tbuckley/cabot-search huggingface dataset:
P01.160 Social needs and social services provision in Brain Tumor patients
Authors: M Rotondi, S Focarelli, V Villani, D Benincasa, L Guariglia, S Ieraci, A Pace
Journal: Neuro-Oncology (2018)

the complex social needs and social services utilization of patients with malignant brain tumors (BTs) and their caregivers are not well documented. Research has described utilization of healthcare services in BT, however, studies systematically examining the social workers’ role and function in the trajectory of disease in BT patients are lacking. This study aims to identify the level and type of social needs for health and social worker activities on integrated care teams among patients with BT, and explore associated clinical and socio-demographical factors. We retrospectively analyzed patients assisted by our neuroncological center in the Regina Elena National Cancer Institute of Rome since March 1, 2015 to May 31, 2018, to evaluate the social needs and their modifications during the trajectory of disease. 502 patients affected by malignant gliomas have been assisted at home in the period of observation. Clinical record including social worker intervention were reviewed to evaluate social needs expressed and social services delivered. Among the 502 patients who were assisted at home by our neuroncological center until death, 287 (57%) were assisted by the social service and received some kind of social assistance. The most frequent social worker activity was: information about social security patients’ rights (early retirement, income support, work capacity reduction/modification) in 100% of patients; assistance to patients’ “navigation “by guiding them through complex healthcare and community service systems (48%); linking with community resources connecting patients to services to address the social determinants of health including help in transportation (13,6%), caretaker (25,6%), rehabilitation and speech therapy services activation (respectively 58,9% and 15,3%). the complex social needs of care of BT patients and their families should receive more attention. In order to plan and improve provision of comprehensive social care in BT patients and their caregivers, it is critical to promote proactive dissemination of information, education and psychosocial support, facilitating easier access to social support services. Needs for healthcare and social services in patients with BT should be assessed in a systematic manner, in order to provide adequate comprehensive care during the course of disease. Better understanding of the roles and functions that social workers play on integrated care teams could improve supportive care of brain tumour patients and their carers.
Body image, self-esteem and quality of life during oncology treatment in breast cancer, cervical cancer, and prostate cancer in comparison to the healthy population.
Authors: Anna Kieszkowska-Grudny, Monika Rucinska, Robert Ciesak, Marta Wisniewska
Journal: Journal of Clinical Oncology (2017)

e21550 Background:Cancers are the second most common cause of death. Treatment of cancers is complex and might be aggressive, takes a long time and is usually difficult to accept for patients. As a result of disease and treatment a body image(BI) is impaired and can reduce quality of life(QoL),which has become a very important factor. The objective of the study was to investigate BI and QoL during oncological treatment of breast cancer(BCa), cervical cancer(CeCa) and prostate cancer(PCa) patients and to compare with healthy groups of men(HM) and women(HW). Methods:The analysis included 280 participants: 31 BCa-pts just after oncological surgery (age26-86 years,M = 63,23,Me = 65), 44 BCa-pts during adjuvant radiotherapy (age37-69years, M = 57,23,Me = 60), 21 CeCa-pts during therapy (age30-68years,M = 54,43,Me = 60), 52 PCa-pts with clinical stage T1-T2N0M0 (age57-86;M = 70,65;Me = 70) after standard three-dimensional conformal radiation treatment (3DCRT), 32 PCa-pts (age59-84;M = 74;Me = 75) after stereotactic hypofractionated radiotherapy (HRT), than without any type of cancer 50HM (age47-92years;M = 62,28;Me = 60) and 50HW (age30-84 years,M = 51,46,Me = 50). The subjects filled out the questionnaire EORTC QLQ-C30 (ver3.0.) and a specially designed questionnaire for a body image assessment. Results:All factors associated with BI between groups differed significantly (p &lt; 0,05): general appearance, self-esteem, physical and sexual attractiveness. The highest assessment in all categories were done by HRT-pts and the lowest by BCa-pts during radiotherapy, than BCa-pts after surgery. HM and HW perceived BI on a similar level, however lower than HRT-pts. Overall QoL was significantly lowest in BCa-pts after surgery (p &lt; 0,05), but physical, role, emotional, and general functioning were the worst in BCa-pts during radiotherapy (p &lt; 0,05). The lowest social QoL was assessed by CeCa-pts (p &lt; 0,05). Conclusions:It seems that oncological treatment influences significantly BI of cancer patients and worsens QoL especially in breast cancer women just after surgery and adjuvant radiotherapy. HTR-pts assesses BI and general QoL even better than healthy groups.
Control of Postprandial Hyperglycemia in Type 1 Diabetes by 24-Hour Fixed-Dose Coadministration of Pramlintide and Regular Human Insulin: A Randomized, Two-Way Crossover Study
Authors: Matthew C. Riddle, Rajaa Nahra, Jenny Han, Jessica Castle, Kathryn Hanavan, Marcus Hompesch, David Huffman, Poul Strange, Peter Öhman
Journal: Diabetes Care (2018)

