tbuckley/cabot-search huggingface dataset:
Survivors' narratives of the value of cancer survivorship care plans and clinical services.
Authors: Guadalupe R. Palos, Megan Hebdon, Sara McComb, Richard W Wagner, Maria Alma Rodriguez
Journal: Journal of Clinical Oncology (2016)

57 Background: Providers in primary care practice can benefit from having a better understanding of cancer survivors’ perceptions of the value of survivorship treatment summaries and care plans. Our objective was to qualitatively explore survivors’ perceptions of care received in dedicated outpatient clinics for survivors of breast, genitourinary (GU), and head/neck cancers. Methods: This study was conducted from August 8, 2014 to October 2, 2014 in 3 clinics, selected on variation in infrastructure, patient populations, and disease site. A convenience sample of survivors scheduled for an appointment in these clinics was eligible. Semi-structured interviews were conducted by research staff trained in qualitative methodology. Demographic and clinical data were collected. Groups explored a) experience with care/services, b) value of care plan, service coordination and clinic operations and c) gaps/strengths in transition to clinics. Descriptive statistics were used to summarize and analyze demographic and clinical data. Discussions were transcribed verbatim with confirmation of themes among a team of researchers. Results: A total of 36 survivors, X= 62.3 (SD = 10.9) years, were interviewed. Of these 27.8% breast survivors, 38.9% head/neck, and 33.3% GU, with X= 8.33 (SD = 5.83) years since their cancer diagnosis. Of these, 80.5% were Caucasian, 8.3% Hispanic/Latino, and 5.6% Asian/Pacific Islander, and 5.6% African-American. 61.1% were male and 78.6% married or living with someone. Survivors cited concerns about inconsistency in methods used to distribute care plans to survivors, inadequate communication about the purpose of the care plan, and vague recall of receiving care plans. Survivors reported the value of receiving survivorship care were “having an awareness of what’s up the road, establishing a constant relationship with their provider and addressing gaps in care”. Conclusions: The value of offering survivorship care is supported by the narratives of these survivors. Additional training and education on effective communication about survivorship care plans may be useful to oncology specialists and primary care providers.
Reducing pain, agitation and delirium to optimize outcomes in mechanically ventilated critically ill oncology patients.
Authors: Michele Kennedy, Dana Bullick, Sharon Barniak, Joanne McGovern, Trisha Patel, Jeffrey Hoag
Journal: Journal of Clinical Oncology (2016)

233 Background: Greater than 60% of cancer patients experience chronic pain which is heightened in critical illness. Optimal pain assessment is challenging in the critically ill leading to under treatment due to sedation during mechanical ventilation (MV). The Society of Critical Care Medicine (SCCM) favors treating pain with intermittent boluses rather than continuous infusions; however,appropriate analgesic doses and means of titration are elusive leading to over sedation, prolonged ventilation, and delirium. Utilization of protocols promotes better nursing assessment of sedation-delirium scores which reduce the use of sedatives. The purpose of this study was to assess the need for a nurse driven pain-sedation protocol in ventilated oncology patients. Methods: This retrospective study included 51 mechanically ventilated oncology patients admitted between12/2013 and 6/2015. The analgesics, sedatives, dosing and duration of MV were collected. Sedative titration was evaluated relative to analgesics used by nursing staff. Results: Fentanyl was administered in 94% of patients, an average rate of 142mcg/hr (3413mcg/day) significantly higher than rates of 43mcg/hr). Midazolam was administered at an average rate of 1.25mg/hr in 57%, while 54% received propofol (15.5mcg/hr), demonstrating concurrent use of sedatives and analgesics. In 49%, sedatives were increased without prior adjustment of analgesics indicating that pain was unaddressed and undertreated. In the setting of over-sedation nursing neurological assessment was difficult and associated with prolonged duration of MV (9.7 days). Conclusions: Guidelines recommend “analgesia-first sedation” to promote use of analgesic agents over sedatives to treat pain and agitation and reduce undertreating pain. This becomes crucial in the oncology population. This study demonstrates inconsistencies with guidelines and further supports the need for a structured pain-sedation protocol to decrease over-sedation, adequately treat pain and potentially decrease delirium and prolonged MV. Subsequently, a protocol has been developed which will be implemented after education has been provided to the multidisciplinary team.
Incidence and risk factors predictive of recurrent venous thromboembolism in patients with cancer at a comprehensive cancer center.
Authors: S. Vadhan-Raj, X. Zhou, R. S. Benjamin, G. W. Gladish
Journal: Journal of Clinical Oncology (2011)

