tbuckley/cabot-search huggingface dataset:
Hapten-enhanced personalized chemoimmunotherapy by intratumoral drug delivery in advanced pancreatic cancer.
Authors: Baofa Yu, Yuanfei Lu
Journal: Journal of Clinical Oncology (2014)

333 Background: Currently cancer therapy is not satisfied with the effectiveness of available treatment. Engaging the power of immune system of individual patient has been considered as a highly attractive way for cancer treatment. Sipuleucel-T is an autologous cellular vaccine and represents a significant milestone for cancer immunotherapy. To evaluate the clinical effective of hapten enhanced personalized chemoimmunotherapy by intratumoral delivery of a combined drugs solution called ChemoCancerVac (CCV) in the treatment of advance pancreatic cancer and further to analyze the effect of immune adjuvant. Methods: Introtumoral injection of CCV into late stages of pancreatic cancer (92 cases), which is a proprietary therapeutic regimen composed of three components for modulation of chemoimmunotherapy, i.e. an oxidant, a cytotoxic drug and a hapten. The patients (47 patients with effect analysis and 45 patients with complete survival data were randomly divided into two groups: introtumoral chemotherapy (ITCT) alone received the CCV without hapten and introtumoral chemoimmunotherapy (ITCIT) received the CCV with the hapten. Results: In the ITCT and ITCIT groups, the clinical response rates were 92.86% and 82.88%, the median survival time and 6-month survival rate were 6.45 months vs 4.98 months and 45% vs 64%, respectively. All of mentioned above were showed no statistical difference (p&gt;0.05), whereas 1-year survival rate of the ITCT group was 5% while that of ITCiT group was 28%. The difference was significant (p&lt;0.05). Conclusions: The hapten enhanced personerlized immunotherapy by intratumoral injection of CCV was effective in the pancreatic cancer, meanwhile, the hapten plays an important role in prolong the patient survival time which are valuable in the clinic application.
Emergency department use and expenditures among cancer survivors in the United States, 2008-2011.
Authors: Rebecca Salisbury Lash, Janice Bell, Robin L. Whitney, Sarah Reed, Andra Davis, Jill G. Joseph
Journal: Journal of Clinical Oncology (2014)

3 Background: The number of cancer survivors in the US surpassed 13 million in 2012. In response to rising costs or care and greater demand for services, recent national reports and policies promote cancer care coordination to reduce costly and potentially avoidable services such as Emergency Department (ED) visits. Such efforts must be informed by reliable estimates and improved understanding of ED use and costs among oncology patients. This study quantifies the extent to which cancer survivors use the ED compared to individuals with other chronic conditions and estimates related annual expenses. Methods: Data from the 2008-2011 Medical Expenditure Panel Survey (MEPS) and survey-weighted regression models were used to determine the odds of any ED use (logistic), counts of ED visits (negative binomial) and mean annual medical expenditures attributed to ED use (generalized linear models) in three groups of respondents: cancer survivors, those with chronic conditions other than cancer, and those with neither (reference group). All models were adjusted for important confounding variables (age, sex, race/ethnicity, education, health insurance and health status). Estimates are generalizable to US non-institutionalized populations. Results: Among individuals with cancer, other chronic conditions, and neither condition, 17%, 15% and 9% visited the ED, respectively. Mean annual expenditures attributed to ED use among those with visits were $1471 (95% CI: $1262-$1678), $1517 (95% CI:$1395-$1640) and $1106 (95% CI: $984-$1228). Cancer survivors and individuals with other chronic conditions consistently had significantly higher ED use and costs than did the reference group. The likelihood of having any ED visit was similar between cancer survivors and those with other conditions, however cancer survivors incurred more visits (IRR: 1.17; 95% CI: 1.01, 1.36). Conclusions: ED use and expenditures are substantial among cancer survivors and equal or exceed the same outcomes in individuals with other chronic conditions. Future research is recommended to explore specific areas of unmet health need that may be driving increased frequency of ED visits in the growing population of cancer survivors.
Treatment-related costs of pediatric acute lymphoblastic leukemia.
Authors: Sapna Kaul, Richard S. Lemons, Kent Korgenski, Christi Ng, Richard Nelson, Elizabeth A. Raetz, Mark Fluchel, Anne C. Kirchhoff
Journal: Journal of Clinical Oncology (2014)

