tbuckley/cabot-search huggingface dataset:
Progress in understanding hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs
Authors: Inmaculada Doña, Natalia Pérez‐Sánchez, Ibon Eguiluz‐Gracia, Rosa Muñoz-Cano, Joan Bartra, María José Torres, José Antonio Cornejo‐García
Journal: Allergy (2019)

Nonsteroidal anti-inflammatory drugs (NSAIDs), the medications most commonly used for treating pain and inflammation, are the main triggers of drug hypersensitivity reactions. The latest classification of NSAIDs hypersensitivity by the European Academy of Allergy and Clinical Immunology (EAACI) differentiates between cross-hypersensitivity reactions (CRs), associated with COX-1 inhibition, and selective reactions, associated with immunological mechanisms. Three phenotypes fill into the first group: NSAIDs-exacerbated respiratory disease, NSAIDs-exacerbated cutaneous disease and NSAIDs-induced urticaria/angioedema. Two phenotypes fill into the second one: single-NSAID-induced urticaria/angioedema/anaphylaxis and single-NSAID-induced delayed reactions. Diagnosis of NSAIDs hypersensitivity is hampered by different factors, including the lack of validated in vitro biomarkers and the uselessness of skin tests. The advances achieved over recent years recommend a re-evaluation of the EAACI classification, as it does not consider other phenotypes such as blended reactions (coexistence of cutaneous and respiratory symptoms) or food-dependent NSAID-induced anaphylaxis. In addition, it does not regard the natural evolution of phenotypes and their potential interconversion, the development of tolerance over time or the role of atopy. Here, we address these topics. A state of the art on the underlying mechanisms and on the approaches for biomarkers discovery is also provided, including genetic studies and available information on transcriptomics and metabolomics.
High-Sensitivity Troponin and the Application of Risk Stratification Thresholds in Patients With Suspected Acute Coronary Syndrome
Authors: Anda Bularga, Kuan Ken Lee, Stacey Stewart, Amy V. Ferry, Andrew R. Chapman, Lucy Marshall, Fiona E. Strachan, Anne Cruickshank, Donogh Maguire, Colin Berry, Iain Findlay, Anoop S.V. Shah, David E. Newby, Nicholas L. Mills, Atul Anand
Journal: Circulation (2019)

Guidelines acknowledge the emerging role of high-sensitivity cardiac troponin (hs-cTnl) for risk stratification and the early rule-out of myocardial infarction, but multiple thresholds have been described. We evaluate the safety and effectiveness of risk stratification thresholds in patients with suspected acute coronary syndrome.
Validation of a new prognostic body composition parameter in cancer patients.
Authors: Paolo Pedrazzoli, Riccardo Caccialanza, Nicole Stobäus, Annalisa Turri, Catherine Klersy, Marilisa Caraccia, Silvia Brugnatelli, Simona Secondino, Daniela Cicognini, Ilaria Imarisio, Andrea Riccardo Filippi, Teresa Monaco, Atonello Giannoni, Kristina Norman, Emanuele Cereda
Journal: Journal of Clinical Oncology (2019)

11597 Background: In cancer patients protein-calorie imbalances are responsible for decreased lean body mass and, in turn, for worse clinical outcome. We evaluated the prognostic value of a new body composition parameter (creatinine height index [CHI]) obtained from bioimpedance vectorial analysis-derived body cell mass and its association with nutritional and functional status. Methods: Data from Italian and German cancer patients based on information from previous prospective cohort studies were used. Multivariable models (adjusted for age, gender, hydration status, performance status, and disease stage) were built in both cohorts to assess the association between body composition outcome parameters (low fat-free mass [FFM], &lt;15 [females] and &lt;17 [males] kg/m 2 ; low standardized phase angle [SPA], &lt;-1.65; low CHI, &lt;510 [females] and &lt;660 [males] mg/24h/m) and 1-year all-cause mortality, low body mass index (BMI; &lt;20 [&lt;70 years] and &lt;22 [&gt;/=70 years] kg/m 2 ), clinically significant weight loss (WL; &gt;/=10% in 6 months) and low handgrip strength (HG; &lt;20 [females] and &lt;30 [males] kg). Results: Overall, 1084 cancer patients were included (Italians, N=454; Germans, N=630). Low CHI was independently associated with mortality in both Italian and German cohorts (Table). Low FFMI and low SPA did not predict survival in the German cohort. In patients with low CHI, worse nutritional and functional status were observed in both study populations. Performance of models addressing the study endpoints showed substantial consistency with both cohorts, particularly of those including low CHI. Conclusions: We validated a new prognostic body composition parameter, which is easier to interpret than standard nutritional parameters and may be useful for identifying cancer patients at nutritional risk, requiring early nutritional support. [Table: see text]
The effect of the APPRISE mandate on use of erythropoiesis-stimulating agents and transfusion rates in ovarian cancer patients.
Authors: Jonathan David Boone, Christy Lynn Walters, Janelle M. Fauci, Jenny M. Whitworth, Kerri S. Bevis, Ronald David Alvarez
Journal: Journal of Clinical Oncology (2012)

