tbuckley/cabot-search huggingface dataset:
ARIX: A randomized trial of acupuncture versus oral care sessions in patients with chronic radiation-induced xerostomia following treatment for head and neck cancer.
Authors: Richard Simcock, Lesley Fallowfield, Kathryn Monson, Ivonne Solis-Trapala, Louise Parlour, Carolyn I Langridge, Valerie A Jenkins
Journal: Journal of Clinical Oncology (2012)

5527 Background: Radiation induced xerostomia impairs quality of life of in head and neck cancer survivors. Prior small non-randomised studies suggest that acupuncture may alleviate symptoms. We report the first large randomised trial comparing 8 weeks of group acupuncture with oral care sessions as a control. Methods: 145 patients with radiation induced xerostomia&gt;18 months were recruited from 7 UK Cancer centres. Subjects received standardised group sessions of oral care (OC) education and 8 sessions of weekly group acupuncture (A) in a randomised crossover design with a 4 week washout (Group One OC/A and Group Two A/OC). Acupuncture was standardised to a technique previously piloted (3 auricular points and two distal points bilaterally). Patients completed the EORTC QLQ H&amp;N questionnaire at baseline and weeks 5, 9, 13, 17 and 21 in addition to rating 4 key dry mouth symptoms. The primary outcome was patient reported improvement in dry mouth symptoms. The statistical analysis was longitudinal based on logistic regression models and adjustment for potential carry over. Stimulated and unstimulated saliva was measured. Results: An improvement for 5/7 symptoms was noted following acupuncture. In Group One 24% showed improvement 8 weeks following A (19% after OC). In Group Two 26% reported improvement in severe dry mouth after A (14% after OC). The estimated OR of improved dry mouth 5 weeks after A compared to OC was 2.0 (p=0.031), after adjusting for effects of time, potential carry-over, centre and patient characteristics. The estimated odds ratios of improvement in severity of symptoms for A compared to OC were (OR=1.67, p=0.048) for sticky saliva, (OR=2.08, p=0.011) for needing to sip to swallow food and (OR=1.71, p=0.013) for waking up at night needing to drink. Mean attendance rate for A was 89% and 80% for OC. There was no significant change in saliva production over time or by intervention. Mean global QoL score did not change significantly over time either within or between groups. No adverse events were seen. Conclusions: Eight sessions of weekly group acupuncture provides significantly better relief of radiation induced xerostomia than group oral care education.
John Kenneth Roberts
Authors: David Williams
Journal: BMJ (2019)

John Kenneth Roberts (“Ken”) was born in a humble terraced house in Holyhead. His father was on the footplate of the LMS locomotives, including the Irish Mail. At the Victoria Terrace practice as a small boy he would stand trembling at the corner of Dr Ted Hughes’s desk. Hughes was a legendary character, who performed many operations at the local cottage hospital, and young Ken wanted to be a doctor like him. Advancing through local primary and grammar schools he was fortunate to gain a postwar state scholarship taking him to Manchester, covering all expenses. In 1958 he married Margaret, also from Holyhead, whom he met when she was 16. His first house post was in orthopaedics …
Tailored surgical staging and radiation therapy in clinical stage I endometrioid endometrial adenocarcinoma (EEA)
Authors: K. M. Bermudez Wagner, M. B. Thomas, C. Miyamoto, B. Micaily, E. Hernandez
Journal: Journal of Clinical Oncology (2009)

