tbuckley/cabot-search huggingface dataset:
Is it necessary to obtain a second review on outside pathology for patients referred with non-muscle invasive (NMI) bladder cancer?
Authors: Jared Brown, Caitlin Hensel, Jiaxian He, Megan McDonald, Philip Newhall, Stephen Boyd Riggs
Journal: Journal of Clinical Oncology (2020)

e17049 Background: Correct pathological staging is paramount in treatment recommendations for patients with non-muscle invasive disease. As a referral center, we sought to evaluate the quality of outside pathology determined by College of American Pathology (CAP) recommendation as well as discordance in AUA risk group stratification. Methods: We retrospectively reviewed our database of patients who originally underwent resection of bladder tumors at external facilities that were subsequently referred to our cancer institute between 2015 and 2018. 75 initial pathologies were overread by one of our GU pathologists all with non-muscle invasive bladder cancer. We evaluated the discordance rate between outside pathology reports and our overread using the CAP criteria for reporting. Additionally, we included the association in risk stratification category as well as the change in risk stratification group following overread. Cohen’s kappa (κ) statistics were used to evaluate concordance in pathology report between LCI and external facilities. Comparisons of risk stratification between LCI and external facilities were analyzed using Fisher’s exact test. Results: 5 criteria for quality were evaluated to assess reporting. A relatively high agreement in reporting tumor grade between LCI and external facilities (κ = 0.65, p &lt; 0.001) and moderate agreement in microscopic extent (κ = 0.41, p &lt; 0.001). LVI was not commented on in 58.7% of outside reports. 6/12 (50%) of patients were upstaged from Low Risk (LR) to Intermediate Risk (IR), 2/11 (18%) from IR to High Risk (HR), and 6/46 (13%) from HR to MIBC (Table). Conclusions: Initial pathology reports from outside facilities were often lacking minimum criteria as recommended by the CAP. Furthermore, a significant number of patients were upstaged after review, including 13% of HR patients being overread as muscle invasive disease. Second review of outside pathology should strongly be considered as re-review may have implications on treatment recommendations. [Table: see text]
Germline mutations in DNA repair genes in a large series of unselected Chinese prostate cancer patients.
Authors: Yu Wei, Yao Zhu, Junlong Wu, Dingwei Ye, Hao Zeng, Yonghong Li, Stephen J. Freedland, Fangjian Zhou, Cai-Yun He, Guangxi Sun, Sha Zhu, Jinge Zhao
Journal: Journal of Clinical Oncology (2020)

