tbuckley/cabot-search huggingface dataset:
Familial chilblain lupus with TREX1 mutation and cerebrovascular disease
Authors: Takuma Nohara, Teruki Yanagi, Ichiro Yabe, Nakao Ota, Nobuo Kanazawa, Hideyuki Ujiie, Hideyuki Kosumi, Yosuke Mai, Hiroshi Shimizu
Journal: The Lancet Rheumatology (2020)
Safety and clinical activity of intratumoral MEDI9197 alone and in combination with durvalumab and/or palliative radiation therapy in patients with advanced solid tumors
Authors: Lillian Siu, Joshua Brody, Shilpa Gupta, Aurélien Marabelle, Antonio Jimeno, Pamela Munster, Juneko Grilley-Olson, Alain H Rook, Antoine Hollebecque, Rebecca K S Wong, James W Welsh, Yuling Wu, Christopher Morehouse, Oday Hamid, Farzana Walcott, Zachary A Cooper, Rakesh Kumar, Charles Ferté, David S Hong
Journal: Journal for ImmunoTherapy of Cancer (2020)

Background MEDI9197 is an intratumorally administered toll-like receptor 7 and 8 agonist. In mice, MEDI9197 modulated antitumor immune responses, inhibited tumor growth and increased survival. This first-time-in-human, phase 1 study evaluated MEDI9197 with or without the programmed cell death ligand-1 (PD-L1) inhibitor durvalumab and/or palliative radiation therapy (RT) for advanced solid tumors. Patients and methods Eligible patients had at least one cutaneous, subcutaneous, or deep-seated lesion suitable for intratumoral (IT) injection. Dose escalation used a standard 3+3 design. Patients received IT MEDI9197 0.005–0.055 mg with or without RT (part 1), or IT MEDI9197 0.005 or 0.012 mg plus durvalumab 1500 mg intravenous with or without RT (part 3), in 4-week cycles. Primary endpoints were safety and tolerability. Secondary endpoints included pharmacokinetics, pharmacodynamics, and objective response based on Response Evaluation Criteria for Solid Tumors version 1.1. Exploratory endpoints included tumor and peripheral biomarkers that correlate with biological activity or predict response. Results From November 2015 to March 2018, part 1 enrolled 35 patients and part 3 enrolled 17 patients; five in part 1 and 2 in part 3 received RT. The maximum tolerated dose of MEDI9197 monotherapy was 0.037 mg, with dose-limiting toxicity (DLT) of cytokine release syndrome in two patients (one grade 3, one grade 4) and 0.012 mg in combination with durvalumab 1500 mg with DLT of MEDI9197-related hemorrhagic shock in one patient (grade 5) following liver metastasis rupture after two cycles of MEDI9197. Across parts 1 and 3, the most frequent MEDI9197-related adverse events (AEs) of any grade were fever (56%), fatigue (31%), and nausea (21%). The most frequent MEDI9197-related grade ≥3 events were decreased lymphocytes (15%), neutrophils (10%), and white cell counts (10%). MEDI9197 increased tumoral CD8+ and PD-L1+ cells, inducing type 1 and 2 interferons and Th1 response. There were no objective clinical responses; 10 patients in part 1 and 3 patients in part 3 had stable disease ≥8 weeks. Conclusion IT MEDI9197 was feasible for subcutaneous/cutaneous lesions but AEs precluded its use in deep-seated lesions. Although no patients responded, MEDI9197 induced systemic and intratumoral immune activation, indicating potential value in combination regimens in other patient populations. Trial registration number NCT02556463 .
Relationship between Chronic Kidney Disease (CKD) and Myocardial Contractile Reserve (MCR) Determined by Tissue Doppler Imaging with Dobutamine Stress Echocardiography (DSE)
Authors: Kimura Shinpei, Ito Masahiro, Tanaka Komei, Fuse Koichi, Chinushi Masaomi, Sato Masahito, Okabe Masaaki, Hirono Satoru, Kodama Makoto, Aizawa Yoshifusa
Journal: Circulation (2008)
The role of telehealth in improving patient care and satisfaction during a pandemic: University of California Cancer Consortium experience.
Authors: Pelin Cinar, Debra Burgess, Kathryn A. Gold, Maki Yamamoto, Kimberly A. Ternavan, Emi Kamiya
Journal: Journal of Clinical Oncology (2020)

