tbuckley/cabot-search huggingface dataset:
Impact of a community-based pediatric oncology nursing model
Authors: J. Sussman, C. Gage
Journal: Journal of Clinical Oncology (2008)

20645 Background: The care of pediatric cancer patients is complex, involving multiple providers. Despite high cure rates, the care experience is known to place significant supportive care burden on patients and family members. New and evolving models of nursing care have been developed to address the complex needs of of patients and help address the perceived gaps in coordination of care but to date, there are few reports of outcomes. In this study we examined the impact of a community based specialist oncology nursing program as reported from the perspective of members of pediatric cancer care teams in Ontario, Canada. Methods: Qualitative case study using semi structured interviews with oncology teams in the 5 regional pediatric cancer programs in Ontario, Canada. Interview guides were devloped using literature on impacts of nursing interventions, expert opinion and data from a previous study in adult populations to determine role, overlap, barriers and impacts on patients and the care system. Interviews were transcribed and coded by 2 independant investigators using a pre specified coding schema. The constant comparative method was used to indentify themes not covered by the coding template. Data triangulation was used to confirm findings and member checking was used to validate responses. Results: 20 interviews were completed with oncologists (n=6), case managers (n=4), hospital nurses (n=5) and social workers (n=5) across the 5 regional centres. Respondants consistently reported that the program has had postitive impacts on meeting supportive care need of patients and families, that care coordination had improved and that utilization of hospital services had decreased. Particularly notable was the establishment of consistent palliative care and school/social integration for survivors. Oncologists noted improvements in workload specifially around supportive care and infromational support. No role conflict was reported by hospital nurses but social workers did suggest some role overlap with the nursing program. Conclusions: These results support the positive impact of the specialist nursing program in the care of pediatic cancer patients in Ontario, Canada from the perspective of care providers. Future research is planned to study impact from the perspective of patients and family members. No significant financial relationships to disclose.
Chronic Myeloid Leukemia Stem Cells (LSCs) and Leukemia Progenitor Cells (LPCs) Display Overlapping and Unique Mechanisms of Genomic Instability: The Role of PI3k-AKT and PI3k-Rac2-PAK Pathways
Authors: Margaret Nieborowska-Skorska, Sylwia Flis, Tomasz Skorski
Journal: Blood (2014)
Usability and acceptance of automated home-based symptom monitoring by urban and rural cancer patients in community-based care settings in Indiana
Authors: D. E. Theobald, D. L. Butler, S. Edgerton, W. M. Dugan, C. S. Cleeland, J. Coburn, K. A. Iseminger
Journal: Journal of Clinical Oncology (2005)

8085 Background: Experts recommend that providers routinely and regularly ask patients about pain, depression, fatigue and other cancer-related symptoms, using brief, validated assessment tools. Current paper-based symptom assessment is costly, inefficient, and limited to the point of care. We tested the usability and acceptance by patients of an automated symptom assessment system, incorporating interactive voice response (IVR) telephone technology and the Internet, to track symptoms while patients are away from the clinic. Methods: We recruited 120 cancer patients at 7 community-based, urban and rural cancer care sites to test the system. Patients were instructed to use the system and asked to choose the day and time of day to receive scheduled calls to their home, work, or mobile phone. Patients could also call a toll-free number or log onto a secure site on the Internet to provide a self-report. The M.D. Anderson Symptom Inventory was used to measure severity and interference of 13 common cancer symptoms. After using the system, we called each participant for debriefing. Results: Participants used the system from one to 13 weeks. Over 67% of patients used the system more than 5 times. Participants averaged 10 self-reports each. Ages ranged from 28 to 87 years. Participants preferred the telephone to complete their surveys - 95 percent of surveys were done by IVR; 5 of surveys were completed on the Internet. Patient satisfaction with the system was high –8.2 on a 0 (lowest) to 10 (highest) scale; 74 percent of patients rated their satisfaction at 8 or higher. The system was easy to use for 86%; 81% found it convenient. Over 65% of patients said they would participate in automated symptom monitoring if it were offered as standard care. Conclusions: Community-based cancer patients of all ages readily accept automated symptom monitoring as part of their routine cancer care. They prefer to self-report using the telephone. Patients of all ages have little difficulty learning to use the system; they are very willing and able to provide regular, complete symptom severity self-reports. They would welcome such a system as an integral part of their standard care. No significant financial relationships to disclose.
Single-institution experience using transarterial chemoembolization (TACE) with carboplatinum (carbo) and doxorubicin in patients (pts) with hepatocellular carcimona (HCC) awaiting liver transplantation (LTx).
Authors: B. A. Switzer, K. Harvey, S. R. Grossman, D. A. Phillips, S. A. Shah, A. Bozorgzadeh, B. Piperdi
Journal: Journal of Clinical Oncology (2011)

