tbuckley/cabot-search huggingface dataset:
Impact of cardiac arrhythmias on in-hospital mortality in patients with cytokine release syndrome: Insights from National Inpatient Sample.
Authors: Wissam Karam, Abdul Rahman Akkawi, Joud Zakhour, Anas Alqam, Raj N. Shah, Nassim H. Nabbout
Journal: Journal of Clinical Oncology (2024)

e24017 Background: Cytokine release syndrome (CSR) is a pervasive inflammatory response characterized by elevated body temperature and multi-organ dysfunction. This syndrome is linked to chimeric antigen receptor (CAR)-T cell therapy, various immunotherapies, or haploidentical hematopoietic cell transplantation (HCT). It can manifest as a fever, fatigue, headache, rash, diarrhea, arthralgia, and myalgia. In some cases, it can progress to hypotension, hypoxia, and an uncontrolled systemic inflammatory response leading to circulatory collapse, pulmonary edema, renal damage, and multi-organ failure. Cardiac evaluation in the context of CSR is crucial for assessing these manifestations, but little is known about the arrhythmias associated with this therapy, and there is limited information in the literature. Methods: A retrospective study using the National Inpatient Sample to identify patients diagnosed with CRS, and the arrhythmias they experienced during their hospitalizations between January and December 2020. The primary endpoint was the incidence of various arrhythmias. Furthermore, Independent predictors of in-hospital mortality were analyzed, with p values, adjusted odds ratios (aOR) and confidence intervals (CI) calculated for each variable. Results: A total of 4675 patients were diagnosed with CRS in 2020, 39% of whom were females. The mortality rate of patients with CRS was 22%. In addition, the mortality rate of patients who developed arrhythmias was 43% while that of patients who did not was 17% (p &lt; 0.01). The mean age was higher in the arrhythmia cohort compared with the non-arrhythmia cohort (70 vs 60.7 years, p &lt; 0.01). Predictive factors associated with increased mortality included development of arrhythmias, age, hispanic race, asian or pacific islander race, obesity, previous myocardial infarction, and electrolyte abnormalities with an aOR of 2.22 (P &lt; 0.01, CI 1.51-3.28), 1.03 (P &lt; 0.01, CI 1.01-1.05), 1.85 (P = 0.04, CI 1.02-3.34), 2.57 (P = 0.014, CI 1.02-3.34), 1.72 (P = 0.018, CI 1.09-2.69), 3.26 (P = 0.008, CI 1.36-7.8), and 4.19 (P &lt; 0.01, CI 2.7-6.4) respectively. Female sex was found to be protective against mortality with an aOR of 0.5 (P = 0.004, CI 0.31-0.8). Conclusions: Our study reveals that developing arrhythmias is more common in older patients with CRS. Patients diagnosed with arrhythmias during their hospitalization experienced poorer outcomes. Adjusted predictors of mortality include the development of arrhythmias during hospitalization, age, hispanic race, asian or pacific islander race, obesity, previous myocardial infarction, and electrolyte imbalances. Additionally, female sex was found to be a protective against mortality. Given these findings, physicians should strive to be more vigilant when treating patients with CRS who have any of these predictors of mortality until further data is available.
Adoption of the International Cognition and Cancer Task Force recommendations for harmonizing studies of cancer-related cognitive impairment: A systematic review of published literature.
Authors: Robert J. Ferguson, Janvi V. Patel, Naomi Massoud Orosco, Chloe Sinagra
Journal: Journal of Clinical Oncology (2024)

