tbuckley/cabot-search huggingface dataset:
Minimizing wait time between chemotherapy and radiotherapy treatments.
Authors: James J. Sauerbaum, Gina DeMaio, Bradley Geiger, Regina Cunningham, Marianna Holmes, Amy Avellino, Roger B. Cohen, James M. Metz, Tracey L. Evans
Journal: Journal of Clinical Oncology (2012)

82 Background: Members of the scheduling teams at the Abramson Cancer Center observed prolonged delays between chemotherapy and radiation therapy treatments scheduled by staff from 2 independent departments leading to inconvenience for patients receiving concurrent chemo- and radiation therapy (CRpts). Methods: An analysis of baseline data over 6 weeks revealed that for 157 unique consecutive patients undergoing daily chemotherapy and radiation (a total of 353 encounters), the mean time between scheduled treatments was 122 minutes. For 39% of encounters the wait time was greater than 120 minutes. To improve the adjacency of chemotherapy and radiation appointments and to consistently reduce wait time between treatments to less than 120 minutes, we formed a Chemotherapy/Radiation Scheduling Task Force consisting of patient service representatives, practice managers, and physician and nurse advisors. We determined that CRpts should be scheduled using a “huddle” strategy whereby prospectively identified CRpts are simultaneously scheduled for both treatments in a coordinated manner. Identifying CRpts for coordinated scheduling was facilitated by the creation of a chemo-radiation scheduling inbox to which clinicians and support staff e-mail names of new CRpts in order to alert the scheduling team. Our two lead schedulers meet 2-3 times per week to coordinate patient schedules. A weekly scorecard of the wait times for CRpts patients is distributed via e-mail to the clinicians and support staff. Results: Over the past 6 months, we have used the huddle method for 80% of 986 consecutive CRpt encounters. Our average wait time for huddle-scheduled encounters has been reduced to 62.5 minutes with only 9% of encounters having wait times over 120 minutes. For non-huddle-scheduled encounters, the average wait time is 129 minutes with 57% having wait times over 120 minutes. Conclusions: Utilization of a huddle scheduling method has successfully reduced wait time for CRpts. Use of the huddle method continues to grow with staff training and awareness of the new process.
Cyclophosphamide Overcomes the Suppressive Effect of LenalidomideTherapy on Stem Cell Collection in Preparation for Autologous Stem Cell Transplantation for Multiple Myeloma.
Authors: Tomer Mark, David Jayabalan, Roger N. Pearse, Jessica Stern, Jessica Furst, April Rambo, John Harpel, Tsiporah Shore, Michael Schuster, John P. Leonard, Paul J. Christos, Morton Coleman, Ruben Niesvizky
Journal: Blood (2007)
Quality of life outcomes after neobladder and ileal conduit following cystectomy for bladder cancer using a validated bladder-specific instrument: A prospective multi-institutional study.
Authors: Jacques Irani, Gaunez Nicolas, Eric Huyghe, Morgan Roupret, Raphael Briffaux, Stephane Larre, Christian Pfister, Nicolas Mottet, Yann Neuzillet
Journal: Journal of Clinical Oncology (2016)

359 Background: Cystectomy followed by urinary diversion impacts significantly patients' quality of life. The aim of this study was to evaluate health-related quality of life of patients who had neobladder or ileal conduit. Methods: Eight centers participated in this prospective study that included consecutive patients. They had to complete the validated self-administered Bladder Cancer Index (BCI) and a Visual Analogic Score (VAS) preoperatively and at 6 and 12 months postoperatively. The primary outcome measure was the diversion satisfaction (VAS) at 12months. Results: Between May 2012 and November 2013 the study was proposed to 106 patients of whom 95 gave their informed consent and 71 completed their pre-operative questionnaires. No patient had neo-adjuvant chemotherapy. Patients' peri-operative characteristics by diversion procedure are reported in the table. Baseline urinary, bowel, sexual function, and body image were not different between both groups. At month 6, 58 patients completed their questionnaires (Ileal conduit 30; Neobladder 18) showing significant differences in favor of the neobladder group for body image, urinary pain (mostly because of stoma problems) and constipation, but on the other hand the ileal conduit group reported a better urinary control and less leaks (day and night). At month 12, 34 patients completed their questionnaires (Ileal conduit 19; Neobladder 15). The findings were similar to those of month 6. All patients reported a poor sexual life and the related lack of satisfaction. VAS assessing diversion overall satisfaction was not different between the groups at the 6 th and the 12 th month. Conclusions: Even if the results of this prospective non randomized study reflect partly the age difference between groups, they clearly show an advantage for the neobladder regarding body image and an advantage for ileal conduit regarding urinary control. In both groups, overall self-assessed satisfaction of the diversion was excellent. [Table: see text]
Subdural hematomas in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia receiving imatinib mesylate in conjunction with multi-agent chemotherapy.
Authors: S. B. Patel, I. Gojo, M. Tidwell, Y. Ning, X. F. Zhao, E. A. Sausville, M. R. Baer
Journal: Journal of Clinical Oncology (2011)

