tbuckley/cabot-search huggingface dataset:
Opioid prescriptions after breast cancer surgery: Perception and reality.
Authors: Ko Un Park, Kristin Kyrish, John Allen Terrell, Catherine Liebig Akay, Isabelle Bedrosian, Dalliah MaShon Black, Abigail Suzanne Caudle, Cristina Checka, Barry W. Feig, Kelly Hunt, Rosa F. Hwang, Henry Mark Kuerer, Anthony Lucci, Funda Meric-Bernstam, Ana Paula Refinetti, Chantal Reyna, Merrick I. Ross, Mediget Teshome, Alastair Mark Thompson, Sarah Marie DeSnyder
Journal: Journal of Clinical Oncology (2018)

e18799 Background: Post-operative analgesia requirements vary, but no guidelines exist for opioid prescription (Rx) after breast surgical oncology (BSO) procedures. Given the national opioid epidemic, we sought to characterize opioid prescribing and patterns of use in a large academic BSO practice. Methods: Consecutive patients (n = 253) undergoing BSO operation from November 13, 2017 to January 12, 2018 at a cancer center were surveyed 1 week post-operatively for number of opioid pills used. Surgeons (n = 17) were surveyed about pain management preferences by surgery type. Opioids were converted to an equivalent dose between analgesics known as oral morphine equivalents (OME). CPT codes were collected for surgeries performed in 2017. Amount of opioid used relative to surgeon preferred Rx was calculated. Results: Seven (41.2%) surgeons stated they do not tailor Rx to surgery type (group A), while 10 (58.8%) do (group B). Mean OME preference by group A for each procedure was 177, while mean OME prescribed by group B varied from 136.8 to 256.9 (Table 1). Patients who underwent segmental mastectomy (SM) and sentinel lymph node dissection (SLND) had the lowest mean opioid use (34 OME), while those undergoing total mastectomy (TM) and axillary lymph node dissection (ALND) had the highest (247 OME) (Table 1). Twenty-seven cases (1 SM and 26 TM) had paravertebral block (PVB). Compared to 54 TM cases without PVB, those with PVB did not have less opioid use (PVB 89 OME, no PVB 87). Considering type of BSO surgeries performed (1028 SM±SLND, 146 SM+ALND, 488 TM±SLND, and 229 TM+ALND), group A prescribers would have 199,039 unused OME and group B would have 200,674. Conclusions: There was wide variation in opioid use by BSO procedure. Evidence-based guidelines are needed to tailor analgesic prescriptions by type of surgery and patient need to avoid overprescribing. Table 1. Surgeon Rx preference and actual use by surgery type Procedure Cases (N) Opioid use (mean, OME) Group A (mean, OME) Group B (mean, OME) SM±SLND 142 34 177 136.8 SM+ALND 24 66.6 187.5 TM±SLND 48 70.6 224.4 No reconstruction 13 28.7 Pre-pectoral implant 17 61.5 Post-pectoral implant 18 109.4 TM+ALND 32 246.9 256.9 No reconstruction 24 92.3 Pre-pectoral implant 2 57.5 Post-pectoral implant 6 221.3
Pain after curative treatment for breast cancer.
Authors: Catherine J. Datto, Patricia Johansen, Oscar de Leon-Casasola
Journal: Journal of Clinical Oncology (2018)

e22200 Background: Literature reports that cancer-related pain is experienced by 17-30% of patients with non-metastatic disease and 56-85% with advanced cancer. The characterization of pain following curative breast cancer treatment is the subject of this analysis. Methods: This post hoc analysis utilized the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial database. This study enrolled over 9000 postmenopausal women with invasive, operable, nonmetastatic breast cancer who had completed primary breast cancer therapy (surgery and chemotherapy if given) and were eligible to receive adjuvant hormonal therapy. Median follow-up was 120 months and the database included patient reports of pain types and pain treatments. The data assessed was a portion of those enrolled who had informed consent that allowed for post hoc analysis of the data. This analysis of pain and pain treatment was conducted without respect to the randomized treatment. Pain was considered cancer-related when the investigator specifically identified the pain as related to cancer or its treatment; all others were considered non-cancer pain. Results: Of the 3434 women whose data were available for analysis, 2466 (71.8%) reported any pain medication exposure during the study period; 1633 (47.6%) reported any opioid use and 25.5% of these patients reported any concomitant laxative use. Non-cancer related pain was more commonly reported regardless of the duration of pain medication use: 7-30 days (n = 83): 67.5% non-cancer only and 8.4% cancer-related pain only; ≥30 days (n = 2321): 77.4% non-cancer only and 2.0% cancer-related pain only. Most common conditions associated with opioid pain medications taken for ≥30 days were musculoskeletal pain (35.3%), headache (10.1%), cancer-related pain (6.9%), and use related to non-cancer surgeries (3.9%). Conclusions: In this study of cancer survivors, almost half reported the need for opioid pain management over the follow-up period. The incidence of non-cancer pain was consistently higher than cancer-related pain regardless of opioid therapy duration. Laxative use concomitant with opioid therapy was limited. Consequently, practitioners caring for these patients should be aware of the current pain guidelines to appropriately manage these patients.
Organ preservation with daily concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion for locally advanced tongue cancer: analysis of therapeutic results in 101 cases.
Authors: Kenji Mitsudo, Senri Oguri, Shuhei Minamiyama, Masaki Iida, Toshinori Iwai, Hideyuki Nakashima, Toshiyuki Koizumi, Makoto Hirota, Mitomu Kioi, Iwai Tohnai
Journal: Journal of Clinical Oncology (2016)

