tbuckley/cabot-search huggingface dataset:
Docetaxel use, analgesics use, and survival in prostate cancer: Survival analysis using a large claims database (2003-2009).
Authors: R. Dhawan, Y. Wu, M. Mehra
Journal: Journal of Clinical Oncology (2011)

e15073 Background: Docetaxel has been the standard of care among late-stage prostate cancer patients. We analyzed a large group of prostate cancer survival data using a large commercial claims database to investigate the impact of docetaxel treatment and other patient and treatment characteristics on survival. Methods: Patients with a diagnosis of prostate cancer (ICD 9 code: 185.X) who had a claim for docetaxel in 2003 onwards were identified from the PharMetrics database, a nationally representative, non-payer-owned integrated commercial US claims database. All patients had ≥ 12 months of enrollment prior to initiation of docetaxel. Patients were followed from their first docetaxel claim until lost to follow-up or Oct 31, 2009 (censored). This follow-up was used to estimate survival. Patients were stratified by baseline characteristics: chemotherapy use (docetaxel only vs. subsequent chemotherapies post docetaxel), age (≤65 or >65), and analgesic use (yes or no) suggesting presence/absence of pain. Results: A total of 3,642 patients treated with docetaxel were included in the analysis. Mean age of patients was 69.6 years (SD 10.2). Average duration of docetaxel treatment was 5.6 months and mean time to study end/lost to follow-up was 15.8 (SD 13.8) months from the index date. Among these patients, 2744 (75%) had no other additional chemotherapy, 737 (20%) had one other chemotherapy, and 161 (4%) had two or more other chemotherapies. Chemotherapy exposures were associated with survival - patients receiving just docetaxel had improved survival compared to those patients receiving additional one or two or more chemotherapies (mean survival: 18,15,10 months, respectively). Baseline analgesics use was also associated with survival. Patients who did not use analgesics at baseline (58%) had improved survival compared to those who did use analgesics at baseline (21 vs.17 months). All p-values were significant (log-rank test p-values<0.001). There were no survival differences by age at baseline. Conclusions: Use of subsequent chemotherapies after docetaxel and presence of pain is indicative of progressive disease and hence worse outcomes, suggesting a high unmet need in these patients.
Is there a place for neoadjuvant chemotherapy in the management of advanced malignant germ cell tumors of ovary?
Authors: L. Kumar, S. Talukdar, R. Hariprasad, A. Gupta, A. Mookerjee, S. Kumar, N. Bhatla, S. Mathur
Journal: Journal of Clinical Oncology (2011)

5079 Background: There is limited data on the role of neoadjuvant chemotherapy (NACT) in advanced malignant ovarian germ cell tumors (MOGCT).We attempted NACT in 20 Pts of advanced MOGCT who were considered high risk for surgery (very poor general health; ECOG performance status, 3-4) in order to preserve fertility. Methods: Between 1988 and December 2009, 20 of 211 patients with MOGCT were considered unsuitable for exploratory laparotomy because of their high risk status. Pts median age was 19 yrs, ranging from 14-28 yrs. All had stage III (n=17) or IV (n=3) disease. Diagnosis was confirmed by FNAC /Biopsy & baseline tumor marker levels. 11 pts had dysgerminoma, 6 had mixed subtype & 3 had endodermal sinus tumor (EST). All were planned for four cycles of BEP chemotherapy followed by fertility sparing surgery (U/L salpingo-oophorectomy + omentectomy ± Lymphadenectomy). Results: 18 Pts were evaluable for treatment response & outcome. One Pt died after 1st cycle of CT due to progressive disease and another Pt was lost to FU after 2 cycles. Post 4 cycles of chemotherapy, 18 responded: CR-13, PR-5. 15 Pts underwent surgery with pathological CR in 13/15 (86.6%); 2 Pts had residual disease, both of them achieved CR following 2 cycles of salvage chemotherapy. Remaining three Pts refused for surgery; 2 out of 3 relapsed at 9 and 12 months, both achieved CR with salvage chemotherapy and subsequent fertility sparing surgery; third Pt continues to be alive and in good health. Currently 18 of 20 patients are alive and disease free and in one status is unknown at a median follow-up of 48 months (range: 12-96 months). All of them have resumed menstruation and 3 eligible Pts have delivered full term healthy babies. Conclusions: NACT followed by fertility sparing surgery is an effective treatment strategy for patients of advanced MOGCT who are high risk candidates for surgery.
Disparities in stage at presentation and treatment of colorectal cancer among Hispanic and non-Hispanic white patients.
Authors: Rodrigo Rodriguez, Melissa Gonzalez, Bridget N. Fahy, Anita Kinney, Ashwani Rajput
Journal: Journal of Clinical Oncology (2014)