e17523 Background: Germline DNA repair gene (DRG) mutations has emerged as a potential determinant of cancer risk and therapeutic response in PCa. Despite substantial advances in delineating the germline mutation in DRGs among Caucasian population, the prevalence of mutations in DRGs are largely unknown among a large series of unselected prostate cancer patients in Chinese population. Methods: We enrolled 1003 prostate cancer patients from three different hospitals in China, unselected for family history of cancer or age at diagnosis. All patients received germline genetic testing using a clinician-selected multi-gene panel. The 18 DNA repair genes and HOXB13, which has established or emerging potential clinical actionability in PCa, were analyzed in our study. Results: A total of 94 (9.7%) deleterious germline mutations were identified among the 1003 unselected prostate cancer patients. Of these, 5.6% patients carried a BRCA1 or BRCA2 mutations (5.2% in BRCA2 and 0.4% in BRCA1), 3.6% patients carried other DRG mutations (including 10 genes) and 0.5% patients carried HOXB13 mutations. Besides, variants with uncertain significance (VUS) were found in approximately 45% patients. We also divided 633 metastatic PCa patients into 542 de novo metastastic PCa and 91 recurrent metastastic PCa and found mutation frequencies did not differ between these two groups (9.0% vs 11.6%, p = 0.6). Patients with younger age of onset or family history of cancers were more likely to harbour germline mutations in DRGs. However, the rate of germline mutations were still at a high level for patients more than 70 years old (6.7%) and patients without family history of cancers (7.5%). There is no statistically significant difference in the mutation frequencies between patients with metastasis and without metastasis (7.5% vs 9.2%, p = 0.4), which may be because 85% patients without metastasis in our cohort were in high to very high risk group or have lymph node metastasis. Conclusions: To our knowledge, our study reported the largested series of Chinese PCa patients who received germline genetic testing. Our study provided a rationality for germline genetic testing criteria from high risk to metastastic PCa regardless of family history considering the high proportion. In addition, we recommended a multigene panel covering 13 genes ( ATM, BRCA1, BRCA2, CHEK2, FANCA, HOXB13, MSH2, MSH6, NBN, PALB2, RAD51C, RAD51D, TP53) in China. Nevertheless, the high prevalence of VUS (45%) in Chinese PCa patients warrant further efforts.
Implementation of 11 system-wide, disease-specific, multidisciplinary tumor boards connecting 24 hospitals in an integrated health care system.
Authors: Brook Clayton, Craig Nielsen, Jane Jensen, Allison Tonkin, Paul Urie, Timothy Joseph Yeatman, Brandon M. Barney, Margaret Elizabeth McCormick Van Meter, Mark Andrew Lewis, Jodie Miles, Ivan Zendejas, Vilija N. Avizonis, Mark W. Dodson, Clarke Alan Low, David Michael Gill, Grant Kirton Hunter, Tawnya Lynn Bowles, Daanish Hoda, Derrick S. Haslem
Journal: Journal of Clinical Oncology (2020)

e19152 Background: Cancer treatment is becoming more complex, necessitating subspecialty expertise and multidisciplinary approaches to treatment planning. Simultaneously, there is increasing demand to provide care as close to home as possible. While tumor boards have long been an institutional backbone to providing high-quality multidisciplinary care in tertiary facilities, connecting several hospitals and dozens of cancer specialists in a large integrated healthcare system is unique and potentially transformational for smaller facilities and communities. Methods: Using highly-secure, network firewall-protected Cisco Telepresence and WebEx capabilities, 11 disease specific tumor boards (Breast, GI, Sarcoma, GU, Thoracic, Head/Neck, Melanoma, Neuro, Heme, Hepatobiliary, Gyn) were organized across Intermountain Healthcare’s 24 geographically and medically diverse hospitals spanning over 500 miles. Meetings for each of these disease-specific tumor boards have been held at least every 1-2 weeks, at set times and days since July 2019. Cases are submitted to the appropriate tumor board by individual providers from anywhere in the system. Submitted cases are reviewed by a designated subspeciality leader. Cases are either added to the system-wide agenda, or at times, the clinical decision can be resolved immediately. Included cases’ records including pathology, radiology and pertinent medical history are obtained for display and discussion. After each tumor board, recommendations and conclusions are recorded by nurse navigators for future review and consultation. Results: From July 2019 to February 2020, 1,598 patient cases were discussed. Just as relevant, 293 unique oncology providers (surgeons, medical oncologists, radiation oncologists, genetic counselors, nurse navigators, and therapists) participated in tumor board discussions. These deliberations provided insight, experience and recommendations directly related to patient care. Conclusions: Our system-wide, disease-specific, multi-disciplinary tumor boards are useful in connecting oncology providers and subspecialists. This effort has led to better collaboration, coordination and delivery of high-quality cancer care to patients throughout a large healthcare system that includes thousands of patients and dozens of cancer providers in smaller/rural communities. In addition, provider engagement has improved. Work is ongoing to prospectively evaluate the effects on treatment decisions and clinical outcomes.
World No Tobacco Day: smoking, nicotine and children
Authors: Jørgen Vestbo, Jonathan Grigg, Charlotta Pisinger, Andy Bush
Journal: European Respiratory Journal (2020)

