tbuckley/cabot-search huggingface dataset:
Performing combined breast and gynecologic surgery does not increase the rate of surgical site infections: A NSQIP database analysis.
Authors: Paul Mayor, John Etter, James Brian Szender, Emese Zsiros, Peter Jonathan Frederick, Shashikant B. Lele
Journal: Journal of Clinical Oncology (2017)

e18093 Background: The purpose of this study is to determine and compare the overall rates of surgical site infections (SSI) in patients undergoing breast surgery, hysterectomy and combined breast surgery and hysterectomy. Methods: We inspected the National Surgical Quality Improvement Program (NSQIP) Participant Use Files from 2005-2014 for subjects undergoing breast surgery (CPT codes 19300-19307, 19340, 19342, 19350, 19357, 19361, 19364, 19366-19369, 19380, 19396), Gynecologic surgery ( CPT Codes 58150, 58152, 58180, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290-58294, 58541-58544, 58548, 58550, 58552-58554, 58570-58573), or a combined surgery (the NSQIP databased was queried for encounters that contained both a breast surgery code and hysterectomy procedure code). We then queried the database for SSI rates within 30 days of surgery. SSI rates were compared using a χ 2 test with a nominal value of p &lt; 0.05 as a test for significance. Results: We identified a total of 174,605 patients who underwent a breast surgery and found a SSI rate of 2.59%. We identified a total of 137,121 patients who underwent hysterectomy and found a SSI rate of 2.58%. We identified 383 patients who underwent a combined breast surgery and hysterectomy and found a SSI rate of 2.87%. When comparing SSI rates of combined breast surgery and hysterectomy, to breast surgery or hysterectomy alone, we found no significant difference in the rates of SSI between these groups (p = .7304). We analyzed SSI rates in patients by different surgical approaches including combined breast surgery and open hysterectomy and found an SSI rate of 4.35% (p = .357), combined breast surgery and laparoscopic hysterectomy and found an SSI rate of 2.38% (p = .931), and combined breast surgery and laparoscopic assisted vaginal hysterectomy and found an SSI rate of 2.75% (p = .916). Conclusions: The rates of SSI in patients undergoing combined breast surgery and hysterectomy is not significantly different from breast surgery or hysterectomy alone. Gynecologic oncologist should coordinate with breast surgeons to perform a combined procedure in patients who require both breast surgery and hysterectomy.
Abstract 17235: Incidence of Urinary Tract Infection After Catheter Ablation of Atrial Fibrillation
Authors: Andrew Cluckey, Alexander C Perino, Jun Fan, Mariam Askari, Javed Nasir, Gregory M Marcus, Tina Baykaner, Sanjiv N Narayan, Paul J Wang, Mintu P Turakhia
Journal: Circulation (2017)

Introduction: Urinary tract infection (UTI) is common after surgical procedures and is a surgical quality improvement target. For prolonged non-surgical procedures such as catheter ablation of atri...
Comparison of chemoradiotherapy (CRT) using carboplatin/paclitaxel (CP) versus cisplatin/5-FU (CF) for esophageal or gastroesophageal junctional (GEJ) cancer.
Authors: Hao-Wen Sim, Bryan Anthony Chan, Akina Natori, Charles Henry Lim, Di Maria Jiang, Stephanie Moignard, Eric Xueyu Chen, Geoffrey Liu, Gail Elizabeth Darling, Carol Jane Swallow, Savtaj Singh Brar, James D. Brierley, Jolie Ringash, Rebecca Wong, John Kim, Patrik Rogalla, Sara Hafezi-Bakhtiari, Jennifer J. Knox, Raymond Woo-Jun Jang, Elena Elimova
Journal: Journal of Clinical Oncology (2017)