433 Background: Although incidence rates for colorectal cancer (CRC) for Hispanics are similar to non-Hispanic whites (NHW) in New Mexico, the cause-specific mortality is higher among the Hispanic population. Hispanics have also been shown to be less likely to be current with colorectal cancer screening guidelines as compared to NHW. The purpose of this study was to determine if there was a difference between Hispanics and NHW in stage at presentation and if the care provided was concordant with NCCN guidelines at our NCI designated cancer center. Methods: A prospective data base of all patients who presented with colorectal cancer between June 2009 and July 2013 was queried. A total of 197 patients were identified. Data was extracted that included: demographics, stage of CRC at first diagnosis, treatments given, and pathology results. Frequencies of stage at presentation and NCCN guideline concordance (meeting the 12 lymph node metric, receipt of adjuvant therapy for stage III disease and radiation therapy for locally advanced rectal cancer) were recorded. Results: The Table shows the results. There were 107 (55%) males. There was not a statistical difference in the stage of presentation for Hispanics and NHW for patients with colon cancer. Hispanic patients with rectal cancer, however, presented with more advanced stage of disease as compared to NHW (p&lt;0.05). There was no statistically significant difference in concordance with NCCN guidelines for the three metrics analyzed. Conclusions: Hispanics and NHW with colon cancer presented with similar stage of disease and were concordant with NCCN guideline metrics. Hispanics with rectal cancer, however, presented at a more advanced stage of disease as compare to NHW patients. The reason for this disparity remains to be elucidated. Future studies to include outreach, education, screening and molecular profiling of these disparate populations are planned. [Table: see text]
Chronic lymphocytic leukemia (CLL) patients at a VA medical center: Comorbidity and survival.
Authors: L. Soriano, S. Srinivas, M. Tufail, K. Kim, R. Paulin, V. T. Chang, B. Kasimis, M. L. Gonzalez
Journal: Journal of Clinical Oncology (2011)

6602 Background: To determine whether co morbidity indices predict survival in chronic lymphocytic leukemia (CLL) patients (pts). Methods: In an IRB-approved protocol, we reviewed the records of 107 pts diagnosed with CLL at a VA Medical Center from January 2001 to May 2010. Records were reviewed for demographic, clinical, pathological data. ECOG PS, Veteran status (V-Vietnam) treatment status and survival were tabulated. Comorbidity was assessed using Charlson Comorbidity Index (CCI), The Kaplan-Feinstein Index (KFI), the Cumulative Illness Rating Scale (CIRS) and the VA comorbidity Index. We preformed Cox regression analysis to determine predictors of survival. Results: There were 107 pts with a median (M) age of 72 yo (48-94). The M hemoglobin(Hgb) was 13.6 g/dl (7.3-16.7), M WBC 15.4 K/cmm (2.8-289), M platelets 201 K/cmm (50-1077), M blood urea nitrogen (BUN) 19 mg/dL (1-88), M creatinine (Cr) 1.1 mg/dl (0.4-3.6), M lactate dehydrogenase (LDH) 177 IU/L (105-1635), M beta 2-microglobulin 2.3 mg/dl (0.9-8.9) and M BMI 28.7 kg/m2 (15.06-43.1). Early stage pts numbered 94 (88%). The M CCI was 4 (0.8-8.7), M KFI 1 (0-3), M CIRS 15 3 (1-6), M CIRS 16 7 (1-14), M CIRS 17 2 (1-4.5), M VA comorbidity 3 (0-8).106 pts had a PS 0-2. By immunophenotyping 42 ptswere CD38/ ZAP-70 positive. 65 pts (75 %) non-V, 30 (28%) V. The M survival was 1290 days (4-6715). In univariate analysis age (P<0.01), stage (p< 0.03), BMI (P 0.05) beta 2-microglobulin (p< 0.0001), Hgb (p<0.005), WBC (p<0.0004), BUN (p<0.0006), Cr (p<0.0002), LDH (p<0.0033,), second malignancy (P<0.0436) and V (p<0.04) were significant predictors of survival. In the multivariate analysis, B2-Microglobulin was the only significant independent predictor of survival (p < 0.0172). Comorbidity indices were not predictors of survival. Conclusions: Co morbidity indices were not able to able predict survival in this group as many patients were early stage pts with good performance status.
Multicenter evaluation of adjuvant therapy for gallbladder cancer.
Authors: J. Wang, C. C. Hsu, C. D. Fuller, T. M. Pawlik, R. C. Miller, B. G. Czito, R. Tuli, E. Ben-Josef, J. M. Herman
Journal: Journal of Clinical Oncology (2011)