e16511 Background: Pelvic lymph node dissection (LND) requirement to adequately stage endometrial cancer has been subject of debate. We conducted an outcome analysis of clinical stage I endometrioid endometrial adenocarcinoma (EEA) patients who underwent surgery with tailored LND and adjuvant therapy (radiation (RT) or chemotherapy) between 1997 and 2008. Methods: Retrospective chart review was performed at our institution. All patients underwent exploratory laparotomy, cytology, total abdominal hysterectomy and bilateral salpingoophorectomy. Pelvic and para-aortic LND was perforned in high-risk patients when technically possible. Cox proportional hazards and the Kaplan Meier method were used for data analysis. Results: 119 patients (stage I 92, II 11, III 15, and IV 1) were identified. Median BMI was 34 and 81% had significant co-morbidities. 50% underwent para-aortic LND (median 4 nodes) and 25% underwent pelvic LND (median 15 nodes), of whom 8% and 10% were positive, respectively. Postoperative complications occurred in 22%. 26% received RT. With a mean follow-up of 20 months, 5-year progression-free survival (PFS) and overall survival (OS) was 71% and 84%. The OS for stage I and IIIC was 88% and 83%, respectively. OS for patients with or without LND was not statistically different ( 73% vs.82%). 12 (10%) recurrences were noted, 8 of which were hematological (HF) with a 5-year HF probability of 21%. On multivariate analysis only myometrial invasion &gt; 50% was independent risk factor for HF. Patients receiving RT showed a trend toward decreased in local recurrences ( 0% vs.30% p = 0.1) but no improvement in OS. Conclusions: In patients with EEA, a tailored approach to LND and adjuvant therapy results in good outcome, but many still have therapy-associated adverse events. Although no difference was found in OS between patients who underwent LND and those who did not, similar survival for patients with stages I and IIIC suggests that therapy directed by the knowledge of nodal status may have an impact on survival. No significant financial relationships to disclose.
Assessing low mood during pregnancy
Authors: Natalie Kirby, Anna Kilsby, Ruth Walker
Journal: BMJ (2019)

### What you need to know

A woman who is 16 weeks pregnant with her second child presents to her general practitioner feeling tired. She is initially reluctant to discuss her mental health but, on further exploration, describes feeling irritable, tearful, and anxious for the past few weeks. 

Depression in the perinatal period is common. It affects some 12% of women antenatally and up to 20% of women during the first postnatal year.123 Reluctance to disclose symptoms, perceived stigma, and diagnostic uncertainty are among the challenges facing healthcare professional trying to identify and help women with antenatal depression. As a result, pregnant women are less likely than non-pregnant women to be diagnosed with depression, and less than half of those diagnosed receive appropriate treatment.45

In this article we outline an initial assessment of a woman presenting with low mood in pregnancy, based on current guidelines, evidence, and our own clinical experience.

Consider any symptom as part of the broader clinical picture. Symptoms that are more pervasive, have lasted longer than two weeks, and are significantly affecting a woman’s ability to function and carry out her usual activities are more suggestive of depression.

Symptoms of depression —Minor or transient fluctuations in mood are common during pregnancy and do not necessarily indicate depression. However, significant experiences of mood fluctuations, fatigue, changes in appetite, and sleep disturbance should be carefully explored and not immediately minimised as normal experiences of pregnancy. Many of the …
A phase I/II study of bevacizumab (beva), erlotinib (erl), and 5-fluorouracil (5-FU) with concurrent external beam radiation therapy (RT) in locally advanced rectal cancer (LARC)
Authors: L. S. Blaszkowsky, T. S. Hong, A. X. Zhu, E. L. Kwak, H. J. Mamon, P. C. Shellito, J. C. Cusack, D. Berger, K. Horgan, D. P. Ryan
Journal: Journal of Clinical Oncology (2009)