4053 Background: For resectable esophageal or GEJ cancer, trimodality therapy improves survival compared to surgery alone and represents the current standard of care. The optimal CRT regimen for neoadjuvant or definitive treatment of locoregional esophageal or GEJ cancer remains uncertain. Methods: A retrospective comparison of CF and CP for locoregional esophageal or GEJ cancer (2011-2015) was performed. Overall survival (OS) and disease-free survival (DFS) were assessed using multivariable Cox proportional hazards regression, controlling for age, performance status and Charlson comorbidity index. Results: 101 patients (pts) were identified (61 CF, 40 CP). 75% were male. Median age was 62 years (range 30-84). Primary sites were esophageal (52%, with 65% squamous histology) and GEJ (48%). Surgery was undertaken in 34 (56%) CF and 27 (68%) CP pts. Median follow-up was 43 months. Overall, there was a non-significant trend for improved OS with CF compared to CP (HR 0.61, 95% CI 0.33-1.14, p = 0.12). In the subgroup having surgery (N = 61), we found no significant difference in OS (HR 0.99, 95% CI 0.39-2.55, p = 0.99). In the subgroup without surgery (N = 40), CF was significantly superior to CP (HR 0.21, 95% CI 0.08-0.53, p &lt; 0.001). Comparing only pts in this subgroup who received equitable radiation doses (N = 33), CF was still significantly superior to CP (HR 0.09, 95% CI 0.03-0.32, p &lt; 0.001). OS was similar by histology (adenocarcinoma/squamous) in all-comers (p = 0.54), and in CF (p = 0.90) and CP subgroups (p = 0.63). DFS results corresponded with OS. There was a non-significant numerical difference in pCR rates between CF (31%) and CP (18%) (p = 0.35), which were lower than previously reported. Conclusions: Survival is similar for CF and CP CRT regimens in pts undergoing trimodality therapy, but for those who do not proceed to surgery, it appears that CF is more effective than CP. Clinicians may prefer CP for surgical candidates given its favourable toxicity profile. However, when treating with definitive CRT, CF may be preferable to CP as a standard regimen.
Abstract 47: Weight-loss Diets, Adiponectin, and Changes of Cardiometabolic Risk in the 2-year Pounds Lost Trial
Authors: Wenjie Ma, Tao Huang, Yan Zheng, Molin Wang, George A Bray, Frank M Sacks, Lu Qi
Journal: Circulation (2016)

Background: Evidence suggests that the beneficial effects of weight-loss diet interventions on improvement in cardiovascular risk factors may be partly through modulating secretion of adiponectin from adipose tissue. However, it remains unclear whether the long-term weight-loss diets change adiponectin levels; and how such changes, if exist, affect cardiometabolic risk. Objectives: To investigate effects of weight-loss diets with different compositions of macronutrients on long-term changes of circulating adiponectin concentrations and cardiometabolic risk factors, as well as dietary interactions with variation in the adiponectin gene. Methods: In the 2-year Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) trial, 811 overweight or obese adults were randomly assigned to 1 of 4 diets; the targeted percentages of energy derived from fat, protein, and carbohydrates in the 4 diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%. The current analysis was restricted to participants who had baseline plasma adiponectin measurement (n=768). Circulating adiponectin and cardiometabolic outcomes were repeatedly measured at baseline, 6 months, and 2 years. We genotyped single-nucleotide polymorphism rs266171 in the adiponectin gene. Linear mixed models were used to compare changes in adiponectin concentrations across diet groups over the intervention and predict trajectory of changes in cardiometabolic risk factors. Results: Circulating adiponectin concentrations significantly increased over 2 years, similarly in 4 weight-loss diet intervention groups. Change of plasma adiponectin was significantly associated with decreases in weight, waist circumference, triglycerides, fasting insulin, and insulin resistance measured by homeostasis model assessment of insulin resistance (HOMA-IR), and increase in HDL cholesterol, after adjusting for age, gender, ethnicity, follow-up time, diet group, and baseline level of respective outcome trait. The associations remained similar after further controlling for concurrent weight change. In addition, we observed significant interactions between rs266717 genotype and dietary fat on changes in fasting insulin and HOMA-IR (P for interaction=0.03 for both) at 6 months with adjustment for covariates. Participants who are homozygous for T allele of rs266717 had more reductions in fasting insulin and HOMA-IR than those with other genotypes in response to the high-fat diet, but such differences were not observed in the low-fat diet group. Conclusions: Regardless of macronutrient compositions, weight-loss diets beneficially increased circulating adiponectin, which was related to improvement of cardiometabolic profiles. Dietary fat intakes modified the effect of adiponectin variant rs266717 on improvement of insulin resistance.
Cascade Genetic Testing of Relatives for Hereditary Cancer Risk: Results of an Online Initiative
Authors: Jennifer L Caswell-Jin, Anjali D Zimmer, Will Stedden, Kerry E Kingham, Alicia Y Zhou, Allison W Kurian
Journal: JNCI Journal of the National Cancer Institute (2018)

