tbuckley/cabot-search huggingface dataset:
Preliminary results of induction chemotherapy plus chemoradiotherapy in patients with locally advanced non-small cell lung cancer
Authors: M. Kocak, A. Mayadagli, A. Ozkan, S. K. Gul, C. Parlak, F. Oruc, G. Yaprak, H. Tepetam
Journal: Journal of Clinical Oncology (2008)

7599 Background: The purpose of this study is to evaluate patients treated with induction chemotherapy (CT) plus chemoradiotherapy (CRT) in our clinic between years 2006 and 2007. Methods: Forty-four patients with the diagnosis of locally advanced NSCLC have been treated with 3 cycling of induction CT (gemcitabine 1.2 g/m2 d1, d8 and cisplatin 75 mmg/m2 d1, q21) followed by CRT (66 Gy in 33 fractions concomitantly with docetaxel 20 mg/m2/w and cisplatin 30 mg/m2/w). Results: Of the 44 cases, 43 were male (97.7%), and median age was 59.5 years (41–79). Performance status was ECOG 0–1 in 42 cases (95.4%), and ECOG 2 in 2 (4.5%). Histological types were squamous cell carcinoma in 39 cases (65.9%), adenocarcinoma in 7 cases (15.9%), and undifferentiated histologies in 8 cases (18.2%). Most of the patients were Stage IIIB (n: 37, 84.1%). After induction chemotherapy disease control was achieved in 31 patients (70.5%), and 13 cases (29.5%) revealed disease progression. Of the 44 patients, 35 were able to receive CRT. Response rates to RCT were CR in 5 cases (11.4%), PR in 15 cases (34.1%), SD in 12 cases (27.3%), and only 1 case showed disease progression. Overall, the treatment was well-tolerated. Toxicities encountered with induction chemotherapy were nausea (n:21), uremia (n:13), anemia (n:9) and neutropenia (n:5). Most common toxicity of CRT was esophagitis that was grade 1–2 in 21 cases (47.7%) and grade 3 in 7 cases (15.4%). Median follow-up time was 10 months (4–21). Twenty seven patients (61.4) were still alive at the time of analysis. Median OS and TTP were 13 months (95% CI:8.8–17.2) and 10 months (95% CI:8.3–11.7), respectively. One- and 2-year OS were 94.5% and 84.4% while 1- and 2-year PFS were 97.1% and 80.4%. Conclusions: In this study, although follow-up time is short, addition of induction CT with gemcitabine and cisplatin to the CRT with docetaxel and cisplatin appears to have a limited impact on OS and PFS. No significant financial relationships to disclose.
Intensive Consolidation with Clofarabine and Intermediate-Dose Cytarabine (CLARA) in Patients with High-Risk AML in First CR: The ALFA-0702 Pilot Study.
Authors: Xavier Thomas, Ida Lobe, Emmanuel Raffoux, Nicolas Boissel, Quoc-Hung Le, Franck Nicolini, Adrienne de Labarthe, Sandrine Hayette, Jean-Michel Cayuela, Hervé Dombret
Journal: Blood (2008)
The examination of appropriate surveillance after resection of GIST from 115 recurrent patients.
Authors: Noriko Wada, Tsuyoshi Takahashi, Toru Masuzawa, Junji Kawata, Toshirou Nishida, Yukinori Kurokawa, Kiyokazu Nakajima, Yasuhiro Miyazaki, Tomoki Makino, Makoto Yamasaki, Shuji Takiguchi, Masaki Mori, Yuichiro Doki
Journal: Journal of Clinical Oncology (2016)