336 Background: LTx is the best treatment option for multinodular HCC and those with advanced liver dysfunction. Tumor progression occurs in 20-50% of pts on liver transplant list. TACE is increasingly used as locoregional therapy and as a bridge to LTx. We report here our single institutional experience with TACE using carbo and doxorubicin in pts with HCC awaiting LTx. Methods: Retrospective chart review was performed in all pts who had TACE between 2008 and June 2010. Our institutional protocol uses a fixed dose of carbo 300mg, doxorubicin 50mg, in 10ml of lipoidol solution. We analyzed pt demographics, etiologies of liver disease, Child-Pugh status, CLIP scores, size of tumor, alpha-fetoprotein (AFP), toxicity, length of stay, and transplantation statistics. Results: 32 pts (28 men) were treated with 39 TACE procedures. The median age was 57 (32-83). 28 of 32 had cirrhosis with Child's A/B/C 36/51/18% respectively. The major etiologies of cirrhosis were hepatitis C (HCV) 8, alcohol and HCV 19, alcohol 7; portal vein thrombosis in 8 pts. The median tumor size was 6.2 cm (range 2-12 cm) and 81% were multifocal CLIP score 0,1/2,&gt;3 were 5/62/38%. There were no mortality within 30 days of TACE procedure. The majority of the pts were discharged after 24 hr observation; 6 pts require readmissions within 30days. There was no systemic hematologic toxicity. 11 pts had elevated AFP at baseline and 6/11 (54%) had &gt;50 % reduction in AFP value. 11pts (34%) received Ltx; 3 pts came off the LTx list due to disease progression, 2 pts are still on transplant list, and 16pts not able to be listed. 42% of pts received sorafenib in addition to TACE. The median time from last TACE to LTx was 55 days and 4 pts received transplantation within 30days. Very good pathological treatment effect was observed in 8/11 explanted liver. Conclusions: Our regimen of TACE with carbo/doxorubicin appears to be a safe and tolerable approach for localized treatment as a bridge to liver transplantation. It has acceptable toxicity and is associated with good AFP and pathological responses. We plan to evaluate different baseline parameters for better pt selection. No significant financial relationships to disclose.
Monosomal Karyotype In Primary Myelofibrosis Is Prognostically Worse Than Otherwise Unfavorable Karyotype
Authors: Rakhee Vaidya, Domenica Caramazza, Kebede Begna, Naseema Gangat, Daniel L. Van Dyke, Curtis A. Hanson, Animesh Pardanani, Ayalew Tefferi
Journal: Blood (2010)
Induction chemotherapy followed by chemoradiotherapy and TME for high-risk locally advanced rectal cancer with and without synchronous resectable metastases.
Authors: Carla Hajj, Martin R. Weiser, Aoife McErlean, Marc Gollub, Andrea Cercek, Pei-Rong Ding, Leonard Saltz, Karyn A. Goodman
Journal: Journal of Clinical Oncology (2012)

