tbuckley/cabot-search huggingface dataset:
Implementation of a new patient health questionnaire into standard practice in outpatient cancer clinics to improve patient care and quality of treatment.
Authors: Kathryn Estey, Catherine Brown, Andrea Perez-Cosio, Gursharan Gill, Mindy Liang, Geoffrey Liu
Journal: Journal of Clinical Oncology (2016)

214 Background: Patient socio-demographic, lifestyle, and risk factor information at the Princess Margaret Cancer Centre (PM) is routinely collected for clinical purposes. The only standardized patient information presently being gathered in the outpatient cancer clinics at the PM is symptom management data, which is linked directly into the electronic medical records. Collecting and recording additional data can improve the quality of patient care, help identify risk factors, and guide treatment options. Our aim was to determine the feasibility of collecting this additional information in a clinical setting. Methods: This pilot cohort study was implemented in the thoracic outpatient oncology clinic at the PM. It involved developing a questionnaire utilizing literature sources, expert review, and pilot testing. Adult cancer patients completed the questionnaire and a complementary acceptability survey during their first clinic visit. Results: 170 patients with thoracic tumours, primarily lung cancer, took part in the feasibility study. Of these, 51% were female, 67% were Caucasian, and the median age was 65 (range 32 to 88) years old. The acceptability survey demonstrated that: 76% of respondents found that the questionnaire did not make their clinic visit more difficult, 68% found that it asked the right questions, 79% thought the questionnaire contained pertinent information for their doctor and other healthcare providers to know, and 51% found that it was time consuming to complete. Conclusions: This study determined that it is feasible to implement a standardized questionnaire that gathers patient socio-demographic, lifestyle, and risk factor information in routine clinical cancer care. Since half of the study population found the questionnaire time consuming to complete it should be administered prior to patient visits, in an electronic format, and with greater explanation/education. The next phase is converting the questionnaire into an electronic version, which aligns with the preferences of study participants and will allow the information to be more easily accessible by clinicians/researchers.
Novel use of MR spectroscopy in detecting CSF lactate for diagnosis of neoplastic meningitis.
Authors: C. L. Weston, O. Zalatimo, J. Sheehan, R. Harbaugh, D. A. Bota, A. Shedden, M. J. Glantz
Journal: Journal of Clinical Oncology (2011)

2071 Background: Neoplastic meningitis is a devastating and increasingly frequent complication of solid tumor, hematologic, and primary brain cancers. Early diagnosis and intervention may prevent neurologic morbidity and prolong survival, but is hampered by the poor sensitivity (40-60%) of CSF cytology, the current diagnostic gold standard. Methods: A retrospective chart and imaging review was performed on 21 patients with known cancer and suspected neoplastic meningitis who underwent ventricular MRS. For each patient, basic demographic data, tumor histology, conventional MRI, CSF cytology, and CSF laboratory results, type of tumor-directed therapy, clinical and cytologic response, and survival were collected. Ventricular MRS was reviewed by an independent neuro-radiologist blinded to clinical, CSF cytology and conventional MRI imaging results. Results: 71% patients were male. Median age was 65 (range 37-79). Tumor types included glioblastoma (7), DLBCL (3), Melanoma (3), breast, SCLC, NSCLC, renal cancer, rectal cancer (1 each) and other (3). CSF lactate by MRS had a sensitivity of 93% a specificity of 71%, a positive likelihood ration (LR +) of 3.3 a negative LR of 0.1, and substantial agreement (kappa = 0.67) compared with CSF cytology. One patient with a false positive ventricular MRS result developed a positive CSF cytology three weeks after ventricular MRS. If this patient was considered a true positive MRS result, the sensitivity (93%), specificity (83%), LR+ (5.6) LR- (0.08), and kappa statistic (0.77) all improve. If 19% of patients with cancer who develop a new neurologic finding actually have neoplastic meningitis (Glass 1979), a positive MRS result increases this likelihood to 57% while a negative MRS decreases this likelihood to 1.8%. Conclusions: Measurement of the ventricular lactate level in cancer patients using MRS is a sensitive and non-invasive diagnostic technique which may supplement or even supplant CSF cytology, and may be particularly valuable as a screening tool in patients at high risk for developing neoplastic meningitis (for example, patients with ALL, high-risk NHL, and triple negative breast cancer).
Patient and oncologist discussions of treatment costs.
Authors: Lauren M. Hamel, Susan Eggly, Louis Penner, Robert Chapman, Justin Frank Antoni Klamerus, Terrance Lynn Albrecht
Journal: Journal of Clinical Oncology (2016)

