tbuckley/cabot-search huggingface dataset:
Results from a Train-the-Trainer Communication Program for Oncology Nurses.
Authors: Elaine Wittenberg, Betty R. Ferrell, Jo Hanson, Susan Eggly
Journal: Journal of Clinical Oncology (2016)

26 Background: Oncology nurses working across the cancer continuum need communication tools in order to navigate between oncology and palliative care for the benefit of patients and their families. An evidence-based communication training course funded by the National Cancer Institute and identified by the acronym COMFORT was provided to 187 oncology nurses across the nation. Launched in 2015, it is the first train-the-trainer communication training course for nurses and addresses communication across the cancer continuum. Methods: The curriculum, emphasizing team communication, teaches nurses how to provide life-altering news, assess patient/family health literacy needs, practice mindful communication, acknowledge family caregivers, and address communication openings and goals. The curriculum covers the continuum of cancer care (diagnosis, treatment, survivorship, recurrence, end of life). Two courses were held and participants were contacted at six months for follow-up evaluation. Results: Course participants reported teaching an additional 2,460 healthcare providers, primarily nurses (1,961) and physicians (264). On average, each participant trained 21 nurses and two physicians. The training manual, which was provided during the course, was used by 81% of course participants and was rated as effective (7.71 out of 10). The most commonly taught curriculum modules were Communication (25.5%), Mindful Communication (22.3%), Team Communication (18.5%), and Family Caregivers (11.4%). Course participants reported that their institution were most effective with communication during treatment (7.21 out of 10) and least effective communication occurred during bereavement (5.02), at time of death (5.97), through survivorship (5.63), and with patients facing end of life (6.09). Conclusions: The train-the-trainer model for communication training appears to be a viable and promising strategy for broadly teaching communication across the cancer continuum. Train-the-trainer is less costly than traditional on-site training methods and allows instruction to be tailored to address the institution’s least effective communication practices across the cancer continuum.
Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management.
Authors: Cleo A. Samuel, Kea Turner, Heidi AS Donovan, G J. Van Londen
Journal: Journal of Clinical Oncology (2016)

155 Background: Adjuvant endocrine therapy (AET)-related symptom management (SM) among breast cancer survivors (BCS) typically involves a multidisciplinary team of health care providers; yet few studies have examined provider perspectives on AET-related SM. The purpose of this study was to examine provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. Methods: We conducted 3 focus groups (FGs) with a multidisciplinary group of health care providers (n = [6] physician; n = [7] non-physician) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM and its barriers and facilitators as well as recommendations for improvement. All FGs were held at the University of Pittsburgh, audiotaped, and transcribed. We analyzed FG transcripts using qualitative software to identify key themes. Results: Providers described patient-, provider-, and system- level facilitators and barriers to AET-related SM. At the patient-level, facilitators included social support and provider communication about symptoms while cancer-related distress, misinformation and misinterpretation of online information were identified as barriers. Provider-level facilitators included strong relationships with other providers and ongoing communication with patients; however, lack of time, insufficient resources, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Finally, at the system-level, electronic health records were described as both a facilitator and barrier to SM. Moreover, poor care coordination among different providers and lack of clear guidelines on which provider “owns” AET-related SM emerged as key system-level barriers. Conclusions: Findings suggest that efforts to improve AET-related SM should span multiple levels, in order to address patient-, provider-, and system-level barriers to SM. Recommendations include increased education for patients, greater access to clinical decision support tools for providers, and improved coordination of survivorship resources within hospitals.
Molecular and clinical determinants of survival following relapse after curative treatment of stage II-III colon cancer (CC): Results of the translational study on the PETACC 3-EORTC 40993-SAKK 60-00 trial.
Authors: A. Roth, D. Klingbiel, P. Yan, R. Fiocca, M. Delorenzi, R. Labianca, D. Cunningham, E. Van Cutsem, F. Bosman, S. Tejpar
Journal: Journal of Clinical Oncology (2010)

