tbuckley/cabot-search huggingface dataset:
Association between oncologists’ dispositional affect and depressive symptoms in their patients with metastatic cancer.
Authors: William F. Pirl, Jennifer Lerner, Justin Eusebio, Lara Traeger, Lauren Fields, Areej El-Jawahri, Joseph A. Greer, Jennifer S. Temel
Journal: Journal of Clinical Oncology (2015)

9559 Background: While caring for patients with metastatic cancer can be emotional, relationships between the emotions of oncologists and their patients have not been examined. As patients and oncologists read emotional cues in encounters, emotions of one or both may impact the other. We explored associations between dispositional affect, tendencies to emotionally respond to situations in certain ways, in oncologists and depressive symptoms in their patients with newly diagnosed metastatic lung and gastrointestinal (GI) cancers. Methods: As part of an ongoing trial of early palliative care, participants were assessed at baseline for depressive symptoms (Patient Health Questionnaire-9, PHQ9) within 8 weeks of diagnosis with metastatic lung and GI cancers. Oncologists providing care for these patients completed the Positive and Negative Affect Scale (PANAS), a validated measure of dispositional affect with positive and negative dimensions. Associations between patient depressive symptoms and positive and negative dispositional affect were tested with rank sum tests and multivariate linear regressions. Results: Sixteen of the 18 oncologists with patients in the trial completed the PANAS. Among 323 participants with baseline assessments, 277 (86%) had oncologists who completed the PANAS. Mean age = 64.6, 129 (46%) were female, 159 (57%) had GI and 118 (43%) lung cancer, and mean PHQ9 score = 6.5. Positive and negative dispositional affect were not associated with oncologists’ sex, years from training, hours in clinic, and cancer specialization. Patient depressive symptoms were significantly higher if their oncologists reported greater negative dispositional affect (p = .04). The relationship remained significant adjusting for patient age, sex, cancer type, ECOG PS, smoking, and number of oncology visits (β = .13, t= 2.1, p = .04). PHQ9 scores were not associated with oncologists’ positive dispositional affect. Conclusions: Depressive symptoms in patients with metastatic lung and GI cancers appear to be associated with their oncologists’ negative dispositional affect. Determining the direction of the association may lead to new ways of improving patients and/or oncologists moods.
Retrospective review of symptoms and palliative care interventions in women with advanced cervical cancer.
Authors: YuJung Kim, Mark F. Munsell, Ji Chan Park, Larissa Meyer, Charlotte C. Sun, Alaina J. Brown, Diane C. Bodurka, Janet L. Williams, Dana Meredith Chase, Eduardo Bruera, Lois M. Ramondetta
Journal: Journal of Clinical Oncology (2015)

104 Background: Symptoms reported by women with cervical cancer (CCx) include pain, fatigue, lymphedema, sexual dysfunction, proctitis, cystitis, constipation and diarrhea. The objective of this study was to delineate and measure the symptom distress experienced by patients with advanced CCx at the time of palliative care (PC) referral. Methods: A total of 156 advanced CCx patients were referred to PC from 2010 to 2012. Of these, 88 patients had completed the Edmonton Symptom Assessment System (ESAS) and were included in the analysis. Descriptive statistics were used to summarize the data. Results: At the time of presentation mean age was 45 (25-76), 47% were Caucasian, 18% African American, and 33% Hispanic. Fifty-one percent were married; 64% had no advance directives; 75% had recurrent disease. Clinically significant symptoms (defined as ESAS scores ≥ 4) were pain (81%), anorexia (72%), a poor feeling of well-being (70%), fatigue (69%), and insomnia (54%). The chief complaint was pain in 94% of patients. According to the PC specialists’ assessment, pain (96%), emotional distress (77%), and constipation (50%) were predominant symptoms. Various palliative care interventions including opioids, laxatives, and expressive supportive counseling were provided. The median time from advanced cervical diagnosis to PC consultation was 6.0 months (95% CI 5.0-7.8) and the median survival after first PC visit was 4.8 months (95% CI 3.4-6.2). Clinically significant symptoms including nausea, depression, anxiety, and feeling of well-being showed significant improvements at follow-up visits. Conclusions: More than half of patients with advanced CCx were significantly burdened with pain, anorexia, poor feeling of well-being, fatigue, insomnia, and constipation at the time of PC referral. Clinically significant symptoms showed improvements at follow-up visits. In patients with significant symptom distress, early PC involvement may be important to improve quality of life.
Paragangliomas of the urinary bladder: Experience at the National Cancer Institute.
Authors: Michael Weintraub, Minhaj Siddiqui, Srinivas Vourganti, Brian Shuch, Piyush Agarwal, W. Marston Linehan
Journal: Journal of Clinical Oncology (2013)

