tbuckley/cabot-search huggingface dataset:
Cancer care near the end of life (EOL) in the era of molecular-targeted agents: Changes of trend during 10 years at single institution.
Authors: Younak Choi, Bhumsuk Keam, Tae Min Kim, Se-Hoon Lee, Dong-Wan Kim, Dae Seog Heo
Journal: Journal of Clinical Oncology (2014)

9543 Background: In the era of molecular targeted agents, EOL care and use of chemotherapy at the EOL seems to be changed over time. The purpose of this study was to investigate and compare the cancer care near the EOL during 10 years. Methods: Advanced solid cancer patients who received palliative chemotherapy and had died at Seoul University Hospital were enrolled. We categorized the consecutive patients into two groups; died in 2002 (n=57), and died in 2012 (n=206). Medical records of the patients were reviewed. Aggressiveness of cancer care near the EOL was evaluated and compared in terms of following aspects; intensive care unit (ICU) care within the last one month, ER visit within the last one month, period between last chemotherapy and death, number of regimens, cycles of chemotherapy, and consultation for hospice. Results: The median patient age was 62 years, and 65.4% of patients (n=172) were male (primary tumor: 91 lung cancer, 27 colorectal cancer, 18 breast cancer, and 127 other). ICU care within the last month increased from 2.7 % in 2002 to 19.9% in 2012 (P < 0.001), and ER visit within the last month also increased from 33.6 % to 74.8% (P < 0.001). Median time between last chemotherapy and death has been significantly shortened from 66.0 days in 2002 to 34.0 days in 2012 (P < 0.001). Mean number of regimen and cycles of chemotherapy also significantly increased (1.8 to 2.5, P < 0.001, 5.5 cycles to 11.6 cycles, P < 0.001, respectively). Of note, 17.0% patients received molecular targeted agents as the last chemotherapy regimen in 2012, while none of patients received molecular targeted agents in 2002 (P < 0.001). Although consultation for hospice care increased from 9.1% to 37.4% (P < 0.001), timing of consultation was delayed from median 53 days before death to 8 days before death (P = 0.004). Conclusions: Cancer care near the EOL becomes aggressive in the era of molecular targeted agents. ICU care before death and chemotherapy use near the EOL, including molecular targeted agents, has increased and becomes aggressive during 10 years, while hospice referral has been delayed. Further nation-wide investigations are warranted.
Factors influencing a specific histologic diagnosis of non-small cell lung cancer.
Authors: J. A. Sulpher, S. P. Owen, H. Hon, K. Tobros, F. A. Shepherd, E. Sabri, G. Liu, C. M. Canil, P. Wheatley-Price
Journal: Journal of Clinical Oncology (2011)

7541 Background: Non-small cell lung cancer (NSCLC) not otherwise specified (NOS) was historically sufficient information to guide systemic treatment decisions. Increasingly specific classification of NSCLC is required to select optimum therapy. We performed a multi-centre retrospective review of NSCLC cases to identify factors associated with a specific histological diagnosis. Methods: With ethics approval, non-operative and palliative NSCLC cases at the Ottawa Hospital Cancer Centre (2008) and Princess Margaret Hospital (2007-2010), Toronto, were identified. Charts were reviewed for patient demographics, disease stage, treatment intent, and methods of obtaining the diagnosis. The number of cases and factors associated with attaining a specific histological diagnosis are reported. Results: Of 739 patients, 51% were male, the age range was 31-91 years (median 66 ), 85% were treated palliatively and 61% had good performance status (ECOG 0/1). 53% of patients were diagnosed in an academic cancer centre, and 59% were diagnosed by respirologists or thoracic surgeons. Cytology alone was available in 65%; histology was available in 35%. In 68% of cases the tissue source was the primary lung mass. CT-guided biopsy was the most common method (50%) followed by bronchoscopy (24%). CT biopsy yielded cytology alone in 88% of cases. Pleuroscopy yielded histology in 100% of cases, followed by thoracoscopy (83%) and bronchoscopy (57%). The final common diagnoses were adenocarcinoma (38%), squamous cell carcinoma (10%) and NOS (30%). Overall, 54% were considered to have a specific diagnosis. Factors associated with obtaining a specific diagnosis were presence of histology rather than cytology alone (p<0.0001), and diagnosis obtained in a community hospital (p=0.0002) or teaching hospital (p<0.0001) rather than an academic cancer centre. Conclusions: Almost half NSCLC cases do not have a specific subtype diagnosis, which usually requires histology rather than cytology. While CT-guidance is the most common method of diagnosis, it is the least likely method to attain sufficient histology.
Impact of comorbidity in the choice of curative treatment for esophageal cancer: A population-based study.
Authors: Zohra Faiz, Margreet Van Putten, Rob H.A. Verhoeven, Johanna W. van Sandick, Grard A. P. Nieuwenhuijzen, Valery E. P. P. Lemmens, Bas P.L. Wijnhoven, John Theodorus Plukker
Journal: Journal of Clinical Oncology (2016)

