinical Oncology (2016)

28 Background: Under the ACA, more women are insured with Medicaid which should improve access to cancer care. However, Disproportionate Share Hospitals (DSH) are due to receive reduced subsidies thereby threatening resource stressed facilities and poorer hospitals are experiencing greater financial penalties due to higher readmission rates. In NYS, 83% of Medicaid breast cancer patients got their cancer surgery at DSH hospitals. As women gain more choice and access, they will require information about hospitals’ quality and outcomes of cancer care. We sought to determine whether there are survival advantages among breast cancer patients treated at hospitals with varying proportions of Medicaid patients. Methods: We used non-obstetric delivery Medicaid discharges from NYS hospitals in 2005-13 to create quintiles of hospitalized patients with Medicaid. Women treated for breast cancer were identified with a diagnostic and procedure code for breast cancer. Based on NYS hospital discharge database linked with vital statistics death records, we calculated hazard ratios using marginal Cox model with a robust sandwich variance estimator controlling for clustering of patients within the hospital, age and comorbidity. Results: Quintiles of Medicaid hospitals ranged from low (0-15%), to low medium (15-22%), medium (22-29%), medium-high (29-50%), to high ( &gt; 50%). 26% of breast cancer patients were treated at the low; 22% at the low medium; 20% at the medium; 21% at the medium-high and 11% at high quintile hospitals. Patients treated in hospitals with &gt; 50% Medicaid patients had a higher long-term mortality (HR = 1.51; 95%CI: 1.19-1.93) compared to those treated at the lowest quintile hospitals. Sensitivity analyses to adjust for stage are underway. Conclusions: While the ACA may improve access to breast cancer treatment, the long term impact on survival remains questionable as women with breast cancer treated at hospitals with high proportions of Medicaid patients may have worse survival. Analyses to control for stage are underway. Pending these results, hospitals with high proportions of Medicaid patients may need to target cancer quality improvement efforts to assure equitable outcomes.