tbuckley/cabot-search huggingface dataset:
Evaluation of the physician-patient communication assessment tool (CAT) in a hematology-oncology practice.
Authors: Amrita Desai, Adam J. Olszewski
Journal: Journal of Clinical Oncology (2013)

14 Background: Interpersonal communication skills are critical for building physician-patient relationships. The usefulness of feedback instruments to assess communication in oncology is uncertain. The simple, 15-item, patient-oriented CAT (Makoul G, et al. Patient Educ Couns 2007;67:333) was previously validated in non-oncologic specialties, using 20-30 samples per physician. The mean proportion of “Excellent” scores (MPES) was recommended as a summary estimate (76% in the above study). We evaluated the usefulness of this survey in a hematology-oncology practice. Methods: We administered CAT anonymously to all consenting outpatients during visits in our center, from January to March 2013. The association of “Excellent” scoring with patient age, gender and type of visit (cancer-related or unrelated) was studied using random-effects logistic regression. Results: We obtained 144 surveys (23-52 per physician). Median patient age was 65 years (range, 19-93) with 67% women and 54% cancer-related visits. The MPES for each survey question varied between 86% and 96%. The average MPES per physician was 92.1% (range 88.5-95.8%). MPES was higher for patients &gt;65 years old (94.9% vs. 90.4%), men (96.7% vs. 90.3%), and for cancer-related visits (94.8% vs. 89.7%). In a multivariable model, the association was significant for age&gt;65 (odds ratio, OR 5.38, 95%CI 1.06-27.5, p=.043) and female sex (OR 0.12, 95%CI 0.02-0.76, p=.024). The physician score strongly correlated with satisfaction with office staff recorded as part of the CAT (odds ratio, OR, 28.5, p&lt;.0001). Conclusions: In a hematology-oncology practice, CAT results were considerably more skewed towards “Excellent” scores than in other previously studied specialties. Patients’ age and gender significantly influence the scores, which may confound comparisons between physicians or practices in quality assessment projects. As the needs, concerns and problems of cancer patients may differ from other medical settings, further research is needed to establish if CAT can be used for performance improvement, and whether oncology-specific questions can provide more discriminating measures of patient satisfaction and physician communication skills.
Effect of lymph node harvest for squamous cell cancer of the esophagus on survival.
Authors: Jeremiah Lee Deneve, Jill M. Weber, Sarah E. Hoffe, Ravi Sridhar, Khaldoun Almhanna, James S. Barthel, Richard C. Karl, Kenneth Meredith
Journal: Journal of Clinical Oncology (2012)

102 Background: The optimal number of lymph nodes harvested remains controversial in patients with esophageal cancer. Pathologic response to neoadjuvant therapy (NT) has demonstrated improved survival. However, little is known regarding the impact of NT or nodal harvest in patients with squamous cell carcinoma (SCC) of the esophagus. We examined the extent of LN harvest and outcome in patients who underwent esophagectomy for SCC. Methods: After IRB approval, using a comprehensive esophageal cancer database we identified patients who underwent esophagectomy between 1994-2011. Clinical and pathologic data were compared using Fisher’s exact and chi-square when appropriate while Kaplan-Meier estimates were utilized for survival analysis. Nodal strata were set at 12 (ST-1), 15 (ST-2), and 20 nodes (ST-3). Pathologic response to NT was defined as complete (pCR), partial (pPR), or non-response (pNR). Results: We identified 76 patients who underwent esophagectomy for SCC between 1994-2011. The median age was 62.5 years (40-85 months) with median follow up of 18.5 months (1-157 months). 48 (63%) were male and 28 (37%) were female. Twenty-eight patients (37%) underwent primary esophagectomy alone (PE) while 48 (63%) patients were treated with NT. Extent of lymphadenectomy had no significant impact on overall survival (OS) or disease free survival (DFS) for the entire cohort ST-1 p=0.8 and p=0.9, ST-2 p=0.5 and p=0.4, and ST-3 p=0.5 and 0.4, respectively. Among the patients who received NT, pCR was observed in 28 (58%), pPR in 14 (29)%, and pNR in 6 (13)%. When examining the degree of pathologic response to treatment, extent of LN harvest had no significant impact on OS or DFS for patients who underwent esophagectomy after NT (p=ns across all strata). Conclusions: The extent of LN harvest failed to demonstrate an overall or disease free survival benefit in patients with squamous cell carcinoma of the esophagus. Moreover, patients treated with NT also did not benefit from increased nodal resection irrespective of their pathologic response.
Using a collaborative approach for rapid deployment of advance care planning in the outpatient oncology setting.
Authors: Jane Alcyne Severson, Jeffrey B. Smerage, Jamie Lindsay, Laura Petersen, Keith Mark Swetz, Arif Kamal
Journal: Journal of Clinical Oncology (2016)

