tbuckley/cabot-search huggingface dataset:
Contemporary utilization trends of systemic chemotherapy for upper tract urothelial carcinoma (UTUC).
Authors: Mohammed Haseebuddin, Elizabeth Handorf, Joshua Jones, Alexander Kutikov, Nikhil Waingankar, Benjamin T. Ristau, Miki Haifler, Yu-Ning Wong, Rosalia Viterbo, Richard Evan Greenberg, Robert G. Uzzo, David Y. T. Chen, Marc C. Smaldone
Journal: Journal of Clinical Oncology (2016)

441 Background: There is currently no consensus regarding the use of systemic therapy (ST) for surgically-treated patients with invasive UTUC. Using a large national cancer registry, our objective was to assess temporal trends in utilization of ST for stage II-IV UTUC undergoing definitive resection. Methods: The National Cancer Database (NCDB) was queried for all patients surgically treated (nephroureterectomy, segmental resection) for stage II-IV UTUC from 1998-2012. Temporal trends in receipt of ST [neoadjuvant (NAT), adjuvant (AT), or unknown timing (UKT)] were assessed using chi square analyses. After exclusion of patients receiving NAT or UKT, adjusting for patient and clinicopathologic characteristics, multivariable logistic models were used to examine the association between clinicopathologic characteristics and receipt of ST within 9 months of resection. Kaplan Meier analyses and stratified log-rank tests were performed comparing overall survival (OS) between patients receiving ST &lt; 9 months and those who did not. Results: Of 7,629 patients identified over the study period, 24.1% of patients surgically treated for stage II-IV UTUC received any ST (NAT: 1.44%, AT: 19.11%, UKT: 3.51%). Utilization of any ST significantly increased from 1998-2012 (20.2% vs. 28.7%, p &lt; 0.0001). Following adjustment, patients of increased age (61-70 years: OR 0.62 [CI 0.42-0.91], 71+ years: OR 0.26 [CI 0.17-0.38]) were less likely to receive ST, and patients with high grade (OR 2.46 [CI 1.95-3.09]), Stage III (OR 4.75 [CI 3.89-5.79]), and Stage IV (OR 9.37 [CI 7.49-11.74]) disease were more likely to be treated with ST. When restricted to stage III-IV disease, receipt of ST &lt; 9 months was significantly associated with improved OS after adjustment for age, grade, and charlson index (p &lt; 0.002). Conclusions: In hospitals reporting to the NCDB, while utilization has significantly increased from 1998-2012, less than one third of patients surgically treated for stage II-IV UTUC receive ST. In addition to unmeasured characteristics (decline of renal function following surgery), the lack of explicit guidelines and prospective evidence may contribute to limited use of systemic treatment.
Opportunities for improvement (OFI) in guideline concordance (GLC) at National Comprehensive Cancer Network (NCCN) member institutions (MI).
Authors: Jennifer Lyle, Jonathan L. Vandergrift, Kimary Kulig
Journal: Journal of Clinical Oncology (2012)

172 Background: The NCCN is implementing a performance improvement initiative using breast cancer (BC) practice data from NCCN MIs to improve institutional delivery of GLC and identify tailored opportunities for improving efficiency and quality of care delivered. Methods: This initiative includes evaluation of baseline GLC, review of non-concordant (NC) cases, design of tailored institutional interventions, and post-intervention evaluation of GLC and reasons for NC. BC patients presenting from July 2007 to March 2009 at 11 NCCN MIs were included in the baseline review. Six Category 1 GLC and 3 ASCO/NCCN quality measures evaluating adjuvant chemotherapy (CTX), endocrine therapy (ET), and radiation (XRT) were reviewed. GLC was assessed using the NCCN Outcomes database. Results: Aggregate GLC across all measures was 90% (MI range 66% to 100%). Review of NC cases was used to develop tailored OFI interventions. Three MIs are focusing on clinical practice improvement via provider education and feedback and integration of electronic medical record flags for treatment consideration. Nine MIs are working on improving access and reducing time-to-treatment lags. Currently, half of MIs are implementing and half are evaluating OFI interventions. Conclusions: This program supports data-driven QI efforts at MIs with the goal of improving efficiency and quality of care delivered to patients at participating sites, as well as serving as a model for data-driven quality improvement programs. [Table: see text]
A Novel DNA Vaccine Platform Enhances Neo-antigen-like T Cell Responses against WT1 to Break Tolerance and Induce Anti-tumor Immunity
Authors: Jewell N. Walters, Bernadette Ferraro, Elizabeth K. Duperret, Kimberly A. Kraynyak, Jaemi Chu, Ashley Saint-Fleur, Jian Yan, Hy Levitsky, Amir S. Khan, Niranjan Y. Sardesai, David B. Weiner
Journal: Molecular Therapy (2017)
Psychological distress and communication with children about a parent's advanced cancer: A mixed-methods study.
Authors: Claire Emery Hailey, Justin M Yopp, Allison Mary Deal, Deborah Mayer, Katherine Elizabeth Reeder-Hayes, Laura C Hanson, Gili Grunfeld, Donald L Rosenstein, Eliza M Park
Journal: Journal of Clinical Oncology (2016)

