1University of Pennsylvania, USA
2Symphony Health Solutions Horsham, USA
3Georgia Cancer Specialists, Affiliated with Northside Hospital, USA
Background: The transition in oncology to electronic charting offers the potential to improve the quality of patient care and value of observational research. Data fields that are more complete, have common standards, and are searchable are critical to help meet these goals. As a key data field, and proof-of-concept we studied the additional gain in recorded stage and agreement in cancer staging by adding ‘missing’ stage information into an oncology practiceʼs electronic medical records (EMR) from a state cancer registry.
Methods: In this observational study, patient records were matched and compared between a practice-based (EMR) database (Georgia Cancer Specialists [GCS]) and a state cancer registry (Georgia Comprehensive Cancer Registry [GCCR]). Impact on recorded cancer stage following a merge of the EMR and registry data was assessed. Eligible patients had 31 visit to any GCS practice site during the study period (1/1/200512/31/2008) and had a diagnosis of a primary, malignant solid neoplasm (except brain or spine).
Results: The final sample included 38,248 patients from GCS files, with 13,486 matched to patients with a solid malignant tumor in the GCCR files. There were 3,424 (25%) patients without staging information prior to GCCR integration, which was reduced to 12% after GCCR integration - a relative gain of 52%. Differences between initial GCS stage and initial GCCR stage occurred in 45% of the sample, and varied by cancer type.
Conclusions: Adding information from external data sources can help create more complete patient records. The concept is feasible and has the potential to improve data quality. Patient data collected in different systems for different reasons will often be discordant.
Gregory Hess currently serves as EVP & Chief Medical Officer (CMO) at Symphony Health Solutions – formerly Chief of Clinical Informatics. He also practices clinically at the CVIM Clinic in West Chester and teaches at the Drexel University College of Medicine Philadelphia. His academic appointments include Senior Fellow at the University of Pennsylvania Leonard Davis Institute for Health Economics. He also serves as Chair of ASCOʼs CancerLinQ Data Advisory Committee.
Previously Dr. Hess was CMO, Global Health Economics & Outcomes Research and for the US Business at IMS Health, VP for Health Economics & Outcomes Research and Chief Medical Officer at SDI (acquired by IMS). Additional positions have included SVP of CareScience, Inc., worldwide VP and Managing Director of Market Economics for SmithKline Beecham Pharmaceuticals, and Director for clinical research at the Sandoz Research Institute. Before joining the private sector, Dr. Hess was a member of the Bush Sr. administration. In addition to a White House Fellowship, successive positions included various senior advisory roles, and serving with the Presidentʼs Council on Competitiveness. Working as Liaison for FDA, EPA, and other Departments, his work focused on environmental issues, health affairs, health care delivery, and human health risk assessment.
Inflammation, Aging and Cancer Research; National Cancer Institute, NIH, USA
Factors involved in failed cancer targeted therapies include lack of systematic and logical understanding of the loss of immune surveillance that control growth of cancer or other chronic diseases. In 1980ʼs we established models of acute and chronic inflammatory diseases that included tumorigenesis and angiogenesis. We demonstrated multistep interactions and synergies between host immune cells (e.g., mast, goblet & B cells) and recruiting cells (e.g., eosinophils, TAMs) during altered immune dynamics and induction of tumors in conjunctival-associated lymphoid tissues. Results of these studies became ‘accidental’ discoveries in cancer research and therapy. Without being in cancer research in 1980ʼs, we presented systematic evidence on multiple first findings of early and late immune response dynamics toward tissue growth and angiogenesis. In 2008, acute inflammation was defined as balance between two biologically opposing arms, Yin (tumoricidal) and Yang (tumorigenic) of immunity. Chronic inflammation is loss of Yin-Yang and a common denominator in genesis of all age-associated diseases or cancer. Future research efforts should focus on systematic understanding of host-pathogen interactions that lead to carcinogenesis and to promote the Yin -Yang balance for effective immunity. Outcomes are expected to hold real promise in our understanding of how cancer cells become threat to body and for translation of cancer biology into cost-effective drug designs and clinical trials.