6579 Background: Imatinib mesylate (IM) and other tyrosine kinase inhibitors that inhibit BCR-ABL have revolutionized the treatment of chronic myelogenous leukemia and also improved Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) outcomes. BCR-ABL inhibitors are generally well tolerated, but both IM and dasatinib induce platelet dysfunction, which is of particular concern in the setting of thrombocytopenia in ALL patients. Three Ph+ ALL patients receiving IM in conjunction with systemic and intrathecal (IT) chemotherapy at the University of Maryland Greenebaum Cancer Center (UMGCC) developed subdural hematomas (SDH). We sought to define risk factors for SDH. Methods: Charts were reviewed for SDH risk factors, including thrombocytopenia, coagulopathy, lumbar punctures and meningeal leukemia, and SDH incidence was compared in Ph+ and Ph- ALL patients receiving multi-agent systemic and IT chemotherapy with and without IM, respectively, at UMGCC from 2007 through 2010. Results: Three Ph+ ALL patients developed SDH during treatment courses 1, 3, and 3, respectively. SDH was unilateral in two patients and bilateral in one. All were thrombocytopenic and had undergone repeated lumbar punctures, but none was coagulopathic nor had meningeal leukemia. SDH was treated with burr hole surgery in two patients, and conservatively in one. One patient died of resistant leukemia and one of post-transplant complications, while the third is alive and in remission 26 months after diagnosis and 22 months after SDH. SDH incidence was significantly higher in Ph+ compared to Ph- ALL patients receiving treatment with and without IM, respectively (3 of 10 vs. 0 of 22; p<0.05). Conclusions: Our data suggest that IM is a risk factor for SDH, likely due to IM-induced platelet dysfunction, and that patients with Ph+ ALL receiving IM, and likely dasatinib, in conjunction with systemic and IT chemotherapy may be at increased risk of SDH and should be closely monitored for subtle manifestations of this serious complication.
K-RAS codon 13 mutation in advanced colorectal cancer: A single-center retrospective study investigating prognostic outcomes and treatment strategies.
Authors: Vincenzo Dadduzio, Michele Basso, Maria Bensi, Silvia Cona, Eleonora Cerchiaro, Antonia Strippoli, Marco Campitiello, Sabrina Rossi, Armando Orlandi, Francesca Plastino, Maria Alessandra Calegari, Alessandra Cassano, Carlo Barone, Diana Semenova
Journal: Journal of Clinical Oncology (2015)

