tbuckley/cabot-search huggingface dataset:
Experience of patient death and subsequent bereavement by members of the oncology team in the outpatient setting.
Authors: Eve Easton
Journal: Journal of Clinical Oncology (2016)

244 Background: Working with cancer patients is considered inherently stressful with high levels of burnout reported. There is limited research that focuses on the multidisciplinary team as a whole; research to date tends to focus on patient death from the perspective of the bedside oncology nurse, the physician or social worker. With the focus on those disciplines individually, thereby ignoring the centrality of the multidisciplinary nature of oncology care and excluding fundamental team members who provide care and are potentially impacted by the death of the patient. What is evident in current research is that long term meaningful relationships are developed between members of the multidisciplinary team and patients, with the consequences and implications of unresolved or unacknowledged grief being well documented as burnout and compassion fatigue. It is suggested that better support, acknowledgement of patient death and grief has implications for individual staff wellbeing, for staff training, support and the healthcare system, all of which have impact on the quality of patient care, improve retention, decrease burnout and compassion fatigue. The aim of this research is to explore the experience of death and subsequent bereavement from the perspective of those healthcare professionals who provide direct patient care at an outpatient oncology clinic. Methods: A qualitative study using a phenomenological approach was conducted to explore multidisciplinary team members experiencing regarding patient death and subsequent bereavement in the outpatient oncology setting. Individual interviews were conducted with 11 members of staff from 5 oncology teams based in the outpatient clinic of a magnet designated hospital. Results: Qualitative analysis yielded the following themes: insight, mortality, relationships, communication, grieving and bereavement, training and education, support and coping. Conclusions: To understand how patient death affects team members who provide patient care and support mechanisms used. Participants identified a need for acknowledging patient death in the work environment and had multiple suggestions for creating a supportive environment.
Overall survival (OS) analysis of a phase II study using a pox viral-based vaccine, PSA-TRICOM, in the treatment of metastatic, castrate-resistant prostate cancer (mCRPC): Implications for clinical trial design
Authors: R. A. Madan, J. L. Gulley, W. L. Dahut, K. Y. Tsang, S. M. Steinberg, J. Schlom, P. M. Arlen
Journal: Journal of Clinical Oncology (2008)

3005 Background: Vaccine strategies represent a novel therapeutic approach for mCRPC. PSA-TRICOM is a pox viral-based vaccine that contains the transgene for PSA and 3 co-stimulatory molecules required for T-cell activation. The vaccine employs a prime/boost strategy; after an initial vaccinia-based vaccine, all subsequent vaccinations utilize a fowlpox-based vaccine. PSA-TRICOM was well tolerated in a phase I study. Methods: 32 chemotherapy naive patients (pts) with mCRPC were treated with PSA-TRICOM subcutaneously monthly with or without adjuvant GM-CSF in this phase II study with 4 cohorts. Pts were re-staged every 3 months (mos) with CT and bone scans. Elispot assay pre and post treatment was done to evaluate PSA-specific T cell response. An OS analysis has been performed on these pts; we also compared actual to predicted OS based on the Halabi Score (HS) and compared OS stratified according to T-cell responses. Results: On study median age=65.6 years, median Gleason Score=8 (range 6–10), median PSA=76.3, PSA doubling time=2.2 mos, HS=129. 12/32 pts (37.5%) had a PSA decline; 7 pts>20%, 5 pts>30% (max=72%). 22/32 pts lived longer than predicted by HS (p=0.05). For pts with HS>130: 10/15 lived beyond their individual predicted OS (p=0.30); 3 remain alive beyond Halabi predicted OS. For pts with HS<130: 12/17 lived beyond their OS as predicted by HS (p=0.14) with 11 pts still alive at a median follow-up of 35.8+mos. All 5 pts who had an increase in PSA specific T-cell response >6 fold remain alive 35–45+mos after enrollment compared to a median OS of 20.3 mos in pts with <6 fold response(p=0.038); 4 of these 5 pts had a HS<130. Conclusions: mCRPC pts treated with PSA-TRICOM may have potential to have superior OS than predicted (p=0.05). 11/17 pts with HS<130 are alive after a median 35.8+mos follow-up and 12/17 exceed the OS predicted by HS. Furthermore, the ability of pts to mount a >6 fold increase in T-cell responses was associated with an increase in OS. These results thus provide the rationale that mCRPC pts, especially those with more indolent disease, may benefit from vaccine-mediated monotherapy; however this will need to be confirmed with larger, randomized studies. No significant financial relationships to disclose.
