tbuckley/cabot-search huggingface dataset:
Assessing the cost of cancer care delivery using a time-driven, activity-based costing software.
Authors: James Incalcaterra, Alexis B. Guzman, Yu-Ting Huang, Monica DelValle-Garza, Christian C. Kolom, Xin Zhao, Danson N Mutua, Krishan Dhingra, Thomas W. Feeley
Journal: Journal of Clinical Oncology (2016)

25 Background: Poor costing systems and measurement have led to cross-subsidies and cost-shifting in health care. A large academic cancer center has adopted Robert Kaplan’s bottom-up cost accounting methodology called time-driven, activity-based costing (TDABC). TDABC in health care has been proven to be an effective cost accounting tool to measure and improve care delivery by standardizing and creating transparency around patient care processes. The project aims to process map and identify event triggers associated with each process map, use a software applications to compute the costs and resource capacities. Methods: Information technology and financial subject-matter experts integrated clinical, resource, and financial data from the institution’s enterprise information warehouse, general ledger, resource and asset management systems into the software application. Clinical business managers, nurse managers and other clinical content experts helped identify patient-level care processes. Results: The institution deployed a project team to integrate data from the institution’s enterprise information warehouse and aid in the process mapping across three multidisciplinary care centers. The team was able to successfully cost both direct and overhead costs associated with 69 head and neck, 18 endocrine, and 15-20 proton therapy patient-level processes over 7 different business department within 7 months. The resource capacity analysis was the most difficult to analyze due of the lack of transparency around resource’s clinical, administrative, and research responsibilities. Dashboards are currently being developed to help assess changes in patient care processes, cost or resource utilization. Conclusions: This methodology can be used across all health care organizations in all countries to analyze the true cost of care delivery.
Nationwide trends in diagnosis and outcomes of gastrointestinal stromal tumors in the era of targeted therapy.
Authors: E. R. Witkowski, J. K. Smith, S. Ng, T. P. McDade, S. A. Shah, W. B. Al-Refaie, J. F. Tseng
Journal: Journal of Clinical Oncology (2011)

121 Background: Gastrointestinal stromal tumors (GISTs) have historically been inconsistently categorized in tumor registries. Discovery of c-kit expression in 1998 allowed for more precise diagnosis, and use of tyrosine kinase inhibitors for GIST in 2000 marked a new era in management. We examined nationwide trends in the diagnosis, management, and outcomes of GIST in this post-imatinib era. Methods: Patients ≥ 18 years old with GIST were identified in the SEER database 1998-2007, using the GIST-specific ICD-O-3 code. After a period of steady increase, incidence stabilized after 2001. Trends from 2002 to 2007 were examined. Univariate and multivariate analyses were performed. This cohort was further divided into 2002-2004 and 2005-2007 for survival analysis by Kaplan-Meier methods and Cox proportional-hazard ratios. Results: 3,604 patients were identified. There was a dramatic increase in diagnoses from 1998 to 2001 (109 to 376 cases, p &lt; 0.0001), but no significant change from 2002 to 2007 (p = 0.572). During this period of stable incidence (2002-2007), the proportion of patients recommended for surgery continued to decrease (85.2% to 80.1%, p = 0.0006), while utilization of radiation (which dropped to 1.1% by 2001) remained relatively constant (p = 0.101). Anatomic distribution remained stable (p = 0.529), with stomach (52.9%) and small bowel (29.3%) predominating. There was also no change in stage distribution (p = 0.811). Late stage, black race, and advanced age were predictive of not receiving resection. Female sex, younger age, local disease, later year of diagnosis, and resection were associated with lower risk of death. Survival for patients diagnosed in 2005-2007 improved over 2002-2004 for both unresected (p = 0.027) and resected (p = 0.0998) groups. Resection was an independent predictor of survival in both periods (p &lt; 0.0001). Conclusions: Incidence of GIST as identified in the SEER database has stabilized 2002-2007, likely reflecting more accurate diagnosis. Survival for both resected and unresected patients has improved since the introduction of imatinib, and continues upward. These population-level findings confirm the significant benefit of surgical therapy beyond clinical trials. No significant financial relationships to disclose.
Fludarabine and Targeted Busulfan Is Safe and Effective Conditioning Before Hematopoietic Stem Cell Transplantation in Adult Patients with Acute Lymphoblastic Leukemia in First Remission
Authors: Ghada M Kunter, Janelle Perkins, Lia Perez, Joseph Pidala, Teresa Field, Marcie Tomblyn, Hugo F. Fernandez, Claudio Anasetti
Journal: Blood (2011)
Elevation of HE4 and CA 125 in symptomatic patients with invasive epithelial ovarian cancer.
Authors: R. Knapp, F. O. Recio, M. C. Miller, Z. Vucetic
Journal: Journal of Clinical Oncology (2011)

