tbuckley/cabot-search huggingface dataset:
Body mass index and mortality in patients with pancreatic cancer: A systematic review and meta-analysis of observational studies.
Authors: Arjun Gupta, Kaustav Majumder, Nivedita Arora, Shiraj Sen, Harris V. K. Naina, Preet Paul Singh, Siddharth Singh
Journal: Journal of Clinical Oncology (2015)

e15293 Background: Obesity is associated with increased risk of developing pancreatic cancer (PaC), but it is unclear whether it influences mortality in patients with PaC. We performed a systematic review and meta-analysis to assess the association between obesity and PaC mortality. Methods: Through a systematic search of major databases and conference proceedings, up to December 2014, we identified observational studies reporting the association between obesity (premorbid body mass index [BMI] ≥ 30 kg/m2) and all-cause mortality in patients with PaC. We estimated summary adjusted hazard ratio (aHR) with 95% confidence intervals (CI), comparing highest BMI category with normal reference category in each study, as well as mortality risk per 1kg/m2 increase in BMI, using random effects model; heterogeneity was measured using the inconsistency index (I2). Results: We identified 10 studies (including 3 pooled cohort studies) with 3,349,338 people, of whom 23% were obese. On meta-analysis, compared with PaC patients with normal BMI, obese PaC patients had a 35% higher mortality (aHR, 1.35; 95% CI, 1.19-1.52) with minimal heterogeneity (I2= 35%), after pooling maximally adjusted HRs. Each 1kg/m2 increase in BMI above normal was associated with 13% increased mortality (aHR, 1.13; 95% CI, 1.06-1.22) with minimal heterogeneity (I2= 20%). On subgroup analysis, obesity was associated with increased mortality in Western populations (8 studies; adjusted HR, 1.41; 95% CI, 1.28- 1.56) but not in Asia- Pacific populations (2 studies; adjusted HR, 0.98; 95% CI, 0.76- 1.27). Conclusions: Based on meta-analysis, obesity appears to be associated with increased mortality in patients with PaC in the Western but not Asia-Pacific populations. This may be due to differences in PaC pathophysiology and disease behavior in different geographical locations. Targeting obesity-induced metabolic abnormalities may provide novel pathways for PaC therapy.
Efficacy of peripheral androgen blockade on prostate cancer: Results of CALGB 9782
Authors: J. Picus, S. Halabi, E. Small, A. Hussain, G. Philips, E. Kaplan, N. Vogelzang
Journal: Journal of Clinical Oncology (2004)

4559 Background: The treatment of patients with elevated PSA after definitive local therapy continues to be elusive. Many patients are reluctant to undergo androgen suppression therapy due to long-term effects. Enthusiasm has been seen for peripheral androgen blockade for such patients. Methods: We enrolled 101 patients with a climbing PSA after definitive local therapy in a mult-institutional trial. All patients had undergone previous definitive therapy defined as either a radical prostatectomy or radiation therapy. All patients had a rising PSA, above 1 ng/ml, with no detectable evidence of recurrent disease. CT and bone scans were negative. Patients received a combination of oral therapy consisting of Finasteride, at a dose of 5 mg/day, and Flutamide, at a dose of 250 mg TID. Results: The median age was 71, with a median baseline testosterone level of 322 ng/dl. A >80% PSA decline was seen in 91/94(97%) of the patients. The other three patients had drops of 77%, 73% and 38%, all of which were maintained for at least 28 days. The median time to nadir of PSA was 3.2 months. Currently, 64 patients remain on therapy with a median follow up of 33 months. Only 21 patients have progressed through this therapy, and some of these have responded to additional hormonal maneuvers, such as Flutamide withdrawal and gonadal androgen deprivation. The toxicity is very mild, with almost no reported grade 3/4 toxicity, and most grade 2 toxicity reported at <5% level. Conclusions: The combination of Finasteride and Flutamide is highly effective in suppressing PSA levels in patients with serologic progression after local therapy. Median response duration has not been reached at nearly 3 years. Its apparent efficacy and favorable toxicity profile suggest that further investigation in randomized trials may be warranted. No significant financial relationships to disclose.
Improving patient care through implementation of a QOPI-focused interactive patient note template.
Authors: Andrew Shaw, Brittany K. Ragon, Luis Baez Vallecillo, Alyssa G. Rieber
Journal: Journal of Clinical Oncology (2017)

