tbuckley/cabot-search huggingface dataset:
Increased length of stay and cost of hospitalization in patients receiving inpatient radiation therapy.
Authors: Shirin Attarian, Elham Azimi-Nekoo, Justin Tang, Janaki Neela Sharma, Rafi Kabarriti, Adam Binder
Journal: Journal of Clinical Oncology (2018)

e18936 Background: Determining length of stay (LOS) and the attributable costs for hospital admissions are of critical importance for patients (Pts), providers, payers, and hospital management. Increased LOS can sometimes be due difficulties in coordinating a safe and timely discharge plan. The goal of the present study was to evaluate oncology Pts receiving inpatient radiation therapy (RT) to determine the extra days of hospitalization without an acute medical reason and the associated cost. Methods: A single-center, retrospective, observational study was performed. Pts who received an inpatient radiation oncology consultation between 1/1/2017 and 6/30/2017 were screened. 198 inpatient episodes were reviewed. Pts with prolonged hospitalization despite being medically cleared for discharge were included. Extra hospitalization days, costs and contributing factors were assessed. Results: Of the 198 Pts reviewed, 38 were included in our study. Average age was 64.42 years (range 30-98) and 53% were men. The most common cancer types were lung (n = 11), prostate (n = 4), and cancer of unknown origin (n = 4). Fourteen Pts were newly diagnosed and 29 had metastatic disease. The most common sites of RT were brain (n = 14) and spine (n = 6). The most common reason for RT were pain (n = 16) and brain metastasis (n = 14). RT was with curative intent in 5 Pts. Delays in Pt discharge led to an average increase LOS of 10 days (range 1-33, SD = 8.2) and overall cost of $805,220 (Mean = $21,190 per pt). There was no association between age, sex, BMI, or ECOG performance status and cost. Linear regression models showed an association between new cancer diagnosis and LOS independent of age and sex (p = 0.015). Hospital stay without medical reason was most commonly due to transport issues, lack of accepting facility or Pt preference. Conclusions: Increased LOS in cancer Pts receiving inpatient RT is associated with significant hospital costs. Pts with new cancer diagnosis are particularly at risk for increase in LOS. This information can be used to develop interventions aimed at facilitating discharge of pts receiving RT. Interventions to facilitate transitioning to outpatient RT may result in decreased costs, increased revenue, and improved Pt care.
Doing better with less: Can a quality improvement intervention to increase adherence to evidence-based cancer screening guidelines reduce health care costs?
Authors: Vineeth Sukrithan, Alejandro Recio Boiles, Jose Nahun Galeas, Karenza Alexis, Tarek N. Elrafei, Marianna Strakhan
Journal: Journal of Clinical Oncology (2016)

6590 Background: The cost of cancer care in the U.S. is projected to reach $158 billion by 2020. The ASCO Value in Cancer Care Task Force recently released a framework assessing the value of new cancer therapies based on benefits, toxicities, and costs. Reducing under and over-screening can improve the quality of cancer care while also reducing costs. Multiple studies have shown that adherence to U.S. Preventative Services Task Force (USPSTF) screening guidelines remains sub-optimal. We tested whether distributing a low-cost educational tool consisting of a Health Maintenance (HM) card among house staff of a large teaching hospital would impact adherence to updated cancer screening guidelines. We also calculated the potential impact on health care expenditure from this intervention. Methods: In January 2013, HM cards with USPSTF recommendations were posted in each Ambulatory Medicine clinic exam room. We assessed the adherence to screening guidelines by comparing a historical control of clinic visits from December 2012 (n = 336) to those from December 2013; a year after the intervention (n = 306). In order to calculate charges associated with screening procedures, Center for Medicare and Medicaid Services’ Physician Fee Schedule was used. Results: Adherence to USPSTF guidelines showed a significant increase of 40.8% (p < 0.01) for cervical, 33.2% (p < 0.01) for breast and 20.5% (p < 0.01) for colorectal cancer screening. Inappropriate screening actions were reduced by 26.8% (p < 0.01) for cervical and 32.8% (p < 0.01) for breast cancer. A non-significant 1.1% increase (p = 0.829) was observed for colorectal cancer. Based on the number of inappropriate screening procedures averted, we calculated annualized potential savings to the healthcare system amounting to $1,138,464 (95% CI; $680,640 - $1,597,140). Conclusions: The low-cost HM card increased appropriate cancer screening while reducing unnecessary testing and producing substantial savings to the healthcare system in a large urban cohort. In an era of expensive personalized cancer care, low cost-interventions to improve the quality of care delivery may help mitigate the burden on the health care system.
Characteristics and clinical outcomes of French patients diagnosed with advanced soft tissue sarcoma (aSTS) in real-life setting: Data from the European sarcoma biological and clinical data banking (ESBCB).
Authors: Jean-Yves Blay, Axel Le Cesne, Florence Duffaud, Nicolas Penel, Simone Mathoulin-Pélissier, Francoise Ducimetiere, Yulia D'yachkova, Florence Chartier, Hisham Rassam, Pauline Cloitre
Journal: Journal of Clinical Oncology (2018)

