tbuckley/cabot-search huggingface dataset:
Allogeneic (allo) stem cell transplant (SCT) for multiple myeloma (MM): A retrospective single center analysis.
Authors: E. Medvedova, J. Cerny, R. Nath
Journal: Journal of Clinical Oncology (2010)

e18536 Background: Allo SCT may be curative for patients with MM but is not widely used because of high transplant related mortality. Methods: We performed retrospective analysis of all allo SCTs performed for MM at UMass Memorial Medical Center till December 2009. Results: 14 patients were identified who received 15 allo SCT procedures. There were 10 males and 4 females. Median age at the time of SCT was 49 (range 28 to 68) years. Myeloma subtype was IgA lambda 4, IgG lambda 4, IgG kappa 3, IgA kappa 1 and kappa free light chain 1. Median time from diagnosis to transplant was 22 (range 5 to 86) months and median number of chemotherapy cycles prior to transplant was 3 (range 1 to 5). 9 patients had received a prior autologous SCT. Disease status at the time of allo SCT was complete remission (CR) 2, partial remission (PR) 10, stable disease (SD) 2 and progressive disease (PD) in 1 patient. Preparative regimens consisted of single agent melphalan (200 mg/m2) 1, fludarabine/melphalan (90 – 200mg/m2) 11, fludarabine/cyclophosphamide 2 and cyclophosphamide/TBI 1. Donor was a matched sibling for 12 (1 patient had 2 SCT from the same donor) and unrelated donor for 3 SCT procedures.Graft versus host disease (gvhd) prophylaxis was cyclosporine with methotrexate (MTX)/mycophenolate mofetil (MMF) in 11; tacrolimus with MTX/MMF in 3 and T cell depletion in one patient. Median number of CD 34 cells infused was 4.91 (range 1.93 - 15.8) × 106/Kg. Median time to neutrophil engraftment was 11 (range 10 to 19) days and median time to platelet engraftment was 17 (range 9 to 34) days. Grade 2-4 acute gvhd occurred in 8 and chronic gvhd occurred in 10 (8 extensive, 2 limited) patients. 100 day and one year mortality was 20 percent and 40 percent respectively. Response status post transplant was CR 6, PR 4, PD 2 and SD in 1 patient. Nine patients have died (5 PD, 3 toxicity, 1 unknown). Five patients are alive at 46, 44 (16 month post second), 42, 31 and 24 months post allo SCT. Two patients progressed post SCT but went into remission with additional therapy (2nd allo SCT 1; chemotherapy 1). All 5 patients are currently in remission. Conclusions: Allo-SCT can be performed safely in MM and needs to be evaluated further in prospective clinical trials. No significant financial relationships to disclose.
The Irish experience of changes in treatment outcomes in patients diagnosed with glioblastoma multiforme over a 10 year period.
Authors: K. Rock, O. Mcardle, P. Forde, C. Faul
Journal: Journal of Clinical Oncology (2011)

e12512 Background: Glioblastoma Multiforme (GBM) is the most common primary brain tumour in adults. The most recent figures from the National Cancer Registry of Ireland revealed 180 new cases of GBM diagnosed in Ireland in 2008. In 2005 a phase III clinical trial demonstrated a significant improvement in survival over two and subsequently five years with the addition of concurrent and adjuvant temozolomide (TMZ) to radical radiotherapy (RT) (Stupp R, Hegi M, van den Bent M et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009:10:459-66.) The aim of this study was to investigate if the demonstrated improved survival in the literature translated to clinical practice. Methods: This is a retrospective study looking at 273 patients diagnosed with GBM and treated with adjuvant RT over a ten year period from 1998 to 2008 in Dublin, Ireland. The statistical analysis was carried out using SPSS v16. Results: The median survival for the overall group (n=273) was 7.6 months. In total 146 patients received radical RT. 103 received radical RT with concurrent and adjuvant TMZ. 43 patients received RT alone. The median survival for radical RT with TMZ was 13.4 months (95% CI 10.9-15.8) vs. 8.6 months for RT alone (95% CI 6.9-10.7, P=0.011). Two year survival figures were 21.2 vs. 4.7% respectively. A multivariate analysis identified independent predictors of survival. Palliative RT had a HR of 2.62 of death at any time (95% CI 1.66-4.12, p<0.0001) as compared to radical RT. Patients who did not receive TMZ were at a significant higher risk of death than those patients who did (HR 1.86, 95% CI 1.31 – 2.63, p<0.0001). With regards to surgical procedure biopsy only was inferior to any debulking (HR 1.54 95% CI 1.14-2.00, p< 0.004). Conclusions: This paper demonstrates improved treatment outcomes evidenced in a large phase III clinical trial translate to routine clinical practice. As shown on multivariate analysis radical debulking, radical RT, concurrent and adjuvant TMZ are independent predictors of survival.
Housestaff perspectives on end-of-life training during medical school and residency.
Authors: Jessica Marie Schmit, Lynne Meyer, Jennifer Michelle Duff, Julia Lee Close
Journal: Journal of Clinical Oncology (2015)

