tbuckley/cabot-search huggingface dataset:
Palliative outpatient hot clinic: Rapid access for oncology patients visiting emergency department in a tertiary hospital in Singapore—A 1-year experience.
Authors: Choon Meng Yee, Mervyn Yong Hwang Koh, Jia Fang Lee
Journal: Journal of Clinical Oncology (2016)

137 Background: Oncology patients often present with symptoms at Emergency Department (ED). While most patients require admission for further management, some patients can be discharged from ED with outpatient follow-up. However, most patients were given 4 to 6 week appointment. In the light of this service gap, our department collaborated with ED to facilitate rapid access to Palliative Outpatient Hot Clinic (POHC) within 3 working days from ED visit in 2015. Methods: We performed a retrospective review of all patients seen in the ED who satisfied the referral criteria to POHC. The time / date of ED visit and basic demographics of patients were collected. Various outcomes of POHC referral were documented using a pre-determined protocol. Results: 17 out of 68 (25%) patients who attended ED and referred to POHC were included. 11 (64.7%) patients were seen after-office hours. 12 (70.6%) patients were ≥ 60 years old, 14 (82.4%) were male, and 11 (64.7%) had Eastern Cooperation Oncology Group (ECOG) ≤ 2. Among them, 6 (35.3%) patients were known to Palliative Home Care Service and 5 (29.4%) patients were referred after-office hours. The most common oncological diagnosis was gastro-intestinal carcinoma (N=6; 35.3%). 8 (47.1%) patients were receiving oncological treatment. All patients were referred for poor symptom control [Pain (N = 8; 47.1%), dyspnoea (N = 5; 29.4%) and vomiting (N = 1; 5.9%)]. 10 (58.5%) patients were given an appointment with POHC within 3 days. 4 (23.5%), 7 (41.2%) and 10 (58.5%) patients were seen in POHC within 3, 7 and 30 days of ED visit respectively. Among 13 patients who were not seen within 3 days, 7 (53.8%) referrals were screened and rescheduled, 3 (23.1%) were readmitted to hospital; 2 (15.4%) requested to change appointment and 1 (7.7%) defaulted the appointment. 10 (58.5%) patients were eventually seen by POHC. Conclusions: Rapid access to POHC is vital in the partnership with ED to allow the seamless and timely provision of Palliative Care for Oncology patients.
The significance of ascites in patients with pancreatic cancer: A case-control study.
Authors: Bhargavi Pulluri, Anjaneya Kathait, Hua-Ling Tsai, Amanda L. Blackford, Joseph M. Herman, Daniel A. Laheru, Lei Zheng, Dung T. Le, Zeshaan Rasheed, Ana De Jesus-Acosta
Journal: Journal of Clinical Oncology (2015)

445 Background: Malignant ascites confers a poor prognosis in patients with metastatic pancreatic cancer (PC). It is unknown if radiographic ascites in patients with localized disease is a poor prognostic factor and if this finding should be sufficient to avoid upfront local therapies. We aimed to evaluate the survival outcomes of patients with PC and ascites. Methods: Retrospective case control study with overall survival as primary outcome. Eighty newly diagnosed PC patients with ascites (case group) and 80 similar controls without ascites were collected.Cases and controls were matched on age, gender, stage, ECOG performance, surgical treatment, lymph node status and margin status. Overall survival was compared between groups with Cox proportional hazards models by stages, and with a gamma frailty term to account for the correlation between matched pairs on entire cohort. Results: The 80 matched cases included 19 with resectable disease, 9 borderline resectable, 22 locally advanced and 31 with metastatic disease. 29 patients underwent pancreaticoduodenectomy. Table 1 summarizes the overall survival. Ascites patients had higher risk of death compared to patients without ascites (conditional hazard ratio = 1.58 (95% CI: 1.11-2.27), p=0.01). Conclusions: PC patients with ascites have poor overall survival compared to patients without ascites. Even in the setting of resectable disease, survival is similar to patients with advanced disease. This data suggest that all patients with ascites regardless of disease stage should be considered for systemic chemotherapy prior to attempting local treatments. [Table: see text]
Identifying women at high risk for invasive breast cancer at the time of screening mammography.