11548 Background: This study describes clinical characteristics of a large cohort of aSTS patients (pts) and effectiveness of chemotherapy (CT) based on real world data. Methods: Multicenter retrospective cohort analysis using data from the French centers of the ESBCB (Conticabase.org) with an extraction in 2017. This study included adult pts with a diagnosis of sarcoma (WHO2013) between 2010 and 2013 in soft tissue or viscera, excluding GIST and Kaposi’s sarcoma. Results: 2747 pts were included with a diagnosis of STS. 34.6 % of them had an aSTS and were described in this study. Among them were 608 with secondary (metachronous) metastasis, 299 metastatic at diagnosis (synchronous) and 61 pts with locally aSTS, not amendable to surgery. The mean age at diagnosis was 59.3 years (+/- SD 16.9), 52.3% of pts were female and 21.2% had cancer of viscera. Most frequent sarcoma subtypes were undifferentiated sarcoma (24.9 %), leiomyosarcoma (23.8%) and miscellaneous sarcoma (14.7%). Sarcoma were grade 1 for 4.4%, 2 for 27.3% and 3 for 55.0 %, missing for 13.3%. Surgery for primary tumor was more frequent in the metachronous metastasis group than in the synchronous metastatic one (89.6% vs 41.5% respectively). At least one line of CT was administered to 56.9% and 61.2% pts with synchronous and metachronous metastasis, respectively. Anthracyclin-containing CT regimen were delivered in 63.6% of pts treated by first-line chemotherapy. Responses rates to first line chemotherapy were 30.6 % for pts with synchronous metastasis and 19.1 % for those with metachronous metastasis. For the entire aSTS population, the median overall survival was 1.45 years (95% CI : [1.23; 1.63]). The rates of overall survival (OS) at 3 years were 35.7% [22.2%; 49.3%] for pts with locally advanced disease, 29.4% [23.8%; 35.2%] for the pts with metachronous metastasis and 21.1 % [15.2%; 27.7%] for pts with synchronous metastasis. Conclusions: In this large nationwide database, therapeutic strategies and OS differed across groups of cancer diagnosis dates. These data are useful to provide real world treatment patterns and outcomes in a hard to study disease.
Long-term outcomes after induction chemotherapy with docetaxel, cisplatin and 5-FU (TPF) followed by concurrent chemoradiotherapy for locally advanced nasopharyngeal cancer.
Authors: Sang-Hee Cho, Hyun-Jeong Shim, Jun-Eul Hwang, Woo Kyun Bae, Ik-Joo Chung
Journal: Journal of Clinical Oncology (2018)

