tbuckley/cabot-search huggingface dataset:
Midlevel provider utilization within a large community oncology network.
Authors: Sabrina Q. Mikan, Melinda Madison Cody, Lori Lindsey, Patricia Carter, J. Russell Hoverman, Debra A. Patt
Journal: Journal of Clinical Oncology (2013)

282 Background: The Association of American Medical Colleges (AAMC) reports that 56% of Oncologists work with midlevel providers (MLPs). MLPs include physician assistants (PAs) and advanced practice nurses (APNs). Within our large network of community oncology practices,there are 241 MLPs (88 PAs and 153 APNs). The MLP role encompasses the continuum of care beginning with genetic risk assessment throughout treatment, health promotion teaching, survivorship management and advance care planning (ACP) services. Methods: We used an online survey to elicit self-reported proficiency in eight core health care delivery roles. A 52 item, 5-point Likert scale (novice, advanced beginner, competent, proficient, expert) survey was sent in March 2013 to all MLPs. Results: Of all MLPs (n=241) invited to participate, 103 (43.5%) responded anonymously. Over half of all MLPs reported feeling proficient in the areas of collaborating with multi-disciplinary teams to formulate a plan of care (50.4%), facilitating patient and family decision-making in treatments, symptom management and end-of-life care (53.3%), and providing information to patients and families to facilitate adherence to cancer treatments and supportive care (54.2%). Secondly, the MLPs were confident in their ability to provide proficient care in health assessment through physical exam (46.6%), disease progression signs and symptoms (44.7%), and incorporating resources that meet diverse needs of the patients into the planning and delivery of care (52.3%) areas. Finally, the areas where MLPs reported feeling less than proficient were in specialty areas such as survivorship (34.2%) and genetics (34.2%). Also noted, for 45.7% of respondents, ACP was performed only 1-20% of their time. Conclusions: Self-assessment is one form of measurement that allows the individual provider to identify their strengths and weaknesses. It is important so that educational resources can be created, tested, and shared amongst providers to continue to improve their confidence and care delivery. Ongoing work in developing strong tools for survivorship visits, advance care planning, and genetic counseling within our network, is recognized as an imperative part of advancing PA and APN skills and quality patient care.
The incidence and impact of poor nutrition in gastrointestinal malignancies.
Authors: Douglas Eric Guggenheim, Allyson J. Ocean, Elizabeta C. Popa, Amanda R Magli, Irene Karpenko, Paul J. Christos, Veronica A. Rosales, Erika Ocampo Florendo, Joseph T. Ruggiero, Manish A. Shah
Journal: Journal of Clinical Oncology (2013)

e20549 Background: The impact and significance of malnutrition in gastrointestinal oncology is understudied. The Subjective Global Assessment (SGA) is a validated clinical tool to assess nutritional status. We examined baseline SGA to determine its significance across GI malignancies. Our hypothesis is that malnutrition is prevalent in gastrointestinal malignancies and may significantly affect treatment-related morbidity. Methods: The Weill Cornell Medical Center GI registry is a prospective database to collect clinical standardized data from all patients who present for evaluation in the outpatient academic practice office. We examined baseline SGA score (A=well nourished, B=moderate malnutrition, C=severe malnutrition) in all patients newly diagnosed with a GI malignancy, and correlated with baseline patient demographics, tumor type, and dose reductions in the first 2 months of chemotherapy treatment by the chi-square test and t-test. Results: From May-Dec 2012, 101 newly diagnosed GI cancer patients referred to oncology were enrolled. 23% of patients were SGA-B/C, and significantly associated with race and albumin. Among upper GI patients with poor nutrition, 75.0% required dose reductions within the first 2 months of treatment, resulting in a mean percent dose received of 78.3 ± 19.1. Conclusions: Moderate to poor nutrition is prevalent in ~23% of patients with GI malignancies, and significantly more prevalent in upper GI and pancreatobililary cancers. Moderate malnutrition is associated with low albumin, and for upper GI patients, reduced chemotherapy delivery, suggestive of increased toxicity. [Table: see text]
CD4 Cell Count of More Than 250/Microl in the Peripheral Blood Is Associated with Improved Overall Survival in Patients with Diffuse Large B-Cell Lymphoma (DLBCL) Independent of the aaIPI
Authors: Hossein Borghaei, Mitchell Smith, Michael Millenson, Tianyu Li, Danielle Shafer, Tahseen I. Al-Saleem
Journal: Blood (2008)
Fluorescence in situ hybridization biomarkers of gastric cancer risk in intestinalized <i>Helicobacter pylori</i> pangastritis.
Authors: B. Kim, M. P. Bronner
Journal: Journal of Clinical Oncology (2011)

