tbuckley/cabot-search huggingface dataset:
Developing electronic health record (EHR)-based program to deliver survivorship care plans (SCPs) and visits at the UW Breast Center.
Authors: Lori A. Seaborne, Karol Hueneberg, Aaron Bohler, Gillian Schroeder, Terri White, Mary E Sesto, James Edward Haine, Lee G. Wilke, Heather B. Neuman, Amye Tevaarwerk
Journal: Journal of Clinical Oncology (2016)

56 Background: Accreditation guidelines require all breast cancer patients receive SCPs within 6 months of end of treatment (EOT) in 2016. SCPs require significant resources to provide, which EHR assistance might decrease. Our objective was to develop a standardized program for creating, providing, and tracking SCPs using an EHR. Methods: Clinicians and EHR analysts developed processes for implementing an EHR-based program, using our existing SCP to guide overall structure. We piloted this program 5/2015-6/2015 to identify barriers &amp; facilitators to creating EHR-based SCPs, providing EHR-based visits and EHR-based tracking of both. Results: The pilot included 24 patients (2% of annual volume). Facilitators were: 1) pre-entry of cancer history, 2) clearly defined responsibilities for SCP &amp; visit; barriers were: 3) no identified method to assess concerns or track referrals, 4) variability in EOT due to treatment heterogeneity, 5) limited time during routine follow up for SCP provision. The following changes were implemented: 1) SCP auto-population, requiring consensus on essential clinical data, 2) assigning staff roles (MD, NP/PA, RN) for all aspects of SCP creation &amp; visit provision; 3) creating 1-page survey addressing NCCN recommended topics to pre-screen for concerns discussed at SCP visit and using a visit template to track topics covered plus information and referrals provided, 4) establishing processes and delivery dates for SCP &amp; visit to newly diagnosed patients and 5) developing algorithms for referral for SCP &amp; visit (4-8 weeks from EOT) including adding “SCP visits” to EHR-chemotherapy plans and other auto-reminders. Clinic-wide implementation began 7/2015; updated results will include: EHR-tracked, provision rate, type and frequency of survivor concerns and referral patterns and time for SCP creation and visits. Survivor/clinician satisfaction with EHR-based program will also be included. Conclusions: EHR-based SCP creation, provision and tracking is feasible. Future plans include assessing time and personnel resources required, and comparing the accuracy of EHR-tracking with cancer registry data or other standards used to address guideline compliance.
Irinotecan (Iri) and buparlisib (B) in previously treated patients (pts) with metastatic colorectal cancer (mCRC).
Authors: Joaquina Celebre Baranda, Greg Reed, Stephen K. Williamson, Raymond P. Perez, Maxine L. Stoltz, Chris Mackay, Rashna Madan, Ziyan Y. Pessetto, Andrew K. Godwin
Journal: Journal of Clinical Oncology (2015)

655 Background: The PIK3CA pathway has oncogenic role in mCRC. Buparlisib is an oral pan-class PIK3CA inhibitor. It is currently being studied in combination trials for various malignancies. The primary objective of this phase I trial was to identify the maximum tolerated dose (MTD) for Iri plus B in pts with previously treated mCRC, with or without previous Iri therapy. We also performed PK analysis of each drug alone and in combination, determined clinical response to the combination, and evaluated achieval FFPE samples for somatic mutations in a panel of cancer associated genes, including PIK3CA for clinical correlation. Methods: A 3+3 dose titration method was used. Iri was administered intravenously every 14 days (one cycle) and B orally daily. Pts received the first dose of Iri on Cycle1 Day1. B was started 24 hours after the first dose of Iri. Safety and toxicity assessments were performed every cycle. Results: Twenty patients were enrolled: 4 in cohort 0 (Iri 120 mg/m 2 + B 50 mg/d), 11 in cohort 1 (Iri 150 mg/m 2 + B 50 mg/d), 5 in cohort 2 (Iri 150 mg/m 2 + B 80 mg/d). The most common Grades 3/4 adverse events were neutropenia and abdominal pain. The MTD was Iri 150 mg/m 2 + B 50 mg/d. The DLTs include male genital mucositis, grade 3 diarrhea, and asymptomatic grade 3 hyponatremia. In cohort 1, one pt experienced grade 2 delirium and a pt in cohort 2 had grade 3 psychosis. Of the 4 pts who received 4 cycles of therapy 2 had stable and 2 had progressive disease. No objective responses were seen. There is no significant change in the PK of Iri between Cycles 1 and 2. B at 50 mg had no consistent effect on the disposition of Iri given at 120 mg/m 2 and 150 mg/m 2 . The C max and AUC for B show clear dose proportionality. Using targeted re-sequencing, a 48-gene panel that included AKT1, BRAF, KRAS, and PTEN was performed. The complete analysis of the correlative study will be presented in the meeting. Conclusions: This first human trial established that Buparlisib (50 mg qd) and Iri (150 mg/m 2 q14d) are tolerable in combination. However, it is too early to determine the activity of this combination in the treatment of mCRC. Clinical trial information: NCT01304602.
Is PET/CT useful in the staging of anal cancer?
Authors: Neel Bhuva, Robert Glynne-Jones, Mark Harrison
Journal: Journal of Clinical Oncology (2012)

