tbuckley/cabot-search huggingface dataset:
The influence of caregiver burden on bereavement outcomes of spousal and adult-child family caregivers of patients who have died of cancer.
Authors: Sarah McLean, Barbara Gomes, Natalia Calanzani, Katherine Bristowe, Jonathan Koffman, Irene J. Higginson
Journal: Journal of Clinical Oncology (2015)

49 Background: Family caregivers (FCs) provide unpaid care to patients, outside of a formal framework. A demographic imperative currently exists to allow patients to be cared for in their own homes. FCs are a vital part of this support. However, their needs, and the burden of caregiving, are often under-recognised. Challenges facing FCs, in particular adult-child FCs, include a need to combine paid employment and other family commitments with caregiving. Negative consequences associated with caregiving include a higher risk of complicated grief in bereavement. Aims: To describe and compare the bereavement outcomes of spousal and adult-child FCs of patients who died of cancer, and to evaluate the factors of care associated with adverse bereavement outcomes for each FC group. Methods: Secondary data analysis was performed of data regarding bereavement outcomes, as measured by the Texas Revised Inventory of Grief (TRIG) scores of participants in the QUALYCARE study – a mortality follow-back study of FCs. Results: 484 caregiver-patient dyads were included: 246 adult-child FCs and 238 spousal FCs. Spousal FCs were older (68.4 vs. 50.7 years, p &lt; 0.001). Caregiving intensity was similar in both groups of FCs, but adult-child FCs were more likely to continue working outside the home while caregiving (χ2, p &lt; 0.001). Patients with adult-child FCs were more likely to die in a nursing home than those with a spousal FC (p &lt; 0.001). Grief intensity was highest in spousal FCs whose relative had died in hospital or a nursing home, and lowest in adult-child FCs whose relative had died in a nursing home (n = 31, p &lt; 0.001). Caregiver burden predicted 11.6% of variance in grief intensity for adult-child FCs vs. 0.5% for spousal FCs. Conclusions: Caregiving burden has particular implications for adult- child FCs as compared to spousal FCs, in terms of bereavement outcomes. Role strain describes overlapping responsibilities with simultaneous family roles. The risk of complicated grief may be modifiable through ensuring the provision of practical supports, as well as psychological support for the caregiver, and the excellent management of both physical and psychological symptoms experienced by the patient.
A phase I trial of vorinostat and bortezomib in children with refractory or recurrent solid tumors: A Children's Oncology Group study.
Authors: J. A. Muscal, P. A. Thompson, T. M. Horton, A. M. Ingle, C. H. Ahern, R. M. McGovern, J. M. Reid, M. M. Ames, B. Weigel, S. Blaney
Journal: Journal of Clinical Oncology (2011)

9522 Background: Vorinostat and bortezomib have demonstrated single agent anti-tumor activity in preclinical models of pediatric solid and CNS tumors, including synergistic anti-tumor activity when the agents are utilized in combination. A pediatric phase I trial was performed to determine the maximal tolerated dose, dose-limiting toxicities (DLTs), and pharmacokinetics (PK) of vorinostat and bortezomib, as well as to assess the impact of bortezomib on NF-κB binding activity and Grp78 protein expression in peripheral blood mononuclear cells (PBMCs). Methods: Oral vorinostat was administered on days 1-5 and 8-12 of a 21 day cycle (starting dose 180 mg/m2/day with dose escalations to 230 and 300 mg/m2/day). Bortezomib (1.3 mg/m2 i.v.) was administered on days 1, 4, 8, and 11. PK and correlative biology studies were performed during cycle 1. Results: 23 eligible patients, 18 male, median age 12 yrs (range, 1-20) were enrolled. 6/23 patients were not fully evaluable for toxicity; 2 did not complete cycle 1, 2 missed required safety studies, 1 received an incorrect dose, and 1 withdrew consent. No patients experienced a DLT at dose levels 1 or 2 (vorinostat 180 and 230 mg/m2/day). Cycle 1 DLTs occurred in 2/6 patients at dose level 3 (vorinostat 300mg/m2/day) and were grade 3 sensory neuropathy (n=1) and grade 3 nausea and anorexia (n=1). Non-DLT grade 3 or 4 events related to protocol therapy included anemia (n=4), neutropenia (n=2), lymphopenia (n=5), leukopenia (n=1), thrombocytopenia (n=6), nausea (n=1), vomiting (n=2), and hypokalemia (n=1). No objective responses were observed (median number of cycles = 1). Results of PK and correlative biology studies will be presented. Conclusions: Vorinostat 230 mg/m2/day PO on days 1-5 and 8-12 in combination with bortezomib 1.3 mg/m2/day i.v. on days 1,4, 8, and 11 of a 21 day cycle appears to be well-tolerated in children with recurrent or refractory solid tumors.
