tbuckley/cabot-search huggingface dataset:
Early recognition and treatment of febrile neutropenia in a community hospital.
Authors: Therese M. Mulvey, Carme M. Tripp, Gina Camara, Elizabeth M. Blanchard
Journal: Journal of Clinical Oncology (2012)

90 Background: Febrile neutropenia (FN) is a medical emergency leading to significant morbidity if unrecognized. The use of G-CSF has made FN a less frequent presentation to community hospitals. Significant delays in antibiotic initiation were seen in our community hospital system. Antibiotic selection was variable and blood cultures were often not obtained prior to antibiotics. In November 2011, a FN program was initiated to increase recognition of patients at risk for FN, reduce time to antibiotic initiation, improve antibiotic selection using guideline driven antibiotic (GDA) selection, and decrease morbidity. Methods: A FN Card was developed providing a link to the hospital website detailing the approach to FN, obtaining blood cultures, and use of GDA for patients with or without venous access devices. Patients were educated to carry the card with them and present the card to the triage nurse on ER arrival if their home temperature was over 100.4F. A nurse driven protocol was developed for assessment, blood cultures, and early initiation of GDA and an educational program was provided to the ER staffs at all hospitals in our system. Results: In the 6 month lead up to the initiation of the FN program, 31 patients were identified with FN; 22 as the result of malignancy or therapy, 9 because of benign disease. The median time to antibiotics was 6.3 hours, no patient received GDA, and 32% had blood cultures performed. Three months after initiation of the program, 26 patients presented to the ERs over a 12-week period; 20 from malignant disease or its therapy, 6 from benign disease. Seven patients had received a FN card in clinic and 2 presented the card to the ER triage nurse. Median time to GDA was 2 hours and all 26 patients received GDA, 22 patients (85%) had blood cultures performed prior to GDA. Conclusions: A FN educational program including a FN Card linked to the hospital web site resulted in a significant increase in the number of patients recognized early presenting with FN, reduced time to antibiotic initiation, improved GDA selection and improved blood culture rates before GDA. Data regarding reducing morbidity are pending.
Predicting survival in resected pancreatic cancer: A Canadian provincial experience.
Authors: Gillian Gresham, Sylvia Ng, Anderson Chang, Shannon Valdez, Sharlene Gill
Journal: Journal of Clinical Oncology (2012)

361 Background: Surgical resection offers the only hope for long-term disease control in patients (pts) with pancreatic adenocarcinoma. Randomized trials (ESPAC 1, ESPAC3) further support a role for adjuvant chemotherapy (AC) in the management of pancreatic cancer (PC). Trial outcomes may not reflect clinical reality due to pt selection bias, and it is often difficult to predict which pts are most likely to benefit from adjuvant intervention. Methods: Consecutive pts between 2003 and 2008 referred to the BC Cancer Agency (BCCA) with operative intent at diagnosis (dx) were retrospectively reviewed. Results: 145 pts were identified; median age 65 years (y) (range 38-84), male/female (45.5%, 54.5%). EUS/PET staging was performed in 21% of pts. Median CA19-9 value at dx was 210 ku/L. Pancreaticoduodenectomy was performed in 65% of pts. Complete resection (RO) of tumours occurred in 87 pts (60%) overall. 66% of pts were node positive. 43% of pts were subsequently treated with adjuvant therapy (AT) where 5% of these pts received chemoradiotherapy and 95% received AC (65% gemcitabine). There was no statistically significant difference in either OS (p=0.39) or DFS (p=0.28) amongst resected pts who were treated by sx alone versus pts who received AC. In subgroup analysis, AC was associated with significantly improved OS in pts (n=58) with positive margins (R1) (median 17.3 mos vs 8.9 mos, p=0.0045) but benefit was not seen in R0 pts (n=87) (22.9 mos vs 22.4 mos, p=0.20). In multivariate analysis, poor performance status (ECOG 3-4), weight loss of more than 10% of initial body weight, baseline CA19-9 value greater than 210 ku/L, positive nodes, R1 status and histological grade 3-4 were significant adverse prognostic factors. Conclusions: PC continues to have poor outcomes with a 5yOS of 5% in pts treated with sx alone. Among pts with resectable PC treated at the BCCA, AC tended towards increased DFS and OS. Although R1 status was associated with inferior OS, the benefit of AT was greater in this subgroup. [Table: see text]
Phase I study of the oral platinum agent satraplatin (S) in sequential combination with capecitabine (C) in patients with advanced solid tumours
Authors: C. Sessa, D. Hess, J. Bauer, C. Droege, E. Gallerani, M. Miani, A. Tinazzi, O. Krieter, R. Angst, C. Nay
Journal: Journal of Clinical Oncology (2008)

