tbuckley/cabot-search huggingface dataset:
Pain, palliation, and opioid use patterns: A nationwide analysis of neoplasm-related pain admissions and trends (2016-2020).
Authors: Rajvi Gor, Pranav Gwalani, DHAIRYA GOR, Anand Shah, Rahul Kumar Thakur, Abhishek Kumar
Journal: Journal of Clinical Oncology (2024)

e24068 Background: Neoplasm-related pain (NRP) remains a significant contributor to the diminished quality of life in cancer patients. We aimed to study the epidemiological characteristics and trends among patients hospitalized for NRP from 2016 to 2020. Methods: A retrospective study of patients hospitalized for primary or secondary diagnosis of NRP from 2016-2020 was conducted using the National Inpatient Sample (NIS) database. Temporal trends in the prevalence, mortality rate (MR), length of stay (LOS), hospitalization cost, palliative care consults, and opioid use/dependence/abuse (OUD) were assessed using linear regression or the Cochran-Armitage test. Further, the NIS database was searched to identify all patients admitted with a diagnosis of OUD. Amongst them, the proportion of patients with a coexisting diagnosis of NRP was calculated. Analysis was done using R 4.3.2 and SAS 9.4. Results: 174,530 cases with NRP were identified from 2016-2020, with a median age at hospitalization of 61(IQR: 52,70). The number of hospitalizations increased from 28,036 in 2016 to 41,013 in 2019 and then dropped to 38,040 in 2020 (p &lt; 0.001). The total inpatient MR was 7.8%, decreasing from 8.5 % in 2017 to 7.0% in 2020 (p &lt; 0.0001). The mean cost of hospitalization increased significantly from $64,162.5 in 2016 to $82,943.8 in 2020 (p &lt; 0.001). There was no significant change in the mean LOS. The number of palliative care consults increased from 29.8% in 2016 to 31.5% in 2019 and then dropped to 31.3% in 2020 (p &lt; 0.001). Among 174,530 NRP patients, 5,844 (3.4%) had a coexisting diagnosis of OUD, which increased from 832 (3.0%) in 2016 to 1419 (3.7%) in 2020 (p &lt; 0.001). A total of 737,971 patients with a diagnosis of OUD were admitted from 2016-2020, of which 5844 (0.79%) had a coexisting diagnosis of NRP. Conclusions: We observed increased hospitalizations for NRP and related palliative care consults from 2016 to 2019, with a subsequent decline in 2020. This drop could be related to the impact of the COVID-19 pandemic. Despite the rise in the cost of hospitalizations, there has been a declining trend in MR, potentially due to improved quality of care. The gradual rise in the coexistence of OUD among NRP patients is notable. Yet, NRP patients remain a minority within the broader context of OUD-related admissions, underscoring the need for nuanced, patient-centered approaches in NRP management. [Table: see text]
The Clinicopathological Significance of Tumor Cell Subtyping in Appendiceal Neuroendocrine Tumors: A Series of 135 Tumors
Authors: Ozgur Mete, David W. Dodington, Daniel L. Shen, Sylvia L. Asa
Journal: Endocrine Pathology (2024)

Appendiceal neuroendocrine tumors (NETs) are common and often are identified as incidental lesions at the time of appendectomy. The guidelines for management are based on tumor size, degree of invasion, and the Ki67 proliferation index. Most small bowel NETs are composed of serotonin-producing EC-cells, but there are multiple other neuroendocrine cell types. In the rectum, there are L-cell tumors that express peptide YY (PYY), glucagon-like peptides (GLPs), and pancreatic polypeptide (PP); they are thought to have a better prognosis than serotonin-producing tumors. We investigated whether the appendix has distinct neuroendocrine tumor types based on cell type and whether that distinction has clinical significance. We collected 135 appendiceal NETs from the pathology archives of UHN Toronto and UHCMC (Cleveland). We analyzed the expression of biomarkers including CDX2, SATB2, PSAP, serotonin, glucagon (that detects GLPs), PYY, and pancreatic polypeptide (PP) and correlated the results with clinicopathologic parameters. Immunohistochemistry identified three types of appendiceal NETs. There were 75 (56%) classified as EC-cell tumors and 37 (27%) classified as L-cell tumors; the remaining 23 (17%) expressed serotonin and one of the L-cell biomarkers and were classified as mixed. EC-cell tumors were significantly larger with more extensive invasion involving the muscularis propria, subserosa, and mesoappendix compared with L-cell tumors. Mixed tumors were intermediate in all of these parameters. Both EC-cell and mixed tumors had lymphatic and/or vascular invasion while L-cell tumors had none. Unlike EC-cell NETs, L-cell tumors were not associated with lymph node metastasis. Tumor type correlated with pT stage and the only patient with distant metastatic disease in this series had an EC-cell tumor. Our study confirms that appendiceal NETs are not a homogeneous tumor population. There are at least three types of appendiceal NET, including EC-cell, L-cell, and mixed tumors. This information is important for surveillance of patients, as monitoring urinary 5HIAA levels is only appropriate for patients with serotonin-producing tumors, whereas measurement of GLPs and/or PP is more appropriate for patients with L-cell tumors. Our data also show that tumor type is of significance with EC-cell tumors exhibiting the most aggressive behavior.
B7-H3: a robust target for immunotherapy in prostate cancer
Authors: Rafael Pulido, José I. López, Caroline E. Nunes-Xavier
Journal: Trends in cancer (2024)