31 May, 2020 is World Health Organization (WHO) World No Tobacco Day. The theme this year is “Protecting youth from industry manipulation and preventing them from tobacco and nicotine use” [1]. WHO wishes this year's campaign to serve the following: 1) debunk myths and expose manipulation tactics employed by the tobacco and nicotine industries, particularly marketing tactics targeted at youth, including through the introduction of new and novel products, flavours and other attractive features; 2) equip young people with knowledge about the tobacco and nicotine industries' intentions and tactics to hook current and future generations on tobacco and nicotine products; and 3) empower influencers (in pop culture, on social media, in the home, or in the classroom) to protect and defend youth and catalyse change by engaging them in the fight against Big Tobacco. In line with @WHO, @EuroRespSoc will work to protect children from being addicted to smoking and nicotine use <https://bit.ly/3fNpVas>
Underuse of spirometry in rural community introduced the missed diagnosis of chronic obstructive pulmonary disease
Authors: Xiaolan Hu, Chunling Hou, Ting Rui, Ying Tian, Yuqin Peng, Haiyan Zhao, Guangxi Li
Journal: BMJ (2015)

Objective
To survey the under-using status of spirometry in rural community and assess its impact on the missed diagnosis of chronic obstructive pulmonary disease (COPD).


Methods
A total of 708 participants aged 60 years or more were sampled by cluster random sampling from 4 administrative villages in Qiaozi, Huairou, Beijing in this cross-sectional study. Questionnaire survey and spirometry were performed to each person. Patients with FEV1/FVC<70% were further diagnosed as COPD.


Results
96 patients were diagnosed as COPD and the rude prevalence of COPD was 13.56%(95%CI: 11.04%-14.08%) among elder people aged 60 years or more in rural community. However, only 8 of 96 patients with COPD (8.33%) have been acquired spirometry. Among 708 participants, only 34 patients (4.80%) have been checked by spirometry. The multivariate logistic regression analysis was conducted to explore the potential cause of taking spirometry which showed patients with bronchitis were more inclined to seek spirometry (OR: 5.39; its 95%CI: 2.20-13.19). The results of multivariate logistic regression analysis to explore the potential diagnostic indices of COPD showed age, smoking (the cumulative amount was more than 100 cigarettes or 5 packages) and wheezing was statistically significant.


Conclusions
The underuse of spirometry in rural community of China results in the missed diagnosis of COPD in community. It was suggested that general practitioners should advise the elderly smokers with wheezing to acquire spirometry in the community timely or referral to hospital so that patients with COPD could be diagnosed earlier and be managed.


Key words: 
Pulmonary disease, chronic obstructive; Respiratory function tests; Rural Health services; Cross-sectional study
Incorporating molecular markers in standard prognostic models for DLBCL patients using real-world data.
Authors: Shivam Mathura, Vicki Kay Fung, Keshava Dilwali, Ashwin Subramanian Lakshmanan
Journal: Journal of Clinical Oncology (2020)

