tbuckley/cabot-search huggingface dataset:
Establishing survivorship care planning in a comprehensive cancer center to meet clinic needs and accreditation standards.
Authors: Sheetal Mehta Kircher, Sofia M Garcia, Megan Rae Oden, Aubri Veneruso, June M. Mckoy, Frank J. Penedo
Journal: Journal of Clinical Oncology (2016)

59 Background: Standard 3.3 of the American College of Surgeons Commission on Cancer (CoC) patient-centered care guidelines requires that accredited institutions deliver SCPs to all patients completing cancer treatment with curative intent (10% of eligible patients in 2015 and increasing incrementally to 100% in 2019). Implementation of SCP delivery has been challenging and limited to date. We describe our implementation process at the Robert H. Lurie Comprehensive Cancer Center. Methods: We established a multidisciplinary working group that developed and administered a survey of providers’ attitudes towards SCPs and preferences for delivery, assessed clinical workflows, then developed and vetted customized SCP templates within the electronic health record (EHR) and two complimentary SCP delivery models. Results: Twelve providers completed the survey (6 physicians, 5 advanced practice providers [APPs], 1 nurse). 67% viewed SCPs as feasible within workflows, 75% felt designated survivorship clinicians were best equipped to deliver SCPs; All reported SCPs were beneficial to patients; and 92% felt SCPs were beneficial to inter-provider communication. Cited barriers were: time and staff required and non-optimal billing. To harmonize with existing workflows, we established two delivery models: (1) clinical groups with a low volume of survivors relative to available nursing staff complete and deliver SCPs themselves; (2) clinical groups with high volumes of survivors relative to available nursing staff refer patients to a centralized survivorship clinic where SCPs are delivered by designated survivorship APPs. All elements of the ASCO templates were incorporated into our EHR templates. We reduced free-text data entry by designing templates where 20% of the fields are auto-populated from existing EHR data and another 65% use drop-down menus. Mean completion time is 12 minutes (range 10-30 minutes; n= 30). Conclusions: CoC-accredited institutions across the nation are working to meet Standard 3.3. We present our experiences developing and implementing SCP delivery models, including lessons learned to inform models of survivorship care under development at other institutions.
Uptake of genetic testing by relatives in Lynch syndrome: A systematic review.
Authors: Ravi Sharaf, Parvathi Myer, Christopher Stave, Lisa Diamond, Uri Ladabaum
Journal: Journal of Clinical Oncology (2013)

374 Background: Screening of persons with newly diagnosed colorectal cancer (CRC) for Lynch Syndrome (LS) can yield substantial population-level benefits at acceptable costs, presuming sufficient uptake of genetic testing by first-degree relatives (FDRs) of LS probands. We reviewed systematically the published literature addressing the frequency and predictors of uptake of genetic testing by FDRs of LS probands. Methods: A literature search was conducted in four electronic databases (CINAHL, PsycInfo, PUBMED, and SCOPUS) for articles published through May 2011 that reported the uptake of genetic testing by relatives of LS probands. Two investigators independently screened articles to determine whether they met inclusion criteria, and abstracted data inthree broad categories: study population, methodology, and uptake of genetic testing. A narrative, qualitative systematic review was performed. The data were not amenable to meta-analysis. Results: 1,258 potentially relevant articles were identified with 533 studies undergoing full text review. Eight articles met inclusion criteria. 52% or less of FDRs of LS probands underwent genetic testing. For each LS proband, 4.6 or fewer relatives underwent genetic testing. Demographic factors (age &lt;50 years, female gender, parenthood, education level, employment, participation in past medical studies), psychological factors (lack of depressive symptoms), and family history (greater number of relatives with cancer) were associated with uptake of genetic testing. Conclusions: Genetic testing may be underutilized by FDRs at risk for LS. The economic feasibility of screening persons with CRC for LS depends on optimizing family-wide uptake of genetic testing. Future research and clinical efforts should focus on ways to overcome barriers to genetic testing.
