tbuckley/cabot-search huggingface dataset:
The effects of peripheral chemoreflex suppression on ventilatory efficiency and exercise duration in pulmonary arterial hypertension
Authors: Michael J. Plunkett, Ana Luiza C. Sayegh, Tanya J. McWilliams, Sasiharan Sithamparanathan, Julian F.R. Paton, James P. Fisher
Journal: European Respiratory Journal (2024)

Exercise intolerance is debilitating for people with pulmonary arterial hypertension (PAH), limiting their ability to undertake work, exercise, and impedes daily personal care and household tasks [1]. Dyspnoea limits exercise capacity in PAH and may arise due to ventilatory inefficiency secondary to heightened peripheral chemoreflex sensitivity ( i.e. excessive hypoxic ventilatory response) [2]. Indeed, hyperoxia, which inhibits the peripheral chemoreflex, improved ventilatory efficiency and doubled exercise duration in PAH, although results are confounded by associated improvements in skeletal muscle and cerebral oxygenation [3]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflicts of interest: SS declares receipt of travel grants from Janssen and Merck, and research grants from Janssen. Conflicts of interest: MJP, ALCS, JFRP and JPF have no conflicts of interest to disclose.
Mortality trends in idiopathic pulmonary fibrosis in Europe between 2013 and 2018
Authors: Francesca Gonnelli, Martina Bonifazi, Richard Hubbard
Journal: European Respiratory Journal (2024)

Previous research has suggested that the incidence of idiopathic pulmonary fibrosis (IPF) is increasing in the UK and elsewhere. The aim of this study is to provide contemporary estimates of IPF mortality rates across 24 European Union (EU) countries from 2013 to 2018, using death certificate data from the European Statistics Institution (EUROSTAT) database.
Functional impairments, fatigue, and pain in newly diagnosed solid-tumors: Retrospective path analysis.
Authors: Dori Michelle Beeler, Danielle Boselli, Patrick L. Meadors, Declan Walsh
Journal: Journal of Clinical Oncology (2024)

12066 Background: A large patient cohort study found functional impairments (FI) are associated with cancer-related fatigue (CRF). This was before anti-cancer treatment for solid tumors. Another found functional limitations increased with self-reported pain severity. We hypothesize that both (a) a direct association between pain and CRF and (b) an indirect association between the symptoms through a mediation pathway involving FI may exist. Our retrospective, single-institutional study evaluated this model. Methods: We sourced Electronic Distress Screening (EDS) and Cancer Registry databases (Jan 2017 - Jan 2022). Patients identified were ≥18 years old and completed EDS within two (±2) weeks of a solid tumor diagnosis and before any anti-cancer therapy. Three EDS questions assessed FI with a two-week recall: 1) “How well have you managed your daily life?”; 2) “Has your physical health kept you from doing things like household chores or climbing stairs?”; 3) “Do you have limited movement in any body part?”. Pain and CRF were assessed on a numerical rating scale [0 (none) to 10 (worst possible)]. Structural equation modeling tested the multiple mediation model. The 95% confidence intervals of the estimated total and FI domain-specific indirect effects, the effects of pain on CRF working through FI, were assessed to exclude zero. Results: N=4326. Median age = 63 years (range 18 - 97); 69% female and 78% White. The commonest tumor site groups were breast (30%), upper GI (17%), and gynecologic (16%); 21% had Stage 4 disease. Median CRF was 4 (range 0-10); 57% had clinically significant CRF (fatigue ≥4). Median pain was 3 (range 0-10); 51% had clinically significant pain (pain ≥3). A significant minority had FI. N=753 (17%) had either “very poor” or “fairly poor” management of day-to-day life. N=778 (18%) had “a lot” of difficulty in performing chores. N=1252 (29%) had limited movement of any body part. FI partially mediated the pain/CRF relationship (indirect effect (IE total )=0.25, 95% CI 0.24-0.27). Two mediators had statistically significant contributions to the total indirect effect: management of daily life (IE manage =0.12, 95% CI 0.11-0.13); and difficulty in performing chores (IE chores =0.13, 95% CI 0.11-0.14). The limited movement of any body part did not impact the pain/CRF relationship (IE movement =-0.01, 95% CI -0.01-0.01). Conclusions: Most patients had clinically significant pain and CRF at diagnosis. A significant minority had FI at diagnosis. FI partially mediated the direct relationship between pain/CRF severity. This helps us understand that FI accounts for some of the relationship between pain and CRF. It is insufficient to conduct symptom assessments without also evaluating FI before treatment or at diagnosis.
Incidence of osteonecrosis of the jaw (ONJ) in the randomized non-inferiority phase III trial SAKK 96/12 REDUSE comparing denosumab (DN) administered every 4 weeks (q4w) versus every 12 weeks (q12w).
Authors: Roger Anton Fredy Von Moos, Andreas Mueller, Stefanie Hayoz, Michael Thomas Mark, Stefanie Fischer, Razvan A. Popescu, Mathias Konrad Fehr, Claudine Egger, Sandro Anchisi, Florian Schmid, Khalil Zaman, Christoph J Ackermann, Alexander Schreiber, Priska Bützberger, Catrina Uhlmann Nussbaum, Marc Küng, Corinne Schaer, Silke Gillessen, Arnoud J. Templeton
Journal: Journal of Clinical Oncology (2024)