131 Background: Surgery after neoadjuvant chemoradiotherapy (nCRT) is the most common treatment with curative intent for esophageal cancer (EC) patients. Definitive chemoradiotherapy (dCRT) is an alternative for patients who are not eligible for resection because of comorbidity. The purpose of this retrospective study was to evaluate patient and tumor characteristics which are associated with the type of treatment. Methods: We selected all consecutive patients with a locally advanced EC (cT1 N + / T2-3N0-3M0-1a) who were treated with curative intent (nCRT, dCRT or surgery only) in the South East Netherlands between 1995 and 2013. For a proper assessment of the impact of co-morbidity, T4 tumors were excluded. The effect of co-morbidity on treatment decision and on survival was analyzed using a multivariable logistic regression and Kaplan-Meier method. Survival time was defined as time from 6 months after diagnosis until death or until January 1st 2015 for patients who were still alive. Results: Of the 1098 patients, surgery only was performed in 46%, nCRT in 28% and dCRT in 26%. Patients with ≥ 2 co-morbidities underwent more frequently dCRT (OR = 2.35; 95% CI: 1.45-3.86), or resection only (OR = 2.29; 95% CI: 1.41-3.69). Patients &gt; 75 years (OR = 6.66; 95% CI: 3.48-12.77), patients with hypertension and diabetes (OR: 4.05;95% CI: 1.96-8.37-3.90) and patients with cardiovascular (mostly myocardial infarction) and pulmonary comorbidity (OR = 3:33; 95% CI: 1:51 to 7:34) underwent frequently more dCRT than nCRT. Patients with esophageal squamous cell carcinoma (ESCC) also had more frequently dCRT (OR = 2.27; 95% Cl: 1.38-3.73). Patients with an adenocarcinoma and ≥ 2 co-morbidities had favorable 3-year overall survival (OS) after nCRT compared with dCRT and surgery alone (p &lt; 0.01). However, the 3-year OS after nCRT was similar after dCRT in ESCC patients with ≥ 2 co-morbidities (p = 0.75). Conclusions: The results of this study support the treatment with dCRT in patients with SCC of the esophagus, and with at least two co-morbidities, in particular, the combination of cardiovascular / pulmonary disorders and hypertension plus diabetes.
Wiskott-Aldrich Syndrome: A Retrospective Study on 575 Patients Analyzing the Impact of Splenectomy, Stem Cell Transplantation, or No Definitive Treatment on Frequency of Disease-Related Complications and Physician-Perceived Quality of Life
Authors: Jannik S Glasmacher, Tanja C Bittner, Hans D Ochs, Alessandro Aiuti, Peter D Arkwright, Dmitry Balashov, Uta Behrends, Bernd H. Belohradsky, Elisa Bertoni, David K. Buchbinder, Michael Browning, Anastasiia Bondarenko, Fabio Candotti, Alessandro Cattoni, Liudmyla Chernyshova, Joseph H. Chewning, Peter Ciznar, Theresa Cole, Beatriz T Costa-Carvalho, Wojciech Czogala, Gregor Dueckers, David M Edgar, Fatih Erbey, Anders Fasth, Renata Formankova, Tomas Freiberger, Eleonora Gambineri, Andrew Gennery, Frederick D Goldman, Luis I Gonzalez-Granado, Tiago N Gulmaraes, David Hagin, Fabian Hauck, Tarja Heiskanen-Kosma, Manfred Hoenig, Hanna Juntti, Hirokazu Kanegane, Leena Kainulainen, Neslihan E Karaca, Sara S Kilic, Christoph Klein, Sylwia Koltan, Irina Kondratenko, Dawei Liu, Susanne Matthes, Juliana T L Mazzucchelli, Isabelle Meyts, Siraj Misbah, Zohreh Nademi, Gulnara Nasrullayeva, Lucia D Notarangelo, Pere Soler-Palacin, Olga Pashchenko, Srdjan Pasic, Isabelle Pellier, Claudio Pignata, Camilla Roepstorff, Catharina Schuetz, Ansgar S Schulz, Gesmar R S Segundo, Anna Shcherbina, Joanne Smart, Robert A. Sokolic, Polina Stepensky, Troy Torgerson, Svetlana Vakhlyarskaya, Joris van Montfrans, Kim Vettenranta, Beata Wolska-Kusnierz, Xiaodong Zhao, John B Ziegler, Xuan Zhang, Michael H. Albert
Journal: Blood (2016)
The prognostic significance of uncoupled proliferation and EGFR expression in oral cancer treated with surgery and radiation.
Authors: P. Bose, A. C. Klimowicz, S. K. Petrillo, S. Chandarana, N. Brockton, W. Matthews, A. M. Magliocco, J. C. Dort
Journal: Journal of Clinical Oncology (2011)