In cascade testing, genetic testing for an identified familial pathogenic variant extends to disease-free relatives to allow genetically targeted disease prevention. We evaluated the results of an online initiative in which carriers of 1 of 30 cancer-associated genes, or their first-degree relatives, could offer low-cost testing to at-risk first-degree relatives. In the first year, 1101 applicants invited 2280 first-degree relatives to undergo genetic testing. Of invited relatives, 47.5% (95% confidence interval [CI] = 45.5 to 49.6%) underwent genetic testing, and 12.0% (95% CI = 9.2 to 14.8%) who tested positive continued the cascade by inviting additional relatives to test. Of tested relatives, 4.9% (95% CI = 3.8 to 6.1%) had a pathogenic variant in a different gene from the known familial one, and 16.8% (95% CI = 14.7 to 18.8%) had a variant of uncertain significance. These results suggest that an online, low-cost program is an effective approach to implementing cascade testing, and that up to 5% of the general population may carry a pathogenic variant in 1 of 30 cancer-associated genes.
Can we discharge mastectomy patients directly home?
Authors: Elizabeth Peace Tito, Laurie Halloran
Journal: Journal of Clinical Oncology (2018)

e18547 Background: The current practice for the majority of patients undergoing mastectomy is an overnight hospital admission. We theorize patients can be discharged directly home after mastectomy because pain control is adequate, care is minimal and complications are low. Methods: Patients undergoing mastectomy with or without tissue expander placement were prospectively studied after being discharged directly home after mastectomy. VNA services were set up if indicated and JP drain care was taught to the patient preoperatively. Patients were excluded if they had medical conditions requiring hospitalization. Questionnaires were given to patients on their follow-up appointment. Endpoints included pain control, complication rates, failure to go home and readmission rates. Results: 26 patients were enrolled. Age range was 34-83. Twelve women had tissue expanders placed. One woman had bilateral expanders placed. Exparel was injected into the pectoralis muscle if tissue expanders were placed. Patients were given prescriptions for hydrocodone/Tylenol and Valium. Twenty four women went home the day of surgery. 22/24 women completed the questionnaire. One woman was admitted immediately postoperatively for new onset atrial fibrillation during surgery. One woman opted to stay after surgery. 2/12 (16.6%) reconstructed patients had infections > 3 weeks after surgery. No other infections were noted. Conclusions: : Patients can safely be sent home immediately after mastectomy, including women who have breast reconstruction with tissue expander placement. Patients have adequate pain control, have a low rate of readmission and a low rate of complications. Potential advantages include lower overall costs, better social support, and potentially better bacteria flora exposure for patients undergoing reconstruction. Patients admitted immediately post operatively 7.7% (2/26) Readmission rate 0% Immediate complications 0% Adequate pain control 100% Would recommend going home 100%
Opioid use in long term cancer survivors.
Authors: Lisa Catherine Barbera, Rinku Sutradhar, Doris Howell, Deborah Dudgeon, Hsien Seow, Mary Ann O'Brien, Clare Atzema, Amna Husain, Craig Earle, Jonathan Sussman, Elyse Corn, Carlo DeAngelis
Journal: Journal of Clinical Oncology (2018)

