tbuckley/cabot-search huggingface dataset:
Affordable Care Act Medicaid expansion does not reduce guideline concordant cancer care disparities in vulnerable populations.
Authors: Michelle Ju, James-Michael Blackwell, Patricio Polanco, John C. Mansour, Sam C. Wang, Matthew R. Porembka, Herbert Zeh, Adam Charles Yopp
Journal: Journal of Clinical Oncology (2020)

2039 Background: The receipt of timely, guideline concordant cancer amongst racial/ethnic and socioeconomic vulnerable populations remains a significant health policy issue. The Affordable Care Act (ACA) with implementation of Medicaid Expansion sought to reduce cancer disparities by reducing uninsured rates, theoretically improving healthcare access and delivery. We assessed the impact of Medicaid expansion on racial/ethnic disparities in the receipt of timely guideline concordant cancer care. Methods: We identified patients between 40-64 years of age with all stages of cancer (lung, colorectal, breast, uterine, and cervical) in the National Cancer Database, 2012-2015. Patients were assigned to Medicaid expansion cohort based on state of residence and whether Medicaid expansion was enacted at date of diagnosis in that state. Guideline concordant care was defined based on NCCN guidelines. We constructed an ecological model with multivariate regression analysis on rate of guideline concordant care receipt with covariates including race/ethnicity, Medicaid expansion, SES, gender, Charlson-Deyo score, and treatment facility type. Results: We identified 445,952 patients, 12% Black, 6% Hispanic white, median age 55 years. Patients in the lowest SES quartile following Medicaid expansion had the greatest increase in rates of insured status, although all SES quartiles had increased insured rates compared to non-Medicaid expansion regardless of race/ethnicity. In our ecological model, the rate of receipt of guideline concordant care declined by 0.5% per year between 2012-2015. After adjusting for covariates, Asians were 2.8% less likely to receive guideline concordant care than non-Hispanic whites, Blacks 3.8% less likely, and Hispanics 6.3% less likely (p &lt; 0.0001). Racial/ethnic disparities in receipt of guideline concordant cancer care remained after Medicaid expansion with no differential benefit. Conclusions: Insurance gains under the ACA Medicaid expansion did not affect the rate of guideline concordant care receipt. Significant racial disparities persist in the likelihood of receiving guideline concordant care, particularly among Hispanics. Further studies are needed to determine additional barriers to cancer care access/delivery and identify key targets aimed at improving equity.
Trends in the incidence and survival outcomes in patients with lung neuroendocrine neoplasms in the United States.
Authors: Rohit Gosain, Shrunjal Shah, Arvind Dasari, Thorvardur Ragnar Halfdanarson, Sarbajit Mukherjee
Journal: Journal of Clinical Oncology (2020)

e19120 Background: The incidence and prevalence of Neuroendocrine Neoplasms (NENs) are rapidly rising. Epidemiologic trends have been reported for common NENs, but specific data for lung NENs has been lacking. Methods: We conducted a retrospective population-based analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) database, and studied lung NENs patients from 1988 to 2015. Associated population data was utilized to report the annual age-adjusted incidence and overall survival trends. Trends in the incidence and survival of large-cell lung cancer (LCLC) and atypical carcinoid (AC) were reported from 2000-2015, while that for typical carcinoid (TC) and small cell lung cancer (SCLC) were reported from 1988-2015. Results: We examined a total of 115,995 lung NENs [103,980 – SCLC; 3,303 – LCLC; 8,146 – TC; 656 – AC]. The age-adjusted incidence rate revealed decline in SCLC from 8.6 in 1988 to 5.3 in 2015 per 100,000; while other NENs showed an increase: TC increased from 0.57 in 1988 to 0.77 in 2015 per 100,000, AC increased from 0.17 in 2001 to 0.22 in 2015 per 100,000, and lastly, LCLC increased from 0.35 in 2001 to 0.41 in 2015 per 100,000. On multivariable analyses, the median overall survival (OS) and disease-specific survival (DSS) rate varied significantly by stage, grade, age at diagnosis, histological type, insurance type, marital status, and race. The 5-year OS rate among SCLC and LCLC patients was 5% and 17%, respectively, consistent with their high-grade nature. On the other hand, TC and AC, representing low-grade neuroendocrine tumors, had good 5-year OS: 84% and 64%, respectively. Conclusions: The incidence of lung NENs is rising, possibly because of advanced radiological techniques. However, we have seen a downtrend in the incidence of SCLCs likely because of declining smoking habits. Such population-based studies are essential for resource allocation and to prioritize future research directions.
Screening practices for late effects in pediatric patients on tyrosine kinase inhibitors.
Authors: Stephanie M Smith, Himalee S. Sabnis, Rebecca Williamson Lewis, Karen Elizabeth Effinger, Daniel John Bergsagel, Briana Patterson, Ann C. Mertens, Kathleen Sakamoto, Lidia Schapira, Sharon M. Castellino
Journal: Journal of Clinical Oncology (2020)