178 Background: Financial toxicity–the burden of treatment costs and its impact on well-being, treatment decisions, and outcomes—affects many cancer patients, especially racial minorities. Discussing cost during clinic visits may ease financial toxicity, but oncologists are often hesitant to discuss cost. A better understanding of cost discussions is needed to improve care and inform oncologist training interventions. We conducted an observational study of patient-oncologist treatment cost discussions during clinic visits. Methods: Data were video-recorded clinic visits of African American patients (114) and their medical oncologists (19) meeting for the first time to discuss treatment. Cost discussions were any verbal expression of a direct (paying for scans) or indirect (time off work) expense to the patient for treatment. Trained coders observed the videos and coded for presence, duration, initiation, topic, oncologist response, and patient reaction of cost discussions. Results: Cost discussions occurred in 44% (n = 50) of the visits with a range of 1-6 per visit for a total of 93 discussions (M = 35 seconds; SD = 28). Patients initiated (61%) more than oncologists (38%), and patients were more likely to initiate multiple times. Time off work was discussed most (48%), followed by insurance (26%), transportation (12%), paying for treatment (8%), and job loss (4%). Time off work was the most commonly patient initiated topic and insurance was the most commonly oncologist initiated topic. Oncologists typically addressed the issue (72%), and patients often reacted positively (81%) but passively. A few times (9%) the oncologist acknowledged the patient’s initiation but did not address it. Negative patient reactions were rare and only occurred when the oncologist responded to a patient initiation (5%). Younger patients were more likely discuss cost than older patients (p = .02) and retired patients were less likely to discuss cost (p = .05). Conclusions: Findings suggest discussing indirect cost is important to patients, but oncologists infrequently initiate and do not always respond adequately when patients initiate. Further research and interventions are needed to address patient-oncologist cost discussions and the economic impact of cancer treatment.
The prognositc value of lymphopenia in advanced gastric cancer.
Authors: S. M. Lim, Y. R. Kim, J. S. Park, H. S. Park, J. Y. Lim, J. Y. Cho
Journal: Journal of Clinical Oncology (2011)

e14500 Background: Although a few histologic and biologic markers in advanced cancers are suggested to predict overall survival, the prognostic marker of stage IV AGC is unknown. While lymphopenia is known to be a prognostic marker in advanced sarcoma and non-Hodgkin lymphoma, its role in AGC has not been elucidated. There are some theories that low absolute lymphocyte count (ALC) may be associated with immune status or consequence of lympholytic cytokines produced by the lymphoma cells. Thus, we studied the role of ALC at diagnosis with clinical outcome in stage IV AGC. Methods: We analyzed the prognostic value of ALC in 129 patients diagnosed with advanced gastric cancer. The median age of 54 (range 24-86) years. Median ALC at the time of diagnosis was 1670 (range 309-12,340/μL). Patients were divided into two groups according to ALC count 1,500/μL. The median ALC level was 1,090/μL (range, 300-1,480/μL) in the low ALC group (N = 50) and 2,220/μL (range, 1,530-12,340/μL) in high ALC group (N=79). Lymphopenia was not statistically different from any clinical variables such as gender, age, histologic subtype and metastatic sites. Median follow-up duration was 12 months (range 0.2-75.6 months). Results: Overall survival was higher in patients with ALC >1,500/μL compared to those with ALC < 1,500/μL (median OS: 16.2 months vs 8.1 months, p=0.008). In the univariate analysis, bone metastasis and peritoneal metastasis were associated with overall survival (p<0.001, p<0.002, respectively). The median ALC was low in patients with bone metastasis compared with no metastasis patients (1,385/μL (309-2,330/μL) vs 1840/μL (620-12,340/μL), p=0.034). In the multivariate analysis, low ALC was an independent poor prognostic factor for overall survival (p = 0.046, 95% CI, 1.170-2.573) (Hazard Ratio 1.7, 95% confidence intervals 1.1?2.5; p<0.007), along with bone (HR 3.57, 95% CI 1.89-6.75 p < 0.001) and peritoneal metastasis (HR 1.68, 95% CI 1.12-2.5 p < 0.001). Conclusions: This study suggests that low ALC is an independent prognostic factor of overall survival in patients with stage IV AGC. As lymphopenia is associated with bone metastasis, we suggest AGC patients with low ALC count undergo skeletal survey.
HIF-1 alpha expression as a predictor of bevacizumab efficacy in metastatic colorectal cancer.
Authors: Giorgia Marisi, Paola Ulivi, Emanuela Scarpi, Alessandro Passardi, Giovanni Luca Frassineti, Martina Valgiusti, Wainer Zoli, Dino Amadori
Journal: Journal of Clinical Oncology (2015)

