tbuckley/cabot-search huggingface dataset:
Assessing the need for a nurse-led breast cancer telephone follow-up clinic in Alberta, Canada.
Authors: Sasha M. Lupichuk, Cindy Railton, Jenny J. Ko, Jennifer McCormick, Lihong Zhong, Anil Abraham Joy, Barbara Walley, Janine Giese-Davis
Journal: Journal of Clinical Oncology (2013)

111 Background: Routine follow-up of breast cancer (BC) patients is largely transferred to primary care due to limited tertiary care resources and evidence supporting the acceptability and safety of this approach. It is unknown how BC survivors are faring in the community with treatment and surveillance goals, and if there is an unmet need for access to specialist care. Objectives of this cross-sectional study of BC survivors were to examine: concordance with endocrine therapy and follow-up recommendations; perceived need for help with achieving these recommendations; and, perceived need for a telephone follow-up clinic. Methods: Eligible participants were women with stage I-III BC diagnosed June 2006-September 2009 who had been seen in consultation at a tertiary cancer centre (TCC) in Alberta, Canada. 960 potentially eligible women were invited to participate via mail-out from the Alberta Cancer Registry. Consenting participants completed a structured telephone interview. Further patient, disease, endocrine therapy and surveillance data were obtained from the electronic chart and pharmacy databases. Results: 240 participants completed the telephone interview. 68.8% had been discharged from a TCC. 87.1% reported having had a clinical breast examination, and 97.1% with remaining breast tissue reported having had a surveillance mammogram within the past year. Concordance with endocrine therapy varied between pharmacy dispensing records (95.4%) versus self-report (82.0%). Top participant-identified gaps in post-treatment services were: side effect management, achieving body weight and physical activity goals, psychosocial health, and sexual health. 71.7% of participants reported that they would have used a telephone follow-up clinic. Factors associated with telephone follow-up clinic use included younger age, no endocrine therapy, fatigue, and non-urban residence. Conclusions: Concordance with measurable follow-up goals (exam, mammography, endocrine therapy) was better than expected. Despite this, interest in a nurse-led BC telephone follow-up clinic was high. Perceived needs included management of symptoms plus support for life-style behavior change.
Incorporation of geriatric assessment into oncology practive: Views and attitudes of physicians participating in the IN-GHOregistry.
Authors: F. Honecker, U. Wedding, S. Huschens, C. Bokemeyer
Journal: Journal of Clinical Oncology (2011)

e19607 Background: The IN-GHO registry collects data of >3,000 elderly cancer patients (pts). Part of the registry is a geriatric assessment (GA). While there is a widespread notion that GA is helpful in geriatric oncology, little is known about physicians' (ps) perception of GA in oncology practice. Methods: Using a structured interview, we interrogated participating ps between 12/2009 - 02/2010 about their perception of GA in oncology practice. The 6-item GA of the registry comprises activities of daily living (ADL), instrumental activities of daily living (IADL), comorbidity (Charlson index), mobility (timed-up&go), cognition (MMSE), and depression (SCID screening). 97 of 112 (86.7%) ps responded, 66 by telephone interview, 33 in written form. Results: 66% of ps performed GA exclusively within the registry, 34% used some form of GA also outside the registry. 20% of ps performed GA themselves, 49% delegated GA to medical assistance staff, in 31% both were involved. 65% of ps considered GA as meaningful and practicable, 30% as meaningful but impracticable, and 5% thought it was not helpful. The mean ranking of the items of the GA from most important (5 points) to least important (0 points) was as follows: 3.5 ADL, 3.3 comorbidity, 2.8 IADL, 2.2 mobility, 1.7 depression, and 1.7 cognition. 67% of ps rated acceptance of a GA among pts as very good/good, 24% as moderate (information missing 9%). 52% of ps stated that results of GA influenced their perception of fitness for treatment (37% not influenced, 11% missing). 36% of ps stated that their treatment decision was actually influenced by GA (48% not influenced, 16% missing). Treatment decision was influenced as follows: 41% of ps chose less aggressive treatment, 5% no cytotoxic treatment, and 17% more intensive treatment. Conclusions: Among ps participating in the registry, general acceptance of GA was high. 30% of ps found a 6-item GA too time consuming. More than 50% of ps stated that GA influenced their judgement of fitness for therapy; 36% reported a direct influence on choice of treatment. Interestingly, GA did not inevitably result in less aggressive treatment, but could also lead to more intensive therapy.
Suicide in patients with cancer in California: 2000-2005.
Authors: H. R. Mirshahidi, K. Nasseri, P. K. Mills
Journal: Journal of Clinical Oncology (2011)