e18008 Background: Although the acute toxicities during induction TPF are well known, little is studied about the long term outcomes including complications. The purpose of this study is to evaluate the survival and long term complications in NPC patients treated with induction TPF followed by CCRT. Methods: From May 2004 to December 2016, 244 patients diagnosed as NPC and 101 patients who completed the 3 cycles of TPF followed by CCRT were evaluated. During radiotherapy, cisplatin was given at a dose of 40 mg/m2/wk or 100 mg/m2 per 3 weeks (Clcr adjusted) and radiotherapy (65–70 Gy) was starting 4–6 wks after the third cycle of IC. After completing IC and CCRT, follow up imaging and regular physical examination for ENT by specialist were checked. Results: The median follow-up duration was 60 months (range, 7-135). Fiver year-OS rate and 3Y-PFS rate were 88.9±3.7% (95%CI 81.65-96.15) and 80.4±4.5 (95%CI 71.58-89.22). PFS was significantly associated with TNM (p= 0.001), especially N stage (N3, 3Y-PFS 42.9%, p= 0.001). ENT complications such as hearing impairment, chronic infection, ear drum perforation were shown in 27 patients (26.7%) and these were significantly higher in elderly ( > 65 years, p = 0.004), advanced T stage (p = 0.022). Renal impairment was developed in 19 patients (18.8%) showing a tendency related to age (p = 0.084). Both ENT and renal toxicities were not associated with the dose of radiation or cumulative cisplatin (Table). Conclusions: TPF followed by CCRT is an effective treatment scheme for locally advanced NPC. However, long term complications in ENT were considerable in elderly, advanced T stage. Therefore, the close follow up and management for these complications should be performed. Also optimal treatment approach for elderly patients is needed to prevent acute as well as chronic complications. < 65 years ≥ 65years P Cumulative RT dose (cGy) 6484 6148 0.143 Cumulative cisplatin (mg/m2) (during radiation) 187 136 0.005 CR after IC (%) 21.7 22.2 0.589 CR after completing CCRT (%) 80.4 93.1 0.157 PFS (mean, months) 58.4 40.7 0.056 OS (median, months) 61.9 42.72 0.034 ENT complication (%) 20.5 55.6 0.004 Renal impairment (%) 15.7 33.3 0.084
CEA, CA15.3 and 18-FDG PET in the follow-up of early breast cancer (BC) patients (pts): A prospective, multicentric, randomized trial—KRONOS patient-oriented new surveillance study Italy.
Authors: Claudio Zamagni, Massimo Gion, Luigi Mariani, Petra Stieber, Daniela Rubino, Stefano Fanti, Richard P. Baum, Ralph M Wirtz, Rossella Hakim, Alessandra Bernardi, Nicoletta Cacciari, Sara Quercia, Angela Fini, Manuela Lenzi, Cinzia Pizzirani, Maria Pagliaro, Sara Tomasini, Sonia Toracchio, Marianna Carapelle, Elena Barbieri
Journal: Journal of Clinical Oncology (2017)

TPS11627 Background: Current recommendations for breast cancer (BC) surveillance in asymptomatic patients (pts) include only mammography and physical examination and arise from two trials conducted in the 80’s. Since then new findings about BC biology, treatment and the introduction of cutting-edge diagnostic technologies such as 18-FDG PET have deeply modified our clinical scenarios. The aim of this prospective randomized trial is to verify if the serial measurement of CEA and CA15-3 followed by 18-FDG PET can anticipate the diagnosis of BC recurrence compared to control arm by estimation of the difference of restricted mean survival time (RMST) between the two arms. If the end-point will be met a subsequent extension trial will investigate the impact of the earlier diagnosis of distant metastases on survival. Methods: Pts diagnosed with stage I-III BC, who underwent adequate surgery are eligible. Special histologies and low-risk cases according to St. Gallen criteria are excluded. The study includes pts at the beginning of the follow-up after the conclusion of primary treatment (cohort 1), and pts that have concluded without relapse the first 5 years of follow-up (cohort 2). Eligible pts will be randomized in a 1:1 ratio to follow-up according to local practice (control arm) or to three-monthly serial dosing of CEA and CA15-3 and subsequent 18 FDG-PET only in case of an increase of CEA and/or CA 15.3 greater than a critical difference compared to baseline (experimental arm). The following stratification factors will be used: node negative vs positive, HER2 negative vs positive, ER positive vs negative. Eight-hundred pts will be enrolled over 3 years. For such a calculation, we made the assumption of a 20% baseline 5-year incidence of relapse. The target reduction of three months in RMST implies a median time of diagnostic anticipation, conditional on having BC recurrence, of 10 months. The follow-up will continue until 10 years from surgery. Since 23 rd October 2014 573 pts have been enrolled. The present trial was approved by the Ethical Committee of each participating centre and is registered on Clinical trial information: NCT02261389.
An investigator-initiated phase I study of crizotinib in combination with enzalutamide in metastatic castration-resistant prostate cancer (mCRPC) before or after progression on docetaxel.
Authors: Lauren Christine Harshman, Kathryn P. Gray, Laura Polacek, Mary-Ellen Taplin, Atish Dipankar Choudhury, Mark M Pomerantz, Joaquim Bellmunt, Channing Yu, Zijie Sun, Sandy Srinivas, Philip W. Kantoff, Christopher Sweeney
Journal: Journal of Clinical Oncology (2016)

