tbuckley/cabot-search huggingface dataset:
A comparison of primary care providers’ and oncologists’ preferences for different models of cancer survivorship care.
Authors: Winson Y. Cheung, Anne Michelle Noone, Noreen Aziz, Julia Howe Rowland, Arnold L. Potosky, John Ayanian, Katherine S. Virgo, Patricia A. Ganz, Michael Edward Stefanek, Craig Earle
Journal: Journal of Clinical Oncology (2012)

6006 Background: There is increasing interest in developing more efficient and effective strategies for coordinating and delivering cancer and non-cancer related follow-up care to survivors. The objectives of this nationwide survey were to describe and compare US physician preferences for different cancer survivorship care models. Methods: The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) was mailed to PCPs and oncologists in order to evaluate their views regarding physician responsibilities, knowledge levels about survivorship, and cancer follow-up testing. Using weighted univariate and multivariate models, we analyzed PCPs’ and oncologists’ preferences for different cancer survivorship care models (PCP/shared vs. oncologist vs. non-physician provider) and examined how physician attitudes towards and self-efficacy with their own skills during breast and colorectal cancer follow-up affected these preferences. Results: Of 3,434 physicians surveyed, 2,202 (64%) responded of whom 2,026 (59%) provided eligible outcomes for this study: 938 (46%) PCPs and 1,088 (54%) oncologists. In unadjusted analyses, most PCPs (51%) supported a PCP/shared care system whereas the majority of specialists (59%) strongly endorsed an oncologist-based model (p&lt;0.001). A number of PCPs and oncologists (23% for both) preferred to involve non-physician providers. A significant proportion of cancer specialists (87%) did not feel that PCPs can take on the primary role for cancer follow-up. Many PCPs believed that they have the skills to perform breast and colorectal cancer follow-up (57%), detect recurrent cancers (74%), and offer psychosocial support (50%), but only a minority (32%) were willing to assume exclusive responsibility. In adjusted analyses, PCPs already involved with cancer surveillance (43%) were more likely to prefer a PCP/shared care system than an oncologist-based survivorship care model (OR 2.08, 95%CI 1.34-3.23, p&lt;0.001). Conclusions: PCPs and oncologists have different preferences for models of cancer survivorship care. Prior involvement with cancer follow-up was one of the strongest predictors of PCPs' willingness to assume this responsibility.
Third-line therapy and beyond for patients with advanced/metastatic non-small cell lung cancer (NSCLC).
Authors: Jesus Corral Jaime, Miriam Gonzalez de la Peña, Miriam Alonso, Amparo Sanchez Gastaldo, Maria Dolores Mediano, Marta Amerigo, Carlos Enrique Robles
Journal: Journal of Clinical Oncology (2013)

e19160 Background: Lung cancer is the leading cause of cancer-related deaths globally, with a 15% 5-year survival rate. Platinum-based chemotherapy constitutes the main treatment modality, with a median overall survival (OS) of approximately 10–12 months. The current National Comprehensive Cancer Network (NCCN) guidelines recommend several options for first-line and second-line therapies but endorse only erlotinib/gefitinib as third-line therapy in unselected patients, as well as crizotinib in ALK-positive selected patients.The paucity of approved agents for third-line therapy and beyond for patients with non-small cell lung cancer (NSCLC) constitutes an important unmet medical need. Methods: Retrospective analysis of 22 patients with advanced/metastatic NSCLC in progression after a minimum of 3 lines of therapy. Results: Between January 2009 and October 2012, 22 patients were analysed. Median age at diagnosis was 62 years old. 15% of patients were never smokers and 72.7% had non squamous NSCLC histology. Stage at diagnosis resulted: 6 (27.3%) stage IIIA, 3 (13.6%) stage IIIB and 13 (59.1%) stage IV. 3 (13.6%) patients were EGFR mutation carriers and 1(1%) patient had ALK translocation. Third line therapy options resulted a clinical trial (27.3%), erlotinib (22.7%), paclitaxel/gemcitabine (13.6%), docetaxel (9.1%) and crizotinib (4.5%). Estimated median progression-free survival (PFS) between first and second line therapy was 5.3 months; PFS between second and third line resulted 4.4 months. Median PFS and overall survival (OS) beyond third line treatment has not been reached yet. Conclusions: Currently, erlotinib/gefitinib and crizotinib, which target EGFR and ALK, are the only recommended agents for third-line therapy in patients with advanced/metastatic NSCLC. Real-world clinical practice reveals a variety of chemotherapeutic agents used in this setting. Additional systemic and/or targeted therapeutic under development, with complementary biomarker analysis, should be the key in identifying those patients most likely to benefit from newer agents.
Epidermal growth factor receptor expression in stage II-III colon carcinoma: A preliminary study
Authors: C. Pericay, E. Musulén, Y. García-García, S. Fernández, L. Fernández-Morales, E. Dalmau-Pórtulas, E. Gallardo-Díaz, J. Montesinos, M. Rey, E. Saigí
Journal: Journal of Clinical Oncology (2004)

