tbuckley/cabot-search huggingface dataset:
The acceptability to African-Americans of a structured conversation guide to improve advance care planning in the setting of cancer: A focus-group study.
Authors: Justin J Sanders, Katherine W. Sterba, Dee Ford, Susan Block
Journal: Journal of Clinical Oncology (2015)

11 Background: African-Americans are less likely than whites to participate in advance care planning (ACP), which may contribute to disparities in the receipt of goal-concordant care. Literature points to multiple factors: the impact of religion, mistrust, different preferences for life-sustaining measures, family-decision making styles and poor knowledge about ACP. Early ACP conversations are associated with improved outcomes at the end of life, including goal-concordant care. A systematically-developed, serious illness conversation guide (“guide”) for oncologists, embedded in a systems-based approach to improving illness care, has demonstrated more frequent, higher-quality, and earlier ACP conversations in a predominantly white and middle class cohort of cancer patients. This study aimed to explore the acceptability and need for modification of the guide in more diverse populations. Methods: We conducted a series of focus groups with panels of clinicians and researchers, African-American church members, and seriously ill patients and their caregivers to assess barriers to ACP and preferences concerning modifications to the guide. We used template analysis to code themes at the individual, interpersonal and systems levels. Results: At the individual level, participants confirmed the importance of religion and the impact of perceived discrimination (e.g., receipt of inferior care) and superstition (e.g., talking about death may make it happen). Interpersonal-level factors influencing ACP included family, trust, and concerns about provider abandonment. Participants confirmed systems-level barriers of access and mistrust in the healthcare system and highlighted community outreach as a key part of the process. Participants reported positive responses to the tone and content of the guide and found the guide to be acceptable when it included a question that elicited coping mechanisms, including religion. Conclusions: Participants in our study found the use of a serious illness conversation guide to identify patient goals and priorities acceptable, and emphasized the importance of adding a question focused on coping and religion.
Bevacizumab and irinotecan in patients with recurrent glioblastoma (GBM): Results of a retrospective cohort study of the OMIT Bretagne and Pays de la Loire.
Authors: F. Grude, M. Campone, J. Frenel, P. Soulie, E. Vauleon, Y. Hadjarab, G. Ganem, F. Denis, J. Egreteau, A. Lortholary, M. Porneuf, H. Simon, P. DAM Hieu, V. Klein, B. Dominique, P. Deguiral, H. Desclos, P. Menei, S. Traoré
Journal: Journal of Clinical Oncology (2011)

2086 Background: The OMIT (Drugs and Emerging Therapeutics Observatory) is a French structure created in 2003 by the Regional Health Agencies of Western France (Bretagne and Pays de la Loire). This network gathers clinical data from 50 public and private institutions. Its medical staff (oncologists, surgeons, pharmacists, biologists, etc) has a global reflection on drugs management in cancer patients and is also a task force for French Health Authorities. Despite several promising publications (Vredenburgh Clin Cancer Res 07, Kreisl JCO 09, Friedman JCO 09), the approval of bevacizumab in recurrent glioblastoma patients was declined, in November 2009, by European Medical Agencies. Methods: The aim of this retrospective study was to evaluate the objective responses, progression free survival, overall survival and tolerance of bevacizumab and irinotecan in community practice and, eventually, to define relevant criteria of responders. The data of 162 patients out of 200, treated between July 2007 and June 2010, have already been analysed. Results: 65% males, 35% females, mean age: 53 years [51-55]. 87% of the patients underwent a complete or partial tumor resection and 89% received the Stupp protocol as first line therapy. 31% discontinued treatment before 3 months. At 3 months, objective responses were observed in 43% of the patients and disease stabilization was achieved in 42% of them. The progression free survival and overall survival were respectively 5.57 months IC95% [4.88-6.25] and 8.07 months IC95% [7.11-9.03]. Grade 3-4 toxicities included haematologic (10%) and digesitve toxicities (4%), vein thrombosis and pulmonary embolism (3%), high blood pressure (1%), intratumoral bleeding (1%), asthenia (1%) and others (2%). They were mainly manageable. Updated results will be presented at the meeting. Conclusions: The first results of this cohort show that, after 3 months of treatment, 85% of the patients obtained a clinical benefit. Overall survival is comparable to those reported in other retrospective studies. Cost effectiveness and cost utility studies are necessary. A prospective study is needed to identify prognostic and predictive factors.
Impact of follow-up imaging on overall and cancer specific survival after radical and partial nephrectomy.
Authors: Seth A. Strope, Siobhan Sutcliffe, Goutham Vemana, Gurdarshan Singh Sandhu, Mario Schootman
Journal: Journal of Clinical Oncology (2014)