1535 Background: Compared to general population, cancer patients are at higher risk of suicide, which is clustered in White men diagnosed with cancers with poor prognosis. The objective of this study was to calculate suicide age-adjusted rates in cancer patients by detailed race/ethnicity and compare it with similar rates in general population. Methods: 929,369 cases registered with the California Cancer Registry for the years 2000-2005 and 716 suicides in them were used to calculate the sex, and race/ethnicity specific age-adjusted rates. Suicide rates in general population was calculated from the California Death Certificate Master files for the same period and same race/ethnicity. Relative risks (RR) for stage at diagnosis, marital and socioeconomic status were also calculated. Results: Although 0.2 percent of all death among cancer patients was suicide, its RR in the non-Hispanic White men and women, and Hispanic men were 5.87, 4.99, and 8.05, respectively. Close to 50 percent of all suicides were completed in the first six months post diagnosis, and age specific rates in young patients was raised to form a “blip”. Men with cancers of the Esophagus, Stomach, Pancreas, Lung and Bronchus, Melanoma of the Skin, Prostate, Urinary Bladder, Kidney and Renal Pelvis, Non-Hodgkin Lymphoma, and those labeled as Miscellaneous had significantly higher RR. In women, the high RR was noticed only for patients with the breast and ovarian cancers. No significant association was found with the stage of diagnosis, marital, and socioeconomic status. Conclusions: Considering the multifactorial nature of suicide and the lack of association with severity of the disease, and some of the patients’ demographics, it is concluded that diagnosis of cancer acts as “precipitating” factor for suicide in patients who are already “suicidal”. Oncologists who diagnose and manage cancer cases need to include psychological evaluation in their routine to prevent it from happening.
A prospective observational study on chemotherapy-induced nausea and vomiting for esophageal cancer patients in Japan.
Authors: Sachiko Yamamoto, Ryu Ishihara, Naoya Yoshida, Hideaki Shimada, Tsuyoshi Noguchi, Tatsuya Miyazaki, Takaki Yoshikawa, Takushi Yasuda, Yasuaki Nakajima, Yuko Kitagawa, Hideo Baba, Keisuke Aiba
Journal: Journal of Clinical Oncology (2014)

135 Background: Chemotherapy-induced nausea and vomiting (CINV) is still one of the major problems in cancer treatment. However detailed profile of CINV in patients with esophageal cancer is not known. Prospective multi-center observational study was conducted to assess the current status of CINV in Japan. Methods: Between May 2011 and December 2012, 193 patients with esophageal cancer who underwent systemic chemotherapy with high (HEC) or moderate emetogenic agents (MEC) were registered. Antiemetic drugs (5-HT 3 receptor antagonists, dexamethasone and NK 1 receptor antagonist) were used to suppress CINV. Occurrence and severity of CINV were assessed with a diary provided to the patients prior to chemotherapy. Acute phase (within 24 hours from the start of chemotherapy) and late phase CINV (24 hours or later) were assessed separately. Multivariate logistic regression analysis was conducted to identify the predictive factors for acute and late phase CINV. Results: Of 193 patients 165 were male and 28 were female. Median age was 66 (range 40-84). HEC and MEC were administered in 180 and 13 patients, respectively. Acute phase nausea and vomiting were observed in 9 (4.7%) and 7 (3.6%) of 193 patients, respectively. Late-phase nausea and vomiting were observed in 75 (38.9%) and 18 (9.3%) of 193 patients, respectively. Risk factors for acute phase nausea, acute phase vomiting, late phase nausea and late-phase vomiting were assessed separately. By multivariate analysis for late-phase vomiting, younger age (Odds ratio 0.523 [every 10 years]; 95%CI 0.278-0.986; p=0.045) and male gender (Odds ratio 5.796; 95%CI 1.806-18.603; p=0.003) were independent predictive factors. By multivariate analyses for acute phase nausea, acute phase vomiting and late-phase nausea, no independent predictive factor was identified. Conclusions: Acute phase CINV was effectively suppressed by antiemetic drugs, while late phase CINV was not sufficiently suppressed. Further intervention to suppress late phase CINV should be considered, especially in high-risk patients. Clinical trial information: UMIN000005971.
Are PSA baseline levels an indicator for suitability of intermittent androgen deprivation in patients with PSA relapse after radical prostatectomy?
Authors: Ulf W. Tunn, Giorgio Canepa, Erika Kienle
Journal: Journal of Clinical Oncology (2013)