4106 Background: The German Rectal Cancer Study Group established neoadjuvant therapy as a standard of care in patients with T3/T4 rectal cancer. Beva, a vascular endothelial growth factor (VEGF) inhibitor with demonstrated activity in colorectal cancer, and erl, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor may both serve as radiation sensitizers. Methods: Twenty one pts with LARC, defined as T3 or T4 disease by MRI or endorectal ultrasound, were enrolled from May 2006-December 2008. Pts had adequate hepatic, renal and hematopoietic function, and an ECOG performance status of ≤2. Treatment consisted of 5-FU 225 mg/M2/day by continuous infusion for the duration of radiation (50.4 Gy). Beva 5 mg/kg was administered on days 1, 15 and 29. The first cohort received erl 50 mg, the second cohort 100 mg, and third cohort 150 mg daily until completion of radiation. Pts underwent surgery 6–9 weeks following the radiation. The primary endpoints were determination of the maximally tolerated dose (MTD) and pathologic complete response (pCR). Secondary endpoints included toxicity (TOX), local control (LC), progression free survival and median survival. A total of 25 pts will be treated at the MTD. Results: Twenty-one pts began study therapy: 2 withdrew consent prior to completing study therapy, and 2 pts were removed prior to completion for clostridium difficile colitis and cardiac ischemia. No dose limiting toxicities were achieved. Erl 100 mg was chosen as the MTD. Two pts have not yet completed study treatment. Fifteen pts have completed study therapy and have undergone surgery, of whom 7 (47%) have demonstrated a pCR. At a median follow-up of 7 months, there have been no local recurrences in patients who completed study therapy. Grade 3–4 treatment related TOX included: lymphopenia 6 (59%), diarrhea 4 (24%), rash 2(12%), cardiac ischemia 1(6%), transaminitis 1(6%), mucositis 1(6%). One pt developed an anastomotic leak. Conclusions: Beva and erl in combination with infusional 5-FU and RT appears to be a highly active preoperative regimen for locally advanced rectal cancer. [Table: see text]
The impact of medical comorbidities on the quality of care for patients with head and neck cancer.
Authors: Brenda Ernst, Mary T Busowski, Randal S. Weber, Thomas D. Shellenberger
Journal: Journal of Clinical Oncology (2012)

e16030 Background: Objectively assessing the treatment of patients with cancer offers a basis for raising the standard of care. Quality indicators provide criteria by which the safety of care can be measured and compared to defined benchmarks. However, variables influencing the metrics in quality can limit generalizability and applicability. Medical comorbidities pose significant threats to the care of patients with head and neck cancer. We sought to investigate the impact of medical comorbidities on quality indicators for patients undergoing management by the multidisciplinary team. Methods: Comorbidities were assessed in relation to quality indicators in 49 patients treated for squamous cell carcinoma of the head and neck over a 16-month period. Treatment with surgery, radiation, and chemotherapy was classified by the number and type of modalities delivered. Surgical procedures were stratified by high and low acuity as defined by extent. By univariate and multivariate analysis, medical comorbidities were correlated with length of hospital stay, readmission within 30 days, return to the operating room within 7 days, 30-day mortality, use of blood products, and surgical site infection. Results: Cardiovascular disease was present in 49% of patients, diabetes mellitus in 12%, liver disease in 8%, previous congestive heart failure in 4%, and chronic obstructive pulmonary disease in 17%. The presence of any single comorbidity was correlated with each of the negative indicators (p&lt;0.05), and with multiple negative indicators (p&lt;0.05). Comorbidities occurred more frequently in patients undergoing high acuity surgery (p&lt;0.05) and combined modality therapy (p&lt;0.05). Decreasing performance status and major clinical predictors were the factors most strongly associated with negative quality indicators. Conclusions: Approaches to adjust for comorbid status are critical to accurate assessment of quality indicators. Risk stratification of patients at initial evaluation can offer valuable criteria for selecting treatment. Evaluation and management of comorbidities by evidence-based guidelines may improve care.
The inflammation based index (IBI) predicts survival advantage after transarterial chemoembolization in hepatocellular carcinoma.
Authors: Delali Akosua Adjogatse, George Karamanakos, David James Pinato, Rohini Sharma
Journal: Journal of Clinical Oncology (2013)

