tbuckley/cabot-search huggingface dataset:
Prognostic significance of microvessel density and vascular endothelial growth factor expression in 105 sinonasal carcinomas
Authors: M. Airoldi, G. Valente, C. Mamo, A. Bena, S. Marchionatti, F. Beatrice
Journal: Journal of Clinical Oncology (2005)

5522 Background: A great deal of interest has been paid to the predictive value of neoangiogenesis (represented as microvessel density) on the clinical progression and prognosis of several types of tumors. Many studies showed a relationship between neoangiogenesis and expression of growth factors with proangiogenetic activity, such as Vascular Endothelial Growth Factor (VEGF-C). Methods: The prognostic significance of microvessel density and proliferative activity of the neoplastic cells, evaluated respectively by CD31 and Ki-67 positivity, and immunohistochemical expression of VEGF-C was retrospectively investigated in 105 cases of sinonasal carcinoma. The most represented histologic types were intestinal-type adenocarcinoma, 36 patients, squamous cell carcinoma 34, mucinous adenocarcinoma (mainly made up of signet ring cell patterns) 15 and adenoid cystic carcinoma 7. Results: Microvessel density values (in terms of vessels/mm2), VEGF-C and Ki-67 were not dependent on histologic type but were rather correlated to the histologic grading of intestinal-type adenocarcinoma and squamous cell carcinoma, as well as to VEGF-C expression (p= 0.01). Clinical data were available for 92/105 patients (87.6%), with minimum follow-up 48 months. Most of the patients (81.5%) were at an advanced stage (T3-T4) at diagnosis. The values of all markers were correlated to tumor stage (p=0.03). Multivariate analysis showed that both microvessel density and proliferative activity of the neoplastic cells were independent prognostic parameters (mortality hazard ratio 1.33 and 1.60 respectively). Although VEGF-C expression was not correlated to prognosis on the whole series (p= 0.06), it was a powerful prognostic marker when the analysis was restricted to the group of squamous cell carcinomas (hazard ratio 3.02, 90%C.I.1.58–5.80). Conclusions: Tumor neoangiogenesis, expressed by microvessel density, together with proliferative activity, is a pathologic marker with a strong prognostic impact in sinonasal carcinomas. It may be a useful tool in this field so as to carry out therapeutic protocol planning, which may be further enhanced by the adoption of the more recent antiangiogenic molecules. No significant financial relationships to disclose.
Outpatient documentation of advance care planning (ACP).
Authors: Jennifer Carrie Obel, Bruce Brockstein, Tiffany Benfield, Chad Konchak, Ari Robicsek, Michael Raymond, Cory Tabachow, Maureen Kharasch, Michael Marschke, Thomas A. Hensing
Journal: Journal of Clinical Oncology (2013)

169 Background: To increase and systematize outpatient ACP, our quality improvement team developed enhancements in 2 oncologists’ cohorts of newly diagnosed, incurable cancer patients (pts). At 1 st consultation, an ACP form is given to pts; a nurse assesses knowledge about medical POAs and goals of care. Pts return for chemotherapy teaching and ACP education session conducted by a nurse utilizing an ACP workbook describing end-of-life (EOL) scenarios. After reviewing the workbook, the nurse or social worker fills out an Advance Directive Note (ADN). At next visit, the oncologist reviews the plan, cosigns the ADN and inputs code status orders (CSOs). Alternatively, oncologists may choose to create the ADN. Methods: An EOL quality database of 9 metrics was created via the Electronic Health Record to measure quality of EOL care for cancer patients. Before pilot implementation, baseline assessment of ACP documentation in deceased cancer pts was obtained utilizing the EOL database for a 3 month time frame (12/12-2/13) for 2 oncologists (GI and thoracic oncology). These rates are compared to ACP documentation for newly diagnosed incurable cancer patients in the outpatient clinic during the 3 month pilot occurring from 3/13-5/13. Results: During the pilot, 5/13 (38%) new thoracic oncology patients and 13/17 (76%) GI patients had outpatient ADNs. The average days to ADN placement from 1 st visit, was 14 and 10 in thoracic and GI, respectively. GI oncology placed 6/13 ADNs on the 1 st visit; 12/13 GI pts had ADNs placed less than 10 days from 1 st visit. GI oncology also placed 10/17 outpatient CSOs of which 8/10 were less than 10 days from 1 st visit. In the same thoracic oncologist’s deceased patients during the baseline period, 2/20 (10%) had outpatient ADNs compared to 7/20 who had inpatient ADNs; 2/20 thoracic patients had outpatient CSOs compared to 15/20 with inpatient CSOs. In two comparable practices which did not participate in the pilot from 3/13-5/13, 0/26 and 1/26 new patients had outpatient ADNs and CSOs, respectively. Conclusions: Outpatient ACP is feasible early in the care of cancer patients through systematic improvement in work flow and motivated providers. Future research will focus on whether ACP soon after a cancer diagnosis affects downstream metrics of quality and cost of care during EOL.
Standardization of oral chemotherapy delivery to improve patient safety: A pilot study.
Authors: Tejas Desai, Maritza Carvalho, Ron Fung, Devi Ahuja, Simerjit Gollee, Bernadette Almeida, Gurpreet Grewal, Katherine Enright
Journal: Journal of Clinical Oncology (2016)

