tbuckley/cabot-search huggingface dataset:
Outcomes of patients with advanced cancer admitted to intensive care units
Authors: T. D. Gilligan, J. P. Burns, A.-L. Puopolo, T. A. Brennan
Journal: Journal of Clinical Oncology (2005)

8064 Background: There has been a greater reluctance historically to utilize critical care resources for cancer patients than for patients with other diseases that carry a similarly poor prognosis. We performed a prospective cohort study to evaluate whether cancer patients treated in intensive care units (ICUs) utilize greater resources, have greater limitations placed on their care, or are more dissatisfied. Methods: We compared 157 patients with advanced cancer to 1380 non-cancer patients with regard to utilization of resources, mortality, satisfaction, quality of life, and documented discussions and decisions regarding resuscitation. Satisfaction was measured using surveys completed by patients or their surrogates while other data was obtained through chart review. Results: Cancer patients were more likely to have code status discussions (Odds ratio [OR] = 3.3, p<0.001), to be designated “do not resuscitate” (OR 3.4, p< 0.001), and to die during their hospitalization (32% vs. 18%, OR = 1.9, p=0.005), but 68% of cancer patients were discharged alive. No differences were seen in hospital costs, length of stay, pain or overall quality of life. Cancer patients were more likely to rate their care as fair to poor (6.3% vs. 2.2%, p<0.001) and reported slightly higher levels of emotional distress. Conclusions: Critically ill cancer patients treated in ICUs have a high probability of surviving to discharge. Intensive care for cancer patients does not consume greater resources than critical care for other patients nor is it associated with large difference in quality of life relative to other critically ill patients. No significant financial relationships to disclose.
Sex differences in the inflammatory response and inflammation-induced vascular dysfunction
Authors: Krishnaraj Rathod, Vikas Kapil, Shanti Velmurugan, Rayomand Khambata, Umme Siddique, Saima Khan, Lorna Gee, Jaspal Bansal, Kavi Pitrola, Christopher Shaw, Fulvio D'Acquisto, Romain Colas, Federica Marelli-Berg, Jesmond Dalli, Amrita Ahluwalia
Journal: The Lancet (2017)
Lessons learned from the development of the CancerLinQ prototype: Clinical decision support.
Authors: Richard L. Schilsky, Sandra M. Swain, Robert Hauser, Joshua Mann, George W. Sledge, Peter Paul Yu, Allen S. Lichter, Clifford Hudis
Journal: Journal of Clinical Oncology (2013)

237 Background: CancerLinQ (CLQ) is a rapid learning system (RLS) for oncology in development by ASCO. CLQ is based on the transfer of electronic health records (EHR) from participating oncology practices to a data warehouse where data aggregation and de-identification occurs. A prototype was built using open source software and has collected de-identified data on 170,000+ pts with breast cancer (BC) from 31 community oncology practices using 4 different EHRs. The primary goals for the prototype were 1. Aggregate patient data from any EHR platform, process it and create a longitudinal record; 2. Develop quality reports from EHRs; 3. Point of care Clinical Decision Support (CDS) from ASCO guidelines; 4. Data visualization for hypothesis generation; 5. Demonstrate desire to share data for quality improvement; 6. Describe lessons learned (LL). This report focuses on LL about CDS. Methods: Physician experts identified specific elements from each ASCO BC guideline to make machine readable (MR). Abstractors then GEM-cut the elements using the GEM Abstraction Manual and Style Guide. The output reports were reviewed for comprehensiveness, accuracy, and style. Following verification of the GEM-cut content, reports were sent for meta-tagging, done by selecting widely used EHR vocabulary from the Unified Medical Language System (UMLS). The GEM-cut output and meta-tags were converted to DROOLS syntax and the resulting coded files were inserted into the DROOLS rules engine. When the rules engine encounters a combination of facts that match a rule, that rule is presented to the user. The enduring responses are collected using ‘queries’ and the CDS results are delivered to the EHR. Results: Guidelines are often not written as “if”/“then” statements which is key for computer-based CDS. Any unintentional ambiguity must be removed for machine MR CDS. Using new methodologies, we have been able to convert narrative guidelines into MR CDS. Conclusions: Conversion of ASCO’s clinical guidelines into a MR format is possible. New and emerging methods such as GLIDES, BRIDGE-Wiz, and GEM-cutting provide excellent tools to migrate existing narrative recommendations into MR format that can populate CDS tools, such as those provided by CancerLinQ.
Prognostic factors of adenoid cystic carcinoma of head and neck.
Authors: Y. Choi, S. Kim, S. Y. Kim, S. Y. Nam, S. Choi, J. Roh, J. H. Lee, S. Lee, K. Cho
Journal: Journal of Clinical Oncology (2011)

