tbuckley/cabot-search huggingface dataset:
False-positive elevations of carcinoembryonic antigen in patients with a history of resected colorectal cancer.
Authors: Anna Maria Litvak, Andrea Cercek, Neil Howard Segal, Diane Lauren Reidy, Zsofia Kinga Stadler, Rona D. Yaeger, Nancy E. Kemeny, Martin R. Weiser, Melissa Pessin, Leonard Saltz
Journal: Journal of Clinical Oncology (2014)

403 Background: Routine monitoring of carcinoembryonic antigen (CEA) is standard practice in patients with a history of resected colorectal cancer. While it is known that false positive elevations of CEA can occur, the incidence of false positives and the upper limits of false positive elevations have not been previously well characterized. We evaluated these factors retrospectively in a large, single center, 10-year experience. Methods: Computerized medical records of Memorial Sloan-Kettering were searched electronically and then manually confirmed to identify patients who underwent an R0 resection of local-regional colorectal cancer between January, 2003 and December, 2012 and who had a rise in CEA above the normal range after a normal perioperative CEA. CEA elevations were regarded as false-positive if workup failed to identify the source of the CEA with at least 1 year follow up after the CEA first became abnormal. Results: 728 patients were identified who met all inclusion criteria. Of these, 358 patients (49%) were determined to have had a false-positive CEA elevation, 335 patients (46%) had a true-positive CEA elevation indicative of recurrent colorectal cancer, and 35 patients (5%) had a true positive CEA elevation indicative of development of a new, non-colorectal malignancy. Of those with false elevations, 111 had a single isolated CEA elevation (median highest CEA of 5.5ng/ml, range: 5.1-45.2ng/ml) with no further abnormal CEAs, while 247 had CEA elevations on two or more readings with median highest CEA of 6.7 (range: 5.2-34.9ng/ml). Of these 247 patients with confirmed false-positive CEA elevations, only 5 patients (2%) were above 15ng/ml and no confirmed CEA elevation over 35ng/ml was a false positive. Conclusions: False positive CEAs in the 5-15 range are relatively common. Confirmation of CEA elevation in this range prior to initiating imaging studies may be appropriate. False positive CEAs above 15 are rare. In our large data set, all CEAs above 35 were associated with actual cancer recurrence; hence CEA levels above 35 appear to be virtually diagnostic of the presence of cancer.
Integrating a simple screening tool in the electronic medical record to standardize patient needs identification process.
Authors: Valaree Williams, Audrey Caspar-Clark, Neal Niznan, Rebecca Cammy
Journal: Journal of Clinical Oncology (2016)

156 Background: Unidentified psychosocial and nutrition needs can impede a patient’s quality of life during cancer treatment. Nutritional, social, and logistical patient needs may be overlooked without a standardized identification process. With the increasing use of the electronic medical record (EMR), simple screening tools to identify psychosocial needs and nutritional concerns can be implemented. Methods: The University of Pennsylvania’s Department of Radiation Oncology integrated a simple six-question “yes” or “no” response screen directly into the nursing assessment in the EMR to quickly and easily trigger high-risk patient referrals to social work and nutrition services. The screen identifies multiple patient needs (i.e. home supports, weight loss) in a formalized approach across distinct time periods in the treatment course. Staff collected data on new patient encounters and the subsequent referral source (i.e. screen, physician). Results: For social work, 24.5% of the new patient referrals from July 2013 – February 2014 were triggered via the screening tool in the EMR. While it is not clear from this data that overall referrals to social work increased due to the screening tool, it can be inferred that these patients were identified earlier in the treatment trajectory for supportive services. For nutrition services, 51.2% of new patient referrals were triggered via the screening tool. A comparison of data prior to the implementation of the screen in January 2012 showed a 78% increase in nutrition referrals triggered by the screen. Conclusions: This method facilitates quick intervention and fosters better communication among staff. The screen allows the staff to readdress psychosocial and nutrition impact symptoms on a regular basis and provide appropriate interventions along the continuum of care. The screen also reduces the subjectivity of medical staff referrals and is an additional measure to identify oncology patients who would otherwise be overlooked. Lastly, the screening tool in the EMR denotes a targeted intervention and contributes to the establishment of a supportive patient relationship.
Brain metastases in breast cancer and Ki67 expression.
Authors: D. Sartori, M. Bari, G. L. Pappagallo, F. Rosetti, P. Zambenedetti, S. Spatafora, O. Vinante
Journal: Journal of Clinical Oncology (2011)