236 Background: Cancer affects 1.6 million parents with dependent children in the United States, many of whom experience heightened distress related to the impact of their illness on children. Palliative medicine and oncology providers frequently recommend open communication with children. However, there is little empirical research on the relationship between illness-related communication with children and parental psychological distress. The objective of this study was to explore the association between parental psychological distress and communication with children about a parent’s advanced cancer. Methods: This was a cross-sectional, mixed-methods observational study of patients with stage IV solid tumor malignancies who had at least one dependent biologic or adopted child. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a semi-structured interview. Reports of illness-related communication with children were categorized as “minimal,” “partial,” or “full.” We conducted linear regression models to evaluate the association between extent of communication and HADS scores. Results: Of the 42 parents, 7 participants (17%) had minimal illness-related communication with their children, 13 (31%) had partial communication, and 22 (52%) had full communication including discussion of their prognosis. HADS Anxiety scores, but not HADS Depression scores, were higher with greater extent of communication (4.1 vs. 7.6 vs. 10.4, p = 0.003), even when controlling for performance status and children’s age. Conclusions: In this pilot study, parents who had more extensive communication with children about their advanced cancer and prognosis also reported more symptoms of general anxiety. Palliative and supportive care interventions should address psychological distress relevant to parenting and should provide guidance for communicating with children.
Evaluation of tolerance to chemotherapy/radiotherapy (Ch/Rt) in older breast cancer patients
Authors: N. G. Pilnik, O. G. Mareca, M. A. Ibero, M. M. Nasetta
Journal: Journal of Clinical Oncology (2008)

20584 Background: Older women have high risk of developing breast cancer and are more likely to present multiple co-morbid conditions. Besides, age affects the pharmacokinetics of antineoplasic agents and increases the susceptibility of complications. Methods: 145 breast cancer pts older than 65yrs stages II, III, and IV, were treated with Ch and or Rxt. Pts selection was conducted according to the Basic Activities of Daily Living (ADL) score. 44 pts had ADL score A; 58 pts had ADL score B; and 43 pts had ADL score C. The Instrumental Activity Daily Living (IADL) was evaluated too. All pts had adequate cardiac, hepatic, renal and bone marrow functions. Pts were divided in two groups: G I (65–69 yrs), and G II ( ≥ 70 yrs). Co-morbidities studied were: hypertension, diabetes, arrhythmia, coronary disease and digestive disease. Toxicities were evaluated following the WHO criteria. and studied according to age, co-morbidities, the use of more than 3 drugs over Ch (poly-pharmacy), ADL, and IADL scores. Statistical analysis: Chi Square Pearson, Mann-Witney U test, Irwin-Fisher exact test, Kaplan-Meier survival curves and Logrank test were used. Results: The most common toxicities were digestive,leukopenia, and anemia. There was no correlation between age and toxicity profiles. No significant differences was found between the number of toxicity events in both groups. The relationship of poly-pharmacy with leukopenia, genitourinary and neurological toxicities was statistically significant (p=0.0008; 0.0015; 0.0160). Kaplan Meier Survival analysis showed statistically differences between pts who used more than 3drugs over the Ch vs the other pts (log-rank test p=0.000341). The Cox proportional hazard model was fitted to survival time. The variables were age, ADL, and IADL scores. The best model was only for ADL score (p<0.001). Survival according to co-morbidities showed that only coronary disease had a significant effect on survival (p=0.0032). Conclusions: 1-Toxicities in both groups allowed us that to continue the treatment in most patients. 2- Ch in older breast cancer pts with controlled co-morbidities is feasible. No significant financial relationships to disclose.
Medical and psychosocial predictors of delay in seeking medical consultation for breast symptoms in low-income women
Authors: L. C. Friedman
Journal: Journal of Clinical Oncology (2005)