Do informed patients have different CIPN outcomes? Results of a Research Advocacy Network survey.
Authors: Mary Lou Smith, Carol B. White, Elda Railey, Robert Bellucci, Cara Thompson
Journal: Journal of Clinical Oncology (2016)

60 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is common in cancer patients (pts). CIPN impacts quality of life (QoL) and causes emotional distress and treatment (Tx) delays. No agents are recommended for prevention and one agent is recommended for Tx of CIPN (ASCO Guidelines, 2014). Limited data exist about pt experiences with CIPN. The study goal was to understand pt experiences related to CIPN. Methods: An online, 67-question survey was completed by pts with breast or lung cancer. All had chemotherapy and self-reported moderate (mod) or severe CIPN within the past 2 years (mild CIPN excluded). Pts rated CIPN symptom frequency, socioemotional wellness, and impact on a 6- or 7-point scale (depending on item) and bothersomeness on a 5-point scale. Results were not analyzed by chemotherapy type. Results: Respondents had early breast cancer (EBC; n = 114), metastatic breast cancer (MBC; n = 96), or lung cancer (LC, all stages; n = 65). All EBC and MBC and 72% of LC pts were women; &gt; 80% were White. Moderate CIPN existed in 63%, 67%, and 82% of EBC, MBC, and LC pts; severe CIPN occurred in 37%, 33%, and 18%, respectively. CIPN severity was associated with reduced QoL. Very/extremely bothersome effects on QoL occurred in 63% severe CIPN (n = 86) and 15% mod CIPN (n = 189) pts. Almost all EBC (94%) and two-thirds of MBC and LC pts had persistent CIPN. Symptoms included foot (97%)/hand (88%) numbness/tingling, foot (92%)/hand (81%) discomfort, foot/leg pain (85%), and joint pain (83%). Pts reported reduced physical function, productivity, and socioemotional wellness. Receiving information before Tx was linked with greater chance of mod vs severe CIPN. More pts with mod vs severe CIPN (37% vs 21%) received information about CIPN before chemotherapy. Having healthcare providers (HCPs) ask about symptoms was linked with a greater chance of mod vs severe CIPN. More pts with mod vs severe CIPN (28% vs 17%) had HCPs ask about CIPN symptoms. Conclusions: Learning about CIPN before chemotherapy was associated with a lower chance of severe CIPN. Early and ongoing communication with pts about risks, manifestations, and importance of reporting CIPN may limit severe CIPN and preserve QoL specifically with regards to socioemotional wellness.
Effect of continued imatinib (IM) in pts with detectable BCR-ABL after ≥ 2 years on study on deep molecular responses (MR): 36-month update from ENESTcmr.
Authors: Nelson Spector, Nelma Cristina D. Clementino, Pedro Enrique Dorlhiac-Llacer, Brian Leber, Timothy P. Hughes, Francisco Cervantes, Anthony P. Schwarer, Donna L. Forrest, Suzanne Kamel-Reid, Israel Bendit, Sandip Acharya, LaTonya Collins, Darshan Dalal, Jeffrey H. Lipton
Journal: Journal of Clinical Oncology (2014)

7025 Background: With 24 mo f/u, ENESTcmr demonstrated higher rates of stable, deep MRs with nilotinib (NIL) vs IM in pts on long-term (≥ 2 y) IM with residual disease. Here, we present 36-mo results, including crossover from IM to NIL after 2 y on study. Methods: Pts with Philadelphia chromosome–positive CML-CP (N = 207) with complete cytogenetic response but detectable BCR-ABL (by RQ-PCR with a sensitivity of ≥ 4.5 logs) after ≥ 2 y on IM were randomized to NIL 400 mg twice daily (BID; n = 104) or IM 400 or 600 mg once daily (QD; n = 