9059 Background: Patients (pts) with cancer and venous thromboembolism (VTE) are at high risk for recurrence of VTE. However, the exact incidence and risk factors are not well-known for recurrence. Methods: Medical records of all pts with VTE, confirmed by radiological studies, during one year period (2006) were reviewed for the type of VTE, the incidence of recurrence during one-year from the primary event, and the baseline risk factors for recurrent VTE, including demographics, history of VTE, erythropoiesis-stimulating agents, transfusions, blood counts, BUN/creatinine, and D-dimer. Univariate and multivariate Cox models were built to identify the risk factors for recurrent VTE. Results: 1215 episodes of VTE were diagnosed in 980 patients (532 males and 448 females); 480 DVT, 478 PE, and 22 DVT and PE. 138 of 980 pts (14.1%) had recurrent VTE during 1 year; majority of pts (99 pts, 72%) had recurrence during 3 months. We, therefore, examined risk factors for recurrence during 3 months. The recurrence rate for pts < 60 years was 13.0% (60/461) as compared to 7.5% (39/519) for those >60 years, p=0.0043. Pts with PE had higher recurrence rate than pts with DVT [12.4% (62/500) vs. 7.7% (37/480), p=0.015]. Pts with HGB >12 g/dL had higher recurrence rate than pts with < 12g/dL [13.5% (39/289) vs. 8.7% (60/691), p=0.023]. Pts with PLT counts < 25 k/uL had lower recurrence than those with > 25k/uL [3.2% (3/93) vs. 10.8% (96/887), p=0.021]. Men had higher recurrence than women [11.7% (62/532) vs. 8.3% (37/448), p=0.079]. Multivariate analysis showed that younger pts [<60 vs > 60 years, hazard ratio (HR):2.08, 95%CI: 1.36-3.19, p=0.0007), pts with PE [PE vs DVT, HR 1.82(1.18-2.81), p=0.0071], and male gender [male vs female, HR 1.56(1.02-2.40), p=0.041] were independent risk factors predictive of recurrence. Conclusions: Incidence of VTE recurrence is high among cancer pts, especially during first 3 months. Male pts, younger (<60 years) pts, and pts with PE were at significantly higher risk for recurrent VTE and may help identify high risk patients for prevention strategy for recurrence.
Reliable mite-specific IgE testing in nasal secretions by means of allergen microarray
Authors: Margot Berings, Stefania Arasi, Natalie De Ruyck, Serena Perna, Yvonne Resch, Christian Lupinek, Kuan-Wei Chen, Susanne Vrtala, Giovanni Battista Pajno, Claus Bachert, Bart N. Lambrecht, Melissa Dullaers, Rudolf Valenta, Paolo Maria Matricardi, Philippe Gevaert
Journal: Journal of Allergy and Clinical Immunology (2017)
Prevalence of fractures among men with stage IV prostate cancer (S4PC).
Authors: Abdulla M. Abdulhalim, Ebere Onukwugha, Corinne Woods, Yi Qian, Jorge Arellano, Arun Balakumaran, C. Daniel Mullins, Arif Hussain
Journal: Journal of Clinical Oncology (2014)

143 Background: Fractures (fx) are common in men with stage 4 prostate cancer (S4PC), resulting in significant clinical consequences, such as increased pain and decreased quality of life. The aim of this study was to estimate the prevalence of fx among men diagnosed with non-metastatic (M0) or metastatic (M1) S4PC and evaluate risk factors associated with fx. Methods: We estimated the prevalence of fx among men age 66 or older diagnosed with M0 or M1 S4PC using data from the U.S. SEER-Medicare datasets between 2000 to 2007. Men were followed through December 2009 or until they were lost to follow up. Codes indicating “pathologic fracture” or “fracture,” excluding codes suggesting accidents/falls in the 14 days prior to the fx, were used to identify fx. Results: Among 9,826 men with S4PC (M1 = 7301; M0 = 2525), 12.9% experienced a post-diagnosis fx based on the codes used. The prevalence of fx was nearly twice as high in men with M1 versus M0 S4PC (M1 = 14.7%; M0 = 7.5%). The median time from diagnosis of S4PC to first fx was five months for men with M1 S4PC versus 34 months for men with M0 S4PC. Compared to men with no fx, men who experienced fx were more likely to be older (20.3% vs. 17.8%), of white/non-Hispanic race (81.1% vs. 75.3%), have well (cancer grade 1) or moderately (cancer grade 2) differentiated tumors (48.7% vs. 41.7%), have a claim of osteoporosis (2.4% vs. 0.6%) or osteoarthritis (9.3% vs. 6.5%) in the year prior to S4PC diagnosis, and to have taken a bone mineral density (BMD) test (13.5% vs. 8.1%). All differences were significant at p&lt;0.05 level. Overall, 92% of men did not receive BMD testing at any time post diagnosis despite the fact that 67% of the men received ADT. Conclusions: In men with M1 S4PC at diagnosis, the prevalence of fx is higher and the time to fx is substantially shorter than in men with M0 S4PC at diagnosis. Furthermore, most men with S4PC do not receive BMD testing. A significant need remains to monitor bone health and treat fx, particularly among M1 S4PC patients.
The association between the transfer of emergency department boarders to inpatient hallways or off-service beds and the quality of oncology care.
Authors: Simron Singh, Maureen E. Trudeau, Kevin Robert Imrie, Ben De Mendonca, John Fralick, Matthew C. Cheung
Journal: Journal of Clinical Oncology (2012)