9718 Background: Epidermal growth factor receptor (EGFR) is a protoncogen that is found overexpressed in colorectal carcinomas (CRC) and it correlates with a worse prognosis. The aim was to describe EGFR overexpression patterns in non-metastatic CRC and to correlate these data with follow-up. Methods: We analyzed a series of 56 CRC. Inclusion criteria were: a) resected primary adenocarcinoma; b) curative surgery; c) pT3 N0–2 M0 without progression during the first 6 months post surgery; d) minimum follow-up over 3 years. EGFR overexpression was analyzed by immunohistochemistry (IHC) using the Dako PharmaDx kit (Glostrup, Denmark). As positive control the Dako slides and a bloc cell of A431-AAM cells were used. Presence of cytoplasmic and membrane patterns (intensity 1(+), 2(+) and 3(+)) were evaluated as well as the percentage of positive cells. Statistical analysis: association between qualitative variables was analyzed by Fisher's exact test. Disease-free and overall survival distributions were estimated by the Kaplan-Meier method and were analyzed with the log rank test. All P values are from two-sided statistical tests. Results: Characteristics of the patients (pts) were as follows: mean age: 68,4 years (range: 28–91); sex: 24 male and 32 female; location: 19 right colon and 37 left colon; follow-up: 44 pts alive without disease (78,5%), 9 died of disease (16,5%) and 3 died of other causes (5%). 10 pts had metastasis in the follow-up. IHC: Forty-two cases were positive (75%) and were classified as follows: 17 with >50% of positive cells (30%), 7 with 25–50% of positive cells (13%) and 18 cases with < 25% of positive cells. Patterns of staining were cytoplasmic predominance in 27 cases (48%) and 15 with membrane predominance (27%): 4 with intensity 1(+), 9 with 2(+) and 2 with 3(+). Only those patients with tumors harboring membrane positivity 2(+) and 3(+) had more probability to present metastasis (p= 0.067). Conclusions: EGFR overexpression evaluated as a membrane pattern with 2(+) and 3(+) intensity is related with metastatic development in colon carcinoma. Suported by a grant of C.I.R. Hospital de Sabadell. Consorci Sanitari Parc Taulí. Sabadell. Spain No significant financial relationships to disclose.
Phase I clinical, biology &amp; pharmacokinetic study of the combination of GW 572016 and capecitabine in patients with advanced solid tumors
Authors: G. Schwartz, Q. S.-C. Chu, L. A. Hammond, M. Mita, J. Curtright, M. J. Versola, K. Koch, L. N. Pandite, P. T. C. Ho, E. K. Rowinsky
Journal: Journal of Clinical Oncology (2004)

3070
JAK1 As a Convergent Regulator of Hematopoietic Stem Cell Function and Stress Hematopoiesis
Authors: Maria Kleppe, Matthew H Spitzer, Sheng Li, Lauren Dong, Efthymia Papalexi, Corinne Hill, Sofie De Groote, Matthew Keller, Priya Koppikar, Franck Rapaport, Jorge Gandara, Christopher E. Mason, Garry P. Nolan, Ross L. Levine
Journal: Blood (2016)
Interventions to improve oral chemotherapy safety and quality: A systematic and grey literature review.
Authors: Jessica A. Zerillo, Benjamin Adam Goldenberg, Ritesh R. Kotecha, Alok Tewari, Monika K. Krzyzanowska, Joseph O. Jacobson
Journal: Journal of Clinical Oncology (2017)

