tbuckley/cabot-search huggingface dataset:
Necessity of long follow-up schedule after surgery and partial nephrectomy for patients with T1 renal cancer.
Authors: Yukio Naya, Kazuhiro Araki, Masahiro Sugiura, Satoko Kojima, Shinichi Sakamoto, Takahito Suyama, Naoki Nihei, Tomohiko Ichikawa, Tatsuo Igarashi
Journal: Journal of Clinical Oncology (2013)

e15521 Background: Almost renal cancers are renal cell carcinoma (RCC). Short term treatment results are excellent with 90% or more disease specific and overall survival at 5year. Follow up schedule of NCCN guideline for low risk group was up to 5 years after surgery. Although, we have experienced late recurrence in such a low risk cases. Therefore, we examined the recurrence of T1 and T2 renal carcinoma in our institute, retrospectively. Methods: Between March 1997 and September 2009, 580 patients with renal carcinoma were undergone surgical excision of renal tumor at Chiba University Hospital. In these cases,349 patients were T1 without metastasis. We analyzed the clinopathological deta of these 349 patents. Univariate and multivariate analysis were conducted to identify the prognostic factor of T1a or T1b patients with surgical excision. Results: During follow up, 5, 10, 15 and 20 years overall survival rate(OS) of T1a were 98.1%, 98.1%, 90.6% and 90.6%, respectively. Those of T1b were 95.8%, 92.7%, 90.2% and 90.2%, respectively. 5, 10, 15 and 20 years disease free survival rate (DFS) of T1a was 93.1%, 86.6%, 76.8%, 38.4%, respectively. 5, 10, 15 and 20 years DFS of T1b was 82.9 %, 66.5%, 58%, 50.8% ,respectively. 33% of metastasis was lung 10% of metastasis was contralateral kidney. Conclusions: 20 years OS of T1a was an excellent, however, 20 years DFS was 38.4%. Life expectancy of Japanese men and women in 2009 were 79.59 years old and 86.44 years old. Almost patients with T1a renal carcinoma might have a late recurrence. We think it is necessary to long follow p schedule for T1 cancer and partial nephrectomy is recommended.
Improper Medicaid Payments
Authors: Jeff Lyon
Journal: JAMA (2017)

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Early computed tomography modifications following bronchial thermoplasty in patients with severe asthma
Authors: Marie-Pierre Debray, Marie-Christine Dombret, Marina Pretolani, Gabriel Thabut, Loubna Alavoine, Pierre-Yves Brillet, Camille Taillé, Antoine Khalil, Pascal Chanez, Michel Aubier
Journal: European Respiratory Journal (2017)

Bronchial thermoplasty (BT) is a recent, promising and well-tolerated technique for the treatment of severe asthma. By delivering thermal energy to the airway wall, this procedure can induce early pulmonary opacities seen on computed tomography (CT). We aimed to examine early CT modifications induced by BT and to determine their association with respiratory symptoms. Unenhanced chest CT was performed the day after each BT session in 13 patients with severe asthma, leading to the examination of 38 treated lobes. A total of 15 BT-treated lobes were evaluated in 11 patients at 1 month. The first two patients also underwent CT at 1 week. No symptoms suggestive of pulmonary infection were noted following BT in any patient. Peribronchial consolidations and ground-glass opacities were observed in all treated lobes on day 1, with three lower lobes showing complete collapse. Mild involvement of an adjacent untreated lobe was observed in 12 out of 38 (32%) cases. Opacities had decreased in 5 out of 15 (33%) and disappeared in 10 out of 15 (67%) at 1 month. BT induced early pulmonary peribronchial hyperdensities in all treated lobes. These alterations were unrelated to clinical symptoms and spontaneously decreased or disappeared after 1 month.
An updated systematic review and meta-analysis for treatment of multidrug-resistant tuberculosis
Authors: Mayara Lisboa Bastos, Zhiyi Lan, Dick Menzies
Journal: European Respiratory Journal (2017)

