tbuckley/cabot-search huggingface dataset:
Development and implementation of an instrument for assessing the proficiency of oncology fellows in the delivery of bad news.
Authors: Mark Allan Hoffman, Daniel Cannone, Maria Louise Barilla-Labarca, Myriam Kline
Journal: Journal of Clinical Oncology (2018)

11006 Background: Breaking bad news is the quintessential difficult communication task for oncologists. Baile et. al., (The Oncologist, 2000) published SPIKES, a six step protocol for delivering bad news. ”S” stands for optimizing the environment and physical approach to the patient, “P” assessing the patient’s perception, “I” obtaining invitation to give the news, “K” giving knowledge, “E” addressing emotion and “S” summary and strategy. Methods: At Northwell Cancer Center, we have recently developed a 2-month Communication Course for multidisciplinary first year oncology fellows, addressing core communication skills, spirituality/coping, assessing for depression, discussing sexuality, delivering bad news, communication with adolescents/young adults, communication with families and transition to palliative care. We have formulated a version of SPIKES, named “MR. SPIKES” for teaching bad news delivery. ”MR.” represents pre-encounter Mental preparedness and Rehearsal (agenda setting, anticipating patient’s concerns). The “S” now encompasses six functions: Summary, Strategy, Survey of all concerns, Sustaining realistic hopes/goals, Support/reinforcement of coping systems and Statement of continuing partnership. A 21-item assessment tool was synthesized assessing the expanded SPIKES component of MR.SPIKES (2 items for setting, 6 items for emotion/empathy,1 item for perception, 1 for invitation,2 for preparation,4 for delivery of news, 1 for strategy, 1 for concerns,1 for hope/goals, 1 for coping assessment, 1 for partnership). The tool was then used by 4 experienced raters to assess videotaped encounters between trainees and standardized patients. Results: Preliminary assessment of inter-rater reliability using Gwet’s ’AC1 resulted in coefficients ranging from moderate to substantial (0.47 to .075) agreement. Inter-item reliability was also good (Cronbach’s alpha of 0.84). Conclusions: A 21 item instrument based a modified version of SPIKES has been developed to assess proficiency of trainees in breaking bad news, and has shown very promising reliability.
Abstract 14082: Pulmonary Hypertension With Thickening of Adventitial Area due to Decreased eNOS Bioavailability in Senescence Marker Protein-30 Knock-out Mice
Authors: Koichi Sugimoto, Akihiko Sato, Shunsuke Watanabe, Satoshi Suzuki, Hitoshi Suzuki, Shu-ichi Saitoh, Yasuchika Takeishi
Journal: Circulation (2016)

Background: Senescence marker protein (SMP) -30 is known as an anti-aging protein. Recently, we have reported that endothelium-dependent vasodilation of the coronary artery is reduced in SMP-30 knock-out mice. In the hind limb ischemia model of SMP-30 knock-out mice, development of collateral vessels is impaired because of decreased vioavailability of endothelial nitric oxide synthase (eNOS). These results strongly suggest that SMP-30 affects the eNOS function in aging. It is widely known that eNOS is implicated in pathophysiology of pulmonary hypertension. However, the role of SMP-30 on pulmonary vessels is still unclear. In this study, we examined the role of the SMP-30 in pulmonary hypertension and its mechanism using the SMP-30 knock-out mice. Methods: We used SMP-30 knock-out mice at the age of 20 to 25 weeks. We measured right ventricular systolic pressure (RVSP) by a micro-manometer catheter inserted from jugular vein and the ratio of right ventricular weight to left ventricular weight including ve...
Collection and utilization of oncology big data.
Authors: Shubham Pant, Taofeek Kunle Owonikoko, Catherine S. Magid Diefenbach, Sungjin Kim, Zhengjia Chen, Elaine L. Towle, Lori J. Pierce, Kathryn Finch Mileham
Journal: Journal of Clinical Oncology (2017)

