tbuckley/cabot-search huggingface dataset:
Total parenteral nutrition utilization in metastatic cancer patients: A nationwide 10-year analysis from 2006 to 2015.
Authors: Yuzhou Liu, Mohammad Ghanbar, Qian Wang, Changchuan Jiang, Danny Khalil
Journal: Journal of Clinical Oncology (2018)

e18693 Background: TPN use in metastatic cancer patients is controversial. We aim to explore the characteristics, trend of utilization and outcome of TPN use in metastatic cancer patients. Methods: We used the Nationwide Inpatient Sample (NIS) database to identify 1,278,063 patients with metastatic cancer within which 43,741 patients received TPN from 2006 to 2015. Longitudinal analysis was conducted to determine trends of use and outcome of TPN. Multivariate logistic regression was performed to determine the association between TPN use and independent variables. Results: During the study period, the percentage of the patients with metastatic cancer who received TPN decreased from 3.50% to 2.67%. TPN use is less in Hispanic patients (OR 0.80, 95% CI 0.74-0.85) and patients with low household income (OR 0.84, 95% CI 0.74-0.85). Among all the patients who received TPN, palliative care encounters increased from 1.95% to 18.21%. This might indicate better patient selection for TPN and thus a lower cost (from 53327 US dollar to 45210 US dollar). Patients whose hospital course was complicated by sepsis increased from 15.15% to 23.26% and the requirement for pressor support increased from 1.23% to 2.75%. Interestingly, the mortality decreased from 16.02% to 11.10%. This might be due to improved recognition and prompt treatment of sepsis. GI malignancies are the most common cancer types in the study population and the strongest predictors for TPN use possibly due to compromised GI tract. However, they are related with lower mortality when compared to non-GI cancers such as hematologic malignancy. Conclusions: TPN use decreased among patients with metastatic cancer. However, access disparity exists. Certain cancer types are related to more TPN utilization and worse outcomes. TPN use in carefully selected patients may improve in-hospital mortality. Cancer Type Patients who received TPN, % Adjusted OR for TPN utilization Adjusted OR for mortality Colorectal 23.71 3.12 0.67 Pancreas 7.33 2.04 0.68 Stomach 7.09 1.56 0.75 Lung 8.42 0.39 2.21 Breast 6.44 0.39 1.10 Prostate 1.94 0.35 1.00 Blood 1.33 0.94 2.14
Deliberations of the Strategic Advisory Group of Experts on Immunization on the use of CYD-TDV dengue vaccine
Authors: Annelies Wilder-Smith, Joachim Hombach, Neil Ferguson, Michael Selgelid, Kate O'Brien, Kirsten Vannice, Alan Barrett, Elizabeth Ferdinand, Stefan Flasche, Maria Guzman, Hillegonde Maria Novaes, Lee-Ching Ng, Peter G Smith, Piyanit Tharmaphornpilas, In-Kyu Yoon, Alejandro Cravioto, Jeremy Farrar, Terry M Nolan
Journal: The Lancet Infectious Diseases (2018)
Patterns of total cost for patients (pts) with active treatment (Tx) of myelodysplastic syndromes (MDS).
Authors: B. Douglas Smith, Amy Elizabeth Dezern, Gary Binder, Syed Rizvi, Frank A. Corvino, Steven R. Arikian, Andy Surinach, Jianyi Lee
Journal: Journal of Clinical Oncology (2016)