This systematic review aimed to update the current evidence for multidrug-resistant tuberculosis (MDR-TB) treatment. We searched for studies that reported treatment information and clinical characteristics for at least 25 patients with microbiologically confirmed pulmonary MDR-TB and either end of treatment outcomes, 6-month culture conversion or severe adverse events (SAEs). We assessed the association of these outcomes with patients' characteristics or treatment parameters. We identified 74 studies, including 17 494 participants. The pooled treatment success was 26% in extensively drug-resistant TB (XDR-TB) patients and 60% in MDR-TB patients. Treatment parameters such as number or duration and individual drugs were not associated with improved 6-month sputum culture conversion or end of treatment outcomes. However, MDR-TB patients that received individualised regimens had higher success than patients who received standardised regimens (64% versus 52%; p&lt;0.0.01). When reports from 20 cohorts were pooled, proportions of SAE ranged from 0.5% attributed to ethambutol to 12.2% attributed to para-aminosalicylic acid. The lack of significant associations of treatment outcomes with specific drugs or regimens may reflect the limitations of pooling the data rather than a true lack of differences in efficacy of regimens or individual drugs. This analysis highlights the need for stronger evidence for treatment of MDR-TB from better-designed and reported studies.
Development of a nomogram model using a very large sample of patients (pts) to predict the risk of <sup>99m</sup>Tc-bone scan (BS) positivity in pts receiving androgen deprivation therapy (ADT) for prostate cancer (PCa).
Authors: Geoffrey Gotto, Changhong Yu, Melanie Bernstein, James Andrew Eastham, Michael W. Kattan
Journal: Journal of Clinical Oncology (2012)

4552 Background: Decisions to start imaging pts with PCa can be difficult due to the heterogeneous nature of the disease. Nomograms can combine information on multiple disease factors to improve predictive accuracy and are not influenced by subjective confounders that may affect clinical judgment. However, currently available nomograms for PCa predict current or future risk of positive BS in ADT-naive pts only. We have developed a new nomogram to predict current BS positivity in ADT-treated pts with PCa using a very large pt sample. Methods: All BS records from 1650 ADT-treated pts who received treatment at the Memorial Sloan-Kettering Cancer Center from 2000 to 2011 were analyzed. Pts were followed up from the start of ADT until the first positive BS or last hospital visit. Multivariate logistic regression analysis was used to model the variables that could be used for predicting likelihood of metastases and the variables were incorporated into the nomogram model. The current probability of bone metastasis was generated by the nomogram using the pt variables at each BS and the predictive accuracy was quantified by calculating the concordance index (C-index). Results: In total, 3949 BS records were analyzed and 950 pts had a positive scan. There was an average of 1.1 prior negative scans before a positive result was recorded. Median prostate-specific antigen (PSA) was 2.5 ng/mL and mean PSA doubling time (PSADT) was 7.8 months. At the same time of the positive scans, 49.4% of pts had a PSA &lt;10 ng/mL. Based on clinical relevance and data availability, 13 variables were included in the nomogram model: number of previous negative BSs, PSA, PSADT, prostatectomy, radiotherapy, brachytherapy, chemotherapy, immunotherapy, estrogen therapy, cryotherapy, clinical trial enrollment, and most recent primary and secondary Gleason grades. C-index for the nomogram was 0.76. Conclusions: This is the first nomogram to predict current BS positivity in pts with PCa following ADT. The nomogram was devised from a very large data set from a single center and provides high predictive accuracy.
Incidence, classification and diagnosis of hyponatremia in patients admitted to the oncology ward.
Authors: Gloria Marquina Ospina, Isabelle Runkle de la Vega, Aránzazu Manzano, Mónica Granja, Carlos Aguado De La Rosa, Pedro Pérez Segura, Eduardo Diaz-Rubio
Journal: Journal of Clinical Oncology (2015)