2560 Background: S is a novel, oral platinum (P) analogue with a preclinical safety and activity profile comparable to carboplatin. C is an oral pro-drug of 5'-DFUR approved as single agent or in combination with other cytotoxic agents for the treatment of breast and colon cancer. A sequential administration schedule of S and C was assessed in an open-label phase Ib study in adult patients (pts) with advanced solid tumours. Methods: S was given QD to fasting pts from d1 to 5, C BID from d8 to 21 of a 4-week cycle. The starting daily doses were S 60 mg/m2 and C 1,650 mg/m2 (825 BID). Prophylactic oral 5HT 3 antagonists and steroids were given 30–60 min before S. Three to six pts were entered per dose level (DL). The maximum tolerated dose (MTD) was one dose level below the dose at which ≥2 of 3 or ≥2 of 6 pts experienced dose-limiting toxicities (DLTs). Eligibility criteria included ECOG PS ≤2, adequate renal/liver function, ≤2 lines of prior chemotherapies (CTs) for advanced disease, lack of resistance to approved P and/or fluoropyrimidine compounds, absence of clinical situations significantly affecting oral absorption. Results: 38 pts with a variety of solid tumours (20 prostate, 7 ovarian, 4 gastrointestinal, 7 other) entered the study at 4 Swiss centres (SAKK-SENDO phase I network). All pts but 1 (hormone-resistant prostate cancer) had received prior CTs, including P compounds in 13 pts. Dose-limiting thrombocytopenia G3–4 occurred in 2/6 pts at DL S 80 mg/m2 and C 1,650 mg/m2. The MTD and thus the RD was determined at S 70 mg/m2 and C 2,000 mg/m2, with DLT nausea G3 and long-lasting moderate neutropenia in 1/6 pts. Main non-haematological toxicities were nausea, anorexia, diarrhoea and mild to moderate fatigue. In 24 pts evaluated, 2 confirmed partial responses (PR) were seen in P-sensitive ovarian cancer, 1 PR and 4 stable diseases (SD) in prostate cancer pts. Conclusions: The phase II RD of the sequential combination has been defined at S 70 mg/m2 and C 2,000 mg/m2 (1,000 BID). Preliminary results suggest that the sequential administration of S and C represents a well tolerated and convenient oral treatment for pts with advanced solid tumours. No significant financial relationships to disclose.
The effect of distance to a high-volume center on receipt of treatment for invasive bladder cancer.
Authors: Jason Lomboy, Matthew Macey, Troy Sukhu, Anne-Marie Meyer, Ke Meng, Matthew Edward Nielsen, Raj Pruthi, Eric Wallen, Michael Woods, Angela Smith
Journal: Journal of Clinical Oncology (2016)

461 Background: Regionalization of major surgery such as cystectomy has spurred interest in the association of high-volume centers (HVC) &amp; improved postoperative outcomes. However, concerns have been raised regarding access to care, with increasing travel distance playing a role in treatment selection. Our objective was to evaluate the effect of distance to closest HVC on treatment selection for muscle-invasive bladder cancer (MIBC). Methods: Using a linked data resource combining NC Cancer Registry with administrative claims data from Medicare, Medicaid, and private insurance plans, we included adult patients diagnosed with Stage 2 bladder cancer from 2003-2008. We created 2 mutually exclusive treatment groups (standard: cystectomy or chemo-radiation; non-standard: other or no treatment). HVCs were identified as those performing &gt; 15 cystectomies during the study period. Nearest distance was calculated by using straight-line distance between zip code of the patient and closest HVC. Bivariable analyses and multivariable logistic regression were used to evaluate the effect of nearest distance to a HVC on receipt of non-standard treatment for MIBC. Results: 274 patients with confirmed MIBC were identified, with n = 123 undergoing standard and n = 151 non-standard treatment. Mean age of patients in the standard group was 73.1 vs. 77.7 in the non-standard group (p &lt; 0.001). Groups also differed by race and insurance type (minority patients and those with Medicaid or Medicare were more likely to receive non-standard treatment). However, no significant difference was noted for comorbidity, gender, or education. Patients who underwent non-standard therapy had shorter distances to a HVC (73% have a distance of &lt; 30 miles) vs. those who received standard therapy (56%, &lt; 30 miles) (p &lt; 0.004). On multivariable analysis, distance &gt; 30 miles to a HVC was associated with lower likelihood to undergo non-standard therapy (p = 0.005), even when controlling for age, gender, race, comorbidity, insurance and other factors. Conclusions: Distance to HVC is not associated with increased likelihood of receipt of standard therapy for MIBC. Regionalization of care may not significantly impact access to care as previously hypothesized.
Neurocognitive function (NCF) in long-term survivors of testicular cancer (TC)
Authors: P. J. Shapiro, L. A. Jacobs, S. C. Palmer, J. C. Coyne, A. T. Meadows, D. J. Vaughn
Journal: Journal of Clinical Oncology (2005)