B7-H3, an immune checkpoint glycoprotein, facilitates immune evasion and the promotion of tumors and is highly expressed on the surface of prostate cancer (PCa) cells, which makes it a feasible and robust candidate for immunotherapies against advanced prostate cancer. Here, we summarize and discuss recent findings on the suitability of targeting B7-H3 in PCa treatment.
Biosocial determinants inform on enduring cancer disparities
Authors: David P. Turner, Robert A. Winn, Victoria J. Findlay
Journal: Trends in cancer (2024)

Social, environmental, and biological risk factors influence exposures to newly termed 'biosocial determinants of health'. As molecular factors that lie at the intersection between lived experiences and individual biology, biosocial determinants may inform on the enduring complexity of cancer disparity across transdisciplinary studies.
Implementing circulating tumor DNA as a prognostic biomarker in resectable non-small cell lung cancer
Authors: Chris Abbosh, Darren Hodgson, Gary J. Doherty, Davina Gale, James R.M. Black, Leora Horn, Jorge S. Reis-Filho, Charles Swanton
Journal: Trends in cancer (2024)

Systemic treatment of resectable non-small cell lung cancer (NSCLC) is evolving with emerging neoadjuvant, perioperative, and adjuvant immunotherapy approaches. Circulating tumor DNA (ctDNA) detection at clinical diagnosis, during neoadjuvant therapy, or after resection may discern high-risk patients who might benefit from therapy escalation or switch. This Review summarizes translational implications of data supporting ctDNA-based risk determination in NSCLC and outstanding questions regarding ctDNA validity/utility as a prognostic biomarker. We discuss emerging ctDNA capabilities to refine clinical tumor-node-metastasis (TNM) staging in lung adenocarcinoma, ctDNA dynamics during neoadjuvant therapy for identifying patients deriving suboptimal benefit, and postoperative molecular residual disease (MRD) detection to escalate systemic therapy. Considering differential relapse characteristics in landmark MRD-negative/MRD-positive patients, we propose how ctDNA might integrate with pathological response data for optimal postoperative risk stratification.
Quantification of treatment-related time toxicity in patients with advanced stage cancer.
Authors: Yuhang Zhou, Madeline Campbell Fitzpatrick, Marisabel Hurtado Castillo, William Steele Sessions, Kyaw Lwin Aung, Om Narayan Pandey, Boone Wilder Goodgame
Journal: Journal of Clinical Oncology (2024)