e21018 Background: Ten to 15% of patients (pts) with breast cancer (BC) will be diagnosed with central nervous system (CNS) metastases, and autopsy series suggest that up to 30% of pts have evidence of CNS disease at the time of death. The identification of factors influencing prognosis may help lead to possibly improve the disease management. Methods: BC pts with CNS metastases were identified within a database of 1,609 BC diagnoses from 1995 to 2010 at the Department of Oncology, Azienda ULSS 13 VE. Pathologic features of tumor samples were examined using standard immune-histochemical assays. Results: Seventy-two pts with CNS metastases were identified. Median age at primary BC diagnosis was 49 years (range, 28-81); median time to CNS metastases was 44 months (range, 0-244). HER2 overexpression was found in tumors from 34 pts (47.2%); 27 pts (37.5%) had tumors lacking overexpression of HER2, estrogen receptors (ER), and progesterone receptors (PgR) (TNBC). Overexpression of p53 (at least 20% tumor cells positive), Ki67 (at least 20%), and BCL2 (at least 30%) were detected in tumors from 22 pts (30.6%), 41 pts (56.9%), and 22 pts (30.6%), respectively. Median survival from CNS involvement was 3.8 months (95% CI 2.72-4.88), with 21.6% and 12.0% of patients estimated to be alive at 12 and 24 months, respectively (Kaplan-Meier product limit method). At univariate log-rank analysis TNBC had a significant poorer survival than HER2 positive patients (3.8 vs 16.6 months) only in the Ki67-negative cohort. The Cox proportional hazards analysis found that Ki67 overexpression and age at diagnosis >50 years were the only factors independently associated with a increased risk of death (2.5-fold and 2.2-fold increase, respectively [Table]). Conclusions: In our series of BC pts with CNS metastases, 85% of patients had either HER2 overexpression or TNB, Ki67 being the prognostic discriminant for survival, mainly in the HER2-positive cohort. Beta SE(beta) Exp(beta) 95%CL (exp)beta)) P TNBC .510 .462 1.665 .674 to 4.113 .270 HER2 positive -.646 .447 .524 .218 to 1.258 .148 P53 positive -1.999 .304 .512 .452 to 1.486 .819 Ki67 positive .911 .312 2.488 1.349 to 4.588 .004 BCL2 positive -.308 .331 .735 .384 to 1.407 .352 Age >50 .800 .313 2.225 1.204 to 4.112 .011
Genetic variations in multiple drug action pathways and survival in advanced-stage non-small cell lung cancer treated with chemotherapy.
Authors: P. Yang, Y. Li, Z. Sun, J. M. Cunningham, M. Aubry, J. A. Wampfler, G. Croghan, C. Johnson, D. Wu, J. Aakre, J. R. Molina, L. Wang, V. S. Pankratz
Journal: Journal of Clinical Oncology (2011)

7009 Background: The prognosis for patients with advanced-stage non-small cell lung cancer (NSCLC) remains very poor. Inherited predictive markers may assist treatment optimization. Genetic variants in glutathione metabolism (GSH), DNA repair, cell cycle and epidermal growth factor receptor (EGFR) pathways were systematically investigated for their association with survival in advanced-stage NSCLC treated with commonly used chemotherapy drugs. Methods: A total of 894 tagging single nucleotide polymorphisms (SNPs) in 70 genes from the four pathways were genotyped in a 1076-patient cohort. Association with overall survival was analyzed at single-SNP and whole-gene levels within all patients and major drug combination subgroups. Results: Poorer survival was observed in patients with genetic variations in MAP3K1 from the EGFR pathway (HR=1.25, 95% CI=1.05-1.50) and GSS from the GSH pathway (HR=1.45, 95% CI=1.20-1.77). From stratified analysis of the subgroup treated with platinum-taxane doublet, a predictive yet opposite effect on survival was observed in MAP3K1 (HR=1.38, 95% CI=1.11-1.72) versus in RAF1 (HR=0.64, 95% CI=0.5-0.82) variations of the EGFR pathway. In the subgroup treated with platinum-gemcitabine doublet, RAF1 and GPX5 (GSH pathway) variations showed protective effects on survival (HR=0.54, 95% CI=0.38-0.77; HR=0.67, 95% CI=0.52-0.85, respectively), whereas NRAS (EGFR pathway) and GPX7 (GSH pathway) variations showed hazardous effects on survival (HR=1.91, 95% CI=1.30-2.8; HR=1.83, 95% CI=1.27-2.63, respectively). All genes that harbored these significant SNPs remained significant by whole-gene analysis. Conclusions: Genetic variations in genes involved in the EGFR and glutathione pathways may be associated with overall survival among patients with advanced-stage NSCLC treated with platinum-, taxane, and/or gemicitabine combinations.
Retrospective registry evaluating the PSA flare phenomenon with cabazitaxel in metastatic castration-resistant prostate cancer (mCRPC).
Authors: Antoine Angelergues, Florence Mercier, Aude Flechon, Aline Guillot, Sylvestre Le Moulec, Gwenaelle Gravis, Philippe Beuzeboc, Christophe Massard, Karim Fizazi, Thibault De La Motte Rouge, Reza-Thierry Elaidi, Stephane Oudard
Journal: Journal of Clinical Oncology (2013)