258 Background: The adoption of telemedicine in providing patient-centric care has been limited due to concerns related to upfront cost and the uncertain reimbursement models. Telehealth modalities, which encompass broader services, quickly became a central focus of how we delivered care in cancer centers across the nation during the COVID-19 (C19) pandemic. Our aim is to describe five University of California (UC) Cancer Centers’ experience with telehealth during the pandemic. Methods: Between March and June 2020, UC Cancer Centers developed or increased the use of telehealth modalities to continue to provide care to our oncology patients during the pandemic. Digital platforms were used to screen for symptoms and exposures related to C19, as well as for symptoms of distress. In addition, providers performed remote visits via video and telephone visits. Each of our centers monitored visit volumes as well as patient satisfaction scores during the pandemic. Results: Our Cancer Centers, each with various levels of pre-pandemic (Jan-Feb) use of telehealth, saw an increase in the volume of patients who were seen via remote visits including video and telephone visits during the pandemic (Mar-Apr). UC Davis, UC Los Angeles and UC San Francisco had implemented telemedicine prior to the pandemic, but the rates of use were 1%, 0.4% and 7%, respectively. In contrast, UC Irvine and UC San Diego did not offer remote visits prior to the pandemic. Despite these differences, during the pandemic, telemedicine rates increased to 50-70% of visits in the cancer centers. In addition, patient satisfaction scores were comparable to in-clinic visits. The use of digital platforms allowed 80% of patients to be screened for risk of C19 prior to their in-clinic visits. Conclusions: While differing levels of implementation was in place for telehealth services in our cancer centers prior to the pandemic, each cancer center was able to continue to see patients via remote visits. In addition, telehealth technology automated activities that would have been performed manually pre-pandemic. The increased use of telemedicine visits with high patient satisfaction scores is an indication that some patients can continue to receive their care via telehealth beyond the pandemic.
An independent oncology second opinion program: 2020 pilot project.
Authors: Philip D. Leming, Jillian M. Hunt, Thomas J. Herzog, Abdul-Rahman Jazieh, William Barrett
Journal: Journal of Clinical Oncology (2020)

179 Background: The estimated number of new cancer cases in the United States in 2020 is 1.8 million with an estimated 606,000 deaths. The science and technology of oncology has dramatically increased in recent years. EMR demands, RVU reimbursements, restriction of time/visit demanded by systems, bureaucratic hurdles, and physician burnout has resulted in reduced patient-focused time available for oncologists. A pilot project for 2020 was established to determine if a fully funded oncology second opinion consult program would be feasible and have value to patients/families and their physicians. Methods: Planning started December 2019 for an independent oncology second opinion program that was of no cost to the patient, funded by The Cincinnati Cancer Foundation. The first patient was seen January, 2020. Two hours of face to face or teleconference time was spent with the patient and family including a comprehensive history and physical in face to face cases. After the initial consultation, a comprehensive literature, clinical trial, and case data review was completed. A phone call was made to the treating physician to discuss the case and recommendations. A one-time follow-up was offered to the patient where recommendations were reviewed and the patient’s questions answered. Surveys were sent to the patient and treating physicians for real-time feedback. Results: From 1/2/2020 to 6/1/2020, 70 patients were seen in consultation from 12 different hospital systems with 29 different diagnoses. 4% (3) of consultations were done by video conferencing and 96% (67) were done in person. 54% (36/67) of patient surveys were returned. The overall value of the consultation (1-5 scale with 5 being the best) to the patient was: 97% (35)-5, 3% (1)-4. 20.5% (18/88) of physician surveys were returned. The overall value of the consultation to the physician was: 83% (15)-5, 17% (3)-4. Of the 70 patients, the amount of change in the patient’s plan of care due to the consultation was: None 28.5% (20), Small 50% (35), Moderate 18.5% (13), Significant 3% (2). Conclusions: Our findings establish the feasibility of a comprehensive second opinion service in cancer. The feedback from participants support the value and acceptance of an independent oncology second opinion consultation program to both patients and referring physicians.
Preliminary Clinical and Molecular Analysis Results From a Single-Arm Phase 2 Trial of Brigatinib in Patients With Disease Progression After Next-Generation ALK Tyrosine Kinase Inhibitors in Advanced ALK+ NSCLC
Authors: Thomas E. Stinchcombe, Robert C. Doebele, Xiaofei Wang, David E. Gerber, Leora Horn, D. Ross Camidge
Journal: Journal of Thoracic Oncology (2020)
Protecting high-risk oncology patients during the pandemic of COVID-19 by creating an outpatient cancer clinic for febrile neutropenia (California clinic).
Authors: Manidhar Reddy Lekkala, Mohammad Abedi, Tammy Clarke, Bahar Moftakhar, Arpan Patel
Journal: Journal of Clinical Oncology (2020)