e22527 Background: BCR-ABL tyrosine kinase inhibitors (TKIs) have revolutionized treatment of Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ALL) and chronic myeloid leukemia (CML). The off-target effects of long-term TKI use in children are poorly understood. We evaluated institutional screening practices for cardiac and endocrine late effects in those who had received TKIs at two large pediatric cancer centers. Methods: This retrospective cohort included patients diagnosed with Ph+ALL (post completion of frontline therapy) or CML at age &lt; 21 years with ≥1 years of follow-up. Patients were censored at stem cell transplant, blast crisis, secondary neoplasm, death, or last contact. Demographics, clinical features, and incidence of screening echocardiogram (ECHO), electrocardiogram (EKG), dual-energy x-ray absorptiometry (DXA), bone age, and thyroid function (TSH) were abstracted. Descriptive statistics and incidence of screening are presented by diagnosis. Results: The cohort (n = 68) was 50% female, 28% non-Hispanic white, 24% non-Hispanic black, 24% Asian, and 19% Hispanic. CML: Patients were diagnosed at 12.9±4.6 years of age and had 6.3 (0.9-15.6) years of TKI exposure and 6.3 (0.9-15.6) years of follow-up. Imatinib was most commonly used (80%) followed by dasatinib (59%); 48% were exposed to &gt; 1 TKI. Excluding tests at diagnosis, 48% had an ECHO and 48% had an EKG during the follow-up period. TSH, DXA and bone age were measured in 50%, 9% and 11% patients, respectively. Ph+ALL: Patients were diagnosed at 10.8±5.1 years of age and had 2.8 (0.6-11.6) years of TKI exposure and 5.7 (2.1-11.8) years of follow-up. Dasatinib was most commonly used (73%) followed by imatinib (64%); 36% were exposed to &gt; 1 TKI. All received anthracyclines and steroids. Excluding tests at diagnosis, 91% had an ECHO and 77% had an EKG. TSH, DXA and bone age were measured in 82%, 68% and 36% patients, respectively. Conclusions: We note inconsistent cardiac and endocrine screening in patients receiving TKIs for CML and Ph+ALL. Evidence-based guidelines for long-term follow-up and structured monitoring for potential off-target effects are needed. A prospective screening study is in progress and may enhance our understanding of the prevalence of late effects of TKIs. [Table: see text]
The effectiveness of colorectal cancer screening for cancer survivors.
Authors: Chia-Jen Liu, Tzu-Yu Lai, Chiu-Mei Yeh, Chun-Kuang Tsai, Po-Min Chen, Jin-Hwang Liu, Tzeon-Jye Chiou, Chung-Jen Teng
Journal: Journal of Clinical Oncology (2020)