677 Background: Delay in seeking consultation for breast symptoms is associated with more advanced stage of breast cancer. Understanding demographic, medical, and psychosocial factors related to delay is important for reducing breast cancer morbidity and mortality, especially for populations at increased risk for delay such as African Americans, Hispanics and the socioeconomically disadvantaged. Methods: In this cross-sectional survey, 77 women with breast symptoms attending an outpatient breast clinic in a county general hospital completed questionnaires measuring demographic, medical and psychosocial variables. Our outcome variable was delay in seeking medical consultation. Pearson correlation coefficients, one-way ANOVAs and Chi square and multivariate analyses were performed. Results: Mean age was 46 years. Forty-three per cent were Hispanic, 33% African-American, 14% Caucasian and 10% Asian. Sixty-four per cent were unemployed. Thirty-nine per cent waited longer than three months after noticing their symptom(s). Younger age, less education, absence of a lump, lower perceived risk, less spirituality, cost and worry about treatment were related to delay (all p’s ≤ 0.05). Emotional distress upon noticing breast symptoms and family history of breast cancer were not related to delay. Multivariate analyses showed absence of a breast lump (p = .016), lower risk perception (p = .001), less spirituality (p = .009) and more patient-oriented barriers (p = .002) collectively accounted for 45.6% of the variance in delay in seeking medical consultation. Conclusion: Results suggest interventions targeting low-income women should emphasize the importance of breast symptoms other than lumps, especially to younger and less educated women. Reducing indirect costs such as time away from work and child care expenses through a rapid, single day multidisciplinary diagnostic evaluation could remove additional barriers to early diagnosis. No significant financial relationships to disclose.
Risk factors of gastric carcinogenesis in underlying gastric mucosal atrophy.
Authors: Ji Hyun Song, Sang Gyun Kim, Eun Hyo Jin, Joo Hyun Lim, Sun Young Yang
Journal: Journal of Clinical Oncology (2016)

28 Background: Atrophic gastritis and intestinal metaplasia were considered as premalignant lesions. The prevalence of chronic atrophic gastritis is very high in Korea. The aims of this study were to evaluate the risk factors of gastric carcinogenesis in underlying gastric mucosal atrophy. Methods: A total of 10187 subjects underwent upper gastrointestinal endoscopy for health checkup between 2003 and 2004 were enrolled in this retrospective cohort study. Follow-up endoscopy was performed between 2005 and 2014. Atrophic gastritis and intestinal metaplasia were assessed according to the Kimura-Takemoto classification by endoscopy. Helicobacter pylori (Hp) was evaluated by serum IgG antibody. Results: The number of atrophic gastritis was 3716 (36.5%) in baseline endoscopy, and 2146 were undergone follow-up endoscopy (82.8±38.3month); 1139 showed aggravation of atrophy and 1007 showed no change. A total of 71 subjects were diagnosed as gastric neoplasms (34 adenoma, 37 carcinoma). Age (HR = 1.019, 95%CI 1.010-1.028), alcohol intake (HR = 1.002, 95%CI 1.001-1.002), Salt intake (HR = 1.295, 95%CI 1.038-1.617) and Hp infection (HR = 1.584, 95%CI 1.220-2.057) were associated with aggravation of mucosal atrophy. The risk factors for gastric neoplasm in underlying mucosal atrophy were age (HR = 1.041, 95%CI 1.004-1.079), alcohol intake (HR = 1.003, 95% CI 1.001-1.005), Salt intake (HR = 2.553, 95% CI 1.141-5.712), Extent of mucosal atrophy (HR = 2.375, 95% CI 1.201-4.695 in C3-O1; HR = 4.255, 95% CI 1.612-11.229 in O2-O3), and intestinal metaplasia (HR = 2.599, 95% CI 1.286-5.251). Conclusions: Hp was a risk factor for aggravation of atrophy, but not for gastric neoplasm. Salt intake, extent of mucosal atrophy, and intestinal metaplasia were important risk factors for gastric neoplasm.
The soluble form of the IL-2 receptor (sCD25) as a novel biomarker for hepatocellular carcinoma.
Authors: M. A. Ararat, A. I. Fitian, T. Brusko, Y. Xu, C. Wasserfall, M. Atkinson, C. Liu, C. J. Allegra, D. Nelson, R. Cabrera
Journal: Journal of Clinical Oncology (2011)