5584 Background: Adenoid cystic carcinoma is a rare malignancy, accounting for about 1% of head and neck cancer. We assessed clinical characteristics and prognostic factors affecting clinical outcomes in patients with ACC of head and neck. Methods: From February 1991 to July 2009, a total of 88 patients with ACC of head and neck who underwent curative intent surgery with or without adjuvant radiotherapy (RT) at Asan Medical Center, Seoul, Korea were analyzed retrospectively. Results: R0 resection was done in 29 (33.0%). Sixty-four (72.7%) received postoperative RT. Median dose of RT was 61.1 Gy (range, 18.0-70.0). Thirty five patients recurred, 18 of whom developed distant metastasis. Most common metastasis site was lung (72.2%). Disease free survival (DFS) rate at 3-years and 5-years was 66.3% and 48.9%, respectively. Overall survival (OS) at 5-years and 10-years was 89.7% and 70.3%, respectively. On multivariate analyses, ACC of salivary gland showed significantly lower recurrence rate than that of other sites (p=0.028). Postoperative RT at 33 fraction or more had a significant impact on recurrence rate (p=0.027) and DFS (p=0.001). Young (under 40) and old (60 or older) age, histologic feature of solid form, stage III or IV were significantly associated with shorter DFS (p=0.029, p=0.003, and p=0.010, respectively). The age of 60 or older significantly affected OS adversely (p=0.034 and p=0.034, respectively). Conclusions: Age, tumor location, histologic feature, stage, adequate fraction of postoperative RT were significant prognostic factors on ACC of head and neck. Multivariate analysis of clinical parameters. Clinical parameters P value Odds ratio/hazard ratio (95% CI) Recurrence Tumor location (salivary glands) 0.028 0.307 (0.10.7-0.883) Postoperative RT (>33Fx) 0.027 0.308 (0.109-0.872) Disease-free survival Age (<40 or > 60 y) 0.029 2.408 (1.096-5.290) Histologic feature, solid form 0.003 8.784 (2.130-36.223) Stage III or IV 0.010 2.845 (1.288-6.285) Postoperative RT (>33Fx) 0.001 0.229 (0.095-0.553) Tumor location (nasal cavity, paranasal sinus or pharynx) 0.071 2.195 (0.936-5.145) Overall survival Age>60 y 0.034 2.760 (1.078-7.066)
Microenvironmental Stromal Cells Rescue CLL Cells from Apoptosis Via Hypoxia That Can be Targeted Therapeutically
Authors: Irina Idler, Deyan Yosifov, Nupur Bhattacharya, Michaela Reichenzeller, Viola Meyer-Pannwitt, Daria Ezerina, Annika Scheffold, Sabrina Kugler, Tobias Dick, Hartmut Dohner, Stephan Stilgenbauer, Daniel Mertens
Journal: Blood (2015)
Front-line treatment for advanced pulmonary adenocarcinoma based on EGFR mutation status.
Authors: S. Wang, H. Yang, W. Ou, Q. Fang
Journal: Journal of Clinical Oncology (2011)

