tbuckley/cabot-search huggingface dataset:
THU0553 Tnf-inhibitor and leflunomide combination therapy in polyarticular juvenile idiopathic arthritis in clinical practice – lessons from the german biologics jia registry (BIKER)
Authors: M. Napp, G. Horneff
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Leflunomide has been shown to be a safe and effective therapy for adult rheumatoid arthritis. <h3>Objectives</h3> Safety and efficacy of combination of TNF inhibitors with leflunomide versus methotrexate for treatment of polyarticular-course juvenile idiopathic arthritis (pcJIA) were assessed in the prospective BIKER registry 2000–2016. <h3>Methods</h3> 3 cohorts of pcJIA patients ageing 3–17 years were analysed: Patients receiving leflunomide starting a TNF inhibitor,<sup>1</sup> a TNF inhibitor starting leflunomide,<sup>2</sup> methotrexate starting a TNF inhibitor.<sup>3</sup> Efficacy was determined using the JADAS response criteria, JADAS-10 minimal disease activiy (MDA) and remission. Safety assessments were based on adverse events reports from the responsible physician. <h3>Results</h3> We identified 94 patients treated with Leflunomid-TNF-inhibitor in combination. 44 started a TNF-inhibitor on background Leflunomide, 50 started Leflunomide on background TNF inhibitor. 1361 patients starting a TNF-inhibitor on background Methotrexate served as control group. Differences in patients’ chararteristics at baseline limit direct comparison. Patients of cohort 3 had higher CRP, patients of cohort 2, already treated with a biologic, had lower disease activity parameters such as mean active joint count, physician and patient global disease activity judgement and JADAS10. At month 6, upon MTX +TNFi 54.6%/41.7%/19.6% and upon LEF +TNFi 35.0%/36.2%/13.8% reached JADAS improvement/JADAs minimal disease activity/JADAS remission. Thus significantly more patients with MTX +TNFi reached JADAS improvement (OR 2.22 [1.44–3.44]; p&lt;0.001) while there comparable rates of patients reached JADAS-MDA and JADAS-remission. In the LEF cohorts, there were 95 adverse events in 54 patients (58%) compared to 1845 events in 626 (46%) on MTX (OR 1.6 [1.0–12.4] p=0.031). No differences were noted for the number of infections, nausea or elevated transaminases. <h3>Conclusions</h3> Combination with both leflunomide and methotrexate to treatment with TNF-inhibitors resulted in clinically meaningful improvements with a comparable rate of patients reaching JADAS-MDA and JADAS-remission at month 6 of treatment. Leflunomide turned out to be a well-tolerated alternative to methotrexate for polyarticular JIA. <h3>Disclosure of Interest</h3> None declared
Fractional Flow Reserve Versus Angiographically-Guided Coronary Artery Bypass Grafting
Authors: Anne Langhoff Thuesen, Lars Peter Riber, Karsten Tange Veien, Evald Høj Christiansen, Svend Eggert Jensen, Ivy Modrau, Jan Jesper Andreasen, Anders Junker, Poul Erik Mortensen, Lisette Okkels Jensen
Journal: Journal of the American College of Cardiology (2018)
Polypharmacy and medication costs at end of life among commercially insured adults age 65 and older with cancer.
Authors: Cara L. McDermott, Catherine R. Fedorenko, Qin Sun, J. Randall Curtis, Karma L. Kreizenbeck, Ted Conklin, Bruce Smith, Gary H. Lyman, Scott David Ramsey
Journal: Journal of Clinical Oncology (2018)

