tbuckley/cabot-search huggingface dataset:
Abstract 14983: Consistent Healthy Lifestyle Practice and Health-Related Quality of Life Trajectories in Older Age: The Chicago Heart Association Detection Project in Industry (CHA) Health Surveys
Authors: Thanh Huyen T Vu, Martha L Daviglus, Norrina B Allen, Kiang Liu, Daniel B Garside, Donald M Lloyd-Jones
Journal: Circulation (2015)

Background: Healthy lifestyle (HL) practices such as not smoking, frequent exercise and having normal BMI are related to better health-related quality of life (HRQoL). However, data on associations of long-term patterns on the combined effects of these HL practices in older age and in HRQoL is limited. Methods: We included 4,074 participants mean age 70 in 1996 from the CHA study who participated in a health survey in 1996 and at least two more in 2001, 2003, and 2012. HRQoL was assessed by Health Status Questionnaire-12 (HSQ-12) on health perception, and physical and mental well-being. The higher the HSQ-12 score, the better the quality of life. The number of HL practices was defined as a sum of the following three HL factors: never smoked, exercised frequently, and had a normal BMI. Results: Using Group-Based modelling, we identified three HL practice trajectories [practiced high (15.8%), medium (45.0%), and low number (39.1%) over time], and three HSQ-12 score trajectories for the total sum of scores and for the physical and mental component score separately (see Table for group identifications). With adjustment for age, sex, race, education attainment, marital status, alcohol intake, and comorbidities in 1996, odds ratios (95% confidence intervals) for having the best (high score and slow decline) QoL over 16 years of follow-up were highest in persons who maintained a high and moderate number of HL practices compared to those with a low number of HL practices were 8.72 (6.23-12.22) and 2.54 (1.92-3.37), respectively; findings were similar for having moderate (medium score and fast decline) QoL over time, and after stratifying by sex. Conclusions: Highly maintained healthy lifestyle practices in older ages is associated with high score and slow decline in health-related quality of life over time. This finding underscores the importance of consistently maintaining ideal healthy lifestyle practices in older age for better maintenance of quality of life.
Dosimetric analysis of the effect of bladder volume on brachytherapy dose to organs at risk (OARs) in volume based intracavitary brachytherapy of carcinoma cervix: An institutional study.
Authors: Jyoti Poddar, Ashutosh Das Sharma, U Suryanarayan K, Sonal Patel Shah, Ankita Parikh
Journal: Journal of Clinical Oncology (2017)

e17006 Background: External beam radiotherapy combined with intracavitary brachytherapy is the standard of care in Carcinoma cervix. Due to its characteristics of rapid dose fall off, brachytherapy limits the toxicity to organs at risk while escalating radiation dose to target. Still, the organs near the radioactive source are at risk of considerable exposure, toxicity and post treatment morbidity. Alteration of bladder volume, alters the relative anatomy of uterus, rectum, sigmoid colon causing changes in the radiation dose to these organs. Methods: Aim:To correlate between the bladder volume and its effects on the dose received by bladder, rectum and sigmoid colon in volume based HDR brachytherapy in carcinoma cervix.30 patients (78 Intracavitary Brachytherapy applications) of Carcinoma Cervix (FIGO stage II-III) treated with EBRT followed by volume based HDR brachytherapy at our institute between July 2014 to Jan 2016 were studied. Bladder volume data was tabulated into five groups according to increasing volume of bladder. It was correlated with D2cc dose received by bladder, rectum and sigmoid colon. Results: Statistical Analysis Linear regression and correlation analysisof the HRCTV with dose to the bladder was 0.2 (.i.e HRCTV does not influence the bladder dose.) Pearson correlation of bladder volume and D2cc bladder and D2cc rectum was positive for all groups and for sigmoid D2cc was positive for group B and negative for all other groups. P value = 0.064 Conclusions: Keeping the bladder volume low (&lt;130 cc) during brachytherapy would reduce the dose to bladder and rectum and the probability of late bladder and rectal toxicity reduces. [Table: see text]
Comparative nocebo effects in older patients enrolled in cancer therapeutic trials: Observations from a 446-patient cohort—NCCTG 97-24-51 and ACOSOG Z9001 (Alliance A151602).
Authors: Jennifer Le-Rademacher, Jared C. Foster, Josephine Louella Feliciano, Ajeet Gajra, Drew K. Seisler, Ronald P. DeMatteo, Jacqueline M. Lafky, Arti Hurria, Hyman B. Muss, Harvey Jay Cohen, Aminah Jatoi
Journal: Journal of Clinical Oncology (2017)