17 Background: H. pylori (HP) intestinalized pangastritis predisposes to gastric adenocarcinoma. Biomarkers to identify the less than 10% subset of chronic gastritis patients who will develop gastric cancer are greatly needed to focus surveillance efforts onto those patients most likely to benefit. Investigations in ulcerative colitis and Barrett's esophagus reveal that chromosomal alterations in far distant and nondysplastic mucosa are powerful cancer biomarkers. We hypothesized a similar situation in gastric tumorigenesis. Methods: The full morphologic spectrum of gastric neoplasia was examined using flow-sorted gastric epithelial cells from 10 gastric cancer resections versus 20 normal gastric control patients. Then we addressed whether we could distinguish the subset of HP intestinalized pangastritis patients who develop cancer (progressors), from those who remain neoplasia-free (nonprogressors). A single nondysplastic intestinalized gastric antral biopsy collected using chromoendoscopy on each of 41 Korean progressors with gastric cancer and 30 nonprogressors without dysplasia. Interphase FISH on whole epithelial cell preparations using 4q32-q33, 10q22.1, 18q21.2 and 19p11-q11 chromosomal arm probes was performed. Results: Increasing chromosomal alterations occurred throughout the morphologic spectrum of gastric neoplasia. Significantly increased FISH alterations for chromosomes 4q32-q33 (p = 0.016) and 10q22.1 (p = 0.028) occurred as early in the neoplastic spectrum as nondysplastic distant intestinal metaplasia. Subsequent nondysplastic antral biopsy testing of progressors versus nonprogressors revealed parallel FISH results for 4q32-q33 (p = 0.039) and 10q22.1 (p = 0.023), and 19p11-q11 (p = 0.019). Receiver operator characteristic analysis for these 3 combined probes demonstrated a sensitivity of 0.53 and specificity of 0.92 with optimal choice of thresholds. Conclusions: Interphase FISH for 4q32-q33, 10q22.1, and 19p11-q11 chromosomal probes on nondysplastic intestinalized antral mucosa shows promise as a biomarker of gastric cancer in multifocal HP intestinalized pangastritis. No significant financial relationships to disclose.
Difference in adverse-event profiles between mTOR inhibitors, temsirolimus, and everolimus for advanced renal cell carcinoma.
Authors: Masahiro Nozawa, Takashi Kikuchi, Mitsutoshi Nishimoto, Yasuyuki Kobayashi, Hirotsugu Uemura
Journal: Journal of Clinical Oncology (2013)

461 Background: Everolimus and temsirolimus have proven their efficacy and are used for patients with metastatic renal cell carcinoma (mRCC). They both are rapamycin derivatives and are categorized as mTOR inhibitors. There have been few reports that examined the difference between these two agents regarding adverse events. Our objective was to investigate the difference in the safety of both agents on the basis of our clinical experience. Methods: We identified patients with mRCC who had been treated with everolimus or temsirolimus at our hospital. Treatment duration, relative dose intensity, laboratory data, and adverse events during treatment with each agent were evaluated. Results: A total of 55 patients were evaluable. 43 of those had been treated with everolimus, 22 with temsirolimus, and 10 with both agents. There was no significant difference in age and gender between the two treatment groups. Median treatment durations of the everolimus and temsirolimus groups were 2.4 months and 1.8 months, respectively. Relative dose intensities of the everolimus and temsirolimus groups were 71.6 % and 75.4 %, respectively. Anemia, hyperglycemia, stomatitis, and interstitial lung disease (ILD) were detected with higher frequency in the everolimus group. In the everolimus group, 31 % of patients developed any grade of ILD including 15 % of grade 3, whereas ILD was reported in only one patient treated with temsirolimus with no grade 3 or higher. Frequencies of adverse events of grade 3 or higher were 49 % in the everolimus group and 26 % in the temsirolimus group. Conclusions: Adverse-event profiles of everolimus and temsirolimus may differ from each other. Respiratory disorders may occur more frequently and severely in patients treated with everolimus than temsirolimus. These findings suggest the difference in the pharmacodynamics, pharmacokinetics, and treatment regimen of these two agents may result in different adverse events even though they target the same molecule.
Increased incidence of adverse events after concomitant hepatic arterial infusion plus systemic chemotherapy and bevacizumab for colorectal cancer with liver metastasis.
Authors: S. Sadahiro, T. Suzuki, Y. Maeda, A. Tanaka, K. Okada, K. Ogoshi, A. Kamijo
Journal: Journal of Clinical Oncology (2011)