e18252 Background: Lenalidomide (LEN) and azacitidine (AZA) are 2 standard active Tx options recommended by national guidelines for pts with MDS. Limited information exists on the total cost of care for pts treated with these agents. This descriptive analysis evaluated real-world costs for US pts without higher-risk MDS at diagnosis. Methods: Pts were identified from the MarketScan US claims database (2008–2013) by ICD-9 codes. Initial MDS diagnosis defined the index date. Pts with ≥ 12 months pre- and ≥ 6 months post-index enrollment were included; pts with codes for high-grade MDS or acute myeloid leukemia at diagnosis, or concomitant LEN + AZA use, were excluded. Pt cohorts based on first active Tx post-index were followed up to the earliest of: end of data, 24 months, or Tx change. A generalized linear model was used to control for baseline differences between groups. Results: 1,402 pts met the inclusion criteria (LEN, n = 456; AZA, n = 946). At baseline, 48% and 52%, respectively, were aged ≥ 75 years, with similar total cytopenias (P = 0.12) and comorbidities (P = 0.08). Initial monthly costs were similar (Table). By 12 months, costs had declined 39% for LEN-treated pts vs 23% for AZA-treated pts, resulting in $2,874 higher mean monthly total costs for AZA. Mean monthly medical costs were 51% higher for AZA (P = 0.0014), while pharmacy (Rx) costs were 20% higher for LEN (P < 0.0001). Conclusions: For pts with lower-risk MDS treated with LEN or AZA, initial total cost of care was ≥ $16,000 per month. Greater reductions in medical costs over time for LEN-treated pts led to lower mean monthly total costs for those pts. With the more recent availability of generic AZA in the USA, the total cost difference may be smaller; generic AZA unit prices would have to be > 70% lower to offset the higher medical costs for AZA-treated pts. Lenalidomide Azacitidine Transfusions pre-index, % 44.1 47.4 Thrombocytopenia 2 months pre-index, % 20.8 35.1 Del(5q), % 36.8 9.2 TOTAL COSTS, $ (per pt-month) Selected time periods months 1–3 16,692 (n = 456) 17,131 (n = 946) months 10–12 10,174 (n = 227) 13,259 (n = 461) Overall Inpatient 2,797 4,358 Ambulatory medical 3,966 5,835 Rx 5,308 4,461 Mean total cost (medical + Rx), $ 12,071 14,655 Adjusted mean total cost, $ 11,719 14,593
Limitations in the Effect of Screening on Breast Cancer Mortality
Authors: Anna-Belle Beau, Per Kragh Andersen, Ilse Vejborg, Elsebeth Lynge
Journal: Journal of Clinical Oncology (2018)

Purpose Randomized, controlled trials showed that screening reduces breast cancer mortality rates, but some recent observational studies have concluded that programmatic screening has had minor effect on breast cancer mortality rates. This apparent contradiction might be explained by the use of aggregated data in observational studies. We assessed the long-term effect of screening using individual-level data. Materials and Methods Using data from mammography screening in the Copenhagen and Danish national registers, we compared the observed breast cancer mortality rate in women invited to screening with the expected rate in absence of screening. The effect was examined using the “naïve model,” which included all breast cancer deaths; the “follow-up model,” which counted only breast cancer deaths in women diagnosed after their first invitation to screening; and the “evaluation model,” which is similar to the follow-up model during screening age, but after screening age, which counted only breast cancer deaths and person-years in women diagnosed during screening age. Results We included 18,781,292 person-years, 976,743 of which were from women invited to screening. The naïve and follow-up models showed, respectively, 10% and 11% reduction in breast cancer mortality after invitation to screening. However, many breast cancer deaths occurred in women whose cancer was diagnosed when they were no longer eligible for screening. Accounting for this dilution, the evaluation model showed a 20% (95% CI, 10% to 29%) reduction in breast cancer mortality after invitation to screening. Conclusion Screening had a clear long-term beneficial effect with a 20% reduction in breast cancer–associated mortality in the invited population. However, this effect was, by nature, restricted to breast cancer deaths in women who could potentially benefit from screening. Our study highlights the complexity in evaluating the long-term effect of breast cancer screening from observational data.
Molecular mechanism of transformation from adenocarcinoma to small-cell lung cancer after EGFR-TKI.
Authors: Jie-Fei Han, Qiu-Yi Zhang, Bin-Chao Wang, Qing Zhou, Li-Xu Yan, Huajun Chen, Zhen Wang, Hai-Yan Tu, Jian Su, Zhi Xie, Fei-Yu Niu, Yi-Long Wu, Jin-Ji Yang
Journal: Journal of Clinical Oncology (2016)