3504 Background: We presented the prognostic (prog) impact of molecular markers (MM) on relapse free survival (RFS) of stage II-III CC (ASCO proc 2009, 27, abstr. 4002). We analyze now the impact of the 8 same MM on the overall survival (OS) after relapse of stage II-III CC in PETACC 3, an adjuvant trial with 3278 patients (pts). Methods: 1,564 blocks were prospectively collected, tumor (Tu) DNA extracted and 8 MM assessed as described previously. Markers prog value was analysed by Cox regression for OS, multivariate analysis (MA) and Kaplan-Meier estimates of median survival (MS). Time to recurrence (TTR) of ≤18m defined early relapse (ER), >18m late relapse (LR). Results: 392 out 990 relapsing pts were assayed for the 8 MM, 221 ER, 171 LR. The MA investigating prog factors impacting on OS after relapse is presented in the Table. BRAF, Tu site, and TTR were found to be major predictors of OS after relapse. MS (95%CI) according to BRAF was 7.5 m (4.8-11.2) vs. 25.2m (21.1-29.5) p=1.9e-11, according to Tu site 16.1 m (12.6-19.0) vs. 27.6 m (22.9-33.6) p=2.71e-06, according to TTR 17.9m (15.5-20.3) vs. 30.0 m (24.7-38.4) p=0.00032. Similar MS according to Tu site (16.2 m vs. 28.6 m, p=4.52e-14) and TTR (18.4 m vs. 30.5 m, p=2.18e-08) were observed in the full relapsing pts set (n=990). Conclusions: Whereas BRAF and Tu site had no prog value on RFS of stage II-III CC (Roth AD, doi: 10.1200/JCO.2009.23.3452), BRAF, Tu site, and TTR are strong determinants of CC OS after relapse and should imperatively be used to stratify studies in metastatic CC. The independent effects of Tu site and TTR might be indicative of additional non-yet-identified MM. HR (95% CI) P value TTR (ER/LR) 1.60 (1.23-2.09) 0.0005 Age 1.00 (0.99-1.01) 0.98 Sex 1.24 (0.95-1.62) 0.11 Tu grade 1.52 (1.02-2.25) 0.04 Stage 1.53 (1.00-2.36) 0.051 Tu site (right/left) 1.69 (1.29-2.21) 0.0002 Treatment group 1.09 (0.84-1.39) 0.52 Microsat. instabil. 0.51 (0.28-0.95) 0.034 Thymidilate synth. 0.99 (0.68-1.44) 0.95 SMAD4 1.21 (0.91-1.60) 0.18 p53 0.96 (0.73-1.26) 0.76 hTERT 1.37 (0.96-1.96) 0.09 18qLOH 0.86 (0.60-1.24) 0.43 BRAF mutation ± 3.61 (2.24-5.81) 1.24e-07 KRAS 1.13 (0.85-1.51) 0.40 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Pfizer Pfizer Pfizer
Supportive cancer care in-patient unit: A 3-year experience.
Authors: Florian Scotte, Karine Legeay, Thyphaine Maupoint de Vandeul, Pauline Leroy, Christophe Aubaret, Stephane Hans
Journal: Journal of Clinical Oncology (2014)

185 Background: An in-patient unit for supportive care in oncology (USSO) was created in 2011 in the Georges Pompidou European Hospital. Its primary objective is to improve patient care and manage the complications of cancer as well as their specific treatment. Patients are previously screened by a cross disciplinary team at an early stage before complication. Methods: A prospective observational study was performed through a yearly evaluation of the unit’s activity from January 1st, 2011 to December 31st, 2013. Results: 594 patients were admitted in the unit during the three years period of study. Most of them (64.3%) came directly from home, with an increase of this rate along this period (59.4% to 67.6%). The early screening thereby rendered emergency admission from 17.7% (2011) to 6.5% (2013). The predominant diseases observed were head and neck cancer (42.4%) and lung cancer (23%), followed by breast (7.2%) and ovarian cancer (7.2%). The main grounds for hospitalization were state of health impairment 32%, pain 12.8%, and invasive procedures 11.8%, increasing from 2011 to 2013. Therefore, an interdisciplinary approach is the cornerstone of the unit with the daily collaboration of dieticians (for 90% of inpatients), social workers, psychologists, physiotherapists and pain specialists (34%, 46%, 56% and 50% of inpatients respectively). The average length of stay decreased from 2011 (10.2 days) to 2013 (8.3 days) and 58.4% of the patients were home discharged. With the help of a social worker, 12% of the patients were transferred to a recovery unit and 9.7% to a palliative care unit while 9% died in the unit. Conclusions: With the opening of the in-patient USSO, and the development of its interdisciplinary strategy, most of the patients recover faster and regain better health. Preventive care can accommodate a majority of patients coming from home and allows for ambulatory secured discharge. These positive results conducted to enhance the USSO’s beds capacity and supportive care development in order to improve cancer care organisation in the hospital as well as patient’s quality of life.
Patients’ versus physicians’ roles in detecting recurrent Hodgkin lymphoma.
Authors: A. Bestawros, L. Foltz, N. Srour, J. M. Connors
Journal: Journal of Clinical Oncology (2011)