Assessment of the impact of systemic chemotherapy (SC) on the quality of life (QOL) in patients with metastatic unresectable appendiceal epithelial neoplasms (AEN).
Authors: Cathy Eng, Jennifer Choe, Michael J. Overman, Keith F. Fournier, Jonathan Phillips, George Baum, Robert A. Wolff, Richard E. Royal, Paul F. Mansfield, Karen Basen-Engquist
Journal: Journal of Clinical Oncology (2013)

522 Background: AEN is a rare malignancy ranging from indolent well-differentiated carcinoma to highly aggressive signet ring carcinoma. Optimal therapy is cytoreductive surgery (CRS) followed by heated intraperitoneal chemotherapy (HIPEC). Yet some patients (pts) are suboptimal for CRS/HIPEC, and are considered for SC. We have previously reported our retrospective analysis suggesting overall survival (OS) benefits from SC. We then opted to assess the impact of SC on QOL in unresectable AEN pts for which no standard of care exists. Methods: 50 pts who initiated SC were prospectively enrolled at our institution between Oct. 2008 and Nov. 2011. EORTC (3.0) QLQ-C30 and QLQ-OV28 surveys were provided at baseline and quarterly for one year. Data were analyzed with Linear Fixed Effects models using SAS Proc Mixed. Baseline and 6 month follow-up scores were tested separately for all QOL outcomes. Subscale means were converted to scaled values from 0 to 100. Positive change over the interval indicated improvement, except in symptom scales where positive change indicated worsening symptomatology. Results: 26 pts (52%) were male, median age was 64 (37-80). All pts received 5-FU-based treatment, and 37 (74%) received a biologic agent. 18 pts (36%) had poorly differentiated histology. Statistically significant change was noted in 2 subscales (Table). Overall, the Global subscale demonstrated no significant change from baseline (MME=2.9095, p=0.4422). Conclusions: In light of the possible OS benefit of systemic treatment in unresectable AEN as previously presented, our data suggest that palliative SC does not decrease QoL and in fact correlates with improved emotional well-being, and diminished symptoms including myalgias, arthragias and weakness. Awareness of these clinical and psychiatric results will better enable clinicians to ensure optimal outcomes for their AEN patients while on treatment.[Table: see text]
Effect of conversations about values and goals on anxiety in patients.
