tbuckley/cabot-search huggingface dataset:
Establishing a health economics and value unit at the Children’s Cancer Hospital–Egypt: Introducing a practical approach for evidence-based decision making.
Authors: Ranin Soliman, Nourhan Tarek, Sandra Samir, Shimaa Okail, Wael Eweida, Sherif Abouelnaga
Journal: Journal of Clinical Oncology (2021)

e18859 Background: Health Economics is a multi-disciplinary practice that recently gained recognition in healthcare management systems. Value-based healthcare (VBHC) focuses on improving patient outcomes while using fewer healthcare resources. Integrating the principles of health economics and VBHC are essential to better inform decision-making based on evidence, especially in resource-limited settings, that need ultimate efficiency in managing resources. Egypt has the highest second estimated number of incident childhood cancer cases in the Eastern Mediterranean Region (EMR), based on GLOBOCAN 2020. Thus, childhood cancer in Egypt is an urging priority due to the large number of patients, limited resources, and poor outcomes. There is a need to optimize resource use and promote value in care delivery for childhood cancer care in Egypt, based on real-world evidence. Methods: This work aims to highlight the role of establishing a health economics and value (HEV) unit at the Children’s Cancer Hospital 57357 –Egypt (CCHE), to improve care and outcomes for children with cancer efficiently. CCHE is a not-for profit pediatric oncology center, treating around 50–60% of childhood cancers across Egypt free of charge. Results: The HEV unit was established in 2017 as a sub-function of the upper management at the hospital. The core mission of the unit is to translate health economics and VBHC concepts into practice to promote evidence-based decision-making, through applying the following functions and activities: monitoring trends in childhood cancer survival, resource use, and costs; applying health economic evaluation tools such as cost-effectiveness analysis (CEA) and multi-criteria decision analysis (MCDA); applying time-driven activity based costing (TDABC); implementing VBHC on a disease- and a hospital-level; monitoring costs and benchmarking. Some of these functions/activities reflect on operational processes such as integrating the CEA tools within the hospital procedures to maximize value of money spent; and restructuring hospital-wide cost centers for accurate costs reporting. Capacity building is also an important pillar in the unit’s framework, where the unit team conducts internal and external training sessions and workshops to spread the knowledge about health economics, VBHC, and evidence-based healthcare. Conclusions: The HEV unit at CCHE presents a unique model of applying health economics and value-based healthcare at a micro level in a pediatric oncology center in Egypt. This is a novel approach for healthcare management in Egypt and making informed decisions based on real-world evidence.
Functional status of patients suffering from ovarian cancer: A cross-sectional study.
Authors: Marcos Iglesias Campos, Bella Pajares, Cristina Roldán Jiménez, Maria-Jose Bermejo-Perez, Emilio Alba, Antonio Cuesta Vargas
Journal: Journal of Clinical Oncology (2021)

e17556 Background: Physical activity displays multiple benefits in oncology patients, with the strongest evidence related to breast cancer. But there is little information about patient with ovarian cancer, even less in those who are metastatic. The main objective of this study was to assess and describe the performance´s in patients suffering from ovarian cancer in terms of function and cancer-related fatigue (CRF). Methods: Patients willing to join therapeutic exercise program (TEP) were at the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. A physiotherapist carried out an interview and a baseline assessment. The following outcomes were recorded: number of repetitions (n) performed in 30 seconds sit-to-stand test (30-STS), handgrip strength (Kg), cancer related fatigue (CRF) measured by Piper Fatigue Scale (0-10), upper and lower limb function measured by Upper Limb Functional Index (ULFI) and Lower Upper Limb Functional Index (LLFI), respectively (%). Results: Patients recruited had a diagnosed of an advanced ovarian cancer receiving or not active treatment. All participants had a good performance status (PS) and signed informed consent. 8 women were included, with a mean age of 52.66 (9.53) years and a mean BMI of 27.22 (4.56) kg/m 2 . Women performed 22 (4.24) repetitions of 30-STS test. Handgrip strength was 22 (2.7) Kg and CRF 5.43 (2.91) points. Patients reported 64.81% (34.65) and 66.83% (37.91) in ULFI and LLFI questionnaires, respectively. Conclusions: At the light of these preliminary results, ovarian cancer patients present a good level of function measured by 30-STS and a good grip strength. However, they report a moderate level of CRF and affected upper and lower limbs function. In additions, patients measured had function enough to participate in a therapeutic exercise program. Given the heterogeneity of the sample and its low number of participants, future studies with a wider sample should be carried out.
Comparison of the predictive accuracy of multiple definitions of cognitive impairment for incident dementia: a 20-year follow-up of the Whitehall II cohort study
Authors: Marcos D Machado-Fragua, Aline Dugravot, Julien Dumurgier, Mika Kivimaki, Andrew Sommerlad, Benjamin Landré, Aurore Fayosse, Séverine Sabia, Archana Singh-Manoux
Journal: The Lancet Healthy Longevity (2021)

