tbuckley/cabot-search huggingface dataset:
Circulating microtumors: A functional hallmark for cancer detection and management.
Authors: Vineet Datta, Dadasaheb B Akolkar, Darshana Patil, Timothy Crook, Raymond Page, Sewanti Limaye, Revati Patil, Pradip Fulmali, Pooja Fulmali, Pradip Devhare, Sachin Apurwa, Shoeb Patel, Sanket Patil, Stefan Schuster, Cynthe Sims, Rohit Chougule, Ajay Srinivasan, Rajan Datar
Journal: Journal of Clinical Oncology (2020)

3544 Background: There are presently no accepted non-invasive means for detection of cancers in asymptomatic individuals or suspected cases. Radiological and serological investigations, though non-invasive, are not confirmatory and necessitate an invasive biopsy to establish malignant status of suspected findings. Invasive biopsies, in turn, face challenges due to non-representative tumor tissue or in cases where biopsy is impossible or unviable. We hypothesized that Circulating Microtumors (also called as C-ETACs: Circulating Ensembles of Tumor Associated Cells) in peripheral blood are universally present in solid organ cancers and their detection can be linked to malignant status. Methods: We obtained peripheral blood from 14,138 patients with various solid organ cancers as well as 10,625 asymptomatic individuals with age associated elevated risk of cancer. Out of the 14,138 patients with cancer, 25.1 % had local (non-metastatic) disease and 56.4% had metastatic disease as confirmed by radiological evaluation. C-ETACs were enriched and harvested from PBMCs using an epigenetically activating medium that is cytotoxic towards non-malignant epithelial and hematolymphoid cells in blood but confers survival benefit on apoptosis resistant circulating cells of tumorigenic origin and their heterotypic clusters (C-ETACs) in peripheral blood. Viable C-ETACs were identified and further characterized by immunocytochemistry (ICC) profiling. Results: C-ETACs were detected in 89.7% of samples from solid organ cancers irrespective of stage, treatment or present radiological status. C-ETACs were rarely detected (3.0%) in asymptomatic individuals. The asymptomatic individuals where C-ETACs were detected are being followed up periodically so as to enable detection of cancer based on clinical or radiological manifestation of symptoms. Conclusions: C-ETACs are ubiquitous in cancers and unexpected in asymptomatic individuals. Detection of C-ETACs in asymptomatic individuals may be indicative of risk of latent undiagnosed malignancy. The non-invasiveness of this approach makes it convenient for screening large populations for cancer.
The impact of early integrated supportive care on length of stay at an NCI-designated cancer center.
Authors: Jessica Kaltman, Can-Lan Sun, Matthew J. Loscalzo, Erik Kronstadt, Elizabeth Goodspeed, Samina Qamar, Christine Glaser, Finly Zachariah, Andrew Leitner, Les Biller, William Dale
Journal: Journal of Clinical Oncology (2020)

2024 Background: With movement towards value-based care, institutions seek ways to reduce costs by decreasing inpatient stays. A multidisciplinary approach to supportive care, especially when provided early, is one way to realize value-based care. We assess the impact of pre-admission versus post-admission involvement of an Integrated Supportive Care Model (ICSM) on inpatient length of stay (LOS) at a NCI-designated cancer center. Methods: Data was collected from 2014 to 2016 at City of Hope. The Integrated Supportive Care Model at City of Hope includes: palliative care, psychiatry, psychology, interventional pain, social work, child-life, distress screening, and couples program. “Pre-admission” was defined as seeing at least one service prior to hospital admission; “Post-admission” defined as seeing at least one service during admission. “Short LOS” for hematology patients was categorized as ≤ 14 days and for oncology patients as ≤ 3 days. Continuous LOS between patients receiving an ISCM intervention pre- and post-admission was compared using Kruskal-Wallis test. Univariate and multivariable logistic regression was done to examine association between involvement of ISCM pre- and post-admission and categorical LOS. P-values &lt; 0.05 were considered statistically significant. Results: 1,627 (809 with hematologic malignancy, 818 with oncologic malignancy) patients with only one hospitalization during the study time were included. For hematology patients, involvement with the ISCM pre-admission was associated with shorter LOS ( ≤ 14 days) compared with involvement post-admission (29.3 vs 11.1%, multivariable OR = 4.08, P &lt; 0.001). Median LOS for hematology patients who participated in the ISCM pre-admission was shorter than those who received ISCM services post-admission (21 vs. 22 days, p = 0.049). Similarly, for oncology patients, ISCM involvement pre-admission was associated with shorter LOS ( ≤ 3 days) compared to involvement post-admission (91.4% vs 8.6%, multivariable OR = 3.74, P &lt; 0.001). Median LOS for oncology patients who received an ISCM intervention pre-admission was shorter than those who received an ISCM intervention post-admission (2 vs. 6 days, p &lt; 0.001). Conclusions: In hematologic and oncologic malignancies, use of an ISCM prior to patient’s first hospitalization is associated with significantly shorter LOS compared with those who received ISCM services during the hospital stay. This suggests efforts should be made to include an ISCM early in the trajectory of illness, prior to first hospitalization.
Phase Ib study of decitabine in combination with gemcitabine in treatment of advanced soft tissue and bone sarcomas.
Authors: Varun Monga, Rebecca Dodd, Amanda Scherer, Wade Robert Gutierrez, Munir Tanas, Sarah L. Mott, Mohammed M. Milhem
Journal: Journal of Clinical Oncology (2020)