90 Background: Oral chemotherapy (OC) presents unique challenges to patient safety. In contrast with parenteral chemotherapy, patient education and comprehension are crucial to the safe administration of OC, appropriate toxicity interventions and patient adherence. At Trillium Health Partners we identified a lack of standardization to OC education and monitoring, that resulted in gaps in patient care. Using the American Society of Clinical Oncology/Oncology Nursing Society 2013 chemotherapy safety standards as guidance, we developed and piloted a multi-disciplinary oral chemotherapy care pathway (OCCP) to improve the approach to education and monitoring of patients newly started on OC. Methods: Patients newly started on OC between 03/15–06/15 were enrolled by 2 participating physicians representing a predominantly lung/GI practice. Baseline data was abstracted retrospectively in the 3 months prior to the pilot to reflect all study participants. The OCCP included in-person and telephone assessments by an oncology pharmacist and nurse over 2 cycles of OC. Pilot outcomes included pharmacy interventions, dose modification for toxicity, medication errors, the percent of prescriptions on computerized physician order entry (CPOE), adherence documentation and comprehension of treatment plan. Results: The pilot enrolled 20 patients and compared them against 21 baseline patients. During the pilot there were improvements in the percentage of patients who had pharmacy interventions, documentation of adherence and assessment of comprehension of the treatment plan as well as a reduction in dose modifications due to toxicity (Table 1). Conclusions: Use of a newly developed oral chemotherapy care pathway demonstrated both feasibility as well as improvements in a variety of key patient safety indicators. These results suggest that implementation of a standardized oral chemotherapy care pathway can feasibly improve patient safety outcomes. [Table: see text]
The Distancing-Embracing model of the enjoyment of negative emotions in art reception
Authors: Winfried Menninghaus, Valentin Wagner, Julian Hanich, Eugen Wassiliwizky, Thomas Jacobsen, Stefan Koelsch
Journal: Behavioral and Brain Sciences (2017)

Why are negative emotions so central in art reception far beyond tragedy? Revisiting classical aesthetics in the light of recent psychological research, we present a novel model to explain this much discussed (apparent) paradox. We argue that negative emotions are an important resource for the arts in general, rather than a special license for exceptional art forms only. The underlying rationale is that negative emotions have been shown to be particularly powerful in securing attention, intense emotional involvement, and high memorability, and hence is precisely what artworks strive for. Two groups of processing mechanisms are identified that conjointly adopt the particular powers of negative emotions for art's purposes. The first group consists of psychological distancing mechanisms that are activated along with the cognitive schemata of art, representation, and fiction. These schemata imply personal safety and control over continuing or discontinuing exposure to artworks, thereby preventing negative emotions from becoming outright incompatible with expectations of enjoyment. This distancing sets the stage for a second group of processing components that allow art recipients to positively embrace the experiencing of negative emotions, thereby rendering art reception more intense, more interesting, more emotionally moving, more profound, and occasionally even more beautiful. These components include compositional interplays of positive and negative emotions, the effects of aesthetic virtues of using the media of (re)presentation (musical sound, words/language, color, shapes) on emotion perception, and meaning-making efforts. Moreover, our Distancing-Embracing model proposes that concomitant mixed emotions often help integrate negative emotions into altogether pleasurable trajectories.
Amphiregulin (AREG) expression and response to first-line panitumumab (pmab) plus FOLFIRI in metastatic colorectal cancer (mCRC).
Authors: Claus-Henning Kohne, Ralf Hofheinz, Laurent Mineur, Henry Letocha, Richard Greil, Josef Thaler, Brian Twomey, Kelly Smith Oliner, Michael Boedigheimer, Jan-Henrik Terwey, Meinolf Karthaus
Journal: Journal of Clinical Oncology (2015)