401 Background: While imaging after radical and partial nephrectomy has been shown to detect recurrent disease, impacts on mortality are unclear. We assessed effects of imaging on overall-survival (OS) and cancer specific survival (CSS) in Medicare patients. Methods: From linked SEER-Medicare data we defined a cohort of patients treated with radical or partial nephrectomy from 1992 to 2007. All post-operative imaging was collected and stratified as abdominal (CT or US) or chest (CT or CXR). Ascertainment of imaging tests was stopped at the time of possible recurrence based on an algorithm of cancer directed therapy, surgery, or visit to a medical or radiation oncologist. After limiting the cohort to patients treated in hospitals with at least 30 cases, we developed a hospital level average rate of scans per patient for the first five years of patient follow up. The rates were then stratified into three groups for abdominal imaging (Scans less frequent than every 24 months, every 18 to 24 months, more than every 18 months) and chest imaging (Scans less frequent than every 18 months, every 12 to 18 months, more than every 12 months). These categories were then applied in survival analyses at the patient level for OS and CSS and then stratified by final cancer stage. Results: Our cohort included 3,167 patients treated in 62 hospitals. Patients treated in hospitals with higher rates of chest imaging had marginally better OS (HR 0.77 and 0.83, CI 0.60 to 1.01 and 0.63 to 1.08 for scans 12-18 and &lt;12 months respectively), but no effect was found for CSS. Treatment in hospitals with higher rates of abdominal imaging had no impact on OS or CSS. The OS benefit of treatment in hospitals with higher rates of chest imaging appeared limited to patients with stage 1 cancer (HR 0.53 and 0.57, 95% CI 0.38 to 0.76 and 0.40 to 0.80 for scans 12-18 and &lt;12 months respectively). Conclusions: With the exception of chest imaging for stage 1 patients, we found no evidence that higher rates of imaging are associated with better OS or CSS after radical or partial nephrectomy. These results suggest more conservative follow-up imaging protocols can be used in this patient population.
Assessment of the quality of the pathological evaluation of total mesorectal excision specimens: Differences in evaluation between local pathologists and a review committee in the context of an improvement project.
Authors: Pieter Demetter, Tamara Vandendael, Christine Sempoux, Nadine Ectors, Claude Cuvelier, Nathalie Nagy, Anne Hoorens, Anne Jouret-Mourin
Journal: Journal of Clinical Oncology (2013)

481 Background: Data on quality control of the pathologic evaluation of total mesorectal excision specimens are scarce. Differences between evaluation by local pathologists participating in PROCARE, a Belgian improvement project on rectal cancer, and a review panel were assessed. Methods: Based on photographic material and histopathology slides, a review committee of pathologists with a particular interest in colorectal pathology re-evaluated the mesorectal plane, the circumferential resection margin (CRM), the tumour differentiation grade, the (y)pT stage and the tumour regression grade (according to Dworak) in 444 cases (354 low anterior resection and 90 abdomino-perineal resection specimens). Results: The surgical plane was reported in 89% and the CRM in 88% of cases by the local pathologist. The median number of lymph nodes harvested in patients undergoing long-course neoadjuvant radiochemotherapy was 11, whereas this was 14 in the other patients. The review committee downgraded the surgical plane of 17% of patients from (intra)mesorectal to intramuscular, and upgraded it in 27% from intramuscular to (intra)mesorectal. Tumour differentiation grade, T stage and tumour regression grade differed between local pathologists and review committee in 15%, 10% and 38%, respectively. T stage was upgraded in 8% of cases, mainly from T2 to T3. Tumour regression was judged by the review panel to be less advanced in 15% of cases. Conclusions: Acknowledging some shortcomings (comparison between a photographical evaluation and an evaluation on a fresh specimen), this study gives a realistic view of clinical practice. There are differences in interpretation with regard to macroscopic and microscopic analysis of TME specimens. These findings indicate a need for more objective and reproducible criteria in histopathology. Being aware of this is a first step for improvement.
Assessing cancer-related myths in relatives of cancer patients and the general public: A Turkish Oncology Group study.
Authors: F. Dane, N. S. Turhal, D. Unsal, S. Sari, C. u. Ulus, N. Senturk, D. Bingol, T. Korkmaz, S. Seber
Journal: Journal of Clinical Oncology (2011)