e20601 Background: In patients with advanced non–small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) activating mutations, EGFR-tyrosine kinase inhibitors (TKIs) are often recommended as first-line treatment due to favorable clinical efficacy. However, acquired resistance inevitably develops after a median progression-free survival (PFS) of 9-14 months. Small cell histologic transformation was reported to account for nearly 5% of acquired resistance. However, the molecular details underlying this histological change and resistance to EGFR-TKI therapy remain unclear. Methods: Among 320 patients with advanced lung adenocarcinoma who underwent re-biopsy after resistance to EGFR-TKI, 14 were confirmed to develop small cell histologic transformation. We analyzed the clinical parameters of these patients by using chi-square test and Kaplan-Meier analysis. To detect gene alterations that may contribute to small-cell lung cancer (SCLC) transformation, next generation sequencing (NGS) was performed on four pairs of matched pre- and post-resistant tissue samples. We further performed NGS on one pair of matched pre- and post-resistant plasma samples to explore the potential mechanism of resistance to EGFR-TKI. Results: The median PFS and overall survival (OS) of SCLC-transformed patients treated with EGFR-TKI compared to those without transformation were 11.9 vs 12.20 months (P= 0.473) and 26.1 vs 25.9 months (P= 0.664), respectively. The pre- and post-trans tissue samples all preserve the same EGFR and TP53 mutation, increased copy number of five genes (EGFR, APCDD, NOTCH4, DAXX and CUL4A) were identified in post-trans tissue samples detected by the NGS. The NGS result on plasma from one post-trans patient showed an EGFR T790M mutation, which is not found in the post-trans tissue sample from the same patient. Conclusions: The PFS and OS to EGFR-TKI in SCLC-transformed patients are equivalent to those without SCLC-transformation. The gene copy number gain might contribute to this kind of transformation. The mechanisms of acquired resistance to TKI could be the emergence of classic drug resistance mutations such as T790M, which is undetectable due to the intra-tumor heterogeneity.
Management of Primary Ovarian Insufficiency Symptoms in Survivors of Childhood and Adolescent Cancer
Authors: Emma Gargus, Rebecca Deans, Antoinette Anazodo, Teresa K. Woodruff
Journal: Journal of the National Comprehensive Cancer Network (2018)

Cancer treatments can damage the ovaries, causing primary ovarian insufficiency (POI), a condition associated with numerous sequelae that impact long-term quality of life. This article systematically reviews the literature on the prevalence, surveillance, and treatment of POI in survivors of pediatric and adolescent and young adult (AYA) cancers. A systematic review of the literature was conducted in January 2018 through a search of Medline, Embase, Web of Science, and SCOPUS, alongside the screening of relevant reference lists. An initial search identified 746 potentially relevant studies. A total of 36 studies were included in the final review. Studies were categorized into one of the following categories: incidence/prevalence of POI, measurement of ovarian reserve, and other. Depending on patient characteristics, cancer diagnosis, and treatment, the prevalence of POI ranged from 2.1% to 82.2%. Risk factors for POI included exposure to alkylating agents and abdominal/pelvic radiation. POI may be associated with a number of complications, including low bone mineral density and poor cardiovascular health. Radiotherapy and chemotherapy are known to cause gonadal damage in female survivors of pediatric and AYA cancers. Acute or chronic effects depend on the dose of treatment, age of the individual, radiotherapy field, and ovarian reserve of the individual. Some women experience short-term loss of reproductive function and then may resume menstrual cycles, months or even years later. Although protecting fertility through banking of mature eggs, embryos, and tissue samples has become standard of care, additional steps need to be taken to ensure that patients have adequate hormone levels to maintain whole-body health, including life expectancy, bone health, cardiovascular health, quality of life, sexual and genitourinary function, and neurologic function. Surveillance and management of each of these comorbidities is critically important to survivor health.
Predictors of advanced imaging use during breast cancer surveillance.
Authors: Randy C. Miles, Christoph I. Lee, Qin Sun, Aasthaa Bansal, Catherine R. Fedorenko, Jennifer M. Specht, Scott David Ramsey, Gary H. Lyman, Janie M. Lee
Journal: Journal of Clinical Oncology (2017)