23 Background: Few studies have examined costs of pediatric cancer care and we lack a clear understanding of cost trends. In this study, we examined longitudinal treatment- and patient-related hospitalization costs within 5 years of diagnosis of acute lymphoblastic leukemia (ALL), the most common childhood cancer in the United States. Methods: We used data on N=555 patients diagnosed with pediatric ALL from 1998 to 2013 identified through the Intermountain Healthcare System in UT. The majority of these patients (&gt;95%) were diagnosed and treated at the Primary Children’s Hospital (PCH) in Salt Lake City, UT. PCH encompasses the largest coverage area in the continental U.S. served by a single children’s hospital. We computed the average annual per patient hospitalization cost (aggregate and by components such as room, care and nursing cost, pharmacy cost, therapy and diagnostics costs). We used the generalized estimating equations (GEE) regression framework to identify patient characteristics (sex, age, race, rural/urban residence, insurance, high vs. standard risk, relapse, bone marrow transplant (BMT), and year of diagnosis) associated with hospital-related treatment costs (total cost per encounter). Results: Annual average cost of per patient hospitalization increased by 26% from 1998-2005 to 2006-2013. Most of this increase was driven by annual increases in room, care and nursing costs (increased by 29%) and pharmacy cost (increased by 79%). Our GEE models indicated the greatest costs among relapsed patients (average difference (δ) =$15,507 vs. those without relapse), BMT patients (δ=$15,184 vs. no transplant) and patients older than 10 years at diagnosis (δ=$8,539 vs. patients younger than 10 years at diagnosis). Publically insured patients had per encounter hospitalization costs that were greater (δ=$931) than privately insured. Conclusions: Average annual cost of hospitalization for pediatric ALL care has increased over the past fifteen years. Management of room, care and nursing, and pharmacy costs need to be considered in efforts to address the cost burden. In addition, patient-centered strategies to manage higher costs, such as better management of patients who are older at diagnosis or publically insured, may be warranted.
Identifying factors impacting subsequent gemcitabine dose intensity in patients undergoing chemoradiation for locally advanced pancreatic cancer.
Authors: Talha Shaikh, Meher Burki, Lora S Wang, Brian Egleston, John Parker Hoffman, Steven J. Cohen, Joshua E. Meyer
Journal: Journal of Clinical Oncology (2015)

455 Background: Systemic therapy is a critical part of the management of locally advanced pancreatic cancer (LAPC) due to the risk of distant failure. In the clinic, anecdotal evidence suggests that maintaining dose intensity of chemotherapy is more challenging after prior chemoradiotherapy (CRT). We thus evaluated whether treatment or patient factors limit the amount of systemic therapy received in LAPC patients receiving CRT. Methods: Following IRB approval, we retrospectively reviewed all patients diagnosed with LAPC undergoing CRT between 2006 and 2012. Exclusion criteria included receipt of non-gemcitabine chemotherapy or chemotherapy prior to CRT. Patient and treatment factors were evaluated for their relationship to total gemcitabine dose received during CRT and within the first three months post-CRT. Statistical analysis was performed using regression models. Results: A total of 76 patients met the inclusion criteria with a median age of 69 (range 44-89) and a median follow-up of 13.2 months (range 3-68). The median gemcitabine dose received during CRT was 3,000 mg/m2 of a planned 3,600 mg/m2 and post-CRT was 5000 mg/m2 of a planned 9,000 mg/m2. Patients receiving a higher percentage of the desired chemotherapy dose during CRT received a lower percentage of desired chemotherapy dose post-CRT (p&lt;0.01). Patients who underwent subsequent surgical resection (p&lt;0.01) or received a higher radiation dose (p=0.03) were more likely to have received a higher total post-CRT chemotherapy dose. There were no variables correlated to chemotherapy dose received during CRT. Conclusions: Our analysis suggests that chemotherapy dosing during CRT rather than radiation dose impacts subsequent gemcitabine dose intensity. As a number of different CRT regimens are utilized in practice, this finding warrants further confirmation in a larger database.
Impact of chemotherapy on health-related quality of life among ethnically diverse breast cancer survivors treated with breast-conserving therapy.
Authors: Aseel Veronica Amora, Jessika Tano, Francisco A. Conde
Journal: Journal of Clinical Oncology (2016)