122 Background: PSA initial flare followed by a decrease is documented in up to 18% of mCRPC patients (pts) treated with docetaxel (D). There is no standard definition of this phenomenon, and its significance in terms of treatment efficacy and prognosis remains unclear. We evaluated the PSA flare incidence and characteristics with cabazitaxel (C), a new taxane developed to overcome D resistance, and its impact on outcome. Methods: A retrospective review of 84 consecutive pts (median 67 yrs) treated with C for mCRPC progressing during or after D was conducted in 8 French centers. Baseline characteristics, disease history, PSA values before and during C, overall survival (OS) and radiological or clinical progression-free survival (PFS) were collected. Results: At C initiation, most pts (84%) were ECOG 0-1, 59.5% had pain and 23.8% received ≥2 chemotherapy lines. Metastases were located in bone (92.9%), lymph nodes (48.8%) and visceral/soft tissues (9.5%). Median number of C cycles was 6 (range 2-14). Median OS and PFS from first C cycle were 16.4 and 6.7 months, respectively. Flare incidence, PFS and OS varied with the definition used (table). Definition [3] seems to us the most clinically relevant, and showed a close estimate of PFS compared to pts with immediate PSA decrease from baseline. We recommend to use this definition in clinical practice. Conclusions: PSA flare occurred in 16% pts treated with C and was associated with as good outcome as immediate responders. C should not be withdrawn prematurely in case of isolated initial PSA rise. This finding supports the PCWG 2 recommendation that early rise (prior to 12 weeks) with cytotoxics should be ignored in determining PSA response. [Table: see text]
Spanish registry and screening program for families at high risk of pancreatic adenocarcinoma.
Authors: Carmen Guillen-Ponce, Evelina Mocci, Mirari Marquez, Julie Earl, Carmen T Guerrero, Maria Teresa Salazar, Maria Celia Calcedo, Francisco X Real, Nuria Malats, Alfredo Carrato
Journal: Journal of Clinical Oncology (2012)

192 Background: 5-10% of pancreatic cancer (PC) cases show familial aggregation. 20% of these correspond to syndromes: Peutz Jeghers, hereditary pancreatitis, familial multiple melanoma, breast and ovarian cancer (HBOC) and others. Familial pancreatic cancer (FPC) is defined as: ≥2 first degree relatives with PC and with no other known syndromes. FPC seems to have autosomal dominant inheritance, but the genetic cause is unknown. Methods: The objectives are: 1) To develop the first FPC Spanish Registry, connecting different groups interested in this disease 2) To study inheritance, phenotypic and molecular characteristics of the FPC, and families with early PC 3) To establish a strategy for early detection of PC in high-risk individuals and to implement it 4) To characterize preneoplastic lesions and diagnosed PC by monitoring high-risk individuals. 16 Spanish hospitals are participating. This study has two components: 1) Cohort to identify families with FPC and hereditary PC. Sources for the families are the PanGen-ES Study, a case-control study of PC which identifies families through a questionnaire on family history of cancer, and Genetic Counseling Units, 2) Cohort of high-risk families. The latter will be followed up by endoscopic ultrasound (EUS) and CT ± abdominal magnetic resonance imaging. In addition, circulating tumor cells (CTC) in peripheral blood will be determined. Results: The assessment of family history of the 421 cases included in the PanGen Study has identified 32 (7.6%) families with FPC and 52 patients with PC ≤ 50 years (12.4%). In addition, the 190 families presenting PC aggregation with other neoplasms are being further evaluated. At this time we have obtained clinical data and blood samples to carry out molecular studies of 23 individuals: 17 belonging to 3 families with FPC, and 6 members of 2 families with an HBOC with some cases of pancreatic cancer. 18 relatives at risk began a follow-up with EUS and CT, with no detection of any suspicious pancreatic lesion; also CTC have not been detected. Conclusions: This initiative will permit to know more about FPC and will serve to evaluate protocols and PC markers in screening the high-risk population, and promote connections with other international groups.
Evaluation of reprimo, a p53-dependent G2 arrest mediator candidate, for monitoring response to treatment in gastric carcinoma.
Authors: M. Garrido, L. Medina, M. J. Maturana, M. Slako, R. Funke, A. H. Corvalan
Journal: Journal of Clinical Oncology (2011)