136 Background: Intermittent androgen deprivation (IAD) for prostate cancer patients is currently discussed as a treatment option to improve quality of life and to delay hormone resistance. So far only limited data are available indicating whether certain subgroups of patients with PSA relapse without local recurrence after radical prostatectomy are best suited for this therapy. Methods: In a prospective randomized phase III trial, men with unfavourable prognostic factors and a systemic PSA progression (PSA ≥ 1ng/ml) following an initial fall to &lt; 0.5 ng/ml within 3 months after radical prostatectomy were enrolled. They underwent a 6-months androgen deprivation (AD) induction phase with a microencapsulated leuprorelin acetate 3-month depot formulation plus an overlapping antiandrogen to prevent tumor flare-up. Achieving a PSA level &lt; 0.5 ng/ml, they were randomized to either an IAD treatment arm or to continuous AD. In the IAD arm, retreatment was started when PSA rose to ≥ 3 ng/ml. During Off-Treatment-Time (OTT) PSA and Testosterone were controlled on a monthly basis. Results: Analysis of the first IAD cycle, confined as induction phase + OTT, revealed two subgroups of patients with a cycle length ≤ 15 months (group 1) and ≥ 20 months (group 2) respectively. This was due to a significant difference in the time from testosterone normalization (≥ 2.3 ng/ml, TN) to an increased PSA-value ≥ 3 ng/ml. See Table. Conclusions: Our data show a significant (p=0.001) relationship of low PSA baseline levels to delayed biochemical PSA progression during OTT. Thus IAD might be most suitable for patients with low PSA baseline levels leading to a slow increase of PSA after TN during OTT, providing time to improve quality of life and delay potential hormone resistance. Further large scale studies will be necessary to confirm our findings. Clinical trial information: AP 06/95.[Table: see text]
Digital health application for real-time patient-reported outcomes during prostate radiotherapy.
Authors: Daniel Xiao Yang, Jackson Thea, Yi An, James B. Yu
Journal: Journal of Clinical Oncology (2016)

157 Background: The use of digital health technology, including mobile applications, in the clinical setting is becoming increasingly more prevalent. Such technology is currently being explored as clinical research tools. While the side effects of prostate radiotherapy are well documented after treatment, there remains a paucity of data on patient-reported outcomes and changes in quality of life (QOL) during the treatment period. Therefore, mobile applications represent a practical platform to enable patient reporting in real-time during prostate radiotherapy. Methods: Using an existing open source code framework (Apple ResearchKit), we developed a novel mobile application that enables prostate cancer patients to report, either during or immediately following daily radiation treatment, changes in urinary, bowel, sexual, and hormonal QOL domains. The mobile application utilizes validated questions from the Expanded Prostate Index Composite for Clinical Practice (EPIC-CP) Survey, and allows for survey responses to be tracked over time throughout the treatment period and at routine follow up. Results: For the initial phase of our study, we are currently piloting the mobile application at a single institution with a goal of accruing 50 patients. Study results will be compared to data from traditional surveys, which are available at follow-up but impracticable for real-time symptom reporting. By ASCO 2016 Genitourinary Cancers Symposium, we plan to begin the second phase of our study where any patient can enroll online through a mobile software distribution platform (Apple App Store). Conclusions: We demonstrate the feasibility of using a mobile application to enable patients to report quality of life changes in real-time during prostate radiotherapy. Moreover, our application facilitates clinical trials where patient data collection can be automated and completed at scale. Future prospective studies are planned to evaluate validity of clinical trial data gathered through such methodology.
Clinical outcome of gamma knife (GK) radiotherapy for central nervous system (CNS) metastases from renal cell carcinoma (RCC).
Authors: D. J. Seastone, P. Elson, J. A. Garcia, S. T. Chao, J. H. Suh, L. Angelov, B. I. Rini
Journal: Journal of Clinical Oncology (2011)

