tbuckley/cabot-search huggingface dataset:
Telehospice: Implementation lessons from rural hospice care with mobile tablets.
Authors: Gary C. Doolittle, Eve-Lynn Nelson, Ashley Spaulding, Sandy Kuhlman
Journal: Journal of Clinical Oncology (2017)

6546 Background: In underserved rural communities, hospice personnel often travel great distances to reach patients, resulting in challenges to maintain access, quality, cost-effectiveness and safety. To address these disparities, the University of Kansas Medical Center piloted the country’s first TeleHospice (TH) service in 1998. Barriers such as technology limitations, costs and attitudes towards technology limited adoption (Cook et al., 2001). An updated academic-community project utilizes secure mobile videoconferencing to support TH services in Kansas’ frontier communities. Methods: Leveraging lessons learned from the early work, a secure cloud-based videoconferencing solution was chosen for ease of use. To maximize limited resources, the selection of hospice partners was guided by Gustafson et al.’s (2003) Organizational Change Manager, which also informed implementation gaps. The academic team partnered with Hospice Services, Inc., a leader in rural hospice care, providing services to 16 Kansas counties. Results: From February 2016 through January 2017, 116 TH encounters occurred, encompassing 707 attendees over 7,462 minutes. The most common TH uses to date have been: administrative (e.g., connecting hospice staff across 16 counties); professional-to-professional (e.g., connecting hospice nurses at homes to additional TH professionals); and family support (e.g., connecting adult children with loved ones). Initial use of videoconferencing for administrative purposes developed a comfort level in using it for clinical and family support purposes. For staff meetings alone, the hospice has saved approximately $2,500/month in travel, with TH staff noting increased morale driven by increased team communication. Conclusions: Compared with early work, technology advances and a community-centered approach have increased TH adoption. With decreasing budgets as well as rural hospice closures, innovative, cost-effective and community-driven approaches such as TH are needed to decrease disparities. As dissemination occurs in national hospice organizations, continued research is needed to understand best fit within frontier hospices, to inform future urban applications and to address reimbursement.
Understanding the non-curative potential of palliative chemotherapy: Do patients hear what they want to hear?
Authors: Andrea Catherine Enzinger, Jen Wind, Elizabeth Frank, Nadine Jackson McCleary, Christine Cronin, Hanna Kelly Sanoff, Katherine Van Loon, Khalid Matin, Andrea J. Bullock, Neal J. Meropol, Hajime Uno, Deborah Schrag
Journal: Journal of Clinical Oncology (2017)

6575 Background: Misconceptions about the curative potential of PC are common, and may arise from gaps in informed consent. Another contributing factor could be patients’ desire, or lack of desire, for information about prognosis and PC outcomes. Methods: We surveyed 137 patients with advanced colorectal (N = 102) or pancreatic cancer (N = 35) within 2 weeks of consultation about 1 st or 2 nd line PC, as part of randomized trial of a PC education intervention at 6 US sites. Patients rated how much information they wanted about PC risks/benefits, including impact on prognosis. Responses ranged from no information to as much as possible on a 5-point Likert scale. They reported decision-making preferences; whether a doctor discussed curability, and how likely they thought PC was to cure their cancer. Chi square and Wilcoxon tests examined whether information and decision-making preferences, or curability discussions were associated with expectations of cure. Multivariable logistic regressions evaluated whether associations were modified by age, race, gender, marital status, or cancer type. Results: Only 44.5% of patients accurately reported that their cancer was not at all likely to be cured by PC. Most patients wanted a lot, or as much information as possible about PC risks/benefits, including likelihood of cure (81.7%), cancer control (84.7%), and impact on length of life (80.3%). Most patients preferred shared (70.8%) versus active or passive decision-making. Neither decision-making nor prognostic information preferences were associated with expectations of cure. Patients (13.9%) who did not recall curability discussions were less likely to have accurate expectations (21% v 48%; OR, 0.29; 95% CI, 0.07-.97). Patient characteristics did not significantly confound this association. Conclusions: Most patients value shared decision-making and want maximal information about PC risks/benefits, including impact on prognosis. Despite wanting prognostic information and reporting curability discussions, many patients report inaccurate expectations about cure from PC. Future studies should examine whether these assertions reflect misunderstandings, differences in belief, or expressions of hope.
P01.073 Hypofractionated radiation therapy (over 3 weeks) can replace conventional radiation therapy schedule (over 6 weeks) in newly diagnosed glioblastoma patients? The times are ripe
Authors: P Navarria, E Clerici, F Pessina, C Franzese, L Bello, M Simonelli, S Tomatis, A Leonetti, M Scorsetti
Journal: Neuro-Oncology (2018)