Studies generally use cognitive assessment done at one timepoint to define cognitive impairment in order to examine conversion to dementia. Our objective was to examine the predictive accuracy and conversion rate of seven alternate definitions of cognitive impairment for dementia.
National survey on the effect of oncology drug shortages in clinical practice: A Hematology Oncology Pharmacy Association (HOPA) survey.
Authors: Sarah Hudson-Disalle, David L. DeRemer, Larry W Buie, Mark Hamm, Jeffrey Pilz, Ali McBride
Journal: Journal of Clinical Oncology (2021)

e13609 Background: Drug shortages are a clear and growing challenge. Prominent shortages included oncology medications and supportive care products essential for the care of cancer patients. Oncology drug shortages often result in disruptions in the timing of chemotherapy treatments, alterations in the dose or regimen administered, or even missed doses when alternative agents are unavailable. The purpose of this survey was to characterize the impact of oncology drug shortages across the United States, including the experiences of health care organizations, resource implications, and the impact on patient safety, patient care, and clinical trials. Methods: A 34-item online survey was distributed to HOPA membership of the Hematology Oncology Pharmacy Association to gather information on shortages of oncology drugs (i.e., all drugs essential in the care of cancer patients, including supportive care agents. Results: Sixty-eight organizations completed the survey; almost all completed by pharmacists, and analysis completed. Sixty-three percent of institutions reported one or more drugs shortages a month, with a 34.33% increase in 2019 from 2018. Sixty four percent of responded had incurred increased costs from oncology drugs shortages, with 7% noting reimbursement issues when switched to brand name therapies due to shortages. Treatment delays, reduced doses or alternative regimens were reported by 74.63% of respondents. The most common disease states which causes a dose delay of treatment included Acute Lymphocytic Leukemia, Lymphoma and Multiple Myeloma with dose reductions noted in 36.36%, 36.36 and 15.91%. The top five oncology drugs on shortage included epirubicin, flutamide, decitabine, mechlorethamine, dactinomycin with the top 5 supportive care drugs on shortage being noted as hydrocortisone, bivalirudin, promethazine, mycophenolate sodium and scopolamine. Respondents noted medication errors related to oncology drug shortages at 4.48%, with noted errors including incorrect conversion from iv to oral etoposide and incorrect EMR drug builds. Oncology Drug shortages impacted clinical trials in 13.4% of respondents in which 54.55% of respondents noting patients not being enrolled in clinical trials. Conclusions: A survey of US oncology pharmacists and technicians indicated that oncology drug shortages occurred frequently in 2020. Shortages led to delays in chemotherapy and changes in treatment or omission, complicated clinical research and increased the risk of medication errors and adverse outcomes.
Efficacy and safety of anlotinib in the treatment of lung cancer.
Authors: Xinliang Zhou, Yan Dou, Da Jiang
Journal: Journal of Clinical Oncology (2021)

