tbuckley/cabot-search huggingface dataset:
Health care utilization among long-term cancer survivors.
Authors: Emily Jo Rajotte, Leslie Heron, Karen Leslie Syrjala, Kevin Scott Baker
Journal: Journal of Clinical Oncology (2016)

22 Background: Survivors of adult cancer face lifetime health risks that are dependent on their cancer, cancer treatment exposures, comorbid health conditions, and lifestyle behaviors. A shared care model, including planned and formal transition of the cancer survivor from the oncologist to the primary care physician needs to be established to ensure appropriate care. Methods: As a LIVESTRONG Survivorship Center of Excellence Network member, the Survivorship Program at the Fred Hutchinson Cancer Research Center has established an outpatient clinic at the Seattle Cancer Care Alliance to meet the clinical needs of cancer survivors. Before their survivorship-focused clinic appointment, adult cancer survivors are asked to complete a comprehensive survey that includes questions on health care utilization. Results: Between August 2013 to December 2014, 142 clinic patients completed the survey. They were 70.4% female, mean age 48 years (SD 16.3, range 22-83) and 21.1% breast cancer, 30.2% leukemia/lymphoma, and 17.6% reproductive cancer survivors. Patients were a mean of 7.8 years (SD 9.5, range 0-43) from their cancer diagnosis at the time of clinic appointment. 70.4% reported receiving oncology care and 87.3% primary care within the 12 months before their survivorship visit. Forty percent reported more than 12 clinic visits in the past year in which they saw a physician, nurse practitioner or physician assistant compared with 6.5 clinic visits in the general population based on CDC, National Health Care Survey reference data. 41.5% had one or more visits to a hospital emergency or urgent care facility within the last year, compared with 39.4% in the CDC NHCS survey. Conclusions: Cancer survivors seen in a Survivorship Clinic utilize healthcare at a much higher rate than the general population. A shared-care model for cancer survivors, including a delineation of roles and specific points of communication, between the oncologist and the primary care physician may help address issues surrounding over-utilization. A cancer treatment summary and a survivorship care plan may be valuable tools to facilitate this shared care approach.
Open versus minimally invasive management of gastric GIST: An international multi-institutional analysis of short- and long-term outcomes.
Authors: Danielle Anna Bischof, Yuhree Kim, Dan G. Blazer, Shishir Kumar Maithel, T. Clark Gamblin, Todd W. Bauer, Paul Jack Karanicolas, Calvin Law, Fayez A. Quereshy, Timothy M. Pawlik
Journal: Journal of Clinical Oncology (2014)

85 Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the GI tract. Overall surgical experience with minimally invasive surgery (MIS) has increased, however, published reports on MIS resection of GIST are currently limited to small, single institution experiences. Methods: 397 patients who underwent surgical resection of a gastric GIST between 1998 and 2012 were identified from an international, multi-center database. The impact of the MIS approach on recurrence and survival was analyzed by the use of propensity-score matching by comparing clinicopathologic factors between patients who underwent open vs MIS resection. Results: Median patient age was 65 years and 50% were female. Median tumor size was 4.3cm (IQR 3.0-7.6cm). A minority of patients received neoadjuvant therapy (6%). Overall, 186 (47%) patients had a MIS approach: laparoscopic (89%), laparoscopic hand assist (4%), combined laparo-endoscopic (3%) and robotic (4%). There were 19 (10%) conversions to open; the most common reasons for conversion were tumor more extensive than anticipated (26%) and unclear anatomy (16%). Patients who underwent MIS resections had smaller tumors (MIS: 3.5cm vs open: 5.8cm; p&lt;0.01). MIS resections were associated with minimal blood loss (MIS: 50 cc vs open: 225 cc) and shorter operative time (MIS: 160 min vs open: 201 min) (both p&lt;0.01). There was no difference in rates of tumor rupture (MIS: 1.1% vs open: 0.9%; p=0.81). An R0 resection was achieved in the majority of patients (MIS: 98% vs open: 92%; p=0.07). MIS patients had a lower incidence of grade 3 or 4 complications (MIS: 3% vs open: 10%; p=0.01) and a shorter length of stay (MIS: 3d vs open: 8d; p&lt;0.01). After propensity score matching for age, sex, tumor size, mitotic rate and tumor rupture, there was no difference in risk of recurrence or overall survival for the MIS treated group vs. the open group (HR 0.65 &amp; HR 0.76, respectively; both p&gt;0.05). Conclusions: An MIS approach for gastric GIST is associated with a low incidence of complications and a comparable R0 resection rate. The long-term oncological outcome following MIS is excellent and therefore the MIS approach should be considered preferable.
Weekly bolus 5-fluorouracil and bevacizumab in the palliative treatment of metastatic colorectal cancer.
Authors: Michelle Jane Cook, Carole Connor, Mohammed Mojid Khan, Peter Denzil Correa
Journal: Journal of Clinical Oncology (2016)

