tbuckley/cabot-search huggingface dataset:
Real-world data and patient perspectives on quality care and maintenance therapy (MT) decision-making for recurrent ovarian cancer (ROC).
Authors: Robert L. Coleman, Rebecca R Crawford, Jeffrey D. Carter, Tamar Sapir
Journal: Journal of Clinical Oncology (2020)

e19174 Background: Despite clinical evidence illustrating the efficacy of MT for ROC, complexities, such as patient-, treatment-, and disease-related factors, and team-based care coordination, limit its optimal use in ROC. In a quality improvement (QI) program, conducted at 2 oncology systems, we evaluated gaps in evidence-based, quality ROC care. Methods: Between 09/2019-02/2020, retrospective EMR audits of 200 patients with ovarian cancer were analyzed for demographics, disease characteristics, treatment history, and shared decision-making (SDM) involving MT. Surveys were administered to evaluate challenges, barriers and experiences of healthcare professionals (HCP; N = 35) and their patients with ROC (N = 21). The HCP teams participated in audit-feedback sessions and developed action plans for resolving identified gaps. Results: EMR audits revealed low utility of MT among patients with ROC (Table), and only 20% of patients reported that MT was discussed as a treatment option. Lack of access to newer therapies was most commonly identified (27%) by HCP as the biggest challenge in treating patients with ROC. Furthermore, survey results revealed that HCP are challenged to correctly integrate guidelines for patient selection for PARP inhibitor MT based on BRCA mutation status (18% of HCP answered correctly), response to previous chemotherapy (49% correct), and line of therapy (46% correct). Data indicated a low level of SDM – none of the patients indicated a high level involvement in treatment decisions and only 20% indicated a high level of agreement that their care team understood their treatment goals. EMR audits also illustrate low documentation of multiple aspects of SDM (Table). Oncology team members formulated plans to develop guidance documents to assist in therapy sequencing and tools to improve patient education. Conclusions: Overall, data from this QI program indicate gaps, challenges, and barriers in evidence-based, MT decision-making and engagement of patients in SDM. These areas for improvement may be relevant for future interventions to improve the provision of quality ROC care. [Table: see text]
Affective Social Learning serves as a quick and flexible complement to TTOM
Authors: Fabrice Clément, Daniel Dukes
Journal: Behavioral and Brain Sciences (2020)

Abstract Although we applaud the general aims of the target article, we argue that Affective Social Learning completes TTOM by pointing out how emotions can provide another route to acquiring culture, a route which may be quicker, more flexible, and even closer to an axiological definition of culture (less about what is , and more about what should be ) than TTOM itself.
Determining the impact of chemotherapy-induced peripheral neuropathy: A survey of cancer survivors.
Authors: Eva Battaglini, David Goldstein, Susanna Park
Journal: Journal of Clinical Oncology (2020)

e24080 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a major yet poorly understood side effect of cancer treatment, leading to symptoms including numbness, tingling and pain. It can lead to cessation of effective treatment, long-term functional disability and reduced quality of life. Despite this, there is currently little understanding of its impact. Methods: The aim of the study was to investigate the impact of neurotoxic chemotherapy side effects on the lives of cancer survivors. Data was collected via an online survey covering demographics, cancer diagnosis and treatment, CIPN and other side effects of chemotherapy, using standardised measures to assess comorbidities, quality of life, physical activity, pain and CIPN symptoms. Results: Data was analysed from 986 respondents who were treated with neurotoxic therapies (83% female, 16% male), with mean age 59 years ( SD 10.7 years). A majority of respondents were treated for breast cancer (59%), 14% for colorectal cancer and 11% for multiple myeloma. Chemotherapy types received included paclitaxel (32%), docetaxel (32%) and oxaliplatin (13%), and respondents completed treatment a mean of 3.6 years ago. The majority of respondents (80%) reported experiencing neuropathic symptoms after finishing chemotherapy, with 77% reporting current CIPN. Those with CIPN reported functional impacts, with 23% reporting moderate to severe problems with hand function and 28% reporting moderate to severe walking difficulties. CIPN was second most commonly rated as the treatment side effect having the greatest impact, following fatigue. Respondents with high levels of current CIPN symptoms had poorer quality of life, more comorbid health conditions, higher BMI and more often received multiple neurotoxic chemotherapies than those with low levels of CIPN symptoms. In addition, respondents who reported meeting government physical activity guidelines had lower CIPN and higher quality of life scores than those who did not meet the guidelines. Regression analyses investigating the association between quality of life and clinical and sociodemographic characteristics resulted in a model with comorbid health conditions, CIPN symptoms, years since treatment, age and physical activity as significant predictors of quality of life. Conclusions: These findings suggest that CIPN has a lasting impact on cancer survivors, leading to decreases in quality of life, often occurring alongside poorer general health. This impact supports the need for further research to improve assessment, prevention and treatment.
“Where did you read that?” External sources of information and patients perceptions of prognostic goals.
Authors: Rushad Patell, David Johnson Einstein, Eric James Miller, Jennifer Halleck, Laura Dodge, Mary K. Buss
Journal: Journal of Clinical Oncology (2020)

