tbuckley/cabot-search huggingface dataset:
What factors influence older people’s intention to enrol in nursing homes? Across-sectional observational study in Shanghai, China
Authors: 罗梦云, 薛雅炯, 张舜行, 董媛媛, 莫丹丹, 董伟, 钱琨, 方越, 梁会刚, 张智若
Journal: BMJ (2019)

目的
上海市老年人对长期照护的需求不断增加，但养老院的入住率却很低，本研究尝试探索到底哪些因素会影响老年人入住养老院的意愿。


研究设计
本次研究基于理性行为理论开展了一项横断面调查，通过面对面访谈形式收集研究数据。采用结构方程模型进行数据分析。


研究地点
在上海市区、郊区和城乡结合部各挑选2家，共计6家社区卫生服务中心开展此次调查。


研究对象
共调查了641名60周岁以上的老年人。


结果
结构方程模型结果显示，研究模型和数据匹配良好（χ2/df=2.948, CFI=0.972, RMSEA=0.055）。态度（β=0.41，P<0.01）、主观规范（β=0.28，P<0.01）和增值服务（β=0.16，P<0.01）都与入住意愿直接相关，共解释了意愿32%的方差。孤独（β=-0.08，P<0.05）、自我效能（β=0.32, P<0.01）和羞耻感（β=-0.24，P<0.01）会影响态度，生活满意度（β=-0.15，P<0.01）和羞耻感（β=-0.43，P<0.01）会影响主观规范。


结论
本研究促进了有关老年人入住养老院意愿的影响因素的知识。研究发现中国老年人的羞耻感对他们入住养老院的意图具有最强的间接作用，这是中国背景下特有的现象，对中国和其他具有类似社会文化背景的亚洲国家的老年人护理具有实际意义。
阿尔茨海默病的社区照料策略
Authors: 魏镜
Journal: BMJ (2006)

本人从事阿尔茨海默病(AD)的临床、研究和教学工作16年余,在对患者进行评估、诊断、治疗、护理指导和家属教育的过程中深有感触.在赴美国访问期间,我有幸与美国东麻省阿尔茨海默协会(Alzheimer's Association of Eastern Massachusetts)家庭照料与支持部主任Paul A Raia博士一起工作了近两年。
Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study
Authors: Gurdeep S Mannu, Zhe Wang, John Broggio, Jackie Charman, Shan Cheung, Olive Kearins, David Dodwell, Sarah C Darby
Journal: BMJ (2020)

Abstract Objective To evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening. Design Population based observational cohort study. Setting Data from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service. Participants All 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014. Main outcome measures Incident invasive breast cancer and death from breast cancer. Results By December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer. Conclusions To date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.
A prospective cohort study of stability in preference for place of death among patients with stage IV cancer.
Authors: Ling En Koh, Chetna Malhotra, Eric Finkelstein
Journal: Journal of Clinical Oncology (2020)

e24148 Background: Advanced care planning (ACP) involves discussion and documentation of patients’ care preferences including their preference for place of death. This process assumes that patients’ preference will not change over time; yet evidence for this is inconclusive. The primary aim of this study was to test whether patient preference for place of death changes over time and to identify factors associated with this change. We also assessed whether patients who do not change their preference for place of death during the study duration have greater congruence between actual and baseline preference for place of death. Methods: As part of an ongoing cohort study, we surveyed 466 advanced cancer patients every 6 months in Singapore for a period of two years. We asked patients their preference for place of death (home/ institution/ unclear). We assessed proportion of patients who changed their preference from baseline and at every time point. We ran univariable and multivariable multinomial logistic regression models to assess the association between change in preference for place of death and patient socio-demographics (gender, race, education, housing, marital status) as well as time varying variables (quality of life (Functional Assessment of Cancer Therapy- General), pain severity (Brief Pain Inventory), psychological distress (Hospital Anxiety and Depression Scale), any intervening hospitalization). We used a logistic regression model to assess if no change in preference during the study period was associated with congruence between actual and baseline preference for place of death. Results: More than a quarter of patients changed their preference for place of death every 6 months with 55% changing their preference at least once within 2 years. There was no clear trend in direction of change in preference. Patients who were psychologically distressed at the time of survey had a greater relative risk of changing their preferred place of death to home (Relative Risk Ratio (RRR) 1.81; 95% Confidence Interval (CI): 1.16-2.82) and to institution (RRR 2.00; 95% CI: 1.17-3.42) relative to no change in preference. Having no change in preference for place of death during the study period was not associated with congruence between actual and baseline preference for place of death. Conclusions: The study provides evidence of instability in advanced cancer patients’ preference for place of death. It calls into question the validity of patient preference for place of death recorded on ACP documents and suggests that we should regularly re-evaluate these documents.
Assessing the effect of immunosuppressive agents for immune-related adverse event management on tumor response.
Authors: Pankti Reid, Daniel Olson, Thomas Gajewski
Journal: Journal of Clinical Oncology (2020)