11550 Background: Sarcomas are a heterogeneous group of tumors and are associated with high rates of metastases leading to poor prognosis. Numerous epigenetic changes including hypermethylation have been identified in several sarcoma subtypes. Restoration of normal methylation patterns using DNA hypomethylating agent when combined with chemotherapy has shown to slow tumor growth in preclinical studies. Low continuous dosing of hypomethylating agent has epigenetic modulating effect with less toxicity. We conducted a Phase 1b study evaluating safety &amp; tolerability and identifying the recommended phase 2 dose (RP2D) of subcutaneous (SQ) decitabine (DEC) given with fixed dose infusion gemcitabine (GEM) in patients with advanced soft tissue sarcomas (STS) and bone sarcomas. Methods: Eligible patients at least age 18 yrs with metastatic histologically confirmed STS or bone sarcoma after progression on one line or if refused adriamycin for STS were included. Prior GEM use was permitted. A modified 3+3 dose escalation design was used exploring two dose cohorts of DEC, 0.1 and 0.2 mg/kg SQ administered on a twice weekly schedule for three weeks and GEM given as 900 mg/m 2 , IV over 90 min on days 1, 8 &amp; 15 of a 28-day cycle. Treatment was continued until disease progression or unacceptable toxicity. Dose limiting toxicity (DLT) was defined as any drug related non-hematological grade 3 or 4 toxicity per CTCAE v4.0. Disease assessment was performed every 8 weeks using RECIST v1.1. Results: 31 patients (25 STS &amp; 6 bone sarcomas) were enrolled of which 7 were non-evaluable. There were 12 evaluable patients in each dosing cohort. Of the total 744 adverse events (AE) 17.2% were grade 3/4 and most were neutropenia without neutropenic fever. 45.7% AEs were possibly (44.6%) or probably (1.1%) attributed to DEC use. The toxicities were not significantly different between DEC doses. No DLTs were observed. One patient died due to progressive disease. Conclusions: Combination of fixed dose infusion GEM with low dose subcutaneous DEC is moderately toxic. Most toxicities were hematological. While there were few responses, the RP2D of DEC selected was 0.1 mg/kg as it showed prolonged disease stabilization. Clinical trial information: NCT02959164 . [Table: see text]
Cancer site distribution in district hospital in central India.
Authors: Dinesh Pendharkar, Chandramauli Tripathi
Journal: Journal of Clinical Oncology (2020)

e13627 Background: Many state governments have started district cancer care program to offer cancer services in district general hospitals. These places are most frequented by every level of population. The access is free, close to their residence and has an equitable atmosphere. The program created de-facto registry of local cancer patients. We, here analyze trends of various types of cancer in one such hospital of central India. Methods: All patients reporting to this unit for various support in cancer are registered with unique id. The registry takes their local residential details and details of the medical history related to cancer. They are offered support all through their journey of cancer from diagnostics to end of life care, palliative care. Data of 2014-2019 are analysed from District Ujjain in central India. Results: Total of 3562 patients were registered with proven diagnosis of cancer. There were 1805 male (50.7%) and 1757 females (49.3%.In female group age varied between 2to 97 years, with a mean of 51.41 and median age of 50 years. In male group,the age ranged between 1 to 92, with mean age of 53.46 and median of 55 years. The five commonest cancer amongst female included breast, head and neck, ovary, cervix and lung. In males the commonest five were-Head and neck, lung, prostate, oesophagus and colo-rectal (Table). The group of head and neck cancer include all sites of the head and neck area together. Conclusions: The pattern of cancer in districts is giving new geopathological information. It is clear that tobacco related cancer predominates in male and female both, but breast cancer is number one even in a relatively rural area. In female ovary is increasing and cervix is coming down compared to national data.In view of governments putting in extensive pressure on early detection schemes in India,this data is extremely important. Based on these realistic data, the strategy may be changed for the district. [Table: see text]
Caregiver and patient distress in young adults with new cancer diagnoses.
Authors: Laura Van Metre Baum, Emma Schremp, Scott C. Borinstein, Debra L. Friedman
Journal: Journal of Clinical Oncology (2020)

