tbuckley/cabot-search huggingface dataset:
Implementing a patient-centered approach to immunotherapy treatment on an inpatient step-down unit.
Authors: Buenagracia Delacruz, Joylynn Mae Estrella, Elizabeth Reimschissel, Melissa Gonzalez, Joaquin Buitrago, Bindu Kuriakose, Tara Partee
Journal: Journal of Clinical Oncology (2017)

38 Background: Executing an innovative investigational therapy within a pre-existing infrastructure, while incorporating the organizational mission and vision is a complex process. Literature supports the use of patient-centered framework and integration of evidence in standardizing nursing practice to promote efficient workflow, accountability, and ultimately, optimal patient-care outcomes. The aim of this presentation is to describe the experience of a step-down unit at a comprehensive cancer center in developing and implementing processes to safely administer immunotherapy. Methods: A multidisciplinary workgroup reviewed the pre-existing infrastructure, determined the financial impact of new clinical trials and availability of resources, distinguished roles and stakeholder responsibilities, and developed staff education and technology utilization. A unit-prospective analysis, using the Strengths, Weaknesses, Opportunities, and Threats (SWOT) methodology was performed to assist in planning and reducing variations in processes during initial implementation. Results: This initiative resulted in the standardization of immunotherapy treatment workflow and development of patient care tools. The workflow consisted of patient education and treatment pathways, whereas the tools included the treatment calendar and nursing assessment forms comprised of daily handwriting sentence construction and CAR-T Toxicity (CARTOX) Grading Assessment. EHR collaboration resulted in the incorporation of CARTOX into nursing documentation in EMR. These workflow and tools are essential in ensuring timely assessment and management of treatment-related toxicities, escalation of care needs, and reduction of potential missed care and adverse events that impact staffing needs and health care costs. Conclusions: A patient-centered approach provides a framework in implementing innovative changes that promote patient safety. Engaging the frontline staff throughout the journey promoted empowerment and accountability. Multidisciplinary planning and nursing leadership transparency in orchestrating multi-level routines for actualization of competence proved immensely invaluable.
Treatment and outcome of hepatocellular carcinoma in renal transplant patients
Authors: F. Perazzo, E. Ridruejo, O. G. Mandó, M. Davalos, C. Diaz, A. Vilches
Journal: Journal of Clinical Oncology (2004)

4212 Background: Hepatocellular carcinoma (HCC) is a complication of chronic liver diseases and the incidence in the renal transplant (RT) population is higher than in the general population (1.4–4% vs. 0.01–0.05%). The natural history and outcome of treatment of HCC in this population are unknown. Methods: We retrospectively evaluated the incidence, the treatments performed and the outcome of HCC in the population transplanted in our center between January 1980 and December 1998 and followed up to August 2003. Results: During the study period 534 renal transplants were performed. We found 6 HCC (incidence 1.12% of the entire population and 2.29% of patients with chronic viral hepatitis), 5 were men, and all had chronic viral hepatitis: 3 HBV, 1 HCV and 2 had an HBV/HCV coinfection. HCC was diagnosed 124.1 (range, 45 to 244) months after transplantation. All patients presented abnormal liver function tests and tumors larger than 5 cm. Four had more than 3 tumors and 3 had an alpha-fetoprotein level higher than 400 IU/ml. Three patients received no treatment (CLIP score 5, 6 and 4; survival 1, 1 and 4 months respectively); in 2 patients chemoembolization was performed (CLIP score 3 and 2; survival 6 and 12 months respectively) and 1 received ethanol injections (CLIP score 2, survival 4 months). The overall survival was 4.5 months. Conclusions: HCC in RT patients is a common complication: the CLIP score adequately predicted prognosis; the outcome was poor, because HCC was detected in an advanced stage. Screening strategies for early diagnosis should be evaluated as different treatment modalities. No significant financial relationships to disclose.
National trends, outcomes, and costs of radiation therapy in the management of low- and high-intermediate risk endometrial carcinoma.
Authors: Rudy Sam Suidan, Weiguo He, Charlotte C. Sun, Hui Zhao, Grace L. Smith, Ann Klopp, Nicole D. Fleming, Karen H. Lu, Sharon Hermes Giordano, Larissa Meyer
Journal: Journal of Clinical Oncology (2017)

