tbuckley/cabot-search huggingface dataset:
A body image and a quality of life after stereotactic hypofractionated radiotherapy (HRT) and standard three-dimensional conformal radiotherapy (3DCRT) of prostate cancer patients.
Authors: Monika Rucinska, Anna Kieszkowska-Grudny, Joanna Rad
Journal: Journal of Clinical Oncology (2016)

e16624 Background: Prostate cancer is the second most common solid tumor in men worldwide. There are over 1 million new prostate cases each year in the world. Several patients are diagnosed at an early stage and the standard treatment is radical prostatectomy or radiotherapy. Treatment results are good and therefore quality of life (QoL) after treatment has become a very important factor. The primary objective of this study was to investigate the subjective assessment of body image and QoL of prostate cancer patients after radical radiotherapy. Methods: The analysis included 134 individuals: 84 prostate cancer patients, clinical stage T1-T2N0M0: 52 patients (age 57-86; mean and median 70 years) after standard three-dimensional conformal radiation treatment (3DCRT), 32 patients (age 59-84; mean 70; median 74) after stereotactic hypofractionated radiotherapy (HRT) and 50 healthy men (without any type of cancer, age 47-92; mean 62; median 60) as a control. The subjects filled out EORTC QLQ-C30 and a specially designed questionnaire for a body image assessment. Results: The general QoL and some QoL subscales (physical, emotional, social and role functioning) among patients after radiotherapy was good and even better than in group of the healthy men. Patients after HTR reported the better then patients after 3DCRT rate in a self-body assessment, a self-esteem, as well as in both a physical and a sexual attractiveness (however not statistically significant). Conclusions: Prostate cancer and its treatment with radiotherapy (both 3DCRT and HRT) have not a significant impact on a self-esteem and a self-body assessment. The QoL after radiotherapy of prostate cancer patients is good.
A propensity-matched analysis of stereotactic body radiotherapy and sublobar resection for stage I non-small cell lung cancer in patients at high risk for lobectomy.
Authors: Wucheng Chen, Qingren Lin, Xiaojiang Sun, Jinshi Liu, Yaping Xu, Qixun Chen, Weimin Mao
Journal: Journal of Clinical Oncology (2017)

e20076 Background: The aim of this study was to perform a survival comparison between stereotactic body radiotherapy (SBRT) and sublobar resection (SLR) in patients with stage I non-small cell lung cancer (NSCLC) at high risk for lobectomy. Methods: All patients who underwent SBRT or SLR because of medical comorbidities for clinical stage I NSCLC from January 2008 to December 2015 were reviewed retrospectively. Propensity score matching was performed to reduce selection bias between SBRT and SLR patients based on age, gender, performance status, tumour characteristics, pulmonary function. Overall survival (OS) and recurrence-free survival (RFS) were estimated with Kaplan–Meier method. Results: Forty-nine patients were matched into each group of SBRT and SLR (include 27 underwent segmentectomy, 22 underwent wedge resection). There were 32 and 30 men with median age of 67 and 69 years, respectively. Median follow-up was 25 months. In terms of treatment-related mortality, the 30- day mortality rates for the SBRT and SLR groups were 0 and 2.0 %, respectively. Patients treated by SBRT had a tendency to increase 3-year OS compared with SLR (94.0% versus 78.1%; P = 0.064).There was no difference between two groups in 3-year RFS (61.8% versus 65.7%; P = 0.864). In a subanalysis, 3-year OS after SBRT was greatly better than wedge resection subgroup (94.0% versus 67.4%; P = 0.026), but there was no significant difference between SBRT and segmentectomy in 3-year OS (94.0% versus 88.0%; P = 0.212). Conclusions: SBRT had a tendency to increase OS compared with sublobar resection in patients who are not medically fit for lobectomy with clinical stage I NSCLC. However, OS after SBRT was better than wedge resection subgroup. SBRT can be an alternative treatment option to segmentectomy for patients who cannot tolerate lobectomy because of medical comorbidities. A randomized prospective study is necessary to determine survival in compromised SBRT and sublobar resection.
Neutrophil/lymphocyte ratio as surrogate of cetuximab antibody-dependent cell-mediated cytotoxicity in first line metastatic colorectal cancer: A preliminary and exploratory analysis of the ERMES phase III trial.
Authors: Maria Alessandra Calegari, Armando Orlandi, Michele Basso, Carmela Di Dio, Maria Bensi, Matteo Ramundo, Evaristo Maiello, Antonino Cassata, Emiliano Tamburini, Francesco Di Costanzo, Nicola Normanno, Carmine Pinto, Carlo Antonio Barone
Journal: Journal of Clinical Oncology (2018)