e16632 Background: Although there are many myths about cancer in Turkey, except our published pilot study there is no study evaluating Turkish public’s knowledge about cancer. The goals of our research were to: 1) measure the extent of knowledge of cancer among the Turkish public; 2) determine the differences in extent of cancer-related knowledge between participants who have relatives with cancer and those who do not; 3) determine the sources of knowledge possessed; and 4) compare the extend of cancer related knowledge in participants from Ankara (Group A) and from Istanbul (Group I). Methods: Data were obtained from a total of 622 participants (339 female, 283 male), 415 participants were included in the study from the Marmara University Hospital and 207 were from the Gazi University Hospital outpatient clinics. Each participant completed a 3-part questionnaire. Appropriate statistical tests were used for comparison. Results: The median age was 42 (range: 18-87) years. Of 622 participants, 453 (72.8%) stated that they had one or more cancer patient in their immediate family; 28.6% of the participants had a high-school and 41.8% had a university education. Overall 7.1% of the individuals think that the cancer is contagious. Over 7% of the participants think “cancer occurs in individuals who have done harm to others”. The questionnaire showed that, depending on the question, anywhere from 3.9% to 64.5% of the general public possesses some false information. Only 4 specific questions, related to the following ideas, rendered answers that were statistically significantly different between relatives of cancer patients and non-relatives: breast cancer is only seen in females (p <0.004), cancer is always very painful (p: 0.0001), eating sweets causes proliferation of cancer (p: 0.014), and, skinny people have an increased risk of cancer (p: 0.046). Unexpectedly, we found some statistically significant differences in accuracy between group A and group I participants. Conclusions: The proportion of false knowledge about cancer was unacceptably high in our cohort. Additional training in universities as well as continuing educational programs is recommended to inform the Turkish public about cancer.
Neoadjuvant therapy (NAT) for breast cancer at the Odette Cancer Centre: What have we been doing and how do we compare?
Authors: Claudia Arce, Sonal Gandhi
Journal: Journal of Clinical Oncology (2012)