307 Background: Bladder paragangliomas (BP, also referred to as bladder pheochromocytomas) represent 0.06% of bladder tumors. They occur both sporadically and with familial cancer syndromes such as von Hippel-Lindau (VHL) or Succinate Dehydrogenase-B (SDH-B) deficiency. Here we describe the clinical manifestations and management of BP at our institution. Methods: A retrospective review was performed of all cases of BP treated by the Urologic Oncology Branch at the National Institutes of Health (NIH) Clinical Center from 1989 – 2012. Using an approved database, we reviewed the demographics, radiologic, pathologic, laboratory data, surgical approach, and clinical outcome of patients with BP. Results: A total of 7 patients were treated for BP. Five were part of familial syndromes (3 with VHL, 2 with SDH-B deficiency, mean tumor volume (TV): 4cc), while 2 were sporadic cases (mean TV: 43cc). There was no significant age or gender difference in sporadic versus familial patients. 6 of the 7 patients presented with at least two of the three classic symptoms of headache, palpitations, and diaphoresis. 3 patients had micturition-related symptoms. For diagnosis, urine and plasma normetanephrines and urine norephinephrine showed the greatest sensitivity (0.75, 0.75, and 0.8, respectively). MRI was performed in all patients and had a sensitivity of 100% for detection of the mass. MIBG scan was also 100% sensitive, but was only performed in 3 of the 7 patients. CT missed the lesion in one patient. 3 patients were treated with TURBT (mean TV: 2.2cc), 2 underwent partial cystectomies (mean TV: 11.6cc), and one had a radical cystectomy (TV: 63cc). 2 patients had metastatic disease detected 7 and 9 years after initial treatment. No difference was seen in outcome based on the treatment modality. Conclusions: BP in familial and sporadic cases present with similar characteristics except for size. BP is best detected with catecholamines and MIBG/MRI. Surgical management is largely dictated by the extent of disease and includes TURBT, partial, and radical cystectomy. Long-term monitoring is recommended as distant recurrences can occur.
Transgenic Expression of Inducible Caspase9 Suicide Gene for In Vivo Elimination of Antigen Specific Cytotoxic T Cells (CTLs) Engineered To Produce Cytokines.
Authors: C. Quintarelli, V. Juan, B. Savoldo, G. Giordano, A. Foster, M. Pule, Helen M. Heslop, C. Rooney, Malcolm K. Brenner, G. Dotti
Journal: Blood (2006)
Platinum-based adjuvant chemotherapy (ACT) in elderly patients with non-small cell lung cancer (NSCLC) in the SEER-Medicare database: Comparison between carboplatin- and cisplatin-based regimens.
Authors: F. Gu, G. M. Strauss, J. P. Wisnivesky
Journal: Journal of Clinical Oncology (2011)

7014 Background: Cisplatin (Cis)-based ACT has shown an overall survival (OS) benefit in Randomized Controlled Trials (RCTs) for stage II-IIIA NSCLC and become the "standard" therapy. However, elderly patients are under-represented in these trials and are perceived to have poorer tolerance of Cis. Carboplatin (Carbo) is better tolerated but there is only one phase III Carbo ACT trial that exclusively focused on stage IB NSCLC; this trial was unfortunately underpowered and showed only a trend toward improved OS. Therefore, effectiveness of Carbo-based ACT has been controversial. Our objective is to compare OS and toxicity among elderly patients with stage II-IIIA NSCLC treated with adjuvant Carbo versus Cis. Methods: We have identified 3,324 pts 65 yrs or older from the SEER-Medicare database with surgically resected stage II-IIIA NSCLC, diagnosed between 1992 and 2005. Among them 636 or 19% received platinum-based ACT that started within 3 months of surgery. They were followed until death or the end of the study period (Dec 31, 2007). We used propensity score methods to assess and compare the association of Carbo versus Cis ACT with postoperative OS, while controlling for potential confounders. Cox regression analysis was used to compare the outcomes of patients treated with either chemotherapy while controlling for their propensity scores. Results: The 636 patients who received platinum ACTs have significant improved survival (HR 0.79, 95% CI: 0.71-0.89). Among them 105 or 16.5% received Cis- and 489 or 76.9% received Carbo- based ACT only, 42 or 6.6% received both Cis- and Carbo- based regimens and were excluded in the Cis vs Carbo comparisons. There appears to be no difference in survival (HR for Carbo 0.91; 95% CI 0.70-1.18). Chemo-related toxicities are mostly comparable except for a decrease in rate of infection, emesis and borderline for dehydration favoring Carbo. Conclusions: The SEER-Medicare data allows a comparison of Carbo versus Cis ACTs in elderly resectable NSCLC. Carbo is much more commonly used and provides a comparable OS benefit and a slightly better toxicity profile than Cis.
Frequency of estrogen receptor-negative breast cancer in women with African ancestry: Results from an international study
Authors: L. A. Newman, I. K. Martin, R. J. Zarbo, B. Awuah, D. S. Schultz, V. Takyi, A. Darko, A. Stark
Journal: Journal of Clinical Oncology (2008)