e18134 Background: Big Data includes data sets whose size is beyond the ability of typical database software tools to capture, store, manage, and analyze. We sought to gain insight on ASCO members’ perspectives towards Big Data in Oncology. Methods: The survey was conducted as part of the ASCO Leadership Development Program and was electronically distributed to US-based ASCO members. Survey questions explored demographics, practice type, EHR utilization, perceptions about Big Data, and awareness and understanding of ASCO Big Data initiative, CancerLinQ. Statistical analysis was conducted and the data were reviewed. Results: Seventy percent of survey respondents were physicians (n = 1261); 50% had some knowledge of Big Data but only a minority (38%) planned to champion participation in Big Data initiatives. The most frequently cited barriers to participating in Big Data collection were perceived added burden of data retrieval and submission (68%), privacy breach (49%) and potential misuse of patient data (49%). The most valuable aspect of Big Data for practices was population level information for patient management (75%); the most important factor in choosing a Big Data organization was emphasis on privacy and confidentiality of data (53.5%). Participants from NCI-Designated Cancer Centers were more likely to share oncology patient data. Years in practice was inversely correlated with a willingness to share data. Only 25% of respondents were very likely to share oncology data with Big Data organizations, with participants in oncology practice for &gt; 30 years least likely to share data as compared to those with less than 5 years (p = 0.010) and those 11-20 years in practice (p = 0.004). Physicians in practice for &gt; 20 years were least likely to trust information from Big Data (p = 0.004). A majority of patients had heard about Cancer LinQ mostly from ASCO sources, however only 25% were familiar with the details. Conclusions: Big Data has the great potential to provide physicians with novel insights and enhance care for cancer patients although some concerns and barriers exist. Education, outreach and physician champions are keys in further realizing the promise of Big Data for cancer patients.
Retrospective study of feasibility of high-dose methotrexate in adult osteosarcoma patients over 40 years.
Authors: Nadia Hindi, Alejandro Falcon, Roberto Lasso, Maria Pilar Sancho Marquez, Inmaculada Sanchez-Simon, Ana Fernandez-Teijeiro, Catalina Marquez, Manuel Noguer, Javier Martin Broto
Journal: Journal of Clinical Oncology (2016)

e22509 Background: High-dose methotrexate (HDMTX) is a backbone of systemic therapy of osteosarcoma along with cisplatin and doxorubicin. Children excrete MTX more effectively than adults and on this basis most protocols exclude HDMTX in patients (pts) aged over 40 years. Folinic rescue, hydration and plasma drug concentration are critical in the HDMTX management. Here we review our experience with HDMTX in a series of pts > 40y Methods: Those osteosarcoma pts treated in our institution with chemotherapy containing HDMTX (12g/m2), since July 2006 to October 2015 were reviewed. Data regarding clinicopathologic characteristics, therapy, toxicity, and survival were collected. Kaplan-Meier method was used for overall survival (OS) and relapse free survival (RFS) analysis Results: 18 pts were identified: M/F 9/9; median age 51y (41-63), localized disease in 14 (78%) and metastatic in 4 (22%). Median total dose per patient of MTX was 50 mg/m2. Neoadjuvant HDMTX was given at a dose intensity (DI) of 3.5 g (2.2-5.3)/m2/week, whereas in adjuvant phase, HDMTX was administered at 2.5 g (1.4-8.0)/m2/week. This represents 112% and 78% of planned DI in pre and postoperative phase respectively. Regarding G > 3/4 toxicity,10 pts (56%) had febrile neutropenia, 3 pts (17%) thrombopenia and 6 pts (33%) anemia, all related with anthracycline/platinum administration. With regard to MTX-related toxicity, 5 pts (28%) had G3-4 transaminitis (ALT). Delayed MTX-excretion was reported in 14 pts (78%). Creatinine levels did not significantly vary after HDMTX administration. In those pts receiving neoadjuvant HDMTX median necrosis on surgical specimen was 50% (0-100), with 27% of pts achieving good pathological response (pR) (necrosis > 90%). 66% of pts with poor pR relapsed and no pts achieving a good pR have relapsed. In pts with localized disease, 5-y RFS rate was 53.8%, and 6 pts (43%) relapsed at the time of this analysis. Globally, 4 pts (28.5%) have died, resulting in an actuarial 5-y OS of 70% Conclusions: HDMTX in pts with osteosarcoma > 40y is feasible with a good dose intensity. Although delayed excretion was more frequent than reported in younger patients, toxicity profile reproduced data from previous reports on children and adolescents
Abstract 13670: Vitamin D Deficiency is Associated With Increased Risk of Subclinical Myocardial Damage in Younger but not Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Erin D Michos, Elizabeth Selvin, Jeffrey R Misialek, John W McEvoy, Chiadi E Ndumele, Aaron R Folsom, Myron D Gross, Christie M Ballantyne, Pamela L Lutsey
Journal: Circulation (2015)