e15101 Background: Transarterial chemoembolization (TACE) is a standard treatment for unresectable, intermediate stage hepatocellular carcinoma (HCC). Survival after TACE, however, can be highly variable, with no suitable biomarker predicting for therapeutic outcome. The inflammation based index (IBI) has previously been shown to independently predict overall survival in all stages of HCC. This retrospective study explored the prognostic ability of the IBI as a predictor of survival after TACE. Methods: Sixty three eligible patients who had undergone TACE for intermediate stage HCC were selected. The IBI was calculated using serum albumin and CRP levels as previously described; giving a score of 0-2, equating to low, intermediate and high risk respectively. Survival was calculated from the date of TACE to date of death. Dynamic changes in the IBI before and after TACE were studied as predictors of survival using both a univariate and multivariate Cox regression model. Results: Patients with a normal IBI prior to TACE had a significant improvement in survival in comparison to those with an intermediate or high-risk score (p=0.02). Other predictors of survival on univariate analysis were radiological response to TACE (p&lt;0.001), pre-TACE CLIP score (p&lt;0.01), initial tumour diameter &gt;5 cm (p=0.049) and AFP &gt; 400 (p&lt;0.001). On multivariate analysis; normalisation of IBI post TACE was associated with improved overall survival, compared to patients showing a persistently abnormal index (p&lt;0.001; HR 5.5, 95% CI 1.9 – 16.5). Conclusions: Normalisation of IBI after TACE is shown to be an independent predictor of survival. Patients with a persistently raised IBI following TACE have a worse survival outcome. As a simple and accessible stratifying biomarker, IBI aides the identification of patients with a significant survival advantage following TACE.
NSCLC driver mutations in the Quebec population: Epidemiologic and clinical evaluation.
Authors: Wissam Saliba, Mustapha Ali Tehfe, Roula Albadine, Danh Tran-Thanh, Denis Soulieres, Isabelle Gorska, Xiaoduan Weng, Boli Fan, Marie Florescu, Marie-Lise Audet, Francois Gougeon, Normand Blais
Journal: Journal of Clinical Oncology (2013)

e22159 Background: Recent advances in lung cancer treatment embrace the recognition of molecular pathways implicated in its pathogenicity, paving the path to personalized therapies. We conducted a retrospective analysis to characterize the molecular features of the population treated for non-squamous non-small cell lung cancer (NS-NSCLC) in the province of Quebec. Methods: 622 patients with NS-NSCLC and adequate tumor blocks, treated at the CHUM between 2006 and 2008, were included. All samples were tested for ALK translocations (by IHC and FISH), EGFR classical exon 19 and 21 mutations by PCR (fragment analysis and qPCR) and for KRAS codon 12 and 13 mutations by mismatch PCR-RFLP. Molecular features were matched to demographic characteristics and clinical outcomes. Results: So far, complete results are available for 153 patients. Considering the amount of tumor tissue available, this population is largely represented by patients with local or loco-regional disease (n= 140, 91.5%). A minority of patients (10.3%) was never or light smokers (&lt; 10 pack-yrs). Only 2 patients (1.3%) were of Asian descent. The following table depicts the outcomes of this cohort of patients segregated according to mutation status and extent of disease. Conclusions: ALK rearrangements were not identified in this unselected NS-NSCLC population characterized by localized disease and strong smoking history. ALK translocation prevalence in different populations is likely to be largely influenced by its tumor stage distribution, tobacco exposure and the use of selection criteria for molecular testing. An expanded cohort of patients will be presented at the meeting. [Table: see text]
Association of increases in quality of care with the NCI Community Cancer Center Program (NCCCP) pilot.
Authors: Michael T. Halpern, Pamela Spain, Debra J. Holden, Andrew Stewart, Erica J. McNamara, E. Greer Gay, Steven B. Clauser, Irene Prabhu Das
Journal: Journal of Clinical Oncology (2012)

6046 Background: The NCCCP pilot is an initiative designed to enhance research and improve cancer care at community hospitals. As part of a multi-method evaluation of this pilot, we assessed changes in quality of care among the 16 pilot NCCCP hospitals over time (before vs. after program initiation) and in comparison to a group of 25 similar hospitals that did not participate in the NCCCP. Methods: We compared changes in 5 NQF-approved quality of care measures (3 for breast cancer, 2 for colon cancer) from 2006/07 (before NCCCP initiation) vs. 2008/09/10 (post-initiation) for NCCCP and comparison group hospitals. Data were collected from all study hospitals using the Commission on Cancer’s Rapid Quality Reporting System, which allowed near real-time tracking of quality of care process measures. Results: Analyses included 18,608 breast cancer and 7,031 colon cancer patients. Patient-level concordance rates for all 5 quality of care measures increased significantly among both NCCCP and comparison group hospitals. The change (from baseline to post-NCCCP) in quality of care among NCCCP hospitals was significantly greater than the change among comparison group hospitals for two measures: radiation therapy following breast conserving surgery (RT-BCS) and hormonal therapy for women with hormone receptor positive breast cancer (HT). For the RT-BCS measure, NCCCP patients from underserved populations also experienced significantly greater changes in concordance than did corresponding populations from comparison group hospitals. In multivariate regression analyses controlling for patient characteristics, the change for the HT measure among NCCCP hospitals was significantly greater than that among comparison group hospitals. Conclusions: While both NCCCP and comparison group hospitals showed improved quality of care, participation in the NCCCP was associated with significantly greater improvements for a subset of measures. Including a separate comparison hospital group was critical for assessing changes associated with NCCCP participation while controlling for broader U.S. trends in improved quality of care. Future work will examine how hospital networks may have facilitated improvements in quality of care.
Assessment of multimodality therapy use for extremity sarcoma in the United States.
Authors: Karen L. Sherman, Jeffrey D. Wayne, Mark Agulnik, David J. Bentrem, Karl Y. Bilimoria
Journal: Journal of Clinical Oncology (2013)