12 Background: Previous studies have proposed some risk classifications and contributed to the prediction of the prognosis in gastrointestinal stromal tumor (GIST) patients after resection. However, optimal postoperative surveillance has not been established yet. We investigated the characteristics of GIST patients who developed recurrence after resection to establish optimal postoperative surveillance for recurrence. Methods: Between July 1978 and November 2014, 115 patients developed recurrence after macroscopically complete resection for primary GIST. We investigated the clinicopathological factors, time to recurrence (TTR) and first recurrence sites to determine the optimal duration and methods of surveillance. We also compared the characteristics between the two subgroups with TTR ≤ 5 years or &gt; 5 years. Results: The median age was 60 (15-84) years old and 62% of the patients were men. The most common primary tumor site was the stomach (39%), followed by the small intestine (37%), duodenum (11%), large intestine (10%) and esophagus (2%). The median tumor size was 8.5 (1.5-30.0) cm and the median mitotic count was 4 (0-165) /50 HPF. The site of recurrence was liver (57%), followed by peritoneum (48%), local (21%), bone (4%) and lymph node (2%). Almost all patients, except one lung recurrence by esophageal GIST, showed primarily recurrence in the abdominal site. The median period of recurrence after resection 21 (1-172) months and 12% of the recurrence occurred over 5 years. We divided the two groups by the period of recurrence, Early-group (E) ( ≤ 5 years), and Late-group (L) ( &gt; 5 years). Comparing the two groups, E group showed a smaller size (median, 3.5 vs. 9.0 cm) (p &lt; 0.001) and a lower risk classification (p &lt; 0.001) than L group. Although liver recurrence was the most frequent in E group (60 %), local recurrence was the most frequent in L group (43 %). Conclusions: Twelve percent of the recurrence occurred over 5 years, and almost all patients showed primarily recurrence within the abdomen. This may indicate that postoperative surveillance after complete resection for primary GIST is recommended over 5 years by abdominal examination.
EMR-linked cancer tracker facilitates lung and liver cancer care.
Authors: Tamar H. Taddei, Laura Hunnibell, Anne DeLorenzo, Mirta Rosa, Donna Connery, Donna Vogel, Vijay Garla, Caroline Taylor, Michal G. Rose
Journal: Journal of Clinical Oncology (2012)

77 Background: VA Connecticut Healthcare System has developed a web-based, EMR-linked Cancer Care Tracking System (CCTS) to facilitate tracking and follow-up of patients with imaging abnormalities concerning for lung or liver cancer. The tracker was developed to facilitate the efforts of a multidisciplinary team at the center of which is a cancer navigator. Methods: CCTS was first envisioned in 2007 when VACT hired a care navigator and implemented a radiology coding system to identify potential cancers. This created the need for a tool to process abnormal images and track the clinical steps required to reach a definitive diagnosis and treatment plan. CCTS was initially used for lung cancers and was expanded to track hepatocellular carcinoma (HCC) in 2009 with additional funding. In addition to case discovery, it offers easy access to patient information with live links to the VA EMR, a surveillance feature, and scheduling, alerting, and reporting functions. In 2011, the system was enhanced with a natural language processing (NLP) program that automatically identifies radiology reports describing potentially malignant lung or liver lesions. Results: CCTS has been in daily operation since February 2010, with 1,778 patients and 2,503 patients tracked in 2010 and 2011, respectively. Addition of NLP technology significantly increases the accuracy of identification of patients with lung or liver nodules. The NLP system identified 21% of all new cases with potential malignancies whose management could have been delayed through coding omissions or errors. Benefits of CCTS and our cancer care coordination program have included a decrease of 25 days in the time from abnormal image to treatment of lung cancer, a significant increase in the diagnosis of stage I/II lung cancers from 32% to 48%, and an increase in the incidence of liver cancer from 1% to 5% of all cancers at VACT. Conclusions: A web-based, EMR-linked cancer care tracking system (CCTS) improves cancer detection, prevents loss to follow-up, provides a safety net for radiology coding omissions or errors, and improves provider efficiency. CCTS is an innovative tool to support multidisciplinary cancer care and has broad applicability to any electronic medical record.
Rapid Clearance of Rituximab Contributes to the Continued High Incidence of Autoimmune Complications of Chemoimmunotherapy for Chronic Lymphocytic Leukemia
Authors: Clifton C. Mo, Mohammed Z.H. Farooqui, Paul V. Beum, Ndegwa Njuguna, Gerald E Marti, Wyndham H. Wilson, Ronald P. Taylor, Adrian U. Wiestner
Journal: Blood (2010)
Intravesical ethiodized oil injection technique for image-guided radiation therapy for bladder cancer.
Authors: Adam S. Baumgarten, Justin B. Emtage, Richard Wilder, Matthew C. Biagioli, Shilpa Gupta, Philippe E. Spiess
Journal: Journal of Clinical Oncology (2014)