9 Background: Our objective was to assess treatment patterns, outcomes, and costs for women with low- (LIR) and high-intermediate risk endometrial cancer (HIR) who are treated with and without adjuvant radiotherapy (RT). Methods: All pts with endometrioid endometrial cancer who underwent surgery from 2000 – 2011 were identified from the SEER – Medicare database. LIR was defined as G1-2 tumors with &lt;50% myometrial invasion or G3 with no invasion. HIR was defined as G1-2 tumors with ≥50% or G3 with &lt;50% invasion. Pts were categorized according to whether they received adjuvant RT (vaginal brachytherapy [VBT], external beam radiotherapy [EBRT], or both) or no RT. All costs incurred up to 6 months postoperatively were analyzed. Outcomes were compared using the χ 2 test and a Cox PH regression model. Multivariate analyses were performed on both survival and costs. Results: 10,842 pts were included, of which 70% were LIR and 30% were HIR. 9% of pts with LIR had RT, compared to 46% of those with HIR. Among all pts who underwent RT, the use of VBT increased from 25% in 2000 to 71% in 2011, while EBRT use declined from 41% to 18%, and concurrent VBT/EBRT declined from 34% to 11% (p&lt;0.001). In the LIR group, there was no difference in 10-year overall survival (OS) between pts who had RT and those who did not (67% vs. 65%, multivariate HR 0.95, 95% CI 0.81 – 1.11). In the HIR group, pts who underwent RT had a significant increase in 10-year OS (60% vs. 47%, multivariate HR 0.75, 95% CI 0.67 – 0.85). Similar outcomes were noted on subgroup analysis stratifying by RT modality. RT was associated with an increased risk of gastrointestinal (7% vs. 4%, p&lt;0.001), genitourinary (2% vs. 1%, p&lt;0.001), and hematologic (16% vs. 12%, p&lt;0.001) 2-year complications. Compared to pts who only had surgery, RT was associated with increased mean adjusted costs ($22.5k vs. $14.4k, p&lt;0.001). Costs for pts receiving VBT, EBRT, and concurrent VBT/EBRT were $20.6k, $23.3k, and $26.5, respectively (p&lt;0.001). Conclusions: RT was associated with improved OS in women with HIR, but not in the LIR cohort. RT also had significantly increased costs and a higher morbidity risk. In the absence of other risk factors, consideration of observation without RT in LIR may be reasonable.
The oncology prognosis and informed consent: Presentation of a new model to best inform patients.
Authors: Benjamin Garmezy, Jennifer Blumenthal-Barby
Journal: Journal of Clinical Oncology (2017)

146 Background: Receiving a malignant diagnosis is challenging and patients must be properly informed of their prognosis to make the best decisions for themselves and their families. The general population has a low degree of statistical literacy and therefore approximations should be considered favorable. However, given that half of patients desire quantitative data, physicians must provide this information within a context that is relevant and comprehensible. Single-point median survival data is less meaningful for patient decision-making. What is preferable is that physicians give experience-based estimations on how a patient might compare to the ‘average’. Including this information leads to more informed consent and best follows the ethical principle of autonomy. Methods: This is a novel framework for providing a prognosis that builds upon the multiples-of-the-mean model established in 2010 by Kiely, Tattersall, and Stockler. This framework was derived from original ethics research involving patient preferences, statistical comprehension, healthcare communication, and medical decision-making. Results: Graphical representation of Kiely’s model provides an intelligible view of quantitative data and allows for the physician to include an experience-based estimation. Steps: (1) Draw a Horizontal line, (2) Calculate from median survival data by using five multiples: 0.25 (Worst-Case, 10% of patients), 0.5 (Lower-Typical, 25%), 1 (Median, 50%), 2 (Upper-Typical, 75%), and 3 (Best-Case, 90%), (3) Label the chart using simple time points in months or years (4) Draw a circle over the region that best represents the patient’s expectation, (5) Provide the diagram alongside easy-to-understand language that clarifies the meaning of the numerical data with written likelihood of the occurrence, such as “almost no chance”, “not likely”, “even chances”, “likely”, and “fairly confident”. Conclusions: Kiely’s model has proven an accurate estimation in colorectal, castration-resistant prostate, non-small-cell lung, and metastatic breast cancer. A graphical representation should provide physicians an easy tool to strengthen informed consent and better aid their patients in decision-making.
Tuberculosis notification rate decreases faster in residents of native origin than in residents of foreign origin in the EU/EEA, 2010 to 2015
Authors: V Hollo, J Beauté, C Ködmön, MJ van der Werf
Journal: Eurosurveillance (2017)

