tbuckley/cabot-search huggingface dataset:
Enhancing the quality of the patient experience in an academic medical center.
Authors: Gerard Colman, Emily Hardeman, Julianna Grisham Moorad
Journal: Journal of Clinical Oncology (2013)

149 Background: As value-based purchasing evolves, there is a constant focus on efficiency and quality of care delivered during patient interactions before, during, and after each encounter. While perception of quality varies amongst patients, effective communication, patient involvement, and employee engagement have proven to impact patient satisfaction and perceived quality. MD Anderson Cancer Center is re-thinking its practices to provide exceptional quality in clinical care and operations. Methods: MDA has developed a Patient Experience Steering Committee to lay the foundation for the experience strategy and standardization of quality care. The creation of a dedicated patient experience position and the formation of inpatient and ambulatory experience groups have helped to focus initiatives around patient feedback and satisfaction scores. Steps have been taken to enhance patient-focused care: Incentive goals for staff/faculty; Focused communications; Enhanced standards and accountability; Formal rounding; Patient Ambassador pilot; Physician partnerships; New Employee Orientation re-design; Patient involvement; Language of Caring. Results: Ambulatory satisfaction awareness began in July 2011 with an overall score (including custom questions) of 85.6. Focused initiatives began fall 2011, and by March 2013 the score jumped 2.1 points to 87.7. The standard score moved from 88 to 89.6 taking MDA’s C4QI percentile ranking from 6 to 35 over 20 months. Incentive goals focused on information around delays (75.2 to 79.3) and courtesy of staff (93.6 to 94.3). Satisfaction around wait times to see physicians increased from 74.8 to 79.3. Focused efforts revealed increased scores for reaching office staff on the phone and wait time between 1 st call and appointment. Conclusions: While a portion of value realized by these initiatives will be evident through reimbursement, VBP rules have led to a much needed structure of standardized operational practices and quality across an academic system. We understand that quality of administrative practices substantially impacts the patient experience, but with over 19,000 employees that treat over 100,000 patients per year, identifying ways to change those practices is not always simple.
Dosimetric evaluation of different IMRT treatment plans for non-small cell lung cancer.
Authors: M. Shenglin, X. Yaping, W. Jian, L. Pu, D. Xiaoyun, S. Xiaojiang, J. Yongling, J. Hao
Journal: Journal of Clinical Oncology (2010)

e17513 Background: Intensity modulated radiation therapy (IMRT) represents an advance in the better delineation of the target contours and more accurate dose distributions. However,the optimal treatment planning of IMRT for non-small cell lung cancer (NSCLC) is still controversial. The purpose of this study was to evaluate the dosimetric advantages with different IMRT plans in NSCLC. Methods: Two types of treatment plans were designed. In the first plan (PTV 60 plan), 60Gy was prescribed to the planning target volume (PTV) which was created using CTV (GTV+6∼8 mm) plus the margin for organ motion and setup uncertainties. And in another plan (PTV70 plan), 70Gy was prescribed to the PTV which was created using GTV plus the margin for organ motion and setup uncertainties. All plans were compared according to dose-volume histogram, the planning target volume coverage, and other dosimetric parameters of normal structures. Results: A total of 20 patients with non-resectable NSCLC were enrolled between 05/09 and 