tbuckley/cabot-search huggingface dataset:
FDG-PET/CT imaging in gynecologic cancers: Is there an advance on patient management?
Authors: M. Dalla Palma, M. Gregianin, L. Evangelista, A. R. Cervino, G. Saladini, L. Borgato, M. O. Nicoletto, V. Zagonel
Journal: Journal of Clinical Oncology (2011)

5080 Background: FDG-PET/CT has emerged as a powerful diagnostic tool in oncology. Here, we aimed to evaluate our current practice so as to define the appropriate use of PET/CT in gynecologic malignancies management in our institution. Methods: Included in this retrospective analysis were 116 patients affected by gynecologic tumors who underwent PET/CT imaging at our Institution between 2005 and 2010. Indications were as follows: 1) suspicion of recurrence based on clinical symptoms, elevated CA-125 serum level, and/or uncertain conventional imaging, 2) assessment of treatment response, and 3) on routine follow up. The results from PET/CT were correlated with patient clinical follow-up information and findings from other imaging modalities. Receiver-operating characteristic (ROC) curve for the identification of CA-125 marker cutoff were used. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were determined by person-based analysis. Results: The primary tumor sites were ovarian cancer (n = 88), uterine cancer (n = 19), and cervical cancer (n = 9). The median age was 56 years (range 20-82 years). All patients had been treated with curative intent for gynecologic cancer according to FIGO stage. The table below summarizes FDG-PET/CT results in relation to the indications for which the test was performed. ROC analysis showed an optimal cutoff point for CA125 of 36 U/ml (AUC 0.841, p= <0.0001) to individuate positive PET/CT. Conclusions: The greatest utility of FDG-PET/CT was seen in setting of suspected gynecologic cancer recurrence. PET/CT helped in defining the extent of metastatic disease, including metastasis in normal-sized pelvic and retroperitoneal lymph nodes, and in unsuspected distant sites. PET/CT allowed a better disease’s restaging and optimization of treatments, especially in those cases for which surgical resection of single metastatic lesions could be performed. Indication No. of patients (%) Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%) Assessment of relapse 67 (58) 98.3 83.3 98.3 83.3 97 Assessment of treatment response 30 (26) 75 88.8 81.8 84.2 83 Follow-up 19 (16) NA 89.4 NA 100 89 Abbreviation: NA, not applicable due to absence of patients with true positive findings.
Psychological benefits of theater-depicting cancer treatment.
Authors: Samantha Carlson, Becky Jones, Linda Grossheim, Joseph Mirro
Journal: Journal of Clinical Oncology (2016)

203 Background: The number of cancer survivors in the United States is increasing and estimated to exceed 13 million. Consequently, the quality of life of these patients and their family members has become a high priority. The best interventions to decrease distress, improve coping and quality of life for survivors are poorly understood but are becoming an important focus of research. We therefore, undertook a prospective pilot study using a questionnaire to measure the emotional impact of a play depicting cancer treatment on cancer survivors and their family members. This research project was reviewed and approved by the West Michigan Cancer Center Institutional Review Board (IRB). Methods: The emotional feelings and perceived levels of coping were measured and compared before and after the play. Statistical analyses of responses included chi-square and t-tests for continuous variables, or Fisher’s test or Wilcoxon’s test where parametric assumptions were not met. Results: A total of 60 survivors and 49 family members completed the research questionnaire. The most promising finding was that a majority of survivors and family members 51.0% (n = 50) felt they were coping better (p &lt; 0.0001) after the play. Of the survivors, 73.0% said the play reflected their experiences and 78.0% felt it was helpful dealing with their emotions. Overall, 94.0% of those attending the play requested additional theater performances. Conclusions: Our preliminary data demonstrates that theater depicting cancer treatment has a strong emotional impact and potential therapeutic effects for cancer survivors and family members. Increased feelings of coping with the diagnosis occurred following the play. Attendees also felt less alone (59.5%) and more hopeful (53.4%) after the play.
The prognostic value of hypermethilation 14-3-3 sigma promoter in breast cancer patients.
Authors: J. Martínez-Galan, J. R. Delgado, B. Torres-Torres, R. Del Moral, P. Ballesteros, J. A. Ortega, J. Peñalver, J. Garcia, S. Ríos, M. I. Núñez
Journal: Journal of Clinical Oncology (2011)