8034 Background: Cisplatin-based chemotherapy (CBCT) regimens are standard treatment for TC, delivering long-term survival and cure rates. However, cisplatin is a neurotoxin with documented iatrogenic nervous system effects, including neuronal degeneration and myelin thinning. TC occurs primarily in men aged 15 to 35, coinciding with maturation of the frontal lobes and the continuing myelination extending through middle adulthood. Thus, CBCT occurs at a time of increased neurocognitive vulnerabilty and may impact NCF. Despite recent interest in the neurocognitive sequelae of chemotherapy, little is known about the effects of CBCT on NCF in TC survivors. Method: This study compared NCF between TC survivors who had completed either CBCT (n = 16) or localized treatment (LT; n = 7). NCF was assessed with a standard neuropsychological battery. Participants also completed measures of psychological distress, fatigue, and quality of life (QOL). Results: Men ranged in age from 23–64 years (M = 41), were at least 2.5 years post-diagnosis (M = 7.4), and were primarily college educated (78%). Demographics, psychological distress, fatigue, and QOL did not differ between treatment groups (all ps > .3). Compared to men who received LT, men treated with CBCT demonstrated poorer performance on two executive function measures, Stroop Interference (p = .028), and the Penn Conditional Exclusion Test (PCET: p = .008). Increased PCET errors were associated with poorer Functional QOL (p = .007). Psychological distress and fatigue were unrelated to NCF (all ps ≥ .2). Conclusions: Although preliminary, these data suggest that TC survivors treated with CBCT have mild deficits in NCF that impact QOL. Given the similarity of the treatment groups, and that NCF was unrelated to psychological distress or fatigue, the most likely mechanism is cisplatin associated neurotoxicity. Larger scale studies are needed to elucidate the mechanisms underlying NCF deficits in TC survivors and to explore the real-life impact of these deficits on QOL. No significant financial relationships to disclose.
Contralateral prophylactic mastectomy decision-making in the population-based iCanCare study of early-stage breast cancer patients.
Authors: Reshma Jagsi, Sarah T. Hawley, Kent A. Griffith, Nancy K. Janz, Allison W. Kurian, Kevin C. Ward, Ann S. Hamilton, Steven J. Katz, Monica Morrow
Journal: Journal of Clinical Oncology (2016)

177 Background: Contralateral prophylactic mastectomy (CPM) use is increasing in women who are not at increased risk of contralateral cancer development and will experience no survival benefit from the more morbid procedure. Little is known about treatment decision-making or provider interactions. Methods: We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer who were treated in 2013-14, identified through the population-based SEER registries of Los Angeles and Georgia about 3 months after surgical treatment, and merged with SEER data (N=2632, RR=70%), to determine receipt of diagnostic tests and factors related to the decision about surgery (including knowledge and perceived physician recommendation). Results: Nearly half of 2,436 respondents with unilateral non-metastatic cancer considered CPM (25% strongly). Only 37% of those who considered CPM knew that it does not improve survival for all women with breast cancer (24% believed it does, 39% didn’t know). Among women receiving CPM, 37% believed it generally improves survival. Ultimately, 1,464 (60%) received BCS and 972 (40%) mastectomy (of whom 438, or 18% overall, received CPM). On multivariable analysis, pts who received CPM were younger, more likely to be white, and more likely to have a family history, private rather than Medicaid insurance, and received MRI. Even among pts without a deleterious genetic mutation or family history in multiple relatives (2,303), 400 (17%) received CPM. CPM was uncommon among pts who reported that their surgeons recommended against it (2.0% [17/832]) but much higher among those who reported no surgeon recommendation regarding CPM (21.3% [229/1,077]), and among those who perceived their surgeons to have recommended it (55.4% [147/265]). Conclusions: Many patients consider CPM, but knowledge is low. Use of CPM is substantial among patients without clinical indications but is low when patients report their surgeon recommended against it. In the context of shared decision-making, surgeon recommendations against CPM might help reduce potential overtreatment.
TKI therapy-related proteomic patterns in serum from patients with metastatic renal cell carcinoma.
Authors: K. Junker, M. Walter, N. Kroeger, T. Steiner, F. von Eggeling, H. Wunderlich
Journal: Journal of Clinical Oncology (2010)

