tbuckley/cabot-search huggingface dataset:
A pilot study of a comprehensive financial navigation program in cancer survivors.
Authors: Veena Shankaran, Tony Leahy, Jordan Steelquist, Kate Watabayashi, Erin Singleton, Kathleen Gallagher, Alan James Balch, Hannah M. Linden, Naomi Schwartz, Scott David Ramsey, Karen Overstreet
Journal: Journal of Clinical Oncology (2017)

e18079 Background: Although financial toxicity is associated with poorer clinical outcomes in cancer survivors, few studies have attempted to address this toxicity. We developed a financial navigation program in collaboration with our partners (Consumer Education and Training Services (CENTS) and Patient Advocate Foundation (PAF)) to improve patients’ knowledge about cancer treatment costs, provide financial counseling, and help with out-of-pocket expenses. We conducted a pilot study to assess feasibility and early impact of this program. Methods: Patients (pts) within 1 year of a solid tumor diagnosis and 6 months of chemotherapy and/or radiation were recruited at the Seattle Cancer Care Alliance. Pts received a financial education course followed by monthly contact with a CENTS financial counselor and PAF case manager for 6 months. We measured program adherence, self-reported financial burden, anxiety about costs, program satisfaction, and type and amount of assistance provided. Results: We consented 34 pts (median age 60.5), the majority of whom were white (85%) and commercially insured (50%). Participants (n = 20) and non-participants (n = 14 who withdrew or were lost to follow up early on) did not differ in age, race, gender, education, income, or insurance type. Debt, income declines, and loans were reported by 55%, 55%, and 30% of pts. High financial burden and anxiety about costs (4 or 5; Likert scale) were reported by 37% and 47% of pts. High satisfaction with the education course, CENTS counselors, and PAF case managers were reported by 73%, 80%, and 91% of pts. CENTS counselors assisted pts most often with budgeting, retirement planning, and medical bill questions. PAF case managers assisted pts with gaps in insurance, debt or cost of living issues, and employment rights and disability applications. A total of $7,667 ($1,267 for pts and $6,400 for institutions) was obtained through charitable entities. Conclusions: Our findings confirm that a financial navigation program is feasible to implement, associated with high satisfaction, and provides concrete assistance to pts in navigating the cost of cancer care. Future work will focus on improving program adherence and measuring its impact on financial and clinical outcomes.
Liver metastases and sensitivity to checkpoint inhibition in patients with non-small cell lung cancer (NSCLC).
Authors: Rathi Narayana Pillai, Alice O. Kamphorst, Taofeek Kunle Owonikoko, Madhusmita Behera, Suchita Pakkala, Fadlo Raja Khuri, Rafi Ahmed, Suresh S. Ramalingam
Journal: Journal of Clinical Oncology (2016)

e20665 Background: Inhibitors of Programmed Cell Death 1 (PD-1) and Programmed Cell Death Ligand 1 (PD-L1) have therapeutic efficacy in patients with advanced NSCLC. We examined the patterns of response in NSCLC patients treated in a single institution. Methods: We performed a retrospective analysis of patients treated at the Winship Cancer Institute of Emory University with PD-1 and PD-L1 inhibitors on clinical trials or enrolled in an IRB approved biorepository protocol. Clinical and demographic data were collected and response evaluation by RECIST 1.1 was recorded. Results: A total of 31 patients were analyzed. All patients had advanced stage disease with the following characteristics: median age 67.5, 69% male, 69% Caucasian, 91% former and current smokers, 50% adenocarcinoma, and 44% squamous histology. Treatment characteristics (n): nivolumab in 20, pembrolizumab in 9, and atezolizumab in 3 patients. Best treatment response was partial response (PR) in 28%, stable disease (SD) in 31%, and disease progression (PD) in 41%. The median time to progression was 2.3 months. The 9 patients who achieved PR had disease involving the lung only (n = 5), or minimal disease in extrathoracic lymph nodes and bones (n = 3) or brain (n = 1). In six patients with liver metastases, there were no responders and only 2 patients with SD. Conclusions: In our dataset, no objective responses were seen in patients with liver metastases. All clinical responders had primarily intrathoracic disease with limited lymph node, osseous, or CNS involvement. Strategies to improve responsiveness of checkpoint therapy in patients with hepatic involvement should be investigated.
P05.68 Secondary Central Nervous System Lymphomas retrospective review of a single hospital center
Authors: V E Espírito Santo, R Jesus, B Mesquita, M Guerra, M Cunha, P Guimarães
Journal: Neuro-Oncology (2018)

