tbuckley/cabot-search huggingface dataset:
Engaging a statewide network to expand survivorship care to rural and urban cancer survivors.
Authors: Jennifer R. Klemp, Carol Bush, Ashley Spaulding, Hope Krebill, Gary C. Doolittle
Journal: Journal of Clinical Oncology (2016)

23 Background: Advances have been made in elevating cancer survivorship as a public health priority and defining elements needed to deliver high-quality follow-up care to survivors. However, a lack of research on how best to care for survivors and the most effective and efficient strategies for delivering survivorship care in the community setting still exists. We report our assessment of the current state of practice, knowledge and professional development, and plan to increase access to care of urban and rural practices across the state of Kansas. Methods: In 2014, the Midwest Cancer Alliance (MCA), a membership-based outreach arm of The University of Kansas Cancer Center, convened an educational summit and survey to assess the survivorship landscape in Kansas. Post-summit, individual interviews were conducted. Survey and interviews included questions regarding health records, treatment summaries, survivorship care plans (SCP), availability of survivorship programs and resources, access to primary care and specialists, distress screening, community support, and educational needs. Results: Ten MCA member health systems were invited to participate and 7 indicated interest in participating in the project. Only one organization provided an SCP to survivors. Barriers included lack of an integrated approach and knowledge. A majority of survivorship care could be delivered close to home, however, services including fertility preservation, genetic counseling, oncology rehab, sexual health, and second opinions, required travel of more than 50 miles. Identified educational needs focused on comprehensive survivorship care across the health care team. Conclusions: Survivorship care remains fragmented across the state of Kansas. Based on this project, we have secured a CDC survivorship grant that will facilitate clinical and technical assistance related to process improvement and electronic health record integration focused on survivorship care and delivery of an SCP. Next steps include engaging primary care providers and survivors to assure the SCP meets the needs of stakeholders. This work will focus on a translational process to meet the growing needs of the survivors and complex health care organizations.
FGFR3 Activates RSK2 To Mediate Hematopoietic Transformation through Both Tyrosine Phosphorylation of RSK2 and Activation of the MEK/ERK Pathway.
Authors: Sumin Kang, Shaozhong Dong, Ting-lei Gu, Michael S. Cohen, Sagar Lonial, H. Jean Khoury, D. Gary Gilliland, Jack Taunton, Roberto D. Polakiewicz, Jing Chen
Journal: Blood (2006)
Identifying knowledge-translation opportunities in the treatment of locally advanced breast cancer.
Authors: Yanchini Rajmohan, Robyn Leonard, Sophie Hogeveen, Jalal Ebrahim, Dolly Han, Audrey Wong, Jean-Francois Boileau, Sonal Gandhi, Justin Lee, Robert Edward Dinniwell, Muriel Brackstone, Christine E. Simmons
Journal: Journal of Clinical Oncology (2013)

47 Background: Guidelines are usually developed using systematic literature reviews. Expert opinion plays a key role but can be difficult to incorporate. The objective of this study was to develop a national consensus of expert opinion on the management of Locally Advanced Breast Cancer (LABC) and subsequently identify gaps in knowledge translation in current practice. Methods: 361 Canadian oncologists were subdivided into LABC experts (n = 83) and non-experts (n = 278). Experts were surveyed with a modified Delphi protocol to establish consensus. A systematic literature review was performed and compared to expert opinion. Non-experts were then surveyed with a 29-item questionnaire to determine current practice patterns. Z test was used to assess discordance. Results: Response rate for the expert survey was 61% (51/83). Consensus was achieved in all key aspects of care and was concordant to published literature in areas of: clinical assessment with caliper at each cycle, option of lumpectomy if good clinical response, radiotherapy to loco-regional lymph nodes, and no further adjuvant chemotherapy outside of clinical trial if residual disease found at time of surgery. Response rate for the non-expert survey was 50% (140/278). Areas of discordance are highlighted below. Conclusions: A national practice consensus guideline reflective of current evidence and expert opinion has been developed on the management of LABC. Differences in expert opinion and current practice have been identified as targets for knowledge translation interventions (KTIs) that may improve quality of care and resource utilization. Further exploration of KTIs to address identified gaps is warranted. [Table: see text]
Investigating the prognostic value of a panel of biomarkers after curative intent resection of pancreatic ductal adenocarcinoma.
Authors: Benny Johnson, Maged F. Khalil, Joseph Blansfield, Fan Lin, Shaobo Zhu, Lester Kirchner
Journal: Journal of Clinical Oncology (2013)