e21146 Background: Oral squamous cell cancer (OSCC) is characterized by poor prognosis, high morbidity and mortality. The epidermal growth factor receptor (EGFR) is overexpressed in most OSCCs; however, the association between EGFR and survival is inconsistent. Despite being linked to proliferation in normal tissue, few studies have examined the relationship between proliferation and EGFR expression, and OSCC outcomes. Methods: This retrospective study evaluated OSCC patients treated with surgery (n=17) or surgery and post-operative RT (n=47) between 1998-2005 at the Tom Baker Cancer Centre, Calgary, AB, Canada (median follow-up: 43 months). Tissue microarrays were assembled from pre-treatment formalin-fixed paraffin embedded tumor tissue. Clinico-pathologic data were obtained from chart review. EGFR and Ki67 expression were quantified using fluorescent IHC and AQUA technology. Regions of high and low EGFR expression were defined for each tumor core. We measured the ratio of Ki67 levels between high versus low EGFR expressing regions (Ki67EGFR-hi/Ki67EGFR-lo) to evaluate the relationship between proliferation and EGFR expression. Continuous variables were dichotomized using Xtile. Biomarker association with recurrence free survival (RFS) 5-year disease-specific survival (DSS) was analyzed using the Cox model. Results: In OSCC RFS and DSS associated with pathologic T-stage [RFS HR 2.8 (1.3-6.3), p=0.01; DSS HR 3.6 (1.5-8.4), p=0.004], and lymph node status [RFS HR 3.5 (1.6-7.7), p=0.002; DSS HR 6.4 (2.5-16.2), p<0.001]. Neither Ki67 nor EGFR alone significantly correlated with RFS or DSS. We observed a high Ki67EGFR-hi/Ki67EGFR-lo ratio in normal oral epithelium. In OSCC, a high Ki67EGFR-hi/Ki67EGFR-lo ratio (similar to normal epithelium) associated with improved survival [RFS HR 0.50 (0.23-1.08), p=0.076; DSS HR 0.46 (0.20-1.06), p=0.07]. The association with survival outcomes was more pronounced in patients who received RT [RFS HR 0.31 (0.12-0.83), p=0.02; DSS HR 0.40 (0.14-1.13), p=0.08]. Conclusions: Our results suggest that the uncoupling of proliferation and EGFR expression in OSCC represents a more aggressive and RT resistant tumor phenotype.
Postoperative complications in neoadjuvant treatment including bevacizumab for HER2-positive inflammatory breast cancer (IBC): Results from a phase II prospective trial.
Authors: R. Rouzier, E. Lambaudie, J. Pierga, T. Petit, T. Delozier, J. Ferrero, M. Campone, J. Gligorov, F. Lerebours, H. Roche, D. Pau, P. Viens, R. J. Salmon
Journal: Journal of Clinical Oncology (2011)

