tbuckley/cabot-search huggingface dataset:
Improving quality of cancer survivorship care: From framework to action.
Authors: Larissa Nekhlyudov, Michelle Mollica, Paul B. Jacobsen, Ann M. Geiger
Journal: Journal of Clinical Oncology (2018)

49 Background: One decade after the Institute of Medicine report recommended the development of quality of cancer survivorship care measures, there remains little progress in achieving that goal. Our goal was to develop a framework for quality measurement and outline the next steps needed to drive research, policy and clinical care. Methods: We conducted a scoping review to identify quality domains and indicators for cancer survivorship care that included: (1) published cancer/cancer survivorship guidelines; (2) National Cancer Institute and Patient-Centered Outcomes Research Institute-funded cancer survivorship studies; (3) U.S. state Comprehensive Cancer Control Plans; (4) indicators developed by national quality organizations. We also reviewed published literature, specifically focusing on narrative and systematic reviews, commentaries/editorials and position papers addressing cancer survivorship care quality. We then conducted interviews with key experts in cancer survivorship and quality. Once the framework was developed, we convened a stakeholder meeting to outline actionable next steps. Results: Key domains focused on (1) cancer and its treatment, specifically prevention and surveillance of recurrences and second cancers as well as surveillance and management of physical and psychosocial effects and (2) primary health care needs such as management of multiple medical conditions and health promotion. Patient experience, communication, care coordination and health care delivery structure are critical domains in cancer survivorship care that must be measured. Lastly, domains included health care outcomes, such as utilization, costs, mortality and quality of life. Respective indicators and findings from stakeholder meeting will be presented at the Symposium. Conclusions: We developed a framework that will promote a systematic approach to (1) designing effective, evidence-based clinical care for cancer survivors in oncology and primary care settings, (2) expanding research initiatives to address identified gaps in quality measurement and (3) developing policy recommendations to encourage the implementation of standardized measures for quality improvement.
Comparing quality of care for Medicaid and commercially insured patients with cancer in Washington State.
Authors: Catherine R. Fedorenko, Laura Elizabeth Panattoni, Julia Rose Walker, Li Li, Karma L. Kreizenbeck, Scott David Ramsey
Journal: Journal of Clinical Oncology (2018)

75 Background: Uniformity in receipt of high quality cancer care is imperative to reduce health care disparities. In order to help prioritize efforts aimed at reducing disparities in care, we compared several quality metrics for Washington State cancer patients enrolled in Medicaid and commercial insurance plans. Methods: We linked 2014-2016 Washington state cancer registry records for cancer patients under the age of 65 with enrollment and claims records for the two largest commercial insurers in the state and Medicaid. We then generated thirteen nationally recognized quality measures. Outcome measures were adjusted for age, sex, comorbidity score, stage, cancer site, and treatment factors where appropriate. Process measures were not adjusted. Results: 6,868 commercially insured and 2,379 Medicaid patients are represented in the reported quality measures. Conclusions: Care of Washington state cancer patients enrolled in Medicaid is comparable or superior to commercially insured patients, except for significantly higher ED use during chemotherapy. Further research is needed to understand why Medicaid-enrolled cancer patients utilize the ED at more than double the rate of commercially insured patients.[Table: see text]
Providing oncologic care with access to clinical trials to an underserved and minority population: The Mayo Clinic/Indian Health Service experience.
Authors: Donald W. Northfelt, Chara Chamie, Farhia Omar, Janet Okamoto, Timothy Mathews, Tom R. Fitch
Journal: Journal of Clinical Oncology (2018)

79 Background: Novel mechanisms are needed to provide high quality oncologic clinical care and clinical trial access to underserved and minority populations (UMP). UMP are underrepresented in cancer clinical trials, thus limiting the generalizability of the research. As a National Cancer Institute-Comprehensive Cancer Center, Mayo Clinic has the responsibility to ensure that its cancer care reaches a diverse patient population. Mayo Clinic in Arizona developed a clinical oncology practice in collaboration with the US Indian Health Service at Phoenix Indian Medical Center (PIMC), in part to address these needs. The relationship between Mayo and PIMC is invaluable and serves a crucial need in the community. The Mayo consultants serve as staff physicians in the “Oncology Center of Excellence” at PIMC and see 100 – 200 tribal members annually with new diagnoses of cancer or blood disorders. Being onsite at PIMC allows Mayo consultants to integrate seamlessly into the wider PIMC practice. Methods: Descriptive demographic data from the MCA-PIMC clinical practice were obtained from the PIMC practice database 2008 - 2017. Enrollment of MCA-PIMC patients into MCA cancer clinical trials were prospectively enumerated. Results: Between the time period of 2008-2017, 356 breast cancer patients and 259 colorectal cancer patients were seen by Mayo Clinic oncologists and the PIMC nurse practitioner. During the period of 2016-2017, there were 13 clinical trial referrals from PIMC with 8 of those patients being enrolled in Mayo cancer clinical trials. Conclusions: High quality oncologic clinical care can be provided via unique collaborations between academic oncology program and UMP-focused care provider. This mechanism allows access to cancer clinical trial opportunities for UMP. Prior to the established partnership, there were no Native American patients referred to clinical trials from PIMC, showing the critical pathway that has been forged. Importantly, this is the only known program of its kind in the country. By imbedding the cancer provider in the community, we are able to build trust with the underserved community and create a pathway to a quality care and clinical research.
Cost-effectiveness analysis of pembrolizumab in cancer therapy: A systematic review.
Authors: Claudette Donatien, Lori-Ann Foster, F. Ellen Loh
Journal: Journal of Clinical Oncology (2018)

