tbuckley/cabot-search huggingface dataset:
Electronic chemotherapy ordering: Optimizing accuracy and decreasing errors.
Authors: Shweta Gupta, Barbara Yim, Thomas E. Lad
Journal: Journal of Clinical Oncology (2016)

e18195 Background: John Stroger Hospital is one of the largest public hospitals in the country, providing chemotherapy to 60-70 patients a day. Over 2014-2015, we designed, built and now use 285 electronic chemotherapy plans. This study was done to compare the old system with new for improvement in patient care with chemotherapy medications Methods: We reviewed all adult chemotherapy paper orders (PO) for year 2013 from pharmacy. The POs were written in triplicate by providers, with original copy for medical records, second copy for nursing and the third (bottom) copy for the pharmacy. One order could contain multiple cycles. Comparison was made with all electronic chemotherapy-medication orders (ECO) from January 2016. We studied all the chemotherapy medication orders (CMO) that needed dose modification/correction by the pharmacist (near misses) and POs that were illegible needing clarification from the physician or copy of the original order, to be processed. Orders with fixed dose chemotherapy not needing dose calculation were excluded. A fisher exact test was used to compare the two groups. We also studied the impact on meaningful use (MU) and Computerized Provider Order Entry (CPOE) requirements for physicians Results: A total of 710 POs were screened and 100 were excluded. First 303 POs from the records were studied in detail comprising of 3203 CMOs, of which 795 (25%) needed dose modification/correction compared to 373 (13%) of the eligible 2805 ECOs from January 2016 (p < 0.0001). No ECOs were incomplete compared to 2.3% POs missing height/weight/BSA. About 44% POs were deemed illegible. With the POs 10 of 12 providers were failing MU primarily in CPOE. After implementation of ECO, all providers are meeting MU, all with CPOE over 95%. A survey showed all providers preferred the new system Conclusions: Despite no IV chemotherapy related sentinel events in a decade, ECO improved the manual process of dose check/correction, decreasing the rate of near-miss wrong doses by half, decreasing the risk of potential patient harm. The cycles are ordered in a staggered way, allowing dose changes based on updated weight, which is easier with ECO. It also helped physicians improve compliance with regulatory requirements of practice, at no added effort
P14 MYELOID TRIB1 PROMOTES EXPERIMENTAL ATHEROSCLEROSIS
Authors: J M Johnston, A Angyal, R Bauer, S E Hamby, S K Suvarna, K Baidžajevas, Z Hegedus, N T Dear, M Turner, H L Wilson, A H Goodall, D J Rader, C C Shoulders, S E Francis, E Kiss-Toth
Journal: Cardiovascular Research (2018)
Effect of antiviral therapy on overall survival in hepatitis c virus-infected patients with diffuse large b-cell lymphoma.
Authors: Jeff Hosry, Parag Mahale, Francesco Turturro, Roberto N. Miranda, Minas P. Economides, Bruno Palma Granwehr, Harrys A. Torres
Journal: Journal of Clinical Oncology (2016)

7540 Background: Chronic Hepatitis C virus (HCV) infection is associated with increased incidence of non-Hodgkin lymphoma. Several studies have demonstrated regression of indolent lymphoma with antiviral therapy (AVT) alone. However, the role of AVT in HCV-infected patients with diffuse large B-cell lymphoma (DLBCL) is unclear. We therefore analyzed AVT’s impact on oncologic outcomes of infected patients who developed DLBCL. Methods: All HCV-infected DLBCL patients (cases) seen at our institution from 6/2004 to 5/2014 were reviewed retrospectively. They were matched at a ratio of 1:3 with uninfected counterparts (controls) based on year of DLBCL diagnosis, age, sex, and Ann Arbor stage. Cases were further divided based on their previous exposure to AVT, resulting in three new groups: cases never given AVT, cases given AVT before DLBCL diagnosis and uninfected controls. Outcomes included response to first line chemotherapy (CT), relapse rate, DLBCL response at last examination, 5-year overall survival (OS), 3-year progression free survival (PFS) and disease free survival (DFS) rates. AVT consisted of interferon-based regimens. Results: We studied 304 patients (76 cases and 228 controls). More cases than controls had extranodal (79% v 72%; P = .07) and upper gastrointestinal (GI; 42% v 24%; P = .004) involvement. Cases never given AVT had DLBCL more refractory to first-line CT than that in the controls (33% v 17%; P = .05) and exhibited a trend toward more progressive lymphoma at last examination compared to controls (50% v 32%; P = .09) or cases given AVT (50% v 27%; P = .06). Cases never given AVT had worse 5-year OS rates than did the controls (hazard ratio, 4.88 [95% confidence interval, 1.55-15.36]; P = .006). AVT improved 5-year OS rates among cases (hazard ratio, 0.19 [95% confidence interval, 0.04-0.81]; P = .02). The impact of AVT on OS was greater in cases with upper GI involvement (77% v 43% without AVT; P = .02) than in those without it (46% v 65% without AVT; P = .63). No significant differences were noted in rates of DLBCL relapse, PFS and DFS. Conclusions: Treatment of HCV infection improves response of DLBCL to CT and 5-year OS, particularly in patients with upper GI involvement of DLBCL.
Omega-3 fatty acid use for obese breast cancer patients with aromatase inhibitor-related arthralgia (SWOG S0927).
Authors: Sherry Shen, Joseph M. Unger, Katherine D. Crew, Cathee Till, Heather Greenlee, Julie Gralow, Shaker R. Dakhil, Lori M. Minasian, James Lloyd Wade, Michael Jordan Fisch, Norah Lynn Henry, Dawn L. Hershman
Journal: Journal of Clinical Oncology (2018)