e21129 Background: Anlotinib was approved by the National Medical Products Administration (NMPA) on 5/8/18 and 8/30/19 for the third-line treatment of patients with advanced NSCLC and SCLC. But in the real world, Anlotinib is also used in the second-line treatment of lung cancer. This study aims to evaluate the efficacy of using Anlotinib in the second-line or further treatment of lung cancer in the real-world. Methods: We conducted a retrospective case-control study of NSCLC/SCLC patients at our center from 1/1/19 to 6/30/20. Patient demographic, clinicopathologic, therapeutic and outcomes data were collected. Kaplan-Meier curve and Cox proportional hazards were utilized. Results: Of 167 patients were enrolled in this study, 106 were in Anlotinib group and 61 were in chemotherapy group. The analysis found that pathological types, ECOG PS, and therapeutic were independent factors affecting PFS and OS in lung cancer patients (P &lt; 0.05- can be a specific value). There was a significant difference in DCR between the anlotinib group and chemotherapy group(P &lt; 0.05), and the anlotinib group was better than chemotherapy group in mPFS (4.1 vs 3.1 months, P = 0.001) and mOS (7.682 vs 6,386 months, P = 0.011). Among the second-line treatment patients, ORR, DCR and PFS were no difference between Anlotinib group and chemotherapy group (P &gt; 0.05). The Anlotinib group was significantly better than Chemotherapy group in mOS (10.083vs6.737 months, P = 0.026). In third-line and further treatment patients, therapeutic and ECOG PS were independent factors of PFS and OS (P &lt; 0.05), and pathological type was an independent factor of OS (P &lt; 0.001). There was a significant difference in DCR between anlotinib group and chemotherapy group (P = 0.011). The mPFS (3.8vs2.5 months, P &lt; 0.001) and mOS (7.407vs5.412 months, P = 0.023) are significantly better than chemotherapy group. In terms of adverse events, the incidence of hypertension (32.80%vs9.84%) and hand-foot syndrome (28.30%vs14.75%) in anlotinib group was higher than that in chemotherapy group, but the incidence of leukopenia (4.72%vs37.7) %), fatigue (14.15%vs34.42%), anorexia (16.04%vs39.34%) and other adverse events was lower than chemotherapy group, and the incidence of III-IV adverse events is low. Conclusions: Compared with using chemotherapy alone, the second-line and further treatment of Anlotinib can significantly elevate the survival of lung cancer patients, and the safety and tolerability are better.
Patterns of Genomic Associations Can Define Acute Myeloid Leukemia (AML) Phenotype
Authors: Aziz Nazha, Mikkael A. Sekeres, Karam Al-Issa, Ahed Makhoul, Vera Adema, Cassandra M. Hirsch, Anjali S. Advani, Bartlomiej P. Przychodzen, Teodora Kuzmanovic, Babal K Jha, Aaron T. Gerds, Hetty E. Carraway, Sudipto Mukherjee, Matt Kalaycio, Jaroslaw P. Maciejewski
Journal: Blood (2017)
Clinical Factors Impact on Pharmacokinetics of CT-P10 and Reference Rituximab in Patients with Advanced-Stage Follicular Lymphoma
Authors: Won Seog Kim, Bertrand Coiffier, Christian Buske, Michinori Ogura, Larry W Kwak, SangJoon Lee, YunJu Bae, SuYoung Kim, MinJu Kim, SangMi Lee, DaHye Kwak, HyunJin Lee
Journal: Blood (2017)
The prognostic impact of <i>RAS</i> and <i>TP53</i> mutation according to primary tumor location in colorectal liver metastases.
Authors: Yongjun Cha, Bun Kim, Seung Jae Roh, Moon Ki Choi, Dong Woon Lee, Sung-Sik Han, Seong Hoon Kim, Sang-Jae Park, Ji Yeon Baek, Sung Chan Park, Hee Jin Chang, Jae Hwan Oh
Journal: Journal of Clinical Oncology (2021)