731 Background: Biomarker analyses have shown that patients (pts) with RAS wild-type (WT) mCRC can achieve overall survival (OS) benefits with first-line pmab plus chemotherapy. Other biomarkers may exist that could optimize pt selection. Epidermal growth factor receptor ligand (eg AREG) levels have been correlated with OS during anti-EGFR therapy. Here we investigate the relationship between AREG expression and treatment outcome in a single-arm first-line mCRC study of pmab + FOLFIRI. Methods: Qualified reverse transcription quantitative polymerase chain reaction (RT-qPCR) assays were used to measure AREG RNA expression in archival formalin-fixed, paraffin embedded tumor samples from mCRC pts in two pmab trials (STEPP and 314). The STEPP analysis was used to establish a cut-off point in AREG expression that identified the best responders. This cut-off was applied prospectively to samples previously analyzed for KRAS in the 314 trial. Using the KRASMT subgroup as a non-responding comparator, Cox proportional hazards (PH) models were used to evaluate AREG expression levels as a continuous covariate. Decision curves were used to estimate the progression-free survival (PFS) hazard ratio (HR) with increasing levels of baseline AREG expression. Results: In the 314 trial 100 pts had evaluable AREG levels. Among 50 KRAS WT pts, high AREG expression was associated with objective response (OR) (Table). The high AREG group had better PFS HRs (KRAS WT/KRAS MT: 0.30 [95% CI, 0.12–0.75]) compared with the low AREG group (PFS HR 0.49 [95% CI 0.21–1.1]). There was a significant biomarker-by-AREG expression interaction in the Cox PH model (p=0.03). Conclusions: Treatment decision curves based on the PH model suggest that most KRAS WT patients express AREG at levels where treatment benefit is predicted. Future analysis of samples from a RASWT population may provide further insights. Clinical trial information: NCT00508404. [Table: see text]
Diagnostic performance of MUC1 for pancreatic ductal adenocarcinoma: A meta-analysis
Authors: Z. M. Jiang, D. R. Xie, Q. Yang, D. L. Chen, Z. F. Bi
Journal: Journal of Clinical Oncology (2008)

15680 Background: Pancreatic ductal adenocarcinoma and its variants accounted for over 90% of pancreatic malignancies. Early diagnosis of pancreatic cancer was difficult with transabdominal ultrasonography, computed tomography (CT) or serum CA 19–9. Previous studies found that MUC1 might be a valuable tumor marker for early diagnosis of pancreatic cancer, but there was no convincing evidence. Therefore, systematical assessment for diagnostic performance of MUC1 in pancreatic ductal adenocarcinoma was necessary. Methods: All studies on early diagnosis of pancreatic cancer with MUC1 were comprehensively searched in MEDLINE, EMBASE, CBMdisc and CNKI database and so on (date of last search was Nov 2007). References from reviews and original articles also were screened to capture missing clinical trial data that met our inclusion criteria. Keywords used in the Search as follow: pancreatic cancer, pancreatic neoplasms, pancreatic carcinoma, pancreatic adenocarcinoma, pancreas, MUC1, mucin-1. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available studies. The evaluation indexes in meta-analysis included sensitivity, specificity, diagnostic odds ratio (DOR), area under curve (AUC) and Q* index. Results: 18 studies met inclusion criteria, at last, 17 studies involving 1363 patients were enrolled in the meta- analysis. Due to significant heterogeneity (except for threshold effect), a meta-analysis was performed using random effect model. Pooled accuracy indicators like sensitivity, specificity, and DOR were 0.83 (95% CI 0.81–0.86), 0.63 (95% CI 0.59–0.66), 20.44 (95% CI 9.53–43.85), respectively. AUC of SROC (summary receiver operating characteristics) curve was 0.8879 and Q* index was 0.8185. Conclusion: The meta-analysis suggested a moderate diagnostic accuracy for MUC1 in pancreatic ductal adenocarcinoma. It can be an optional examination of pancreatic cancer. No significant financial relationships to disclose.
Management of dysphagia in esophageal cancer (EC): A population-based study.
Authors: Sameh Mikhail, Alice Hinton, Evan John Wuthrick, Kyle Perry, Robert Merritt, Terence Marques Williams, Darwin Conwell, Tanios S. Bekaii-Saab, Somashekar Krishna
Journal: Journal of Clinical Oncology (2016)

