tbuckley/cabot-search huggingface dataset:
Longitudinal changes in health care utilization by adult survivors of childhood cancer in the Childhood Cancer Survivor Study (CCSS).
Authors: Jacqueline N. Casillas, Qi Liu, Melissa M. Hudson, Mark Greenberg, Mark W. Yeazel, Kirsten K. Ness, Leslie L. Robison, Gregory T. Armstrong, Wendy M. Leisenring, Yutaka Yasui, Kevin C. Oeffinger, Paul C. Nathan
Journal: Journal of Clinical Oncology (2012)

6030 Background: The incidence of late effects increases as childhood cancer survivors age. Survivors require lifelong care focused on the risks arising from prior cancer therapy (survivor-focused care). Methods: We assessed longitudinal changes in health care utilization in adult survivors of childhood cancer participating in the CCSS. Utilization at baseline and most recent follow-up was classified into one of three mutually exclusive hierarchical categories: no health care, general medical care, or survivor-focused care. Relative risk (RR) and 95% confidence intervals (CI) were calculated for predictors of reduction in care over time from survivor-focused to general or no care. Multivariable models, adjusted for key treatment exposures, were created to assess the risk factors for reductions in level of care over time. Results: Among 8591 eligible survivors, mean age at last follow-up was 35.1 years (SD=7.8) with a mean of 11.6 years (SD=2.2) since baseline. Of 3993 (46%) survivors who reported survivor-focused care at baseline, 2383 (59.7%) reported a lower level of care at follow-up. Among 4598 (54%) not receiving survivor-focused care at baseline, 915 (20%) reported survivor-focused care at follow-up. Baseline predictors of a decreased level of care were no health insurance (RR=1.5, 95% CI 1.2-1.9), male sex (RR=1.4, 95% CI 1.2-1.6), being 10-19 years from diagnosis compared with 20+ years (RR=1.4, 95% CI 1.1-1.7). In contrast, factors associated with a maintenance in survivor-focused care were Canadian residency compared to U.S. residency with insurance (RR=0.7, 95% CI 0.6-0.9), unemployment (RR=0.8, 95% CI 0.7-0.9), physical limitations (RR=0.7, 95% CI 0.6-0.9), cancer-related pain (RR=0.7, 95% CI 0.5-0.8), poor emotional health (RR=0.7, 95% CI 0.5-0.9), having mild-moderate (RR=0.5, 95% CI 0.4-0.6) or severe-disabling chronic health condition (RR=0.6, 95% CI 0.5-0.7). Conclusions: Less than a third of adult survivors of childhood cancer report survivor-focused care. Rates decrease over time. Targeted interventions to maximize survivor-focused care in at-risk survivors should be tested so preventive and risk-reducing opportunities are not lost.
A phase I/II study of docetaxel /S-1 with radiation for esophageal cancer patients
Authors: T. Hirai, H. Matsumoto, Y. Hirabayashi, A. Urakami, K. Yamashita, J. Hiratsuka, Y. Imajyo, T. Tsunoda
Journal: Journal of Clinical Oncology (2007)