251 Background: To assess the effect of adjuvant therapy in gallbladder adenocarcinoma (GBC). Methods: Retrospective review was conducted at five institutions to identify pts who had surgery for confirmed dx of GBC from 1985-2008 (N = 189). Pts were excluded if they had chemo alone (N = 8), path other than adenoca (N= 7), carcinoma in situ (N=1), &lt; 30 days of follow-up (N = 2), or missing data (N=14). Of the remaining 156 pts, 58 received surgery only and 98 received adj RT ± chemo. Kaplan-Meier was used for overall survival (OS) and Cox proportional hazards to compare risk factors. Results: Median age of dx was 64.4, 68.0% were female, 37.9% had ≥ stage 2b, 37.2% had + nodes, and 32.1% had + margins. Overall, 35.9% of the patients had simple cholecystectomy (SC) only and 64.1% had radical resection (ER). mOS for pts treated with surgery alone was 49.7 months (95% CI: 24.8 to Inf). On univariate analysis, + margins (HR 2.72, p&lt;0.001) was associated with worse OS, whereas ER compared to SC improved survival in both univariate (HR 0.46, p&lt;0.001) and multivariate (HR 0.53, p=0.033) analyses after adjusting for node/margins, T-stage, adj RT, age, gender, and institution. mOS for the entire cohort vs. adj RT (median 50.4 Gy) ± chemo was 30.7 months (95% CI: 19.2 to 46.9) vs. 26.9 months (95% CI: 15.5 to 39.1). But, compared to surgery alone, the adj group was more likely to have had node +, margin +, or T-stage 3+ (all p&lt;0.001). The adj RT group was also less likely than surgery alone pts to have undergone ER (p = 0.007). On multivariate analysis, decreased OS was also found for node + (HR 2.09, p=0.004), margin + (HR 1.84, p=0.043), and T3/T4 disease (HR 2.37, p=0.002). After adjusting for surgical extent, node, margin, T stage, age, gender, and institution, there was improved OS with adj therapy (HR: 0.43, p = 0.020). When stratified by surgical extent, the risk estimate for adj RT improved OS among those with SC (n=56; HR 0.20, p=0.135) and ER (n=100; HR 0.46, p=0.067), but was not statistically significant. Conclusions: ER was associated with improved OS, whereas node/margin+ and T-stage 3+ were associated with worse survival. In multivariate analysis, adj RT improved OS after surgery. Given the poor prognosis of GBC patients with advanced disease, consideration of adj therapy is appropriate. No significant financial relationships to disclose.
Surgical decisions of newly diagnosed breast cancer patients following genetic referral.
Authors: Jennifer McAlister, Nayana Dekhne, Siddhartha Yadav, Dana Zakalik, Heather Lowry, Angela DeLaere
Journal: Journal of Clinical Oncology (2015)

40 Background: In response to many recent publications and mandates to assure referrals to genetic counseling for oncology patients, the Royal Oak (RO) Breast Care Center (BCC) at Beaumont Health System (BHS) evaluated the surgical outcomes of genetic referral(GR) in breast cancer (BC) patients. The goal of this study was to determine the impact of GR on surgical decision making and evaluate outcomes in this population. Methods: A retrospective chart review was performed, to identify patients who had a BC diagnosis and met criteria for GR from July 2012- July 2014. Age, histology, laterality of cancer, prior history of cancer, neoadjuvant chemotherapy, plastic surgery consultation, MRI, reason for MRI, additional testing, type of surgery, laterality of surgery, reconstruction, lymph node surgery, and time from diagnosis to surgery were evaluated using Chi Square analysis. Results: A total of 506 patients with a new BC diagnosis seen at the RO BCC at BHS within the inclusion dates were analyzed. There were 191 patients referred to the GP for counseling and possible genetic testing. Eighty percent of the referred patients underwent genetic testing. Twelve patients tested positive for deleterious mutations in BRCA 1 or 2. A statistically significant difference was found in the BC patients referred to the GP with respect to age, MRI usage, neoadjuvant chemotherapy, type and laterality of surgery, ALND, plastic surgery consult &amp; reconstruction, and time from diagnosis to surgery. MRI usage in patients referred to GP was 43.5% vs. 12.7% in those not referred. Mastectomy rate in patients referred to GP was 51.3% vs. 25.5% (p&lt;0.001) in those not referred. Bilateral mastectomy was 30.9% vs. 5.8% (p&lt;0.001). Conclusions: We have found that patients referred to the GP have increased the use of MRI testing, which in itself has been shown to increase mastectomy rates. We also identified a trend in these patients toward bilateral mastectomy. According to our outcomes, there are multiple possible reasons for this trend, including family history, physician bias, stage at diagnosis, age and factors intrinsic to the patient. Furthermore, a multivariate analysis is needed to assess the relationship between a GR and a patient’s surgical decision.
Complications during cisplatin-based primary chemotherapy in patients with testicular cancer: Is there a need for thromboembolic prophylaxis?
Authors: David J. K. P. Pfister, Daniel Porres, Ingrid Wolsky, Andrea K. Thissen, Axel Heidenreich
Journal: Journal of Clinical Oncology (2014)