6032 Background: Extended surgery for patients with locally advanced oral tongue squamous cell carcinoma markedly reduces the patient’s quality of life (QOL). To preserve function while improving locoregional control and survival rates, concurrent chemoradiotherapy represents one of the standard treatment modalities for definitive treatment of locoregionally advanced oral cancer. Retrograde superselective intra-arterial chemotherapy for oral cancer has the advantage of delivering a high concentration of the chemotherapeutic agents to the tumor bed, it can be used to provide daily concurrent chemoradiotherapy for patients with advanced oral cancer. The purpose of this study was to evaluate the therapeutic results and rate of organ preservation for patients with locally advanced tongue cancer treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy. Methods: Between August 2006 and June 2015, 101 patients with tongue squamous cell carcinoma (20 with stage II, 25 with stage III and 56 with stage IV disease, M0) underwent intra-arterial chemoradiotherapy. Catheterization from the superficial temporal and occipital arteries was performed. And treatment consisted of superselective intra-arterial chemotherapy (docetaxel 50-70 mg/m2, cisplatin 125-175 mg/m2) and daily concurrent radiotherapy (50-70 Gy, median 60 Gy) for 5-7 weeks. Results: The median follow-up for all patients was 36 months (range, 3-113 months). After intra-arterial chemoradiotherapy, primary site complete response was achieved in 96 (95.0%) of 101 cases. Twenty three patients (22.8%) died. Using the Kaplan-Meier method, three-year overall and disease free survival rates were 78.7% and 67.3%, respectively. Three-year local control rate was 86.1% (stage II: 100%, stage III: 88.9%, stage IV: 80.3%). Conclusions: Daily concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion for locally advanced tongue cancer can result in organ preservation and provide good overall survival, thus preserving organs and contributing to patients’ QOL.
The use of 18F-fluoroestradiol (FES) and 18F-fluorodeoxyglucose (FDG) PET in the evaluation of breast cancer heterogeneity.
Authors: Lanell M Peterson, Brenda F Kurland, Alena Novakova, Jean H Lee, Jennifer M. Specht, Mark Muzi, Perrin Romine, Vicky Wu, David A. Mankoff, Paul Kinahan, Hannah M. Linden
Journal: Journal of Clinical Oncology (2017)