Professor Mahin Khatami received her PhD on Molecular Biology from University of Pennsylvania (UPA) in 1980. She was a researcher and faculty of medicine at UPA involved in cell/molecular biology of diabetic retinopathy/maculopathy and ocular inflammatory diseases. In 1998, at National Cancer Institute (NCI)/NIH she was program director, involved in concept development for molecular diagnosis and prevention of cancer for large clinical trials (PLCO). At NCI, extension and promotion of her earlier discoveries initially met with severe opposition and denial. However, she awakened the cancer community to the importance of inflammation in cancer research and immunotherapy. In the last decade numerous funded programs have focused on the topic that she promoted. In 2009, she retired from NCI, as director of IMAT program and assistant director of technology program development, OTIR/OD/NCI, at professor level. Since her retirement, Dr. Khatami continued extension of her pioneering studies in several articles, edited 2 books on inflammatory diseases and cancer; involved in editorial activities; international lectures and collaborations.
1University of Texas School of Dentistry at Houston, USA
2M.D. Anderson Cancer Center, USA
Objective: The objective of this study was to compare the salivary protein profiles from an individual diagnosed with Mantel Cell Lymphoma (MCL) before, during, and after chemotherapy.
Methods: Saliva specimens were serially acquired from a volunteer patient prior, during, and after chemotherapy. Experimentally, the specimens were trypsinized and the peptide digests labeled with the appropriate iTRAQ reagent. Labeled peptides from each of the digests were combined and analyzed by reverse phase (C18) capillary chromatography on an LC-MS/MS mass spectrometer equipped with an LC-Packings HPLC. The Swiss-Proteome database was employed for protein identification.
Results: The results yielded 258 comparative salivary proteins between the baseline and post-treatment samples. Among the total number of proteins, 26 were significantly differentially expressed between the evaluations. The results of the study suggest salivary protein alterations secondary to MCL and that a number of the proteins were changed as a result of chemotherapeutic intervention implying that the treatment, from a proteomic perspective, was efficacious. However, there were protein signatures that were unchanged and remained differentially expressed.
Conclusions: The results of the study suggest that salivary protein alterations are altered secondary to MCL and may be useful in monitoring the efficacy of treatment. It is also interesting to observe that a number of the proteins were changed as a result of chemotherapeutic intervention; however, there were a number of proteins that were unaffected by the intervention implying that a patient may be in clinical remission, but not molecular remission leaving the patient vulnerable to future disease recurrence. The study proposes that salivary secretions may be used as a “real-time” in vivo model for studying MCL progression and treatment efficacy.
Dr. Streckfus has over 100 peer-reviewed journal articles and has been invited to speak at numerous national and international conferences. He has received many honors and awards which include the prestigious Presidentʼs Award for Scientific Excellence, Presented by the International Society for Preventive Oncology, awarded atthe Pasteur Institute, Paris, France, the NIH Award of Merit for his statistical analysis of the NHANES III Study, the ADA recognition award for services on the Council of Scientific Affairs, the American Academy of Oral Medicine Service Award and the Mayor of Baltimore City Baltimoreʼs Best Award for rendering dental services to the underserved citizens of Baltimore. He was granted 4 patents for his work in breast cancer biomarker research all which were assigned to the University of Mississippi Medical Center and the University of Texas Health Science Center. He is the first dentist to ever receive funding from the Komen Breast Cancer Foundation.
1Department of Cancer Systems Imaging, U.T.-M.D. Anderson Cancer Center, USA
2Department of Pediatric Radiology, Texas Childrenʼs Hospital, USA
3Department of Imaging Physics, U.T.-M.D. Anderson Cancer Center, USA
4Department of Gynecologic Oncology, U.T.-M.D. Anderson Cancer Center, USA
5Department of Bioengineering, University of California, USA
6Department of Radiology, U.T.-M.D. Anderson Cancer Center, USA
The degree of cytoreduction at surgery is a major prognostic factor for ovarian cancer. A multimodality agent that can be used with magnetic resonance (MR) for staging and pre-surgical planning, and with optical imaging to aid surgical removal of tumors, would present a new paradigm for ovarian cancer. We assessed whether a dual-mode, dual-Gadolinium (DM-Dual Gd-ICG) contrast agent can be used to visualize intraperitoneal ovarian tumors by multimodal MR and near infra-red imaging (NIR). Intraperitoneal ovarian tumors (Hey-A8 or OVCAR3) in mice enhanced on MR two days after intravenous DM-Dual Gd-ICG injection compared to controls (SNR, p<0.05, n=6). As seen on laparotomy and excised tumors views and confirmed by radiant efficiency measurement, Hey-A8 or OVCAR3 tumors from animals injected with DM-Dual Gd-ICG had increased fluorescence (p<0.05, n=6). This suggests clinical potential to localize ovarian tumors by MR for staging and surgical planning, and, by NIR at surgery for resection.