e15539 Background: Ovarian cancer screening is not recommended in the general population. However, women at elevated risk of ovarian cancer (those with a genetic predisposition, adnexal mass or abdominal symptoms) are routinely evaluated using an annual pelvic exam, imaging and CA 125. CA 125 is associated with a high false-positive rate among women with non-malignant conditions. Human epididymis protein (HE4) has the potential to improve ovarian cancer detection. Methods: We retrospectively evaluated a multicenter study of 494 women undergoing surgery for adnexal mass to determine whether the elevation of both CA 125 and HE4 together was predictive of ovarian cancer. HE4 and CA 125 were determined in preoperative serum. Sensitivity, specificity, positive and negative predictive value were calculated. Results: A total of 472 cases were evaluated out of which 344 (73%) were benign and 128 (27%) were malignant. Borderline ovarian tumors were excluded from the analyses. A total of 115 cases (24%) showed dual elevation of CA 125 and HE4, out of which 98 cases (85%) were malignant and 17 (15%) were benign. Three hundred fifty seven cases (76%) did not exhibit dual elevation of CA 125 and HE4. In this group, 327 patients (92%) had benign disease and 30 (8%) had malignancy. The elevation of both markers resulted in a specificity of 95.1% (95% CI = 92.2-97.1%), a sensitivity of 76.6% (95% CI = 68.3-83.7%), a PPV of 85.2% (95% CI = 77.4-91.1%) and a NPV of 91.6% (95% CI = 88.2-94.3%). Conclusions: Strategies for early detection of ovarian cancer require high sensitivity (>75%) and high specificity (99.6%) to achieve a positive predictive value of 10%. When used alone, conventional markers and other diagnostic tests fall short of this required accuracy. Therefore, using both HE4 and CA125 in addition to early symptoms, imaging and pelvic examination may be more useful in at risk population rather than CA125 alone.
Patient satisfaction and surgeon experience: Does system quality matter?
Authors: S. J. Katz, S. T. Hawley, A. S. Hamilton, T. Hofer
Journal: Journal of Clinical Oncology (2008)

6525 Background: Surgeon experience has been associated with greater satisfaction with treatment decision-making for patients with breast cancer. Do delivery system quality measures play a role? Methods: 2,030 women with breast cancer diagnosed from 8/05–5/06 and reported to the LA County SEER registry were identified and surveyed shortly after surgical treatment (n=1,338, response rate 71.2%). Surgeons of respondent patients were surveyed (n=188, response rate 74.5%) and data from patients, surgeons, and SEER were combined (n=999 patients and 181 surgeons). We examined the association of surgeon experience (% practice devoted to breast cancer) with surgeon report of 3 delivery system quality scales that we developed: availability of clinical information at time of consultation (clininfo), multidisciplinary physician-patient communication (mdpat), and patient decision and care support (pcare). We examined associations of surgeon experience and delivery system measures with patient satisfaction with treatment decisions using mixed model regression. Results: 40%, 35%, and 25% of surgeons reported low (<15% of practice devoted to BC), moderate (15%-49%), and high experience (>50% devoted to BC). More experienced surgeons had higher delivery system scores: mean scores across surgeon experience categories on a 5-pt scale were 2.0, 2.7, 3.5 for clininfo (p<.001); 1.5, 1.7, 2.3 for mdpat (p=.019); and 1.4, 1.7, and 2.0 for pcare (p=.025). Patients treated by more experienced surgeons were more satisfied with surgery decision-making (p=.031). Delivery system factors were only moderately associated with patient satisfaction. For example, the mdpat delivery system factor was modestly associated with patient satisfaction (coefficient=.11, p=.008) and did not explain the surgeon experience effect. Conclusion: Delivery system quality scores were low for surgeons treating patients with breast cancer, though higher for more experienced surgeons. Both surgeon experience and delivery system quality were independently associated with patient satisfaction. No significant financial relationships to disclose.
The effect of time to adjuvant chemotherapy on survival in nonmetastatic resectable pancreatic adenocarcinoma: A retrospective analysis.
Authors: A. Pisa, C. Pericay, E. Dotor, J. Alfaro, R. Orellana, M. Pujal, M. A. Amador, F. Garcia Borobia, R. Mato, E. Saigí
Journal: Journal of Clinical Oncology (2011)