OBJECTIVE Healthy pancreatic β-cells secrete the hormones insulin and amylin in a fixed ratio. Both hormones are lacking in type 1 diabetes, and postprandial glucose control using insulin therapy alone is difficult. This study tested the pharmacodynamic effects of the amylin analog pramlintide and insulin delivered in a fixed ratio over a 24-h period. RESEARCH DESIGN AND METHODS Patients with type 1 diabetes were stabilized on insulin pump therapy with insulin lispro before a randomized, single-masked, two-way crossover, 24-h inpatient study in which regular human insulin was administered with pramlintide or placebo using separate infusion pumps in a fixed ratio (9 μg/unit). Meal content and timing and patient-specific insulin doses were the same with each treatment. The primary outcome measure was change in mean glucose by continuous glucose monitoring (CGM). Profiles of laboratory-measured glucose, insulin, glucagon, and triglycerides were also compared. RESULTS Mean 24-h glucose measured by CGM was lower with pramlintide versus placebo (8.5 vs. 9.7 mmol/L, respectively; P = 0.012) due to a marked reduction of postprandial increments. Glycemic variability was reduced, and postprandial glucagon and triglycerides were also lower with pramlintide versus placebo. Gastrointestinal side effects were more frequent during use of pramlintide; no major hypoglycemic events occurred with pramlintide or placebo. CONCLUSIONS Coadministration of fixed-ratio pramlintide and regular human insulin for 24 h improved postprandial hyperglycemia and glycemic variability in patients with type 1 diabetes. Longer studies including dose titration under daily conditions are needed to determine whether this regimen could provide long-term improvement of glycemic control.
One in seven operations cancelled on day of surgery, study finds
Authors: Ingrid Torjesen
Journal: BMJ (2018)

Ongoing pressure on NHS hospitals resulted in cancellation of one in seven operations on the day they were due to take place in one week in March last year, researchers have found.1

The research group, led by the Health Services Research Centre at the Royal College of Anaesthetists and the UCL Surgical Outcomes Research Centre, examined the factors associated with last minute cancellations. Their observational cohort study used data from 245 hospitals (more than 90% of NHS hospitals across England, Wales, Scotland, and Northern Ireland) during one week in March 2017.

They found a total of 26 171 inpatient operations scheduled to take place between 21 and 27 March. Of these, 3724 were cancelled or postponed …
Abstract 17302: Validity of Discharge Diagnosis Codes for Acute Myocardial Infarction in Primary versus Secondary Positions: ARIC Study
Authors: Gautam R Shroff, Rachel Kloss Silverman, Alvaro Alonso, Tibor Fulop, Cameron Guild, Erin D Michos, Aaron Folsom, Wayne Rosamond
Journal: Circulation (2017)