15061 Background: The combined therapy of CDDP/5-FU with radiation is the standard therapy for esophageal cancer patients. However, this therapy is associated with a comparatively high incidence of gastrointestinal disorders resulting in therapy interruptions and long hospital stays. Herein, we propose a new regimen of Docetaxel / S-1 combined with radiation to improve the success rate and outcome. The clinical phase Istudy was conducted from May, 2004 until June, 2006. and we report on the results in this paper. Methods: Patients were given S-1 (60mg/m 2 /day) orally from days 1 to 14, and Docetaxel (20mg/m 2 in level 1, 25mg/m 2 in level 2, and 30 mg/m 2 in level 3) intravenously on days 1 and 8. Patients received radiation in 2.0 Gy daily fractions from days 1 to 21, for a total of 30 Gy. Patients were given a seven-day rest after the first course, and then treated with the same regimen from days 28 to 49.P The phase I study was completed for 10 cases. Results: All patients completed the treatment schedule, with no treatment-related deaths and no grade 4 adverse events were observed. As for hematotoxicity, one case revealed leucopenia of grade 3 and neutropenia of grade 2. A non-hematotoxic adverse event (grade 3 anorexia) was observed in one patient. The response rate evaluated by RECIST was 66 % (CR in 2 cases, PR in 4 cases). We assumed that the recommended dosage of TXT and S-1 was 30mg/m 2 and 60mg/m 2 , respectively, combined with a radiotherapy dose of 60Gy. Conclusions: This combination therapy may be superior to other treatments because of its lower rate of adverse events and higher response rates. We continue this study to Phase II in order to generate data on the response rate and adverse effect rate in a greater number of patients with esophageal cancer. No significant financial relationships to disclose.
Trial of concurrent versus sequential tamoxifen with radiotherapy in breast cancer patients with study of the combination of pentoxifylline and tocopherol for prevention of radiation-induced lung fibrosis.
Authors: Soheir Sayed Ismail, Zeinab Mohamed Abdel-Hafeez, Dalia Abd-Elghany El Khodary, Mohamed rada Kelany
Journal: Journal of Clinical Oncology (2013)

e11599 Background: Although the efficacy of both radiation and tamoxifen (TAM) in early-stage breast cancer is well established, data are lacking about the impact of this sequence on outcomes, including local recurrence and complications of therapy. These are questions of practical importance in the treatment of breast cancer patients, many of whom require both radiation (RT) and adjuvant TAM. Methods: 160 eligible patients were prospectively randomized 1:1 into two groups: The control group (80 patients) , containing one arm (C) received sequential TAM and RT and the intervention group which was further subdivided into arm (A) (40 patients), received concurrent TAM 20 mg/day with RT, arm( B) (40 patients), received concurrent TAM + Pentoxifylline (PTX) ( 800 mg/day )+ Alpha-Tocopherol (AT) (1000 U/day) and RT. The primary endpoint was to compare the radiation induced pulmonary fibrosis using serial high resolution computed tomography (HRCT) and the role of the PTX and AT combination in reduction of pulmonary fibrosis, the secondary endpoint was to evaluate loco-regional control in the three arms usingChi-Square test, Fisher’s exact test, Log rank test andAnova test. Results: Analysis of the incidence of clinical pneumonitis was 25% in arm A ( TAM) , 12.5% in arm B (TAM+PTX+AT) and 18.8% in arm C (control) with p=.110. The incidence of lung fibrosis was 26.5% in arm A( TAM) , 12.9% in arm B (TAM+VIT.E) and 23.4% in arm C (Control) with p=.608. As regard loco-regional relapse, the preliminary result, revealed no significant difference in the 3 arms (1.3% in control arm, 5 % in TAM, 2.5% in TAM+VIT) (p=.827). Conclusions: It seems that the interaction between tamoxifen and radiotherapy could affect the tissue remodeling rather than the damage induction step of the radiation pathogenesis. In this case, temporal separation of the two modalities (Concurrent Versus Sequential) may not make much difference in the incidence of radiation induced lung fibrosis.
20-year trends in cause-specific heart failure outcomes by sex, socioeconomic status, and place of diagnosis: a population-based study
Authors: Claire A Lawson, Francesco Zaccardi, Iain Squire, Suping Ling, Melanie J Davies, Carolyn S P Lam, Mamas A Mamas, Kamlesh Khunti, Umesh T Kadam
Journal: The Lancet Public Health (2019)

Heart failure is an important public health issue affecting about 1 million people in the UK, but contemporary trends in cause-specific outcomes among different population groups are unknown.
Prevalence of high-risk human papillomavirus in uterine cervical lesions among older Japanese women.
Authors: Kazuhiro Takehara, Hiroko Nakamura, Osamu Samura, Tomoya Mizunoe, Akihisa Saito, Kazuya Kuraoka, Morie Nishiwaki, Kiyomi Taniyama
Journal: Journal of Clinical Oncology (2012)