e13577 Background: Aberrant CpG methylation of 14-3-3 σ promoters results in inactivation of tumor suppressor genes induced in response to DNA damage, and has been implicated in G2/M cell cycle arrest by p53. The p53-regulated gene 14-3-3sigma undergoes frequent epigenetic silencing in several types of cancer including of the breast. To correlation methylation levels of promoter 14-3-3σ with association prognostic factors in breast cancer. Methods: This is a prospective study we quantified methylation levels of promoter 14-3-3σ gene in 107 women with breast cancer and 108 control subjects by Real Time QMS-PCR SYBR green and analyzed association with prognostics factor in breast cancer. Results: Median age was 58 years (32-88); 69% were postmenopausal women. Nodal involvement N0; 63%, N1; 30%, N2; 7%), tumor size (T1; 58%, T2; 35%, T3; 4%, T4; 4%) and grade (G1; 20%, G2; 37%, G3; 30%). The methylation of 14-3-3σ were 60% of sporadic breast cancer patients and were 34% of normal breast (p=0.0047). The methylation of 14-3-3σ gene in serum was markedly related with T3-4 stage (p<0.05), nodal positive status (p<0.05) and poor outcome. With a median follow-up of 7 years we saw more probability of developing distance metastasis in patients with methylation 14-3-3σ (p<0.05). Conclusions: Hypermethylation of the 14-3-3σ a promoter is an early and frequent event in breast neoplastic transformation, leading to the suggestion that silencing of 14-3-3σ may be an important event in tumor progression and particularly in breast carcinogenesis. Therefore, it is possible that loss of σ expression contributes to malignant transformation by impairing the G2 cell cycle checkpoint function, thus allowing an accumulation of genetic defects. Perhaps in the detection of CpG methylation of 14-3-3σ may be used for diagnostic and monitoring disease status and treatment response.
A survey of patient/family use of internet for medical information on cancer.
Authors: K. Kumar, K. Chan, Y. Ko
Journal: Journal of Clinical Oncology (2011)

e16551 Background: Although physicians have been a primary source of information in the past, patients and family members are now looking to other resources, such as the Internet, to gain information. Used by 83% of the US population to look for medical information, the Internet has become more accessible than ever, especially due to advances in technology. The objective of this study was to survey the use of the Internet by patients and their family members for information regarding their cancer diagnosis and treatments. The impact of this information seeking on the patient-physician relationship was also examined. Methods: A 22-item anonymous survey was distributed to patients and their family and friends at the outpatient chemotherapy units and the new patient chemotherapy teaching information sessions at a comprehensive cancer centre over a 4-week period between February and March 2010. The study was approved by the IRB. Summary statistics were calculated and non-parametric rank sum tests were used to compare ordinal responses among baseline respondent characteristics. Results: Of the 203 responses obtained, 74% of the responders were patients and 26% were family or friends who accompanied the patients. 61% of the respondents were male and 39% were female. The mean age was 55 years (17-89). 12% had a graduate degree and 59% had a university/college degree. The majority of those surveyed (87%) had home Internet access. Patients with a higher educational background used and valued their physicians as an information source less than the rest of the respondents and relied on the Internet more (p<0.01). The majority of patients (89.5%) stated that they would ask their physicians about information on the Internet. Older patients, in particular, felt that information obtained from the Internet had a positive impact on their relationship with their physicians. A small proportion of patients (11%) would decline recommended treatment based on the information from the Internet. Conclusions: The use of Internet as a primary source of medical information is prevalent among cancer patients as well as amongst their family and friends. The patient-physician relationship from the patient’s perspective, however, has not suffered a negative impact.
Use of palliative care measures to support improved patient outcomes and quality of life.
Authors: Ken Williams, Tilithia McBride
Journal: Journal of Clinical Oncology (2012)

