tbuckley/cabot-search huggingface dataset:
Long-term prognosis of new adult-onset asthma in obese patients
Authors: Pinja Ilmarinen, Adrienn Pardo, Leena E. Tuomisto, Iida Vähätalo, Onni Niemelä, Pentti Nieminen, Hannu Kankaanranta
Journal: European Respiratory Journal (2020)

Obesity has been associated with poor outcomes of asthma in cross-sectional studies, but long-term effect of obesity on asthma remains unknown.To study the effects of obesity, found at the time of diagnosis of adult-onset asthma, on 12-year prognosis by focusing on oral corticosteroid (OCS) use and respiratory-related hospital admissions.Patients diagnosed with adult-onset asthma (n=203) were divided into three categories based on diagnostic body mass index (BMI) (<25 kg·m-2, 25-29.9 kg·m-2, ≥30 kg·m-2) and followed for 12 years as part of the Seinäjoki Adult Asthma Study. Self-reported and dispensed OCS were assessed for the 12-year period. Data on hospital admissions were analysed based on medical records.12 years after diagnosis, 86% of the patients who were obese (BMI ≥30 kg·m-2) at diagnosis remained obese. During the follow-up, no difference was found in weight gain between the BMI categories. During the 12-year follow-up, patients obese at diagnosis reported more frequent use of OCS courses (46.9% versus 23.1%, p=0.028), were dispensed OCS more often (81.6% versus 56.9%, p=0.014) and at higher doses (median 1350 (interquartile range 280-3180) mg versus 600 (0-1650) mg prednisolone, p=0.010) compared to normal-weight patients. Furthermore, patients who were obese had more often one or more respiratory-related hospitalisations compared to normal-weight patients (38.8% versus 16.9%, p=0.033). In multivariate logistic regression analyses, obesity predicted OCS use and hospital admissions.In adult-onset asthma, patients obese at diagnosis mostly remained obese at long-term and had more exacerbations and respiratory-related hospital admissions compared to normal-weight patients during 12-year follow-up. Weight loss should be a priority in their treatment to prevent this outcome.
Improved Survival Associated with Local Tumor Response Following Multisite Radiotherapy and Pembrolizumab: Secondary Analysis of a Phase I Trial
Authors: Jason J. Luke, Benjamin E. Onderdonk, Sandeep R. Bhave, Theodore Karrison, Jeffrey M. Lemons, Paul Chang, Yuanyuan Zha, Tim Carll, Thomas Krausz, Lei Huang, Carlos Martinez, Linda A. Janisch, Robyn D. Hseu, John W. Moroney, Jyoti D. Patel, Nikolai N. Khodarev, Joseph K. Salama, Patrick A. Ott, Gini F. Fleming, Thomas F. Gajewski, Ralph R. Weichselbaum, Sean P. Pitroda, Steven J. Chmura
Journal: Clinical Cancer Research (2020)

Abstract Purpose: Multisite stereotactic body radiotherapy followed by pembrolizumab (SBRT+P) has demonstrated safety in advanced solid tumors (ASTs). However, no studies have examined the relationships between irradiated tumor response, SBRT-induced tumor gene expression, and overall survival (OS). Patients and Methods: Patients with AST received SBRT (30–50 Gy in 3–5 fractions) to two to four metastases followed by pembrolizumab (200 mg i.v. every 3 weeks). SBRT was prescribed to a maximum tumor volume of 65 mL. Small metastases received the complete prescribed coverage (complete-Rx), while larger metastases received partial coverage (partial-Rx). Treated metastasis control (TMC) was defined as a lack of progression for an irradiated metastasis. Landmark analysis was used to assess the relationship between TMC and OS. Thirty-five biopsies were obtained from 24 patients: 19 pre-SBRT and 16 post-SBRT (11 matched) prior to pembrolizumab and were analyzed via RNA microarray. Results: Sixty-eight patients (139 metastases) were enrolled with a median follow-up of 10.4 months. One-year TMC was 89.5% with no difference between complete-Rx or partial-Rx. On multivariable analysis, TMC was independently associated with a reduced risk for death (HR, 0.36; 95% confidence interval, 0.17–0.75; P = 0.006). SBRT increased expression of innate and adaptive immune genes and concomitantly decreased expression of cell cycle and DNA repair genes in the irradiated tumors. Elevated post-SBRT expression of DNASE1 correlated with increased expression of cytolytic T-cell genes and irradiated tumor response. Conclusions: In the context of SBRT+P, TMC independently correlates with OS. SBRT impacts intratumoral immune gene expression associated with TMC. Randomized trials are needed to validate these findings.
Fostering interspeciality learning in cancer survivorship care: Learning suite results.
Authors: Genevieve Chaput, Tristan Williams, Jonathan Sussman
Journal: Journal of Clinical Oncology (2020)