To estimate trends in tuberculosis (TB) notification rates by geographical origin, we retrieved surveillance data from 2010 to 2015 for 29 European Union and European Economic Area countries. The TB notification rate decreased at an annual rate of 5.3%. The decrease in notification rate was higher in native residents (7.0%) than in those of foreign origin (3.7%). Targeted screening and facilitated access to care and treatment could help prevent and control TB in migrants.
Relationship between survival and estrogen receptor (ER) status in pts with metastatic breast cancer (MBC) treated with capecitabine (C) and docetaxel (D): An exploratory data analysis
Authors: S. Gluck, C. Russell, J. O'Shaughnessy, G. Yuan, D. Odom, B. Sherrill, J. Blum
Journal: Journal of Clinical Oncology (2009)

1024 Background: Previous studies in pts with MBC have shown that women with ER+ tumors have a longer survival time compared to women with ER- tumors. An exploratory analysis was conducted to describe the relationship between survival and ER status among MBC pts treated with combination therapy consisting of C+D. Methods: This analysis used data from an open-label, randomized phase III trial of C+D vs D alone in pts with advanced and/or MBC. Survival analysis was used to investigate the effect of baseline ER status of the primary and metastatic tumors on overall survival (OS). ER status was defined as positive if positive for any tumor, negative if at least 1 negative test, otherwise unknown. Results: Among 506 intent-to-treat pts (randomized, received ≥1 dose), ER status was identified in 356. C+D: 90 ER+, 88 ER-; D alone: 95 ER+, 83 ER-. The unadjusted log-rank test showed a significant difference in OS between the C+D and D groups for ER+ but not ER- pts. In the ER+ group, median OS was longer in C+D vs D pts (538.5 vs 379.0 d) (hazard ratio [HR] 0.65; P=0.007). OS was significantly longer in ER+ vs ER- pts in the C+D group (538.5 vs 329.0 d) (HR 0.68; P=0.019) but not in the D group (379.0 vs 301.0 d) (HR 0.90; P=0.514). OS by time from diagnosis to recurrence and baseline tumor size showed no significant differences between ER+ and ER- pts. Conclusions: This exploratory analysis suggested a significant difference in OS between the C + D and D groups in ER+ (HR 0.65) but not ER- (HR 0.90) pts. Also, within the C+D group, the median OS was significantly longer in ER+ than ER- pts (HR 0.68). [Table: see text] [Table: see text]
The influence of intravenous amifostine on xerostomia and survival during radiotherapy for head and neck cancer: Two year follow-up of a prospective randomized trial
Authors: D. M. Brizel, T. Wasserman
Journal: Journal of Clinical Oncology (2004)

5536 Background: Amifostine (A, Ethyol) reduced radiotherapy (RT)-induced xerostomia without diminishing tumor control at 12 months in a prospective, randomized trial of patients receiving head and neck RT (Brizel et al, J Clin Oncol 2000;18:3339–45). The FDA approved A for protection against xerostomia based on that trial. We now evaluate follow-up data 12–24 months after RT to further assess both long-term radioprotective effects of A and tumor control. Methods: Adults with head and neck cancer who underwent once-daily fractionated RT for 5–7 weeks (total dose 50–70 Gy) received open-label intravenous A 200 mg/m2 15–30 minutes before each RT fraction (n=150) or no treatment before RT (control; C; n=153). Xerostomia, disease progression, and survival were assessed at 12, 18, and 24 months. Results: Minimum followup for all survivors is now 2 years. A continued to result in diminished xerostomia during the second year of follow-up (Table), based on incidence of RTOG Grade ≥2 xerostomia and proportion of patients with meaningful (>0.1 g) unstimulated saliva production. Patients reported less mouth dryness (P<.001) and greater mean benefit overall (P=.053) with A vs C on a Patient Benefit Questionnaire. Locoregional tumor control, progression-free survival, and overall survival were similar between groups (Table). Conclusions: Amifostine provides radioprotection from xerostomia that continues for at least 2 years without evidence of change in tumor control. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Medimmune Oncology, Inc. Medimmune Oncology, Inc. US Bioscience, Inc.
Correlation of selected molecular markers to in vitro chemo sensitivity of node-negative primary human breast cancer
Authors: U. Vogt, A. V. Assen, J. Packeisen, K. Gregorowicz, K. Bielawsk
Journal: Journal of Clinical Oncology (2004)