11572 Background: 18 F-Fluoroestradiol (FES) is an estrogen analogue that has been shown to be a promising biomarker in ER imaging of breast cancer. FES uptake correlates to ER expression, provides qualitative and quantitative assessment of multiple tumor sites simultaneously, and can predict response to endocrine therapies. Tumor heterogeneity is a known feature of metastatic breast cancer. Our work and others has shown that patients that have tumors with high FDG-PET SUV and low FES-PET SUV uptake have a poorer prognosis. Biopsies of metastatic disease may be done initially for diagnosis of metastatic disease, but are generally only performed in the setting of target identification for clinical trials. A change in ER or HER2 expression, however, can result in a change in therapy. FES-PET imaging offers a virtual biopsy and can reveal heterogeneity of the entire tumor burden. Methods: We reviewed our prior evaluations of tumor heterogeneity with FES-PET from 3 different studies. 46 breast cancer patients with metastatic disease (de novo or recurrent) who had biopsy proven ER+ primary breast cancer underwent FES-PET and FDG-PET imaging and a biopsy of a metastatic lesion prior to therapy initiation. ER and HER-2 expression was reviewed. Results: Of the 46 patients, 5 (11%) had ER- metastatic biopsies. One (2%) biopsy changed from ER+/HER-2 neg to ER-/HER-2+, and one (2%) biopsy changed from ER+/HER-2+ to ER+/HER-2-. All 5 patients (11%) with changes in ER/HER2 expression underwent a change in therapy due to the unexpected findings by metastatic biopsy. FDG findings helped to guide selection of biopsy sites. FES quantitative measures correlated with biopsy findings. Conclusions: Biopsy resulted in a change in therapy for &gt; 10 % of patients enrolled in trials of FES imaging. Imaging can help identify heterogeneous tumor locations to assist identification of evolving tumor targets in breast cancer. In addition, FES imaging may reveal a change in tumor phenotype that can ultimately affect choice of therapy. Research Support: P01CA42045, R01CA72064
Breast cancer in Tunisian men: About 146 cases.
Authors: Khaled Rahal, Mona Rezgani, Olfa Jaïdane, Syrine Abdeljaoued, Imen Sassi, Ilhem Bettaieb, Mohamed Hssairi, Monia Hechiche, Amor Gamoudi, Jamel Ben Hassouna, Tarek Ben Dhiab
Journal: Journal of Clinical Oncology (2018)

e13609 Background: Breast cancer, the first malignant disease in women, remains a rare disease in men. Given the rarity of this disease, the only way to study its characteristics is the retrospective analysis of several small series over several years. The purpose of this work is to specify the epidemiological data, the clinical, radiological and histological characteristics, to determine the therapeutic modalities and to release the prognostic factors of the breast cancer in men. Methods: This was a retrospective study of 146 men who were treated for breast cancer between 1994 and 2011 at the Salah Azaiez Institute. Results: The mean age was 65,4 years. A family history of breast cancer was reported in 11 patients (7.5%). Stage T4 was the most frequent (53,5 %). Patients were metastatic at diagnosis in 29 cases. Mean tumor size was 37mm. Ductal breast carcinoma was the most common histological subtype (91,8%). Axillary lymph node involvement was found in 67,9% of cases with 49.6% in capsular rupture. Breast surgery was performed in 95,2% of cases. It was modified radical mastectomy in 89,7%. Hormone receptors were positive in 87 patients and negative in 12. HER overexpression was tested in 61 patients. It was overexpressed in only 3 patients. Adjuvant radiotherapy was delivered in 72 patients and adjuvant chemotherapy was administered in 58 patients. Endocrine therapy by Tamoxifen was adjuvant in 77 patients. Overall survival and disease free survival at 5 years were 55,4% and 61,4% respectively. Prognostic factors for overall survival were the presence of metastasis, SBR grade, histological tumour size, lymph node involvement, capsular rupture and axillary lymph node dissection. Conclusions: Breast cancer in men is rare, it occurs in the elderly man. It is usually discovered at a late stage. A better sensitization of the population and the physicians would allow an earlier diagnosis allowing a less aggressive treatment and the improvement of the prognosis of this cancer.
Role of primary surgery for persistent residual disease after more than 5 cycles of chemotherapy for primary advanced ovarian cancer.
Authors: Philipp Harter, Helmut Plett, Sonia Prader, Beyhan Ataseven, Florian Heitz, Mareike Bommert, Stephanie Schneider, Pier Alesina, Alexander Traut, Andreas Du Bois
Journal: Journal of Clinical Oncology (2018)

