tbuckley/cabot-search huggingface dataset:
Bloodless tandem autologous stem cell transplant for multiple myeloma in Jehovah's Witness patients.
Authors: Fnu Rafiullah, Sarah L Mott, Allyson Schultz, Guido J. Tricot
Journal: Journal of Clinical Oncology (2017)

e19523 Background:, Cases of Jehovah’s Witnesses (JW) who undergo, and survive, autologous and allogeneic stem cell transplant(SCT) are increasingly reported. Tandem autologous stem cell transplantation(ASCT) for multiple myeloma has not been previously reported in JW. We are describing the first reports of four JW patients who successfully underwent tandem bloodless ASCT for multiple myeloma. Methods:, We retrospectively studied the outcome of four JW patients who underwent tandem ASCT from November 2000 to January 2017. . The bleeding complications, number and cost of transfusion of blood products were compared with last 100 consecutive tandem autologous transplants done from November 2014 till January 2017. Results:,There were 4 JW patients and 59 non-JW patients. Among 4 JW patients 3 were male and 1 was female. Among 59 non-JW 24(40.7%) were female and 35 (59.3%) were female. Median age was 60-years (range 54–66) and 59-years (range 36–71) for JW and non-JW patients, respectively. At Day+30 one JW patient had grade III pulmonary hemorrhage and Non-JW patients had no grade III or higher bleeding problems .The median number of CD34 cells transfused was 7.48 millions cells/kg in non-JW patients while it was 9.44 millions/kg in JW patients. Complete Remission(CR) was achieved in 33(59%) after 1 st tandem and 35(81.4%) after the second tandem transplant in Non-JW patients as compared to 100% CR rate in JW patients . The median number of platelet transfusions in non-JW patients was 2(range 0—21) and PRBC units was 1(range 0—7) at day+30 . Total cost of PRBC and platelet transfusions for the 59 non-JW patients was ~ 192,374 dollars (average 1923.74$/transplant). This excludes the supply costs and management of transfusion reactions costs. Conclusions: 1) Tandem autologous transplant for multiple myeloma in JW population is practical and largely safe. 2) Blood products are expensive and can be further minimized based on the JW patient data
Chemotherapy (CT) for advanced soft tissue sarcoma (STS) in older patients (pts): Toxicity and outcomes in a single center experience.
Authors: Antonella Brunello, Selma Ahcene-Djaballah, Benedetta Chiusole, Umberto Basso, Marco Maruzzo, Pasquale Fiduccia, Antonio Di Maggio, Carlo Riccardo Rossi, Maria Cristina Montesco, Vittorina Zagonel
Journal: Journal of Clinical Oncology (2016)

e21527 Background: Data on first-line CT in elderly pts with advanced STS are scarce. Anthracyclines are first choice, yet toxicity is of concern. The aim of this study is to describe efficacy and toxicity of CT for advanced STS in unselected older pts. Methods: Electronic records of pts aged ≥ 65 years with advanced STS treated at Istituto Oncologico Veneto from January 2009 to December 2014 were reviewed. Vital status was recorded as of January 31st2016, and response assessed as per Response Evaluation Criteria in Solid Tumors. Overall survival (OS) was estimated with Kaplan-Meier method, and univariate analysis for OS was performed with Cox regression. Results: Out of 75 pts aged ≥ 65, 58 pts were eligible (17 excluded because of single access), median age 72 (range 65 - 88), 34 (58%) male, 26 (32%) aged ≥ 75 years. The prevalent histotypes were liposarcoma (31%), leiomyosarcoma (12%) and undifferentiated pleomorphic sarcoma (11%). Most pts had ECOG PS 0-1 (72%). Comprehensive Geriatric Assessment was performed in 22 pts (38%): 9 vulnerable, 5 frail, 7 fit pts; 33 (57%) pts had grade 3 or 4 comorbidity according to CIRS-G scale. Thirty-seven pts (64%) received first-line CT: 75% anthracycline-based CT (doxorubicin, 5 pts; liposomal doxorubicin, 9 pts; epirubicin/ifosfamide 14 pts) and 25% other regimens (trabectedin, 3 pts; other, 6 pts). Six pts had a response (CR, 1 pt; PR, 5 pts), 13 pts had stable disease (35%), 14 (38%) pts had progressive disease. Median number of cycles was 2 (range 1-7). Pts treated with CT had median OS 20 months (IC 95% 12.6 – 27.5) while pts not treated 3.3 months (IC 95% 0.0-9.7), p < 0.005. No difference in OS was seen according to comorbidity, primary tumor site or metastatic sites, whereas PS retains a prognostic significance (PS 0 vs ≥ 1, p = 0,049). Grade 3 or 4 toxicity was experienced by 18 pts (49%), and 48% received a reduced dose. Median time from last CT dose and death was 91 days (range 3-597). Conclusions: Older pts with advanced STS may benefit from palliative CT as well as younger pts (Karavasilis V, Cancer 2008). Despite high rate of toxicity and dose reductions, older pts who received CT had better OS. Prospective studies of less toxic regimens for older pts with STS are needed.
Do accountable care organizations impact prostate cancer screening?
Authors: Quoc-Dien Trinh, Alexander P Cole, Anna Krasnova, Ashwin Ramaswamy, David F. Friedlander, Jesse Sammon, Joel S. Weissman, Sean A. Fletcher, Adam S. Kibel, Maxine Sun
Journal: Journal of Clinical Oncology (2018)