65 Background: Polypharmacy, or the concurrent use of multiple medications, may expose patients to drug-drug interactions and excessive costs. There are limited data on polypharmacy for commercially insured older adults, primarily Medicare Advantage patients, that may have better access to medication management services than Medicare fee-for-service patients. We characterized medication use and out-of-pocket (OOP) medication costs in the last month of life among patients age 65+ who did not enroll in hospice to examine medication use in this population. Methods: We linked enrollment and claims records from two regional commercial insurers to Surveillance, Epidemiology, and End Results (SEER) Cancer Surveillance System and Washington State Cancer Registry records for patients diagnosed with a stage IV malignancy in Washington State between January 1, 2007-December 31, 2016. We calculated OOP costs as the difference between allowed and paid claim amounts and adjusted OOP costs (aOOP) for inflation to 2017 dollars. Results: Among 345 patients with medication claims in their last month, 156 (45%) had a chemotherapy claim. Average age was 74 years (range 65-95), 55% (n = 190) were male, and 150 had lung cancer (44%). Patients averaged 7.7 medication claims (range 1-50); 151 (44%) had 1-4, 99 (29%) had 5-9, and 95 (27%) had 10+. Common symptom-related medications were opioids, benzodiazepines, anti-emetics. Chemotherapy was associated with higher odds of 10+ prescriptions (OR 1.38, 95% CI 1.26-1.51). Excluding four patients with aOOP chemotherapy costs &gt; $14,000, average aOOP costs were $101 for chemotherapy claims (range $0-$8957) and $33 for non-chemotherapy claims ($0-$1993). Costs for those in the highest quartile ranged from $320-$8957 for chemotherapy claims and $100-1993 for non-chemotherapy claims. Conclusions: Most subjects had at least five medication claims in their last 30 days. One-quarter had 10+ claims, which was associated with chemotherapy receipt. Hospice enrollment could reduce OOP costs, as hospice provides symptom-related medications. Interventions facilitating hospice enrollment and reducing chemotherapy use may minimize polypharmacy and cost burden for patients and families.
The integrated care service: Impact of a multidisciplinary supportive care service for medical oncology patients in a NCI-designated cancer center.
Authors: Finly Zachariah, Denise Morse, Lucia Kinsey, Marianna Koczywas, Ravi Salgia, Sara Caiazza, Austin Thornhill, Matthew J. Loscalzo, Natalie Schnaitmann, Terry Irish, Jill Prudhomme-Hunter, Dung Banh, Stefanie Mooney, Chandana Banerjee, Purvi Patel, Sorin Buga, Susan Brown, Brenda Thomson, Vijay Trisal, William Dale
Journal: Journal of Clinical Oncology (2018)

134 Background: Palliative care (PC) has shown benefits to inpatient length of stay (LOS), symptom burden reduction, utilization decrease, and time on hospice. It has shown less impact on the rate of hospice referrals. We assessed the impact of an integrated care model on these outcomes. Methods: From Jan-July, 2018, the Department of Supportive Care Medicine collaborated with medical oncology (med onc), nursing and administration to create the Integrated Care Service (ICS). Multi-disciplinary rounds include med onc, supportive care (PC, social work, spiritual care, psychiatry, psychology, hospice liaison), nursing, case management, nutrition, and physical and occupational therapy. The admission criteria include: 1) Later-stage disease; 2) Non-curative intent therapy; 3) High distress burden; and 4) Poor prognosis. The ICS was designed to have geographic co-location, morning PC and med onc rounds, multidisciplinary rounds, and post-acute management. The ICS was compared with other med onc patients (non-ICS) and Mantel-Haenszel Chi-Square statistical significance (p&lt;0.05) was calculated using Epi Info StatCalc. Results: In 6 months, 190 med onc patients (pts) were admitted to ICS versus 537 non-ICS pts. Compared with non-ICS, the ICS pts had a higher Case Mix Index (1.81 vs. 1.56) and metastatic disease incidence (95% vs. 78%, p=0.008). Discharge to hospice was higher from ICS versus non-ICS (23% vs. 7%, p=&lt;0.001), and average time on hospice increased from 9 to 15 days. No chemotherapy was given in the last two weeks of life to any pts on ICS (0 vs. 6 non-ICS pts). Length of stay (LOS) was higher on ICS as compared to non-ICS (8.45 vs. 5.26 days) and readmission rates were similar (12% vs. 13%). Conclusions: For medical oncology pts in a comprehensive cancer center, the ICS, an integrated, multidisciplinary supportive care service, significantly improved discharge rates to hospice, increased LOS on hospice by almost a week, avoided patients receiving chemotherapy, and maintained similar readmission rates. LOS was higher for complex ICS patients as compared to non-ICS. Based on this pilot, the ICS is planning for expansion to include hematology and surgical services.
Pembrolizumab in Combination With Erlotinib or Gefitinib as First-Line Therapy for Advanced NSCLC With Sensitizing EGFR Mutation
Authors: James Chih-Hsin Yang, Shirish M. Gadgeel, Lecia VanDam Sequist, Chien-Liang Wu, Vassiliki A. Papadimitrakopoulou, Wu-Chou Su, Joseph Fiore, Sanatan Saraf, Harry Raftopoulos, Amita Patnaik
Journal: Journal of Thoracic Oncology (2018)
Carfilzomib, Pomalidomide and Dexamethasone (KPd) in Patients with Multiple Myeloma Refractory to Bortezomib and Lenalidomide. the EMN011 Trial
Authors: Pieter Sonneveld, Sonja Zweegman, Michele Cavo, Kazem Nasserinejad, Rosella Troia, Ludek Pour, Sandra Croockewit, Paolo Corradini, Francesca Patriarca, Kalung Wu, Jolanda Droogendijk, Annemiek Broyl, Monique C Minnema, Bruno Costa, Karim Saad Iskander, Mario Boccadoro
Journal: Blood (2018)
OWE-006 Should we be using the shock index to assess patients presenting with upper GI bleeding?
Authors: Clare Blackwell, Stig B Laursen, Loren Laine, Harry Dalton, Jing Ngu, Michael Schultz, Rebecca Norton, Adrian J Stanley
Journal: Endoscopy (2018)