e18043 Background: The first-line use of gefitinib may be recommended for patients with non-small lung cancer harbouring mutation in the epidermal growth factor receptor (EGFR) gene. And for patients with advanced pulmonary adenocarcinoma, pemetrexed plus platinum doublet chemotherapy is a standard first-line therapy. In this study, the efficacy of front-line treatment based on EGFR-mutation has been investigated in advanced pulmonary adenocarcinoma. Methods: Previously, untreated patients (n=104) with pulmonary adenocarcinoma of stage IIIB or IV and Eastern Cooperative Oncology Group performance status of 0 or 1 were eligible to the study. Patients with EGFR-mutation pulmonary adenocarcinoma were assigned to receive gefitinib (250 mg/d) until disease progression. Then these patients would be administered with pemetrexed as second-line treatment(Group A). Those with EGFR wild-type pulmonary adenocarcinoma patients received pemetrexed 500 mg/m2 plus carboplatin area under the curve (AUC) 5 for 4 cycles followed by maintenance pemetrexed until disease progression. Then patient would cross to gefitinib as second-line treatment (Group B). The primary end point is progression-free survival (PFS) in the front-line and second-line treatment. Results: 104 patients were evaluable for efficacy in front-line treatment. The median PFS of the whole group, Group A and Group B was 7.8 months(95% CI 5.1-10.5), 10.1 months (95% CI 6.2-14.0) and 5.7 months (95% CI 4.4-7.1), respectively. At the data cut-off, a total of 64 patients had disease progressed (32 patients in Group A and 32 patients in Group B) and 61 patients was across to second-line therapy. Median PFS of second-line was 2.4 months (95% CI 0.4-4.5) in whole group, while 5.8 months (95% CI 4.1-7.5) in Group A and 1.4 months (95% CI 0.7-2.0) in the Group B,respectively. Conclusions: The frond-line use of gefitinib, followed by pemetrexed as second-line when disease progressed, is an option in advanced pulmonary adenocarcinoma patients with EGFR mutations. The frond-line choice of pemetrexed plus carboplatin followed by continuation maintenance pemetrexed until disease progression is acceptable for advanced pulmonary adenocarcinoma with wild-type EGFR
The impact of dose intensity on the efficacy of gemcitabine plus carboplatin (GC) therapy for recurrent platinum-sensitive ovarian cancer (PSOC): A retrospective analysis of AGO-OVAR 2.5.
Authors: C. Kurzeder, L. Zhao, E. A. Eisenhauer, I. B. Vergote, A. Du Bois, D. Tai, Y. Wang, J. F. Gill, H. W. Hirte, B. Richter, L. C. Hanker, J. Bentley, U. A. G. Wagner, M. Plante, R. Kimmig, J. Pfisterer
Journal: Journal of Clinical Oncology (2011)

5088 Background: The gemcitabine plus carboplatin combination (GC) is known to provide a clinical advantage compared to single-agent C for patients (pts) with recurrent PSOC. Dose reductions and delays for toxicity are common during standard GC therapy. To evaluate the potential impact of G and C dose adjustments on clinical outcomes in pts with PSOC, we retrospectively analyzed dose intensity (DI) data from the phase III trial AGO-OVAR 2.5. Methods: Data analyses were performed for 175 GC-treated pts. G and C weekly DIs were calculated as the mean dose of drug received divided by the planned weekly dose for each pt through each cycle of treatment. Progression-free survival (PFS) and response rate (RR) were compared across G DI groups for pts who received 6 cycles using the log-rank test and Fisher’s exact test, respectively To reduce the bias of time dependence, we examined subsequent PFS after cycle 2 stratified by G DI within the first 2 cycles (in pts who received >2 cycles). Results: A total of 99 pts (56.6%) completed 6 cycles. The mean weekly G DI ranged from 89.5% at cycle 1 to 73.0% at cycle 6; the mean weekly C DI ranged from 99.5% at cycle 1 to 91.5% at cycle 6. Results for pts receiving either 6 cycles or >2 cycles are shown in the table. There were no significant differences across G DI groups for either PFS (P=0.199) or RR (P=0.537) for pts receiving 6 cycles or for subsequent PFS (P=0.249) when pts were grouped by G DI within the first 2 cycles. Comparisons of G and C DI based on the numbers of cycles completed (up to 8) also showed no significant differences in PFS or RR. Conclusions: Differences in DI of both G and C for pts receiving from 2 to 8 cycles of standard GC chemotherapy had no impact on either PFS or RR in the AGO-OVAR 2.5 trial. Protocol-specified dose adjustments do not appear to impact the efficacy of GC therapy for pts with PSOC. Patients receiving 6 cycles (n=99) Patients receiving >2 cycles (n=158) Mean DI of G by quartile N RR P Median PFS (months) P N Median PFS (months) P DI <25th percentile 25 64% 0.537 11.5 0.199 39 9.1 0.249 25th percentile ≤ DI < median 24 50% 8.9 39 8.4 Median ≤ DI <75th percentile 25 64% 10.0 40 6.4 DI ≥75th percentile 25 48% 7.6 40 7.7
Patients’ use of humour in discussing sensitive end-of-life issues
Authors: I. N. Olver, J. Eliott
Journal: Journal of Clinical Oncology (2008)

