tbuckley/cabot-search huggingface dataset:
Efficacy of acupuncture (ACU) therapy for cancer-related pain management in oncology patients (pts).
Authors: Jai Narendra Patel, Katherine Miller, James Thomas Symanowski, Connie Edelen
Journal: Journal of Clinical Oncology (2015)

196 Background: Cancer-related pain negatively affects symptom burden, morbidity, and mortality. Evidence suggests the use of ACU to relieve cancer-related pain. We investigated ACU efficacy and patient-specific factors associated with pain improvement. Methods: Medical charts were reviewed from oncology pts receiving ACU and concurrent palliative medicine management. Pre- and post-ACU pain scores, as assessed by the Edmonton Symptom Assessment Scale (ESAS), were measured at each session. Univariate logistic regression models, including an over-dispersion parameter to account for multiple observations per pt, were used to investigate the association between patient-specific variables (Table) and significant pain improvement, defined as a ≥ 2-point reduction in ESAS pain score, at each session. Results: A total of 122 ACU sessions from 53 pts were included in the analysis. Significant pain improvement was observed in 47% of all sessions (mean reduction 1.8). Baseline non-neuropathic pain was significantly associated with a higher odds of achieving pain reduction (OR 2.351; P = 0.047). Conversely, an opposite association was identified for baseline neuropathic pain (OR 0.421; P = 0.048). Age, stage, number of sessions and tumor type were not significantly associated with pain improvement, although several trends were noted (Table 1). Conclusions: ACU is an appropriate adjunct therapy for cancer-related pain, particularly for non-neuropathic pain. Larger studies to confirm patient-specific variables and further investigation into therapy related side effects will assist in determining a personalized approach to ACU therapy in the oncology population. [Table: see text]
Need for postradiotherapy neck dissection by tumor site and nodal stage for head and neck cancer.
Authors: J. Thariat, A. W. Ahamad, K. Ang, J. Myers, D. I. Rosenthal, B. S. Glisson, W. H. Morrison, R. S. Weber, P. Allen, A. S. Garden
Journal: Journal of Clinical Oncology (2010)

5517 Background: “Planned” neck dissection is controversial in node-positive patients whose primary head and neck squamous cell cancers (HNSCC) are treated by definitive radiotherapy ± chemotherapy. This analysis was undertaken to assess the risk of withholding planned neck dissection in patients who obtain a complete nodal response to irradiation, and to determine the benefit of a neck dissection in less than complete responders by tumor site. Methods: This single-institution retrospective study included 935 patients with T any N1-3M0 HNSCC of the oropharynx, larynx or hypopharynx without prior nodal surgery who presented between 1994 and 2004. Control rates were determined by the Kaplan-Meier Method, comparisons of rates with the log-rank test and prognostic factors by univariate and Cox analyses. Results: Half the patients achieved a clinical (using high-quality CT) complete nodal response. There were 12% neck failures after definitive radiotherapy. Those who had complete clinical resolution of all nodal disease had no planned neck surgery while the others underwent neck dissection or were either medically unfit, had continued toxicity or unresectable/progressive disease (n=92). There were 43 cases of isolated neck failure, of which 5% occurred in patients who had post-radiotherapy neck dissection and 6% in those who had none (p NS). In patients who had neck dissection, pathologic responses were highly associated with neck control and survival. Patients with hypopharyngeal N2 disease with nodes over 3 cm had significant failure rates even after complete nodal response. Conclusions: With 96% 5-year isolated neck control rate without neck dissection after complete response, there is little justification for systematic neck dissection. However, bulky neck disease might benefit from neck dissection in hypopharyngeal tumors even after complete response. The addition of a neck dissection resulted in higher neck control after partial response. However, viable tumor on pathology specimens did not have a clear advantage from a neck dissection. The identification of that subgroup that benefits from additional treatment remains a challenge. No significant financial relationships to disclose.
Uptake of aromatase inhibitors (AI) and trastuzumab (T) during the first 5 years after market introduction. A North American and European comparison
Authors: U. Wilking, B. Jonsson, N. Wilking, J. Bergh
Journal: Journal of Clinical Oncology (2008)