3066 Background: High grade immune-related adverse events (irAEs) to cancer immune checkpoint inhibitors (ICI) require considerable immunosuppression (IS) with high-dose steroids and steroid-sparing IS (SSIS) for steroid-dependent cases. T lymphocyte-specific IS has generally been avoided or used with significant caution due to the fear that these agents may negatively impact ICI efficacy. We sought to determine whether T cell-specific IS agents, such as calcineurin inhibitors (CNIs), have an adverse effect on tumor control when compared to other immunomodulatory drugs (IMDs). Methods: We retrospectively analyzed clinical annotations of adult patients treated with ICIs for malignancy from 1/1/2000-12/31/2019, highlighting patients who were managed with SSIS, specifically those most commonly used for autoimmune disease therapy. Topical IS use was excluded. Patients were categorized as tumor responders or non-responders, and irAEs were graded according to National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE). Progression-free survival (PFS) was assessed via Kaplan-Meier curve. Results: 1331 unique individuals were prescribed ≥1 ICIs, with 526 prescribed systemic steroids (39.5%) and 90 (6.8%) patients prescribed SSIS agents, 25 patients with &gt;1 SSIS: mycophenolate (39), methotrexate (26), leflunomide (5), azathioprine (3), rituximab (24), tocilizumab (3), infliximab (8), etanercept (1), adalimumab (1), golimumab (1) and CNIs (18): cyclosporine, tacrolimus. IMDs hydroxychloroquine (6) and sulfasalazine (5) were also prescribed. The objective response rate was 50.0% in the CNI group compared to 45.5% in the IMD cohort and 45.4% in the irAE group (CTCAE grade matched) with steroids alone without any SSIS. Median PFS were compared between CNI cohort (5.4 months, range 1.3-34 months) to IMD (1.1 months, range 0.4-6.4, p=0.02) and steroid alone (2.4 months, range 0.69-17.7, p=0.48). Multiple regression analysis identified irAE presence as an independent correlates to tumor response (p=0.02). Conclusions: T cell-specific IS should not be excluded from irAE treatment algorithm as we observed that PFS was comparable to immunomodulators and similar efficacy was observed compared to steroids alone. Rapid identification and management of irAEs can help mitigate morbidity but there are virtually no reliable clinical trials to guide irAE management with SSIS. These findings support the need for larger, prospective evaluation of immunosuppression use for high grade irAE therapy.
Tanning bed exposure in association with multiple primary melanoma.
Authors: Lilit Karapetyan, Xi Yang, Hong Wang, Arivarasan Karunamurthy, Cindy Sander, Ashley Moyer, Melissa Wilson, John M. Kirkwood
Journal: Journal of Clinical Oncology (2020)

