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At least 19 records

Systematic Review of Radiation Therapy Toxicity Reporting in Randomized Controlled Trials of Rectal Cancer: A Comparison of Patient-Reported Outcomes and Clinician Toxicity Reporting

The use of multimodal treatments for rectal cancer has improved cancer-related outcomes but makes monitoring toxicity challenging. Optimizing future radiation therapy regimens requires collection and publication of detailed toxicity data. This review evaluated the quality of toxicity information provided in randomized controlled trials (RCTs) of radiation therapy in rectal cancer and focused on the difference between clinician-reported and patient-reported toxicity. Medline, EMBASE, and the Cochrane Library were searched (January 1995-July 2013) for RCTs reporting late toxicity in patients treated with regimens including preoperative (chemo)radiation therapy. Data on toxicity measures and information on toxicity reported were extracted using Quantitative Analyses of Normal Tissue Effects in the Clinic recommendations. International Society for Quality of Life Research standards on patient-reported outcomes (PROs) were used to evaluate the quality of patient-reported toxicity. Twenty-one RCT publications met inclusion criteria out of 4144 articles screened. All PRO studies reported higher rates of toxicity symptoms than clinician-reported studies and reported on a wider range and milder symptoms. No clinician-reported study published data on sexual dysfunction. Of the clinician-reported studies, 55% grouped toxicity data related to an organ system together (eg “Bowel”), and 45% presented data only on more-severe (grade ≥3) toxicity. In comparison, all toxicity grades were reported in 79% of PRO publications, and all studies (100%) presented individual symptom toxicity data (eg bowel urgency). However, PRO reporting quality was variable. Only 43% of PRO studies presented baseline data, 28% did not use any psychometrically validated instruments, and only 29% of studies described statistical methods for managing missing data. Analysis of these trials highlights the lack of reporting standards for adverse events and reveals the differences between clinician and patient reporting of toxicity. Recommendations for improving the quality of adverse event data collection are provided, with the aim of improving critical appraisal of outcomes for future studies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Extraction of Tumor Site from Cancer Pathology Reports using Deep Filters

Purpose: Pathology reports are the primary source of information concerning the millions of cancer cases across the United States. Cancer registries manually process the pathology reports to extract the pertinent information including primary tumor site, behavior, histology, laterality, and grade. Processing a large volume of the pathology reports in a timely manner is a continuing challenge for cancer registries. The purpose of this study is to develop an information extraction pipeline to reliably and efficiently extract reportable information. Method: We have developed a novel inverse-regression (IR) based information extraction pipeline. The inverse-regression based supervised filter has been successfully applied to many application domains. However, its application to the information extraction from unstructured text is hindered primarily by the extreme high-dimensionality of n-gram representations of text. In this study, we attempt to overcome the obstacles by a novel bootstrapping strategy. First, we use an information-theoretic mutual information based filter to discard the excessive and redundant n-gram features. This step reduces the size and improves the condition number of the sample covariance matrix, thus reducing the computational cost and improving the numerical stability of the subsequent inverse-regression step. Then we use localized sliced inverse-regression (LSIR) to learn a low-dimensional discriminatory subspace for information inference. In particular, we use the k-nearest neighbors of an unlabeled pathology report in the learned representation to infer the desired information from the labeled data in a supervised manner. Results: The experiments were conducted on a set of de-identified pathology reports with human expert labels as the ground truth. Our pipeline consistently performed better than or comparable to the best performing state-of-the-art methods while reducing the training and inference times substantially. Conclusion: Our results demonstrate the potential of inverse-regression based information extraction pipeline for reliable and efficient information extraction from unstructured text. The information extracted from the pathology reports can be used along with clinical information, medical imaging, and genomic information to instigate discoveries in cancer research.

Dubey, Abhishek↗

Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.

60 APPLIED LIFE SCIENCES↗

Feasibility of Patient Reporting of Symptomatic Adverse Events via the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial

Purpose: To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Methods and Materials: Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12 weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. Results: Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66 years; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range, 30-240 minutes), and median time for CRAs to teach a patient to self-report was 10 minutes (range, 2-60 minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling “too sick.” Conclusions: Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by allowing patients to self-report electronically between visits, and by using central compliance monitoring. These approaches are being incorporated into ongoing studies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Comparisons and challenges of modern neutrino scattering experiments (TENSIONS2016 report)

Over the last decade, there has been enormous effort to measure neutrino interaction cross sections important to oscillation experiments. However, a number of results from modern experiments appear to be in tension with each other, despite purporting to measure the same processes. The TENSIONS2016 workshop was held at University of Pittsburgh July 24–31, 2016 and was sponsored by the Pittsburgh Particle Physics, Astronomy, and Cosmology Center (PITT PACC). The focus was on bringing experts from three experimental collaborations together to compare results in detail and try to find the source of tension by clarifying and comparing signal definitions and the analysis strategies used for each measurement. A set of comparisons between the measurements using a