e16091 Background: Colorectal cancer (CRC) is one of the highest-incident neoplasms in many countries. Although the incidence of CRC is increasing gradually, the mortality rate has not increased due to early detection and multidisciplinary treatment. CRC screening programs, including colonoscopy and fecal occult blood tests, have been reducing CRC-related mortality worldwide. In Taiwan, the CRC screening program uses a biennial fecal immunochemical test (FIT) as the initial screening tool. FIT-positive participants receive a colonoscopy as a CRC confirmation examination. Cancer survivors have a higher incidence of secondary primary malignancies. Methods: We conducted a nationwide population-based study in Taiwan. The cancer survivors with FIT in the Nationwide Colorectal Cancer Screening (NCCS) Program between January 2010 and September 2014 were enrolled as the study group. The patients aged under 50, diagnosed with CRC before the FIT were excluded. The screening participants without a cancer history were served as the comparison group. The primary endpoint was CRC diagnosis within six months after a FIT. The cancer diagnosis was identified by using Taiwan Cancer Registry. The ratios of positive FIT, confirmatory colonoscopy, and CRC diagnosis in the cancer survivors and the comparison cohort were calculated and compared. Analyses were adjusted for participants’ characteristics by using multilevel logistic regression models. Results: We identified 288,919 cancer survivors who participated in the NCCS Program. Of them, 41.1% were male and the median age was 59 (interquartile ranges 54–64). There were 417,907 FITs performed in the study cohort. The FIT positive rates were 11.3% and 7.4% in the study and comparison groups, respectively (OR 1.59 95% CI 1.57–1.60). Of the FIT positive participants, 50.5% and 52.3% received confirmatory colonoscopy or the related examinations within six months, respectively (OR 0.93 95% CI 0.91–0.95). Then 3.0% and 4.4% of those receiving confirmatory colonoscopy were diagnosed with CRC in the study and comparison groups, respectively (OR 0.68 95% CI 0.63–0.74). After adjustment for age, sex, income, a family history of CRC, and comorbidities, the cancer survivors in this screening program had a similar rate of CRC diagnosis compared with those without antecedent malignancies (adjusted OR: 0.97, 95% CI 0.87–1.08). Conclusions: Although the cancer survivors had a higher rate of positive FIT, the CRC diagnosed by the screening did not increase. We further identified the risk factors associated with CRC in the cancer survivors.
Primary analysis of a phase II study of metastasis-directed ablative therapy to PSMA (<sup>18</sup>F-DCFPyL) PET-MR/CT defined oligorecurrent prostate cancer.
Authors: Rachel Glicksman, Ur Metser, Doug Vines, Rosanna Chan, John Valliant, Peter W. M. Chung, Mary K. Gospodarowicz, Andrew Bayley, Charles N. Catton, Padraig Richard Warde, Joelle Helou, Srinivas Raman, David Green, Nathan Perlis, Neil Fleshner, Robert James Hamilton, Alexandre Zlotta, Antonio Finelli, David Jaffray, Alejandro Berlin
Journal: Journal of Clinical Oncology (2020)

5553 Background: Despite maximal local therapies (MLT) (radical prostatectomy followed by radiotherapy [RT]), 20-30% of men will progress to incurable prostate cancer (PCa). Most recurrences in this scenario are characterized by rise in PSA with negative bone scan (BS) and computed tomography (CT). We conducted a phase II trial for men with rising PSA after MLT using 18 F-DCFPyL (PSMA) PET-MR/CT followed by metastasis-directed therapy (MDT) to PET positive foci. We report the results of our primary analysis. Methods: Patients with rising PSA (0.4-3.0 ng/mL) after MLT, negative BS/CT and no prior salvage ADT were eligible. All patients underwent PSMA PET-MR and PET-CT. Those with limited disease burden amenable to MDT underwent either stereotactic ablative RT (SABR) or surgery (lymph node dissection). No ADT was used. The primary endpoint was biochemical response rate (complete [undetectable PSA] or partial [PSA decline ≥50% from baseline]) following MDT. A Simon’s two-stage study design was employed. Estimated time of delay in salvage ADT was calculated using the Kaplan-Meier method. Toxicity was prospectively recorded (CTCAE v4.0). Results: After a median of 63 months (range 3-180) post MLT, 72 patients underwent PSMA PET-MR/CT with median PSA 0.98 ng/mL (range 0.4-3.1). Sixteen patients had negative and 56 had positive PET-MR/CT scans, of which 37 (51%) were amenable to MDT. The median number of treated lesions was 2 (range 1-5). Of the treated patients, 30 (81%) had miT0N1M0 disease, 2 (5.5%) had miT0N1M1a, 2 (5.5%) had miT0N0M1a and 3 (8%) had miT0N0M1b. Twenty-seven patients underwent SABR (median 30 Gy in 3 fractions) and 10 had surgery. At a median of 11 months (range 1-29) post MDT, 8 patients (22%) had complete (CR) and 14 (38%) had partial (PR) responses. Among the 8 CRs, 5 had surgery and 3 had SABR; of the 14 PRs, 2 had surgery and 12 had SABR. The estimated median delay in salvage ADT for the entire cohort, PR and CR subgroups was 13 months (IQR 8-20), 16 months (IQR 13-20) and 30 months (IQR not reached), respectively. Two grade 2+ toxicities were observed, both in surgical patients: deep venous thrombosis and ureteric injury requiring stent placement. Conclusions: 18 F-DCFPyL PET-MR/CT has high detection rates (78%) in men with rising PSA after MLT. We observed a favorable therapeutic index with MDT (60% response rate) for patients with metachronous PSMA-unveiled oligometastatic PCa following MLT. Phase III studies using validated intermediate clinical endpoints are needed before integration into routine practice. Clinical trial information: NCT03160794 .
她的腹痛为什么越来越重
Authors: 李净潜, 高青山, 姜文忠
Journal: BMJ (2008)