97 Background: With the growing use of oral chemotherapy, there is an urgent need to develop safe and effective systems to administer and manage these agents. A comprehensive synthesis of literature on oral chemotherapy care delivery programs to which clinicians can look for best practices is lacking. Methods: We performed a systematic review of PubMed, EMBASE and CINAHL from 1/1995- 5/2016 and the grey literature to identify publications describing oral chemotherapy care delivery programs. Our population of interest was cancer patients of all ages prescribed cytotoxic or targeted anti-cancer oral agents. Interventions could address any part of the oral chemotherapy delivery process from prescribing through disposal but had to report outcomes (adherence and/or safety or toxicity) in relation to a control group. Results: From 7,984 abstracts in the peer-reviewed and 9 from the grey literature, 16 studies met inclusion criteria (7 of these randomized) with 3,612 patients represented. Interventions focused on prescribing (n = 1), preparation/dispensing (n = 2), education (n = 11), administration (n = 5), monitoring (n = 14), and storage/disposal (n = 1). Of the 10 articles with adherence as an outcome, four different measurement methods were used. Many articles lacked formal statistical testing. In the 6 studies with statistically significant improvement in outcomes, 3 utilized nursing phone calls to patients within the first few days of treatment initiation, which resulted in less toxicity (n = 2) or better adherence (n = 1). None of the four studies that evaluated eHealth strategies to increase patient to care team contact demonstrated a statistically significant improvement in outcomes. Conclusions: Limitations in study design impair our ability to draw definitive conclusions on best practices for oral chemotherapy care delivery. A framework for conducting research in this area that defines the processes of oral chemotherapy delivery and standardizes outcomes of success is needed to address this gap. Existing studies suggest that interventions focusing on education and remote phone-based monitoring of patients at therapy initiation may decrease toxicity, and possibly improve adherence.
Electronic Health Records
Authors: Susan Hingle
Journal: Annals of Internal Medicine (2017)

Letters4 April 2017Electronic Health RecordsSusan Hingle, MDSusan Hingle, MDFrom SIU School of Medicine, Springfield, Illinois.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0051 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:I thank Drs. Ronquillo and Zuckerman for their thoughtful comments and perspective on regulatory changes needed to improve the safety and efficacy of EHRs. Theirs is an interesting approach that I had not considered before. Previous approaches focused on adapting workflows ( 1) and integrating such additional technology as voice recognition software ( 2) are simply workarounds that do not address the root cause of the problem. Drs. Ronquillo and Zuckerman's approach is important because it does focus on the fundamental problem, which is dysfunctional and flawed EHR systems. Some possible challenges with their approach include gaining buy-in ...References1. Sinsky CA, Beasley JW. Medical scribes and electronic health records [Letter]. JAMA. 2015;314:519. [PMID: 26241606] doi:10.1001/jama.2015.6944 CrossrefMedlineGoogle Scholar2. Dela Cruz JE, Shabosky JC, Albrecht M, Clark TR, Milbrandt JC, Markwell SJ, et al. Typed versus voice recognition for data entry in electronic health records: emergency physician time use and interruptions. West J Emerg Med. 2014;15:541-7. [PMID: 25035765] doi:10.5811/westjem.2014.3.19658 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From SIU School of Medicine, Springfield, Illinois.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1757. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoElectronic Health Records: An Unfulfilled Promise and a Call to Action Susan Hingle Electronic Health Records Jay G. Ronquillo and Diana M. Zuckerman Metrics 4 April 2017Volume 166, Issue 7Page: 536KeywordsConflicts of interestDisclosureElectronic medical recordsHealth careSafety ePublished: 4 April 2017 Issue Published: 4 April 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Experimental drug seems very effective for frequent menopausal hot flushes
Authors: Ingrid Torjesen
Journal: BMJ (2017)

An experimental drug has been found to cut the number of menopausal hot flushes by almost three quarters in an early trial reported in the Lancet .1

The trial, funded by the UK Medical Research Council and the National Institute for Health Research, tested a neurokinin 3 receptor antagonist (MLE4901), originally developed by AstraZeneca and licensed to Millendo Therapeutics, in women who experienced severe flushing as a menopausal symptom.

