tbuckley/cabot-search huggingface dataset:
Prognostic factors in elderly patients with advanced non-small cell lung cancer treated with platinum-based doublet chemotherapy.
Authors: S. Y. Yi, M. Ahn, J. Y. Park, H. R. Lee, J. Lee, Y. H. Park, J. S. Ahn, K. Park
Journal: Journal of Clinical Oncology (2011)

e19584 Background: To identify prognostic factors in elderly patients with advanced non-small cell lung cancer treated with platinum based doublet chemotherapy. Methods: Between January 2005 and December 2009, 191 patients aged over 70 years with advanced non-small cell lung cancer who were treated with platinum based doublet chemotherapy were analyzed retrospectively. Results: The median age was 72 years (range, 70 – 81 years) and 162 patients (84.8%) were aged 70 to 75. A total of 177 patients (92.7%) were stage IV, and 111 patients (58.1%) were adenocarcinoma. Seventy-nine patients (41.4%) received cisplatin based chemotherapy and 112 patients (58.6%) received carboplatin based chemotherapy. In both groups, gemcitabine was commonly used in combination with platinum (gemcitabine/cisplatin 69 of 79, gemcitabine/carboplatin 108 of 112). The median number of treatment cycles was 4 cycle (range, 1~6). The overall response rate was 40.3% (intent to treat) and overall survival was 10 months (95% C.I. 8.3-11.7). The main grade 3/4 toxicities were neutropenia (33.1%) and thrombocytopenia (17.1%). treatment-related death was 6.3% (12 of 191). Univariate analysis demonstrated that smoking history (never vs ever), body mass index, underlying lung parenchymal disease, history of cerebrovascular accidents (CVA), bone or liver metastasis at diagnosis, subtype (adenocarcinoma versus non-adenocarcinoma), EGFR mutation, hemoglobin (<12 g/dL), serum albumin (<3.5 mg/dL) were significantly associated with overall survival. On multivariate analysis, poor prognostic factors for overall survival were hemoglobin <12 g/dL (hazards ratio [HR] of 1.75; 95% confidence interval [CI], 1.17-2.61 [P =.006]), history of CVA (HR of 2.20; 95% CI, 1.13-4.30 [P =.021]), ever-smoking (HR of 1.73; 95% CI, 1.16-2.58 [P =.007]), liver metastasis at diagnosis (HR of 2.46; 95% CI, 1.25-4.83 [P =.009]), and bone metastasis at diagnosis (HR of 1.64; 95% CI, 1.13-2.39 [P =.009]). Conclusions: Platinum based doublet chemotherapy might be effective and tolerable in fit, elderly patients with advanced non-small cell lung cancer. However, Platinum doublet chemotherapy should be considered for selected patients.
Osteoarticular Pain after Discontinuation of Tyrosine Kinase Inhibitors (TKI): A French Cohort
Authors: Marc G Berger, Bruno Pereira, Charlotte Oris, Sandrine Saugues, Pascale Cony-Makhoul, Martine Gardembas, Laurence Legros, Martine Escoffre-Barbe, Franck E. Nicolini, Philippe Rousselot, Delphine Rea, Joelle Guilhot, Marie Zénut, Agnès Guerci, Stephane Giraudier, Francois-Xavier Mahon
Journal: Blood (2015)
MRI-based selection of patients with metastatic extramesorectal rectal cancer nodes for preoperative chemoradation.