12067 Background: ONJ is a well-known adverse event of bone-modifying agents that can significantly impact quality of life. It is recognized that the risk of ONJ increases with the duration of treatment and can reach rates of up to 10%. Here, we report ONJ rates in a randomized non-inferiority phase 3 study investigating the optimal dose of DN. Methods: Patients with metastatic breast cancer (mBC) or metastatic castration resistant prostate cancer (mCRPC) (planned N=1380) were randomized 1:1 to receive DN q4w (Arm A) versus q12w (Arm B) after a 3-month induction phase with application q4w. Incidence of ONJ is a key secondary outcome of the study (NCT02051218). An oral inspection at baseline as well as before each application of DN was mandatory. In patients with risk factors for ONJ a prophylactic dentist visit was recommended. Data from patients who received at least 1 dose of DN and who were randomized at least one year before data cut-off (December 11, 2023) were included in this interim safety analysis. Since the differentiation between ONJ and tooth infection can be difficult, we also report this outcome. Results: 1271 patients with a median follow-up time of 3 years were analyzed. During the 3-month induction phase 2/1271 patients experienced an ONJ. In Arm A 48/575 (8.3%), in Arm B 32/561 (5.7%) patients experienced an ONJ. Time to first ONJ and/or tooth infection differs remarkably with a clear advantage for the 3-months arm (HR 0.67; 95% CI 0.48-0.93). Details are shown in the table. Conclusions: The observed ONJ rate of 8.3% is in line with the literature for patients who received denosumab q4w for over two years (mBC: 6.0%, mCRPC: 8.2%). Administration of DN q12w reduces the risk of ONJ and/or tooth infections substantially. The numerical difference of events to the standard arm as well as the time to first ONJ and/or tooth infection is clinically relevant with a risk reduction by 33%. Efficacy data for the primary endpoint time to first symptomatic skeletal event is eagerly awaited. Clinical trial information: NCT02051218 . [Table: see text]
Shortness of breath after in vitro fertilisation
Authors: Tom Jaconelli, Ahsan Iftikhar, Jacqueline Tang
Journal: BMJ (2024)

A woman in her 30s presented to the emergency department with a three day history of shortness of breath and right sided pleuritic chest pain.She was receiving in vitro fertilisation (IVF) treatment and had undergone embryo transfer one week earlier.She was previously well and had no relevant history.On examination her airway was patent.Auscultation of her chest showed reduced breath sounds up to the midzone on the right, with dullness to percussion, a respiratory rate of 22 breaths/min, and oxygen saturations of 95% on air.Her pulse rate was 109 beats/min with a blood pressure of 112/80 mm Hg.Her Glasgow coma scale score was 15/15.Her abdomen was soft and non-tender on palpation.An electrocardiogram showed sinus tachycardia, and plain radiography of the chest (fig 1) was performed.
Proactive, automated monitoring of uncontrolled symptoms in prostate cancer survivors across the cancer control continuum.
Authors: Miguel Muniz, Daniel S Childs, Kathryn Jean Ruddy, Veronica Grzegorczyk, Deirdre R. Pachman, Alicia K. Morgans, Ewan Kemar Cobran, Joan M. Griffin, Ashley Wilder Smith, Kurt Kroenke, Charles L. Loprinzi, Brian Addis Costello, Jacob Orme, Irbaz Bin Riaz, A. Oliver Sartor, Sandra A. Mitchell, Andrea L. Cheville
Journal: Journal of Clinical Oncology (2024)