281 Background: Key public-private quality improvement entities, such as the National Quality Forum (NQF) and the National Priorities Partnership, have identified palliative care measures as being critical for the care of cancer patients. In this study, Avalere sought to understand whether current palliative care measures are adequate to support desired patient outcomes, including quality of life. Methods: Avalere conducted searches of large, national quality measure databases—including the Agency for Healthcare Research and Quality’s National Quality Measure Clearinghouse and NQF—as well as public quality measurement programs to better understand the range of existing palliative care measures and the use thereof. In addition, Avalere augmented this research through a review of the white and grey literature to determine how such measures may be better used to support desired outcomes. Results: Several organizations—most notably the American Society of Clinical Oncology (ASCO); the American Medical Association–convened Physician Consortium for Performance Improvement, with the National Comprehensive Cancer Network and ASCO; and the RAND Corporation—have developed measures addressing palliative care for cancer patients. Several of these measures have been subsequently endorsed by NQF. Despite this, few palliative care measures have been incorporated into national quality measurement programs, outside of ASCO’s proprietary Quality Oncology Practice Initiative (QOPI). Conclusions: While it is widely acknowledged that palliative care measures are critical for the care of cancer patients, particularly as it relates to supporting quality of life, little has been done to ensure such measures are incorporated into national public quality improvement initiatives, such as the Centers for Medicare &amp; Medicaid Services’ Physician Quality Reporting System. As calls for increased use of patient-reported outcomes and other palliative care measures continue to rise, policymakers may need to consider incorporating existing, NQF–endorsed measures, such as those used in QOPI, into public programs.
Premastectomy sentinel lymph node biopsy: A strategy to enhance outcomes in immediate breast reconstruction.
Authors: S. Agarwal, C. Teven, N. T. Jaskowiak, J. Park, I. Seitz, D. Song
Journal: Journal of Clinical Oncology (2011)

e19688 Background: Pre-mastectomy sentinel lymph node biopsy (PM-SLNB) is a technique in which SLNB is performed as an outpatient procedure prior to mastectomy. As nodal status can dictate the need for adjuvant radiotherapy, having this knowledge prior to mastectomy affords accurate planning for either immediate or delayed reconstruction to avoid deleterious effects of radiation on reconstruction. We studied the safety and efficacy of PM-SLNB in the management of breast cancer therapy and reconstruction. Methods: Pre-mastectomy sentinel lymph node biopsy (PM-SLNB) is a technique in which SLNB is performed as an outpatient procedure prior to mastectomy. As nodal status can dictate the need for adjuvant radiotherapy, having this knowledge prior to mastectomy affords accurate planning for either immediate or delayed reconstruction to avoid deleterious effects of radiation on reconstruction. We studied the safety and efficacy of PM-SLNB in the management of breast cancer therapy and reconstruction. Results: Seventy-seven patients underwent PM-SLNB of 78 axillae. Infiltrating ductal carcinoma was found in 60 breasts, infiltrating lobular carcinoma in 7 breasts, and ductal carcinoma in situ in 11 breasts. PM-SLNB was positive in 23% of patients (n=18). All positive PM-SLNB patients underwent delayed reconstruction. There were no complications associated with PM-SLNB. Mastectomy was performed on 75 breasts. After PM-SLNB, 3 patients (2 with negative PM-SLNB and 1 with positive PM-SLNB) opted to undergo breast conservation therapy (lumpectomy and radiotherapy). Conclusions: PM-SLNB predicted the need for adjuvant radiotherapy prior to mastectomy and prevented the adverse effects of radiation to reconstruction in over 20% of our study patients. PM-SLNB is both safe and effective. A multi-disciplinary approach with open communication among clinical oncologists, radiation oncologists, surgical oncologists, and plastic surgeons allows for effective use of PM-SLNB.
Inferior vena cava thrombus recurrence after radical nephrectomy in renal cell carcinoma.
Authors: Caroline Kauffmann, David A. Pfister, Daniel Porres, Axel Heidenreich
Journal: Journal of Clinical Oncology (2015)

