tbuckley/cabot-search huggingface dataset:
The impact of live education on the competence and performance of oncology practitioners who care for patients with ovarian cancer.
Authors: Vanessa Carranza, Bryan Carson Taylor, Susan H. Gitzinger, Joan B. Fowler, Jessica Hall
Journal: Journal of Clinical Oncology (2021)

e23010 Background: About a third of ovarian cancer patients in the US have limited access to a gynecologic oncologist (GO) due to geographic disparities. A survey by The Society of Gynecologic Oncology (SGO) found that the majority of GOs found it was vital to coordinate local access to care, from diagnosis to survivorship, for patients living in areas of disparity. This allows rural/underserved patients broader access to novel therapies, as they increasingly become standard of care. It is critical for not only GOs to be current on the latest ovarian cancer data, but all clinicians who care for these patients. Methods: CEC Oncology developed two educational initiatives focused on PARP inhibitor therapy in ovarian cancer, which was targeted to all US healthcare professionals caring for ovarian cancer patients. Evaluations were collected from attendees attending an SGO Symposium and Ground Round (GR) series to assess impact on practice, increased competency, and intent to make a change in practice. Learning, knowledge, and competence was objectively assessed by analyzing pre-test, post-test, and follow-up survey data (sent 4-6 weeks post-activity). Chi-square analysis was conducted with a priori significance set at 0.05. Results: A total of 830 clinicians were educated, with SGO attendees primarily practicing in academic settings and GR attendees mostly from community practices. SGO attendees were asked case questions at baseline, immediately after the activity, and 4-6 weeks after the activity. Knowledge increased from pre- to post-test regarding current genetic testing recommendations (23% increase; P= .004) and appropriate selection of PARP inhibitor therapy (25% increase; P= .017). Knowledge was sustained at follow-up analysis. At follow-up, 90% of SGO and 84% of GR attendees made a change as a result of attending the activities. More attendees were able to incorporate germline multigene testing into practice, than originally intended; increase of 29% for SGO and 7% for GR audiences. All attendees experienced the barrier lack of patient education about the importance of genetic testing/counseling more than anticipated; increase of 7% for SGO and 13% for GR audiences. At follow-up, there was a 9% increase in GR attendees listing staying current with trial data and practice guidelines as a barrier. Conclusions: There were some notable differences seen in competence/performance among attendees of the two ovarian cancer educational initiatives. Differences may be attributed to practice setting (SGO primarily academic; GR primarily community.) Overall, GR attendees were more likely to face barriers, suggesting that community-based clinicians have fewer resources and experience more barriers to implementing best practices. Thus, it is vital to offer education for clinicians in community-based practices, particularly in areas that are considered ‘geographically disparate’.
To determine correlation of inter reader variability in sum of diameters using RECIST 1.1 with end point assessment in lung cancer.
Authors: Manish Sharma, Anitha Singareddy, Surabhi Bajpai, Jayant Narang, Michael O'Connor, Rudresh Jarecha
Journal: Journal of Clinical Oncology (2021)