6536 Background: During the 1990s both 3rd generation AIs (anastrozole; A, exemestane; E and letrozole; L) as well as T got their first global approval in metastatic breast cancer/MBC (A in 1995; E in 1999; L in 1996; T in 1998). Both AIs and T have later been approved for early breast cancer (EBC). The report focuses on similarities and differences in the usage during the first five years of use of the drugs in Europe and North America. Methods: Based on data from IMS Health, sales/uptake of AIs and T were studied in Denmark; DK, Germany; GE, Norway; NO, Sweden; SE, Switzerland; CH and the UK; UK, as well as in Canada; CA and USA; US. The uptake, measured as accumulated sales per capita during the first five years after first sale (market introduction) in each country, was related to number of deaths in breast cancer in 2001 in each country. Results: GE and CH had the fastest uptake of AI in Europe. DK had low uptake, while the other countries had relatively similar uptake. The US, SE and CH had the fastest uptake of T, while UK and NO were far below other countries. Conclusions: This study reveals very different patterns of uptake of new innovative breast cancer drugs, both between AIs and T and within the group of AIs. While US were relatively slow with the introduction of AIs, they were at the top with CH and SE with the introduction of T. Most remarkable is the slow introduction of T in UK and Norway. The US, GE, SE and CH were on top with respect to “investment” in new targeted drugs for breast cancer during 1996–2005. Sales in euros per patient dying of breast cancer of AIs and trastuzumab during the first 5 y anastrozole exemestane letrozole AI(A+E+L) trastuzumab AI/T AI+T US 3 923 2 050 1 987 7 960 21 108 0.38 29 067 CA 4 132 1 657 1 804 7 593 11 548 0.66 19 142 DK 535 1 428 2 940 4 903 12 119 0.40 17 022 GE 3 526 3 639 2 891 9 683 11 106 0.87 20 789 NO 4 387 2 990 802 8 179 8 671 0.94 18 337 SE 4 555 1 403 984 6 943 15 184 0.46 22 127 CH 2 810 3 073 4 663 10 546 21 770 0.48 32 316 UK 5 027 1 235 209 6 470 5 786 1.12 12 257 Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Pfizer, Roche AstraZeneca, Novartis, Roche
Outcome of adjuvant treatment in elderly Turkish breast cancer patients
Authors: M. Ekenel, G. Basaran, F. Dane, S. Iyikesici, F. Yumuk, S. Turhal
Journal: Journal of Clinical Oncology (2005)

896 Background: The number of elderly people is increasing due to improved public health and increased life expectancy. In this study we evaluated the tumor and patient characteristics of Turkish elderly breast cancer patients and their clinical outcomes after adjuvant therapy in our clinic. Methods: We retrospectively analyze the data of 69 patients aged ≥65 years old among a total of 412 breast cancer patients who are treated in our clinic since 1997. The parameters reported are histology, T size, nodal involment, type of surgery, hormone receptor status and type of adjuvant therapy received. Results: The median age was 69 (65–85) years and median follow up was 30 months. Histologically, 76% of elderly patients had invasive ductal carcinoma. The percentage of T1, T2, T3 and T4 tumors were 33%, 60%, 6%, and 1% respectively. Patients having lymph node involment were 56%. Estrogen and progesterone receptor status was positive in 40% and either one or both receptor was positive in 56% of patients. Breast conserving surgery was performed in 23% of patients. 39% of patients received hormonal therapy as primary adjuvant therapy. Rest of patients were treated with antracycline-based therapy (52%), taxane-based therapy (3%), cyclophosphomide-methotrexate-fluorouracil [CMF] therapy (6%) and tamoxifen according to their hormonal receptor status. Also 59% of the patients received adjuvant radiotherapy. Five patients developed distant metastases and 6 patients died during follow up. Only 1 patient expired due to pulmonary emboli. The 5-year disease free survival and overall survival for all patients were 88% and 87% respectively. Conclusions: Our outcome results in elderly patients are similar when data on patients younger than 65 years of age are analyzed in western studies. Taking into consideration of this finding, adjuvant therapies should be considered in management of elderly patients. No significant financial relationships to disclose.
Comparative effectiveness of cisplatin-based and carboplatin-based chemotherapy for treatment of advanced urothelial carcinoma.
Authors: M. D. Galsky, G. J. Chen, W. K. Oh, J. Bellmunt, B. J. Roth, R. Petrioli, L. Dogliotti, R. Dreicer, G. Sonpavde
Journal: Journal of Clinical Oncology (2011)