e14503 Background: Gastric cancer (GC) is the second leading cause of cancer death worldwide. No clinically usefull biomarkers that detect early gastric cancer and have prognostic/predictive value are available. DNA methylation of promoter region of Reprimo (RPRM), a p53-dependent G2 arrest mediator candidate gene, has been postulated as a potential biomarker for early diagnosis of GC (Clin Cancer Res. 2008;14:6264-9). Since RPRM has been found methylated in more than >90% of GC cases, we evaluate RPRM for monitoring response to treatment. Methods: We enroll 14 patients with GC. Staging classification was carried out by AJCC system and evaluation of clinical response by RESIST criteria. DNA was obtained from plasma/serum by Proteinase K/quiagen and bisulfite converted by EZ DNA Methlyation Direct Kit (Zymo Research). Absolute quantification of DNA Methylation in serum/plasma of RPRM was performed by MethyLight technology. The IRB of PUC approved this study. All patients gave informed consent. Results: Among 14 patients with histological diagnoses of GC, average age was 64 y.o.(38-81 y.o.), male/female ratio 2.3/1, low/high-risk counties 1.6/1, stage III (3 cases), stage IV (10 cases) and 1 undefinded. Three patients underwent total gastrectomy and 11 cases received standard chemotherapy (CHM), 2 with neoadjuvant CHM. At initial diagnoses, RPRM was detected in 78% (11/14) of plasma/serum (967/471 copies per mL), respectively. All 3 negative RPRM cases suggest familial criteria of hereditary GC. In cases with clinical response, and at least three detections of RPRM, agreement was 100%. At 3 months of treatment, levels of RPRM were 226/0 copies per mL, plasma/serum, respectively. Currently, progression of disease has been found in 1 case. In this case, RPRM anticipate in 2 months this clinical progression. Conclusions: RPRM could be a potential biomarker for monitoring response to treatment in GC. Both, plasma or serum could be used for this detection. Levels of RPRM anticipate clinical progression. RPRM might not be usefull for monitoring hereditary GC. All these findings should be evaluated in a large, prospective clinical trial.
Non-small cell lung cancer in patients aged 75 years and older: A community-based experience
Authors: S. K. Reddy, M. Berdan CTR, M. Curti, M. Janis, R. Minow
Journal: Journal of Clinical Oncology (2008)

20676 Background: The definition of elderly has been steadily increasing in recent years. We reviewed our records to evaluate a truly elderly subset greater than 75 years of age which represents a unique, growing and under-studied subset of the cancer population. Methods: A retrospective review of all patients 75 years or older with newly diagnosed non-small cell lung cancer between January 1, 2000 and December 31, 2005 identified 116 patients. Records were available for 83 patients with follow-up until death or present if still living, and were abstracted by the tumor registrar. Results: Median age was 81 years (range: 75–92). Median survival of the entire population was 8 months regardless of stage at diagnosis. Sex distribution is 43 female (53%) and 40 male (47%). Histology was adenocarcinoma 42%, squamous cell 35%, and other histology 23%. Treatments actually received were radiation therapy n=53 patients (64%), chemotherapy n=36 (43%), surgery n=14 (17%) and no treatment n=12 patients (14%). Chemotherapy and radiation was delivered to n=23 patients (28%), chemotherapy plus surgery n=4 (5%), radiation plus surgery n=8 (9.6%), and chemotherapy plus radiation plus surgery n=2 (2%). Stages were as follows: stage I/II n=22 (27%), IIIA n=6 (7%), IIIB n=22 (27%), IV n=26 (31%), and stage unknown n=7 (8%). The stage I/II group had a median age of 79.5 years with a median survival of 14.5 months, while the stage IIIB/IV group had a median age of 81.5 years with a median survival of 7 months. The untreated group (n=12) had a median age of 86 with a median survival of only 1 month. Conclusions: In this group of very elderly patients with NSCLCa only 7% of patients had stage IIIA disease, however, 28% received a combination of chemotherapy and radiation therapy, while 27% of patients had stage I/II disease but only 17% received surgery suggesting that treatment patterns in the very elderly differ than in younger patients. The untreated group had a survival of only 1 month, far below any other treatment subset, suggesting that treatment is associated with survival benefit in the very elderly who are fit to receive treatment. No significant financial relationships to disclose.
Using technology to improve patient-provider communication and delivery of quality care.
Authors: Gabrielle Betty Rocque, Amanda Hathaway, Karina I. Halilova, Michele Gaguski, Kathryn A Thomas, Carrie Tompkins Stricker, Karen Hammelef, SarahLena Panzer, Paul B. Jacobsen, Joanne S. Buzaglo, Douglas W. Blayney
Journal: Journal of Clinical Oncology (2016)