12137 Background: Treatment-related Time Toxicity (TrTT) in cancer patients is a recently proposed metric to describe the burden of time spent in pursuing medical care, including office/hospital visits, side effect management, lab tests, imaging scans, and travel time. Time toxicity is a valuable concept in patient-centered shared-decision making, especially in the palliative management of end-stage cancer patients with limited life expectancy. Despite tremendous progress in cancer treatment, most of the guideline-recommended treatment options convey short survival benefits of around 3-6 months when compared to supportive care. While medication toxicities are meticulously reviewed with patients, the cumulative burden and impact of time are rarely included in the discussion, partly due to the lack of standardized measurement of TrTT, and the absence of data from clinical trials. Thus, there is a compelling need for the quantification of time toxicity to guide clinical practice and patient preference. Methods: This was an observational analysis of the time toxicity from palliative treatment for patients with incurable solid tumors at a regional safety-net oncology office that focuses on underserved communities. Time toxicity is calculated as the number of days a patient spent with any healthcare-related encounters during a 3-month period from our medical record system. Results: The median age of the total 94 included patients was 57. 54% of the population were Hispanic. The ratios for mild, moderate, and severe time toxicity were 38%, 44%, and 18%, respectively. Immunotherapy was associated with significantly less time toxicity (TrTT = 8.5 days, 95% CI = 6.3-9.7) compared to chemotherapy (26.3 days, 95% CI = 18.3-34.4, P &lt; 0.001), while targeted therapy (13.4, 95% CI = 7.0-19.8, P = 0.01) and hormone therapy (11.9, 95% CI = 4.1-19.7, P &lt; 0.01) also has lower TrTT than chemotherapy. Patients with a worse performance status (ECOG PS 3-4, 30.1 days, 95% CI = 18.3-41.9) experienced higher time toxicity than fitter patients (PS 0-2, 16.7 days, 95% CI = 13.2-20.2, P &lt; 0.05). Among different cancer types, gastrointestinal malignancies were associated with the highest time toxicity with average TrTT of 30.2 days/3 months (95% CI =22.5-37.2). Conclusions: This is the first comprehensive study to quantify real-world Treatment-Related Time Toxicity across multiple cancer and therapy types in an underserved population. We found 18% of patients with incurable solid malignancies experienced severe time toxicity (&gt; 1 in 3 days). Higher TrTT was associated with cytotoxic chemotherapies, GI malignancies, and poor performance status. Time toxicity should be taken into account with other quality-of-life outcomes in treatment pathways and patient-centered oncology care.
Effect of sodium-glucose cotransporter 2 inhibitor dapagliflozin on systemic H-FABP and monocyte-to-lymphocyte ratio in preclinical models of antracycline induced cardiotoxicity.
Authors: Nicola Maurea, Maria Laura Canale, Irma Bisceglia, Michelino De Laurentiis, Francesca Bruzzese, Giuseppe Palma, Antonio Luciano, Martina Iovine, Andrea Paccone, Ilaria Giacobbe, Vienna Giordano, Francesca Izzo, Matteo Barbato, Raffaele Arianna, Alessandro Inno, Vincenzo Quagliariello
Journal: Journal of Clinical Oncology (2024)

e24012 Background: Anthracyclines are an effective and widely used chemotherapy agent in the treatment of multiple solid organ tumors and hematologic malignancies. The use of anthracyclines as a standard cancer therapy is limited by the potential for the development of cardiac dysfunction, arrhythmias, and clinical heart failure. Dapagliflozin exerts several cardiometabolic benefits in patients with and wthout T2DM through SGLT2-NLRP3 mediated pathways. In this study, we highlighted on new beneficial properties of Dapagliflozin in preclinical models of doxorubicin-induced cardiotoxicity. Methods: Female C57Bl/6 mice were untreated (Sham, n = 6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n = 6), DAPA at 12 mg/kg (DAPA, n = 6) or doxorubicin combined to DAPA (DOXO–DAPA, n = 6). After treatments, plasma levels of H-FABP and monocyte-to-lymphocyte ratio were determined through selective quantitative methods. Results: Dapagliflozin associated to Doxorubicin reduces of 48,7% plasma levels of H-FABP compared to DOXO group (p &lt; 0.001). Myocardial expression of H-FABP were also reduced, indicating cardioprotective properties of SGLT2i. Moreover, monocyte-to-lymphocyte ratio was strongly enhanced after DOXO therapy, indicating systemic pro-inflammatory properties; notably, Dapagliflozin reduced of 32,8% the monocyte-to-lymphocyte ratio compared to only DOXO treated mice (p &lt; 0.005). Conclusions: For the first time, Dapagliflozin demonstrated a significant reductions of monocyte-to-lymphocyte ratio during doxorubicin therapy, indicating new potential pathways of cardioprotection in cancer patients
The influence of psychosocial factors on first-time chemotherapy-induced nausea and vomiting: A prospective multicenter cohort study.
Authors: Xiaoxiao Shi, Liang Xu, Jie Liu, Ying Wang, Xiaoyun Yang, Hongyu Zhuo, Jie Zhang, Ye Chen, Hongmei Xiao, Ke Xie, Wuning Zhong, Yu Jiang, Yaotiao Deng
Journal: Journal of Clinical Oncology (2024)