患者女,15岁,近10天持续腹痛,尤以脐周更为明显,阵发性加剧,不能忍受,伴有恶心、呕叶,皮肤轻度黄染,痛苦面容,于2001年12月3日去某市医院就诊,以急性胆囊炎、胆道蛔虫症收住院治疗。
Non-brachytherapy approach for locally advanced cervical cancer treatment.
Authors: Nidal Salim, Vladimir Nosov, Daria Zvereva, Olga Novikova, Anna Tedeeva, Irina Trofimenko, Nadezhda Gromova, Pavel Koposov
Journal: Journal of Clinical Oncology (2020)

e18023 Background: Concomitant chemoradiation therapy (CRT) that includes both external beam radiotherapy (EBRT) and brachytherapy (BT) is the current standard of care in treatment of locally advanced cervical cancer (LACC). Adaptive EBRT using volumetric modulated arc technology without BT allows dose escalation and decreases toxicities. Non-brachytherapy treatment is an evolving alternative approach provides geographical radiation accuracy but the oncological outcomes still to be evaluated. Methods: Patients with LACC (stages 1B3–IVA) who underwent non-brachytherapy CRT using adaptive EBRT with simultaneous integrated boost at our institution were evaluated prospectively from May 2015 to December 2019. All patients were initially assessed by a gynecologic oncologist, pelvic MRI and 18FDG-PET/CT scan were conducted. Follow-up pelvic examinations with cytology every 3 months and PET/CT at 3 and 12 months after completion of treatment were performed. Oncological outcomes and toxicities were assessed. Results: Twenty-one patients were analyzed: median age was 54 years (30–76 years); 19 patients had squamous cell histology and 2 had adenocarcinoma. Median follow-up was 32 months (8–56). The average dose administered to the gross tumor volume was 90.2 Gy (79.5–96.6), 79.8 Gy to all PET/MRI positive lymph nodes (63.0–89.7). No patents received BT; all but 3 received chemotherapy. Three-year local control was 100% (PFS = 90.4% and OS = 100%). There were 2 recurrences: a solitary skull lesion 18 months following CRT in a patient with mesonephric adenocarcinoma and a metastasis to a transposed ovary 15 months after CRT. No grade 3–4 toxicities were seen. Only 1 patient (4.7%) had late rectal grade II toxicity. Conclusions: Non-brachytherapy adaptive CRT for LACC is feasible. It allows for a significant dose escalation, thus providing better local control and likely increases PFS and OS at no cost of serious toxicity. Randomized studies comparing this approach to the current standard of care are needed.
Monitoring through flow cytometry as a biomarker of early response to checkpoint inhibitor.
Authors: Elisabeth Perez Ruiz, Juan Luis Onieva Zafra, Marilina Garcia-Aranda, Belen Sojo, Constanza Gallardo, Aurora Laborda-Illanes, Martina Alvarez, Rosa Villatoro, Jose Antonio Bernal, Pedro Jimenez Gallego, Miguel-Angel Berciano-Guerrero, Javier Oliver, Manuel Cobo Dols, Isabel Barragán
Journal: Journal of Clinical Oncology (2020)