e24043 Background: This abstract presents a review of published research literature to determine research investigators’ rate of adoption of the International Cognition and Cancer Task Force (ICCTF) recommended criteria for defining cancer-related cognitive impairment (CRCI). Published in 2011, the ICCTF recommendations were intended to identify psychometric standards that would facilitate harmonization of neuropsychological test data across studies for improved accuracy of estimating prevalence of CRCI in cancer populations. The ICCTF recommended standards could help decipher variability or stability of CRCI prevalence across various cancer groups, such as individuals within a diagnostic classification (e.g., lung or breast cancer) or type of cancer treatment (e.g., chemotherapy, immunotherapy, or radiation therapy). However, since publication in 2011, the use of the ICCTF recommendations in CRCI research has not been examined. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we restricted study selection to only published studies that examined CRCI using standardized neuropsychological tests (vs. self-report measures). We then identified studies that used the ICCFT recommendations based on the ICCTF psychometric definition of cognitive impairment: In a standard battery of neuropsychological tests, one neuropsychological test score &gt;2 standard deviations (sd) below the mean of a healthy control sample, or 2 neuropsychological test scores of &gt;1.5 sd’s below the control mean, is considered a case of cognitive impairment. Results: We screened 146 CRCI studies published since 2011, with 93 manuscripts that utilized neuropsychological tests to evaluate CRCI. Of those, 35 (37.6%) incorporated the ICCTF recommendations in their methodology and data analysis. Between 2011 and 2022, there was a gradual adoption of ICCTF recommended standard of defining CRCI, ranging from 0% of published studies in 2011 to 56.2% in 2022, but a decline to 40% in 2023. With respect to cancer populations, ICCTF guidelines were most often used in studies of individuals with breast cancer (n = 17;18%). Conclusions: This review demonstrates increased use of the ICCTF recommended definition of CRCI in empirical investigations since their 2011 introduction but a decline in 2023. Use of the ICCTF recommendations can improve accuracy of estimating CRCI prevalence across different cancer disease populations and/or groups of individuals undergoing different cancer therapies. Greater adoption of the ICCTF definition of CRCI is encouraged especially considering a 2023 drop in its use. Broadening the study of CRCI using ICCTF recommendations among cancer populations beyond breast cancer is encouraged to better understand the breadth of impact CRCI across the spectrum of disease.
Factors influencing the mortality risk of heart failure in patients receiving antineoplastic immunotherapy: A national inpatient database study 2016-2020.
Authors: Purva Shah, Abdullah Ahmad Orakzai, Himal Kharel, Aditya Sanjeevi, Basant Eltaher, Jose M. Easow
Journal: Journal of Clinical Oncology (2024)

e24011 Background: Immunotherapy is increasingly being used for management of solid and lymphoproliferative tumors due to their more desirable side effect profile as compared to traditional cancer therapies. However, these medications are associated with cardiac complications and little is known about the factors influencing the prognosis in these patients. Methods: This is a retrospective analysis of the National Inpatient Database from 2016 to 2020 using the International Classification of Diseases (ICD) 10 codes performed with STATA BE 18.0. Chi square test was used for crude analysis and multivariate logistic regression was performed to assess the risk of inpatient death among cancer patients with heart failure receiving immunotherapy. Results were adjusted for potential confounders like age, gender, race, hypertension, diabetes, coronary artery disease, smoking, and alcohol consumption. Multicollinearity of the model was assessed using Variance Inflation Factor (VIF) post-estimation test. Results: Out of 5166 cancer patients receiving immunotherapy with a mean age of 43.63 土 26.33 years and 41% females, 45 patients had heart failure. Logistic regression showed that heart failure was significantly associated with mortality (LR 𝜒² 38.74, p value &lt; 0.001) on adjusting for potential confounders. Although the effect size was small, increased age (OR 1.025, CI 1.01-1.04) had a significantly higher risk of mortality. Patients belonging to the female gender and white, hispanic, and asian races had a lower risk of mortality while those belonging to the african american race and those with coronary artery disease had a higher mortality risk, although not statistically significant. Diabetes and alcohol consumption had a fourfold and sixfold increased risk of mortality respectively. Hypertension and smoking that are known to increase mortality risk in heart failure patients showed a paradoxically protective effect in this cohort. Conclusions: This study highlights the importance of risk stratification and prognostication among patients with heart failure receiving antineoplastic immunotherapy. Increased age, african american race, diabetes, alcohol consumption, and coronary artery disease have shown an increased mortality risk in these patients. [Table: see text]
Influence of intensity-modulated radiation therapy on long-term survival and late injury in patients with nasopharyngeal carcinoma after induction chemotherapy.
Authors: Xiuyun Gong, Feng Jin
Journal: Journal of Clinical Oncology (2024)

