tbuckley/cabot-search huggingface dataset:
Enhancing cancer survivorship through improved provider communication, care coordination, and professional education.
Authors: John M. Daly, Alan G. Howald, Kelly Ann Filchner, Bonnie J. Miller, Leanne Lyons, Crystal Shereen Denlinger, Patrick O'Brien, Amanda Schlueter, Evelyn Gonzalez, Jennifer Seggev
Journal: Journal of Clinical Oncology (2016)

104 Background: Care coordination among oncology and primary care physicians (PCPs) is an essential element of survivorship care. Providers at an NCI-designated comprehensive cancer center noted gaps in coordinating care with PCPs. We sought to develop a program that enhances communication and education between provider groups to ensure a seamless continuum of care thereby improving overall survivorship care. Methods: The Fox Chase Cancer Center (FCCC) Care Connect program was created to comprehensively connect PCPs in the regional service area with cancer center providers. Program participation requirements for PCP’s include attendance at 2 of 4 targeted professional education programs and participation in quality measures for breast, cervical, and colon cancer screening. Formalized processes to efficiently move patients between oncologists and PCP’s were established. Communication gaps were addressed by providing electronic access via a secure physician portal, access to FCCC disease navigation services, and establishment of designated referral navigators to coordinate clinical needs between provider groups. Results: FCCC initiated the Care Connect program with 5 PCP practices. During a 3 month pilot phase, FCCC directed 19 patients to Care Connect PCP’s to manage ongoing clinical needs and implement survivorship plans. Eight-six percent of referrals were classified as non-urgent. Median time from referral to PCP appointment was 16 days, 24% below regional average. One CME education program was conducted during the pilot phase. Of the attendees, 91% reported an intent to change current practice by implementing a new procedure, discussing new information or seek additional information. Attendees identified potential care barriers which will be included in future program development. Post-education, one practice referred 3 patients to the lung cancer screening program. Conclusions: A formal program that aligns PCPs and oncologists is an effective initiative to improve communication and awareness of cancer patient survivorship needs in oncology and primary care settings.
Science of quality: Communication, decision making, and behavior.
Authors: Deb Harrison, J. Russell Hoverman, Sabrina Q. Mikan, Kevin Donald Olson, Cynthia Taniguchi, Aimee Ginsburg Arlen, Susan Ash-Lee
Journal: Journal of Clinical Oncology (2013)

22 Background: Addressing advance care planning (ACP) early in metastatic disease is a challenge for providers across oncology. Providing a systematic method to engage providers and patients in these discussions offers opportunities to improve end of life outcomes, improve patient quality of life and engage in shared decision making that supports effective transition to appropriate palliative care and hospice. Methods: A multidisciplinary group of oncology providers developed a framework for ACP which included defining a target population for early introduction, utilizing a standard patient-centered measurement tool (Values Assessment), reviewing practice workflow to schedule ACP conversations, and incorporating documentation elements embedded in the electronic health record. The model included physician referral of patients to a nurse practitioner or social worker who scheduled meetings with patients to assess values, assist patients with advance directives (AD), and explore patient end-of-life wishes based on disease. Seven cancer center sites of service engaged in the pilot study for a 90-day period to test tools, workflow and effectiveness of implementation methods. Documented values assessments, code status, and advance directives were pilot outcomes measures. Results: All sites in the pilot study implemented the framework and participated for 90 days. Workflows were validated to support scheduling of ACP conversations. Use of the values assessment tool was slow to be incorporated in ACP process as was physician referral for introduction. Conclusions: Engaging in a systematic approach to gather and assimilate information provides an opportunity to comparatively assess adoption of an ACP program. Providers are not inherently experienced in basic ACP introduction or deeper ACP discussions. Communications training, including conversations for values assessment and ACP, is in development for use with pilot and new practices engaging in the program, which supports program scalability. [Table: see text]
Patients’ expectations for the development of chemotherapy-induced nausea are related to their individual characteristics
Authors: A. R. Shelke, J. A. Roscoe, G. R. Morrow, J. T. Hickok, J. P. Kuebler, T. R. Fitch, T. K. Banerjee
Journal: Journal of Clinical Oncology (2005)

