tbuckley/cabot-search huggingface dataset:
A survey to evaluate our physician-trainees' comfort and knowledge in communicating their final good-bye to their terminally ill patient.
Authors: Joel Marcus, Badi Edmond El Osta, Bradley Sumrall, Frank Mott
Journal: Journal of Clinical Oncology (2014)

114 Background: Although dealing with end of life (EOL) issues is common and can be stressful in cancer care, very little is taught and written in regards to how healthcare professionals should communicate their final good-bye with their terminally ill patients. There is a wealth of literature available about communicating “bad news”, but a literature review elicited scant data about this topic. Methods: We conducted a pilot survey on 88 house staff physicians to evaluate the frequency, their level of comfort, whether they had prior training and their knowledge about communicating their final good-bye at the EOL and their interest to learn more about this communication skill. Results: 42% were first year trainees across all specialties. 61% encountered at least 1 patient monthly at the EOL. 45% felt comfortable saying good-bye to a patient they were unlikely to see alive again. 54% have expressed interest in learning how to communicate their final good-bye to their patient at the EOL. However, only 5.7% have reported receiving a thorough training and 2.2% endorsed being very knowledgeable in this communication skill. 81% were interested to learn these skills from experienced mentors. Conclusions: Communicating the final good-bye with the terminally ill patient is an important skill that is not routinely taught to our physician-trainees. The majority of them expressed their interest to learn this skill from experienced mentors. Palliative care healthcare professionals can play a pivotal role in our physician training programs by mentoring our trainees on communicating their final good-bye to their terminally ill patient effectively and compassionately. Once implemented, further studies will be needed to assess the impact of experienced mentors on the comfort and knowledge of our physician-trainees in this communication skill.
Funding academic oncology clinical trials.
Authors: H. Seow, M. N. Levine, D. Bainbridge, B. Kowaleski, A. M. Arnold
Journal: Journal of Clinical Oncology (2011)

e16507 Background: Oncology clinical trials departments (CTD) improve patient care by addressing clinical problems through clinical trials. CTDs participate in trials sponsored by industry (e.g. pharmaceutical company) or academic research groups (e.g. co-operative group trial). However, many CTDs operate in a fiscal deficit, relying upon the host centre or hospital for financial support. This study compared the net income trend of academic and industry trials to illuminate how different payment models contribute to the financial burden of CTDs. Methods: We retrospectively examined the lifetime costs for 2 academic and 2 industry oncology clinical trials. Studies were conducted at the CTD within a large academic cancer hospital in Ontario, (approximately 75-100 active trials on-going). For each trial, we analyzed the monthly net income (cash flow minus costs) from accrual start date to end of follow-up, up to 10 years. Data sources included accrual start and end dates from patient charts and estimated costs (e.g. staff time) from departmental financial records. Results: The payment schemes and lifetime trial costs differed markedly for academic vs. industry trials. For academic trials, payments typically occurred upon each patient’s accrual with little or no remuneration for follow-up visits. Once accrual ended, monthly net income quickly became negative. In contrast, payment for the industry trials occurred in stages, beginning at patient accrual and continuing at each visit or milestone. Follow-up duration was also considerably shorter for industry compared to academic trials, meaning deficits due to follow-up costs were minimal. Conclusions: The payment model of academic trials resembles a ponzi scheme: CTDs are using the revenue earned by accruals from an existing academic trial to pay for the follow-up costs of a past trial that is no longer generating revenue. Reforms are needed to prevent a global “bail-out” to save the industry of conducting clinical trials.
Genetic Variation in AKAP13 Is Associated with Increased Risk of Relapse after Allogeneic Hematopoietic Cell Transplantation Following Non-Myeloablative Conditioning.
Authors: Brian Kornblit, Tania Masmas, Hans O Madsen, Mette V Larsen, Anette Stryhn, Søren Buus, Peter Garred, Lars Vindelov
Journal: Blood (2008)
Impact of hemoglobin (Hb) on outcomes of adjuvant chemotherapy (ACT) with cisplatin/vinorelbine in patients (pts) with completely resected non-small cell lung cancer (NSCLC) in JBR.10
Authors: I. Gauthier, K. Ding, T. Winton, F. Shepherd, R. Livingston, D. H. Johnson, J. R. Rigas, M. Whitehead, B. Graham, L. Seymour
Journal: Journal of Clinical Oncology (2005)