237 Background: Breast cancer (BC) is the most common cancer among women in the U.S. Public awareness and advances in BC screening have resulted in more women being diagnosed with early stage BC and treated with breast-conserving therapy (BCT) (lumpectomy followed by radiation therapy). Depending on prognostic factors and recurrence risk, systemic chemotherapy may be prescribed. Purpose of this study was to examine the impact of chemotherapy on quality of life (QOL) and needs of BC survivors treated with BCT for early stage BC. Methods: A list of 750 breast cancer survivors, aged 18 or older and who completed breast-conservation therapy for stages 0-II from 2001 - 2010, was obtained from a hospital’s tumor registry. Consent form and questionnaires, including a demographic questionnaire, City of Hope’s quality of life survey, and an investigator-developed questionnaire to assess for needs of cancer survivors, were mailed. T-test was used to compare mean subscales and overall QOL scores between those who received chemotherapy and those who did not. Frequencies and percentages were used to summarize the needs of BC survivors. Results: 119 completed surveys were received. Majority of respondents were Asians (56.3%), Caucasians (21.8%) and mixed ethnicity (13.4%). 55 patients received BCT plus systemic chemotherapy and 64 received BCT alone. Those who received systemic chemotherapy scored significantly lower on psychological subscale (p&lt; 0.01), social subscale (p= 0.04), and overall QOL (p= 0.03) compared to survivors treated with BCT alone. Regarding needs, BC survivors want to learn about nutrition (40.3%), pain management (39.5%), improving memory (37.8%), and physical activity (33.6%). Conclusions: Although chemotherapy may decrease the risk of recurrence for early stage BC, lasting effects of treatment can negatively impact QOL. Understanding the impact of chemotherapy on various domains of QOL can be beneficial to patients and healthcare providers when discussing the risks and benefits of adjuvant systemic therapy. Further interventions are needed to improve QOL and address the needs among BC survivors treated with breast-conserving therapy.
Classification of the components of the MedDietScore in relation to colorectal cancer prevalence.
Authors: N. Kontou, D. B. Panagiotakos, T. Psaltopoulou, N. Soupos, E. Polychronopoulos, D. Xynopoulos, D. Dimitroulopoulos, A. Linos, E. Paraskevas, M. A. Dimopoulos
Journal: Journal of Clinical Oncology (2011)

1593 Background: Mediterranean diet has been proposed to have a protective effect towards chronic diseases, including various types of cancer. This study aimed to evaluate whether Mediterranean diet as a whole or its specific components are associated with colorectal cancer, which increases worldwide. Methods: This is a case-control study. Between December 2009 and July 2010, 234 cases (aged 63±11, 60% males) with first diagnosis of colorectal cancer were consecutively selected from our hospitals. At the same period 250 subjects (controls) (aged 55±12, 45% males) with no clinical symptoms, signs or suspicious of any type of cancer in their medical history, were group matched to the patients by age (±5 years) and gender. The number of the enrolled subjects was decided through power analysis. Adherence to the Mediterranean diet was accessed using MedDietScore; a dietary index, validated for cardiometabolic diseases, that incorporates inherent characteristics of this pattern (theoretical range 0-55). Multi-adjusted logistic regression and linear discriminant analysis using Wilks’ lambda (ranges 0-1, the lower values, the better), applied. Results: Adherence to the Mediterranean diet was associated with lower likelihood of colorectal cancer (for 1-unit increase in the MedDietScore, OR==0.87, 95%CI 0.83-0.92). Linear discriminant analysis revealed that poultry consumption (Wilks’ lambda == 0.938, p<0.001), followed by potatoes (λ== 0.951, p<0.001), alcohol (λ== 0,968, p<0.001), cereals (λ== 0,976, p==0.001), red meat (λ== 0,979, p==0.001), vegetables (λ== 0.984, p==0.005) and dairy products (λ== 0.988, p==0.016) had the best discriminating ability in predicting colorectal cancer cases. Fruit, fish, legume and olive oil consumption were not found to have any significant discriminating ability. Total score, i.e. the MedDietScore, had λ== 0.960 (p<0.001). Conclusions: The Mediterranean diet has a protective effect against colorectal cancer, whereas focusing on its components meat, potatoes, cereals, vegetables, dairies and alcohol consumption had the best discriminating ability; these findings may help to further explore the association of this dietary pattern with the pathophysiology of colorectal cancer.
Automating a program for the evidence-based reimbursement of oncology drugs across a complex network: Benefits and challenges.
Authors: John Gilks, Marta Yurcan, Tim Yardley, Scott Gavura, Vishal Kukreti
Journal: Journal of Clinical Oncology (2014)