8144 Background: Previously, we have reported that a patient’s specific expectation of nausea is a strong predictor of its subsequent occurrence; however, factors contributing to the development of these expectations are poorly understood. Methods: We examined the degree of association among several patient characteristics and expectations about the development of nausea in 194 chemotherapy naïve women about to receive their first infusion of doxorubicin-based chemotherapy for breast cancer. These patients were randomized to the standard care control group in a multicenter Community Clinical Oncology Program (CCOP) study, and all received a standard antiemetic regimen on the day of treatment and whichever antiemetic medications their treating oncologist prescribed for subsequent days. Expectation of developing nausea was measured prior to the patient’s first chemotherapy treatment using a 5-point Likert-scale, anchored at one end by “1” = “I am certain I WILL NOT have this,” and at the other end by “5” = “I am certain I WILL have this.” We also assessed optimism in these patients with the Revised Life Orientation Test (Scheier, Carver, & Bridges, 1994). Patients self-reported nausea severity on a 7-point scale four times daily for five days by diary. Results: Correlational analyses demonstrated a significant association between nausea expectancy and patient characteristics, including age (r = -0.158, p < 0.05), susceptibility to motion sickness (no - yes) Spearman’s rho = 0.193, p < 0.01, and history of nausea during pregnancy (no or not applicable - yes) Spearman’s rho = 0.275, p < 0.01. Trait optimism, and years of education did not significantly correlate with nausea expectations. Conclusions: Patients’ characteristics, such as age, susceptibility to motion sickness, and a prior history of pregnancy-related nausea are related to their expectations about the development of nausea, which in itself is a strong predictor of actual occurrence of nausea. Supported by NCI grant U10CA 37420 No significant financial relationships to disclose.
Mammographic imaging after partial breast reconstruction: Impact of a bioabsorbable breast implant.
Authors: Steven Harms, Gail Lebovic, Cary Steven Kaufman, Michael Cross
Journal: Journal of Clinical Oncology (2015)

111 Background: Marking the site of the excised tumor bed during partial mastectomy is critical for radiation targeting and surveillance for breast cancer recurrence. However, delineating the lumpectomy cavity margins is challenging, and dense fibrosis and scarring often present obstacles when reviewing post-operative mammograms for signs of early recurrence. To determine whether implantation of a "mini" breast implant used for partial breast reconstruction adversely affected post-operative breast imaging, we reviewed clinical imaging of 100 patients that had been implanted with a new bioabsorbable breast implant over a three year period. Methods: Following informed consent, 110 patients were implanted at the time of partial mastectomy with a bioabsorbable implant with a primary purpose of marking the surgical site of tumor excision for radiotherapy. In each case, the surgeon sutured the implant into the cavity at the location believed to be at greatest risk for recurrence. Implants were used for partial breast reconstruction, a guide for radiation treatment planning and routine mammographic follow-up. Mammograms were reviewed for implant visibility, presence of artifacts and other diagnostic criteria. Results: In all cases the implant was rated as easily visible on mammography and CT without appreciable artifact or interference with diagnostic capabilities. In addition, there was notably less dense fibrotic tissue visualized on mammographic imaging at the tumor excision site containing the implant. In some cases, the marker clips coalesced in the center of the surgical cavity. The marker was also seen on US and MRI during routine follow-up. Conclusions: Mammographic imaging in patients implanted with this new device was not adversely affected by its presence. The implant visually assisted with verification of the excised tumor bed without introducing any artifact or diagnostic interference and there was notable in-growth of normal breast tissue clearly seen on mammography. In this group of patients there were no abnormal calcifications in or around the implant and there were no recurrent cancers detected within this 36 month period.
Association between provider-level factors and lymph node dissection outcomes during radical prostatectomy: A national cancer database analysis.
Authors: Jonathan E Kiechle, Elyn Wang, James B. Yu, Cary Philip Gross, Robert Abouassaly, Edward E Cherullo, Marc C. Smaldone, Nilay Shah, Quoc-Dien Trinh, Maxine Sun, Simon P. Kim
Journal: Journal of Clinical Oncology (2015)