e14519 Background: The optimal timing for pancreatic cancer surgery to initiation of adjuvant chemotherapy (CT) is unknown. Most studies establish a maximum period of 56 days after surgery to treat patients in the adjuvant setting. We report a retrospective analysis to determine the relationship between time to adjuvant chemotherapy (TTAC) and survival. Methods: We retrospectively reviewed 29 consecutive patients with nonmetastatic resectable pancreatic adenocarcinoma who underwent curative surgery and adjuvant CT at our institution from January 2005 to December 2010. Our aim was to identify differences in PFS and OS depending on TTAC. We defined two groups of patients depending on TTAC: group A with TTAC ≤ 56 days and group B with TTAC > 56 days. Results: We identified 29 patients with resectable pancreatic adenocarcinoma who had undergone radical surgery and adjuvant CT with gemcitabine based on CONKO-001 phase III study. Nineteen were men and the median age was 61 years old (range 36-78). The median TTAC was 47 days (range 22-183). The most common reason for delaying adjuvant CT was post-operative complications. Seventeen patients initiated adjuvant CT within 56 days after surgery (group A). There were no significant statistic differences in age, gender, stage and palliative CT used at progression between the two groups. Median PFS and median OS in the whole group were 10.9 (95% CI 3.6-18.2) and 20.6 (95% CI 14.7-26.4) months respectively. Median OS was 26.4 months (95% CI 13.5-39.2) in group A and 14,8 months (95% CI 8.6-20.9) in group B. These differences were statistically significant (p value 0.015). No patient died of toxicity or post-operative complications. We could not find any significant statistic differences in median PFS between the two groups. Conclusions: This study demonstrates a higher risk of death in the group of patients who started adjuvant CT after 8 weeks of radical surgery for pancreatic adenocarcinoma. Nevertheless, no differences in PFS were found between the two groups. Theses findings indicate the need for clinicians and health systems managers to take the steps necessary to keep TTAC as short as reasonably achievable.
Prediction of response and prognosis by a score including only pretherapeutic parameters in 410 neoadjuvant treated gastric cancer patients.
Authors: S. Lorenzen, S. Blank, K. Becker, R. Langer, F. Lordick, D. Jaeger, J. R. Siewert, K. Ott
Journal: Journal of Clinical Oncology (2011)

4037 Background: Response to neoadjuvant chemotherapy is an independent prognostic factor in locally advanced gastric cancer. However, no prospectively tested pretherapeutic parameters predicting response and/or survival in gastric cancer are available in clinical routine so far. Methods: We evaluated the prognostic significance of various clinicopathologic parameters in 410 patients who were treated with neoadjuvant chemotherapy followed by gastrectomy. Clinical and histopathological response evaluation was performed using standardized criteria. A prognostic score was created on the basis of the variables identified in the multivariate analysis. Results: Three pretherapeutic parameters were identified as positive predictive factors for response and prognosis by multivariate analysis: tumor localization in the middle (p=0.001), well differentiated tumors (p=0.001) and intestinal tumor type according to Laurén’s classification (p=0.03). A prognostic index was constructed, dividing the patients into three risk groups: low (n=73), intermediate (n=274) and poor (n=63). The three groups had significantly different clinical (p=0.007) and histopathological response rates (p=0.001) and survival times, with a median survival for the low, intermediate and poor risk groups being not reached, 39.3 and 20.5 months, and the corresponding 5 year survival rates being 65.3%, 41.2%, 21.2% (p<0.001), respectively. Conclusions: A simple scoring system based on three clinicopathologic parameters accurately predicts response and prognosis in neoadjuvant treated gastric cancer. This system provides additional useful information that could be applied to select gastric cancer patients pretherapeutically for different treatment approaches. Prospective testing of the score in an independent patient cohort is warranted.
根治的前立腺切除後の高リスク前立腺癌に対するアンドロゲン除去アジュバント療法: SWOG S9921試験
Authors: B Dorff Tanya, W Flaig Thomas, M Tangen Catherine, H A Hussain Maha, P Swanson Gregory, P Wood David, A Sakr Wael, A Dawson Nancy, B Haas Naomi, Crawford E. David, J Vogelzang Nicholas, M Thompson Ian, Glode L. Michael
Journal: Journal of Clinical Oncology (2011)
From trial to practice: The Princess Margaret Hospital (PMH) experience with docetaxel and prednisone for men with metastatic castration resistant prostate cancer (mCRPC).
Authors: Arnoud Templeton, Lisa Wang, Francisco Vera-Badillo, Mirna Attalla, Paulo De Gouveia, Raya Leibowitz-Amit, Jennifer J. Knox, Malcolm J. Moore, Srikala S. Sridhar, Anthony Michael Joshua, Ian Tannock
Journal: Journal of Clinical Oncology (2013)

