tbuckley/cabot-search huggingface dataset:
Relationships among skeletal muscle, symptom burden, health care use, and survival in hospitalized patients with advanced cancer.
Authors: Chinenye C. Azoba, Emily E. Van Seventer, Jan Peter Marquardt, Amelie S. Troschel, Till D. Best, Nora K. Horick, Richard Newcomb, Eric Roeland, Michael Hayden Rosenthal, Cristopher P. Bridge, Joseph A. Greer, Areej El-Jawahri, Jennifer S. Temel, Florian J. Fintelmann, Ryan David Nipp
Journal: Journal of Clinical Oncology (2020)

7006 Background: Loss of skeletal muscle mass (quantity) is common in patients with advanced cancer, but little is known about muscle density (quality). Hospitalized patients with advanced cancer are a highly symptomatic population at risk for the adverse effects of muscle loss. Thus, we sought to describe associations between muscle mass and density, symptom burden, health care use, and survival in these patients. Methods: We prospectively enrolled hospitalized patients with advanced cancer from 9/2014-4/2017. Upon admission, patients reported their physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire 4 [PHQ4]) symptoms. We used computed tomography (CT) scans performed per routine care ≤45 days prior to enrollment to evaluate muscle mass and density at the level of the third lumbar vertebral body. We categorized patients as sarcopenic using validated sex specific cutoffs. We used regression models to examine associations between muscle mass and density and patients’ symptom burden, health care use, and survival. Results: Of 1,121 patients enrolled, 677 had evaluable CT scan data (mean age = 62.86±12.95 years; 51.1% female). The most common cancer types were gastrointestinal (36.8%) and lung (16.7%) cancer. Most met criteria for sarcopenia (64.0%). Older age and female sex were associated with lower muscle mass (age: B = -0.16, p &lt; .01; female: B = -6.89, p &lt; .01) and density (age: B = -0.33, p &lt; 0.01; female: B = -1.66, p = .01), while higher BMI was associated with higher muscle mass (B = 0.58, p &lt; .01) and lower muscle density (B = -0.61, p &lt; .01). Higher muscle mass was significantly associated with improved survival (HR = 0.97, p &lt; .01), but not with symptom burden or health care use. Higher muscle density was significantly associated with lower ESAS physical (B = -0.17, p = .02), ESAS total (B = -0.29, p &lt; .01), PHQ4 depression (B = -0.03, p &lt; .01) and PHQ4 anxiety (B = -0.03, p &lt; .01) symptoms. Higher muscle density was also associated with decreased hospital length of stay (B = -0.07, p &lt; .01), risk of readmission or death in 90 days (OR = 0.97, p &lt; .01), and improved survival (HR = 0.97, p &lt; .01). Conclusions: Most hospitalized patients with advanced cancer have muscle loss consistent with sarcopenia. We found that muscle mass (quantity) correlated with survival, whereas muscle density (quality) was associated with patients’ symptoms, health care use, and survival. These findings underscore the added importance of assessing muscle quality when seeking to address the adverse effects of muscle loss in oncology.
Awareness of pulmonary tuberculosis prevention and treatment and its related factors in Xingang community of Shanghai
Authors: Bao-fu Yao, Hui-jun Zhou
Journal: BMJ (2010)

Household questionnaire survey was conducted in 200 residents of Tilan and Zhanhqiao neighborhoods, Xingang community, Shanghai to know their awareness of knowledge about pulmonary tuberculosis (TB) prevention and treatment. Results showed that 87.0% of the residents surveyed knew TB symptoms, but only 42. 5% knew cough and expectoration were pulmonary TB symptoms, 76. 5 % knew that TB could not be transmitted by use something that was used by TB patients, 85.5 % knew government policy of free and payment reduction for TB treatment, and 82. 0% knew there existed some hospitals for TB treatment designated by local health administrations. There was significant difference in the awareness between the two neighborhoods ( P ＜ 0. 01 ). Factors related to their awareness of TB prevention and treatment knowledge included family annual income, educational level, publicity by telecision and broadcasting.