255 Background: The Michigan Oncology Quality Consortium (MOQC) is a quality collaborative supported by Blue Cross Blue Shield of Michigan with the goal of improving cancer care in Michigan by using data gathered as part of the national Quality Oncology Practice Initiative (QOPI) program. In spring 2014, MOQC launched a statewide collaborative focused on advance care planning (ACP) with the following aim: to provide training and resources on how to engage patients in a discussion of goals, preferences, and priorities for care. Methods: The collaborative was comprised of three half day learning sessionsthat included an overview of legal and documentation requirements, and facilitator-lead role play with patient actors. Lean resources (templates, workflows) to support standard work in the clinic were disseminated. Eight oncology practices participated ranging in size from 1-25 physicians. ASCO QOPI data were analyzed pre and post collaborative in spring 2014 and spring 2015. Results: Improvement in QOPI performance from spring 2014 to 2015 on “hospice enrollment, palliative care referral/services, or documented discussion” (73.8% to 77.6%) and “for patients not referred, hospice or palliative care discussed within the last 2 months of life” (17.7% to 23.9%) was noted for participating practices (n = 8). Collaborative participants also compared favorably to all other MOQC practices (n = 47) in spring 2015 on “hospice enrollment, palliative care referral or documented discussion” (77.6% vs. 66.2%) (p &lt; 0.001). Conclusions: Use of a collaborative education modelthat includes facilitator-lead role play and dissemination of lean resources to create standard work may be an efficient and effective approach to improve discussion and documentation of advance care planning.
Second-line FOLFOX chemotherapy in patients with metastatic gallbladder cancer and cholangiocarcinoma.
Authors: Jose Luis Leal, Juan Carlos Roa, Nicolas Jarufe, Jorge Madrid, Carolina Ibanez, Maria Elisa Herrera, Marcelo Garrido, Bruno Nervi
Journal: Journal of Clinical Oncology (2014)

322 Background: After first-line treatment with gemcitabine-based regimen, there is not standard second-line chemotherapy for patients with metastatic gallbladder cancer (GB) and cholangiocarcinoma (CC). The aim of this study was to evaluate the activity, progression free survival (PFS), and overall survival (OS) of the FOLFOX4 regimen as second-line chemotherapy. Methods: We performed a retrospective analysis of all metastatic GB and CC that were treated with gemcitabine (Gem) based first-line chemotherapy, and second-line FOLFOX4 chemotherapy (oxaliplatin 85 mg/m2, day 1; leucovorin 200 mg/m intravenously, days 1 and 2; 5-fluorouracil 400 mg/m intravenous bolus, days 1 and 2; and 600 mg/m in 22 h intravenously, continuous infusion days 1 and 2; every 14 days) in our Institution since 2003. The response rate was evaluated every 2 to 4 months according to the RECIST criteria, and PFS/OS were calculated according to the Kaplan-Meier method. Results: Eighty patients (n=40 GB; n=40 CC) received Gem based first-line treatment (42 Gem alone; 38 Gem + platinum). There was no survival difference between Gem or Gem+platinum treatment (161 versus 254 days; p=0.09). Response rate (complete and partial response) was 16% and stable disease was 31%. Ca19-9 at presentation was predictive for OS: &lt;100U/ml =403 days versus &gt;100 U/ml =223 days (p=0.025). Eighteen patients (22%; n=10 GB and n=8 CC) were treated with second-line FOLFOX4. In the second-line group, stable disease was achieved in 4 patients (22%), and 11 patients progressed (66%). The median DFS and OS were 96 and 138 days respectively. The median OS for patients that received one versus both lines of chemotherapy were 161 versus 400 days (p=0.009). Conclusions: FOLFOX4 has activity in second line chemotherapy for patients with metastatic GB and CC. A prospective study is warranted to confirm this observation.
Survival comparison of patients treated with one versus five fraction palliative radiotherapy.
Authors: Sara Dudley, Yushen Qian, Aadel Chaudhuri, Kiran Kumar, Sonya Aggarwal, Daniel Tandel Chang
Journal: Journal of Clinical Oncology (2015)