6546 Background: Accountable care organizations (ACO) are an alternative payment model designed to incentivize efficient, high value care. In this model, groups of providers are reimbursed together, with incentives for high-value, coordinated care. Prostate cancer screening is a service with large variations in use and questionable value—especially in men over 70. We analyzed trends in PSA screening and biopsies of American men depending on whether their providers joined ACOs. Methods: We relied on Medicare claims data to identify men whose primary care providers joined ACOs between 2010 and 2014. We examined whether trends in PSA and biopsy rates were different in men with ACO-affiliated providers versus those with non-ACO affiliated providers. Inverse-probability weighting and difference-in-differences analyses were utilized to compare utilization of both screening tests. Analyses were stratified by age groups: 1) 66-69 and 2) ≥70. Results: For men whose providers joined ACOs between 2010 and 2014, the prevalence of PSA screening for men aged 66-69 declined from 62.4% to 55.9%. Non-ACO affiliated providers also had a similar decline in rates of PSA screening of 62.4% to 55.9%. Trends in biopsy rates were similar in both groups: 4.7% to 5.3% in ACOs and 4.6% to 5.3% in non-ACOs. The difference-in-differences analyses showed that the change in use of PSA from 2010 to 2014 was not significantly different at ACOs and non-ACOs (p = 0.3). The trend in biopsies was not significantly different in ACOs and non-ACOs (p = 0.7). Similar non-significant differences were observed in men aged ≥70 years old (Table 1). Conclusions: Overall, trends in PSA screening and biopsies from 2010 to 2014 were similar at both ACO and non-ACO affiliated providers, regardless of patient age. This suggests that the implementation of ACOs did not impact on the use of PSA screening or biopsy, including in older age ranges where PSA screening is considered lower value. Biopsy and PSA screening prevalence in 2010 and 2014 with difference in difference analysis comparing ACO and non-ACO patients. ACO Non-ACO Difference in Difference 2010 2014 2010 2014 p value Ages 66-69 PSA 62.4 55.9 60.5 54.4 0.3 Biopsy 4.7 5.3 4.4 5.2 0.7 Ages 70+ PSA 54.3 46.0 54.2 46.4 0.2 Biopsy 4.3 4.8 4.1 4.6 0.5
Abstract 033: Associations of Smoke-Free Policies With Blood Pressure Changes in the Coronary Artery Risk Development in Young Adults Study
Authors: Stephanie Mayne, Pamela Schreiner, Rachel Widome, David Jacobs, Penny Gordon-Larsen, Kiarri Kershaw
Journal: Circulation (2018)