6520 Background: Our research team previously found that the rate of opioid use in cancer patients surviving at least 5 years beyond diagnosis was 1.2 times higher compared with age-sex matched controls without cancer. The purpose of this study was to evaluate the factors associated with opioid use after 5 years of survival from cancer diagnosis. Methods: We conducted a retrospective cohort study using linked provincial administrative data. Patients were aged 24-70 and economically disadvantaged, making them eligible for government funded pharmacare. The index date was defined as the 5 year anniversary from the diagnosis date. Patients were accrued continuously between April 1, 2010 and March 31, 2015 on their index date. Those with any evidence of recurrence (resuming anti-cancer therapy, palliative care) were excluded. Patients were observed until death, relapse or end of data accrual. The main outcome was opioid prescription rate after index date. The main exposures were opioid use prior to diagnosis date, opioid use between diagnosis date and index date (none, continuous, at diagnosis only, other), certain cancer surgeries (e.g. thoracotomy) and chemotherapy agents known to cause neuropathy. A negative binomial regression model was used to estimate the relative rates of opioid use after index date. Results: Our cohort included 7,431 individuals. The factors most strongly associated with a higher rate of opioid use after index date was continuous opioid use between diagnosis and index date. The RR was 63.4 (95% CI 39.4-102.1) for those with no pre-diagnosis opioid use and 76.6 (95% CI 40.7-144.0) for those with pre-diagnosis opioid use. The only group with no increased risk used opioids only at diagnosis and had no prior use. Surgery was not significant. Chemotherapy was not significant with the exception of those who used opioids initially. A history of depression, comorbidity and more than 2 years of diabetes were also associated with higher risk. Conclusions: Cancer patients who use opioids continuously after diagnosis are at increased risk of continued use after 5 years of survival. Further work is needed to understand the reasons for ongoing use after diagnosis. Increased attention is needed to ensure safe prescribing for this group to minimize issues with dependence.
The social value of tisagenlecleucel, a CAR-T cell therapy, for the treatment of relapsed or refractory pediatric acute lymphoblastic leukemia in the United States: What are consequences of treatment delays?
Authors: Julia Thornton Snider, Michelle Brauer, Katharine Batt, Pinar Karaca-Mandic, Jie Zhang, Dana P. Goldman
Journal: Journal of Clinical Oncology (2018)

10529 Background: Despite the recent approval of tisagenlecleucel, a CAR-T cell therapy, to treat pediatric and young adult patients with relapsed or refractory acute lymphoblastic leukemia (pALL) in the United States, patients have faced barriers to treatment. This study quantifies the social value of tisagenlecleucel and the value lost from treatment delays. Methods: The social value of tisagenlecleucel reflects its economic value to patients and the manufacturer, relative to the standard of care (clofarabine). To quantify the social value, we obtained estimates of life expectancy, quality-adjusted life years (QALYs), and healthcare costs from a cost-effectiveness model for tisagenlecleucel and valued each QALY gained at $150,000. Health and monetary values were discounted at 3.0%, and costs were inflated to 2016 US dollars. The social value of tisagenlecleucel was calculated using a price of $475,000. To quantify lost value from monthly treatment delays, we assumed patients would start clofarabine treatment while awaiting access to tisagenlecleucel. Expected survival for patients on clofarabine was obtained from a clinical trial, and social value and QALYs gained with tisagenlecleucel were calculated conditional on surviving to receive it. Results: Our study population included 20 incident cohorts of 500 patients with pALL. Patients treated with tisagenlecleucel gained 37,018 QALYs. The total social value was $4.6 billion. However, when treatment was delayed 1- 3 months, $452 million to $2.1 billion of social value and 3,634 to 17,100 QALYs were lost. Over half the social value, value to patients, and QALYs from tisagenlecleucel were lost when treatment was delayed 4 months. Conclusions: Innovative therapies such as tisagenlecleucel have the potential to provide substantial social value from improvements in life expectancy, QALYs and productivity. However, the magnitude of benefit depends upon the ability of patients to access these treatments promptly. Efficient payment mechanisms and sufficient technological capabilities will be required to minimize treatment delays for patients.
Prevalence, clinical risk factors and outcomes of patients with lung cancer presenting with brain metastases.
Authors: Saiama Naheed Waqar, Pamela Parker Samson, Cliff Grant Robinson, Jeffrey D. Bradley, Siddhartha Devarakonda, Ashiq Masood, Ramaswamy Govindan, Mark Watson, Feng Gao, Varun Puri, Daniel Morgensztern
Journal: Journal of Clinical Oncology (2016)