27 Background: Participating in end-of-life discussions and delivering bad news is integral to oncology practice. Poor communication skills can negatively impact a patient’s understanding and acceptance of their disease process, increase their anxiety, and lead to anger and depression. Hematology/Oncology fellowship training (HOFT) programs may assume incoming fellows are capable of doing this well. A study by Hebert et al. revealed 37% of HOFT programs provide little to no formal training in this area. Our study sought to assess housestaff preparedness and comfort with end-of-life (EOL) discussions. Methods: An email survey was sent to 787 residents and fellows at a single institution in February 2015. Housestaff were queried as to extent of training, experience, supervision and comfort with EOL communication in both medical school and residency. Results: 176 surveys (22.4 %) were returned.During Medical School: Many housestaff (55.1%) reported “little” to “no” classroom training on EOL discussions. Most, 85.1%, reported having five or fewer EOL discussions. Most encounters (78.6%) were supervised by an attending or resident. Only 45.5% felt “somewhat” to “fully prepared” to have EOL discussions when graduating medical school. During Residency: Housestaff reported even less classroom training on EOL discussions: 88.2% reported “little” to “no training”. EOL discussions were more common: 51% reported more than 10 EOL conversations with patients. The level of supervision decreased: only 38.6% reported encounters were mostly supervised. Most housestaff (75%) feel comfortable with having EOL discussions at their current level of training. Conclusions: Despite increased awareness regarding the importance of EOL discussion education, it remains an area that a significant number of medical students and housestaff receive little to no training. EOL discussions by housestaff are frequently unsupervised, reducing opportunities for improvement via feedback. Competence in delivering bad news is an important skill for hematologists/oncologists. Our findings support the previously published perception of HOFT program directors that additional training and resources in delivering bad news is needed.
ASCO Quality Oncology Practice Initiative (QOPI) quality measures for smoking cessation and survival in metastatic NSCLC.
Authors: I. T. Lennes, J. S. Temel, J. A. Greer, J. O. Jacobson, E. R. Park, V. A. Jackson, E. R. Gallagher, H. Bemis, W. F. Pirl
Journal: Journal of Clinical Oncology (2011)

6074 Background: According to the ASCO Quality Oncology Practice Initiative (QOPI) quality measures, smoking status should be documented and smoking cessation counseling should be done by the second oncology office visit. Although smoking during NSCLC treatment is associated with treatment complications, it is unknown whether meeting these quality standards impact cancer outcomes. We analyzed the association of adherence to smoking treatment recommendations with survival in this cohort of patients with metastatic NSCLC. Methods: This retrospective cohort study includes 68 deceased patients with metastatic NSCLC enrolled in a longitudinal survey study at Massachusetts General Hospital between 2007-2010 and received all of their cancer care at MGH from initial visit to death. Smoking history and pack years were obtained independently by patient reported smoking status and full chart review. QOPI Core quality measures were assessed including 1) documentation of smoking status by the second office visit and 2) smoking cessation counseling recommended to cigarette smokers by the second office visit. The defect-free composite measure of smoking cessation administered appropriately (combined measure 1 and 2) was the indicator for receiving high quality smoking care. Univariate differences between groups were tested using Chi-square and t-tests. Median survival was estimated using Kaplan-Meier method and survival differences were tested with Cox proportional hazards models. Results: By the second office visit 94% (64/68) patients had smoking status documented; 10 subjects (15%) smoked at enrollment; 50% had smoking cessation counseling documented. Of the total cohort 87% (59/68) had smoking cessation administered appropriately. There were no differences in pack years smoked, age, sex, performance status (PS), and race between groups. Controlling for age, sex, race, PS and pack/years smoked, patients who received high quality smoking care had significantly longer survival (7.2 months vs. 4.3 months; HR 0.33, p=0.009). Conclusions: Meeting QOPI standards for documentation of recommended quality smoking care was associated with longer survival in patients with metastatic NSCLC.
Perioperative chemotherapy with docetaxel, cisplatin, and capecitabine (DCX) in gastroesophageal adenocarcinoma: A phase II study of the Arbeitsgemeinschaft Internistische Onkologie (AIO).
Authors: P. C. Thuss-Patience, R. Hofheinz, D. Arnold, A. Florschütz, S. Daum, A. Kretzschmar, L. Mantovani-Löffler, D. Bichev, B. Gahn, G. Schumacher, M. Kneba
Journal: Journal of Clinical Oncology (2011)