Introduction: Laws banning smoking in indoor public places have been associated with reductions in second-hand smoke exposure and cardiovascular disease among non-smokers. Second-hand smoke exposure has been associated with hypertension in prior studies. However, it is unknown whether smoke-free policies are associated with changes in blood pressure. Hypothesis: We tested the hypothesis that living in an area with a smoke-free policy banning smoking in restaurants, bars, and/or other workplaces is associated with reductions in systolic and diastolic blood pressure among non-smokers. Methods: Longitudinal data from 2,896 non-smoking participants of the Coronary Artery Risk Development in Young Adults (CARDIA) Study (aged 18-30 at enrollment, 1985-2011, 14,193 person-exam-years) were linked to state, county, and local 100% smoke-free policies in bars, restaurants, and/or non-hospitality workplaces based on participants’ census tract of residence at each exam. Fixed-effects linear regression estimated associations of each type of smoke-free policy (restaurant, bar, workplace) with within-person changes in systolic and diastolic blood pressure (SBP and DBP). Models adjusted for time-varying covariates: exam year (categorical), socio-demographic (education, income, marital status), health-related (body mass index, total physical activity, alcohol use), and policy (state cigarette tax, self-reported ban on smoking in their workplace) covariates, and interactions of baseline covariates (age, sex, race, field center) with exam year to account for differences in blood pressure patterns that were associated with these characteristics (p&lt;0.05 for all interactions). Blood pressure values were adjusted to reflect antihypertensive medication use (+10 mmHg for SBP, +5 mmHg for DBP for those on medication). Results: At baseline, mean SBP was 110.5 mmHg and mean DBP was 69.3 mmHg. By year 25, a majority of participants were exposed to smoke-free policies in restaurants (1,759 of 2,264, 78%), bars (1,536 of 2,264, 68%), and other workplaces (1,518 of 2,264, 67%). Smoke-free policies were associated with within-person reductions in SBP and DBP in fully adjusted models (expressed as average change between exams in mmHg). Mean reductions in SBP were -0.77 (95% CI: -1.51, -0.02) for restaurant policies, -0.73 (95% CI: -1.54, 0.08) for bar policies, and -0.79 (95% CI: -1.51, -0.08) for workplace policies. Mean reductions in DBP were -0.67 (95% CI: -1.27, -0.06) for restaurant policies, -0.54 (95% CI: -1.20, 0.11) for bar policies, and -0.86 (95% CI: -1.44, -0.28) for workplace policies. Conclusions: Smoke-free policies in restaurants and other workplace are associated with within-person reductions in systolic and diastolic blood pressure among non-smokers. These results suggest an additional health benefit of these policies beyond those previously described in the literature.
Non-small cell lung cancer (NSCLC) as a second primary: Analysis of the National Cancer Data Base (NCDB).
Authors: Madhusmita Behera, Theresa Wicklin Gillespie, Yuan Liu, Yaqi Jia, Kristin Ann Higgins, Conor Ernst Steuer, Nabil F. Saba, Dong Moon Shin, Suchita Pakkala, Rathi Narayana Pillai, Taofeek Kunle Owonikoko, Walter John Curran, Chandra Prakash Belani, Fadlo Raja Khuri, Suresh S. Ramalingam
Journal: Journal of Clinical Oncology (2016)

e20022 Background: The prevalence of NSCLC as a second primary tumor has been increasing over the past decades, though very little data have been published about it. We analyzed the NCDB, an oncology outcomes database administered by the American College of Surgeons and the American Cancer Society, to study the outcomes and patterns of treatment of patients (pts) diagnosed with NSCLC as a second or subsequent primary (SP). Methods: The NCDB was queried from 2004 to 2012 for NSCLC pts. Pts diagnosed with NSCLC as SP were compared with pts with de novo (DN) NSCLC. Univariate (UV) and multivariable analyses (MV) with overall survival (OS) were conducted by Cox proportional hazards model. KM plots were produced to compare the survival curves by subgroups along with log-rank p-values. All statistical analyses were conducted using SAS Version 9.3. Results: A total of 207,518 pts in SP and 697,709 pts in DN groups were included in the analysis, which accounted for 22% and 74% of all NSCLC pts respectively. Pt characteristics (SP/DN %): median age 72/68, male 53/53, white 89/84, stage IV 28/41, academic centers 33/32, government insured 72/57, mean tumor size (cm) 3.5/4.4. Surgery was performed in 39% of SP group vs. 28% in DN. An increasing trend in incidence of SP was observed (19.5% in 2004 to 24% in 2012) vs. a decreasing trend in DN (75.6% in 2004 to 72.8% in 2012). On UV and MV analysis, SP was associated with better survival than DN (HRs 0.84 and 0.93 respectively; p < 0.001). The SP group had higher 5-year OS (23% vs. 19.6%, p < 0.001) and a higher median survival (17 vs. 11.5 months) compared to DN. On stratifying by stage, DN had inferior survival in stage IV pts (HR 1.12, p < 0.001) compared to SP but better survival in stage I and II pts (HRs 0.86 and 0.93, p < 0.001). No difference in OS was seen in stage III pts (HR 1.01, p = 0.4). Conclusions: The incidence of second primary has increased over the past decade. Second primary NSCLC is diagnosed at an earlier stage, smaller tumor size, and is associated with a better survival, compared to de novo NSCLC.
A patient safety approach to assessing adverse events in oncology: Results from CHARM (Cancer Harm) study.
Authors: Allison Nicole Lipitz Snyderman, David Classen, David G. Pfister, Aileen Killen, Andrew S. Epstein, Christopher B. Anderson, Coral L. Atoria, Elizabeth Fortier, Saul N. Weingart
Journal: Journal of Clinical Oncology (2016)