The standard of care for newly diagnosed glioblastoma multiforme consists of surgery, followed by conventional radiation therapy (CRT) with concurrent and adjuvant temozolomide chemotherapy. All the attempts to enhance the efficacy of RT were unsuccessful. Recently, the impact of hypofractionated radiation therapy (HFRT) has been investigated with promising results. We conducted a prospective phase II study, and subsequently a propensity score analysis to evaluate whether HFRT can be comparable to CRT. In the phase II study, all patients underwent surgery, HFRT with concomitant and adjuvant temozolomide chemotherapy. The dose prescribed was 60 Gy over 3 weeks. The propensity score matched analysis compared CRT 60 Gy/30 fractions vs HFRT 60 Gy/15 fractions in an homogeneous population for patients, tumor and treatments characteristics. The two cohorts were selected by using a logistic regression considering age, KPS, extent of surgery, MGMT and IDH status, recorded as factors affecting survival. From August 2013 to December 2015, 97 newly diagnosed GBM patients were treated in the phase II study. The median,1,2-year OS were 16 months, 72.2%, and 30.4%. All patients completed the schedule HFRT plan. Neuropsychological scores before and after HFRT remained unchanged. The analysis showed no detrimental effect of HFRT on cognitive functions (language, short and long term verbal and visuo-spatial memory, working memory, attentive and executive functions). Particularly, a significant performance improvement was detected. The greater benefit of treatment was observed in patients younger than 60 years and with KPS 100 with 40% and 50% alive beyond two years, respectively (p=<<0.01). For propensity score matched analysis a total of 267 patients were included; before PSM 169 were in CRT-group and 98 in HRFT-group. After 1:1 matching, 82 patients resulted in each group. The median OS time was 17.9 months for the CRT group and 16.7 months for the HFRT-group; the 1, 2, 3-year OS rates were 75.6%, 32.7%, and 15.5% for the CRT-group, and 75.6%, 33.3%, and 18.9% for the HFRT-group No statistically significant differences were recorded between the two radiation therapy treatments performed (p value = 0.8). in our evaluation HFRT schedule has proven to be not inferior to CRT in terms of outcome, and less burdensome for these poor prognosis patients. Open questions remain the optimal radiation total doses to deliver and the schedule to utilize, but HFRT within a multimodal therapeutic approach, seems a way forward to improve the outcome of patients with glioblastoma.
Abstract 12854: Uric Acid In-hospital Change Provides the Additional Long-Term Prognostic Information to Acute Kidney Injury in Patients Admitted for Acute Decompensated Heart Failure
Authors: Takahisa Yamada, Takashi Morita, Yoshio Furukawa, Shunsuke Tamaki, Yusuke Iwasaki, Masato Kawasaki, Atsushi Kikuchi, Takumi Kondo, Masashi Ishimi, Hideyuki Hakui, Tatsuhisa Ozaki, Yoshihiro Satoh, Masahiro Seo, Iyo Ikeda, Eiji Fukuhara, Masatake Fukunami
Journal: Circulation (2015)

Backgrounds: Acute kidney injury (AKI) during heart failure treatment is associated with poor outcome in patients admitted with acute decompensated heart failure (ADHF). In patients with ADHF,increased uric acid (UA) level is also a prognostic marker, but there is no information available on the long-term prognostic significance of UA in-hospital change, relating to AKI in patients admitted for ADHF. Methods and Results: We studied 237 patients admitted with ADHF and discharged with survival. The measurements of serum UA and creatinine (Cr) levels were repeated during hospitalization, and the change of UA was obtained by subtracting the value at admission or discharge from the maximum value. AKI was defined according to AKI Network criteria (stage 1, ≥0.3mg/dl absolute or 1.5-to 2.0-fold relative increase in Cr; stage 2, &gt;2- to 3-fold increase in Cr; stage 3, &gt;3-fold increase in Cr or Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). During a follow-up period of 4.3±3.3 yrs, 59 patients had cardiovascular death (CVD). At multivariate Cox analysis, UA change (p=0.02) and stage 2 or 3 AKI (p=0.01) were significantly associated with CVD, independently of age, systolic blood pressure, serum sodium, hemoglobin, UA and Cr levels, although stage 1 AKI showed no significant association with CVD. Patients with both higher degree of UA change (top quartile:≥4.4 mg/dl) and stage 2 or 3 AKI had a significant increased CVD risk, compared to patients with either higher UA change or stage 2 or 3 AKI (75% vs 34%, p=0.006, hazard ratio 3.8[95%CI 1.4-8.6]). Furthermore, patients with either higher UA change or stage 2 or 3 AKI also had a significant increased CVD risk, compared to patients with none of these two variables (34% vs 19%, p=0.01, hazard ratio 2.0[95%CI 1.1-3.5]). Conclusion: Uric acid in-hospital change could provide the additional long-term prognostic information to moderate to severe AKI in patients admitted for ADHF.
The approach of community oncology providers towards pre-treatment assessment of older patients with metastatic breast cancer (MBC).
Authors: Efrat Dotan, Elizabeth A. Handorf, Caitlin R. Meeker, Bianca Lewis, Kelly Ann Filchner, Jennifer Shih Winn, Lori J. Goldstein
Journal: Journal of Clinical Oncology (2018)