Authors: Monique Maas, Doenja MJ Lambregts, Freek Gillissen, Sanne ME Engelen, Max J Lahaye, Jeroen Buijsen, Regina GH Beets-Tan, Geerard L Beets
Journal: Journal of Clinical Oncology (2012)

570 Background: 20% of rectal cancer patients have metastatic lymph nodes outside the mesorectum (EMRs). These EMR node positives are associated with poor prognosis. Accurate selection would help to tailor treatment and improve prognosis for these patients. Methods: Rectal cancer patients were included in a study in which treatment was based on (contrast-enhanced) MRI. EMR-status was predicted by an expert radiologist. Based on this prediction patients underwent chemoradiation (CRT) of the EMRs. 6-8 weeks after CRT EMRs were restaged. If still involved, the EMRs were resected. When the EMRs were sterilised by the CRT, they were not resected. Patients were followed 3 to 6-monthly after surgery by a combination of modalities. 3-year outcome was estimated with Kaplan-Meier curves. Results: 50 patients with suspected EMRs were included. Median follow-up was 26(0-50) months. In 13 patients EMRs were resected after CRT and in only 2/13 positive nodes were found. Of the remaining 37 patients 5 had a local recurrence (LR). In total 32+11=43 patients (86%) had no involved EMRs after CRT. Five patients had metastasis of whom 2 also had a LR. 3-year LR was 2.3%, 3-year DFS was 86% and 3-year OS was 90%. Conclusions: MRI-based selection of patients with EMRs for CRT provides adequate local control. Distant metastasis is the main cause of poor prognosis in these patients. When MRI is used for EMR identification and thus for identification of patients who need CRT also on the obturator regions, patients can be spared an extensive resection with associated morbidity.
Distress themes encoded in narratives of the “last day”: A study among surviving caregivers.
Authors: Elizabeth Paige Walsh, Catherine Riessman, Paul Mathew
Journal: Journal of Clinical Oncology (2015)

23 Background: Survey studies have determined the prevalence of dissatisfaction among survivor caregivers related to end of life care. Toward improvement in care at EOL, we hypothesized that novel themes of distress would be identified in narratives of the “last day” from the recently bereaved. Methods: Extended narrative accounts of patients’ last day of life were collected from adult, English-speaking, caregivers (n=5) present at the death of a cancer patient. Interviews (45-120 minutes) featured open-ended questions prompting the subject to share an account of the last day, their care and coping experience. Interviews were conducted and transcribed by the author and analyzed thematically. Results: A theme of distressed communication with health care providers [HCP] could be identified in narrative segments in all 5 interviews, linked to transitions such as changes in treatment or clinical status. Narrative fragments exemplary of distress arising from communication are presented. I. A pain crisis so severe “she asked God to take her.” “I am ready to call the nurse practitioner…and she wouldn’t allow it... She doesn’t want to be a burden.” II. “I said, I don’t want you telling him directly anything. I want you to tell me first so we can go in together and tell him…the right way” including an option to “spend time together.” Soon after, the physician “came rushing into the room and as if we’d never had the conversation…, OK, we’re going to take you to the ICU.” III. “I had asked the nurse…to make sure that she had her clothes on when the funeral parlor came.” It was “important to me for her dignity.” The nurse responded: “they just cut the clothes off anyhow.” IV. “Now you’re going to pull chemo out of your hat? Look at him!...He doesn’t want to leave us but he’s ready to go.” “After we said no to chemo, [his doctor] never came near S again.” Conclusions: This pilot study of last day narratives obtained from surviving caregivers points toward a high prevalence of distress content relating to impaired communication with HCP with consequences including uncontrolled pain, conflict, perceived loss of dignity and abandonment. These data indicate the need for larger-scale studies focused on the content and style of bidirectional communication at the EOL.
The evolving radiation therapist role in a multidisciplinary palliative radiotherapy clinic.