8041 Background: The optimal post-treatment surveillance of patients with Hodgkin lymphoma (HL) in first complete remission (CR) is unknown. Guidelines are based on consensus rather than high-quality evidence. Recurrences may be detected as a result of the investigation of symptoms or by routine screening of asymptomatic patients. It is unknown if routine screening leads to earlier relapse detection or translates into better outcomes. Screening CT, PET and other scans in particular are associated with possible toxicity and cost, with no proven benefit. Moreover, the negative psychological impact of routine scanning of asymptomatic patients has been documented. Methods: Using the British Columbia Cancer Agency (BCCA) Lymphoid Cancer Database with more than 2500 patients diagnosed since 1981, we identified 258 patients with relapse after first CR. We reviewed their charts to determine whether the recurrence was detected as a result of new patient symptoms (PT group) or through routine physical exams or tests ordered by the physician in the absence of symptoms (MD group). The information was missing or ambiguous for 10 patients who were excluded. Results: Of the 248 recurrences, 176 (71%) were in the PT group. The median time to diagnosis of recurrence was similar in both groups (PT group=1.6 y; MD group=2 y; logrank p = 0.88). The post-relapse progression free survival (PFS) did not differ significantly between the groups (logrank p=0.28), nor did the post-relapse overall survival (OS) (PT group, median = 17.7 y; MD group=20.8 y; logrank p=0.22). Adjustment for age, sex and initial stage using a Cox proportional hazards model did not change these conclusions for time to diagnosis of recurrence (p=0.85), post-relapse PFS (p=0.77) or OS (p=0.32). Conclusions: Patients are much more likely to detect recurrence than their physicians employing routine follow-up testing. There is no difference in PFS or OS between patients whose recurrence is diagnosed at the time of symptoms and those whose recurrence is diagnosed through routine screening. Our findings suggest there is no demonstrable benefit in early detection of HL recurrence based on screening tests and thus do not support the routine use of these potentially anxiety-provoking tests.
The prognostic utility of LDH and disease-specific graded prognostic assessment for melanoma brain metastases.
Authors: M. Lowe, A. Cavitt, J. Shelton, N. Maynard, I. R. Crocker, G. W. Carlson, K. A. Delman, D. H. Lawson, M. Rizzo
Journal: Journal of Clinical Oncology (2011)