22015 Background: Lifetime breast cancer (BC) incidence is lower yet BC mortality is higher for African American (AA) compared to White American (WA) women. These paradoxical patterns have generated speculation regarding a possible genetic association between BC risk and African ancestry. Little is known about the BC burden of Africa. The African ancestry of AA populations can be traced to western sub- Saharan Africa as a consequence of the colonial-era slave trade. We therefore studied BC patterns in Ghana, since contemporary Ghanaian/African (Afr) and AA women are likely to have some shared ancestry. Methods: Creation of an international BC registry was approved by IRBs of University of Michigan, Henry Ford Hospital (HFH) and Komfe Anoyke Teaching Hospital in Kumasi, Ghana. Features of Ghanaian breast tumors (25 unselected cases) were compared to 435 AA and 812 WA tumors from Michigan by t-test and Chi-squared analyses. Results: AA cases were younger than WA cases (mean age 62.4 versus 60.8 yrs; p=0.05); precise ages were unknown for several of the Afr cases, but it is known that more than half of the Afr cases were younger than 45 yrs. Significant differences were observed for estrogen receptor (ER) expression and frequency of “triple negative” disease (tumors neg for ER, PR and HER2/neu expression) between the three populations (Table). Frequency of ER-neg and triple neg tumors was highest in the Afr cases, lowest in WA cases, and intermediate in AA cases. Results were unchanged when cases were matched on tumor grade. Conclusion: AA and Afr women have an elevated risk of endocrine-resistant and triple-negative breast cancer. The sequential increase in frequency of these aggressive subtypes observed for WA versus AA versus Afr women suggests a possible association with extent of African ancestry. Future international studies of breast cancer in women with African ancestry may improve insights regarding the pathogenesis of ER-negative disease. Frequency of ER-negative breast CA in White American, African American, and Ghanaian African Women Marker Expression White American African American Ghanaian African p-Value ER-negative 21.5% 35.2% 64% < 0.001 ER/PR/HER2-negative 14.4% 24.4% 56% < 0.001 No significant financial relationships to disclose.
Pulmonary adverse drug reactions in patients treated with gemcitabine and a combination of gemcitabine and a taxane
Authors: J. Kilgour-Christie, A. Czarnecki
Journal: Journal of Clinical Oncology (2005)

8274 Background: The rare specific adverse drug reactions (ADRs) classified asPulmonary toxicity (Ptox) are known to occur with the use of gemcitabine (gem) and both taxanes docetaxel and paclitaxel. All three drugs are used as single agents and increasingly in combination treatment. The administration of gem in combination with either taxane, specifically in breast cancer has raised a concern whether the safety profile and incidence of Ptox reported with this combination were different from the one already associated with a single agent. Methods: MedDRA terms (pulmonary oedema, ARDS, dyspnoea and pneumonitis) entered onto spontaneous databases were searched for gem and gem+taxane combination. Identified reports were reviewed individually and as aggregate data, and Proportional Reporting Rates (PRR) were calculated on Lilly and on FDA-FOI databases to assess the strength of association. Results: Ptox ADRs reported to Lilly in patients treated with gem+taxane combination were compared to those reported in patients receiving gem monotherapy. An aggregate review did not provide evidence of a different safety profile for gemcitabine used in combination with taxanes nor any increased Ptox evoked by gem. The strength of association (PRR) for gem+taxane combinations and gem were similar, which indicates similar Ptox profiles for all three drugs. The PRRs calculated on the FOI database fully supported the Lilly results. In addition, the calculations on the FDA data suggest a greater association between pulmonary toxicity of either taxane in comparison to the gem data. The exact calculations will be provided. Conclusions: The review of Ptox cases from the Lilly database indicated that there was no substantial difference in Ptox reported with the combination of gem and taxanes in comparison to gem alone. The strength of association (PRRs) with respect to Ptox calculated on data from the FDA-FOI and Lilly safety database support this review. In addition PRR calculations for taxanes on the FDA-FOI database seemed to indicate a similar safety profile (PTox) for all three drugs. Therefore any potential additive toxicity of these drugs used in combination is probably due to both components of the combination. No significant financial relationships to disclose.
Maintained sensitivity to EGFR tyrosine kinase inhibitors (TKIs) in EGFR-mutant lung cancers that recur after adjuvant TKI.
Authors: G. R. Oxnard, Y. Y. Janjigian, M. E. Arcila, M. G. Kris, M. Ladanyi, C. G. Azzoli, V. A. Miller
Journal: Journal of Clinical Oncology (2011)

