tbuckley/cabot-search huggingface dataset:
KANSURVIVE: Testing a telementoring model for improving cancer survivorship care in rural practice.
Authors: Jennifer R. Klemp, Catie J. Knight, Edward F. Ellerbeck, Christie A. Befort, Eve-Lynn Nelson, Anne O'Dea, Prabhakar Chalise, Dorothy Hughes, Allen Greiner
Journal: Journal of Clinical Oncology (2024)

e13791 Background: Cancer survivors require long-term, coordinated care to address the physical, emotional, and psychosocial effects of cancer and its treatment. KanSurvive, a single arm feasibility trial, evaluated the effectiveness of the KanSurvive ECHO intervention combined with practice facilitation (PF) to promote better adoption of evidence-based practice (EBP) survivorship care guidelines for breast, colorectal, lung, and prostate cancer among rural survivors. Methods: Fifteen primary care clinics in Kansas (80% in RUCA codes 4-10), including 62 healthcare professionals, were invited to participate in four, 1-hour Project ECHO telementoring program held in 2021. Real-time videoconferencing sessions covered EBP survivorship guidelines for breast, colorectal, lung, and prostate cancer. Clinics used brief plan-do-study-act cycles with PF supporting implementation of the quality improvement process. Utilizing the National Quality Forum framework, a performance indicator booklet with established measures in preventive health and cancer survivorship was developed as a data collection and quality improvement resource. Performance indicators included EBP screening actions related to cancer surveillance, lifestyle factors, distress, evidence of a review of family history of cancer, and the patient’s cancer diagnosis documented in the EHR. Results: Three clinics (7 = healthcare professionals) withdrew from the project citing competing demands and a provider leaving the practice. The COVID-19 pandemic delayed project initiation and prevented clinic visits. Recruitment and study procedures were implemented remotely. Clinic staff identified 138 cancer survivors (M = 13, IQR [6-16] per practice) seen in the year pre-intervention, and 129 survivors in the year prior to post-intervention. Pre-intervention, overall tumor surveillance was 91%, but lung cancer surveillance was lower than other tumor types at 70%. Other than surveillance, measures of baseline performance were similar across tumor types: screening for distress 84%, assessment of BMI 97%, screening for tobacco use 83% and documentation of family history 70%. Post-intervention performance indicators were similar except for documentation of family history which increased to 89% (p &lt; 0.01). Conclusions: Standardized survivorship metrics can facilitate quality assessment as part of an ECHO-based cancer survivorship program. Although there are modest opportunities for improvement, PCPs in this study caring for rural patients perform reasonably well across a variety of cancer survivorship performance metrics comparable to national primary care quality measures. Documented assessment of family history of cancer lags other metrics and improved after participation in the KanSurvive telementoring program.
Patient reported outcomes for anterior and postpectoral prosthesis implantation in single-port laparoscopic breast.
Authors: Xiangmei He, Juliang Zhang, Lan Hou, Kexin Chang, Donghui Wang, Danxi Li, Yangchi Jiao
Journal: Journal of Clinical Oncology (2024)