59 Background: As survivorship provision declines within cancer centres, primary care providers are increasingly entrusted in the follow-up care of cancer survivors. Empowering specialists and primary care providers about survivorship through educational interventions is essential. Interspecialty education is poorly integrated into residency training, which may impede collaboration between different providers in practice. Interspecialty partnership can positively impact patient and resource- use outcomes. The aim of this study was to assess if a cancer survivorship learning suite (LS) impacts attitudes of family medicine, radiation oncology and medical oncology trainees towards interspecialty collaboration in Montreal, Canada. Methods: A survivorship (LS) developed by a Manitoba-based team under the sponsorship of a Canadian Partnership Against Cancer grant held by Cancer Care Ontario was delivered to 49 McGill University family medicine, radiation oncology, and medical oncology trainees. The LS comprised in-person delivery of a 3-hour case-based workshop, presented by a radiation oncologist and a family physician, both experienced in the field of survivorship. An adapted version of the Readiness for Interprofessional Learning Scale (RIPLS) was completed by participants before and after workshop delivery. Statistical analyses included Wilcoxon Signed-rank test comparisons. Results: Response rate was 63.2%, and included family medicine (65%), radiation oncology (26%), and medical oncology (10%) trainees, respectively. Following the workshop, participants were significantly more likely to agree that interspecialty learning in residency “would help physicians become better team workers”, (Z = 2.7, p &lt; 0.008, n = 31), and “improves relationships between physicians of different specialties in independent practice afterwards”, (Z = 2.6, p &lt; 0.009, n = 31). Participants were also significantly more likely to agree that “shared interspecialty learning &lt; would &gt; increase &lt; their &gt; ability to understand clinical problems”, (Z = 2.8, p &lt; 0.005, n = 31). Conclusions: While much literature has focused on interprofessional collaboration at different levels of education and practice, few studies have assessed interspecialty collaboration of physicians of different specialties. This survivorship LS demonstrated favorable changes in attitudes towards interspecialty learning.
EHR innovations to optimize cancer care delivery in New York City during the COVID-19 pandemic.
Authors: Aarti Sonia Bhardwaj, Edward Gu, Joseph Pratko, Michael McLean, Damaris Peralta Hernandez, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2020)

249 Background: The Mount Sinai Health System was in the epicenter of the COVID-19 pandemic in NYC. We implemented dynamic testing, isolation and treatment policies in order to continue delivering necessary cancer treatments and ensure the safety of our patients and our staff. Here, we describe the rapid rollout of IT optimizations to enhance the delivery of quality cancer care during the COVID-19 pandemic. Methods: We developed a cancer center incident command structure that involved integration of a health informaticist, IT analyst, and data analyst along with cancer center leadership to help create and optimize electronic health record (EHR)-based tools to support the clinical mission. Results: We developed and implemented EHR-based COVID-19 screening protocols, clinical decision support, reporting and analytics tools, and telehealth technology related to COVID-19 (Table). Conclusions: Dynamic EHR optimizations were essential to continue our cancer care delivery services during the pandemic. [Table: see text]
Trimester-Specific Blood Trihalomethane and Urinary Haloacetic Acid Concentrations and Adverse Birth Outcomes: Identifying Windows of Vulnerability during Pregnancy
Authors: Yang Sun, Yi-Xin Wang, Chong Liu, Ying-Jun Chen, Wen-Qing Lu, Carmen Messerlian
Journal: Environmental Health Perspectives (2020)