Authors: Mary Lorraine Lopresti, Kathryn L. Edmiston, Rahul Sood, Shrinkala Khanna
Journal: Journal of Clinical Oncology (2013)

6 Background: Most mammography centers collect reproductive, family, and environmental data on patients presenting for screening mammograms. These data, if entered into a Gail Model Risk Assessment Tool, can help identify those patients at increased risk. These patients can then be referred to high-risk centers that will focus on risk-reduction strategies. Methods: This study is an observational prospective cohort of 1,000 women presenting for mammographic screening or diagnostic evaluation at mammography clinics affiliated with a single institution. Women at the time of their mammogram were asked to fill out a standard intake sheet by the institutional clinic. These data sheets were gathered and Gail model risk scores were calculated. Women with a 5-year risk of invasive breast cancer of 1.7% or greater were identified. Patients with a history of breast cancer or who underwent diagnostic mammography were excluded. A high risk subgroup was identified and risk factors were analyzed. Women at particularly high risk ( ≥ 3.4% or double the 5-year risk) were analyzed separately. Results: Of 1,000 women screened, 366 had ≥ 1.7% 5-year risk of invasive breast cancer. 26% (96) of these women were under 60 years old while 74% (270) were ≥ 60 years old. Among the latter group, 19.6% (53) were found to have ≥ 3.4% of developing invasive cancer. In these women with double the 5-year risk, 96.2% had a family history of breast cancer and 92.4% had a prior biopsy. Similarly, in women under 60, greater than half were high risk secondary to a prior biopsy or family history. Conclusions: 1/3 of patients who receive annual screening are at high risk for breast cancer. These patients can be identified from data routinely obtained at the time of screening mammography. Many were found to be at increased risk due to a strong family history or prior biopsy. Mammography centers may be the ideal setting in which to alert these patients of their risk and refer them to high risk centers for genetic counseling and consideration of chemoprevention.
Impact of body mass index on postoperative complications and long-term survival in patients with esophageal squamous cell carcinoma.
Authors: Kenichi Kamachi, Soji Ozawa, Tsutomu Hayashi, Akihito Kazuno, Eisuke Ito, Osamu Chino, Hideo Shimada, Hiroyasu Makuuchi
Journal: Journal of Clinical Oncology (2014)

37 Background: Chachexia and undernutrition have been suggested to be risk factors for postoperative complications and survival in cancer patients. The aim of this study was to investigate whether body mass index (BMI) is related to the short-term and long-term outcomes in patients who undergo an esophagectomy for the resection of esophageal squamous cell cancer. Methods: Three hundred forty patients who underwent an esophagectomy for the resection of esophageal squamous cell cancer between 2003 and 2008 were retrospectively reviewed. The patients were divided into two groups: an L-BMI group characterized by a BMI &lt; 18.5 kg/m 2 , and an N-BMI group characterized by a BMI ≥ 18.5 kg/m 2 . The overall and disease-free survival curves of the two BMI groups were determined using the Kaplan-Meier method and were compared using a log-rank test. A Cox proportional hazards regression analysis was used for the univariate and multivariate analyses. Results: The study included 40 patients in the L-BMI group and 300 patients in the N-BMI group. Pulmonary complications seemed to occur more frequently in the L-BMI group (P = 0.006). A histopathological assessment showed that nodal involvement was seen more frequently in the L-BMI group (P = 0.016). The 5-year overall survival rate was higher in the N-BMI group (63.6%) than in the L-BMI group (32.3%) (P &lt; 0.001). The 5-year disease-free survival rate was also higher in the N-BMI group (64.2%) than in the L-BMI group (32.3%) (P = 0.014). In a multivariate analysis, a lower BMI, an upper tumor location, an advanced pathological T stage, and a larger number of metastatic lymph nodes were independent prognostic factors for overall survival (P &lt; 0.05). Conclusions: Our data suggested that a lower BMI not only increased pulmonary complications but also impaired overall and disease-free survival after an esophagectomy for the resection of esophageal squamous cell cancer.