e18337 Background: Our objectives were to determine advanced imaging use (whole body imaging with bone scan, CT, or PET-CT and breast MRI) during breast cancer surveillance, and to identify drivers of potential imaging overuse as outlined by ASCO’s Choosing Wisely initiative. Methods: Cancer registry records for 2923 women diagnosed with primary breast cancer in Washington State from January 1, 2007 to December 31, 2014 were linked with claims data from two regional commercial insurance plans. Inclusion criteria included women with AJCC stage 0-3 disease treated with curative intent. Women without continuous insurance enrollment from 3 months prior to diagnosis until 14 months after diagnosis were excluded. Surveillance began 4 months after the end of primary therapy and lasted for 15 months or until restart of treatment. Women’s (age, race, family history) and tumor (grade, receptor status, stage) characteristics were collected. Evaluation and management codes from claims data were used to determine mammography, advanced imaging, and tumor biomarker use during the peri-diagnostic and surveillance periods. Multivariate logistic regression models were used to identify factors associated with advanced imaging use during surveillance. Results: Of eligible women, 80.0% (2332/2923) received mammography, 16.5% (483/2932) received whole body imaging, and 21.5% (670/2932) received breast MRI during the surveillance period. Whole body imaging was significantly associated with increasing stage of disease (stage 3: OR = 3.39, 95% CI: 2.30-5.02), peri-diagnostic whole body imaging (OR = 1.80, 95% CI: 1.36-2.38), and surveillance tumor biomarker use (OR = 1.83, 95% CI: 1.46-2.31). Significant predictors of surveillance breast MRI included young age ( &lt; 45 years: OR = 2.40, 95% CI:1.78- 3.25), family history (OR = 1.58, 95% CI:1.26-1.98), peri-diagnostic breast MRI (OR = 2.01, 95% CI: 1.56-2.59), and surveillance tumor biomarker use (OR = 1.74, 95% CI:1.41-2.17). Conclusions: Peri-diagnostic use of advanced imaging and surveillance use of tumor biomarkers are associated with advanced imaging use during surveillance, and may represent targets for interventions to increase adherence to Choosing Wisely clinical guidelines.
The Affordable Care Act, Breastfeeding, and Breast Pump Health Insurance Coverage
Authors: Kandice A. Kapinos, Lindsey Bullinger, Tami Gurley-Calvez
Journal: JAMA Pediatrics (2018)

This Viewpoint reviews the evidence suggesting that the Affordable Care Act policy change requiring private health insurers to cover breast pumps for new mothers without cost sharing resulted in more mothers attempting breastfeeding, as well as breastfeeding for a longer period.
Survival of crizotinib continuation plus brain radiotherapy among ALK positive non-small cell lung cancer (NSCLC) patients with brain metastases during crizotinib treatment.
Authors: Guangjian Yang, Di Ma, Puyuan Xing, Haiyan Xu, Li Junling, Xuezhi Hao, Yan Wang
Journal: Journal of Clinical Oncology (2018)

e21142 Background: Anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer(NSCLC)patients treated with crizotinib, the first-generation ALK inhibitor, would inevitably develop resistance despite an initial response. Since other ALK inhibitors have not been approved in China, it remains uncertain about the optimal therapy to ALK positive NSCLC patients who had developed brain metastases during crizotinib treatment. The aim of this study was to evaluate survival of crizotinib continuation plus brain radiotherapy among ALK positive NSCLC patients who developed brain metastases during crizotinib treatment. Methods: A total of 155 Chinese NSCLC patients with ALK gene rearrangement who had acquired crizotinib resistance were enrolled in this retrospective single-center study. 25 patients (36%) continued crizotinib treatment plus brain radiotherapy when they developed brain metastases. The median survival from disease progression of crizotinib and from diagnosis of metastatic NSCLC were calculated, respectively. Results: Median survival from disease progression of crizotinib was 28.9 months (95% CI: 2.3-55.5) and median survival from diagnosis of metastatic NSCLC had not reached. There were no treatment-related deaths or grade 3-4 treatment related adverse events. Grade 1-2 adverse events of brain radiotherapy among these patients included alopecia (76%), nausea (28%), dizziness (16%), anorexia (8.5%), fever (8.0%), cough (4.0%) and skin reaction (4.0%). Conclusions: Crizotinib continuation beyond progressive disease plus brain radiotherapy is a feasible strategy and may prolong survival among patients who developed brain metastases during crizotinib treatment in China.
Percutaneous nephrostomy drainage to improve renal function in patients with advanced versus recurrent or progressive disease in cervical cancer with similar complications.
Authors: Flavia Morales-Vasquez, Hector M Caballero, Horacio Noe López-Basave, Enrique Cabelle, Claudia Cano Blanco
Journal: Journal of Clinical Oncology (2016)