e15656 Background: The ERMES trial is an ongoing phase III RCT comparing standard treatment with FOLFIRI+Cetuximab (Cet) until PD (arm A) to de-escalating Cet monotherapy after 4 months of induction with FOLFIRI+Cet (arm B) in first line RAS/BRAF WT mCRC. NLR has been reported as an independent prognostic factor in mCRC, whereas its predictive impact is still questioned. We hypothesized that NLR could represent a surrogate of lymphocyte activity, acting as a marker of Cet-mediated ADCC. We performed an exploratory analysis to assess the predictive role of NLR in pts receiving Cet maintenance monotherapy (arm B). Methods: Pts enrolled at Fondazione Policlinico Gemelli were included in this analysis. NLR, defined as ANC/ALC, was calculated at baseline (BL) and 1 month after treatment allocation (C10D1). Median NLR at C10D1 was adopted as cut-off value to classify pts as low and high NLR. The primary endpoint was DCR assessed after 2 months from treatment allocation (C12) in low vs high NLR. Secondary endpoint was PFS. The impact of BL NLR in the whole population and of C10D1 NLR in arm A was also evaluated. Results: Of 37 enrolled pts, 25 received at least 10 cycles of therapy (17 pts in arm B and 8 pts in arm A) and were included. In arm B 8 pts were classified as low NLR and 9 as high NLR at C10D1. DCR at C12 was 100% (including 2 CR) in low NLR and 66.6% in high NLR (p 0.02). An increase in PFS was detected in low NLR vs high NLR group (10.3 vs 9.2 months; p = 0.1). BL NLR in the whole population and C10D1 NLR in arm A were not associated to treatment efficacy. Conclusions: Low NLR seems to predict response to Cet monotherapy. Such evidence might be explained by a postulated role of NLR as predictor of ADCC. This marker might allow an early selection of pts who may benefit most from a de-escalating monotherapy with Cet after induction with combination chemotherapy and pts who would benefit from restoration of chemotherapy. An extended evaluation on the whole ERMES population is planned to confirm these preliminary results.
Hodgkin lymphoma: The Moffitt Cancer Center Experience.
Authors: Ashley Rose, Alexander Lim, Alex Tungesvik, Leidy Lismeri Isenalumhe, Lubomir Sokol
Journal: Journal of Clinical Oncology (2018)