Authors: Bronwen LeGuerrier, Fleur Huang, Winter Spence, Brenda Rose, Jacqueline Middleton, Megan Palen, Kitta Thavone, Shazma Ravji, Brita Lavender Danielson, Alysa M. Fairchild
Journal: Journal of Clinical Oncology (2016)

158 Background: Radiation therapists (MRTT) have been integrated in varying capacities into outpatient palliative radiotherapy (PRT) services across Canada for nearly two decades. We explored the experience of our centre’s MRTTs who have developed an essential role over nine years, from supporting one half-day PRT clinic per week to five full days of clinical, technical, research, and administrative involvement. Methods: An electronic survey was distributed to all 12 MRTTs who contributed to the PRT program (2007-2016), which was later supplemented by in-person semi-structured interviews. Qualitative analysis of the responses was undertaken to discern common themes. These were contextualized within the operational changes to our multidisciplinary clinical model, from pilot to integrated service. Results: Among seven respondents (range of PRT-specific experience: 1-5 years), five answered all questions. From the narratives, three common themes emerged: responsibilities, challenges, and opportunities. Responsibilities identified included: PRT planning/delivery (cited 13 times), patient assessment (12), multidisciplinary collaboration (MDC) (8), research (8), navigation (7), clinic process innovation (5), administration (5), communication (4), and education (2). Challenges described included: lack of support (cited 10 times), lack of shared understanding (5), high workload (5), pushback from colleagues (3), and inadequate staffing (2). However, opportunities outnumbered challenges, in terms of evolution of involvement in MDC (cited 13 times), patient care (8), increased autonomy (6), professional growth (5), role variation (5), scope of practice expansion (2), and being the team’s key contact for referrals (2). The range of MRTT experiences, responsibilities and challenges encountered reflected specific PRT clinical and operational conditions. Conclusions: As our PRT service model has evolved from short-term pilot to fully integrated departmental service, so has the MRTT role. MRTTs contributing to PRT as part of a MDC model are supportive of advancing non-traditional involvement in the holistic palliative care of patients with advanced cancer.
Stage at presentation and survival outcomes of patients with Gleason 8 to 10 prostate cancer and low PSA.
Authors: Aaron David Falchook, Neil E. Martin, Ronald C. Chen
Journal: Journal of Clinical Oncology (2015)

21 Background: Low prostate specific antigen (PSA) levels among men with Gleason 8-10 prostate cancer may be a result of cellular de-differentiation rather than low disease burden. We hypothesized that men with Gleason 8-10 prostate cancer and low PSA have increased risk for advanced disease and worse survival outcomes. Methods: Men diagnosed from 2004-2006 with Gleason 8-10 prostate adenocarcinoma in the Surveillance Epidemiology &amp; End-Results (SEER) database were included. Patients were stratified by PSA at diagnosis: 0.1-3.9 ng/mL, 4.0-9.9 ng/mL, 10.0-19.9 ng/mL, and ≥ 20.0 ng/mL. Outcomes examined by PSA group included: clinical TNM stage, pathologic stage (for patients who received prostatectomy), and overall survival (for patients with N0 and M0 disease). Results: 18,491 patients were included. Men with PSA &lt;4 were more likely than PSA 4-9.9 to present with clinical T3-4 disease (26 vs. 22%, p&lt;.001), nodal (6 vs. 4%, p&lt;.001) and distant (6 vs. 3%, p&lt;.001) metastasis (Table). For patients who underwent radical prostatectomy, PSA &lt;4 was more likely than PSA 4-9.9 to have pathologic nodal metastasis (10 vs. 7%, p&lt;.001). With a median follow-up of 6 years, 6 year OS was 89.8% (PSA&lt;4) vs. 92.3% (PSA 4-9.9) for prostatectomy patients (Logrank p=.02), and 73.6% vs. 79.3% for radiotherapy (p= 0.01). Conclusions: Patients with Gleason 8-10 cancer and PSA&lt;4 have a more aggressive presentation and worse survival than those with PSA 4-9.9; these low PSA cancers behave more like those with PSA &gt;10. Further study is needed to evaluate any biologic basis for inferior outcomes among men with high Gleason score and low PSA. [Table: see text]
Pathologic complete response to standard preoperative chemoradiation in patients with locally advanced rectal cancer.
