tbuckley/cabot-search huggingface dataset:
Feasibility of a clinic-based central line care teach-back program for pediatric oncology families.
Authors: Chris Ivette Wong Quiles, Marie D Desrochers, Riley M Mahan, Kristen Graham, Margaret Brill-Conway, Kelly Eng, Amy Billett
Journal: Journal of Clinical Oncology (2017)

183 Background: Pediatric oncology (PO) patients with central lines (CLs) are at high risk for CL associated bloodstream infections (CLABSI), which increase morbidity, mortality, and costs. A large portion of ambulatory CL care in the home is provided by families who often have limited opportunities to develop the needed skills and adhere to best practice line care. Methods: A pilot quality improvement initiative was undertaken from 5/2015-6/2016 to develop a coaching program for families to demonstrate external CL care with a nurse during a routine clinic visit (teach-back), either on a simulation model or the patient. Tests of change were implemented to add teach-backs during routine clinic visits and ensure teach-back documentation in the medical record. Initial steps included assessing family interest in teach-backs by conducting surveys about CL care at home and unstructured incorporation into routine care by existing clinic nursing staff. After assessment of the pilot phase, targeted interventions started April 2016 including dedicated staff for scheduling, tracking, and performing teach-backs during routine clinic visits; culture change including an expectation that all families would participate and on-going staff education about the program; language change to increase participation by avoiding family perception of being tested; and incentives (gift-card raffle) for nurses to provide coaching. Results: Before April 2016, less than 25% of families participated due to a combination of family refusal; lack of nursing availability, space, or time; and inability to approach prior to line removal. In April 2016, 52% of families participated, reaching 90% by June 2016. Informal feedback from both staff and patient/family participants suggested increased job satisfaction by nurses and wide acceptance by all. In addition, many families participated in multiple teach-back sessions to improve line care skills. Conclusions: A CL teach-back program in a busy ambulatory PO clinic is feasible, but requires dedicated resources and culture change. Ongoing improvements are in place to ensure sustainability of the program and measure the impact on ambulatory CLABSI rate and family distress and line care skills.
Predictors of no-show among international patients with cancer: A 4-year analysis.
Authors: Nizar Bhulani, Lianchun Xiao, Manal Hassan, Renato Lenzi
Journal: Journal of Clinical Oncology (2017)

23 Background: Patient no-show (NSh) for scheduled medical appointments negatively impacts quality of care, impedes optimal use of resources, has significant negative economic consequences secondary to missed appointments, and uncovered referral processing costs. International patients (IntlPts) present challenging financial/travel arrangements and cultural and linguistic needs. There are currently very limited data regarding numbers of IntlPts visiting the United States for medical care and no data regarding NSh rates. The purpose of this study was to quantify costs and identify IntlPts-related variables correlating with NSh to develop interventions aimed at minimizing the associated negative financial consequences. Methods: A retrospective study of IntlPts accepted and scheduled for an appointment at the International Assessment Center at MD Anderson in fiscal years 2010 – 2013 was conducted. Overall 52 variables were evaluated that included socio-demographic and clinical patient characteristics, financial responsibility, and appointment timeline. For univariate analysis, Chi-square test and Wilcoxon rank sum test were applied. For multivariate analysis, a multivariate logistic regression model was fit. The multivariate logistic model with independent covariates was used to construct a nomogram. The Time Driven Activity-Based Cost method was used to assess the cost of processing referral requests. Results: Of 1031 IntlPts scheduled, 311 (30%) were NSh. NSh was significantly associated (p &lt;0.05) with country of origin, payer, diagnosis, referral source, disease stage, patient-delayed appointment date, number of symptoms, pain, bleeding, fatigue, dysphagia, jaundice, neurological symptoms, comorbidities, and appointment lag time. Direct operational costs were calculated using process maps and TDABC. Conclusions: These results provide the groundwork to understand operational costs and predictors of no-show of oncology IntlPts. Having knowledge of predictive factors for NSh in a new patient outpatient setting represents a necessary step towards decreasing its frequency, addressing associated costs, optimizing continuity of care, and ultimately improving outcomes and value of the provided care.
Impact of “poorly differentiated clusters” in primary lesion as a novel prognostic indicator in colorectal liver metastasis.
Authors: Tsuyoshi Konishi, Hideki Ueno, Yuichi Ishikawa, Masashi Ueno, Akio Saiura, Junji Yamamoto, Yosuke Fukunaga, Satoshi Nagayama, Chiriko Yamamoto, Kazuo Hase, Yojiro Hashiguchi, Kazuo Hatsuse, Tetsuichiro Muto, Toshiharu Yamaguchi
Journal: Journal of Clinical Oncology (2012)