5084 Background: To estimate the prevalence and genotypes of high-risk human papillomavirus (HPV) among older Japanese women, using liquid-based cytology (LBC). Methods: ThinPrep LBC specimens were collected from 11,039 Japanese women (age range, 14-98 years). After classifying cytodiagnosis, specimens were analyzed for HPV DNA using the multiplex polymerase chain reaction method. Cervical smear specimens from 1,302 women showed positive results. To examine the prevalence of HPV in women defined as negative for intraepithelial lesion or malignancy (NILM), 2,563 samples were randomly selected from the remaining 9,737 women. Comparisons were made between women ≥50 years of age (older age group) and women &lt;50 years of age (younger age group). Written informed consent was obtained from all patients. In this study, the high-risk HPV genotypes encountered were 16, 18, 31, 33, 35, 45, 52, and 58. Results: In the older age group with abnormal smear findings, HPV genotypes were detected in 49.7% (148/298), including high-risk HPV genotypes in 40.9% (122/298). In the younger age group with abnormal smear findings, HPV genotypes were detected in 71.7% (720/1004), including high-risk HPV genotypes in 58.1% (583/1,004). In NILM, HPV-positive rates were 4.5% (39/873) in the older age group and 11.8% (199/1,690) in the younger age group. In high-grade squamous intraepithelial lesion (HSIL) or more severe cytological findings, HPV genotypes of each group (older age group/younger age group) were detected in 61.7%/83.1%, and high-risk HPV genotypes were detected in 56.4%/74.7% of women. In positive cervical smears, HPV 16 was the most frequently detected (28.5%) in the younger age group, while HPV 52 (31.3%) and 58 (27.2%) were detected more frequently than HPV 16 (18.4%) in the older age group. Conclusions: In Japan, although HPV infection as a cause of abnormal cervical cytology is more frequent among younger age groups than in older age groups, high-risk HPV infection was more highly associated with older individuals (older age group/younger age group: abnormal smear findings, 82.4%/81.0%; HSIL or more severe cytological findings, 91.3%/89.9%). In older age groups, HPV 52 and 58 were more frequent than HPV 16.
Exercise restores dysregulated gene expression in a mouse model of arrhythmogenic cardiomyopathy
Authors: Sirisha M Cheedipudi, Jinzhu Hu, Siyang Fan, Ping Yuan, Jennifer Karmouch, Grace Czernuszewicz, Matthew J Robertson, Cristian Coarfa, Kui Hong, Yan Yao, Hanna Campbell, Xander Wehrens, Priyatansh Gurha, Ali J Marian
Journal: Cardiovascular Research (2019)

Arrhythmogenic cardiomyopathy (ACM) is a myocardial disease caused mainly by mutations in genes encoding desmosome proteins ACM patients present with ventricular arrhythmias, cardiac dysfunction, sudden cardiac death, and a subset with fibro-fatty infiltration of the right ventricle predominantly. Endurance exercise is thought to exacerbate cardiac dysfunction and arrhythmias in ACM. The objective was to determine the effects of treadmill exercise on cardiac phenotype, including myocyte gene expression in myocyte-specific desmoplakin (Dsp) haplo-insufficient (Myh6-Cre:DspW/F) mice. Three months old sex-matched wild-type (WT) and Myh6-Cre:DspW/F mice with normal cardiac function, as assessed by echocardiography, were randomized to regular activity or 60 min of daily treadmill exercise (5.5 kJ work per run). Cardiac myocyte gene expression, cardiac function, arrhythmias, and myocardial histology, including apoptosis, were analysed prior to and after 3 months of routine activity or treadmill exercise. Fifty-seven and 781 genes were differentially expressed in 3- and 6-month-old Myh6-Cre:DspW/F cardiac myocytes, compared to the corresponding WT myocytes, respectively. Genes encoding secreted proteins (secretome), including inhibitors of the canonical WNT pathway, were among the most up-regulated genes. The differentially expressed genes (DEGs) predicted activation of epithelial-mesenchymal transition (EMT) and inflammation, and suppression of oxidative phosphorylation pathways in the Myh6-Cre:DspW/F myocytes. Treadmill exercise restored transcript levels of two-third (492/781) of the DEGs and the corresponding dysregulated transcriptional and biological pathways, including EMT, inflammation, and secreted inhibitors of the canonical WNT. The changes were associated with reduced myocardial apoptosis and eccentric cardiac hypertrophy without changes in cardiac function. Treadmill exercise restored transcript levels of the majority of dysregulated genes in cardiac myocytes, reduced myocardial apoptosis, and induced eccentric cardiac hypertrophy without affecting cardiac dysfunction in a mouse model of ACM. The findings suggest that treadmill exercise has potential beneficial effects in a subset of cardiac phenotypes in ACM.
Treatment patterns among metastatic colorectal cancer patients by line of therapy and original stage of diagnosis.
Authors: Benjamin Chastek, Mahesh Kulakodlu, Satish Valluri, Brian S. Seal
Journal: Journal of Clinical Oncology (2012)