Background:  Discharge codes for acute myocardial infarction (AMI) in the primary position have declined since 2011 but increased in any secondary position among Medicare beneficiaries. The objective of this study was to assess validity of AMI hospital discharge codes in primary vs. secondary positions compared to adjudicated AMI criteria from the Atherosclerosis Risk in Communities (ARIC) Study.   Methods:  From ARIC, a continuous surveillance of hospital discharges for AMI among residents aged 35-74 years in 4 US communities between 2005-2013 was evaluated. Based on annual hospital discharges, a probability sample of AMI (ICD9-410) codes was captured, further sub-categorized into AMI in primary vs. secondary positions. The accuracy of ICD-9-CM codes for AMI in primary vs. secondary positions was compared to the gold standard, i.e. diagnosis of AMI by ARIC criteria (based on cardiac pain, electrocardiographic criteria and cardiac biomarkers).   Results:  The study population was 53% men, 72% white. After weighting for sampling probabilities, 15,097 AMI discharge codes were identified. When discharge diagnosis of AMI was coded in the primary position (n=9,968) 79% were identified as definite/probable AMI and 21% identified as suspected/no AMI using ARIC criteria (table). In contrast, when discharge diagnosis of AMI was coded in any secondary position (n=5,129), 43% were identified as definite/probable AMI and 57% as suspected/no AMI using ARIC criteria. The positive predictive value for ICD-410 in the primary position was 1.8 times higher than in any secondary position.   Conclusions:  The accuracy of a discharge code for AMI in a secondary position was low compared to AMI classification by ARIC criteria, indicating that this entity has different clinical, economic and epidemiological implications compared to AMI in a primary position. Researchers using claims data should be cautious about the use of ICD-9 code 410 in a secondary position to identify patients with AMI.
P05.53 Long-term cognitive function after radiation therapy for primary brain tumours grade I-III
Authors: L Haldbo-Classen, A Amidi, S Lukacova, L Wu, G von Oettingen, H Gottrup, R Zachariae, M Høyer
Journal: Neuro-Oncology (2018)

After neurosurgery, radiotherapy (RT) is the main treatment for many brain tumours. Irradiation, however, may have detrimental effects on cognitive functions. So far, most studies investigating radiation-induced cognitive impairments have used healthy participants as comparison. This approach, however, does not account for tumour-related impairments. In the present cross-sectional study, we compared cognitive functioning in patients with grade I-III brain tumours who received surgical resection with and without RT. Adult patients with specified grade I-III brain tumours treated at Aarhus University Hospital between 2006–2016 underwent neuropsychological assessment. Standardized tests included Trail making Test (TMT); Hopkins Verbal Learning Test (HVLT); Controlled Oral Word Association Test (COWAT) - Animals and S; Coding and Digit Span from WAIS-IV; Paced Auditory Serial Addition Test (PASAT); Stroop Test. Test outcomes were converted to z-scores using adjusted normative data and analyzed with one-sample and independent sample t-tests. Test-specific and overall cognitive impairment (OCI) frequencies were determined using ICCTF criteria, and between-group differences were tested with Fisher’s exact test. 110 participants were recruited at the time of analysis. 81 had received RT (RT+), while 29 had not (RT-). Mean age was 53,6 years with an average time since diagnosis of 7.8 years. Compared with normative data, lower average scores were observed for the entire group on HVLT-total (p<0.001), HVLT-delayed (p<0.001), PASAT (p<0.001), Coding (p = 0.01) and Stroop (p<0.001). Further indication of lower scores was noted for TMT-B (p=0.05). General OCI frequency was 37.9%. Compared with RT-, RT+ scored lower on Coding (p=0.032), and Stroop (ps< 0.05) with indication of lower scores on COWAT-Animals (p=0.07). Higher impairment frequency was observed in RT+ (16%) on COWAT-Animals (p=0.02). Long-term cognitive impairment was evident in the majority of patients treated for brain tumours. Our results indicate that radiotherapy may have additional detrimental effects on cognitive functions.
A phase 1b study of famitinib plus docetaxel as 2<sup>nd</sup> line setting in patients with metastatic non-squamous non-small cell lung cancer and EGFR wild type.
Authors: Caicun Zhou, Shengxiang Ren, ChunXia Su, Fengying Wu, Xiaoxia Chen, Fei Zhou, Jing Zhao, Tao Jiang, Jing Wang, Qing Yang, Yuanyuan Yu
Journal: Journal of Clinical Oncology (2016)