211 Background: Pancreatic adenocarcinoma (PDAC) is the fourth leading cause of cancer mortality in the United States. 80% of tumors are discovered with distant metastasis upon presentation. Of patients eligible for curative intent surgery, the 5-year survival rate is only 20%. Identification of a panel of biomarkers correlated with patient specific prognosis upon diagnosis can serve as a way to individualize treatment options. Methods: A retrospective cohort study analyzing pathology of patients who underwent curative intent surgery at our institution from 1998-2011 to identify whether the expression patterns of six biomarkers:S100P, Maspin, KOC, CEA, p53, and Ki-67 can be predicative of patient specific prognosis. Tissue microarrays of specimens were assessed by immunohistochemistry. Results: A total of 62 patients are included. Comparisons between groups on overall survival (OS) and progression free survival (PFS) are estimated using the Kaplan-Meier method and the log-rank test. Each biomarker was represented as low and high expression by categorizing the expression score at &gt;4, based on intensity and extent of cells stained. 40 deaths occurred in the sample. Distant metastasis and differentiation (well/moderate vs. poor) were borderline related to OS (p=0.0120, p=0.0086). Interestingly, patients with a poor differentiation were less likely to die due to any cause (HR=0.41, 95% CI: 0.21, 0.82). 29 patients progressed in their disease. High/low KOC expression were significantly related to progression free survival (p=0.0556). Incorporating previously reported data on KOC, patients with a high KOC expression were more than 2 times more likely to progress compared to those with a low KOC expression (HR=2.04, 95% CI: 0.97, 4.29). Conclusions: In our study S100P, Maspin, CEA, p53 and Ki-67 expression patterns were not statistically significant in identifying PFS or OS in PDAC patients. However, our data is suggestive of KOC being a useful prognostic biomarker for identifying those patients with PDAC who have a high risk for early progression and distant metastasis. Larger studies are needed to determine whether KOC can be a therapeutic target in the treatment of pancreatic cancer.
Prostate patterns of care.
Authors: Lindsay Burt, Dennis C. Shrieve, Jonathan D. Tward
Journal: Journal of Clinical Oncology (2015)

117 Background: The aim of this study is to describe initial treatment of men diagnosed with prostate cancer in the United States (US) between 2004 and 2011. Methods: Subjects with adenocarcinoma of the prostate were identified using the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results (SEER) Program between 2004 and 2011. Subjects were staged according the American Joint Committee on Cancer (AJCC) 7th edition criteria. The National Comprehensive Cancer Network (NCCN) risk group classifications were used to stratify subjects into low risk (LR) including very low risk, intermediate risk (IR), high risk (HR) and very high (VHR) groups. Surgical intervention was grouped into no surgery, prostatectomy or other which included cyroablative therapy, hyperthermia, laser ablation, TURP, etc. Descriptive statistics and analysis were performed using Microsoft Office 2013 Excel. Results: There were 306,694 PC subjects with sufficient data to be risk categorized. Overall, 35.0% of subjects had LR, 36.1% had IR, 22.5% had HR, 1.2% had VHR, 0.6% had node positive and 4.6% had metastatic disease. Table 1 reveals the surgical and radiation treatment distribution for each risk group. Between 2004 and 2011 the use of prostatectomy, no treatment and external beam RT (EBRT) increased and the use of brachy including brachy monotherapy and brachytherapy in combination with EBRT decreased. Age is a strong influence on treatment delivered. Conclusions: This patterns of care study shows the heterogeneity of therapy for PC stratified by risk group in a contemporary series. Trends in treatment may reflect the development of new technology and findings from randomized trials. [Table: see text]
Independent predictors of overall survival and recurrence in biphenotypic hepatocellular cancer.
Authors: Manik Amin, Ling Chen, Neeta Vachhajarani, Elizabeth Brunt, Maria Majella Doyle, Benjamin R. Tan
Journal: Journal of Clinical Oncology (2014)