e16509 Background: Inhibition of the androgen receptor (AR) may de-repress c-Met, which could play a role in progression to CRPC, metastasis, and therapeutic resistance. Preclinical work has shown that crizotinib (crizo), a multi-kinase inhibitor including c-Met receptor tyrosine kinase, ROS1, and anaplastic lymphoma kinase, can inhibit prostate cancer growth in cell lines and mouse models. To capitalize on the established efficacy of enzalutamide (enza) in mCRPC while counteracting induction of c-Met due to AR inhibition, we investigated the combination of crizo plus enza. Methods: A phase 1, standard 3+3 dose-escalation design was executed to assess the safety, tolerability, and pharmacokinetics of the combination in patients with mCRPC. The primary objective was to identify the maximally tolerated dose (MTD). A fixed standard dose of enza 160 mg daily plus escalating doses of crizo (250 mg daily, 200 mg bid, 250 mg bid) were administered in Cohorts 1, 2 and 3, respectively. The dose limiting toxicity (DLT) period was the first cycle (28 days). Results: The dose escalation phase has completed. 16 men with ECOG PS 0 or 1 were enrolled. Median age was 69.5 years. Median baseline PSA was 18.9 ng/dL (range: 0.91-822.2). Visceral disease was present in 31%. The majority (56%) had prior docetaxel. The MTD was full doses of both agents. Cohorts 2 and 3 each had 1 of 6 patients with a grade 3 DLT of transaminitis. The most common, all grade treatment-related AEs were: elevated ALT (10), fatigue (9), elevated AST (9), nausea (6), hypertension (5), diarrhea (4), vomiting (4), constipation (3), edema (2), and dysgeusia (2). Most AEs were grade 1 or 2. There were 6 grade 3-4, at least possibly treatment-related adverse events (AEs): increased ALT (2), hypertension (1), cardiac (3 AEs in same event: cardiac arrest, Vfib, prolonged QTC). All transaminase elevations occurred in the same 4 patients. The dose expansion phase is ongoing at the MTD. Conclusions: Full doses of crizotinib and enzalutamide can be combined in mCRPC. The potential for hepatotoxicity exists with both agents but dose limiting toxicity is low. (NCT number: 02207504) Clinical trial information: 02207504.
TCT-582 Network meta-analysis of diagnostic test accuracy studies on non-invasive imaging for coronary artery disease: evidence on 13 isolated or hybrid tests, 661 studies, and 97,173 patients
Authors: Giuseppe Biondi-Zoccai, Giacomo Frati, Sebastiano Sciarretta, Valentina Valenti, Mariangela Peruzzi, Arturo Giordano
Journal: Journal of the American College of Cardiology (2018)
Self-reported functional assessment by patients receiving different prostate cancer strategies: Five-year results from the VICAN large prospective cohort.
Authors: G Raldine Pignot, Rajae Touzani, Anne Deborah Bouhnik, Patricia Marino, Jochen Walz, Stanislas Rybikowski, Naji Salem, Slimane Dermeche, Gwenaelle Gravis, Marc Karim Bendiane
Journal: Journal of Clinical Oncology (2018)

10077 Background: Several treatment options are available for prostate cancer (PC) with different functional side effects. The aim of our study was to assess the long-term consequences of the therapeutic strategies on continence, sexual function and quality of life (QOL) for men with a diagnosis of PC from the 5-year VICAN survey. Methods: The VICAN survey consisted in a French representative sample of 4174 5-years cancer survivors. Self-reported data were collected through telephone interviews. The questionnaire aimed to document the living conditions and quality-of-life (using the SF-12 questionnaire) of cancer survivors, including treatments’ side-effects. Results: 447 out of 4174 survivors had PC, median age 71 [57-86] years. Strategies included: radical prostatectomy alone (RP) (42.8%) or with salvage radiotherapy (RP+RT) (7.5%), radiotherapy alone (RT) (17.5%) or in association with hormonal therapy (RT+HT) (11.6%), surveillance (17.4%), and hormonotherapy alone (HT) (3.2%). A total of 51.5% of patients had urinary leakage (sometimes 36.2%, often 12.3%, or very often 3.0%), with a significant impact on physical and mental QOL, and perceived discrimination (p = 0.049, p = 0.020, and p = 0.025, respectively). Patients treated with RP had significantly more urinary leakage than other strategies (59.0% versus 36.6% for RT, and 47.3% for RT+HT, p = 0.026). Among 380 pts assessable for sexual function, 56.0% reported dysfunction, with a significant difference to the detriment of RP+RT (74.1% versus 63.5% for RP, 48.6% for RT, 58.2% for RT+HT, 43.4% for HT and 37.8% for surveillance, p = 0.004). More significant decrease in the number of sexual intercourse (70.6%) and libido (74.6%) were reported in case of HT (p = 0.035), with a significant impact on depressive symptoms, physical and mental QOL (p = 0.002, p < 0.001, and p = 0.002). Conclusions: Self-assessed functional outcomes 5 years after PC diagnosis remain poor, specifically for continence after RP and sexual dysfunction after HT, with a significant impact on QOL. Implementation of new long-term management strategies for these patients is required to improve their urinary, sexual function and QOL.
The challenge of pediatric oncology: New business models to accelerate innovation.
Authors: Sonya Das, Raphael F. Rousseau, Peter C. Adamson, Andrew W Lo
Journal: Journal of Clinical Oncology (2018)