e21603 Background: Despite the efforts, there is still no biomarker that is able to predict the response and / or that can be used in the monitoring of patients treated with check-points inhibitors (ICI). Methods: Prospective study of a panel of blood biomarkers that help predict the response to ICI treatments. Since June 2019, a total of 60 patients with non-small cell lung cancer (NSCLC) or melanoma have been included. Prior to the start of treatment (T1 moment), after the first cycle of ICI (T2), and to progression (Tp) or 6 months after the start, blood sample has been drawn to the patients and the analysis has been carried out by flow cytometry of the percentage of lymphocytes CD8, CD3, Treg, Myeloids, NK and B lymphocytes. The one.way statistical test has been carried out that allows us to see the effect of the response on the variable at each time. Results: Of the 60 patients included, we have radiological assessment in 38. 80% are patients with NSCLC. In the evaluation at 8-10 weeks we found stable disease / partial response in 25 patients (66%), 8 progressions (21%) and 2 unknown reevaluations (13%). A significant increase in CD3, CD8, CD4, and B lymphocytes was observed in responders (p &lt; 0.005); however, an increase in NK was observed in patients in progression (p &lt; 0.02). No significant differences in Treg have been described and the result related to myeloid cells is pending analysis. Conclusions: Our results open a door to peripheral blood monitoring as a new tool for the management of ICI. However, our data are preliminary, having not yet reached the expected sample size and with aspects that we must clarify as the increase in NK in progressors. In addition, the final objective of this study is to generate a score combining several biomarkers of blood and tissue to be used as a predictor of response to ICI (data pending analysis).
A survey on current status of two-way referral among residents in Beijing communities
Authors: Chao-ying Qu
Journal: BMJ (2011)

A cross-sectional survey on two-way referral using self-report questionnaire was conducted in a sample of 1423 residents living in 4 communities in Caobeidian area, Chaoyang District and 4 communities in Dongcheng District from April to July 2009. Among the residents who responded the questionnaire, 19.7% (88/446) from Gaobeidian and 8.2% ( 80/977 ) from Dongcheng District were referred to hospitals in 2008. And 30.7 % (27/88) in Gaobeidian and 43.8% (35/80) in Dongcheng District referred to hospital based on their own decision rather than doctors' recommendation; 45. 5% (40/ 88) in Gaobeidian and 45. 0% (36/80) in Dongcheng District of referrals were officiary processed by health institutions. The survey also showed that 57.6% and 59.4% of the respondents from the two districts preferred to free referral between community health service centers and hospitals.

Key words: 
Referral and consultation;  Cross-sectional studies
心房颤动经导管消融治疗的现状和困惑
Authors: 徐亚伟, 张劲林
Journal: BMJ (2006)

在过去的10多年里,临床心电生理发展最活跃的领域就是心房颤动(房颤)的经导管消融治疗.在不断获得理论和技术突破的基础上,房颤的导管消融术逐渐成熟.下面简要介绍有关这一治疗的现状、问题及前景。
PIT-1: Randomized phase II trail of pemetrexed-cisplatin plus bevacizumab or concurrent thoracic radiation therapy followed by surgery in stage IIIA (N2) nonsquamous non-small cell lung cancer.
Authors: Kazuya Takamochi, Kenji Suzuki, Masahiro Tsuboi, Seiji Niho, Satoshi Ishikura, Shunsuke Oyamada, Takuhiro Yamaguchi, Ichiro Yoshino, Hiroyuki Ito, Norihito Okumura, Fumihiro Tanaka, Hisashi Saji, Masanori Tsuchida, Hirotoshi Horio, Satoshi Shiono, Motoki Matsuura, Norihiko Ikeda, Toshiki Tanaka, Morihito Okada
Journal: Journal of Clinical Oncology (2020)