12079 Background: Many troublesome symptoms experienced by men with prostate cancer are not specific to a particular disease state or treatment modality. As such, these issues' scope is neither fully appreciated nor characterized in the reporting of clinical trial data. A modern accounting of poorly controlled symptoms is needed to better inform survivorship and supportive care efforts. Methods: Data are drawn from the Enhanced, EHR-facilitated Cancer Symptom Control (E2C2) study, a cluster-randomized stepped wedge trial examining the effectiveness of routine symptom assessment and management on patient-centered outcomes and healthcare utilization (NCT03892967). This is a population-level study supporting patients with cancer, who are cared for in medical oncology clinics across the Midwest United States. The trial utilizes an automated symptom monitoring system with EHR-enabled algorithms for symptom triage and intervention. The current analysis focuses on pre-intervention surveys. The cohort includes E2C2 participants with prostate cancer (as determined by the Mayo Clinic Cancer Registry) receiving curative or palliative-intent therapies, along with prostate cancer survivors who previously completed their treatment. The prevalence of SPPADE symptoms (sleep disturbance, pain, impaired physical function, anxiety, depression, fatigue [low energy]) was assessed using 0 to 10 numerical rating scales (NRS), with scores of 4-6 indicating moderate symptoms and 7-10 indicating severe symptoms. Results: A total of 1,388 men with prostate cancer completed a pre-intervention survey between March 2019 and January 2023. The median age at completion of first survey was 74 years. The cohort includes patients living in diverse settings, including urban (n=718, 52%), micropolitan (n=250, 18%), small town (n=218, 16%), and rural (n=200, 14%) environments. The proportion of patients experiencing moderate-to-severe symptoms (NRS score ≥4) was 47% for fatigue, 40% for impaired physical function, 32% for sleep disturbance, 27% for pain, 22% for anxiety, and 20% for depression/emotional distress. The three domains with the highest prevalence of severe symptoms (NRS score ≥7) were fatigue (17%), impaired physical function (12%), and sleep disturbance (10%). Conclusions: Proactive symptom monitoring identifies a high overall burden of moderate-to-severe symptoms, particularly fatigue and impaired physical function, among prostate cancer patients and survivors. Collaborative care approaches and symptom control trials are needed to mitigate and manage these burdensome symptoms. Clinical trial information: NCT03892967 . [Table: see text]
Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.
Authors: Khushi Kohli, Mahi Kohli, Bhav Jain, Nishwant Swami, Sruthi Ranganathan, Fumiko Chino, Puneeth Iyengar, Divya Yerramilli, Edward Christopher Christopher Dee
Journal: Journal of Clinical Oncology (2024)

12069 Background: Despite the benefits of early palliative care (PC), inequities exist in receipt of PC for patients diagnosed with metastatic cancer. We sought to characterize disparities in receipt of PC for disaggregated Asian American, Native Hawaiian, and Pacific Islander (AA&amp;NHPI) patients with metastatic prostate, breast, or lung cancer. Methods: The National Cancer Database (NCDB) allows for evaluation of receipt of palliative care as part of first line of treatment. Therefore, we analyzed patients with metastatic breast, lung, or prostate cancer between 2004-2018 who were White (largest reference group) or of self-identified Asian Indian/Pakistani, Chinese, Filipino, Native Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Pacific Islander, Thai, or Vietnamese descent. Multivariable logistic regressions defined adjusted odds ratios and 95% confidence intervals of receiving palliative care when comparing i) White vs. AA&amp;NHPI patients as a single cohort and ii) White vs. disaggregated AA&amp;NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates. Results: Among 775,289 individuals diagnosed with metastatic cancer, no significant differences in PC receipt were observed between White patients and aggregated AA&amp;NHPI patients among patients with prostate cancer, breast cancer, or lung cancer. However, disaggregated analyses revealed reduced palliative care receipt for patients with breast cancer of Asian Indian/Pakistani descent (AOR=0.75, P=0.011) and for patients with lung cancer of Chinese, Vietnamese, Thai, and Asian Indian/Pakistani descent compared to White patients (Chinese AOR=0.88, P=0.001; Vietnamese AOR=0.89, P=0.032; Thai AOR=0.64, P=0.016; Asian Indian/Pakistani AOR=0.83, P=0.001). Receipt of PC was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese AOR=1.92, P=0.001; Hawaiian AOR=2.09, P=0.009), breast cancer (Japanese AOR=1.72, P=0.001; Hawaiian AOR=1.70, P=0.021), and lung cancer (Japanese AOR=1.92, P &lt;0.001; Hawaiian AOR=2.95, P&lt;0.001), as well as patients of Pacific Islander descent with lung cancer (AOR=1.62, P&lt;0.001). Conclusions: Although in aggregate AA&amp;NHPI patients were no less likely to receive PC than White patients, we found significant within-group disparities among AA&amp;NHPI patients with metastatic cancer. Patients of Asian Indian/Pakistani, Chinese, Vietnamese, and Thai descent were less likely to receive PC, underscoring the need for i) disaggregated research on PC access and ii) targeted interventions to address cultural, socioeconomic, and healthcare system barriers that contribute to the disparities in PC among patients with cancer.
Trends and racial disparities in palliative care utilization among patients with prostate cancer: A ten-year retrospective study.
Authors: Stanley Ozogbo, Ayobami Gbenga Olafimihan, Inimfon Jackson, Chiamaka Elsie Nwachukwu, Gbolahan Olatunji, Emmanuel Kokori, Nicholas Aderinto, Tochukwu Nzeako, James J. Kim
Journal: Journal of Clinical Oncology (2024)