736 Background: Patients with metastatic colorectal cancer (mCRC) are often elderly with multiple co-morbidities making them poor candidates for combination chemotherapy. Evidence suggests significant benefit from the addition of Bevacizumab (Bev) to single agent fluoropyrimidine chemotherapy in the palliative treatment of mCRC. There is no current trial data to support use of weekly bolus 5-fluorouracil (5-FU) chemotherapy combined with Bev. We present details of our experience with this treatment regimen. Methods: Patients with mCRC treated with weekly bolus 5-FU 370 mg/m 2 and Bev 5mg/kg every 2 weeks (Weekly-5FU-Bev) as a new line of palliative treatment were reviewed. All were deemed unsuitable for Capecitabine. Data were collected retrospectively from patient records. Survival statistics were calculated from date of treatment initiation using Kaplan-Meier methods. Results: From 2012-2015, 21 patients were treated with Weekly-5FU-Bev. Median age was 80 years (range 56-90 years), 57.1% were performance status (PS) 0, 19% PS 1 and 23.8% PS 2. 61.9% patients were Ras wild-type. Median treatment duration to date is 20 weeks (range 4-117 weeks). Treatment was stopped in 8 due to progressive disease, 1 due to toxicity and 4 for other reasons. Treatment was generally well tolerated with significant fatigue the most commonly reported side effect in 24%. 3 patients experienced venous thrombo-embolic events, 1 developed uncontrolled hypertension and 1 suffered a non-fatal tumour perforation. There were no treatment related deaths. Clinical benefit rate determined by best response to treatment was impressive at 66.7% with 1 complete response, 1 partial response, 1 biochemical response (non-measurable disease) and 12 patients with stable disease. Median progression free survival was 9.3 months (95% CI 2.8-15.8 months). Median overall survival has not been reached with 15 patients still alive. Conclusions: Acknowledging the limitations of this retrospective analysis of a carefully selected patient group, Weekly-5FU-Bev appears to be well tolerated and efficacious in the treatment of elderly patients with mCRC and can be considered an option in patients unsuitable for or intolerant of Capecitabine.
Be “less precious” about training, royal colleges are told
Authors: Gareth Iacobucci
Journal: BMJ (2017)

Medical royal colleges must be “less precious” about the content of their training programmes in order to deliver the workforce competencies and skills needed to transform local health and care services, the chair of Health Education England has said.

Keith Pearson said that plans to integrate the planning and delivery of health and social care across England would only succeed if the whole medical workforce was equipped with “a suite of skills” that transcended individual specialties.

Speaking at an event hosted by the King’s Fund to discuss how to make the 44 sustainability and transformation plans (STPs) across England a success, Pearson warned colleges that delivering the STPs “may not fit …
Phase II trial of weekly docetaxel, vinorelbine, and trastuzumab in the first-line treatment of patients (pts) with HER2-positive metastatic breast cancer (MBC)
Authors: N. W. Peacock, J. R. Infante, D. A. Yardley, H. A. Burris, F. A. Greco, C. Farley, C. Webb, D. R. Spigel, J. D. Hainsworth
Journal: Journal of Clinical Oncology (2008)