Key words: 
Tuberculosis,lungs;  Questionnaires
Real-world use of second-line treatments in patients with advanced hepatocellular carcinoma (HCC) of varying liver dysfunction: Analysis at a Hispanic-majority cancer center.
Authors: Jeffrey Xia, Sukeshi Patel Arora
Journal: Journal of Clinical Oncology (2020)

e16676 Background: Hispanics have a higher incidence of HCC but are underrepresented in clinical trials leading to approvals of new therapies for HCC. Further, there is a lack of prospective trials comparing second-line treatments for HCC. Therefore, we reviewed the treatment patterns and tolerability of second-line treatments for HCC at our Hispanic-majority NCI-designated cancer center. Methods: Retrospective analysis of patients with advanced HCC, diagnosed at Mays Cancer Center at UT Health San Antonio from 1/2015-3/2019, who received second-line therapies, including, tyrosine kinase inhibitors (TKIs; Ie, cabozantinib, regorafenib) and immunotherapy (IO; ie, nivolumab), clinical trials, hospice/best supportive care (BSC). Child Pugh cirrhosis and adverse events were be compared. Results: Median age 59 (n = 58), Hispanics n = 43 (74%), Cause of cirrhosis: HCV 42 (74%), HBV 1, EtOH 33, NAFLD/NASH 13. BMI overweight/obese 33 (57%). Child-Pugh: A 9 (16%), B 30 (52%), C 16 (28%) (Table). BCLC B 6 (10%), C 47 (81%). CLIP: 1-2 (16%), 3 (38%), 4+ (41%). Second-line treatments: TKI (4, 7%), IO (24, 41%), Clinical trials (3, 5%), BSC (24, 41%). Toxicities (Table). Dose interruptions or reductions: All 18 (31%), TKIs 3 (75%), IOs (58%), trials (33%). Conclusions: In our Hispanic-majority cohort, 41% of patients with HCC were not candidates for second-line treatments (BSC). Of those who received second-line treatments, most received IOs, including patients with Child-Pugh B and C cirrhosis, with 58% requiring dose interruptions. Only 5% enrolled on clinical trials. Real-world patients are significantly different than clinical trial populations, and we need more prospective real-world analyses of these treatments to better understand efficacy, tolerability and quality of life. [Table: see text]
Combating Discrimination in Medical Education
Authors: Oliver Salazar, Yean Uk Rho
Journal: JAMA Internal Medicine (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 Internal Medicine 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 Internal Medicine journal
Diabetic Retinopathy Screening Using Smartphone-Based Fundus Imaging in India
Authors: Maximilian W.M. Wintergerst, Divyansh K. Mishra, Laura Hartmann, Payal Shah, Vinaya K. Konana, Pradeep Sagar, Moritz Berger, Kaushik Murali, Frank G. Holz, Mahesh P. Shanmugam, Robert P. Finger
Journal: Ophthalmology (2020)
Patient factors associated with changes in functional status during systemic cancer therapy in older adults: A systematic review.
Authors: Vivian Lam, Kah Poh Loh, Katey R Webber, Simran Padam, Mina S. Sedrak, Vivek Musinipally, Madison Grogan, Carolyn J Presley, Janice Grandi, Chandrika Sanapala, Grace Digiovanni, Daniel Castillo, Louise Christie Walter, Melisa L. Wong
Journal: Journal of Clinical Oncology (2020)

e24022 Background: Maintaining function and preventing functional decline during cancer treatment is critically important to older adults. This systematic review characterized and identified patient factors associated with functional change during systemic cancer therapy in older adults. Methods: Following PRISMA guidelines, we searched PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials for articles examining changes in function during systemic cancer treatment published in English through 1/11/19. Studies were eligible if they included adults age &gt;65 and analyzed associations between patient factors and change in function. At least two independent investigators reviewed each article with discrepancies resolved by consensus. Major findings were summarized; no meta-analysis was planned a priori given the heterogeneity in studies. Results: We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 69 studies, which enrolled &gt; 11,000 patients with cancer. Most studies enrolled adults of all ages; 20% included only adults age &gt;65 and 13% only adults age &gt;70. A quarter of studies enrolled patients with lung cancer while 22% included all solid tumors and hematologic malignancies. The majority of studies evaluated function during chemotherapy (96%) with 9% including targeted therapy and 4% immunotherapy. Function was primarily measured with patient-reported outcomes (93% of studies). Reporting of functional change was heterogeneous with many reporting change scores or means at multiple time points. Among studies that reported the percentage of patients who developed functional decline, results ranged widely from 6% to 90%. Functional improvement occurred among 2% to 57% of patients. The most common patient factors associated with functional decline during systemic cancer therapy were older age (n = 8 studies), fatigue (n = 8), worse baseline performance status (n = 8) and physical activity (n = 5), and anemia (n = 5). Only 10 studies examined factors associated with functional recovery, identifying 12 unique patient factors. Conclusions: Among older adults with cancer, functional changes during systemic cancer therapy are common. Interventions to target modifiable patient factors associated with functional decline are needed to help patients maintain or improve function during treatment. Additionally, evaluating both functional decline and improvement is necessary to better characterize functional trajectories during systemic cancer therapy.
Upfront or delayed radiation with next generation tyrosine kinase inhibitor therapy in driver mutation positive NACLC brain metastasis.
Authors: Mike Yang, Joshua David Palmer, Xiaokui Mo, David Paul Carbone, Meng XU Welliver
Journal: Journal of Clinical Oncology (2020)