10/09 receiving radiation therapy with curative intent. Central and peripheral lung cancer were 14 and 6 cases, respectively. Commpared with the PTV60 plan, the PTV70 plan significantly improved 60Gy volume with regard to PTV coverage (t =4.374, p=0.001), and without significant difference in the heterogeneity. The V20 of lung was reduced with a median reduction of (1.69±0.42) (95% CI 0.757∼2.613)%, the difference was significant (t =4.047, p=0.002). And the V5 of lung was reduced with a median reduction of (1.29±1.09 ) (95% CI -1.141∼3.723)%, without significant difference (t =1.183, p=0.264). Conclusions: The IMRT planning of 70Gy to the PTV using GTV plus the margin for organ motion and setup uncertainties were trend better than that of 60Gy to the PTV using CTV (GTV+6≈8 mm) plus the margin for organ motion and setup uncertainties. Clinical study is needed to further validate the advantages. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Zhejiang Provincial Medicine and Health Science Research Funds
Antitumor activity of two ruthenium (Ru) compounds
Authors: S. Radulovic, S. Bjelogrlic, S. Arandjelovic, Z. Tesic
Journal: Journal of Clinical Oncology (2005)

2116 Background: The success of cisplatin and related platinum complexes as anticancer agents stimulated the search for other active transition metal anticancer complexes. A range of Ru agents has been synthesized and tested for antitumor properties. Despite their low cytotoxic potential in vitro many complexes delay tumor growth in vivo, possibly by antiangiogenic activity. Two Ru(III) organometalic complexes with bidentate acethylacetonato (acac) or 3-fluoroacethylacetonato (tfac) ligands have been developed and tested for their antiproliferative activity. Methods: In vitro antiprolifartive activity of Ru analogues was investigated against various cancer cell lines (B16 and FemX melanoma, HeLa and U2OS osteosarcoma) by Sulphorhodamin B test. In in vivo study both drugs were applied in two daily doses (25 mg/kg and 50 mg/kg) for 10 days in B16 tumor bearing mice. Their antitumor activity was evaluated using inhibition rate of tumor growth comparing to non-treated control, body weight reduction and survival rates. Results: The analogues showed low cytotoxicity and IC50 were obtained after prolonged exposure (48 or 72 h) only. Ru(tfac) 3 revealed IC50 of 39,2 μM in U2OS/Pt, human osteosarcoma platinum-resistant sub-clone compared to IC50 of 49,7 μM in parental cell line. After 24 or 72 h of continuous exposure, both Ru analogues (100 μM) induced apoptosis in A2780 cells measured as sub-G1 DNA content. Ru(acac)3 was more effective reaching 72% (50 mg/kg) and 61% (25 mg/kg), while Ru(tfac)3 obtained only 48% (50 mg/kg) and 20% (25 mg/kg) of tumor growth inhibition on day 11. Neither of two analogues provoked loss in body weight during the treatment. Supprisingly, both drugs applied in lower dose decreased lifespan compared to control. Higher doses of both Ru analogues did not prolong significantly life span compared to control animals. Conclusions: Since Ru(acac)3 and Ru(tfac)3 showed relatively low cytotoxic potential in vitro against various cancer cell lines including B16, their antiproliferative activity in vivo is not due to direct interaction with cancer cells. No significant financial relationships to disclose.
A T2* MRI Prospective Survey on Cardiac and Hepatic Iron in Non-Trasfusion-Dependent Thalassemia Intermedia Patients Treated with Desferrioxamine
Authors: Antonella Meloni, Aurelio Maggio, Carlo Cosmi, Alfonso D'Ambrosio, Elena Facchini, Roberta Chiari, Leonardo Sardella, Emanuele Grassedonio, Gianluca Valeri, Maria Giovanna Neri, Vincenzo Positano, Alessia Pepe
Journal: Blood (2014)
Time to antibiotic.