e20603 Background: This phase Ib study was designed to evaluate the safety and efficacy of famitinib plus docetaxel in previously 1st line treated non-squamous metastatic NSCLC patients with EGFR wild type. Methods: All patients previously received plantium based first line chemotherapy. Patients were treated with docetaxel 60 mg/m2, on day 1; famitinib was administered orally on days 2-21 of a 21-day cycle. In a standard 3+3 design, famitinib was explored at 3 different dose levels. The primary objective was to determine the maximum tolerated dose (MTD) of the combination of docetaxel and famitinib. Secondary objectives included establishing the safety profile (CTCAE v4) of the combination, exploring the efficacy (RR by RECIST 1.1, PFS, and OS). Results: 17 patients were treated with combined docetaxel and famitinib: 15 mg (n = 3), 20 mg (n = 10), and 25 mg (n = 4). Women: 7/17, Median Age: 54 (range 40-68), ECOG PS1: 17. Median duration of treatment: 15 mg group = 23.5 weeks, 20 mg group = 19.6 weeks (6 patients are still on-treatment), and 25 mg group = 12.7 weeks. There were one grade III neutropenia in the middle and high dose group each and no DLTs and in the first-cycle. The MTD was not reached. The most common toxicities were neutropenia (82.35%), leucopenia (76.47%), proteinuria (35.3%), elevations in alanine aminotransferase (35.3%), aspartate aminotransferase (29.4%), hand-foot syndrome (29.4%) and fatigue (29.4%). Grade 3/4 neutropenia (n = 9) and Grade 3 proteinuria (n = 2), Grade 3 hand-foot syndrome (n = 1) was observed. 2 patients stopped therapy due to toxicity. 9 discontinued due to PD. 6 patients continue on treatment. PR = 23.5% (4/17), SD = 64.7% (11/17). All the patients who get a partial response were come from famitinib 20 mg group. Median PFS in the first enrolled 10 patients was 4.35 months. Conclusions: In patients with non-squamous NSCLC and EGFR wild type, docetaxel and famitinib can be combined. MTD of famitinib was not reached in the studied 3 different doses. Since 25 mg was the recommendation dose for monotherapy and 20 mg showed a higher response rate combining with docetaxel, famitinib 20 mg orally was recommended as a proper dose in the subsequent ongoing Phase II study. Clinical trial information: NCT02364362.
Pre-judgement significance of endometrial echo complex in postmenopausal type 2 endometrial cancer.
Authors: Yi Zhu, Chang Wang, Guo-Nan Zhang, Jie Zhang
Journal: Journal of Clinical Oncology (2016)

e17117 Background: To determine the ultrasonographic characteristics of the endometrial echo complex (EEC) of postmenopausal patients diagnosed with type 2 endometrial cancer (EC), including uterine papillary serous carcinoma (UPSC), clear cell carcinoma (CCC), and other endometrial high-grade carcinomas (HGC). Methods: Postmenopausal patients with EC who underwent preoperative ultrasound from 2010 to 2015 were identified from our institutional database. Histologic diagnoses were made by biopsy or hysterectomy. Ultrasound reports were abstracted for the following parameters: EEC thickness, presence of intracavitary fluid or lesion, myometrial mass, uterine size, and adnexal mass. Differences between type 1 and type 2 ECs were determined. Results: Among 205 patients with postmenopausal EC, 121 had type 1 EC while 84 had type 2 EC. 10.2% of the cohort had an EEC ≤ 4 mm, including 0.8% of patients with type 1 EC and 23.8% of patients with type 2 EC (P < 0.001). When limited only to patients with postmenopausal bleeding, 0.9% with type 1 EC and 25.0% with type 2 EC had an EEC ≤ 4 mm (P < 0.001). 56 patients with type 2 EC had a thickened EEC measuring ≥ 5 mm. In 20 cases, the EEC measured ≤ 4 mm. In an additional 8 patients the EEC was indistinct. One or more other ultrasound abnormalities were found in each of the 20 cases with a non-thickened EEC: intracavitary fluid (4; 20.0%), intracavitary lesion (5; 25.0%), myometrial mass (15; 70.0%), enlarged uterus (14; 70%), or adnexal mass (2; 10.0%). Conclusions: A thin endometrial stripe, especially when associated with postmenopausal vaginal bleeding does not reliably exclude type 2 EC and cannot supplant histologic evaluation.
Chemotherapy efficacy and prognosis of patients with mediastinal seminoma. Single institution experience.
Authors: Mikhail Fedyanin, Alexey Tryakin, Anatoly Bulanov, Olga Sekhina, Ilya Pokataev, Boris Polockii, Tatiana Zakharova, Avgust Garin, Sergei Tjulandin
Journal: Journal of Clinical Oncology (2016)