599 Background: Induction chemotherapy (ICT) followed by chemoradiation (CRT) may improve tumor downsizing and disease control among patients (pts) with locally advanced rectal cancer (LARC). We retrospectively assessed the safety and short-term efficacy of ICT followed by CRT and total mesorectal excision (TME) in pts with high-risk LARC with or without synchronous resectable metastases. Methods: We reviewed records of 44 consecutive stage III (n=23) or stage IV synchronous (n=27) pts with LARC treated with ICT followed by CRT between 12/06 – 12/10. Pts had high-risk primary tumors based on advanced T and/or N stage by endorectal ultrasound and/or MRI: T3 (n= 35), T4 (n=7) and N1 (N=18), N2 (n=19). Recurrence-free (RFS) and overall survival (OS) were estimated by Kaplan-Meier methods. Results: Median age was 52 yrs, 66% were female. Pts received a median of 6 cycles of 5-FU based ICT combined with oxaliplatin (n=44). CRT (median dose 50.4 Gy) was delivered with continuous infusion 5-FU; two pts did not complete the prescribed CRT. During induction CT, 10 (22.7%) pts experienced grade 3+ neutropenia. Grade 3+ neutropenia or GI toxicity occurred in 3 (6.8%) and 3 (6.8%) pts, respectively during CRT. Imaging or endoscopic assessment showed that 35 pts had disease regression after ICT, whereas 1 pt progressed and 2 had stable disease. Response to ICT was not assessed in 6 pts. 7 pts did not undergo surgery due to: progression of disease (n=2); comorbid disease (n=2); or pt refusal (n=3). 37 pts proceeded to TME including 17 with known distant metastasis, 16 of whom underwent metastasectomy. 17 pts had tumor response &gt; 90% including 8 with pathologic CR. With a median follow-up of 29.4 mos, 1 pt who underwent TME developed local recurrence. Amongst the 9 pts who had distant recurrences, 7 had initial stage IV disease. The 3-yr RFS among the resected stage III pts was 95%; the 3-yr OS for stage III pts and stage IV pts were 100% and 80% respectively. Conclusions: In this retrospective series, ICT prior to CRT was associated with acceptable toxicity and a substantial incidence of tumor regression. OS and RFS appear promising in this high-risk group of patients.
Efficacy and safety of cisplatin and gemcitabine (CG) chemotherapy for advanced biliary tract cancer (ABC) in jaundiced patients (pts).
Authors: Angela Lamarca, Sarah Benafif, John A. Bridgewater, Paul J. Ross, Juan W. Valle
Journal: Journal of Clinical Oncology (2014)

294 Background: The ABC-02 study established cisplatin/gemcitabine (CG) as a 1 st -line regimen for pts with advanced/metastatic biliary tract cancer (ABC). Biliary tract obstruction (BTO) is common in ABC and pts with bilirubin (bili) ≥1.5xULN were excluded from ABC-02. We assessed retrospectively the safety/efficacy of CG in ABC pts with high bili despite optimal stenting. Methods: Eligible pts had biopsy-proven ABC; received 1 st -line CG; baseline bili levels ≥1.5xULN and had follow-up, response and toxicity data available. Survival analysis (Kaplan-Meier), long-rank test, Cox regression and multiple linear regression analyses were performed. Results: Thirty-three pts (of 545 pts screened) met inclusion criteria: median age 58.8 years (range 23-79); male 58%; cholangiocarcinoma 76%; gallbladder 18% or ampullary cancer 6%; locally advanced 42%; metastatic 58% (79% in liver); 68% had a biliary stent; and 97% of pts had good baseline performance status (PS) 0/1/2: 33%/64%/3%. Median baseline bili was 55umol/l (range 32-286); due to BTO in 76% or liver metastases (LM) in 24%. A median of 6 (range 1-8) cycles were given, 70% of pts started full dose CG; 40% completed 8 planned cycles; 40% needed a dose reduction. Early discontinuation (61% of all pts) was due to toxicity (25%), clinical (60%) or radiological progression (15%). Bili normalised in 64% of pts after CG; no unexpected side effects occurred. Most pts achieved stable disease (61%); with one partial response (3%); the median PFS was 6.9 mo (95%-CI: 4.4-9.0) and median OS 9.5 mo (95%-CI: 5.7-12.8). BTO pts had a trend for longer PFS than LM (7.0 vs. 2.6 mo; p=0.1633). Normalisation of bili and completion of CG were associated with longer OS (11.4 vs. 2.9 mo, HR 0.49; p=0.08 and 15.2 vs. 5.4 mo, HR 0.12 p&lt;0.001, respectively). Completion of CG was an independent prognostic factor for OS (multivariate analysis, p=0.001); no difference in OS was shown between the percentiles of baseline bili (p=0.57). Conclusions: For fit ABC patients with high bili, CG can be employed safely with encouraging results. Cause of jaundice (BTO, rather than bilirubin level), completion of chemotherapy and normalisation of bili are associated with improved OS.
Multisolution variance–based optimization (MVBO) versus multisolutions dose volume histogram-based optimization (MDVHO): A comparative analysis of anatomy-based multisolution blind inverse planning optimizations in Oncentra Prostate.
Authors: M. A. Laviraj, G. K. Rath, H. Kunhiparambath, R. Prabhakar, D. Sharma, P. K. Julka
Journal: Journal of Clinical Oncology (2011)