10000 Background: Although aromatase inhibitors (AIs) prolong survival in postmenopausal women with breast cancer (BC), AI arthralgia can lead to discontinuation. Obese patients have higher rates of AI arthralgia than non-obese patients. Omega-3 fatty acid (O3-FA) treatment for AI arthralgia has produced mixed results. We performed an exploratory analysis to evaluate whether the effects of O3-FAs are associated with body mass index (BMI). Methods: SWOG S0927 was a randomized placebo-controlled trial of O3-FA use for AI arthralgia. Post-menopausal women with stage I–III BC taking an AI were randomized to 24 weeks of O3-FAs or placebo. Brief Pain Inventory (BPI) pain scores and serum were assessed at baseline, 6, 12, and 24 weeks. Global change in joint pain was assessed with scores ranging from -3 for “very much worse” to +3 for “very much better” than baseline. Results: Among the 249 participants, 139 had BMI < 30 (56%) and 110 had BMI ≥30 (44%). Patients with BMI ≥30 had higher rates of diabetes (19% vs. 8%, p= 0.009) and hypertension (53% vs. 31%, p= 0.0005), were more likely to have ≥2 cardiovascular risk factors (33% vs. 17%, p= 0.009), and had lower HDL levels (49.9 vs. 60.3, p< 0.0001). O3-FA use was associated with significantly reduced triglyceride levels at 12 weeks compared with placebo in patients with BMI ≥30 (-22.42 vs. +1.59, p= 0.03), but not in those with BMI < 30 (p= 0.12, interaction p= 0.09). Among patients with BMI ≥30, O3-FA use was associated with a 2.89-point decrease in BPI worst pain score after 24 weeks compared to a 1.49-point decrease with placebo use (p= 0.02), whereas there was no significant difference between O3-FAs and placebo in those with BMI < 30 (p= 0.40, interaction p= 0.05). Trends were similar using global change in joint pain for O3-FA use compared to placebo (BMI ≥30, +0.98 vs. +0.48 respectively, p= 0.05; BMI < 30, +0.57 vs. +0.50 respectively, p= 0.80), though the interaction was not statistically significant (p= 0.22). Conclusions: In BC patients with BMI ≥30, O3-FA use was associated with significantly reduced AI arthralgia and significantly lower triglyceride levels compared to placebo. If confirmed, O3-FA use may lead to improved AI adherence in this subset of BC patients. Clinical trial information: NCT01385137.
Palliative care referrals and related outcomes among advanced cancer patients: A study revealing our institutional shortcomings.
Authors: Ramy Sedhom, David Barile
Journal: Journal of Clinical Oncology (2017)