e13557 Background: Lung cancer is the leading cause of cancer death in the world including more than 160,000 deaths in the US. The purpose of the study was to determine whether inter reader variability in Sum of Diameters (SOD) of tumor burden has any correlation with variability in end point assessment in lung cancer progression. RECIST 1.1 is based on the SOD of target lesions seen on imaging studies. Response criteria for evaluation of target lesions include - Complete response (CR), Partial response (PR), Progressive disease (PD) and Stable disease (SD). The key determinant of patient response is based on Target Lesion response which in turn is determined by SOD. Inter reader variability study plays an important role in the development of reliable diagnostic tools and understanding of imaging outcomes given the confounding factors like effusion, atelectasis and consolidation in lung cancer that affect Target Lesion selection. Methods: Retrospective analysis of 470 patients was carried out using RECIST 1.1. Double read with adjudication is the preferred read model for submission studies where images are read by two independent reviewers blinded to treatment allocation. As per RECIST 1.1, lesions were measured in the longest diameter for non-nodal and short axis for nodal lesions. This was followed by the calculation of SOD for total tumor burden. If these two primary reviewers disagree, then a third radiologist, the “adjudicator”, reviews the assessments performed by the first two radiologists and selects between the more accurate one. For further analysis, patients were divided into 2 groups, the one with no adjudication i.e. agreement between both readers and the second group with adjudication i.e. disagreement between both readers and ANOVA was used to perform analysis of Variance. Results: Of 470 patients, 332 patients with disagreement were adjudicated, while there was agreement on 138 patients assessments between both readers. SOD of baseline visits for all patients was assessed using ANOVA - single factor with following results: F ratio of 4.76 for Disagreement group was more than F crit (3.86) with P-value 0.03, while for Agreement group F value was less than F crit. Conclusions: There is a direct relationship of variability in SOD at baseline between two readers to the possibility of disagreement in their end point assessment. Additional rules around selection and measurement of Target Lesions should be proposed in protocol to reduce variability and improve endpoint assessment outcomes.[Table: see text]
Individual and institutional predictors of sexual orientation and gender identity data collection in oncology practice: An ASCO survey.
Authors: Charles Stewart Kamen, Gwendolyn P. Quinn, Liz Garrett-Mayer, Melinda Kaltenbaugh, Shail Maingi, Steve C. Meersman, Janette K. Merrill, Mandi L. Pratt-Chapman, Matthew B. Schabath, Caroline Schenkel, Shine Chang
Journal: Journal of Clinical Oncology (2021)

6520 Background: Most oncology practices do not collect patients’ sexual orientation (SO) or gender identity (GI) (SOGI), prohibiting assessment of sexual and gender minority (SGM) patients’ cancer disparities and identification of such patients in cancer care or research. Studies report that 90% of SGM patients would disclose their SOGI, while 78% of clinicians believe that patients would not. Preliminary evidence indicates that SOGI disclosure improves health outcomes. Organizations, including ASCO and NIH, have called for routine SOGI data collection, but institutional barriers, e.g. lack of SOGI fields in EMRs, hinder progress. This study aimed to delineate institutional and individual-level factors related to SOGI data collection in oncology. Methods: From Oct to Nov 2020, an anonymous 54 item online survey was distributed to ASCO members via direct outreach, listservs and social media. The survey assessed whether respondents’ institutions collect SOGI data, factors related to SOGI data collection, respondents’ attitudes about SOGI data and SGM patients, and demographics. Simple and multiple logistic regression modeling determined factors associated with respondents’ reports of SOGI data collection at their institutions. Results: Nearly half of 257 respondents reported their institutions collect SO and GI data (42%, 48%, respectively); over a third reported their institutions did not collect SO or GI data (36%, 34%, respectively); and a fifth were unsure (22%, 18%, respectively). Collection of both SO and GI was associated in unadjusted models with leadership support and having resources for SOGI data collection. SO collection was also associated with type of institution, having an SGM family member, and belief that knowing SO is important for providing quality care. GI collection was associated with the respondent’s role, SO, political leaning, past SGM training, and belief that knowing GI is important for providing care. Odds ratios (OR) from adjusted models with 95% confidence intervals (CI) comparing respondents who reported SO or GI collection as “Yes” vs. “No” are reported (comparisons to “Unsure” not presented). Most respondents (79%) felt it was important to know both SO and GI to provide quality care, while 14% felt neither was important. Conclusions: Whether or not institutions collect SOGI data is related to many factors. Despite limited statistical power, the same three factors emerged as drivers of data collection: leadership support, resources and individuals’ attitudes. These are critical and possibly self-reinforcing elements for collecting SOGI data.[Table: see text]
Different thyroid assays may greatly affect diagnosis and management of hypothyroidism
Authors: Tejas Kalaria, Anna Sanders, Jonathan Fenn, Harit N Buch, Clare Ford, Helen L Ashby, Pervaz Mohammed, Rousseau Gama
Journal: BMJ (2021)