10559 Background: National guidelines for extremity sarcoma recommend multidisciplinary consultation, but treatment approaches are not standardized. Our objectives were to (1) examine trends in the multimodality treatment of extremity sarcoma in the US, (2) examine adjuvant therapy practice patterns, and (3) identify factors associated with the use and sequencing of adjuvant treatment. Methods: Using the National Cancer Data Base (2000-2009), use of multimodality treatment for non-metastatic extremity sarcoma was examined. Regression models were developed to identify factors associated with adjuvant therapy receipt and treatment sequence. Results: A total of 22,051 patients underwent resection (Stage I: 45%, stage II: 28%, Stage III: 27%). Trend analysis demonstrated relatively constant rates of radiation therapy (RT) (58% to 65%), chemotherapy (21% to 23%), and any adjuvant therapy (65% to 72%), however the proportion receiving neoadjuvant therapy increased (RT: 14% to 28%; chemotherapy: 9% to 13%; any: 18% to 27%; all p &lt;0.001). Stage-specific treatment use is shown in the table below. Though RT rates were similar for all histologies, chemotherapy rates for synovial sarcoma were higher for all stages (I: 24.3%; II: 24.9%; III: 53.2%, p &lt; 0.001). After adjusting for differences in tumor factors, patients were more likely to receive neoadjuvant therapy (chemotherapy and/or RT) if treated at high-volume academic center (p&lt;0.001). After adjusting for histology, patients were more likely to receive adjuvant radiation therapy if younger, healthier, privately insured, or tumor size &gt;5cm. Patients were more likely to receive adjuvant chemotherapy if were younger, healthier (fewer comorbidities), underinsured, treated at a high-volume academic center, or tumor size &gt;5cm. Conclusions: Use of a multimodality approach for extremity sarcoma management has increased over time, particularly for neoadjuvant therapy. However, practice patterns are related to hospital type and socioeconomic factors. There may remain opportunities to increase multidisciplinary care and multimodality treatment for extremity sarcoma in the United States. [Table: see text]
Naloxone Co-prescribing to Patients Receiving Prescription Opioids in the Medicare Part D Program, United States, 2016-2017
Authors: Christopher M. Jones, Wilson Compton, Meena Vythilingam, Brett Giroir
Journal: JAMA (2019)

Part D Program, United States, 2016-2017Co-prescription of naloxone to patients receiving long-term opioid therapy provides an opportunity to expand naloxone access to patients at risk for opioid overdose. 1 The 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain recommends that clinicians consider co-prescribing naloxone to patients at increased overdose risk, such as those receiving daily opioid dosages of 50 morphine milligram equivalents (MME) or greater or those receiving benzodiazepines. 2 In 2017, Vermont mandated naloxone co-prescribing when patients receive opioids at dosages of 90 MME/d or greater or concomitant benzodiazepines, 3 and Virginia mandated co-prescribing when patients receive opioids at dosages of 120 MME/d or greater or concomitant benzodiazepines. 4 To date, the extent of naloxone co-prescribing is unknown.We used Medicare Part D data to compare national and state rates of naloxone co-prescribing in 2016-2017.Methods | Dispensed prescriptions for opioids, benzodiazepines, and naloxone were identified by National Drug Codes in the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse, a census of Medicare