e24165 Background: A cancer diagnosis is stressful for both patients and caregivers, and there may be interdependence of mental health. Integration of caregivers into support for AYAO patients may improve outcomes. Methods: We enrolled dyads of AYAO patients (age 15-39) and their caregivers within the first month of treatment. Eligible patients were treated with curative intent or expected remission of at least 5 years. We assessed participants at baseline using validated self-reported survey methods, including the COmprehensive Score for financial Toxicity (COST), Impacts of Events Scale-Revised (IES-R), Adult Self-Report (ASR), NCCN Distress Thermometer and Problem List, and FACT-G and FACT-GP instruments. Results: We enrolled 13 dyads with patient age range 22 to 39 (median 29) years with 60% male patients and 30% male caregivers. Median scores for the NCCN Distress Thermometer were 5.0 for patients (sd 2.9) and caregivers (sd 2.4), with a score of 3 consistent with significant distress. On the Problem List, greater than half of both patients and caregivers reported “yes” to problems with “insurance/financial,” “work/school,” “treatment decisions,” “fears,” “sadness,” “worry,” and “fatigue,” and independently with “family health issues” and “work/school,” respectively. Median patient FACT-G summary score was 78, with median sub-scale scores (27.5 social, 19.5 functional, 17.5 emotional, 15.5 physical). Likewise, median caregiver FACT-GP score was 58 with sub-scale scores (20 physical, 20 functional, 15 social, 10 emotional), with higher scores indicating better quality of life. COST median scores were 12 for patients (sd 9) and caregivers (sd 7), where max score 44 indicates least financial toxicity. IES-R median patient and caregiver scores were 16 (sd 16) and 46 (sd 26), respectively, with scores &gt;24 concerning for PTSS. In contrast, median patient and caregiver ASR depression and anxiety sub-scales were not in the range for concern. Conclusions: Diagnosis is a critical moment of distress for caregivers and patients alike. Effective interventions are needed to alleviate acute suffering and to improve short-term psychological and financial wellbeing for both caregivers and patients. Such outcomes may translate to longer-term benefit. As we continue to accrue dyads, we will follow them over 6 months to assess changes in distress pattern over time and identify the critical time periods for intervention.
Impact of augmented intelligence (AI) on utilization of palliative care (PC) services in oncology.
Authors: Ajeet Gajra, Marjorie Zettler, Jonathan Kish, Kelly Miller, John Frownfelter, Amy W. Valley, Sibel Blau
Journal: Journal of Clinical Oncology (2020)

12015 Background: Timely integration of palliative care in the management of patients with advanced cancer is a quality benchmark in oncology. However, PC is often underutilized as evidenced by delays in identification of appropriate patients, in referrals to a PC service, and in enrollment to hospice. Jvion has developed a prescriptive analytics solution, the Machine, which combines AI algorithms with machine learning techniques and applies them to clinical and exogenous datasets to identify patients with a propensity for poor outcomes. The Machine was applied to risk for patients’ mortality within next 30 days, and recommended patient-specific, dynamic, and actionable insights. Use of the Machine requires no additional documentation within the electronic health record (EHR) and the insights generated can be integrated back in to any EHR to help inform the care plan. Herein, we report the results of a study evaluating the impact of AI-driven insights on PC utilization at a large community oncology practice. Methods: All patients were scored weekly using the Machine PC vector. The Machine risk stratified the patients and generated recommendations for the provider to consider as they developed a care plan. Patients identified as “at risk” by the Machine were assessed for a supportive care visit (PC referral) and then were referred as deemed clinically appropriate. The average monthly rates of PC consults and hospice referrals were calculated 5 months prior to and for 17 months after the launch of the Machine in the practice. Results: The oncology practice has 21 providers managing an average of 4329 unique patients per month (PPM). The mean rate of PC consults increased from 17.3 to 29.1 per 1000 PPM pre and post Machine deployment respectively (+168%). The mean monthly rate of hospice referrals increased by 8-fold from 0.2 to 1.6 per 1000 PPM pre and post deployment respectively. Eliminating the first 6 months of Machine deployment to account for user learning curve, the mean rates of monthly PC consults nearly doubled over baseline to 33.0, and hospice referrals rose 12-fold to 2.4 per 1000 patients in months 7-17 post Machine deployment. Conclusions: This oncology practice found deployment of this novel AI solution to be feasible and effective at generating actionable insights. These AI driven insights could be incorporated into workflow and improved the decision-making for whether and when a patient should be referred to PC and/or hospice services for end of life care. Further study is needed to confirm the value of AI for management of cancer patients at end of life.
Analysis of information demands in home-care providers for patients with terminal cancer
Authors: 曹伟华, 陈俊辉, 陈晓君, 李文苑, 林端
Journal: BMJ (2006)