e15187 Background: Oncentra Prostate real-time system for HDR prostate implants consists of most advanced inverse planning tools which assures rapid achievement of required dosimetric parameters. This system consists of various optimization tools in which we compared multi-solution variance based optimization and multi-solutions dose volume histogram based optimization. Methods: The planning study is carried out on four localized prostate cancer patients. Trans-rectal ultrasound image were acquired for this patients, the structures prostate (PTV), bladder and rectum (OAR’s) are contoured. The plans for multi-solution variance based optimization and multi-solutions dose volume based optimization were generated for each patient. The analysis is carried out with respect to coverage of the PTV and dose to organ at risk structures. For the prostate (PTV) D100, D90, V100, V90 and V200 are calculated and for bladder and rectum V75 is calculated and for urethra V125 is calculated. Coin index is compared and for comparison of means, p value is obtained using SPSS version 14. Results: The results are as shown in the table. Conclusions: The multisolution dose volume histogram-based optimization shows better dose coverage and almost similar critical organ dose compared to multisolution variance-based optimization. Dose parameters Multisolution variance-based optimization Multisolutions dose volume histogram-based optimization PTV D90 94.02% 101.11% D100 59.59% 63.65% V90 93.45% 96.33% V100 80.79% 90.91% V200 6.82% 11.11% Urethra V125 0% 0 mm3 27.10% 1,571.02 mm3 Bladder V75 0% 0 mm3 0% 0 mm3 Rectum V75 20.42% 2,150.91 mm3 22.60% 2,380.53mm3 COIN 0.71 0.68
Incidence and determinants of 1-month mortality after cancer-directed surgery.
Authors: Brandon Arvin Virgil Mahal, Gino Inverso, Ayal Aaron Aizer, David R. Ziehr, Andrew Hyatt, Toni K. Choueiri, Karen Elizabeth Hoffman, Jim C. Hu, Clair Beard, Anthony Victor D'Amico, Neil E. Martin, Peter F. Orio, Quoc-Dien Trinh, Paul Linh Nguyen
Journal: Journal of Clinical Oncology (2014)

282 Background: Death within 1 month of surgery is considered treatment related and serves as an important healthcare quality metric. We sought to identify the incidence of and factors associated with 1-month mortality after cancer-directed surgery. Methods: We used the Surveillance, Epidemiology and End Results Program to study a cohort of 1,110,236 patients diagnosed from 2004-2011 with cancers that are among the 10 most common or most fatal who received cancer-directed surgery. Multivariable logistic regression analyses were used to identify factors associated with 1-month mortality after cancer-directed surgery. Results: 53,498 patients (4.8%) died within 1 month of cancer-directed surgery. Patients who were married, insured, or who had a top 50th percentile income or educational status had lower odds of 1-month mortality from cancer-directed surgery ([adjusted odds ratio (AOR) 0.80; 95% CI 0.79 – 0.82; P&lt;0.001], [AOR 0.88; (0.82 – 0.94); P&lt;0.001], [AOR 0.95; (0.93 – 0.97); P&lt;0.001], and [AOR 0.98; (0.96 – 0.99); P=0.043], respectively). Patients who were non-white minority, male, or older (per year increase), or who had advanced tumor stage 4 disease all had a higher risk of 1-month mortality after cancer-directed surgery, with AORs of 1.13 (1.11 – 1.15), P&lt;0.001; 1.11 (1.08 – 1.13), P&lt;0.001; 1.02 (1.02 – 1.03), P&lt;0.001; and 1.89 (1.82 – 1.95), P&lt;0.001 respectively. Conclusions: Unmarried, uninsured, non-white, male, older, less educated, and poorer patients were all at a significantly higher risk for death within 1 month of cancer-directed surgery. Efforts to reduce 1-month surgical mortality and eliminate sociodemographic disparities in this adverse outcome could significantly improve survival among patients with cancer.
The transcription factor Olig2 is important for the biology of diffuse intrinsic pontine gliomas
Authors: Jane L. Anderson, Ranjithmenon Muraleedharan, Nicole Oatman, Amanda Klotter, Satarupa Sengupta, Ronald R. Waclaw, Jianqiang Wu, Rachid Drissi, Lili Miles, Eric H. Raabe, Matthew L. Weirauch, Maryam Fouladi, Lionel M. Chow, Lindsey Hoffman, Mariko DeWire, Biplab Dasgupta
Journal: Neuro-Oncology (2016)