3582 Background: Somatic gene mutations have been suggested to impact survival following resection of colorectal liver metastases (CRLM). However, most studies included a selected population with known mutation data and did not employ homogeneous methods. This study aimed to determine the prognostic impact of somatic gene mutations and microsatellite instability (MSI) in CRLM using a standardized protocol and assess their survival effects according to primary tumor location. Methods: A total of 568 patients who underwent resection of CRLM during 2001-2014 were identified from a prospectively maintained registry of the National Cancer Center. MassARRAY based mutation profiling of cancer-related genes ( KRAS, NRAS, HRAS, BRAF, PIK3CA, MET, PTEN, APC, TP53)/MSI analysis was made in primary tumors from 538 (94.7%)/526 (92.6%) patients. Results: Primary tumor locations were: right colon for 51 (9.0%); transverse colon for 42 (7.4%); left colon for 238 (34.5%); rectum for 279 (49.1%) patients. Right sided tumors were associated shorter overall survival (OS) after liver resection compared to left colon primary tumors (5-year OS, 31.4% vs. 54.0% [ P = 0.011]). Mutation frequencies were: 45.9% for RAS ; 2.4% for BRAF ; 8.4% for PIK3CA ; 0.2% for PTEN ; 0.4% for MET ; 12.1% for APC ; 24.3% for TP53. RAS (5-year OS, 40.8% vs. 55.7% [ P = 0.001], PIK3CA (5-year OS, 31.1% vs. 50.5% [ P = 0.027]), and TP53 mutation (5-year OS, 42.7% vs. 50.8% [ P = 0.035]) were associated with worse OS after liver resection. On multivariable analyses, RAS (hazard rato [HR] 1.27; P = 0.033) and TP53 mutation (HR 1.35; P = 0.014) were significantly associated with poor OS after adjustment for covariates. Co-mutation in RAS/ TP53 (12.4%) was associated with the worst oncologic outcome (HR 1.81; P &lt;.001). Notably, while the negative prognostic impact of RAS mutation did not differ significantly according to primary tumor location, the adverse effect of TP53 mutation was limited to rectal cancer (interaction P = 0.002). In this study, MSI-high (2.3%) was not associated with survival. Conclusions: Both RAS and TP53 mutation are associated with worse survival following CRLM resection. In contrast to RAS mutation, the negative prognostic impact of TP53 mutation appears to be limited to CRLM from the rectal origin.
Landscape of COVID-19 vaccine uptake in the colorectal cancer community: Responding to community needs.
Authors: Andrea Dwyer, Michael Marosits, Elsa Weltzien, Reese Garcia, Anjee Davis
Journal: Journal of Clinical Oncology (2021)

e15577 Background: The novel coronavirus (COVID-19) has caused numerous disruptions across the cancer prevention and treatment landscape. A model released by the National Cancer Institute (NCI) predicts that delays in care will cause 10,000 excess breast and colorectal cancer deaths over the next 10 years due to the pandemic. Vaccines will play an integral role in colorectal cancer patients and their support systems to return to care and resume ‘normal activities’; but based on anecdotal reports from the oncology and prevention community, there are questions about patients’ willingness to receive vaccines when available. The goal of this analysis was to better understand general uptake of vaccines at various time points, intention to vaccinate when available and what questions and concerns patients have about getting a vaccine. Methods: In January, 2021 Fight Colorectal Cancer (Fight CRC) distributed an online survey to the colorectal cancer community asking about vaccine related questions. The survey was a convenience sample approach distributed through social media channels and targeted emails from mid-January to early February 2021. Virtual focus groups and repeat surveys will be administered in spring of 2021 to further gather detail about the uptake of the vaccine, including barriers and facilitators to care. Results: In total, 201 individuals responded to the survey (survivor = 77%, family member = 11%, caregiver/friend = 8% other = 3%). The colorectal cancer patient sample was composed mostly of later stage patients (stage III and IV = 77%). Approximately 30% of patients reported vaccine uptake, 81% noted they would likely get vaccinated when a vaccine became available to them. Of all the patients, 16% noted they would need more information about the vaccine before deciding if they would be vaccinated. The majority indicated needing tips to discuss receiving the vaccine with their doctor, including impact on treatment, and the top questions patients have are: 1) Is the vaccine safe? 2) Will the vaccine interrupt my cancer treatment care? Conclusions: People with cancer face unique challenges since the pandemic, including treatment disruptions. Even with a vaccine, not all patients have access or are convinced they will receive the vaccine when it becomes available to them. Understanding patient needs and how to respond to ensure patients receive the most credible information to make informed decisions is critical.
Lessons from COVID-19, challenges of remote learning for childhood cancer survivors.
Authors: Kathy Ruble, Lisa Carey, Juliana Pare-Blagoev, Kimberly Milla, Sydney Henegan, Katrina Cork, Clifton Thornton, Lisa Jacobson
Journal: Journal of Clinical Oncology (2021)