e21545 Background: A nocebo is an inert substance that causes adverse events. Although previous studies have examined the favorably positive (placebo) effects of an inert substance, few studies have examined negative (nocebo) effects, particularly in older patients who sometimes experience frequent and severe adverse events from cancer therapy. Methods: This study focused on placebo/nocebo-exposed patients who participated in two double-blind, placebo-controlled, cancer therapeutic studies, namely, North Central Cancer Treatment Group (NCCTG) 97-24-51 and American College of Surgeons Oncology Group (ACOSOG) Z9001, with the goal of reporting comparative, age-based adverse event rates. Results: Among the 446 patients who received placebo/nocebo exclusively, 161 were 65 years of age or older at the time of respective trial entry; 5234 adverse events occurred. Unadjusted adverse event rates did not differ significantly between patients 65 years of age or older and those younger: rate ratio (99% confidence intervals (CI): 1.01 (0.47, 2.02) with similar findings for grade 2 or worse adverse events and for all symptom-driven adverse events (for example, pain, loss of appetite, anxiety). Adjustment for sex, ethnicity, baseline performance score, and trial resulted in no significant age-based rate differences in adverse event rates. Similar findings were observed with an age threshold of 70. Conclusions: A nocebo effect appears to occur irrespective of age. This observation suggests that adverse events should be taken no less seriously in older than in younger cancer patients and that education to manage patients’ expectations from cancer therapy might improve tolerability. [Table: see text]
Abstract 13118: Urinary Sodium and Potassium Excretion are Associated With Blood Pressure among Adults in the United States
Authors: Sandra L Jackson, Mary E Cogswell, Lixia Zhao, Sallyann M Coleman King, Te-Ching Chen, Ana L Terry, Chia-Yih Wang, Jacqueline Wright, Catherine M Loria, Robert Merritt, Barbara Bowman
Journal: Circulation (2016)

Introduction: One in three US adults has hypertension, a major risk factor for cardiovascular disease. We aimed to assess the associations between 24-h urinary excretion of sodium, potassium, and sodium-potassium ratio with blood pressure and hypertension status among US adults. Hypothesis: We hypothesized that urine sodium excretion and urine sodium-potassium ratio would be positively and urine potassium excretion would be inversely associated with blood pressure and hypertension. Methods: Cross-sectional data on up to two 24-h complete urine collections were analyzed from 765 non-institutionalized participants aged 20-69 y in the 2014 US National Health and Nutrition Examination Survey (NHANES). Urine collection started and stopped in the NHANES mobile examination center. Approximately half of participants had two complete collections; usual sodium and potassium excretion, and sodium-potassium ratio, were estimated using measurement error models accounting for day-to-day variability. Analyses adjusted for age, sex, race/ethnicity, body mass index, history of cardiovascular disease, diabetes, chronic kidney disease, smoking status, and physical activity, as well as the complex survey design. Results: In fully adjusted linear regression models, sodium excretion was positively associated with systolic (4.43 mmHg per 1000 mg/day, 95% CI 2.31,6.56) and diastolic (1.93 mmHg, 95% CI 0.34,3.51) blood pressure. Sodium-potassium ratio was also positively associated with systolic blood pressure (2.86 mmHg per .5 unit increase, 95% CI 1.15,4.56), and potassium excretion was inversely associated with systolic blood pressure (-3.39 mmHg per 1000mg/day increase, 95% CI -6.05,0.72). Adjusted odds ratios for hypertension, for excretion in the highest compared to the lowest quartiles, were 4.34 (95% CI 1.37,13.79) for sodium and 0.39 (95% CI 0.17,0.88) for potassium. Results were robust in sensitivity analyses restricted to persons not taking antihypertensive medications. Conclusions: Using a nationally-representative sample of US adults and a “gold-standard” urine biomarker, these data further support the strong relationship of higher sodium and lower potassium excretion with higher blood pressure and hypertension risk.
Short and long term impact of financial toxicity on quality of life in the Carolina Breast Cancer study.
Authors: Jennifer Spencer, Katherine Elizabeth Reeder-Hayes, Laura C Pinheiro, Lisa A. Carey, Andrew F Olshan, Stephanie B. Wheeler
Journal: Journal of Clinical Oncology (2017)