Background: Some disinfection by-products (DBPs) are reproductive and developmental toxicants in laboratory animals. However, studies of trimester-specific DBP exposure on adverse birth outcomes in humans are inconsistent. Objective: We examined whether trimester-specific blood and urinary biomarkers of DBP were associated with small for gestational age (SGA), low birth weight (LBW), and preterm birth. Methods: A total of 4,086 blood and 3,951 urine samples were collected across pregnancy trimesters among 1,660 mothers from Xiaogan City, China. Blood samples were quantified for biomarkers of trihalomethanes (THMs): chloroform (TCM), bromodichloromethane, dibromochloromethane, and bromoform. Urine samples were quantified for biomarkers of haloacetic acids (HAA): dichloroacetic acid and trichloroacetic acid. Birth outcomes were abstracted at delivery from medical records. We used Poisson regression models with log link functions to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for SGA, LBW, and preterm birth across tertiles (or categories) of DBP biomarker concentrations measured across pregnancy trimesters. We also examined the relative exposure differences across gestation comparing adverse outcomes with normal births using mixed-effects models. Results: Blood TCM concentrations in the second trimester were associated with an elevated risk of SGA comparing middle vs. lowest (RR, 2.34; 95% CI: 1.02, 5.35) and highest vs. lowest (RR, 2.47; 95% CI: 1.09, 5.58) exposure groups. Third-trimester blood TCM concentrations were also associated with an increased risk of SGA comparing the second tertile with the first (RR, 2.61; 95% CI: 1.15, 5.92). We found that maternal blood TCM concentrations were significantly higher for SGA compared with non-SGA births across the period from 23 to 34 wk gestation. Other blood and urinary DBP biomarkers examined were unrelated to SGA, LBW, or preterm birth. Conclusion: Blood TCM concentrations in mid to late pregnancy were associated with an increased risk of SGA, whereas other biomarkers of DBPs examined across pregnancy were not associated with birth outcomes. https://doi.org/10.1289/EHP7195
Endoscopic ultrasound-guided recanalization of complete pharyngoesophageal stenosis
Authors: Belén Martínez-Moreno, Lucia Medina-Prado, Sandra Baile-Maxía, Carolina Mangas-Sanjuan, Juan A. Casellas, José R. Aparicio
Journal: Endoscopy (2020)

A 74-year-old man was referred because of complete esophageal obstruction. He had a diagnosis of T3N1 hypopharyngeal squamous cell carcinoma and had undergone chemoradiotherapy with a complete response. He had a percutaneous endoscopic gastrostomy (PEG) for nutrition and had had aphagia for 18 months.
Redevelopment and validation of the SYNTAX score II to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation
Authors: Kuniaki Takahashi, Patrick W Serruys, Valentin Fuster, Michael E Farkouh, John A Spertus, David J Cohen, Seung-Jung Park, Duk-Woo Park, Jung-Min Ahn, Arie Pieter Kappetein, Stuart J Head, Daniel JFM Thuijs, Yoshinobu Onuma, David M Kent, Ewout W Steyerberg, David van Klaveren
Journal: The Lancet (2020)
Impact of the Covid-19 pandemic onmedical oncology utilization at a busy urban academicmedical center
Authors: Sidharth Anand, Anne Walling, Neil Wenger, Katrina Fischer, Lisset Huerta-Cruz, Lisa Wilen, John Glaspy
Journal: Clinical Cancer Research (2020)

Background: The unprecedented global pandemic of Covid-19 caused major shifts in medical care throughout theworld  Because chemotherapy delays have been shown to lead to worse outcomes, one of the foremost challengesfor health care systems during this crisis was maintaining uninterrupted care for patients with cancer  Methods: The Division of Hematology-Oncology at UCLA Health has 56 medical oncologists working at 17community practices  Using scheduling data stored within our electronic medical record, we defined three distinctperiods related to the intensity of precautions related to the COVID-19 pandemic in LA county;2/3/20-3/15/20 wasbefore stay-at-home orders were announced (baseline), 3/16/20-5/8/20 was during a period of the strict stay-at-home order, and 5/9/20-6/5/20 was during a period of reopening in the new COVID era  Results: In the baseline period, UCLA Health had an average of 4,555 total patient encounters per week, 0% ofwhich were telemedicine encounters (TE)  During the strict stay-at-home period, visits dropped to 3,728 per week(an 18% absolute decrease) and an average of 472 (13%) were TE each week  Since reopening was initiated, visitshave increased to an average of 4,433 patient encounters per week (97% of baseline), with 516 (14%) TE per week In the baseline period, UCLA Health had an average of 115 infusion cancellations per day with 51% being patientinitiated, 35% physician initiated, and 14% for other reasons (i e , patient hospitalizations, treatment plan changes, or deaths)  During the period of strict stay-at-home orders, cancellations increased from 115 to 133 per day (16%increase), with 47% being patient initiated, 41% being physician initiated, and 12% for other reasons  Sincereopening began, UCLA Health has had an average of 98 infusion cancellations per day with 47% being patientinitiated, 37% being physician initiated, and 16% for other reasons  Conclusion: The Covid-19 pandemic led to a significant decrease in patient encounter volume and an uptick inchemotherapy infusion cancellations  Future study will be needed to examine the effect of this on patient outcomes Compared to national statistics of changes in patient encounter volume, oncology fared better than most otherspecialties, particularly procedural specialties  Upon reopening, there appears to be a rapid return to baselinepatient encounter volumes and fewer chemotherapy cancellations per day  The pandemic appears to have spurredan increase in the use of telemedicine in medical oncology, previously not utilized by medical oncologists at UCLAHealth, as an important adaptation to maintain continuity of care  This trend has continued even after reopening Alternative visit models, such as telemedicine, hold promise for ensuring patient-centered continuity care in thiscritical patient population
Real-world patterns of chemotherapy and immunotherapy utilization at end of life in a large community oncology network.
Authors: Stephen Matthew Schleicher, Garrett Young, Edward Arrowsmith, Cheryl A. Prince, Lynn Kay Winters, Aaron J. Lyss, Christopher A. Waynick, Sandhya Mudumbi, Duncan Allen, Natalie R. Dickson, Lee S. Schwartzberg
Journal: Journal of Clinical Oncology (2020)