422 Background: The use of 18 flurodeoxyglucose PET or PET/CT in staging of anal cancer is becoming increasingly fashionable. However, evidence endorsing it as a definitive staging modality it is still emerging. The largest published series to date from the UK found sensitivity of PET to be superior for detection of regional nodal metastases and overall PET changed stage in 23% and management in 16% of cases [de Winton E et al. The impact of 18-fluorodeoxyglucose positron emission tomography on the staging, management and outcome of anal cancer. BJR 2009; 100: 693-700]. We initially performed a retrospective pilot feasibility study for the period 2009-2010 and found that PET/CT altered staging in 42% of the 43 patients included, predominantly upstaging nodal status. We continue our analysis and report this prospective series - to assess the usefulness of PET/CT in the staging of anal cancer. Methods: 47 patients were treated radically for anal cancer at Mount Vernon Cancer Centre (UK) between January 2010 and July 2011, of which 27 had PET/CT scans. Staging was compared following conventional modalities and PET/CT. The TNM clinical staging system was used. Results: In 9 patients the PET/CT stage differed from MRI staging. In total, there were 4 ‘T stage’ changes and 8 ‘N stage’ changes. Of these, 1 case showed a difference in ‘T’ staging alone 5 showed a change in ‘N’ staging alone and 3 showed a change in ‘T’ and ‘N’ staging. PET/CT altered staging in 33% of patients. Conclusions: We conclude that PET/CT alters staging in a significant number of cases correlating with the literature and our own retrospective analysis. Furthermore there is agreement that PET/CT shows greater sensitivity for detection of lymph nodes. Although PET/CT cannot replace CT/MRI as the optimal modality for planning, it can reveal useful information regarding tumour extent, nodal involvement and distal metastases. PET/CT can account for greater definition of dose delivery, and more accurately ascertain the need to include/exclude pelvic lymph nodes. With more precise staging, acute and late toxicity profiles will be greatly influenced, especially with more advanced radiotherapy techniques such as Intensity Modulated Radiotherapy (IMRT), whilst maintaining satisfactory outcomes.
Clinical implications of luminal membrane expression of mesothelin in intraductal papillary mucinous neoplasms.
Authors: Takahiro Einama, Hirofumi Kamachi, Hiroshi Nishihara, Shigenori Homma, Futoshi Kawamata, Munenori Tahara, Masahiko Taniguchi, Hiroyuki Furukawa, Toshiya Kamiyama, Akinobu Taketomi, Yoshihiro Matsuno, Satoru Todo
Journal: Journal of Clinical Oncology (2013)