4053 Background: Perioperative chemotherapy with ECF or ECX is a standard approach in Europe for resectable gastro-esophageal cancer. Docetaxel significantly improves efficacy if added to cisplatin and 5-FU as palliative treatment. To translate this efficacy into the curative approach this phase II study investigates docetaxel (D), cisplatin (C) and capecitabine (X) in the perioperative setting. Methods: Pts with curatively resectable adenocarcinoma of the distal esophagus, gastroesophageal junction (GEJ) or stomach UICC stage > 2 were treated with 3 preop and 3 postop cycles of chemotherapy: D 75 mg/m2 d1, C 60 mg/m2 d1 and X 1875 mg/m2/d d1-14, q3w. Primary endpoint: R0 resection rate. G-CSF was not routinely administered. Results: From Nov 2008 to Jan 2010, a total of 51 pts were included. Pts' characteristics: Male/female: 48/3: Med. age: 65 yrs (37-74). Karnofsky PS: 100%/90%/80%/70%: 22/24/4/1pts. Lokalisation: distal esophagus 9.8%, GEJ 60.7%, gastric body 29.4%. Histology: intestinal 39.2%, diffuse 21.6%, not specified 39.2. Cycles delivered preop: 0/1/2/3: -/-/5.9/94.1% of pts, postop: 0/1/2/3: 27.5/13.7/5.9/52.9% of pts. 51.4% of pts starting postop chemo had at least one drug reduced. Main toxicities CTC grade 3 + 4 (>5%): preop/ postop: nausea 6.1%/ 5.6%, loss of appetite 6.1%/ 2.8%, diarrhea 12.2%/ 5.6%, neutropenic fever 22.5% /8.3%, leukopenia 46.9%/ 33.2%, neutropenia 79.5%/ 61.1% Efficacy: Surgical resection rate: R0: 90.2%, R1: 5.9%, no resection: 3.9%, reported D2 LN dissection: 82.4%, post-OP complications: 29.4%, 30 day mortality: 0%, Histopathologic remission rate (Becker et al. 2003): 1a: (pCR) 13.7%, 1b (<10% viable tumor cells): 7.8%. After a median follow up of 11.8 months (range 3.7-25.4) 9 pts had tumor recurrence so far. Conclusions: DCX can be safely administered as perioperative treatment for locally advanced esophagogastric adenocarcinoma with 94.1% of pts receiving all scheduled preop cycles and 52.9% receiving all postop cycles. Routine use of G-CSF may be considered. The pCR rate of 13.7% is among the highest reported thus far in comparable trials using three-drug regimens.
Gemcitabine-cisplatin (GC) plus radical cystectomy-pelvic lymph node dissection (RC-PLND) for patients (pts) with muscle-invasive bladder cancer (MIBC): Assessing impacts of neoadjuvant chemotherapy (NAC) and the PLND.
Authors: Christopher Michael Tully, Bernard H. Bochner, Guido Dalbagni, Emily C. Zabor, Harry W. Herr, S. Machele Donat, Irina Ostrovnaya, Ashley Marie Regazzi, Philip H. Kim, John P. Sfakianos, Jonathan E. Rosenberg, Dean F. Bajorin
Journal: Journal of Clinical Oncology (2014)