Background: Vitamin D deficiency has been associated with increased risk of coronary heart disease (CHD) and heart failure (HF) in epidemiologic studies. It is unknown whether low 25-hydroxyvitamin D [25(OH)D] is associated with subclinical myocardial damage as assessed by high-sensitivity cardiac troponin T (hs-cTnT), and whether this association varies by age or race. Methods: We studied 11,311 white and black ARIC participants (median age 56 yrs) free of prevalent CHD and HF who had 25(OH)D and cTnT measured at baseline (1990-1992). 8,990 participants had a repeat hs-cTnT measurement 6 years later (1996-1998). We used logistic and Poisson regression models to characterize the cross-sectional association of 25(OH)D categories with elevated hs-cTnT (≥14 ng/L) and the prospective association with incident elevated cTnT at followup (among those without elevated hs-cTnT at baseline, n=8733). We tested for interaction by age and race. Results: The prevalence of elevated hs-cTnT at baseline was 4% (n=433). After adjustment for age/sex/race, 25(OH)D deficiency (&lt;20 ng/ml) was cross-sectionally associated with elevated hs-cTnT [OR 1.35, 95% CI 1.01-1.81]; however findings were no longer significant after adjustment for behavioral/lifestyle factors [OR 1.17, 0.87-1.59]. At followup, there were 517 cases of incident elevated hs-cTnT. 25(OH)D was not associated with incident troponin elevation in the overall cohort, but significant interactions were present by age (p-interaction 0.01). Low 25(OH)D was associated with incident elevated hs-cTnT in younger but not older adults ( Table ). There were no interactions by race. Conclusions: The association of low 25(OH)D with incident elevated hs-cTnT varies by age. If these associations are causal, further research is needed to understand mechanisms by which low 25(OH)D confers subclinical myocardial damage among younger but not older adults and whether vitamin D supplementation can prevent myocardial damage.
Abstract 20452: Blood Pressure Control and Dipping Patterns in Patients With Resistant Hypertension: Combined Effects of Aldosterone and Sodium
Authors: Charles German
Journal: Circulation (2016)

Background: High sodium intake and hyperaldosteronism are independently linked to increased cardiovascular morbidity and mortality. Hyperaldosteronism contributes to resistant hypertension (RHTN) and is associated with higher 24- hour ambulatory blood pressure (BP) levels. Nocturnal hypertension and non-dipping are associated with increased CV risk, but mechanisms are not fully elucidated. Objective: This study was designed to determine if high dietary sodium intake, and /or hyperaldosteronism mediate the development of abnormal diurnal BP patterns and nocturnal hypertension. Methods: A single-center cohort of 326 African American (AA) and Caucasian patients with RHTN were evaluated by assessing plasma renin activity (PRA), 24-hr urinary aldosterone (UAldo), sodium (UNa+) levels, and 24-hr ambulatory blood pressure monitoring (ABPM). Daytime, nighttime, and 24-hr BP levels and dipping patterns were determined. High sodium excretion was defined as UNa+ > 200 mEq/24hr and hyperaldosteronism was defined as U...
SUV Harmonization Between Different Hybrid PET/CT Systems
Authors: Domenico Rubello, Patrick M. Colletti
Journal: Clinical Nuclear Medicine (2018)