200 Background: Choice of fractionation scheme for palliative radiotherapy has received greater attention in recent years, particularly in the current healthcare environment where issues of cost and quality of life have taken on increasing importance. The ASTRO Choosing Wisely campaign recommends against routine use of extended fractionation schemes ( &gt; 10 fractions) for palliation of bone metastases given equivalent pain relief between 30 Gy in 10 fractions and 8 Gy in 1 fraction, and strong consideration for use of 8 Gy in 1 fraction is urged for patients with a limited prognosis or transportation difficulties. We investigated whether there was a difference in survival between patients treated with an intermediate fractionation scheme (5 fractions) and patients who received single-fraction treatment. Methods: We identified 220 patients who received a total of 264 courses of palliative radiotherapy with either 8 Gy in 1 fraction (n = 91) or 20 Gy in 5 fractions (n = 173). Date of death was obtained from either the patient’s medical record, the Social Security Death Index, or publicly available obituaries. If none of these yielded a date of death, patients were censored at the date of their last clinical encounter. The majority of patients (n = 192) were treated for bone metastases. All primary sites were included, with the three most common histologies being lung, breast and prostate (n = 80, 31 and 16, respectively). Results: Overall, we found no significant survival difference between the two groups. Patients treated with 8 Gy in 1 fraction had a median survival of 146 days, whereas patients treated with 20 Gy in 5 fractions had a median survival of 183 days (p = 0.43). Conclusions: Given no difference in survival between fractionation schemes of 20 Gy in 5 fractions and 8 Gy in 1 fraction, delivery of palliative radiation in a single fraction should be strongly considered. Previous studies have identified a higher re-treatment rate in single-fraction treatments, although closer analysis of this data revealed no difference in absolute pain scores prior to re-treatment. Thus, re-treatment for single-fraction radiotherapy may be due instead to a greater clinical willingness to re-treat as opposed to a greater clinical need.
Efficacy and safety of ipilimumab induction and maintenance dosing in patients with advanced melanoma who progressed on one or more prior therapies
Authors: S. J. O'Day, R. Ibrahim, V. DePril, M. Maio, V. Chiarion-Sileni, T. F. Gajewski, H. Pehamberger, A. Hoos, R. Humphrey, J. Wolchock
Journal: Journal of Clinical Oncology (2008)

9021 Background: Ipilimumab (ipi) is a monoclonal antibody directed against cytotoxic T-lymphocyte antigen-4. The current study was designed to determine the efficacy and safety of ipi in patients (pts) with advanced melanoma who developed progressive disease (PD) on prior therapies. Methods: Advanced melanoma pts with PD during or after >1 prior therapeutic regimen were eligible for enrollment into this single-arm, multicenter, phase II study. Ipi induction was given at 10 mg/kg every 3 weeks (Q3W)×4; eligible pts received maintenance Q12W starting at Week (Wk) 24. The primary objective was to evaluate the best overall response rate (BORR, complete + partial response [CR+PR]). Efficacy endpoints were assessed with modified World Health Organization (mWHO) criteria; the first assessment was at Wk 12. Follow-up tumor evaluation beyond PD (defined by an overall tumor burden increase of >25%) by mWHO and before the administration of non-ipi anticancer therapy was permitted as per protocol. Results: The study included 155 treated pts. The median number of prior therapies was 2. The BORR as per an Independent Review Committee (IRC) was 5.8% (9/155) [95% CI, 2.7 - 10.7]. The disease control rate (DCR, best response of CR + PR + stable disease [SD]) was 27.1% (42/155) [95% CI, 20.3 - 34.8]. New exploratory response criteria revealed a >25% reduction of measurable total tumor burden in 25.8% of patients. The progression free survival rate at Wk 24 was 49.1% [95% CI 41.2, 57.9]. Immune-related adverse events (irAEs) occurred in 70.3% of pts. Most patients (46.5%) had Grade 1/2 irAEs. The rates of patients with Grade 3/4 irAEs were: gastrointestinal 8.4%; hepatobiliary 7.1%; endocrine 1.3%; and skin 3.2%. Most irAEs were medically manageable. There were no bowel perforations. Conclusions: Ipi 10 mg/kg induction/maintenance dosing is effective and well tolerated in pts with PD on prior therapies. Clinical activity, in the form of either objective response or SD occurred in 27% of patients. Based on preliminary results from previous studies (eg, MDX010–15), we expect pts with a BOR of SD or better to remain progression free for months to years. Follow up of these pts is ongoing; survival data will be presented at the meeting. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Medarex
90.y-Ibritumomab Tiuxetan (Zevalin®) May Enhance Anti-Lymphoma Effect of Reduced-Intensity Fludarabine and Melphalan Regimen in Patients with Relapsed, Refractory B-Cell Non-Hodgkin Lymphoma (NHL) Undergoing Allogeneic Hematopoietic Cell Transplant (Allo-HCT).
Authors: Auayporn P. Nademanee, Andrew Raubitschek, Joycelynne Palmer, Dave Yamauchi, Maria Delioukina, Leslie Popplewell, Firoozeh Sahebi, Eileen Smith, Anthony Stein, Neil Kogut, Margaret O'Donnell, Stephen J Forman
Journal: Blood (2009)
First-in-human fractal methodology for modeling the hepatic arterial tree and tumor microvasculature for <sup>90</sup>Y-microsphere brachytherapy.
Authors: Andrew S. Kennedy, Rachel Clipp, David Christensen
Journal: Journal of Clinical Oncology (2014)