7200 Background: Cisplatin ACT induced anemia may correlate with adverse events (AEs), poor Quality of Life (QoL), inability to deliver ACT, relapse free survival (RFS) or overall survival (OS). Methods: JBR.10 showed improved OS and RFS for pts with resected NSCLC treated with ACT (n=243) compared to observation (obs) (n=239) (Winton, ASCO 2004). Exploratory analyses were performed evaluating the predictive value of baseline (BL, all enrolled pts) and during-treatment (DT, ACT pts only) Hb (median,minimum and % drop) on RFS and OS. Analyses were adjusted for BL prognostic factors (age, gender, PS, disease stage, LDH, surgery type and histology). Hb was also correlated with AEs (lethargy, dizziness, headache, dyspnea, ischemia, venous thromboembolic events (VTE)), QoL, morbidity and ACT dose intensity (DI). Results: BL Hb was significantly lower in female pts, older pts and pts with PS =1. BL Hb was not predictive of RFS or OS (log-rank), although in adjusted Cox model there was a trend to shorter OS (p= 0.1) in pts with BL Hb <12. Lower BL Hb predicted for more frequent hospitalization (ACT pts only, p=0.04) while higher BL Hb predicted for better QoL (obs only, SOB, p=0.03). There was no impact on AEs, or DI. Median DT Hb was associated only with increased fatigue (p=0.02), while lower nadir DT Hb was associated with longer RFS (p=0.08) Maximum DT Hb drop < 10% was associated with shorter OS and RFS (p=0.01) even when DI was included in the model. Maximum DT Hb drop was also associated with worse QoL (fatigue, 0.07), fatigue (0.003) and VTE (0.07) Conclusion: Lower BL and DT Hb levels appear to be associated with fatigue, poorer QoL, increased hospitalization and higher rates of VTE. Lower BL Hb is associated with shorter OS (NS) while smaller falls in Hb during treatment appear to predict for shorter OS and RFS. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen, Bayer, GlaxoSmithKline, Ligand Amgen, Genentech, GlaxoSmithKline, Ligand, sanofi-aventis Abbott, Amgen, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, ImClone, Ligand, Merck, NCI, Ortho-Biotech, OSI, Pfizer, Roche, sanofi-aventis, Telik
End-of-life wishes of patients with cancer: Results of study from a private hospital in Kathmandu, Nepal.
Authors: B. R. Ghimire
Journal: Journal of Clinical Oncology (2011)

e19711 Background: Nepal is a predominantly Hindu, conservative society where people don’t talk about their disease and death very openly. Most of the cancer cases are diagnosed in advanced stage but palliative care is not available in most part of the country. We wanted to understand how the cancer patients in our hospital think about their death and what wishes they might have regarding their death. This is the probably the first study of this kind in Nepal. Methods: Diagnosed cancer patients of any age, sex, religious or educational background, type or stage visiting the cancer center of Om Hospital and Research Center (OHRC), Kathmandu, Nepal from March 2010 to Oct 2010 for counseling, chemotherapy or palliative care were included in this study. Total of 20 pre-formed multiple choice questions regarding various aspect of end-of-life wishes were asked verbally for illiterate or asked to tick the appropriate answer for the literate patients after taking the written consent. Results: Total of 278 cancer patients were approached. 102 (36.6%) patients declined to participate or opted to drop out after few questions. So, the total of 176 patient’s answers was analyzed. 35% of patients were illiterate while 65% of patients could read and write. 80% wanted to be sedated at the time of dying. 52% wished to die at home, 35% at hospital and 13% at religious place. 90% said they haven’t planned for their death. 65% wanted family to be told first about their death, 65% didn't want to know they were dying. 85% didn’t want to donate organs after death, 5% said yes, 15% didn't care. 76% wanted family to do all rituals after death, 94% wanted their body to be taken care properly after death. 69% didn't want to publish condolence message in newspapers. 72% wanted to take care of legal issues/properties before death. 68% wanted to hear god’s prayer at the time of death. 80% wanted their symptoms to be under control with medications at the time of death. Conclusions: It was very challenging to question about death to cancer patients in our society and as expected we faced many hostile situation during this study. The result is different from the western world as in our society people depend on families to care for them and take decisions for them at the time of death.
Randomized phase II study of gemcitabine (G) plus anti-IGF-1R antibody MK-0646, G plus erlotinib (E) plus MK-0646 and G plus E for advanced pancreatic cancer.
Authors: M. M. Javle, G. R. Varadhachary, D. R. Fogelman, R. T. Shroff, M. J. Overman, L. Ukegbu, B. N. Bekele, S. P. Kar, R. A. Wolff, J. L. Abbruzzese
Journal: Journal of Clinical Oncology (2011)