e15090 Background: Development of targeted therapies including tyrosine kinase inhibitors (TKIs) established new therapeutical options in patients with metastatic renal cell carcinoma. However, the primary clinical response, development of resistance as well as serious side effects are different in individual patients. Currently, no predictive biomarkers exist for these treatment options. Therefore, our aim was to define protein patterns in serum of patients treated by TKIs correlating with therapy benefit. Methods: Thirty patients who received TKI therapy (sorafenib or sunitinib) were included in our study. Clinical response and follow-up data were known in all cases. Data were analyzed considering best response after 3 month and response or progression after 9 month for the respective therapy. To establish biomarkers pre-therapeutic samples were analyzed by Surface-enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-TOF MS) in combination with the ProteinChip Arrays Q10, CM10 and IMAC30. Bioinformatic analysis was performed using the Fuzzy c- means method for clustering and the relevance index by Kiendl. Results: For both TKI treatments it was possible to define specific protein patterns in serum which can be related to clinical response and development of drug-resistance. Using bioinformatics, candidate protein peaks were identified which are highly relevant for prediction of therapy response. Conclusions: From our results it seems possible to predict therapy response analyzing serum samples obtained before targeted therapy. In this ungoing study, candidate proteins have to be identified to recognize their role in therapy response and development of resistance. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bayer, Wyeth
Demographics, clinical profile, management and outcome of retinoblastoma
Authors: V. A. Reddy, S. G. Honavar, D. Shome, K. Shah, R. Murthy, M. Naik, G. K. Vemuganti
Journal: Journal of Clinical Oncology (2008)

10051 Background: Retinoblastoma is the most common intraocular tumor in children. Comprehensive data on the clinical spectrum and outcome of protocol-based management in a large clinical series will help further understand the disease and plan future clinical trials. Methods: Our prospective case series included consecutive patients of retinoblastoma at a Retinoblastoma Center from January 1990 to December 2004 with 3y follow-up. Demographics, clinical features, treatment and outcome (survival, organ salvage and function salvage) were analyzed. Management comprised of focal therapy for small tumors, standard triple drug chemoreduction for larger (>4mm) tumors, high dose chemoreduction and periocular chemotherapy for vitreous seeds, and enucleation for advanced tumors. Adjuvant therapy was provided in patients with histopathologic high-risk factors for systemic metastasis. Orbital retinoblastoma was managed with a multimodal treatment protocol. Results: Of 460 patients, 66% presented <3y age. Although 41% were bilateral, family history of retinoblastoma was forthcoming in only 4%. Leucocoria (71%) was the most common symptom, followed by visual loss (12%), proptosis (7%) and squint (6%). The tumor was intraocular in 94% eyes while 6% were extraocular. Tumor grouping is shown in table. Enucleation was the most common primary treatment (236 of 451, 52%), followed by chemoreduction (26%), focal therapy (11%), external beam radiation (55) or chemotherapy alone (4%). Histopathologic risk factors predictive of metastasis were found in 55% of eyes that underwent enucleation. Chemoreduction with focal therapy resulted in eye and vision salvage in 109 of 118 (92%). Outcome (eye salvage) by tumor grouping is shown in the table. At the final follow-up, 434 (94%) children were alive and well. Conclusions: Retinoblastoma currently has excellent prognosis for survival, eye salvage and vision salvage. Advocacy for early diagnosis coupled with a better management approach for advanced retinoblastoma may optimize the outcome. Outcome by Reese Ellsworth Group Reese Ellsworth Group Eyes Included Eyes Salvaged 1 6.30% 100% 2 7.60% 100% 3 6.00% 100% 4 4.10% 90% 5 76.00% 75% No significant financial relationships to disclose.
Defining Treatment Paradigms for BK Virus-Induced Hemorrhagic Cystitis in the Post-Allogeneic Hematopoietic Stem Cell Transplant Setting
Authors: Devi D Morrison, Samith Thomas Kochuparambil, David Deremer, Ethan Speir, Kristen Sterling, Meghan Sterrett, Vamsi Kota, Anand P. Jillella, Farrukh T Awan
Journal: Blood (2011)
Colorectal cancer risk from cigarette smoking increases over 5 decades
Authors: L. J. Peppone, K. B. Moysich, M. E. Reid, G. R. Morrow, A. Hyland
Journal: Journal of Clinical Oncology (2008)