6601 Background: Patient safety is a critical concern in clinical oncology, but our ability to measure the frequency, spectrum, and preventability of adverse events (AEs) across cancer care is limited by a narrow focus on treatment-related toxicities. The objective of this study was to assess the nature and extent of AEs among cancer patients. Methods: Retrospective cohort study to identify AEs using guided manual reviews of medical records and reports from local reporting databases. The cohort included 400 medical and surgical patients age 18 years or older with breast (n=128), colorectal (n=136), or lung (n=136) cancer at a comprehensive cancer center. Patients began their first cancer-directed treatment in 2012 and were followed as in- and outpatients for up to 1 year. The association between demographic, administrative and clinical factors, and risk of an AE was estimated in a multivariable logistic regression model. Results: We identified 318 AEs, for a rate of 2.38 events per 1000 patient days. 36% of patients had at least 1 AE (95% CI: 31-40%). 35% of events were considered likely preventable, and for 12% of the likely non-preventable events, harm could have been mitigated. Examples of AEs considered likely preventable included hypomagnesemia and pressure ulcer, and likely non-preventable AEs included anemia and mucositis. From the multivariable analysis, Hispanic/Latino ethnicity, late stage diagnosis, reported medication allergy, anticoagulants, diabetes medications, a palliative care consultation, surgery, and chemotherapy were associated with increased odds of an AE. Conclusions: We identified a large number of AEs in this longitudinal cohort of patients with breast, colorectal, and lung cancers. The risk factors we identified can help target high risk patients for quality improvement activities to reduce the occurrence of, or harm associated with, AEs in the inpatient and outpatient settings. Cancer No. of patient cases % of patients with at least 1 AE No. of AEs identified % of AEs with permanent harm, requiring life sustaining interven tion, or resulting in death % of AEs deemed likely preventable Total 400 36% 318 5% 35% Breast 128 23% 50 12% 18% Colorectal 136 43% 139 4% 31% Lung 136 40% 129 5% 45%
Man vs machine: Are febrile neutropenia rates different using an in-clinic vs on-body injection?
Authors: Hank Ng, Daniel Douce, Annelies Byington, Megan Hinton, Daniel Krakauer, Marie Wood, Hibba Rehman
Journal: Journal of Clinical Oncology (2018)

e18867 Background: The granulocyte-colony stimulating factor pegfilgrastim can either be administered as an injection in clinic or as an on-body (Onpro) injection that delivers a standard dose 27 hours after placement. Given potential issues with placement and deployment, we examined whether febrile neutropenia rates were different between the two types of administration. Methods: All patients prescribed pegfilgastrim at the University of Vermont Cancer Center between 1/2016 and 11/2017 were identified. Demographic and clinical data were extracted from the medical record, including rates of febrile neutropenia and delays in chemotherapy administration. Episodes of febrile neutropenia were verified by a provider. Associations were measured using chi-square tests, t-tests, and logistic regression where appropriate. Results: There were 326 patients identified who received pegfilgrastim, of which 91 were Onpro. The median number of injections per patient was 6 (range 1-37). The average patient age was 58 years, and 63.2% were women. The average BMI was 27.2 and 33.8% had stage IV disease. The most common cancers included breast (31.6%), lymphoma (14.1%), GI (13.5%), lung (9.5%), and GU (8.3%). 24 (7.4%) of the cohort developed febrile neutropenia, 7.7% among those receiving Onpro, and 7.2% receiving in-clinic injections (p = 0.86). There were no significant differences between rates of recorded non-febrile neutropenia or delays in chemotherapy. Multivariable analysis, adjusting for age, sex, BMI, chemotherapy, type or stage of cancer did not reveal any association between delivery method and febrile neutropenia. There was an increased odds of developing febrile neutropenia in breast cancer and lymphoma regimens independent of G-CSF delivery method (OR 2.32 [95% CI 1.0-5.36] and OR 2.78 [95% CI 1.08-7.12] respectively). Conclusions: We found no difference in rates of febrile neutropenia regardless of the type of administration (in-clinic vs on-person). This was true regardless of personal characteristics, tumor type, stage or type of chemotherapy. Despite the potential for error in either placement or delivery of the on-person device, we have shown, in a real-world setting, equivalent effectiveness.
Detection of germline homologous recombination deficiency (HRD) in patients with metastatic esophagogastric (EG) cancer using clinical next generation sequencing (NGS).
Authors: Yelena Yuriy Janjigian, Philip Jonsson, Yelena Kemel, Vijai Joseph, Yaelle Tuvy, Zarina Shameer, Vignesh Ravichandran, Liying Zhang, Diana Mandelker, Geoffrey Yuyat Ku, Jaclyn Frances Hechtman, David Paul Kelsen, David H. Ilson, Kenneth Offit, Michael F. Berger, Nikolaus Schultz, Mark E. Robson, David B. Solit, Barry S. Taylor, Zsofia Kinga Stadler
Journal: Journal of Clinical Oncology (2018)