e24048 Background: To retrospectively analyze the effect of nasopharyngeal primary tumor (GTVnx) target delineation after induction chemotherapy on the long-term survival and late injury of patients after intensity-modulated radiotherapy, so as to provide a reference for the optimal treatment of nasopharyngeal carcinoma. Methods: Retrospective analysis was performed on 52 patients with nasopharyngeal carcinoma who underwent target delineation and radiotherapy after induction chemotherapy in our department from December 2011 to October 2013. All patients underwent long-term survival follow-up and analysis of late injury. The survival rate was calculated by Kaplan-Meier method and log-rank test, Univariate prognostic analysis was performed. Cox model was used to conduct multivariate prognostic analysis. The late radiation toxicity was Evaluation by RTOG/EORTC. Results: From December 2011 to October 2013,52 patients were enrolled in the study group. The follow-up period was up to December 2020. Among them, 23 patients died and the mortality rate was 44.23%, the recurrence rate was 0.38%. Serious adverse reactions occurred in 7 cases (13.2%). The 1,3,5,8 year survival rates were as follows: OS was 94.2%, 82.7%, 65.4%, 49.6%, LRFS was 96.2%, 82.7%, 63.5%, 46.2%, the survival rates of DMFS were 94.2%, 78.8%, 59.6% and 44.2%. Conclusions: The 5 and 8-years OS, LRFS and DMFS of NPC after induction chemotherapy patients treated with IMRT was relatively high, Distant metastasis was the main cause of treatment failure, The main late injuries include grade Ⅰ / Ⅱ hearing impairment, dysphagia dental, caries, xerostomia, the grade Ⅲ and Ⅳ late radiation injury was lower.
Helen Salisbury: Don’t ask Jeeves—ask your GP
Authors: Helen Salisbury
Journal: BMJ (2024)

GPs are busy.There's a mismatch between available appointments and patient demand, with growing dissatisfaction over waiting times. 1 And while we're trying to look after everyone-from new baby checks to end-of-life care, managing preventive medicine and treating complex, long term health problems-patients are being bombarded with advice to consult their GP.
Effect of lactobacillus rhamnosus DY801 on methionine metabolism and Th17 cells in the treatment of acute radiochemotherapy induced bowel injury.
Authors: Lu Yu, Zhenhui Chen, Hongying Fan, Yi Ding
Journal: Journal of Clinical Oncology (2024)

e24099 Background: Radiation and chemotherapy are important treatments for patients with pelvic malignant tumors, and they will inevitably lead to the occurrence of radiochemotherapy-induced intestinal injury. Acute radiochemotherapy-induced intestinal injury reduces the quality of life and treatment compliance of patients, which ultimately affects overall survival. However, at present, the treatment of acute intestinal injury is limited. Therefore, alleviating acute radiochemotherapy-induced intestinal injury is an important scientific problem to be solved urgently in tumor treatment. Methods: The stool samples of patients before and after treatment were analyzed by 16S rRNA sequencing to explore the intestinal bacteria associated with radiochemotherapy-induced intestinal injury. The changes in intestinal bacteria and metabolism related to radiochemotherapy-induced intestinal injury were explored through mice in vivo experiments, metagenomics, and non-target metabolomics analysis. New strains of Lactobacillus were obtained from fresh human fecal samples. The molecular mechanism of the therapeutic effect of Lactobacillus rhamnosus DY801 was explored through in vivo experiments, RNA-sequencing, Crispr/cas9 gene knockout, immunohistochemistry, flow cytometry, LC/MS, and western blot. Results: 16S rRNA sequencing of stool samples from patients before and after treatment suggested that the abundance of Lactobacillus and Bacteroides decreased after radiotherapy and chemotherapy. In vivo experiments in mice showed that the decrease in abundance of Lactobacillus and Bacteroides, the decrease of methionine metabolism, and the increase of activated Th17 cells were related to the severity of radiochemotherapy-induced intestinal injury. Ten new strains of Lactobacillus were isolated, cultured, and identified from the feces of matched normal people. Among them, Lactobacillus rhamnosus DY801 had a resistance to acid and bile salt, and has the strongest ability to treat radiochemotherapy-induced intestinal injury. In vivo and in vitro experiments suggest that Lactobacillus rhamnosus DY801 inhibited the proinflammatory Th17 cells through methionine, a production of metB gene, and significantly improve acute intestinal injury. Conclusions: Lactobacillus rhamnosus DY801 regulated methionine metabolism and inhibited Th17 cells in the treatment of the acute radiochemotherapy-induced intestinal injury.
End of life treatment in gynecological cancers in an integrated care model: A single institution experience from Oman.
Authors: Aref Zribi, Amnah Faisal Abdellatif Ahmed, Hasan Al-Sayegh, Ikram A Burney
Journal: Journal of Clinical Oncology (2024)