e14629 Background: We have previously shown that the soluble form of the alpha-subunit of the IL-2 receptor (sCD25) is significantly elevated in a small series of HCC patients compared to controls. These preliminary studies showed a significant correlation with tumor stage and a novel immuno-inhibitory function for sCD25. Aim. To determine the correlation of serum levels of sCD25 with the presence and extent of HCC using a large well characterized series of HCC patients and controls with cirrhosis. Methods: Serum samples were collected from 87 patients with HCC and 30 patients with compensated cirrhosis without HCC. The levels of sCD25 were quantified using ELISA. We then performed descriptive statistics, ROC analysis and correlation analysis. Results: The level of sCD25 in the serum of HCC patients was significantly higher (mean + SE: 12,799 + 2,030 pg/mL) than in the control group having cirrhosis without HCC (3,585 + 293 pg/mL; p.0.00002). We found a significant positive correlation between the level of sCD25 in the serum of HCC patients and the tumor stage of patients with HCC (R=0.4; p=0.0001). The ROC curve analysis showed that at a cut-off of >5,150 pg/mL the serum level of sCD25 had a sensitivity of 62.1% and a specificity of 83.3% (AUC=0.740, p< 0.0001. A significant negative correlation was found between serum level of sCD25 and survival of HCC patients (R=-0.3, p<0.01). Conclusions: Peripheral levels of sCD25 show early promise as a novel immune biomarker for HCC with the potential to predict presence of more aggressive HCC and poor outcome.
Lymphatic targeting chemotherapy for refractory lymph nodes in patients with breast cancer after neoadjuvant chemotherapy: Preliminary experience.
Authors: J. Chen, Q. Yao, J. Zhang, B. Wang, T. Wang, H. Wang, Y. Lv, Z. Han, L. Wang
Journal: Journal of Clinical Oncology (2011)

e13010 Background: Primary systemic chemotherapy is increasingly used to downstage breast cancer. However, in some cases, it was observed that contrary to sufficient regression of cancer, the tumor-involved lymph nodes remained stable. In this study, we performed lymphatic targeting chemotherapy on patients with refractory nodes and evaluated its efficacy and safety. Methods: From October 2004 to August 2007, 318 node-positive breast cancer patients were submitted to three cycles of neoadjuvant chemotherapy. After two cycles, 72 patients showed responsive tumor but nonresponsive nodes. Of them, 42 received an additional subcutaneous injection of pegylated liposomal doxorubicin during the third cycle; the other 30 who refused to receive the targeting therapy were regarded as control. Results: Lymphatic targeting treatment substantially increased both clinical and pathological node response rate [62% (26/42) vs 13% (4/30) and 12% (5/42) vs 0 (0/30), respectively], and induced a higher apoptosis level of metastatic cells (median, 41% vs 6%), as compared with the control. Moreover, a higher disease-free survival was observed after a median follow-up of 4 years (69% vs 56%). Inflammatory reaction surrounding injection site was the most common side effect. Conclusions: Lymphatic chemotherapy has reliable efficacy and well-tolerated toxicity for breast cancer patients presenting refractory lymph nodes after neoadjuvant chemotherapy.
Social disparities in perceived coordination of care and use of chemotherapy among patients with stage III colorectal cancer.
Authors: Arden M. Morris, Jennifer J. Griggs, Rachel Davis, Mousumi Banerjee, Paul Abrahamse, Kevin Ward, Ikuko Kato, Sarah T. Hawley
Journal: Journal of Clinical Oncology (2012)