100 Background: Dysphagia is associated with significant morbidity in patients (pts) with EC. Our study is the first report of national trends in hospitalizations due to EC and dysphagia, with special emphasis on nutritional interventions and related outcomes. Methods: The analysis included all adult inpatients with EC and dysphagia in the Nationwide Inpatient Sample from 2002-2012. We examined temporal trends and performed multivariate analysis for key outcomes; controlling for demographics, hospital factors, comorbidities, and interventions. Results: Among 509,593 hospitalizations involving pts with EC, 12,205 were related to dysphagia. The percentage of all hospitalizations for EC (1.52 vs. 3.28%; p &lt; 0.001) and EC with dysphagia (0.0025 vs. 0.0059%, p &lt; 0.001) doubled over the study period. Among all pts with EC, inpatient mortality for EC with dysphagia was 4.39%. Mean length of stay (LOS) and cost of hospitalization were 8.1 days and $15,171, respectively. Feeding tube (FT) placement was performed in 27 % of pts, esophageal stenting in 13% and peripheral nutrition (TPN) was used in 11%. The incidence of stent placement was higher in urban teaching hospitals (33%) vs. urban non-teaching (21%) or rural nonteaching hospitals (17%). On multivariate analysis, placement of FT and stents was associated with comparable inpatient mortality and LOS, but TPN was associated with higher mortality (OR 2.25; 95% CI 1.93, 2.62) and prolonged LOS (+3.4 days, CI 2.79, 3.97). Compared to FT, stents (+ $3,042, CI 432, 5,652) and TPN (+ $10,573, CI 8,766, 12,380) resulted in higher cost of hospitalization. More pts developed sepsis on TPN (6.1%) compared to FT (2.5%) or stents (1.8%). Inpatient mortality associated with any nutritional intervention was lower in urban teaching compared to rural nonteaching hospitals (0.71; CI 0.65, 0.79). Conclusions: Hospitalizations for EC and dysphagia are increasing and mortality in such pts is high and multifactorial. TPN is associated with sepsis and mortality in this setting. Nutritional intervention practices and possibly outcomes vary significantly based on hospital type. This finding should be further explored to better define the most appropriate interventions and treatment setting for this patient population.
Outcomes of Children with Acute Lymphoblastic Leukemia Treated with 2 Consecutive Protocols: Ramathibodi Hospital Experience
Authors: Pacharapan Surapolchai, Samart Pakakasama, Nongnuch Sirachainan, Usanarat Anurathapan, Ampaiwan Chuansumrit, Suradej Hongeng
Journal: Blood (2008)
Regional initiative to define, collect, and report value metrics in cancer care.
Authors: Karma L. Kreizenbeck, Erin E. Hughes, F. Marc Stewart, Thomas David Brown, Eric Y. Chen, John M. Corman, Thomas Curry, Michael Glenn, Matt Lonergan, Renato Martins, John Rieke, Elie P. Saikaly, Mark Szalwinski, Rakesh T Chauhan, Gary H. Lyman, Scott David Ramsey
Journal: Journal of Clinical Oncology (2014)

25 Background: In the context of numerous national initiatives aimed at measuring quality and value in cancer care, the Hutchinson Institute for Cancer Outcomes Research, in partnership with local healthcare delivery organizations, patient advocacy groups, payers, and policymakers launched a regional, stakeholder-driven initiative to define 3-5 “value-based metrics” for cancer care for Washington State. Methods: Representatives from major cancer care delivery organizations, patient advocacy groups, payers, and policymakers were invited to participate in a day-long Value Summit. Attendees were tasked with identifying metrics that considered both costs and outcomes. Trained facilitators helped participants identify metrics for 9 domains: appropriate use of effective therapies, adherence to best practices, survival, comprehensive disease management, efficiency of care, hospice/palliative care, patient and family satisfaction with care, patient reported outcomes/preferences and safety. After the initial list was generated, attendees were then asked to rank the metrics on the basis of feasibility to collect, clinical relevance, ability to act on, meaningfulness to multiple stakeholders, and willingness to report statewide. Attendees were then asked to participate in 3 domain-specific facilitated breakout sessions to prioritize the top metrics for each domain. Breakout sessions reported top metrics for a final group prioritization exercise. Following the Summit, attendees provided feedback on the final rankings. The metrics were then presented at a Town Hall style meeting for public comment. Results: Over 70 participants, representing 20 different organizations, identified 750 unique metrics from 9 domains. The prioritization process yielded 3 areas of interest, with 2 specific metrics within each: end of life and palliative care (metric 1, metric 2); adherence to best practices (metric 3, metric 4); and coordinated and efficient care (metric 5, metric 6). Follow-up surveys of Summit attendees and the Town Hall forum showed widespread support for these metrics Conclusions: Using an iterative, transparent, multi-stakeholder process, it is feasible build regional consensus around value metrics in cancer care.
Improving the quality of abstract reporting for economic analyses in oncology.
Authors: Maria Yi Ho, Kelvin Chan, Stuart Peacock, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2012)