Challenges of implementing the ASCO/ONS oral chemotherapy standards in a community practice network.
Authors: Carole Kathleen Dalby, Jodi Thiele, Jeanna Hamilton Walsh, Frances Fuller, Michael Constantine, Reanne Burke, Meredith Faggen, Heather Gilchrist, Andrew David Norden, Judith Kostka, Joseph O. Jacobson
Journal: Journal of Clinical Oncology (2014)

93 Background: In March 2013, The American Society of Clinical Oncologists and the Oncology Nursing Society published standards for the safe administration of oral chemotherapy. Gap analysis at Dana-Farber Cancer Institute (DFCI) Satellites revealed opportunities in planning, education, and monitoring of patients prescribed oral chemotherapy. As a quality improvement initiative, the DFCI Satellites designed and implemented a multidisciplinary approach to oral chemotherapy administration. Methods: The Model for Improvement was employed. A process map highlighted gaps in oral chemotherapy. Several improvement opportunities were identified. 1) Pharmacists developed oral chemotherapy treatment algorithms in the EMR. 2) Providers adapted the parenteral chemotherapy treatment plan (CTP) for use with oral chemotherapy. 3) A nursing education program was created, and implemented following completion of the CTP and consent. 4) Continuous monitoring for toxicity and adherence was initiated by providers via clinic visits and telephone screening. Results: Monthly compliance reports measured CTP completion, consent, initial education, and monitoring for adherence. Aggregated rates indicate practice variability. Some sites perform well, while others continue to show room for improvement. Conclusions: Developing a process for oral chemotherapy is challenging. Systems are not set up for oral drug safety. Although we had success with introduction of the intervention, results have not yet demonstrated sufficient reliability. System limitations and human factor challenges have impeded progress. Given the risk potential of oral chemotherapy, adopting a robust process to deliver oral chemotherapy is essential for safe patient care. Oral chemotherapy administration is a work in progress that must be refined to achieve high reliability. [Table: see text]
DNA Methylation Differences in Twins Discordant for Adolescent/Young Adult Hodgkin Lymphoma
Authors: Jun Wang, Amie Hwang, Dan Weisenberger, David J. Van Den Berg, Victoria K. Cortessis, Marta Epeldegui, Otoniel Martinez-Maza, Timothy Junius Triche, Ann S. Hamilton, Bharat N. Nathwani, David V. Conti, Steve Horvath, Thomas M. Mack, Wendy Cozen
Journal: Blood (2015)
Interim results of a screening protocol for early detection of pancreatic cancer in asymptomatic high-risk patients.