7029 Background: Adjuvant TKI therapy for oncogene addicted cancers is now an established strategy following the FDA approval of imatinib for resected GIST. Given the efficacy of EGFR TKIs in advanced EGFR-mutant lung cancer, adjuvant therapy with EGFR TKIs is also biologically appealing. However, there are conflicting findings to date regarding the potential benefit of adjuvant TKI in patients (pts) with lung cancer harboring EGFR mutations (Janjigian JTO 2010; Goss ASCO 2010) To better understand these results, we studied the natural history of EGFR-mutant lung cancers which recurred despite adjuvant TKI. Methods: Pts with recurrent EGFR-mutant lung cancer were identified from an institutional database of pts who received adjuvant/neoadjuvant TKI using an IRB approved waiver. Recurrent cancer specimens, when available, were tested for the T790M resistance mutation. Sensitivity to retreatment with EGFR TKI was evaluated. Results: 23 pts were identified; all cases had an EGFR mutation (61% exon 19 deletion, 35% L858R, 4% other). Pts received adjuvant/neoadjuvant TKI for a median of 19 total months (range 1-39 months); median time to progression (TTP) was 29 months. 8 pts recurred while receiving TKI; 7 of these cases were tested for T790M, which was detected in 4 (57%). 15 pts recurred after stopping TKI (median of 13 months off TKI); however, T790M was not detected in any of the 8 cases tested (p=0.026, Fisher’s exact test). 13 pts who recurred after stopping TKI were retreated with a median TTP of 10 months. Radiographic response was seen in 8 of 10 pts (80%); 3 pts had no evaluable disease. Conclusions: Pts with EGFR-mutant lung cancer who develop recurrence after stopping adjuvant TKI do not harbor T790M and commonly remain sensitive to TKI treatment. Recurrence of EGFR-mutant lung cancer after adjuvant TKI should not preclude a trial of TKI retreatment; a phase II trial of erlotinib in this setting is underway (NCT01189435). Studies of adjuvant TKI may underestimate the potential benefit for resected EGFR-mutant lung cancers if TKI retreatment at recurrence is not explicitly considered. Funding: Supported by ASCO (Young Investigator Award) and the NIH (R21-CA115051, P01-CA129243).
Cost-effectiveness of adjuvant therapy for treatment of stage II colon cancer in patients with diabetes.
Authors: T. Dinh, P. Alperin, B. H. O'Neil
Journal: Journal of Clinical Oncology (2011)

421 Background: The decision to treat stage II colon cancer patients with adjuvant chemotherapy involves assessment of life expectancy, risk for recurrent disease, and the potential benefit and likelihood of adverse effects from treatment. This is a challenging task, particularly for patients with pre-existing chronic illnesses such as diabetes, which may increase side effects and potentially lessen response to chemotherapy. Methods: We use the Archimedes Model to analyze cost effectiveness of adjuvant therapy in stage II colon cancer patients with pre-existing diabetes. The Archimedes Model is a large-scale, integrated mathematical model of human physiology, diseases, and healthcare systems, including pathways relating to diabetes, cardiovascular disease, and cancers of the breast, lung, and colon. The colon cancer model is built using the SEER, ACCENT databases and meta-analyses of clinical trials. Costs relating to colon cancer, diabetes and its complications are based on Medicare reimbursement rates. We simulate a trial in which stage II colon cancer patients are subjected to two treatment strategies: no treatment vs. adjuvant chemotherapy by FOLFOX regimen. We report incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life year (QALY) gained, of adjuvant therapy compared with no treatment. Results: Cost effectiveness is strongly dependent on a patient's tumor profile, age and duration of diabetes. For instance, adjuvant therapy saves ∼0.2 QALYs per person in stage IIA patients who are 75 and older and have been diagnosed with diabetes &gt;10 years, at an ICER of &gt;$150,000/QALY gained. In contrast, it saves 1.1 QALYs per person in stage IIB patients aged 60-65, recently diagnosed with diabetes, at an ICER of &lt;$30,000/QALY gained. Results are sensitive to assumptions on efficacy and side effects of chemotherapy in diabetic patients, as well as cost of adjuvant therapy. Conclusions: The current study suggests that the decision to proceed with adjuvant chemotherapy requires careful assessment of severity of diabetes in stage II colon cancer patients with pre-existing diabetes. No significant financial relationships to disclose.
Novel reconstruction using tumor-containing autologous bone grafts frozen in liquid nitrogen.
Authors: H. Tsuchiya, K. Hayashi, T. Shirai, H. Nishida, A. Takeuchi, S. Miwa, R. M. Hoffman
Journal: Journal of Clinical Oncology (2010)