337 Background: Bladder sparing trimodality therapy consisting of maximal TURBT, radiation, and chemotherapy offers a feasible and effective option to patients with muscle invasive bladder cancer that are unwilling to undergo cystectomy. The shape and position of the bladder change significantly during radiation therapy, and it is possible to miss the tumor bed when a radiation boost is delivered to only part of the bladder. This study describes the technique of injecting ethiodized oil in the submucosa of the urinary bladder wall as a novel modality to improve localization of muscle invasive bladder tumors prior to image-guided radiation therapy (IGRT). Methods: Eight patients underwent submucosal ethiodized oil injections at the time of transurethral bladder tumor re-resection. A rigid cystoscope with a working port was used to inject ethiodized oil into bladder submucosa circumferentially around the tumor bed (2-3 mm from margin of resection). Roughly 20-30 injections were used to demarcate the tumor bed for external beam radiation therapy, which was used as part of a bladder sparing approach. All patients were diagnosed with clinically localized, high-grade, muscle invasive carcinoma and were deemed nonsurgical candidates or were unwilling to undergo radical cystectomy. Results: 5 of the 8 patients underwent IGRT at our institution. 95% of ethiodized oil injections were visible on treatment planning CT scans and kV portal images throughout the 7-week course of IGRT. In 2 of 5 patients, the tumor bed based upon ethiodized oil extended outside a planning target volume that would have been treated with radiation therapy based upon cystoscopy reports and computed tomography scans without ethiodized oil. There were no adverse events or treatment-related toxicities secondary to ethiodized oil injection. Conclusions: Intravesical ethiodized oil injection is an easy-to-perform technique that is safe and effective. Ethiodized oil serves as a fiducial marker that improves tumor bed localization for radiation therapy, thereby reducing the likelihood of missing the tumor.
Bringing provincial improvements to oral chemotherapy prescribing through co-ordinated regional initiatives.
Authors: Vicky Simanovski, Noor Ahmad, Leonard Kaizer, Erin Redwood, Kathy Vu, Colleen Fox, Elaine Meertens, Monika K. Krzyzanowska
Journal: Journal of Clinical Oncology (2016)

107 Background: Oral chemotherapy delivery is complex, making safe medication practices a high priority. Cancer Care Ontario, the provincial government agency responsible for continually improving cancer services in Ontario, undertook a jurisdiction-wide quality improvement initiative to ensure that all oral chemotherapy drugs are prescribed using Computerized Prescriber Order Entry (CPOE) or standardized Pre-printed Orders (PPO). The initiative was further enabled by changes to the provincial funding approach that flows facility funding for oral chemotherapy delivery. Methods: All 35 facilities prescribing chemotherapy in Ontario across 14 regions implemented strategies to work towards the common aim of reducing handwritten/verbal oral chemotherapy prescribing to zero by June 30 th , 2015. Baseline audits were completed between Sept-Nov 2014; repeat audits were performed between Mar-May 2015. Each facility reported the number of patients that received an oral chemotherapy prescription, and the method of prescribing. Results: At baseline, 30% of audited prescriptions across the province were handwritten or verbal, which decreased to 9% by June 2015. Improvements were seen in thirteen of the 14 regions. Thirteen out of 35 facilities met the aim of 0 handwritten/verbal orders, with an additional 16 facilities seeing an improvement. Alignment with funding mechanisms, an early physician engagement strategy, and education of key stakeholders on CPOE systems were identified as key enablers to implementation. Conclusions: Though the goal of zero handwritten/verbal prescriptions was not met by all facilities, the initiative encouraged a change in implementing safe prescribing practices for oral chemotherapy. Further audits will assess that the gain was sustained and that the provincial goal is achieved. This initiative is part of a larger strategy to standardize care for systemic treatment patients and promote a culture of safety in hospitals. [Table: see text]
Cancer therapy and heart failure: Successful management through collaborative interdisciplinary practice.
Authors: Anecita P. Fadol, Jean-Bernard Durand, Barbara L. Summers, Myrshia L. Woods, Katie Lewis, Patty Johnston, Nancy Tomczak, Joylynn Mae Estrella, Lisa M. Kidin, Douglas Browning
Journal: Journal of Clinical Oncology (2012)