Optimal prognostic lymph node staging system for gallbladder adenocarcinoma: A multi-institutional study.
Authors: Neda Amini, Yuhree Kim, Ana Wilson, Cecilia Grace Ethun, Shishir Kumar Maithel, George A. Poultsides, Thuy Tran, Kamran Idrees, Chelsea A Isom, Ryan C. Fields, Sharon M. Weber, Ahmed Abdel-Fattah Salem, Robert C. G. Martin, Charles Raben Scoggins, Perry Shen, Harveshp Mogal, Carl Richard Schmidt, Ioannis Hatzaras, Rivfka Shenoy, Timothy M. Pawlik
Journal: Journal of Clinical Oncology (2016)

364 Background: The American Joint Committee on Cancer (AJCC) classification is the most universally accepted lymph node (LN) staging system for gallbladder adenocarcinoma (GBA); however, it focuses more on location of LN metastasis than number of LN metastasis. Other lymph node staging systems have been proposed for GBA. We therefore sought to examine the performance of different staging systems including AJCC LN staging system, number of metastatic LN (NMLN), log odds of metastatic LN (LODDS), and LN ratio (LNR). Methods: Patients who underwent curative-intent resection for GBA between 2000 and 2015 and who had lymphadenectomy were identified from a multi-institutional database. The prognostic performance of four staging systems was compared by Harrell’s C and Akaike information criterion (AIC). Results: Overall 214 patients with a median age of 66.7 years (IQR 56.5, 73.1) were identified. A total 1,334 LNs were retrieved from 214 patients, with a median of 4 (IQR 2-8) LNs per patient. In the study cohort, 98 (45.5%) patients had LN metastasis with total of 271 positive LNs [median of 1 (IQR 1-3)]. Patients with LN metastasis had an increased risk of death (HR 1.87, 95%CI 1.24-2.82; P = 0.003). In addition, risk of death increased by each additional LN metastasis (HR 1.20, 95%CI 1.06-1.37; P = 0.005). In the entire cohort, LNR, in either a continuous (C-index: 0.603, AIC: 808.4) or a discrete scale (C-index 0.609, AIC 802.2), provided better discrimination versus LODDS, AJCC LN staging system, and NMLN. The relative performance of all scoring systems was better among patients who had ≥ 4 LN examined. In the cohort of patients with ≥ 4 LN examined, LODDS (C-index 0.621, AIC 363.8) had the best performance compared with LNR (C-index 0.615, AIC 368.7), AJCC LN staging system (C-index 0.601, AIC 373.4), and NMLN (C-index 0.613, AIC 369.5). Conclusions: LODDS and LNR performed better than the AJCC LN staging system. Among those who had more LN examined, LODDS performed better than LNR. LODDS and LNR should be incorporated into the AJCC LN staging system of GBA.
Role of chemoradiotherapy alone in the management of unfit patients with nonmetastatic locally advanced squamous cell carcinoma of the esophagus.