e14503 Background: NSCLC with driver mutations may be managed with SRS, WBRT, and TKIs. Prior studies have demonstrated a worse survival with a delay in brain radiotherapy. We sought to determine if there is a difference in CNS PFS, OS, and cumulative incidence of intracranial brain failure (CI IBF) with next generation TKIs. Methods: A total of 69 patients with driver mutation NSCLC patients with brain metastasis were included. CNS PFS was measured from brain metastasis diagnosis. CI ICF was measured as any new or progressive disease on MRI Brain imaging. Results: The 1 year OS was 65.7% vs 60% (p = 0.9) for the RT and TKI arms. The CNS PFS was 82% vs 72% and CI ICF 13.5% vs 22% in the RT vs TKI arms, respectively. Conclusions: There was no difference in overall survival in our cohort when giving TKI therapy upfront or delayed with radiation. There was a clinically meaningful improvement in CNS PFS at 1 year but was not significant. There findings warrant further study.
影响急性ST段抬高心肌梗死患者延迟就医的因素分析
Authors: 郭金成, 华琦, 刘东霞, 陈海翎, 许骥, 温宇梅, 李东宝
Journal: BMJ (2006)

对宣武医院和潞河医院2003年9月至2004年11月连续住院并确诊急性ST段抬高心肌梗死患者,用调查表的形式记录患者就医延迟以及患者的临床、社会描述和社会心理因素.将患者分为短患者延迟组(≤ 60 min)和长患者延迟组(>60 min).结果329例急性ST段抬高心肌梗死患者进入研究,患者延迟和院前延迟中位数分别为90 min和170 min.多元logistic回归分析表明与患者就医延迟有关的独立变量为服用止痛药物、等待症状消失、不愿打扰他人、梗前心绞痛、年龄≥65岁、逐渐起病、发病时周围有人、严重疼痛和重视症状。
Complementary and alternative medicine use among cancer patients at a private hospital in Brazil.
Authors: Eliza Dalsasso Ricardo, Denise Oishi, Marcelo Oliveira Dos Santos, Renata D'Alpino D'Alpino
Journal: Journal of Clinical Oncology (2020)

e14144 Background: Complementary and alternative medicine (CAM) use is relatively common among cancer patients. Data regarding CAM use in Brazil is scarce. We sought to define CAM use by cancer patients and investigate factors that might influence it. Methods: We conducted a cross-sectional survey of adults diagnosed with any cancer type who came to appointments at our outpatient clinic in January 2020. Chi-square tests were used to investigate the association between CAM use and age and gender Results: We interviewed 156 patients who consented to the face-to-face interview and all of them completed the questionnaires. Most patients were between 51 and 70 years-old; 56% were female and 55% had their cancer diagnosed in the last 12 months. Most cancer types were breast (17.4%), colorectal (16.7%), and lung (16.1%). More than 90% of the participants were on any active treatment. The prevalence of current CAM use was 29.6%. 58.7% of the patients did not believe CAM has anti-cancer properties, including 32.6% of patients who reported CAM use. Two-thirds of the participants have never discussed about CAM with their oncologists. Only 5.1% of the respondents would abandon conventional cancer treatment in order to use just CAM. Among CAM users, 55% referred multiple therapies use. Of those therapies, spiritual surgery was the most prevalent one. There was a significant higher proportion of females reporting CAM use (p = 0,029) as well as a higher proportion of CAM use among younger patients (p = 0,008). Conclusions: CAM use was common among our study population, especially spiritual surgery. Women and younger patients were more prone to use CAM. Although most patients would not abandon conventional treatment, many of them have never discussed about CAM with their oncologists.
Pathological response rates and quality of life outcomes of neoadjuvant cabazitaxel and cisplatin chemotherapy for muscle-invasive transitional cell carcinoma of the urinary bladder.
Authors: Amarnath Challapalli, Susan Masson, Paul White, Narges Dailami, Sylvia Pearson, Edward Rowe, Anthony Koupparis, Jon Oxley, Janice Ash-Miles, Alicia Bravo, Emily Foulstone, Raj Persad, Amit Bahl
Journal: Journal of Clinical Oncology (2020)