e15027 Background: Cisplatin-based chemotherapy is the first-line treatment standard for metastatic urothelial carcinoma, though carboplatin-based chemotherapy is frequently substituted for reasons of improved tolerability and ease of administration. Because comparative effectiveness in clinical outcomes of cisplatin- versus carboplatin-based chemotherapy is lacking, a meta-analysis of published randomized trials was performed. Methods: PubMed was searched for articles published in the English language from 1966 until 2010. Eligible studies included prospective randomized trials evaluating cisplatin- versus carboplatin-based regimens in patients with metastatic urothelial carcinoma. Individual patient data were not available and progression and survival data were inconsistently reported. Therefore, the analysis focused on overall (OR) and complete response (CR). The Mantel-Haenszel method was used for combining trials and calculating pooled risk ratios (RR). Results: A total of 286 patients with metastatic urothelial carcinoma from 4 randomized trials (3 phase 2 and 1 phase 3 trial) were included. Cisplatin-based chemotherapy was associated with a significantly higher likelihood of achieving a CR (RR = 3.54; 95% CI: 1.48, 8.49; p = 0.005) and OR (RR = 1.34; 95% CI: 1.04, 1.71; p=0.02). Survival endpoints could not be adequately assessed due to inconsistent reporting among trials. Conclusions: Cisplatin-based, as compared with carboplatin-based, combination chemotherapy significantly increases the likelihoods of both OR and CR in patients with metastatic urothelial carcinoma. The impact of improved response proportions on survival endpoints could not be assessed. In the absence of definitive phase 3 trials, these results lend further support to the use of cisplatin-based combination chemotherapy as the preferred first-line treatment of metastatic urothelial carcinoma.
Cancer versus non-cancer caregivers: An analysis of communication needs from the 2015 Caregivers in the U.S. study.
Authors: Erin E. Kent, Margaret Longacre, Lisa Weber-Raley, C. Grace Whiting, Gail Hunt
Journal: Journal of Clinical Oncology (2016)

4 Background: Informal caregiving for cancer patients can be both demanding and burdensome – physically, emotionally, and financially – for many caregivers. Cancer caregivers play a large role in advocating for and administering care for their recipients. The current study aimed to explore if cancer caregivers differ from non-cancer caregivers with regard to communicating with healthcare providers, and need for information about end-of-life care. Methods: Data were used from the 2015 Caregiving in the U.S. (CGUS) dataset, a nationally-representative online probability-based panel study of unpaid adult caregivers. The analysis compared cancer and non-cancer caregivers to determine similarities and differences in characteristics and experiences, with a focus on unmet needs in communication with healthcare providers and end-of-life decision-making. Statistical significance was determined at the p &lt; 0.05 level. Results: Approximately 7% (2.8 million) of caregiver participants in the CGUS study indicate cancer as the primary reason for providing care. Cancer caregivers report higher burden than non-cancer caregivers (62% vs. 38%) and significantly more hours per week caregiving (32.9 vs. 23.9 hours per week). Significantly more cancer caregivers indicate interacting with key providers, agencies, and professionals on behalf of their care recipients: 82% report communicating with healthcare professionals (vs. 62%), 76% monitor/adjust care (vs. 66%), and 62% report advocating for care recipient (vs. 49%). Finally, almost twice the number of cancer caregivers than non-cancer caregivers (40% vs. 21%) report needing more help/information with making end-of-life decisions. Conclusions: These findings indicate the burdensome and demanding role of cancer caregiving. These caregivers play a substantial role in directing, monitoring, and advocating for survivor care. Yet, many need more information about end-of-life care. This suggests a gap in preparation despite the roles provided, and suggest a need to explore strategies to engage patient-provider-caregiver communication about care, particularly end of life care.
The impact of primary Gleason grade on biochemical outcome following brachytherapy for Gleason score 7 prostate cancer
Authors: W. Butler, G. Merrick, K. Wallner, R. Galbreath, Z. Allen, E. Adamovich
Journal: Journal of Clinical Oncology (2005)

