tbuckley/cabot-search huggingface dataset:
Inadequacies in genetic testing referrals and counseling in prostate cancer.
Authors: Yash Suri, Lakshminarayanan Nandagopal, Arnab Basu
Journal: Journal of Clinical Oncology (2020)

43 Background: Recent studies have recognized the high prevalence of germline mutations in genes affecting DNA repair in patients with prostate cancer. In recognition of their growing clinical significance, the NCCN guidelines recommend genetic counselling in prostate cancer pts with certain risk factors. The application of these guidelines in clinical practice were evaluated. Methods: All new clinic visits of prostate cancer pts at UAB from January 2019 – June 2019 were identified and analyzed. We constructed a flow diagram of the UAB two-step referral model, and performed a chart review and analyzed the new clinic visits. We then sent a 10-item questionnaire to providers at UAB to collect information on germline genetic testing patterns, general approach to testing, and the barriers of GC, and actions to overcome barriers. Results: From January to June 2019, 57 new prostate cancer patients were seen, of which 23 had metastatic disease, 20 had high or intermediate risk localized disease and remaining had biochemical recurrence. In total, 38 had an indication for GC. The most common indication was metastatic disease in 23 pts (40%) and localized high risk in 15 pts (26%). Significantly 33% of 24 patients with early onset prostate cancer &lt; 60 yrs did not meet NCCN defined criteria for testing. Only 39% of the 38 eligible patients were referred, with testing completed in 11% of those with indications. The response rate to the survey was 91%. 30% of respondents reported that they would be comfortable completing genetic counseling themselves, and the most commonly reported barrier to providing the testing themselves was time, and lack of expertise/experience. 70% percent of providers cited that lack of genetics workforce was a barrier to genetic testing, and 60% cited lack of knowledge of genetic testing and genetics and the inadequate coordination of referrals were barriers. Conclusions: While a majority of prostate cancer patients seen in the oncology clinic meet criteria for GC, referrals are inconsistent, and only a handful of eligible patients complete testing. From the survey results, the areas that need to be improved from the provider’s side are education and comfort with genetic testing. From a systems perspective, the need for more genetics workforce, and better process workflows are required to improve the uptake of Genetic Testing Referral and Testing. The interventions of practice transformation and education need to be implemented, and tested at UAB to improve adherence to the NCCN guidelines for genetic testing of prostate cancer.
Decoding the brain through research—the future of brain health
Authors: David Z Wang, Lee H Schwamm, Tianyi Qian, Qionghai Dai
Journal: BMJ (2020)

Decoding the brain through research-the future of brain health David Z Wang and colleagues look at the latest advances in brain research and how they might affect treatment of brain disorders ligence will likely be part of brain science and assist or replace certain brain function• Genetic or protein alterations may provide a cure for many brain disor-
Appropriate Analysis of Duration of Response Data in Cancer Trials
Authors: Zachary R. McCaw, Lu Tian, Lee-Jen Wei
Journal: JAMA Oncology (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Oncology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Oncology journal
Prospective validation of a clinical tool developed with machine learning to identify high-risk patients with cancer and reduce emergency department visits.
Authors: Lorinda A Coombs, Abigail Orlando, Blythe J.S. Adamson, Sandra D. Griffith, Shreyas Lakhtakia, Alexander Rich, Pooja Shaw, Xiaoliang Wang, Rebecca A. Miksad, Kathi Mooney
Journal: Journal of Clinical Oncology (2020)