e22107 Background: Patients with primary cutaneous melanoma are at increased risk of subsequent new primary melanoma. Indoor tanning is a risk factor for melanoma. The primary objective of this study was to determine the association between indoor tanning and multiple primary melanoma (MPM). The secondary objective was to compare clinical and pathological characteristics of primary and secondary malignant melanoma. Methods: This retrospective case-control study of MPM and gender-matched controls with single primary melanoma retrieved at 2:1 ratio from the University of Pittsburgh Cancer Institute Melanoma Center Biological Sample and Nevus Bank from January 1996 through October 2019. Logistic regression models were used to examine the association between MPM and risk factors. Results: In total, 330 patients (39.1% men; median [SD] age, 51 [15] years) were enrolled, including 110 with single and 220 with MPM. Median time between diagnosis of first and second primary melanoma was 13 months. 22.7% of patients with MPM had 3 or more primary melanomas. Compared with patients who had a single primary melanoma, patients with multiple melanomas were younger at diagnosis of first melanoma (median age 46 vs 52, p = 0.006), more likely to be discovered at Stage 0 and 1 (68% vs 49%, p &lt; 0.0001), and to have had indoor tanning exposure (34% vs 10%, p &lt; 0.0001), family history of melanoma (18% vs 8%, p = 0.0045), atypical moles (37% vs 13%, p &lt; 0.0001), dysplastic nevi (21% vs 5%, p &lt; 0.0001), and Breslow thickness of less than 1 mm (61% vs 33%, p &lt; 0.0001). Compared with the patient’s first melanoma, subsequent melanomas were more likely to be thinner (0.6mm vs 1.2mm, p = 0.0007) or in situ (24% vs 13%, p = 0.0004). The estimated probability of locus that was the same for first and second primary melanomas was 34% with (95% CI 25%, 44%). The most common location for second primary melanoma was upper extremity (34%). In univariate analysis, lifetime tanning bed exposure of &gt; 10 sessions was associated with an increased risk of second primary melanoma OR 4.60 [95% CI, 2.52-8.42, p &lt; 0.0001]. In multivariate analysis after adjusting for age, family history of melanoma, presence of atypical and dysplastic nevi, recreational sun exposure, indoor tanning remained significantly associated with MPM (OR 4.32 [95% CI, 1.54-12.15, p = 0.0026]). Conclusions: Indoor tanning for &gt; 10 sessions is associated with increased risk of second primary melanoma. Subsequent melanomas are more likely to be thin or in situ, and to occur in different anatomic locations.
三级医院相关人员对全科医学与社区卫生服务的认知情况调查
Authors: 刘冬莹
Journal: BMJ (2005)

为了解三级医院卫生技术人员、管理人员对全科医学与社区卫生服务的认知度,对151名相关人员进行了相应的调查.结果显示,调查对象对相关内容的知晓度低、参与度低,但已经开始关注和了解全科医学;大部分卫生技术人员感兴趣,愿意参与相关工作。
Patient preferences and expectations of systemic therapy in renal cell carcinoma.
Authors: Dena Battle, Cristiane Decat Bergerot, Pavlos Msaouel, Eric Jonasch, Tian Zhang, Daniel J. George, Michael D. Staehler
Journal: Journal of Clinical Oncology (2020)

5083 Background: In metastatic renal cell carcinoma, the systemic therapy landscape has expanded to include multiple VEGF inhibitors, immunotherapies, and combination therapy. Little is known about patient expectations and preferences when making decisions about systemic therapy. We sought to gather independent data from online kidney cancer patient communities to assess patient perspectives on what matters most when considering treatment options. Methods: The KCCure online survey was performed between August 1, and September 30, 2019. Patients were recruited via the KCCure website, social media channels (Twitter, Facebook) and through fliers distributed at cancer centers. Those who agreed to participate were surveyed for demographics (age, gender, race, income, country) and clinical characteristics (date of the diagnosis, disease stage, treatment history). Key questions focused on treatment selection and side effect management. Results: Out of 1,136 patients responding, 411 patients were on systemic therapy with a median age of 57 years (range 28-86). 223 (54%) of patients on systemic therapy were male. Patients were primarily from the U.S. (83%). Median duration on therapy was 24.7+/- 1.9 months. When asked to select the most important outcome for treatment selection, 58.8 % of patients chose complete response, followed by tumor control (10.2%), low risk of toxicity (5.7%) and the chance to discontinue therapy (3.7%). Patients ranked cost as the least important factor in selecting treatment (2.9%). 10.9% preferred infusion therapy and 42.1% oral therapy, whereas 47% were indifferent about the route of administration. Even if it would be safe to discontinue therapy, 62.8% of patients would be anxious about cancer progression. 23.2% would rather stay on treatment and 39.3% would want increased scanning intervals. Only 34.4% of patients would look forward to having more time off therapy. When asked to define treatment success, 86.3% selected reduction in tumor size, followed by stable disease (71.7%), freedom from symptoms (35.1%) and better quality of life (47.7%). Conclusions: Patients rank efficacy as the most important outcome when considering treatment options. Toxicity, time off therapy and cost are not significant priorities for patients. Further data is warranted investigating the impact of communicating treatment options, potential discontinuation of therapy and resulting expectations.
Results of the randomized phase II study of sipuleucel-T (Sip-T) +/- Radium-223 (Ra-223) in men with bone-metastatic castration resistant prostate cancer.
Authors: Catherine Handy Marshall, Jong Chul Park, Wei Fu, Hao Wang, Theodore L. DeWeese, Serina King, Michaella Afful, Julia Hurrelbrink, Charlotte Manogue, Patrick Cotogno, Nancy P. Moldawer, Pedro C. Barata, Charles G. Drake, Edwin Melencio Posadas, Andrew J. Armstrong, A. Oliver Sartor, Emmanuel S. Antonarakis
Journal: Journal of Clinical Oncology (2020)