2075 Background: There is limited data on the prevalence of brain metastases at presentation in patients with non-small cell lung cancer (NSCLC). We queried the National Cancer Database (NCDB) to determine the frequency of brain metastases in patients diagnosed with NSCLC and clinical risk factors associated with their presence. Methods: We identified patients with NSCLC diagnosed between 2010 and 2013 using the NCDB database, as during this time period, brain metastasis information was captured. Odds ratios (ORs) for presence of brain metastasis were calculated for individual pre-specified covariates of interest using logistic regression analysis. All statistical tests were 2-sided and p < 0.05 was considered significant. Results: Brain metastases were observed in 47,546 (9.4%) of the 504,151 patients with NSCLC during our study time period. On multivariate analysis the following variables were significantly associated with presence of brain metastasis: age (OR, 0.72 per 10 year increase in age; 95% confidence interval [CI]: 0.71, 0.73); adenocarcinoma histology (OR 2.75; 95% CI:2.67,2.83); tumor size > 3 cm (3.1 to 5 cm OR 1.55; 95% CI: 1.51, 1.60 and > 5 cm OR, 1.75; 95% CI: 1.70, 1.80); tumor grade ≥ II (grade II OR 2.11; 95% CI:1.95, 2.29, grade III OR 3.87; 95% CI: 3.59, 4.18 and grade IV OR 3.60; 95% CI: 3.2, 4.05) and node positive disease N1 OR 1.86; 95% CI: 1.79, 1.94, N2 OR 2.08; 95% CI: 2.03, 2.14 and N3 OR 1.76; 95% CI :1.65, 1.77). We re-categorized age as < 70 or ≥ 70 years and the incidence of brain metastasis ranged from as low as 0.6% in patients with only 1 risk factor to as high as 19.5% in patients with all 5 risk factors. The median follow-up time for patients with brain metastases was 22 months. The median survival for patients with brain metastases was 6.08 months (95% CI 5.98-6.18), and their overall survival (OS) rates at 1, 2 and 3 years were 30.1%, 14.5% and 8.5% respectively. Conclusions: Brain metastases are seen in 9.4% of patients with NSCLC at presentation. If validated, our model may be used to guide the staging work-up for patients with newly diagnosed NSCLC without symptoms suggesting brain metastases.
Evaluating clinical trials: What exactly do medical oncologists know and use? A re-evaluation.
Authors: Kenneth Robert Hoffman
Journal: Journal of Clinical Oncology (2016)

e18184 Background: The correct evaluation and use of clinical trial data is essential for giving our patients the best treatment. Methods: Twenty-five medical oncologists participated in a study evaluating their knowledge of recently published clinical trials (2013-15), including their knowledge of trial design, ability to evaluate the data and what was missing for better patient care. Results: This is a follow-up study to one done in 2010 (JCO, 28:15 supp (May 20 Supplement), 2010: 6152). Sixteen oncologists were in both studies. Part 1 of the study listed 12 studies involving breast cancer, non-small cell lung cancer, renal cell carcinoma, multiple myeloma or malignant melanoma. While 80% of participants knew which disease was being studied but only 60% (15/25) knew which agents were being studied. While 80% of physicians were able to tell which trials were Phase II or Phase III, only 60% (15/25) were able to explain the difference. In part 2, the name of the trial, the drug(s) used, the stage of the disease and the line(s) of therapy were provided. The oncologists were asked to identify the primary end point of the study: response rate, progression free survival or overall survival. Only 76% (19/25) were able to correctly identify the end points of at least eight studies. Over 50% of respondents (13/25) felt that progression free survival was equivalent to overall survival while 88% (22/25) of oncologists gave the study agents a better response rate (average over 60%) and efficacy rate (over 50%) than the published data. The studies were then shown. In Part 3, particpants needed to define common statistical terms including p-value, power, hazard ratio, confidence levels and how they are used in clinical decisions. Only 32% (8/25) oncologists correctly understood all these terms. Lastly, all particpants wished that authors would discuss the financial cost of the published therapy, treatment strategies, clearer toxicity information and survival data, when available, with quality of life and functional status evaluation. Conclusions: Oncologists continue to need help in evaluating clinical trial data for optimal patient care. Study summaries need to be clearer in how their findings will help our patients live better lives.