Authors: Joanna Paladino, Rachelle Bernacki, Mathilde Hutchings, Stuart R. Lipsitz, Bridget A. Neville, Atul Gawande, Susan Block
Journal: Journal of Clinical Oncology (2015)

9 Background: Patients with serious illness routinely receive treatments that do not align with their goals. Earlier clinical conversations about patients’ values and priorities lead to more goal-concordant care and improved quality of life, but clinician concerns about harming patients and taking away hope are barriers to appropriately timed discussions. Methods: A cluster-randomized controlled trial with oncology patients at high risk of death, identified by the surprise question. The intervention included a structured, patient-centered discussion about values and priorities conducted by trained oncology clinicians using the Serious Illness Conversation Guide. Patient anxiety (GAD-7) was measured by survey at baseline and every 2 months; anxiety, patient acceptability, and patient-reported behavior change were measured by survey 1 week after the intervention and at a matching time point for controls. Results: 342 patients enrolled (median age 62y): 176 intervention; 166 control. 102 conversations were completed in the intervention group. The mean anxiety (GAD-7) score prior to the intervention in the intervention group was 3.75 and in the control group was 3.80 (p = 0.72). However, a week after the intervention conversation (on average, the conversation was 10.4 weeks from baseline, IQR 3-13 weeks), there were significant differences. At 11.4 weeks, the intervention anxiety mean was 2.87, and the control mean was 4.26 (p = 0.011). Reductions persisted for 2 months after the conversation. Among patients who had the serious illness conversation and completed the acceptability survey: 86% reported that the conversation was worthwhile; 66% reported positive behavior changes as a result of the discussion; more than 80% reported that their hopefulness, peacefulness, and sense of control over medical decisions increased or did not change. Conclusions: The Serious Illness conversation lowered patient anxiety; this reduction was sustained for at least 2 months after the conversation. Patients viewed the serious illness conversation as worthwhile and reported enacting concrete positive behavior changes as a result of the discussion. Clinical trial information: NCT01786811.
The role of the development of hypertension or proteinuria in predicting outcome with the use of bevacizumab for patients with glioblastoma multiforme (GBM).
Authors: C. S. Nangia, D. Wang, L. Scarpace, L. Schultz, A. Khanshour, T. Mikkelsen
Journal: Journal of Clinical Oncology (2011)

2021 Background: Antiangiogenic therapy using bevacizumab has become the standard of care for managing GBM patients with recurrent disease. Hypertension and proteinuria commonly encountered in patients receiving bevacizumab may predict therapeutic benefit from bevacizumab therapy Methods: Between 2005 and 2010, 166 patients with histologically proven glioblastoma who had received bevacizumab were eligible for this retrospective analysis. Data collection included demographics, blood pressure, urinary protein, brain MRI, progression-free survival and overall survival after initiation of bevacizumab-containing regimens. Results: See table. Of these, 120 patients (75%) developed hypertension. This correlated to a statistically significant increase in both median PFS (7.0 vs. 2.9 months, p<0.001) and OS (11.7 vs. 5.7 months, p<0.001) in comparison to normotensive patients. A statistically significant increase in both PFS (7.1 vs. 6.0 months, p=0.002) and OS (13.2 vs. 9.3 months, p=0.008) were also observed in 65 patients (39%) who developed proteinuria. Conclusions: Much higher incidences of hypertension and proteinuria have been observed from bevacizumab-treated patients with GBM than those reported in solid tumors. Both hypertension and proteinuria developed from bevacizumab therapy were correlated to prolonged PFS and OS. Prospective validating these markers in predicting therapeutic benefit of antiangiogenic agent may be built into future clinical trials. Overall survival Progression-free survival Variable N Median survival time (months) (95% CI) P value (adjusted p value) Median survival time (months) (95% CI) P value (adjusted p value) Protein Yes 65 13.2 (10.7, 16.7) 0.008 (0.001) 7.1 (5.7, 10.4) 0.002 (0.006) Urea No 101 9.3 (7.6, 10.5) 6.0 (4.4, 7.4) Hypertension status HTN 120 11.7 (9.3, 12.5) HTN vs. Pre 0.134 (0.027) HTN vs. N 0.0004 (<0.001) Pre vs. N 0.068 (0.039) 7.0 (5.5, 8.3) HTN vs. Pre 0.565 (0.207) HTN vs. N <0.001 (<0.001) Pre vs. N 0.036 (0.009) Pre-HTN 27 8.9 (3.7, 12.3) 6.0 (3.2, 7.4) Normal 14 5.7 (1.1, 10.8) 2.9 (1.1, 5.6)
Assessment and management of the risk of recurrence of resected gastrointestinal stromal tumors.