10528 Background: Few patient populations are as helpless and in need of advocacy as pediatric cancer patients. Pharmaceutical companies have historically faced significant financial disincentives to pursue pediatric oncology therapeutics, including low incidence, high costs of conducting pediatric trials, and a lack of funding for early-stage research. One way to accelerate innovation in this field is the formation of a collaborative business model involving private, public, and philanthropic stakeholders. We explore this idea by simulating the financial returns of a hypothetical collection of pediatric cancer drug projects under several different business structures. Methods: Using published studies of pediatric oncology research and the cost of drug development, and existing clinical trials of pediatric oncology therapeutics at clinicaltrials.gov, we identified 77 potential drug development projects to be included in a hypothetical portfolio. The returns of this portfolio were simulated so as to compute the financial returns and risk. Simulated business strategies include combining projects at different clinical phases of development, obtaining partial funding from philanthropic grants, and obtaining government guarantees to reduce risk. Results: The purely private-sector portfolio exhibited expected returns ranging from -34.2% to 0.0%, depending on the model parameters assumed. This suggests significant financial disincentives for pursuing pediatric oncology therapeutics and implies that financial support from the public and philanthropic sectors is essential. Phase diversification increases the likelihood of a successful drug, and yielded expected returns of -17.8% to 36.4%. Standard philanthropic grants had a marginal impact on expected returns. Government guarantees were more effective by reducing downside exposure, with returns ranging from -9.5% to 12.8%. Conclusions: A combination of financial and business strategies has the potential to maximize expected return while eliminating some downside risk—in certain cases enabling expected returns upwards of 36.4%—which can overcome current financial disincentives and accelerate the development of pediatric oncology therapeutics.
Accuracy of the Pediatric End-stage Liver Disease Score in Estimating Pretransplant Mortality Among Pediatric Liver Transplant Candidates
Authors: Chung-Chou H. Chang, Cindy L. Bryce, Benjamin L. Shneider, Jonathan G. Yabes, Yi Ren, Gabriel L. Zenarosa, Heather Tomko, Drew M. Donnell, Robert H. Squires, Mark S. Roberts
Journal: JAMA Pediatrics (2018)

<h3>Importance</h3> Fair allocation of livers between pediatric and adult recipients is critically dependent on the accuracy of mortality estimates afforded by the Pediatric End-stage Liver Disease (PELD) and Model for End-stage Liver Disease, respectively. Widespread reliance on exceptions for pediatric recipients suggests that the 2 systems may not be comparable. <h3>Objective</h3> To evaluate the accuracy of the PELD score in estimating 90-day pretransplant mortality among pediatric patients on the United Network for Organ Sharing (UNOS) waiting list. <h3>Design, Setting, and Participants</h3> Patients who were listed from February 27, 2002, to March 31, 2014, for primary liver transplant were included in this retrospective analysis and were followed up for at least 2 years through June 17, 2016. The study analyzed 2 cohorts using the UNOS Standard Transplant Analysis and Research data files. The full cohort comprised 4298 patients (&lt;18 years of age) who had chronic liver disease (excluding cancer). The reduced cohort (n = 2421) excluded patients receiving living donor transplantation or PELD exception points. <h3>Main Outcomes and Measures</h3> Observed and expected 90-day pretransplant mortality rates evaluated at 10-point interval PELD levels. <h3>Results</h3> Among the 4298 patients in the full cohort (mean [SD] age, 2.5 [4.2] years; 2251 [52.4%] female; 2201 [51.2%] white), PELD scores and mortality were concordant (C statistic, 0.8387 [95% CI, 0.8191-0.8584] for the full cohort and 0.8123 [95% CI, 0.7919-0.8327] for the reduced cohort). However, the estimated 90-day mortality using the PELD score underestimated the actual probability of death by as much as 17%. <h3>Conclusions and Relevance</h3> With use of the PELD score, the ranking of risk among children was preserved, but direct comparisons between adult and pediatric candidates were not accurate. Children with chronic liver disease who are in need of transplant may be at a disadvantage compared with adults in a similar situation.