Diffuse intrinsic pontine glioma (DIPG) is a high-grade brainstem glioma of children with dismal prognosis. There is no single unifying model about the cell of origin of DIPGs. Proliferating cells in the developing human and mouse pons, the site of DIPGs, express neural stem/progenitor cell (NPC) markers, including Sox2, nestin, vimentin, Olig2, and glial fibrillary acidic protein, in an overlapping and non-overlapping manner, suggesting progenitor cell heterogeneity in the pons. It is thought that during a restricted window of postnatal pons development, a differentiation block caused by genetic/epigenetic changes leads to unrestrained progenitor proliferation and DIPG development. Nearly 80% of DIPGs harbor a mutation in the H3F3A or the related HIST1H3B gene. Supporting the impaired differentiation model, NPCs derived from human induced pluripotent stem cells expressing the H3F3A mutation showed complete differentiation block. However, the mechanisms regulating an altered differentiation program in DIPG are unknown.
Comparison of HER2 amplification in primary tumors and lymph node metastases of urinary bladder cancer.
Authors: A. Fleischmann, R. Seiler, D. Rotzer, G. N. Thalmann
Journal: Journal of Clinical Oncology (2010)

4577 Background: HER2 is a growth factor receptor that serves for targeted therapies when overexpressed in breast cancer. Overexpression of HER2 is primarily related to gene amplification. Aim of this study was to evaluate the HER2 status by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) in primary bladder cancer and matched lymph node metastases. Methods: A tissue microarray was constructed from 150 lymph node positive urothelial bladder cancers treated by cystectomy and standardized extended pelvic lymphadenectomy. Four tissue cores were taken per patient, two from the primary tumor (center and invasion front) and two from the nodal metastases. HER2 gene/Centromer 17 FISH (PathVysion; Vysis-Abbott) ratios > 2.2, 1.8-2.2 and <1.8 were considered positive, borderline and negative for amplification, respectively. HER2 expression (Herceptest, DAKO) was classified according to the Herceptest criteria (score 0-3). Results: HER2 FISH status was significantly different between the primary tumors and the lymph node metastases (p=0.003) with amplification in 8.8 % of the primary tumors and 15.3% of the lymph node metastases. Of the primary tumors with HER2 amplification/borderline-amplification 94.7% had the same findings in the metastases. There was a high degree of concordance in FISH results between the two cancer spots from the primary tumors (Cohen's Kappa: 0.8530) and the nodal metastases (Cohen's Kappa: 0.9300). Conversely, the concordance between IHC results and FISH data was lower in the primary tumor (Cohen's Kappa: 0.5661) and the nodal metastases (Cohen's Kappa: 0.6734). Her2 data (IHC, FISH) were not significantly related to pT stage or nodal tumor burden (pN, diameter of largest metastasis, total diameter of all metastases). The trend for poorer survival in HER2 positive cancers (amplified OR IHC 3+) was not significant. Conclusions: HER2 amplification is highly homogeneous in each tumor component and significantly more frequent in lymph node metastases than in primary bladder cancer. This suggests determining the HER2 status in the metastasizing tumor component and argues for a possible response of HER2 amplified cases to anti-HER2 therapies. No significant financial relationships to disclose.
The future delivery of oncology care: Thoughts on the impact of quality improvement, personalized medicine, and integrating interprofessional collaboration.
Authors: Caroline Osborne Robinson, Maziar Abdolrasulnia, Holder Nevins, John E. Ruggiero
Journal: Journal of Clinical Oncology (2012)

19 Background: A significant thrust within recent innovation has been focused on improving the quality of diagnostics and system adherence to guidelines; equally important are attempts to improve patient-specific therapy plans, or personalized medicine. These two approaches—quality improvement and personalized medicine—have equally laudable goals toward improving cancer care and outcomes, yet have not been fully examined for their concomitant impacts, particularly among and within interprofessional teams, in which a mix of health care providers present varied foci within the oncology care delivery process. Methods: Twenty phone-based qualitative interviews were facilitated with community-based medical oncologists in active practice in July 2012. Transcripts of the interview sessions were examined through grounded qualitative analysis, and overall findings are presented. Results: Oncologists hold varied definitions of personalized medicine, yet share understanding of the central nature of the patient within personalized medicine care delivery. More varied are oncologists’ perceptions of the goals and value of implementation of quality improvement initiatives, which range from those focused on pragmatic concerns of the oncology clinic, such as patient flow, to the quality of clinical decision-making and outcomes. Oncologists value well-functioning and clearly defined roles within interprofessional teams within oncology practices, both among other clinicians and allied team members. However, functional and perceptional gaps remain in the practical application of quality improvement objectives within interprofessional teams and within the implementation of personalized oncology care delivery. Conclusions: This exploratory qualitative analysis approach provides grounded identification of practicing oncologists’ definitions of quality improvement, personalized medicine, interprofessional care delivery, and the practical interrelationships between these domains, enabling a framework for future research and quality initiatives.