591 Background: FOLFOX+bevacizumab (BEV) is the standard systemic chemotherapy for metastatic colorectal cancer (CRC). We investigated the combination of FOLFOX4 and hepatic arterial infusion (HAI) in patients who had isolated liver metastasis from CRC. We also compared efficacy and safety between this combination therapy and its concomitant use with BEV. Methods: Twenty-five patients entered a phase I/II trial of HAI (5-FU 250 mg/d, leucovorin 25 mg/d; d1-7, q2w) combined with FOLFOX4. Fourteen other patients with a similar background received HAI + FOLFOX4 combined with BEV and the two regimens were compared. Results: In the phase I/II study, the recommended doses for FOLFOX were as follows: L-OHP, 85 mg/m 2 ; l-LV, 100 mg/m 2 ; 5-FU (bolus), 400 mg/m 2 ; and 5-FU (infusion), 600 mg/m 2 . Sixteen patients who received this regimen showed a response rate of 93.8% (2 CR and 13 PR), a median progression-free survival of 323 days, and a one-year survival rate of 93.7%. In the subsequent phase II trial of HAI + FOLFOX4 with BEV, 14 patients were enrolled and the response rate was 78.6% (2 CR and 9 PR). The outcome was inferior when BEV was used concomitantly. The median numbers of doses were 10 (range: 1-27) for FOLFOX4 and 9 (1-27) for HAI without BEV, whereas the corresponding numbers with BEV were 8 (1-12) and 2 (0-9), respectively. There was a marked decrease in the number of HAI procedures when BEV was used. Thrombosis occurred in 8 patients who received concomitant BEV, which was the most common reason for cessation of HAI. Other adverse events (≥Grade 3) were neutropenia (n=7; 43.8%) and thrombocytopenia (n=2; 12.5%) without BEV or neutropenia (n=7; 43.8%) and diarrhea (n=1; 7.1%) with BEV, and no marked difference was seen between the two regimens. Both regimens were well tolerated. Severe neuropathy was only observed in 1 patient (6.3%; Grade 3) who received concomitant BEV. Conclusions: In the present study, HAI + FOLFOX combined with BEV caused thrombosis and disturbance of wound healing, thereby increasing the incidence of complications and making it difficult to continue treatment. These findings suggest that BEV should not be administered with HAI therapy. No significant financial relationships to disclose.
Blue-light cystoscopy’s effects on management of bladder cancer when compared to traditional white-light cystoscopy.
Authors: Andrew Mount, Stephen Bentley Williams, Colin P. N. Dinney, H. Barton Grossman, Curtis Alvin Pettaway, Brian Francis Chapin, Neema Navai, Surena F. Matin, William F. Graber, Ashish M. Kamat
Journal: Journal of Clinical Oncology (2016)