109 Background: Increasing costs of cancer drugs underscore the importance of EA, which convey key information about the relative costs and benefits of new interventions. Although guidelines for abstracts exist for phase I, II, and III oncology trials, similar recommendations for EA are lacking. Our objectives were to 1) identify items considered to be essential for EA abstracts; 2) evaluate the quality of EA abstracts submitted to ASCO, ASH, and ISPOR meetings; and 3) propose guidelines for future reporting. Methods: Health economic experts were surveyed and asked to rate each of 24 possible EA elements on a 5-point Likert scale. A scoring system for abstract quality (0=poor and 100=excellent) was devised based on EA elements with an average expert rating ≥ 3.5. All EA abstracts from ASCO (‘97–‘09), ASH (‘04–‘09) and ISPOR (‘97–‘09) were reviewed and assigned a quality score. Results: Of 99 experts surveyed, 50 (51%) responded. Characteristics of respondents: average age = 53; male = 78%; US / Europe / Canada = 54% / 28% / 18%. A total of 216 abstracts were reviewed: ASCO 53%, ASH 14% and ISPOR 33%. Median quality score was 75 (range 48 to 93), but notable deficiencies were observed. For instance, the cost perspective of the EA was reported in only 61% of abstracts, while the time horizon was described in only 47%. An association was seen between year of presentation and overall quality of abstracts (p=0.001), with those from recent years demonstrating better quality scores. There were also disparities in quality scores among EA of different cancer sites (p=0.005). Conclusions: Quality of EA abstracts for oncology has improved over time, but there is room for improvement. Abstracts may be enhanced using guidelines derived from our survey of experts (see table). [Table: see text]
Predictive and prognostic significance of early positron emission tomography/computed tomography (PET/CT) in advanced transitional cell carcinoma.
Authors: Patrizia Giannatempo, Alessandra Alessi, Rosalba Miceli, Daniele Raggi, Elena Farè, Nicola Nicolai, Gianluca Serafini, Barbara Padovano, Luigi Piva, Davide Biasoni, Tullio Torelli, Mario Catanzaro, Silvia Stagni, Massimo Maffezzini, Luigi Mariani, Alessandro M. Gianni, Guru Sonpavde, Roberto Salvioni, Flavio Crippa, Andrea Necchi
Journal: Journal of Clinical Oncology (2014)

341 Background: A risk-adapted treatment for TCC may guide new trial designs for early-recognized unresponsive patients (pts). We aimed to prospectively identify early fluorodeoxyglucose (FDG)-PET/CT as a predictor of response and outcome. Methods: Pts with newly-diagnosed advanced/metastatic TCC receiving first-line chemotherapy underwent CT and FDG-PET/CT at baseline, a restaging with PET/CT after 2 cycles only (PET2), and a CT (± FDG-PET/CT) at the end of treatment and during follow up. The endpoints were PET2 metabolic response, RECIST response, progression-free (PFS) and overall survival (OS). Univariable (UVA) and multivariable (MVA) Cox models were fitted. Prespecified variables were presence of visceral metastases, nodal or soft tissue disease, and PET2 response. Results: In the time-frame 05/2010-10/2012, 31 pts with ECOG-PS 0 received a modified MVAC regimen according to Institutional protocol, every 3 weeks. After 2 cycles of MVAC, 6 patients (19.3%) had a complete (CR) and 17 (54.8%) a partial metabolic response (PR) (74% total responders; 95% CI, 55.4-88.1%), 4 had stable disease (SD), 4 progressed. Metabolic response (CR + PR) was associated with final CT response (p=0.007 at Fisher exact test). Metabolic CR was followed by a RECIST CR in all but one cases and metabolic progression at PET2 corresponded to a RECIST PD in all four patients and they all switched to second line chemotherapy. Median follow up was 18 months (IQR: 10-47). Those with metabolic response had a median (95% CI) PFS of 8 (7-11) months compared to 3 (2-5) months of patients without response (p=0.024). PET2 responders had a significant benefit in 8-month PFS (p&lt;0.001) and 15-month OS (p=0.016 at Klein test). A significant association was observed between PET2 response and longer PFS in both UVA and MVA (p=0.027 and p=0.023, respectively). Results are limited by small numbers. Conclusions: PET2 response might confer an independent prognostic impact on PFS and OS. Results warrant a validation series, a comparison with the impact of early RECIST response as well as a detailed cost-efficacy analysis prior to devise a new strategy of first-line treatment.