5060 Background: Erythropoiesis-stimulating agents (ESAs) have long been used to support chemotherapy-induced anemia in patients with epithelial ovarian cancer (EOC). Recent studies have demonstrated that ESAs may lead to increased tumor growth and shorter survival. The FDA mandated new guidelines (APPRISE, for Assisting Providers and Cancer Patients with Risk Information for the Safe use of ESAs) for consenting patients before ESA administration. We sought to quantify the change in ESA use and RBC transfusion rates after the APPRISE mandate was instituted. Methods: A retrospective chart review identified patients with EOC undergoing chemotherapy after initiating the APPRISE mandate. A similar subset of patients treated prior to the APPRISE guidelines served as a control cohort. Abstracted data included patient demographics, primary or second line treatment status, chemotherapy regimen, number of patients requiring ESA or RBCs, or both, and a cost savings analysis. Results: 84 patients with EOC were identified as having undergone 367 cycles of first or second line chemotherapy after the APPRISE guidelines were instituted. A matched set of 88 patients receiving 613 cycles of chemotherapy within a year prior to institution of the APPRISE guidelines was analyzed for comparison. The two groups were statistically similar. Most patients in each group were initially diagnosed with advanced stage disease, were receiving primary chemotherapy, and were receiving taxane/platinum-based chemotherapy. 45 of 88 patients (51%) in the pre-APPRISE group received a total of 196 ESA injections compared to 0 of 84 patients (0%) in the post-APPRISE group. In spite of discontinuing the use of ESAs and no change in transfusion thresholds, RBC transfusion in the post-APPRISE group was similar to that in the pre-APPRRISE group (8.3% vs. 14.8%, p=.28). Omission of ESAs in the post-APPRISE group resulted in a cost-savings of an estimated $700,000 in billable charges. Conclusions: In our institution, the APPRISE guidelines resulted in complete cessation of ESA use in patients with EOC, resulting in considerable cost savings. Importantly, RBC transfusion rates did not increase after the guidelines were imposed.
Phase II Study of Proton Beam Radiation Therapy for Patients With Breast Cancer Requiring Regional Nodal Irradiation
Authors: Rachel B. Jimenez, Shea Hickey, Nicolas DePauw, Beow Y. Yeap, Estelle Batin, Michelle A. Gadd, Michelle Specht, Steven J. Isakoff, Barbara L. Smith, Eric C. Liao, Amy S. Colwell, Alice Ho, James L. Januzzi, Jonathan Passeri, Tomas G. Neilan, Alphonse G. Taghian, Hsiao-Ming Lu, Shannon M. MacDonald
Journal: Journal of Clinical Oncology (2019)

To evaluate the safety and efficacy of proton beam radiation therapy (RT) for patients with breast cancer who require regional nodal irradiation.
Mindful fellows: Study results from a pilot wellness curriculum in hematology oncology.
Authors: Monica Sheila Chatwal, Christine Vinci, Richard R. Reich, Marc McDowell, Angela Reagan, Jhanelle Elaine Gray
Journal: Journal of Clinical Oncology (2019)