e14013 Background: National Comprehensive Cancer Network (NCCN) guidelines recommend use of approved biologics combined with common chemotherapy agents for treatment of metastatic colorectal cancer (CRC). Five classes of chemotherapy/biologics are available for treatment of CRC. Methods: Adult patients with a diagnosis of CRC between 01/01/05 and 05/31/10 were identified from the Impact Intelligence Oncology Management (IIOM) registry. Patients with either stage 4 CRC at original diagnosis or development of a metastasis were included. Registry data included original date of diagnosis and stage information. Linked healthcare claims from a large US health insurance database affiliated with OptumInsight were used to identify lines of therapy and patient characteristics (e.g., development of metastases). Lines of therapy were based on patients’ use of chemotherapy/biologic agents after becoming metastatic. Treatment regimens were assessed and stratified by line of therapy (1 st , 2 nd , 3 rd , 4 th ) and stage at diagnosis (0-2, 3, 4, unknown). Results: 16% of the 598 study patients who developed metastasis received no chemotherapy. Of those who did, 84%, 52%, 27%, and 14% received a 1 st , 2 nd , 3 rd , and 4 th line of therapy, respectively. 71% of patients who progressed from stage 0-2 or 3 received a 2 nd line compared to 90% of patients who initially presented with stage 4 CRC. In the 1st line, 59% received an oxaliplatin-based regimen, 15% received an irinotecan-based regimen, and 11% received 5-FU alone. In 2 nd and 3 rd line therapy, percentages of patients treated with irinotecan-based regimens increased to 45% and 50%, respectively, and use of oxaliplatin-based regimens dropped to 27% and 16%, respectively. Overall, use of anti-EGFR agents increased steadily from 4% in the 1 st line to 12%, 29%, and 38%, respectively in the 2 nd , 3 rd , and 4 th lines. Conclusions: Patients who presented with stage 4 CRC had the highest rates of chemotherapy use. Despite NCCN guidelines, 11% of patients received 5-FU monotherapy as 1 st line treatment.
Safety and efficacy of <sup>90</sup>y resin microspheres in elderly (≥70 years) compared to younger patients with colorectal liver metastases (mCRC).
Authors: Andrew S. Kennedy, David Ball, Steven J. Cohen, Michael Cohn, Douglas M. Coldwell, Alain Drooz, Edward Ehrenwald, Samir Kanani, Fred M Moeslein, Charles W. Nutting, Samuel G. Putnam, Steven C. Rose, Michael Savin, Sabine Schirm, Navesh K Sharma, Eric Wang
Journal: Journal of Clinical Oncology (2013)