10054 Background: More than half of childhood cancer survivors (survivors) will have neurocognitive deficits that impact schooling, most commonly reflecting attention and executive dysfunction. Schools are legally bound (IDEA, 2004) to support eligible students with Individualized Education Program (IEP) informed instruction and related services (e.g. assistive technology, speech-language, physical, or occupational therapy) to foster academic success. However, these service provision were not designed under the constraints of remote learning. The COVID19 shift to remote learning is likely to extend beyond the pandemic especially for medically fragile students. This quality improvement project describes challenges for survivors during remote learning and recently developed related patient education materials. Methods: Interviews with families were used to identify themes around challenges during remote learning, which informed development of a 29-question survey disseminated via flyer in local oncology clinics and social media posts by local childhood cancer organizations in Fall 2020. Results: The survey was completed by 67 parents describing their affected child (mean age= 8.6 years; 60% male; 78% White, 12% Black, 95% non-Hispanic). Most children (74%) had completed therapy (43% for leukemia, 18% for brain tumor; 39% other). The majority (86%) attended public school and 37% received special education or related services: speech-language (26%), occupational (23%), and physical (14%) therapies, and vision services (3%). Fully remote learning was reported for 73%, in-person 4%, and hybrid learning for 14%. The majority (57%) reported observing greater difficulty with attention and focus during RL, indicating difficulty occurred about half of the time during related services therapies, class and/or small group video instruction. Technology-related challenges included difficulty navigating online instruction/equipment (28%), reading difficulty (16%), and difficulty seeing materials/lack of vision supports (18%). Findings did not differ based on treatment or IEP status (p&gt;0.50). Few (14%) reported their school team discussed assistive technology options for online learning. Parents indicated the most helpful supports for addressing challenges included speech-to-text tools, screen readers, and audio books. Parents reported their oncology team was helpful in making referrals to neuropsychology and therapies and completing documentation necessary to secure supports. Conclusions: Childhood cancer survivors, irrespective of diagnosis or IEP status, report challenges with remote learning. Families find a lack of information or special accommodations as roadblocks to success. Oncology providers were identified as valued resources, so educational materials ( https://tinyurl.com/nxbhj5or ) were developed for oncology teams to share with families.
In-hospital outcomes of percutaneous coronary intervention with drug-eluting stent in patients with localized and metastatic cancer.
Authors: Estefania Gauto, Juan Del Cid Fratti, Miguel Salazar, Hugo Macchi, Shristi Upadhyay Upadhyay Banskota, Binav Baral, Catherine Weir, Kriti Ahuja, Juan Adolfo Cattoni
Journal: Journal of Clinical Oncology (2021)

e18631 Background: Patients with localized and advanced malignancy are usually excluded from randomized clinical trials of drug-eluting stents and anti-platelet therapy. We aimed to evaluate short term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with localized and metastatic malignancy. Methods: Analysis from the Nationwide inpatient sample January 2016 to December 2018 of patients with localized and advanced malignancy admitted for a percutaneous coronary intervention with drug-eluting stents. Primary outcome was in-hospital mortality. Secondary outcomes were post-procedural complications and healthcare-utilization. Multivariate regression analysis was performed to adjust for confounders. Results: During 2016 – 2018 a total of weighted 1, 244, 550 PCI with DES were performed. 97.9 % in patients without cancer, 1.6% (n=21,125) patients with localized cancer and 0.3 % (n=4,765) with metastatic cancer. During hospitalization patient with cancer were more likely to develop respiratory failure, need for mechanical ventilation, AKI, and to receive blood products. After multivariate regression analysis patients with localized malignancy did not have any difference in-hospital mortality, total charges, cost, cardiac arrest or post procedural bleeding but had less LOS, respiratory failure, AKI requiring HD, post-procedural CVA and higher post-procedural blood transfusion when compared with patients without cancer. Conclusions: Patients with metastatic malignancy have higher in-hospital mortality when compared to patients without cancer. Patients with localized or advanced malignancy do not have higher in hospital complications. Blood transfusion is higher in patients with malignancy but is not related to procedure.[Table: see text]
Upregulated Cholesterol Biosynthesis Is a Biomarker for Isolated Central Nervous System Relapse in Acute Lymphoblastic Leukaemia
Authors: Antony Cousins, Elke Markert, Matilda Degn, Orianne Olivares, Yasar Mehmood Yousafzai, Saeeda Bhatti, Pawel Herzyk, Alison M. Michie, Kjeld Schmiegelow, Eyal Gottlieb, Christina Halsey
Journal: Blood (2017)