e16053 Background: Patients with mediastinal nonseminomatous germ cell tumors belong to poor prognostic group by IGCCCG. Mediastinal seminoma is very rare disease and data of the prognosis and chemotherapy efficacy are scarce. We retrospectively studied the outcome and prognostic factors of patients with mediastinal seminoma. Methods: We analyzed data of 39 (7.9%) patients with mediastinal seminoma from 493 patients with metastatic morphological verified pure seminoma and with normal AFP level and β-hCG < 500 mIU/ml, who were treated in our department during 1986-2014. Median age was 30 years (range: 15-64). All patients had good prognosis according IGCCCG. Medians β-hCG and LDH levels were 15 (range: 0.1-500) and 454 U/l (upper limit of normal is 450 U/l; range 120-2455), respectively. Metastasis were seen in 11/39 (28.2%) patients. Median follow-up time was 33.5 months (range 2-291). All patients were initially treated with chemotherapy; BEP/EP - 31/39 (79.5%), VAB6 or CP (cyclophosphamide/cisplatin) – 8/39 (20.5%) patients. Only 9/39 (23%) patients received < 4cycles of chemotherapy. Surgery resection of residual tumor was performed in 1/39 (2.6%) patient (histological report – necrosis). Statistical analyses was performed using Statistical Package for the Social Sciences Version 22.0 (SPSS Inc., Chicago, IL). Results: Marker negative objective response was revealed in 100% patients: complete response – in 9/39 (23%), partial response - 30/39 (77%) patients. A relapse (2.5%) occurred 12 years after the treatment. That patient was saved with salvage chemotherapy. One patient died from cardiac disease 9 years following chemotherapy. Three-year PFS and OS were 100%. Level of β-hCG (p = 0.4), LDH (p = 0.5), age (p = 0.9), number of cycles of chemotherapy (4 vs 2-3) (p = 0.6) did not alter the PFS. In addition, the scheme of regimen (EP vs BEP) did not influence on PFS – all cases are censured. Conclusions: Patients with mediastinal seminoma have an excellent prognosis in contrast to patients with mediastinal nonseminomatous germ cell tumors. Low number of relapses precluded analysis of prognostic factors.
Association of higher PD-L1 expression in tumor cells of metastatic ccRCC lesions with worse overall survival.
Authors: Kathleen Margaret Mahoney, Ritesh R. Kotecha, Marcella Callea, Opeyemi Jegede, Paul J. Catalano, Jiaxi Song, Laurence Albiges, Guillermo de Velasco, Hilla Conen, Alexander Carlson, Craig Norton, Toni K. Choueiri, M Dror Michaelson, Mamta Gupta, David F. McDermott, Gordon J. Freeman, Rupal Satish Bhatt, Sabina Signoretti
Journal: Journal of Clinical Oncology (2016)