20552 Background: The use of humour has been reported as a strategy for countering existential ambivalence or normalising difficult situations such as serious illness and its treatment, and as part of coping with them. Its use has also been associated with reduced anxiety and depression. We therefore expected that humour would be used as part of communication about end-of-life issues. Methods: Taped semi-structured interviews with 51 patients (27 females and 24 males) with all stages of cancer who were being interviewed to obtain their views of end-of-life decision- making in order to inform policy (Olver et al., Psycho-Oncol 2002, 11(3): 181–187, Eliott et al, Qual Health Res 2007; 17(4): 442–455) were analysed for the use of humour in discussing sensitive issues. Reading and rereading and a qualitative software package were employed to sort the interviews into categories, and for this study speech associated with laughter was analysed. Results: When specifically referring to humour patients indicated its importance for them to “lighten the atmosphere” but also indicated that the use of humour was a desirable attribute of their doctors. There were 5 broad categories where patients used laughter. The most common was when they were uncertain about an answer (e.g. the ideal timing of discussing ‘do not resuscitate orders’ with patients). The others included when embarrassed at discussing personal or family issues or physical symptoms, or when making rash generalisations. Patients laughed when they purposely told amusing anecdotes or used colloquialisms for sensitive concepts like death, as well as laughing in response to humour expressed by the interviewer. The topics discussed that were most associated with patients’ use of humour were death, euthanasia, funerals (particularly their own), hope, religion, and when patients described complementary and alternate therapies. Conclusions: Patients utilise humour to help discuss issues that they find stressful or embarrassing such as those associated with end- of-life decision-making and it is important to create an empathetic environment in which this can occur to assist them in expressing their views. No significant financial relationships to disclose.
Tumor-targeted cancer vaccination (GeneVieve Protocol): A phase I/II study of intravenous Rexin-G and Reximmune-C for chemotherapy-resistant cancers.
Authors: J. G. Ignacio, H. Bruckner, R. E. Manalo, F. S. San Juan, L. Baniqued, A. Madamba, E. M. Gordon, F. L. Hall
Journal: Journal of Clinical Oncology (2011)

2589 Background: Rexin-G and Reximmune-C are tumor-targeted retrovectors bearing a cytocidal cyclin G1 ‘knockout’ construct and a controllable GM-CSF expression construct, respectively. The working hypothesis for this bipartite tumor-targeted cancer vaccination strategy is that the personalized vaccination of a patient against his/her own specific cancer can be achieved by combining (1) a targeted vector bearing a tumoricidal payload, i.e., Rexin-G with (2) a targeted vector bearing a potent immuno-stimulatory gene, i.e. Reximmune-C. Purpose: To evaluate the safety and potential anti-tumor activity of intravenous infusions of Rexin-G followed by Reximmune-C pulses in chemotherapy-resistant solid malignancies. Methods: Sixteen patients received Rexin-G (2 x 10e11 cfu) on Days 1, 3, and 5, plus Reximmune-C (0.5, 1.0 or 2.0 x 10e10 cfu: Dose Level I, II or III respectively) on Day 3, followed by the administration of valacyclovir at 3 gms/day p.o. on Days 6-19 (to terminate the Reximmune-C vaccine pulse), comprising one cycle. These treatment cycles were repeated up to 6 cycles, if there was < Grade 1 toxicity. Results: There were no treatment-related adverse events, nor was circulating GM-CSF protein elevated in post-treatment serum samples. The results are shown in the table below. Histopathologic examination of biopsied tumors demonstrated vector localization and paracrine secretion of GM-CSF in tumors, with varying degrees of apoptosis, necrosis, reparative fibrosis, and tumor infiltrating lymphocytes (expressing CD4, CD8, or CD20), indicating an immunologic response. Conclusions: These findings suggest that the strategic combination of Rexin-G plus Reximmune-C is safe and well-tolerated, and may help control tumor growth and prolong survival, thus advancing the protocol and the molecular biotechnologies of personalized cancer vaccination as a promising approach. Reximmune-C treatment dose level Tumor response Median PFS (months) Median OS, from start of Rexin-G treatment (months) Percent of patients with > 1-year survival I (n=5) 2PR, 1SD, 2PD 3 21 80 II (n=4) 1PR, 3SD 8.5 13 50 III (n=7) 1PR, 4SD, 2PD 6 >15 86
Differential receipt of sentinel lymph node biopsy within practice-based research networks.
Authors: Anne-Marie Meyer, Katherine Elizabeth Reeder-Hayes, Huan Liu, Stephanie B. Wheeler, Dolly Penn, Bryan Weiner, Karyn Beth Stitzenberg, William Ruffin Carpenter
Journal: Journal of Clinical Oncology (2012)

