tbuckley/cabot-search huggingface dataset:
Measuring palliative and end-of-life care for cancer patients who die in hospital in Canada.
Authors: Kristen Decaria, Deborah Dudgeon, Esther Green, Raquel Shaw Moxam, Rami Rahal, Jin Niu, Corinne Daly, Heather E. Bryant
Journal: Journal of Clinical Oncology (2017)

58 Background: High acute hospital utilization rates near end-of-life can signal that community-based palliative care may not be suiting patients’ needs. Early integration of comprehensive palliative care can greatly reduce unplanned visits to the emergency department, reduce multiple admissions to hospital, shorten hospital stays, and increase the number of home deaths as well as improving the quality of life of advanced cancer patients. This analysis reports on indicators that describe the current landscape of acute-care hospital utilization at end-of-life and indirectly examines access to palliative care in patients who died of cancer in a hospital. Methods: Data were provided by the Canadian Institute for Health Information. The Discharge Abstract Database was used to extract acute-care cancer death abstracts. Data on ICU admissions include only facilities that report ICU data. Emergency department visit data were obtained from the National Ambulatory Care Reporting System. The analysis was restricted to adults aged 18+ who died in an acute-care hospital in fiscal years 2014/15 and 2015/16 for nine provinces and three territories. Results: A total of 48,987 (43%) cancer patient deaths occurred in an acute-care hospitals, with 70% admitted through the emergency department. Preliminary analysis revealed interprovincial variation in the cumulative length of stay in hospital 6 months prior to death from a median stay of 17 to 25 days. Some variation was also seen in the proportion of patients admitted to hospital two or more times in the last month of life (ranging from 18% to 33%), and the proportion of cancer patients admitted to ICU in the last 14 days of life (ranging from 15% to 6%). Patient demographics (age, sex, place of residence) and clinical factors (cancer type) were often predictors of hospital utilization at end-of-life. Conclusions: This study provides information on the current landscape of acute-care hospital utilization by cancer patients at end-of-life across Canada and identifies interprovincial variations in management of end-of-life care. An area of focus for the Palliative and End-of-Life National Network continue to be developing nationally agreed upon system-wide palliative care indicators.
A brief educational intervention to increase communication about complementary and alternative medicine (CAM) in community oncology settings.
Authors: Lorenzo Cohen, Diana Urbauer, Michael Fisch, Bryan Fellman, Holly Hough, Jessica Miller, Victor J. Lanzotti, Mindy Whisnant, Matthias Weiss, Lori Fellenz, Martin J. Bury, Patricia Kokx, Kathleen T. Finn, Maureen Daily, Patricia A. Parker
Journal: Journal of Clinical Oncology (2012)

6054 Background: The widespread use of CAM in academic oncology settings has been well documented. However, there is a lack of communication between patients and health care professionals on CAM that may have negative health consequences. No comprehensive study of CAM use in community oncology settings exists. We examined the benefits of a brief educational intervention on nurse discussions of CAM with patients. Methods: A multi-site, randomized trial of an educational intervention (brief video, resource list) designed to encourage oncology nurses to discuss CAM use with their patients was conducted within the MD Anderson CCOP network. Nurses (N=175) and patients (baseline N=699 and different set of patients after intervention N=650) completed questions about CAM use, communication, and knowledge. Results: Nurses were 97% female, 96% non-Hispanic white. Two months after the intervention, nurses in the intervention group reported that they were more likely to ask about CAM use than those in the control group (OR=4.2; p&lt;.005) and asked more of their last 5 patients about CAM use (p=.003). No significant intervention effect was found for the proportion of patients in the clinic who indicated they were asked about CAM use after the intervention (OR=1.6, p&gt;.10). Approximately 40% of patients reported using CAM following their cancer diagnosis yet the majority of nurses estimated less than 25% of their patients used CAM. Conclusions: CAM use in community-based oncology patients is high and there is an underestimation of use by the oncology nurses. This very brief intervention significantly improved how often nurses reported asking patients about their CAM use. However, the patients of the nurses did not reflect this change in communication. Additional types of interventions are needed to increase communication between patients and nurses.
Adverse event reporting in surgical trials and early phase studies: the need for new and joint perspectives
Authors: Kerry N L Avery, Sara T Brookes, Hollie Richards, Shelley Potter, Ashley Blom, Rob Hinchcliffe, Jane M Blazeby
Journal: BMJ (2017)