e24166 Background: Patients receiving palliative cancer treatment frequently misperceive likelihood of benefits/toxicity. Physicians fear that external sources of information regarding treatment enhance misperceptions and complicate decision-making. We investigated the sources of external information used, how much it affects patients' misperception and influences their treatment choices. Methods: We prospectively surveyed patients with advanced solid cancers and their oncologists regarding benefits/risks of palliative therapies including likelihood of tumor response and toxicity. Patients reported information-seeking behavior pre-treatment. We compared patients’ perceptions of benefits/risks to that of their oncologists. Results: Across four disease groups, 119 eligible patients enrolled. Their median age was 65 years (range 59–73), 55% were male, and 56% had undergone prior treatment. Treatments included chemotherapy (61%), targeted therapy (15%), and immunotherapy (24%). Over two thirds, 69% of participants stated that they wanted as much as possible information from their oncologist, and nearly all (95%) stated that they felt the amount of information provided by their clinician was “just right.” However, 60% wanted at least a moderate amount of information from external sources, and 58% reported obtaining information from sources other than their oncologist. The most common external sources of information used by participants were printed materials (35%), word of mouth (26%), the American Cancer Society (24%), and WebMD (21%). Nearly one in 3 (31%) of participants felt the information from external sources influenced their decisions more than a small amount. There was no correlation between self-education and misperception of tumor response (coefficient -0.04 p = 0.6) or of treatment toxicity (coefficient 0.05, p = 0.6) relative to their treating physicians’ estimates. Conclusions: While many patients sought information from external sources, most felt they were not substantially influenced by this information. Almost all felt their oncologists provided them with adequate information. Information-seeking behavior was not associated with greater misperception regarding the treatment goals/expectations. Thus, despite a common concern about misinformation in external information sources, oncologists should support patients who seek such sources and discuss their findings.
Depression, anxiety and quality of life in newly diagnosed hypertensive patients
Authors: Chun-ping Liu, Jun-xia Li, Ya-ping Wang, Li-li Niu, Yu-bin He, Jun-yu Cui
Journal: BMJ (2012)

Fifty outpatients of newly diagnosed hypertension (NDH,with course of disease ≤ 3 months) and 50 patients with routinely revisit hypertension (RRH,with course of disease ≥ 1 year) were consecutively enrolled respectively from February 2010 to July 2010.They were asked to complete the Beck Depression Inventory (BDI),Spielberger State-Trait Anxiety Inventory (STAI) and the SF-36 questionnaire.The results showed that compared with the RRH group,the NDH group were more worried about being diagnosed as hypertension,dependence and side effects of antihypertensive drugs and complications of hypertension (all P ＜ 0.05).The NDH group displayed significantly higher level of anxiety compared with that of the RRH group (P ＜ 0.001).No significant differences were found in depression and 8 dimensions of SF-36 forms between two groups (P ＞ 0.05).The results indicated that patients of NDH have significant higher level of anxiety than that of RRH,they should be given more psychological intervention and appropriate health education.