10508 Background: Rates of physician burnout, depression, and career dissatisfaction are rising. It is imperative to develop solutions. Studies find mindfulness is an effective therapeutic means for physician burnout, but few programs address this in clinical trainees, specifically hematology oncology fellows. The aims of this pilot study were to determine the feasibility and acceptability of a mindfulness-based wellness curriculum. To our knowledge, this is the first study assessing this type of intervention in this population. Methods: In this single center, nonrandomized study, six monthly 30-45 minute sessions were integrated within the framework of existing didactic conferences. Each session had two parts – didactics on mindfulness and guided meditation exercises. Sessions were led by a social worker trained in mindfulness techniques. Participants completed pre and post intervention questionnaires, including Mindfulness Attention Awareness Scale (MAAS) (Carlson, 2005), Perceived Stress Scale (PSS) (Cohen, 1983), and reflection questions, with an opportunity for free responses. The primary endpoint was feasibility as determined through recruitment (target 70%) and treatment adherence defined as participation and questionnaire completion (target 80%). A secondary aim was acceptability determined through self-reflection questions (target 80%). Results: A total of 27 participants (59% female) enrolled with 37% in post-graduate year 6 (PGY-6). Of the eligible fellows, 96% enrolled and 96% of participants completed questionnaires. On self-reflection questions, 65% reported that the program was useful and 81% reported they would participate again in the future. Participants suggested modifications including location, timing, and a broader scope to include skills in addition to mindfulness (e.g. resiliency-focused). Data on self-reported levels of stress and self-awareness, an exploratory aim, will be presented at the meeting. Conclusions: Findings indicate that a mindfulness-based wellness curriculum was both feasible and acceptable for hematology oncology fellows. Modifications are being made to expand on this program, and incorporate it as a recurring component of the existing curriculum.
Oncology fellows’ knowledge and current practice regarding outpatient oncology and palliative care.
Authors: Amy Johnson, Erin V. Newton, Lyle Fettig, Amber Comer
Journal: Journal of Clinical Oncology (2019)

10527 Background: Patients with advanced cancers often suffer from a number of symptoms and need guidance when discussing treatment goals as their diseases’ progress. Palliative care competencies include the assessment and management of both physical and psychological symptoms, as well as, the conduct of goals of care conversations and advanced care planning. Palliative medicine is subspecialty that specially addresses these needs in patients with advanced cancers, but is not universally available. Oncology fellowship training must include these competencies and there is little evidence regarding the palliative care educational experiences of oncology fellows. This study examines fellows’ experiences with palliative care education and fellows’ attitudes about concurrent palliative care in the outpatient setting. Methods: An electronic nationwide survey of medical oncology fellows was conducted in the second half of the academic year in 2018. Results: 43 of 191, 22.5%, of oncology fellows contacted at 17 institutions responded. 96% of fellows indicated they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics. 93% of fellows agree or strongly agree with being comfortable managing cancer related pain, but only half agree or strongly agree with being comfortable managing depression and anxiety. 91% agree or strongly agree they are comfortable with discussions about transitions to best supportive care, while only 31% of fellows always or often assist patients in completing advance care documents. 70% of fellows are always, often, or sometimes receiving feedback on their communication and symptom management skills. Conclusions: Oncology fellows fell comfortable with some aspects of palliative care more than others. Fellows in this survey report feeling comfortable with goals of care conversations and pain management, but are not as comfortable managing other symptoms like depression and anxiety. Respondents are not universally assisting patients in advanced care documentation and only two-thirds of responding fellows are receiving frequent feedback on their communication and symptom skills. There is a consensus among responding fellows about a desire to have palliative care embedded in their future clinics.
Lung cancer stigma: A ten-year look at patient and oncologist attitudes about lung cancer.
Authors: Jennifer C. King, Eleni Rapsomaniki, Maureen Rigney
Journal: Journal of Clinical Oncology (2019)