e19251 Background: NCCN-IPI is a prognostic scoring system that outperforms other risk classification mechanisms in diffuse large B-cell lymphoma (DLBCL) but does not consider the molecular profile of patients. We evaluated the predictive value of NCCN-IPI and clinically relevant molecular markers on the overall survival (OS) of patients with diagnosed DLBCL in real-world data (RWD). Methods: Patients diagnosed with DLBCL were identified in the COTA RWD population, and then subset to those with sufficient attributes to calculate NCCN-IPI at diagnosis (age, stage, LDH ratio, performance status, extranodal disease) and those who received a monoclonal antibody targeting CD20 (n = 383). This population was further filtered to patients tested for BCL-2, BCL-6, and C-MYC (n = 176). Disease characteristics were summarized using descriptive statistics and chi-square tests of independence were performed to assess the relationship between NCCN-IPI Risk-Group and molecular marker results. A Cox proportional hazard model was used to identify prognostic features of OS. Results: There were statistically significant relationships between NCCN-IPI Risk-Group and both BCL-2 (p = 0.007) and C-MYC (p &lt; 0.001) after Bonferroni correction for the number of molecular markers tested. A Cox proportional hazard model with the three molecular markers as covariates revealed a statistically significant correlation between the presence of C-MYC alteration and decreased OS (HR = 2.02, CI: 1.24-3.32, p = 0.005). However, when NCCN-IPI Risk-Group was added as a covariate, the relationship between C-MYC and OS was no longer significant. The hazard ratios associated with high-intermediate and high risk groups were larger than that of the low-intermediate group. All three of these risk groups were statistically significant in the model (p &lt; 0.038). Conclusions: The inclusion of molecular markers to the NCCN-IPI prognostic model did not increase predictive power in this RWD cohort. We validated the NCCN-IPI model and found it to be a robust tool for classifying risk and estimating OS in patients who have received a CD20 monoclonal antibody. A larger sample size would increase power to further explore the impact of molecular markers on overall survival. [Table: see text]
Effect of adolescent and young adult cancer placements on advanced communication skills.
Authors: Helen Hatcher, Cameron Magrath, Debbie Critoph Hatcher
Journal: Journal of Clinical Oncology (2020)

e24182 Background: Communication with adolescent and young adult cancer (AYA) patients and their families can be challenging and requires extensive skills, often developed over time. Medical students can be afraid to encounter such challenges and treating teams can be protective of these vulnerable patients. Therefore, medical students can have little contact and experience communicating with AYA putting them at a disadvantage. We have developed a special study module (SSM) for students with the AYA multi-disciplinary team to promote student awareness of the unique challenges of communicating with AYA patients and provide essential skills for later practice. We present the findings from the first year of this module. Methods: Students at the University of Cambridge were offered a 6-week placement with the AYA cancer service. This involved shadowing members of the multi-professional cancer team and time on the AYA ward to talk with patients and their families in order to practice triadic communication skills. Mid-placement, an experiential learning experience with simulated patients focused on triadic interviews was also offered in line with our local clinical communication skills courses. After the module students were questioned about how they felt this had affected their practice and knowledge of communicating with AYA with cancer. Results: 12 students enrolled for the SSM over the year. All students found the placement widened their communication skills as well as their knowledge of AYA cancers and treatments. 4 main areas of learning were evident. 1.The problems faced by AYA patients as they try to establishing independent adult identities in the midst of severe illness or at the end of life and the implications for the triadic interview. 2. Information sharing during patient denial. 3. The AYA perspective: desire for control and their difficulty of communicating. 4.Challenges of communicating well in emotionally-charged situations. Conclusions: Experiential learning during the placement highlighted techniques for balancing both patient and parental involvement during consultations to maximise efficacy of information gathering. AYA cancer placements provide opportunities to develop advanced communication skills and can be augmented with experiential learning.
Prior authorization process improvement for pain medications in an oncology unit: Timely initiation of test claim request form.
Authors: Susy Varghese, Jaya Sheela Amaram-Davila, Marina C. George
Journal: Journal of Clinical Oncology (2020)