113 Background: Emergency department (ED) crowding is an important issue in the delivery of high-quality medical care. At our quaternary care hospital a policy was implemented to ease ED crowding by moving suitable admitted patients into inpatient hallway beds or off-service beds. This study assesses the impact of off service and hallway bed admissions on patient care and satisfaction. Methods: Retrospective and prospective data were collected from Jan 1 to Dec 31, 2011, on admissions to the oncology service via the ED. Patient care data was collected as follows: chest/abdominal exams performed at first MD visit, number of MD visits within 48 hours, time to antibiotic administration, time to complete vitals, and mean time spent in the ED. Satisfaction surveys were also given to all patients. Results: One hundred and eighteen patients were admitted to a hallway bed (HALL). A random sample of 90 patients were used for comparison in the on service (ON) and off service (OFF) groups. Among HALL patients, 4% percent discharged themselves against medical advice (0% of OFF and ON patients). MD visits within 48 hours were the same among all groups (mean=6). Forty-two percent of hallway patients had a chest/abdominal exam during the first MD visit (32% and 33% for OFF and ON patients, respectively). Time to first completion of vitals was 1:05 (hh:mm) for HALL patients (1:21 and 00:34 for OFF and ON patients, respectively). Time to antibiotic administration was 15:34 for hallway patients (23:59 and 12:35 for OFF and ON patients, respectively). More HALL patients expressed dissatisfaction with their hospital stay (16.7%) compared to OFF (0%) and ON patients (0%). Mean time for admitted patients in the ED awaiting their HALL bed was 9:14, considerably longer than for OFF patients (3:08) and ON patients (4:19). Conclusions: Admission of oncology patients in hallway or in off-service beds did not appear to compromise the timeliness or frequency of medical assessments. However, delays in nursing care (completion of vital signs and drug administration) were noted and patient satisfaction was decreased. Moreover, the policy did not meet its intent to reduce patient time spent in the ED.
Feasibility and efficacy of second-line chemotherapy at recurrence for pediatric low-grade gliomas: A comparative population-based study
Authors: K. Scheinemann, U. Bartels, A. Huang, C. Hawkins, E. Bouffet, U. Tabori
Journal: Journal of Clinical Oncology (2008)

2069 Background: Chemotherapy is widely accepted as the first-line therapy for pediatric low-grade gliomas (PLGG). Treatment modalities for further progression are controversial. Radiation therapy is still widely used, but the role for repeated chemotherapy remains unclear. The aim of the study was to determine treatment outcome for PLGG treated by chemotherapy at recurrence. Methods: The study group consisted of patients who received chemotherapy due to progression after initial chemotherapy protocol. These were compared to patients treated with chemotherapy at diagnosis, patients who received chemotherapy at third progression and to patients who received radiotherapy at recurrence. Results: From 1990–2007, 80 patients received chemotherapy as first-line treatment for PLGG. 36 received chemotherapy as second-line and 11 at further recurrence. 31 patients were treated with radiation at recurrence. There was no gender preference. Median follow-up time was 6.85 yrs. Histology revealed grade 1 astrocytoma in 73%. The most common location was optic pathway with 49%, followed by brainstem and suprasellar (14 %) and thalamic and spinal location (11 %). The most common initial protocol was vincristine and carboplatin (80%). The most common protocol at relapse was vinblastine (87%). Five-year progression-free survival (PFS) for first-line chemotherapy was 49% ± 6 compared to 41 ± 9% with second-line chemotherapy (p=0.2). For further chemotherapy PFS was comparable but so far with shorter follow-up. Five years PFS for the second-line chemotherapy and radiotherapy at recurrence group were 41 ± 9% and 78 ± 5 % respectively (p=0.003). Only 4 patients died, out of whom only 2 due to tumor progression. Conclusions: This is the first study to address the role of chemotherapy for recurrent PLGG. In contrast to other tumours chemotherapy at diagnosis as well as at first recurrence is associated with similar outcome. Nevertheless in this study radiotherapy was superior to chemotherapy. Prospective studies to assess toxicity and long-term outcome are needed. No significant financial relationships to disclose.
The value of advance care planning (ACP) in cancer critical care.
Authors: Diane G. Portman, Jeffrey E. Lancet, Hugo Francisco Fernandez
Journal: Journal of Clinical Oncology (2014)