1032 Background: The combinations of trastuzumab/docetaxel and trastuzumab/vinorelbine are both highly active and well tolerated. Docetaxel/vinorelbine is also an active combination, with myelosuppression as the dose-limiting toxicity. We investigated the feasibility and safety of a 3-drug combination of trastuzumab, docetaxel, and vinorelbine as first-line therapy in HER2+ MBC. Methods: 61 pts with previously untreated, measurable, HER2+ MBC (IHC 3+[HercepTest] and/or FISH+) were treated between July 2001 and April 2005 in this multicenter, phase II trial. Additional eligibility critieria included: ECOG PS 0–2, normal baseline LVEF; informed consent. Pts received docetaxel 30 mg/m2 IV and vinorelbine 25 mg/m2 IV on days 1 and 8 of each 3 week cycle. Trastuzumab was given weekly (4 mg/kg loading dose followed by 2 mg/kg/wk). Pts were evaluated for response (RECIST) after 6 weeks; responders/stable pts continued treatment until progression. This phase II trial was designed to detect a response rate of 70% (± 8%). Results: Pt characteristics: median age 53 years (range 28–79); prior adjuvant chemotherapy 38% (20% with prior taxane); > 2 metastatic sites 52%. The most common sites of metastatic disease were lung (49%), liver (43%), and bone (33%). The median number of cycles administered was 11 (range 1–22). Major responses were seen in 41 of 61 pts (67%; CR 26%, PR 41%). An additional 8 pts (13%) had stable disease for > 6 months. After a median follow-up of 58 months, median PFS was 11.3 months (95% CI 8.3–16.3), and the median overall survival was 39.1 months (95% CI 25-NR). Neutropenia (72% grade 4) was the most common hematologic toxicity; 8 pts (13%) were hospitalized for febrile neutropenia. Other grade 3/4 toxicities included fatigue (12%), hyperglycemia (7%), and myalgias (7%). There were no treatment-related deaths. Conclusions: First-line therapy with the combination of trastuzumab, docetaxel, and vinorelbine in pts with HER2+ MBC is effective with manageable toxicity. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Bayer, Genentech GlaxoSmithKline, sanofi-aventis Bristol-Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, GPC Biotech, sanofi-aventis
Patient support call center: Interaction with the oncology clinic.
Authors: Marcus A. Neubauer, Melissa Jameson, Kathryn Eagye, Mitra Abdullahpour, Michael A. Kolodziej, Maria Sipala, Amy Supraner, J. Russell Hoverman
Journal: Journal of Clinical Oncology (2016)

84 Background: Cancer patients receiving chemotherapy can become ill, often leading to hospitalization, adding huge costs to care. This is especially true with older cancer patients. Innovent Oncology (IO), an oncology disease management program, and Texas Oncology (TO) are conducting a novel program, funded by Aetna. Patients who begin IV chemotherapy are called by an IO nurse, working remotely, but with access to TO’s Electronic Medical Record. If the call center nurse detects a concern she notifies the practice. IO then tracks the action taken by the practice. We report on the incidence of practice notification, intervention that occurred, and incidence of hospitalization within 7 days of practice contact. Methods: This pilot program enrolls patients of Medicare age (Aetna Medicare Advantage members). Intervention calls (IC) to the practice are made at the discretion of the IO nurse. We identified all IC’s made from June 2013 to June 2015. We then categorized the actions taken by the practice and report on the four most common actions. IO receives a daily file from Aetna with hospital data. We looked at hospitalizations within 7 and 14 days from the IC. Results: 430 patients were enrolled over the above time period. 164 had at least one IC (215 total); 38% of patients had at least one IC. The four most common actions taken by the practice were: new medication prescription (N = 128); education over the phone (76); office visit within 24 hours (45); lab work ordered (22). 14 patients were admitted within 7 days of IC and 18 (inclusive of the 14) admitted within 14 days of IC. Conclusions: The IC’s are made when the IO nurse detects a problem during telephonic outreach. Therefore, this group of patients is at some risk for deterioration. Out of 215 IC’s made, 14 patients were admitted within 7 days of the call. We believe this number is low in this Medicare-age population and the results are promising. We believe the coordination between the patient support nurse and the clinic is partly responsible. This is a novel program so we can’t compare the IC/hospitalization rate to other data bases but, at the least, we can use this as a baseline going forward.
Heterogeneity of patients with advanced solid tumors in terms of quality of life impairment
Authors: A. Novik, T. I. Ionova, S. A. Kalyadina, A. V. Kishtovich, I. V. Rykov
Journal: Journal of Clinical Oncology (2008)