76 Background: Shared decision making (SDM) is a cornerstone of patient-centered care with 85-90% of breast cancer (BC) patients preferring an active or shared role in decision-making for breast surgery. SDM has been shown to, improve patients’ understanding of treatment options, result in more conservative care choices, and lead to lower healthcare costs. However, implementation is complex as numerous misconceptions exist. Methods: We are conducting a multi-site, quality improvement (QI) project to improve SDM behaviors and adherence to quality measures through a combination of provider education and use of a novel technology platform, the Carevive Care Planning System. This platform elicits patient preferences, concerns, history, and symptoms, and presents these data with algorithm-driven recommendations as part of a treatment plan. We report results from baseline provider surveys assessing perception and knowledge of SDM. Results: Baseline surveys from 28 participants were analyzed; 43% from a university based cancer center and 57% from community based cancer centers. Survey respondents were MDs (43%), NPs (7%) and RNs (46%), all specializing in Hematology and/or Oncology. When asked, “What percentage of breast cancer patients prefers an active or shared role in decision making?”, only 29% believed 85-90% of BC patients desired an active or shared role as suggested by surgical literature; 43% believed between 55-70% of patients wanted to be engaged in decision-making. Commonly reported barriers to SDM are shown in the table below. Conclusions: Physicians may underestimate patient’s desire to participate in shared decision-making. The barriers to implementing SDM in oncology practice will likely require multi-faceted interventions to overcome. We aim to address these gaps through an intervention aimed at enhancing knowledge and patient-provider engagement through treatment summaries. [Table: see text]
Influenza vaccine immunization in a pediatric oncology ambulatory practice.
Authors: David Tishler, Erika Escobedo, Waseem Alhushki, Ashley S. Margol, Bhakti Mehta, Teresa Rushing
Journal: Journal of Clinical Oncology (2013)

139 Backround: Complications from Influenza infection remain an important cause of morbidity and mortality among immunosuppressed children and adolescents. Seasonal Influenza vaccine has been shown to be both safe and effective in pediatric and adolescent patients on chemotherapy treatment although at the Childrens Center for Cancer and Blood Diseases (CCCBD), immunization rates remain suboptimal. We initiated a comprehensive campaign for the 2012-13 flu season with these objectives: 1) evaluate provider attitudes regarding Influenza vaccine, 2) provide a data capture form in the patient medical record to improve vaccine compliance and 3) retrieve electronic medical record (EMR) data on immunization incidence. Methods: The study period was October 1, 2012 through January 31, 2013; a hybrid hard copy/EMR was in use. A Survey Monkey questionnaire was given to CCCBD oncology providers to assess individual influenza vaccine practices. Information was provided how to document vaccination in the EMR. A reminder/data capture form was attached to the hard copy medical record and collected following each patient visit. Forms were tracked to ensure completion for each active oncology patient seen during the campaign period. Patient medical record numbers were cross-referenced with EMR data to determine immunization incidence and the success of the campaign. Results: 100% of providers (46/46) responded to the survey. All respondents believed that the flu vaccine was both safe and efficacious; many reported that the priority of oncology care pre-empted ordering vaccine (27%). Total vaccine doses dispensed increased by 28 % over the previous season (502 doses in 2012-13 vs. 361 doses in 2011-12). 61% of eligible patients with Acute Lymphoblastic Leukemia (ALL) were immunized in 2012-13 compared to 40% of ALL patients in 2011-12. EMR documentation of vaccination also improved during the campaign. Conclusions: A comprehensive campaign to promote Influenza immunization during the most recent flu season was overwhelmingly successful. In-progress improvement in the institutional EMR will further advance our ability to document and retrieve influenza vaccine data for this at-risk population of children and adolescents.