371 Background: Cisplatin-based chemotherapy is an integral part of the multimodal therapy of patients with testicular cancer. The purpose of this analysis is to evaluate the chemotherapy associated side effects of primary treatment in a modern patient cohort and to correlate them to clinical stage and IGCCCG risk profile. Methods: We retrospectively analyzed charts of patients with testicular cancer in our institution from January 2003 until today. A total of 88 patients received systemic treatment, among those 74 as a primary treatment with 2 to 4 cycles of PEB. Side effects had been categorized according to the Common Terminology Criteria for Adverse Events (CTCAE), version 4. Results: 46 of 74 patients receiving PEB had at least one side effect. The most common side effects were haematotoxic with leucopenia in 34 (45.9%), febrile neutropenia in 10 (13.5%), gastrointestinal in 22 (29.7%), and thromboembolic events in 10 (14.8%) of the patients including three therapy associated deaths. Adverse events in clinical stage I are low. Nevertheless there is one therapy associated death due to neutropenic fever. Although there are no differences in haematotoxic AEs in clinical stage II and III there is a significant trend of developing pulmonary embolism. Patients with clinical higher than stage IIb and intermediate/poor prognosis have the highest risk of pulmonary embolism (20% ). Conclusions: In patients with curative treatment with PEB there are significant AE´s. To reduce therapy associated morbidity and mortality, supportive treatment with granulocyte stimulating factor and therapeutic anticoagulation should be discussed at least in high-risk patients.
The Degree of Response of Philadelphia Chromosome Positive Acute Lymphatic Leukemia to Allosteric Inhibition by GNF-2 Depends on the Presence of Either p185-BCR/ABL or p210-BCR/ABL
Authors: Afsar Mian, Anna Metodieva, Yousef Najajreh, Hubert Serve, Oliver Ottmann, Jamal Mahajna, Martin Ruthardt
Journal: Blood (2010)
Prognostic markers of time to local recurrence and overall survival in early-stage rectal cancer.
Authors: Sagar A Patel, Yu-Hui Chen, Jason L. Hornick, Paul J. Catalano, Jonathan Nowak, Lawrence R. Zukerberg, Theodore S. Hong, Harvey J. Mamon
Journal: Journal of Clinical Oncology (2013)

473 Background: Surgical resection without adjuvant therapy results in a low recurrence rate for patients with early stage (i.e. T1-2 N0) rectal cancer, in the range of 4-15% at 5 years. There are limited data regarding clinical or pathologic markers that are prognostic for recurrence in this population. This study assesses factors associated with time to local recurrence (TTLR) and overall survival (OS) in these patients. Methods: From 2000 to 2008, 177 patients with stage I rectal cancer treated with surgery alone were identified. Data were retrospectively reviewed to identify markers associated with TTLR and OS, including staging method, preoperative CEA, type of surgery, tumor size, lymph node resection, histological grade, circumferential resection margin, and presence of lymphovascular invasion (LVI), lymphocytic infiltration, or ulceration on pathology. Data were analyzed using a Cox proportional hazards regression model. Results: Of the eligible cohort, 137 patients had complete follow up data for analysis of TTLR, and 23 (16.8%) locally recurred. Among these 23 patients, the median TTLR was 1.1 years (0.1-7.8). On univariate analysis, male gender, current alcohol use, LVI and tumor ulceration were associated with heightened risk for LR, and male gender (HR 3.3, p=0.02), current alcohol use (HR 3.4, p=0.01) and tumor ulceration (HR 4.2, p=0.001) remained statistically significant on multivariate analysis. Of the original cohort, 173 patients had complete follow up for OS analysis. Among these patients, the median OS was 12 years. On univariate analysis, age at diagnosis &gt; 65 years, T2 pathologic stage, and tumor size &gt; 4.5 cm were associated with decreased OS, and age at diagnosis &gt; 65 years (HR 2.1, p=0.04) and T2 pathologic stage (HR 2.5, p=0.008) were predictors of reduced OS on multivariate analysis. Conclusions: For patients with stage I rectal cancer treated with surgery alone, male gender, current alcohol use, and tumor ulceration are poor prognostic markers for TTLR. Within this population, age at diagnosis &gt; 65 years and T2 pathologic stage are predictive for reduced OS. These results provide important prognostic information for patients and may help identify those who could benefit from additional therapy.
Time-to-simulation for radiation oncology patients in an academic department.
Authors: Nirav S. Kapadia, Kathy Ann Lash
Journal: Journal of Clinical Oncology (2013)