e19516 Background: Hodgkin lymphoma (HL) comprises 10% of malignant lymphomas. Classical HL (cHL) includes 4 histological subtypes: lymphocyte rich (LR), nodular sclerosis (NS), mixed cellularity (MC), and lymphocyte depleted (LD). Nodular lymphocyte predominant (NLPHL) type is a separate entity. Greater than 75% of patients (pts) are cured with current treatment modalities. Prognosis is based on stage, presence of B-symptoms, bulky disease and treatment. In this large single institution database, we analyzed demographics, prognostic features and survival over a 27 year period. Methods: We evaluated 761 pts with HL diagnosed between 1990-2017. We estimated overall survival (OS) by Kaplan Meier curve and Cox Proportional Hazards regression to analyze risk factors. Relationship between clinical features and prognosis was tested using the Chi-square test, Fisher’s test or the Cochran-Armitage trend. Results: 55.3% of pts were male and the majority was Caucasian (79.2%). Mean age at diagnosis was 38.5 years. 60% of pts were ≤39 years of age, 31% were 40-64 years old, and 9% were 65 and older. Histological subtypes included NS 72.2%, MC 19%, LR 3%, LD 0.7%, and NLPHL 5.1%. Stage at diagnosis; I-6.9%, II- 47.5%, III 22.7%, IV 22.9%. B-symptoms were present in 50.4% of pts and 22.6% had bulky disease. There was a significant difference in mean age at diagnosis according histological subtypes; with nodular sclerosis more prominent at younger ages (35.7yrs) compared to lymphocyte depleted (50yrs) (p-value < 0.05). The mean time of follow-up was 7.2 years. Median survival was 17.8 years with a 5-year OS of 83.1% and 10-year OS of 70.9%. Survival was significantly different among the age cohorts ≤39yrs, 40-65, and ≥65 years with 10-year OS survival 73.4%, 71.7% and 47.3% respectively (p-value < 0.001). Survival was longer in pts with NLPHL in comparison to cHL subtypes. NLPHL had a median survival of 37.4 years with a 5-year OS of 96.9% compared to cHL histology with a median survival of 16.8 years and a 5-year OS of 82.8%. Conclusions: Our data suggests that pts with HL have great long-term outcomes. Significant indicators of poor prognosis include classical histology type, advanced stage at diagnosis, presence of B symptoms, and advanced age. Outcomes based on treatment are in progress.
Optimizing infusion scheduling through lean methods and data science.
Authors: Bruno C. Medeiros, Donna Healy, Sridhar Belavadi Seshadri, Eben Lloyd Rosenthal, James Martin, Mohan Giridharadas, Hugh Cassidy, Sofia DeMarco
Journal: Journal of Clinical Oncology (2016)

e18240 Background: Mid-day peaks in chair utilization commonly result in long waiting times for patients and a surge in pharmacy and nursing workload. The size of the solution space is enormous – a 35-chair infusion center operating 12 hours per day with appointments scheduled at 10 minute intervals throughout the day has 3.3 * 10^106 possible configurations. It is therefore impossible to “find” an optimal solution using the traditional approaches of scheduling by chair or by nurse. Methods: We have applied an optimization algorithm, based on the lean principle of level loading demand (Heijunka). The algorithm captures center-specific parameters such as the operating hours, nurse staffing/schedule and patient volume/acuity as constraints. It then analyzes the expected duration of each appointment and “shuffles the appointment deck” by sequencing the start time of appointments in the order that would level load the infusion chairs throughout the day. The final output is a “fingerprint” template unique for each hour of each day given the specific operating parameters of the infusion center. This template works within the existing scheduling system so that schedulers do not experience any change in their workflow. Results: The solution has been stable for approximately a year with positive results (Table). Conclusions: Level loading chair utilization improves both the patient experience as well as the financial performance of the infusion center. The patient experience is improved by creating more appointment slots and by reducing wait times especially in the middle of the day. Financial performance is improved by reducing overtime dollars and by completing more treatments within the existing fixed cost structure. Improvements in infusion center performance. Metric Baseline (Q4 FY 13) Current (Q1 FY 16) Improvement (%) Number of treatments 54,000 (in 2013) 65,000 (in 2015) 20.4% increase Median Wait time 14:36 minutes 10:00 minutes 31.5% reduction % patients with a wait time under 15 minutes 51% 66% 29.4% improvement Emergency Callback (ECB) per pay period N/A N/A 81.6% reduction Unit cost of service N/A N/A 17% reduction Nurse satisfaction N/A N/A 25 percentile point improvement
Impact of YOCAS yoga and influence of sleep and fatigue on quality of life (QOL) in breast cancer survivors.
Authors: Anita Roselyn Peoples, Charles E. Heckler, Joseph A. Roscoe, Charles Stewart Kamen, Michelle Christine Janelsins, Luke Joseph Peppone, Ian Kleckner, Jeffrey K. Giguere, Rakesh Gaur, Janet C. Ruzich, Benjamin Esparaz, Karen Michelle Mustian
Journal: Journal of Clinical Oncology (2016)