109 Background: Findings from previous research on the effect of advance directives (ADs) on patient outcomes have been mixed and are limited in the oncology population. A palliative care project in our Cancer Center’s ICU revealed patients with long length of stay (LOS) and ICU death without ADs in place. The Center’s Bone Marrow Transplant (BMT) program has implemented a protocol to obtain ADs pre-transplant. We sought to determine the presence and effect of ADs on end-of-life cost of care (COC) and LOS in critical care patients at our Center. Methods: We compared the 2013 COC and LOS of all ICU patients to the subset of patients for whom ICU care proved futile. The presence of ADs and DNR orders for expired ICU patients were matched to their respective COC and LOS. The COC of floor and ICU care were compared to determine potential cost savings from ICU avoidance. BMT-specific data was reviewed to establish the effect of early ADs on care and LOS. Results: Floor care proved to cost on average $2,000 less per day than ICU care. Thirty-eight percent of ICU patients had ADs. Only 41% of patients who expired in the ICU had an AD. If an AD was present, it was most likely to be a Living Will (LW) with DNR. The daily COC was highest for patients without ADs and lowest for those with LWs with DNR, despite a longer LOS in the LW/DNR group. In the BMT group, AD prevalence was 83% and resulted in earlier discussions about futility and shorter LOS. Conclusions: Obtaining timely ADs with DNR is likely to result in the lowest daily COC for critical patients. The greatest savings is likely to result from early ACP and ICU avoidance. Further study is needed to understand and overcome barriers to timely ACP implementation.
Superior Outcomes with Matched Unrelated Donors Compared with One Human Leukocyte Antigen Mismatched Related Donors In Allogeneic Hematopoietic Stem Cell Transplantation
Authors: Stefan O. Ciurea, Rima M. Saliba, Gabriela Rondon, Poliana A. Patah, Fleur Aung, Borje S. Andersson, Partow Kebriaei, Uday Popat, Marcelo Fernandez-Vina, Richard E. Champlin, Marcos de Lima
Journal: Blood (2010)
Temporal trends and factors associated with receipt of systemic therapy among patients undergoing cytoreductive nephrectomy.
Authors: Marc C. Smaldone, Elizabeth Handorf, Simon Kim, Robert Houston Thompson, Brian Addis Costello, Anthony Corcoran, Yu-Ning Wong, Robert G. Uzzo, Bradley C. Leibovich, Alexander Kutikov, Stephen A. Boorjian
Journal: Journal of Clinical Oncology (2014)

503 Background: We evaluated temporal patterns in the utilization of systemic therapy among patients undergoing cytoreductive nephrectomy (CN) for metastatic Renal Cell Carcinoma (mRCC) from a large national cancer registry and assessed patient characteristics associated with receipt of systemic treatment. Methods: We reviewed the National Cancer Database to identify patients with stage IV RCC who underwent CN between 1998-2010. Systemic therapy was defined as any treatment with immunotherapy and/or chemotherapy (including targeted agents). We evaluated the association between clinicopathologic features and receipt of systemic therapy using multivariable logistic regression with generalized estimating equations, and assessed the interaction of treatment with time, stratified as immunotherapy (1998-2004) versus targeted-therapy (2005-2010) eras. Results: Of 22,409 patients with mRCC undergoing CN, 8,830 (39%) received systemic therapy. Receipt of systemic therapy increased from 32% in 1998 to 49% in 2010 (p&lt;0.001), largely due to increased utilization of chemotherapy (13.9% vs. 46.7%; p&lt;0.001). Following adjustment, increasing patient age (51-60 years: OR 0.82 [CI 0.73-0.92]; 61-70 years: OR 0.67 [CI 0.59-0.76]; ≥71 years: OR 0.36 [CI 0.31-0.43]), as well as coverage with Medicaid (OR 0.61 [CI 0.5-0.74]), Medicare (OR 0.70 [CI 0.62-0.79]), or no insurance (OR 0.75 [CI 0.63-0.91]) were associated with decreased utilization of systemic therapy. Although use of systemic therapy in the elderly (≥71 years) and in patients with Medicare/Medicaid remained lower throughout the study period, each of these cohorts was significantly more likely to receive systemic treatment in the targeted versus immunotherapy era (all p values &lt;0.05). Conclusions: Utilization of systemic therapy among patients undergoing CN has increased over time, coinciding with the introduction of targeted therapies. Nevertheless, still less than half of such patients receive systemic treatment. While the etiology for lack of treatment is likely multifactorial, the potential health policy implications of continued disparities in care warrant further investigation.
Correlation of distinctive angiogenetic profiles with clinical outcome for different treatment sequences in mRCC.
Authors: Maristella Bianconi, Mario Scartozzi, Luca Faloppi, Cristian Loretelli, Antonio Zizzi, Riccardo Giampieri, Alessandro Bittoni, Michela Del Prete, Luciano Burattini, Rodolfo Montironi, Stefano Cascinu
Journal: Journal of Clinical Oncology (2014)