3625 Background: Preoperative predictors for survival are needed in colorectal liver metastasis in order to select poor-risk group that truly requires perioperative chemotherapy. This study aimed to elucidate survival predictors in patients undergoing curative hepatectomy for colorectal liver metastasis, particularly focusing on the impact of poorly differentiated clusters (PDC); a novel histologic grading system in primary lesion. Methods: A total of 424 consecutive patients undergoing curative resection of both primary colorectal cancers and metastatic liver lesions at two referral centers were enrolled in the study. Determinants of overall survival (OS) and recurrence free survival (RFS) after hepatectomy were investigated by univariate and multivariate analysis, using detailed clinicopathological parameters in primary and metastatic lesions. Cancer clusters of ≥5 cancer cells and lacking a gland-like structure were counted under a x20 objective lens in a field containing the highest number of clusters at invasive front of primary lesions, and tumors with &lt;5, 5 to 9, and ≥10 clusters were classified as PDC grade (G)1, G2 and G3, respectively (n=65, 132, and 227 tumors, respectively). Results: OS and RFS at 3 years were 59% and 27%, respectively, with average follow up period of 43 months. PDC grade in primary lesion was strongly associated with both 3-year-OS (83%, 62%, and 51%, respectively, p&lt;0.0001) and 3-year-RFS (55%, 30%, and 17%, respectively, p&lt;0.0001). Multivariate analysis revealed that PDC grade in primary lesion was the most potent prognostic factor after hepatectomy independent of T and N of primary lesion and size of liver metastasis. Conclusions: PDC grade in primary lesion is a novel potent prognostic indicator in colorectal liver metastasis, which is independent of T and N. It is noteworthy that PDC grade can bias the survival in clinical studies targeting perioperative chemotherapy in colorectal liver metastasis.
Nutritional intervention in high-risk patients receiving radiation for a broad spectrum of tumor types.
Authors: Chelsea Hertel, Amir Harandi, Cliff P. Connery, Dimitrios Papadopoulos
Journal: Journal of Clinical Oncology (2017)

203 Background: Malnutrition is very common in patients receiving radiation therapy. This can result in significant weight loss, decreased functioning, depression, increased mortality, and dramatic declines in quality of life during and after treatment. Targeting patients at risk with nutritional counseling and progressive intervention can have important clinical implications. Methods: A total of 106 patients at a hospital-based cancer center getting radiation for a wide spectrum of cancers (breast, lung, gastrointestinal, genitourinary, and other types) were evaluated for individualized nutritional counseling and education. Patients with identified risk factors were deemed to be at high risk by nursing staff if meeting pre-specified criteria for weight loss ( &gt; 2.5%), body mass index &lt; 18.5%, and/or gastrointestinal symptoms (poor appetite, diarrhea, or constipation affecting quality of life). After high risk patients were identified by a nursing staff triage questionnaire, an automatic computer generated referral was made to the nutritionist. Results: Prior to the institution of this protocol, 13.7% of patients getting radiation therapy were noted to be at high risk and not receiving any nutritional intervention during their course of radiotherapy. However, after the initiation of adequate screening by nursing staff triggering a nutrition referral, the percentage of high risk patients without an associated nutrition consult declined to 1.1%. Conclusions: This study conveys important information for having a systemic screening process in place to identify those at risk for progressive malnutrition while getting radiotherapy for a broad spectrum of tumor types.
Administration of the ASCO Pain Survey to identify patient education deficiencies in patients with cancer.
Authors: Chelsea Hagmann, Joseph Ma, Arlene Cramer, Michelle Russell, Alexandra Dullea, Yael Cohen-Arazi, Eric Roeland
Journal: Journal of Clinical Oncology (2017)