125 Background: Docetaxel (75mg/m 2 every 3 weeks [q3w]) plus prednisone (5mg bid) is standard first-line chemotherapy for men with mCRPC since FDA approval in 2004. It is unclear how results from trials translate to daily practice. Our hypothesis was that patients (pts) treated in trials would have better outcome and less toxicity. Methods: We reviewed all pts with mCRPC treated with docetaxel at PMH until the end of 2011. Primary outcomes were overall survival (OS) and PSA response rate (confirmed decline ≥ 50%). Secondary outcomes were reasons for discontinuation, febrile neutropenia and predictive factors for the primary outcomes. Data were analyzed using the Kaplan-Meier method and Cox regression for OS. Results: 438 men were treated between 2001 and 2011. At start of treatment median age was 71 (range 44 – 90) years, 80 (18%) had visceral metastasis, and the median number of docetaxel cycles was 6 (range 1 – 15). Outcomes are shown in the table. Reasons for treatment discontinuation were progressive disease (38%), completion of treatment (27%), toxicity (22%), death within 30 days of last administration (5%), and other reasons (8%). In multivariate analysis better performance status (p &lt; 0.0001), and more recent treatment (p &lt; 0.0001) were baseline factors associated with longer OS for pts receiving primary treatment with docetaxel q3w. Conclusions: In less selected pts with CRPC treated with docetaxel/prednisone PSA response rates are similar, OS shorter and toxicity more frequent as compared to men treated in the pivotal or in other trials. Supported by a research grant from CIHR. [Table: see text]
An interim evaluation of efficacy and safety of the combination of panitumumab, gemcitabine, and irinotecan in patients with advanced or metastatic cholangiocarcinoma: A phase II study.
Authors: Weijing Sun, Davendra Sohal, Kristine Mykulowycz, Ursina R. Teitelbaum, Nevena Damjanov, Bruce J. Giantonio, Mary Carberry, Paul Stephen Wissel, Mona Jacobs-Small, Peter James O'Dwyer
Journal: Journal of Clinical Oncology (2012)

328 Background: Cholangiocarcinoma is an aggressive neoplasm. Current chemotherapy approaches suggest that combinations may be superior to single agents in this disease. Over-expression of epidermal growth factor receptor (EGFR) is associated with tumor stage and prognosis. This study was designed to evaluate the efficacy and tolerability of the combination of panitumumab, a monoclonal anti-EGFR antibody, with gemcitabine and irinotecan in patients with advanced and metastatic cholangiocarcinoma. Methods: Pts with advanced unresectable or metastatic cholangiocarcinoma, ECOG PS 0-2, and adequate liver, kidney and bone marrow function were treated with panitumumab (9 mg/kg) on day 1, gemcitabine (1000 mg/m 2 /100 min) iv and irinotecan (100 mg/m 2 ) iv on days 1 and 8 of a 21-day cycle. Tissue specimens were collected based on availability for future biomarker analyses. The primary objective was to evaluate the 5-month progression-free survival (PFS) rate. The secondary objectives include overall response rate (ORR), overall survival rate (OS) and toxicity of the combination. Results: There have been 24 (of planned 42) pts recruited to the study. Toxicity of the combination was assessed in all enrolled pts. There were no treatment related deaths. The most common gr 3 or higher toxicity was were neutropenia (10 pts [40%]), thrombocytopenia (6 pts, [25%]), skin rash (4 pts [17%]) and diarrhea (3 pts, [12%]). One pt developed a gr 2 infusion reaction, which was considered related to panitumumab. Efficacy was evaluated in 20 pts. Among them, there were 2 CR, 6 PR, and 10 SD (with disease control rate of 90%), and 2 PD (assessed by RECIST criteria). Two pts went on to have surgical resection. Eight pts had ≥ 10 cycles of the therapy, and dose modification/interruption were needed for some of these pts. Conclusions: The data of this on-going study showed encouraging results of the combination of panitumumab with gemcitabine and irinotecan in both tolerability and efficacy. The pre-specified efficacy criteria to continue enrollment were met. Further analysis by biomarker status (KRAS/BRAF/EGFR) is forthcoming.
Pulmonary Hypertension in Sickle Cell Disease: Cardiopulmonary Evaluation and Response to Chronic Phosphodiesterase 5 Inhibitor Therapy.
Authors: Roberto F. Machado, Sabrina E. Martyr, Anastasia Anthi, Gregory J. Kato, Lori A. Hunter, Wynona A. Coles, James S. Nichols, Oswaldo L. Castro, Mark T. Gladwin
Journal: Blood (2004)
Aggregating administrative and claims data from multiple payers to estimate population-based health outcomes: A validation study.
Authors: Tzy-Mey Kuo, Anna Schenck, Anne-Marie Meyer
Journal: Journal of Clinical Oncology (2014)