291 Background: Biphenotypic hepatocellular cancer (BPHCC), which is a combined hepatocellular cancer (HCC) and cholangiocarcinoma (CC), is a rare form of primary liver cancer, whose long term prognosis is extremely poor as compared to either HCC or CC alone. Little is known about the recurrence rates and predictors of recurrence in BPHCC. Our objective was to 1) identify both overall survival and recurrence rates after primary resection or systemic and liver directed therapies and 2) to evaluate the independent predictors of survival and recurrence. Methods: Our Hepatobiliary Registry identified 65 patients with BPHCC from February 1999 till April 2013 at Siteman Cancer Center, Washington University, St. Louis MO. We conducted univariate Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression to identify factors independently associated with overall survival. We also conducted multivariable logistic regression analysis to identify factors independently associated with recurrence. Results: Of the 65 patients in our study, 18 (28 %) with prior resection, 2 (3 %) after OLT, 45 (69 %) ineligible for surgery, 40 (62 %) were treated with chemotherapy, 17 (26%) with liver directed therapies. Overall survival was 39.2 % at 1 year. Independent factors associated with survival were: smoking (HR 2.84, 95% CI 1.29-6.23, p = 0.0089), tumor thrombus (HR 5.45, 95% CI 2.05-14.50, p = 0.0007), any liver directed treatment (HR 3.01, 95% CI 1.21-7.48, p = 0.0175), multiple satellite lesions (HR 3.17, 95% CI 1.71-8.58, p = 0.025) and prior tumor resection (HR 2.65, 95% CI 1.16-6.03, p = 0.020). Risk of recurrence was independently predicted by male sex (OR 3.98, 95% CI 1.30-12.15, p = 0.015) and multiple satellite lesions (OR 15.42, 95% CI 2.68-88.62, p = 0.0076). Conclusions: Patients with biphenotypic cancers have a devastating overall survival. Tumor thrombus and satellite lesions were the strongest predictors of poor survival; satellite lesions also strongly predicted recurrence. In this rare form of cancer, this is the largest study to identify factors associated with overall survival and recurrence. These factors should help guide clinical care of patients with BPHCC.
Compliance of subjects using electronic patient-reported outcomes (ePRO) in multinational prostate trials.
Authors: Susan M. Dallabrida
Journal: Journal of Clinical Oncology (2014)

232 Background: Patient Reported Outcomes (PRO) and electronic PRO (ePRO) are increasingly becoming an important aspect of cancer clinical trials and patient care, especially with regard to measuring drug efficacy, patient quality of life and drug safety. Subject compliance with completion of PRO/ePRO assessments is an important component for obtaining accurate and high-quality data when conducting clinical trials. It has been hypothesized that patient health status, length of time in a trial and country of origin, may affect compliance. Methods: To address this hypothesis, an operational analysis was conducted to assess oncology subject completion compliance of PRO reports using an electronic tablet to determine its suitability and performance in use. Toward this objective, the compliance of prostate cancer patients in completing three electronic questionnaires that were administered at clinic visits was evaluated. Subjects were asked to complete the Brief Pain Inventory – Short Form (BPI-SF) at every clinic visit. At some clinic visits, subjects were asked to additionally complete the Functional Assessment of Cancer Therapy – Prostate (FACT-P) and the Euro Quality of Life 5 Dimensions (EQ-5D). Questionnaires were completed electronically on the tablet. Percent completion was calculated as the number of questionnaires completed divided by the number of questionnaires expected, based on attended clinic visits compiled for this review and the administration schedule for the questionnaires. Results: This review draws on the experience of over 1,000 subjects from 21 countries, and describes the individual and overall compliance with the expected questionnaire completion, the variance between subsequent visits, and compliance by country. Conclusions: The collection of ePRO using a clinic-based tablet yielded a highly complete data set in prostate cancer subjects demonstrating that this is an effective and feasible approach for recording symptoms and quality of life assessments.
Criteria for use of omics-based predictors in NCI-sponsored clinical trials.
Authors: Lisa A. McShane, Barbara A. Conley, Margaret M. Cavenagh, Tracy G. Lively, David A. Eberhard, Paul M. Williams, William L. Bigbee, Jill P. Mesirov, Mei-Yin C. Polley, Kelly Y. Kim, James V. Tricoli
Journal: Journal of Clinical Oncology (2012)