511 Background: Local recurrence after radical nephrectomy in renal cell carcinoma occurs in about 2-4% of the patients. An isolated intracaval thrombus is described in only very few cases. We report about our experience in the diagnosis and theapy of this random entity. Methods: 5 patients (2f, 3m) were referred to our institution with the diagnosis of an IVC thrombus recurrence. All patients had underwent a radical nephrectomy 1-9 years before the relapse. In 3 patients, the thrombus was diagnosed within the routine follow up, another 2 presented with swelling/deep vein thrombosis. The staging showed no other metastases. Results: The mean patient age at time of diagnosis was 73.8 (70-81) years. 2 patients presented with a level II thrombus, 2 with level III and one with a level IV thrombus. We could resect the thrombus completely in 4 cases and close the cava with a running suture. In one case we had to resect the inferior vena cava completely and replace it with a gortex prosthesis. The mean blood loss was 1.7 (0-8) liters at an operating time of 5.5 (4.3-7.6) hours. The mean follow up was 3.5 (0.5-8) years, until today occured one case of pulmonal metastatic disease. Significant perioperative complications classified after Clavien-Dindo occured in one case with an intraoperative bleeding and rupture oft he spleen that required a mass-transfusion. Conclusions: Although it is a technical demanding procedure, the surgical resection of a recurrent vena cava thrombus is the method of choice with only a little perioperative morbidity and high oncological effectivity. This random type of recurrent disease illustrates the importance of an adequate primary therapy as well as a regularly follow up after cava-involvement.
Utilizing design theory to create a patient-centered palliative care model in cancer survisorship care.
Authors: Erika Lauren Tribett, Jordan Chavez, Alison Morris
Journal: Journal of Clinical Oncology (2016)

164 Background: Palliative medicine (PM) is an essential component of survivorship care from point of diagnosis. While PM is philosophically committed to supporting patient and family survivorship goals, very few programs incorporate patient and family input into the formation of a patient-centered model of care for symptom management and quality of life. We utilized design theory to develop novel interventions for primary and specialist PM delivery. Methods: Baseline data collected in Fall 2014 revealed a need for assistance navigating support services as well as barriers to PM integration including branding, lack of primary palliative skills, and poor understanding of outcomes of PM integration. In February 2015, we convened a multidisciplinary group of 25 patients, family members, oncology clinicians and experts in patient experience and health services research, to evaluate current state data and formulate ideas for optimizing PM to support symptom management and quality of life. During a 1-day workshop, the group generated interventions for primary and specialist PM. Small teams were assigned to pilot projects based on these recommendations. Proposed solutions are being tested from July - October 2015. Results: The design team generated five focus areas for meeting patient needs and overcoming barriers: standard processes for access to PM, education on primary PM, rapid reporting of outcomes, relationship-building with referring clinicians, and improved access to primary and specialist palliative resources. Three interventions are being developed to address these: 1. A subspecialist “hub” that allows single referrals and streamlined access to supportive care, 2. a novel two-question probe about goals conducted by the oncologist, and 3. a peer support system between PM social work and nursing staff to proactively manage patients with complex needs. Conclusions: Patient and family-centered PM mandates a novel approach. Design theory allows for clear delineation of problem areas, generation of multiple solution sets, and rapid testing and refinement prior to large-scale adoption. A participatory design approach emphasizes user values and limitations and creates values-based solutions.
Association of radical prostate cancer therapy with a survival benefit in the older man.
Authors: Paul Cathcart, Amundeep Johal, Jan van der Meulen, Mark Emberton
Journal: Journal of Clinical Oncology (2013)