e22043 Background: Special consideration is required for management of older MBC pts to ensure appropriate pt care and optimize outcomes. Geriatric Assessment (GA) is a comprehensive assessment including thorough evaluation of physical, psychological and social well-being and is the recommended tool for evaluating an older cancer pt's fitness for treatment. We sought to define the gaps that exist in community clinical practices in the assessment and management of older MBC pts. Methods: This is the first phase of an ongoing study aimed to implement GA into the community practices. In this phase, we assessed the current approach community oncology providers towards the care of older MBC patients. Following informed consent providers completed questionnaires capturing their current approach towards pre-treatment evaluation of MBC pts > = 70 years old. We distinguished between comprehensive methods (i.e. validated scales) versus using interview only for identification of treatment altering concerns. Results: 25 providers at 6 community hospitals participated in the study. Majority were male, Caucasian, > 40 years old, and < 11 years in practice. Majority of providers found GA to be useful in evaluation of older MBC patients (72%), however, only 28% reported routinely conducting a GA for pre-treatment evaluation. The vast majority of geriatric domain evaluations were conducted through interview rather than validated assessment tools. Validated scale was used most commonly to evaluate cognition (32%). In other domains, validated tools were used less often: psychosocial (20%), socioeconomic (20%), nutritional status (16%), toxicity risk (12%). The limited use of validated evaluation tools was not influenced by the provider’s demographics or their acknowledgement of GA utility. Conclusions: Despite acknowledgement of the value associated with pre-treatment GA, most providers in the community do not routinely conduct such an assessment. Furthermore, most providers use interview rather than validated assessment tools to identify age related treatment-altering concerns. A prospective study is ongoing to promote incorporation of comprehensive GA into the community setting.
Predictive tools for bevacizumab therapy in patients with aggressive HER 2-negative metastatic breast cancer: 2-years results from an observational study.
Authors: Encarnación González Flores, Isabel Alvarez, Luis Manso, Jose Luis Alonso Romero, Juan J. Cruz-Hernández, Vicente Carañana, Isabel Gallegos, Maria Quindós Varela, José Juan Illarramendi, Elena Vicente, Ana Isabel Ballesteros Garcia, Antonia Perello, Antonio Llombart-Cussac, Analia Adela Rodriguez, Jose Vidal-Martinez
Journal: Journal of Clinical Oncology (2018)