e20656 Background: Hyponatremia (HN) is associated with a poor prognosis in several malignancies. It is classified by volemic status into hypovolemic, euvolemic and hypervolemic hyponatremia. HN in Oncology patients is often considered primarily euvolemic, secondary to the Syndrome of Inappropriate Anti-diuretic Hormone Secretion (SIADH). Yet the incidence, classification and diagnosis of HN has not been studied in patients in the Oncology ward. Methods: This is a retrospective, descriptive study of patients admitted to the Medical Oncology ward at the Clínico San Carlos Hospital (Spain) from May 2013 through May 2014. HN was detected at the Emergency Room or during hospitalization. Volemic status was assessed by physical examination (manual ocular/central venous/blood pressure, edema, ascites), confirmed by lab tests when needed, and the cause diagnosed. Initial serum glucose, urea, creatinine, sodium (SNa) and potassium (K) were determined in all patients. Serum total proteins, uric acid, and osmolality; urine sodium, K and osmolality were available in some patients, and Verbalis criteria for diagnosis of SIADH applied. HN was classified as mild (SNa 130-134 mmol/L), moderate (SNa 120-129) and severe (SNa < 120). SNa was corrected for glycemia. Results: HN was detected in 83/345 patients (24%). 48% were men. The average age was 62 (ranging from 20-86). HN was mild in 79%, moderate in 21%. 60% of patients were hyponatremic when admitted. 40% developed HN during hospitalization. Most hyponatremic patients were hypovolemic (50%), 42% euvolemic and 9% hypervolemic. Causes of hypovolemic HN: 31% gastrointestinal loss (diarrhea, vomiting) and 36% sepsis. In euvolemic HN, 71% of the cases were secondary to pain, and 29% to SIADH. Conclusions: HN is a common disorder among patients in the Oncology ward, albeit usually mild. Although most hyponatremic patients already presented HN at admission, the development of HN during hospitalization is frequent. Most hyponatremic patients are hypovolemic. In euvolemic patients, pain is a more frequent cause of HN than SIADH. These results underline the importance of a correct classification and diagnosis of HN in admitted Oncology patients, to assure correct management.
Sustained response of complex giant cell tumors with denosumab: Single center 8-year experience.
Authors: Neal Shiv Chawla, Susan V. Bukata, Kamalesh Kumar Sankhala, William E. Mendanha, Vivek Narasimhan, Lawrence Menendez, Nicholas Bernthal, Earl W. Brien, Victoria S. Chua, Sant P. Chawla
Journal: Journal of Clinical Oncology (2015)

10528 Background: GCTB are aggressive osteolytic tumors, which are characterized by local bone destruction and soft tissue invasion. There have been limited non-surgical treatments, including radiation therapy. However, an unacceptable rate of post radiation sarcomas has been well established. Such tumors have osteoclast like giant cells/stromal cells that express surface RANK ligand. Denosumab is an FDA approved drug used in the treatment of unresectable GCTB or GCTB with severe morbidity related surgery. It is a monoclonal antibody that targets the RANK ligand characteristic to GCTB. We report our 8-year experience in the treatment of complex GCTB using denosumab. Methods: Review of 43 skeletally mature patients (N = 43) who were treated with subcutaneous (SC) denosumab for the treatment of GCTB, in whom surgery was not feasible without severe morbidity. Denosomab was dosed at 120 mg on days 1, 8, 15, 29, and every 4 weeks thereafter. CT, PET/CT, or MRI was used to determine radiographic disease burden, along with clinical examination assessing symptoms of disease and side effects of treatment. Results: Average best response per RECIST 1.0 criteria was stable disease. Patients received denosumab on average 159 weeks (range: 12 - 310 weeks), with few complications. 5% (2/43) of patients developed mandible infections, 7% (3/43) of patients developed osteonecrosis of the jaw (ONJ), and 2% (1/43) of patients developed an atypical traumatic fracture during treatment. Overall, as a treatment of GCTB, denosumab proved safe and efficacious over prolonged use, with very low rates of complications and a sustained disease response. Conclusions: This study represents the longest reported single center use of denosumab in the treatment of GCTB. Overall, it shows the safety and efficacy in the use of denosumab in the treatment of GCTB.
Comorbidities and prognosis of myelodysplastic syndromes
Authors: K. Naqvi, J. Oh, G. Garcia-Manero, S. Pierce, M. E. Suarez-Almazor
Journal: Journal of Clinical Oncology (2009)