633 Background: Ras genes are markers of resistance to anti-EGFR therapies. Emerging evidences suggest that each mutation, independently from its predictive role of response/resistance to specific treatments, may be expression of different diseases with different biologic behaviours. We collected data of mCRC patients harbouring K-Ras codon 13 mutation to evaluate response to therapy, PFS and OS. Methods: We retrospectively collected data of advanced colorectal cancer patients harbouring K-Ras codon 13 mutation treated at our Institution between 2004 and 2014. Results: A total of n.33 K-Ras codon 13 mutated patients were analysed. N.24 patients (72,7%) had synchronous metastatic disease. None of the patients received anti-EGFR treatment, while n.25 patients received anti-VEGF agent bevacizumab in association to chemotherapy with fluoropirimidines plus oxaliplatin and/or irinotecan (n.21 as frontline therapy, n.4 in second line). ORR was 51,5% (17/33) on first-line therapy, 22,2% (6/27) on second-line therapy and 16,6% (2/12) on third-line therapy. Median PFS was 14,1 months after first-line therapy, 9,3 months after second-line therapy, 6,4 months after third-line therapy. Median OS was 35,5 months (events: 19/33). N.14 patients received metastases surgery with radical intent. OS in this population has not been reached yet at a median follow-up of 38 months, even though all patients had a relapse. OS among patients undergone to systemic only strategy was 31 months. Conclusions: At our knowledge, this is the first report suggesting a favourable prognosis for K-ras codon 13 mutated patients, with a median overall survival even superior to pan-RAS wild-type patients. Indeed, the high percentage of advanced patients at diagnosis (72.7%), the high responsiveness to chemotherapy even in third line, the high percentage of patients converted to surgery (42.4%) in an unselected population, together with the high risk or relapse after surgery, suggest K-ras codon 13 mutated disease is probably a biologically aggressive disease. Nevertheless our data prompt that these patients may benefit aggressive strategies of treatment and multidisciplinary evaluation.
Phase II, open-label trial to assess the effect of continuous oral afatinib (BIBW 2992) at a daily dose of 50 mg on QTc, pharmacokinetics, and efficacy in relapsed or refractory solid tumors including brain metastases and glioblastoma that is not amenable to other therapy.
Authors: H. Kristeleit, M. Puglisi, G. W. Middleton, D. Propper, M. T. Kelleher, L. Trani, K. A. Denholm, G. Wallenstein, P. Stopfer, S. Buschke, M. M. Uttenreuther-Fischer, E. Bent, D. O'Brien, J. F. Spicer, L. R. Molife
Journal: Journal of Clinical Oncology (2011)

2613^ Background: Afatinib (BIBW 2992) is an oral, irreversible ErbB family blocker. This trial prospectively evaluated the possible proarrhythmic potential of afatinib by assessing QTc interval, as well as its PK and clinical efficacy. Methods: Patients (pts) with tumors known to overexpress EGFR or HER2, including those with brain metastases and GBM were eligible for treatment with daily afatinib 50mg. Pts with a QTcF-interval >470 ms, a PR-interval >230 ms, a QRS-interval >120 ms and ST-segment and T/U-wave abnormalities at screening, as assessed by central cardiology review, were excluded. 60 pts were treated. Time-matched 24-h ECGs were performed prior to drug exposure, after single dose and at steady state. Pharmacokinetic (PK) samples were drawn on days coincident with ECGs. Results: 49 of 60 pts were analyzed for the QTcF. The largest mean time matched QTcF change from baseline to Day 14 was 1.6 ms (90% CI –2.1, 5.2) at 1 h post dosing. The analysis of the relationship between the afatinib concentrations and time-matched QTcF changes from baseline revealed a statistically significant negative slope and a predicted negative QTcF change from baseline (90% CI -2.83, 2.55 ms). No relevant effect of afatinib on other cardiac intervals was detected. The overall AE profile was consistent with the known safety profile of afatinib. The median tmax value for afatinib was approximately 3 h after a single dose (Day 1) and at steady state (Day 14). The gMean accumulation ratio was 2.05 based on Cmax values and 2.67 based on AUC values. Efficacy was assessed in 60 pts including NSCLC (35%), breast cancer (10%), GBM (7%) & GI tumors (32%). Two pts had brain metastases. 42% of the pts received > 4 treatment cycles, 18% > 6 cycles, and one pt 19 cycles. Conclusions: Afatinib at doses of 50 mg daily did not suggest any drug-induced QT/QTcF prolonging effects compared with baseline. Afatinib showed clinical efficacy in this patient population.
Attitude and support to inform clinical predictions of survival in patients with advanced cancer.
Authors: Alysa M. Fairchild, David L Ma, Kim Paulson, Sunita Ghosh, Bronwen LeGuerrier, Karen P Chu, Diane Severin, Fleur Huang, Sharon Watanabe, Ann Huot, John Amanie, Samir Patel, Tirath Nijjar, Ericka Wiebe, Brita Lavender Danielson, Brock J Debenham
Journal: Journal of Clinical Oncology (2016)