8590 Background: A previously described diagnosis-specific graded prognostic assessment (DS-GPA) for melanoma showed that number of brain metastases (BM) and Karnofksy Performance Score (KPS) were significant prognostic factors. The purpose of this study was to test this DS-GPA in our patient population undergoing stereotactic radiosurgery (SRS) and to determine if other prognostic factors could enhance the prognostic accuracy and utility of this index. Methods: All patients who underwent SRS for melanoma BM from 1999 to 2009 were identified. Demographic, disease and survival data were collected. Continuous variables were stratified according to previously published prognostic models (age <50, 51-59, ≥60; number of BM1, 2-3, >3; KPS <70, 70-80, 90-100). The primary endpoint was overall survival (OS), calculated using Kaplan-Meier method with log rank and multivariate (Cox) analysis. Results: 126 patients underwent SRS for newly diagnosed melanoma BM. Median OS was 8.1 months (range 1.0 to 143.0 months). Increasing number of BM (10.7 versus 7.2 versus 4.9, p=0.030), LDH greater than 200 (11.4 versus 5.4, p=0.032) and decreased KPS (12.4 versus 7.1 versus 5.6, p=0.007) correlated with worse survival, but age, extracranial metastases, and treatment with temozolomide, whole brain radiation or resection did not. On multivariate analysis KPS (HR 2.89, CI 1.34-6.25) and LDH (HR 1.71, CI 1.03-2.83) maintained significance. When analyzed with only number of BM and KPS, the two validated DS-GPA prognostic factors, LDH remained a negative prognostic factor (HR 1.73, CI 1.06- 2.83). Conclusions: If confirmed in a large prospective study, the addition of LDH may improve the prognostic accuracy and utility of a previously described prognostic index based on number of BM and KPS for patients with melanoma metastatic to the brain.
Efficacy and Safety of Yttrium 90 (90Y) Ibritumomab Tiuxetan in Autologous and Nonmyeloablative Stem Cell Transplantation (NST) for Relapsed Non-Hodgkin’s Lymphoma (NHL).
Authors: Issa F. Khouri, Rima M. Saliba, Chitra Hosing, Rosamar Valverde, William D. Erwin, Luis Fayad, Farzaneh Maadani, Martin J. Korbling, Grace-Julia Okoroji, Anne M. Stachowiak, Barry I. Samuels, Paolo Anderlini, Daniel R. Couriel, Marcos de Lima, Sergio Giralt, Uday Popat, Partow Kebriaei, Naoto T. Ueno, Muzaffar H. Qazilbash, Peter W. McLaughlin, Fredrick B. Hagemeister, Anas Younes, Donald A. Podoloff, Richard E. Champlin
Journal: Blood (2006)
Next-generation sequencing (NGS) in advanced pancreatic adenocarcinoma (PA): A Brazilian experience.
Authors: Raphael Brandao Moreira, Matheus Bongers Alessandretti, Aline Da Rocha Lino, Rodnei Merlrina Martins Junior, Marcus Paulo Fernandes Amarante, Jessica Ribeiro Gomes, Tarcia Tarciane Soares de Sousa, Carina Mina Abrahao, Carolina Kawamura Haddad, Renata D'Alpino Peixoto, Fernando C. Maluf, Antonio C. Buzaid, Marcelo Rocha Cruz
Journal: Journal of Clinical Oncology (2015)

315 Background: Metastatic PA is a lethal malignancy with poor prognosis and limited therapeutic options. We hypothesized that a comprehensive next-generation sequencing (NGS) assay could identify novel therapy targets not routinely explored in PA patients. Methods: We included patients with advanced pancreatic adenocarcinoma (PA) with accessible lesion for biopsy. Paraffin-embedded tumor tissues were evaluated by the method of NGS (Foundation Medicine, Cambridge, MA, USA). Hybridization capture of 3,769 exons from 236 cancer-related genes and 47 introns of 19 genes commonly rearranged in cancer was applied to ≥ 50 ng of DNA extracted from 10 PA specimens and sequenced to high, uniform coverage. Genomic alterations (GAs), were characterized and reported for each patient sample. Actionable GAs were defined as those identifying anti-cancer targeted therapies either available on the market or in registered clinical trials. Results: A total of 10 PA patients were included. Median age was 56 years (range 31-79). All cases harbored at least one GA with a mean of 2.7 actionable GAs per tumor. The most common actionable GAs were KRAS (90%), PTCH1 (20%), STK11 (10%) and GNAS (10%). KRAS mutations potentially treatable with MEK-inhibitor were identified in 9 patients. However, none of them received a MEK-inhibitor. Activating STK11 point mutations not detectable by IHC/FISH, potentially targetable with m-Tor inhibitor therapies were identified in 1 patient, who received everolimus and had a long-lasting (&gt; 6 months) partial response. Conclusions: NGS of PA was able to reveal genomic alterations that may be potentially responsive to available targeted therapy. We are just at the dawn of exploring this strategy and NGS can effectively contribute for increasing the understanding of the disease.
Increased dose-density (DD) Is feasible: A pilot study of epirubicin and cyclophosphamide (EC) followed by paclitaxel (T), at 10–11 day interval with filgrastim support, for women with early breast carcinoma (BC)
Authors: M. N. Fornier, A. D. Seidman, D. Lake, G. D’Andrea, J. Bromberg, M. Robson, C. H. van Poznak, K. Panageas, L. Norton, C. Hudis
Journal: Journal of Clinical Oncology (2005)