7086 Background: Cancer patients often experience comorbidities that may affect their therapeutic plan, prognosis, and outcome. Few studies have evaluated comorbidities in myelodysplastic syndromes (MDS). The aim of our study was to determine the effect of comorbidity on the survival of patients with MDS. Methods: We reviewed the medical records of consecutive adult MDS patients who presented to our comprehensive cancer center in 2002. The Adult Comorbidity Evaluation-27 (ACE-27), a validated 27-item comorbidity index for cancer patients, was used to assess the severity of comorbid conditions. For each patient, we obtained demographic data and specific staging information based on the International Prognostic Scoring System (IPSS). We also collected information on bone marrow transplantation (BMT), mortality and survival. Kaplan-Meier methods and log-rank tests were used to assess survival. Results: Of the 55 patients included in this preliminary report, 41 (74.5%) were male, and 47 (85.5%) were white; mean age was 66.4 years; mean follow-up 22.2 months. The three most common comorbidities were hypertension, diabetes mellitus, and coronary artery disease. A total of 90.9% of patients had an IPSS risk of intermediate or higher. The ACE-27 comorbidity scores were as follows: none, 18 patients (32.7%); mild, 17 (30.9%); moderate, 9 (16.4%); and severe, 11 (20.0%). Fifty patients (90.9%) died, whereas 9 (16.4%) underwent BMT. Median survival according to ACE-27 scores was: 22 months for patients with no comorbidity, 11 months for patients with mild or moderate comorbidity, and 8 months for those with severe comorbidity; this trend did not reach statistical significance (p = 0.42). A linear trend was observed between the severity of comorbidity and having received BMT: half of the patients with no comorbidities received BMT compared to none in the group with a severe score (p = 0.02). Conclusions: A small trend was observed between survival and comorbidity. Most of our patients had an advanced IPSS stage which may have decreased the strength of this association. Patients with comorbid conditions received BMT less often than those without comorbidity. Further studies are needed to evaluate the effects of comorbidities on the prognosis and therapeutic options of patients with early-stage MDS. No significant financial relationships to disclose.
An analysis of corrective action plans to address slow accruing NCI-held IND early phase trials.
Authors: Holly A Massett, Elizabeth Godwin, Lawrence Rubinstein, Percy Ivy, Kate DiPiazza, James Zwiebel, Steve Friedman, Andrea Denicoff, Grace E Mishkin, Jeffrey Abrams
Journal: Journal of Clinical Oncology (2015)