e18299 Background: High cancer treatment costs are associated with considerable distress and worse outcomes in cancer patients, a phenomenon known as “financial toxicity”. We examined changes in health-related quality of life (HRQoL) among women experiencing financial toxicity after cancer diagnosis compared to cancer patients without financial toxicity in a racially diverse cohort of breast cancer patients. Methods: HRQoL was self-reported at approximately 5 and 25 months post-diagnosis using the Functional Assessment of Cancer Treatment (FACT-G) in a prospective, population-based, cohort study with oversampling of Black and young (&lt;50 years old) women. Women reported on the financial burden of their breast cancer, including whether they had declined or delayed care due to cost or transportation barriers and whether they lost a job, experienced a reduction in household income, or lost insurance coverage after their cancer diagnosis. We assessed changes in HRQoL from 5 to 25 months according to financial toxicity experience. Results: 2,432 women completed 5- and 25-month HRQoL surveys and were included in analyses. Forty-nine percent were non-Hispanic Black and 51% were non-Hispanic White; other minorities were excluded due to small numbers. Overall, 49% of women reported at least one indicator of financial toxicity (59% Black vs. 39% White). Women who reported any financial toxicity had significantly lower scores on the FACT-G at baseline (75.5 vs 87.2, p&lt;0.001) and reported significantly less improvement in HRQoL from 5- to 25-months than women who did not report financial toxicity (incremental difference: +1.4 vs +3.8, p=.01). Black women reported lower overall HRQoL than White women (p=0.03), but impact of financial toxicity on HRQOL was similar among black and white women in stratified analyses. Conclusions: Financial toxicity is associated with lower HRQoL and with less improvement in HRQoL in the two years following breast cancer diagnosis. [Table: see text]
Factors associated with quitting action following smoking cessation counseling.
Authors: Kadir Mutlu Hayran, Deniz Yuce, Mustafa Erman, Omer Dizdar, Saadettin Kilickap, Beril Huseyin, Ismail Celik
Journal: Journal of Clinical Oncology (2018)

e18750 Background: Turkey has achieved a significant success in tobacco control, and key step of this is providing high-quality smoking cessation services to the public. Hacettepe University Cancer Institute is a comprehensive cancer center in Turkey, and incorporates a well-equipped smoking cessation unit (SCU) since the beginning of the tobacco control activities in Turkey. This study presents the factors associated with early adherence to smoking cessation treatment. Methods: Patient records of the SCU were evaluated retrospectively for demographic and clinical data. Medical history, smoking status and exposure assessments, comorbidities, treatment schemes and follow-up data were recorded by chart review. Quit rates were evaluated according to treatment and year of admission. Results: A total of 5967 patients have been admitted to the smoking cessation unit between 2008 and 2016. 57.4% of patients were male (M/F: 1.4:1), 65% were married, mean age of smoking initiation was 24 years, mean number of daily smoked cigarettes was 22.3, median Fagerstrom score of nicotine dependence was 5, and mean amount of exposure was 25.3 pack.years. 16% of patients had a history of at least 1 quit attempt. Treatment options were 62.3% for varenicline, 22.4% for bupropion, 13.3% for nicotine replacement therapies, and 2% for non-medicinal psychosocial support. For the cases with follow-up at 1st month, 82.4% had quit successfully, 8.2% had postponed their quitting date, and 9.3% had completely gave-up quitting. Being divorced/widow (OR: 1.5; 95% CI: 1.002-2.2; p = 0.048) and admissions before the year 2011 (OR: 2.3; 95% CI: 1.5-3.6, p < 0.001) were significantly associated with poor quitting success. Conclusions: Ministry of Health had provided cessation drugs free of charge to the public after 2011. Our quit rates that correspond to this period showed that providing public with free drugs may significantly increase the quit rates. Our results suggest that free of charge drugs are prominent motivating factors in quitting. On the other hand, being divorced or losing spouse negatively affected quitting.
CMET-40. LONG-LASTING RESPONSE IN SPINAL METASTASES FROM ALK REARRANGED NON-SMALL-CELL LUNG CANCER TREATED WITH DIFFERENT ALK INHIBITORS
Authors: Alessia Pellerino, Roberta Rudà, Federica Franchino, Giulia Marchese, Francesco Bruno, Francesca Mo, Riccardo Soffietti
Journal: Neuro-Oncology (2018)