e21506 Background: Palliative care (PC) has an important role in the care of cancer patients at the end of life. Unfortunately, referral occurs very late in the illness trajectory, often within days of patient death. We examined palliative care referral among advanced cancer patients and associated outcomes during their final 2 weeks of life at our academic medical center. Methods: We reviewed the medical records of 269 cancer inpatients with solid malignancies that died in the past three years at our institution. We retrospectively compared patients who accessed palliative care services with those who did not. A multivariate logistic regression model including age, gender, type of cancer and metastatic status was conducted. Results: 74/269 patients (28%) had a palliative care consult prior to death. The most common cancer types were respiratory (26%) and gastrointestinal (21%). Patients with breast and gynecologic malignancies had significantly greater referral to palliative care services. The overall aggressiveness of care for the last year was significantly less (p = 0.003) for patients who were referred to palliative care. Patients referred to PC received less chemotherapy in the last 2 weeks of life (8% versus 21%, p &lt; 0.001). We found that patients who were not referred to palliative care services experienced death more frequently in the ICU (16% versus 2%, p &lt; 0.001), and in the emergency room (12% versus 1%), p &lt; 0.001). Conclusions: Despite increased awareness of the importance of palliative care, and their overall improvement in survival among cancer patients, there are still disparities regarding access to palliative care and location of death. Patients receiving palliative services receive less aggressive interventions during their 2 last weeks of life and are less likely to die in the intensive care unit or emergency room. Quality improvement projects are underway addressing our shortcomings to palliative care services for our patients with advanced malignancies.
First-in-man study of Ad-sig-hMUC1/ecdCD40L vaccine for immunotherapy of MUC1 overexpressing epithelial cancers.
Authors: Tira Jing Ying Tan, John Whay Kuang Chia, Hui-Shan Chong, Xinhua Li, Sze Huey Tan, Richard Hopkins, Who-Whong Wang, Han Chong Toh
Journal: Journal of Clinical Oncology (2018)

3098 Background: Ad-sig-hMUC1/ecdCD40L vaccine is an adenoviral vector encoding the human MUC-1 epithelial antigen bound to an immune stimulant, the extracellular domain of the CD40 ligand (CD40L) and an adenovirus signal sequence encoding the secretory signal peptide. Pre-clinical studies have demonstrated efficacy of CD40L in activating endogenous dendritic cells to elicit potent anti-MUC1 immunity. We report results of the dose-escalation cohort in a phase 1 study of Ad-sig-hMUC-1/ecdCD40L vector vaccine. Methods: Patients (pts) with advanced adenocarcinoma of the breast, ovary, lung, colon or prostate with tumor overexpressing MUC-1 on immunohistochemistry or elevated serum CA 15-3 were recruited on a 3+3 design phase 1 dose escalation study. Study endpoints were safety, tolerability, maximum tolerated dose (MTD) and antitumor activity. Serum CA 15-3 measurements performed monthly and initial CT evaluation of disease in month 2. Immune biomarkers for analysis included antigen-specific T-cell interferon-gamma Elispot assays, and serum cytokine multiplex assays. Results: Eighteen pts were treated, median age 58 (range 34-88 years), 17 females, 1 male, 11 (61%) breast, 6 (33%) ovarian and 1 (6%) lung cancer. Six cohorts of 3 pts recruited. The first 4 cohorts were single injections starting at 1 x 109 viral particles (VP) escalating to 1 x 1011 VP. Cohorts 5 and 6 involved 2 (days 1 and 7) and 3 (days 1, 7 and 21) 1 x 1011 VP injections. The most common adverse events (AE) were injection site reaction 13 (72%) and rash 5 (28%). All drug related AE were of low grades 1-2. There were no dose limiting toxicities and MTD not reached. 16 patients were evaluable for serum CA 15-3, 2 recorded > 30% decline. 13 pts had measurable disease, 5 demonstrated a reduction in tumor size not amounting to partial response. 1 ovarian cancer pt in cohort 5 received 2 x 1011 VP recorded a 60% CA 15-3 decrease and 25% decrease in tumour size. Immune and translational correlates will be reported. Conclusions: This first-in-man study of Ad-sig-hMUC-1/ecdCD40L vector vaccine in cancers expressing MUC1 has demonstrated low toxicity and encouraging antitumor activity. Our data supports further clinical evaluation in a larger study cohort. Clinical trial information: NCT02140996.
Overall survival of patients with pancreatic adenocarcinoma and <i>BRCA1</i> or <i>BRCA2</i> germline mutation.
Authors: Kyaw Lwin Aung, Spring Holter, Ayelet Borgida, Ashton Connor, Melania Pintilie, Neesha C. Dhani, David W. Hedley, Jennifer J. Knox, Steven Gallinger
Journal: Journal of Clinical Oncology (2016)