5563 Background: It has been suggested that immune modulation can be augmented by radiation, possibly by enhancing tumor-antigen display. SipT-induced antigen-specific immune responses in mCRPC patients correlate with survival. We hypothesized that the combination of Ra223 and SipT would enhance SipT-related immune response and improve outcomes compared to SipT alone. Methods: Patients with asymptomatic, bone-predominant mCRPC, without visceral mets &gt;1.0 cm, were randomized (1:1) to SipT alone or with 6 doses of Ra223 (NCT02463799). Men in the SipT+Ra223 arm started SipT between the 2 nd and 3 rd dose of Ra223. The primary immunologic endpoint was PA2024-specific T-cell proliferation 6 wks after the first SipT infusion. Secondary immune endpoints were PA2024-specific ELISPOT response, PAP-specific proliferation and ELISPOT, humoral responses against both antigens, and antigen spread. Clinical endpoints were radiographic PFS, PSA response (≥50% decline), AlkPhos response (≥30% decline), and safety. Results: 32 men were randomized, 16 per arm. Baseline characteristics in SipT+Ra223 and SipT arms were similar: age (median 71 vs. 70 yrs), Gleason (8-10: 69% vs. 69%), baseline PSA (med 25 vs. 33 ng/mL), AlkPhos (med 89 vs. 92 U/L) and ECOG score (≥1: 31% vs. 19%). There was no significant difference in prior use of abi/enza (38% vs. 44%), or chemo (0% vs. 25%). At 6 weeks, absolute PA2024-specific T-cell proliferation was 2.1-fold higher in the Sip-T arm compared to the SipT+Ra223 arm (35.6 vs. 16.6; P=0.03) and remained higher through week 26. Relative to baseline, the 6-week PA2024-specific T-cell proliferation change was 3.6 times greater in the Sip-T arm compared to the SipT+Ra223 arm ( P=0.007) and remained higher through week 14. There were no significant differences in antigen spread or humoral responses. Median radiographic PFS was longer in the SipT+Ra223 arm (9.3 vs. 3.2 months; HR 0.26, 95% CI 0.11–0.61; P=0.007). PSA and AlkPhos responses were better in the SipT+Ra223 arm (PSA50: 5/15=33% vs. 0/14=0%; P=0.04; AlkPhos30: 9/15=60% vs. 1/15=7%; P=0.01). There was no difference in SREs (13% vs. 7%). Conclusions: SipT+Ra223 was associated with improved clinical outcomes and a higher rate of PSA responses compared to SipT alone, although surprisingly, the SipT arm demonstrated higher peripheral PA2024-specific T-cell proliferation. Since neither agent reliably induces PSA responses alone, these data suggest a synergistic effect of the combination. Larger randomized studies of this combination are planned. Clinical trial information: NCT02463799 .
Immunomagnetic separation in LAK generation in patients with breast cancer.
Authors: Tatiana V. Shamova, Oleg I. Kit, Anastasia O. Sitkovskaya, Elena Yu. Zlatnik, Elena S. Bondarenko, Inna A. Novikova, Larisa N. Vashchenko, Emma E. Kechedzhieva, Irina R. Dashkova, Tatiana V. Ausheva, Elena Andreiko, Natalya S. Saforyan, Liubov Yu Vladimirova, Aleksandr E. Lisutin
Journal: Journal of Clinical Oncology (2020)