20609 Grading of quality of life (QoL) impairment and analysis of symptom burden is worthwhile to provide adequate management of advanced cancer. According to the model of grading of QoL impairment, cancer patients may experience no, mild (25% decrease from a population norm), moderate (25–50%), severe (50–75%) or critical (>75%) QoL impairment. The goal of the research was to study heterogeneity of patients with advanced cancer in terms of their QoL and evaluate symptom burden in the groups with different QoL impairment. 350 patients with advanced solid tumors - breast cancer (44.6%), lung cancer (26.6%), gastrointestinal tumors (18.6%), gynecological tumors (5.4%), germinal tumors (1.7%), others (3.1 %)- were enrolled in the study (male/female - 131/219; mean age 56, stages III-IV). The SF-36 and M.D. Anderson Symptom Inventory were used for QoL and symptom assessment, respectively. Statistical significance of differences between groups was tested by Kruskall-Wallis ANOVA and Mann-Whitney U-test, correlation analysis was performed by Gamma-method. The majority of patients experienced critical(36%) or severe (19.7%) QoL impairment. Moderate and mild QoL impairment was observed in about 11.4 and 8.6% of patients. 24.3% of patients had no QoL impairment. The QoL indices differed significantly depending on the grade of QoL impairment (p=0.002). The number and severity of symptoms differed depending on the grade of QoL impairment (Gamma 0.6, p=0.01). In the group with no QoL impairment less than 50% of patients experienced symptoms; in the vast majority of patients they were mild. In the group with critical QoL impairment nearly all the patients had fatigue (97.6%) and pain (97.6%); in 80% these symptoms were moderate or severe. Sleep disturbance, distress and sadness were experienced by 93.7% of patients; in a half of them these symptoms were significant. The majority of patients with advanced solid tumors exhibit critical or severe QoL impairment as compared to a population norm. Identification of the grade of QoL impairment is the starting point in management of advanced solid tumors. Grading of QoL impairment is worthwhile to provide adequate management of advanced cancer. No significant financial relationships to disclose.
Accelerated partial-breast irradiation using strut-based brachytherapy in ductal carcinoma in situ patients: A report on 321 patients with median 25-month follow-up.
Authors: John Paul Einck, Steven E. Finkelstein, Ben Han, Robert Hong, Lydia T. Komarnicky, Robert R. Kuske, Sudha B. Mahalingam, Constantine Mantz, Serban Morcovescu, Stephen S. Nigh, Kerri L. Perry, Jondavid Pollock, Jay E. Reiff, Daniel Scanderbeg, Jon F. Strasser, Catheryn M. Yashar
Journal: Journal of Clinical Oncology (2013)

92 Background: Limited data are available on the treatment of ductal carcinoma in situ (DCIS) with accelerated partial breast irradiation (APBI). The American Society for Radiation Oncology (ASTRO) consensus guidelines on APBI classify patients with DCIS as “cautionary”. We present the largest series of DCIS patients reported to date treated with APBI using strut-based brachytherapy. Methods: The SAVI Collaborative Research Group (SCRG) database was used to identify APBI patients with DCIS at 15 institutions treated with strut-based brachytherapy. All patients had a histologic diagnosis of DCIS and received monotherapy APBI (34 Gy in 10 fractions). Data on patient age and margin status, implant dosimetry, device size, disease status and toxicity in this population were analyzed. Results: From 2007-2011, 321 patients (322 breasts) with DCIS received APBI using strut-based brachytherapy. Patient ages ranged from 40-88 with a median age of 62. 51 patients were under 50 years of age. Detailed dosimetry data were reported on 245 patients. Long-term follow up was available on 221 breasts (median F/U = 25 months). Sixty patients have been followed for &gt;3 years. Skin spacing was a challenge in a significant number of patients including 52 with skin spacing ≤ 5mm and 20 with skin spacing ≤ 3mm. Median maximum skin dose in those patient groups were 87% and 84% of prescription dose (PD), respectively. Overall reported dosimetry (n=245) was excellent: median percent of target volume receiving 90% PD was 96.9%, median maximum skin dose was 83.2%, V150% and V200% (volume at 150% and 200% PD) were 25.2 cc and 12.7 cc respectively. The ipsilateral recurrence rate was 2.2% (1.1% TR/MM). Late toxicity (grade ≥ 2) was low: hyperpigmentation = 0.0%, telangiectasias =1.4%, seroma = 3.2%, and fat necrosis in 1.8%. Conclusions: APBI using strut-based brachytherapy appears to be an effective treatment for patients with DCIS with acceptably low ipsilateral breast recurrence rates and low rates of late toxicity. 52 patients in our series had skin spacing 5 mm or less. APBI using brachytherapy may not have been possible for these women with other single-entry devices.
Development of a side-effect self-monitoring HOME notebook (HNB): Results from a single institution experience.
Authors: Elvira de Marino, Sabrina Rossetti, Teresa Posca, Sara Lattuada, Laura Chiavola, Mara Cecutti, Veronica Pettinati
Journal: Journal of Clinical Oncology (2013)