We support the consensus recommendations from Lineberry and colleagues for improving the credibility and transparency of the reporting of adverse events in publications of research sponsored by industry.1

We also support a similar process for the development of standards and consensus for the reporting of benefit and harm outcomes in surgical trials, including early phase surgical studies. Recent reviews have …
Body Iron Stores and the Gender Gap in Risk of Incident Myocardial Infarction—Reply
Authors: Grethe Albrektsen, Kaare Harald Bønaa
Journal: JAMA Internal Medicine (2017)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Abstract P344: Tipped-wage Work is Associated With Greater Perceived Stress in US Women
Authors: Sarah B Andrea, Janne Boone-Heinonen, Lynne C Messer
Journal: Circulation (2017)

Background: Low income and income volatility are risk factors for stress and stress-induced illnesses such as hypertension. Subminimum wage, ranging from $2.13 to $7.82 in 43 states, applies to certain service occupations such as wait staff. The implicit assumption behind this law is that, combined with tips, subminimum wage ensures earnings equal to or greater than the minimum wage. However, tips are unpredictable and vary based on shift, day of week, season, and fluctuations in the economy. Women make up 67% of the tipped-wage workforce. We tested the hypothesis that women in tipped-wage occupations experience greater perceived stress and hypertension relative to women in non-tipped service occupations and non-tipped non-service occupations. Methods: We used data from the National Longitudinal Study of Adolescent to Adult Health (Wave IV, 2007-2008; age 24-33 years; n=3,562). In multivariable ordinal logistic regression, perceived stress tertiles (Cohen’s Perceived Stress Scale score: 0-3, 4-6, and 7-16) and hypertension (Normotensive, Stage 1, and Stage 2 relative to 7 th Report of the Joint National Committee standards) were modeled as a function of self-reported occupation type (US Bureau of Labor Statistics categories, classified as tipped-wage, non-tipped service, and non-tipped non-service). Models were adjusted for early life and adolescent confounders, such as parental socioeconomic status (SES) and experiences of maltreatment. Results: On average, women in non-service non-tipped occupations were from higher SES families and were themselves more educated than tipped and non-tipped service workers. Women in tipped and non-tipped service occupations were similar, with non-tipped workers coming from slightly lower SES families. For women in tipped-wage occupations, the odds of being in a higher perceived stress score tertile were 54% greater than women in non-tipped service occupations (OR: 1.54; 95%CI: 1.08,2.19) and 65% greater when compared to women in non-tipped non-service occupations (OR: 1.65; 1.21,2.26). The odds of having a higher hypertensive stage among tipped-wage workers were 45% lower than women in non-tipped service occupations (OR: 0.55; 95%CI: 0.32,0.94) but were similar to women in non-tipped non-service occupations (OR: 0.72; 95%CI: 0.43,1.21). Conclusions: In a nationally representative sample of women, working in a tipped-wage service occupation was associated with greater perceived stress, even when compared to other service occupations that similarly offer low wages with limited job control and employ women from relatively similar backgrounds. The negative association between tipped-wage occupations and hypertension may reflect selectivity related to the physical demands of tipped-wage work. Our findings suggest that reliance on tips to supplement wages may exacerbate stress relative to similar work afforded a reliable minimum wage.
Pharmaceutical assistance foundations in the financing of cancer care.
Authors: Aaron Philip Mitchell
Journal: Journal of Clinical Oncology (2017)