123 Background: Heart failure (HF) is a clinical problem of emerging importance in cancer care. The advances in cancer detection and complex treatment regimens have resulted in increased cancer treatment induced HF. The literature indicates that more than 50% of all patients exposed to anthracyclines will show some degree of cardiac dysfunction either acutely or 10 to 20 years after treatment, and 5% of those patients will develop overt HF. Successful management requires a collaborative, interdisciplinary approach. The purpose of this presentation is to discuss how the “Heart Success Program” (HSP) resulted in cost effective and clinical quality outcomes in patients with cancer and HF. Methods: The HSP was piloted in the emergency center and telemetry units with high volume admission of HF patients. The HSP includes comprehensive education of patients, families, and health care providers regarding HF management in cancer patients. HSP implementation includes a HF order set, patient education booklet, and educational videotape specific for patients with cancer and HF. Weekly interdisciplinary clinical rounds provide a forum for discussion of identified patient’s problems and formulation of solutions. Endpoint outcomes include compliance with the Center for Medicare and Medicaid Services (CMS) core measures for HF, as well as decreasing HF readmissions. Results: The pilot implementation of the HSP resulted in decreased hospital length of stay by 57%, and average hospital admission cost by 60%. Despite multiple co morbid conditions, patients were discharged with improved functional status and compliance with CMS HF core measures. Conclusions: The findings from this quality improvement project showed significant impact in clinical and cost outcomes for patients with cancer and HF. The multidisciplinary team approach that provided support to patients and their families and allowed for patients to continue their cancer treatment resulting in improved outcomes. As we move toward value-based purchasing, the HSP provides an example of how collaboration and standardized process improvement impacts cost and quality in the oncology population.
Living with hepatocellular carcinoma from the patient perspective: A longitudinal study.
Authors: Lissi Hansen, Gina M. Vaccaro, Susan J. Rosenkranz
Journal: Journal of Clinical Oncology (2014)

373 Background: Hepatocellular carcinoma (HCC) is a growing problem. For those diagnosed with terminal HCC, there is no curative treatment. Despite a high death rate, no longitudinal studies were found examining the illness experience of patients with HCC as they are approaching death. The aim of this study was to describe the experience of living with terminal HCC and how it may affect end of life care from the perspective of patients. Methods: This was a longitudinal, prospective mixed methods pilot study using quantitative and qualitative approaches. Semi-structured interviews were conducted with a convenience sub-sample of 14 patients with HCC once a month for a 6-month period. The interview guide included questions about living with HCC, pain and symptom management strategies, treatment decisions, and any current concerns of significance. Interview data were analyzed using qualitative description. Results: This poster reports on qualitative analysis of 45 interviews from the sub-sample. Eleven patients were male and 3 were female (mean age=61.5, range=54-68 years). Findings included 4 major themes: 1) illness perceptions, 2) uncertainty about treatments over time, 3) quality of life, and 4) coping strategies. Patients perceived HCC as isolating as compared to other cancers. Patients lacked information to prepare them for the journey ahead. They struggled with symptom management over time and chose to stop treatment, delay treatment in hope of improvement, or regretted starting treatment once underway. Conclusions: For patients, the impact of HCC and treatment side effects on quality of life was challenging and filled with uncertainty. From this first step, knowledge gained is serving as the foundation for a proposed larger scale study. The goal is to develop future interventions to address challenges (e.g., symptom management and treatment decision making) at the end of life for these understudied cancer patients.
EUS-FNA with rescue FISH for the diagnosis of pancreatic carcinoma in patients with inconclusive on-site cytopathology.
Authors: I. I. Akunyili, C. M. S. Rocha Lima, J. Macintyre, N. Solis, J. R. Merchan, D. Sleeman, J. U. Levi, A. Ribeiro
Journal: Journal of Clinical Oncology (2011)

