tbuckley/cabot-search huggingface dataset:
Intensity of end-of life-care in children with cancer: A population-based study.
Authors: Emily E. Johnston, Elysia Marie Alvarez, Olga Saynina, Lee Sanders, Smita Bhatia, Lisa J Chamberlain
Journal: Journal of Clinical Oncology (2017)

10574 Background: There is growing evidence that adult oncology patients who know they are dying choose less intense care. Further, high intensity care is associated with worse caregiver outcomes. Little is known about pediatric oncology end-of-life care intensity. Methods: Using the California Office of Statewide Health Planning and Development administrative database linked to death certificates, we performed a retrospective population based analysis of cancer patients aged 0-21 who died between 2000 and 2011. The frequency of previously defined end-of-life intensity markers (hospital death, intense medical interventions, IV chemotherapy, and gastrostomy and tracheostomy tube placement) were calculated and multivariable logistic regression was used to determine clinical and sociodemographic factors associated with &gt; 2 intensity markers (as above), intense medical intervention (cardiopulmonary resuscitation, intubation, ICU admission, or hemodialysis), and hospital death. Results: The 3,732 pediatric cancer decedents were 34% non-Hispanic whites and 45% Hispanic; 41% had hematologic malignancies and 59% solid tumors. The most prevalent intensity markers included: hospital death (63%) and ICU admission (20%). 65% had &gt; 1 intensity marker, 23% &gt; 2, and 22% &gt; 1 intense medical intervention. There was a bimodal association between age and intensity: the youngest patients (age &lt; 5) and adolescent patients (age 15-21) were more likely to receive intense care: &lt; 5y (intense medical intervention: OR = 1.42; 95% CI, 1.1-1.9; hospital death: OR = 1.72; 95% CI, 1.4-2.2; &gt; 2 markers: OR = 1.37, 95% CI 1.1-1.8); 15-21y (intense medical: OR = 1.48; 95% CI, 1.2-1.9; hospital death: OR = 1.39; 95% CI, 1.1-1.7; &gt; 2 markers: OR = 1.35, 1.1-1.7) (references: 5-9y). Other factors associated with intensity included, hematologic malignancies, minority status, and death between 2008 and 2011 vs. &lt; 2008. Conclusions: Nearly two-thirds of the pediatric cancer decedents had ≥1 marker of intense care and disparities exist. Patients &lt; 5 and adolescents were more likely to receive intense end-of-life care. Further research needs to determine if these rates and variation are consistent with patient goals and factors associated with goal concurrent care.
Feasibility of incorporating patient reported outcomes (PROs) into routine care for oropharyngeal carcinoma (OPC).
Authors: Shrujal S. Baxi, Jennifer R Cracchiolo, Snehal G. Patel, Sean Matthew McBride, Jocelyn Migliacci, Nancy Y. Lee, Rachel Kurtzman, David G. Pfister, Richard J. Wong
Journal: Journal of Clinical Oncology (2017)

e21652 Background: We assessed the feasibility of using PROs as part of routine care to better understand the trajectory in quality of life (QOL) following treatment of OPC. Methods: The Memorial Sloan Kettering Cancer Center (MSK) head and neck disease management team (DMT) assembled a parsimonious paper survey composed of validated PRO measures (EORTC QLQ 30 and HN-35, Neck Dissection Impairment Index, Skindex-16, and COST-FACT) to assess QOL at baseline, immediately and 3 months post treatment. From Jan-May 2016, a DMT PRO coordinator identified patients with non-metastatic OPC and notified clinical teams to print the surveys to be completed in the waiting room. We assessed the feasibility of incorporating PROs into routine care across the DMT using this process by examining response rates (RR) and identifying potential barriers (i.e., regional site of treatment, number of treatment modalities, hospitalizations, demographic variables) to completing PROs. Results: Of 54 patients with non-metastatic OPC, 3 non-English speakers and 5 protocol patients were excluded. Median age was 61.3 years (43.8-78.4). Patients were mostly male (89%), married (74%) and presented with locally-advanced OPC (89%) due to HPV (89%). 89% received multimodality therapy (89%), of which 36 (88%) received chemoradiation, and nearly half (48%) were treated at MSK regional sites. The RR decreased substantially over time (Table 1). 2 patients died* and 17 patients were hospitalized within these 3 months. In bivariate analyses, no prespecified demographic or clinical barriers to completion of PROs were identified. On deeper investigation, decline in RR overtime resulted from not capturing change in scheduling, which occurs more frequently after treatment completion. Conclusions: Implementation of longitudinal PROs into routine care is feasible and generally acceptable by the patients, but requires a coordinated effort to sustain an acceptable RR. For future efforts, the project coordinator will use a portal messaging system to communicate directly with patients and use an electronic PRO format. [Table: see text]
Hair loss associated with aromatase inhibitor treatment among breast cancer patients.
Authors: Lisa Gallicchio, Carla Calhoun, Kathy J. Helzlsouer
Journal: Journal of Clinical Oncology (2017)