e15071 Background: Current treatment modalities for RCC CNS metastases include resection, GK and whole-brain radiotherapy. Existing series describing treatment outcomes include a mix of tumor types, and thus provide little insight into CNS metastasis response by tumor type. Although RCC has historically been considered radioresistant, GK is increasingly being applied to RCC CNS metastases. Methods: RCC pts with brain metastases treated with GK between 1996 and 2010 were retrospectively identified. Pt, GK and systemic therapy characteristics were recorded. Pts were followed radiographically at 30 days post GK and every 3-6 months thereafter with MRI scans. Local failure was defined as treated tumor progression after GK and distant failure was defined as new CNS metastases not in the GK field. Results: One hundred sixty-six patients were identified: 75% male, median age 60, 55% performance status 0, 21% received systemic therapy within 30 days of GK and 97% clear cell histology. Two hundred thirty-three GK procedures were performed on a total of 487 CNS lesions, most commonly in the frontal lobe (32%), parietal lobe (17%), cerebellum (12%), occipital lobe (11%) and temporal lobe (9%). The median interval from diagnosis of RCC to first GK was 20 months (range, 0.1-310). The majority of pts (65%) received a GK dose of 24 Gy with a mean of 1.8 targets per GK procedure. 76% of pts received 1 GK and 24% received multiple GK procedures. Considering all GK procedures, local control was 87%, with an additional 38% of patients having distant CNS failure. The median time to local or distant failure was 9.9 months (range, 5.9-12.9). Local control and failure-free interval of a second GK procedure was not different from the first GK procedure (p=.31, sign test). Potential predictors of CNS failure were examined, and only age >60 (p=.07) and number of targets > 2 (p=.09) approached significance. Prognostic variables, GK treatment characteristics or systemic targeted therapy within 30 days of GK did not predict for subsequent CNS relapse. Conclusions: GK is a common treatment modality for RCC CNS metastases, providing excellent local control and freedom from CNS relapse for several months.
Can we improve the quality of documented end-of-life conversations using a structured, multicomponent intervention?
Authors: Joanna Paladino, Joshua Lakin, Stephen Miranda, Jonathon Gass, Rachelle Bernacki, Luca Koritsanszsky, Jane Kavanagh, Marissa Palmor, Lisa Hirschhorn, Daniela Lamas, Justin Sanders, Bridget Neville, Stu Lipsitz, Susan Block
Journal: Journal of Clinical Oncology (2016)

49 Background: Conversations about serious illness care goals are often inadequate and fail to address key elements of high-quality discussions. Methods: As part of a cluster-randomized trial of a multi-component communication intervention, we conducted a retrospective chart review of 147 deceased oncology patients to assess frequency and timing of documentation of end-of-life (EOL) conversations; charts of a subset of 20 intervention and 20 matched control patients underwent detailed review to assess quality. A systematically developed abstraction tool was used by two blinded researchers. The tool contained 25 elements reflecting four EOL conversation domains: goals/values, illness understanding/prognosis, EOL care planning, life-sustaining treatments. Results: Of 153 intervention patients, 44.4% died (n = 68); of 161 controls, 49.1% died (n = 79). Significantly more intervention patients than controls (92.7% vs 74.7%, p = 0.006) had at least 1 documented EOL discussion before death; intervention conversations occurred 3 months earlier (median 147 days vs 62 days, p = 0.003). 59.4% of intervention conversations were documented in a retrievable EHR location compared to 10.2% of controls (p = 0.001). In the detailed review, 85% (n = 17) of intervention and 40% (n = 8) of controls had at least 1 documented discussion about values/goals (p = 0.0001), with an average of 3.6 of 8 elements (0.7 of 8 for controls) (p = 0.0003). 85% percent (n = 17) of intervention and 30% (n = 6) of controls had at least 1 documented discussion about prognosis (p = 0.0014), with an average of 2.5 of 7 elements (0.5 of 7 for controls) (p = 0.001). 85% of intervention (n = 17) and 55% of controls (n = 11) had at least 1 documented discussion about EOL planning (p = 0.009). 55% of intervention and 30% of controls had at least 1 documented discussion about life-sustaining treatments (p = 0.20). Conclusions: The intervention resulted in more, earlier and better documentation of serious illness care goals. Across 3 of 4 domains of quality, intervention patients had more detailed information about their EOL care preferences, demonstrating that the intervention results in more patient-centered, comprehensive discussions. Clinical trial information: NCT01786811.
International Comparison Study of Toxic Iron Assays in Patients with Iron Overload Disorders
Authors: Louise De Swart, Jan C.M. Hendriks, Lisa Van der Vorm, Ioav Z. Cabantchik, Patricia J. Evans, Eldad A. Hod, Gary M. Brittenham, Yael Furman, Mirian C.H. Janssen, Bart J Biemond, Marius A. MacKenzie, Vera E.J.M. Mattijssen, Raffaella Origa, Renzo Galanello, Robert C. Hider, Dorine W. Swinkels
Journal: Blood (2014)
Comparison of cancer drug access and funding in three Canadian provinces.
Authors: M. L. De Lemos, K. Boyce
Journal: Journal of Clinical Oncology (2011)