4026 Background: IGF-1R activation results in the phosphorylation of IRS-1 and the PI3-Kinase/Akt, mTOR and S6 kinase pathways in pancreatic cancer. Monoclonal antibody MK-0646 blocks IGF-1-receptor interaction, internalizes and degrades IGF-1R. Receptor cross-talk between IGF-1R and EGFR and IGF-1R-induced PI3-kinase mediates resistance to anti-EGFR agents. Prior phase I established the maximal tolerated dose of MK-0646 as 10 mg/kg with G and 5 mg/kg with G+E. Methods: Patients (pts) with stage IV, previously untreated pancreatic cancer, ECOG performance status (PS) 0-1, adequate hematologic and organ function were enrolled. Uncontrolled hyperglycemia or cardio-respiratory conditions were exclusions. Phase II study has 3 arms and uses adaptive randomized design with progression-free survival (PFS) as primary endpoint: Arm A (G + MK-0646), Arm B (G + E + MK-0646) and Arm C (G + E). G was administered as 1,000 mg/m2 over 100 min, weekly x 3, MK-0646 weekly x 4 and E 100 mg daily. Cycles repeated q 4 weeks. On progression, arm C pts crossed over to arm B. Secondary endpoints: overall survival (OS), response rate and toxicity. Results: 58 pts enrolled (53 evaluable), 34 males, 3 prior Whipple, 48 PS 1, 5 PS 0. Median of 2 cycles administered (range 1, 12+). Accrual: Arm A= 20, B=23, C=10 pts. Median follow up A=48, B=30, C=26 weeks. Grade 3-4 toxic events/ arm: neutropenia 9/A, 26/B, 1/C; platelets 5/A, 10/B; anemia 2/B; AST 3/B,3/C; hyponatremia 1/A, 5/B; hyperglycemia 3/A, 3/B; dehydration 1/B; thrombus 2/B and infection 2/B. Partial responses: 20% Arm A, 25% Arm B, 10% Arm C. Median PFS Arm A=17 weeks (CI:7,34), Arm B=8 weeks (8,18), Arm C= 8 weeks (3,22); PFS was significant in favor of arm A (p=0.0425). OS arm A=48 wks (14,82), B=30 wks (18,56), C=26 wks (8,40). No significant difference noted in OS in the 3 arms (p=0.4) in this cross-over study. Sustained responses (> 8 weeks) occurred in arms A and B only; greater proportion of arm A pts survived >40 weeks (p=0.04). Conclusions: MK-0646 is tolerable in combination with G; toxicities were higher with G+ E+ MK-0646. Sustained PRs, limited toxicity and encouraging survival were noted with G+ MK-0646 (arm A) in this preliminary analysis.
Comparisons of outcomes for patients with high-risk prostate cancer treated with brachytherapy, external beam radiation, or radical prostatectomy.
Authors: Jay P. Ciezki, Harguneet Singh, Chandana A. Reddy, Steven C. Campbell, James Ulchaker, Kenneth Angermeier, Andrew J. Stephenson, Rahul D. Tendulkar, Kevin L. Stephans, Eric A. Klein
Journal: Journal of Clinical Oncology (2016)

63 Background: There is no consensus on how to best treat patients (pts) with high-risk prostate cancer. Methods: The outcomes for 2,736 high-risk prostate cancer pts treated with radical prostatectomy (RP), external beam radiotherapy (RT), and I-125 brachytherapy (BT) at a single institution from 1996 to 2012 were reviewed. The majority of RT pts were treated prior to 2002 because of our preference for RP and BT over time. High-risk was defined per the NCCN criteria. The outcomes assessed were biochemical failure (bF), clinical failure (cF), and prostate cancer mortality (PCM). Results: The distribution by treatment was RP 54%, RT 27%, and BT 19%. The median follow up for all pts was 4.6 years (y) (range 0.1-19.5): 3.8 y (0.1-18.7) for RP, 7.7 y (0.1-19.4) for RT, and 4.1 y (0.1-16.8) for BT pts. No patient received RT+BT, and 44% received androgen deprivation therapy (ADT). On multivariable analysis (see table) RP pts were at higher risk for bF vs. RT; BT pts and RT pts were at higher risk for cF vs. RP; and RT pts were at higher risk for PCM vs. RP. All multivariable analyses were adjusted for clinical stage, biopsy Gleason score, pre-treatment PSA, and duration of ADT. Conclusions: RP is associated with worse bF but better cF and PCM. There is no difference between BT and RT for bF, cF, or PCM while BT and RP had similar PCM. These outcomes may be a result of selection bias or differences in follow up time among the three treatment arms so no demonstration of modality superiority is possible. [Table: see text]
Pretreatment metabolic tumor volume (MTV) as a predictor of survival in borderline resectable pancreatic cancers treated with neoadjuvant therapy.
Authors: Alex Cruz, Dung-Tsa Chen, William J. Fulp, Michael Chuong, Sarah Hoffe, Ravi Shridhar, Nikhil G Rao, Pamela Joy Hodul, Mokenge Peter Malafa, Nicholas Figura, Edward Eikman, Gregory M. Springett
Journal: Journal of Clinical Oncology (2013)