e15220 Background: The purpose of the study was to evaluate the effect of IL-2 and INF-γ on the proliferation and phenotype of lymphocytes in patients with breast cancer (BC) after T-regs removal from the pool in vitro. Methods: Lymphocytes were isolated from the blood of 11 patients with stage II BC, T-regs were removed by immunomagnetic separation, and samples were cultured for 6 days with cytokines: IL-2 - 0.1/1 μg, INF-γ - 10 IU and their combinations. Results: The level of NK cells in the samples with IL-2 was maintained throughout the experiment, with IFN-γ - gradually decreased, and in the control (samples without stimulation) it decreased sharply. In experimental samples (IL-2, IL-2+IFN-γ), the amount of NKT remained at the initial level by day 6, and in the control it decreased by 2 times (p &lt; 0.05). The number of CD335+ NK cells with high cytotoxicity against target cells increased after 3 days in the test samples with IL-2 by 5.2 times, and after 6 days - by 11.6 times in comparison with the control (p &lt; 0.05). On day 6, the level of double-positive T cells increased by 1.8 times in co-culturing with IL-2+INF-γ (1 μg/10 IU), (p &lt; 0.05). The percentage of double-negative T cells increased in the dynamics of cultivation from days 1 to 6, in some cases statistically significantly (IL-2 - 1 μg: by 2 times; IL-2+INF-γ - 0.1 μg/10 IU: by 1.8 times; p &lt; 0.05). The percentage of CD4+CD38+ cells on day 6 of incubation with IL-2 at both doses increased by 1.8-2 times compared with the control, and CD8+CD38+ by 4-6 times. The percentage of CD4+HLA-DR+ cells after 6 days of cultivation with IL-2 increased by 6 times, and CD8+HLA-DR+ by 8-9 times. Cultivation with INF-γ reduced the stimulating effect, and in some cases it did not appear. The combined effect of IL-2 and INF-γ on day 6 led to an increase in the proportion of CD4+CD25+CD127dim cells by 1.8 times in comparison with the control (p &lt; 0.05), and when exposed to INF-γ only, the number of these cells remained at the control levels. Conclusions: INF-γ is not an effective inducer of activation of immune effector cells, while the effect of IL-2, both alone and in combination with INF-γ, leads to a significant increase in the proportion of cytotoxic cells, as well as to activation of the T cell unit, including CD4 + CD25 + CD127dim.
TRACC: Tracking mutations in cell-free DNA to predict relapse in early colorectal cancer—A randomized study of circulating tumour DNA (ctDNA) guided adjuvant chemotherapy versus standard of care chemotherapy after curative surgery in patients with high risk stage II or stage III colorectal cancer (CRC).
Authors: Gayathri Anandappa, Naureen Starling, Clare Peckitt, Annette Bryant, Ruwaida Begum, Paul Carter, Shelby Hatt, Shelize Sadrudin Khakoo, Andrea Turner, Shannon Kidd, Julie Duncan, Laura Hobbis, Kyriaki Giorgakoudi, Michaela Smalley, David Lowery, Pete Wheatstone, Ian Chau, Michael Hubank, David Cunningham
Journal: Journal of Clinical Oncology (2020)

TPS4120 Background: Adjuvant chemotherapy (ACT) is routinely offered to patients with high risk (HR) stage II or stage III CRC following potentially curative surgery. Over 50% of stage III and &gt; 80% of stage II patients are cured by surgery alone but are being exposed to unnecessary chemotherapy with short- and long-term side effects. Post-operative ctDNA identifies minimal residual disease (MRD) after surgery in CRC. Our national study, TRACC, compares ctDNA guided versus standard of care (SoC) decision making in patients undergoing ACT. Methods: This is a UK-wide, multi-centre, prospective, two-arm, randomised trial. Patients with HR risk stage II or stage III CRC who have undergone R0 resection and have detectable ctDNA in their pre-surgical sample are eligible. Patients who undergo neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer with detectable ctDNA pre-CRT are also eligible. Patients are randomised in a 1:1 ratio to receive either SoC ACT or ctDNA guided ACT. In the ctDNA guided arm, patients who are ctDNA negative post-operatively have chemotherapy de-escalated i.e., 3 months(m) of Capecitabine and Oxaliplatin (CAPOX) doublet ACT is reduced to 3 m single agent Capecitabine; 6 m single agent Capecitabine reduced to no chemotherapy. In this group, ctDNA is re-tested at 3 months and if detectable, patients receive 3 months of CAPOX. Primary end-point is 3-year disease free survival (DFS). Secondary end-points include overall survival, neurotoxicity, quality of life and health economics. Based on a standard 3-year DFS of 75% in SoC ACT arm, to demonstrate a non-inferiority margin of 1.25, 810 patients are required per arm (85% power, α = 0.1). Stratification is by tumour staging and site of primary tumour. Target accrual is over 4 years. The study opened to recruitment in January 2020 and is supported by the MRC-NIHR Efficacy and Mechanism Evaluation Grant ( NIHR128529 ). Clinical trial information: NCT04050345 .