e21619 Background: Hair loss and thinning have been reported by breast cancer patients treated with aromatase inhibitors (AIs); these side effects are documented to be reasons that patients discontinue their AI therapy and have been shown to be associated with a decrease in quality of life. Despite this knowledge, there is a paucity of detailed data on hair changes over the course of AI therapy. The purpose of this study was to examine hair changes and risk factors for hair loss among breast cancer patients initiating aromatase inhibitor therapy and followed for one year. Methods: Data were analyzed from a cohort of 146 breast cancer patients initiating AI therapy and followed over the first year of their AI treatment. At baseline (prior to AI therapy) and at 1-year, a questionnaire was administered that ascertained data on demographics, health behaviors, and symptoms. Detailed hair loss questions, including those pertaining to family history and specific location of hair loss, were added during the study period when study staff noticed that hair loss and thinning were commonly being reported on the symptom checklist after initiation of AI therapy. Multivariable logistic regression analysis was conducted to examine factors related to AI-attributed hair loss. Results: Among the 86 breast cancer patients who completed the detailed hair loss survey at 1-year (mean age = 63y), 43% reported experiencing hair loss after the initiation of AI therapy. The most frequently reported time period of onset of the AI-attributed hair loss was between 3 and 6 months post-AI initiation (43.2%), with 67.6% of patients noting hair loss in the mid-scalp (top of head). Factors significantly associated with AI-related hair loss at 1-year were: hair loss prior to AI therapy, having a BMI &gt; 30 kg/m 2 (odds ratio (OR) = 6.5), being a current smoker (OR = 7.8), and maternal history of hair loss or hair thinning (OR = 9.1). ORs were similar when patients with prior chemotherapy were excluded. Conclusions: Hair loss is a common side effect of AI therapy that can negatively affect a patient’s quality of life and potentially lead to treatment discontinuation. Treatment options for this AI-related side effect should be explored, especially for patients who are at increased risk.
Aerobic and strength training did not improve cognitive function in mild to moderate dementia
Authors: Sharon Straus, Jennifer Watt
Journal: Annals of Internal Medicine (2018)

Source Citation Lamb SE, Sheehan B, Atherton N, et al; DAPA Trial Investigators. Dementia and physical activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial. BMJ. 2018;361:k1675. 29769247
Cardiac toxicity with anti-HER2 therapy: Historical series over 10 years in an Oncology Reference Center.
Authors: Ana Luiza Mattos Da Silva, Alessandra Menezes Morelle
Journal: Journal of Clinical Oncology (2016)