68 Background: The Doris Howell Palliative Care (PC) Outpatient Consultation Service consists of a multidisciplinary team. Reasons for consultation include pain management, treatment of other physical symptoms, education about non-drug options for pain, and advanced care planning. To assess methods used for patient education, the PC team administered the ASCO pain survey to those prescribed opioid pain medications. Methods: The survey was a 26-item questionnaire evaluating patient education content communicated by a provider to a patient during a routine clinic visit. Twenty surveys were completed anonymously. After survey review, the outpatient PC team developed an intervention to address patient education concerns. The intervention consisted of written and verbal instructions on pain medication management reviewed by the PC nurse with the patient and/or caregiver at the end of the outpatient visit. Another twenty surveys were completed anonymously with patients after intervention implementation. Time required to complete the intervention was less than two minutes per patient. The Fisher’s exact test was used to analyze the differences between surveys completed with or without the intervention. Results: The majority of patients stated that his/her provider adequately explained the use (n = 40, 100%), side effects (n = 37, 93%), and storage (n = 32, 80%) of pain medications, regardless of the intervention. Both groups also indicated that the provider and/or nurse adequately explained the risks associated with medical history (n = 34, 85%) and other medications while taking pain medications (n = 33, 83%). The intervention did increase understanding to avoid sharing pain medications (75% vs. 85%, p &lt; 0.05) and to use a lock box to secure pain medications (45% vs. 60%, p &lt; 0.05). Additionally, asking patients if family members have a history of alcohol or substance abuse was also significant (p &lt; 0.05). Conclusions: Written and verbal instructions as an intervention improved patient understanding to avoid sharing pain medications and to secure pain medications in a lock box.
Effects of qigong on quality of life, fatigue, stress, neuropathy, and sexual function in women with metastatic breast cancer: A feasibility study.
Authors: Byeongsang Oh, Phyllis Noemi Butow, Frances Boyle, Philip James Beale, Daniel Costa, Nick Pavlakis, David R. Bell, SM Choi, MS Lee, David S. Rosenthal, Stephen John Clarke
Journal: Journal of Clinical Oncology (2014)

e20712 Background: Women with metastatic breast cancer (MBC) suffer from psychological and physiological symptoms and side effects of therapy. When the treatment is non-curative, quality of life (QOL) is a major issue. This study aimed to examine the feasibility, safety, and effects of Medical Qigong (MQ: integration of gentle exercise and meditation) in improving QOL in women with MBC. Methods: Women with MBC were randomized to a MQ group (n=14) or meditation control group (n=13). QOL, fatigue, stress, neuropathy symptoms and sexual function were measured by the Functional Assessment of Cancer Therapy - Breast (FACT-B), Functional Assessment of Cancer Therapy-fatigue (FACT-F), Perceived Stress Scale (PSS), neurotoxicity subscale of the FACT/GOG-NTX, and Sexual Functioning Questionnaire (SFQ) subscales at pre-intervention and weeks 5 and 10. Results: No serious adverse events were reported during or after MQ intervention. Sixty three percent of participants completed the study (MQ intervention (n=9) and meditation control (n=8)). There were no significant differences in overall QOL (p= 0.84), fatigue (p= 0.71), perceived stress level (p= 0.52), sexual satisfaction (p= 0.55), sexual activities (p= 0.95) and sexual relationship (p= 0.79) between the groups, although difference in neuropathic symptoms (p=0.014) were significant. Conclusions: A MQ trial in women with MBC is feasible and safe. MQ may have the potential to relieve symptoms experienced by women with MBC and prevent deterioration of neuropathy. A larger study with adequately power to confirm these results and detect clinically relevant effects is needed.
Anti-CD3 immunotoxin to induce remissions in cutaneous T-cell lymphoma patients.
Authors: Arthur E. Frankel
Journal: Journal of Clinical Oncology (2012)