569^ Background: In BC, postoperative complications have been poorly explored in neoadjuvant chemotherapy including bevacizumab (BV). Methods: We evaluated post-operative complications in patients with IBC (T4d M0) cancers over-expressing HER2 enrolled in the phase II multicenter trial, BEVERLY 2. This study investigated the efficacy of BV (15mg/kg q3w given concurrently) in combination with sequential neoadjuvant chemotherapy of 4 cycles of FEC followed by 4 cycles of docetaxel-trastuzumab. BV was stopped at least 4 weeks before and reintroduced after mastectomy either concurrently with radiotherapy or after completing the radiotherapy period. Seromas, wound healing complications (WHC), infections and bleeding occurring within 60 days after surgery were considered as post-operative complications. Univariate analyses were performed to identify factors associated with complications. Results: From Oct 2008 to Oct 2009, 52 patients were included and 49 were operated on and were evaluable for post-operative course. The pathologic complete response (pCR) rate was 63%. The median interval from the last BV dose to surgery was 36 days (range, 28-77). Post-operative events included 12 seromas (25%), 5 WHC (10%), 2 infections (4%), but no bleeding requiring surgery. No significant associations were identified between patient characteristics, treatment factors (including delay) and WHC. A delay >60 days for onset of radiation was observed only for 2 patients with WHC. Conclusions: These data suggest that the use of BV with neoadjuvant chemotherapy is well tolerated. The post-operative WHC rate in this study is within the high range of previous reports of WHC rates after neoadjuvant chemotherapy without BV. It has to be counterbalanced with the high pCR rate and its potential benefit for patients.
Enhancing the cancer survivors' experience with tailored supportive services.
Authors: Guadalupe R. Palos, Paula A. Lewis-Patterson, Patricia Chapman, Katherine Ramsey Gilmore, Maria Alma Rodriguez
Journal: Journal of Clinical Oncology (2015)

236 Background: Maintaining health and well-being is a primary goal throughout the cancer experience. The dynamic nature of a survivor’s trajectory makes it difficult to tailor education and supportive care services to their actual needs. We sought to determine information and education needs preferred by survivors who had returned to their communities after completing their treatment. Methods: We partnered with survivors' advocacy groups to conduct a needs assessment with adult survivors attending a community survivorship conference. Once eligibility was confirmed, verbal consent was obtained, and instructions were given on survey completion. A modified version of the NCI Follow-Up Care Use among Survivors survey was used. Analyses focused on clinical/sociodemographic characteristics, preferences for follow-up care, information/education needs, and sources for receiving health information. Simple descriptives were used to report the results. Results: We distributed 284 questionnaires and 169 were returned, yielding a 59.5% response rate. Respondents were mostly female (79.9%), married (58.6%), college educated (81.7%) and had ver 10 post-treatment years (47.3%). 51.3% were diagnosed with breast cancer and 81.8% reported being in good to excellent health. 57.3% had follow-up cancer care, 30.8% did not recall having a discussion with their provider about late-effects, and 57.6% reported not receiving a summary care plan. 83.7% preferred to have the same provider follow them and 95.2% reported their oncologist would be their ideal doctor. Survivors preferred more information on ways to improve memory/concentration (83.9%), energy/exercise (83.3%), and maximizing the benefits of their survivorship care plan (74.6%). Preferred information sources were health care providers (78.0%) and the internet (39.3%). Conclusions: These survivors reported a high level of unmet information needs related to self-management of physical symptoms. Patient-provider communication about late-effects and benefits of survivorship care plans continues to be inadequate. Physicians and other providers are in ideal positions to initiate conversations about supportive survivorship care early in the patient experience.
cMET expression in HER2+ MBC patients with first-line lapatinib (L) treatment
Authors: Y. Liu, L. Liu, H. Shi, J. G. Greger, K. D. Jackson, P. Marty-Ethgen, T. M. Gilmer, A. Martin
Journal: Journal of Clinical Oncology (2009)

1073 Background: Overexpression of MET correlates with poor prognosis in breast cancer (Garcia et al., 2007) and is a factor associated with decreased sensitivity to L in HER2+ breast tumor cell lines in vitro (Liu et al., submitted). To test whether MET expression was associated with resistance to L in the clinic we evaluated baseline tumor MET expression levels and clinical outcome to L in 64 patients who participated in the EGF20009 trial of monotherapy L as first-line treatment in HER2+ advanced or MBC. Methods: RNA was extracted from FFPE tumors and MET and HER-2 gene expression was measured by qRT-PCR (Response Genetics, Inc., Los Angeles, CA). The correlation between expression levels of MET, HER2, and clinical outcome (overall response and progression free survival) was performed using JMP software. Results: A trend towards an association with increased MET expression and decreased response (p &lt; 0.054) was observed.. Patients with high HER2 and low MET gene expression had the longest PFS (median difference = ∼9 weeks) compared to patients with low HER2 and high MET gene expression (p &lt; 0.0038). Conclusions: These data support investigating a combination study of L and GSK1363089, a multi-kinase MET inhibitor, in HER2+ BC patients with high MET gene expression. [Table: see text]
Modeling and improving chemotherapy patient flow.
Authors: Inga Tolin Lennes, Ana Cecelia Zenteno Langle, Michael Duk, Avital Levy Carlis, Mara Bloom, Elizabeth Souza, Retsef Levi, David P. Ryan
Journal: Journal of Clinical Oncology (2014)