89 Background: Lymph node counts have been proposed as a quality metric for patients undergoing radical prostatectomy (RP) and pelvic lymph node dissection (PLND). It is unclear whether surgical approach and hospital characteristics independently determine the number of lymph nodes removed at PLND. Therefore, we assessed the variation in lymph node counts from a population-based cohort of patients undergoing surgery for intermediate and high-risk prostate cancer. Methods: Using the National Cancer Database, we identified all surgically treated patients diagnosed with pre-treatment intermediate or high-risk prostate cancer from 2010 to 2011. The primary outcome was the number of lymph nodes retrieved at the time of RP. Generalized estimating equations were used to assess for differences in the adjusted number of lymph nodes retrieved after accounting for patient and hospital characteristics and surgical approach. Results: Overall, 35,876 patients were diagnosed with intermediate (61.2%) and high-risk (38.8%) prostate cancer and underwent RP and PLND. On multivariable analysis, open radical prostatectomy (ORP) and high volume and academic hospitals were independently associated with greater lymph node counts compared to robotic-assisted radical prostatectomy (RARP) and medium/low and community hospitals, respectively (all p&lt;0.001). After adjusting for patient and hospital variables, higher adjusted lymph nodes counts were observed for ORP compared to RARP (7.1 vs. 6.1; p&lt;0.001). Adjusted counts were also higher for high volume compared to medium/low volume hospitals (7.8 vs. 5.9; p&lt;0.001), and academic compared to community hospitals (7.3 vs. 5.6; p&lt;0.001). Conclusions: Among patients with aggressive prostate cancer treated with RP and PLND, lymph node counts varied by surgical approach and hospital characteristics.
Use of CXCR4 expression to predict the efficacy of sorafenib treatment in patients with metastatic renal cell carcinoma.
Authors: J. Guo, B. Tang, X. N. Sheng, C. L. Cui
Journal: Journal of Clinical Oncology (2011)

359 Background: CXCR4, a chemokine receptor, is implicated in the metastastic process. Higher expression of CXCR4 in renal cell carcinoma predicts shorter disease-free survival and poorer prognosis. This study aims to investigate the relationship of CXCR4 expression with the efficacy of target drugs in treatment of metastatic renal cell carcinoma (mRCC). Methods: A total of 58 patients with mRCC treated with target drugs (26 with sorafenib, 23 with sunitinib, 5 with pazopanib, 2 with CCI-779, and 2 with axitinib) as the first-line therapy in Beijing Cancer Hospital between 2006 and 2010 were investigated. CXCR4 expression in tissue was detected by immunohistochemistry. Survival curves were estimated according to the Kaplan-Meier method and evaluated with the Log-rank test. The correlation of CXCR4 expression with Memorial Sloan-Kettering Cancer Center criteria (MSKCC) was assessed with χ 2 test. p &lt; 0.05 was considered statistically significant. Results: CXCR4 expression was negative in 6.9% (4/58) of patients, low in 19.0% (11/58) of patients, intermediate in 56.9% (33/58) of patients and high in 17.2% (10/58) of patients, which was not correlated with MSKCC (p = 0.143). The PFS of patients with negative or low CXCR4 expression (20.0 ± 5.9 months) was longer than those with intermediate or high expression (8.5 ± 1.3 months), which, however, was not statistically different (p = 0.131). The PFS of sorafenib-treated patients with negative or low CXCR4 expression was 20.0±8.0 months while the patients with intermediate or high CXCR4 expression was 6.0 ± 0.8 months (p = 0.038). No such correlation existed in the group of patients treated with sunitinib (p = 0.947). And median OS had not been achieved yet. Conclusions: CXCR4 can predict the efficacy of sorafenib treatment in mRCC patients. Patients with negtive or low CXCR4 expression are more likely to obtain longer PFS than those with intermediate or high CXCR4 expression. [Table: see text]
Clinical significance of MET amplification in metastatic or locally advanced gastric cancer treated with first-line fluoropyrimidine and platinum (FP) combination chemotherapy.
Authors: Seyoung Seo, Seong Joon Park, Sook Ryun Park, Min-Hee Ryu, Baek-Yeol Ryoo, Young Soo Park, Young-Soon Na, Chae-Won Lee, Ju-Kyung Lee, Yoon-Koo Kang
Journal: Journal of Clinical Oncology (2016)