39 Background: Tumour factors (eg primary site, size) helpful in prognostication in early stage cancer may be less important than patient factors, such as Karnofsky performance status (KPS), later in the disease trajectory. We evaluated the utilization of the parameters attitude (ATT) and psychosocial support (PSS) in predicting remaining lifespan by two experienced multidisciplinary teams (MDT). Methods: After clinical assessment of consecutive patients, a quantitative clinical prediction of survival (CPS) was made prospectively, independently and anonymously by each health care provider (HCP). HCP recorded up to 4 factors (free-text) influencing their CPS. The Palliative Radiation Oncology (06/2010-12/2014) and Palliative Care (06/2012-01/2014) teams participated. Demographics, disease information, and date of death were abstracted. Summary statistics (means, standard deviations, and proportions) were calculated. Estimates for actual survival (AS) were obtained. Wilcoxon tests compared continuous variables and chi-square tests were used for categorical variables. Results: 2,582 predictions were made by 11 disciplines for 881 unique patients over 1,054 clinic visits. Median age was 66 years, 58.6% were male and 37.3% had lung cancer. KPS, when recorded, was ≥ 70 at 46.3% of visits. Cognitive status was below expected for 174/460 visits. Mean AS was 177 ± 190 days and mean CPS was 258 ± 300 days. The median number of factors cited was 4 (range 0-4), with disease extent most common. ATT and PSS as perceived by the HCP influenced 6.7% and 5.8% of CPS respectively, varying across disciplines (p &lt; 0.0001). Overall, mean CPS was significantly longer when ATT (337d vs 252d; p &lt; 0.0001) or PSS (310d vs 254d; p &lt; 0.004) was quoted. CPS estimates by Nursing and Students were longer when ATT was mentioned (both p &lt; 0.004). Students’ CPS were longer when PSS was described (p = 0.048). Mean AS was also longer when ATT (259d vs 178d; p &lt; 0.0001) or PSS (224d vs 181d; p = 0.03) were cited overall, as well as within the Nursing, Student and Pharmacist groups (all p &lt; 0.05). Conclusions: Attitude and available psychosocial support as evaluated by MDT appeared to correlate with both clinical prediction of survival and actual survival in this cohort.
Survival by anatomic site, histologic type, and tumor stage in stomach and esophageal cancer patients from the U.S. SEER Cancer Registry.
Authors: L. Wang, L. Chu, M. Shing, W. Dong
Journal: Journal of Clinical Oncology (2011)

28 Background: Data on the association of tumor characteristics and survival for stomach cancer (SC) and esophageal cancer (EC) patients (pts) are limited. The objective of this study was to describe survival in United States. SC and EC pts by anatomic site, histologic type, and tumor stage. Methods: SC and EC pts were identified in the Surveillance, Epidemiology and End Results (SEER) Cancer Registry. SC was classified by anatomic site (cardia and non-cardia/other) and histologic type (intestinal, diffuse, other per Lauren criteria). EC was classified into anatomic site (middle/upper third, abdominal/lower third, overlapping lesions, NOS) and histologic type (adenocarcinoma (AC), squamous cell carcinoma (SQ), other). Frequency distribution and median survival were examined in these subgroups. Results: From 2004-2006, &gt;15,500 SC and &gt; 9,800 EC cases were diagnosed. SC: (29% cardia) and (24% diffuse, 66% intestinal, 10% other). Compared with non-cardia/other pts, cardia pts tended to be male (77% vs 56%), white (88% vs 66%), intestinal type (77% vs 61%) and present with earlier stage disease (stage I-IIIa: 48% vs 42%). With the exception of stage I/II pts, survival was longer in cardia than non-cardia/other pts. The difference was most striking in stage IIIb/IV pts (7 months (mos) cardia vs 4 mos non-cardia/other). Compared to intestinal type, diffuse type tended to be younger (median age: 64 vs 72 yrs), more female (49% vs 34%), and present with more stage IIIb/IV disease (50% vs 39%). No difference in survival by histologic type was observed when accounting for stage. EC: (26% middle/upper, 58% lower, 5% overlapping, 11% NOS) and (57% AC, 34% SQ, 9% other). Among pts with AC histology 78% occurred in the lower third; in SQ most occurred in upper/middle third (56%). Compared to SQ, AC tended to be male (85% vs 63%), white (95% vs 67%), and present with stage IV disease (34% vs 25%). For all stages combined, survival was longer for AC pts (11 mos AC, 9 mos SQ, 4 mos other). This difference was most apparent among early stage (I-III) pts. Conclusions: Survival in SC and EC was associated with staging, anatomic and histologic subtypes. Quantifying this provides insights for the design and interpretation of clinical development programs. [Table: see text]
Intensive up-front treatment versus a sequential approach in advanced gastric cancer patients: Does first-line matter?
Authors: Alessandro Bittoni, Mario Scartozzi, Mirco Pistelli, Eva Galizia, Michela Del Prete, Riccardo Giampieri, Luca Faloppi, Maristella Bianconi, Elena Maccaroni, Stefano Cascinu
Journal: Journal of Clinical Oncology (2012)