254 Background: Clinicians in oncology are often challenged to identify when patients with cancer are at high risk for adverse outcomes and would benefit from more intensive clinical care. Preemptive identification of these patients may improve efficiency and improve patient care. The objective of this quality improvement pilot was to prospectively validate a machine learning (ML)-based clinical tool designed to identify patients with cancer who are at high risk for an emergency department (ED) visit, and whether they met eligibility criteria for clinical services at home, such as Huntsman at Home (H@H). Methods: Patients with cancer who received care at Huntsman Cancer Institute (HCI) between Jan. 4 and Feb. 7, 2020 were included in the analysis. For patients with HCI contact in a given week, the ML-based tool predicted the probability of an ED visit in the next 60 days to identify “high risk” patients using real-time structured EHR data (e.g. demographic characteristics, vital signs, and laboratory values). Risk of an ED visit was used as a proxy for eligibility for H@H. Patients were randomized to two cohorts to assess eligibility precision and outcome forecast precision. Eligibility precision was defined as the percentage of ML-classified high risk patients who were confirmed by a nurse practitioner to be eligible for admission to H@H. Outcome forecast precision was defined as the percentage of ML-classified high risk patients who experienced a future ED event within 60 days and was compared to the baseline prevalence of ED visits within 60 days during the same time period. The IRB determined this to be a quality improvement project. Results: This quality improvement pilot included 1,236 patients; 53% were women, median age was 65 years, and 84% were Caucasian. The most common cancers, excluding non-melanoma, were breast, prostate, lung, and myeloma. The observed prevalence of an ED visit within 60 days was 7%. The tool classified 9% of patients as high risk. The eligibility precision was 0.76 (95% CI: 0.62-0.89), demonstrating concordance with clinician assessment among patients classified as high risk. Compared to a baseline of 0.07, the outcome forecast precision was 0.22 (95% CI: 0.12-0.34) for future ED events. Conclusions: This quality improvement pilot demonstrates the potential application of an ML-based tool to identify patients with cancer who may benefit from further support through the H@H program. The approach creates a framework for ML-based tools to enhance clinical services at home.
Intensive Smoking Cessation Counseling for Patients With Cancer
Authors: Adam O. Goldstein, Kimberly A. Shoenbill, Trevor A. Jolly
Journal: JAMA (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Time to COVID-19 RT-PCR clearance among patients with cancer.
Authors: Wenxin Xu, Andrew Piper-Vallillo, Poorva Bindal, Jonathan W. Wischhusen, Jaymin M. Patel, Daniel Botelho Costa, Mary Linton Bounetheau Peters
Journal: Journal of Clinical Oncology (2020)

49 Background: COVID-19 in oncologic patients presents a clinical dilemma. To reduce the risk of adverse events as well as the risk of exposing others, many institutions have established protocols to define COVID-19 clearance. However, the optimal criteria for discontinuing infection precautions and/or resuming anticancer therapy in COVID-19 patients is unknown. Methods: We identified patients with a positive COVID-19 PCR at a tertiary care hospital between 3/25/2020 and 6/6/2020, and who also had seen an oncologist for a cancer-related diagnosis within the last 3 years. COVID-19 PCR testing was performed using the Abbott Laboratories m2000 platform in conjunction with either the Aldatu Biosciences PANDAA qDxTM SARS-CoV-2 or Abbott RealTime SARS-CoV-2 assays. At our institution, and per current ASCO guidelines, discontinuation of COVID-19 precautions requires two consecutive negative viral PCR tests &gt; 24 hours apart. Results: During the follow-up period, we identified 32 patients with a positive COVID-19 PCR who were receiving active oncology care. Half of this cohort (16/32) had metastatic disease at the time of COVID-19 diagnosis. 17 patients were on active treatment at time of COVID-19 diagnosis (8 receiving cytotoxic chemotherapy). Among patients who met criteria for COVID-19 PCR clearance, median time to clearance was 37 days (range, 10-58 days). When accounting for censoring at the time of last COVID-19 assay, median time to clearance for all patients was estimated at 50 days. 14 patients resumed anti-cancer treatment prior to COVID-19 clearance (5 received cytotoxic chemotherapy), requiring substantial allocation of staff and resources for safe treatment isolated from other oncology patients. Among the 13 patients who met clearance criteria, 2 subsequently had a positive COVID-19 PCR after resumption of treatment. We explored COVID-19 clearance time under an alternative symptom/time based strategy based on CDC criteria (at least 10 days after first positive PCR and 3 days after last day of symptoms). Under this strategy, median time to COVID-19 clearance would be 14 days. Conclusions: In patients with cancer who develop COVID-19 infection, viral shedding can persist for many weeks after disease onset, but the implications of this shedding on likelihood of infection is unknown. Treatment of COVID-19 positive oncology patients requires substantial planning and resources. Test-based versus symptom/time-based strategies for determining discontinuation of precautions and resumption of treatment should be further investigated to provide safe and effective care.
Sequential Prostate Magnetic Resonance Imaging in Newly Diagnosed High-risk Prostate Cancer Treated with Neoadjuvant Enzalutamide is Predictive of Therapeutic Response
Authors: Fatima Karzai, Stephanie M. Walker, Scott Wilkinson, Ravi A. Madan, Joanna H. Shih, Maria J. Merino, Stephanie A. Harmon, David J. VanderWeele, Lisa M. Cordes, Nicole V. Carrabba, John R. Bright, Nicolas T. Terrigino, Guinevere Chun, Marijo Bilusic, Anna Couvillon, Amy Hankin, Monique N. Williams, Rosina T. Lis, Huihui Ye, Peter L. Choyke, James L. Gulley, Adam G. Sowalsky, Baris Turkbey, Peter A. Pinto, William L. Dahut
Journal: Clinical Cancer Research (2020)