Authors: Alexandra Gangi, Mokenge Peter Malafa, Jason Klapman
Journal: Journal of Clinical Oncology (2016)

223 Background: Pancreatic cancer (PC) is the 4th leading cause of cancer deaths in the US but is rarely diagnosed at an early curable stage. Early detection of PC will have measurable improved outcomes in affected patients. This study sets out to evaluate if EUS can detect early stage pre-cancerous or cancerous changes in the pancreas of high risk (HR) patients. Methods: After IRB review, a clinical trial (NCT01662609) to evaluate HR patients was opened to accrual. Study subjects met specified inclusion and exclusion criteria as defined by the protocol. Enrolled subjects underwent EUS followed by screening as defined by study protocol: subjects with normal EUS underwent repeat EUS at 1 year; subjects with abnormal EUS underwent fine needle aspiration (FNA) if a mass or cyst was found and measured ≥ 5mm and did not undergo FNA if the lesion measured &lt; 5mm. Those with indeterminate or benign FNA underwent pancreatic CT scan with repeat EUS/FNA at 3 or 6 months respectively. Those with positive FNA were treated appropriately based on findings. Patients with mass/cyst &lt; 5mm underwent repeat EUS/FNA at 3 months. Targeted follow-up is 5 years. Results: Of the 52 subjects accrued thus far, 41 were available for interim analysis. Twenty-seven (67%) subjects had a normal EUS while 14 (34%) subjects had abnormal findings. Two patients had large cysts with FNA consistent with an intraductal papillary mucinous neoplasms (IPMN). These 2 subjects ultimately underwent surgical resection. The 12 remaining subjects had at least 1 subcentimeter lesion and are being routinely screened per the outlined protocol. Conclusions: EUS screening of asymptomatic individuals who are at high risk for pancreatic cancer as defined by our inclusion criteria frequently detects abnormal lesions in the pancreas. These lesions include high risk IPMNs that warrant surgical resection. Our results validate the results of other high risk screening protocols and support the screening of individuals who are at high risk for development of pancreatic cancer. Clinical trial information: NCT01662609.
Association of HER2 overexpression and prognosis in small primary breast cancer.
Authors: A. Schneeweiss, C. Schumacher, O. Gluz, I. Zuna, S. Eidt, F. Marme, U. Nitz, C. Sohn, J. Rom
Journal: Journal of Clinical Oncology (2010)

e11024 Background: Primary breast cancer (PBC) patients (pts) with small tumors usually have a good long term prognosis. Several retrospective studies, however, suggest that HER2 overexpression is a negative prognostic factor even in those pts. Objectives of the present study were to evaluate disease free survival (DFS), distant disease-free survival (DDFS) and overall survival (OS) of PBC pts with tumors ≤ 2 cm depending on HER2 expression and other risk factors in a multicentric setting. Methods: A total of 1,170 PBC pts with primary tumors ≤ 2 cm diagnosed and treated between 2000–2008 were evaluated. DFS, DDFS and OS were calculated by Kaplan-Meier method. Cox regression analysis was used to determine associations between potential risk factors and DFS, DDFS and OS. Results: 73% (n = 852) of pts had a pT1a/b and 27% a pT1c tumor, respectively. 45% of pts were between 51 and 65 years old, 76% postmenopausal, 85% node-negative, 87% hormone receptor (HR) positive and 11% (n=131) HER2 positive (either HER2 3+ or HER2 2+ and FISH positive). With a median follow-up of 23 months the 1 year (1y)-DFS was 97.8% (66 events), the 1y-DDFS 98,3% (53 events) and the 1y-OS 99.3% (33 deaths). Univariate analysis showed significant impaired DFS in case of age > 65 y (p = 0.0073), ECOG ≥ 1 (p = 0.0006), pronounced node positivity (pN2/pN3 or > 9 nodes positive) (p < 0.0001), peritumoral lymphatic invasion (p = 0.0004) or negative HR-status (p = 0.0022). The same factors were significantly correlated with DDFS and OS. There was a clear trend for a higher risk of recurrence for pts with HER2 positive as compared to HER2 negative breast cancer (p = 0.0363). 10.7% of pts with HER2-positive disease had a DFS event compared to only 5.0% of pts with HER2- negative breast cancer. 40% (n = 53) of all pts with HER2 overexpression had already received adjuvant trastuzumab treatment. Of those pts only 5.7% had a DFS-event in contrast to 14.7% of pts with HER2 overexpression without trastuzumab treatment. Conclusions: HER2 positivity appears to be a risk factor for disease recurrence for pts with tumors ≤ 2 cm. The data suggest a benefit from adjuvant trastuzumab in reducing the risk of relapse in these patients. No significant financial relationships to disclose.
Pharmacologic Evaluation of Orally Bioavailable Inhibitors of the 20S Proteasome.