22 Background: End-of-life anti-neoplastic treatment does not improve quality of life nor prolong survival of advanced cancer patients. It is also not cost-effective. To-date, there has been little data examining real-world patterns of chemotherapy and immunotherapy treatment at end of life. We investigated use of chemotherapy and/or immunotherapy in the last 14 days of life across a community oncology network of 5 practices, 100 sites of care, and 160 oncology providers. Methods: Using a real-time, network-wide database, we identified patients with solid tumor malignancies who died during an episode of active treatment, defined as having received intravenous (IV) chemotherapy and/or immunotherapy within 90 days of death. We then identified patients in this cohort who received IV chemotherapy and/or IV immunotherapy within 14 days of death (TxEoL). We studied TxEoL patterns by cancer type, treatment type, line of therapy, patient age, patient race, and oncology provider years in practice. Statistical significance was assessed using Pearson’s Chi-squared test. Results: 2,858 qualifying solid tumor cancer patients with dates of death between 1/1/2019 and 5/31/2020 were identified. Observed rates of TxEoL were 16.7% for immunotherapy alone vs. 19.6% for chemotherapy +/- immunotherapy (p = 0.09). We found high variation in TxEoL across 132 oncologists that had 5 or more deceased patients (range: 0% to 50%, mean: 19.2%, median: 19.6%). We found no association of TxEOL with physician years in practice, patient age or race. Rates of TxEoL in the first-line setting were significantly higher than in second-line setting or later (23.3% versus 16.4%, p &lt; 0.01). Patients with head and neck, pancreatic, and hepatobiliary malignancies were the most likely to receive TxEoL, while patients with prostate, brain, and ovarian malignancies were the least likely to receive TxEoL. Conclusions: Our data and method identified wide variation in TxEoL patterns across a large community oncology network, suggesting room for provider-level interventions to improve treatment decisions in patients at high risk of death. Studies within our group, such as examining the impact of palliative care referrals on IV anti-cancer treatment in patients potentially facing end of life, are ongoing.
Comparative patient-centered outcomes (health state and adverse sexual symptoms) between adjuvant brachytherapy versus no adjuvant brachytherapy in early-stage endometrial cancer.
Authors: Shari Damast, Kaled M. Alektiar, Shari Beth Goldfarb, Naamit Kurshan Gerber, Anne Eaton, Sujata Patil, Jeffrey Mosenkis, Laura Sit, Lauren J. Rogak, Mario M. Leitao, Jeanne Carter, Ethan M. Basch
Journal: Journal of Clinical Oncology (2012)