5543 Background: The standard of care in patients with advanced ovarian cancer is upfront surgery followed by chemotherapy. An interval debulking after 3 chemotherapy cycles might be an alternative in selected patients. However, some patients attend a referral center after having received 5 or more cycles of neoadjuvant chemotherapy with persistent disease. So far, the role of a "delayed" interval surgery is poorly defined. Methods: Retrospective analysis of the KEM hospital database 2011-2017 of patients with newly diagnosed advanced epithelial ovarian cancer and delayed cytoreductive surgery for persistent disease after a minimum of 5 cycles of chemotherapy. Results: 39 patients underwent delayed interval debulking. 92.3% had a serous high grade ovarian cancer. The median number of pre-OP cycles was 6 (range 5-8). Intra-operatively, the median Peritoneal Cancer Index was 11. 53.8% underwent a bowel resection (5.1% had a protective stoma) and the median surgical complexity score was 7 (2-16). The median duration of surgery was 285 minutes (range 80-510), complete resection was achieved in 84.6%. The rate of severe complications (Clavien Dindo grade 3 or 4) was 23.1%; we observed no post-operative mortality. The median number of chemotherapy cycles after surgery was 2 (range 0-4). 15 (38.5%) patients received bevacizumab before cytoreductive surgery and 16 (41.0%) patients received maintenance therapy with bevacizumab post-operatively. The median PFS and OS in patients with complete resection was 17.2 and 49 months in contrast to only 6.4 and 14 months in patients with incomplete resection. Conclusions: Delayed interval surgery might be restricted to selected pts in whom the probability for achieving a complete resection is high. Patients in whom a complete resection could not be achieved show a very poor prognosis and it is likely that they rather experience harm than any benefit from surgery.
A matched cohort study of adjuvant radiochemotherapy versus radiotherapy alone in soft tissue sarcoma patients.
Authors: Daniela Greto, Mauro Loi, Francesca Terziani, Luca Visani, Pietro Garlatti, Monica Lo Russo, maria Ausilia Teriaca, Cristina Muntoni, Camilla Delli Paoli, Juljana Topulli, Domenico Campanacci, Giovanni Beltrami, Guido Scoccianti, Pierluigi Bonomo, Isacco Desideri, Giulio Francolini, Lorenzo Livi
Journal: Journal of Clinical Oncology (2018)

e23554 Background: Adjuvant radiotherapy is the standard postoperative treatment after conservative surgery in high risk soft tissue sarcoma. The role of adjuvant chemotherapy is still debated. A matched cohort analysis was performed to analyse differences in terms of clinical outcome and toxicity between patients with high risk soft tissue sarcoma treated with concomitant radio-chemotherapy (RTCT) and radiotherapy (RT) alone. Methods: Ninety patients were selected, a half underwent radio-chemotherapy and a half radiotherapy alone. For each patient in RT group was selected a patient in the RTCT group matching for age, T stage and grading. Acute and late toxicity were recorded, overall survival, recurrence free survival and distant metastases free survival were analysed and compared between the two groups. Results: During treatment, grade 3 dermatitis was recorded in 15 (16.7%) patients, 6 (6.7%) associated chemotherapy and during follow-up 12 (13.3%) patients developed grade 2 late fibrosis, 3 (3.3%) joint stiffness and 1 (1.1%) experienced a bone fracture. There were no differences in the rate of acute and late toxicity between the two groups. Nineteen (21.1%) patients developed local recurrence, overall 5-year local relapse-free survival was 83%. There were no differences between the two groups. 29 patients developed distant metastases, 14 (15.6%) in the RTCT group and 15 (16.7%) in the RT group. The 5-year distant metastases-free survival was 67%. Age > 65 years was the only independent factor affecting distant recurrence (HR = 5.7,95% CI 2.7-11.9; p = 0.001). At the time of analysis 15 (16.7%) patients were dead, 6 (6.7%) in the RTCT group and 9 (10%) in the RT group. 5-years overall survival was: 88%. At multivariate analysis age > 65 years was an independent prognostic factor of overall survival (HR = 3.7, 95% CI 1.2-12.1, p = 0.037). Conclusions: Prospective randomized study with large size population and subgroup analysis for histological subtypes are necessary to clarify the role of adjuvant chemotherapy in soft tissue sarcoma. Tailored treatment must be considered in elderly patients to guarantee a better outcome in this high risk and fragile population.
TCT-15 Two-year Outcomes after Transcatheter Aortic Valve Replacement with Mechanically- Versus Self-Expandable Valves: Results from the REPRISE III Randomized Trial
Authors: Michael Reardon, Ted Feldman, Christopher Meduri, Daniel O'Hair, Axel Linke, Dean Kereiakes, Ron Waksman, Vasilis Babaliaros, Robert Stoler, Gregory Mishkel, David Rizik, Vijay Iyer, Didier Tchetche, Joshua Rovin, Maurice Buchbinder, Didier CARRIE, Robert Hodson, Dominic Allocco, Ian Meredith
Journal: Journal of the American College of Cardiology (2018)
Cytogenetic evolution between diagnosis and relapse and impact on acute myeloid leukemia (AML) reinduction outcomes.
Authors: Andrew Mark Brunner, Lillian Werner, Jennifer Lombardi Story, Gabriela Hobbs, Philip C. Amrein, Robert P Hasserjian, Donna S. Neuberg, Amir Tahmasb Fathi
Journal: Journal of Clinical Oncology (2017)