378 Background: Fluorescence cystoscopy (also known as blue-light cystoscopy (BL)) is an adjunct to white light cystoscopy (WL) and aids in visualization of tumors that may be missed with WL as well as allow more complete resection of tumors. Herein we present the impact of BL on subsequent patient management in a real world setting. Methods: A total of 116 consecutive patients who underwent simultaneous BL and WL from January 2013 through December 2014 were included in the study. Pathology and operative reports were reviewed to determine the grade and stage of the tumors and whether they were viewed under BL or WL. Results: Of the 116 patients, a total of 161 biopsies and/or transurethral resected specimens were analyzed. Of these, 46 (28.6%) lesions were seen only with BL, none were seen only with white light, 109 (67.7%) were seen with both, and 7 (4.4%) were identified via random biopsies. Of the 46 lesions seen only on BL, 17 (37%) were positive for cancer, while, of the 109 lesions seen with WL and BL, 84 (77%) were positive. Of the 17 (37%) true positive tumors seen only on BL, the stage and grades were; 5 (29.4%) low-grade Ta, 2 (11.8%) high-grade Ta, 1 (5.9%) high-grade T1, and 9 (52.9%) CIS. There were no instances of a tumor being found on WL that was not also visualized with BL. In this patient cohort, the false positive rates were 23% and 63% for WL and BL, respectively. The false negative rates were 0.9% and 2.1% for WL and BL, respectively. For the 46 (28.6%) lesions that were visible by BL, WL cystoscopy was not able to visualize 10 (21.7%) tumors visualized by BL. In addition, there was one patient who had multiple lesions sent for pathology by BL and WL, and the lesions identified by BL were of higher stage than the lesions visualized by WL. Conclusions: BL identified additional tumors that would have been missed with WL. Moreover, in patients who had tumors visualized only with BL, 11 (26.8%) were high-grade, including one (2.4%) patient with T1 tumor and 8 (19.5%) with CIS. Thus, BL identified a number of high-risk tumors, which had a significant impact on the subsequent management of patients with bladder cancer.
Long Term Efficacy of Percutaneous Vertebroplasty in Multiple Myeloma (MM) Patients: Experience of the “Gruppo Ematologico Di Romagna” (GER)
Authors: Patrizia Tosi, Annalia Molinari, Michele Sintini, Anna Merli, Michela Ceccolini, Manuela Imola, Paolo Savini, Silvana Pasini, Anna M Mianulli, Barbara Castagnari, Pier P Fattori, Giovanni Martinelli, Alfonso Zaccaria
Journal: Blood (2011)
KRAS testing disparities in the state of New Mexico.
Authors: Alissa Greenbaum, Charles Wiggins, Angela W. Meisner, Manuel Rojo, Anita Kinney, Ashwani Rajput
Journal: Journal of Clinical Oncology (2016)

551 Background: ASCO guidelines published in 2009 recommend all patients with metastatic colorectal cancer (CRC) receive KRAS testing to guide anti-EGFR monoclonal antibody treatment. Recent literature examining nation-wide trends via the Surveillance, Epidemiology, and End Results (SEER) database showed New Mexico to exhibit the highest KRAS rates of testing out of 18 registries. We aim to explore disparities in KRAS testing in the state of New Mexico. Methods: The New Mexico Tumor Registry (NMTR), a population-based cancer registry participating in the SEER Program, was queried to identify all incident cases of CRC among New Mexico residents from 2010 to 2013. Chi-square tests were used to identify disparity in KRAS testing with a p-value ≤ 0.05 considered significant. Results: A total of 637 patients were diagnosed with metastatic CRC from 2010-2013. As expected, KRAS testing in Stage 4 patients presented the highest frequency (38.4%), though testing in stage 3 (8.5%), stage 2 (3.4%) and stage 1 (1.2%) was also seen. In those with metastatic disease, younger patients (ages 22-39 and 40-64 years) were more likely to receive testing than patients 65 years and older (p &lt; 0.0001). Patients living in or near a metropolitan center received KRAS testing more often than patients living in non-metro and rural areas (p = 0.016). There were no disparities in testing between male and female patients (39.1 v. 37.7%; p = 0.71) or amongst the predominant ethnic groups (p = 0.66). A small increase in the occurrence of KRAS testing was noted from 2010 to 2013 (34.2 to 42.2%); this trend approached though did not obtain significance (p = 0.07). In stage 4 patients, there were no significant differences in rates of wild-type versus mutant status when examined by age (p = 0.95), sex (p = 0.41), ethnicity (p = 0.41), by progressive years (p = 0.42) or geography (p = 0.35). Conclusions: New Mexico exhibits high rates of KRAS biomarker testing in patients with metastatic CRC. Age and geographic disparities exist in the rates of testing, while sex, ethnicity and the year tested showed no differences. Further study is required to explore the reasons for this disparity in KRAS testing, as well as to determine the motivation for testing in stage 1 through 3 CRC which is contrary to current treatment guidelines.
Validation of specific chemotherapy drugs in Medicare data.
Authors: J. L. Lund, T. Sturmer, R. S. Sandler, H. K. Sanoff, L. C. Harlan, J. L. Warren
Journal: Journal of Clinical Oncology (2011)