e21561 Background: The identification of the HER2 receptor as a drug target was a landmark in the breast cancer treatment. Our objective is to describe a series of breast cancer-affected women treated with anti-HER2 therapy over 10 years, analyzing clinical characteristics and cancer-survival according to breast subtype. Methods: Retrospective analysis of all patients HER2 positive who were treated between 2005-2014 at Hospital Moinhos de Vento, Brazil. Clinical data were transferred from patient files into a database. Cardiotoxicity was considered when 10 percentage points or more from baseline to an LVEF of less than 50% at any time. Statistical analysis was done using SPSS 23. Results: 178 women were treated with anti-HER2 therapy (table 1). Of these 171 (96,1%) were treated, also, with chemotherapy and 91 (51,1%) with hormone therapy. Tumors ER, PR and HER2+ have diagnosis earlier (49,3 years) than other (p < 0,001); 168 (94,%) were treated with adjuvant anti-HER2 therapy. Of these, 22,4% presented cardiotoxicity and in 5 (3,4%) of these, the treatment was suspended; 12,9% and 6,2%, respectively, were treated with 1st line and 2nd line anti-HER2 therapy, and 26,1% presented cardiotoxicity. Conclusions: The cardiotoxicity of these unselected groups of patients reached a higher rate than we found in published literature. These results demonstrated the importance of a task force for a prospective study with a routinely evaluation of patients before and during anti-HER2 therapy in our center. Clinical characterization. Subtipos n (%) Clinical stage at diagnosis Average follow up (years) 5-years survival Deads I-IIa IIb-IIIc IV* N Age at diagnosis Clinical stage Average follow up (years) ER+PR+HER2+ 64 (36%) 38 (61,3%) 23 (37,1%) 1 (1,6%) 4,4 100% 1 (1,6%) 38 2a 5,2 HER2 82 (46,1%) 47 (58,8%) 31 (38,7%) 2 (2,5%) 5,0 93,2% 4 (5%) 52, 37 66, 91 2 = IIa; 1 = Ib; 1 = IV 2,9 ER+PR-HER+ 25 (14%) 18 (72%) 5 (20%) 2 (8%) 5,0 100% - - - - ER-PR+HER2+ 7 (3,9%) 5 (83,3%) 1 (16,7%) 0 4,8 100% - - - -
3D HDR intracavitary brachytherapy combined with complementary applicator-guided external beam radiotherapy for 338 patients with stage IIB-IIIB uterine cervical cancer: A single-center phase II prospective study with long-term follow-up.
Authors: Jin Yi Lang, Zixuan Fan, Peng Xu, Mei Feng, Weidong Wang
Journal: Journal of Clinical Oncology (2017)

5530 Background: For uterine cervical cancer (UCC) patients with asymmetric parametric lesions, 3D HDR-intracavitary brachytherapy (HDR-ICBT) could not cover all the lesions, resulting in residual lesion and treatment failure. To settle this problem, a novel treatment modal of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy (EBRT) was used for UCC patients with stage IIB-IIIB in present study. Methods: Between June 2010 and June 2015, 338 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics stage IIB-IIIB) were treated with concurrent chemoradiotherapy. Imaged guided IMRT was used for external beam radiotherapy, 45Gy/25f. The chemotherapy was weekly cisplatin (40mg/m2). Four fractions of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy were used. The prescribed dose for HR-CTV and IR-CTV was 7Gy (D90) and 5Gy (D90). Dose constraints for organs at risk were D2cc &lt;70 Gy for rectum, and D2cc&lt;90 Gy for bladder in terms of equivalent total dose in 2 Gy fractions as GEC-ESTRO recommendations. Results: Median follow-up was 64 months (11–71 months). The D 90 of GTV, HR-CTV, and IR-CTV in all cases were 93.4 (85.1-107.8) Gy, 86.4 (79.9-91.3) Gy and 72.3 (70.8-75.2) Gy, respectively. The D2 CC of bladder, rectum and sigmoid were 74.3Gy、65.5Gy and 64.1Gy, respectively. 5-year LRC, DFS, and OS was 90.8%, 84.1% and 80.8%, respectively. Treatment was well tolerated. The grade ≥3 genitourinary and gastrointestinal acute and late toxicities were 2.1% and 5.2%, respectively. Conclusions: The combination of HDR-ICBT with an applicator-guided IMRT is feasible for uterine cervical cancer patients with asymmetric parametric lesions. Further study is needed to determine whether this treatment modal could be used to replace the invasive interstitial brachytherapy (ISBT) in the cases of locally advanced cervical cancer where HR-CTV coverage cannot be obtained with ICBT.
Stereotactic body radiotherapy (SBRT) in recurrent or oligometastatic pancreatic cancer: Simultaneus intergrated protection (SIP) versus conventional SBRT A toxicity review of two different treatment approaches.
Authors: Eleni Gkika, Sonja Adebahr, Tanja Schimek-Jasch, Rolf Wiehle, Katja Zirlik, Uwe Wittel, Ursula Nestle, Anca Grosu, Thomas B. Brunner
Journal: Journal of Clinical Oncology (2016)