58 Background: High-throughput omics technologies (e.g., genomics, epigenomics, proteomics, metabolomics) offer exciting opportunities for new biological insights into cancer. The IOM report on translational omics defined omics as the study of related sets of biological molecules in a comprehensive fashion. (IOM (Institute of Medicine) 2012. Evolution of Translational Omics: Lessons Learned and the Path Forward. Washington, DC: The National Academic Press.) The promise of omics technologies has proven problematic to translate into clinically useful tests. Difficulty obtaining biospecimens, unrecognized preanalytical influences, and suboptimal assay analytical performance can lead to unreliable results and conflicting reports. Poor reporting of study details and limited access to data and computer code can thwart efforts to replicate published results or to detect flaws in study design and analysis methods. Methods: NCI held an interactive workshop for a wide variety of stakeholders to explore better approaches to omics-based test development and validation. This workshop heavily informed the ideas presented here. Recommendations are stated concisely, then explained. Results: A checklist of items to consider when evaluating the evidence for clinical use of an omics-based predictor, including in a trial where it will guide therapy, is presented. It covers specimen and assay requirements, the predictor model development process, clinical study design and conduct, and regulatory, ethical, and legal issues. The list applies to any trial involving investigational use of an omics test that will alter the clinical management of patients. The criteria also largely apply to situations in which the test will be evaluated retrospectively on specimens collected from patients who were prospectively enrolled on clinical studies. Conclusions: The proposed checklist should serve as a useful guide to investigators planning to submit proposals for NCI-funded studies involving use of an omics-based test. Ideally, this checklist will be consulted in the assay planning and development phases so that the necessary evidence will have been collected in a well-documented fashion by the time definitive evaluation of the test is desired.
A phase II study of second-line S-1/CPT-11+bev for advanced colon cancer (NCCSG04): Subset analysis by K-ras, EGFR, UGT1A1, and previous bevacizumab.
Authors: Yasumasa Takii, Kouichi Furukawa, Satoshi Maruyama, Toshiyuki Yamazaki, Atsushi Nishimura, Mikako Kawahara, Takemi Tomiyama, Kohei Akazawa, Katsuyoshi Hatakeyama
Journal: Journal of Clinical Oncology (2014)

564 Background: We planned a phase II trial to evaluate the efficacy and safety of irinotecan, S-1, and bevacizumab (IRIS/Bev) as second-line therapy for patients with metastatic colorectal cancer (mCRC). The result of this study was reported an active and generally well-tolerated 2nd-line treatment for mCRC (Takii et al. ASCO-GI 2013 #496). We analyzed subset of EGFR, K-ras, UGT1A1, and previous Bev. Methods: The study design was multicenter, single-arm, open-label phase II study. Eligible patients had to have mCRC with confirmed diagnosis of adenocarcinoma, history of oxaliplatin containing regimen as first-line therapy, an age from 20 to 80 years, ECOG performance status (PS) of 0-1. S-1 65 mg/m 2 daily p.o. was given on days 1-14 and Irinotecan 75mg/m 2 and bevacizumab 10mg/kg i.v. were given on days 1 and 15 of a 28-day cycle. We retrospectively examined progression-free survival (PFS), overall response rate (OR), overall survival (OS), time to treatment failure (TTF) and safety by K-ras, EGFR, UGT1A1, and previous Bev status. Results: Thirty-four patients were investigated. The OR was 21.1% (7/33) and disease control rate was 84.8% (28/33). Median PFS was 8.9 months, median TTF was 8.2 months and median OS was 23.4 months. Median PFS was 9.9 months on K-ras wild group and 6.6 months on K-ras mutant group (p = 0.517). Median OS was not reached on K-ras wild group and 16.4 months on K-ras mutant group (p = 0.097). The EGFR-negative case was three cases, and it did not become a data to compare because of small number. Median PFS was 8.5 months on previous Bev group and 9.9 months on previous no-Bev group (p = 0.637). Median OS was not reached on previous Bev group and 23.1 months on previous no-Bev group (p = 0.701). Median PFS, TTF and OS was no different between UGT1A1 wild group and mutant group. On safety analysis, there were no different between the two groups, respectively. Conclusions: IRIS/Bev is an active and well-tolerated second-line treatment for patients with mCRC. Only K-ras status influendced OS. Clinical trial information: UMIN000001631.
The actuarial incidence of brain metastases in 975 patients undergoing surgery for early-stage lung cancer
Authors: J. A. Boyd, J. L. Hubbs, D. R. Hollis, J. P. Kirkpatrick, D. W. Kim, L. B. Marks, C. R. Kelsey
Journal: Journal of Clinical Oncology (2008)