Authors: A. Pisa, I. Moya, C. Pericay, E. Dotor, J. Alfaro, A. Alvarado, S. Navarro, R. Orellana, M. Pampols, E. Saigí
Journal: Journal of Clinical Oncology (2011)

138 Background: Surgery is considered the best treatment for patients (pts) with non-metastatic locally advanced squamous cell carcinoma of the esophagus who have responded to neoadjuvant chemoradiotherapy (CRT) in terms of locoregional control. However, in these pts PFS and OS have not been proved superior to those achieved by CRT alone. Besides, the addition of surgery to CRT increases treatment-related morbidity and mortality. Unfit pts are usually declined for surgical procedures and included in definitive CRT programs. The aim of this study was to define the role of non-surgical strategies (CRT, CT or RT) in unfit pts considered non-optimal for surgical procedures. Methods: We retrospectively reviewed 90 pts with squamous cell carcinoma of the esophagus who had been diagnosed and treated at our institution from January 2004 to December 2009. Fifty-one pts were non-metastatic among which 19 underwent surgery and 32 a non-surgical procedure (CRT, CT, RT or BSC). Our aim was to identify OS, PFS, RR, data on comorbidity and toxicity in these 32 pts. Results: Thirty out of the 32 pts were men with a median age of 62 years (range 41-90). Comorbidity was detected in 17 pts (53%) as means of respiratory disorders (21.9%), cardiopathy (12.5%), hepatopathy (21.9%), synchronic tumors (25%) and metachronic tumors (25%). Seventeen pts received CRT, 7 received CT, 1 received RT and 7 received BSC alone (53%, 22%, 3% and 22% respectively). Grade 3 and 4 toxicities were observed in 15 pts (46.9%) as means of mucositis (18.8%), oesophagitis (15.6%), diarrhoea (12.5%) and neutropaenia (12.5%). One patient in the CRT group died of toxicity. RR was 43.8% (70.6% for CRT, 14.3% for CT alone). Median follow-up was 17.2 months. Median PFS was 11.3 ± 6.12 months (17.9 for CRT, 5.1 for CT alone). Median OS was 15.6 ± 7.6 months (6.9 for CT alone). Conclusions: Our experience with CRT alone in unfit pts with locally advanced squamous cell carcinoma of the oesophagus supports its use with a median PFS of 17.9 months and controllable toxicity. Data on median OS are lacking due to pending long-term follow-up. No significant financial relationships to disclose.
The expression of frizzled-3 receptor in colorectal cancer and colorectal adenoma.
Authors: W. He, S. C. Wong, B. Ma, S. S. NG, M. Y. Lam, C. M. Chan, T. C. Au, J. K. Chan, A. T. Chan
Journal: Journal of Clinical Oncology (2011)

444 Background: Wnt signaling is well known for its role in colorectal cancer (CRC) formation through transcriptional activities of nuclear β-catenin. Although activation of Wnt signaling depends on specific Wnt/Frizzled receptors (FZD) combinations, the specificity of the interaction and the role of FZD in that particular interaction are still unknown. Among the 10 Wnt receptors of the FZD protein family, FZD-3 is involved in neurodevelopmental abnormalities and gastric cancer carcinogenesis. However, the expression of FZD-3 in CRC is not clear. Therefore in this study, we examined the expression of FZD-3 in CRC cell lines and CRC patient tissues with various pathological stages. The information obtained will be important for us to understand the role of FZD-3 in the development of CRC. Methods: FZD-3 mRNA expression was studied in CRC metastatic SW620, primary SW480 and normal CCD18co cell lines using quantitative real-time polymerase chain reaction with primers and a Taqman minor grove binder probe (Applied Biosystems, Foster City, USA). Moreover, paraffin-embedded specimens of 40 CRC patient tissues, 25 colorectal adenoma (CA) tissues were retrieved from the Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region for FZD-3 immunostaining using an anti-FZD-3 antibody (Catalog no: MAB1001, R&amp;D systems Inc., Minneapolis, USA) in an automatic Ventana Benchmark XT immunostainer (Ventana Medical Systems Inc., Tucson, USA). Results: FZD-3 mRNA was up-regulated in metastatic SW620 cell line (fold-change: 622) and in primary SW480 cell line (fold-change: 820) when compared to that in normal CCD18co cell line. Furthermore, immunostaining showed that FZD-3 protein was expressed in 100% (40/40) of CRC specimens and 84% (21/25) of CA specimens. Detailed analysis showed that FZD-3 protein was significantly up-regulated in CRC, CA when compared to their adjacent normal colorectal epithelial tissues (p &lt; 0.0005, Wilcoxon matched pairs test). Conclusions: This study provided evidence that FZD-3 is involved in CRC carcinogenesis and it is a potential therapeutic target in CRC. No significant financial relationships to disclose.