About 40% of ALK-rearranged NSCLC patients develop brain metastases (BM), while leptomeningeal metastases (LM) occur in 5% of patients, and spinal intramedullary metastases in < 1%. Few data are available regarding the efficacy of ALK inhibitors in neoplastic spinal disease from NSCLC. CASE-REPORT: In March 2014 a 55 year-old woman developed multiple BM after 2 years from the diagnosis of an ALK-rearranged NSCLC who was receiving crizotinib. Crizotinib was continued associated with WBRT with a near-CR (RANO criteria) lasting 12 months. One year later a spinal MRI displayed multiple intramedullary enhancing lesions and diffuse leptomeningeal spread along the cauda equina, with CSF positivity for neoplastic cells. Ceritinib was started and a CR both on MRI and CSF was obtained lasting 18 months. In December 2017 the patient developed bladder dysfunction and paralytic ileus due to multiple intramedullary spinal and leptomeningeal recurrences. Considering the higher BBB penetration of lorlatinib, the patient started the drug and achieved a significant improvement of the urinary incontinence and intestinal transit after 3 months. Conversely, no change of the extent of spinal disease was observed on MRI. At this time, the patient is continuing treatment with lorlatinib and she is free of recurrence since 5 months. The development of CNS disease in ALK-rearranged NSCLC has been suggested to be a natural evolution of the disease and/or is correlated to low CNS penetration of the molecular drugs that control the systemic disease. The PROFILE trials have shown longer OS in patients with BM who received crizotinib beyond progression, but data are lacking on the activity of second- and third-generation ALK inhibitors. This is the first report of a prolonged clinical and radiological response using sequentially different ALK inhibitors in a patient with concurrent LM and spinal intramedullary metastases from an ALK-rearranged NSCLC.
Incidence of pathogenic variants in individuals with a personal or family history of pancreatic cancer.
Authors: Pashtoon Murtaza Kasi, Sarah K Macklin, Stephanie L. Hines
Journal: Journal of Clinical Oncology (2018)

1589 Background: Genetic testing related to pancreatic cancer is expanding. Many companies offer a multi-gene panel with a focus on pancreatic cancer. The purpose of this study was to evaluate the incidence and types of pathogenic variants detected in individuals with a personal and/or family history of pancreatic cancer. Methods: The genetic test results of patients visiting a genetic counselor at Mayo Clinic Florida from January 2012 to February 2018 were examined. Clinical notes and three generation pedigree taken at the time of initial genetics consult were reviewed. Results: Of the 2038 patients that completed testing, 223 (10.9%) were diagnosed with a hereditary cancer syndrome. 59 were referred due to personal history of pancreatic cancer, of which 3 (5.1%) were found to carry a germline mutation discovered in BRCA1/2. One additional patient was found to carry a mosaic pathogenic variant in ATM. Of the 285 that reported any family history of pancreatic cancer, 35 (12.3%) carried a pathogenic variant. These variants were present in APC (3), ATM (4), BRCA1 (5), BRCA2 (13), CHEK2 (5), MSH6 (1), NBN (1), PALB2 (3), and PRSS1 (1). The incidence of pathogenic variants nearly doubled (21.4%) if the individual had at least two relatives with a history of pancreatic cancer. Conclusions: It has been difficult to determine who may benefit from pancreatic cancer screening, but identifying a pathogenic variant in an individual with a family history of pancreatic cancer is sometimes enough evidence to suggest surveillance. Gathering family history is an important piece of evaluating value of pancreas screening. Number of individuals diagnosed with a hereditary cancer syndrome who had a personal and/or family history of pancreas cancer. Category Number of positives / Total (%) Genes Personal history of pancreas cancer 3-4/59 (5.1-6.8%) ATM1, BRCA1 (2), BRCA2 Family history of pancreas cancer 36/285 (12.6%) APC2 (3), ATM (4), BRCA1 (5), BRCA2 (13), CHEK2 (5), MSH6, NBN, PALB2 (3), PRSS1 Family history of 2+ relatives with pancreas cancer ca 12/56 (21.4%) APC2 (2), ATM (2), BRCA1 (2), BRCA2 (4), CHEK2 (2) 1Apparently mosaic pathogenic variant in ATM. 2The APC Ashkenazi Jewish Founder mutation, I1307K.
International, evidence-based consensus treatment guidelines for idiopathic multicentric Castleman disease
Authors: Frits van Rhee, Peter Voorhees, Angela Dispenzieri, Alexander Fosså, Gordan Srkalovic, Makoto Ide, Nikhil Munshi, Stephen Schey, Matthew Streetly, Sheila K. Pierson, Helen L. Partridge, Sudipto Mukherjee, Dustin Shilling, Katie Stone, Amy Greenway, Jason Ruth, Mary Jo Lechowicz, Shanmuganathan Chandrakasan, Raj Jayanthan, Elaine S. Jaffe, Heather Leitch, Naveen Pemmaraju, Amy Chadburn, Megan S. Lim, Kojo S. Elenitoba-Johnson, Vera Krymskaya, Aaron Goodman, Christian Hoffmann, Pier Luigi Zinzani, Simone Ferrero, Louis Terriou, Yasuharu Sato, David Simpson, Raymond Wong, Jean-Francois Rossi, Sunita Nasta, Kazuyuki Yoshizaki, Razelle Kurzrock, Thomas S. Uldrick, Corey Casper, Eric Oksenhendler, David C. Fajgenbaum
Journal: Blood (2018)
Beyond “implementation”: digital health innovation and service design
Authors: James Shaw, Payal Agarwal, Laura Desveaux, Daniel Cornejo Palma, Vess Stamenova, Trevor Jamieson, Rebecca Yang, R. Sacha Bhatia, Onil Bhattacharyya
Journal: npj Digital Medicine (2018)