e24036 Background: The use of chemotherapy closer to the end of life (EOL) and the optimal time of initiating palliative care interventions are subjects of ongoing debate. In a traditional care model (TCM), the institution of EOL care is a complex decision-making process, that involves patient, family members, and the oncologist, and involves transfer of patients from one to the other service. Integrated care model (ICM) is a newer concept, is designed around the needs of the patients, and may have the potential to improve quality of life and reduce the cost of healthcare towards EOL. At our center, we work in ICM in organ-based clinical programs and report the use of systemic treatment in patients with gynecological cancers (GC) nearing EOL. Methods: We analyzed retrospectively the use of chemotherapy and other systemic cancer-directed therapies in patients with GC, who died between Sept 2021 and December 2023 at a single institution. Information on the cancer-type, intention of treatment, and the time between last treatment and death was obtained from electronic patient records (EPR). Results: Over the study period, a total of 22 patients passed away. All patients received palliative care as part of the integrated care. All patients had been declared ‘not for resuscitation’ before death. Twelve patients had ovarian cancer, 5 had endometrial cancer, 4 had cancer of cervix, and one had vulvar cancer. The median age at diagnosis was 53 years (29-80). The systemic treatment was 1 st line in 5 patients (23%), 2 nd line in 8 patients (36%), and 3 rd or more line in 6 patients (27%) respectively. Three patients (14%) did not receive any cancer-directed treatment (aged 80, 71 and 61). The ultimate line of treatment was cytotoxic chemotherapy for all patients, except for one who received Olaparib, and one who received trastuzumab with chemotherapy. There was no treatment-related mortality. The median time from last treatment to death was 55 days. Of the 19 patients who received treatment, 6 patients (32%) received treatment in the last 30 days, 5 between 30 and 60 days (26%), 5 between 60 and 90 days (26%), and 3 more than 90 days before death. Four patients died at home. Age at diagnosis (51 vs 55 years), age at death (51.5 vs 57.5 years), or time from diagnosis to death (11.5 vs 22 months), did not predict whether patients received treatment within the 30 days of death or earlier. Conclusions: All patients received palliative care as part of integrated cancer care. The ICM may have led to lower use of cancer treatment near EOL. The data may provide a benchmark for the region.
Axillary lymph nodes pCR (apCR) versus breast pCR (bpCR): A meta-analysis involving 10,723 patients.
Authors: shengyu pu, Heyan Chen, Huimin Zhang, Jianjun He, Na Hao
Journal: Journal of Clinical Oncology (2024)