109 Background: Cancer treatment is very costly and is further complexed by barriers to healthcare such as the lack of health insurance. Cancer detected at a later stage is more expensive to treat and the outcome can be less successful. Pembrolizumab is an immunotherapy that can be given alone or with chemotherapy. Pembrolizumab, a monoclonal antibody, may be considered first-line treatment in cancer therapy with its increase in life expectancy and successful treatment rates. Methods: A systematic review was conducted to identify relevant studies of the cost-effectiveness of Pembrolizumab treatment in cancer patients. We included studies that compared pembrolizumab to previous treatments, treatment-naive patients, advance melanoma, and metastatic non-small-cell lung cancer. Results: Most of the studies reviewed concluded that pembrolizumab was more cost-effective despite its high drug acquisition cost and disease management costs. Treatment with pembrolizumab was most effective when it was limited to 2 years, however, costs increased when treatment went beyond the two years and disease progression did not cease in most trials. In fact, disease progression occurred in many of the trials and patients had to discontinue treatment with pembrolizumab or other treatment regimens for several reasons not limited to adverse event. Regardless, pembrolizumab, if used as first-line treatment, would reduce the chances of disease progression or costs in drug therapy. Conclusions: Improving a patient’s quality of life is important when choosing the right course of treatment for any type of disease. In these studies, the quality-adjusted life years (QALY) were continuously increased when using pembrolizumab as compared to standard of care treatments and other immunotherapies. In the US healthcare system, the main factors to consider are the Healthcare Budget and the Payers willingness to pay. The US has legislated against the explicit use of cost per QALY thresholds but the $50,000 mark is commonly referred to. More studies should be conducted in the US to further conclude the cost-effectiveness of pembrolizumab in the treatment of cancer.
The influence of patient-reported adverse events on Health Utility Score (HUS) and Health-Related Quality of Life (HRQoL) in small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) patients.
Authors: Sharara Shakik, Ali Vedadi, M. Catherine Brown, Wei Xu, Grainne M. O'Kane, Geoffrey Liu, Frances A. Shepherd, Natasha B. Leighl, Penelope Ann Bradbury, Benjamin H. Lok, Adrian G. Sacher
Journal: Journal of Clinical Oncology (2018)

185 Background: The Patient Reported Outcome version of Common-Terminology-Criteria-for-Adverse-Events (PRO-CTCAE) and Edmonton Symptom Assessment System (ESAS) are validated tools that measure toxicities and symptoms in cancer patients. We compared the extent in which the presence and severity of toxicities and symptoms affected HUS in SCLC and NSCLC patients. Methods: Adult SCLC and NSCLC patients were recruited from the Princess Margaret Cancer Centre and surveyed cross-sectionally for clinico-demographic variables, EQ5D-5L, PRO-CTCAE and ESAS. HUS were estimated using EQ5D-5L. PRO-CTCAE toxicities include diarrhea, constipation, decreased appetite, nausea, vomiting, fatigue, neuropathy and rash. ESAS symptoms include pain, tiredness, drowsiness, appetite loss, nausea, shortness of breath, depression, anxiety and lack of well-being. These were combined to show frequency and average severity of toxicities/symptoms per patient. Univariable and multivariable linear regression analyses identified toxicity/symptom influencing HUS. Results: Of 75 SCLC and 150 NSCLC, 52% were male with median age of 65 years. The mean HUS was 0.76 (SCLC = 0.69; NSCLC = 0.79; p = 0.001). Compared to NSCLC, SCLC patients had a significantly higher number of toxicities (3.14 versus 1.33 using PRO-CTCAE, p &lt; 0.0001); symptoms (6.75 vs 5.45 using ESAS, p = 0.0003) and severity of toxicities/symptoms (PRO-CTCAE 0-4: 0.95 versus 0.35, p &lt; 0.0001; ESAS 0-10: 3.37 versus 2.04. p &lt; 0.0001). There were significant correlations between the average severity of toxicities/symptoms and HUS (p &lt; 0.0001) adjusted for age, histology, smoking pack years and performance status. For each increase in the average severity of toxicities, there was a corresponding mean drop of 0.03 in the HUS; for every increase in the average severity of symptoms, the drop was 0.04. These relationships were similar for both SCLC and NSCLC patients. Conclusions: Patient reported toxicities and symptoms have a significant impact on HUS in both SCLC and NSCLC patients. Early and aggressive management of such adverse events may be necessary to improve patients’ HRQoL.
Abstract 16151: Local Delivery of Zoledronate Attenuates the Aortic Valve Calcification in an Experimental Model of Aortic Stenosis
Authors: Andreas Synetos, Konstantinos Toutouzas, Iosif Cutajar, Maria Drakopoulou, Konstantinos Stathogiannis, Giorgos Agrogiannis, Apostolos Papalois, Efstratios Patsouris, Dennis Cokkinos, Dimitris Tousoulis
Journal: Circulation (2016)