Current PET/CT lutetium oxyorthosilicate (LSO) or lutetium-yttrium oxyorthosilicate crystal scanners are equipped with sophisticated softwares including point-spread function (PSF) and time-of-flight (TOF) image reconstruction. These softwares are associated with increased SUVs compared with 3D-OSEM reconstructions associated with older BGO PET/CT scanners. The European Association of Nuclear Medicine (EANM) identified the problem of SUV harmonization since 2010 through the EANM Research Ltd European Association of Nuclear Medicine Research Ltd [EARL] FDG PET/CT accreditation program. This required processing 2 reconstructions, one optimized for maximum spatial lesion detection and one for harmonized quantitation. We investigated an alternative single reconstruction method for both qualitative and quantitative analysis optimized to maximize spatial lesion detectability, followed by an intrinsic postreconstruction algorithm for SUV harmonization.Phantom and "in vivo" patient data analysis were acquired and analyzed on (a) a Siemens Biograph mCT system with LSO crystals and PSF and TOF algorithms, and on (b) a General Electric Discovery STE system with BGO crystals, without PSF and TOF. A dedicated algorithm (EQ.filter) was tested to harmonize SUV between the 2 scanners compared with EANM/EARL specifications. NEMA IQ phantom and a Jaszczak cylindrical phantom equipped with small fillable spheres (lesion to background ratios of 8:1 and 4:1) were used. Phantom data were validated on 7 oncologic patients with 39 hyperactive lesions ranging from 3 mm to 26 mm.The main benefit of PSF + TOF LSO PET/CT systems was increased contrast for small active lesions. Recovery coefficients measured according to NEMA standards exceeded those obtained by 3D-OSEM reconstruction. SUVmax discrepancies between the 2 PET/CT systems were as high as 149%, dropping to below 10% when optimized by EQ.filter.A single reconstruction optimized by EQ.filter for maximum spatial lesion detectability is an easy and precise solution to harmonize SUVs between different PET/CT scanners, avoiding a second reconstruction with an additional smoothing filter as requested by EANM/EARL.
Cell-free circulating tumor DNA somatic alteration burden and its impact on survival in metastatic cancer.
Authors: Seyed Saeed Pairawan, Kenneth R. Hess, Filip Janku, Nora Sylvia Sanchez, Cathy Eng, Senthil Damodaran, Milind M. Javle, Ahmed Omar Kaseb, David S. Hong, Vivek Subbiah, Siqing Fu, David R. Fogelman, Victoria M. Raymond, Richard B. Lanman, Funda Meric-Bernstam
Journal: Journal of Clinical Oncology (2018)

12022 Background: Prognostication has been a challenging subject in patients with metastatic disease. Physicians are expected to assess prognosis of patients with advanced disease both for determining suitability for clinical trials and for patient counseling. Increasingly, cell-free circulating tumor DNA (cfDNA) sequencing is being performed for clinical decision-making. We sought to determine whether somatic alteration burden (SAB) in cfDNA is associated with prognosis. Methods: We performed a retrospective analysis of 298 patients with metastatic disease who underwent clinical comprehensive cfDNA analysis at a single tertiary care institution. Our primary objective was to determine the influence of SAB (defined as maximum mutant allele frequency) on overall survival (OS). Secondary objectives included the association between the number of nonsynonymous mutations (NSM) and OS, and of site of primary malignancy on mutation detection and SAB. Results: CfDNA mutations were detected in 240 (80%) patients. SAB was classified by quartiles, Q1 lowest, Q4 highest SAB. Median follow-up was 8.4 months after cfDNA testing; we observed 116 deaths (39%) among 298 patients. Median OS was 11.5 months. Higher SAB levels had a statistically significant impact on overall survival in SAB Q3 (HR 2.3, p = 0.0069) and SAB Q4 (HR = 3.8, p < 0.0001) on univariate analysis. On multivariate analysis, SAB Q4 (HR = 2.6, p = 0.0033), male sex (HR = 1.59, p = 0.0033) and albumin level > 3.9 g/dl (HR = 0.40, p = 0.00011) were independent predictors of OS. CfDNA mutation detection, SAB, and number of NSM significantly differed between tumor types (p < 0.0001, p = 0.0013, and p = 0.0001 respectively), being lowest in appendiceal cancer and highest in colon cancer. Having more than one NSM detected was associated with significantly worse overall survival (HR = 2.3, p < 0.0001). Conclusions: Higher levels of cfDNA SAB and higher number of NSM were associated with worse OS in patients with metastatic disease. Further study is needed to determine optimal SAB thresholds for clinical decision-making and the utility of SAB across different tumor types.
Clinical experience with combination chemo-/immunotherapy using trabectedin and nivolumab for advanced soft tissue sarcoma.
Authors: Sant P. Chawla, Kamalesh Kumar Sankhala, Joshua Ravicz, Grace Kang, Seiya Liu, Nathan Stumpf, Bryan Leong, Seth Kim, Susan Arasheben, William W. Tseng, Erlinda Maria Gordon
Journal: Journal of Clinical Oncology (2018)