24 Background: Our prior work demonstrated low uptake of chemotherapy among advanced stage rectal cancer patients and significantly lower uptake among minorities. Underuse of chemotherapy is associated with decreased survival. In this analysis, we hypothesized that health system factors such as inadequate coordination of care contribute to under-use of chemotherapy among minority and low socioeconomic status (SES) patients. Methods: We performed a population-based survey of all stage III colorectal cancer patients diagnosed in the State of Georgia and Metropolitan Detroit SEER catchment areas. Our outcomes of interest were perceived care coordination and self-reported use of chemotherapy. Independent variables included clinical and demographic factors. We used chi square analyses to assess associations between patient characteristics, coordination of care, and use of chemotherapy. Multiple linear regression examined relationships between SES, coordination of care, and use of chemotherapy after adjusting for age, sex, and comorbidity. Results: In preliminary analyses, 215 patients have completed the survey (initial response rate of 60%). To date, most participants have reported good-to-excellent coordination of care (mean=4.3 on scale of 1-5), and care coordination did not differ by clinical or demographic factors. Those who perceived better care coordination were more likely to receive chemotherapy (p&lt;0.001). Respondents with high school education or less had significantly lower uptake of chemotherapy relative to their counterparts (71% vs. 89%, p=0.005), and this difference was significant even when adjusting for coordination of care. Conclusions: SES, in particular education level, was associated with both coordination of care and with receipt of chemotherapy. If these findings are confirmed in our larger sample, we will be able to identify targets for health system intervention and improvement.
Contemporary outcomes of pT3 renal cell carcinoma: A Canadian multi-institutional experience.
Authors: Jasmir Nayak, Clare Gardiner, Zhihui Liu, Simon Tanguay, Anil Kapoor, Antonio Finelli, Ricardo A. Rendon, Peter C. Black, Laurence Klotz, Ronald Brian Moore, Jun Kawakami, Rodney H. Breau, Darrel E Drachenberg
Journal: Journal of Clinical Oncology (2014)

434 Background: A large, multi-institutional analysis was undertaken to examine the pathological and oncological outcomes for patients with pT3 renal cell carcinoma (RCC) treated surgically. Materials and Methods: Institutional databases on patients surgically treated for RCC were obtained from 14 centers across 6 Canadian provinces forming the Canadian Kidney Cancer Information System (CKCis) database. Data were collected on 2204 patients and included patient characteristics, peri-operative information, pathological and oncological outcomes. Results: Of the 2,204 patients, 498 (22.6%) patients had pT3 disease according to the 2009 TNM staging system. Mean pathological tumor size was 8.6 cm. 443 (89.0%) patients underwent a radical nephrectomy (RN) and 55 (11.0%) underwent a partial nephrectomy (PN). Of those treated with RN, 247 (55.8%) were open, 159 (35.9%) laparoscopic and 1 (0.2%) robotic. In the PN group, 37 (67.3%), 14 (25.5%) and 4 (7.3%) patients were treated open, laparoscopic and robotically, respectively. Average operative time was 184 mins, with an average blood loss of 650 cc. Of the pT3 lesions, 365 (73.3%) were pT3a, 97 (19.5%) pT3b and 12 (2.4%) pT3c. 109 (22%) patients had a metastatic diagnosis before or at the time of nephrectomy. Of the remaining 389 patients, 68.9% remained free of disease after a median follow-up of 1.3 years. Common sites of metastatic disease included lung, lymph nodes and bone (77%, 35%, and 25%, respectively). Clear cell RCC was the predominant histopathology (74%). There were no peri-operative (&lt;30 days) mortalities. Complications were found in 14.1% of patients. Systemic therapy was initiated in 132 (26.5%) of patients, most commonly with Sunitinib in 106 (80%) patients. Conclusions: Locally advanced, pT3 renal cell carcinoma is an aggressive disease that is associated with high rates of metastatic disease. Despite this, a significant portion remained disease free at the time of our follow-up.
Impact of prior definitive therapy on survival outcomes in men with new hormone sensitive metastatic prostate cancer (mHSPC).
Authors: Anitha Alex, David D. Stenehjem, Przemyslaw Twardowski, Heather H. Cheng, Tyler Howard Buckley, David Gill, Shiven B. Patel, Ulka N. Vaishampayan, Neeraj Agarwal
Journal: Journal of Clinical Oncology (2016)

269 Background: In mHSPC, treating the primary tumor may have a biologic effect on the metastatic sites, and definitive therapy in this setting has been hypothesized to delay disease progression and even death. Outcomes with prior definitive therapy in this setting have not been reported. Methods: In this multicenter study, men with new mHSPC, starting androgen deprivation therapy (ADT) were included. Index date was the day of starting ADT. Kaplan-Meier and Cox proportional hazard methods assessed time to castrate resistance (CRPC) and overall survival (OS) in those with or without prior definitive therapy. Variables significant at P &lt; 0.05 were included in the final models. Results: A total of 235 men with mHSPC were included (median age ~ 67 yrs). Prior definitive therapy was performed in 64 men (27%). Results are presented in the table. Conclusions: Definitive treatment was associated with improved time to CRPC and OS in univariate analysis; however, when combined with other prognostic factors the significance was not maintained. Analysis of a larger data set is warranted to fully assess the role of prior definitive therapy in mHSPC. [Table: see text]