Authors: Anthony Paul Conley, Medha Sasane, Corey L. Pelletier, Annie Guérin, Alexander R. Macalalad, Qing Huang, Eric Q. Wu
Journal: Journal of Clinical Oncology (2014)

119 Background: For patients with KIT+ gastrointestinal stromal tumors (GIST), several algorithms can evaluate the risk of recurrence and initiation of adjuvant therapy following primary GIST resection. With a variety of risk assessment tools and no standardized approach for assessing risk, it is unclear how physicians estimate the risk of recurrence in real-world clinical practice, and how they use the level of risk when considering adjuvant therapy. Methods: We conducted a cross-sectional survey of US oncologists on August 2013. From an existing panel of US physicians, oncologists were randomly asked to participate in an online survey of their assessment and management of GIST recurrence risk after resection of primary resectable disease. Oncologists’ feedback included rated responses by Likert scale and ranked responses by priority. Results: Of 109 participating oncologists, 69 (63%) were in private practice and 61 (56%) were in practice for &gt;10 years. Mitotic count and primary tumor size were the most influential factors chosen for assessing risk of recurrence, followed by presence of tumor rupture during surgery, tumor location, and presence of genetic mutations. A majority of oncologists (56%) reported the revised NIH criteria as the preferred risk classification tool, mainly because it was easy to use and remember. Initial level of risk assessed after GIST resection was the key factor influencing initiation, dosage, and duration of adjuvant therapy with imatinib. 98% of physicians would treat high risk patients with adjuvant imatinib, whereas 79% would consider adjuvant treatment for intermediate risk patients, and 28% for low risk patients. The percentage who would prescribe at least 3 years of adjuvant therapy varied from 26% for low-risk patients to 52% for intermediate-risk patients and 76% for high-risk patients. Conclusions: Level of risk of recurrence is a key factor when considering adjuvant therapy after resection of resectable GIST. However, significant variability exists in the perception physicians have regarding the initiation of adjuvant therapy among intermediate to high risk patients. This may be attributed to the variability in the different risk assessment tools and criteria.
Accuracy of diagnosing pancreatic ductal adenocarcinoma by EUS-FNA at a single institution.
Authors: Hannah Beal, Jill E. Shea, Benjamin Witt, Douglas G. Adler, Sean J. Mulvihill, Erinn Downs-Kelly, Matthew A. Firpo, Courtney L. Scaife
Journal: Journal of Clinical Oncology (2015)

258 Background: Endoscopic ultrasound-directed fine needle aspiration (EUS-FNA) in combination with imaging is currently the standard preoperative diagnostic method for pancreatic ductal adenocarcinoma (PDA). Previous studies have reported sensitivities and specificities ranging from 80%-90% and accuracies of approximately 85%. Our goal was to determine the accuracy of EUS-FNA for detecting PDA in individual patients at our institution. Methods: We conducted a retrospective chart review using the Clinical Cancer Research Database at Huntsman Cancer Institute (HCI). We included all cases in which pancreatic lesions were evaluated by EUS-FNA and a subsequent surgical resection was performed. All patients that met these criteria at HCI between March 1999 and April 2014 were included. Descriptive variables were calculated by comparing EUS-FNA results to final surgical diagnoses. The variables used to determine these values were; false positive = PDA by EUS-FNA and negative at resection, true positive = PDA for both, false negative = negative for PDA at EUS-FNA and positive at resection, true negative = negative for both. We considered atypical cells positive for PDA since their presence mandates aggressive intervention by the treating clinician. Results: Of the 242 patients that met the inclusion criterion, 139 were female with an average age of 58 +/- 15 (mean +/- standard deviation) and 103 were male with an average age of 62 +/- 13. In terms of diagnosing PDA by EUS-FNA we determined the sensitivity 89% (81%-94%; 95% confidence interval), specificity 76% (68%-83%), positive predictive value of 74% (66%-82%), and negative predictive value 89% (82%-94%). Conclusions: Although our findings are relatively consistent with the current literature, there is discernible potential for inappropriate treatment of patients based purely on EUS-FNA evaluation. Limitations of this study are the appraisal at a single institution and the necessity to evaluate only cases that ultimately had surgical resection of the pancreatic lesion.