e15692 Background: SBRT in pancreatic cancer can be limited by its proximity to critical organs at risk (OAR) of the upper abdomen. In this study we evaluate the toxicity and efficacy of two different treatment approaches. Methods: Patients with recurrent or oligometastatic pancreatic cancer were treated with SBRT. According to the prescription method patients were divided in two cohorts 1 (C1) and 2 (C2). In both groups the planning target volume (PTV) was created through a 4 mm expansion of the internal target volume based on a four dimensional CT. In C2, we created additionally a sub-volume, a simultaneous integrated protection (SIP) PTV in order to reduce the risk of toxicity in critically OAR without reducing the dose to the rest of the PTV. The SIP consisted in the overlap of the PTV with the planning risk volume (PRV) of a specific vulnerable structure to which we prescribed a reduced dose within the specific constraints. Results: Eighteen patients with 23 lesions were included in this analysis. Seven patients were treated for local recurrence or progression, nine for oligometastases (liver, lymph nodes) and two patients were treated for both. Eleven lesions were treated without SIP (C1) and 12 with SIP (C2). The median follow up was 12.8 months. Median overall survival (OS) time for all patients was 11.2 (2.3-42.6) months. The OS rates at 6 and 12 months after SBRT were 87% and 58%, respectively. Freedom from local progression (FFLP) for both cohorts was 93% at 6 months and 67% at 12 months and was not statistically different between the two groups. One patient in C2 (5%) experienced grade 3 acute toxicities (mechanical ileus and gastrointestinal bleeding) during treatment and 1 patient in C1 (5%) experienced a grade 3 late toxicity (gastrointestinal bleeding). Conclusions: We here show outcome data using a novel prescription method for upper abdominal SBRT with a favorable overall toxicity profile . Local control and overall survival after SBRT in this high risk group of patients were good despite of dose sacrifices in small subvolumes in half of the patients where OARs were adjacent to the PTV.
Patterns of care and outcomes for glioblastoma in patients with poor performance status.
Authors: Nikita Malakhov, Anna Lee, Elizabeth Garay, Daniel Jacob Becker, David Schreiber
Journal: Journal of Clinical Oncology (2018)

e14093 Background: Glioblastoma (GBM) is the most common and aggressive primary CNS tumor with dismal survival outcomes. The treatment with tumor resection followed by chemoradiation is generally the accepted standard of care for GBM, however the treatment for patients with poor performance status remains uncertain. Therefore we sought to examine patterns of care and survival outcomes among patients with poor performance status utilizing a large hospital database. Methods: We queried the National Cancer Database for patients with GBM and Karnofsky Performance Status (KPS) < 60 between 2010-2013. Data was collected regarding surgery, radiation therapy and chemotherapy. Logistic regression was used to analyze predictors for utilization of chemoradiation (age, race, surgery, facility type, year of diagnosis, and MGMT status). Kaplan-Meier survival curves were generated and compared using the log-rank test between those who received chemoradiation to radiation alone. Cox regression analysis was performed to assess covariates associated with survival. Results: There were 488 patients included in the analysis of which 51.2% received chemoradiation and 46.1% underwent subtotal or gross total resection. None of the factors analyzed were significantly associated with increased likelihood of receiving chemoradiation over radiation alone. Survival data was available for 236 patients that received radiation therapy with and without combination chemotherapy. The median overall survival for those receiving radiation alone was 3.6 months and 8.7 months in those who received chemoradiation (p < 0.001). On multivariable Cox regression, older age (HR 1.80-2.10, p = 0.001) was associated with worse survival and subtotal/gross total resection compared to no surgery (HR 0.60, p = 0.003) was associated with improved survival. Conclusions: Even patients with poor performance status had better survival outcomes when they received treatment with chemoradiation over radiation alone. Therefore, treatment with chemoradiation could be an acceptable treatment option and should be considered for select patients with low performance status.
A phase II study of pre- and post-operative gemcitabine and erlotinib plus pancreaticoduodenectomy (PD) for patients with resectable pancreatic ductal adenocarcinoma (PDAC): ACOSOG Z5041 trial (Alliance).
Authors: Alice Chia-chi Wei, Fang-Shu Ou, Qian Shi, Eileen Mary O'Reilly, Jeffrey A. Meyerhardt, Robert A. Wolff, Hedy L. Kindler, Douglas B. Evans, Vikram Deshpande, Joseph Misdraji, Eric P. Tamm, Dushyant Sahani, Malcolm J. Moore, Elliot Newman, Nipun B. Merchant, Jordan Berlin, Laura Williams Goff, Peter W. T. Pisters, Mitchell C. Posner
Journal: Journal of Clinical Oncology (2018)