Authors: Madiha Naseem, Joshua Murray, Christine E. Simmons, Nancy Baxter, Marcus J. Burnstein, Christine Brezden-Masley
Journal: Journal of Clinical Oncology (2012)

686 Background: Pathologic complete response (pCR) is associated with lower rates of recurrences and longer disease-free survival rates in locally advanced rectal cancer (LARC) patients. The purpose of this study was to evaluate clinical outcomes of neoadjuvant chemoradiation and pCR among these patients. Methods: A retrospective chart review was performed for all patients treated for LARC between August 2005 and May 2011 at St. Michael's Hospital, Toronto. Patients were stratified into pCR and no-pCR groups and compared with respect to tumor size, nodal status, and treatment characteristics. Descriptive statistics were calculated for all variables of interest. Chi-square and t-tests were conducted to test for associations between categorical and continuous variables respectively. Disease free survival was calculated as the time between diagnosis and recurrence date, censored at last follow up. Results: A total of 92 patient charts were reviewed; 21 patients had metastatic carcinoma and were excluded from analysis. 63.4% (45/71) were male, with a mean age of 61.2 years and median follow up of 15 months. 12.7% (9/71) of patients achieved a pCR, while the remaining 87.35% (62/71) were no-pCR. All pCR patients received and completed standard pre-operative chemotherapy-radiotherapy. 73.4% (52/71) of the patients had complications from chemoradiotherapy. Furthermore, there was a significant association between having a significant response to treatment and achieving a pCR; where 78% (7/9) of pCR patients had a significant response to treatment. Overall, 4/71 patients had a local recurrence, 22.2% (2/9) pCR and 3.2% (2/62) no-pCR. Those with no-pCR had a recurrence at 1 and 2.2 years post diagnosis, while those with pCR had a recurrence at 3.7 years. Conclusions: This study suggests that patients undergoing standard pre-operative chemoradiotherapy are likely to have a significant response and achieve a pCR. Based on this study, although a pCR does not prevent the risk of recurrence, it delays the onset of local recurrence. Longer follow-up is required to determine if these results are robust and to develop future studies to improve efficacy of treatment delivery in LARC patients.
Surveillance strategies after curative therapy for esophageal (EC) and gastric cancer (GC).
Authors: H. R. Kim, H. J. Lim, C. K. Kollmannsberger, D. Schellenberg, W. Y. Cheung
Journal: Journal of Clinical Oncology (2011)

e14647 Background: Despite the high risk of recurrence, evidence-based guidelines for surveillance after curative treatment of early EC and GC do not exist. Our study aims were to 1) review current follow-up practices for EC and GC and 2) assess the utility of different surveillance strategies in modifying outcomes. Methods: All patients diagnosed with early cancers of the distal esophagus (DE), gastroesophageal junction (GEJ) and stomach between January 2001 and June 2010 who were undergoing peri-operative treatment at the British Columbia Cancer Agency were identified. Follow-up practices were reviewed and categorized into 1) discharged to general practitioner (GP), 2) physical exams by the specialist, 3) physical exams and routine bloodwork and 4) imaging or endoscopy. Kaplan-Meier (KM) curves and Cox proportional hazard models were used to explore the effect of surveillance on outcomes. Results: Of 387 cases reviewed, 292 patients were eligible: median age was 63 years; 76% were male; 27% DE, 31% GEJ and 42% stomach; 88% adenocarcinoma and 12% squamous cell carcinoma. For treatment, 65% had resection followed by adjuvant chemoradiation (CRT), 13% received definitive CRT, 12% underwent peri-operative chemotherapy and 10% had neoadjuvant CRT followed by resection. In terms of follow-up, 31% were discharged to GP, 6% underwent routine physical exams by the oncologist, 11% had regular exams and bloodwork and 52% received imaging or endoscopic surveillance. KM curves did not reveal any significant differences in recurrence-free (p=0.59) or overall survival (p=0.34) among the different surveillance strategies. Adjusting for treatment characteristics and prognostic factors, hazard ratios for relapse and death were derived (Table). Conclusions: Wide variations in follow-up practices were observed after curative treatment of EC and GC. Based on our analyses, no standard surveillance strategy can be recommended. Outcomes based on surveillance strategy. Surveillance strategy HR for relapse (95% CI) HR for death (95% CI) Discharged to GP Referent Referent Physical exam only 0.73 (0.25 - 2.28) 0.47 (0.14 - 1.61) Exam and bloodwork 1.74 (0.85 - 3.73) 1.67 (0.79 - 3.53) Imaging and endoscopy 1.09 (0.66 - 1.81) 0.78 (0.46 - 1.35)
Concurrent gemcitabine (GEM) and radiotherapy (XRT) as organ-sparing treatment for muscle-infiltrating bladder cancer (MIBC): Preliminary results of a patient-based cumulative analysis of seven phase I-II trials.