4123 Background: Pathogenic BRCA1/2 germline mutations are found in 4.6% of patients with pancreatic adenocarcinoma (PDAC). Long-term overall survival (OS) of these patients is largely unknown. BRCA1/2 mutations are associated with DNA double strand break repair deficiency and more data are needed to establish whether PDAC patients with a BRCA1/2 germline mutation achieve better OS with DNA cross linking agents such as platinum. Methods: The objective was to evaluate OS including survival outcomes achieved with platinum based chemotherapy in a cohort of BRCA1/2germline mutant PDAC patients. Primary endpoint was 5 year OS for patients with stage I & II operable disease and 2 year OS for patients with inoperable stage III & IV advanced disease. Evaluable patients, diagnosed between January 1997 and December 2015, were identified from the Ontario Pancreas Cancer Study prospective database. Results: Fifty seven patients, 25 female and 32 male, were identified: 14 BRCA1 mutant, 42 BRCA2 mutant, and 1 double mutant. Median age was 63 years (range 29-84). Twenty six patients (45%) had prior cancer diagnoses (13 breast, 3 prostate, 3 bladder, 2 ovarian, 2 thyroid, 1 colon, 1 melanoma and 1 lymphoma). At a median follow up of 18 months (range 2-87), 40 (70%) have died. Twenty four (42%) had a primary tumor resection (4 stage I + 20 stage II). Their median OS was 19.5 months and 5 year OS 17% (95%CI 6-35%). Thirty three patients (58%) had advanced disease (8 inoperable stage III + 25 stage IV). Their median OS was 9.6 months and 2 year OS 24% (95%CI 11.5-43%). Twenty advanced patients received platinum (oxaliplatin, cisplatin or carboplatin) either as part of first line or subsequent lines of palliative chemotherapy. Their median OS was 15.3 months and 2 year OS 35% (95%CI 18-56%). Of remaining 13 advanced patients, treatment details were not available for one. For 12 advanced patients who did not receive platinum chemotherapy, median OS was 8.3 months and 2 year OS 0%. Conclusions: In this large cohort of germline BRCA1/2 mutant PDAC patients, OS for early stage disease was similar to historical controls, whereas OS for advanced disease was superior to historical controls, particularly for patients who received platinum based chemotherapy.
A quantitative analysis of funding for pancreatic cancer research.
Authors: Andrew Eugene Hendifar, Xiao Zhang, Rhonda Aizenberg, Mila McCurrach, Pat Morin, Richard Tuli, Lynn Matrisian, Lynne Davies
Journal: Journal of Clinical Oncology (2015)

4126 Background: Although pancreatic cancer is the fourth most common cause of cancer death, it only receives approximately 2.5% of federal dollars distributed by the NCI. Recognizing the need for research support, patient advocacy groups, private institutions, and public institutions are working together to correct this funding gap. Methods: The International Cancer Research Partnership (ICRP) is an alliance of governmental and charitable organizations funding regional, national and international cancer research. The ICRP maintains a database of grants and awards that its members have provided. We interrogated the ICRP database to review the number of grants and their monetary value for pancreatic cancer and liver cancer ( > 50% relevance) awarded from 2002 to 2012 in the United States. In addition, we received private funding data from the Pancreatic Cancer Action Network, Lustgarten Foundation, and the American Association for Cancer Research. We compared private and public funding for pancreatic cancer and then benchmarked against the funding for liver cancer. Wilcoxon-Mann-Whitney test was used to compare private and public funding from 2002 to 2012. Results: Between 2002 and 2012 total funding for pancreatic cancer has increased nearly ten-fold from $11 million (60 grants) to $92 million (347 grants). Private and charitable funding makes up 27% of the total funding and the mean difference per award (public minus private) has decreased from $139,425 to $6,396 (p < 0.001). Funding for liver cancer has also increased over this time period, from $10.5 million to $59.5 million; however, the contribution from private and charitable organizations is significantly less as compared to pancreatic cancer (13% vs 27% p < 0.001). Conclusions: Funding for pancreatic cancer has increased significantly from 2002-2012. Private and charitable contributions comprise an increasingly larger portion of these funds. As federal funding for research has become increasingly constrained, private and charitable organizations have assumed a growing role in the funding landscape and are helping fill the gap.
HORIZON: A French descriptive cohort of 663 patients treated for melanoma with pembrolizumab with a focus on the mucosal subgroup (n=59).
Authors: Caroline Dutriaux, Nicolas Meyer, Philippe Saiag, Evelyne Boos, Catherine Hunault, Lynda Benmahammed, Laurent Mortier
Journal: Journal of Clinical Oncology (2018)