601 Background: Assome controversies exist regarding the efficacy of bevacizumab (B) for the treatment of metastatic colorectal cancer (mCRC), novel predictive biomarkers are needed to improve patient selection and optimize the use of this agent. We analyzed the potential usefulness of five circulating biomarkers as predictors of B efficacy and in monitoring the disease. Methods: Peripheral blood samples collected at different times (baseline, first clinical evaluation and disease progression) were available for 62 of the 376 patients enrolled in the prospective multicentric ITACa trial (NCT01878422) and randomized to receive FOLFOX4/FOLFIRI (CT) with or without B. Thirty-one of the 62 patients received CT plus B and31 received CT only (control group). All patients were evaluated for response according to RECIST criteria. mRNA was isolated and used for gene expression analysis of HIF-1α, COX2, VEGF-A, EPHB4 and eNOS by a quantitative RT-PCR method. Baseline expression levels of the markers and their modulation during therapy were correlated with objective response (OR) (median test), progression-free (PFS) and overall survival (OS) (Cox proportional hazards model). Potential predictive markers were identified using a treatment-by-marker interaction term in the Cox model. Results: Non-responders (stable and progressive disease) had a median baseline HIF-1α expression significantly higher than responders (complete and partial response) (1.70 vs. 0.94; IQR 1.05-2.32 vs. 0.70-1.12) (p=0.016) in the B-treated group only. In univariate analysis, the high HIF-1α levels of this group were significantly associated with a shorter PFS (HR=1.96, 95% CI 1.17-3.30) (p=0.011) but not with OS. The HIF-1α-treatment interaction was p=0.088. No significant association was found between the other 4 genes and OR, PFS or OS. The results obtained on the modulation of gene expression during treatment are currently being analyzed. Conclusions: Our preliminary datasuggest that high pre-treatment HIF-1α expression levels could represent a predictive biomarker of resistance to bevacizumab. Partially funded by Roche S.p.A. and the Italian Medicines Agency (AIFA).
Genetic polymorphisms by race/ethnicity among colon cancer patients in Los Angeles County.
Authors: Wendy Lee, Marjun Philip Duldulao, Rebecca A. Nelson, Xiaoming Shen, Wenyan Li, Jianming Lu, Julio Garcia-Aguilar, Joseph Kim
Journal: Journal of Clinical Oncology (2012)

492 Background: Though disparate outcomes in colon cancer may be multifactorial, racial/ethnic disparities persist despite adjusting for these factors. Genetic alterations, including single-nucleotide polymorphisms (SNPs), have been shown to predict treatment response in colorectal cancer. Here, we evaluate the variability of genetic alterations in colon cancer patients by examining SNPs in major racial/ethnic groups. Methods: We obtained 76 normal tissue specimens from colon cancer patients of different race/ethnicity at our institution. DNA was extracted and analyzed for 6 SNPs (MTHFR 677C&gt;T, XRCC1 685C&gt;T, XRCC1 1301G&gt;A, XPD 2282A&gt;C, TP53 215G&gt;C, and CCND1 870G&gt;A) by polymerase chain reaction and direct sequencing. Prevalence of each allelic combination was compared between groups by the chi-square test. Results: Archived colon cancer tissues were obtained from whites, blacks, Hispanics and Asians (n=19 per group). From genotyping, we identified statistically significant differences in prevalence of CCND1 870G&gt;A between groups ( Table , p=0.0428). Specifically, whites and Asians had significantly higher prevalence of CCND1 870G&gt;A than blacks and Hispanics (100% and 94%, vs. 68% and 79%, respectively). Furthermore, whites and Asians were more frequently heterozygous (G/A) for the SNP (89% in both), whereas Hispanics comprised the largest proportion (16%) of patients homozygous for CCND1 870G&gt;A. Overall, the allelic frequency of CCND1 870G&gt;A varied among the racial/ethnic groups. Other SNPs in treatment-related pathways were evaluated, but there was no difference in prevalence of the other 5 SNPs between groups. Conclusions: Our findings demonstrate that detection of specific genetic polymorphisms differs between the major racial/ethnic groups with colon cancer. Differences in the prevalence of CCND1 870G&gt;A, which affects cell-cycle progression, suggests a potential mechanism for disparities in cancer susceptibility and progression. Therefore, identification of such genetic variability may support a genetic basis for racial disparities in cancer outcomes. [Table: see text]
Prediction of efficacy and toxicity of post-operative adjuvant chemotherapy for colorectal carcinoma according to PBMC-DPD activity
Authors: S. Yoshihisa, T. Kato, S. Onoue, M. Suzuki
Journal: Journal of Clinical Oncology (2005)