Authors: Orazio Caffo, Catherine Thompson, Maria De Santis, Borut Kragelj, Daniel A. Hamstra, David Azria, Giovanni Pappagallo, Giovanni Fellin, Ananya Choudhury
Journal: Journal of Clinical Oncology (2015)

306 Background: GEM is a highly effective radiosensitiser and has been combined with XRT in MIBC after transurethral resection (TUR) to achieve bladder preservation. Several phase I-II trials confirmed that concurrent GEM and XRT is a feasible treatment able to achieve good disease control and a high rate of organ preservation. We performed a patient-based cumulative analysis of the published trials with concurrent GEM/XRT in MIBC. Methods: Primary data for patients (pts) enrolled in all published studies on GEM/XRT were provided from the institutions. Results: A total of 190 pts were treated in seven phase I-II GEM/XRT trials. The median age was 70 yrs (range 42-87 yrs). The histology was pure transitional in 79% and mixed with squamous features in 21% of the cases. Clinical stage was T2 in 70%, T3 in 21%, and T4 in 8% of the cases, respectively. After TUR, pts received a median XRT dose of 55.5 Gy (range 45-64 Gy) with standard and hypo-fractionated regimes used in 68% and 32% of the cases, respectively. GEM was administered on a weekly or twice-weekly basis, with doses ranging from 10 mg/sqm to 500 mg/sqm; a concurrent administration of cisplatin was planned in 38 pts (20%). Grade ≥ 3 acute and late urinary toxicities were recorded in 7 (4%) and 5 (3%) pts, while grade ≥ 3 acute and late intestinal toxicities were recorded in 20 (10%) and 1 (0.5%) pts, respectively. The complete remission rate was 93.3%. Thirty-six pts (18.9%) experienced a bladder recurrence with 14 pts undergoing cystectomy. The 3- and 5-year survival rates calculated by Kaplan-Meier methods are reported in the table. Conclusions: From this pooled analysis of the clinical outcomes of the pts enrolled in phase I-II studies it appears that GEM/XRT is a treatment with mild toxicity profile, able to achieve a high rate of bladder preservation and producing favorable outcomes compared to other published series for organ-sparing therapy for MIBC. Prospective studies are ongoing to confirm these findings. [Table: see text]
The utility of using area under the curve to analyze symptom burden during radiation/chemoradiation for head and neck cancer.