e23568 Background: Immune checkpoint inhibitors revive pre-existing immune responses that are suppressed in cancer. To restore tumor surveillance that is lost in cancer patients, a tumoricidal agent may have synergistic activity with certain immune checkpoint inhibitors. Herein, we report on our clinical experience using two FDA-approved drugs, nivolumab, a PD-1 inhibitor in combination with trabectedin, an alkylating agent, in advanced soft tissue sarcoma. Methods: Twenty-eight heavily pre-treated STS patients received trabectedin (1.5 mg/m2continuous intravenous infusion, CIV, for 24 hours) every 3 weeks, and nivolumab (3 mg/kg IV over 30 minutes) every 2 weeks. Retrospective analysis of safety/toxicity was conducted using the NIH/NCI CTCAE v.4.03. Tumor responses were assessed by RECIST v1.1 and irRECIST. Results: Histologic subtypes in the 28 patients included undifferentiated pleomorphic sarcoma (UPS; n = 7), liposarcoma (n = 6), leiomyosarcoma (n = 6), synovial sarcoma (n = 4), chondrosarcoma (n = 2), Ewing sarcoma (n = 2), and myofibroblastic sarcoma (n = 1). All patients had metastatic disease and a median of 4 lines of prior chemotherapy. Safety analysis (n = 28): Grade 3 treatment emergent adverse events include anemia (n = 5), fatigue (n = 1), decreased platelet count (n = 1), decreased granulocyte count (n = 2) and increased creatine kinase (n = 1). Efficacy analysis (n = 22): These patients were followed for at least 6 months and their results are reported in Table below. Conclusions: Taken together, the data suggest that paired administration of trabectedin and nivolumab is safe, and that this combined chemo-/immuno-therapy approach may have synergistic activity. Currently, we are conducting two phase 1/2 studies using (1) ipilimumab, nivolumab and trabectedin as first line therapy, and (2) nivolumab and ABI-009 (nab-rapamycin) as 2nd/3rd line therapy for advanced sarcoma. # Patients Recist v1.1 ORR,% Med. PFS, wks PFS rate% Med. OS, wks OS Rate, % ( > 6 mo ff up) & iRecist (Range) (6 mos) (Range) (6 mos) n = 22 4PR, 12SD 18.2 > 45.5 68.2 61.0 91.0 6PD (10- > 95 wks) (19- > 95 wks)
Integrating a touchscreen-based brief geriatric assessment in older adults with multiple myeloma.
Authors: Nitya Nathwani, Supriya Gupta Mohile, Brea Lipe, Karen Carig, Laura DiGiovanni, Agnes Davis, Debra Wujcik, Arti Hurria, Tanya Marya Wildes
Journal: Journal of Clinical Oncology (2017)

e21703 Background: Multiple myeloma (MM) is a disease of older adults (OAs) with &gt; 60% of diagnoses and nearly 75% of deaths occurring in patients &gt; 65 years old (YO). Geriatric Assessment (GA) is associated with toxicity and survival in OAs with MM, but not routinely used in practice. This project pilot tests a tablet-based modified Geriatric Assessment (mGA) that presents compiled GA results, including (the Palumbo) frailty score, to clinicians at a treatment decision-making visit in a single screen dashboard. Methods: In this multisite ongoing study, 210 patients with MM ≥65 YO facing a decision point for care will complete a mGA that includes the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score, and Lawton Instrumental Activity of Daily Living (IADL) Score prior to meeting with a physician. mGA results, including composite frailty score, are provided to physicians at the start of a visit. Results: Thirty-six patients have been enrolled to date; enrollment continues. Participants are 69% (n = 25) white, 64% (n = 23) male, and mean age of 72 YO (range 65-87). Most (74%, n = 20) currently receive ≥1 therapy and have few co-morbidities (CCI median 1, SD 1.95, range 0-8); 57% require assistance with IADLs and 37% require assistance with ADLs. Based on Palumbo score, 36% of participants were frail (n = 13), 33% intermediate (n = 12), and 31% fit (n = 11). Providers report mGA results influenced treatment decision (54%, n = 28) and frailty score was the most frequently cited result to impact treatment decision-making (61%, n = 39). The most common way the mCGA influenced decision-making was to reduce dose/dose intensity (25%, N = 8). Clinicians on average spent 5 minutesreviewing the mGA results. Patients reported an average of 7 minutes to complete the survey, most independently (83%, n = 30), and were satisfied with the electronic program overall (80%, n = 29), including how easy it was to use (88%, n = 32). Conclusions: Preliminary data support feasibility, usability, and acceptability of the tablet-based mGA and that frailty score influences provider decision-making ≥50% of the time. Future analyses will explore the relationship of the mGA with toxicity, dose modification and/or treatment discontinuation in OAs with MM.