11619 Background: The presence of lung cancer stigma is well documented and has been shown to impact the care and treatment of lung cancer survivors (Tod et al. 2008; Carter-Harris et al. 2014). In the past decade, there has been considerable research progress in lung cancer but it is unknown if the level of stigma has changed and how that affects patient care. Methods: 205 oncologists who treat lung cancer, 208 patients with lung cancer, and 1001 members of the general public were surveyed with the same survey instrument from a 2008 survey (Weiss et al. 2014) plus 5-15 additional questions at the end. The survey was carried out with identical methodology by phone and online between June 6 and July 26, 2018. Statistical analysis was performed comparing 2008 and 2018 datasets using paired t-tests if normally distributed or Mann-Whitney U tests for continuous data and Chi-squared or Fisher’s exact test for categorical data. Results: In 2018, significantly more oncologists feel they have adequate treatment options for metastatic lung cancer (67% vs 36%, p &lt; 0.001) and the majority of patients report being satisfied with their medical care (87%) and treatment options (71%). Despite these advances, there was a non-significant increase in oncologists indicating both that there is a stigma associated with lung cancer (68% in 2018 vs 60% in 2008) and that patients blame themselves (67% vs 57%). Significantly more patients felt that there was a stigma associated with having lung cancer (70% vs. 54%, p &lt; 0.001). In addition, 57% of oncologists indicated that patients with different cancers are thought about, approached, or handled differently, similar to 2008. Lung cancer patients were most frequently cited as treated differently. In 2018, 40% of patients agreed with the statement “patients with lung cancer are treated differently by doctors and nurses” compared to 26% a decade ago (p = .01). Both groups felt the most common way patients were treated differently was “received less sympathy from medical staff.” Conclusions: After a decade of research progress in lung cancer, stigma surrounding the disease remains a critical problem even in a healthcare setting. Patients are perceiving stigma at higher levels and oncologists are not reporting any improvement. This work underscores the need to address stigma with proactive multilevel approaches including the need for medical providers to practice empathic communication.
Immune checkpoint inhibitor use near the end of life.
Authors: Chad Glisch, Travis Snyders, Stephanie Gilbertson-White, Yuya Hagiwara, Mohammed M. Milhem, Laurel Lyckholm
Journal: Journal of Clinical Oncology (2019)

11533 Background: Studies of chemotherapy near the end of life reveal increased costs, adverse effects and minimal clinical benefit. Immune Checkpoint Inhibitor (ICI) use near the end of life has not been described. We studied factors related to ICI use near the end of life. Methods: We conducted a single-institution retrospective chart review of patients who received ICI and died between August 2014 and December 2018. End of life ICI (EOL-ICI) was defined as treatment within the last 30 days of life and comparisons were made to patients who received treatment &gt; 30 days from end of life (non EOL-ICI). Results: 441 patients were reviewed. Mean age was 64 and 182 (41%) were female. 294 (67%) received ICI within the last 90 days of life and 117 (27%) within the last 30 days of life. At time of last ICI, 145 (33%) had brain metastases and 416 (94%) were stage 4. The most common cancers were melanoma (124, 28%), NSCLC (118, 27%) and urothelial carcinoma (34, 8%). The EOL-ICI group had a higher proportion of patients with ECOG ≥3 at time of last treatment (22% vs. 7%, p = &lt; .001), higher rate of death in hospital (32% vs. 18%, p = 0.003) and lower hospice enrollment (52% vs. 76%, p = &lt; .001). The EOL-ICI group received fewer ICI doses (mean 5.1 vs 6.7, p = 0.016). A higher proportion of patients in the EOL-ICI group were just beginning treatment and received ≤ 3 doses (60% vs 40%, p &lt; .001). There was no difference in mean age or presence of brain metastases between the groups. Even when the cutoff for EOL-ICI is extended from 30 to 90 days, there remain significant differences in ECOG, hospice enrollment and starting ICI but no difference in rate of dying in the hospital. Conclusions: One out of four patients studied received ICI within the last 30 days of life. EOL-ICI treatment is associated with higher rates of death in the hospital and lower hospice enrollment. Our results suggest that performance status is important when considering treatment with ICI. Use of ICI in the last 30 days of life had minimal clinical benefit and high cost.
Surgical stress and cancer progression: the twisted tango
Authors: Zhiwei Chen, Peidong Zhang, Ya Xu, Jiahui Yan, Zixuan Liu, Wayne Bond Lau, Bonnie Lau, Ying Li, Xia Zhao, Yuquan Wei, Shengtao Zhou
Journal: Molecular Cancer (2019)