Abstract Purpose: For high-risk prostate cancer, standard treatment options include radical prostatectomy (RP) or radiotherapy plus androgen deprivation therapy (ADT). Despite definitive therapy, many patients will have disease recurrence. Imaging has the potential to better define characteristics of response and resistance. In this study, we evaluated prostate multiparametric MRI (mpMRI) before and after neoadjuvant enzalutamide plus ADT. Patients and Methods: Men with localized intermediate- or high-risk prostate cancer underwent a baseline mpMRI and mpMRI-targeted biopsy followed by a second mpMRI after 6 months of enzalutamide and ADT prior to RP. Specimens were sectioned in the same plane as mpMRI using patient-specific 3D-printed molds to permit mpMRI-targeted biopsies to be compared with the same lesion from the RP. Specimens were analyzed for imaging and histologic correlates of response. Results: Of 39 patients enrolled, 36 completed imaging and RP. Most patients (92%) had high-risk disease. Fifty-eight lesions were detected on baseline mpMRI, of which 40 (69%) remained measurable at 6-month follow-up imaging. Fifty-five of 59 lesions (93%) demonstrated &amp;gt;50% volume reduction on posttreatment mpMRI. Three of 59 lesions (5%) demonstrated growth in size at follow-up imaging, with two lesions increasing more than 3-fold in volume. On whole-mount pathology, 15 patients demonstrated minimal residual disease (MRD) of &amp;lt;0.05 cc or pathologic complete response. Low initial mpMRI relative tumor burden was most predictive of MRD on final pathology. Conclusions: Low relative lesion volume at baseline mpMRI was predictive of pathologic response. A subset of patients had limited response. Selection of patients based on these metrics may improve outcomes in high-risk disease.
Improving patient outcomes with oncology hospital at home: A program model.
Authors: Karen Alexandra Titchener, Lorinda A Coombs, Shannon Shepherd, John Harris Ward, Karen Ameloot, Kimberly Dumas, Anna Catherine Beck, Kathi Mooney
Journal: Journal of Clinical Oncology (2020)

5 Background: Hospital at Home provides acute hospital level care to patients in their homes, diminishing the need for inpatient care or emergency department (ED) use. It has been evaluated for a variety of acute and chronic conditions but not in adult oncology. Results from program evaluations have demonstrated equivalent or improved outcomes with lower health care utilization and costs and high patient satisfaction when compared to usual care. The first evaluation of an oncology Hospital at Home program in the United States, Huntsman at Home (HH) was launched in 2018 to provide acute level care after hospitalization and address emergent symptoms that arise in the home between clinic visits. We describe the structure and patient profile of HH over the first 15 months of service. Methods: We compiled data for the 169 cancer patients admitted to HH between 8/2018 and 10/2019. We examined patient characteristics, the reason for referral, team structure, services provided and provider visit pattern. Results: The 169 patients referred to HH were predominately female (62%), white (83%), with metastatic disease (79%) and an average age 62 years. The most common diagnoses were GI, lung, GU and GYN cancer. All required acute level medical care and were referred by their oncology or inpatient provider after hospitalization. The HH multidisciplinary team was led by 9 nurse practitioners (NP) partnering with palliative care hospitalists, and the patient’s oncology team. Registered nurses (RN) and other home health personnel were provided by a community-based home health agency. The most common reasons for referral were acute pain, dehydration and electrolyte imbalance, infection, unstable symptoms, failure to thrive and post-surgical needs. The most common interventions provided by HH were: assessment and management of symptoms, medication monitoring and titration, monitoring lab chemistries, intravenous management and administration of medications and fluids, and wound, drain and line assessment and care. Home visits varied based on need; generally, there were 3 NP visits with 5 RN visits in the first week. Health care utilization and cost outcomes were recently reported at the ASCO Virtual Scientific meeting and demonstrated HH patients had fewer hospitalizations, shorter length of stay, decreased ED use and lower costs than the comparison group. Conclusions: HH has proven to be an effective and efficient way to successfully manage a variety of oncology acute care needs in patients’ homes averting further hospitalization or ED use. Hospital at home shows promise as an oncology care delivery model.
Mechanisms of progressive fibrosis in connective tissue disease (CTD)-associated interstitial lung diseases (ILDs)
Authors: Paolo Spagnolo, Oliver Distler, Christopher J Ryerson, Argyris Tzouvelekis, Joyce S Lee, Francesco Bonella, Demosthenes Bouros, Anna-Maria Hoffmann-Vold, Bruno Crestani, Eric L Matteson
Journal: Annals of the Rheumatic Diseases (2020)