e14545 Background: The effects of advanced age on the clinical outcomes following 90 Y treatment in elderly patients with mCRC are relatively unknown. Methods: A retrospective review was conducted to evaluate clinical outcomes among 160 elderly (≥70 years) and 446 younger (&lt;70 years) patients with unresectable mCRC consecutively treated using 90 Y resin microspheres (SIR-Spheres; Sirtex) from July 2002 to December 2011 at 11 US institutions. Data on background characteristics, prior chemotherapy or other procedures, 90 Y therapy, subsequent adverse events and survival were documented. Results: The mean age (+ SD) of the elderly patients was 77.2 + 4.85 years and 55.9 + 9.45 years in the younger cohort. Regardless of age, patients receiving 90 Y treatment were very similar in the elderly and younger cohorts in terms of sex, race, ECOG performance status and other characteristics. However, elderly patients were more likely to have had their primary resected (7.1% vs. 15.1%; p=0.009), received fewer lines of chemotherapy (p=0.036; 13.1% vs. 2.8% had no prior chemo, p&lt;0.001), a longer period between diagnosis and 90 Y therapy (median 26.9 vs. 20.5 months; p=0.011), and received only one 90 Y treatment (58.8% vs. 46.4%; p=0.007). Overall survival following 90 Y therapy did not deteriorate in elderly patients (median 9.3 vs. 9.7 months; p=0.335). 90 Y treatment was equally well tolerated in both cohorts, with no significant increase in grade 3+ adverse events in elderly patients, but significantly fewer grade 1+ events for abdominal pain (26.3% vs. 41.3%; p&lt;0.001) and nausea (20.6% vs. 29.4%; p=0.038). The most common grade 3+ events included: abdominal pain (3.1% vs. 6.1%), GI ulceration 0.6% vs. 1.3%), nausea (0.6% vs. 1.3%), vomiting (1.3% vs. 1.3%), fatigue (5.6% vs. 4.5%), ascites (1.3% vs. 2.0%), hyperbilirubinemia (3.8% vs. 2.7%) and anorexia (0.6% vs. 0.9%). Analysis of the 98 patients ≥75 years compared to younger patients confirmed equivalent outcomes for survival and toxicity. Conclusions: For patients with unresectable mCRC liver metastases that meet eligibility criteria, 90 Y therapy appears to be as effective and well-tolerated for the elderly as it is for younger candidates.
Computerized intervention for amelioration of cognitive late effects among childhood cancer survivors.
Authors: Heather M. Conklin, Jason M. Ashford, Kellie N. Clark, Karen Martin-Elbahesh, Kristina K. Hardy, Thomas E. Merchant, Robert J. Ogg, Sima Jeha, Shengjie Wu, Hui Zhang
Journal: Journal of Clinical Oncology (2013)

10034 Background: Children treated for cancer with CNS-directed therapy are at significant risk for attention and working memory (WM) problems. There is empirical support for pharmacotherapy and therapist-delivered cognitive rehabilitation; yet, the reach of these approaches is limited by medical contraindications, need for facility proximity and high resource utilization. A computer-based WM intervention has demonstrated efficacy for healthy individuals with attention disorders. We investigated this approach with childhood cancer survivors. Methods: Sixty-eight survivors of childhood acute lymphoblastic leukemia (ALL) or brain tumor (BT) with identified WM deficits were randomly assigned to a computerized WM intervention (18 males/16 females, 23 ALL/11 BT, age= 12.21±2.47) or a wait-list control group (18 males/16 females, 24 ALL/10 BT, age= 11.82±2.42). Participants in the intervention group were asked to complete 25 training sessions at home with weekly, phone-based coaching support. Cognitive assessments were completed pre- and post-intervention. Results: Among 34 participants randomized to intervention, 30 (88%) were adherent while 4 were removed from intervention because they failed to complete training in the allotted time. Survivors who completed the intervention demonstrated significantly greater improvements than controls on measures of attention (e.g., WISC-IV Spatial Span Forward 3.30±3.87 vs 1.33±2.20, p= .02, ES= .63), WM (e.g., WISC-IV Spatial Span Backward 3.13±3.19 vs 0.80±2.46, p= .002, ES= .82) and processing speed (e.g., Conners’ CPT Hit Reaction Time -2.10±8.04 vs 2.36±6.68, p= .02, ES=.60), and showed greater reductions in parent reported executive dysfunction (e.g., Conners’ Parent Rating Scale, III -6.73±8.25 vs .13±8.86, p= .003, ES= .80). No group differences in academic fluency were found (e.g., Woodcock Johnson III Math Fluency 0.90±4.59 vs 1.90±7.18, p= .52, ES= .17). Conclusions: Study results suggest computerized intervention is feasible and efficacious for childhood cancer survivors, with some evidence for generalized benefits. Computerized training may offer a safer, less time intensive and more portable alternative to existing interventions. Clinical trial information: NCT01217996.
Letter to the Editor: Increasing PET Use in Small Cell Lung Cancer
Authors: Prakash Manoharan, Ahmed Salem, Hitesh Mistry, Corinne Faivre-Finn
Journal: Journal of the National Comprehensive Cancer Network (2019)