e12601 Background: Breast reconstruction surgery is on the rise and can significantly improve patients' quality of life, and single-port lumpectomy breast reconstruction surgery is becoming more widely used because of its minimally invasive nature, clear field of view, and aesthetics. However, patient-reported outcome studies of anterior versus posterior pectoralis muscle in this procedure are still scarce, and more evidence is needed to provide guidance to clinicians. Methods: Patients who underwent single-port laparoscopic breast reconstruction surgery at Xijing Hospital between March 2021 to December 2023 were included and divided into two groups according to the position of the prosthesis in the pectoral muscle. Patient safety was assessed for surgical safety and tumor safety. Patient Reported Outcome (PRO) was assessed using the BREAST-Q questionnaire. Results: General situation: This study was included in 58 patients with a single -hole laparoscopic breast reconstruction, and 48 patients were included in the post -pectoral muscle group. Tumor safety: 100% recurrence-free survival, 100% disease-free survival, and 100% overall survival in the follow-up patients; there was no significant difference between the anterior and posterior pectoral muscle groups in the single-port cavity. Surgical safety: there was no significant difference between the pre-pectoral and post-pectoral groups in terms of operative time, intraoperative bleeding, nipple areola complex ischemia, periosteal contracture. there were significant differences in postoperative infection, postoperative pain, and flap ischemia between the two groups, with the anterior pectoralis muscle group having a lower rate of postoperative infection, less pain, and a lower rate of flap ischemia. Patient-reported outcomes: The breast satisfaction of the breast reconstruction of the thoracic muscles under the laparoscopy, the higher social psychological health score, and the lower score in chest pain. Conclusions: In our research, the two groups of patients with single -hole laparoscopic breast reconstruction did not have a bad ending, and the single -hole laparoscopic pectoral muscle reconstruction had lower postoperative complications, and had better patient reporting ending Therefore, without considering the economic situation, we recommend the reconstruction of a single -hole laparoscopic pectoral muscles.
Use of an AI-powered visualization platform to support precision clinical decision-making in patients with breast cancer undergoing neoadjuvant chemotherapy.
Authors: Vincent Reid, Michelle Weitz, Matthew Biancalana, John A. Cole, Barry Rosen
Journal: Journal of Clinical Oncology (2024)

e12618 Background: Chemotherapy to reduce cancer burden and tumor size ("downstaging") is widely used in neoadjuvant treatment of early-stage breast cancer (ESBC) and can have a dramatic impact on selection of further treatment courses, including surgery. The resulting decision-making process between physicians and cancer patients requires detailed and effective communication of the patient's disease status, and clear presentation of this information in Tumor Board settings. Artificial intelligence (AI) -powered visualization platforms offer the potential to aid in evaluating breast tumor location and morphology, and accordingly optimize treatment. Additionally, these tools offer enhanced communication with patients regarding future treatment options, particularly serving as clinical decision support (CDS) tools. Methods: We assessed the performance of an AI platform that employs dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to render three-dimensional (3D) visualizations of breast tumors and 5 additional chest tissues on an independent validation dataset comprise of 100 ESBC cases with ground-truth tumor labels vetted by 2 breast-specialized radiologists. The platform provides 3D depictions of the tumor and its multi-tissue context, as well as functionalities for quantifying tumor morphology, tumor-to-landmark structure distances, excision volumes, and approximate surgical margins. We subsequently evaluated the tool's utility in a real-world setting to understand how the tool impacts clinical decision-making and patient communication, specifically around surgical planning in the context of neoadjuvant chemotherapy (NACT). Results: The platform generated accurate 3D tumor maps, as evidenced by a median Dice score of 75.6% and a median Hausdorff distances of 15.1 mm relative to the radiologist validation set. The automatic longest tumor dimension calculations were linearly correlated with radiologist direct measurements (Pearson correlation coefficient = 0.78) and had a median absolute difference of 6.3 mm. We found strong overlap between the platform’s ground-truth convex hulls, as shown by a median Dice score of 81.5%. When used by a skilled breast-specialized surgeon, the tool enabled rapid and intuitive patient-physician communication of the location and extent of disease, and potential degrees of downstaging to breast-conserving surgery. Conclusions: Detailed 3D tumor and surrounding multi-tissue depictions offer both qualitative and quantitative comprehension of cancer topology and may aid in formulating an optimal treatment approach for breast cancer treatment. We show that detailed depictions enhance communication between physicians and patients and may aid in streamlining decision-making.
Retrospective analysis of factors impacting efficacy of patients with later stage breast cancer receiving neoadjuvant therapy.
Authors: Nan Wang, Anjie Zhu, Ran Ran, Ying Yan, Bin Shao, Xu Liang, Hanfang Jiang, Guohong Song, Lijun Di, Huiping Li
Journal: Journal of Clinical Oncology (2024)