8 Background: The rising cost of cancer drugs may make treatment unaffordable for some patients. Patients often rely on drug manufacturer-administered Pharmaceutical Assistance Programs (PAPs) to obtain drugs at reduced or no cost. The overall impact of PAPs on cancer care delivery is unknown. Methods: We identified all patients obtaining cancer drugs across an academically affiliated, integrated health system in the state of North Carolina during 2014. The proportion of patients receiving PAP assistance, and the retail value of the assistance, were quantified for each oncology drug. Cancer drugs were analyzed with respect to route of administration. Results: 215 unique patients submitted a total of 478 successful PAP requests for cancer drugs. The majority of the retail value of drugs obtained was for oral cancer drugs, particularly targeted therapies including tyrosine kinase inhibitors. Among all cancer patients who received medical treatment, 5.5% required PAP assistance, whereas 10.6% receiving an oral agent required PAP assistance (Table). The proportion receiving PAP assistance varied substantially by drug, ranging from &lt;1% of patients (e.g., carboplatin, methotrexate) to 50% of patients (e.g., ponatinib, temsirolimus). Patients obtained a total of $1,556,575 of imatinib and $1,449,633 of dasatinib, which were the two drugs with the highest aggregate retail value. 40% of PAP-utilizing patients were uninsured, 26% had Medicaid coverage, 20% had Medicare coverage, and 14% were commercially insured. Conclusions: A substantial proportion of patients with cancer receive private charitable assistance through PAPs in order to obtain standard-of-care treatments. In particular, a disproportionate share of patients treated with orally-available cancer drugs require PAP assistance. This includes patients with federal and private insurance, suggesting an inability of patients to meet cost-sharing requirements. [Table: see text]
Prospective meta-analysis of randomised trials of cyclophosphamide, methotrexate &amp; fluorouracil (CMF) vs fluorouracil, epirubicin &amp; cyclophosphamide (FEC) chemotherapy in early breast cancer
Authors: M. E. Marty, R. C. Coombes, C. Peckitt, F. R. Pérez López, A. Tres, F. Morvan, N. Tubiana-Mathieu, M. Espié, J. M. Bliss
Journal: Journal of Clinical Oncology (2004)

592 Background: Our previous study of node positive (N+) patients (Coombes: JCO 1996 14:35–45) compared FEC1/2 vs. CMF1/2 (see table below). At 4.5 years there was no difference in disease free survival (DFS), p=0.61; or overall survival (OS), p=0.31. However, subset analysis suggested that FEC2 was better than CMF2 (DFS:p=0.03;OS:p=0.02). Concurrently a study in node negative (N-) patients was conducted comparing FEC2 with CMF2. This paper updates the previous N+ study, reports N- study outcome, and a combined meta analysis (MA). Methods: Prospective MA of two international randomised trials of CMF vs. FEC chemotherapy in early breast cancer: 1) N+ premenopausal trial, 2 regime options (CMF1/FEC1, CMF2/FEC2). and 2) N- trial (CMF2/FEC2). Main endpoints are OS and DFS. Sample sizes are small by today's standards, hence the prospective MA. Results: N+ recruited 759 (180 CMF1, 180 FEC1, 199 CMF2, 200 FEC2) patients between 1984–1992, median follow-up 100 months. N- recruited 950 (477 CMF2, 473 FEC2) patients between 1990–2000, median follow-up 70 months. Median age was 44 (N+) and 48 (N-) years. Grade 3/4 toxicity (sore mouth, vomiting/nausea, diarrhoea, anorexia, alopecia) occurred twice as often with FEC (54%) than CMF (24%), p<0.001. Grade 3/4 toxicity in N+ (56%) was twice that of N- (25%) patients, p<0.001. MA hazard ratios showed that for OS, CMF was better 1.08 (95% CI 0.87 –1.35, p=0.49) but for DFS, FEC was better 0.97 (95% CI 0.82–1.16, p=0.76). Tests showed OS trial results were heterogeneous (p=0.04) with FEC1 better than CMF1 (p=0.04), and CMF2 better than FEC2 (p=0.06) for N+ but no difference for N- (p=0.87). Conclusions: MA showed no difference between the treatments in terms of OS or DFS. Individual trial results for OS were not homogeneous. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Aventis; Eli Lilly
A phase II study of irinotecan and docetaxel with concurrent radiotherapy as preoperative treatment in resectable esophageal cancer
Authors: J. A. Posey, J. Thornton, S. Russo, R. Cerfolio, M. Heslin, M. Eloubeidi
Journal: Journal of Clinical Oncology (2004)