5030 Background: Neoadjuvant cisplatin-based combination chemotherapy (NAC) improves survival in muscle invasive bladder cancer (MIBC). However, response rates and survival remain suboptimal. We sought to evaluate the efficacy, safety and tolerability of cisplatin cabazitaxel combination in this patient group. Methods: A phase 2 single arm trial (Simon 2 stage), to recruit at least 26 evaluable patients was designed with 80% power to detect the primary endpoint, objective response rate (ORR) of &gt; 35%. ORR was defined as pathological complete response (pCR) plus partial response (pathological downstaging), measured by pathologic staging (T2 or greater at diagnosis, to T1 or less at radical cystectomy). Treatment was with Cisplatin 70mg/m2 and Cabazitaxel 15mg/m2 on day 1 of a 21 day cycle, for 4 cycles prior to surgery. Toxicity was recorded using CTCAE v.4.03. Quality of Life (QoL) data were collected at baseline, prior to each cycle of chemotherapy and at 3-5 weeks after 4 th cycle of chemotherapy using EQ-5D and EORTC QLQ-C30, BLM30 questionnaires. Results: Objective response was seen in 15 out of 26 evaluable patients, 57.7% and over a third of patients achieved pCR (9/26; 34.6%). 78% (21/27) of patients completed all cycles of treatment, with only 6.7% of the reported adverse events (AEs) being graded 3 or 4. There were 6 treatment related SAEs reported but no SUSARs. In patients who achieved objective response the median progression free (PFS) and overall survival (OS) were not reached (median follow up: 41.5m). In contrast, median PFS (7.2m) and OS (16.9m) were significantly worse (p = 0.001) in patients who did not respond. Response rates for EORTC QLQ-C30, BLM 30 and EQ5D questionnaires was 70.4, 70.4 &amp; 63% respectively, at end of treatment. There was no significant difference in EORTC QLQ C30 summary, global health scores and EQ5D score with treatment. There was a significant decline in mean QLQ C30 domain scores after 1st cycle compared to baseline, but no further deterioration with subsequent cycles of chemotherapy. Conclusions: Cabazitaxel with cisplatin as NAC of MIBC can be considered a safe, well-tolerated and effective regimen with higher pCR rate of 34.6%. This compares favorably to that with Cisplatin/Gemcitabine (23-26%). Minimal changes in Global Health &amp; EQ5D observed during NAC further demonstrates the excellent tolerability of this regimen and to our knowledge are the first data regarding QoL in NAC in MIBC. These results warrant further evaluation in a larger phase 3 study. Clinical trial information: 2011 004090 82 .
Efficacy and safety of pegfilgrastim in prophylaxis of chemotherapy-induced neutropenia in breast cancer patients.
Authors: Wen Xia, Fei Xu, Zhongyu Yuan, Ruilian Xu, Yi Jiang, Zhiyong Wu, Qianyi Lu, Qiufan Zheng, Ruoxi Hong, Kuikui Jiang, Jiajia Huang, Xin An, XiWen Bi, Yun Hong, Danmei Pang, Anqin Zhang, Xianming Wang, Qing Zhang, Haibo Zhang, Shusen Wang
Journal: Journal of Clinical Oncology (2020)