2505 Background: The anti-CD3 immunotoxin, AdmDT390bisFv(UCHT1), composed of the catalytic and translocation domains of diphtheria toxin (DT390) fused to two anti-CD3 sFvs showed selective cytotoxicity to normal and malignant human T cells in vitro and in vivo and was prepared for a phase I clinical study (Woo, Protein Exp Purif 58, 1, 2008). FDA approval (BB IND#100712), and IRB approval was obtained. Methods: Nineteen T cell lymphoma patients were screened, and 12 patients treated. Median age was 62 years (range, 39-84 years) with 6 males and 6 females. Disease was previously treated with one (6), two (3), three (1) or four (2) systemic therapies. One patient had stage IV PTCL and the other patients had CTCL (stage IB in 5, IIB in 4, IIIB in 1, and IV in 1). Six patients were treated with 2.5µg/kg x 8; five patients were treated with 5µg/kg x 5 - 8 and one patient treated with 7.5µg/kg x 8. Results: Drug-related toxicities were mild in 11/12 patients and were not dose dependent with transient fevers, chills, lymphopenia, transaminasemia, CMV and/or EBV viremia, and hypoalbuminemia. One 69 year old male with pre-existing heart failure treated at the 5µg/kg x 5 suffered severe vascular leak syndrome and heart failure. Immunotoxin Cmax was 1 – 60ng/mL, and mean half-life was 42min. Four patients had pre-treatment anti-immunotoxin titers &gt;10µg/mL, and the others had lower pre-treatment antibody levels. All evaluable patients except two had increases of antibody titer between day 12 to 30 of 4 – 2000-fold. Among 10 evaluable patients, there were 2 complete remissions (CRs) of 17 and 41+ months durations and 4 partial remissions (PRs) of 1+ - 32+ months. Conclusions: The immunotoxin has exciting clinical efficacy in this heavily pretreated group of patients. Dose escalation is proceeding.
The effect of race on progression-free survival in patients with metastatic hormone-refractory prostate cancer (HRPC): a pooled analysis of CALGB studies
Authors: S. Halabi, E. J. Small, T. Gilligian, R. Barrier, S. George, N. J. Vogelzang
Journal: Journal of Clinical Oncology (2004)

4573 Background: To determine if African-American (AA) men have different progression-free survival (PFS) than non-African-American (non-AA) patients with hormone refractory prostate cancer (HRPC). Methods: Data from eight multicenter trials (four phase II and four randomized phase III studies) conducted by the Cancer and Leukemia Group B (CALGB) from 1992–2002 were combined. Eligible patients had progressive adenocarcinoma of the prostate after androgen ablation (with castrate testosterone levels), an ECOG performance status of 0–2, and adequate hematologic, renal and hepatic function. PFS was defined as the time to objective progression, PSA progression using the PSA consensus criteria, or death, whichever occurred first. A proportional hazards model was used to assess the prognostic importance of race adjusting for important baseline factors. Results: Of the 1216 patients, 173 (14%) patients were AA and 1043 (86%) were non-AA. AA men were younger [median: in AA= 69 years, inter-quartile range (IQR) 63–75; in non-AA=71 years, IQR=65–76; p-value =0.01], had shorter interval between diagnosis and study entry (median=3 years, IQR=2–5, vs. 4 years, IQR=2–6; p-value=0.03), higher PSA levels (median=190, IQR=44–524, vs. median=100, IQR=36–286; p-value<0.01), and lower hemoglobin levels (median=11.7, IQR= 10.4–12.5 vs. 12.6, IQR=11.4–13.5; p-value<0.01). There was no statistical difference between the two groups in the proportion of patients with Gleason sum of 8 or higher (51% vs. 44%, p-value=0.10). The median time to progression was 3.44 months (95% Confidence Interval (CI)= 2.66–4.01) for AA compared to 2.69 months (95% CI= 2.54–2.86, p-value=0.58). In the multivariate analysis, adjusting for age, years since diagnosis, performance status, PSA, LDH, Gleason sum, and hemoglobin, the hazard ratio was 0.86 (95% CI= 0.73–1.03; p-value = 0.10) for AA compared to non-AA men. Conclusions: There was no statistical significance difference in PFS between AA and non-AA men with HRPC enrolled on these clinical trials. It is unknown if these results would hold true in a less selected patient population. No significant financial relationships to disclose.
Letter: Valve closure and second heart sound.
Authors: S Rodbard, N P Matthews
Journal: Circulation (1975)

bances.However, Dr. Gillette has considerable experience in these matters, and if he considers the procedure provides useful information without the necessity of recording from the nonbranching bundle, then we bow to his judgment.Our purpose was to highlight what we considered to be hazardous procedures from our morphological standpoint.In closing we would state that we prefer not to describe the cases under discussion as "ventricular inversion."This is a nonspecific term, and we were careful to state that we studied cases only with atrioventricular DISCORDANCE, transposition, and the presence of two distinct ventricular sinuses, this combination comprising the complex usually termed classically corrected transposition.
p53 mutations in stromal fibroblasts sensitize tumors against chemotherapy
Authors: Daniel Lafkas, Stavroula Kouloheri, Hippokratis Kiaris
Journal: Clinical Cancer Research (2007)