248 Background: 90 Y-microsphere therapy (radioembolization) is an effective and safe brachytherapy procedure for control of unresectable primary and metastatic hepatic malignancies. To advance this treatment approach, a method is proposed which enables complex modeling of the hepatic arterial route, and the tumor microvascular bed in which the radioactive particles will become permanently embedded. Methods: Prior work from our group included hepatic vessel measurements from patients undergoing 90 Y-microsphere therapy including geometry, pressure, velocity and waveforms prior to and during microsphere deposition in real time. A computation particle-fluid dynamics model was built for proximal hepatic arteries of 900 microns, which is the limit of current imaging technology. Fractal methods were programmed in C++ for simulations of both normal liver and tumor arterial trees. Our goal was to produce sufficient generations to achieve daughter arterioles of 50 micron diameter in tumors where microspheres typically lodge in clusters. Results: Normal liver and tumor artery trees were created, with malignant vessels employing a random generator at each node resulting in corkscrew, bifurcation and/or trifurcation daughter vessel pattern. Three key variables were: asymmetry ratio of radii of daughter vessels; power law of the type of flow present in vessels (turbulent or laminar); and area ratio, which is the area between daughters and parent vessel. Simulations of up to 250 generations resulted in successful modeling of 50 micron diameter normal and tumor arterioles. Impedance in each vessel (modulus and phase shift) was tested with a large variety of vessel geometries. Conclusions: Fractal methods were used to develop a software tool that can represent the microvasculature of human liver and different organs, and can account for disease states, such as liver tumors. This is accomplished using corkscrew, bifurcating, trifurcating and randomized structured trees. Predictive modeling may now be possible for radioactive or non-radioactive microspheres exiting from a catheter in the hepatic artery to its final position in a tumor end arteriole, or for systemic therapies.
Cancer stem cell gene variants associated with colon cancer recurrence.
Authors: L. Benhaim, A. Gerger, W. Zhang, D. Yang, P. O. Bohanes, Y. Ning, T. Winder, M. J. Labonte, P. M. Wilson, R. El-Khoueiry, A. B. El-Khoueiry, S. Iqbal, H. Lenz
Journal: Journal of Clinical Oncology (2011)

3612 Background: Recent evidence suggests that cancer stem cells (CSCs) are responsible for colon cancer (CC) progression and tumor recurrence. Despite the potentially high clinical relevance of CSCs, little is known about the prognostic value of CSC markers in CC. There is substantial germline genetic variability in the genes of CSC markers, including single nucleotide polymorphisms (SNPs). SNPs may alter transcription, translation or splicing, thereby causing inter-individual differences. We hypothesized that SNPs analyzed in a comprehensive panel of CSC marker genes predict tumor recurrence in patients with CC. SNPs were selected based on previous literature, functional data and frequency. Methods: Either blood or FFPE tissue specimens were obtained from 234 patients (107 females and 127 males; median age 59 yrs [range 22–87 yrs]) with stage II (105 pts) or III (129 pts) CC at the University of Southern California. The median follow-up was 4.4 years. Twenty-six SNPs in genes of CSC markers (CD44, CD133, CD26, EpCAM, CD166, Msi-1, CD29, CD24, Lgr5 and ALDH1) were determined by PCR-RFLP or direct DNA-sequencing. Primary endpoint of the study was time to tumor recurrence (TTR). This study was conducted adhering to the reporting recommendations for tumor marker prognostic studies (REMARK). Results: The minor alleles of CD44 rs8193 C/T, CD166 rs1157 G/A and Lgr5 rs17109926 T/C showed significantly longer median TTR (5.7 vs 9.4 yrs, HR 0.66, p=0.024; 5.7 vs 11.3 yrs, HR 0.56, p=0.024; 6.6 vs 10.7 yrs, HR 0.33, p=0.023) in univariate analysis. After Cox proportional hazards model adjustment for stage and type of adjuvant chemotherapy and stratification by race these results remained significant (HR 0.71, p=0.034; HR 0.55, p=0.027; HR 0.34, p=0.035). No significant association was found between TTR and the remaining tested gene variants. Conclusions: To the best of our knowledge, this is the first study identifying common gene variants in CSC marker genes as independent prognostic marker in stage II and III CC. Larger prospective trials are warranted to confirm these findings.
Time-resolved gadolinium-enhanced MR imaging of the breast: Impact on accuracy of diagnosis of breast carcinoma.
Authors: Hanan Sherif, Amal Al-Obaidly, Issam Albosom, Ahmed-Emad Mahfouz
Journal: Journal of Clinical Oncology (2013)