Authors: Everett John Equila, Tonette So, Velma Leon-Guerrero, Keriann Moller, Robert Michael Cooper
Journal: Journal of Clinical Oncology (2012)

115 Background: The aim of this quality improvement (QI) project is to identify the interdisciplinary factors that cause delay of antibiotic administration to febrile Hematology/Oncology patients directly admitted to Pediatric department. Pediatric oncology research has shown that there is significant lower mortality associated with antibiotics given within one hour vs. delayed or no treatment (Adderson, Flynn, and Hoffmann, 2011). Methods: This QI project is conducted at a 32 bed pediatric unit at Kaiser Permanente Los Angeles Medical Center. Hematology/oncology patients admitted to the pediatric floor with fever were included in the study. A six month audit (n=22) showed that current workflow was inadequate and did not meet the time to antibiotic (TA) goal. A three-point workflow was designed to improve the TA outcome. The workflow includes initial documentation of actual time patient arrived to pediatric floor to the time admitted patient is entered in the electronic medical record (EMR) system. This is followed by auditing actual time patient is admitted to EMR to the actual time computerized physician order entry (CPOE) for time to antibiotic protocol is entered. Lastly, CPOE to actual time antibiotic was administered was audited. An ongoing six month audit has begun with the implementation of changes to workflow. Results: Audit prior to TA workflow: Patients (n=22) who met the criteria showed that (22.7%) received initial antibiotics within 1 to 2 hours. Eight patients (36.4%) received the antibiotics within 2 to 3 hours of admission. Four patients (18.2%) received initial antibiotics at 3 to 4 hours of admission. Notably, none (0%) of these patients received antibiotic within the goal of one hour. Audit after implementation of TA workflow: A three month audit (n=14) showed that (57.1%) received antibiotic less than 1 hour from time of admission. Two patients (14.2%) received antibiotic less than 2 hours of admission. Two patients (14.2%) received antibiotic less than 3 hours of admission. Two patients (14.2%) of these patients received antibiotics 3 to 4 hours of admission. Conclusions: Based on current data, the TA protocol showed marked improvement in the delivery and administration of antibiotic received by hematology/oncology patients.
CpG island methylator phenotype and KRAS mutation status as prognostic markers in patients with resected colorectal cancer.
Authors: D. H. Koo, Y. S. Hong, K. Kim, J. Lee, H. Chang, Y. Kang, C. S. Yu, J. C. Kim, M. Kim, S. J. Jang, T. W. Kim
Journal: Journal of Clinical Oncology (2011)

3595 Background: CpG island methylator phenotype (CIMP) is a subset of colorectal cancers (CRC) with widespread methylation of promoter CpG islands. KRAS mutation is detected in about 30% to 40% of CRC patients (pts) and associated with epigenetic aberration. Although CIMP and KRAS status has been known to be important in colorectal carcinogenesis, the clinical impacts of CIMP and KRAS status after curative surgery remain controversial. Methods: We analyzed CIMP status, KRAS and BRAF mutation status, and microsatellite instability (MSI) phenotype among 191 CRC pts who underwent curative surgery between March 2005 and December 2005. CIMP positive (+) was defined as ≥3/5 methylated markers using 5-marker panel (CACNA1G, IGF2, NEUROG1, RUNX3, SOCS1) and MSI-high(H) was defined as ≥2/5 markers using 5-marker panel (BAT26, D5S346, BAT25, D17S250, D2S123). Results: Among 191 pts, 153 (80.1%) had stage II and III CRC and 173 (90.6%) received adjuvant chemotherapy with fluoropyrimidines. CIMP+ and mutant (MT) KRAS were detected in 33.0% and 29.8%, respectively. Pts were divided into 4 groups by CIMP and KRAS status: CIMP+/wild-type (WT) KRAS (19.3%), CIMP+/MT KRAS (12.4%), CIMP-/WT KRAS (50.0%), and CIMP-/MT KRAS (18.3%). Clinicopathologic characteristics were balanced between 4 groups. Stage and CIMP+/WT KRAS were associated with 5-year relapse-free survival (RFS) with statistical significances. Age, gender, histology, tumor location and MSI status were not related to 5-yr RFS. In the multivariate analysis, stage was independently associated with RFS (p<0.001), and CIMP+/WT KRAS status showed a trend of better RFS compared to other 3 groups (p=0.071). Conclusions: Although it was not an independent prognostic factor, CIMP+/WT KRAS had more favorable outcomes after curative surgery in CRC pts. Univariate analysis P Multivariate analysis P Stage (5-yr RFS) (Hazard ratio) I 93.1% <0.001 1 0.001 II 89.1% 2.43 III 63.8% 7.99 CIMP/KRAS CIMP+/WT KRAS 97.2% 0.011 1 0.071 Others 77.3% 6.35
Planned interim analysis of phase II study of sorafenib and capecitabine (SorCape) in previously treated metastatic colorectal cancer (mCRC): NCT01471353.