12135 Background: Previous studies have suggested that if cancer patients experience no chemotherapy-induced nausea and vomiting (CINV) or mild symptoms during their first chemotherapy cycle, they are less likely to experience CINV in subsequent cycles, suggesting that the optimal intervention time may be before the first chemotherapy cycle. Consequently, attention should be paid to relevant risk factors. Currently, there is a lack of data on psychosocial risk factors related to chemotherapy among cancer patients in China. Methods: This study was a multicenter, prospective cohort study that included cancer patients from seven hospitals' oncology departments who were scheduled to undergo their first chemotherapy cycle. The chemotherapy regimens administered were either highly or moderately emetogenic protocols. Demographic and baseline clinical characteristics were recorded by clinical oncologists. Participants were asked to complete the Distress Thermometer (DT), the Mini-Mental Adjustment to Cancer (Mini-MAC), and a risk factor questionnaire the day before chemotherapy, and to keep a daily diary describing their CINV experiencing for 21 days after chemotherapy. Results: Between October 2022 and November 2023, a total of 1100 cancer patients were enrolled in this study and 972 cancer patients completed all the questionnaires. A total of 64.1% reported CINV during the first chemotherapy cycle. In logistic regression analysis, CINV was predicted by higher PS score (OR=1.411, p=0.049), highly emetogenic regimens (OR=1.846, p=0.004), failure to follow anti-emetics guidelines (OR=2.323, p&lt;0.001), history of nausea/vomiting for other reasons(OR=1.817, p=0.001), lower number of hours slept before the night of chemotherapy (OR=8.987, p&lt;0.001), expectancy of CINV(OR=1.505, p=0.032), maladaptive coping (OR = 1.03, p = 0.024) and distress (OR = 1.157, p =0.021). Conclusions: Psychosocial factors significantly correlate with chemotherapy-induced nausea and vomiting (CINV) among Chinese cancer patients. These findings underscore the importance of integrating psychosocial assessments into the management of CINV, potentially improving treatment outcomes and patient experiences.
Risk assessment of cardiovascular adverse events with BTK inhibitors in hematological malignancies: Insights from FAERS.
Authors: Muhammad Salman Faisal, Karan Jatwani, Venkatesh Kolli, Noha Soror, Mayur Sarangdhar
Journal: Journal of Clinical Oncology (2024)

12145 Background: Burton tyrosine Kinase inhibitors (BTKi) have revolutionized the care of chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphomas (NHL) – including relapsed/refractory mantle cell, ABC diffuse large B cell lymphoma and and lymphoplasmacytic lymphoma. Ibrutinib was the first BTKi to be approved. The newer covalent BTKi include acalabrutinib and zanubrutinib, both of which are approved for frontline and relapsed CLL as well as relapsed NHL. All these agents have cardiovascular adverse events. We aimed to assess the pharmacovigilance (PV), reporting rate, severity, and reaction outcomes of different approved BTKi in the CLL as cancer reported to the United States Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: We analyzed cardiovascular events in 86,370 patients on BTKi. Cardiovascular event reports were submitted to FAERS between 2004-2023 and analyzed using the AERS Mine framework. We compared these incidences within different BTKI. We divided cardiovascular events to three categories: cardiac arrythmia, major coronary or vascular event (MACE) and pericardial complication including effusion or hemorrhage. Our primary composite endpoint was the PV of cardiovascular events caused by BTKI. To mitigate confounding, BTKI were analyzed as mutually exclusive cohorts: Ibrutinib (n = 79,278), acalabrutinib (5200), and zanubrutinib (1354). Two-way ANOVA testing was done to evaluate for statistical significance across the different groups. Results: Across the 86,370 patients on BTKI, we identified 8500 reports of cardiovascular events – ibrutinib (10.15%), acalabrutinib (5.73%), and Zanubrutinib (4.72%). Arrythmia risk was higher with ibrutinib (6.6%) compared to acalabrutinib (3.12%) and zanubrutinib (2.29%). The major difference in the groups was driven by atrial fibrillation (5.1% vs 2.1% vs 1.8%). The MACE rate was 2.79% vs. 2.4% vs. 2%, and pericardial events were 0.72% vs. 0.21% vs. 0.44% in the ibrutinib, acalabrutinib, and zanubrutinib groups, respectively. All the AEs were to have statistical significance (p = 0.011) across all the BTKI as mentioned in table 1. Conclusions: We report the prevalence rate of BTKI-related cardiovascular events in a large cohort of patients. Ibrutinib has demonstrated a higher incidence of toxicity, especially in cardiac arrythmias, while smaller but significant differences exist in other toxicities, including major cardiovascular events and pericardial effusion or hemorrhage. Patient selection and toxicity monitoring are important aspects of the care of these patients, who stay on these therapies for indefinite periods. [Table: see text]
Prevalence and clinical outcomes of acute heart failure among patients with mediastinal radiation exposure: A propensity score matched analysis.
Authors: Kanchhi Bekoju, Sajog Kansakar, Shreeja Shikhrakar, Ashish Guragain, Dilichukwu Chudy-Onwugaje, Soe Winn
Journal: Journal of Clinical Oncology (2024)