310 Background: A higher initial metabolic tumor burden is associated with lower median survival in locally advanced pancreatic cancer (LAPC), yet the prognostic utility of PET/CT is not defined in the setting of borderline resectable pancreatic cancer (BRPC). Methods: We performed a retrospectivereview of our institutional experience treating BRPC. Initial staging included endoscopic ultrasound as well as pancreatic protocol CT and PET/CT scans. All patients underwent neoadjuvant gemcitabine-based chemotherapy and radiation therapy (RT). RT was delivered using standard fractionation intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). Restaging CT and PET/CT scans were obtained approximately 4 weeks following RT completion. We measured the significance of the pre-treatment and post-treatment SUV maximum and metabolic tumor volume (MTV) 2.5 to 5.0, which was defined as the MTV above a threshold SUV of 2.5, 3.0, 4.0 and 5.0. Cox regression models were used to evaluate the significance between these parameters and disease free survival (DFS) and overall survival (OS). Results: We evaluated a total of 72 BRPC patients. Median follow up was 12.7 months. 56 patients (77%) received induction chemotherapy with gemcitabine, docetaxel and capecitabine (GTX). 43 (59.7 %) underwent surgical resection. Significant predictors for OS in the whole cohort included pre-treatment SUV maximum (p=0.0042), post-treatment SUV maximum (p=0.0183), pre-treatment MTV 2.5 (p=0.0016) and pre-treatment MTV 4.0 (p=0.0111). In addition, the difference between the MTV 4.0 pre-treatment and post-treatment was significant (p=0.0285). In patients who underwent surgical resection, there was a significant correlation between OS with pre-treatment SUV max (p=0.0229) and post-treatment SUV maximum (p=0.0325) but not pre-treatment MTV 2.5 (p=0.0654) nor MTV 4.0 (p=0.0928) nor the differences between each variable pre (0.1482) or post-treatment (0.0959). Conclusions: This is the first study to suggest that pre and post treatment PET activity is prognostic for BRPC.
Novel multiphoton microscopy probe and feasibility study for colon cancer: Probe on trace elements–related antioxidant.
Authors: E. Kim, Y. Jeen, H. Cho, B. Keum, Y. Kim, H. Lee, H. Chun, C. Kim, H. Ryu
Journal: Journal of Clinical Oncology (2011)

463 Background: Multiphoton microscopy (MPM) has gained increasing popularity during the past few years because of the distinct advantages over single-photon microscopy, which includes increased penetration depth and low out-of-focus photodamage. However, there had been no report on multiphoton probes for malignancy. Previous studies reported that Zn and Cu ions which are co-factor of antioxidants such as superoxide dismutase (SOD), altered in malignancy tissue. The aim of this study was to evaluate application of the multiphoton (MP) probe of Zn and Cu for colon cancer tissues. Methods: We monitored the Zn/Cu ions in the colon cancer cell lines with multiphoton probe Microscopy. The multiphoton probe AZn2+ (C38H38N6O3) and ACu+ (C34H47N3O3S4), we developed and obtained the patent on it, were stained in live cancer cell lines. The tissues of colon cancer, adenoma and normal mucosa were obtained by biopsy during colonoscopy. Then the tissues were stained with 20μM of the MP probes for Zn/Cu ions. The distribution and concentration of zinc and copper ions were monitored by MPM by following the change in MPEF along the depth of tissue. Results: The majority of Zn2+ and Cu+ ions distributed in cytosole. The average multi-photon excited fluorescence (MPEF) intensities due to Cu, Zn, and Cu/Zn ratio were remarkably different between the normal mucosa and adenoma/adenocarcinoma tissues. The Zn2+ content was significantly lower and the Cu2+ content was significantly higher to result in a much lower the Zn/Cu ratio in adenoma/adenocarcinoma than in normal mucosa tissues. Conclusions: We have obtained multiphoton microscopy images of normal and cancer cell lines as well as mucosa and adenoma/adenocarcinoma tissues labeled with newly developed MP probes AZn1 and ACu1. No significant financial relationships to disclose.
Identification of a small and lethal subgroup of esophagogastric adenocarcinoma with evidence of responsiveness to crizotinib by MET amplification.
Authors: J. K. Lennerz, E. L. Kwak, M. Michael, S. B. Fox, A. Ackerman, K. Bergethon, G. Y. Lauwers, J. G. Christensen, K. D. Wilner, D. A. Haber, R. Salgia, Y. Bang, J. W. Clark, B. J. Solomon, A. J. Iafrate
Journal: Journal of Clinical Oncology (2011)