e17022 Background: The aim of the study was to evaluate the outcome and complications after percutaneous nephrostomy (PCN) insertion in patients with cervical cancer at the National Cancer Institute (INCan) in Mexico Methods: We analyzed medical records of 685 patients with cervical cancer during 2012 and 2013. We identified 85 patients who undergone PCN. Among this 74.1% had recently diagnosed cervical cancer and 25.9% had recurrent or progressive disease. Results: Eighty five women, aged 20 to 77 (Mean 48.1, SD ±11.7) were included for the analysis. Bilateral nephrostomy was performed in 57.7% and unilateral in 42.4%. The most common indication for PCN was acute kidney injury (AKI). The median serum creatinine before PCN was 3.5 (IQR 7.5) mg/dl. The median serum creatinine level improved 3.5 mg/dL (IQR 7.5) to 1.0 (IQR 0.7) 30 days after intervention (p< 0.001). Renal function normalization occurred in 62.4%. The overall 30-day complication rate was 53.1%. The most frequent complications were urinary tract infections (UTIs) (51.8%) and the loss the PCN catheter (28.2%). The rate of complications was not statistically different among patients with recently diagnosed cervical cancer and recurrent or progressive disease (52.4% vs. 50.0%, p= 0.521). The rate of UTIs was not statistically different among this groups (52.4% vs 50%, p= 0.521). Median overall survival (OS) was 22.7 [95% CI 16.3–29.1] months. Median OS was 19.2 [95% CI 12.8-25.6] and 28.1 [95% CI 19.1-37.3] (p= 0.059) for recently diagnosed cervical cancer and recurrence or progressive disease respectively. Conclusions: These techniques are safe and often improve renal function. The procedures have different roles in women with primary and recurrent gynecologic cancer. The use of percutaneous nephrostomy in patients with recurrent carcinoma of the cervix should be individualized on the basis of expectations for prolonged functional palliation. This retrospective study highlights the difficulty in selection of patients, is necessary to evaluate the quality of life in each case.
Abstract 17829: Frequency-domain Optical Coherence Tomography Findings of Population With High Skin Auto Fluorescence
Authors: Yusuke Fujino, Satoko Tahara, Toru Naganum, Hiroto Yabushita, Wei Wang, Sunao Nakamura
Journal: Circulation (2015)

Objective: We aim to assess the coronary artery plaque features in patients with high skin auto fluorescence (SAF) using frequency-domain optical coherence tomography (FD-OCT). Background: SAF, a non-invasive measurement of the accumulation for glycation end products (AGEs) level of skin, has been reported as a useful marker for micro/macro vascular complications. Moreover patients involved with coronary artery disease (CAD) with higher SAF show worse clinical outcome compared to patients with lower SAF. Due to its unprecedented high resolution (~10μm axial), optical coherence tomography (OCT) has been increasingly used for plaque assessments. In this situation, there is no data evaluating the OCT findings of high SAF population. Methods: We prospectively enrolled 108 consecutive patients with de novo coronary artery disease underwent percutaneous coronary intervention (PCI) with FD-OCT images at pre-PCI. SAF was measured before PCI procedure. We divided the population into two group high SAF group (greater than or equal to 2.6) and low SAF group (less than 2.6), then compared FD-OCT findings between high and low SAF group. Furthermore we evaluated the predictor of thin cap fibroatheroma (TCFA) and plaque rapture by FD-OCT. Results: High SAF group shows much more TCFA and plaque rapture compared to low SAF group (63.9% vs 31.9%, p&lt;0.001 and 32.8% vs 12.8%, p&lt;0.001, respectively). In multivariable analysis, age (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92 to 1.00; p = 0.046) and SAF (&lt;2.6 as reference) (odds ratio [OR]: 5.89; 95% confidence interval [CI]: 2.39 to 14.51; p &lt; 0.001) were considered to be the predictor of TCFA and SAF (odds ratio [OR]: 4.23; 95% confidence interval [CI]: 1.23 to 14.51; p = 0.022), gender (male as reference) (odds ratio [OR]: 0.12; 95% confidence interval [CI]: 0.03 to 0.56; p = 0.007) and LDL (odds ratio [OR]: 1.2; 95% confidence interval [CI]: 1.02 to 1.42; p = 0.029) were considered to be the predictor of plaque rapture. Conclusion: Based on FD-OCT imaging, high SAF group shows the association with TCFA and plaque rapture compared to low SAF group. These OCT findings may explain the worse clinical outcomes of high SAF patients.