12068 Background: Due to improvements in cancer therapies and treatment strategies, survivorship among patients with prostate cancer continues to increase, thus necessitating the utilization of palliative care services for symptom management. We examined the prevalence, trends and predictors of palliative care utilization among hospitalized prostate cancer patients in the US. Methods: A retrospective longitudinal study using the Nationwide Inpatient Sample (NIS) database (2010-2019) was conducted. Using join point regression and multivariable logistic regression, trends and factors associated with palliative care receipt were assessed. Results: The overall prevalence of palliative care utilization in the cohort of over 2 million admissions with prostate cancer, was 5.3%. Over the decade, there was a significant increase in palliative care consultations from 2,970 to 7,509 per 100,000 prostate cancer hospitalizations (p-trend &lt;0.001) with an average annual percentage change of 7.7% over the study period. Individuals ≥70 years with prostate cancer had higher odds (aOR): 1.06; 95% CI: 1.01-1.12) of receiving palliative care relative to those &lt; 70 years. Compared to non-Hispanic whites, non-Hispanic blacks were less likely to receive palliative care services (aOR: 0.93; 95% CI: 0.88-0.98). Patients on Medicaid (aOR: 1.51; 95% CI: 1.38-1.65), private insurance (aOR: 1.3; 95% CI: 1.23-1.38) and other insurance types (aOR: 2.2; 95% CI: 1.85-2.55) had higher odds of palliative care utilization when compared to those on Medicare. Prostate cancer patients discharged to facilities or with home health care were more likely (aOR: 6.4; 95% CI: 6.03-6.8) to receive palliative care. Other factors associated with palliative care receipt were non-elective admissions, admission to urban, large and teaching facilities. Furthermore, longer length of hospital stays (≥5 days vs &lt;5 days) was associated with higher utilization of palliative care (aOR: 1.08; 95% CI: 1.05-1.13). Conclusions: Though the trends in palliative care utilization have improved over the years, it remains suboptimal. Additionally, black patients were less likely to receive palliative care. Further studies are needed to explain these disparities and generate interventions to narrow the identified gaps. Addressing the highlighted sociodemographic and hospital-level disparities will ensure optimal utilization of palliative care in this patient population.[Table: see text]
Experience of young patients with cancer discussing cannabis with their providers.
Authors: Amrit Baral, Bria-Necole A. Diggs, Ranya Marrakchi El Fellah, Nicolas Hernandez Ortega, Jessica Yasmine Islam, Marlene Camacho-Rivera, Frank J. Penedo, Denise Christina Vidot
Journal: Journal of Clinical Oncology (2024)