69 Background: Amplification of the MET proto-oncogene has been reported in a subset of gastric cancer (GC). However, clinical information of MET amplified GC is limited, especially in the metastatic setting. We investigated the clinical significance of MET amplification in GC patients treated with palliative chemotherapy. Methods: MET amplification was analyzed in formalin-fixed, paraffin-embedded GC tissues by a quantitative PCR-based copy number assay, using advanced GC cohorts between 2008 and 2014 in Asan Medical Center (AMC), Seoul, Korea. A total of 327 patients with tumor portion ≥ 70% were analyzed for clinical features and among them, 260 patients treated with first-line FP were analyzed for survival. MET amplification was defined as &gt; 5 copy number. Results: Twenty one out of 327 patients (6.4%) were classified as harboring MET amplification. Clinical characteristics were compared between patients with or without MET amplification (AMP vs. no AMP group). The AMP group was related with ECOG performance status ≥ 2 (33.3% vs. 10.5% p = 0.007), peritoneal metastasis (76.2% vs. 46.2%, p = 0.008) and poor risk category (47.6% vs. 14.2%, p = 0.001) by AMC prognostic model (Koo et al. Cancer Chemother Pharmacol 2011, 68:913-921). A total of 174 patients had measurable lesions from 260 patients treated with FP and 80 patients (51.4%) obtained objective responses. There were no significant differences in response rate between two groups (61.5% vs. 52.2%, p = 0.518). With a median follow-up of 27.8 months (range, 8.2-68.5), median overall survival (OS) and progression-free survival (PFS) were 12.7 and 5.8 months, respectively. In univariate analysis, neither PFS nor OS was different between two groups (hazard ratio [HR] = 0.677, 95% confidence interval [CI] 0.347-1.322, p = 0.254 for PFS; HR = 0.676, 95% CI 0.347-1.318, p = 0.251 for OS). Conclusions: In advanced GC, MET amplification was associated with poor performance status, peritoneal metastasis, and poor risk category. However, MET amplification was not an independent prognostic predictor in patients with metastatic or locally advanced GC treated with palliative FP chemotherapy.
Differential alteration of drug metabolizing enzyme activities in vivo after cyclophosphamide/doxorubicin administration in operable breast cancer patients
Authors: E. T. Elkiran, K. Altundag, M. O. Babaoglu, U. Yasar, Y. Ozisik, N. Guler, A. Kara Dincel, A. Bozkurt
Journal: Journal of Clinical Oncology (2005)

2095 Background: Cyclophosphamide (CPA) is widely used for cancer chemotherapy and immunosuppression. It has been reported that CPA (but not adriamycin) could alter the activities of a variety of drug metabolizing enzymes in rats via multiple mechanisms. However, the effects of CPA in drug metabolism in human are largely unknown. Losartan metabolism has been suggested as a marker for determination of CYP2C9 activity, and caffeine is a commonly used probe to assess the metabolic activities of CYP1A2, CYP2A6, N-acetyltransferase 2 (NAT2) and xanthine oxidase (XO). The present study was designed to analyze the effects of CPA on these drug-metabolizing enzymes by using losartan and caffeine as probe drugs. Methods: A single oral dose of 25 mg losartan and a cup of coffee (approximately 100 mg caffeine) was given to 10 operable breast cancer patients three times (two days before, after 2–4 hours and after three weeks of first cycle of adjuvant CPA/adriamycin chemotherapy [CPA 600 mg/m2/day, adriamycin 60 mg/m2/day, repeated in every 3 weeks]). Losartan, caffeine and their metabolites were analyzed by using high pressure liquid chromatography. Results: CYP1A2 and NAT2 activities were increased after the administration of cyclophophamide/adriamycin chemotherapy by 37% and 50%, respectively (p=0.02). CYP2A6 activity was reduced by 14% on the day of cyclophophamide/adriamycin administration (p=0.03). There was no acute or chronic effect of the chemotherapy administration on CYP2C9 and XO activities. Conclusion: Differential effect of CPA/adriamycin treatment on drug metabolizing enzyme activities might add an important information on efficacy and toxicity, as well as drug related interactions. This study was supported by Turkish Scientific and Technical Research Council (SBAG-COSTB15–2356). No significant financial relationships to disclose.
Impact of adjuvant trastuzumab on outcomes of HER2-positive breast cancer patients treated with HER2-targeted therapy in the metastatic setting.
Authors: Rashmi Krishna Murthy, Ankur Varma, Priyankana Mishra, Kenneth R. Hess, Elliana J. Young, James L. Murray, Kimberly Higginbotham Koenig, Marjorie C. Green, Stacy L. Moulder, Amal Melhem-Bertrandt, Daniel J. Booser, Vicente Valero, Gabriel N. Hortobagyi, Francisco J. Esteva
Journal: Journal of Clinical Oncology (2012)