e14641 Background: Endoscopic ultrasound guided biopsy and cytology (EUS-FNA) is commonly used in the diagnosis of pancreatic cancer (PC) with a sensitivity (Sn) of 60%-90%. This study is to determine the Sn and specificity (Sp) of FISH analysis in patients with inconclusive on-site cytopathology (OC). Methods: Retrospective analysis of patients undergoing diagnostic EUS-FNA for solid pancreatic masses in a single University Tertiary Cancer Center from January 2009 to December 2010. Non-diagnostic OC samples were sent for cytology and FISH (UroVysion probe, Abbott Molecular, Des Plaines, IL) to detect aneuploidies of chromosomes 3, 7, 17 and deletions of 9p21. Positive FISH for malignancy was defined as ≥5 cells with ≥3 signals in at least two chromosomes (polysomy), >5 cells with 9p21 deletion, extra copy of chromosome 7 in > 10 cells (trisomy). Confirmation of cancer was based on pathologic diagnosis on surgical specimen, disease progression on extended follow-up or autopsy. Sn, Sp, positive and negative predictive values of cytology and FISH were obtained based on binomial distribution. The Fisher exact test was utilized to compare sensitivity between cytology, FISH and cytology plus FISH. A p value < 0.05 was considered statistically significant. Results: 212 EUS-FNA were performed in 206 patients over a 24 month period. The diagnosis of carcinoma was obtained in 164 patients. OC established the diagnosis in 110 patients that were excluded in addition to patients with neuroendocrine tumor (22), insufficient follow-up (1), FISH not obtained (3) and pancreatic metastasis (1). Sixty-nine patients with inconclusive or non-available OC comprised the study cohort and had FISH analysis, of which 15 patients had benign diseases. The Sn for the diagnosis of PC by cytology, FISH and the combination were 61%, 74% and 85% respectively (p=0.009). FISH detected an additional 13 cases missed by cytology with no false positives in benign diseases. Conclusions: FISH to detect polysomy of chromosomes 3, 7, 17 and deletion of 9p21 should be considered when cytology is negative for malignancy in patients with pancreatic mass. Rescue FISH can detect additional cases missed by cytology without compromising specificity.
HICOR IQ: Developing a regional oncology metric reporting platform.
Authors: Catherine R. Fedorenko, Karma L. Kreizenbeck, Avital Sadot, Britt Piehler, Jessi Murray, Michael Gersch, Gary H. Lyman, Scott David Ramsey
Journal: Journal of Clinical Oncology (2016)

165 Background: The Hutchinson Institute for Cancer Outcomes Research (HICOR) has adopted a multi-stakeholder approach to identify and prioritize metrics to characterize oncology care in the Western Washington. In March 2015, HICOR released a beta version of an oncology informatics platform, named HICOR IQ, which allows regional payers, providers and patient advocates to view and interact with community-prioritized metrics. Methods: Surveillance, Epidemiology, and End Results (SEER) records for patients diagnosed with cancer in Western Washington state between January 1, 2007 and May 31, 2014 were linked with enrollment and claims from two regional commercial insurance plans. Algorithms were developed to characterize the 2012 ASCO Choosing Wisely (CW) recommendations in the claims-registry database. HICOR partnered with LabKey Software to develop a regional metric reporting platform. Results: The beta version of HICOR IQ displays regional results for the CW recommendations, then allow users to customize the reports by stratifying and/or filtering by different demographic (age, race, gender), clinical (cancer site, stage) and provider (clinic volume) characteristics. In addition, de-identified clinic specific adherence can be plotted to show variation in care throughout the region. A convenience sample of oncology clinic leaders was asked to review and comment on the beta-version. Primary suggestions were as follows: Display clinic-identifying information based on logged in user; Expand the flexibility of the tool to allow for user-created metrics; Keep the tool intuitive and easy to use; Protect the data and identity of patients. Future development of the tool will take an iterative process to allow for continued user feedback. The next planned version of HICOR IQ will incorporate user feedback by displaying clinic-identifying information based on the user and expanding the reporting of regional metrics. Conclusions: It is feasible to create a tool that reports regional adherence rates to oncology metrics. An iterative process that incorporates user feedback is an important step to build a tool that is adopted by the community.