179 Background: We recently explored that the expression of mesothelin was related to an unfavourable patient outcome in pancreatic cancer. Furthermore, in gastric cancer, we investigated that the luminal membrane expression of mesothelin was a reliable prognostic factor. Intraductal papillary mucinous neoplasms (IPMNs) often exhibit a spectrum of dysplasia ranging from adenoma to carcinoma in the same lesions. Therefore, we investigated the immunohistochemical analysis of mesothelin expression in IPMNs, especially focusing on the localization of mesothelin. Methods: Tissue samples from37 IPMNs were immunohistochemically examined. The types of IPMNs were classified into 2 groups: low, intermediate and high-grade dysplasia (L-H grade dysplasia) and IPMN with an associated invasive carcinoma (Invasive carcinoma). The proportion and intensity of constituent tumor cells with mesothelin expression were analyzed and classified as positive expression or negative expression. Furthermore, among the ‘mesothelin-positive’ cases, the staining localisation of mesothelin was evaluated as ‘luminal membrane positive’ and/or ‘cytoplasmic positive’. Results: In 37 cases of IPMNs, mesothelin expression was observed in 21 cases (56.8%), 46.2% (12 of 26) of L-H grade dysplasia and 81.8% (9 of 11) of Invasive carcinoma; p=0.071. Luminal membrane positive was observed in 10 cases (27%), 18.2% (4 of 22) of L-H grade dysplasia and 21% (6 of 11) of Invasive carcinoma; p=0.00016. Cytoplasmic positive was observed in 17 cases (27.0%), 38.5% (10 of 26) of L-H grade dysplasia and 63.6% (7 of 11) of Invasive carcinoma; p=0.28. Among 37 IPMNs, 6 cases showed recurrence after surgery. Five cases exhibited mesothelin expression, and all 5 cases exhibited luminal membrane positive. Conclusions: we demonstrated the clinicopathological significance of the luminal membrane expression of mesothelin in IPMNs. The immunohistochemical examination of mesothelin expression should be clinically useful for prognostication and for decision making about further treatment procedures after surgical therapy in patients with IPMNs.
Association between blood groups and breast cancer subtype.
Authors: M. Solak, F. P. Turkoz, I. Petekkaya, C. Arslan, N. Kertmen, Ö. Keskin, E. Dogan, Y. Y. Ozisik, M. K. Altundag
Journal: Journal of Clinical Oncology (2011)

e11041 Background: The majority of breast carcinomas are the luminal type, which has the higher levels of estrogen receptor, tend to be low grade with a favorable prognosis. Altered glycosylation, a common feature of cancer cells, is related with both expressions of HER2/neu and ABO blood groups. The present study was designed to investigate the association between blood groups and the risk of luminal-type breast cancer. Methods: 1652 patients with breast cancer were analyzed retrospectively. Variables studied included age at diagnosis, menopausal status, estrogen, progesterone and HER2/neu receptor status, TNM stage and ABO blood type with Rh status. Results: Patient age ranged from 20 to 89 years, with a mean 49.1±11.6 years. 48.4% of patients were premenopausal and 45% were postmenopausal. Estrogen receptor (ER) was positive in 71.9%, progesterone receptor (PR) was positive in 72.6% and HER2/neu receptor was positive in 22.1% of the patients. The most frequent blood types in breast cancer were A Rh positive (28.8%), 0 Rh positive (21.3%) and B Rh positive (9.8%), respectively. According to TNM stage, patients with blood group A and 0 had significantly fewer nodal metatasis (p=0.023, p=0.004; respectively), and patients with blood group 0 had significantly smaller tumor size (p=0.048) than other blood subgroups. Patients with blood group 0 had significantly higher levels of ER (p=0.036) and PR (p=0.045). There was no association between HER2/neu status, and ABO blood group or Rh status. Conclusions: Women with breast cancer were more likely to have blood type of A and 0. Blood type of 0 blood was found to be associated with luminal-type breast cancer and an earlier tumor stage. Further studies are required to sort out the relationships between blood types and breast cancer risk and prognosis.
Impact of sarcopenia (Sp) on outcomes in patients (pts) undergoing trimodality therapy for esophageal cancer.
Authors: Brian Weston, Talha Shaikh, Elizabeth Handorf, Walter Joseph Scott, Steven J. Cohen, Joshua E. Meyer
Journal: Journal of Clinical Oncology (2015)