527 Background: Trastuzumab (T) was approved for the adjuvant treatment of women with early-stage, HER-2 overexpressing (HER2+) breast cancer in 2006. There are limited data outlining the outcomes of patients with HER2+ breast cancer who receive adjuvant T-based therapy and then receive T and/or lapatinib in the metastatic setting. Methods: We identified 540 patients with HER2+ breast cancer treated with T or lapatinib as part of their first-line treatment for metastatic disease from 01/1997 to 11/2011. HER-2 positivity was assessed by immunohistochemistry (score, 3+) or fluorescence in situ hybridization (HER2/CEP17 ratio ≥ 2). We excluded 17 patients from this analysis because they were either lost to follow-up or received less than 2 cycles of therapy at the institution. Statistical analyses were performed using the chi-square test to compare proportions between groups and the Cox proportional hazards regression analysis to compare survival times and estimate the corresponding hazard ratio with 95% confidence interval. Results: Of the 523 patients eligible for analysis, 76 patients had received T in the adjuvant setting and 447 had not. In the group who did not receive adjuvant T, 48% (213/447) of patients achieved a complete or partial response (CR/PR), whereas only 13% (14/76) achieved a CR/PR in the adjuvant T group (P&lt;.0001). After adjustment for age, disease-free interval, post-menopausal status, stage at presentation, ER/PR status, and nuclear grade, the odds ratio was 0.27 (CI 0.13 - 0.56, p = 0.0004). Overall survival from first evidence of metastasis was significantly longer in the group who did not receive adjuvant T (39 months vs. 24 months, HR = 1.8, 95% CI 1.3-2.4). For OS, the adjusted hazard ratio was 1.5 (CI 1.04 - 2.1, p = 0.029). Age, DFI and stage were also significant predictors of OS. Conclusions: Patients with HER2+ metastatic breast cancer who were T naive, had a higher response rate (CR/PR) to front line HER2 targeted therapy and a longer OS compared to patients with metastatic HER2+ breast cancer who received T in the adjuvant setting. These findings highlight the importance of recognizing a pre-treated population and calls for further research in this area.
再発/難治性びまん性大細胞型B細胞リンパ腫におけるサルベージ療法への反応に予後的影響を及ぼす胚中心/活性化B細胞下位分類: バイオCORAL研究
Authors: Thieblemont Catherine, Briere Josette, Mounier Nicolas, Voelker Hans-Ullrich, Cuccuini Wendy, Hirchaud Edouard, Rosenwald Andreas, Jack Andrew, Sundstrom Christer, Cogliatti Sergio, Trougouboff Philippe, Boudova Ludmila, Ysebaert Loic, Soulier Jeam, Chevalier Catherine, Bron Dominique, Schmitz Norbert, Gaulard Philippe, Houlgatte Remi, Gisselbrecht Christian
Journal: Journal of Clinical Oncology (2011)
Cancer testis (CT) antigen (Ag) expression in non-small cell lung carcinoma (NSCLC) paired primary (1°) and secondary (2°) tumours.
Authors: P. Mitchell, F. J. Chionh, A. Chakrabarti, S. Deb, S. Knight, J. S. Cebon
Journal: Journal of Clinical Oncology (2010)

e21047 Background: The importance of CTAgs in NSCLC was recently highlighted with evidence that MAGE-A3 expression is not only a poor prognostic factor but also a promising target for adjuvant immunotherapy (Vansteenkiste, Proc ASCO 2007; abs 7554). With progressive stage, loss of or failure to acquire CTAg expression may indicate susceptibility of the tumor to immunoediting, where selective pressure from the host immune response results in Ag-negative variants that evade immune recognition. This may facilitate disease progression. This has implications for the effectiveness of cancer vaccination. We therefore compared expression of CTAgs in paired NSCLC 1° and metastatic 2° tumour tissue. Methods: 43 patients (pts) with histologically confirmed 1° NSCLC resected at Austin Hospital from April 1, 1992 to April 1, 2009, with available paired 2° lung or brain metastases were studied. Immunohistochemical staining was performed on tissue microarrays of formalin-fixed paraffin-embedded tissues, with human testis as the positive control. We examined the proportions of tumours expressing 4 CTAgs (MAGE-A3, MAGE-A1, NY-ESO-1, MAGE-C1) in the paired samples. Results: Among all 1° or 2° tumours MAGE-A3 was most frequently expressed in 65%, followed by MAGE-C1 in 56%, MAGE-A1 in 47% and NY-ESO-1 in 40%. Expression of any CTAg was seen in 22/27 (81.5%) 2° NSCLC brain metastases and in 10/16 (62.5%) 2° NSCLC lung metastases, p = 0.25. CTAg expression occurring in both 1° and 2° tumours was most common for MAGE-A3 (44%) and MAGE-C1 (26%). Acquisition of expression in 2° tumours occurred most commonly for MAGE-A1 (26%) and least commonly for NY-ESO-1 (9%), whereas loss of CTAg expression in 2° tumours was most common for NY-ESO-1 (19%) and MAGE-C1 (14%). Conclusions: With progression to metastatic NSCLC, NY-ESO-1 expression was most frequently lost and least frequently acquired. In contrast, MAGE-A1 was the CTAg most frequently acquired in 2° tumours. Results of this small series support previous observations in malignant melanoma that the highly immunogenic CTAg, NY-ESO-1 may be particularly susceptible to immunoediting, whereas MAGE-A1 may be less so (Barrow. Clin Cancer Res. 2006;12:764-71). No significant financial relationships to disclose.