103). Crossover from IM to NIL was allowed for pts with detectable BCR-ABL after 24 mo, treatment failure, or confirmed (≥ 2 consecutive assessments) loss of response at any time. Results: Significantly more pts achieved MR4.5 by 36 mo with NIL (Table). Median time to MR4.5 was 24 mo in the NIL arm and not reached in the IM arm with 36 mo f/u. 46 of 103 (45%) pts randomized to IM crossed over to NIL. When accounting only for responses up to crossover, 47% and 24% of pts on NIL and IM, respectively, achieved MR4.5 (P = .0003). At 24 mo, 52 pts on NIL and 78 pts on IM had detectable disease; 4/52 who continued NIL, 0/35 who continued IM, and 11/43 who crossed over from IM to NIL achieved undetectable BCR-ABL by 36 mo. The rate of MR4.5 appeared higher in pts randomized to NIL (33% by 1 y in pts without MR4.5 at baseline [BL]) than in pts who crossed over to NIL (21%) with similar follow-up. Adverse event profile was similar to the 12 mo report. Conclusions: By 36 mo, significantly more pts achieved MR4.5 by switching to NIL vs remaining on IM and median time to MR4.5 was accelerated by more than 1 y in the NIL arm. Pts with detectable disease who crossed over from IM to NIL after 24 mo were able to achieve deep MRs by 36 mo on study, whereas no pts who remained on IM achieved undetectable BCR-ABL. Delaying switching from IM to the more potent BCR-ABL inhibitor NIL does not increase the proportion of pts achieving deep MR. Clinical trial information: CAMN107A2405. NIL 400 mg BID (n = 98) IM 400 or 600 mg QD (n = 96) P Value MR4.5 in pts without MR4.5 at BL (intention to treat analysis) n (%) n (%) By 12 mo 32 (33) 13 (14) 0.0020 By 24 mo 42 (43) 20 (21) 0.0006 By 36 mo 46 (47) 32 (33) 0.0453 By 36 mo, excluding pts who crossed over to NIL 46 (47) 23 (24) 0.0003
Mutational Characterisation and Tracking Disease Progression Using Circulating Cell-Free Tumor DNA in Multiple Myeloma Patients
Authors: Sridurga Mithraprabhu, Tiffany Khong, Malarmathy Ramachandran, Annie W.S. Chow, Daniela Klarica, Laura Mai, Stephanie Walsh, David Broemeling, Andre Marziali, Matthew Wiggin, Jay Hocking, Anna Kalff, Brian G.M. Durie, Andrew Spencer
Journal: Blood (2016)
Combination therapy with gefitinib and fulvestrant (G/F) for women with non-small cell lung cancer (NSCLC)
Authors: A. M. Traynor, J. H. Schiller, L. P. Stabile, J. M. Kolesar, C. P. Belani, T. Hoang, S. Dubey, J. Eickhoff, S. M. Marcotte, J. M. Siegfried
Journal: Journal of Clinical Oncology (2005)

7224 Background: Estrogen receptors (ERs) have been detected in NSCLC specimens. Fulvestrant has blocked estradiol-stimulated tumor growth in NSCLC cell lines. Preclinical data show an inverse cross-talk between the EGFR and ER pathways. Objectives: Determine safety and efficacy of G/F and correlate with markers of ER and EGFR pathways. Methods: Post-menopausal women with advanced NSCLC received gefitinib 250 po mg daily and fulvestrant 250 mg IM monthly, every 28 days. Results: Accrual goal is 22 pts; 15 have enrolled to date. Median age is 72 yrs. 8 pts had adenocarcinoma, 3 squamous cell, 3 NSCLC-NOS, and 1 bronchoalveolar carcinoma. 5 pts never smoked; 9 were former smokers. Prior lines of chemotherapy received: ≥2 (6 pts), 1 (5 pts), 0 (4 pts). PS: 0 (7 pts), 1 (6 pts), 2 (2 pts). Gr 3/4 treatment-related toxicities: Gr 4 dyspnea (1 pt). No unexpected toxicities have been seen. 11 pts are evaluable for response: 2 confirmed PRs (1 adenocarcinoma and 1 NSCLC-NOS), both in never smokers. Median number of cycles of treatment, PFS, and OS are 5.29 cycles, 21 wks, and 28+ wks (not yet reached; range 7–38+). 