4699 Background: Although the perception exists that biochemical outcome in Gleason score 7 patients with dominant pattern 4 histology is inferior to Gleason 3+4 patients, conflicting conclusions have been reported for both radical prostatectomy. In this study, we evaluate the effect of the dominant histologic pattern in Gleason score 7 prostate cancer on biochemical progression-free survival following permanent prostate brachytherapy. Methods: Between April 1995 and October 2001, 273 consecutive hormone naïve patients underwent permanent interstitial brachytherapy for clinical T1c-T3a NxM0 (2002 AJCC) prostate cancer. No patient underwent seminal vesicle biopsy or pathologic lymph node staging. All patients underwent brachytherapy more than 3 years prior to analysis. The median follow-up was 4.4 years. Biochemical progression-free survival was defined by a PSA cutpoint ≤ 0.4 ng/mL after nadir or by the ASTRO consensus definition. Clinical, treatment and dosimetric parameters evaluated for biochemical progression-free survival included primary Gleason grade, clinical T-stage, pretreatment PSA, risk group, percent positive biopsies, perineural invasion, patient age, isotope, supplemental XRT, prostate volume, brachytherapy planning volume, the percent of the target volume receiving 100%, 150%, and 200% of the prescribed dose (V100/150/200), the minimum percent of the prescribed dose covering 90% of the target volume (D90), tobacco consumption, hypertension and diabetes. Results: The actuarial 8-year biochemical progression-free survival rate was 94.1% and 94.3% using a PSA cutpoint ≤ 0.4 ng/mL after nadir and the ASTRO consensus definition, respectively and a median posttreatment PSA of < 0.1 ng/mL. When stratified by the dominant histologic pattern, no statistical difference in outcome was noted for any of the evaluated parameters. Only pretreatment PSA and percent positive biopsies were statistically significant predictors of biochemical outcome. Conclusions: In hormone naïve Gleason score 7 patients, prostate brachytherapy results in a high probability of 8-year biochemical progression-free survival and is independent of Gleason 3+4 versus 4+3 histology. No significant financial relationships to disclose.
Impact of KRAS mutational status on clinical outcomes in patients receiving capecitabine based chemotherapy.
Authors: Nirit Yarom, Gillian Gresham, Nana Boame, Derek J. Jonker
Journal: Journal of Clinical Oncology (2013)

436 Background: Mutations affecting the KRAS gene are established predictive markers of outcome with anti–epithelial growth factor receptor antibodies in metastatic colorectal cancer (mCRC). The relevance of these markers for chemotherapy has not been established. This analysis was performed to assess the predictive impact of KRAS mutation status in patients receiving chemotherapy. Methods: KRAS mutational status was available for 223 patients treated for mCRC. Predictive analysis of mutational status by type of fluoropyrmidine the 1 st -line regimen contained (either capecitabine [C] based chemotherapy or infusional 5Fluorouracil [I-5Fu]) for clinical outcomes: progression-free survival (PFS), time to chemotherapy resistance (TTCR) and overall survival (OS). Results: KRAS mutations were observed in 43.5% of the patients. 165 patients received I-5Fu, 44 patients received C. KRAS mutation status (wild type [WT] v mutated [MT]) had no prognostic impact for OS (hazard ratio [HR], 0.81; CI, 0.69 to 1.1 p=0.17) for PFS (hazard ratio [HR], 0.87; CI, 0.66 to 1.14 p=0.3) and TTCR (hazard ratio [HR], 0.85; CI, 0.65to 1.12 p=0.26). C based 1 st -line chemotherapy vs. I- 5FU based was predictive of PFS (hazard ratio [HR], 0.52; CI, 0.37 to 0.74 p=0.0003) and TTCR (hazard ratio [HR], 0.54; CI, 0.38 to 0.75p=0.0005) and not of OS (hazard ratio [HR], 0.74; CI, 0.52 to 1.1 p=0.1). KRAS mutational status had predictive impact in patients receiving C based 1 st -line chemotherapy on OS (hazard ratio [HR], 0.47; CI, 0.23 to 0.948 p&lt;0.0001) TTCR (hazard ratio [HR], 0.49; CI, 0.25 to 0.97 p=0.0398) and was not predictive of PFS (hazard ratio [HR], 0.78; CI, 0.4 to 1.53 p=0.47) Conclusions: KRAS gene mutation status was predicitve for OS and for TTCR in patients who received C based 1 st -line chemotherapy.
Gene expression signatures of conventional prognostic factors in multiple myeloma
Authors: S. Kumar, S. V. Rajkumar, J. L. Haug, M. Shammas, C. Li, M. Q. Lacy, A. Dispenzieri, M. A. Gertz, T. E. Witzig, K. C. Anderson, N. Munshi
Journal: Journal of Clinical Oncology (2005)