10129 Background: Cancer and its treatment produce interrelated symptoms of sleep disturbance and fatigue, which are significantly correlated with diminished QOL, allowing for the possibility that improvement in these symptoms could improve QOL. We previously showed from a 2-arm phase III RCT that YOCAS Yoga improved sleep quality and fatigue compared to standard care in cancer survivors with disturbed sleep. Herein, we performed secondary analyses to examine (i) the effect of YOCAS Yoga on QOL and (ii) the mediating effects of changes in sleep and fatigue on QOL. Methods: Study assessments were performed on 245 female breast cancer survivors (mean age 54) prior to the 4-week Yoga intervention (baseline) and at post-intervention. Sleep was assessed by the Pittsburgh Sleep Quality Inventory (PSQI) and the Insomnia Severity Index (ISI). Fatigue and QOL were assessed by individual items on the Symptom Inventory (SI, 0 = none to 10 = worst scale). QOL was also assessed by the Functional Assessment of Cancer Therapy-General (FACT-G). Simple change scores from baseline to post were calculated for all measures for patients who did (N = 123) or did not (N = 122) receive Yoga. Results: QOL scores at baseline and post for the Yoga group were: SI-QOL: 3.6, 2.5 and FACT-G: 79.7, 82.8, and for the non-Yoga group were: SI-QOL: 3.4, 3.4 and FACT-G: 77.5, 78.4. ANCOVA controlling for baseline showed significantly better scores on both QOL measures at post in the Yoga group than non-Yoga group (both p’s ≤ 0.01). Changes over time in the SI-QOL and FACT-G were significantly associated with concurrent changes in the PSQI, ISI and SI-Fatigue (all R’s ≥ 0.29; all p’s < 0.0001). Linear regression showed that one unit improvements in the PSQI, ISI, and SI-Fatigue were associated with an improvement in SI-QOL of 0.14, 0.11, and 0.21, respectively (all p’s ≤ 0.01) and FACT-G of -0.83, -0.89, and -2.0, respectively (all p’s ≤ 0.001). Conclusions: In breast cancer survivors with sleep disturbance, Yoga significantly improved QOL and this improvement in QOL may be mediated by concurrent improvements in sleep disturbance and fatigue. Further research is needed to confirm these findings. Funding: NCI grants 1R01CA181064, R25CA10618 and UG1CA189961. Clinical trial information: NCT00397930.
Radiofrequency ablation for cholangiocarcinoma: it works, but how?
Authors: Peter Bauerfeind, Marianne Ortner
Journal: Endoscopy (2018)

See also: Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trialEndoscopy 2018; 50(08): 751-760DOI: 10.1055/s-0043-124870
Incidence and clinical implications of a new definition of hyperprogression (HPD) with immune checkpoint inhibitors (ICIs) in patients treated in phase 1 (Ph1) trials.
Authors: Ignacio Matos, Juan Martin-Liberal, Cinta Hierro, María Ochoa De Olza, Cristina Viaplana, Marinha Costa, Eudald Felip-Falg’s, Gemma Mur-Bonet, Maria Vieito, Irene Brana, Analia Azaro, Coral Perez-Gago, Victor Rodriguez-Freixinos, Guillem Argiles, Mafalda Oliveira, Enriqueta Felip, Eva Muñoz-Couselo, Josep Tabernero, Rodrigo Dienstmann, Elena Garralda
Journal: Journal of Clinical Oncology (2018)