6 pts have stable disease [SD] (1 current smoker, 4 former smokers, 1 never smoker); the median duration of SD is 21 wks. There was no correlation between total ER or amount of nuclear ER staining and response to treatment or histology in 8 tumors examined. 1 patient receiving 2nd-line treatment had a heterozygous point mutation (G2591A) in EGFR exon 21 and SD for 21 wks; neither pt with PR had sufficient tumor for mutation analysis. None of the 6 tumors analyzed displayed EGFR gene amplification. Genotyping for MDR-1 and CYP3A4*1B was performed in 11 tumors; variants did not correlate with toxicity or response. Conclusions: G/F in post-menopausal women with NSCLC is well-tolerated and demonstrates disease activity. Correlative studies indicate there is no relation between amount of ERα, ERβ or EGFR expression in the tumor and response to treatment. 5 of the 6 pts with SD were active or former smokers. 1 pt with an EGFR mutation had prolonged SD, but no PR. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration AstraZeneca, EMD, Genentech, Millenium, Taiho AstraZeneca, GlaxoSmithKline, Lilly Oncology, Taiho AstraZeneca, CellGate, GlaxoSmithKline, Lilly Oncology
Disseminating team training across an academic cancer center and community-based satellites.
Authors: Anne Gross, Susan Mann, Saul Weingart, Michael Kalfin, Andrew David Norden, Lori A. Buswell, Michael Constantine, Frances Fuller, Frederick Briccetti, Jodi Thiele, Rolf Freter, Judith Kostka, Geoffrey K. Sherwood, Janet O'Connor, Craig A. Bunnell
Journal: Journal of Clinical Oncology (2013)

188 Background: Dana-Farber Cancer Institute is the first cancer center to implement Team Training (TT). This program illustrates critical lessons about disseminating a quality improvement initiative across an academic center and its regional community-based satellites. Methods: We adapted TT principles to the needs of our satellite centers. This required recognizing different work flows and communication patterns, identifying hazards in routine communications, integrating satellite-main campus communication, and facilitating situational awareness when practicing at multiple sites. Key components included: support from executive leadership and Board of Trustees; previous success at the main campus; use of data and actual near-miss scenarios; development of workflows for critical communications; and workflows for shared care of patients at different sites. Results: Staff surveys demonstrated safer, more efficient, and more respectful practice environments. Higher scores were seen across most categories in comparison to main campus. We observed an increase in the number of chemotherapy orders without issues (81.7% to 91.9%) and a decrease in the number of missing (7.0% to 3.4%) or noncommunicated order changes (3.1% to 1.0%) when the patient arrived for treatment pre TT vs. post TT. Patient perception of teamwork, measured by Press-Ganey, showed a statistically significant increase at both the main and satellite campuses. Conclusions: TT improved communication, task coordination, perceptions of efficiency, quality, safety, and patient perception of care coordination, at both the academic main campus and our community-based satellite practices. [Table: see text]
Salvage endoscopic submucosal dissection for the treatment of esophageal squamous cell carcinoma after local treatment failure with chemotherapy, radiotherapy, or chemoradiotherapy.