We read with interest the study by Hong et al 1 on stage migration in small cell lung cancer (SCLC) after increased FDG-PET use.The authors postulate that this led to improved survival because appropriate treatment was delivered due to accurate staging provided by FDG-PET.The authors should be commended for reporting data from a large retrospective cohort.However, as they acknowledged, there are many confounders and selection biases in this study that limit the ability to draw firm conclusions.For this reason, their findings do not provide sufficient evidence to support the routine clinical use of FDG-PET/CT in SCLC.The survival improvement reported over the course of the study could be due to improvements in supportive care or chemoradiotherapy delivery techniques, both unaccounted for in their analysis.Hong et al compare their outcomes to those of the CONVERT trial, 2 in which 57% of patients were staged with FDG-PET/CT in addition to conventional imaging (thorax/ abdomen CT, brain imaging 6 bone scintigraphy).We would like to note our re-
Association of Primary Care Continuity With Outcomes Following Transition to Adult Care for Adolescents With Severe Mental Illness
Authors: Alène Toulany, Thérèse A. Stukel, Paul Kurdyak, Longdi Fu, Astrid Guttmann
Journal: JAMA Network Open (2019)

<h3>Importance</h3> Adolescents with severe mental illness often age out of pediatric care without a clear transfer of care to adult services. The extent to which primary care provides stability during this vulnerable transition period is not known. <h3>Objective</h3> To analyze the association between primary care continuity during the transition from pediatric to adult care and need for acute mental health services in young adulthood. <h3>Design, Setting, and Participants</h3> This population-based cohort study used linked health and demographic administrative data for all adolescents aged 12 to 16 years with severe mental illness ascertained by hospitalization for schizophrenia, eating disorder, or mood disorder between April 1, 2002, and April 1, 2014, in Ontario, Canada. Participants were followed up through March 31, 2017. Data were analyzed from July 2018 to January 2019. <h3>Exposures</h3> Continuous primary care (same physician as baseline [age 12-16 years] always or sometimes), discontinuous primary care (visits to a primary care physician during the transition period who was not the patient's usual physician), and no primary care during the transition period (age 17-18 years). <h3>Main Outcomes and Measures</h3> Mental health–related hospitalizations and emergency department visits in young adulthood (age 19-26 years) adjusted for sex, rurality, neighborhood income, mental illness type, and health service use before transition. <h3>Results</h3> Among 8409 adolescents with severe mental illness (5720 [68.0%] female; mean [SD] age, 14.8 [1.2] years), 5478 (65.1%) had continuous primary care, 2391 (28.4%) had discontinuous primary care, and 540 (6.4%) had no primary care during the transition period. Youths with no primary care during transition were more likely to be male (57.2%), have lower socioeconomic status (31.5%), and have no usual primary care practitioner at baseline (25.6%). Compared with continuous care, patients with discontinuous and no primary care had an increased rate of mental health–related hospitalization in young adulthood (adjusted relative rate, 1.20; 95% CI, 1.10-1.30; and adjusted relative rate, 1.30; 95% CI, 1.08-1.56, respectively). <h3>Conclusions and Relevance</h3> In the context of decreasing outpatient specialist mental health visit rates following transition to adult care, ensuring adequate access to primary care during this vulnerable period may improve mental health outcomes in young adulthood.