Siskind and colleagues do not mention the impact of thyroid assays and reference ranges on the diagnosis and management of hypothyroidism.1 It is generally believed that assay differences are accounted for by assay specific reference intervals. We found, however, that the diagnosis and management of subclinical hypothyroidism (SCH) is strikingly different depending on thyroid stimulating hormone (TSH) and free thyroxine …
Stereotactic body radiation therapy as palliative management for incurable thoracic malignancies.
Authors: Grace S. Ahn, Andrew Bruggeman, Edmund M. Qiao, James Don Murphy, Ajay Sandhu
Journal: Journal of Clinical Oncology (2021)

e24097 Background: Radiation therapy plays an important role in symptom palliation for patients with incurable cancer. Currently limited data exists regarding the role of SBRT vs conformal radiation for the palliation of symptoms due to malignancy. We report the symptom management and local control of palliative SBRT for incurable thoracic malignancies at a single institution. Methods: We retrospectively identified patients who underwent palliative SBRT between Jan 1 st , 2009 and March 26 th , 2019. Patients all had thoracic tumors that were not candidates for curative radiation due to age, stage, comorbidity, and/or prior treatment. We identified courses with total doses between 25-50 Gy (median 40) and total fractions between 3-10 (median 5). Symptoms such as cough, chest pain, hemoptysis, and shortness of breath were assessed at time of consult and first follow-up between 1-6 months post treatment. We also reviewed follow-up CT imaging to evaluate for local control using RECIST criteria. Descriptive statistics were used to evaluate patients’ clinicopathologic data and symptom palliation. Local control was analyzed via Kaplan-Meier method. Results: Of the 76 patients who completed palliative SBRT to 92 total lung lesions, 45 patients reported symptoms at consult and completed 50 courses of radiation to 55 lesions. Within this symptomatic cohort, average age was 71 (range, 42-93), 32 were female (58%), and most were stage IV (n = 42, 76%). Most lesions treated were non-small cell lung cancer (n = 34, 62%) while the most common primary site of metastatic lesions was colorectal (n = 6, 11%). Additional primary sites included breast, renal, sarcoma, and others (n = 15, 27%). Of the 53 lesions treated with follow-up within 6 months, 21 (40%) showed relief of at least 1 symptom and 31 (58%) showed stable symptoms. Only 1 patient (2%) showed symptom progression. All patients with hemoptysis at presentation achieved hemostasis following SBRT. Among 48 treated lesions with follow-up CT imaging, 1 (2%) showed complete response, 28 (58%) showed partial response (PR), 15 (31%) showed stable disease (SD), and 4 (8%) showed progressive disease. With further follow-up (median 23 months), 30 of the 53 lesions with initial PR or SD demonstrated local control until death. Conclusions: There is conflicting literature regarding the ideal palliative radiation dose for thoracic tumors. SBRT has the advantage of allowing a higher biologic dose without protracted treatment courses in the setting of palliation of symptoms. Our symptomatic cohort showed good symptom palliation and long-term local control of treated lesions. Prospective studies are required to further confirm the role of palliative SBRT for symptomatic thoracic tumors.
Gut microbes impact stroke severity via the trimethylamine N-oxide pathway
Authors: Weifei Zhu, Kymberleigh A. Romano, Lin Li, Jennifer A. Buffa, Naseer Sangwan, Prem Prakash, Aaron N. Tittle, Xinmin S. Li, Xiaoming Fu, Charlie Androjna, Anthony J. DiDonato, Kimberly Brinson, Bruce D. Trapp, Michael A. Fischbach, Federico E. Rey, Adeline M. Hajjar, Joseph A. DiDonato, Stanley L. Hazen
Journal: Cell Host & Microbe (2021)
First data from OUT: The National Cancer Survey of LGBTQ+ survivors.
Authors: Nfn Scout, Michelle ED Veras, Bethany Andrews Rhoten, Reece ED Lyerly, Aurea ED Kasberg, Kk ED Naimool
Journal: Journal of Clinical Oncology (2021)