Authors: Toshiro Iizuka, Daisuke Kikuchi, Shu Hoteya, Akihiro Yamada, Mitsuru Kaise
Journal: Journal of Clinical Oncology (2015)

148 Background: Chemotherapy (CT), radiotherapy (RT), and chemoradiotherapy (CRT) are efficacious treatment options for esophageal squamous cell carcinoma (ESCC). However, local treatment failure remains a major problem. In this study, we applied endoscopic submucosal dissection (ESD) for the treatment of ESCC after local treatment failure with CT, RT, or CRT. The efficacy, safety, and feasibility of salvage ESD were assessed. Methods: Between 2008 and 2014, 611 patients underwent ESD for superficial ESCC in our hospital. Of them, 14 required salvage ESD: 7 for local treatment failure after CT, 4 after CRT, and 3 after RT. Each patient was treated with CT using 5-fluorouracil + cisplatin or RT, which consisted of &gt;50 Gy of irradiation with or without concurrent CT. The following clinical findings were confirmed in all patients: no evidence of lymph node or distant metastasis after treatment, and an endoscopically resectable lesion. Results: The male to female ratio was 11:3 and the mean age was 64.9 (44-81) years. Clinical stages before treatment were T1b/T2/T3/T4 in 10/1/2/1, N0/1 in 7/7, and M0/1 in 13/1, respectively. The mean tumor size was 18.6 mm, and the mean procedure time was 45.7 min. En bloc resection was achieved in 100% of cases, and the R0 resection rate was 78.6%. Histopathological assessment of specimens taken at salvage ESD revealed that 6 lesions (42.9%) had invaded the submucosal layer and had been resected noncuratively because of a positive vertical margin (n = 2) or positive lymphovascular invasion (n = 5). No immediate or delayed complications, including major bleeding or perforation, and no ESD-related deaths occurred. At a mean follow-up period of 26.5 (range, 5–55) months, local recurrence had developed at the treatment site in 2 patient. Overall, 10 patients were still alive. The remaining 4 had developed lymph node metastasis, 2 of whom had died from it. Conclusions: Salvage ESD is an option for ESCC patients with local treatment failure after CT, RT, or CRT.
Chemotherapy order review, activation, preparation, and administration redesign at a large academic cancer center.
Authors: Inga Tolin Lennes, Nie Bohlen, Erika Rosato, Ellen Fitzgerald, Barbara J. Cashavelly, Katie Lafleur, Sami Ahmed, Debra Burke, David P. Ryan
Journal: Journal of Clinical Oncology (2013)

221 Background: Chemotherapy medication errors are potentially catastrophic due to the small window of therapeutic index, high toxicity, and the compromised clinical status of most recipients. Although compliant with major guidelines for chemotherapy administration, MGH Cancer Center still experienced chemotherapy medication errors tracked in the safety reporting system. Analysis of the safety report data prompted the chemotherapy order review, activation, preparation and administration redesign project with two aims: 1) establish the standard for safety checks for chemotherapy order review, mixing, product verification and administration across all areas of adult chemotherapy infusion by April 2013 and 2) reduce to zero the number of chemotherapy related medication errors by January 2014. Methods: A multidisciplinary team including nursing, pharmacy, and physicians was convened and a problem statement, aim statement, project scope, boundaries and measures of success were delineated. Process maps of each chemotherapy administration area (four in total) were created in an iterative fashion via meetings with front line staff and administration. Cause and effect diagrams were created by small groups of staff members from each area and improvement projects were brainstormed and implemented by nursing directors. Error data from safety reports was compiled quarterly and shared with all workers. Results: A single gold standard for MGH Cancer Center chemotherapy order review, activation, preparation and administration was created for all areas that administer chemotherapy to adults. This redesign project has led to several spin off improvement projects including a medication error awareness project led by nursing and a new competency assessment for oncology nurses. The total number of medication related safety reports has decreased by 67%. The time since our last major chemotherapy administration error is 239 days and we are on track to meet our second project aim. Conclusions: This project employed quality improvement tools and practices to redesign and standardize chemotherapy administration and decrease safety reports related to chemotherapy errors by 67%.
A phase I study of hyperfractionated low-dose radiotherapy (RT) as a chemotherapy sensitizer in combination with gemcitabine (G) and erlobtinib (E) in advanced pancreatic cancer.