66 Background: Data from several recent randomised controlled trials have suggested that older men have little to gain from radical prostate cancer therapy. In contrast, observational studies have suggested that older men might be at increased risk of prostate cancer related death than their younger counterparts. Using a national cancer registry, we sought to explore this issue further. Methods: English national mortality records for an 11 year period between 1997 and 2008 were linked to national hospital admission records together with national cancer registration records to generate a working dataset. Complete data were available on 75,735 men. Competing risks regression analysis was employed to identify the effect of age on Prostate Cancer Specific mortality. Results: Older men were more likely to have high-grade prostate cancer (&lt;70 yrs: 20% v’s &gt;79 yrs: 36%) and be staged with locally advanced (&lt;70 yrs: 20% v’s &gt;79 yrs: 35%) or metastatic disease (&lt;70 yrs: 18% v’s &gt;79 yrs: 25%). Older men were less likely to receive radical therapy (&lt;70 yrs: 46% v’s &gt;79 yrs: 4%) although they were more likely to die of their disease. 8-year overall mortality for low, intermediate and high risk disease in men &lt;70 was 8%, 11% and 31% compared to 34%, 36% and 54% for men &gt;79. Comparable figures for 8-year prostate cancer specific mortality were 1%, 5% and 22% for men &lt;70 and 8%, 10% and 32% for men &gt;79.The Number Needed to Treat (NNT) to save one prostate cancer related death for men with low risk disease aged less than 70 was 100 compared to 20 and only 6 for men aged &lt;70 with intermediate and high risk disease respectively. For men aged between 75 and 79, radical prostate cancer therapy was only associated with a survival benefit in men with high risk disease (OR: 0.49, 95% CI 0.36-0.66, p&lt;0.001) for which the NNT was 5. Conclusions: Older men present with more advanced and more aggressive prostate cancer and as such are more likely to die from their disease. Radical therapy was associated with a survival benefit up to the age of 80 providing therapy was targeted to those with higher risk disease.
Suppression of human HCC cell growth in vitro by siRNA silencing of forkhead box M1 expression.
Authors: Keon Uk Park, Ji Hong Kim, Hye-Jin Kim, Yun-Han Lee
Journal: Journal of Clinical Oncology (2013)

173 Background: Development of targeted therapy for hepatocellular carcinoma (HCC) remains a major challenge. The transcription factor forkhead box M1 (FOXM1) is a member of the forkhead family, and it induces the expression of genes involved in the execution of mitosis. Liver regeneration studies that used the albumin promoter/enhancer cre recombinase (Alb-Cre) transgene to mediate hepatocyte-specific deletion of the mouse Foxm1 LoxP/LoxP targeted allele (Foxm1fl/fl) demonstrated that Foxm1 is required for hepatocyte DNA replication and mitosis. Methods: We explored the possibility of FoxM1 being a potential therapeutic target for HCC.To inactivate target gene expression, Huh7 and HepG2 cells were treated with the various doses of three different siRNAs (FoxM1-1, FoxM1-2 and FoxM1-3). The change of FoxM1 expression in mRNA level was then determined by quantitative real-time PCR. Cell growth was analyzed by MTT assay, and apoptosis was estimated by ELISA for the detection of denatured ssDNA only formed during apoptotic progression. Results: Among the three tested siRNA molecules, the FoxM1-1siRNA was the most effective in inhibiting HCC cell growth. Both Huh7 and HepG2 cells transfected with 15nM of FoxM1-1siRNA showed more than 60% growth inhibition by 4 days. Inhibition of cell growth was due to increased rate of apoptotic cell death which was about 2-fold higher than in untreated control cells. Upregulation of apoptosis directly correlated with down-regulation of FoxM1 mRNA level. Furthermore, siRNA-mediated silencing of FoxM1 expression in HCC cells retarded cell cycle progression. Conclusions: These results indicate that FoxM1 plays a pivotal role in HCC pathogenesis and maybe an attractive molecular target for systemic HCC therapy.