197 Background: Participation in the ASCO Quality Oncology Practice Initiative (QOPI) has been shown to improve the quality and value of care provided by oncology practices. Our fellows’ oncology practice participates in QOPI. We sought to utilize QOPI metrics in conjunction with the documentation capabilities of our electronic medical record (EMR) to create a quality-focused standardized new patient note template to be used by all practitioners in our oncology clinic, in an effort to improve patient care through improved communication and efficiency. Methods: We examined the results from our most recent QOPI assessment cycle in spring of 2016 and identified areas where our practice met the metric less than 50% of the time. Oral chemotherapy, tobacco cessation, and fertility preservation counseling were identified as target areas. We surveyed the practitioners in the group to establish baseline knowledge of QOPI metrics and desire for a standardized note template. We then developed and implemented a note template incorporating QOPI metrics, pulling data directly from other areas within the medical record, and excluding extraneous information. Results: Only 58% of the fellows in our fellowship program responded that they had a general idea of the QOPI metrics, and only 37% believed their notes were QOPI-compliant; 84% were interested in a standardized note template that incorporates QOPI metrics. Through the assistance of EMR specialists, we created a standardized note that auto-populates information recorded elsewhere in the patient’s chart and allows physicians to select appropriate options from pre-populated lists based on the patient’s treatment. The physician cannot close the encounter until these selections are made Conclusions: QOPI metrics provide guideposts for oncology practitioners to provide quality care and communicate effectively. We created a note that encourages practitioners to complete recommended QOPI tasks in an effort to improve communication and patient care. Data collection regarding practitioner use and satisfaction with the new template and compliance with QOPI metrics is ongoing.
Percutaneous radiofrequency ablation (RFA) of hepatic metastases in patients with metastatic breast cancer: An interim analysis
Authors: T. K. Helmberger, V. Heinemann, C. Vick, A. Wallnöfer, A. Gotz, M. F. Reiser
Journal: Journal of Clinical Oncology (2004)

613 Background: A subgroup of patients with metastatic breast cancer present hepatic metastasis without extrahepatic spread. Even with systemic therapy the survival outcome is very finite. Since in most of these cases surgical therapy is not considered minimally invasive therapies as radiofrequency ablation (RFA) are gaining an increasing importance. Methods: Between 1999 and 2003, 32 patients (median age 62 years, range 41 -76 years) with syn- (5/32) and metachronous (27/32) solitary liver metastases from breast cancer were treated by RFA (Starburst XL, RITA Medical Systems, Mountainview, CA USA) subsequently/parallel to chemo and/or hormonal therapy. All procedures were performed under CT-fluoroscopical guidance applying conscious sedation and local anaesthesia. Number of lesions, primary success rate, complications, total and disease free survival were recorded and analyzed. Follow-up (by clinical, laboratory, and imaging studies) was achieved over up to 44 months. Results: RFA was performed between 0 to 138 months (median 37 months) after diagnosis of the metastasis. In 32 patients, 73 metastases were treated by RFA successfully without any major adverse event. 13/32 (40 %) patients had a solitary metastasis, the rest had 2 to 5 metastases (8 had 2, 2 had 3, 5 had 4, and 4 had 5). The size of the metastases ranged from 3 to 85 mm with a median diameter of 20.3 mm. During follow-up of 1 to 44 months (median 17.2 months), 25 patients (79 %) remained desease-free in the liver, 1 patient (3 %) developed a local tumor recurrence, and 6 patients (18 %) new hepatic metastases. 9/32 (28 %) patients died 1 to 28 months after RFA due to extrahepatic tumor spread. Among the 7 patients who developed new lesions 6 underwent repeated RFA. Up to the present time of evaluation, the median survival after RFA has not been reached. Conclusion: RFA could be a valuable adjunct to the classic armamentarium of endocrine- and chemotherapy in hepatic metastasis of breast cancer and should be investigated in further comparative studies. No significant financial relationships to disclose.
The effect of fluid overload on sleep apnoea severity in haemodialysis patients
Authors: Owen D. Lyons, Toru Inami, Elisa Perger, Azadeh Yadollahi, Christopher T. Chan, T. Douglas Bradley
Journal: European Respiratory Journal (2017)