目的 调查癌症患者家居主要照顾者的医疗资讯需求,以便为家属提供切实有效的健康教育. 方法采用问卷形式,调查500名癌症患者家庭中的主要照顾者,收集资料包括:被调查者基本资料,有关照顾患者的资讯需求问卷、照顾患者的经验与态度等.结果 家属对医疗资讯的需求中,最迫切希望了解的是关于家庭照顾(100.0%)和患者治疗(95.6%)的相关知识,即如何根据患者的疾病、症状及生理状况进行照顾和相应治疗.结论 必需根据家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧,同时提供适当的心理支持,提升患者家庭的生活质量。
No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020
Authors: Laura Heavey, Geraldine Casey, Ciara Kelly, David Kelly, Geraldine McDarby
Journal: Eurosurveillance (2020)

As many countries begin to lift some of the restrictions to contain COVID-19 spread, lack of evidence of transmission in the school setting remains. We examined Irish notifications of SARS-CoV2 in the school setting before school closures on 12 March 2020 and identified no paediatric transmission. This adds to current evidence that children do not appear to be drivers of transmission, and we argue that reopening schools should be considered safe accompanied by certain measures.
A randomized phase II study of adjuvant sunitinib or valproic acid in high-risk patients with uveal melanoma.
Authors: Takami Sato, Marlana M. Orloff, Matias Emanuel Valsecchi, Ayako Shimada, Inna Chervoneva, Erin Sharpe-Mills, Haley Klose, Jessica Norcini, Jill Belinsky, Shingo Sato, Liam Hulse, Carol L Shields, Jerry A Shields, Michael J. Mastrangelo
Journal: Journal of Clinical Oncology (2020)

e22059 Background: Uveal melanoma is the most common primary intraocular cancer in adults. Despite successful treatment of primary tumors, up to 50% of patients later die of distant metastases. Currently, no effective adjuvant treatment is available. Presence of both monosomy 3 and 8q amplification (M3 + 8q amp) or DecisionDx-UM Class 2 in the primary uveal melanoma characterizes a group of patients with high metastatic death rates with reported 2-year survival rates ranging from 50% to 78%. This study aims to decrease or delay the death from metastatic uveal melanoma. Methods: Uveal melanoma patients with high risk for systemic metastasis defined as any of the following were eligible: A) M3 + 8q amp; B) Class 2. Patients must show no evidence of systemic metastasis and they need to be enrolled within 6 months of initial treatment of primary uveal melanoma. Patients were randomized to receive either sunitinib 25 mg daily or valproic acid (VPA) 750 mg daily as adjuvant treatment for 6 consecutive months. Improvement of 2-year overall survival (OS) rate from historical reference (70%) to 85% was the primary endpoint. The secondary endpoints included 1) systemic relapse-free survival (RFS) rate at 18 months, 2) ability to complete adjuvant treatment and, 3) toxicity assessment. The study was not powered to compare the efficacy between each arm. Results: A total of 90 patients were enrolled in this study. Two patients were excluded from the study including one in the sunitinib arm (did not start treatment after randomization) and one in the VPA arm (refused to stop VPA at 6 months). Nine of 45 patients in the sunitinib arm and 4 of 43 patients in the VPA arm could not complete the 6-month treatment due to toxicity (sunitinib n = 6, VPA n = 2) or systemic progression (sunitinib n = 3, VPA n = 2). The rest of patients completed the 6-month course of study treatments and all patients were followed at least for 2 years. With a median follow-up of 40.2 months, the 2-year OS rates of the sunitinib and VPA group were 95.6% (90% CI 86.5-98.6) and 90.7% (90% CI 80.1 - 95.8), respectively. The 18-month RFS rates of the sunitinib and VPA group were 75.6% (90% CI 63.1 - 84.3) and 62.8% (90% CI 49.4 - 73.5), respectively. Conclusions: Although the study is still ongoing, adjuvant sunitinib and VPA were considered to be safe and tolerable treatments for high-risk uveal melanoma. Sunitinib showed a tendency for a better outcome, thus a Cohort 2 was created to investigate the safety and potential improvement of 18-month RFS rate with 12 months of treatment with sunitinib. Clinical trial information: NCT02068586.
Does extent of resection of glioblastoma multiforme affect survival?
Authors: Emad Eldin Nabil, Ashraf Elyamany
Journal: Journal of Clinical Oncology (2020)