355 Background: NAC and RC-PLND improves survival in MIBC and GC is a standard NAC option. However, little is known about GC efficacy endpoints and the individual contribution of NAC and surgery. Methods: Pts with clinical T2-T4aN0M0 MIBC treated from 1/2000 to 10/2012 with a planned 4 cycles of GC plus RC-PLND within 90 days (D) of NAC were evaluated retrospectively for the number (#) of cycles, dose delivered, D from end of NAC to RC-PLND, margin status, LN status and # of LN identified. Post-NAC pathologic endpoints included complete response (pT0), residual Non-MIBC disease (pTa/Tis/T1;N0) and ≥MIBC disease (≥pT2N0). Associations with overall survival (OS) and disease-free survival were analyzed using Cox regression; non-linear associations with # of resected LN used linear and quadratic terms. Results: 154 pts met inclusion criteria. 5-year (yr) OS was 61% (95% CI 53-71%). Post-NAC pT0 was achieved in 21% (32/154) and Non-MIBC in 25% (39/154 - pTa (2), pTis (25), pT1 (12)). Post-NAC pT0 and Non-MIBC had similar 5-yr OS (85% and 89%, respectively) and combined (&lt;pT2) pts differed significantly from pts with ≥pT2, (87% (95% CI 78, 98%) and 38% (95% CI 27, 53%), respectively; p&lt;0.001). Median D from NAC to RC-PLND was 34 and median # of resected LN was 19. On univariate analysis, # of cycles (4 vs &lt;4), GC dose intensity and total dose, clinical stage (cT2 vs cT3/cT4), # of resected LN, positive (+) LN and + margins were significant for OS. In multivariate analysis, post-NAC pathology ≥pT2 (HR 6.7; 95% CI 2.6-17.4; p&lt;0.001), + LN (HR 3.21; 95% CI 1.6-6.4; p=0.001) and + margins (HR 3.2; 95% CI 1.4-7.5; p=0.007) were significant for increased risk of death. Using a model with these 3 predictors to estimate the benefit of PLND, the hazard ratio decreased with each LN resected until 25 and then plateaued beyond 25 (p=0.016). Conclusions: NAC with GC has excellent drug delivery, permits rapid RC-PLND and achieves meaningful pathologic responses. Survival is similar with &lt;pT2N0 and pT0N0 post NAC pathology. Pts with post NAC ≥pT2, + margins, and + LN do poorly. Increasing LN yield on PLND contributes to OS.
Changing patterns of patient accrual to lung cancer clinical trials in an academic center
Authors: S. Dubey, L. Hammes, M. L. Larson, J. H. Schiller
Journal: Journal of Clinical Oncology (2005)

7225 Background: Less than 10% of oncology patients are enrolled on clinical trials. This has been attributed to patient or physician preferences and trial unavailability. The objective of our study was to document changing patterns of accrual to lung cancer clinical trials at an academic center. We hypothesized that patients are referred to academic centers late in their clinical course. Methods: A review of clinical trial databases at the University of Wisconsin Comprehensive Cancer Center (UWCCC) for the years 1998–1999 and 2003–2004 was conducted. Results: Fifty-three lung cancer patients were accrued to therapeutic clinical trials at the UWCCC in 1999 and 70 were enrolled in 2004. Distribution of patients by stage and disease are indicated in Table 1. To determine why patients were not being enrolled on studies, we evaluated 108 new lung cancer patients seen at UWCCC. Twelve of the 108 (11%) were enrolled on a study. Of the remaining 96, the reasons for non-enrollment were: 26%: currently under treatment by the referring physician; 14.5%: no study available; 13.5%: second opinion only; 7.3% :co-morbid illness; 6.25%: need palliative RT first; 6.25%: no additional treatment indicated; 6.25%: patient not interested in study; 5.2%: travel distance; 3.1%: poor performance status; 2%: not eligible due to prior treatment; 2%: insurance issues; 7.3%: other reasons; 0%: physician preference. Conclusions: Despite an increase in the number of lung cancer patients entered on clinical studies at a major University center, enrollment patterns have changed. Fewer patients are being entered on first line studies and more on second line and non-therapeutic studies. This appears to be due to changes in referral patterns, with more patients receiving first line therapy with their local oncologist. Lack of availability of studies does not appear be to be a major reason. No significant financial relationships to disclose.
Patients' understanding of how genotype variation affects benefits of tamoxifen therapy for breast cancer.
Authors: N. T. Brewer, C. M. Walko, W. K. Chiu, L. G. Dressler, A. Yuen, P. Rubin, O. A. Olajide, S. G. Moore, R. E. Raab, D. R. Carrizosa, S. W. Corso, G. Schwartz, J. M. Peppercorn, H. L. McLeod, L. A. Carey, W. J. Irvin
Journal: Journal of Clinical Oncology (2011)