131 Background: NAT is standard of care for locally advanced breast cancer (LABC). Early breast cancer (EBC) may also benefit, particularly certain subtypes, such as HER2-enriched or basal- like. We developed a clinical care pathway to standardize the assessment and treatment of LABC and higher-risk EBC at the Odette Cancer Centre (OCC). Purpose: Evaluate treatment patterns within the LABC/NAT program at the OCC, and to determine if these patterns changed after the introduction of a clinical care pathway. This study also aimed to evaluate treatment efficacy (pCR rates) by NAT regimen and breast cancer phenotype, as compared to the literature. Methods: Retrospective chart review of patients treated with NAT at the OCC from January 2008 to March 2012. Results: 158 patients were reviewed. Median age at diagnosis was 50 years (28-85), and median tumor size was 7 cm (0-21). 74% were stage IIB-IIIB, and 11.2% were considered non-LABC (or EBC). 65.8% of breast cancers were estrogen receptor positive (ER+), and 29.7% were HER-2 positive (HER2+). 96% of NAT chemotherapy regimens were anthracycline and taxane-based, and trastuzumab was given to 29.7% of HER-2 positive cases. pCR was achieved in 20.9% of all cases and this did not vary by type of chemotherapy regimen; pCR rates did vary by breast cancer phenotype, with 6.25%, 57.5% and 25% pCR achieved for ER+, HER2+ and triple negative (TN) cancers, respectively. Median follow-up was 13 months (0-46), and overall DFS was 90%; survival did not vary by NAT regimen or pCR, but did vary by phenotype, whereby DFS was 100% for HER-2 positive, 90% for ER+, and 78% for TN cancers. There was no significant difference found in types of patients, NAT regimen, or pCR rates before and after the pathway was introduced. Conclusions: Practice patterns at the OCC in NAT for breast cancer remained unchanged before and after development of a clinical care pathway, which was meant to standardize the approach to and to possibly increase the use of NAT from beyond LABC to higher-risk EBC. This is likely due to limited pathway dissemination, but other factors contributing to this should be evaluated. pCR rates by cancer phenotype were similar to those found in the literature.
Molecular profiling of renal medullary carcinoma to reveal frequent alterations in chromatin remodeling genes and to identify EZH2 as a relevant therapeutic target.
Authors: Jianjun Gao, Gabriel G. Malouf, Xiaoping Su, Hui Yao, Priya Rao, Rong He, Liangwen Xiong, Jose A. Karam, Surena F. Matin, Roger Mouawad, Eva Comperat, David Khayat, Christopher G. Wood, Nizar M. Tannir
Journal: Journal of Clinical Oncology (2016)

571 Background: Renal medullary carcinoma (RMC) is a rare and highly aggressive malignancy that affects primarily young adults with sickle cell trait. The prognosis of RMC is poor with a median survival of about 12 months from diagnosis. It has been previously shown that loss of heterozygosity of SMARCB1 occurs in the majority of cases leading to protein loss. However, a comprehensive molecular profiling of this disease remains unknown. Methods: Whole-exome sequencing (WES) of 9 RMC matched tumor-normal cases and 1 unmatched case were performed. In addition, single nucleotide polymorphism (SNP) analysis was done using the Affymetrix SNP 6.0 array. To test differentially expressed genes between RMC cases and normal kidney, RNA sequencing was carried out. The effect of EZH2 inhibition on in vitro RMC tumor cell proliferation was assessed using the MTT assay. Results: WES analysis of 9 paired RMC cases identified 233 non-synonymous somatic mutations (median: 21; range: 12-44). We observed frequent mutations in chromatin remodeling genes in 7 of 10 RMC cases, including mutations in SMARCB1 (n = 2) and SMARCA5 gene (n = 1). SNP analysis demonstrated that only the case with SMARCA5 somatic mutation harbored SMARCB1 monoallelic loss. However, all RMC cases had loss of SMARCB1 protein by immunohistochemistry. Ingenuity pathway analysis using RNA sequencing data identified EZH2 as one of the top over-expressed upstream regulators (Z-score = 3.7; p-value = 1.6x10 -6 ). RT-PCR and western blot analyses confirmed that EZH2 expression is elevated at both mRNA and protein levels corresponding to SMARCB1 loss in RMC tumors. In vitro assessment of a novel RMC tumor cell line derived from the case harboring SMARCB1 deletion showed that EZH2 inhibitor GSK343 inhibited proliferation of this cell line. Conclusions: Our data reveal that 30% of RMC cases showed inactivation of SMARCB1 through somatic mutations or monoallelic loss, suggesting that additional epigenetic mechanisms may lead to gene inactivation. In addition, our data suggest that EZH2 may be a relevant therapeutic target in RMC.
Nonmyeloablative Allogeneic Transplantation in the Imatinib Era: Three Chances To Achieve Molecular Remission in CML.
Authors: Richard E. Champlin, Sergio Giralt, Elizabeth Shpall, Partow Kebriaei, Paolo Anderlini, Muzaffar Qazilbash, John McMannis, Gloria McCormick, Tobi Fisher, Marcos de Lima, Gabriela Rondon
Journal: Blood (2007)
Prediction model for ypΝ status after preoperative chemoradiotherapy in patients with rectal cancer.
Authors: Eunjin Jwa, Jong Hoon Kim, Seungbong Han, Jin-hong Park, Jin Cheon Kim, Chang Sik Yu, Seok-Byung Lim, Tae Won Kim, Yong Sang Hong
Journal: Journal of Clinical Oncology (2013)