3606 We measured dihydropyrimidine dehydrogenase (DPD) activity in peripheral blood mononuclear cells (PBMC), as well as thymidylate synthase (TS) and DPD activity in tissue, in 209 patients with colorectal carcinoma, for the purpose of using PBMC-DPD activity to predict the efficacy and toxicity of postoperative adjuvant chemotherapy. PBMC-DPD and tissue DPD activity were measured by catalytic assay, and tissue TS activity was measured by binding assay. The average value for PBMC-DPD activity was 217.4 pmol/mg/min (range 17.0–795.1). There was no correlation between PBMC-DPD, tissue TS or tissue DPD activity and the clinical stage of the disease, nor was there any correlation between PBMC-DPD activity and tissue TS or DPD activity. Of the 209 patients, 87 underwent adjuvant chemotherapy with fluoropyrimidines. Side effects including vomiting, stomatitis, and diarrhea were observed in eight of these 87 patients (9.2%), but these were all at grade 2 or below. There was no correlation between the type and grade of side effect and PBMC-DPD activity. Among patients who underwent adjuvant chemotherapy, PBMC-DPD activity was significantly higher in those patients who experienced recurrence than in those who did not (p < 0.05). Taking the average value of 217 pmol/mg/min as a cutoff value, the prognosis for patients with a PBMC-DPD activity of greater than 217 pmol/mg/min was poor compared with that for patients with values below this figure, enabling the inefficacy of adjuvant chemotherapy to be predicted with a specificity of 74% (45/61), a sensitivity of 46% (12/26) and a predictable accuracy of 66% (57/87). Conclusion: These results suggest PBMC-DPD activity may be a predictor of the efficacy of postoperative adjuvant chemotherapy for colorectal carcinoma, and an indicator for drug selection. No significant financial relationships to disclose.
miR128 and LET-7 microRNAs as potential biomarkers for selection of patients with metastatic colorectal cancer candidate to cetuximab/panitumumab therapy.
Authors: L. Landi, F. Biagioni, V. Ludovini, A. Sacconi, A. Destro, G. Blandino, M. Roncalli, L. Crinò, F. Cappuzzo
Journal: Journal of Clinical Oncology (2011)

3636 Background: Monoclonal antibodies against epidermal growth factor receptor (EGFR) such as cetuximab and panitumumab demonstrated efficacy in metastatic colorectal cancer patients (mCRC) without mutations in the KRAS gene. MicroRNAs are a new class of non coding RNAs implicated in cancer biology, with miR128 and Let-7 family implicated respectively, in EGFR and KRAS regulation activity. Aim of the present study was to define whether miR128 and Let-7 levels affected response to cetuximab or panitumumab in mCRC. Methods: The study was conducted in a cohort of 89 mCRC treated with cetuximab/panitumumab either alone (N=7) or in combination with chemotherapy (N=82). Patients were analyzed for Let-7 and miR128 levels using Agilent’s miRNA platform. Results: Among the 89 patients included onto the study, miR128 and Let-7 levels were successfully performed in 78 cases. In the study population response rate (RR) was 21.8%, median progression free survival (PFS) 4.3 months and median survival (OS) 12.6 months. Compared to patients with high miR128 (N=43), individuals with low miR128 levels (N=35) had significantly lower RR (8.5% vs 32.5%, p= 0.05) , PFS (2.6 vs 5.2 months, HR= 0.42; p=0.02) and OS (8.1 vs 16.4 months, HR=0.36; p=0.02). High levels of Let-7 (N=40) associated with significantly longer PFS (5.6 vs 2.2 months, HR= 0.52; p=0.002) and OS (16.4 vs 8.4 months, HR= 0.47; p=0.03). In the group of patients with KRAS mutation ( N=32) low levels of miR128 were significantly associated with shorter PFS (1.8 vs 4.5 months, HR=0; p=0.02) and OS (5.8 vs 16.2 months, HR=0.36; p=0.04), while high Let-7 levels associated with longer PFS (3.3 vs 2.1 months, HR=0.33; p=0.11) and OS (16.2 vs 5.8 months, HR=0.36; p=0.04). In the KRAS wild type population (N=38) high Let-7 levels identified patients with higher probability to respond (odds ratio= 2.44), with the lowest risk of progression (HR=0.87) and death (HR=0.75). Conclusions: Our results suggest that miR128 and Let-7 are biomarkers potentially useful for selection of mCRC potentially candidate for anti-EGFR agents. A confirmatory study is ongoing. We thank AIRC Associazione Italiana Ricerca contro il Cancro for supporting the study.
Influence of rituximab (R) on survival of patients (pts) with grade 1 and 2 follicular lymphoma (FL 1-2) over the past three decades.
Authors: G. Bociek, F. R. Loberiza, P. J. Bierman, J. Vose, M. Bast, J. O. Armitage
Journal: Journal of Clinical Oncology (2011)