285 Background: Health insurance claims data are increasingly used for estimating individual health outcomes. However, it is challenging to obtain population-based estimates because of difficulties obtaining and reconciling data from all insurance providers. With incomplete insurance data, methods are needed to estimate the entire insured population. Using multi-payer claims we demonstrate and validate a synthetic method to obtain county level morbidity estimates. Methods: We used data from the Integrated Cancer Information and Surveillance System (ICISS) data resource at the University of North Carolina (NC) at Chapel Hill. ICISS data represent a linked data resource comprised of beneficiaries enrolled in federal as well as private insurance plans and rich ecologic data; and represent 5.5 million unique individuals, about 55% of the NC population. Using specific ICD-9 diagnosis codes, claims data from 2008 were compared to state department of public health data. We computed county level hospitalization rates by summing data from three sub-groups: age 65 and older in the 100% Medicare sample, age younger than 65 in the 100% Medicaid sample, and age younger than 65 represented in the private payer data. For the privately insured population, we used census data to obtain estimates of the entire privately insured population and used the hospitalization rate from beneficiaries in ICISS data to estimate a numerator for the synthetic sample of privately insured beneficiaries. We used State Inpatient Data (SID) from NC County Data Book to validate our method. Results: Overall, our synthetic approach showed moderate to high validity with a Pearson correlation coefficient 0.77 for heart disease and 0.93 for flu or pneumonia. Our hospitalization estimates were slightly lower than the data from SID, because SID data include uninsured individuals and multiple hospitalizations for individuals. Conclusions: Our synthetic method can be useful in estimating population-based health outcomes using linked insurance claims data.
Differences in the symptom distress between young adult and adult patients with advanced cancer admitted to acute palliative care unit.
Authors: Beodeul Kang, Yu Jung Kim, Ji Soo Park, Hye Jin Choi
Journal: Journal of Clinical Oncology (2016)

99 Background: Understanding about young adults with advanced cancer in palliative care was still insufficient. The purpose of this study was to identify the differences in symptom distress between young (20-39 years) and older (≥ 40 years) adults with advanced cancer who were admitted to acute palliative care unit. Methods: We retrospectively analyzed 502 consecutive patients admitted to acute palliative care unit between April 2015 and March 2016 in two tertiary cancer centers. Descriptive statistics, analysis of Edmonton Symptom Assessment Scale (ESAS), and Symptom Distress Scale (SDS) were performed. Results: Among 502 patients, 33 (7%) were aged 20-39 years, and 469 (93%) were aged ≥ 40 years. The most common malignancies among the young adult patients were stomach and colorectal cancers. SDS was similar between young adult (38.7 ± 15.1) and old adult (41.5 ± 13.7) patients. However, pain, nausea, poor feeling of well-being sense, sleep disturbance, and financial distress were numerically higher in young adult group than older adult group. Especially, sleep disturbance (5.72 vs. 4.56, p = 0.030) and financial distress (4.44 vs. 2.87, p = 0.008) showed statistically significant difference. Conclusions: Young adult advanced cancer patients appear to show different symptom profiles. Further research is needed to identify determinants and to provide timely integration of palliative care services for this unique patient cohort.