221 Background: Sp, or severe muscle wasting, has been implicated as an important prognostic factor in cancer pts. We assessed the association between body composition changes and outcomes in pts with esophageal cancer undergoing tri-modality therapy. Methods: Following IRB approval, we reviewed all pts who underwent chemoradiation followed by esophagectomy at an NCI-designated cancer center from 2000-2013. Pts who underwent CT assessment pre- and post-neoadjuvant chemoradiation were included in the analysis. Sp was defined as a lumbar skeletal muscle area/height of 55.4 cm 2 /m 2 for males and 38.9 cm 2 /m 2 for females. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (SFMR), and visceral to subcutaneous adipose tissue ratio (VSATR) were also derived using CT-based measures. Changes in the above parameters and Sp were correlated to post-operative (post-op) complications (cx), treatment (tx) response, disease free survival (DFS), and overall survival (OS). Analysis was performed using non-parametric Wilcoxon and Kruskal-Wallis tests, and Kaplan-Meier curves with log-rank tests. Results: A total of 48 pts met the inclusion criteria; the median age was 62 (range 42-80) with a median follow up of 28 months (range 4-103). Most pts had T3 (85%), N1 (70%), or M0/M1a disease (92%). Ten pts (21%) had Sp at the initiation of tx, with 9 of these remaining Sp post-tx, and 1 patient developing Sp. Post-tx Sp was associated with an increased rate of post-op mortality (p=0.03). Three of the 10 patients with Sp died post-op versus 1/36 in the non-Sp group. Post-tx Sp was associated with a decreased rate of post-op strictures (p = 0.04). Thirteen of the 36 pts in the non-Sp group developed strictures versus none in the Sp group. There was a significant change in all other measures pre vs. post-tx; FM (-4.3 kg/m 2 , p&lt;0.01), FFM (-5.0 kg/m 2 , p&lt;0.01), SFMR (-0.1, p=0.04), and VSATR (-0.02, p&lt;0.01). None of these were correlated with post-op cx, tx response, DFS, or OS. Conclusions: Post-tx Sp was associated with an increased incidence of post-op mortality but a lower rate of strictures. Our study was limited by sample size, and further studies should examine the relationship between Sp and peri-operative outcomes.
Long-term indwelling double-J stent for malignant ureteric obstruction: Tolerance and complications.
Authors: Jacques Irani, Clément Biscans, Guillaume Hugues, Simon Bernardeau, Pierre-Olivier Delpech
Journal: Journal of Clinical Oncology (2016)

170 Background: JJ stent is designed to be placed for short periods. In rare cases, long-term JJ can be considered particularly in malignant ureteric obstruction. The objective of this study was to assess tolerance and complications in patients with indwelling JJ. Methods: Data from consecutive patients who had a JJ stent placed for more than 6 months between 1992 and 2013 were analyzed. Patients were all followed in a single center where JJ stents were changed every 6 months or earlier in case of complications. Results: The study included 36 patients (22 female and 14 male). Mean age was 69.4 yrs. Median ASA 3 (IQ = 1). Mean creatinine before the 1st JJ 204 micromol/L (SD 232). Most frequent causes of obstruction were colorectal (30%), gynecological (25%) and prostate cancer (14%). In 7 cases, a bilateral JJ stent was placed. Median FU was 26.4 months. Median number of JJ changed per patient was 5.5 (IQ 6.0). Median duration for each JJ was 6 months (IQ 2.1). There was one case of broken stent and 5 cases of stent encrustation, all being managed endoscopically in a single procedure.Grade III-IV complications following theClavien-Dindo classification are reported in the table. All 17 deaths (47.2%) were related to cancer progression. Conclusions: Long-term complications related to indwelling JJ stents are not uncommon. However, we found that when changing the stent systematically every 6 months (or earlier in case of complications), and when taking into account the patient's situation (status/disease) that led to the indwelling JJ indication, tolerance and rate of complications were acceptable. [Table: see text]
Supportive/palliative care use among patients with lung cancer: Rates and barriers.
Authors: E. S. Frankel, T. L. Evans, J. Burgess, K. Desai, L. S. Qing, C. J. Langer, J. Mao
Journal: Journal of Clinical Oncology (2011)