Postmortem studies of brain tissue from post-menopausal women have shown that it contains elevated levels of neurokinin B, and researchers at Imperial College London …
Survival differences related to estrogen receptor beta (ERβ) polymorphism and age in female patients with metastatic colon cancer
Authors: O. A. Press, W. Zhang, D. Y. Yang, J. Yun, M. Gordon, N. Mallik, H.-J. Lenz
Journal: Journal of Clinical Oncology (2004)

3618 Background: Estrogen replacement therapy decreases the risk of colon cancer in postmenopausal women. ERβ, not ERα, is expressed in the colon. ERβ function in colon tissue has been linked with tumor development, apoptosis and prognostic markers. ERβ gene contains a polymorphic dinucleotide CA repeat in the 3' noncoding region which is associated with hormone levels in females. Analysis was done on metastatic colon cancer patients to determine: 1) Whether ERβ polymorphism are associated with survival 2) if a difference in survival between young (pre-menopausal) and old (post-menopausal) patients exists. Methods: A population of 388 patients with metastatic colon cancer collected from 1997 to 2003 was selected for by age. The age extremes were selected because estrogen levels were important for this study and menopause will affect hormone levels. 29 patients of young age (<40 years) were identified, 17 pre-menopausal females and 12 males. In the older population (>65 years) there were 82 patients, 33 post-menopausal females and 49 males. Genomic DNA from blood or paraffin embedded tissue was analyzed by 5'-end 33P-rATP labeled PCR to assess the number of CA repeats in the ERβ gene. Results: 1) Women with one or more alleles containing ≤ 18 CA repeats had a 32.1 month median survival while those with both alleles >18 CA repeats had a 19.4 month median survival (p=0.007). Women with both alleles >18 CA repeats had a relative risk of dying 3.12 times that of the other group. 2) There was a significant difference in overall survival among women less than 40 years of age (median survival, 18.7 months) compared with women over 65 years of age (median survival, 30.7 months) (p=0.014), suggesting that younger women have a more aggressive form of disease. Conclusion: Women with metastatic colon cancer that have at least one allele with ≤ 18 CA repeats have better overall survival than those with both alleles >18 CA repeats. Women with metastatic colon cancer under age 40 had a lower overall survival than women with metastatic colon cancer over age 65. This data supports a role for ERβ and estrogens as prognostic markers in colon cancer development. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Chiron
Effect of YOCAS yoga on insomnia and sleep medication usage among breast cancer patients receiving hormone therapy: A URCC CCOP randomized, controlled clinical trial.
Authors: Luke Joseph Peppone, Michelle Christine Janelsins, Anita Roselyn Peoples, Charles Stewart Kamen, Jeffrey J. Kirshner, Rakesh Gaur, James Atkins, Pavan S. Reddy, Karen Michelle Mustian
Journal: Journal of Clinical Oncology (2013)

9531 Background: Insomnia (INS) is a highly prevalent side effect of hormonal therapy for breast cancer. Patients often turn to Rx sleep meds, which may lead to negative interactions with cancer therapeutics, dependency, rebound impairment, and do not cure INS. We conducted a secondary data analysis of a multi-site, phase III RCT examining the efficacy of yoga for improving INS and decreasing sleep medication usage among breast cancer patients currently receiving hormone therapy through the University of Rochester Cancer Center Community Clinical Oncology Program (CCOP). Methods: The original RCT randomized patients with any type of non-metastatic cancer without previous yoga participation into 2 arms: 1) standard care monitoring [controls] or 2) 4-week yoga intervention (2x/wk; 75 min/session) plus standard care. The yoga intervention utilized the UR Yoga for Cancer Survivors (YOCAS) program consisting of breathing exercises, 18 Hatha and Restorative yoga postures, and meditation. Only breast cancer patients currently receiving aromatase inhibitors (N = 95) or tamoxifen (N = 72) were included in this analysis. Changes in INS and sleep meds between the groups were assessed using ANCOVA with baseline values as covariates. Results: Despite using Rx sleep meds at baseline, INS, assessed by the Insomnia Severity Index, was worse for those women compared to women not taking any Rx sleep meds (Rx = 15.3 vs No Rx = 13.1; p&lt;0.01). Yoga participants demonstrated greater improvements in INS compared to controls (CS=change score; Yoga CS = −3.3 vs Control CS = −0.5; p&lt;0.01). In addition to improved INS, yoga participants significantly decreased Rx sleep med usage compared to controls (Yoga = −17.6% vs Control = −3.3%; p=0.04). There was also a trend toward lower combined Rx/Non-Rx sleep med use for the yoga group compared to controls (Yoga = −14.5% vs Control = −3.1%; p=0.09). Conclusions: YOCAS yoga is a safe intervention that significantly improves INS while concurrently reducing Rx sleep medication usage among breast cancer patients receiving hormone therapy. Funding: MRSG-13-001-01-CCE, NCI U10CA37420, K07CA120025 and OCCAM supplement. Clinical trial information: NCT00397930.
Cancer services phone triage center: Using live operators and state-of-the-art communication technology to improve the patient care experience.
Authors: Michelle Carpentier, Candida Rose, Megan Begnoche
Journal: Journal of Clinical Oncology (2017)