Assessing quality in a rural oncology program using the Quality Oncology Practice Initiative (QOPI).
Authors: William S. Loui, Bonnie Auerbach, Jeanette Bince, Sandra Brazzel, William Thomas
Journal: Journal of Clinical Oncology (2012)

275 Background: Molokai General Hospital (MGH) is a critical access hospital for 7,400 people on the isolated island of Molokai. It is a small 14 bed medical center that started an outpatient oncology program six years ago. Over this period, 213 patients received care through an innovative telemedicine program partnership with the Queens Medical Center in Honolulu, Hawaii. Methods: Study design was a retrospective chart review. Results: The most common types of cancers seen were breast cancer 57 (26.7%), lung cancer 29 (13.6%), colon cancer 26 (12.2%), prostate cancer 29 (13.6%), lymphoma 8 (3.7%), and liver cancer 3 (1.4%). Cancer patients were almost 80 % minorities; over 55% were native Hawaiians or part Hawaiian. The percentage of Caucasians, Hispanic, and African American were lower than the national averages. Hawaiian 118 (55.3%), Caucasian 43 (20.8%), Filipino 30 (14%), Japanese 17 (7.9%), African American 2 (0.9%), Other Pacific Islanders 2 (0.9%), Hispanic 1 (0.4%) Using national and local benchmarks from QOPI, areas of excellence and deficiency were identified. In 29% of the core measures, MGH did a better job than the urban comparison in Honolulu, Hawaii. For breast and colon cancer, the quality was better than the national QOPI aggregate. Similarly, the symptom care was better than national average. A survivorship program was initiated 2 years ago and treatment summaries were beginning to be sent. Since its start, 45 of the total 213 (21.1%) patients have been enrolled in the Survivorship program. Conclusions: The QOPI program helped review a small rural program which lacks staff and resources for a full time Quality Improvement program. This may be a model for other small programs to check for quality of care.
Response rates in patients with relapsed/refractory acute myeloid leukemia with <i>FLT3</i>-ITDmutation using 5-azacitadine plus sorafenib.
Authors: Mona Lisa Alattar, Hagop Kantarjian, Jan Andreas Burger, Mary Ann Richie, Guillermo Garcia-Manero, Marina Konopleva, Stefan Faderl, Gautam Borthakur, Naval Guastad Daver, Tapan M. Kadia, Jorge E. Cortes, Farhad Ravandi
Journal: Journal of Clinical Oncology (2012)

6558 Background: The outcome of patients with relapsed acute myeloid leukemia (AML) with FLT3-ITD mutation is poor. Sorafenib is an inhibitor of FLT-3 kinase activity in nanomolar concentrations. We conducted this phase II study to evaluate the efficacy and tolerability of the combination of Sorafenib and 5-Aza for the treatment of patients with refractory or relapsed AML with the particular emphasis on those with FLT3-ITD mutation. Methods: Patients were eligible if they had relapsed or refractory AML and were 18 years of age or older. They received 5-Aza 75 mg/m 2 daily x 7 together with Sorafenib 200 mg BID X 28 days; cycles were repeated in approximately 1-month intervals. Responses were assessed after first cycle and then at the discretion of the treating physician at the time of the best peripheral blood response. Results: 32 patients with AML with a median age of 61 years (range, 24-87) were enrolled. They included 13 (41%) with diploid cytogenetics, 9 (28%) with complex cytogenetics, and 10 (31%) with miscellaneous chromosomal abnormalities. FLT-3-ITD was detected prior to the initiation of treatment in 30/32 patients. Patients had received a median of 2 prior treatments (range, 1-6). 