39 Background: Ontario hospitals are reimbursed for IV chemotherapy through Cancer Care Ontario’s (CCO) New Drug Funding Program (NDFP). By 2009, 54 indications (annual budget $195MM) were managed through largely paper based processes. A new web based system (eClaims) was developed focusing on clinic workflow and integration to chemotherapy ordering systems. Interfaces were developed for CCO’s OPIS and commercial systems (HL7v3). eClaims provides users with clinical best practice, pre-approval, immediate adjudication and simple means of tracking outstanding claims. The benefits and challenges are described. Methods: Evaluation used several strategies: debriefs after each deployment; post-go live user surveys and lessons learned workshops. Results: eClaims was deployed in 80 hospitals over two years. At most sites (50/80) treatment data flows from CPOE systems to eClaims in near real time. Over 50% of claims are machine adjudicated. Newly approved indications can be posted within hours. The main learnings during the deployment process were the need to understand and adjust for hospital specific factors and the unique business relationships among clusters of hospitals. Survey responses were received at a 19% response rate. The later deployment groups reported greater satisfaction than earlier adopters with more positive responses in all categories. Workshop key theme was the need to match complex clinical workflows with design/build processes. Secondly, evaluation of historical data before migration is necessary. Conclusions: Introducing an application into complex, varied clinical workflows is difficult. The phased approach to deployment and evaluation worked, allowing for increasingly smooth go lives. Future work revolves around balancing user needs through eClaims modifications vs simplifying clinical processes to make the tool more usable.
The CD4+CD25highregulatory T Cell Reconstitution after Allogenetic Stem Cell Transplantation and Its Correlations with aGVHD
Authors: Caixia Li, Wu Depei, Dao ping Sun, Yuejun Liu, Weirong Chang, Ming qing Zhu, Jiannong Cen, Qiaocheng Qiu
Journal: Blood (2008)
Role of serum HER2 (sHER2) levels to predict acquisition of HER2 overexpression in patients with metastatic lesions of breast cancer with HER2-negative/unknown at the primary site.
Authors: J. T. M. L. Ribeiro, S. M. Ali, L. Correia, I. M. V. D. Luis, M. Matias, T. Amaral, A. A. F. G. Quintela, K. Leitzel, A. Lipton, L. Costa
Journal: Journal of Clinical Oncology (2011)

e11114 Background: HER2 overexpression occur in 20%-30% of breast cancer (BC) patients being associated with poor prognosis and having a predictive value regarding response to anti-HER2 agents. sHER2 is a circulating oncoprotein cleaved from full-length, membrane-bound HER2 indicator of poor prognosis and of poor response to chemotherapeutic and hormone treatment in metastatic breast cancer when it is elevated. HER2 overexpression in BC metastatic tissue (BCMT) occur in 5,1% of patients that were HER2 negative in the primary tumor (Locatelli et al. 2010). We investigated whether sHER2 correlates with an immunophenothype change in BCMT of patients that were HER2 negative or unknown (primary samples not available) in primary BC. Methods: We determined sHER2 in 27 BC patients that were selected to perform BCMT biopsy because HER2 status was negative or not possible to determine. sHER2 was measured by immunoassay (H2n Advia Centaur Siemens), N< 15μg/L. Localization of BCMT was: 19 liver, 7 bone and 1 skin. Median time between surgery of primary tumor and BCMT analysis: 5,3 years. We analyzed the data using chi-square and t-test. Results: sHER2 was elevated in 19 (70%) patients; median value: 25 μg/L (17 μg/L –2903 μg/L).5/27 (18.5%) patients had HER2 positive metastatic disease. Patients with HER2 negative metastasis had median sHER2 level of 20 μg/L compared to 25 μg/L for HER2 positive metastasis group (p = 0.2, Wilcoxon rank sum analysis). Using a cutoff of 15 - 1/8 (12.5%) patients with normal sHER2 levels and 4/19 (21.05%) with elevated sHER2 levels had HER2 overexpression in BCMT (p= 0.6). Using a sHER2 cutoff of 25 - 2/17 (11.76%) patients with normal sHER2 levels and 3/10 (30%) who had elevated sHER2 levels had HER2 positive metastatic disease (p= 0.24). Conclusions: Patients with elevated levels of sHER2 have higher incidence of HER2 overexpressing BCMT. Patients with normal sHER2 levels had HER2 overexpressing BCMT also. Based on this data we cannot recommend using sHER2 assay to exclude patients for repeat biopsy of the metastatic site.
The effectiveness of nutritional-sensitive approach to restore physical activity in cachexic female palliative patients: A randomized controlled trial.
Authors: Neha Kapoor
Journal: Journal of Clinical Oncology (2016)