175 Background: Chemotherapy administration scheduling is dependent on infusion room hours of operation, availability of oncologist, capacity for treatment, pharmacy hood time, nursing and pharmacy staffing, and physical space limitations. In 2013, the main infusion center at MGH Cancer Center had 45% room/chair utilization reported by the Ambulatory Patient Tracking System and 33% exam room utilization in the clinics. However our infusion center experienced extremely high volume during peak hours, 10am to 2pm, but was underutilized before 10am and after 2pm, making it difficult to add on additional patients. Methods: In November 2013, MGH Cancer Center began collaboration with MIT Operations Management experts to ultimately improve patient flow through the Cancer Center by flattening the bottleneck at peak hours of operation and improving utilization of the infusion area and clinics. In phase I of the project, data was reviewed and refined. Key role groups of schedulers, prescribers, pharmacists and infusion nurses were shadowed by collaborators to gain insight into complex scheduling practices. A multidisciplinary working group met weekly to discuss the progress and suggest areas for further investigation. In phase II, optimization models testing the impact of alternative scheduling practices, physical space changes and alternative clinic configurations will be created. Finally, in phase III, change implementation and measurement will take place. Results: Process flow maps of patient movement through the cancer center were created. Patient tracking data was manipulated to understand key operational metrics. Several insights include an overall same-day chemotherapy cancellation rate of 10.7%, with the majority of cancellations from thoracic, GI and GU disease centers. Our mean scheduled infusion treatment length was 2.13 hours and 25% of appointments booked into infusion are not linked with a same-day clinic appointment. Conclusions: Understanding and refining incomplete or problematic data was a key part of understanding the issues contributing to the middle of the day bottleneck in the infusion area. Future work on this project will include optimization modeling and change implementation.
Changing Current Practice in Urology: Improving Guideline Development and Implementation Through Stakeholder Engagement
Authors: Sara J. MacLennan, Steven MacLennan, Axel Bex, James W.F. Catto, Maria De Santis, Adam W. Glaser, Borje Ljungberg, James N’Dow, Karin Plass, Marta Trapero-Bertran, Hendrik Van Poppel, Penny Wright, Rachel H. Giles
Journal: European Urology (2017)
Amphiregulin and epiregulin mRNA expression in primary colorectal cancer and corresponding liver metastases.
Authors: H. Kuramochi, G. Nakajima, Y. Kaneko, A. Nakamura, Y. Inoue, R. Okuyama, Y. Kondo, T. Kanemura, K. Hayashi, M. Yamamoto
Journal: Journal of Clinical Oncology (2011)

e14023 Background: Amphiregulin (AREG) and Epiregulin (EREG), ligands of Epidermal growth factor receptor (EGFR), are reported to be biomarkers of colorectal cancer patients treated with anti-EGFR antibody agents. The correlation of AREG and EREG expression between primary colorectal cancer and corresponding liver metastases have never been reported. Methods: One hundred twenty colorectal cancer patients with liver metastases (100 with synchronous metastases, 20 with metachronous) were evaluated. No patients had ever received anti-EGFR antibody therapy. AREG, EREG mRNA expression from both primary tumor and liver metastases were measured from formalin-fixed paraffin embedded samples using real-time RT-PCR. Kras codon 12, 13 mutation status was also analyzed by direct sequencing. Results: Modest, but significant correlations were observed between primary tumor and corresponding liver metastases in both AREG mRNA expression (p=0.54, p<0.0001) and EREG mRNA expression (p=0.58, p<0.0001). AREG mRNA expression and EREG mRNA expression were strongly correlated in both primary tumor (p=0.81, p<0.0001) and liver metastases (p=0.87, p<0.0001). No different expression pattern was observed between synchronous and metachronous metastases. In Kras wild patients, those with low EREG mRNA levels in primary site were significantly better overall survival than those with high levels (p=0.018), though there was no significant survival difference between EREG low and high patients when all 120 patients were analyzed. In multivariate analysis, EREG expression was significantly related with overall survival (p=0.006). AREG expression showed the same tendency but did not reach significant difference. Conclusions: AREG and EREG expression had a weak correlation between primary tumor and liver metastases. EREG mRNA expression was appeared to be a useful prognostic marker in Kras wild patients regardless of receiving anti-EGFR therapy.