e14514 Background: Glioblastoma Multiforme (GBM) is the most common primary intracranial tumor. The effect on survival of extent of tumor resection for GBM tumors remains controversial. Our study aims to detect the role of extent of tumor resection in improvement of survival in patients with GBM. Methods: A prospective study for 84 patients with GBM, was conducted between March 2013 and September 2016 in Sohag University Hospital and Sohag Cancer Center. For all of them surgery was done. Either biopsy (stereotactic or open), debulking or gross total resection (complete). All patients received radical radiotherapy concurrent with Temozolomide chemotherapy followed by six to eight cycles of Temozolomide. All patients were followed by clinical examination and brain imaging. Results: 59% of our patients were males and 41% were females. About 78% of the patients had either Eastern Cooperative Oncology Group (ECOG) Performance Status 1 or 2. Median age was 51years with a range (25-70 years). In 38 patients (45.8%) debulking was done, while complete resection was done in 20 patients (24.1%). only biopsy was done in 30% of patients. We found a statistically significant effect for the extent of resection on overall survival (OS)(22 vs 19.5 months) and progression free survival (PFS)(18.25 vs17.42 months) for patients with complete resection vs patients with debulking only. In addition younger age patients had a statistically significant longer survival. Conclusions: Gross total resection (complete resection) of intracranial GBM was associated with longer survival. Gross total resection should be performed whenever possible.
Abstract 17459: Recurrent In-stent Thrombosis: An Atypical Presentation of Malignancy
Authors: Evan C Klein, Deborah L Crabbe
Journal: Circulation (2015)

Management of acute coronary syndromes most typically involves percutaneous coronary intervention with or without stent placement, and this has significantly improved morbidity and mortality in this syndrome. However, intra-coronary stents can lose their patency due to either in-stent restenosis or in-stent thrombosis (IST). More rarely recurrent in-stent thrombosis (RIST) can occur. Here we report the case of a 58 year old African American male with a history of human immunodeficiency virus (on highly active antiretroviral therapy), chronic kidney disease, cerebrovascular accident, chronic obstructive pulmonary disease and tobacco abuse. He presented with 7 non-ST-elevation myocardial infarctions, 6 angiographically documented episodes of coronary artery occlusion and 2 episodes of early in-stent and 2 late in-stent thromboses over the span of less than 7-months. This occurred despite reasonable evidence for compliance with optimal medical therapy. His antiplatelet regimen was changed several times until he presented 1-month after his final IST with gastrointestinal bleeding from a fungating partially obstructing well to moderately differentiated invasive adenocarcinoma in the ascending colon. Unfortunately, he expired 2-months later. Including our patient there have now been 4 reports of early RIST in patients with undiagnosed malignancy. Specific malignancies reported include: prostate, adrenal, renal, bladder, and now gastrointestinal primaries. Trousseau’s syndrome, the prothrombotic state of malignancy, has long been implicated in both venous and arterial thrombosis. We believe this prothrombotic milieu also increases the risk for in-stent thrombosis. In the setting of malignancy, as with myocardial infarction, delay before diagnosis can be catastrophic. While more data is needed on the topic, for now we suggest that physicians consider aggressive screening for malignancy in patients with IST or RIST.
经阴囊切口行鞘状突高位结扎术80例临床分析
Authors: 李强, 赵小锋, 周雷贵
Journal: BMJ (2009)

小儿睾丸鞘膜积液术前误诊为非交通性睾丸鞘膜积液,术中证实为交通性鞘膜积液,传统的鞘膜囊颈高位结扎手术需另行腹股沟切口,破坏了腹股沟管的解剖和生理功能,可留下腹股沟疝形成的隐患[1].我院自2003年1月至2006年3月采取患侧阴囊切口入路治疗小儿交通性睾丸鞘膜积液80例,效果满意,报道如下。