Authors: Christopher J. Kirk, Monette A. Aujay, Mark Ho, Jing Jiang, Guy J. Laidig, Evan R. Lewis, Yan Lu, Tony Muchamuel, Tina M. Woo, Congcong M. Sun, Catherine Sylvain, Jinfu Yang, Han-jie Zhou, Mark K. Bennett
Journal: Blood (2006)
Effect of early palliative care on chemotherapy utilization and end-of-life care in patients with metastatic non-small cell lung cancer (NSCLC).
Authors: J. A. Greer, W. F. Pirl, V. A. Jackson, I. T. Lennes, R. S. Heist, E. R. Gallagher, J. S. Temel
Journal: Journal of Clinical Oncology (2011)

6009 Background: Although we recently observed that introducing palliative care soon after diagnosis for patients with metastatic NSCLC is associated with better quality of life, mood, and survival, the degree to which this care model impacts medical treatment at the end of life requires further study. The aim of this follow-up analysis was to examine the effect of early palliative care on the frequency and timing of chemotherapy utilization and hospice care among patients with metastatic NSCLC. Methods: In this randomized controlled trial, we enrolled 151 patients with newly-diagnosed, metastatic NSCLC presenting to the Massachusetts General Hospital Cancer Center between 6/06 and 7/09. We randomly assigned patients within eight weeks after diagnosis to receive early palliative care integrated with standard oncology care (N=77) or standard oncology care alone (N=74). Participants in the intervention group consulted with palliative care clinicians at least monthly until death. Using Fisher’s exact and log-rank tests, we analyzed differences in the: 1) number and types of chemotherapy regimens; and 2) frequency and timing of chemotherapy administration and referral to hospice care. Results: By one-year follow up, 128 (84.8%) participants had died. Study groups did not differ significantly with respect to the number of chemotherapy regimens or time to second-line or third-line administration. However, compared to those in the standard care group, participants receiving early palliative care had a lower rate of intravenous chemotherapy utilization within 60 days of death (24.1% vs 47.0%, p=0.009), a longer interval between the last dose of intravenous chemotherapy and death (median days=64 vs 41, p=0.01), and higher enrollment in hospice care for greater than one week before death (59.6% vs 33.8%, p=0.006). Early palliative care did not impact utilization of oral chemotherapy. Conclusions: Although patients with metastatic NSCLC received similar numbers of chemotherapy regimens in the sample, early palliative care optimized the timing of final administration of intravenous chemotherapy and transition to hospice services, key measures of quality end-of-life care.
A prospective study of combined colon and endometrial cancer screening in women with Lynch syndrome: A novel, patient-centered approach.
Authors: M. Huang, C. C. Sun, S. Boyd-Rogers, J. K. Burzawa, A. Milbourne, E. Keeler, R. Yzquierdo, P. M. Lynch, S. K. Peterson, K. H. Lu
Journal: Journal of Clinical Oncology (2010)

1563 Background: Endometrial and colorectal cancers are the most common cancers in Lynch syndrome. Consensus guidelines recommend both annual endometrial biopsy (EMB) and colonoscopy. While an EMB is traditionally performed in the office without sedation, it can be a painful procedure. Because colonoscopy is routinely performed with sedation, we assessed the feasibility of performing concurrently an EMB with a colonoscopy and evaluated women's perception of pain, satisfaction and acceptability. Methods: From July 2002 to December 2009 women with a gene mutation for Lynch syndrome, met the Amsterdam II criteria, or had a high risk situation that required screening were prospectively enrolled. After conscious sedation, the procedures were sequentially performed. Patients completed pre- and post-procedure questionnaires assessing pain, level of satisfaction and acceptability. Pain scores for colonoscopies were used as an internal control. The Wilcoxon rank test and Mann-Whitney test were used to compare pain scores. Results: Forty-two women completed the study. Median age was 37 years (range 25- 73). Of the 42 women, 19 had previously had an EMB in the office setting. Women reported significantly lower median levels of pain in the combined procedure compared to previous office setting biopsies (1.0 vs. 6.0, p < 0.001). Regardless of parity, women reported significantly less pain for an EMB as part of the combined screen compared to an office EMB (parous median 1.0 vs. 5.0, p = 0.003;nulliparous median 1.0 vs. 8.0, p = 0.026 respectively). Women expressed a high level of satisfaction reporting more convenience and less pain in the combined procedure. All participants preferred combined screening to separately scheduled procedures and would recommend the combined procedure to their relatives. Conclusions: Combined colon and endometrial cancer screening is a novel, patient centered approach that is feasible, acceptable, and may improve adherence to Lynch syndrome screening recommendations. No significant financial relationships to disclose.