Surgical resection is an important avenue for cancer treatment, which, in most cases, can effectively alleviate the patient symptoms. However, accumulating evidence has documented that surgical resection potentially enhances metastatic seeding of tumor cells. In this review, we revisit the literature on surgical stress, and outline the mechanisms by which surgical stress, including ischemia/reperfusion injury, activation of sympathetic nervous system, inflammation, systemically hypercoagulable state, immune suppression and effects of anesthetic agents, promotes tumor metastasis. We also propose preventive strategies or resolution of tumor metastasis caused by surgical stress.
Distinctive characteristics of non-small cell lung cancer in the young: A SEER analysis of patients under 40 years old
Authors: B. Goodgame, A. Vlahiotis, J. Piccirillo, M. Baggstrom, R. Govindan
Journal: Journal of Clinical Oncology (2007)

7621 Background: Non-small cell lung cancer (NSCLC) is diagnosed at a median age of 65 and is rare in younger people. The presentation and natural history of the disease in younger patients (age &lt; 40) may not be the same as in typical, or older patients (age &gt; 40). Methods: We identified in the SEER (Suveillance Epidemiology and End Results) registry, all patients diagnosed with NSCLC from 1990 to 2005. Patients were grouped by age at diagnosis, &lt; 40 or = 40. Data on gender, cell type, extent of disease, overall survival, and cause of death were obtained from the SEER database. Cancer-specific survival was defined as time to death from cancer, in which case deaths from other causes are counted as censoring events. Results: In the SEER registry, 3,421 patients with NSCLC diagnosed at an age &lt; 40 were identified, along with 323,566 patients age &gt; 40. Younger patients were more likely to be women, 48% vs 43% (p &lt; 0.0001), and more likely to present with distant disease 53% vs 49% (p &lt; 0.0001). Adenocarcinoma and other, or non-specified types of NSCLC were more common in younger patients, 38% and 44% respectively, vs. 35% and 32% in the older patients. Squamous cell carcinoma was far less common in younger patients, 8.5% vs 23.5% in older patients (p&lt;0.0001 for all comparisons). Overall and cancer specific survivals were higher for the younger cohort within each stage group. For example, 3 year overall survival for patients with distant (metastatic) disease was 8.8% in the younger patients and 4.7% in the older patients. For local disease, 5 year cancer specific suvivals were 92% in the younger patients and 62% in the older patients. Conclusions: Patients with NSCLC who are &lt; 40 years old at diagnosis are more likely to be women and have adenocarcinoma and far less likely to have squamous cell carcinoma. Overall and cancer-specific survivals are better in these younger patients. No significant financial relationships to disclose.
A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression
Authors: Pim Cuijpers, Hisashi Noma, Eirini Karyotaki, Christiaan H. Vinkers, Andrea Cipriani, Toshi A. Furukawa
Journal: World Psychiatry (2020)

No network meta-analysis has examined the relative effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression, while this is a very important clinical issue. We conducted systematic searches in bibliographical databases to identify randomized trials in which a psychotherapy and a pharmacotherapy for the acute or long-term treatment of depression were compared with each other, or in which the combination of a psychotherapy and a pharmacotherapy was compared with either one alone. The main outcome was treatment response (50% improvement between baseline and endpoint). Remission and acceptability (defined as study drop-out for any reason) were also examined. Possible moderators that were assessed included chronic and treatment-resistant depression and baseline severity of depression. Data were pooled as relative risk (RR) using a random-effects model. A total of 101 studies with 11,910 patients were included. Depression in most studies was moderate to severe. In the network meta-analysis, combined treatment was more effective than psychotherapy alone (RR=1.27; 95% CI: 1.14-1.39) and pharmacotherapy alone (RR=1.25; 95% CI: 1.14-1.37) in achieving response at the end of treatment. No significant difference was found between psychotherapy alone and pharmacotherapy alone (RR=0.99; 95% CI: 0.92-1.08). Similar results were found for remission. Combined treatment (RR=1.23; 95% CI: 1.05-1.45) and psychotherapy alone (RR=1.17; 95% CI: 1.02-1.32) were more acceptable than pharmacotherapy. Results were similar for chronic and treatment-resistant depression. The combination of psychotherapy and pharmacotherapy seems to be the best choice for patients with moderate depression. More research is needed on long-term effects of treatments (including cost-effectiveness), on the impact of specific pharmacological and non-pharmacological approaches, and on the effects in specific populations of patients.