12043 Background: The determination of monitoring Circulating Tumor Cells (CTC) in patients (pts) with metastatic breast cancer (MBC) is a well-established prognostic marker of efficacy/tolerance. We aimed to determine the predictive value of the normalization of CTC in terms of clinical benefit. Methods: Multicenter, prospective, observational study in pts with aggressive HER2-negative MBC amenable to receive first-line treatment with chemotherapy plus bevacizumab. A 18-month follow-up is planned. CTC levels were determinated in baseline (BL) and after the first cycle. The Spearman correlation coefficient was calculated to CTC and biomarkers. Interim analysis of 2-years with data on the correlation and progression free survival (PFS). Results: At database cut, 111 evaluable pts were enrolled: median (range) age 54.1 (46.4-61.3) years; ECOG 0/1: 50.5/39.6%. Median (range) time from diagnosis was 2.9 (0.8-7.2) years, and 28.8% of pts were “di novo” MBC. Neoadjuvant and/or adjuvant therapy was received by 70.3% pts and 73.0% underwent surgery. Histological grade III found in 49.3% of pts; ER-positive in 74.6% and PR-positive in 50.8%. Metastases were mainly located in liver (62.2%), bone (57.7%) and lung (40.5%). Mean (SD) CTC levels: 83.4 (333.8)/7.5 mL BL and 3.6(10.3)/7.5 mL after first cycle. According to this change, 89.5% were sensitive. Discontinuation in 28 pts (75.0% exitus; 3.6% progression). A 3.5% had complete response, 50.6% partial response and 25.9% stable disease. Median follow-up was 8.2 (5.3-12.9) months. The median PFS was 11.0 (6.6-15.4) months. Median overall survival was not reached. BL CTC levels had a significant correlation with CEA (p < 0.05) and CA 15.3 (p < 0.001). Overall, 79.3% pts presented at least one toxicity. Most common grade III/IV toxicities were hypertension (8.1%), peripheral neuropathy (3.6%), neurotoxicity (3.6%) and neutropenia (2.7%). Two grade V toxicities reported abdominal sepsis and pain upper. Conclusions: The preliminary data shows a correlation with CTC levels and other tested biomarkers. No safety concerns were addressed.
Impact of genomic heterogeneity on PI3K/AKT/mTOR inhibitors (PAMi) efficacy in gynecologic cancer (GYN) patients (pts).
Authors: Victor Rodriguez Freixinos, Fiorella Ruiz-Pace, Lorena Fariñas-Madrid, Ana Christina Garrido Castro, Guillermo Villacampa, Paolo Nuciforo, Ana Vivancos, Rodrigo Dienstmann, Ana Oaknin
Journal: Journal of Clinical Oncology (2017)

5569 Background: Aberrant PI3K/AKT/mTOR activation is common in GYN. Predictive biomarkers to PAMi in GYN have yet to be identified. Methods: Advanced GYN pts with available genomic data, treated with PAMi in phase I/II clinical trials were selected. Mutation (mut) allele fractions (MAFs) were corrected for tumor purity and defined as clonal (cl) (≥ 0.4) or subclonal (scl) ( &lt; 0.4). PAMi efficacy: (i) time to progression (TTP); (ii) clinical benefit rate (CBR: complete/partial response or stable disease &gt; 4 months [m]); and (iii) ratio TTP on PAMi/ TTP on non-standard chemotherapy pre- or post-PAMi (PAMi/nsChemo TTP). Results: From 2010 to 2016, 264 GYN pts (152 ovarian(OC); 75 endometrial(EC); 37 cervical(CC)) had genomic analysis; 50 pts (24 OC [11 PIK3CA mut, 5 KRAS mut], 15 EC [6 PIK3CA mut, 5 PTEN mut, 4 KRAS mut], and 11 CC [9 PIK3CA mut, 3 KRAS mut]) received PAMi (17 pan-PI3K/mTOR or AKT inh, 17 α-PI3K inh, 16 PAMi targeted combos). PAMi therapy was matched (MA) to PIK3CA/PTEN mut in 30 pts (60%). Median age was 57 years (30-70); median number of prior lines was 2 (1-6) and 34 pts (68%) received nsChemo. Efficacy of PAMi: (i) median TTP (3.27 m [95% CI 2.1-4.4] with trend for longer TTP in OC compared to others [3.93 vs. 2.1 m, HR 0.57; p = 0.08], without differences according to MA status [p = 0.26] or regimen [p = 0.5]); (ii) CBR (42% [95% CI 27-58%], without differences according to tumor type [p = 0.47], MA status [p = 1] or regimen [p = 0.86]); and (iii) TTP PAMi/nsChemo ≥ 1.3 (42% [95% CI 24-63%], without differences according to tumor type [p = 0.53], MA status [p = 0.23] or regimen [p = 0.41]). Partial responses were seen in 5 pts (4 PIK3CA mut on single agent PAMi; 1 KRAS mut on PI3K + MEK inh). Of 4 KRAS mut pts, none had CBR with single agent PAMi. PIK3CA mut were cl in 63% of OC, 17% of EC and 40% of CC. Clonal exon 20 PIK3CA mut were more frequent in OC (p = 0.03). We found longer TTP for cl PIK3CA events (4.0 vs. 1.5 m in scl, HR 5.1, p = 0.006) and a trend for exon 20 events (4.4 vs. 1.4 m in exon 9, HR 1.7, p = 0.25). Conclusions: Regardless of PIK3CA/PTEN mut status, PAMi confer CBR in almost 40% of GYN pts. Functionality and clonality of PIK3CA mut impact on TTP and interact with tumor type. Coexisting KRAS mut may drive resistance to single agent PAMi.
P29 Fast Response to Osimertinib in Patients with EGFR Mutated NSCLC with Brain Metastasis and Carcinomatous Meningitis
Authors: N. Torressi, R. Coveñas, V. Wainsztein Vanina, V. Denninghoff, F. Galanternik, A. Avagnina, G. Recondo, G. Recondo, M. Greco
Journal: Journal of Thoracic Oncology (2018)
Preexisting cardiovascular disease in patients undergoing hematopoietic stem cell transplantation.
Authors: Mohamed Khayata, Sadeer Al-Kindi, Linda Njoroge, Marcos J.G. De Lima, Guilherme H Oliveira
Journal: Journal of Clinical Oncology (2018)