e12624 Background: Neoadjuvant treatment is the current standard of care for patients with early breast cancer (EBC), especially for patients with later stage breast cancer (LBC). We conducted this retrospective study to summarize the correlation between pathologic complete response (pCR), disease-free survival (DFS), overall survival (OS) and clinical impacting factors of patients with later stage received neoadjuvant treatment. Methods: We retrospectively analyzed the clinical data of patients receiving neoadjuvant treatment at the Department of Breast Oncology, Peking University Cancer Hospital from Jan. 2013 to Feb. 2022. Statistical analyses were carried out using IBM SPSS Statistics. We calculated pCR rate, DFS and OS. Pearson’s χ2 or Fisher’s exact tests were used for comparison of categorical variables. DFS and OS were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression was used to identify factors impacting on survival. All p values were two sided and p&lt;0.05 was considered to denote statistical significance. Results: Of 198 patients, most of them were in stage II (115/198, 58.1%), followed by stage III (79/198, 39.9%) and stage I (4/198, 2.0%), The pCR rates for different molecular subtypes were 31.6% TNBC, 29.7% for HR-Her2+ BC, 26.1% for HR+Her2+ BC and 1.3% for HR+Her2- BC, respectively (p=0.000). The median DFS of patients with or without pCR was 59.63 months (95%CI: NA-NA) and 29.83 months (95%CI: 21.31-38.35), respectively (p=0.012). DFS of patients who were cT1 [59.63 months (95%CI: 37.95-81.31)] or cT2 [39.56 months (95%CI: 24.19-54.93)] was significantly longer than that of patients who were cT3-4 [25.76 months (95%CI: 14.11-37.41), p=0.041]. Miller Payne (M-P) grade and ypTNM stage were also significantly associated with DFS in univariate analysis and in the multivariate cox regression model after adjusting for molecular subtypes. The 5-year OS were 87.0% for patients who reached pCR and 52.0% for patients who didn’t (p=0.009). Conclusions: The pCR was significantly associated with molecular subtypes. HR negativity and overexpression of Her2 were significantly associated with higher pCR rate. Patients reached pCR had longer DFS and OS. DFS was significantly associated with cT stage (T1 vs T2 vs T 3-4), ypTNM stage and M-P grade.
Optimal neoadjuvant treatment and prognostic factors in patients with HR-positive/HER2-positive early or locally advanced breast cancer: A national real-world study in China.
Authors: Zhenzhen Liu, Jiujun Zhu, Chengzheng Wang, Zhenduo Lu, Xiuchun Chen, Lianfang Li, Xianfu Sun, Chongjian Zhang, Jianghua Qiao, Min Yan
Journal: Journal of Clinical Oncology (2024)