176 Background: In 2011, one of the two clinical simulators in our department was decomissioned in order to enable the construction of a clinical magnetic resonance (MR) simulator. As result, our clinical simulator capacity decreased resulting in increased wait times for patients undergoing treatment planning. In turn, there was a perceived increase in the number of patients added onto the simulator schedule (add-ons) immediately following consultation. This created problems of workflow on the simulator and increased clinic wait times for previously scheduled patients. A clinical Lean team was formed with the intent of 1) quantifying the number of daily add-ons and 2) identifying predictors of add-ons so that the frequency of add-ons could be predicted and if possible, load-leveled. Methods: Over an eight-week period, frequency of simulator add-ons was correlated with de-identified patient data abstracted from the medical record using one-way ANOVA and student t-tests to assess the statistical hypothesis that a patient, disease, or provider factor increased the likelihood of a patient add-on. Interviews were conducted with the clinical staff to determine perceived frequency of add-ons, predictors of add-ons, and to evaluate the rationale for add-ons. Results: On average, 7.9 (range 7.3-8.7) simulations were performed daily in our department and 0.95 (0.7-1.4) patients were added onto the simulator daily. Patient demographics, day of consultation, inpatient vs outpatient status, treating and referring physician, as well as cancer diagnosis were examined. A statistical trend for add-on patients on Friday (p=0.064, vs. Monday) was found. One physician's patients accounted for 36% of the Friday add-ons over the eight week period. The physician was interviewed and her rationale for adding-on patients was determined. Conclusions: The mean number of add-on patients was determined to be acceptably low in our department and was on average less than one patient daily. A trend for an increased likelihoood of add-on patients with a particular Friday provider was noted and as such future efforts will be directed at mitigating the number of this physician's add-on patients.
Relation of tumor localization and metastasis sites in patients with breast cancer.
Authors: Ö. Keskin, C. Arslan, O. Dizdar, S. Aksoy, E. Dogan, D. S. Dede, I. H. Gullu, Y. Y. Ozisik, K. Altundag
Journal: Journal of Clinical Oncology (2011)

e21166 Background: We aimed to investigate whether a relation exists between primary tumor localization at breast and metastasis sites in breast cancer patients. Methods: Data of metastatic breast cancer patients being followed at Hacettepe University Institute of Oncology, Department of Medical Oncology between years 1987 and 2010 were analysed retrospectively. Metastasis sites and primary tumor localizations at breast were evaluated with chi-square test. Results: There were 129 (10.6%) metastatic breast cancer patients diagnosed at the admission or during the follow up period within 1,218 patients. The 13 (10%) patients had primary tumor at inner upper quadrant, 78 (60.4%) at upper outer quadrant, 11 (8.52%) at rero-areolar region, and 10 (7.75%) at inferior outer quadrant. Ten patients (7.75% ) had extensive tumors consisting of all quadrants and 4 (3.1%) had inflammatory breast cancer. The most frequent sites of metastasis were bone (n=43, 33.3%), lung (16, 12.4%) and liver (13, 10%). The 45 (34.9%) patients had metastases at multiple visceral sites. Bone and multiple visceral metastasis were the most frequent pattern of metastasis for all regions of primary tumor localizations. Isolated bone metastasis were less frequent at outer upper quadrant tumors compared to other regions of primary tumor localizations (p=0.043). Metastases at multiple visceral sites were more frequent at outer upper quadrant tumors compared to other primary tumor localizations, but statistical difference was not at significance level (p=0.106). Conclusions: It was shown that breast cancer patients had primary tumors at upper outer quadrant had less isolated bone and more frequent multiple visceral metastases.