Introduction: The inhibition of vascular calcifications has been successfully tested by local delivery of bisphosphonates Hypothesis: The aim of the present study was to evaluate the safety and eff...
REforge associates transcription factor binding site divergence in regulatory elements with phenotypic differences between species
Authors: Björn E Langer, Juliana G Roscito, Michael Hiller
Journal: Molecular Biology and Evolution (2018)

Elucidating the genomic determinants of morphological differences between species is key to understanding how morphological diversity evolved. While differences in cis-regulatory elements are an important genetic source for morphological evolution, it remains challenging to identify regulatory elements involved in phenotypic differences. Here, we present Regulatory Element forward genomics (REforge), a computational approach that detects associations between transcription factor binding site divergence in putative regulatory elements and phenotypic differences between species. By simulating regulatory element evolution in silico, we show that this approach has substantial power to detect such associations. To validate REforge on real data, we used known binding motifs for eye-related transcription factors and identified significant binding site divergence in vision-impaired subterranean mammals in 1% of all conserved noncoding elements. We show that these genomic regions are significantly enriched in regulatory elements that are specifically active in mouse eye tissues, and that several of them are located near genes, which are required for eye development and photoreceptor function and are implicated in human eye disorders. Thus, our genome-wide screen detects widespread divergence of eye-regulatory elements and highlights regulatory regions that likely contributed to eye degeneration in subterranean mammals. REforge has broad applicability to detect regulatory elements that could be involved in many other phenotypes, which will help to reveal the genomic basis of morphological diversity.
Abstract 13150: The Economic Implications of Non-adherence to Aspirin in Patients With Prior Primary Cardiovascular Events
Authors: Robert D Lieberthal, Stefan Varga, Suzanne Adams, Melissa McCarey, Bridget Toroni, David Whellan
Journal: Circulation (2016)

Introduction: Adherence to medications for secondary prevention of cardiovascular events has been shown to be poor in both general and high risk populations. Non-adherent patients are at higher risk of experiencing another CV event, leading to adverse clinical events and high costs. Few prior studies have explored the economic and consequences of non-adherence to aspirin in relation to cardiovascular health. Hypothesis: Improved adherence to aspirin will lead to lower healthcare costs and improved long-term survival rates. Methods: We developed a generalizable Markov model to estimate the cost-effectiveness of aspirin adherence. The rates of aspirin adherence, events and costs were gathered from published literature. We applied the model separately to a general (low-risk) population with no comorbidities and a high-risk population with type II diabetes. Outcomes of interest included fatal and nonfatal events, including secondary myocardial infarction (MI), stroke, other clinical CV events including PAD-related amputation as well as aspirin-related side effects (gastrointestinal bleeding). All costs were inflated to 2016 U.S. dollars to reflect the current cost of treatment. Results: The aspirin adherence rates for the low-risk and high-risk model were 85.8% and 76.5%, respectively. Both models demonstrated neutral average 5-year cost per member when comparing adherent to non-adherent population. The average 5-year survival was 0.26 years or 3.1 months longer amongst the adherent population in the low-risk model and 0.37 years or 4.4 months longer in the high-risk model. As a result, the ICER is $23 for low risk population while adherent strategy is dominant (lower cost, higher effectiveness) for high risk population. Conclusions: Adherence to aspirin therapy after experiencing a primary CV event is critical for patients’ well-being and can facilitate better health outcomes. This study demonstrates that aspirin adherence is essentially cost neutral and extends survival in low and high-risk patient populations, with a potentially cost saving outcome for patients with comorbid conditions such as diabetes.
Role of effective care plans in reducing admissions for sickle cell patients.
Authors: Bilawal Ahmed, Tami Day, Cara Hirner, Michael Trendle, Jonathan Heidt, Sindhu Singh
Journal: Journal of Clinical Oncology (2018)