191 Background: Delivering care for vulnerable cancer patients during a pandemic is challenging given the competing risks of death from cancer versus the high case fatality rates from SARS-COV-2 (CV-19). Data currently available suggests a total fatality rate close to 30%-50% with CV-19 in active malignancy patients. In addition to adapting guidelines from national organizations to reduce the social footprint of patients in order to minimize risk of exposure of CV-19, our cancer center implemented an isolated clinic with personal protective equipment (PPE) and direct access to a CV-19 rule out floor (if admission warranted) in order to manage those with febrile neutropenia (FN) who otherwise would have been triaged to the emergency room (ED). Methods: We implemented an outpatient isolated extended hour clinic with access to PPE, blood work, intravenous antibiotics and fluids for FN patients as a pilot project from mid-April with expected duration during the pandemic with the aim to decrease the ED admissions for FN by 50%. We used the Multinational Association of Support Care in Cancer (MASCC) validated tool to assist with outpatient versus inpatient management of these patients. All patients were screened via polymerase chain reaction nasal swab for CV-19 to identify CV-19 in a high-risk population. Our PDSA (Plan Do Study Act) cycles have been in 2-week sessions with constant re-education to multiple providers. Results: Prior to CV-19, our databases show an approximate 15 to 20 FN hematology and oncology patients per month who are triaged to ED during the business hours. Since the implementation of our clinic in the last 45 days, we have screened 8 patients, of which 2 were discharged home with oral antibiotics on isolation until CV-19 testing returned, 6 were directly admitted to CV-19 rule out floor avoiding ED. Our overall patient numbers were low during the peak of the pandemic and we expect to see increasing number of patients utilizing the clinic over the next few months. Conclusions: Implementing the California clinic has thus far successfully decreased the social footprint of our highest-risk cancer patients, those with FN, in hopes of decreasing their possible exposure to CV-19 as well as the unnecessary exposure of the clinical personnel. [Table: see text]
Blood Pressure Thresholds During Endovascular Therapy in Ischemic Stroke—Reply
Authors: Mads Rasmussen, Jan B. Valentin, Claus Z. Simonsen
Journal: JAMA Neurology (2020)

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Microsphere antioxidant and sustained erythropoietin-R76E release functions cooperate to reduce traumatic optic neuropathy
Authors: C.R. DeJulius, A. Bernardo-Colón, S. Naguib, J.R. Backstrom, T. Kavanaugh, M.K. Gupta, C.L. Duvall, T.S. Rex
Journal: Journal of Controlled Release (2020)
Access to palliative care services for limited English proficient patients with advanced NSCLC.
Authors: Bonnie Leung, Selina Wong, Kiran Malli, Cheryl Ho
Journal: Journal of Clinical Oncology (2020)