12061 Background: Although cannabis use among cancer patients to manage cancer treatment-related symptoms continues to grow, little is known about patterns in patient-provider communication regarding cannabis use. We examined demographic differences in cannabis communication among cancer patients and providers at a National Cancer Institute designated cancer center. Methods: We used data of 495 cancer patients via an anonymous electronic survey administered at the University of Miami via REDCap. Participants with consent to contact notations in their electronic medical record were recruited via phone calls and personalized messages in their MyUCHART portal. Self-reported responses on patients' disclosure of cannabis use to healthcare providers and their comfort on discussing cannabis with cancer doctors were analyzed. Age was categorized as: 20-39y, 40-59y and ≥60y. Chi-squared/Fisher’s exact tests and logistic regression analyses were conducted adjusting for age, sex, and ethnicity. Results: The sample was 51.8% male, 39.4% Hispanic, and mean age was 45.9y (SD=15.1) (41.1% were between 20-39y); 43.8% were undergoing treatment and 35.4% were in follow-up/finished treatment. Almost half (45.5%) reported current (past 30-days) cannabis use. Younger (20-39y) patients had higher prevalence of not disclosing cannabis use than older (&gt;60y) patients (36.8% vs 23.9% p&lt;0.01). There were no sex or ethnicity statistical differences. Majority (67.7%) of current cannabis users reported comfort discussing cannabis use with their provider. However, among individuals aged 20-39y, 40.8% reported feeling uncomfortable discussing cannabis with their cancer doctor. In the 40-59y age group, 21.0% expressed discomfort, while only 5.6% of those over 60 years reported similar unease. After adjusting for age, sex, and ethnicity, newly diagnosed cancer patients had lower odds (aOR:0.41, 95% CI:0.17-0.99) of feeling comfortable discussing cannabis use compared to those in follow-up/finished treatment group. Conclusions: Age was a significant factor in disclosing cannabis use to healthcare providers, with disparities noted by age group. These insights highlight the importance of considering age-related factors and treatment status when addressing cannabis use discussions within the oncology setting.
End-of-life care preferences in patients with gallbladder cancer: Shifting patterns and disparities over two decades.
Authors: Karan Jatwani, Mahnoor Sukaina, Atulya Aman Khosla, Nitya Batra, Rahul Mishra, Mohammad Arfat Ganiyani, Madhan Srinivasan Kumar, Rohit Singh, Shahid Sattar Ahmed
Journal: Journal of Clinical Oncology (2024)

12036 Background: Gallbladder cancer (GBC) is an aggressive malignancy with a combined survival rate of 20%. Some studies have reported less than 10 percent utilization of palliative care services in this population. Place of Death (PoD) is an important determinant of patient and caregiver preference and cost of caregiving at the end of life (EOL). We evaluate trends in PoD for patients with GBC in the U.S. from 2003 to 2020 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Methods: We analyzed data using the CDC WONDER database from January 01, 2003, to December 31, 2020. The data for deaths due to GBC was pooled using the International Classification of Diseases-10th revision code as C23, including all Gallbladder Cancers. The inclusion criteria included patients aged &gt; 18. PoD was defined as deaths at home or hospice versus medical facilities. Annual percentage change (APC), average annual percentage change (AAPC), and joint point analysis were done using the Joinpoint Regression Program, Version 5.0.2. Results: The analysis demonstrated a total of 37,576 deaths from GBC. Fifty-eight percent of deaths (21,805) were at home or hospice; AAPC: 3.23%, CI 1.4 to 5.0 (p = 0.0002). A significantly increasing trend of dying at medical facilities was seen amongst African Americans (AA); AAPC: 1.06%, CI 0.02 to 2.10, (p = 0.04), while Whites had a significant increase in the utilization of home or hospice-based care; AAPC: 2.7%, CI 2.1 to 3.2; p &lt; 0.0001). On age stratification, there was a significant decline in using medical facilities as PoD for the &gt; 65 yrs cohort; AAPC: -2.65% CI -3.1 to -2.1 (p &lt; 0.0001). In contrast, the middle age group (45-64 yrs) had a trend towards decline, which was not significant in the usage of medical facilities as PoD with AAPC: -0.42% CI -1.24 to -0.4 (p = 0.29). Conclusions: To our knowledge, this is the first study providing valuable insights into the evolving PoD preferences among GBC patients in the U.S. The racial disparities highlight the need for targeted interventions and culturally sensitive end-of-life care for different demographic groups. The age-related trends underscore the importance of tailoring end-of-life care strategies to specific age cohorts. The findings emphasize the importance of policies promoting and supporting home and hospice-based care for GBC patients. Targeted efforts are warranted to address disparities in PoD preferences among racial and age groups.