e12630 Background: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) may improve the long-term survival of patients with breast cancer, as scored by disease-free survival (DFS) and overall survival (OS). Axillary lymph node pCR (apCR) is an important prognostic factor and may influence surgical de-escalation strategies; however, there is insufficient evidence to confirm that apCR produces a better prognosis than breast pCR (bpCR). The study aimed to perform a meta-analysis to assess the effect of apCR on survival compared with bpCR. Methods: We searched Cochrane Library, Web of Science, PubMed, Embase, and Clinical Trials.gov for breast cancer clinical trials with NAC. For included studies, we extracted the following data for analysis: study details, characteristics of participants, and survival data. Outcome data were reported as hazard ratios (HRs) and 95% confidence interval (CI) to measure the association between pCR and DFS, and OS. An I² test and subgroup analyses were performed to assess statistical heterogeneity in the included studies. Egger’s test and Begg’s funnel plot were used to determine potential publication bias. Results: We obtained data from 12 studies with 10,723 patients. Those patients with apCR had significantly better DFS than those with bpCR (HR=0.67, 95% CI, 0.60-0.76, P&lt;0.00001), and no significant heterogeneity was observed between studies (I 2 =0%). As for OS, the HR significantly supported apCR (HR=0.72, 95% CI, 0.60-0.86, P=0.0002). There was no significant heterogeneity between studies (I 2 =35%). Subgroup analyses of each variable did not alter the results. Egger's test and Begg’s funnel plots indicated no significant publication bias in this analysis. Conclusions: This meta-analysis demonstrated that apCR is strongly associated with better DFS and OS than bpCR. This finding suggests that apCR has the potential to be an early surrogate endpoint for long-term prognosis.
Author Correction: A motor association area in the depths of the central sulcus
Authors: Michael A. Jensen, Harvey Huang, Gabriela Ojeda Valencia, Bryan T. Klassen, Max A. van den Boom, Timothy J. Kaufmann, Gerwin Schalk, Peter Brunner, Gregory A. Worrell, Dora Hermes, Kai J. Miller
Journal: Nature Neuroscience (2024)
SurvivorCHIP: Evaluation of clonal hematopoiesis in women treated for breast cancer.
Authors: Reem Bahr, Chidera Nosiri, Gege Gui, Devdeep Mukherjee, Pranay Hegde, Stacy K Malloy, Preeti Shastri, Monica Peravali, Ami Chitalia, Christopher Gallagher, Christin DeStefano, Laura W. Dillon, Aarthi G. Shenoy, Christopher S. Hourigan
Journal: Journal of Clinical Oncology (2024)

1082 Background: Clonal hematopoiesis (CH) has been associated with reduced overall survival and is shown to be increased in patients with solid tumors after receiving chemotherapy and radiotherapy. However, the clinical implications of these observations have not been prospectively evaluated among different racial groups. This study was initiated in an urban cancer center to study CH rates before and after cancer therapy in a racially diverse population. Methods: Women aged ≥18 with newly diagnosed non-metastatic breast cancer provided written informed consent for this IRB approved study. Error-corrected DNA-sequencing was performed on 50ng gDNA isolated from blood prior to (pre-Tx), and following (post-Tx), chemotherapy(C), radiotherapy(R), and/or endocrine (E) therapy. Pathogenic or likely pathogenic variants were determined in regions recurrently mutated in CH. Results: 56 patients, median age 59.5y (29-82), provided both pre-Tx and post-Tx blood samples. Median BMI was 31.2 (range: 21.1-52.7) with 48 (85%) overweight (BMI≥25) and 33 (59%) obese (BMI≥30). 21 (38%) were active smokers. CH variants with an allele frequency (VAF) ≥2% were identified in 8 (14%) patients pre-Tx, most commonly DNMT3A (5 patients). For those with CH, median age was 64y (49-80) and 5 were active smokers. BMI was not statistically associated with pre-Tx CH in this cohort. 48 (86%) of the patients self-identified as African American and 7 (15%) had CH pre-Tx. Post-Tx, 10 patients had CH (18%), persistent from pre-Tx in 7. Of those with different CH classifications pre- and post-Tx, 1 had DNMT3A CH pre-Tx no longer detectable post-Tx (CRE), 2 had DNMT3A CH detectable at VAF ≥2% post-Tx (1 with CH undetected prior to RE Tx, 1 with the same DNMT3A variant at 1.2% VAF prior to CRE), and a 3rd had a ATRX variant increase from 1.5% to 2.1% VAF post-Tx (CRE). To investigate potential clinical implications of CH post-Tx, we utilized the clonal hematopoiesis risk score (CHRS) calculator which aims to predict risk of developing MDS and AML (Weeks et al, NEJM). Pre-Tx, 6 of the CH patients were classified as low risk, and 2 as intermediate risk. Patients developing CH post-Tx were all classified as low risk. Risk scores remained otherwise unchanged. At a median follow up of 2y, none of the patients in this study have been reported to develop MDS or AML. Conclusions: In this cohort of patients with newly diagnosed non-metastatic breast cancer, we did not find evidence to justify clinical screening/monitoring for CH before and after therapy.