150 Background: Cancer treatments can be associated with distress and side effects. As therapies are often provided in ambulatory care settings, patients (Pts) have to manage related effects at home, without specialised real-time support. In some cases, Pts are also responsible of prescribed oral adiuvant therapy. In this study we present evaluation results of a self-monitoring and self-education tool to be included in clinical record. Methods: From Jan 2011 to Jan 2013, we enrolled 227 (114M, 113F) Pts new diagnosed with cancer, 204 entered the study, 23 refused. Pts received a note book (HNB) including 2 guidelines about alimentation and skin/mucous/sexuality, 1 daily diary. Pts were asked to complete diary recording side-effects and managing toxicities following the simple guidelines provided. Pts also had a self-administered questionnaire (SQ) to give opinion about tool. Two hundred and four diaries were given; 112 SQ collected. Start-up educational meetings were conducted to illustrate how to register symptoms on diary and monthly we monitored compliance by auditing. Results: SQ analysis shows the following. Average age was 65.14 (median 66); 55% were ≥65 yrs old; 50% received adiuvant treatment, 43% palliative. HNB was used by 33% Pts, 64% Pts and relatives, 3% relatives. 100% Pts say it’s very useful and 98% easy to understand/fill. Most usefull and consulted sections are: alimentation 42%, diary symptoms checklist 31%, skin/mucous/sexuality 25%. Alimentation 42% and diary 24% were the parts they would deepen. Most usefull suggestions about self-care were those on fatigue/decrease in appetite 54%, altered taste 27%, oral cavity inflammation 13%. Sixtynine Pts had nausea and find suggestions given on it useful; 111 rated informations on treatments helpful. Evaluations on study were excellent for 46% Pts, good for 50%, sufficient for 4%. Conclusions: Results confirm HNB efficacy and usefulness. It is easy to understand and fill and provides Pts with heplfull self-managed informations. It’s a precise and higly reliable assessment and monitoring tool at home both for Pts and oncologists. We are evaluating use of HNB as a tool for continuity of care and for phase IV trials.
A phase I/II trial of induction chemotherapy followed by concomitant docetaxel with concomitant boost radiotherapy (CBR) for cancer of the head and neck
Authors: P. Prellop, R. Ove, R. Meredith, J. Bonner, G. Peters, W. Carroll, S. Spencer, L. Nabell
Journal: Journal of Clinical Oncology (2005)

5593 Background: The addition of chemotherapy to XRT has generally resulted in reduced local-regional recurrence. However, the optimal manner in which to integrate chemotherapy has been undefined. This study evaluates the toxicity and response to induction chemotherapy followed by aggressive radiation using CBR and concurrent docetaxel in patients with locally advanced squamous cell carcinoma of the head and neck. Subcutaneous (SC) amifostine was used during CBR to reduce xerostomia. Methods: Patients with stage III/IV nonmetastatic SCCHN were treated with induction docetaxel and cisplatin for 3 cycles, each at a dose of 75 mg/m2. Patients then received weekly docetaxel at 20 mg/m2 concurrently with concomitant boost radiation therapy. SC amifostine was delivered in daily doses of 500 mg during radiotherapy. Results: From the phase I study, 11 patients are evaluable for toxicity and response. Induction chemotherapy was well tolerated with significant clinical regression noted. 8 patients received induction chemotherapy followed by 6 cycles of concurrent chemotherapy with CBR. During chemoradiotherapy, toxicities included ≥ Grade 3 mucositis in 7 patients, ≥ Grade 3 skin toxicity in 4 patients, XRT breaks for 5 patients and 2 patients did not complete the XRT. The protocol was amended to remove chemotherapy during the concomitant boost phase of XRT. 3 patients have been treated with the amended regimen. No patients on this regimen developed greater than grade 2 skin toxicity and only 1 patient developed grade 3 mucositis. Overall, 2 patients recurred locally: 1 died of progressive disease and 1 underwent salvage surgery. 10 patients received ≥ 25 of the 30 planned daily amifostine injections with minimal side effects. Conclusions: This intensive regimen produced a disease-free survival of 80% at 1 year follow-up, but weekly chemotherapy during the concomitant boost phase resulted in excessive toxicity. Accrual will continue with the modified dose. Amifostine was well tolerated during concomitant chemoradiotherapy No significant financial relationships to disclose.