9104 Background: We performed a cross-sectional analysis of survivors of stage I endometrial cancer (EC) to examine the relationship between receipt of adjuvant intra-vaginal radiation therapy (IVRT), health state (HS), and sexual functioning (SF). Methods: Survivors were administered anonymous questionnaires containing demographic and treatment-related items, the EQ5D to measure current HS, and the Female Sexual Function Index (FSFI) to measure current SF. All were disease-free and had undergone simple hysterectomy (SH) with or without adjuvant IVRT at least one year prior to questionnaire completion. None had received chemotherapy or hormonal therapy. The study was IRB-approved under a waiver of consent. The primary endpoint was a comparison of EQ5D-health states and FSFI scores between survivors who had received SH alone and those who had received SH and adjuvant IVRT. Fisher’s exact test was used to compare IVRT and no-IVRT groups and multivariate regression was applied to find associations between factors and the outcome measures. Results: 136 (66.3%) participants had undergone SH alone and 69 (33.7%) had undergone SH and adjuvant IVRT. The SH alone group was younger; otherwise, the two groups were balanced with respect to ethnicity, marital status, education level, medical co-morbidities (diabetes, hypertension, anxiety), type of SH (laparotomy vs minimally invasive surgery-MIS), and baseline sexual activity. In the IVRT and no-IVRT groups, the median EQ5D-health states were 88 (range 40-100) and 85 (range 10-100) respectively, and the median FSFI scores were 14.1 (range 1.2-35.4) and 16.5 (range 1.2-34.8) respectively. Controlling for age and type of SH, receipt of IVRT was associated with better HS (p=0.018) and not associated with poorer SF (p=0.1399). Receipt of laparotomy (vs MIS) was associated with poorer HS and worse SF (p=0.0156 and p=0.0115, respectively), and its detrimental effect on FSFI score was more pronounced in the IVRT compared to no-IVRT group (p=0.0486). Conclusions: Compared to SH alone, receipt of adjuvant IVRT was generally not associated with poorer SF or HS.
Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary Bypass Surgery
Authors: Mario Gaudino, Irbaz Hameed, Michael E. Farkouh, Mohamed Rahouma, Ajita Naik, N. Bryce Robinson, Yongle Ruan, Michelle Demetres, Giuseppe Biondi-Zoccai, Dominick J. Angiolillo, Emilia Bagiella, Mary E. Charlson, Umberto Benedetto, Marc Ruel, David P. Taggart, Leonard N. Girardi, Deepak L. Bhatt, Stephen E. Fremes
Journal: JAMA Internal Medicine (2020)

Mortality is a common outcome in trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG). Controversy exists regarding whether all-cause mortality or cardiac mortality is preferred as a study end point, because noncardiac mortality should be unrelated to the treatment.To evaluate the difference in all-cause and cause-specific mortality in randomized clinical trials (RCTs) comparing PCI with CABG for the treatment of patients with coronary artery disease.MEDLINE (1946 to the present), Embase (1974 to the present), and the Cochrane Library (1992 to the present) databases were searched on November 24, 2019. Reference lists of included articles were also searched, and additional studies were included if appropriate.Articles were considered for inclusion if they were in English, were RCTs comparing PCI with drug-eluting or bare-metal stents and CABG for the treatment of coronary artery disease, and reported mortality and/or cause-specific mortality. Trials of PCI involving angioplasty without stenting were excluded. For each included trial, the publication with the longest follow-up duration for each outcome was selected.For data extraction, all studies were reviewed by 2 independent investigators, and disagreements were resolved by a third investigator in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Data were pooled using fixed- and random-effects models.The primary outcomes were all-cause and cause-specific (cardiac vs noncardiac) mortality. Subgroup analyses were performed for PCI trials using drug-eluting vs bare-metal stents and for trials involving patients with left main disease.Twenty-three unique trials were included involving 13 620 unique patients (6829 undergoing PCI and 6791 undergoing CABG; men, 39.9%-99.0% of study populations; mean age range, 60.0-71.0 years). The weighted mean (SD) follow-up was 5.3 (3.6) years. Compared with CABG, PCI was associated with a higher rate of all-cause (incidence rate ratio, 1.17; 95% CI, 1.05-1.29) and cardiac (incidence rate ratio, 1.24; 95% CI, 1.05-1.45) mortality but also noncardiac mortality (incidence rate ratio, 1.19; 95% CI, 1.00-1.41).Percutaneous coronary intervention was associated with higher all-cause, cardiac, and noncardiac mortality compared with CABG at 5 years. The significantly higher noncardiac mortality associated with PCI suggests that even noncardiac deaths after PCI may be procedure related and supports the use of all-cause mortality as the end point for myocardial revascularization trials.
Offline: Reasons for hope
Authors: Richard Horton
Journal: The Lancet (2020)

Fatigue. Despair. Misery. Cracks are beginning to appear in our mental resilience. 10 months of this calamity. How much more can we bear? It was always so. When the Bishop of Winchester died of plague in 1626, John Milton issued a searing cry of anguish in his Elegia Tertia. The great poet was just 17 years old, "sad...with no companion, and many sorrows clung to my soul". He sought to commemorate this "grim killing" of a revered literary figure, a "dreadful death, fearsome with her sepulchral torch".