4245 Background: Esophageal cancer, while less frequent among cancers in the U.S., it is highly lethal. In the last decade, adenocarcinoma of the esophagus has had the most rapid increase in rate among solid tumors. Patients presenting with local regional disease often succumb to systemic spread. Preoperative chemoradiotherapy followed by surgery appears to offer a survival advantage over surgery alone; however, efficacy with 5-FU/Platinum based therapy is limited partly by failure to eradicate occult disease. Docetaxel and irinotecan are newer agents that have demonstrated activity in GI malignancies. The objective of this study is to determine the response rate and safety of preoperative docetaxel and irinotecan in patients with carcinoma of the esophagus. Methods: 14 patients, 10 adeno. 4 scc, 13M/1F, 4AA, 10C with resectable esophageal cancer have been enrolled to date. Docetaxel 35 mg/m2and irinotecan 50 mg/m2 were given weekly for 3 consecutive weeks. Following a one week break, docetaxel 30mg/m2 was given weekly followed sequentially by irinotecan 45 mg/m2 for 3 weeks. Each agent was given concurrently with radiation. Results: The principal toxicities were neutropenia, wt. loss, asthenia, and nausea. Neutropenia requiring dose modification occurred in 4 of 14 patients during combination chemo alone. 2 patients required feeding tubes; one for early esophagitis. Pretreatment dysphagia resolved during induction chemo in 13 of 14 patients. 2 pCR and 3PR observed among patients who had esophagectomy. 1 pt refused surgery after cCR, 3 pt unfit post chemo/RT and 1 death unrelated to treatment, and 4 pt completing Chemo/RT. Conclusion: The treatment regimen is well tolerated. Preoperative therapy has not altered surgical complication rate or recovery. The pCR rate observed thus far is encouraging for this regimen and accrual continues to determine the true response rate and overall survival. Prophylactic filgrastim has been added to improve adherence to dose schedule. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Ortho-Biotech Novartis
Abstract 14543: Risk Factors Associated with Implantable Cardioverter-Defibrillator Infection in Medicare Beneficiaries
Authors: Muhammad Sohail, Charles Henrikson, Mary Jo Braid-Forbes, Kevin Forbes, Daniel Lerner
Journal: Circulation (2012)

Introduction: Infections of Implantable Cardioverter-defibrillators (ICD) are increasing in frequency and are associated with significant mortality and cost. Understanding patient and procedure characteristics that are associated with higher risk of ICD infection is a pre-requisite for developing effective preventive strategies. Currently there is no accurate risk-stratification tool that has been validated in a large population from diverse practice settings Objectives: To identify risk factors associated with increased odds of infection in a large patient populations receiving ICD therapy.

Methods: ICD-9-CM codes were used to screen the 2007 Inpatient Medicare Standard Analytic File and identified 64,903 admissions for ICD procedures. Regression analysis adjusting for device type, demographics, and 28 comorbidities was used to identify characteristics associated with ICD infection.

Results: The study cohort included 1,855 admissions with an ICD infection (2.86%) and 63,048 without an ICD infection. Patients with ICD infections had higher in-hospital (5.2 vs. 0.7%, P<0.001) and total longer-term mortality (28.4 vs. 15.8%, P<0.001) compared to those without ICD infection. Multivariable regression analysis found CIED infection was significantly associated with male gender (rate ratio (RR) = 1.12 [95%CI 1.01-1.25]), non-white race (RR = 1.16 [1.02-1.32]), age < 65 years (RR = 1.29 [1.10-1.50]), and 7 comorbidities including congestive heart failure (RR = 1.39 [1.27-1.53]), renal failure (RR = 1.63 [1.46-1.83]), fluid and electrolyte disorders (RR = 1.69 [1.49-1.92], coagulopathy (RR = 1.81 [1.49-2.20]), blood loss anemia (RR = 1.91 [1.28-2.84]), weight loss (RR = 3.04 [2.35-3.92]), and AIDS (RR = 2.63 [1.22-5.70]). Single or dual chamber ICDs were associated with a higher risk of infection than biventricular pacemakers with a defibrillator (RR = 1.15 [95%CI 1.04-1.26]).