9667 Background: The present study explores the correlation of the erbB oncogenes family and c-myc average gene copy numbers (AGCN) determined by ddPCR, topoisomerase 2 alpha (topo2), PAI, erbB-2, uPA genes mRNA expression, determined by RT-PCR, and Her-2 protein expression (Hercept test) to the ex vivo chemo sensitivity of the tumor cells in four drug regimens: combination of epirubicin and cyclophosphamide (EC), mitoxantrone (Mit), combination of paclitaxel and epirubicin (ET), and docetaxel and epirubicin (EDoc). Methods: A group of 741 female primary breast cancer (BC) was assessed. Among them 442 patients were node-negative (N-) and 299 node-positive (N+). The cancer cell cultures were treated with EC, Mit, ET, and Edoc, each in six different drug concentrations in the modified ATP-CVA assay. AUC values were calculated using trapezoidal rule. Chemo sensitivity was defined as AUC of more then 18000. Results: No significant correlations were found between all studied parameters and chemo sensitivity to all tested drug combinations in the whole group of BC samples, regardless the nodal status. However, in the group of N- BC, PAI mRNA expression negatively correlates with chemo sensitivity to EDoc (Spearman rank test R=-0.39; p=0.005) and erbB-2 mRNA expression positively correlates to Mit (R=0.34; p=0.02) in the subgroup of estrogen/progesterone negative samples (tested by means of IHC). Conclusions: mRNA expression of PAI and erbB-2 may be important factors differentially related to adjuvant chemo responsiveness, at least in the node-negative and hormone receptors-negative BC patients. No significant financial relationships to disclose.
Demographic transition and the dynamics of measles in six provinces in China: A modeling study
Authors: Sheng Li, Chao Ma, Lixin Hao, Qiru Su, Zhijie An, Fubao Ma, Shuyun Xie, Aiqiang Xu, Yanyang Zhang, Zhengrong Ding, Hui Li, Lisa Cairns, Huaqing Wang, Huiming Luo, Ning Wang, Li Li, Matthew J. Ferrari
Journal: PLoS Medicine (2017)

Background Industrialization and demographic transition generate nonstationary dynamics in human populations that can affect the transmission and persistence of infectious diseases. Decades of increasing vaccination and development have led to dramatic declines in the global burden of measles, but the virus remains persistent in much of the world. Here we show that a combination of demographic transition, as a result of declining birth rates, and reduced measles prevalence, due to improved vaccination, has shifted the age distribution of susceptibility to measles throughout China. Methods and findings We fit a novel time-varying catalytic model to three decades of age-specific measles case reporting in six provinces in China to quantify the change in the age-specific force of infection for measles virus over time. We further quantified the impact of supplemental vaccination campaigns on the reduction of susceptible individuals. The force of infection of measles has declined dramatically (90%–97% reduction in transmission rate) in three industrialized eastern provinces during the last decade, driving a concomitant increase in both the relative proportion and absolute number of adult cases, while three central and western provinces exhibited dynamics consistent with endemic persistence (24%–73% reduction in transmission rate). The reduction in susceptible individuals due to supplemental vaccination campaigns is frequently below the nominal campaign coverage, likely because campaigns necessarily vaccinate those who may already be immune. The impact of these campaigns has significantly improved over time: campaigns prior to 2005 were estimated to have achieved less than 50% reductions in the proportion susceptible in the target age classes, but campaigns from 2005 onwards reduced the susceptible proportion by 32%–87%. A limitation of this study is that it relies on case surveillance, and thus inference may be biased by age-specific variation in measles reporting. Conclusions The age distribution of measles cases changes in response to both demographic and vaccination processes. Combining both processes in a novel catalytic model, we illustrate that age-specific incidence patterns reveal regional differences in the progress to measles elimination and the impact of vaccination controls in China. The shift in the age distribution of measles susceptibility in response to demographic and vaccination processes emphasizes the importance of progressive control strategies and measures to evaluate program success that anticipate and react to this transition in observed incidence.
Lymph node metastases in endocervical adenocarcinoma: Correlation with Silva pattern of invasion.
Authors: Joanne KL Rutgers, Richard J Zaino, Robert H Young, Brigitte M. Ronnett, Teri A. Longacre, Isabel Alvarado-Cabrero, Kay J. Park, Andres Roma, Kathryn Osann, Elvio Silva
Journal: Journal of Clinical Oncology (2013)