e24029 Background: Radiation therapy (RT) for malignancy in mediastinal region is associated with radiation-induced heart disease in subsequent years, including coronary, valvular, myocardial, pericardial and conduction system disease. Although increased risk of diastolic heart failure (DHF) has been established, there is limited data on the prevalence, trends and outcomes of acute DHF admissions in patients with prior mediastinal RT. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of acute DHF with and without history of RT for mediastinal cancer using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 2,356,025 admissions for acute DHF were identified between 2016 to 2020, of which 15,435 (0.65%) had prior mediastinal RT. During the study period, we found an increasing trend in the number of admissions for acute DHF (p trend &lt; 0.01) along with an increased proportion of patients with prior mediastinal RT. (0.55% in 2016 to 0.78% in 2020, p trend &lt; 0.01). After propensity score matching, there was no difference in in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.79-1.58, p = 0.537), or complications such as cardiogenic shock, respiratory failure, stroke, venous thromboembolism, or acute kidney injury between the two cohorts. There was no difference in length of stay, however, cohort with history of mediastinal RT had higher hospital charges ($26,634 vs $31,511, p &lt; 0.01). Conclusions: Exposure to mediastinal RT represents a minority but growing number of hospital admission with DHF. The mortality and complications of RT associated DHF does not differ significantly from those with traditional etiologies of DHF.
Interventions of the nurse navigator in the identification and management of toxicities after the start of treatment in patients with cancer using antineoplastic therapy.
Authors: Anna Carolina R Messias, Cristiane Decat Bergerot, Andre Faria, Camila Tolomelli Gregoli, Alice Sousa Vidal, Juliana Torres Carneiro, Bruno Lemos Ferrari
Journal: Journal of Clinical Oncology (2024)

12139 Background: Monitoring symptoms during chemotherapy is crucial as patients experience adverse effects, requiring therapeutic modifications, supportive care, and education. Patient navigation provides individualized assistance, overcoming barriers to healthcare access for patients, families, and caregivers. A previous study (Tabriz et al. JAMA Netw Open 2023) has shown that 52% of emergency room (ER) visits can be preventable. Thus, this study sought to determine effect of a nurse navigation program on reducing the rate of ER visit. Methods: This retrospective study was conducted from June to December 2023 in two cancer centers within the Oncoclinicas Network, located in the Southeast and Northwest regions of Brazil. Eligible patients were diagnosed with breast, lung, and gastrointestinal cancer, and were undergoing treatment with chemotherapy and/or immunotherapy. These patients were monitored by nurse navigators at post-therapy. Interventions were categorized as home management (care provided at patient’s home), outpatient (referral to the treatment clinic), and hospital (referral to emergency care). All toxicities were graded according to the Common Terminology Criteria for Adverse Events 5.0. Results: A total of 531 patients were included in the analysis, with the majority aged over 61 years old (44.4%), diagnosed breast (%) or colon (%) cancers. Throughout the six month study period, 3,201 toxicities were identified, with the majority graded between 1 and 2 (95.9%). This resulted in 91.9% of patients being managed at home or referred to the outpatient care. The cumulative proportion of patients having their symptoms managed at home or outpatient care is significantly higher than historical controls (P=0.001). Conclusions: Our findings highlight the effectiveness of a nurse navigation program in managing toxicities and symptoms, preventing ER visit. These findings underscore the importance of this program in optimizing patient care and reducing the burden on healthcare facilities. Further research and implementation of such programs may contribute to improved outcomes and patient satisfaction in oncological care.