616 Background: Q 14 day chemotherapy (CRx) was superior to q 21 day treatment in CALGB 97–41. (Citron et al, J Clin Oncol 2003 Apr 15;21(8):1431–9) Hence we hypothesized that even greater DD (q 10–11) could be more effective. This pilot trial assessed the feasibility of neoadjuvant/adjuvant DD CRx consisting of EC x 4 followed by T x 4 at 10–11 day intervals. A 2 day window was allowed for logistical reasons. Methods: 39 women with early stage BC were accrued from April 2004 to October 2004. Median age was 47 (range 26–67). Patients (pts) received therapy with EC (E 100 mg/m2 and C 600 mg/m2) q 10–11 days for 4 cycles followed by T 175 mg/m2 q 10–11 days for 4 cycles, all with filgrastim support from day 2 to 24 hours before the next treatment. Results: As of 12/1/04 31 pts have completed all planned therapy and 38 pts have completed EC. 4 pts are still receiving T. 4 pts did not complete all planned therapy: 1 pt withdrew consent after EC # 1 for non-medical reasons; 2 pts switched to docetaxel after T #3 due to allergic reactions; 1 pt withdrew after T #3 because of grade 3 neuropathy. The median inter-treatment interval was 10 days (range 8–28). 80.3% of pts were treated at 10–11 day intervals or less. One patient had one 8 day interval for T #2 due to scheduling logistics. One patient had one 28 day interval because of logistical delays associated with a venous access device placement. There were 5 dose-reductions of 25% for grade 3 non-hematological toxicity in 5 pts. 6 pts (16%) developed febrile neutropenia (FN) defined as temperature ≥ 38°C with ANC < 1000/μL; 1 pt developed FN twice (7 events). All FN was during EC. There were 9 hospitalizations: 7 FN, 1 pharyngitis and afebrile neutropenia, 1 tissue expander infection. Other grade 3 toxicities include: 3 bone pain/myalgia, 2 hand and foot syndrome, 2 neuropathy, 1 mucositis, 1 nausea and vomiting. Conclusions: EC followed by T at 10–11 days is feasible, without excessive toxicity. The nearly 30% reduction in inter-treatment interval compared to 14 day treatment could increase the efficacy of adjuvant chemotherapy and should be tested in a prospective randomized trial. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen, Pfizer Amgen, Pfizer Amgen, Pfizer
Discussions of cancer screening: What do physicians say, what do patients hear, and how much shared decision making occurs?
Authors: James Austin Talcott, Gina Aharonoff, Maureen Bezuhly, Jessica Herzstein, Michael P. Osborne, Floyd Jackson Fowler
Journal: Journal of Clinical Oncology (2016)

180 Background: Like other medical interventions, cancer screening requires shared decision-making (SDM). To better understand the process, we are performing a cluster-randomized trial of educational supports to improve screening guideline compliance for breast, cervical, colorectal, lung and prostate cancer at two urban academic medical centers. We present interim results that focus on recalled SDM discussions. Methods: We are enrolling an age- and sex-stratified sample of 216 patients aged 30 to 89 years, 18 treated by each of 12 primary care physicians at two affiliated hospitals before a periodic physical examination. Screening guideline format (color-coding) and academic detailing are independently assigned to providers. Patients and providers are surveyed immediately after the encounter to document SDM discussions, recommendations and beliefs. Screening guidelines (recommended, not or controversial) were determined by age, sex and risk factors. Results: The first 107 eligible enrolled patients were racially diverse (non-Hispanic Caucasian 65%) and well educated (college grad 84%). Patient-physician disagreement about whether screening had been discussed ranged from 6% (mammogram) to 36% (cervical cancer) and disagreement about whether the screening test had been recommended ranged from 17% (mammography) to 44% (PSA). In only 24 (12%) of 159 jointly recalled screening discussions did both patients and physicians agree that all 3 elements of SDM – reasons for screening, reasons against and that it is optional – were discussed, although patients and physicians separately reported all elements in 58 (36%) and 45 (28%), respectively. Conclusions: Even immediately after the encounter, many patients and physicians recalled whether screening had been discussed and recommendations differently, and most SDM discussions were incomplete. Clinical trial information: NCT02430948.