8094 Background: The risk of developing brain metastases after definitive treatment for locally-advanced non-small cell lung cancer (NSCLC) is approximately 30%-50%. The risk for patients with early-stage disease is less defined. We sought to investigate this further and study potential factors associated with an increased risk. Methods: The records of all patients who underwent surgery for T1–2 N0–1 NSCLC at Duke University between 1995–2005 were reviewed. Patients who received preoperative therapy, had synchronous primaries, or had a prior history of lung cancer were excluded. The cumulative incidence of distant metastases and brain metastases was estimated using the Kaplan-Meier method. A univariate and multivariate analysis assessed factors associated with the development of brain metastases. Results: Of 975 consecutive patients, 85% were stage I and 15% were stage II. Adjuvant chemotherapy was given to 7%. The 5-year actuarial rate of distant metastases and brain metastases was 31% (95% CI: 27–35%) and 10% (95% CI: 8–13%), respectively. Of patients developing brain metastases, the brain was the sole site of failure in 43%. On multivariate analysis, younger age (HR 1.03), larger tumor size (HR 1.26), lymphovascular space invasion (HR 1.87), and lymph node involvement (HR 1.18) were associated with an increased risk of brain metastases. Conclusions: In this large series of patients treated surgically for early-stage NSCLC, the 5-year actuarial risk of brain metastases was 10%. While prophylactic cranial irradiation is currently under investigation in locally-advanced disease, a better understanding of predictive factors and biological susceptibility is needed to identify the subset of patients with early-stage NSCLC who are at particularly high risk. No significant financial relationships to disclose.
Management of basal cell carcinoma in the United States: Can we simplify care and reduce cost?
Authors: Xinyuan Wu, Elena B. Elkin, Jason Chih-Shan Chen, Ashfaq A. Marghoob
Journal: Journal of Clinical Oncology (2014)

17 Background: Basal cell carcinoma (BCC) is the most common cancer in the US, affecting more than 3 million people every year, and the incidence of BCC is increasing. Traditional management of BCC involves multiple physician visits and a pre-treatment biopsy which may be unnecessary. We assessed the costs of treating BCC, comparing traditional management with a simplified scheme. Methods: We developed a decision analytic model to compare the costs of traditional BCC management with a simplified Detect and Treat (DAT) scheme that eliminates pre-treatment biopsy. We assumed that all patients had an unequivocal BCC diagnosis based on clinical and dermoscopic findings. In the traditional approach, all patients had a biopsy prior to treatment. In the DAT scheme, well delineated lesions ≤1cm in diameter on the trunk and extremities were treated with shave removal and Mohs indicated lesions were referred to Mohs for on-site histologic check, both eliminating pre-treatment biopsy. Distributions of lesion location, size and treatment modality, and estimates of clinical diagnostic accuracy and success of shave removal were from the literature and from an analysis of 240 consecutive BCC cases seen over 5 years at our institution. Costs were based on assumptions about the number of dermatologist visits, tests and procedures required for each strategy, and unit prices from the 2014 Medicare physician fee schedule. Results: The average cost per case in the DAT scheme was $449 for non-Mohs-indicated lesions and $819 for Mohs-indicated lesions, compared with $566 and $864, respectively, with traditional management. DAT was associated with a savings of $117 (21% of total average cost) per non-Mohs-indicated case and $45 (5% of total average cost) per Mohs-indicated case. The combined weighted average savings per case was $95 (15% of total average cost). The magnitude of savings varied with changes in model parameters, but conclusions were similar under a wide range of plausible scenarios. Conclusions: A simplified management strategy that avoids routine pre-treatment biopsy can reduce the cost of treating BCC without compromising quality of care.