474 Background: Renal cell carcinoma treatment has radically changed in recent years, revolutioning patients’ outcome. Treatment strategies comprises TKIs, mainly directed against the angiogenic pathway, and mTOR inhibitors. Patients’ response to these treatments is widely variable and the optimal sequence is still matter of debate. In our previous report VEGF and VEGFR polymorphisms showed a predictive and prognostic role in the first-line treatment with sunitinib or pazopanib. The aim of our study was to evaluate the potential predictive and prognostic role of VEGF and VEGFR polymorphisms in defining a tailored sequence for RCC patients. Methods: 97 formalin-fixed paraffin-embedded tissue blocks from mRCC patients were tested for VEGF-A, VEGF-C and VEGFR-1,2,3 single nucleotide polymorphisms (SNPs). Patients were divided into two groups of sequences TKI-mTOR and TKI-TKI. SNPs results were correlated with progression free survival (PFS) and overall survival (OS). Results: 68 patients received second line treatment, either TKI or mTOR inhibitor. Patients expressing a TT polymorphism of VEGF A rs833061 had a better PFS compared to CC+CT polymorphism patients if receiving a mTOR inhibitor; while patients receiving a TKI had a better PFS if with a CC+CT polymorphism instead of a TT polymorphism of the same SNP (p&lt;0,0001). OS analysis showed a similar correlation between polymorphism and treatment (p=0,0002). Conclusions: Our findings suggest that angiogenetic profile according to VEGF A rs833061 polymorphism may have a relevant role in selecting the most appropriate treatment sequence in mRCC patients. This selection tool would allow clinicians to improve efficacy and avoid unnecessary toxicity thus resulting in a better patients’ outcome and global quality of life.
T-shaped linear-stapled intrathoracic esophagogastric anastomosis for minimally invasive Ivor Lewis esophagectomy.
Authors: YiNan Dong
Journal: Journal of Clinical Oncology (2016)

137 Background: Linear stapler is increasingly used for the gastroesophageal anastomosis in minimally invasive esophageal cancer surgeries; however, it is more commonly used in cervical delta anastomosis, less in totally thoracoscopic Ivor Lewis esophagectomy for esophageal cancer. A standardized rapid linear stapler based gastroesophageal anastomotic technique remains to be developed. Methods: Here we report a new technique for the endoscopic gastroesophageal anastomosis that is completed just with a linear stapler (Ethicon Flex 60). In this technique, a linear stapler is first fired upward to establish the side to side anastomosis of the esophagus and stomach. This creates the anterior and posterior wall of the anastomotic site. The linear stapler is then fired along the extension line of the gastric conduit, to complete the anastomosis and at the same time resect the lesser curvature of the stomach and the esophageal cancer. Upon completion, the anastomotic plane is axial, and contains a superior edge, inferior edge, and anterior edge. Results: By the middle of September 2015, we have performed the minimally invasive Ivor Lewis esophagectomy with this anastomosis for 26 esophageal cancer patients. We are following these patients, and the longest follow up time is about 18 month and the shortest is 12 month. None of these patients has had any anastomotic bleeding, leak, or stenosis. Conclusions: This new technique is less restricted by the limited space during minimally invasive Ivor Lewis procedure. The anastomotic technique is easy to perform and appears to be reliable, safe and effective judging from our limited clinical experience up to this date.