Digital tools have shown great potential to enhance health services' capacity to achieve the goals of the triple aim (enhance patient experience, improve health outcomes, and control or reduce costs), but their actual impact remains variable. In this commentary, we suggest that shifting from a perspective focused on "implementing" new digital tools in health care settings toward one focused on "service design" will help teams execute more successful digital technology adoption projects. We present value proposition design (VPD) as a service design strategy requiring that stakeholders are brutally honest in determining the value of a new digital tool for their everyday work. Incorporating a perspective focused on how the value proposition of a technology is understood by each team member, and implications for their work routines, will help project teams to better understand how services can be reinvented during technology adoption initiatives. We present the simple heuristic [Tool+Team+Routine] as a reminder of the central considerations that make up a service design initiative, and present an illustrative case scenario of designing the use of a digital care coordination platform in an actual digital technology adoption project. We conclude by outlining two important challenges that need to be addressed to advance service design approaches to technology adoption in health care.
Prediction of response and toxicity to immune checkpoint inhibitor therapies (ICI) in melanoma using deep neural networks machine learning.
Authors: Zarmeena Dawood, Nicolas Coudray, Randie H Kim, Sofia Nomikou, Una Moran, Jeffrey S. Weber, Anna C. Pavlick, Melissa Wilson, Aristotelis Tsirigos, Iman Osman
Journal: Journal of Clinical Oncology (2018)

9529 Background: Challenges in treating melanoma patients with ICI include treatment resistance and adverse events, both of which can lead to discontinuation of treatment. Histopathology of metastatic melanoma lymph nodes (LN) reveal varying histological composition(s) of malignant melanocytes and host LN reactions to tumor. Here we tested the hypothesis that deep machine learning on H&E images of metastatic melanoma LN prior to ICI can predict response and/or toxicity. Methods: H&E slides of metastatic and normal LN resected from melanoma patients (n = 45) prior to receiving ICI were digitized and annotated for regions of interest. The Inception v3 Convolutional Neural Network (CNN) was first trained to distinguish tumor LN (n = 56) from independent normal LN (n = 57). Images were tiled (299x299 pixels) at 20X magnification and partitioned into training (70%), validation (15%) and testing (15%) sets. CNNs were next trained on two classifications: 1) complete/partial response (n = 15) vs. progression of disease (n = 30) and 2) no (n = 14) vs. severe (n = 12) toxicity. Images from response (n = 45) and toxicity (n = 26) datasets were partitioned into 80% training and 20% testing sets followed by 5-fold cross validation. Predictive accuracy was measured by area under the curve (AUC) of receiver operating characteristics (ROC) plots. Sensitivity (SEN) and specificity (SPEC) were calculated at the optimal cut-off point of ROC curves. Results: Melanoma-infiltrated LNs were unambiguously distinguished from normal LNs with AUC = 1.00 per slide. Three-class training (tumor vs. lymphocytes vs. connective tissue) reported an average per-slide AUC of 0.99 [CI, 0.98-1.00], with 0.96 SEN & SPEC. In predicting response to ICI, machine learning algorithm showed AUC of 0.76 with 0.71 SEN & 0.64 SPEC. Severe toxicity was predicted with AUC of 0.70 and with 0.71 SEN & 0.64 SPEC. The AUC standard error of mean (SEM) was 0.09 for both analyses. Conclusions: Our data suggest that deep neural networks have the potential to predict patient response and toxicity to ICI with an accuracy of 70%. Independent larger datasets in clinical trial setting are pre-requisite to support validity of this novel approach.