12 (38%) patients had received ≥3 prior regimens and 11 had failed therapy with a FLT3 kinase inhibitor (6 with AC220, 1 with PKC412, and 5 with sorafenib, either as monotherapy or with plerixafor); 2 had failed 2 prior FLT3 inhibitors. 10 patients were inevaluable as they never received therapy or discontinued it before response assessment at one month. The overall CR/CRi rate among the 22 evaluable patients is 50%, including 9 (41%) with CRi and 2 (9%) with CR; with a median of 3 (range, 1-9) treatment cycles. The median time to achieving CR/CRi was 3 months (range, 1-4) and the median duration of CR/CRi was 3 months (range, &lt;1–5.5). Three patients proceeded to allogeneic stem cell transplant. The most common study drug-related adverse events were rash and fatigue with no deaths attributable to study medications. Conclusions: Combination of 5-Aza and Sorafenib is promising for the treatment of patients with relapsed and refractory AML with FLT-3-ITD mutation and may allow them to proceed to stem cell transplant.
Patient risk factors and pegfilgrastim use in cabazitaxel-treated prostate cancer pateints in an academic setting.
Authors: Marina Dusevic Kaymakcalan, Sherri Stuver, Christopher Sweeney, Toni K. Choueiri, Aymen Elfiky
Journal: Journal of Clinical Oncology (2014)

224 Background: Cabazitaxel can offer a survival advantage in patients (pts) with metastatic castration resistant prostate cancer (mCRPC). Febrile neutropenia (FN) has emerged as a serious complication, with a rate of 8% in the TROPIC trial (de Bono, Lancet 2010). Prophylaxis with pegfilgrastim (P) can decrease the risk of FN, although predictors of FN continue to evolve. We performed an analysis on the effect of prophylactic P use on FN and the impact of certain risk factors on FN rates. Methods: We conducted a retrospective analysis of mCRPC patients treated with cabazitaxel from June 2010 to August 2013 at Dana-Farber Cancer Institute. Patient clinical and treatment variables were extracted. Fisher’s exact test was used to evaluate the association between potential risk factors and FN. Results: A total of 89 patients were treated at our institution and included in this analysis. All patients received at least one dose of cabazitaxel and received a mean of four cycles. Five pts (5.6%) developed FN; 3 out of 70 (4.3%) receiving P and 2 out of 19 (10.5%) not receiving P (p=0.3). Of the 24 patients that started cabazitaxel at a reduced dose, none developed FN. No toxic death was reported. Among several risk factors including P use, age older than 65, pre-existing neutropenia, prior chemotherapy, pre-existing infection, poor performance status, liver and renal dysfunction, and recent surgery, only a prior history of palliative radiation had a significant association with FN (p=.002). Conclusions: The rate of FN in a large academic practice is similar to what was reported in the TROPIC trial. Prior radiation may be a risk factor for FN in cabazitaxel-treated mCRPC patients. Other factors that may help better predict the risk of FN in different groups of patients receiving cabazitaxel must be identified.