33 Background: The purpose of the study is to differentiate benign and malignant breast lesions based on very early enhancement of the lesion on time-resolved gadolinium-enhanced MR imaging. Methods: 100 women with breast lesions were examined at 1.5 T (Siemens, Erlangen, Germany), by fast T1-weighted GRE images every 5 s for 1 min after injection of Gd-DOTA (Dotarem, Guerbet, France), followed by 5 spacially-resolved MR image series every 30 s. Images were subtracted; maximum-intensity-projection images were obtained; and images were randomized and reviewed by two blinded readers, who reviewed only the spacially-resolved MR images and gave BIRADS diagnosis. After one month, they evaluated only the time-resolved MR images and noted the time of first appearance of enhancement. Results: The patients had 249 enhancing lesions: 66 malignant on histopathology and 183 benign on basis of histopathology or 1-year imaging follow-up. On time-resolved MR imaging, 15 lesions enhanced at 0-5 s (all malignant), 23 at 5-10 s (21 malignant, 2 benign), 34 at 10-15 s (28 malignant, 6 benign), and 117 at 15-20 s (2 malignant, 115 benign). All malignant lesions enhanced before 20 s. Taking 15s as the cut-off point, early enhancement had sensitivity of 96.9%, specificity of 95.6%, positive predictive value of 88.8%, negative predictive value of 98.8%, and accuracy of 95.9% for diagnosis of carcinoma. Enhancement before 15 s corrected BIRADS diagnosis of the spacially-resolved MR imaging in 14 lesions (5.6%). Conclusions: Lesion enhancement in the first 15s on time-resolved MR imaging is a useful sign for the diagnosis of breast carcinoma.
Associated morbidity related to high dose rate afterloading brachytherapy and neoadjuvant androgen deprivation as a boost to conventional external beam radiation therapy for initial and local advanced prostate cancer
Authors: A. C. A. Pellizzon, P. Novaes, J. Salvajoli
Journal: Journal of Clinical Oncology (2005)

4746 Background: Verify acute and late intestinal (GI) and urological (GU) morbidity when high dose rate brachytherapy (HDR) was used as boost to conventional external beam radiatiotherapy (EBRT) in prostate cancer Methods: From 03/97 to 10/00 108 patients with biopsy proven adenocarcinoma Gleason scored, 1992 AJCC clinical stage T3a or lesser were treated with a course of EBRT 6MV photons to a median dose of 46Gy to the prostate only. For HDR-BT treatments patients were grouped into four groups: low risk (LR) without or with neoadjuvant total androgen deprivation (AD) and high risk (HR) without or with neoadjuvant AD. LR encompassed patients who presented GS ≤ 6, initial PSA ≤ 10ng/ml and or prostate volume ≤35 cc. They received 16Gy (4Gy fractions, BID) HDR. The remaining patients were grouped into HR and received 20Gy (5Gy fractions, BID) HDR. Biological effective doses (BED) for acuter and late responding tissue were calculated and matched with late gastro-intestinal (GI) and urological (GU) morbidity. Results: Median age of patients was 68 years old (range 47 to 83) and median follow-up 42 months (range 24 to 72). Acute GU and GI morbidity G1–2 were seen in 18.5% (20/108) and 10.2% (11/108) of patients. Late GI and GU morbidity G1–2 were seen in 12% (13/108) and 4.6 (5/108) of patients. Three patients (2,7%) developed G3 GU late morbidity, as urethral strictures (UR). When we stratified age for > or < 65 years with presence of NAAD (p=0.0234) and active length of needles greater than 3.5cm (p=0.0395) there was a statistically significant correlation with incidence of UR. Otherwise stratification by age older than 65 years and PUTV more than 35 cc (0.0593) did not have a statically significant correlation. On multivariate analysis by Cox regression age older than 65 years was the only predictive factor for the development of UR (p = 0.027). Conclusions: the most important antages in HDR-BT are the capability of on-line dosimetry and quality control. There is relative low incidence of GU and GI morbidity, but we still need to wait for results of phase III open trials that analyses HDR-BT and conformal therapy. No significant financial relationships to disclose.