6012 Background: Large health care databases are increasingly used for comparative effectiveness research (CER). Yet the ability to correctly identify new cancer treatments using claims data is largely unknown. Methods: We assessed the validity of Medicare claims to identify the receipt of any chemotherapy and specific drugs delivered to patients diagnosed at age ≥65 with stage II or III colorectal cancer (CRC) in 2000 (n=187) or 2005 (n=360) or all stages of non-small cell lung cancer (NSCLC) in 2005 (n=275). Data on chemotherapy administration and specific drugs were collected by the National Cancer Institute’s Patterns of Care studies (POC), which verified treatment through physician contact and medical record abstraction. Patients’ POC data (the study gold standard) were linked and compared to their Medicare claims for the year following diagnosis. Kappa, sensitivity (se), specificity (sp), positive predictive value, negative predictive value and 95% confidence intervals were calculated for the receipt of any chemotherapy and specific drugs. Results: Kappa, se, and sp for any chemotherapy and all intravenous drugs using 6 months of claims post-diagnosis were high (Table). However, Medicare claims poorly identified capecitabine, an oral equivalent to 5-fluorouracil, with a false-negative rate over 50%. Conclusions: Among patients diagnosed with CRC and NSCLC, receipt of chemotherapy and specific drugs administered intravenously can be accurately identified using Medicare claims. These data may be a valuable resource for cancer-related CER; however, their ability to capture oral chemotherapies requires further evaluation. Sensitivity (se), specificity (sp), and 95% confidence intervals (CI) of chemotherapy identified by 6 months of Medicare claims data by cancer site and diagnosis year. Site/year Treatment Se (%) (95% CI) Sp (%) (95% CI) Colorectal (2000) Any chemotherapy 88 (82, 95) 89 (81, 97) 5-fluorouracil 86 (79, 93) 91 (83, 98) Colorectal (2005) Any chemotherapy 87 (92, 92) 94 (90, 98) 5-fluorouracil 88 (83, 94) 94 (91, 97) Oxaliplatin 75 (64, 85) 97 (94, 99) Capecitabine 48 (34, 62) 98 (97, 100) Non-small cell lung (2005) Any chemotherapy 92 (86, 97) 95 (91, 99) Carboplatin 95 (90, 100) 99 (97, 100) Paclitaxel 90 (82, 97) 98 (96, 100)
Prognostic factors in newly diagnosed glioblastoma: Have we missed gender?
Authors: E. Franceschi, A. Tosoni, S. Bartolini, L. Scopece, L. Lombardo, R. Poggi, V. Mazzocchi, L. La Torre, M. Ermani, A. A. Brandes
Journal: Journal of Clinical Oncology (2011)

2058 Background: Following the EORTC/NCIC trial investigating temozolomide concurrent and adjuvant to radiotherapy, this regimen is considered standard treatment for newly diagnosed glioblastoma (GBM). However, although some studies report a marked difference between the incidence of grade 3/4 neutropenia in males and females, the role of gender as a prognostic factor has not yet been evaluated. Methods: We analyzed the charts of all patients with newly diagnosed GBM treated in our department with the EORTC 22981/26981-NCIC trial in order to assess whether there is a correlation between gender and outcome. Results: In the 105 GBM patients (median age: 54 [range 18-70] years; male/female: 63 42) evaluated, resection was total in 49 and subtotal in 56; MGMT promoter was methylated in 45 (43%) and unmethylated in 60 (57%). Median time to disease progression was 11.5 (95%CI: 9.4–13.6) months, and median survival (mOS), 18.7 (95%CI: 16.8–20.7) months; MGMT methylation status (p=0.04), gender (p=0.03) and age (p=0.02) significantly influenced survival. The interaction found between gender and MGMT methylation was significant, females harbouring MGMT methylation surviving longer than other patients (MGMT methylated/unmethylated males and unmethylated females): mOS, 28.6 months (95%CI: 24.7–32.5) and 18.2 months (95%CI: 16.0–20.4), respectively (Table). Findings at multivariate analysis confirmed that age (p=0.004) and interaction between gender and MGMT status (p=0.008) significantly correlate with OS. Conclusions: Since no biological or clinical explanations are available to explain the above findings, we advocate the inclusion of gender as a potential prognostic factor in future trials. mOS (months) 95% CI (months) Overall 18.7 16.8 – 20.7 Male / MGMT methylated 17.7 14.2 – 21.3 Female / MGMT methylated 28.6 24.7 – 32.5 Male / MGMT unmethylated 18.2 14.1 – 22.4 Female / MGMT unmethylated 18.7 13.4 – 23.9