Neoadjuvant therapy in Indian patients with locally advanced gall bladder cancer: Tata Memorial Centre (TMC) experience.
Authors: Bhawna Sirohi, Vipul Sheth, Ashish Singh, Reena Engineer, Mukta Ramadvar, Mahesh Goel, Shailesh V. Shrikhande
Journal: Journal of Clinical Oncology (2014)

379 Background: Gemcitabine/platinum (Gem-P) is currently the standard of care for patients with advanced biliary tract cancers based on the ABC02 study. Pts usually present in locally advanced (LA) stage in India and as surgery remains the only curative option- neoadjuvant (NA) strategy needs to be explored. Methods: This is retrospective analysis of the prospectively maintained database of 38 patients with LA GB cancer treated at TMC between Feb 2009 to May 2013. Aim of the study was to assess resectability rate in patients with LA GB cancer (defined as GB mass invading liver &gt; 2cm without porta hepatis / vascular invasion, GB mass adherent to duodenum and hepatic flexure, coeliac/gastrohepatic adenopathy/portocaval and peripancreatic nodes). Pts received cisplatin 25 mg/m2 and gemcitabine 1000 mg/m2 on D1 and D8 of 21d cycle, for gem-oxaliplatin, pts received gemcitabine 1000mg/m2 D1 and oxaliplatin 100mg/m2 D2 every 14 days. Response was assessed after 3-4 cycles. Results: Of the 38 pts (median age 54 y,30-71; 11M, 29F, median CA19.9 19 (&lt;2-74605), 33patients were treated with Gem-P (25 oxaliplatin, 8 cisplatin; 1cetuximab-Gem-P) based therapy and 5 pts received chemoradiotherapy (CTRT) with wkly gemcitabine 300mg/m2. Site of disease was liver in 22 pts, nodal in 12, adjacent organ in 9 &amp; other in 3 pts. Median number of chemotherapy cycles given were 4 (1-12). Response rate to NA therapy was 5 (13%) complete response (CR), 17(45%) partial response (PR), 9 stable disease (SD), 5 (13%) progressive disease and not assessed in 2 patients (1 pt died post CTRT and 1 was inoperable at surgery). Overall clinical benefit rate (CR+PR+SD) was 82%. Of the 24 pts who underwent surgery, 21 (87%) had curative resection and 3 were inoperable. Of 9 pts with SD, 6 received 2nd –line NA therapy as they were not downstaged enough to undergo surgery– 4 CTRT, 1 gemcitabine-cape, 1 cape-Ox. Perioperative morbidity (biliary leak) was higher post CTRT. Overall, 7 pts have relapsed. Conclusions: This is the first report of the use of neoadjuvant chemotherapy in patients with LA GB cancer. We conclude that preoperative chemotherapy is feasible with acceptable toxicity and perioperative morbidity.
Defibrotide Effectively Prevents Veno-Occlusive Disease of the Liver (VOD) after Allogeneic Stem Cell Transplantation. An Extended Study.
Authors: Yves Chalandon, Eddy Roosnek, Claudine Helg, Frank Verholen, Sabine Knipp, Hulya Ozsahin, Jakob R. Passweg
Journal: Blood (2006)
Identification of New microRNA Biomarkers and Candidate Target Genes in Primitive CML Cells Using Global Comparative RNA analyses
Authors: Hanyang Lin, Katharina Rothe, Jens Ruschmann, Oleh Petriv, Kieran O'Neill, David J.H.F. Knapp, Ryan R. Brinkman, Inanc Birol, Donna L. Forrest, Carl Hansen, Connie J Eaves, R. Keith Humphries, Xiaoyan Jiang
Journal: Blood (2014)
The relationship between cost, quality, and outcomes among women with breast cancer in SEER–Medicare.