e18544 Background: Cultural barriers that inhibit LGBTQ cancer care are a public health crisis. Although LGBTQ cultural competency trainings are rapidly becoming the norm, patient-centered information is lacking for healthcare professionals in cancer care. The purpose of OUT: The National Cancer Survey is to understand the experiences of LGBTQ cancer survivors in order to make cancer care a safer and more welcoming place for survivors and their support teams. Methods: Individuals age 18 or older currently living in the United States who have been previously diagnosed with cancer and who identify as LGBTQ+ were recruited via community partnerships and targeted paid social media advertisements with an oversample of media outreach to Black Indigenous and People of Color (BIPOC). Participants completed a cross-sectional web-based survey of their cancer care experiences. This resulted in a final sample of [1,600+] survivors, the largest known sample of LGBTQ+ cancer survivors in the world. The sample was weighted to adjust for U.S. sex assigned at birth and racial/ethnic demographics. Descriptive statistics were used to summarize participant responses, crosstabs were used to compare responses across demographic categories, and excerpted responses are used to highlight qualitative themes. Results: Participants ranged in age from X to X years (median X). X% of the sample identified as either gay or lesbian, X% as bi, and X% as trans or gender nonconforming. X% of the sample identified as White only, followed by X% as Latine, X% as Black and X% as other or mixed race. Most common cancer types included XYZ. When asked about welcoming care, X% of the sample reported they specifically sought an LGBTQ+ welcoming provider after diagnosis. Most common methods for finding such a provider included: X, X, and X. Most common cues that helped patients identify welcoming providers included X, X, and X. Overall X% reported receiving care in an LGBTQ+ welcoming environment but X% did not. Of those who did not receive care in a welcoming environment, they were more likely to be X, X, and X. Overall, X% of patients were out to their providers, but this varied by X, X, and X. The most common ways of coming out included X, X, and X. When asked what they wanted to tell health care providers to ensure better care, participants highlighted several themes, including: X, X, and X. These findings provide patient driven insights into how cancer care varies within the LGBTQ+ population by different demographic factors and specific strategies providers can take to enhance care for LGBTQ+ people.
Anlotinib plus pemetrexed as a further treatment for patients with platinum-resistant ovarian cancer: A single-arm, open-label, phase II study.
Authors: Jueming Chen, Wei Wei, Lie Zheng, Han Li, Yanling Feng, Ting Wan, Jiaqi Qiu, Xingyu Jiang, Ying Xiong, Min Zheng, Jundong Li, He Huang, Libing Song, Jihong Liu, Yanna Zhang
Journal: Journal of Clinical Oncology (2021)

5533 Background: Non-platinum chemotherapy is widely used in platinum-resistant recurrent ovarian cancer treatment but with limited efficacy. Combing chemotherapy with angiogenic inhibitors is a new therapeutic choice. Anlotinib is a novel tyrosine kinase inhibitor targeting multiple receptors involved in tumor proliferation, vasculature, and tumor microenvironment. The study aimed to further assess the efficacy and safety of anlotinib combined with pemetrexed in platinum-resistant ovarian cancer. Methods: Patients who had received at least two different chemotherapy regimens (including the first line platinum-based regimen), with histologically proven recurrent platinum-resistant or platinum-refractory epithelial ovarian cancer (including salpingocarcinoma and peritoneal carcinoma), ECOG 0-2, were considered eligible for enrollment to receive six 21-days cycles of anlotinib (12 mg QD from day 1 to 14; 21 days per cycle) orally plus pemetrexed intravenously (0.5 g/m 2 on day 1; 21 days per cycle). Subsequent maintenance treatment was anlotinib monotherapy (12 mg QD from day 1 to 14; 21 days per cycle) till disease progression or intolerant toxicity. The primary endpoint was objective response rate (ORR), and the secondary endpoints included disease control rate (DCR), progression-free survival (PFS) and safety. Results: As of Jan 2021, 27 patients were enrolled. The median number of chemotherapy was 4 (range, 2-10) and 51.9% (14/27) of patients had ever received antiangiogenic therapy. The ORR was 36.4% (partial response (PR) in 8 patients; 95% CI, 17.2-59.3). The DCR was 100.0% (PR in 8 patients and stable disease (SD) in 14 patients; 95% CI, 73.5-100). The median time of the first response was 1.6 months (range, 1.3-4.4). The median PFS was 9.3 months (95% CI, NE-NE). Furthermore, the ORR of patients with and without prior antiangiogenic therapy was 16.7% (95%CI, 2.1-48.4) and 60.0% (95%CI, 26.2-87.8) respectively (P = 0.074). Any grades of adverse events (AEs) were observed in 92.6% (25/27) of patients, containing allergic eruption (33.3%), hand-foot syndrome (29.6%), hypertension (25.9%), and fatigue (25.9%). The grade 3-4 adverse events were only observed in 5 patients, including 1 with grade 3 proteinuria, 1 with grade 3 ascites, 1 with grade 3 fatigue, 1 with grade 3 edema limbs and 1 with grade 4 anemia. Conclusions: The treatment of anlotinib plus pemetrexed showed a promising antitumor activity with tolerable toxicity for patients in platinum-resistant and refractory ovarian cancer. Clinical trial information: ChiCTR2000029654.
Survey study of barriers to evidence-based decision-making in oncology care using next-generation sequencing.
Authors: Elizabeth A. Szamreta, Allysen Kaminski, Ruchit Shah, Ning Ning, Jyoti Aggarwal, Arif Hussain, Gboyega Adeboyeje
Journal: Journal of Clinical Oncology (2021)