Hepatocellular carcinoma with portal vein thrombosis treated with yttrium-90 microsphere radioembolization results on 22 consecutive patients.
Authors: M. Pracht, J. Edeline, L. Lenoir, M. La Tournerie, E. Garin, Y. Rolland, J. Raoul, E. Boucher
Journal: Journal of Clinical Oncology (2011)

e14573 Background: Portal vein tumoral thrombosis is a pejorative and a frequent complication of hepatoculluar carcinoma (HCC). PVT shows as the primary tumour, an arterial hypervascularization; his main characteristic is the rationale of this study which aim to assess the safety and the efficacy of a Yttrium-90 microsphere (90Y- microS) treatment with TheraSphere in this advanced situation. Methods: Since 2008 we have treated 22 patients with unresectable HCC and PVT; 24 treatments were done as described by Salem and col (J Vasc Interv Radiol 2006;17:1251-78.). Patients were evaluated at 3, 6 and then every 3 months for response (EASL criterias), survival and toxicity (CTCAEv3.0 criterias). Patients characteristics were as follow : Sex (M/F; n) 17/5; Mean age+/-SD (y) 65.3 +/-7.1. Previous treatment: 19 Etiology of cirrhosis VHC 5–Alcohol 12–Iron overload 3– Dysmetabolic syndrom 2; Child–Pugh grade: A/B/C : 15/7/0, Mean largest diameter +/- SD (cm) 8.3-3.5; Patent portal vein thrombosis: right/left/both: 8/3/11; a-fetoprotein (ng/mL) 849+/-19400- normal in 5 cases. CLIP score (2/3/4): 11/6/3; BCLC score C (n=22). Toxicity, response, and survival analyses were censored at time of last visit or death. Results: Median follow up was 11 months (1-34). Responses were: complete 2 (9%), partial 14 (63%), stable disease 3 (13%), progression 4 (18%), 3 patients were refered to surgery and one to transplantation. Median time to progression and overall survival were respectively 7.2 (95%CI, 3.9-10.5) and 9.0 (95%CI, 5.5-12.5) months. 4 cases of liver disfunction (Child B patients with right and left PVT) were observed, all were grade 2. Conclusions: The safety and efficacy results of in this monocentric cohort of 22 patients challenged those obtained with sorafenib in this indication and are in accordance with previous published data (Gastroenterology, 2010;138: 52-64; J Vasc Interv Radio. 2010; 8:1205-12.). Further clinical trials are waranted to confirm these results and to compare 90Y-microS with or without sorafenib to sorafenib alone, taking into account not only the overall survival but also the possibility of secondary surgery after downstaging.
The Extrinsic Apoptotic Pathway Is Implicated in Myelodysplastic Syndromes through the Fas/Fas-L/FADD System.
Authors: Patricia Ribeiro, Herminia Pereira, Isabel Costa, Maria H. Sousa, Antonio Conduto, Isabel Pocas, Paula Viegas, Maria M. Costa, Cidalia Goncalves, Antonio S. Rodrigues, Aida B. Sousa
Journal: Blood (2006)