9014 Background: PIT-1 (Personized Induction Therapy-1) is a multicenter, open-label, randomized phase II study using selection design of platinum doublet chemotherapy plus angiogenesis inhibitor or concurrent thoracic radiation therapy (TRT) as induction therapy followed by surgery in patients with stage IIIA (N2) nonsquamous non-small cell lung cancer (NSCLC) to investigate the efficacy and safety of these treatment strategies. Methods: Patients with stage IIIA (pathologically proven N2) nonsquamous NSCLC randomly received (1:1) induction therapy consisting of pemetrexed (500 mg/m 2 ) and cisplatin (75 mg/m 2 ) plus bevacizumab (15 mg/kg) intravenously every 3 weeks for three cycles (arm A) or concurrent TRT (45 Gy in 25 fractions) (arm B) followed by surgery. The primary endpoint was 2-year progression-free survival (PFS) rate and key secondary endpoints included overall survival (OS), the objective response rate (ORR) as defined by the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, the pathological complete remission (pCR) rate, feasibility and toxicity. Results: Eighty-eight patients were randomly assigned (each arm, n = 44) between October 2013 and June 2017 and 82 (arm A, n = 42; arm B, n = 40) were treated. Patient demographics were balanced between the two arms. The percentage of patients who received induction therapy followed by surgery was 88.1% (37/42) in arm A and 92.5% (37/40) in arm B. The complete resection rate was 81.1% (30/37) in arm A, and 91.9% (34/37) in arm B. The 2-year PFS rate was 36.8% (95% CI: 22.4-51.2) in arm A, and 50.0% (95% CI: 33.8-64.2) in arm B. The 2-year OS rate was 80.5% (95% CI: 64.7-89.7) in arm A, and 80.0% (95% CI: 64.0-89.5) in arm B. The ORR was 50.0% (21/42) in arm A and 60.0% (24/40) in arm B. The pCR rate was 8.1% (3/37) in arm A and 10.8% (4/37) in arm B. Grade 3 or 4 toxicities occurred during induction therapy in 35.7% of the patients in arm A and 22.5% of the patients in arm B. Grade 3 or 4 surgical complications occurred in 21.4% of the patients in arm A and 20.0% of the patients in arm B. Although no fatal toxicity was observed during induction therapy in either arm, two patients in arm A died after surgery due to bronchopleural fistula. Conclusions: The 2-year PFS rate in arm B was higher than that in arm A. Fatal surgical complications were only observed in arm A. Therefore, we chose pemetrexed-cisplatin plus concurrent thoracic radiation therapy as the investigational induction treatment strategy for a future phase III study. Clinical trial information: 000011941.
踝扭伤
Authors: 金世红
Journal: BMJ (2005)

踝扭伤是一种很常见的骨骼肌肉损伤.有一项来自美国的研究报道,在美国平均每天有2.5万人发生踝扭伤.如果以中美人口的比例来看,每天中国人发生踝扭伤的将是一个多么可观的数字.现在回顾一位最近在Peter医生的诊所里遇到的踝扭伤病人。
改进儿童真性性早熟的治疗增加成年身高的探讨
Authors: 石凤英, 张美和
Journal: BMJ (2007)

对20例真性性早熟的患儿按骨龄和身高情况分组,给予促性腺激素释放激素类似物(GnRHa)单独治疗及择期联合应用生长激素(hGH)治疗,动态观察其对身高的改善情况,结果显示身高＜50百分位者采用GnRHa与hGH联用疗效显著,其生长速度及最后身高较单用GnRHa者差异有统计学意义(P＜0.05)。
Rating scales for anxiety and depression
Authors: Zheng Leilei
Journal: BMJ (2016)

心理量表可对焦虑、抑郁患者的症状予以量化评估，常用的焦虑及抑郁评估量表分为自评和他评量表，包括针对焦虑或抑郁的专项问卷和综合评估。文章介绍了常用的焦虑、抑郁评估量表的评分标准、使用人群及其优点。但在心理评估中须注意心理测验的量表只能作为评估症状是否存在及其严重程度的工具，并不能用作疾病诊断的唯一标准，需结合临床表现对评定结果进行合理解释。
以脑梗死为首发表现的结节性多动脉炎一例
Authors: 杨飞, 孙岩萍
Journal: BMJ (2007)

患者女,38岁,农民,主因头痛、头晕、呕吐2 d,右侧肢体偏瘫昏迷1 h入院.患者2 d前出现头痛、头晕,恶心呕吐,伴全身酸痛,于入院当天早上7:30突然晕厥,约1～2min后苏醒,自感右侧肢体麻木无力,行走困难。
Optimizing perioperative management in fast track surgery
Authors: 王振军, 马华崇
Journal: BMJ (2010)

加速康复外科(fast-track surgery)是20世纪90年代提出的外科新理论,是以循证医学证据为基础,通过对传统的围手术期处理方法进行改良、优化,以减少手术创伤和外科应激,维护器官功能,最终促进患者快速康复。