6029 Background: New genomic markers will increasingly inform clinical care, but some may become available to patients prior to clinical validation. Studies have shown that CYP2D6 is a critical enzyme in the metabolism of tamoxifen and potentially a key determinant in breast cancer outcomes. Our study sought to examine patients’ beliefs about how CYP2D6 genotype would affect their prognosis. Methods: In LCCC 0801, women on tamoxifen for prevention or treatment of breast cancer underwent CYP2D6 genotyping; we increased tamoxifen dose in patients with any intermediate or poor metabolizing (IM or PM) alleles, but not in patients homozygous for extensive metabolizing (EM) alleles. The informed consent said that the purpose of the study was to see if dose adjustment could raise endoxifen concentrations in reduced metabolism patients, but that it is not clear whether this would provide clinical benefit. In an embedded sub-study, 321 patients (84% of possible responders) completed a survey (6 hypothetical vignettes) prior to receiving their genotype. We experimentally manipulated the vignettes to describe whether women hypothetically received tamoxifen treatment (no or yes) and their hypothetical genotype (EM, IM, PM). The outcome was women’s perceived risk of breast cancer recurrence (0% to 100%). We analyzed the data using repeated measures ANOVA to account for the study design. Results: Women expected that tamoxifen treatment would lower their recurrence risk (RR) from 49% to 31% (p<.001). Women believed that genotype would have a small effect on their RR if tamoxifen was not prescribed (46% EM, 48% IM and 53% PM, p<.001). However, they believed that, if they took tamoxifen, genotype would have a substantial effect on their RR (22% EM, 30% IM and 40% PM, p<.001). Conclusions: Women understood that tamoxifen reduced breast cancer risk, but despite study material that described uncertainty about CYP2D6 benefit in clinical-decision making, believed that this benefit was likely to be larger for extensive tamoxifen metabolizers. Though patients are receptive to genomic risk information, the rapidly changing nature of the science calls for caution when communicating clinical utility and results of novel genomic assays.
Cancer stages: What do Chinese cancer patients know?
Authors: B. Huang, P. Wang, Q. Li, Y. Jiang
Journal: Journal of Clinical Oncology (2010)

e19611 Background: Disclosure of cancer diagnosis and prognosis to a patient is still a problem in China. Chinese patients who know their cancer diagnosis may not know the true disease stage. The objective is to investigate whether cancer patient know about their real disease stage. Methods: A questionnaire was delivered to 190 cancer patients who knew their cancer diagnosis Results: One hundred and sixty-five cancer patients (86.8%) completed the questionnaire. Most of them (70.3%) knew cancer diagnosis immediately after the diagnosis. Twenty five patients (15.2%) knew cancer diagnosis within one week after the diagnosis. However, fifty patients (30.3%) said that they knew nothing about their disease stage. Most of these 50 patients were diagnosed as stage 4 diseases (74.0%). One hundred and fifteen patients (69.7%) believed that they knew their disease stages. These stages, which patients believed, differed significantly from their real stages (P = 0.000). Actually, only 70.4% patients among them knew their real stages. Therefore, 50.9% patients (84 out of 165) didn't know their real disease stages. Patient with stage 1-3 cancer was more likely to know the real disease stage than patient with stage 4 disease (67.1% vs. 31.3%, P < 0.001). Conclusions: Our findings indicated that only half of Chinese cancer patients knew the real disease stage. Patient with stage 1-3 cancer was more likely to know the real disease stage than patient with stage 4 disease. No significant financial relationships to disclose.
Survey of acupuncture and complementary medicine use in breast cancer patients
Authors: R. Venkateswaran, B. Oh, J. M. Beith
Journal: Journal of Clinical Oncology (2008)

20719 Background: The use of complementary medicines and therapies, including acupuncture, amongst cancer patients is increasing. However, there are no recent statistics of acupuncture use in Australia. The purpose of our study was to determine the prevalence and types of complementary therapies (CM) in use, with emphasis on the prevalence of, rationale for and attitudes towards acupuncture use in patients with breast cancer in our department via a questionnaire. Methods: Patients were randomly selected from all breast cancer patients, both early and advanced stage, attending oncology clinics at Royal Prince Alfred Hospital. Patients were then requested to complete a survey incorporating questions about prevalence of CM use and rationales and attitudes towards acupuncture use. All completed questionnaires were assessable. Results: Forty eight out of a planned 100 women have completed the survey. The prevalence of complementary therapy use was 75% (36 of 48); vitamin supplements, herbal medicines, relaxation techniques and special exercises (yoga, tai chi, qi gong) were most frequently used. The prevalence of acupuncture use was 37.5% (18 of 48). 10 of 18 patients had used acupuncture after their diagnosis of breast cancer. 6 patients used it specifically for breast cancer related symptoms, including chemotherapy related fatigue or nausea. 66.6% (12 of 18) of patients had not revealed their acupuncture use to the medical oncologist, predominantly because they had not specifically been asked about its use. 89% (16 of 18) patients who had previously used acupuncture would use it again. Of the patients who had never used acupuncture, 56.6% (17 of 30) would try it if it was recommended by their medical oncologist. None of our patients reported adverse events related to acupuncture. Conclusions: This study reveals the use of complementary therapies and acupuncture is significant amongst breast cancer patients. Oncologists need to be aware of patients’ attitudes and use of CM. Its benefit needs to be assessed in scientific studies to ascertain if there is potential value for breast cancer patients. No significant financial relationships to disclose.