e12511 Background: The role of secondary prophylaxis with pegfilgrastim (brand name: Jinyouli) in Chinese breast cancer patients has not been fully evaluated. We assessed the efficacy and safety of pegfilgrastim in secondary prophylaxis of chemotherapy-induced neutropenia in breast cancer patients. Methods: In the open-label, single-arm, multicenter trail, 319 patients were enrolled. Breast cancer patients who developed grades 3/4 neutropenia in the previous chemotherapy cycle were given a fixed dose of subcutaneous pegfilgrastim, 24-48 hours after receiving the same chemotherapy regimen in the subsequent cycle. A dose of 6mg/cycle was given to patients weighed ≥45kg, and a dose of 3mg/cycle was given to patients weighed &lt;45kg. The primary end point was the incidence of grade 3/4 neutropenia and secondary end point was the incidence of febrile neutropenia (FN). Results: In patients who received prophylactic pegfilgrastim, the incidence of grade 3/4 neutropenia was reduced to 12.53% (95% CI, 9.1 to 16.7) and the incidence of FN was reduced from 6.58% (95% CI, 4.1 to 9.9) in the screening cycle to 0.94% (95% CI, 0.2 to 2.7)(Table). Among the 40 patients who still developed grades 3/4 neutropenia after receiving pegfilgrastim, the absolute neutrophil count (ANC) was not significantly different between patients with (n=10) or without (n=30) additional filgrastim treatment. The most common adverse events (AEs) associated with pegfilgrastim were bone pain and myalgia, which were prevalent in 10% to 15% of the patients. However, both AEs were mild or moderate (grades 1/2). Conclusions: Prophylactic administration of pegfilgrastim is effective and safe in reducing the risk of grades 3/4 neutropenia and FN in breast cancer patients after receiving chemotherapy. [Table: see text]
The effect of locality of residence (LOR) and socioeconomic status (SES) on mortality in patients with squamous cell carcinoma of the head and neck (HNSCC): 20-year experience at the UPMC Hillman Cancer Center.
Authors: Janielle Taylor, Yongli Shuai, Linda Robertson, Daniel Paul Normolle, Robert L Ferris, Todd Bear, Marci Lee Nilsen, Jonas T. Johnson, Mark Kubik, Shaum Sridharan, Umamaheswar Duvvuri, Eric Wang, Heath Devin Skinner, David Anthony Clump, James Ohr, Carl Snyderman, Simion I. Chiosea, Rachelle Gish-Johnson, Seungwon Kim, Dan Paul Zandberg
Journal: Journal of Clinical Oncology (2020)

e19043 Background: As cancer centers expand, evaluation of potential disparities in outcomes amongst the catchment area is critically important. We examined the effect of LOR and SES on overall survival (OS) in HNSCC patients treated at HCC, which spans 29 counties in western Pennsylvania with diverse socioeconomic profiles across urban and rural localities. Methods: Retrospective review included patients with primary HNSCC (excluding M1 and recurrent disease) treated at HCC 1997-2018. Using Rural-Urban Commuting Area codes, LOR was classified as urban/suburban or rural according to ZIP code. SES was defined by medium income level (low, moderate (Mod), middle (Mid), Upper) via Federal Financial Institutions Examination Council geocoded census tract data. Kaplan-Meier methods and Cox regression models were used to evaluate OS. Results: 3512 patients were identified. Median age was 61, 72.7% male, 93.2% White, 18% HPV +, 75.5% urban/suburban, and by SES: 4% Low, 21% Mod, 46% Mid, and 19% Upper. Primary site included 35.2% oral cavity, 28.4% oropharynx, 28.1% larynx, 8.3% other, stage was majority III/IVa (61%), 66% had surgery and 54% received multimodality treatment (tx). While median OS differed significantly by race (Black: 5.8 vs. White: 7.3 years, p = 0.0457) and SES (Low: 4.1 vs. Mod: 5.3 vs. Mid: 7.3 vs. Upper: 9.1 years, p &lt; 0.0001), there was no difference by LOR (rural: 7.7 vs. urban/suburban: 7.2 years, p = 0.99). Multivariable Cox Regression showed lower SES was associated with a higher risk of death [(Low vs. Upper, HR: 1.416, 95% CI: 1.023-1.959) (Mod vs. Upper, HR:1.443, 95% CI: 1.214 – 1.716), p = 0.0004], adjusting for LOR and factors associated with OS in univariate analysis (age, smoking status, primary site, staging, tx, HPV status, race, and enrollment on clinical trial). The effect of LOR, race, and enrollment on clinical trial were not significant in multivariate analysis. Conclusions: SES was independently associated with OS in HNSCC patients treated at HCC, while LOR was not associated with OS. The lack of difference by LOR may be partially explained by HCC’s efforts to increase access to care throughout the catchment area by establishing community sites. However, a focus on improving outcomes for lower SES HNSCC patients is needed.