Betancourt, M.↗

Controls Optimization Final Report, Controls Algorithms Report, Control Optimization - SPA II: Heaving Buoy Test Results [Three reports]

The over-arching project objective is to fully develop and validate optimal controls frameworks that can subsequently be applied widely to different WEC devices and concepts. Optimal controls of WEC devices represent a fundamental building block for WEC designers that must be considered as an integral part of every stage of device development. Using a building-blocks approach to optimal controls development, this effort will result in the full development of a feed-forward and feed-back control approach and a wave prediction system. Phase I focused primarily on numerical offline optimization and validation using wave tank testing of three industry partners’ WEC devices, including; CalWave, Ocean Energy, and Resolute Marine Energy. These industry partnerships allowed us to identify optimal control strategies for these different WEC topologies at different maturity levels. Phase II focused on demonstrating an integrated control system on an at-sea prototype that is to be custom-built and maturing the HW and SW required to successfully run our advanced controls code frameworks on at-sea systems. A secondary focus during phase II is to adapt our systems identification, controls and wave-prediction frameworks to become more robust and comprehensive in respect to RT capability, robustness, and reliability.

16 TIDAL AND WAVE POWER↗

Patient-Reported Outcomes in Pediatric Cancer Registration Trials: A US Food and Drug Administration Perspective

Pediatric patient-reported outcome (PRO) data can help inform the US Food and Drug Administration’s (FDA’s) benefit-risk assessment of cancer therapeutics by quantifying symptom and functional outcomes from the patient’s perspective. This study assessed use of PROs in commercial pediatric oncology trials submitted to the FDA for regulatory review. FDA databases were searched to identify pediatric oncology product applications approved between 1997 and 2020. Sponsor-submitted documents were reviewed to determine whether PRO data were collected, which instruments were used, and the quality of collected data (ie, sample size, completion rates, and use of fit-for-purpose instruments). The role of PROs in each trial (endpoint hierarchy) was also recorded in addition to whether any PRO endpoints were included in product labeling. We reviewed 17 pediatric oncology applications, 4 of which included PRO data: denosumab, tisagenlecleucel, larotrectinib, and selumetinib. In these 4 instances, PROs served as exploratory endpoints and were not incorporated in product labeling. Trials that collected PRO data were phase II or phase I/II single-arm studies with sample sizes of 28 to 88 patients. Symptomatic adverse events (AEs) were characterized using clinician-reported Common Terminology Criteria for Adverse Events (CTCAE) without additional patient self-report. PROs were infrequently used in pediatric cancer registration trials. When PROs were used, PRO data were limited by lack of a clear research objective and corresponding prospective statistical analysis plan. Contemporary PRO symptom libraries, such as the National Cancer Institute’s Pediatric PRO-CTCAE, may provide an opportunity to better evaluate the occurrence and impact of symptomatic AEs, from the patient’s perspective, in pediatric oncology trials.

Oncology↗

U.S. Department of Energy Fuels & Lubricants Project on Lubricant Technology - Innovation, Discovery, Design, and Engineering (Final Report)

In 2016, the Vehicle Technologies Office (VTO) of the Department of Energy (DOE) issued a solicitation for the AOP Lab Call research in FY2017 on a number of topics related to vehicles. Topic 6A of the Lab Call focused on research related to advanced lubricants: '...(in) support of the lubricants program goal to, by 2020, demonstrate novel formulations for powertrain and driveline lubricants, compatible with new and legacy vehicles, to achieve at least a 4 percent real-world fuel economy improvement.' Argonne National Laboratory (ANL) in collaboration with Oak Ridge National Laboratory (ORNL) and Pacific Northwest National Laboratory (PNNL) was awarded a 3-year multilab project on 'Lubricant Technology - Innovation, Discovery, Design, and Engineering.' Research on the project began in FY2017 at the three laboratories with industry participation; however, in FY2018, the project was terminated due to budgetary constraints. The following is the final report for the project and highlights progress made during the first year of research. The report is divided into sections that highlight the following: goals, objectives, milestones and deliverables; project highlights; outreach - publications, conferences, and reports; milestones accomplished; research progress.

30 DIRECT ENERGY CONVERSION↗

Report for Task 15: Developed Tool Verification/Validation Report (Deliverable D11): AGGREGATE: dAta-driven modelinG preservinG contRollable dEr for outaGe mAnagemenT and rEsiliency

This report summarizes the verification report for the developed modules. The team conducted verification in two phases. In phase 1, the modules were validated using offline validation methods and in phase 2 the modules were subjected to real-time validation. This report outlines the approach and the results for the modules under offline and real-time settings. The rest of the report details the functional workflow of AGGREGATE modules, we then transition to offline validation followed by real-time validation of modules. We conclude the report by discussing some of the key points of this report.

14 SOLAR ENERGY↗