Long-term outcomes of patients with aggressive non-Hodgkin’s lymphoma treated with ACOMP-B/ML-Y9 regimen
Authors: C. Hashimoto, F. Kodama, S. Motomura, N. Tomita, S. Fujisawa, H. Fujita, R. Sakai, K. Ogawa, H. Kanamori, Y. Ishigatsubo
Journal: Journal of Clinical Oncology (2005)

6604 Background: To evaluate the long-term outcomes of patients (pts) with aggressive non-Hodgkin’s lymphoma (NHL) treated with a third-generation regimen, ACOMP-B/ML-Y9. Methods: Between 1990 and 2002, newly diagnosed and consecutive adult aggressive NHL pts were treated with ACOMP-B regimen {DOX:40 mg/m2(day1,15), CPA:600 mg/m2(day1,15), VCR:1.4 mg/m2 (day1, 15), MTX:400 mg/m2(day8), BLM:8 mg/m2(day1), PSL 40 mg/m2 po(day1–7)} every 4 weeks. If the patients achieved CR after 4 or 5 courses of ACOMP-B, they were treated with multi-drug maintenance therapy, ML-Y9 {CPA 500 mg/m2 and VCR 1.4 mg/ m2 (week 1), MXT 9mg/m2 and VBL 6mg/m2 (week 3), MCNU 50mg/m2 and VDS 2mg/m2 (week 6), PSL 40mg/m2 po, PCZ 50mg/body po for 7 days (week 1, 3, 6), and VP-16 100mg/body po for 5 days (week 1, 3, 6)}. Results: 174 pts were treated with ACOMP-B/ML-Y9 regimen. Patient characteristics were the followings: male/female, 111/63; median age (range), 57yrs (15–77); International Prognostic Index, low/low-intermediate 90(52%), high/high-intermediate 84(48%). Overall CR and response rate were 60%, 83%, respectively. With a median follow-up of 129 months, overall survival (OS) rate at 3 and 10 yrs was 60%, 47% and 3-, 10-yr progression-free survival (PFS) was 48%, 42%. 10-yr relapse-free survival (RFS) was 57%. Rate of late relapse after 24 months from diagnosis was 1.0% per year. TRM was 2.9% (5pts; IP 2pts, sepsis 1pt, pneumonia 1pt, hepatic failure 1pt) and 8 cases of secondary malignancies occurred. Conclusions: ACOMP-B/ML-Y9 therapy is well tolerable and effective in aggressive NHL pts. ACOMP-B/ML-Y9 seems to be better than CHOP (3-yr PFS and OS: 41% and 54%, N. Engl J Med. 328; 1002, ’93). Moreover there is lower risk of late relapse. Comparative randomized controlled study of ACOMP-B and rituximab (R) with CHOP-R in the future is needed. No significant financial relationships to disclose.
Combining serum autoantibody measurements with traditional serum biomarkers for the detection of invasive breast cancer.
Authors: Meredith C. Henderson, David Emery Reese, Sherri Borman, Susan Yeh, Alan Hollingsworth
Journal: Journal of Clinical Oncology (2014)

13 Background: The use of protein biomarkers for serum-based detection of invasive breast cancer has been problematic due in large part to intrinsic variability in the population as a whole. The Provista Biomarker Assay (PBA) has been shown previously to be highly sensitive across a wide spectrum of clinical signals. The detection of autoantibodies (AAb) holds great promise due to the inherent specificity these biomarkers provide. However, as a clinical-quality diagnostic, it is necessary to utilize a panel comprised of multiple autoantibodies, as individual sensitivity is general low. Our hypothesis was that combining serum protein and autoantibodies together in a panel would result in an increased ability to correctly identify breast cancer. Methods: To maximize clinical performance (sensitivity and specificity), we utilized the Meso Scale Discovery ELISA-based system to measure AAbs from patient sera. We analyzed 134 prospectively collected patient serum samples for a variety of autoantibody targets. These data, together with serum protein biomarker concentrations, produced an analytically robust test that is also highly specific. Results: Consistent with our hypothesis, the inclusion of autoantibodies with serum proteins in the Provista Biomarker Assay improved test specificity above that observed in serum protein biomarkers alone. Individual protein targets had limited ability to differentiate benign conditions from invasive breast cancer. However, factoring in autoantibody values resulted in improved overall accuracy to differentiate serum from benign and invasive breast cancer patients. Conclusions: In the novel approach of combining these two different classes of analytes, we exploit the specificity of AAbs while maintaining high sensitivity through the inclusion of more generalized cancer-associated protein biomarkers. The combination of these two approaches clearly offers unique performance benefits in the early detection of invasive breast cancer that is greater than either component alone.