e19608 Background: Lung cancer is the leading cause of cancer mortality and is associated with significant symptomatic co-morbidity along with diminished quality of life. Despite the expanding development of supportive and palliative care services, little is known about the rate of utilization and barriers that prevent use of these services among lung cancer patients. Methods: We performed a cross-sectional analysis of an ongoing cohort study of patients with lung cancer seen in an urban, medical oncology clinic. Patients age 18 or older who had a primary diagnosis of lung cancer and a Karnofsky performance status of 60 or greater were included. Patients self-reported their use of cancer supportive care services along with any perceived barriers. Multivariate logistic regressions were used to evaluate the factors related to the use of supportive care services. Results: 103 patients participated in this survey with a median age of 61, range (27-83). 59.2% were female, 84.5% White/11.7% African American/3.8% others, and 37.9% had an education level of high school or less. Among the participants, 56% had not used supportive services since their cancer diagnosis. The most common services used were nutrition (24.3%), psychiatric/psychological evaluation/counseling (17.5%), and physical therapy (12.6%). Pain/Palliative care and cancer rehabilitation consultations were only used by 5.8% and 2% of the participants respectively. In a multivariate analysis, higher education level was associated with greater use of supportive care, adjusted odds ratio (AOR) 2.55, 95% confidence interval (CI) 1.06-6.22, p=0.04, while being married was associated with less use of supportive care, AOR 0.37, 95% CI 0.16-0.87, p=0.023. The barriers to using these services were lack of awareness (23%), lack of physician referral (23%), lack of time (8.7%), transportation (6.8%) and expense (5.8%). Conclusions: More than half of the lung cancer patients have not accessed supportive care since cancer diagnosis and often cite lack of awareness and lack of physician referral as barriers. Further research is needed to understand how to best facilitate the integration of these services into conventional cancer treatment to improve the overall care of lung cancer patients.
Essential Thrombocytosis: Redefinition in the Genomic Era
Authors: Donna M. Williams, Michael A McDevitt, Brady L Stein, Ophelia Rogers, Michael B. Streiff, David Neal, Sophie Lanzkron, Linda M. S. Resar, Christine O'Keefe, Jaroslaw P. Maciejewski, Jerry L. Spivak, Alison R. Moliterno
Journal: Blood (2014)
The relationship between serum hepcidin levels and clinical outcomes in patients with chemotherapy-associated anemia treated in a controlled trial.
Authors: D. P. Steensma, B. J. Sasu, J. A. Sloan, D. Tomita, C. L. Loprinzi
Journal: Journal of Clinical Oncology (2011)

9031 Background: The Mayo Clinic Cancer Research Consortium recently published results from a phase III, randomized study (MC04CC) of darbepoetin alfa (DA) combined with intravenous (IV) ferric gluconate 187.5 mg q3wks x 5 doses, oral ferrous sulfate, or no iron supplementation for patients (pts) with chemotherapy-associated anemia (CAA) (Steensma et al, J Clin Oncol 2011;29:97-105). There was no benefit from IV iron in the MC04CC trial, possibly due to iron parameters of enrolled pts. The peptide hepcidin is a major regulator of systemic iron homeostasis, but the relationship between hepcidin and response to erythropoiesis-stimulating agents (ESAs) or IV iron therapy has not been systematically studied in pts with CAA. Methods: Serum hepcidin concentration was measured in pre-treatment samples from 405/489 eligible pts enrolled in the MC04CC study, using a sensitive quantitative mass spectrometry-based method. Hemoglobin and transfusion endpoints were analyzed, stratified by hepcidin tertiles and treatment group. Results: See table. Conclusions: Pts with serum hepcidin levels in the lower two tertiles appeared to have a better clinical response to DA plus higher doses of IV iron than either pts with higher hepcidin levels, or pts with lower hepcidin levels who did not receive higher dose IV iron. Hepcidin measurements may help predict response to ESAs and supplemental iron. DA + placebo DA + oral iron DA + IV iron (pts receiving <4 doses IV iron) DA + IV iron (pts receiving 4 or 5 doses IV iron) Hemoglobin response Total 106/163 (65%) 109/163 (67%) 40/71 (56%) 74/92 (80%) Hepcidin 1st tertile (≤20.2 ng/mL) 30/47 (64%) 26/41 (63%) 12/20 (60%) 24/26 (92%) Hepcidin 2nd tertile (>20.2-64.3 ng/mL) 36/53 (68%) 32/53 (60%) 6/11 (55%) 20/21 (95%) Hepcidin 3rd tertile (>64.3 ng/mL) 23/36 (64%) 29/37 (78%) 14/24 (58%) 25/36 (69%) Hepcidin missing 17/27 (63%) 22/32 (69%) 8/16 (50%) 5/9 (56%) RBC transfusion Total 22/163 (13%) 21/163 (13%) 12/71 (17%) 8/92 (9%) Hepcidin 1st tertile 6/47 (13%) 4/41 (10%) 2/20 (10%) 0/26 (0%) Hepcidin 2nd tertile 8/53 (15%) 9/53 (17%) 2/11 (18%) 0/21 (0%) Hepcidin 3rd tertile 6/36 (17%) 5/37 (14%) 4/24 (17%) 6/35 (17%) Hepcidin missing 2/27 (7%) 3/32 (9%) 4/16 (25%) 2/9 (22%)