12116 Background: Although EG cancer is included in Lynch syndrome (LS) and hereditary diffuse gastric cancer (HDGC), the prevalence of HRD-associated germline mutations in patients with EG cancer remains to be elucidated. To determine the potential therapeutic implications, we assessed the prevalence of clinically actionable germline mutations detected by matched tumor-normal sequencing. Methods: The matched tumor-normal DNA were evaluated for somatic (up to 468 genes) and germline (76 genes) alterations under MSK IRB approved protocols. Prevalence of likely pathogenic and pathogenic germline alterations were reported in genes and correlated with clinical and somatic findings. Results: Of 400 consecutive pts with metastatic EG adenocarcinoma: 53% had esophagus/GEJ and 47% gastric cancer. 48 (12%) of patients had clinically actionable mutations conferring cancer susceptibility, including 38 moderate- to high- penetrance mutations. 30 of 400 pts (7.5%) pts had deleterious somatic (n = 17) or pathogenic germline (n = 19) mutations in the most commonly observed HRD genes (ATM, BRCA1, BRCA2). The prevalence of clinically actionable germline mutations among gastric versus esophagus/GEJ tumors was 15.5% and 8.9%, respectively (p = 0.043). Interestingly, one individual harbored both a BRCA1 and an ATM mutation. Germline DNA mismatch repair mutations, diagnostic of LS, were present in only two pts, both with gastric cancer, MSH2 mutations, with both tumors exhibiting a mismatch repair deficient signature. Other germline mutations of interest include: 6 CDH1, 1 TP53, 1 BRIP1, 1 STK11 pts as well as 1 biallelic MUTYH carrier diagnostic of MUTYH-associated polyposis. When available, correlative tumor data, including somatic mutations and loss of heterozygosity in the gene(s) corresponding to the germline mutation will be presented. Conclusions: Clinical NGS in paired germline-tumor DNA samples increases detection of individuals with potential clinically significant germline/somatic mutations. Analysis of therapeutic implications of these HRD mutations is ongoing and updated data will be presented.
When advanced ovarian cancer is not ovarian cancer.
Authors: Robert Dood, Nicole D. Fleming, Robert L. Coleman, Shannon Neville Westin, Anil Sood
Journal: Journal of Clinical Oncology (2017)

e17066 Background:Tissue diagnosis of advanced ovarian cancer (OC) is not universally obtained prior to up-front surgery. This study sought to investigate non-OC cases discovered in the systemic laparoscopic (LSC) workup of presumed advanced OC. Methods: A prospective cohort of presumed advanced OC patients (based on elevated CA125 and/or imaging) presenting to our center without confirmed pathologic diagnosis. Patients with non-OC pathology confirmed in workup were characterized and compared to those with confirmed ovarian pathology using standard statistical tests. Results: 365 patients presented between 5/30/12 and 11/16/16. Non-OC was found in 27 cases (7.4%), including benign ovarian pathology (48%), and metastatic uterine (11%), breast (7%) and gastrointestinal (19%) cancers. A majority used diagnostic LSC or assessment at time of up-front surgery (see Table) for diagnosis. Non-OC cases were less likely to be confirmed by FNA or core biopsy, were more common in Asian patients, had better ECOG scores, and had a lower CA125. Only 1 non-OC patient (uterine sarcoma) received neo-adjuvant chemotherapy. Conclusions: A systematic LSC approach to advanced stage OC minimizes incorrect chemotherapy chemotherapy administration. Asian patients and those with low CA125 values are at highest risk of a false diagnosis of OC, but did not routinely have a diagnostic opportunity prior to systematic LSC. [Table: see text]