6606 Background: Recent advances in Multiple Myeloma have led to identification of novel therapeutic targets and new agents highlighting the need for patient specific treatment plans. We have initiated molecular studies of MM plasma cells (PC) to correlate conventional prognostic factors with the genomic signature of MM PCs. Factors with high discriminatory value will allow clinicians to tailor therapy to the patient, decreasing toxicity and improving outcome. Methods: Gene expression profiling was performed on CD138 sorted PCs from 14 pts with newly diagnosed MM using the Affymetrix U133A platform. The data was analyzed using dChip software (V1.3). Results: We have identified differentially expressed genes with biological relevance that correlates with the important prognostic factors; plasma cell labeling index (PCLI), circulating PCs, LDH and β2 microglobulin. High PCLI was associated with upregulation of growth and proliferation related genes (IGFBP-7, WHSC1 [mapped to 4p16 and correlated with t(4;14)], TIMP1 [related with STAT3 phosphorylation] and down regulation of wnt5a, CD79a (MB1, member of Ig superfamily gene), NEDD9 (associated with β1 integrin signaling), BCR1 (B cell receptor signaling) and Lysosomal associated multispanning membrane protein 5 (described in MM progression). Increased number of circulating PCs was associated with modulation of adhesion-related and migration associated genes such as CD86, metastasis associated protein S100A4, galectin-1 (associated with β1 integrin), hsp27, glucosamine-6-sulfatase, NCAM1, and cyclin D1, among others. Similar analyses performed grouping patients according to LDH, β2 microglobulin also revealed differentially expressed genes that may have correlative significance.Conclusions: Identification of differentially expressed genes that correlates with MM-related prognostic factors can help understand the biological basis for these factors. Additionally, identification of non-overlapping discriminatory genes for individual prognostic factors can lead to development of focused arrays that can be used clinically for prognostication. Ongoing studies with additional patients as well as in vitro studies are underway to validate these results. No significant financial relationships to disclose.
Determining priority symptoms of women with recurrent ovarian cancers: A Gynecologic Oncology Group study.
Authors: Heidi AS Donovan, Lari B. Wenzel, Sandra Ward, Susan M. Sereika, Robert P. Edwards, Michael Spring, Catherine M Bender, Richard T. Penson, Teresa Hagan
Journal: Journal of Clinical Oncology (2016)

101 Background: The purpose of this study is to recommend a core set of priority symptoms to be assessed in research and clinical settings for women with recurrent ovarian cancers. Methods: We used baseline data of 497 women with recurrent ovarian, fallopian, or primary peritoneal cancer participating in a symptom management randomized clinical trial (GOG-0259) to identify a core index of patient-reported priority symptoms. We used the Symptom Representation Questionnaire to assess priority rankings of 28 symptoms based on four criteria: (1) symptom prevalence, (2) patient-reported symptom severity, (3) percentage of women identifying each symptom as one of top three symptoms “I would like to get better control over”, and (4) the association between symptom severity and functional wellbeing as measured by the Functional Assessment of Cancer Therapy - Ovarian. Final priority ranking included all symptoms that were ranked in the top 10 for any of the four criteria. Results: Of the original 28 symptoms, 19 were ranked in the top 10 for at least one criterion: fatigue, sleep disturbance, pain, anxiety, peripheral neuropathy, constipation, abdominal bloating, drowsiness, mood swings, memory problems, weight gain, nausea, sexual concerns, vomiting, hair loss, lymphedema, lack of appetite, shortness of breath, and depression. Fatigue, sleep disturbance, and pain were each ranked one of the top 10 symptoms for all four criteria. Anxiety, peripheral neuropathy, and constipation were each ranked in the top 10 for three of the 4 criteria. Conclusions: We propose a core index of 19 patient-reported symptoms to be systematically assessed among patients with recurrent ovarian cancer. These symptoms are common, severe, poorly managed, and/or interfere with survivors’ functioning and can be efficiently assessed in 1-2 minutes. Systematic assessment in clinical and research settings could advance understanding about the predictors and consequences of poorly managed symptoms and could lead to more proactive, personalized interventions to improve functional well-being in this at-risk patient population.