As in heart failure, obstructive and central sleep apnoea (OSA and CSA, respectively) are common in end-stage renal disease. Fluid overload characterises end-stage renal disease and heart failure, and in heart failure plays a role in the pathogenesis of OSA and CSA. We postulated that in end-stage renal disease patients, those with sleep apnoea would have greater fluid volume overload than those without. End-stage renal disease patients on thrice-weekly haemodialysis underwent overnight polysomnography on a nondialysis day to determine their apnoea–hypopnoea index (AHI). Extracellular fluid volume of the total body, neck, thorax and right leg were measured using bioelectrical impedance. 28 patients had an AHI ≥15 (sleep apnoea group; OSA:CSA 21:7) and 12 had an AHI &lt;15 (no sleep apnoea group). Total body extracellular fluid volume was 2.6 L greater in the sleep apnoea group than in the no sleep apnoea group (p=0.006). Neck, thorax, and leg fluid volumes were also greater in the sleep apnoea than the no sleep apnoea group (p&lt;0.05), despite no difference in body mass index (p=0.165). These findings support a role for fluid overload in the pathogenesis of both OSA and CSA in end-stage renal disease.
A mixed-methods study of adolescent and young adult cancer patient’s preferences for patient navigation services by distance from cancer treatment centers.
Authors: Echo L. Warner, Brynn Fowler, Samantha Pannier, Douglas Beaty Fair, Holly Perlman, Jeffrey Yancey, R Lor Randall, Brad Bott, Carolyn C Reynolds, Anne C. Kirchhoff
Journal: Journal of Clinical Oncology (2017)

155 Background: We describe patient navigator preferences for adolescent and young adult (AYA) cancer patients by geographical distance from cancer treatment centers. Methods: In this mixed methods study, N = 39 participants were recruited primarily from oncology clinics in Utah. Participants were diagnosed between ages 15-39 and had completed ≥ 1 month of treatment. Participants were interviewed and surveyed on preferences for patient navigation. Thematic content analysis revealed navigation preferences based on participants’ travel distance from their treatment center, classified as &lt; 20 miles (local) and ≥ 20 miles (distance). Qualitative data was quantized and the proportion of codes in each theme was compared by travel distance using two-tailed z-scores. Results: Mean travel distance to cancer treatment center was 53.5 miles (SD = 77.4); 53.8% of participants were local ( &lt; 20 miles) and 46.2% were distance ( ≥ 20 miles). There were no differences by age or ethnicity. Local patients were less likely to endorse that travel distance was a challenge for their oncology appointments than distance patients (25.0% vs. 75.0%, p = 0.01). Local patients reported a higher proportion of codes (62.5%) related to believing a patient navigator would be helpful to them compared to distance patients (37.5%, p = 0.01). Connecting with a patient navigator at the time of first diagnosis was endorsed by more local patients than distance (66.7% vs. 33.3%, p = 0.01). Local patients reported a greater need for navigation support regarding finances (local 69.6% vs. distance 30.4%, p = &lt; 0.001) and social support (local 87.5% vs. distance 12.5%, p = 0.03). Most participants, regardless of travel distance, desired navigation primarily via telephone (audio and text messaging). Conclusions: While AYAs with cancer living further from their treatment location were more likely to report that travel was a barrier, local AYAs reported more needs related to patient navigation than remote patients. Patient navigators may need to consider different support services for distanced patients including strategies to address geographic barriers to care.
Toxicity of high-dose interferon for high-risk melanoma in Ontario: A population-based study of health services use.
Authors: Timothy P. Hanna, Tara D. Baetz, Jianfeng Xu, Qun Miao, Craig Earle, Yingwei Peng, Christopher M. Booth, Teresa M. Petrella, Douglas McKay, Paul Nguyen, Hugh Langley, Elizabeth A. Eisenhauer
Journal: Journal of Clinical Oncology (2017)