Authors: Andre A. Konski, Joshua E. Meyer, Philip Agop Philip, Anthony Frank Shields, Michael J. Hall, Minsig Choi, Gail Duncan, Beth Adaire, Erin McSpadden, Steven J. Cohen
Journal: Journal of Clinical Oncology (2013)

268 Background: G can sensitize pancreatic cancer (PC) to radiotherapy (RT). However, this approach requires lower doses of G and thus delays aggressive systemic treatment, which may lead to distant failure. In preclinical models, hyperfractionated low-dose RT sensitizes PC cells to G and erlotinib. We thus initiated a Phase I trial combining hyperfractionated low-dose RT combined with full dose G and a tyrosine kinase inhibitor, E, in the treatment of patients with advanced PC. Methods: Patients (pts) with locally advanced or metastatic PC confined to the abdomen and an ECOG performance status (PS) of 0-1, who had received 0-1 prior regimens (without G or E) and no prior RT were enrolled to successive cohorts in a 3+3 design. Patients were treated in 21 day cycles with G IV days 1 &amp; 8, E once PO QD, and twice daily RT fractions separated by at least 4 hours on days 1, 2, 8, and 9. Whole abdominal RT fields were used. Dosing cohorts were as follows (G in mg per m 2 , E in mg, XRT/fraction in cGy): 1 (1,000, 100, 40), 2 (1,000, 100, 50), 3 (1,000, 100, 60), 4 (1,000, 150, 60). Primary endpoint was to define dose limiting toxicity (DLT) and the maximum tolerated dose (MTD). Results: A total of 27 pts, (median age 64 yrs and 15 male), were enrolled between 11/24/08 and 4/12/12. 17 patients had a PS of 1. The majority of patients were stage IV. Seven pts were enrolled in dose level 1, with 1 pt experiencing a DLT of grade 3 ileus, 3 pts enrolled each in dose levels 2-4 without DLT and 11 pts enrolled in the expanded portion of level 4. Best response by RECIST in 24 evaluable pts and was as follows: partial response 8, stable disease 15 and progressive disease 1. One pt initially found to be unresectable at surgery was subsequently resected with only minimal microscopic residual disease. The majority of grade 3 toxicities were hematologic with 1 grade 5 bowel perforation in dose level 1 in cycle 4. Conclusions: This phase I study combining low-dose hyperfractionated RT as a sensitizer to full dose G plus E was well tolerated with the majority of pts experiencing either a partial response or stable disease. This represents a novel strategy worthy of further investigation in pts with advanced PC. Clinical trial information: NCT00761345.
Effects on the expression of VEGF, MMP-2, and MMP-9 of endostar combined with radiotherapy on transplanted tumor model of CNE1 nasopharyngeal carcinoma in nude mice.
Authors: Q. Songbin
Journal: Journal of Clinical Oncology (2011)

e21016 Background: To evaluate the inhibitory effect on the growth of and to evaluate the effects on the expression level of VEGF, MMP-2 and MMP-9 in transplanted tumor model of CNE1 nasopharyngeal carcinoma in nude mice. Methods: The transplanted tumor model of human CNE1 nasopharyngeal carcinoma on nude mice was established and further divided into four groups, control,endostar, radiation and endostar + radiation group randomly. The later three groups were treated with endostar, radiotherapy, endostar combined with radiotherapy, respectively. The growth characteristics of transplanted tumor were recorded. Four weeks after the treatment, the mice were killed, and the transplanted tumor was sampled and the mRNA expression level of VECF, MMP-2 and MMP-9 in tumor samples was detected by RT-PCR. Results: The combination therapeutic regimen has more significant inhibition effect on the tumor growth compared with other three groups, and the differences were significant (P<0.05).The expression levels of VEGF MMP-2 and MMP-9 in combination group were much lower than in other three groups (P<0.05). The expression level of VEGF has the positive correlation with that of MMP-2 and MMP-9 (P<0.01). Conclusions: Endostar in combination with radiotherapy had much more significanly inhibitory effect on the growth of transplanted CNE1 nasopharyngeal carcinoma in BALB/c nude mice. Endostar could enhance the radiosensitivity of transplanted tumor of nasopharyngeal carcinoma in nude mice to radiotherapy, and its mechanism may attribute to the down-regulation of VEGF and MMP-2 and MMP-9 expression.