102 Background: Sentinel lymph node biopsy (SLNB) is a quality indicator for breast cancer care. Provider-based research networks (PBRNs) promote diffusion of innovations like SLNB into clinical practice; however, evidence is limited. We examined the diffusion of SLNB for early-stage breast cancer through the Community Clinical Oncology Program (CCOP), a community-based PBRN and its interaction with medical school affiliation. Methods: We identified women undergoing breast conserving surgery with axillary staging for stage I or II breast cancer between January 2000 and December 2003 using Surveillance Epidemiology and End Results-Medicare data (n=6,226). The primary outcome was receipt of SLNB vs. ALND. Exposure was constructed by combining information on the CCOP affiliation of the preforming physician with the medical school affiliation of the hospital. Covariates included race, age, marital status, education, Medicaid eligibility, comorbidity, tumor grade, stage, estrogen receptor status, year of diagnosis, SEER region, and NCI cancer center designation. Multivariable generalized linear modeling with generalized estimating equations was used to measure association between CCOP exposure and receipt of SLNB. Results: Women who saw a CCOP physician at a hospital affiliated with a medical school had a three-fold increase in odds of receiving SLNB compared to non-CCOP women. In contrast, the odds of SLNB were equivalent when looking in women who were seen by a CCOP physician but differed only by their hospital affiliation. Conclusions: Women seen by CCOP-affiliated physicians were more likely to receive SLNB; while medical school affiliation did appear to significantly impact receipt. Innovative, high-quality cancer care can be facilitated PBRNs such as the NCI CCOP program. There must be mechanisms by which providers are exposed to advances in clinical practice outside of organizational affiliations. [Table: see text]
Trends of metastasectomy for metastatic renal cell carcinoma and their impact on overall survival.
Authors: Christian P Meyer, Maxine Sun, Guillermo de Velasco, Quoc-Dien Trinh, Toni K. Choueiri
Journal: Journal of Clinical Oncology (2016)

620 Background: The treatment of metastatic renal cell carcinoma (mRCC) has profoundly changed over the last decade. There is little comprehensive evidence evaluating the role of metastasectomy (MSx) in in this context. We assessed trends and predictors of MSx and their impact on overall survival in a large national cohort. Methods: The National Cancer Data Base from 1998-2012 was queried to identify 25,455 mRCC patients with 5,315 undergoing MSx. Covariates included the application of targeted chemotherapy (CTX) and immunotherapy (ITX). Baseline descriptive and multivariable logistic regression analyzes for prediction of MSx were conducted. Trends for chemo- (CTX) and immunotherapy (ITX) as well as MSx were assessed using the annual percent change linear regression technique (EAPC). Kaplan-Meier curves and adjusted Cox-proportional hazard models assessed the impact of MSx on overall survival. Results: Compared to controls, MSx patients were significantly younger (p&lt;0.001), had a lower CCI (p=0.03), more often private insurance (p=0.04) and a higher income (p&lt;0.001). They were more often treated at an academic center (p&lt;0.001), but less often received ITX/CTX (both p&lt;0.001). The rates of MSx increased significantly over the years (9.9-24.5%, EAPC 4.52, p&lt;0.001) while CTX (EAPC 3.08, p&lt;0.001) increased and ITX decreased (EAPC -12.9, p&lt;0.001). Diagnosis after 2006 (OR 1.21, 95%CI 1.02-1.23) and private insurance (OR 1.43, 95% CI 1.14-1.79) were positive predictors of MSx, whereas increasing age (OR0.98, 95%CI 0.98-0.99), black race (OR 0.73, 95%CI 0.63-0.84), ITX (OR 0.8, 95%CI 0.68-0.94) and CTX (OR 0.75, 95% 0.69-0.82) were negatively associated with MSx. The combined treatment with MSx conferred a survival benefit compared to no MSx (HR 0.75, 95%CI 0.72-0.78) and CTX alone (HR 0.82, 95%CI 0.74-0.90). Conclusions: The addition of MSx to CTX conferred a survival benefit in our study despite lower usage of MSx after CTX. This suggests a potential underutilization, which might be a consequence of underlying health care access disparities as implied by lower odds of receiving MSx in blacks and higher odds in privately insured patients.