31 Background: While High-Dose Interferon (HDIFN) is the sole approved adjuvant systemic treatment for melanoma in Ontario and many other jurisdictions, it is toxic, of modest benefit, and costly. We sought to assess the population-level impact of toxicity, particularly neuro-psychiatric toxicity. This can inform value assessment for the adjuvant treatment of melanoma. Methods: This was a retrospective population-based registry study of all patients with melanoma receiving adjuvant HDIFN in Ontario 2008-2012. HDIFN receipt was determined from provincial drug-funding data. Toxicity was investigated through health services use compatible with HDIFN toxicity (e.g. mental health physician billings). Associations between early HDIFN discontinuation and health services use were examined. Using stage data reported from cancer centers on a subset of patients, propensity matched analysis compared utilization in stage IIB-IIIC patients that did and did not receive HDIFN. Results: Of 718 patients receiving HDIFN, 12% were ≥65 years, 83% had little or no comorbidity. One third had ≥1 toxicity-associated utilization within one year of starting HDIFN. 364/420 (87%) of utilization was mental health-related: 54% were family practitioner visits, 39% psychiatrist visits. Early drug discontinuation was more likely with pre-existing mental health issues in multivariable analysis (OR 2.0 (1.1,3.4)). In propensity matched analysis, HDIFN patients were more likely than untreated matched controls to have mental health utilization (51% vs. 42%, p=0.01) between 1 year pre-melanoma diagnosis to 2 years post. Conclusions: Mental health services use is common among stage IIB-IIIC patients with melanoma, especially with HDIFN. This emphasizes an important survivorship issue for these patients, and for those receiving HDIFN, and impacts the value of care. Pre-treatment mental health services use is associated with treatment discontinuation. This is important when contemplating the value of HDIFN use for individual patients. For those receiving HDIFN, optimal support must include mental health care.
A phase II pilot efficacy trial of the combination regimen peg asparaginase/peg liposomal doxorubicin/dexamethasone (ODD) in patients with refractory lymphoid malignancies (NCT00837200).
Authors: Joseph J. Drabick, Ritu Lapsiwala, Giampaolo Talamo, Elliot E Epner, Jeffrey G. Supko, David Claxton, W. Christopher Ehmann, Mary Lander, Michelle St. Pierre, Witold B. Rybka
Journal: Journal of Clinical Oncology (2013)

e19502 Background: Asparaginase is a mainstay of the treatment for ALL depriving the malignant cells of asparagine leading to cell death. There are reports of asparaginase activity in non-ALL malignancies including CLL, NHL, and multiple myeloma. We developed a combination regimen with full dose PEG-Asparagase (O) together with low dose liposomal doxorubin (D) and dexamethasone (D) (ODD regimen) as a non-myelotoxic regimen for pts with advanced lymphoid malignancies and impaired bone marrow function, hoping this novel approach of inducing asparaginine deficiency would translate into benefit. Methods: A phase II trial of ODD with the O given D1 and D15 at 2500 IU/m2, D given D1 and D15 as 20 mg/m2 and the Dex given as 20 mg D1, D8, D15 and D22 of a 28 day cycle was initiated. Pts with any non-ALL lymphoid malignancy were eligible if they had failed at least one prior standard regimen. The study had a Simon 2-stage design with Response Rate as the primary endpoint. Secondary endpoints were safety and correlation of asparginase levels with response/toxicity. Results: 13 pts enrolled of 16 screened of whom 12 were evaluable for response. These included 7 MM pts and 6 with diffuse large B-cell lymphoma. The pts were heavily pre-treated with 3 (range 1 to 8) median prior regimens. 6 of the13 pts were over 70 yrs. One pt progressed before one complete cycle was given so was not evaluable for response. 2 pts (both MM) had a response which was defined as Stable Disease &gt; 2 months; the other 10 had Progressive Disease. One responding pt was later taken off for O-related toxicities (DVT/PE, elevated enzyme levels). Effective Asparaginase levels were obtained in the serum of most tested pts. In general, the regimen was well tolerated considering the advanced nature of these cases, but typical O related toxicities were observed. Conclusions: We conclude that the ODD regimen, although well tolerated, had little appreciable activity in this heavily pre-treated group of pts with refractory DLBCL and MM. Whether it would have meaningful activity in less advanced states of these diseases or other lymphoid neoplasms remains an open question. Clinical trial information: NCT00837200.
Impact of a nurse-calling program on retaining patients with a new diagnosis of cancer.
Authors: Anne Gross, Ryan Leib, Nancy Hilton, Janet Bagley, Rachel A. Burnard, Judith Hirshfield-Bartek, Eric Dorenzo, Kathleen Keavany, David C Read, Craig A. Bunnell
Journal: Journal of Clinical Oncology (2017)