3032 Background: HPD with ICIs has been recently described as progression disease (PD) by RECIST with a ≥ two-fold increase in tumor growth rate experimental vs. reference. However, the implementation of such assessment is challenging and its clinical implications have not been clearly established. Methods: Patients (pts) treated with ICIs in Ph1 trials at Vall d´Hebron Institute Oncology (VHIO) were analysed (n = 214). We defined HPD based on RECIST 1.1 as time to treatment failure (TTF) < 2 months (m) and minimum increase in measurable lesions of 10 mm plus: 1) increase of ≥40% (upper decile of our cohort) in target tumor burden compared to baseline or 2) increase of ≥20% plus the appearance of multiple new lesions. The aim of this study was to correlate HPD with overall survival (OS) in pts who achieved PD as best response, by using a Kaplan-Meier analysis. Results: From Jan'12 to Oct'17, 214 pts were treated, mostly with antiPD1/PDL1 ICIs (53% in combinations with other ICI). Median age 58y (20-85). Tumor types: melanoma 22%, lung 14%, breast 10%, colon 6%, others 48%. 20% had received prior ICI. Best response was PD in 47% pts (n = 101). In total, 33 pts (15%) were considered HPD, representing 40% of evaluable pts with PD as best response. HPD was not associated with age, tumor type, ICI regimens, previous ICI or metastatic site (Fisher test). Median OS was 4.8 m (95% CI: 3.4-7.3) in HPD group versus 8.7 m (95% CI 6.3-10.2) in non-HPD progressors group (HR = 1.87; 95% CI 1.1-3.3; p = 0.03). Overall, 48 pts (22%) received treatment beyond progression (TBP). Time from initial progression to study discontinuation was 0.4 m (95% CI 0.1-NA) in HPD group versus 0.96 m (95% CI 0.7-1.5) in non-HPD progressors (HR = 2.9; 95% CI 1.4-6.2). Only 10 pts with HPD received further therapy: 2 achieved partial responses with chemotherapy and 1 pt had stabilization with erlotinib, whilst the other 6 pts progressed (4 treated with ICI). Conclusions: In our Ph1 Unit population, we established a definition of HPD that is intuitive and easy-to-use in daily clinical practice. Importantly, it correlates with poor OS and represents a clear contra-indication for TBP or switch to alternative ICIs as rescue therapy.
Life-Course Smoking Trajectories and Risk for Emphysema in Middle Age: The CARDIA Lung Study
Authors: Amanda R. Mathew, Surya P. Bhatt, Laura A. Colangelo, Norrina B. Allen, David R. Jacobs, Reto Auer, Mark T. Dransfield, Brian Hitsman, George R. Washko, Ravi Kalhan
Journal: American Journal of Respiratory and Critical Care Medicine (2018)
Rise in long term consultant vacancies in Scotland is “deeply troubling,” says BMA
Authors: Declan C Murphy
Journal: BMJ (2018)

Scotland saw an increase in long term consultant vacancies in the past year, official figures have shown.1

Data from Information Services Division Scotland show that in June 2018 there were 428.6 whole time equivalent (WTE) medical consultant vacancies—a vacancy rate of 7.7%. This is slightly better than the 465.6 WTE vacancies in June 2017 (8.4%).

Of the vacant posts in 2018, however, 265.9 (62%) have been unfilled for six or more months. This is an increase of 18.8% since 2017 when 223.9 posts had been …
Safety and tolerability of adjuvant FOLFOX vs. CAPOX in colon cancer: A real-world experience.
Authors: William J Mullally, Awis Naeem, Colum Dennehy, Caitriona Goggin, Jack Patrick Gleeson, John Patrick Greene, Mohammed Adam Ibrahim Dawod, Seamus O'Reilly, Deirdre O'Mahony, Derek Gerard Power, Richard Martin Bambury
Journal: Journal of Clinical Oncology (2018)