4112 Background: For resectable PDAC (without vascular involvement) postoperative adjuvant therapy remains the standard, though there is considerable interest in a neoadjuvant approach. This study evaluates overall survival (OS) with perioperative gemcitabine + erlotinib (G+E) combined with PD for resectable PDAC. Methods: ACOSOG Z5041 was a prospective, multicenter, single-arm phase II trial of pre- and postoperative G+E for resectable PDAC. Key eligibility requirements were localized biopsy-confirmed PDAC in the pancreatic head, resectable without evidence of tumor involvement of major mesenteric vessels. Patients (pts) received standard G+E (100 mg days 1-43) prior to and following surgery. The primary endpoint was 2-year overall survival (OS); secondary endpoints included toxicity profile, response rate, resection rate and time to progression. The study was closed early due to slow accrual; no formal hypothesis testing was performed. Results: 116 meeting eligibility requirements were enrolled; 114 who initiated treatment were evaluable. By central radiologic review, 97 pts met protocol resectability criteria, 17 pts were beyond. Median age was 66 years (39-88); 55 females (48%). Grade 3+ toxicity was reported in 68 (60%) and 90 (79%) pts during the neoadjuvant phase and overall. 22 (19%) pts did not proceed to surgery. 92 (81%) pts had surgery; 83 (73%) were resected with PD, 9 (8%) were unresectable. R0 and R1 margins were 67 (81%) and 15 (18%) of resected pts, respectively. 54 received postoperative G+E (65% resected, 47% evaluable). 2-year OS for evaluable pts was 40% (95%CI 31-49%) with median OS 21.3 (95%CI 17-26) months. 2-year OS for resected pts was 52% (95%CI 37-59%) with median OS 25.4 (95%CI 22-30) months. Conclusions: For resectable PDAC, neoadjuvant therapy provides 2-year OS similar to pts able to receive standard adjuvant therapy. Importantly, futile PD was avoided in 27% pts. Further evaluation of neoadjuvant therapy in resectable PDAC is warranted as more active chemotherapy regimens emerge. Support: U10CA180821, U10CA180882; Clinical trial information: NCT00733746.
Prognosis of patients with parameningeal rhabdomyosarcoma (PM-RMS): The long term results of five consecutive CWS studies 1981-2009.
Authors: Ewa Koscielniak, Simone Feuchtgruber, Monika Sparber-Sauer, Monika Scheer, Marc W. Muenter, Gustaf Ljungman, Bernarda Kazanowska, Ivo Leuschner, Stefan S. Bielack, Thomas Klingebiel
Journal: Journal of Clinical Oncology (2016)

10529 Background: PM sites (nasopharynx/nasal cavity, the middle ear, the paranasal sinuses, and the infratemporal fossa/pterygopalatine space) are considered as unfavorable factor in RMS. Due to their proximity to skull base they have high risk of meningeal impingement, including cranial nerve palsy (CNP), cranial base bony erosion (CBBE) and intracranial extension (ICE). Our goal was to compare treatment strategies and outcome of patients with localized PM RMS enrolled on five consecutive CWS studies -81 -86, -91, -96 and -2002P. Methods: A total of 404 patients were included. All patients received intensive chemotherapy (3 to 6 drugs: alkylating agents - cyclophosphamide or ifosfamide, actinomycin D, doxorubicin, vincristine, carboplatin and etoposide. Radiotherapy was indicated for all patients except for children < 1 year of age. Irradiation (RT) dose was stratified depending on meningeal involvement, response, histological subtype and age and varied between the studies (32 - 54,4 Gy). Accelarated hyperfractionation was recommended since CWS-86. Proton radiation was recommended if available. Results: The majority of tumors were classified into IRS Group III (95%) and had embryonal type (78%). 85% achieved complete remission, 22 % relapsed, 15% local. The 5yrs event free survival (EFS) and overall survival (OS) was 61% and 65%. 5yrs EFS by study was CWS-81: 42%, CWS-86: 63%, CWS-91: 63%, CWS-96: 62%, CWS 2002P: 66%. Patients with ICE had worst outcome but no difference was seen depending on CNP and CBBE. 92% of patients were irradiated. The median time from initiation of chemotherapy to RT was 14 weeks (range 2-30). 5yrs EFS depending on RT start ( < 10 weeks, > 10 < 20 weeks, > 20 < 30 weeks) did not differ (65%, 67%, 68%). Three patients groups depending on their RT dose: 32-36 Gy, 44-49 Gy, 50-55 Gy showed similar outcome (5yrs EFS 70% vs.68% vs. 67% respectively). Only patients irradiated with > 57 Gy or without RT had significantly worse outcome (5yrs EFS 30%). Conclusions: The outcome has improved between CWS-81 and CWS-86 only. No benefit of very early ( < 10 weeks) or higher irradiation doses was seen.