156 Background: Adults with sickle cell disease (SCD) vaso-occlusive crisis (VOC) frequently seek care in the emergency department (ED) which often results in hospital admissions. The Hematology-Oncology at Ellis Fischel Cancer Center collaborated with organization’s ED to develop and implement individualized care plans for adults with SCD presenting to the ED with the goal of adequate outpatient management and a reduction in hospital admissions. Methods: Baseline data collected from November 2014 through December 2016 indicated that 108 SCD patients accounted for 195 inpatient hospital admissions, and 40% of all 30-day readmissions for the Hematology-Oncology service line. Further, the average length of stay for patients admitted for SCD crisis was 6.8 days per stay. Medical Director, Oncology Unit Manager, and Performance Improvement Professional collaborated with the ED Medical Director and representatives to develop a disease-specific acute care plan for our adult SCD patient population. The care plan include pathways for lab collection, pain medication regimens, prescription opioid refill policies, a timeline for outpatient follow-up, and criteria for hospital admission. These care pathways were then transitioned to order sets in within the organization’s electronic medical record. Results: Implementation of the SCD care plans resulted in significant improvement in the 30-day readmission rate among the SCD patient population, from 40% to 3%. Further, use the SCD care plans helped reduce the average length of stay for patients admitted with SCD crisis from 6.8 days to 3 days. More importantly, we have been able to sustain this improvement over time. Conclusions: This study clearly demonstrates that collaboration with the ED and development of care plans are key to reducing ED and hospital utilization among patients with SCD, and reducing the average length of stay for SCD patients who require hospitalization for disease management.
Antibody persistence after vaccination of adolescents with monovalent and combined acellular pertussis vaccines containing genetically inactivated pertussis toxin: a phase 2/3 randomised, controlled, non-inferiority trial
Authors: Punnee Pitisuttithum, Kulkanya Chokephaibulkit, Chukiat Sirivichayakul, Sirintip Sricharoenchai, Jittima Dhitavat, Arom Pitisuthitham, Wanatpreeya Phongsamart, Kobporn Boonnak, Keswadee Lapphra, Yupa Sabmee, Orasri Wittawatmongkol, Mukesh Chauhan, Wassana Wijagkanalan, Greanggrai Hommalai, Librada Fortuna, Pailinrut Chinwangso, Indrajeet Kumar Poredi, Anita H J van den Biggelaar, Hong Thai Pham, Simonetta Viviani
Journal: The Lancet Infectious Diseases (2018)
Glycolytic Switch Is Required for Transdifferentiation to Endothelial Lineage
Authors: Li Lai, Erin Reineke, Dale J. Hamilton, John P. Cooke
Journal: Circulation (2018)

We have previously shown that activation of cell-autonomous innate immune signaling facilitates the transdifferentiation of fibroblasts into induced endothelial cells, and is required to generate induced endothelial cells with high fidelity for endothelial lineage. Recent studies indicate that a glycolytic switch plays a role in induced pluripotent stem cell generation from somatic cells.Seahorse and metabolomics flux assays were used to measure the metabolic changes during transdifferentiation in vitro, and Matrigel plug assay was used to assess the effects of glycolysis modulators on transdifferentiation in vivo.The metabolic switch begins rapidly after activation of innate immunity, before the expression of markers of endothelial lineage. Inhibiting glycolysis impaired, whereas facilitating glycolysis enhanced, the generation of induced endothelial cells. The toll-like receptor 3 agonist poly I:C increased expression of the mitochondrial citrate transporter Slc25A1, and the nuclear ATP-citrate lyase, in association with intracellular accumulation of citrate, the precursor for acetyl coenzyme A. These metabolic changes were coordinated with increased histone acetylation during transdifferentiation.Innate immune signaling promotes a glycolytic switch that is required for transdifferentiation, both processes being attenuated by ATP-citrate lyase knockdown. These data shed light on a novel link between metabolism and epigenetic modulation in transdifferentiation.
Identifying patients with bacterial infections using a combination of C-reactive protein, procalcitonin, TRAIL, and IP-10 in the emergency department: a prospective observational cohort study
Authors: Y. van der Does, P.P.M. Rood, C. Ramakers, S.C.E. Schuit, P. Patka, E.C.M. van Gorp, M. Limper
Journal: Clinical Microbiology and Infection (2018)
Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial: Data from the HORRAD Trial
Authors: Liselotte M.S. Boevé, Maarten C.C.M. Hulshof, André N. Vis, Aeilko H. Zwinderman, Jos W.R. Twisk, Wim P.J. Witjes, Karl P.J. Delaere, R. Jeroen A. van Moorselaar, Paul C.M.S. Verhagen, George van Andel
Journal: European Urology (2018)
Eliminating Poverty in the 21st Century
Authors: Jim Yong Kim
Journal: JAMA (2018)

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