Lymphomas can have secondary central nervous system (CNS) involvement as an isolated relapse or as part of the progression of systemic disease. This involvement is commonly associated with aggressive lymphomas and usually results in a significant shortening of overall survival. Retrospective analysis of patients diagnosed with secondary CNS lymphomas between January 2013 and December 2017 considering epidemiological factors, disease presentation, diagnosis, treatment and survival. Nine patients (5 males, 4 females) were identified, with a median age of 73 years-old (range between 50 to 83 years-old). The lymphoma had the following histological classification: diffuse large B-cell lymphoma (n=5), follicular lymphoma (n=1), marginal zone lymphoma (n=1), T/NK lymphoma (n=1) and Burkitt lymphoma (n=1). The neurological involvement was present at diagnosis in 2 patients, 3 patients had isolated CNS relapse and 4 patients had multisystem progression. The neurological symptoms began on a median of 60 days (range between 0 to 485 days) after the initial systemic symptoms and 81 days (range between 0 to 432 days) after the treatment onset. The main neurologic complain was: headache (n=3), motor deficit (n=3), visual disorder (n=2), ataxia (n=1). Neuroimaging studies shown meningeal involvement in 5 patients and parenchyma brain lesions in 5 patients (1 with a single lesion; 4 with multiple lesions). Nine patients received chemotherapy, 8 intra-tecal chemotherapy, 3 radiotherapy and 8 corticotherapy. All patients had complications during treatment and one patient stopped chemotherapy due to them. The median overall survival after lymphoma diagnosis was 227 days (range between 65 to 589 days). The median survival after neurologic complains was 67 days (range between 24 to 236 days). One patient was still alive by the end of December 2017. The main causes of death were infection (n=5) and progression of the disease (n=3). With this review we demonstrate the CNS pleomorphic involvement of systemic lymphomas, alerting to the need of recognizing neurological signs of a not uncommon disease progression.
Abstract B007: Stemness features of prostate cancer cells induced by carcinoma-associated fibroblasts
Authors: Muriel A. Nuñez, Javier Cerda-Infante, Marianela Sánchez, Paula Sotomayor, Alejandro S. Godoy, Viviana P. Montecinos
Journal: Cancer Research (2018)

Abstract Introduction: Carcinoma-associated fibroblasts (CAFs) play a key role during cancer progression through several mechanisms, including the induction of the epithelial-mesenchymal transition (EMT) program, giving cancer cells the ability to initiate metastasis. As the cells progress to the mesenchymal state they acquire properties of cancer stem cells (CSC) or mesenchymal stem cell (MSC). However, the contribution of the CAFs in the acquisition of the differential stemness is largely unknown. Here, we studied the stemness features of prostate cancer cells (PC3) during the EMT program induced by fibroblasts obtained from patients with nonmetastatic prostate cancer (CAF) and bone metastatic prostate cancer (mCAF). Materials and Methods: PC3 cells were incubated with conditioned medium (CM) of CAF and mCAF for 7,14, and 21 days to induced EMT. The presence of putative CSCs and MSCs was determined by qPCR, immunocytochemistry and Western blot for the expression of CSCs and MSCs markers, respectively, and functionally evaluated by the ability to perform adipogenic, chondrogrenic, and osteogenic differentiation (MSCs) and in vitro spheroids formation and clonogenic assay (CSCs). Results and Discussion: Our results demonstrate that cancer cells treated with CM-CAF undergo to a partial EMT program, exhibiting certain mesenchymal traits and enriched for cancer stem cells (CSCs). On the other hand, tumor cells exposed to CM-mCAF, exhibited a full EMT conversion with the greater abilities to migrate and invade in vitro and in vivo. This suggests that CAFs and mCAFs induce differential EMT programs in prostate cancer cells, which leads them to acquire CSCs or MSC features enhancing the metastatic capabilities. (FONDECYT 1150397.) Citation Format: Muriel A. Nuñez, Javier Cerda-Infante, Marianela Sánchez, Paula Sotomayor, Alejandro S. Godoy, Viviana P. Montecinos. Stemness features of prostate cancer cells induced by carcinoma-associated fibroblasts [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr B007.
Abstract 14468: Impact of SPRINT-Based Blood Pressure Levels on Clinical Outcomes in a Large, Community-Based Population: The Kaiser Permanente Experience
Authors: Alan S Go, Marc Jaffe, Joseph D Young, Joan C Lo, Stephen Sidney, Thida C Tan, Jingrong Yang
Journal: Circulation (2017)