<h3>Introduction</h3> Upper GI bleeding (UGIB) is a common cause of hospitalisation. The admission Rockall (ARS), Glasgow-Blatchford (GBS) and AIMS65 scores are validated pre-endoscopy risk assessment tools. The UK NCEPOD report into UGIB used Shock Index (SI=pulse/systolic blood pressure) to assess risk of poor outcome. However existing data on SI are mostly from trauma settings. The limited data in UGIB suggest SI&gt;0.7, or SI&gt;1 may predict need for endoscopic therapy or mortality. Our aim was to assess the accuracy of SI to predict clinical outcomes after UGIB. <h3>Methods</h3> We collected demographic, clinical and laboratory data on consecutive patients admitted to six large hospitals across the UK, USA, Denmark, Singapore, and New Zealand over 12 months. We compared the SI, ARS, GBS, AIMS65 and the new international bleeding risk score (IBRS) in their ability to predict need for endoscopic therapy, need for major transfusion (≥4 units PRBCs) and death. We also assessed score thresholds for identifying patients at low or high risk of death, and whether adding the SI as a parameter to the IBRS improved its predictive accuracy. <h3>Results</h3> 3012 patients (mean age 65 years; 58% men) were studied. 574 (19%) required endoscopic therapy and 396 (13.3%) needed major transfusion. 30 day mortality was 7%. This table compares AUROCs of the scoring systems for predicting outcomes. For predicting need for endoscopic therapy or major transfusion, SI had lower accuracy than GBS and IBRS, but similar to AIMS65 and ARS. In contrast to SI≥1, GBS ≥7 correctly identified the majority of patients needing endoscopic therapy (80% vs 21%; p&lt;0.001). For predicting 30 day mortality, SI had lower AUROC than all other scores. GBS ≤1 was superior to SI&lt;0.7 at predicting low-risk of death (mortality rate 0.35% vs 5.2%; p&lt;0.001). Patients with S≥I1 had lower mortality than those with IBRS ≥8 (15.3% vs 34.1%; p&lt;0.001) and IBRS correctly identified a greater proportion of those who died as being high risk (49% vs 28%; p&lt;0.001). Adding SI to the IBRS did not improve its predictive accuracy (AUROC 0.864 vs 0.863). <h3>Conclusions</h3> Existing pre-endoscopy risk scores are superior to the SI in predicting need for endoscopic therapy, major transfusion or mortality after UGIB. Most patients who reach these important clinical endpoints are classified as low risk by SI.
Normal Weight Adiposity and Postmenopausal Breast Cancer Risk
Authors: Isabel Pimentel, Ana Elisa Lohmann, Pamela J. Goodwin
Journal: JAMA Oncology (2018)

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Optimizing the use of a nutrition screening tool for oncology patients.
Authors: Carol Parrales, Maritza Cardena Alencar, Jessica MacIntyre, Chinny Trivedi, Patricia Araujo
Journal: Journal of Clinical Oncology (2018)