513 Background: Pelvic lymph node status after preoperative chemoradiotherapy (CRT) is not only an important indicator for oncologic outcome but critical information to determine the type of a subsequent surgical resection (i.e. curative surgery or local excision) in patients with locally advanced rectal cancer. The purpose of this study is to develop a nomogram to predict the lymph node status after preoperative CRT in rectal cancer patients whose ypT information is available. Methods: Using logistic regression analyses, we constructed a prediction model to predict the probability of lymph node metastasis after preoperative CRT in a cohort of 1,099 patients with rectal cancer treated with preoperative CRT and total mesorectal excision (TME) from 2007 to 2011. The model was internally validated for discrimination and calibration using bootstrap resampling. Results: Pretreatment clinical nodal stage, distant metastasis, pre- and post-treatment tumor differentiation, and ypT stage were reliable predictors for lymph node metastasis after preoperative CRT. The nomogram developed using these parameters represents a valid and accurate method for predicting lymph node metastasis after preoperative CRT in rectal cancer patients. (c-index: 0.75) Patients with low pretreatment nodal stage, nonmetastatic, and well differentiated rectal adenocarcinoma downstaged to ypT0-1 after preoperative CRT will have low chance of pelvic lymph node involvement. Conclusions: Our model is expected to assist clinicians in quantifying the benefit of radical resection and finding out the patient group who can be treated with local excision after preoperative CRT for rectal cancer.
The Life Raft Group and establishment of the Virtual GIST Tumor Board in partnership with NIH.
Authors: Sara Rothschild, Mildred Menos, Norman J. Scherzer, Michelle Durborow
Journal: Journal of Clinical Oncology (2016)

e278 Background: In 2008, the National Institutes of Health (NIH) launched an in-person clinic for the Pediatric and Wild-type GIST community allowing clinicians and researchers from across the world to collaborate with each other and meet patients and their families firsthand. This led to several important breakthroughs, including investigating germline mutations in the succinate dehydrogenase complex (SDH), which helps physicians understand how wild-type GISTs are formed, and that Pediatric GIST can be diagnosed after age 18 and should thus be titled “SDH-deficient GIST.” Yet, decreases in government funding have reduced the number of in-person meetings to one per year. To supplement this loss of an in-person clinic, The Life Raft Group partnered with the NIH to launch the Virtual GIST Tumor Board. Methods: The process is an augmentation of how virtual tumor review boards work. If selected, doctors of GIST patients log on and review their de-identified patient case with a panel of experts using the internet, secure servers, and state-of-the-art video conferencing software. The LRG uses cutting-edge technology to connect the local treating physicians and their team with key opinion leaders in the field of Pediatric (SDH-deficient) GIST. Participants virtually access radiology films such as CT scans and other necessary medical reports to help review particular cases and provide advice. Results: The Virtual GIST Tumor Board has met twice, and reviewed cases from patients as far away as Latin America and the Ukraine. The physicians of these patients have elevated the level of care they provide due to the interaction with experts the Board makes possible. Conclusions: The purpose of the Pediatric GIST Virtual Tumor Board is to bring together leading experts to discuss pediatric/wild-type (SDH-deficient) GIST cases, and be an educational resource for physicians. It is transformative, because it provides valuable access for patients and doctors who would not be able to attend an in-person clinic due to resources or distance; educates doctors on the most up to date treatment options, trials, and studies; serves as a triage to bring patients to the in-person clinic; and encourages collaborative efforts of leading GIST experts around the world.
Hepatocyte growth factor expression in <i>EGFR</i>-mutant lung cancer with intrinsic and acquired resistance to tyrosine kinase inhibitors in a Japanese cohort.
Authors: S. Yano, T. Yamada, S. Takeuchi, K. Tachibana, Y. Minami, M. Noguchi, F. R. Hirsch
Journal: Journal of Clinical Oncology (2011)

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