e18509 Background: Changes in the subclonal composition of AML may occur after diagnosis and be a mechanism of relapse. Cytogenetic changes between diagnosis and relapse may reveal evolution in clonal composition. We sought to determine whether evolution of patient cytogenetics impacts the response to salvage chemotherapy among AML patients who relapse after first remission. Methods: We identified adults with relapsed AML between 2001-2015. Studied patients received induction at diagnosis, achieved remission, relapsed, and received intensive salvage. APL and primary refractory AML were excluded. We identified cytogenetic abnormalities at relapse, and any clonal changes from diagnosis (gain/loss/no change). Associations with CR2 were analyzed by Fisher’s exact test. OS was from salvage therapy to death or censored at last known alive, with Kaplan Meier estimates. Results: 69 patients (median 54 yo, 58% male) received salvage therapy for relapsed AML. Most (81%) had de novoAML. Patients had favorable (7%), intermediate (70%), and adverse risk (23%) cytogenetics at diagnosis; 51% were normal karyotype. 94% received 7+3-based induction. 42% underwent allo-HCT in CR1. Salvage included 7+3 (n = 22), MEC (n = 36), HiDAC (n = 4), or other regimens (n = 7). Median time from CR1 to relapse was 10 mo (IQR 5, 18). At relapse, 29 patients (42%) gained cytogenetic abnormalities, 8 (12%) lost abnormalities, and 31 (45%) were unchanged. The most common acquired abnormalities involved chromosomes 7, 11, or 17 (each n = 6). 55% achieved CR2/CRi2 (CR2 w/ chromosome gain 48%, loss 38%, no change 65%). Longer CR1 duration was associated with greater likelihood of achieving CR2/CRi2 (p = 0.003). Accounting for CR1 duration, cytogenetic evolution from diagnosis to relapse was not significantly associated with CR2. Improved OS was seen with non-adverse diagnosis cytogenetics (p = 0.0003), longer CR1 (p = 0.035), and transplant in CR1 (p = 0.04). Conclusions: Although AML evolution frequently occurs between diagnosis and relapse (54% of this cohort had cytogenetic changes at relapse), this did not impact CR2 or overall survival. Rather, duration of CR1, likely a surrogate for depth of remission, significantly impacted outcomes.
Evaluation of the effect of cost on adherence in a pharmacist driven oral chemotherapy adherence program.
Authors: Iris Chen Zhao, Josephine Lai, Brian Seiki, Machelle Wilson, Laura A Brennan, Tianhong Li, Theodore Wun
Journal: Journal of Clinical Oncology (2016)

e18273 Background: About 1/3 of oncology drugs in development are for oral administration. We created an Oral Chemotherapy Adherence Program (OCAP) to help overcome barriers to adherence including cost, which significantly improved adherence by an average of 9.08% (Zhao et al. ASCO 2015, Abstract #6569). High medication costs continue to be a barrier to treatment initiation and adherence. Previous data have shown that almost 10% of patients choose not to fill their initial prescriptions for oral anticancer medications due to the high costs. The purpose of this study was to assess the effect of cost on adherence to oral anticancer drugs for patients enrolled in this program. Methods: Cost analysis was conducted for patients enrolled in OCAP between Oct 2013 to Oct 2014 and on oral anticancer agents for 2 or more cycles both pre- and post-enrollment. The mean copays per month pre- and post-enrollment were recorded. The Wilcoxon Signed Rank test was used to test for changes in copay. Spearman’s correlation was used to test for association between change in adherence and change in copay. Results: A total of 148 patients were enrolled in OCAP. Of these, 40 patients had received 2 or more cycles of therapy pre- and post-enrollment. While the difference in pre- and post-enrollment mean copay was not statistically significant (p = 0.11), the mean copay pre-enrollment was $175/month, compared to $30/month post-enrollment. Three patients (7.6%, CI = (0, 15%) refused to initiate treatment due to high drug costs pre-enrollment. Enrollment into OCAP resulted in financial assistance for these patients with a mean savings of $1,789/month. There was no significant association between the decrease in copay with the increase in adherence found from our previous study (P = 0.53). Conclusions: Lower mean copays were observed after enrolling into OCAP. Enrollment of patients into OCAP at the time of initiation of oral anti-cancer therapy would likely result in increased overall adherence rates and increased rates of treatment initation. Further analysis with a greater sample size is needed to determine the clinical and real-world significance of this cost reduction on adherence.