Introduction: In the Systolic Blood Pressure Intervention Trial (SPRINT), systolic blood pressure (SBP) <120 mmHg was associated with fewer cardiovascular (CVD) events compared to SBP<140 mmHg base...
The digital transformation of medicine can revitalize the patient-clinician relationship
Authors: Haider J. Warraich, Robert M. Califf, Harlan M. Krumholz
Journal: npj Digital Medicine (2018)

Health professionals within the medical community feel that the principles of humanism in medicine have not been a point of emphasis for information and computer technology in healthcare. There is concern that the electronic health record is eroding the patient-clinician relationship and distancing clinicians from their patients. New analytic technologies, on the contrary, by taking over repetitive and mundane tasks, can provide an avenue to make medical care more patient-centered by freeing clinicians' time, and the time of the whole clinical care team, to engage with patients. Technology such as advanced speech recognition that optimizes clinicians' workflow could revitalize the patient-clinician relationship and perhaps also improve clinician well-being. Digital phenotyping can gain invaluable additional data from patients using technology that is already used for personal reasons by the majority of patients. The digital transformation of healthcare has the potential to make healthcare more humane and personalized, however, several important steps are needed to avoid the pitfalls that have come with prior iterations of information technology in medicine such as a heightened emphasis on data security and transparency. Both patients and clinicians should be involved from the early stages of development of medical technologies to ensure that they are person-centric. Technologists and engineers developing healthcare technologies should have experiences with the delivery of healthcare and the lives of patients and clinicians. These steps are necessary to develop a common commitment to the design concept that technology and humane care are not mutually exclusive, and in fact, can be symbiotic.
How to reduce splenic injury in laparoscopic radical gastrectomy: Criminal ligament priority separating.
Authors: Wei Wang, Wenjun Xiong, Jin Wan
Journal: Journal of Clinical Oncology (2017)

e15528 Background: Iatrogenic splenic injury may lead to conversion or nontherapeutic splenectomy in laparoscopic gastrectomy. A critical point at splenic injury occurs is improper traction of spleen-omentum ligament which was called crimimal ligament (CL). We aimed to explore the efficacy of cirminal ligament priority separating (CLPS) to reduce iatrogenic splenic injury in laparoscopic radical gastrectomy. Methods: Complete videos of 540 laparoscopic radical gastrectomy in Guangdong Provincial Hospital of Chinese Medicine were reviewed. The relationship between CLPS and iatrogenic splenic injury was determined. CL was defined as the ligament between omentum and spleen. CLPS was defined as that CL was firstly separated when mobilization was in left upper quadrant. Results: CL was present in 81.5% (440/540) and were included for analysis. There was variation in the distribution pattern of CL and it mostly appeared in the lower pole of spleen (414/440). CLPS was performed in 24.5% (108/440) and 75.5% (332/440) were not (un-CLPS). In systematic review, the incidence of iatrogenic splenic injury was 10.9% (48/440). Among these patients, 79.1% (38/48) were due to improper traction of CL and they were all in un-CLPS group. Instrument injury was occurred in 2.2% (10/440) and 3 were in CLPS group and 7 were in un-CLPS group. Most iatrogenic splenic injury were successfully handled with electrocoagulation, adhesive and compression technique, except 2 patients underwent conversion to open splenectomy for serious splenic injury in un-CLPS group. Conclusions: In laparoscopic surgery for gastric cancer, iatrogenic splenic injury mostly resulted from improper traction of CL and CLPS could reduce the incidence of iatrogenic splenic injury.
The genomic profile (GP) of early breast cancer (EBC): Daily practice analysis.
Authors: Cristina Morales-Estevez, Alberto Moreno, Ignacio Porras, Maria Teresa Cano, Pedro Sanchez, Helena Fuentes, Beatriz Rodríguez-Alonso, Rosa Maria Rodriguez-Alonso, Maria Jose Ortiz-Morales, María Auxiliadora Gómez-España, Juan de la Haba-Rodriguez, Enrique Aranda, Facundo Alberti-Vargas
Journal: Journal of Clinical Oncology (2016)