Vikas Kundra, M.D., Ph.D. is Professor and Director of Molecular Imaging in the Department of Radiology, U.T.-M.D. Anderson Cancer Center with joint appointment in the Department of Cancer Systems Imaging. He received his M.D. and Ph.D. from Harvard University and completed his radiology training at Brigham and Womenʼs Hospital. He is a Fellow of the Society of Body Computed Tomography-Magnetic Resonance Imaging and a Distinguished Investigator of the Academy of Radiology Research. Clinical work focuses on Body Imaging particularly in cancer and research focuses on molecular imaging, including imaging of gene expression and nanotechnology.
Adjunct Prof., Dept. of Family & Community Medicine, New York Medical College, USA
Director of Medical Research, Heart Disease Research Foundation, USA
President, International College of Acupuncture & Electro-Therapeutics, USA
Introduction: During the past 10 years, the author successfully detected biochemical changes, bacterial and viral infections, and identifying the exact location of the infections of different parts of the heart by ECGs. Recently the author found that using ECGs, not only can information on the different parts of the heart be obtained, but various cancers existing in the body can also be detected.
Method: Various cancers existing at any part of the body were detected from rapidly changing QRS complex as well as rising part of T-wave of every ECG by detecting maximum Electromagnetic Field (EMF) Resonance Phenomenon between 2 identical molecules with the same amount using a simple method which received a U.S patent in 1993. From recorded ECGs, EMF Resonance Phenomenon between specific cancer microscope tissue slides and ECG were only detected from rapidly changing part of QRS complexes of ECGs & a part of rising part of T-waves, which corresponds to vulnerable period for Ventricular Fibrillation.
Results: Strong EMF resonance was found between not only rapidly changing dV/dt at QRS complex of ECGs, but also the author found even at rising part of the T-wave where change of dV/dt is insignificantly small. The author was able to detect caner of various organs including lung, esophagus, breast, stomach, colon, uterus, ovary, prostate gland, common bone marrow related malignancies such as Hodgkinʼs Lymphoma, Non-Hodgkinʼs Lymphoma, Multiple Myeloma as well as Leukemia. In addition, the author was also able to find when the patient had more than one different cancer at different parts of the body. Most of the medicine taken within 8-10 hours before taking ECG can be detected from part of QRS complex & rising part of T-waves. At Borrelia Burgdorferi (B.B.) infected part of ECGs we found significant decrease of Taurine & marked increase of ANP & cardiac Troponin I. At every cancer tissue, Taurine was markedly reduced. Thus, by comparing the same lead of ECGs before and after any treatment, the therapeutic effect of specific cancers or Lyme disease infection of B.B. spirochete infections of AF can be evaluated.
Discussion: If electrocardiogram is taken periodically we can find approximately when cancer information starts appearing in the electrocardiogram. Maximum information from cancer can be found in QRS complex where dV/dt is relatively large. This new concept and method can be applied to any recorded ECGs for detection and Screening of the cancer & infection including Lyme disease. Thus, ECGs can provide not only the information on the heart, but also can provide any single cancer or multiple cancers, which exist in any part of the body of the same individual.
Yoshiaki Omura received Oncological Residency training at Cancer Institute of Columbia University & Doctor of Science Degree through research on Pharmaco-Electro-Physiology of Single Cardiac Cells in-vivo and in-vitro from Columbia Uni.. He studied & researched on EMF Resonance phenomenon between 2 identical molecules at graduate experimental physics dept., Columbia Uni.. He published over 270 original research articles, many chapters, & 9 books. He is currently Adjunct Prof. of Family &Community Medicine, NY Medical College; Director of Medical Research, Heart Disease Research Foundation of NY; President & Prof. of Intʼl College of Acupuncture & Electro-Therapeutics, NY; Editor in Chief, Acupuncture & Electro-Therapeutics Research, Intʼl Journal of Integrative Medicine, (indexed by 17 major intʼl Indexing Periodicals); Editor of Integrative Oncology. Formerly, he was also Adjunct Prof. or Visiting Prof. in Universities in USA, France, Germany, Italy, Ukraine, Brazil, Portugal, Turkey, Serbia, Japan, Korea, Taiwan, & China.