e12514 Background: Few data have been reported regarding breast cancer (BC) population characterized by HR+/HER2+ especially in a real-world setting in China. This analysis aimed at identifying differences in short-term treatment outcomes of different neoadjuvant therapy (NAT) regimens, effects of the demographics and clinical features on short-term outcomes of NAT, and further understanding the prognostic factors related to those outcomes in HR+/HER2+ early (EBC) or locally advanced BC (LABC) pts by using dataset from National Cancer Information Database (NCID) in China. Methods: This retrospective, multicenter, real-world study used electronic medical record data from NCID. We analyzed HR+/HER2+ EBC or LABC Chinese pts who were initially diagnosed between Jan 1, 2019 and May 31, 2022 and received NAT followed by surgery during study period. Primary endpoints included total pathological complete response (tpCR) and breast pCR (bpCR). Secondary endpoints included disease-free survival (DFS) and event-free survival (EFS). Results: 3792 pts from NCID covering 51 hospitals, 26 provinces met inclusion criteria and were included. After controlling for age and post-surgery N staging, 1-, 2- and 3-yr DFS was similar between trastuzumab (T) and T+pertuzumab (P) NAT subgroup (92.79%, 87.20% and 83.32% vs 94.83%, 88.82% and 87.88%; p=0.1120). 1-, 2- and 3-yr EFS was higher in T+P subgroup (T vs T+P: 85.24%, 82.35%, 77.01% vs 90.86%, 89.65%, 82.78%; p = 0.0003). Logistic regression multivariate analysis showed improved tpCR and bpCR was independently positively associated with receiving T+P NAT (vs T: both p &lt; 0.0001), platinum NAT (vs anthracycline: p = 0.0071 and 0.0122, resp.), while negatively associated with receiving no targeted therapy (vs T: p = 0.0002 and &lt; 0.0001, resp.), ≥ 65 yrs (vs &gt; 40 yrs, &lt; 64 yrs: p = 0.0116 and 0.0290, resp.), or post-surgery ER positive (vs negative: both p &lt; 0.0001). Conclusions: HR+/HER2+ EBC or LABC gained short- and long-term benefit from HER2 dual-blockade therapy in clinical practice. Prognostic factors for improved tpCR and bpCR included T+P and platinum NAT, whereas ≥ 65 yrs and post-surgery ER+ were predictive of decreased tpCR and bpCR. [Table: see text]
A phase IV study of ApricityCARE program for cancer adverse events rapid evaluation to improve treatment outcomes of ethnic/racial minority patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICI).
Authors: Brian S. Henick, Rajwanth Veluswamy, Balazs Halmos, Kristen Labbe, Naomi Sender, Sarah Sta Ana, Lanyi Nora Chen, Salman Rafi Punekar, Jasleena Singh, Matthew Lee, Catherine A. Shu, Benjamin Herzberg, Lynda Chin, Vamsidhar Velcheti
Journal: Journal of Clinical Oncology (2024)

TPS1642 Background: ICI have changed the treatment landscape of NSCLC, with many now FDA approved in not just advanced, but even early-stage disease. With the increase in ICI use, the incidence of immune-related adverse effects (irAEs) has also risen, occurring in up to 16% of ICI-treated patients. Prompt recognition and timely management are necessary to avert potential poor outcomes from direct toxicity and/or early treatment discontinuation. However, existing barriers to access care that disproportionately impact racial and ethnic minority patients may amplify challenges in early, effective management of irAEs. Using technology-enabled health interventions in a culturally competent manner can improve access to health care resources and reduce health disparities. These platforms need to be optimized at the technology and health literacy level of underserved minority communities and adapted to meet the community's needs. Methods: We have designed a multi-center phase IV clinical trial to 1) assess factors related to suboptimal and optimal use of the ApricityCARE, a virtual first-response clinical support (or coverage) to provide 24/7 symptom monitoring and side effect management and 2) determine the impact of the program on ICI toxicity management for NSCLC patients receiving ICIs in a highly diverse community. Eligible patients are those with a confirmed diagnosis of NSCLC who self-identify as a member of an ethnic minority or underserved population, prescribed for any treatment regimen that includes an ICI. The study entails a 50-patient run-in phase with two focus group discussions, stratified on a Likert-type scale based on the frequency of utilization, to determine factors impacting usability of the ApricityCare program. This data will inform optimal implementation of ApricityCare for the randomized phase of the study, where 230 patients will be assigned 1:1 to use of ApricityCare versus standard of care. The run-in phase of the study is currently accruing at Columbia University, and is planned to open at NYU, Mount Sinai, and Montefiore (NCT05812274). Clinical trial information: NCT05812274 .
Arthralgia and myalgias associated with aromatase inhibitors: Frequency and characterization in real-life patients.
Authors: Natalia Camejo, Cecilia Castillo, Diego Santana, Lucia Argenzio, Dahiana Amarillo, Guadalupe Herrera, Maria Guerrina, Gabriel David Krygier
Journal: Journal of Clinical Oncology (2024)