10046 Background: Allografts used to reconstruct the bony defects after resection of a tumor offer many advantages. However, the high incidence of complications makes the outcome unpredictable. We describe a new method of reconstruction using tumor- bearing autologous bone grafts treated by liquid nitrogen in 78 patients and show the usefulness for bone tumor surgery. Methods: We have treated 78 cases of malignant bone tumor (61 primary tumors and 17 mets) with frozen autografts. The tumor sites were distributed as follows: 42 femurs, 13 tibias and pelvises, 8 humeri, 1 radius, and 1 calcaneus. In 45 cases, the tumor was excised en bloc and the entire specimen immersed in liquid nitrogen for 20 minutes, thawed at room temperature for 15 minutes, and thawed in distilled water for ten minutes to destroy any tumor cells. The other 33 cases used a pedicle freezing method: after the tumor was exposed, one-site osteotomy or joint dislocation was performed; the bony lesion connected to the limb was rotated and frozen in liquid nitrogen. The reconstructions utilized intramedullary cemented nailings or plates in 53 cases and composite prosthetic replacements in 25 cases. Functional evaluations were performed using the Enneking's system. Results: Postoperative functional outcomes were distributed as follows: 57 excellent, 13 good, 7 fair and 1 poor. At final follow-up (mean 35 months), 18 patients had died, 48 remained disease-free, and 12 were living with disease. No intraoperative complications, such as damage to surrounding soft-tissues or neurovascular injury, were encountered. Five graft fractures, 4 local recurrences and 5 infections were identified on intermediate follow-up. Conclusions: Our new surgical technique utilizing frozen autografts appears to be effective as a biological reconstruction. The advantages are simplicity, sufficient strength, no graft-related infection and no need for a bone bank. No significant financial relationships to disclose.
The relationship between change in tumor size and survival in advanced NSCLC treated with gefitinib
Authors: J. X. Wu, H. Y. Zhao, Y. Zhang, Z. Z. Guan, L. Zhang
Journal: Journal of Clinical Oncology (2008)

19066 Background: Gefitinib is cytostatic agents. A lot of patients treated with this drug might have stable disease (SD) as their best response, rather than tumor regression. In this study, we retrospectively review the data of Chinese NSCLC patients who received a single agent of gefitinib (250mg/day) with the purpose of identifying the relationship between change in tumor size and survival in SD group patients. Methods: 139 NSCLC patients were collected retrospectively from a multi-center clinical trial in during November of 2003 to June of 2004. The relationship between change in tumor size during treatment and the time to progression (TTP) were analysis. The differences in TTP were compared by Kaplan-Meier method and log-rank test. Results: Median TTP of 139 NSCLC patients was 98 days. Median TTP of patients evaluated tumor response (CR+PR), SD, and progressive disease (PD) is 125 days, 91 days and 30 days respectively(P<0.01). 74 patients were evaluated as SD, In this SD group, 19 patients with any evidence of tumor enlargement (sum of the longest diameter of target lesions increase, but <20%, labeled as SD+) had short median TTP ( 38 vs 97 days, p<0.01)comparing those patients without tumor enlargement (sum of the longest diameter of target lesions decrease<30% or not change, labeled as SD−/0). Conclusions: Change in tumor size may also be a useful predictive factor of survival, especially for SD patients treated with gefitinib treatment in NSCLC. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration GlaxoSmithKline, Lilly, Roche Bayer, Novatis