Key words: 
Hypertension;  Anxiety;  Depression
Correlation of gefitinib and its metabolites with gefitinib induced rash in patients with non-small cell lung cancer (NSCLC).
Authors: Shaoxing Guan, Xi Chen, Min Huang, Li Zhang, Xueding Wang
Journal: Journal of Clinical Oncology (2020)

e21712 Background: Gefitinib induced rash is the most common adverse reaction and severe rash of gefitinib often leads to discontinuation or termination of treatment. The concentrations of drug and its metabolites may affect drug induced toxicities, however, the association of gefitinib/metabolites with gefitinib-induced rash are poorly investigated. Therefore, we explored the association between concentrations of gefitinib and its four metabolites with gefitinib-induced rash in non-small cell lung cancer (NSCLC) patients. Methods: A total of 180 advanced NSCLC patients carrying EGFR sensitive mutations receiving gefitinib were enrolled. The concentrations of gefitinib, and its four metabolites including M537194, M387783, M523595 and M605211 were determined by liquid chromatography–tandem mass spectrometry (LC–MS/MS). The associations between concentration of gefitinib/its metabolites and gefitinib-induced rash were analyzed by Mann-Whiney U test. Operating characteristic curves(ROC) were used to determine gefitinib/metabolites cutoff values for gefitinib-induced rash. Results: M605211 was first detected in plasma in NSCLC patients. The concentrations of gefitinib and M605211, M537194 were found to be correlated with the incidence of gefitinib-induced rash ( P= 0.0002, 0.027 and 0.0097, respectively), moreover, the concentration of gefitinib was correlated with severe rash (Grade 0,1 vs. 2+, P= 0.017). Multivariate Logistic regression analysis showed that only gefitinib concentration was independent risk factor for gefitinib-induced rash (grade 0 vs grade1+, OR = 1.006, 95%CI (1.002-1.009), P = 0.00078; grade0,1 vs grade2+, OR = 1.003, 95%CI (1.001-1.005), P = 0.015, respectively). The cutoff values of gefitinib were 160.2 ng/ml (grade 0 vs grade1+, sensitivity = 78.7%, specificity = 47.7%, area under the curve (AUC) = 0.686, P = 0.0002, 95% CI (0.592-0.779)) and 201.7ng/ml (grade0,1 vs grade2+, sensitivity = 69.3%, specificity = 47.6%, AUC = 0.605, P = 0.0168, 95%CI (0.521-0.689)). Conclusions: This research demonstrated that the concentration of gefitinib and its metabolites were associated with gefitinib induced rash in NSCLC patients. Therapeutic drug monitoring of gefitinib concentration may have potential improvement for optimization of treatment with gefitinib. Clinical trial information: NCT01994057.
一位看了三个不同专科门诊的患者
Authors: 陈波
Journal: BMJ (2012)

笔者从事内科临床工作18年,看到过许多种疾病,有些记忆犹新,对前不久所遇一例患者的诊治经历感触就颇多.患者女性,46岁,经营小杂货店.主诉于12年前不明原因出现头晕,乏力,食欲差,胸闷,失眠多梦,记忆力差,未予重视。
Reflection and suggestions on teaching and assessment model for standardized residency training of general practitioners
Authors: Jiatang Zheng, Jing Fang, Aimei Dong, Yuxia Kong, Xiuwen Fei, Chunhua Chi
Journal: BMJ (2019)

A well-established residency standardized training system is crucial for cultivating qualified general practitioners (GPs) . The syllabus has regulated the goals, objectives, contents and forms of training, but not proposed the concrete and effective teaching and assessment models. This article reflects the existing problems in GP training regarding teaching faculty, rotation plan, outpatient teaching, feedback and evaluation mechanisms as well as the assessment methods and contents, the article also gives specific suggestions for future improvement in order to train competent GPs.


Key words: 
General practitioner; Standardized training; Teaching; Assessment
Management of pyrexia in metastatic melanoma patients: A real-world clinical experience survey study.
Authors: Ambika Satija, A. Simon Pickard, Raluca Ionescu-Ittu, François Laliberté, You-Li Ling, Antonio Reis Nakasato, Barinder Kang, Mei Sheng Duh, Jeetvan Patel
Journal: Journal of Clinical Oncology (2020)