7050 Background: Oncology patients with extensive metastatic disease and advanced-stage cancer frequently require controlled medications for pain managements. Insurers require Prior Authorization (PA) for high-cost specialty medications including: Hydromorphone, Oxycodone, Oxymorphone, Fentanyl, Nucynta, Lyrica and Lidocaine patch. Failure to obtain PA may delay patient hospital discharge and attainment of discharge medications, increase patient medication costs, increase hospital readmissions and emergency visits, and exacerbate clinical complications. In order to avoid delays, providers must submit a Claim Request (CR) to initiate the PA process. PA usually takes 48-72 hours after the CR is submitted; therefore, timely CR submission in anticipation of discharge is imperative. Baseline rates for initiating CR in a timely manner was 15%. A quality improvement project was conducted to increase provider-initiated CRs for prescribed pain medications requiring PA and to demonstrate a sustainable process, anchored by development of new policy. Methods: The project revised the provider-initiated CR process by implementing the following interventions: The Electronic Medical Record (EHR) was modified to create a ‘quick link’ to facilitate CR form submissions. The link was made available to providers via their dashboard for easy access to the CR form.The medication reconciliation process was revised to require nurses to send reminders to providers for any of the seven discharge medications requiring CR submission for PA. A new component was incorporated into the discharge planning process by discussing PA and CR during interdisciplinary rounds. Providers and nurses were educated about the revised process. Results: Rates for timely CR submission were collected from the EHR biweekly for 3 months post-intervention. Post-intervention, 77% of timely CR claims increased from baseline of 15% to 87%. Due to the timely initiation of CR, some medications were deemed not to require PA, and the percentage of PA requirement reduced from 95% to 55%. In addition, up to 16% of patients had money refunded as a result of timely CR submission. Conclusions: The new process was effective for ensuring an efficient and effective process for patients who require high-cost controlled medications for pain management, reducing waste and providing a quality experience for the patient. As a result of the project, the new process has become policy and is now being used on other units in the institution for additional medications that requires CR and PA.
Uptake of oophorectomy in women with findings on multigene panel testing: Results from the Prospective Registry of Multiplex Testing (PROMPT).
Authors: Susan M. Domchek, Jamie Brower, Heather Symecko, Vanessa Marcell, Michael Francis Walsh, Jada G. Hamilton, Fergus Couch, Kenneth Offit, Judy Ellen Garber, Mark E. Robson
Journal: Journal of Clinical Oncology (2020)

1508 Background: With the expansion of multigene panel testing for cancer susceptibility, increasing numbers of patients are identified with pathogenic/likely pathogenic variants (P/LP V) in genes which do not have a clearly actionable increased risk of ovarian cancer (OC) (lifetime risk of OC &gt;5%). However, there is concern that patients and/or providers may ascribe OC risk to such genetic findings with the potential for unnecessary oophorectomy (ooph). Methods: The Prospective Registry of Multiplex Testing (PROMPT) is an online registry for individuals with a genetic alteration detected on multiplex panel testing for cancer susceptibility. Participants self-enroll and complete baseline and annual follow-up questionnaires. PROMPT has enrolled 7388 participants (6936; 93.9% women) since September 2014. Results: 1566 women in the PROMPT registry reported ooph, the indications for which were reported as either cancer treatment (n=481, 30.7%) or benign disease (n=432, 27.6%). An additional 186 (12.8%) reported PV in genes associated with lifetime OC risk &gt;5% ( BRCA1, BRCA2, RAD51C, RAD51D, BRIP, or Lynch syndrome genes). The remaining 467 did not have guideline based indications for ooph due to OC risk and are described further here. 92 (19.7%) had a variant of uncertain significance (VUS) in genes associated with OC, 241 (51.6%) had a personal history of breast cancer (BC) and no VUS in OC genes, and 119 (25.5%) had no personal history of BC and no VUS in OC genes. The majority of women had no family history (FH) of OC in first or second degree relatives (Table). Most ooph occurred prior to age 50. Of the 405 women with CHEK2 P/LP, 11.4% reported ooph (59% under age 50 when age known), as did 13.2% (of 228) with CHEK2 VUS, 8.8% (of 261) with ATM P/LP (66.7% under age 50), and 8.3% (of 387) with ATM VUS. In addition, of the 184 women with PALB2 P/LP, 14.1% reported ooph (35.3% under age 50) as did 11.6% (of 198) with PALB2 VUS. Of those who reported provider discussions, 47.2% stated “my provider recommended this” (including &gt;60% in the OC gene VUS group) and an additional 25.2% stated “my provider presented this as an option, but not a requirement”. In those with no FH of OC, 45.8% stated that their provider recommended ooph. Conclusions: 10-15% of women with PV/VUS in genes not associated with a high risk of OC reported ooph without a clear indication. [Table: see text]