99 Background: More than a quarter of people living in British Columbia, Canada speak languages other than English in their homes. Immigrants often encounter communication challenges with their health care providers (HCPs), have poor health literacy, and have a limited understanding on navigating the health care system. NSCLC patients with limited English proficiency (LEP) may receive less palliative care services despite high symptom burden and significant needs due to these factors. The study goals were to observe the difference in access to community palliative home care (CPHC) and rate of completing a Do Not Resuscitate (DNR) form between NSCLC patients who are English proficient (EP) and LEP. Methods: All patients with advanced NSCLC referred to BC Cancer–Vancouver Centre in 2016 and received medical care were included (N=176). Patients seen with a medical interpreter were considered to be LEP. Demographics and clinical information were collected retrospectively. UVA using X 2 test and Fisher’s exact test were used to compare EP and LEP patients. Mann-Whitney test was used to compare the median time from CPHC referral and signed DNR to death between EP and LEP patients. Results: Language of communication: English 65%, Cantonese 22%, Mandarin 6%, Korean 1%, Tagalog 1%, and other 5%. Baseline characteristics: median age 69 EP vs 76 LEP, female 44% EP vs 65% LEP, non-squamous 68% EP vs 72% LEP and squamous 14% EP vs 6% LEP. There was no difference in the rate of CPHC referral (87% EP vs 80% LEP, p=0.342) and signed DNR form (92% EP vs 89% LEP, p=0.549). The median time from CPHC referral to death was 10 weeks EP vs 15 weeks LEP (p=0.039). The median time from signed DNR to death was 5 weeks EP vs 6 weeks LEP (p=0.806). There was no statistically significant difference in location of death between the two groups: acute care 20% EP vs 24% LEP, home 27% EP vs 13% LEP, hospice 36% EP vs 39% LEP, and tertiary palliative care unit 17% EP vs 24% LEP (p=0.251). Conclusions: EP and LEP patients with NSCLC had similar rates of CPHC service referrals and end of life planning. This suggests assistance of medical interpreters at the time of oncology visits help message delivery between LEP patients and HCPs. LEP patients had earlier referrals to CPHC prior to death which may reflect an enhanced awareness and effort by HCPs to have earlier conversations with patients who may have language and cultural barriers with discussing goals of care. Good communication improves patients and their family’s understanding of the goals and scope of palliative care services and allow HCPs to better understand the patients’ wishes.
Disproportionate impact of COVID-19 disease among racial and ethnic minorities in the U.S. cancer population as seen in CancerLinQ Discovery data.
Authors: Danielle Potter, Mark Riffon, Sirisha Kakamada, Robert S. Miller, George Anthony Komatsoulis
Journal: Journal of Clinical Oncology (2020)

84 Background: Patients with cancer may face difficult care decisions during the COVID-19 outbreak in the US. Understanding COVID-19 risk factors may help patients and oncologists identify high-risk patients and plan for the best cancer treatment in a timely fashion. This analysis provides an assessment of racial and ethnic risk factors for COVID-19 disease within the CancerLinQ (CLQ) Discovery database. Methods: CLQ is a health technology platform developed by ASCO, which collects and aggregates longitudinal electronic health record (EHR) data from oncology practices throughout the United States. Patients with a diagnosis of a malignant neoplasm and at least two encounters in the past year at a reporting CLQ practice were defined as the underlying cancer patient population at risk for SARS-CoV-2 infection. COVID-19 cases were identified via a positive RT-PCR test for SARS-CoV-2 RNA and/or an ICD-10 code for coronavirus (e.g., B97.29, U07.1, or U07.2). Relative risks and 95% CI were calculated using SAS. Results: We identified 232,428 patients with cancer. From 1/1/2020-4/30/2020, we identified 223 COVID-19 cases in patients with cancer. Of these, 203 had a positive RT-PCR, 26 had an ICD-10 diagnosis code for SARS-CoV-2, and 6 had both. SARS-CoV-2 cases were identified from 19 of the 35 CLQ practices (52.8%) reporting data during the study period. Compared to white patients, African Americans were approximately 2 times more likely to have COVID-19 disease (RR = 1.95; 95% CI = 1.40-2.71), and Hispanics were more than 4 times more likely (RR = 4.65; 95% CI = 3.36-6.43). Patients with hematologic cancers were 1.5 times as likely to be diagnosed with COVID-19 (RR = 1.53; 95% CI = 1.09-2.16) compared to patients with solid tumors. At the time of this abstract, 10 patients (4.5%) died. Conclusions: These results are based on data from a sample of CLQ practices and represent an initial analysis of COVID-19 in the CLQ population. The elevated risk for COVID-19 among African Americans and Hispanics with cancer is noteworthy, particularly since these patients often suffer poorer cancer outcomes. The elevated risk among patients with hematologic cancers is also worth noting because these patients often have compromised immune systems and are already susceptible to many other types of infection. Because the US is in the midst of an active outbreak, we are continuing to analyze new cases and additional risk factors, such as geographical location, anti-cancer treatments, and other cancer variables (e.g. stage).
Impact of increased understanding of personal and family health history on patients.
Authors: Lynn A. McCain, Bailey Hulswit, Kara J. Milliron, Amanda Cook, David Keren, Lee Schroeder, Sofia Merajver, Jerry Tippie
Journal: Journal of Clinical Oncology (2020)