e19501 Background: Hematopoietic Stem Cell Transplantation (HSCT) has emerged as the treatment of choice for certain malignancies. Because of shared risk factors among malignancies and cardiovascular disease, we aimed to describe the prevalence of preexisting cardiovascular risk factors and disease in HSCT recipients. Methods: Using aggregated electronic medical records from 26 healthcare institutions in the US (Explorys), we identified all patients (35-74 years) who underwent HSCT 10/2016-10/2017. Cardiovascular risk and disease were identified using systemized nomenclature of medical terms, and were compared with patients (without HSCT) in the database. Results: Out of 28,571,030 patients, we identified 2,430 had HSCT. Compared with controls, HSCT had increased prevalence of diabetes (9% vs 26%, P < 0.001), hypertension (22% vs 57%, P < 0.001), hyperlipidemia (19% vs 48%, P < 0.001), tobacco use (11% vs 27%, P < 0.001), coronary artery disease (5% vs 12%, P < 0.001), peripheral vascular disease (6% vs 30%, P < 0.001), and heart failure (2% vs 12%, P < 0.001). Only 4% of HSCT patients were referred to a cardiologist. Conclusions: Preexisting cardiovascular risk factors and disease are prevalent in patients undergoing HSCT. Aggressive screening for cardiovascular risk factors and disease should be considered to reduce cardiovascular morbidity and mortality.
MicroRNA (miR) 203a as a biomarker of response to immunotherapy of HPV related cervical cancer.
Authors: Linda Li, Gina Deiter, Kristin Lambert, Joshua Philip Kesterson, Faoud Ishmael, Rebecca Phaeton
Journal: Journal of Clinical Oncology (2018)

e17508 Background: After demonstrating therapeutic potential of anti-HPV E6 monoclonal antibody (mAb C1P5) compared to isotype control mAb (MopC21) in a murine model of HPV cervical cancer, we sought to determine differential miR signatures. HPV positive cell lines expressing E6 (CasKi and SiHa) and HPV negative cells (C33A) were utilized to distinguish viral specific interactions. We tested the hypothesis that treatment with anti- HPV E6 mAb C1P5 expresses differential miR expression signatures that can be used as a biomarker of immunotherapy response Methods: Primers for miR15b, 16, 23b, 29a, 34a, 146a, 203a, 218, and 324 were chosen as candidates after literature review demonstrating HPV E6 oncoprotein association.1Findings were compared to Cisplatin, a known apoptotic agent that induces a distinct miR profile, as a positive control. After 4, 8, and 24h CasKi, SiHa and C331 cells were harvested and total RNA was isolated according to standard protocol and analyzed using quantitative PCR. miR25 was used as endogenous control. Fold expression of individual miR was compared with baseline expression for untreated cells. Significance was set as p < 0.05, correlating to up regulation > 1.5 and down regulation < 0.5 fold-change as calculated by 2-ΔΔCt. Results: Treatment with C1P5 showed HPV E6 specific response in miR signatures. The lack of interactions between C1P5 and HPV negative cells (C33A) underscore that C1P5 mAb treatment is specific to only HPV infected cells, which promises tumor directed therapy with limited off-target effects. miR203a is significantly upregulated in C1P5 mAb treatment in HPV positive cells distinct from negative cells. Interestingly, the dichotomous fold change based on HPV status was consistently upregulated in Cisplatin treated cells. This suggests a common mechanistic pathway. Conclusions: miR203a shows promise as biomarker and should be further explored in the clinical samples to determine clinical relevance for future Phase 1 trials.