258 Background: Loss of lean body mass, body fat along with inflammation characterizes cachexia in patients with cancer. Nutrition intervention with counseling may ameliorate undernutrition and metabolic alterations. The aim of this study was to improve nutritional status and quality of life by providing nutrients dense natural food (IAtta) along with counseling. Methods: Female patients with cancerwith symptoms of cachexia were randomly distributed into placebo (n = 75) and intervention group (n = 75). Patients were recruited from the palliative clinic, Oncology department in AIIMS, New Delhi, India. In addition to nutritional counseling, patients were instructed to consume 100g nutritional supplement on daily basis with their normal dietary intake and for six months period. The intervention group received 100g of IAtta while placebo group received 100g of whole wheat flour. Body weight – BW; mid upper arm circumference - MUAC, physical activity level - PAL, quality of life – QoL domains and total body water (TBW) were assessed at baseline, three months and after six months. Study variables were analyzed using repeated-measures ANOVA and the Friedman test (P-value &lt; 0.05; 95% confidence interval). Results: After 6 months,patients in group IAtta had significant improvement in PAL and QoL domain (global health status, p &lt; 0.001 and fatigue, p = 0.001). Despite the decrease in BW from 43.3 ± 7.0 to 41.6 ± 5.7 Kg (p = 0.014), TBW and MUAC (p = 0.068) were maintained. Conversely, the QoL in placebo group did not improve (global health status, p = 0.74) neither their PAL. Moreover, significant increase in TBW (due to water retention) and BW (from 42.6±7.1 to 43.5±7.4 Kg, p = 0.001). Conclusions: Nutrition-sensitive approach (IAtta meal), along with nutrition counseling, improve quality of life and physical activity in female cachexia palliative patients with cancer. Clinical trial information: NCT02561143. [Table: see text]
Electrical Differentiation of Mesenchymal Stem Cells into Schwann‐Cell‐Like Phenotypes Using Inkjet‐Printed Graphene Circuits
Authors: Suprem R. Das, Metin Uz, Shaowei Ding, Matthew T. Lentner, John A. Hondred, Allison A. Cargill, Donald S. Sakaguchi, Surya Mallapragada, Jonathan C. Claussen
Journal: Advanced Healthcare Materials (2017)

Graphene-based materials (GBMs) have displayed tremendous promise for use as neurointerfacial substrates as they enable favorable adhesion, growth, proliferation, spreading, and migration of immobilized cells. This study reports the first case of the differentiation of mesenchymal stem cells (MSCs) into Schwann cell (SC)-like phenotypes through the application of electrical stimuli from a graphene-based electrode. Electrical differentiation of MSCs into SC-like phenotypes is carried out on a flexible, inkjet-printed graphene interdigitated electrode (IDE) circuit that is made highly conductive (sheet resistance < 1 kΩ/sq) via a postprint pulse-laser annealing process. MSCs immobilized on the graphene printed IDEs and electrically stimulated/treated (etMSCs) display significant enhanced cellular differentiation and paracrine activity above conventional chemical treatment strategies [≈85% of the etMSCs differentiated into SC-like phenotypes with ≈80 ng mL-1 of nerve growth factor (NGF) secretion vs. 75% and ≈55 ng mL-1 for chemically treated MSCs (ctMSCs)]. These results help pave the way for in vivo peripheral nerve regeneration where the flexible graphene electrodes could conform to the injury site and provide intimate electrical simulation for nerve cell regrowth.