Authors: Thomas J. George, Alison Marguerite Ivey, Karen Colleen Daily, Long H. Dang, Scott Watson, Renee Granicz, Margaret A. McEwan, Joanna Scian, Xiaomin Lu, Atif Iqbal, Sanda Tan, Ivan Zendejas, Carmen Joseph Allegra
Journal: Journal of Clinical Oncology (2014)

548 Background: Inhibition of the MEK/ERK pathway through Raf has been shown to resensitize tumor cells resistant to chemotherapy. Sorafenib (Sor) is an oral multi-tyrosine kinase inhibitor (TKI) affecting tumor proliferation and angiogenesis through inhibition of the Ras/Raf/MEK/ERK, VEGF, and PDGF pathways. A similar TKI, regorafenib, has efficacy as monotherapy in advanced mCRC. Demonstrating activity of this compound class with standard cytotoxic therapy represents a clinical unmet need. Methods: Eligible pts had progressive mCRC after prior oxaliplatin and irinotecan, at least 1 measurable target lesion by RECIST, ECOG PS 0-1, and adequate organ function. Pts received Cape (1000mg/m 2 PO BID D1-14) and Sor (400mg PO BID max via dose escalation per cycle). Cycles were q21d with tumor assessments q9w. Endpoints included progression-free survival (PFS), objective and biochemical response rates, overall survival (OS), toxicity and quality of life. Sample size was based on a 50% improved median PFS from 3 (historical) to 4.5 months (m). Results: 29 of 43 planned pts have received therapy and the first 26 are included in this planned interim analysis. Baseline pt demographics are in the Table. Most frequently observed adverse events (any AE) included HTN (15%), diarrhea (35%), fatigue (65%) and HFS (91%). 19 pts (73%) had a grade 3 AE (12/19 were HFS). There were no grade 4 or 5 toxicities. 11/25 (44%) evaluable pts have radiographic stable disease. With a median f/u of 6.2 mo, interim PFS is 4.4m. Conclusions: Enrollment continues with manageable AEs, despite the overlapping toxicity of HFS. Planned interim PFS data appears promising in this refractory mCRC population. Molecular correlatives for predictors of response are being analyzed. Clinical trial information: NCT01471353. [Table: see text]
An evaluation of plasma homocysteine levels and the hematological toxicity of pemetrexed even with folate supplementation.
Authors: A. Horiike, H. Tanaka, T. Sakatani, R. Saito, K. Kaburaki, N. Yanagitani, K. Kudo, F. Ohyanagi, S. Hagiwara, T. Horai, M. Nishio
Journal: Journal of Clinical Oncology (2011)

2594 Background:Systemic folic acid and vitamin B12 supplementation is necessary for pemetrexed treatment, because severe toxicities of pemetrexed treatment without folate supplementation were observed in patients who had high levels of plasma homocysteine (Hcy) in early clinical trials. However, it was not examined whether the plasma Hcy levels would still associated with the hematological toxicity of pemetrexed in patients receiving folate supplementation. The purpose of this study was to examine the relationship between the pretreatment plasma Hcy levels after folate supplementation and the hematological toxicity of pemetrexed monotherapy in advanced non-small cell lung cancer (NSCLC). Methods: From June 2009 to September 2010, 52 NSCLC patients received pemetrexed monotherapy (500mg/m2, every 3 weeks) and also received oral folic acid (0.5mg) daily and a vitamin B12 injection (1.0mg) every 9 weeks, beginning 1 to 2 weeks before the first dose and continuing until 3 weeks after the last dose of the study treatment. The plasma Hcy levels before the first dose of pemetrexed were measured. Complete blood cell counts were measured at least once a week during first cycle of pemetrexed monotherapy. The relationship between the plasma Hcy levels and hematological toxicities during the first cycle of pemetrexed monotherapy were evaluated. Results: The patient characteristics were as follows: male/female: 22/30; median age: 65 years (39-79); histology, adeno/large: 51/1; PS, 0/1/2/3: 25/24/2/1. The mean pretreatment plasma Hcy was 9.01μmol/ml (3.8-34.6μmol/ml). The pretreatment plasma Hcy significantly correlated with the nadir of the absolute leukocyte counts (r=-0.315 p=0.023) and the nadir of the absolute thrombocyte counts (r=-0.302 p=0.032). In addition, the pretreatment plasma Hcy significantly correlated with the decline rates of leukocytes (r=+0.351 p=0.012), hemoglobin (r=+0.414 p=0.002) and thrombocytes (r=+0.417 p=0.002). Conclusions: The Plasma Hcy levels are thus considered to be associated with the hematological toxicity of pemetrexed monotherapy even with folate supplementation.