256 Background: The InheRET personal and family health history survey was administered to 384 patients at three Michigan Medicine Clinics (2 primary care (11% of patients) and one breast and ovarian cancer risk clinic (89% of patients)) between October 1, 2018 and May 31, 2019. Since family history alone misses ~30% of those with deleterious germline mutations, this study follows these patients to determine what, if any, impact completion of the histories had on patients’ lifestyle choices, cancer prevention screenings, and risk-reducing therapies adopted based on perceived risk status: Meeting or not meeting NCCN Guidelines for referral to genetics for further evaluation. Methods: One year after patients completed their health histories, a follow-up survey was emailed to patients inquiring into actions taken following completion of the InheRET health history form. Anonymous responses were automatically collected into a Google Datasheet and analyzed. Results: As of June 16, 2020, 61 patients had returned their surveys; 37 (60.7%) reported being referred to a genetics specialist, of whom 92% kept their counseling appointments and 100% of these were recommended to be tested. At the time of survey completion, 29 patients had been tested and 32 patients had not been tested. We analyzed the actions taken between these two groups and discovered that 75% of patients who did not meet NCCN Guidelines and were not recommended for counseling and testing (population risk patients) still made lifestyle changes to improve their health and engaged in at least one cancer screening activity in the past year to reduce their cancer risk. The only preventive medical treatments received by this group were Tamoxifen (12.9%) and Hormone Replacement Therapy (3.2%). Among patients meeting NCCN Guidelines and tested (4 positive, 17 negative, 8 inconclusive/VUS/unknown results), 58.6% made positive lifestyle choices, 86.5% engaged in one or more cancer screening activities, and 34.5% sought additional medical interventions such as chemoprevention, hormone replacement and/or prophylactic surgery. Conclusions: By learning more about their personal and family health histories, patients who did not meet referral guidelines and were not referred for counseling and testing were proactive in taking actions to improve their overall health and reduce their cancer risk. This demonstrates the importance of knowing and understanding one’s family health history, even for those not meeting NCCN referral guidelines.
The covid-19 elimination debate needs correct data
Authors: Michael G Baker, Nick Wilson
Journal: BMJ (2020)

Many of the arguments made by Thornley and colleagues against taking an elimination approach to covid-19 are misleading and incorrect 1 -in particular, their assertion that the infection fatality risk (IFR) for covid-19 is "similar to that for seasonal flu."Research conducted in New Zealand and internationally suggests that the IFR for covid-19 is typically at least an order of magnitude higher than for seasonal flu.The most detailed study of seasonal influenza mortality in NZ to date estimated average annual mortality of 13.5 (95% confidence interval 13.4 to 13.6) per 100 000 population. 2 Furthermore, the proportion of the NZ population infected with influenza in a year has been measured from a seroconversion study at 35% (95% CI 32% to 38%). 3 Combining these figures suggests an IFR for seasonal influenza of about 0.039% in NZ.This seasonal influenza IFR is 17 times lower than that estimated for covid-19 at 0.68% 4 and 0.65%, 5 based on international data (there have been too few covid-19 cases in NZ to produce an IFR estimate).As Lee points out in the same debate, there is growing evidence of long term health impacts from covid-19 which need to be considered when comparing the elimination strategy with the alternative suppression or mitigation approaches. 6 It is reasonable to debate the covid-19 elimination strategy as it is likely that the feasibility of achieving this goal will vary by country circumstances.That is, it seems hard for countries with large land borders, federal systems, and dysfunctional governments; but more feasible for island nations such as New Zealand. 7 But such debates need to use correct data.