101 Background: Oncology infusion centers play a crucial role in detection of malnutrition. In one month, the Sylvester Comprehensive Cancer Center chemotherapy infusion center in Miami (SCCC CTU) treats over 400 oncology patients. Research shows that 40-80% of patients with a cancer diagnosis are malnourished (Isenring et al., 2006). In April, 1.89% of patients seen at the Miami CTU were referred to an oncology nutritionist. The goal was to increase the percentage of patients referred by 2% by June through adequate screening and referral. Methods: SCCC Miami CTU nursing staff’s knowledge on the use of the Malnutrition Screening Tool (MST) and the referral process were assessed through a survey. The survey also functioned as an educational instrument. Additionally, one-on-one discussions about the referral process were conducted with the SCCC CTU nurse practitioners. Results: The survey was available to CTU RNs with a 35% completion rate. Results portrayed that 82.35% were aware of the MST screening tool; however, 88.25% were unaware of the appropriate code to refer patients to nutritionist. Therefore, if nutritional consults were placed, it was unlikely that the nutritionist would receive the request. Identified obstacles included having to call a provider to initiate a consult, lack of time for proper assessment and the availability of a nutritionist. Conclusions: Although results did not yield a significant increase of referrals through the use of the appropriate code, there was a 1.22% increase on the overall referrals placed. Lack of training and knowledge on the MST, improper use of the referral code, and the intricacy of the workflow, were contributing factors to the inadequacy in screening and referral process. Participation of all staff in education initiatives and interventions should be a vital component in improving quality care of oncology patients. [Table: see text]
Exacerbation Patterns in Adults with Asthma in England. A Population-based Study
Authors: Chloe I. Bloom, Thomas Palmer, Johanna Feary, Jennifer K. Quint, Paul Cullinan
Journal: American Journal of Respiratory and Critical Care Medicine (2018)

Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease.To describe exacerbation patterns over a prolonged follow-up in a population that includes patients of all disease severity.We used electronic health care records to identify patients with asthma aged 18-55 years and their exacerbations from 2007 to 2015. A cohort with greater than or equal to 7 years of data was used to describe exacerbation patterns by asthma severity defined by medication use. Effect estimates for risk factors were calculated for sporadic (single year of exacerbations) and recurrent (>1 yr) exacerbation patterns, using logistic regression. In a nested case-control design, the association between a history of exacerbations, spanning 5 years, and a future exacerbation was examined.A total of 51,462 patients were eligible for the 7-year cohort; 64% had no exacerbations. Of those who exacerbated, 51% did so only once; exacerbation frequency increased with disease severity. Only 370 patients (0.7%) were characterized by a frequent-exacerbator phenotype (yearly exacerbations), of whom 58% had mild/moderate asthma. Exacerbation risk factors were not uniquely associated with a particular exacerbation pattern. A past exacerbation increased the risk of a future exacerbation more than all other factors, although this effect dissipated over 5 years.During 7 years of follow-up, exacerbations occur in around one-third of patients. Of those who exacerbate, half do not do so again; the timing of future exacerbations is largely unpredictable. Just 2% exhibit a frequent-exacerbator phenotype. Past exacerbation patterns are the most informative risk factor for predicting future exacerbations.
Supportive care in cancer: Impact of marital status on outcome of end-stage head and neck cancer.
Authors: Matthew C Simpson, Aleksandr R Bukatko, Allison P Knewitz, Connor L Donovan, Eric Adjei Boakye, Nosayaba Osazuwa-Peters
Journal: Journal of Clinical Oncology (2018)

18 Background: The impact of marital status on cancer survival, including head and neck cancer (HNC), has been previously described. However, no previous study has shown whether being married impacts head and neck cancer patients with end-stage disease. The objective of this study was to determine the impact of marital status on survival of patients with stage IVc HNC. Methods: Patients ≥18 years from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with end-stage (AJCC stage IVc) head and neck squamous cell carcinoma from 2007-2015 ( n=2,886) were included. Kaplan-Meier survival estimated crude survival differences stratified by marital status (married/partnered, never married, divorced/separated, widowed) using log-rank test, and in-between differences were determined using Bonferroni adjustments. Competing risks proportional hazards model determined the effect of marital status on death from HNC while controlling for covariates (age, year of diagnosis, county-level poverty percentage, sex, race/ethnicity, insurance, anatomic subsite, and treatment modality). Results: Patients were predominantly male (81%) and white (65%), with mean age of 62 years. Median overall survival for the cohort was 11 months. The Kaplan-Meier curves indicated at the end of follow-up that divorced/separated (HNSCC-specific survival percentage=13%), never married (8%), and widowed patients (12%) had significantly lower survival than married/partnered patients (20%) (Bonferroni p&lt;0.01). After adjusting for covariates, the proportional hazards model indicated that divorced/separated (aHR=1.16, 95% CI 1.01, 1.33), never married (aHR=1.20, 95% CI 1.07, 1.36), and widowed patients (aHR=1.23, 95% CI 1.02, 1.48) were significantly more likely to die from HNSCC than married/partnered patients. Conclusions: Married patients with HNC enjoy better survival outcomes than those unmarried, and those widowed and divorced have worse outcomes. This study illustrates that supportive care, in the form of being married, impacts patients, including those with end-stage disease.
Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England
Authors: Zoë C. Venables, Philippe Autier, Tamar Nijsten, Kwok F. Wong, Sinéad M. Langan, Brian Rous, John Broggio, Catherine Harwood, Katherine Henson, Charlotte M. Proby, Jem Rashbass, Irene M. Leigh
Journal: JAMA Dermatology (2018)