Conclusions: Analysis of this large Medicare Beneficiary population, receiving ICD therapy in diverse practice settings, identified 3 demographic features and 7 ICD-9-CM-coded comorbidities that are associated with an increased risk of ICD infection.
Final results of a phase III trial of gemcitabine (G) versus PEFG regimen in stage IVA or metastatic pancreatic adenocarcinoma (PA)
Authors: M. Reni, S. Cordio, A. Passardi, M. G. Panucci, P. Passoni, C. Oliani, G. Luppi, L. Galli, R. Nicoletti, E. Villa
Journal: Journal of Clinical Oncology (2004)

4010 Background: Single agent G is the standard therapy in advanced PA, yielding 10% objective responses (OR) and 20% 1-yr overall survival (OS). PEFG regimen is active in PA (JCO 2001; 19: 2679–86) Methods: A randomized phase 3 trial compared arm A: cisplatin (P) and epirubicin (E) 40 mg/m2 on day 1, G 600 mg/m2 on days 1 and 8 and 5fluorouracil (F) as continuous infusion 200 mg/m2/day on days 1 to 28 of 4-week cycles, with arm B: G 1 g/m2 over 30 minutes given for 7 of 8 consecutive weeks in cycle 1 and for 3 of 4 weeks thereafter. Eligibility criteria included age 18–70 years and performance status (PS) >40. Arm B patients (pts) could receive PEFG at progression (PD). Due to the potential impact of salvage therapy on OS, the primary endpoint of the study was PD free survival (PFS). The sample size was calculated on the probability of being PF at 4 months (PFS4) from enrollment. Assuming a PFS4 of 35% for G and of 65% for PEFG (α .05, β.10, one sided p-test), the study was to enroll 100 pts over 3 years. PFS and OS were analyzed on an intent-to-treat basis Results: Between April 2000 and April 2003, 104 pts, stratified by center and stage, were enrolled: 5 pts were ineligible due to liver function (2 in each arm) and biliary tract cancer (1 arm B), 52 pts were allocated to arm A and 47 to arm B. Main pt characteristics were balanced (A/B): median age 62/59, PS > 70 71/74%, metastatic disease 71/70%. Two arm A pts did not receive PEFG due to death before treatment start or delivery of G alone. Actual/planned dose intensity was P/E/F/G 95/95/81/86% vs G 92%. Main per cycle grade 3–4 toxicity was (A/B): neutropenia 43/19% (p<.01), thrombocytopenia 29/2% (p<.01), anemia 4/4%, mucositis 4/3%, vomiting 2/4%, fatigue 3/4%. PEFG significantly improved PFS4 (A vs B) (60±7% vs 28±6%; log-rank p=.003), OR (20/50 or 40%, 95% CI 26–54% vs 4/48 or 8.5%, 95% CI 0.5–16.5% Fisher p<.001), and 1-yr OS (38±7% vs 22±6% log-rank p=.06). Salvage therapy was given to 54% of arm B pts and 41% of arm A pts. Time to 2nd PD was longer in arm B (p=.05) Conclusions: PEFG yielded a significantly better outcome than standard G. This is the 1st time that a combination chemotherapy has resulted superior to a single agent in advanced PA No significant financial relationships to disclose.
Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials
Authors: Michael Böhm, Helmut Schumacher, Koon K Teo, Eva M Lonn, Felix Mahfoud, Johannes F E Mann, Giuseppe Mancia, Josep Redon, Roland E Schmieder, Karen Sliwa, Michael A Weber, Bryan Williams, Salim Yusuf
Journal: The Lancet (2017)