e14663 Background: The definition of the standard chemotherapy regimen for advanced gastric cancer is still a matter of debate. A recent meta-analysis suggested that the addition of a third drug to a doublet regimen should be considered the state-of-the-art strategy to improve overall survival. Aim of our analysis was to retrospectively assess whether an intensive, three-drugs, front line approach could be comparable to a sequential (two-drugs front line then second line) in terms of RR (response rate), PFS (progression free survival) and OS (overall survival) in advanced gastric cancer patients. Methods: Patients with metastatic gastric cancer who have received a first-line combination chemotherapy with a two or three-drugs regimen were included in our analysis. We divided our patients into two groups, A and B, based on the first line chemotherapy administered (group A=three drugs; group B= two drugs). Results: A total of 390 patients were eligible for our analysis. 211 patients (54%) received three chemotherapeutic agents (group A) and 179 patients (46%) received a two drugs regimen as first-line combination chemotherapy (group B). The 2 groups of patients resulted comparable for all known prognostic factors of clinical relevance. RR for group A and B was 46.5% and 28%, respectively (p=0,0007), median PFS was 7.12 months in group A and 3.96 months in group B (p&lt;0,0001). No significantly difference resulted for the median OS of patients in the two groups (13 months for group A and 11.8 months for group B; p= 0.962). Conclusions: The addition of a third drug to a doublet chemotherapy regimen appeared more active in terms of response rate and PFS. However median OS resulted comparable. On this basis, a triplet regimen may represent an optimal choice, particularly when response and PFS are relevant treatment endpoints. Nevertheless the use of a sequential approach may also represent a reasonable strategy for patients unwilling or unable to undergo a more intensive treatment without compromising OS.
Understanding disparities and organisational variation in cancer patient experience: Lessons from the English National Cancer Patient Experience survey.
Authors: Georgios Lyratzopoulos, Catherine L Saunders, Silvia Mendonca, Gary Abel
Journal: Journal of Clinical Oncology (2014)

181 Background: Surveys of the experience of cancer patients are currently being introduced in several countries, including the U.S. and Canada. Insights to inform the development and use of such surveys can be acquired from the English Cancer Patient Experience Survey programme. Methods: Each of the three national surveys (2010, 2011/12 and 2012/13) had a responder sample of ~70,000 patients (response rate 64-67%) and included about 60 evaluative questions on all domains of experience, from cancer diagnosis to care after hospital treatment. Anonymous data were analysed, using appropriate logistic regression models for positive/negative experience outcomes, based on public reporting conventions. We illustrate a research programme using the survey data focusing on two questions. 1. Who are the patients at greater risk of a negative experience? 2. Does case-mix explain apparent variation between hospitals? Results: There was evidence of socio-demographic variation in cancer patient experience, consistently across questions: younger and very old patients, ethnic minorities, and women reported poorer experience. Regarding variation between patients with 36 common and rarer tumours, those with hepato-biliary and thyroid cancers were most likely to be less satisfied with their overall experience, whereas patients with breast cancer were least likely (top-to-bottom odds ratio 3.7, p&lt;0.0001). There were disparities in experience between patients treated by the same specialty for 5/9 services (p&lt;0.0001). For example, patients with ovarian, multiple myeloma, anal and renal cancer reported worse experiences than patients with other gynaecological, haematological and urological malignancies, respectively. There was high concordance between crude and adjusted ranks of hospital scores (median Kendall's τ=0.84; interquartile range: 0.82-0.88). Conclusions: Initiatives to improve cancer patient experience may be suitably targeted on patients at higher risk of poorer experience. Evidence about disparities in experience and the effect of case-mix provide useful priors to motivate similar inquiries in other healthcare settings.