e18757 Background: Next-generation sequencing (NGS) has the potential to accelerate precision medicine in oncology by informing efficient and improved clinical treatment decision-making. However, discussions on the utility of NGS in clinical practice are ongoing. This survey study examined clinical utility barriers to adoption of NGS into oncologic care. Methods: A cross-sectional online survey was sent to a nationally representative sample of oncologists/hematologists, surgeons, and pathologists (N=201). The survey gathered information on physician demographics, practice characteristics, perceived barriers to NGS testing, and potential strategies for increasing adoption. Results: Almost all physicians in the sample (99.5%) reported using NGS. Physicians reported the following aspects of NGS as the most valuable: ability to guide decision-making (73.1%), more accurate identification of corresponding treatment (56.7%), comprehensive genomic coverage (54.2%), efficient technology with faster turnaround time (49.8%), and more accurate diagnosis or prognosis (41.3%). Physicians reported that NGS results guided treatment decisions for 63% of patients (Range: 2% - 100%). Over 85% of physicians reported that confidence in interpreting results and availability of clinical guidelines were important in undertaking NGS. Correspondingly, limited evidence of clinical utility was a top barrier to testing (80.1%), with pathologists and surgeons more likely than oncologists/hematologists to consider this. Overall, 76% of physicians shared that strategies to alleviate these clinical utility barriers included increased evidence, standardized guidelines, and interpretation support. Conclusions: Given the high uptake of NGS testing in this physician sample, but the lower rates of application of test results to guide treatment, the clinical impact of NGS may not be fully optimized. This discrepancy highlights the ongoing need for real-world evidence to better understand and further optimize the evolving role of NGS in the context of the overall management of the cancer patient. [Table: see text]
A cerebellar-thalamocortical pathway drives behavioral context-dependent movement initiation
Authors: Joshua Dacre, Matt Colligan, Thomas Clarke, Julian J. Ammer, Julia Schiemann, Victor Chamosa-Pino, Federico Claudi, J. Alex Harston, Constantinos Eleftheriou, Janelle M.P. Pakan, Cheng-Chiu Huang, Adam W. Hantman, Nathalie L. Rochefort, Ian Duguid
Journal: Neuron (2021)

Executing learned motor behaviors often requires the transformation of sensory cues into patterns of motor commands that generate appropriately timed actions. The cerebellum and thalamus are two key areas involved in shaping cortical output and movement, but the contribution of a cerebellar-thalamocortical pathway to voluntary movement initiation remains poorly understood. Here, we investigated how an auditory "go cue" transforms thalamocortical activity patterns and how these changes relate to movement initiation. Population responses in dentate/interpositus-recipient regions of motor thalamus reflect a time-locked increase in activity immediately prior to movement initiation that is temporally uncoupled from the go cue, indicative of a fixed-latency feedforward motor timing signal. Blocking cerebellar or motor thalamic output suppresses movement initiation, while stimulation triggers movements in a behavioral context-dependent manner. Our findings show how cerebellar output, via the thalamus, shapes cortical activity patterns necessary for learned context-dependent movement initiation.