4130 Background: Amplification of the MET proto-oncogene in gastroesophageal cancer (GEC) may constitute a molecular marker for targeted therapy. We examined a GEC cohort with follow-up and report the response in two patients with MET-amplified tumors to the small molecule inhibitor crizotinib. Methods: From 2007-2009 patients with GEC were genetically screened as a consecutive series of 489 tumors. MET, EGFR and HER2 amplification status was assessed using fluorescent in situ hybridization with a strict definition of amplification. The clinical response of two additional patients enrolled in an expanded phase I cohort study (ClinicalTrials.gov NCT00585195) is included. Results: 10 patients out of 489 screened (2%) harbored MET amplification, 23 (4.7%) harbored EGFR amplification, 44 (8.9%) harbored HER2 amplification, and 411 (84%) were wild-type for all three genes (triple negative, TN). MET-amplified tumors were typically high-grade adenocarcinomas that presented in advanced stages. EGFR-amplified tumors showed the highest fraction of squamous cell carcinoma. HER2-amplified tumors were typically better differentiated, presented with lower stages and had prior intestinal metaplasia/Barrett’s esophagus. Survival analysis in patients with advanced/metastatic disease showed substantially shorter median survival in MET/EGFR-amplified groups with the overall rank order for all groups (from most to least aggressive) as MET (7 mo., P< 0.0005) < EGFR (11, P=0.16) < HER2 (16, P=0.89) ≤ TN (16 mo.). Two patients with MET-amplified tumors experienced tumor shrinkage (-30% and -16%). Conclusions: MET amplification defines a small but lethal subset of GEC with early evidence of sensitivity to the targeted MET inhibitor crizotinib (PF-02341066).
<i>Mycobacterium mucogenicum</i> blood stream infections after hematopoietic cell transplantation (HCT).
Authors: K. R. Wells, R. F. Cornell, S. Schmidt, K. W. Ahn, J. Y. Lee, P. Hari
Journal: Journal of Clinical Oncology (2011)

e19649 Background: M. mucogenicum is a rapid growing, nontuberculous acid-fast bacterium that causes catheter related bloodstream infection (CRBI) in immunocompromised hosts. Methods: Analysis of incidence and clinical features of M. mucogenicum in 713 HCT recipients between 2004 and 2010. M. mucogenicum CRBI was identified in 56 patients. Multivariate analyses were performed using Cox proportional hazards model. Results: Of the 56 patients with infection, 39 (70%) were male. Median age was 51.2 years (23-75). 23 patients (41%) developed infection during HCT (HCT group) and 33 (59%) after recovery from HCT (post-HCT group). Central catheters were present in 52 (45%), PICC line in 30 (55%) with a median of 24 days from placement to infection. Signs were cytopenias in 25 (45%), fever in 35 (63%) and line tunnel irritation in 4 (7%). Malignancies were multiple myeloma in 23 (41%), acute leukemia in 14 (25%), chronic leukemia in 8 (14%) and others in 11 (20%). HCT type was autologous in 21 (37%), allogeneic 33 (61%), syngeneic 1 (2%). Acute graft vs. host disease (GVHD) present in 17 (30%) correlated with infection risk (p=0.0117 RR=3.419). In the HCT group, the median number of days to infection after transplant was 10, with median ANC of 300. Median number of hospital days in the post-HCT group attributed to infection was 9. Catheters were removed in 53 (96%). The majority were treated with amikacin for 3 weeks and a macrolide for 6 weeks with infection resolution. No deaths were directly attributed to the infection. Overall mortality was 30%. Samples from surfaces, ice, and water supplies were negative. Infection control measures implemented, including HyTape wrapped catheter tips and avoidance of frequent “capping,” led to decline in incidence. Conclusions: We describe the largest series of M. mucogenicum infection related to HCT. Infection presents with fever, tunnel irritation or cytopenias and results in increased hospitalization and antibiotic use. Successful treatment is achieved by central line removal and treatment with amikacin and a macrolide. Presence of acute GVHD significantly increases the risk of infection in the post HCT period. Incidence rates declined with HyTape wrapping and decreased “capping” of lines.