Authors: M. J. Hassett, B. A. Neville, J. C. Weeks
Journal: Journal of Clinical Oncology (2011)

6001 Background: Breast cancer (BrCa) is responsible for the largest share of cancer-related spending in the US. While the cost of cancer care is substantial and increasing yearly, little is known about the relationship between cost and quality or outcomes. Methods: For women 65-70 years old diagnosed 7/97-12/05 with stage 0-III BrCa who were continuously enrolled in fee-for-service Medicare, we evaluated performance relative to 27 surgical, radiation and chemotherapy quality measures: 20 recommending for proven therapies and 7 recommending against unnecessary therapies. Using health care service area (HSA) as the unit of analysis, we derived aggregate measures of practice performance, calculated the median per-patient cost in the year after diagnosis (part A and B expenditures in 2010 inflation adjusted $US) and described 5-year overall survival (OS) rates. After stratifying the population into quintiles based the median per-patient cost per HSA, we looked for variation in measure concordance and OS by quintile (using the Kruskal-Wallis and log-rank tests, respectively). Results: We identified 15,357 women with stage 0-III BrCa and compiled quality, cost and outcomes data for 99 HSAs. The median number of patients per HSA was 85 (IQR 47-162), and the proportion of patients alive at 5 years was 87.5%. Significant relationships between cost and measure concordance/OS appear in the table (p<.01). When stratified into quintiles by measure concordance rather than cost, there was no difference in 5-year OS by quality performance quintile (p=0.14). Conclusions: There is wide variation in the cost of initial BrCa care, but only marginal difference in the quality or outcomes experienced by patients representing different cost quintiles. Additional efforts to evaluate factors that impact the relationship between cost and quality/outcomes are needed. Cost quintile Lowest Highest Number of patients 3052 3180 3022 3721 2382 Median expenditure per patient ($US) 17,319 19,719 22,217 24,574 27,233 Median proportion concordant All measures (27) 81% 80% 80% 81% 81% Measures assessing overuse (7) 90% 85% 86% 83% 85% Measures assessing underuse (20) 80% 80% 80% 81% 80% Proportion alive at 5 years 85.5% 88.3% 87.2% 89.5% 85.8%
Tolerability and efficacy of first-line bevacizumab (B) plus chemotherapy (CT) in elderly patients with advanced breast cancer (aBC): Subpopulation analysis of the MO19391 study
Authors: L. Biganzoli, H. Cortes-Funes, C. Thomssen, K. I. Pritchard, J. Pierga, A. Kupp, S. Borstnar, I. Smith
Journal: Journal of Clinical Oncology (2009)

1032 Background: Limited data exist on the efficacy and safety of biological agents in elderly patients with aBC. This is essentially due to the lack of studies specifically targeting the older population and to strict inclusion criteria in clinical trials. B significantly improved the efficacy of 1st-line taxane therapy in two large, randomized phase III trials, E2100 and AVADO. Methods: In study MO19391, 1st-line B 10mg/kg q2w or 15mg/kg q3w + CT (primarily but not exclusively taxane monotherapy) was investigated in a broader, large aBC patient population, with the aim of understanding safety and efficacy in patients seen in routine clinical practice, including elderly patients. Results: A total of 2,027 patients were enrolled. Median age was 54 years (range 21–93); 359 patients (17.7%) were aged ≥65 years and 169 (8.3%) were ≥70 years. Baseline characteristics and safety and efficacy results according to age are shown below (Table). Conclusions: Treatment with B is feasible in elderly patients. Hypertension was the only grade 3 B-related side effect reported more frequently in the older than in the younger cohort. Efficacy was similar in the two subgroups. These results suggest that the combination of B with 1st-line CT shows a similar therapeutic index regardless of age. Data on compliance according to the different CT regimens, the impact of comorbidities on safety, and analyses in the subgroup of patients ≥70 years will be presented. [Table: see text] [Table: see text]