A20  Mutations in p53 tumor suppressor gene, besides their presence and well studied cell-autonomous role in cancer cells, have also been described in stromal fibroblasts of breast and prostate cancers. Their presence was shown to play a positive role in the development of the disease stimulating tumorigenesis, pointing to a non-cell-autonomous action of p53 in tumor growth. The fact that besides its well established role in carcinogenesis, p53 is also considered a major regulator of the efficacy of anticancer therapy, prompted us to address if p53 mutations in stromal fibroblasts can also modulate the response of a tumor against conventional chemotherapy. Tumor reconstitution experiments by human cancer cells and fibroblasts differing in the p53 status showed that both MCF7 breast and PC3 prostate cancers containing p53- null fibroblasts developed tumors faster than their counterparts with wild-type p53, consistently with published results showing that p53 mutations in stromal fibroblasts accelerate tumorigenesis. When however, these p53-null-fibroblasts containing tumors were treated by the anticancer agents DOX and cis-platinum they were more sensitive in the treatment than their counterparts reconstituted with wild type fibroblasts. Consistently with these findings, conditioned media from treated, wild type fibroblasts stimulated the growth of cancer cells more efficiently than those from treated, p53-null fibroblasts, while this effect was reversed when conditioned media from untreated fibroblasts were used. It is likely that the ratio of senescent fibroblasts following anticancer treatment affects the paracrine regulation of chemotherapy, depending on the status of p53. It is conceivable that any genetic or epigenetic modulation of the activity of genes in stromal fibroblasts involved in the regulation of cell cycle and eventually entrance into senescence, may elicit similar effects upon application of anticancer therapy. These results identify stromal fibroblasts as important modulators of the efficacy of anticancer therapy. Furthermore they imply that specific, transient inhibition of senescence, i.e. by suppression of p53 activity, during or shortly after application of therapy may increase the efficacy of anticancer therapy. This project is co-funded by the European Social Fund and National Resources -(EPEAEK II/Pythagoras II) to S.K. and H.K.
Abstract 285: Overexpression of SK3 in a Murine Model Results in Sudden Cardiac Death
Authors: Nathan R Tucker, Saagar Mahida, Robert Mills, Bridget Simonson, Vincenzo Macri, Marc Lemoine, Saumya Das, David J Milan, Patrick T Ellinor
Journal: Circulation Research (2013)

Background: Recently, the gene responsible for encoding SK3, KCNN3, was implicated in a genome-wide association study as a susceptibility locus for atrial fibrillation. SK3 is one of a family of three small conductance, voltage-independent, calcium-activated potassium channels which is abundantly expressed in cardiac tissues. Therefore, we hypothesized that transcriptional misregulation of the KCNN3 gene could result in arrhythmogenesis. Methods: We characterized a mouse line which had constitutive ubiquitous overexpression of Kcnn3 using ambulatory cardiac rhythm monitoring, optical mapping and in vivo electrophysiology studies. Both homozygote (SK3 T/T ) and heterozygote (SK3 T/+ ) animals were compared to their wild-type (SK3 +/+ ) littermates for assessment of cardiac phenotypes. Results: SK3 T/T mice displayed increased expression of SK3, as assessed by qRT-PCR, in all four chambers of the heart, although highest increase of expression was observed in the ventricles. Examinations of SK3 T/T mice revealed no gross morphological changes in the myocardium, no observable cardiac fibrosis, and normal echocardiograms when compared to SK3 +/+ mice. However, pups from SK3 T/+ crosses did not produce expected Mendelian ratios (SK3 +/+ = 17%), and 7 out of 19 SK3 +/+ mice died suddenly by 3 months of age, whereas all of the SK3 T/+ or SK3 +/+ survived. To address potential mechanisms, we performed ambulatory monitoring on mice beginning at approximately one month of age. Of the 6 SK3 +/+ mice, 4 died suddenly, whereas neither of the wild-type controls expired. The cardiac rhythm recorded at the time of death in three of the four mice was heart block followed by severe bradycardia. Additionally, during the period of ambulatory monitoring, SK3 T/T mice had a lower mean heart rate compared to the SK3 +/+ control mice, and SK3 T/T mice also displayed frequent episodes of atrioventricular dissociation, both at rest and during periods of activity. SK3 T/T mice also displayed more pronounced variability of the heart rate and the PR interval. Optical mapping revealed slower ventricular conduction velocity. Conclusion: These data suggest a mechanism whereby overexpression of SK3 leads to sudden death due to bradyarrhythmias and heart block.