69 Background: In 2013, Dana-Farber Cancer Institute began an initiative to improve the new patient experience. Our goal was to remove barriers to access and, as much a possible, begin to care for individuals even before they step foot through our door. A key component of this initiative was for each patient to receive a phone call from an oncology nurse shortly after speaking to a new patient coordinator to schedule their first appointment. The purpose of the call was to answer questions about their diagnosis, the care they will receive and to begin the process of assessing their individual needs. Methods: The program was supported by over 40 full and part-time oncology nurses who devote a portion of their time each day to calling new patients prior to their first visit. In total nurses made over 10,000 phone calls per year. Through a survey given to patients after the intake process, we gathered feedback from over 1,200 patients, which overwhelmingly demonstrated a positive response to receiving a phone call from a nurse. We also investigated if receiving a phone call from a nurse prior to the first visit impacted the likelihood of retaining the patient for their treatment. Results: Comparing 9,000 new patients over one year, we found that patients who spoke to a nurse prior to their first appointment had a 13.5% higher relative retention rate compared to patients who did not speak to a nurse (see figure 1, absolute difference is 42.9% vs. 37.8%, odds ratio = 1.24, confidence interval 1.10-1.39, P &lt; 0.0005). Controlling for confounding variables, a logistical regression with 15 variables was performed (e.g. time to first appointment, age,). Receiving a call from a nurse was one of the most predictive, statistically significant variables for patient retention. Conclusions: Given the positive qualitative response from patients and the quantitative impact on retention, we continue to build the program to ensure all patients receive a phone call from a nurse prior to their first visit. [Table: see text]
Diagnosis of anxiety expression using self-portrait drawn by patients during chemotherapy
Authors: H. Koufer, H. Arbel, F. Barak
Journal: Journal of Clinical Oncology (2004)

8244 The aims of the study were to discover the incidence of anxiety among women with breast and gynecological cancers, compared to healthy women and to describe the characteristics of this anxiety using self-portraits. Self-portraits of 51 patients and 23 workers in an oncology ward were analyzed as indicators of each participant's self-image. Of the 51 patients, 34 suffered from breast cancer and 17 from gynecological cancers. In this group, 55% were married, 43% divorced and 2% single. The Israeli-born patients comprised 14% of the group; another 14% were born in Asia/Africa, 4% European and North American, and 68% Eastern Europe. 47% had an academic education and 53% were only high school graduates. Of the 23 healthy participants, 83% were married, 8% were divorced and 9% were single. 35% were born in Israel, 13% in Asia/Africa, 22% in Europe or North America, and 30% in Eastern Europe. 74% had an academic education and 26% completed high school. Limbs, eyes, hair/baldness, body-positioning, shadows and other details were examined. A comparison between the two groups was done according to the T-test. The differences between the groups were considered only if p-value was less than 0.05. Significant differences were noted between the two groups when analyzing the head and body (P value < 0.01). In fact, the eyes and loss of hair was found to be the most significant (P value < 0.005). The evaluation of each picture revealed the type and depth of anxiety due to body image damage that the patient was suffering and its effect on the individual's self-image. The indices of body image and factors influencing anxiety were analyzed. Excluding indices and factors characteristic of organ damage or loss, anxiety was very obvious in the expressions portrayed in the drawings. The demographic variables had no effect on the level of anxiety of the participants.\(\underline{\mathrm{Conclusions:}}\) “Drawing of self image” is a simple and effective system not only for measuring the anxiety of cancer patients but also for diagnosis of additional problems that are not always expressed verbally. No significant financial relationships to disclose.
Preliminary results of a phase II study of irinotecan and etoposide combination as first line chemotherapy for extensive small-cell lung cancer
Authors: F. S. Farhat
Journal: Journal of Clinical Oncology (2004)

7366 Background: The purpose of this study is to evaluate the antitumor activity and toxicity of a new combination of irinotecan and etoposide for previously untreated extensive small-cell lung cancer (E-SCLC). Methods: 23 patients of 30 expected are included in the study. 17 are male and 6- female with a median age of 64 (46–79 years). 15 patients were at metastatic stage and 7 were locally advanced. The chemotherapy combination included irinotecan 60–80 mg/m2 day 1,8, 15, and etoposide 80 mg/ m2 days 1–3, every 4 weeks for 6 cycles. Evaluation is made every second cycle. Colony stimulating factors are allowed. Results: Among the 23 patients included 3 are under treatment and not yet evaluable. 13 (62%) showed an objective response with 5 (24%) complete responses, 3 (14%) stable disease and 5 (24%) progressive disease. Incidences of grade III-IV febrile and non-febrile neutropenia were 7, 7. Diarrhea was observed in 7% of all courses. Grade III-IV nausea and vomiting occurs in 3(14%) patients. No treatment-related death was observed. Conclusion: The combination of irinotecan and etoposide shows a promising objective response rate with a well-tolerated toxicity in patients with E-SCLC. Detailed results will be presented after longer follow-up. No significant financial relationships to disclose.