9563 Background: Advanced mucosal melanoma is a rare subgroup of tumors for which few data on immune therapeutic approaches is available as they are rarely or not included in pivotal trials. Pembrolizumab, a monoclonal anti-PD1 antibody, has been approved in France as a first-line treatment of patients with advanced melanoma since October 2015. Although it has been shown to significantly improve OS and PFS of cutaneous melanoma, we have few data on its efficacy in mucosal melanoma. Methods: Horizon is a real-life setting descriptive cohort analysis of patients treated with pembrolizumab from June 2014 to September 2015 in the context of the French national early access program, at the dose of 2 mg/kg/3 weeks. Here are presented the results of the second interim analysis (data cut-off January 7th, 2017) in the mucosal melanoma subpopulation. Results: A total of 663 patients were included with a median follow-up of 12.95 months (95%CI: [11.15-16.16]). Among those patients, 59 (8,9%) had a primary mucosal melanoma. Twenty-two (37,3%) had no prior therapy. The median OS was 7.54 months (95%CI: [5.25-10.52]) versus 16.75 months (95%CI: [13.15-18.89]) in the non-mucosal melanoma population (p < .0001). The median PFS was 2.69 months (95%CI: [2.26-3.05]) versus 3.41 months (95%CI:[3.02-4.03]) in the non-mucosal group (p < .0001). The ORR was 11.9% (31.5% in the no- mucosal group), the DCR was 18.6% (44.2% in the non-mucosal group), and the median DR was 7.64 months (not reached in the non-mucosal group). Withdrawal of pembrolizumab was necessary for 47 patients (79,7%); the main reason for discontinuation was disease progression (68,1%), far ahead toxicity (14,9%) or complete remission (6,38%). Immune related adverse events were consistent with previous reports on pembrolizumab. Conclusions: Pembrolizumab provides objective activity in some mucosal melanoma patients, although less than that observed in the non-mucosal population. Anti-PD1 should be considered as a relevant treatment option for these patients. Nevertheless, further studies are warranted to describe underlying resistance mechanisms involved in order to improve management of this rare subgroup.
Outcomes after pericardial window surgery (PWS) for palliation of malignant pericardial effusion (MPE).
Authors: Raúl Alejandro López Saucedo, Edgardo Jimenez-Fuentes, Miguel Patricio Moscoso-Fernandez Salvador, Josue Andres Gonzalez-Luna, Oscar Gerardo Arrieta Rodriguez, Jose F. Corona-Cruz
Journal: Journal of Clinical Oncology (2018)

e22193Background: MPE is a serious manifestation occurring in 10% of all cancer patients (ptes) and is associated with decreased survival (SV). Optimal window procedure has yet to be established, b...
Abstract 11077: Overestimation of Pretest Probability of Coronary Artery Disease by Duke Clinical Score: Evaluation Using Coronary CT Angiography
Authors: Kazuhisa Takamura, Kanako Kumamaru, Takeshi Kondo, Hiroshi Arai, Tadaaki Orihara, Jyunichi Sugiyama, Makoto Kondo, Akira Endo, Hiroshi Fukazawa, Hideki Nagaoka, Akitsugu Oida, Frank J Rybicki, Sinichi Takase
Journal: Circulation (2013)

Background: The Duke Clinical Score (DCS) is based on catheter angiography as a reference standard for a diagnosis of coronary artery disease (CAD). Coronary CT Angiography (CCTA) is applied to wid...
Variations in cost for non-metastatic HER2- breast cancer (BC), non-small cell lung cancer (NSCLC), and colorectal cancer (CRC).
Authors: Jennifer Malin, Stacey DaCosta Byfield, Benjamin Chastek, Stephanie Korrer, Thomas Horstman, Lee N. Newcomer
Journal: Journal of Clinical Oncology (2017)

e18106 Background: We aim to quantify economic outcomes of the most commonly used chemotherapy regimens for BC, NSCLC, and CRC in a commercially insured population. Methods: This analysis used clinical data from a prior authorization program for chemotherapy regimens linked with administrative claims data from 6/1/2015 to 5/31/2016. Clinical data included cancer type, stage at diagnosis, and biomarkers. Eligible patients were commercially insured members with a prior authorization request for one of the most commonly used NCCN recommended regimens for BC, NSCLC and CRC. Outcomes, including total healthcare cost and cost of chemotherapy were tracked from first claim for chemotherapy until end of treatment due to discontinuation, death or change in treatment. Patients were censored at 5/31/2016 or end of enrollment. Results: There were 1612 BC, 237 NSCLC, and 386 CRC non-censored patients who received therapy during the study period. Mean (SD) total and monthly drug costs and total health care costs for the most common regimens by cancer are summarized in the table. Conclusions: The relative value of the most common therapies for BC, NSCLC, and CRC varied significantly depending on the metric used underscoring the importance of comparing total healthcare costs when assessing the value of therapies. Information on these and other regimens will increase as the database grows over time. [Table: see text]