e16518 Background: Endocervical adenocarcinoma (EA) is the 2nd most common uterine cervical malignancy (after squamous cell carcinoma). Early stage tumors are defined by depth of invasion (DOI); although used to guide nodal dissection, DOI not an entirely reliable criteria, and most patients have negative nodes. Thus, pathologic criteria that better predict risk of nodal metastases are needed. A prior study of 352 cases from 12 US and international institutions, with complete pathological and clinical follow-up averaging 52 months, found classifying EA by a newly proposed ‘Silva Pattern of Invasion’ (SPI) is the best predictor of nodal metastases. SPI are defined as A: no destructive stromal invasion or lymph-vascular invasion (LVI); B: small foci (&lt;4 mm) of fragmented, angulated glands, solid aggregates or individual tumor cells associated with desmoplastia or LVI; and C: diffuse destructive invasion. Pattern A, 25% of cases, had no nodal metastases or recurrences. Approximately 25% were B, with 5% nodal metastases, 2% recurrence, and no tumor deaths. Pattern C cases: nodal metastases 23%, recurrences 21%, and death from tumor 9%. SPI appeared simple to diagnose, but a formal assessment of reproducibility is needed. Methods: Reproducibility for diagnosing SPI, and for the standard measurement of DOI is compared. Four Gynecological Pathologists, who have read the initial manuscript, but not involved in the original study nor from the participating institutions, and blinded to clinical information examine 1or 2 hematoxylin and eosin-stained glass slides from 90 cases from the original series. Results: 30 cases each of Pattern A, B, and C are reviewed. Kappa statistics will be estimated. With 90 samples, we will have &gt;80% power to detect a true kappa of 0.7 in a test of the null hypothesis that kappa = 0.5 vs the alternative that kappa≠0.5 with equal frequencies in each SPI category. Conclusions: A good reproducibility outcome would indicate that the SPI could be applied in general practice. Accurate use of SPI requires examination of the entire lesion unless pattern B or C is found in the biopsy specimen. Use of the SPI system to guide nodal dissection will require validation in a large series.
A meta-analysis of microsatellite instability and colorectal cancer prognosis
Authors: S. Popat, R. Hubner, R. S. Houlston
Journal: Journal of Clinical Oncology (2004)

9576 Background: A number of studies have investigated the relationship between microsatellite instability (MSI) and colorectal cancer (CRC) prognosis. Although many have reported an improved overall survival with MSI, estimates of the hazard ratio (HR) between studies differ. To derive a more precise estimate of the prognostic significance of MSI, we have reviewed published studies and carried out a meta-analysis of the published literature. Methods: Studies stratifying survival in CRC patients by MSI status were eligible for analysis. The principle outcome measure was the HR. Data from eligible studies were pooled using standard meta-analysis techniques. Results: Thirty-two eligible studies reported survival in a total of 7642 cases, including 1277 with MSI. Studies varied greatly in size (median 159, range 30–1000). There was no evidence of publication bias (p>0.1, Egger's test). MSI was associated with a better prognosis. The combined HR estimate for overall survival associated with MSI was 0.65 (95% CI: 0.59–0.71, heterogeneity p=0.16, I2=20%). This benefit was maintained restricting analyses to clinical trial patients (HR=0.69, 95% CI: 0.56–0.85) and patients with locally advanced CRC (HR=0.67, 95% CI: 0.58–0.78). In patients treated with adjuvant 5-fluorouracil (5FU) CRCs with MSI had a better prognosis (HR=0.72, 95% CI: 0.61–0.84). While data is limited, adjuvant 5FU showed a significant benefit in tumors without MSI (HR=0.72, 95% CI: 0.57–0.92), but no benefit in tumors with MSI (HR=1.24 95% CI: 0.72–2.14). Conclusions: CRCs with MSI have at least a 15% improved survival compared to those with intact mismatch repair. Additional studies are needed to further define the benefit of adjuvant chemotherapy in locally advanced tumors with the MSI phenotype. No significant financial relationships to disclose.