e12504 Background: Adjuvant treatment with aromatase inhibitors (AI) in estrogen receptor (ER) and/or progesterone receptor (PR) positive breast cancer (BC) has been shown to increase overall survival (OS). However, arthralgias and myalgias are common adverse effects in patients treated with AI. Objective: To evaluate the frequency and characteristics of arthralgias and myalgias in patients with early BC, treated adjuvantly with AI at the Mastology Unit of the Oncology Service of the Hospital de Clínicas and the Soriano Departmental Hospital. Methods: A prospective, cross-sectional, descriptive study was conducted. A questionnaire was administered to the patients to assess the presence and characteristics of arthralgias and myalgias associated with AI. Statistical analysis: "Age" was described using measures of central tendency and dispersion. Qualitative variables were presented in absolute and relative frequencies. Logistic models were used to assess the association between patient, tumor, and treatment characteristics and the presence of pain. Results: Results were presented using Odds Ratio and p-value, using R software (version 4.1.2) with a significance threshold of 5%. 83 patients were included, with a median age of 69 years. 75.9% presented treatment-related arthralgias and/or myalgias, with an average intensity of 5 to 7. 80.9% received NSAIDs, achieving satisfactory analgesia. The presence of arthralgias and myalgias was significantly associated with age and time since last menstruation, being more frequent in patients over 50 years old and those with more than 5 years since the last menstruation. Conclusions: Approximately 70% of the patients presented arthralgias or myalgias. These findings suggest a possible role of estrogen withdrawal in their development mechanism. It is crucial to carry out multidisciplinary and translational research to evaluate the etiology and therapeutic options for patients with AI-related arthralgia.
Efficacy and safety of concurrent capecitabine and radiotherapy as adjuvant treatment in triple negative breast cancer.
Authors: Oana Gabriela Trifanescu, Laurentia Minea Gales, Ana Ciornei, Luiza Serbanescu, Denisa Zamfir, Rodica Maricela Anghel
Journal: Journal of Clinical Oncology (2024)

e12534 Background: Triple-negative breast cancer remains a very aggressive disease with few treatments option. Neoadjuvant dose dense chemotherapy, adjuvant therapy with capecitabine for residual disease and radiotherapy are standard treatments. The aims of this study were to evaluate the efficacy and safety of capecitabine concurrent with radiotherapy in initially clinical stage III patients with triple negative breast cancer in order to improve locoregional control and survival of these patients. Methods: We prospectively analyzed 24 patients with triple negative breast cancer with residual disease after dose dense neoadjuvant chemotherapy with Epirubicin and Cyclophosphamide and Docetaxel (in some cases with carboplatin) who received concurrent Capecitabine and radiotherapy in adjuvant setting. External beam radiotherapy to the hole breast was administered at a dose of 45–50.4 Gy in 25–28 fractions, concurrent with Capecitabine 825 mg/m2, 5 days/week. Results: Median age at diagnostic was 47.1±7.4. Stage distribution was as followed: 45.8% stage IIIA, 25% stage IIIB and 29.2% stage IIIC. Median follow-up was 31 months. Median Disease-Free Survival (DFS) was 48 months, with 76%, 68%, and 46% of patients without recurrence at 24, 36 and 48 months respectively. All patients presented with distant relapses. Median overall survival (OS) was not reached, and 3 years survival rate was 88%. Most common toxicities of concurrent radiotherapy and capecitabine were radiation dermatitis all grades in 100% of patients, grade 3 in 37.5% and grade 4 in 4.1%. Other side effects were neutropenia grade 4 in 8.3% and lymphopenia grade 4 in 45.8% of patients. Conclusions: Capecitabine concurrent with radiotherapy appears to be very efficacious and safe in the adjuvant treatment of breast cancer, especially in preventing local recurrence.
Endoscopic ultrasound-guided drainage for infected biloma using a unique long-type balloon catheter
Authors: Yuichi Takano, Naoki Tamai, Jun Noda, Tetsushi Azami, Fumitaka Niiya, Fumiya Nishimoto, Masatsugu Nagahama
Journal: Endoscopy (2024)

Endoscopic ultrasound (EUS)-guided drainage is a widely performed procedure. However, tract dilation can sometimes present challenges and many dedicated devices have been developed [1] [2] [3]. Herein, we describe a case of successful tract dilation using a unique long-type balloon catheter ([Fig. 1]).