e23221 Background: PD-L1 expression by tumor cells and immune cells has been associated with worse prognosis in patients (pts) with clear cell renal cell carcinoma (ccRCC), but its role in predicting response to immuno-therapy remains unclear. We previously demonstrated discordant PD-L1 expression between primary and metastatic sites in ccRCC, suggesting that PD-L1 analysis in metastatic lesions might more accurately predict clinical outcome. Here we investigated the prognostic value of PD-L1 expression assessed in either primary tumors or corresponding metastases in pts with metastatic ccRCC. Methods: De-identified primary and metastatic paired ccRCC samples were immunostained for PD-L1 expression (9A11 mAb, Freeman). We obtained IRB approval to perform a chart review of pts and study whether tumor cell PD-L1 expression in primary tumors or metastatic lesions was associated with survival. Both 1% and 10% cutoffs for PD-L1 positivity were evaluated. Results: Thirty-six pts charts were reviewed. Eighty percent of pts had distant metastasis at the time of diagnosis (n = 29); 88% had metastatic disease within a year of their nephrectomy. Pts were treated with 0-5 treatments, consisting of 64% anti-VEGF, 47% high-dose IL-2, 11% mTOR inhibitor, 5% immune checkpoint blockade and 14% with no systemic therapy. Pts with positive PD-L1 expression on tumor cells appeared to have decreased survival. Differences in overall survival were statistically significant (9 vs 43 m, p = 0.049)* at the 10% PD-L1 threshold when the analysis was performed in metastatic lesions but not primary lesions. Conclusions: Our studies in a cohort consisting largely of pts whose ccRCC has high-risk features suggest that pts with higher levels ( ≥ 10%) of tumor cell PD-L1 expression have rapidly progressive disease. The association between high levels of PD-L1 expression and survival will be explored in a larger number of samples and presented at the meeting. PD-L1 Threshold Site Median OS (95% CI) PD-L1 positive in months PD-L1 negative 1% Primary 22.9 (6.1, 109.5); n = 13 61.1 (19.8, 94.9); n = 23 1% Met 36.5 (1.1, 66.3); n = 10 41.0 (19.8, 94.9); n = 26 10% Primary 6.5 (1.1, NA); n = 5 43.0 (19.8, 86.6); n = 31 10% Met* 9.0 (1.1, 66.3); n = 6 43.0 (21.3, 94.9); n = 30
Assessment of HER2 status in adenocarcinomas of the stomach or gastroesophageal junction in a Western population.
Authors: Nieves Martinez Lago, Maria Elena Padin Iruegas, Ihab Abdulkader, Dora Insua Santamaria, Juan Jose Carrera, Jose Ramón Antunez Lopez, Rafael López López
Journal: Journal of Clinical Oncology (2017)

e15548 Background: HER2 status is a predictive biomarker to response to trastuzumab in metastatic adenocarcinomas of the stomach our gastroesophageal junction. However, relatively little is known about the role of HER2 in the non-metastatic disease in western population. Methods: This study included 106 patients with gastric cancer who underwent surgery between January 2007 and June 2014 at Universitary Hospital of Santiago de Compostela. Immunohistochemical expression of HER2 was analyzed using the DAKO-HercepTest™ and gene amplification using DAKO-DuoCISH kit; both was scored according to published reports. Correlations between HER2 status, clinicopathological characteristics, survival and relapse sites were retrospective analyzed. Results: HER2 expression rate by IHC was: 76 patients (71.7%) classificated as negative, 7 patients (6.6%) as positive and 23 patients (21.7%) as equivocal. HER2 gene amplification by DuoCISH was positive in 14 patients (13.2%). HER2 status was associated with intestinal subtype (p = 0.010), tumor grade (well-moderately differentiated, p = 0.008), lower tumor invasion (p 0.018) and distant relapse (p = 0.048). There was a significant interaction between HER2 status and significantly worse disease-free survival (DFS) (P = 0.039) and overall survival (OS) (P = 0.028), respectively. Conclusions: In our population, HER2 status appears to be associated with differentiated clinicopathological characteristic, worse OS and DFS and distant site of relapse in patients with resected gastric cancer.