Interstitial lung diseases (ILDs), which can arise from a broad spectrum of distinct aetiologies, can manifest as a pulmonary complication of an underlying autoimmune and connective tissue disease (CTD-ILD), such as rheumatoid arthritis-ILD and systemic sclerosis (SSc-ILD). Patients with clinically distinct ILDs, whether CTD-related or not, can exhibit a pattern of common clinical disease behaviour (declining lung function, worsening respiratory symptoms and higher mortality), attributable to progressive fibrosis in the lungs. In recent years, the tyrosine kinase inhibitor nintedanib has demonstrated efficacy and safety in idiopathic pulmonary fibrosis (IPF), SSc-ILD and a broad range of other fibrosing ILDs with a progressive phenotype, including those associated with CTDs. Data from phase II studies also suggest that pirfenidone, which has a different-yet largely unknown-mechanism of action, may also have activity in other fibrosing ILDs with a progressive phenotype, in addition to its known efficacy in IPF. Collectively, these studies add weight to the hypothesis that, irrespective of the original clinical diagnosis of ILD, a progressive fibrosing phenotype may arise from common, underlying pathophysiological mechanisms of fibrosis involving pathways associated with the targets of nintedanib and, potentially, pirfenidone. However, despite the early proof of concept provided by these clinical studies, very little is known about the mechanistic commonalities and differences between ILDs with a progressive phenotype. In this review, we explore the biological and genetic mechanisms that drive fibrosis, and identify the missing evidence needed to provide the rationale for further studies that use the progressive phenotype as a target population.
Changes in lung cancer treatment as a result of the COVID19 pandemic: A prospective observational study
Authors: Suzanne Kazandjian, Nathaniel Bouganim, Arielle Elkrief
Journal: Clinical Cancer Research (2020)

Background: Patients with lung cancer are at high risk from COVID19  Efforts are ongoing to limit exposure ofpatients with lung cancer to the health care system  As a result, the COVID19 pandemic has drastically changedcancer care, but the extent and type of these changes are unknown  The goal of this study was to evaluate thechanges in lung cancer treatment during the peak of the COVID19 pandemic  Methods: We prospectively assessed the cancer management plan of all patients seen in the thoracic oncologyclinic at our center between March 2 and April 30, 2020  Inclusion criteria for this study were a diagnosis of eithernon-small cell lung cancer or small-cell lung cancer  Those who had a diagnosis of COVID19 were excluded fromthe study  Primary endpoints were to describe the extent of changes in the cancer treatment plan and qualify thetypes of changes observed  Results: A total of N=289 patients were evaluated between March 2 and April 30, 2020  N=14 patients wereexcluded due to presence of other tumor histology, and 2 patients were COVID19-positive  Among the 275 patientsincluded, median age was 68 and 47% were male  Among the 238 patients (86 5%) with non-small cell lung cancer,172 (62 5%) had advanced disease  Among the 37 patients (13 5%) with small-cell lung cancer, 11 (4%) hadextensive disease  211 were receiving active treatment (76 5%), with 35 1% on chemotherapy, 21 8% on oralagents, 31 8% on immune checkpoint inhibitors, and 11 4% on combination therapy  121 (57%) of patientsexperienced at least one change in their lung cancer treatment plan as a direct result of the COVID19 pandemic, with 19 (9 0%) patients experiencing more than one change  The majority of changes encompassed delay orcessation of palliative treatment, N=48 (39 7%), N=18 (14 9%), respectively  Mean time to resumption of palliativetreatment was 36 days, and 3% of patients stopped palliative treatment permanently as a direct result of thepandemic  Changes in dosing and schedule occurred in N=32 (26 4%), which included changing pembrolizumab toq 6 weeks or durvalumab to q 4 weeks  A minority of patients experienced delays in adjuvant chemotherapyadministration (N=3 (2 5%)) with a mean delay of 42 days  Lastly, 6 6% of patients experienced deferrals orcancellations of surveillance scans or visits due to COVID19  Other changes included the decision not to pursuepalliative chemotherapy  Conclusion: Our study demonstrated that a significant proportion (57%) of patients experienced changes in theirlung cancer management plan as a direct result of the COVID19 pandemic  Given the preliminary findings thatactive cancer treatment is not associated with increased complications from COVID19, lung cancer treatments andsurveillance visits should continue to proceed with caution, and oncology care providers should continue to carefullyproceed with evidence-based care in lung cancer