Novel prognostic model of overall survival in patients undergoing cytoreductive nephrectomy: Importance of pretreatment clinical and serological parameters.
Authors: David D. Buethe, Nilesh Verma, Hui-Yi Lin, Julio Pow-Sang, Wade Jeffers Sexton, Xiuhua Zhao, Mayer N. Fishman, Philippe E. Spiess
Journal: Journal of Clinical Oncology (2012)

430 Background: Over the past decade, there has been an increasing interest in combining surgical and systemic therapy to combat metastatic renal cell carcinoma (mRCC) with upfront cytoreductive nephrectomy (CN) favored in well selected patients. This study presents a novel risk stratification model to identify those who may benefit from upfront CN within the current targeted therapy era. Methods: Eighty-two patients with mRCC who underwent CN within our tertiary care referral center were identified. Potential pre-operative clinical and serologic predictors of overall survival (OS) were evaluated using both univariate and multivariable Cox-Regression analyses. A Recursive Partitioning and Regression Tree (RPART) model was subsequently developed allowing for stratification of patients into risk groups on the basis of OS. Results: The derived RPART tree, was able to stratify patients into 4 risk groups ranging from “low risk” to “very high risk” with respect to their expected OS utilizing the number of metastatic sites at diagnosis, serum hemoglobin (Hgb), and serum white blood cell count (WBC) count as partitioning parameters. Within the 4 groups, the median OS ranged from 4.3 months to 72 months. Conclusions: Our proposed simple quantitative risk-stratification model based on the pre-operative metastatic burden, Hgb, and WBC count is useful to predict OS when contemplating upfront CN prior to systemic therapy. Furthermore, a pre-operative serum WBC count ≥ 7.15 K/uL appears to be indicative of a poor prognosis.
Pathologic and clinical outcomes in cT2N0 esophageal cancer: A cohort study.
Authors: Gauri Bhuchar, Mohammad Altujjar, Siva Raja, Sudish C. Murthy, Daniel Raymond, Gregory M.M. Videtic, Michael J. McNamara, Alok A. Khorana, David J. Adelstein, Davendra Sohal
Journal: Journal of Clinical Oncology (2016)

157 Background: The management of clinically staged T2N0 (cT2N0) esophageal cancer remains controversial and clinical staging can be inaccurate. We evaluated concordance between clinical and pathologic staging as well as outcomes in a cohort study of patients initially staged as cT2N0. Methods: We conducted a cohort study of consecutive patients with esophageal cancer staged as cT2N0 after imaging (CT, PET scans) and endoscopic ultrasound, who underwent surgical resection and were followed at the Cleveland Clinic from Jan 2000 to Jun 2014. Clinical, chemotherapy (CT), radiation (RT), pathologic, and survival details were evaluated. For statistically significant associations, adjusted hazard ratios (HR) with 95% confidence intervals (CI) and 2-sided p-values are presented. Results: The study population comprised 66 consecutive patients with cT2N0 esophageal cancer. Median age was 60 years; 76% were male; 97% were Caucasian. Gastroesophageal junction was the primary site in 56%; distal esophagus in 29%; middle esophagus in 14%; histology was adenocarcinoma in 62 (94%) cases. 20 patients received preop treatment (Rx): CT+RT (15), CT (5). In patients without preoperative Rx (n = 46, 70%), pathologic staging was &gt; T2N0 in 54% (n = 25; T3 = 17, T4 = 1, N+ = 20), &lt; T2N0 in 37% (n = 17), and T2N0 in 9% (n = 4). No &lt; T2N0 or T2N0 patient received postop Rx. Of 25 &gt; T2N0, 15 received postop Rx: CT+RT (14), CT (1). 