e15689 Background: Prospective clinical trials comparing FOLFOX to CAPOX are limited in the adjuvant setting and the only published trial was stopped early for poor accrual (Pectasides et al, 2015). We performed a retrospective analysis to investigate the tolerability of both regimens in patients with high-risk stage II or stage III colon cancer. Methods: Prospectively maintained pharmacy databases in our regional cancer group were interrogated for patients who were prescribed adjuvant FOLFOX (12 cycles) or CAPOX (8 cycles). Baseline patient characteristics were collected as well as treatment data including number of chemotherapy cycles administered, dose modifications or delays, hospitalizations and reported toxicities according to CTCAE v4. Disease free survival (DFS) and overall survival (OS) were recorded. Results: Between 2011 and 2017, 268 patients who received 5-flourouracil and/or oxaliplatin based regimens were identified; 96 of these were treated in the adjuvant setting for colon cancer and were eligible for analysis (28 FOLFOX, 68 CAPOX). Tolerability data is shown in the table 1. The most common reason for dose reduction and early discontinuation was peripheral sensory neuropathy in both groups. When comparing FOLFOX to CAPOX, rates of grade 3/4 febrile neutropenia was 0%/2%, coronary vasospasm 7%/9% and diarrhea 0%/10%. After a median follow-up of 28 months, the 3 year DFS was 71%/76% and OS was 84%/88% in FOLFOX and CAPOX groups respectively (p = 0.70). Conclusions: 82% of patients prescribed adjuvant FOLFOX completed their full intended duration of chemotherapy compared with 42% of patients prescribed CAPOX. FOLFOX was better tolerated in our patients which is in keeping with prior international data but may be exacerbated by pharmacogenomic factors in our region and this is under exploration. The IDEA collaboration suggested 3 months of chemotherapy is sufficient for some of these patients which will improve treatment completion rates going forward. Table 1: Summary of tolerability data. FOLFOX (n = 28) CAPOX (n = 68) p-value All intended cycles completed at full dose 18% 10% 0.31 All intended cycles completed but needed dose reduction 64% 32% < 0.01 All intended cycles not completed 18% 57% < 0.01
Paraneoplastic syndrome and survival in thymic epithelial tumors (TET): The Indiana University experience.
Authors: Weili Wang, Hong Zhang, Ray Lu, Jessica Smith, Louise Conces, Sunil S. Badve, Kenneth Kesler, Robert P Nelson, Feng-Ming (Spring) Kong, Patrick J. Loehrer
Journal: Journal of Clinical Oncology (2017)

8574 Background: Paraneoplastic syndromes (PNS) are commonly associated with thymic epithelial tumors (TET), especially thymoma. The purpose of this analysis is to examine the clinical impact of PNS in TET. Methods: Patients with pathologically diagnosed TET at a single institution were reviewed retrospectively. The primary and second endpoints for this study were overall survival (OS) and recurrence rates. Clinical factors included age, gender, race, performance score, histology, WHO classification, Masaoka stage, post-operative status, tumor size and number of positive lymph nodes. Cox proportional hazards model was used to identify significant prognostic factors for OS between different PNS groups. Results: From 1975 to 2016, 733 patients with TET (thymoma (T) -71%, thymic carcinoma (TC) -26% and neuroendocrine tumor (NET)-3%) were seen at Indiana University. Of these, 203 (28%) had PNS including myasthenia gravis (n = 130), red cell aplasia (n = 20), hypogammaglobulinemia (n = 14), systemic lupus erythematosus (n = 12) or other PNS (n = 64). Among these, 37 (18%) had two or more types of PNS. PNS were seen in 35% (183/523) of T, 9% (16/187) of TC and 15% (3/20) of NET ( p &lt; 0.001), respectively. Recurrence rates and mortality at 5 year were 8% and 10% in PNS (+) group compared to 13% and 16% in PNS (-) group ( p &lt; 0.05). Intrathoracic recurrences were more common in PNS (+) patients (89% vs 77%; p = 0.016). In both groups, adverse factors for survival included: older age, advanced stage, number of positive lymph nodes and TC histology (all p-values &lt; 0.05). However, post-operative R1/2 status was adverse prognostic factor only in the PNS (-) group ( p = 0.001). Conclusions: PNS is common in TETs. Patients with PNS have lower risk of recurrence and mortality compared to patients without PNS, but may have a higher risk of intrathoracic recurrence.