e22102 Background: Patients with BRAF+ metastatic melanoma (MM) have more options for treatment, including targeted therapy and immunotherapy. However, the risk of toxicities may contribute to lower treatment rates and duration. Pyrexia is a reversible adverse event commonly associated with BRAF/MEK inhibitors. However, little is known about the features, management strategies, as well as variations in pyrexia management in clinical practice. Methods: The study was conducted over two phases. Phase 1 was a qualitative study conducted with expert nurses to develop a pyrexia management questionnaire. The questionnaire was further enhanced through a pre-test with nurses to improve reliability and internal validity of the responses captured for this study. During Phase 2, a cross-sectional web-based questionnaire was administered to oncology registered nurses, nurse practitioners and physician assistants. All respondents were required to have managed pyrexia in patients with MM receiving dabrafenib+trametinib (D+T). Results: Respondents (N = 201, 57.2% academic center and 42.8% community based), on average, had 12.5 years of experience and &gt;50% had managed more than 10 patients with BRAF-MEK inhibitor in the past 12 months. Almost all respondents (97.5%) discussed pyrexia with patients at D+T initiation. At the onset of the first episode of pyrexia in a patient, most respondents either try to keep patients on the starting dose (34.9% for D, 42.8% for T) or withhold the medication only temporarily (52.4% for D and 47.8% for T), even with a fever of 104°F. Mean time to treatment reinitiation was 1.5 days and, in more than half of the instances (52.3% for D and 51.4% for T), respondents would ask the patients to reinitiate at the starting dose. Respondents also asked patients to initiate antipyretics (87.5%) or corticosteroids (34.5%) to manage pyrexia symptoms. Even at pyrexia recurrence, respondents generally preferred keeping patients on treatment, with only 4.2% recommending permanent discontinuation. In general, respondents were very comfortable in managing pyrexia-related symptoms in their patients (mean score 7.8, 1 = very uncomfortable, 10 = very comfortable). Conclusions: In clinical practice, respondents were very comfortable in managing pyrexia. They tried to keep patients on D+T as long as possible. Experienced oncology nurses, nurse practitioners and physician assistants are able to manage pyrexia symptoms and keep patients on treatment for a longer duration to help obtain maximum clinical benefit.
Obesity and metabolic syndrome correlate with a higher risk of biochemical recurrence in high risk and intermediate risk prostate cancer patients who underwent robotic-assisted laparoscopic prostatectomy.
Authors: Shifeng Mao, Ralph Miller, John Lyne, Jeffrey Cohen, Arash Samiei
Journal: Journal of Clinical Oncology (2020)

5580 Background: Obesity and metabolic syndrome (MS) is prevalent in our society, and have been linked to a higher incidence of prostate cancer (PCa). The relationship of obesity or MS and cancer control has yielded mixed results in previous studies. We examined the correlation between the incidence of biochemical recurrence (BCR) with MS and BMI in a cohort of patients with PCa who underwent robotic-assisted laparoscopic prostatectomy (RALP). Methods: A retrospective study of patients who underwent RALP at a single center from 2007 to 2015 was conducted. Parameters including preoperative BMI, fasting glucose, lipid profile, blood pressure, PSA, Gleason score, pathologic stage, time to BCR, and surgical margin status were analyzed. Patients were categorized in high (HR), intermediate (IR), and low-risk (LR) groups based on the National Comprehensive Cancer Network (NCCN) guidelines. WHO classification was used for MS criteria, and BCR was defined as two consecutive postoperative PSA volume of ≥ 0.2 ng/mL. Obesity is defined as BMI ≥30 kg/m 2 . Results: A total of 726 patients with 189 in HR, 471 in IR and 66 patients in LR groups were included in this study with the median age of 59 (interquartile range [IQR] 55-64) years old. The median follow-up from surgery was 38 (IQR 22-46) months. More obese patients were found in the HR group compared to IR/LR group (46.5% vs. 33.1%, p&lt;0.01). There were also more patients with MS in the HR group compared to IR/LR group (36.5% vs. 12.0%, p&lt;0.01). Obese patients had a higher rate of BCR across risk groups in comparison to non-obese patients 32.1% vs. 15.4% (P&lt;0.001), specifically 68% vs. 40%(p&lt;0.01) in HR group and 21.3% vs. 12.7% (p=0.035) in the IR group. Similarly, patients with MS had a higher rate of BCR in HR and IR groups in comparison to the patients without MS, 39.1% vs. 18.7% (P&lt;0.01); specifically, 67.7% vs. 42.2% (p&lt;0.01) in HR and 29% vs. 11.6% (p&lt;0.01) in the IR group. No correlation between MS or obesity and BCR was observed in LR group. There was no statistically significant difference in the positive surgical margin rate between obese and non-obese cohorts in each risk group. Conclusions: Among HR and IR-PCa patietns who underwent RALP, both obesity and MS correlate with increased risk of BCR. There were significantly more obesity and MS in HR-PCa patients, suggesting a potential pathophysiologic interplay between obesity or MS and cancer progression.
Phase II study of intraperitoneal paclitaxel combined with S-1 plus cisplatin for gastric cancer with peritoneal metastasis: SP + IP PTX trial.
Authors: Daisuke Kobayashi, Ryoji Fukushima, Mitsuhiko Ota, Sachio Fushida, Naoyuki Yamashita, Kozo Yoshikawa, Shugo Ueda, Hiroshi Yabusaki, Tetsuya Kusumoto, Takaaki Arigami, Akio Hidemura, Takeshi Omori, Hironori Yamaguchi, Yasuo Hirono, Yasushi Tsuji, Kentaro Kishi, Toshihiko Tomita, Hironori Ishigami, Joji Kitayama, Yasuhiro Kodera
Journal: Journal of Clinical Oncology (2020)