5-fluourouracil-cisplatin was the most common CT regimen. Median overall survival (mOS) after 7 years of median follow-up was: overall, 48 mths (34 deaths, 52%); &lt; T2N0/T2N0, 93 mths; &gt; T2N0 with postop Rx, 69 mths; &gt; T2N0 without postop Rx, 15 mths (p &gt; 0.05 for comparison). Only node-positive disease on pathology was associated with mortality (mOS for N+ vs. N- was 28 vs. 118 mths, HR for mortality = 2.74, 95% CI = 1.30-5.76, p = 0.008); T-stage, surgical margins, timing or type of therapy were not. Conclusions: Clinical staging of cT2N0 esophageal cancer is concordant with pathologic staging in less than 10% of patients; a majority are under-staged. Strong consideration should be given to pre- or post-operative treatment in this population. Improvements in clinical staging approaches are urgently needed to avoid over- and under-treatment in this setting.
Impact of HER2-targeted therapy on overall survival (OS) in patients (pts) with HER2-positive (HER2+) metastatic breast cancer (MBC).
Authors: A. Berghoff, R. Bartsch, Z. Bago-Horvath, P. C. Dubsky, M. Rudas, U. Pluschnig, C. Wiltschke, M. Gnant, G. G. Steger, C. Zielinski
Journal: Journal of Clinical Oncology (2011)

572 Background: Trastuzumab (T) prolongs OS over chemotherapy alone in pts with HER2+ MBC. Upon disease progression, pts may switch to lapatinib (L) or continue on T. We aimed at assessing the impact of both strategies on OS in all pts treated for HER2+ MBC at the Department of Medicine 1, Medical University of Vienna, from 1999-2009. Methods: 201 pts were identified from a BC databank. 115 pts (572%) received multiple lines of T, whereas 58 (28.9%) were treated with a single line of T-based palliative therapy. A control group of 28 pts (13.9%) had never received T as they were treated before 1999, when T was introduced. HER2 was determined by immunohistochemistry and reanalyzed by FISH if a score of 2+ was gained. OS from diagnosis of metastatic disease was defined as primary study endpoint and estimated using the Kaplan-Meier method. A Cox proportional hazards model was applied to correct for other factors associated with OS. Results: T significantly prolonged OS in HER2+ MBC (41 vs. 13 months; p<0.001). T in multiple lines further numerically improved OS (47 vs. 28 months; p=0.069), which however did not reach statistical significance. In the Cox regression model, brain metastases (BM) (HR 0.67; 95% CI 0.47-0.96) predicted for shorter OS, while positive estrogen receptor (ER) status (HR 1.6; 95% CI 1.13-2.27) was significantly associated with better outcome. Addition of L did not further improve OS in patients receiving multiple lines of T (62 vs. 47 months; p=n.s.), while in pts with BM, L improved OS in an univariate model (6 pts; 22 vs. 5 months; p=0.022). Furthermore, numerically less pts treated with L developed BM (30.8% vs. 39.6%; p=n.s.). Incidence of BM in the total sample was 39% and was independent of ER-status (44% vs. 37%; p=n.s.). Conclusions: Introduction of T improved OS in pts with HER2+ MBC, with a further numerical improvement when administered in multiple lines. As in HER2-negative tumours, ER-negative disease was associated with worse outcome, although no higher risk for BM was observed. In this homogenous sample of pts treated with T in multiple lines, L did not further improve OS; however, L might reduce the risk for developing BM and improve OS in pts with BM.