e23143 Background: The genomic assays (GA) are acquiring an important role in helping the choice of adjuvant treatment for Early-stage Breast cancer (EBC). Data have value in predicting the benefit of hormone therapy and risk of recurrence at 5-10 years.We analyze two currently in use GA determinations on EBC biopsies and its involvement in adjuvant treatment decisions in the period between January 2013 and January 2015. Methods: Indications for performing measurements on two different GA (reasons of opportunity), Mammaprint (Symphony) and PAM50 (Prosigna) were reviewed, including discrepancies in prognostic factors, decision to pretest and final treatment outcomes. Tumor size, lymph node involvement, histology, grade differentiation, hormone receptor expression (Allred score), Ki67 and HER2 were analyzed. Handling of the samples were homogeneous, quality was measured by the tumor cell percentage ( < 30%). Results: 71 determinations were made in the Mammaprint and 23 Prosigna assays. The median age was 58 years (range 36-82) and a determination by < 30% cellularity was dismissed. The majority was ductal histology. 61 negative lymph nodes, 7 micrometastases and 4 positives nodes. In the multivariate analysis: Ki67 (p = 0.527), grade (p = 0,078) and HER2 (p = 0.257) were not significance (ANOVA), the largest discrepancies were between grade vs Ki 67 and Allred. It was decided at pretest 29 times QT + HT and 42 HT alone, finally received QT + HT 25 patients and HT 46, having modified the decision of HT to QT + HT 9 times and 13 were changed QT + HT to HT. Conclusions: GA for determining gene expression in EBC have impacted our decision to treatment (30,9 %) and believe that could be a support for their possible prognostic / predictive value. Other indications could be assessed in future studies.
Use of QT interval prolonging drugs (QT drugs) and electrocardiogram (ECG) monitoring in patients (pts) receiving first-line anti-cancer systemic therapy (tx): A population-based analysis.
Authors: Rossanna C. Pezo, Andrew T Yan, Craig Earle, Kelvin K. Chan
Journal: Journal of Clinical Oncology (2018)

6598 Background: QT interval prolongation, measured on ECG, is a known toxicity of many drugs used in oncology and can lead to serious arrhythmias. To our knowledge, there are no published studies investigating ECG use in pts on standard systemic tx involving QT drugs. Methods: All cancer pts ≥ 66 years diagnosed in 2005-2011 in the Ontario Cancer Registry were linked to population-based administrative databases to ascertain pt demographics, comorbidities, systemic tx and ECG use. The Ontario Drug Benefit Program database was used to identify prescription QT drug use (as per CredibleMeds.org classification). Univariable and multivariable analyses were used to examine factors associated with ECG use within 30 days of systemic tx initiation. Results: A total of 59,484 pts (median age 74; 48% women) were included. Common cancers were breast (23%), prostate (22%), lung (10%) and colon (9%). Prior diagnoses included hypertension (56%), diabetes (24%), coronary artery disease (CAD; 24%), and heart failure (HF; 9%). Among pts on at least 1 QT drug (n = 48,236; 81%), the majority (n = 41,727; 87%) received a prescription within 30 days of systemic tx initiation, commonly for anti-emetics (n = 18,232; 44%). Overall, only 27% pts on QT drugs had an ECG within 30 days of systemic tx initiation; ECG use was low even among pts with CAD (35%), HF (42%), pts on ≥3 concurrent QT drugs (37%) and pts on anti-emetic (30%) and anti-cancer (21%) QT drugs. On multivariable analysis, adjusting for age, sex, comorbidities, rural setting and cancer type, ECG use was associated with recent cancer diagnosis (2011 versus 2005; OR = 1.37, 95% CI 1.26-1.49), Charlson score ≥1 (OR = 1.22; 95% CI 1.15-1.29) and multiple QT drugs (OR = 1.15 per each additional QT drug, 95% CI 1.12-1.17). Use of anti-emetic (OR = 0.93; 95% CI 0.88-0.99) and anti-cancer QT drugs (OR = 0.74, 95%CI 0.70-0.79) were paradoxically associated with fewer ECG use. Conclusions: Our study highlights common use of QT drugs and under-use of ECG in cancer pts at risk of arrhythmia. Since ECG is an inexpensive, non-invasive and widely available test, it should be used routinely for monitoring the QT interval in such pts.
Quantification BCL6 tissue expression using FISH and immunohistochemistry in diffuse large B-cell lymphoma by digital image analysis
Authors: V. Kushnarev, N. Matyashina
Journal: Annals of Oncology (2018)