e16516 Background: Access to costly new cancer drug treatments is a problem in many countries. In Canada, health care funding is a provincial responsibility and there could be considerable variability in access to new cancer drugs across provinces. In March 2007, an interim national Joint Oncology Drug Review (JODR) process was implemented to promote more consistent approach to reviewing funding of new cancer drugs. We compared the formularies in Canadian provinces to see if there was a convergence of funding conditions for new cancer drugs. Methods: The funding status of cancer drug treatments licensed between 2007 and 2010 was obtained from the websites of the funding agencies and compared across three provinces: British Columbia (Systemic Therapy Program, BC Cancer Agency), Alberta (Outpatient Cancer Drug Benefit Program, Alberta Health Services), and Ontario (Cancer Care Ontario, Ontario Drug Benefit, Exceptional Access Program). These provinces collectively represented 86% of the population of the participating provinces of JODR and 63% of the Canadian population. Results: Of the 29 new cancer drug treatments identified, 23 of them were reviewed by the JODR. The number of funded new drug treatments seemed to be decreasing over the three fiscal years examined (Table). For example, 4 to 7 of the 11 new treatments were funded in 2007-08, only 2 to 4 of the 10 new treatments were funded in 2009-10. Overall, British Columbia appeared to have slightly more drugs funded during the same fiscal year as a new drug treatment received its licence. However, there seemed to be a convergence of the number of funded new treatments across the three provinces. For example, while during the 2007/08 fiscal year the highest number of funded treatments was 7 vs. the lowest at 4, this variability was much reduced in 2009-10 (highest 4, lowest 2). Conclusions: We found a continuing variability in funding new cancer drug treatments across three Canadian provinces, although this difference appeared to be decreasing over time. This convergence seemed to coincide with the inception of an interim national cancer drugs review process. Fiscal years No. of new treatments Brisith Columbia Alberta Ontario 2009-2010 10 4 2 3 2008-2009 8 6 4 5 2007-2008 11 7 5 4
Final skin toxicity (ST) and patient-reported outcomes (PRO) results from PRIME: A randomized phase III study of panitumumab (pmab) plus FOLFOX4 (CT) for first-line metastatic colorectal cancer (mCRC).
Authors: Jean Yves Douillard, Salvatore Siena, Josep Tabernero, Ronald L. Burkes, Mario Edmundo Barugel, Yves Humblet, David Cunningham, Feng Xu, Zhongyun Zhao, Roger Sidhu
Journal: Journal of Clinical Oncology (2012)

531^ Background: Final PRIME results showed that pmab + CT significantly improved progression-free survival (PFS) and objective response rate vs CT alone for first-line wild type (WT) KRAS mCRC. Efficacy and PRO by ST severity from the final descriptive analysis of PRIME are presented. Methods: Patients (pts) had no prior chemotherapy for mCRC, ECOG performance status ≤ 2, and tumor tissue available for biomarker testing. The final analysis occurred 30 months after the last pt was enrolled; the primary endpoint was PFS; secondary endpoints included OS, objective response, and safety. Pts who received treatment and were alive without progression at day 28 were included in the ST analysis. Results: 1183 pts were randomized. 1057 pts with WT or MT KRAS mCRC met the criteria for inclusion in the ST analysis. Maximum grade ST was observed by day 28 in &gt; 50% of pts. Results are shown ( table ). Overall differences in change from baseline of the least square means from a mixed effects model of the EQ-5D Overall Health Rating for pmab + CT (n = 285) minus CT alone (n = 294) and for ST gr 0-1 (n = 53) minus ST gr 2-4 (n = 232) were −1.069 (95% CI: −3.6277 to 1.4896) and 0.8971 (95% CI: ‐4.0224 to 5.8167), respectively. The overall safety profile was broadly comparable across ST groups and treatment arms. Conclusions: Pts with WT KRAS mCRC receiving pmab with ST gr 2-4 had longer PFS and OS vs pts receiving CT alone. PRO were not adversely affected by ST severity. [Table: see text]