4529 Background: Intraperitoneal (IP) chemotherapy is a promising treatment option for gastric cancer with peritoneal metastasis. Although a phase III study failed to show a statistically significant superiority of IP paclitaxel (PTX) combined with S-1 and intravenous PTX over S-1/cisplatin (SP), the standard of care as a first-line treatment in Japan, the sensitivity analysis suggested clinical efficacy of the IP PTX. Thus, attempts to combine IP PTX with other systemic therapies with higher efficacy have been warranted. After a dose-finding study, we sought to explore efficacy of a new regimen that combined IP PTX with SP. Methods: Gastric cancer patients with peritoneal metastasis confirmed by diagnostic imaging, laparoscopy or laparotomy were enrolled in the phase II multi-institutional prospective trial. In addition to the established SP regimen (S-1 administered orally at a dose of 80 mg/m 2 bid for 21 days followed by a 14-day rest and cisplatin administered intravenously at a dose of 60 mg/m 2 on day 8), IP PTX was administered on days 1, 8 and 22 at a dose of 20 mg/m 2 . The primary endpoint is overall survival (OS) rate at one year after treatment initiation. Secondary endpoints are progression free survival (PFS), response rate and toxicity. Results: Fifty-three patients were enrolled and fully evaluated for OS and toxicity. The median number of courses was 7 (range 1-20). The 1-year OS rate was 74% (95% CI, 60-83%). The median survival time was 19.4 months (95% CI, 16.7 months-). The 1-year PFS rate was 57% (95% CI, 42-69%). The overall response rate was 20% (95% CI, 1-72%) in 5 patients with target lesions. Cancer cells ceased to be detected by peritoneal cytology in 23 (64%) of 36 patients. Fourteen (26%) patients underwent gastrectomy after response to chemotherapy. The incidences of grade 3/4 hematological and non-hematological toxicities were 43% and 47%, respectively. The frequent grade 3/4 toxicities included neutropenia (23%), anemia (29%), diarrhea (13%) and anorexia (17%). Intraperitoneal catheter and implanted port-related complications were observed in 4 patients. There was 1 treatment-related death. Conclusions: IP PTX combined with SP is well tolerated and active in gastric cancer patients with peritoneal metastasis. Clinical trial information: UMIN000023000 .
醋酸曲安奈德胸腔注射治疗结核性渗出性胸膜炎
Authors: 丁明伟, 宋健奎, 杨淑梅
Journal: BMJ (2005)

将70例结核性渗出性胸膜炎患者随机分为观察组(A组)和对照组(B组),均接受抗结核治疗.两组抽净胸液后,A组胸腔内注射醋酸曲安奈德,B组序贯口服醋酸泼尼松.治愈率、近期并发症发生率 A组明显优于B组.提示曲安奈德胸腔注射对缩短疗程、减少胸膜肥厚和包裹性积液有作用。
Team management model for diabetic patients in urban community
Authors: Yingqi Zheng, Die Cui, Yunfeng Yu, Hao Wang
Journal: BMJ (2018)

Taking Hangzhou Wenhui Subdistrict Community Health Service Center as an example, this article introduces the construction, service pattern and content of diabetes special management team in the urban community. The article also evaluated the roles of the model in blood glucose control, comprehensive management, contracted service with type 2 diabetic patients. This hierarchical referral system consisted of contracted general practitioner (GP), diabetes special clinic in health service center, joint diabetes clinic with hospital specialist, specialist service in tertiary hospital. This model would be an ideal approach for comprehensive management of type 2 diabetic patients in urban community.


Key words: 
Community health services; Diabetes mellitus, type 2; Disease management