Authors: T. R. Mendoza, G. B. Gunn, C. D. Fuller, X. S. Wang, D. I. Rosenthal, C. S. Cleeland
Journal: Journal of Clinical Oncology (2011)

5525 Background: Patients undergoing radiation therapy alone (RT) or with chemotherapy (CRT) for head & neck cancer (HNC) experience acute toxicity. Using patient-reported outcomes to report symptom burden is widely accepted, but analytical techniques that utilize such information are lacking. Summary measures like area under the curve (AUC) are potential quality indicators and have been used as primary endpoints in symptom intervention trials. We compared 3 methods of analyzing patient-reported symptom burden data in a prospective longitudinal study. Methods: HNC patients completed the M. D. Anderson Symptom Inventory Head & Neck module (MDASI-HN) before and weekly for up to 7 weeks during RT/CRT. We calculated the AUC and the aggregated mean for selected symptoms, and we compared them by treatment group (RT/CRT) using independent t-tests with Bonferroni correction (p=.006). We fit linear mixed models for each selected symptom, with time, treatment group and group-by-time interaction as covariates. Results: Of 152 enrolled patients, 118 provided 7 weeks of complete data. We found that the treatment groups differed significantly on fatigue AUC (122.7 vs 173.4, p<.002) and aggregated mean (2.8 vs 3.8, p<.004). The AUC of 173.4 represents an average daily rating of 3.5 on a 0–10 scale. The groups also differed significantly on drowsiness AUC (90.1 vs 136.6, p<.003) and aggregated mean (2.1 vs 3.0, p<.005). The groups differed significantly on lack of appetite AUC (104.2 vs 150.9, p<.005), but not on aggregated mean (2.4 vs 3.4, p<.007). In all cases, CRT resulted in higher AUCs and aggregated means than did RT. The group-by-time interaction terms in the linear models were not significant for drowsiness (p<.18) or fatigue (p<.12). The group-effect terms were not significant for drowsiness (p<.04) or fatigue (p<.02) when compared to the adjusted p-value. Conclusions: The AUC is more sensitive than aggregated mean in detecting group differences and may require smaller sample sizes to show group differences. Although linear mixed models did not detect significant differences in treatment groups, the additional information provided by longitudinal analysis supplements those provided by the AUC.
Analysis of skin toxicity in elderly patients (older than age 65) with metastatic colorectal cancer (mCRC) treated with cetuximab: Results of a German Noninterventional Study (NIS).
Authors: C. Jehn, L. Böning, H. Kroning, K. Possinger, D. Lueftner
Journal: Journal of Clinical Oncology (2011)

e14129 Background: This non-interventional German study (NIS) was designed to evaluate the efficacy and toxicity of cetuximab as monotherapy or in combination with chemotherapy in elderly pretreated patients (pts) with metastatic colorectal cancer (mCRC). The aim of this toxicity analysis was to evaluate specifically the skin toxicity profile of cetuximab treated patients aged > 65 years and the relationship between skin rash and response rate. Methods: Between 04/2005 and 11/2007, the data of 614 fully documented pts (out of 657 pts) with mCRC were analyzed applying descriptive statistics and X2- or Fisher's exact test. Results: Age group 18-65 years included 309 pts and had a median age of 59 years (23-65), whereas the elderly patient group included 305 pts with a median age of 71 years (66-89). There was no difference in ECOG status between the 2 groups (p=0.49). There were 793 skin reactions documented in 428 pts, with skin rash being the most frequent type of skin toxicity (64.2%). Most skin reactions were grade 1 or 2 (83.5%). Elderly pts showed a trend towards higher grade skin toxicities (p=0.05), while younger pts had significantly longer durations of skin toxicity (42 days vs. 30 days, respectively; p=0.005). Only 12.5% of pts received a prophylactic skin therapy in both age groups. A total of 52% of skin reactions were treated with topical therapy only, whereas in 13.5% of the cases a systemic therapy was also necessary. In 46.3% of skin reactions, the pretreatment skin condition could be restored. Only 2.6% of the pts discontinued cetuximab treatment due to unmanageable skin toxicity. Patients who achieved a complete remission (CR) or partial remission (PR) as best response showed a skin rash in 90.8% of the cases, compared to only 76.2%, who did not respond (no change: NC, progressive disease: PR; p< 0.0001). Conclusions: Cetuximab has a similar skin toxicity profile for elderly pts aged > 65years compared to younger patients 18-65 years. Skin rash also correlates with response rate. Cetuximab-induced skin toxicity rarely demands discontinuation of treatment, thus not compromising its efficacy in elderly patients with mCRC.