1527 Background: Earlier studies (1950s-1960s) that examined smoking and colorectal cancer risk failed to find an association. Studies in the 1980s consistently observed an increased risk for colorectal adenomas among smokers. The majority of subsequent, well-designed studies observed an increase in colorectal cancer risk among the heaviest smokers, while a smaller number of studies still did not find an increased risk. Methods: This study used 3 separate data analyses to examine the association between smoking and colorectal cancer. Analysis #1 (1957–1965), analysis #2 (1965–1975), and analysis #3 (1982–1997) used a hospital-based case-control design to examine colorectal cancer risk by smoking. Primary, incident colorectal cancer cases were frequency matched to malignancy-free controls on age (5 year intervals) and gender. Logistic regression was used to calculate colorectal cancer risk by various tobacco smoke exposure measures while controlling for the relevant covariates which were available. Results: Analysis #1 failed to find an association between smoking and colorectal cancer (>40 Years: OR=0.89, 95%CI=0.68–1.15, >42 Pack-Years: OR=0.92, 95%CI=0.72–1.19). Analysis #2 also did not find a positive association between smoking and colorectal cancer (>36 Years: OR=0.70, 95%CI=0.55–0.90, >41 Pack-Years: OR=0.69, 95%CI=0.45–0.89). Analysis #3 found a small association between smoking and colorectal cancer (>39 Years: OR=1.06, 95%CI=0.88–1.28, >40 Pack-Years: OR=1.23, 95%CI=1.02–1.48) and the risk was greater when those with second-hand smoke exposure were removed (>36 Years: OR=1.75, 95%CI=1.19- 2.58, >40 Pack-Years: OR=2.12, 95%CI=1.42–3.15). Although the risks were slightly greater for males compared to females, no significant interaction by gender was noted in any of the analyses. Conclusions: While the results prior to 1975 suggests no association, the results after 1982 indicates a positive association between heavy, long-term cigarette smoking and colorectal cancer. The results of the study are in accord with the previous literature. The increase in colorectal cancer risk from cigarette smoking might be due to the increased exposure time among the population, a change in the product over time, or a combination of the two factors. No significant financial relationships to disclose.
Inferior glucose metabolism and chemosensitivity of post-radiotherapy local recurrence in comparison with distant metastases as assessed by serial 18F-FDG PET/CT imaging.
Authors: L. Xing, X. Sun, C. Liu, X. Sun, J. Yu
Journal: Journal of Clinical Oncology (2011)

e21004 Background: Patients locally recurring after radiotherapy have increased risk of metastatic progression. This study is to compare the glucose metabolism and chemosensitivity of recurrences and metastases in the same patient by serial FDG PET/CT imaging. Methods: The 18F-FDG PET/CT images of patients with both local recurrences and distant metastases after initial treatments (definitive radiotherapy/chemo-radiotherapy as radiation group, or radical surgery as surgery control group) were reviewed. The tumor maximal diameter on CT and PET images (DCT and DPET), maximal SUV (SUVmax), mean SUV (SUVmean) were measured. PET/CT scans were performed again within 1-4 weeks after further chemotherapy. The relative changes of DCT, DPET, SUVmax and SUVmean for each focus were calculated and compared between the recurrences and metastases for both groups. Results: In surgery group (10 patients), no significant difference was found in tumor size, FDG uptake and chemosensitivity between recurrences (20 foci) and metastases (32 foci). However, in radiation group (23 patients), both SUVmax (mean ± SE: 7.03 ± 0.46) and SUVmean (4.33 ± 0.22) of recurrences (57 foci) were lower than those (8.45 ± 0.53 and 5.36 ± 0.30, respectively, P < 0.05) of metastases (68 foci). Moreover, the response extents of recurrences (45 foci) were lower than that of metastases (46 foci), with ΔSUVmax% (-21.83 ± 6.41% vs. -44.37 ± 3.96%), ΔSUVmean% (-29.31 ± 5.68% vs. -49.93 ± 4.16%), ΔDCT% (-23.12 ± 6.43% vs. -50.45 ± 4.95%), and ΔDPET% (-21.8 ± 7.19% vs.-49.5 ± 5.49%, P < 0.05). Conclusions: The local recurrences within pre-irradiated field and distant metastases in the same patient do not share the same biological characteristics and treatment response, with the inferior glucose metabolism and chemosensitivity in local recurrent tumors.