6577 Background: In 2011, NCI began requesting Corrective Action Plans (CAP) for early phase trials accruing < 50% of their projected accrual rate after Qtr 2 for Phase 1 (Ph1) or Qtr 3 for Phase 2 (Ph2). Study PIs of low accruing trials are asked to complete and return a CAP within 2 weeks and identify reasons and possible actions to address accrual. We report findings from an analysis of CAPs received on all NCI Cancer Therapy Evaluation Program (CTEP) held IND studies active between Aug 2011 and Feb 2013 (N = 327). Methods: Three methods were employed: 1) content analysis of CAPs to categorize slow accrual reasons and proposed actions (3 coders, intercoder reliability = 78%; 100% after post-coding deliberation); 2) analysis of CAP trial timelines and accrual data; 3) assessment of whether closed CAP trials met their primary scientific objectives. Results: CTEP requested CAPs for 150 (46%) of the 327 trials; 135 were eligible for analysis with 51% Ph1 (n = 69) and 49% Ph2 trials, and 88% adult trials (n = 119). CAP trials were open a median of 30 months (14 mo pre- and 16 mo post-CAP), and 70% (n = 94) were closed to accrual at analysis. Of closed CAP trials: 68% (n = 64) met their primary objective but took 3x longer than projected; those not meeting their objective(s) were open 6x longer before closing; and 27% (n = 25) had an accrual rate increase, post-CAP, associated with a greater likelihood of meeting the objective(s). For Ph1 trials, safety delays dominated slow accrual reasons while institutional/administrative reasons were common for Ph2. Site activation delays and access to patients ranked high for both. Only 54% of proposed corrective actions matched the reasons given for slow accrual. Conclusions: CAP requests had a positive impact on accrual for over one-quarter of the trials analyzed; however, most trials receiving a CAP took substantially longer to complete than projected. CTEP’s new Experimental Therapeutics Clinical Trial Network (ETCTN) is poised to address many concerns identified in this analysis. CAPs should be implemented prior to Q2/Q3 to identify and address slow accruing trials earlier. CTEP is standardizing the CAP data collection to develop statistical algorithms to aid decisions related to trial closure for slow accrual.
Patient expectations of palliative cancer treatment.
Authors: Katherine E. Faricy-Anderson, Susan M. Allen, Nancy J. Freeman, Kenneth D. Bishop, Vincent Mor
Journal: Journal of Clinical Oncology (2015)

e17703 Background: Many people with advanced non-curable malignancies have unrealistic expectations of palliative treatment including a belief that treatment may cure their cancer. However, qualitative data describing how patients define “cure” or other treatment goals are lacking. We initiated a pilot study to assess patient understanding of treatment goals and perceptions of communication with their oncologists. Methods: Patients with any advanced non-curable malignancy at a single institution were eligible. Enrolled patients completed three semi-structured interviews over three treatment time points. Results: We enrolled 30 patients initiating non-curative anti-cancer treatment. Ages ranged from 58 to 92 years. The most common malignancies were lung (10/30) and prostate (5/30) cancer. 28/30 (93%) reported that their doctors explained things in “a way you can understand” and provided “as much information as you want.” However, despite explicit discussion that treatment was not curative, only 53% accurately reported that treatment was “not at all likely” to cure their cancer; 40% reported some chance of cure; and 7% weren’t sure after their first visit. Patient-reported definitions of “cure” included “make it go away,” “no further symptoms,”and “less pain.” Of those who reported a chance of cure, about half defined cure as eradication but half used palliative terms instead. Overall, 80% reported that treatment was “very” or “somewhat” likely to help them live longer. Given the heterogeneity of diagnoses, some differences in likelihood or length of survival benefit were expected, however, patient-reported definitions ranged widely from “wake up the next morning” to “20 more years” to “live to 105.” Patients’ perceptions of cure and living longer were generally stable over time, although there was some fluctuation over subsequent visits. Conclusions: Although the vast majority of patients reported good communication with their oncologists, many still reported unrealistic expectations after multiple visits. Patient-reported definitions of “cure” and other treatment goals varied widely. These results suggest the need for improved patient-physician communication to ensure that patients fully understand the goals of their palliative treatments.
Doctors at India’s top hospital call for new inquiry into woman’s death after resident is sacked
Authors: Sumi S Dutta
Journal: BMJ (2017)

Doctors from the All India Institute of Medical Sciences (AIIMS) in New Delhi have called for a fresh inquiry into the death of a patient during a Caesarean section, after a senior anaesthesiologist was sacked for alleged “wilful absence” from duty.

Faculty members and resident doctors at AIIMS, India’s top teaching and referral hospital, are angry at what they view as an attempt by the hospital to gloss over deficiencies in operating theatres and inadequate supervision by placing blame on resident doctors.

At least 28 of the anaesthesiology department’s 39 faculty members have signed a letter to the director in which they accuse the panel investigating the woman’s death of “undue bias” in its focus on the senior anaesthesiologist’s absence during the operation. Together with the Resident Doctors Association they have called …