e18509 Background: Advanced stage FL 1-2 is considered incurable with conventional therapies. Randomized trials over the past decade have demonstrated a survival advantage associated with the use of R in combination with chemotherapy compared to chemotherapy alone. We performed an analysis of pts in the Nebraska Lymphoma Study Group database to evaluate the impact of the use of R on survival over the past three decades. Methods: All pts diagnosed with FL 1-2 between June 1981 and January 2008 were included. Patient and treatment related variables were collected for analyses. Treatment related variables included the use of radiation therapy, use of autologous stem cell transplantation (ASCT), and use of R. Pts were classified as having never received R (R-N), those who received R with salvage (R-S), and those who received R with initial therapy (R-I). Overall survival was calculated from the date of diagnosis to date of death from any cause. Univariate comparison of survival probability was conducted using Kaplan-Meier estimates with log rank testing. Multivariate analysis used the Cox proportional hazards regression to control for other prognostic factors. Results: The median duration of follow-up for survivors was 10 yr, 11 yr and 6 yr (R-N, R-S, R-I). The median age at diagnosis was 60, 53, and 52 yrs for these groups, respectively. The 5-year probability of survival for R-N, R-S, and R-I groups was 72%, 90%, ad 89% respectively (p<0.001 by log rank). In multivariate analysis, compared to R-N, R-S and R-I had a significantly lower risk of death (Hazard ratio [HR]; 95% confidence interval [CI] = 0.60; 0.41-0.89 for R-S and 0.33; 0.17-0.64 for R-I. The follicular lymphoma international prognostic index (FLIPI) score was also independently predictive of survival (HR; 95% CI =1.69; 1.11-2.58 for the intermediate risk group vs low, and 3.39; 2.31-4.96 for the high risk group vs low). Conclusions: In this analysis, pts in the Nebraska Lymphoma Study Group database with FL 1-2 treated with R had prolonged survival compared to those who never received R. This effect was independent of FLIPI score and the effect size was greatest for pts who received R starting with their initial therapy.
Timely management of febrile neutropenia in children with cancer.
Authors: Aditi Vedi, Richard Jules Cohn, Victoria Pennington, Matthew O'Meara, Kylie Stark, Paul Hunstead, Wendy Londal, Kirsten Adnum, Anne Senner, Lucy Maurice, Alan James
Journal: Journal of Clinical Oncology (2013)

220 Background: Sepsis is a major cause of morbidity and mortality in pediatric oncology patients, particularly during periods of neutropenia, which is a well-recognized complication of immunosuppressive therapy. The current international standard of care is recognized as rapid assessment and delivery of empiric antibiotics within one hour of onset of fever for all febrile and potentially neutropenic patients. Although pediatric oncology services are centralized to tertiary hospitals in Australia, peripheral referral centres regularly provide essential supportive care for this immunosuppressed group of patients close to home in a “shared-care” model. The objective of this study was to ensure delivery of empiric antibiotics to all children with fever and suspected neutropenia within one hour of presentation to tertiary and peripheral hospitals. Methods: The records of all oncology patients presenting to an emergency department over a 3-month period were reviewed and time to first antibiotic administration recorded. Potential causes of delay in commencement of antibiotics were identified through focus groups and a questionnaires involving patients, medical and nursing staff. These were evaluated to develop an algorithmic management guideline using current available consensus data, and the introduction of the practice change was supported by staff education. Follow-up data was collected at 12 and 60 months post intervention at the tertiary and peripheral hospitals. Results: The median time to empiric antibiotics was reduced from 180 minutes to 75 minutes at 12 months post intervention, and the results were sustained at 5 years, with the median time being 65 minutes. Conclusions: The introduction of the guideline has resulted in an improvement in practice, meeting international standards and sustained results at 5 years at both tertiary and peripheral hospitals. [Table: see text]