<h3>Importance</h3> Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer with metastatic potential, but epidemiologic data are poor. Changes to the National Cancer Registration and Analysis Service (NCRAS) in England have allowed more accurate data analysis of primary and metastatic cSCC since 2013. <h3>Objective</h3> To assess the national incidence of cSCC and metastatic cSCC (mcSCC) in England from 2013 through 2015. <h3>Design, Setting, and Participants</h3> This national population-based study identified a cohort of patients with cSCC and mcSCC in England from January 1, 2013, through December 31, 2015. Patients were identified using diagnostic codes derived from pathology reports in the NCRAS. Data were analyzed from March 1, 2017, through March 1, 2018. <h3>Main Outcomes and Measures</h3> Incidence rates across sex and risk factors for cSCC were derived from the NCRAS data. Risk of occurrence of mcSCC among the population with cSCC was assessed with Cox proportional hazards regression analysis to determine indicators of mcSCC. <h3>Results</h3> Among the 76 977 patients with first primary cSCC in 2013 through 2015 (62.7% male; median age, 80 years [interquartile range, 72-86 years]), the age-standardized rates for the first registered cSCC in England from 2013 through 2015 were 77.3 per 100 000 person-years (PY) (95% CI, 76.6-78.0) in male patients and 34.1 per 100 000 PY (95% CI, 33.7-34.5) in female patients. Increased primary cSCC tumor count was observed in older, white male patients in lower deprivation quintiles. After a maximum follow-up of 36 months, cumulative incidence of mcSCC developed in 1.1% of women and 2.4% of men with a primary cSCC. Significant increases in the risk of metastasis with adjusted hazard rates of approximately 2.00 were observed in patients who were aged 80 to 89 years (hazard ratio [HR], 1.23; 95% CI, 1.07-1.43), 90 years or older (HR, 1.35; 95% CI, 1.09-1.66), male (HR, 1.79; 95% CI, 1.52-2.10), immunosuppressed (HR, 1.99; 95% CI, 1.64-2.42), and in higher deprivation quintiles (HR for highest quintile, 1.64; 95% CI, 1.35-2.00). Primary cSCC located on the ear (HR, 1.70; 95% CI, 1.42-2.03) and lip (HR, 1.85; 95% CI, 1.29-2.63) were at highest risk of metastasis. <h3>Conclusions and Relevance</h3> This study presents the first national study of the incidence of mcSCC. With limited health care resources and an aging population, accurate epidemiologic data are essential for informing future health care planning, identifying high-risk patients, and evaluating skin cancer prevention policies.
Abstract 11798: The Nitric Oxide-Donor MPC-1011 Stimulates Angiogenesis and Arteriogenesis and Improves Hindlimb Ischemia via a cGMP-dependent Pathway Involving VEGF and SDF-1 Alpha
Authors: Branko Simic, Brigida Gomes de Almeida Schirmer, Margot Crucet, Simona Stivala, Goran Vucicevic, Luciola da Silva Barcelos, Paul M Vanhoutte, Giovanni Pellegrini, Giovanni Camici, Petra Seebeck, Svende Pfundstein, Sokrates Stein, Francesco Paneni, Thomas F Lüscher
Journal: Circulation (2017)

Introduction: Peripheral arterial disease (PAD) is an important cause of morbidity and mortality with little effective treatment currently available. Occlusive atherosclerosis in lower limbs occurs...