Background: Computational method was developed to study how nucleus alterations would influence on cell cycle progression in cancer. It was verified that information retrieved from chromatin organisation areas and their heterogeneity can be used to infer nuclear morphological features. Diffuse large B-cell lymphoma (DBLC) is heterogeneous entity due to its morphologic alteration of cells. Numerous studies have attempted to further understand how nuclear morphology and expression antiapototic genes interfere on cell interaction and pathogenesis. Objective: To determine the immunohistochemical (bcl-6) molecular marker and morphological characteristics of nucleus (FISH probe BCL6) using digital pathology algorithm in patients with DBLC. Methods: The study included data on 14 patients with diffuse large-cell B-cell lymphoma (mean age 50 ± 15 years) before therapy. TMA templates were prepared for BCL6 FISH break apart probe as well as for immunohistochemical (ihc) marker bcl-6. Fluorescence microscopy images obtained from tissue slides by histologic scanner. The number of stained pixels / area was quantified using computer quantitative ihc, nuclear and histopattern algorithms for each TMA core. The study of the nuclear morphology was pursued through the analysis of the first and second sets of DAPI staining images and the study of distribution green and red signals into cells. In this work, a semi-automatic bioinformatic application was implemented to manage the images sets and process them. Results: Concerning the nuclear morphological features evaluated (area, density of chromatin - eccentricity and solidity), the results demonstrated that the quantification of the nuclei area was the most meaningful parameter to disclose significant biological information as translocation of BCL6 gene. Besides it was associated with aneuplody and amplification of BCL6 genes and overexpression of bcl-6 protein. These nuclear morphological features revealed significant differences between cells with translocation of BCL6 and cells without translocations. Conclusions: These findings support the hypothesis that morphology of nuclei are mediated by the rearrangement of the chromatin density and cytoskeleton interaction. Legal entity responsible for the study: Anna Artemyeva. Funding: Petrov Cancer Research Center. Disclosure: All authors have declared no conflicts of interest.
BRAF mutation as a prognostic marker for survival in malignant melanoma: A systematic review and meta-analysis.
Authors: Lars Ny, Marta Nyakas, Micaela Hernberg, Jussi Koivunen, Lars Oddershede, Mie-Ran Yoon, Xuan Wang, Patricia Guyot, Jürgen Geisler
Journal: Journal of Clinical Oncology (2018)

e21566 Background: BRAF mutation analysis has become increasingly common in the diagnosis of cutaneous melanoma and BRAF inhibitors constitute a cornerstone in the treatment of metastatic disease. However, the impact of BRAF mutational status on survival remains unclear. The present study aimed to assess the prognostic significance of BRAF mutant vs. wild type (WT) malignant melanoma on overall survival (OS). Methods: A systematic literature search of EMBASE, Medline and Cochrane CENTRAL was performed according to PRISMA guidelines. Studies were included if they reported OS for BRAF mutant vs. WT patients as a hazard ratio (HR) or in Kaplan Meier (KM) curves. When only KM data were available, curves were digitized and HRs estimated. Data from patients with ongoing treatments consisting of BRAF/MEK inhibitors were excluded. Random-effects (DerSimonian and Laird) models were used to pool HRs by disease stage and across all studies. Heterogeneity was assessed using Higgins I2. Results: Data from 59 studies, representing 9,243 melanoma patients were pooled. The presence of a BRAF mutation was statistically significantly associated with reduced OS (HR [95% confidence interval (CI)]: 1.18, [1.07, 1.31]), with substantial heterogeneity between the studies (I2: 57.0%). For subgroup analyses performed by disease stage, results were (HR [95% CI]; for stage III: 1.52 [0.99, 2.33], III-IV: 1.11 [0.94, 1.30] and IV: 1.08 [0.90, 1.29]), with substantial or moderate heterogeneity (I2for stage III: 76%, III-IV: 39%, and IV: 44%). Findings from a scenario analysis excluding 6 studies with OS defined as melanoma-related death were consistent with the main findings (1.21 [1.08, 1.35], I2: 57%). Meta-regression and sensitivity analyses showed that age, sex and BRAF testing method did not have a significant effect on the OS HR. Conclusions: This is the largest meta-analysis investigating the correlation between BRAF mutation and OS in melanoma. Although there was considerable heterogeneity between the studies, the overall results demonstrated a poorer prognosis and OS of patients harboring BRAF mutations. Future studies should take this observation into account in order to evaluate treatment effects of new interventions.