185 Background: The term “telephone triage” best represents a large proportion of customer interactions carried out by telephone versus other contact channels. It’s often referred to as the “front door” to a business and is the place where the most crucial customer interactions take place. Therefore, the effective and efficient operation of managing these interactions is a key ingredient to the overall success of any organization. Over the last several years, customer feedback and monitoring of trends on the Press Ganey Patient Satisfaction surveys showed opportunity for improvement in the overall patient care experience at our centers. This led to the development of a strategic goal to create a decentralized phone triage center that would manage these interactions as a group across the service line. Methods: A subgroup of key stakeholders came together for a Failure Mode Effects Analysis of the current state. Results were used in the creation of standard work and process flow algorithms for training the new staff. Staff training included: customer service education; shadow experiences across sites; one to one mentoring on new software and technology Results: The Phone Triage room opened this fall and is staffed daily to manage roughly 400 calls. We track quality metrics that fall into three categories: service, quality and efficiency measures. Service measures include the total number of incoming call; number of abandoned calls; length of time the caller is on hold; and statistics on the telephone and answered service factor. Quality measures include: knowledge/competency of service agents; adherence to protocol; first call resolution rate and transfer rate. Lastly, efficiency measures include average handle time; on hold time; schedule efficiency; and agent availability. In October, the center managed 4657 calls over a 14-day period, 98% were answered in under 2.5 minutes with a 2% abandon call rate. Conclusions: Early data shows pooling of service line resources and utilization of technology has increased customer satisfaction. We plan to monitor trends on several key Press Ganey performance indicators with the next quarter results available in January 2017.
Fever in a Traveler Returning From Africa
Authors: Erica S. Herc, David Manthei, James Riddell
Journal: JAMA (2017)

A 35-year- old man had 4 days of fever, confusion, and jaundice after travel to Sierra Leone, where he did not take malaria prophylaxis or use insect repellent. His blood smear showed Plasmodium falciparum ring forms. What would you do next?
Docetaxel/gemcitabine followed by gemcitabine and radiotherapy in patients with pancreatic adenocarcinoma
Authors: J. M. Pipas, R. J. Barth, B. Zaki, T. A. Colacchio, S. R. Gordon, J. E. Sutton, G. H. Ripple, M. J. Tsapakos, J. M. Cates, R. P. Perez
Journal: Journal of Clinical Oncology (2004)

4109 Background: Docetaxel (DOC) and gemcitabine (GEM) are active against pancreatic cancer. GEM is a potent radiosensitizer. Rigas et al have reported an every-two week schedule of DOC and GEM. We have defined the maximum tolerated dose of GEM twice weekly when given with radiotherapy (XRT) in pancreatic cancer. We are conducting a Phase II trial to evaluate these therapies in combination. Eligibility include biopsy proven, untreated pancreatic adenocarcinoma with stage I-III disease. Pretreatment evaluation includes chest x-ray, abdominal CT scan, serum CA19–9 and laparoscopy. Methods: DOC 65mg/m2 IV over one hour and GEM 4000mg/m2 IV over 30 minutes were given on days 1, 15 and 29. On day 43, therapy continued with XRT given at 1.8 Gy per fraction to a dose of 50.4 Gy, together with GEM 50mg/m2 IV over 30 minutes twice weekly for 12 doses. A proton pump inhibitor was given prophylactically. Following completion of therapy, patients were restaged and considered for resection. Results: Since January 2002, 24 patients were enrolled. The regimen was generally tolerable with grade III vomiting, dehydration, fatigue, hypoalbuminemia and edema seen. Grade III-IV hematotoxicity in several patients, but neutropenic fever did not occur. One patient was treated for pneumocysitis felt secondary to inappropriate use of decadron. Two others developed pneumonitis: one viral in nature, the other ARDS. One patient stopped therapy early due to toxicity. There were no deaths on treatment. Nineteen completed therapy and are evaluable for response. Eleven of 19 patients (57%) have responded by RECIST criteria including one radiographic complete response. No patient had local tumor progression. Fourteen patients underwent resection. Margin (-) resections were performed in 11 patients, including eight patients whose disease was felt to be unresectable or borderline unresectable prior to treatment. Conclusions: This regimen is active and tolerable and can downstage tumors to allow for margin negative resections in some patients. Updated data will be presented at meeting time. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Oncology