Person: Hughes, Kevin
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Hughes
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Kevin
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Hughes, Kevin
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Publication BRCAPRO Validation, Sensitivity of Genetic Testing ofBRCA1/BRCA2, and Prevalence of Other Breast Cancer Susceptibility Genes(American Society of Clinical Oncology (ASCO), 2002) Berry, Donald A.; Iversen, Edwin S.; Gudbjartsson, Daniel F.; Hiller, Elaine H.; Garber, Judy; Peshkin, Beth N.; Lerman, Caryn; Watson, Patrice; Lynch, Henry T.; Hilsenbeck, Susan G.; Rubinstein, Wendy S.; Hughes, Kevin; Parmigiani, GiovanniPublication Long-term Risk of False-Positive Screening Results and Subsequent Biopsy as a Function of Mammography Use(Radiological Society of North America (RSNA), 2006) Blanchard, Karen; Colbert, James; Kopans, Daniel; Moore, Richard; Halpern, Elkan F.; Hughes, Kevin; Smith, Barbara; Tanabe, Kenneth; Michaelson, JamesPublication Reply to E. Ramos et al(American Society of Clinical Oncology (ASCO), 2018) Hughes, KevinPublication Identifying Health Information Technology Needs of Oncologists to Facilitate the Adoption of Genomic Medicine: Recommendations From the 2016 American Society of Clinical Oncology Omics and Precision Oncology Workshop(American Society of Clinical Oncology) Hughes, Kevin; Ambinder, Edward; Hess, Gregory; Yu, Peter; Bernstam, Elmer; Routbort, Mark; Clemenceau, Jean; Hamm, John; Febbo, Phillip; Domdek, Susan; Chen, James; Warner, JeremyAt the ASCO Data Standards and Interoperability Summit held in May 2016, it was unanimously decided that four areas of current oncology clinical practice have serious, unmet health information technology needs. The following areas of need were identified: 1) omics and precision oncology, 2) advancing interoperability, 3) patient engagement, and 4) value-based oncology. To begin to address these issues, ASCO convened two complementary workshops: the Omics and Precision Oncology Workshop in October 2016 and the Advancing Interoperability Workshop in December 2016. A common goal was to address the complexity, enormity, and rapidly changing nature of genomic information, which existing electronic health records are ill equipped to manage. The subject matter experts invited to the Omics and Precision Oncology Workgroup were tasked with the responsibility of determining a specific, limited need that could be addressed by a software application (app) in the short-term future, using currently available genomic knowledge bases. Hence, the scope of this workshop was to determine the basic functionality of one app that could serve as a test case for app development. The goal of the second workshop, described separately, was to identify the speci- fications for such an app. This approach was chosen both to facilitate the development of a useful app and to help ASCO and oncologists better understand the mechanics, difficulties, and gaps in genomic clinical decision support tool development. In this article, we discuss the key challenges and recommendations identified by the workshop participants. Our hope is to narrow the gap between the practicing oncologist and ongoing national efforts to provide precision oncology and value-based care to cancer patients.Publication Quality of Cancer Family History and Referral for Genetic Counseling and Testing Among Oncology Practices: A Pilot Test of Quality Measures As Part of the American Society of Clinical Oncology Quality Oncology Practice InitiativeHughes, Kevin; Wood, Marie; Kadlubek, Pamela; Pham, Trang; Wollins, Dana; Lu, Karen; Weitzel, Jeffrey; Neuss, MichaelPurpose: Family history of cancer (CFH) is important for identifying individuals to receive genetic counseling/ testing (GC/GT). Prior studies have demonstrated low rates of family history documentation and referral for GC/GT. Methods: CFH quality and GC/GT practices for patients with breast (BC) or colon cancer (CRC) were assessed in 271 practices participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative in fall 2011. Results: A total of 212 practices completed measures regarding CFH and GC/GT practices for 10,466 patients; 77.4% of all medical records reviewed documented presence or absence of CFH in first-degree relatives, and 61.5% of medical records documented presence or absence of CFH in second-degree relatives, with significantly higher documentation for patients with BC compared with CRC. Age at diagnosis was documented for all relatives with cancer in 30.7% of medical records (BC, 45.2%; CRC, 35.4%; P .001). Referall for GC/GT occurred in 22.1% of all patients with BC or CRC. Of patients with increased risk for hereditary cancer, 52.2% of patients with BC and 26.4% of those with CRC were referred for GC/GT. When genetic testing was performed, consent was documented 77.7% of the time, and discussion of results was documented 78.8% of the time. Conclusion: We identified low rates of complete CFH documentation and low rates of referral for those with BC or CRC meeting guidelines for referral among US oncologists. Documentation and referral were greater for patients with BC compared with CRC. Education and support regarding the importance of accurate CFH and the benefits of proactive high-risk patient management are clearly needed.Publication Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer: Long-Term Follow-Up of CALGB 9343(American Society of Clinical Oncology, 2013) Hughes, Kevin; Schnaper, Lauren; Bellon, Jennifer; Cirrincione, Constance; Berry, Donald; McCormick, Beryl; Muss, Hyman; Smith, Barbara; Hudis, CliffordPurpose: To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age 70 years with early-stage breast cancer. Patients and Methods: Between July 1994 and February 1999, 636 women (age 70 years) who had clinical stage I (T1N0M0 according to TNM classification) estrogen receptor (ER) –positive breast carcinoma treated by lumpectomy were randomly assigned to receive tamoxifen plus radiation therapy (TamRT; 317 women) or tamoxifen alone (Tam; 319 women). Primary end points were time to local or regional recurrence, frequency of mastectomy, breast cancer–specific survival, time to distant metastasis, and overall survival (OS). Results: Median follow-up for treated patients is now 12.6 years. At 10 years, 98% of patients receiving TamRT (95% CI, 96% to 99%) compared with 90% of those receiving Tam (95% CI, 85% to 93%) were free from local and regional recurrences. There were no significant differences in time to mastectomy, time to distant metastasis, breast cancer–specific survival, or OS between the two groups. Ten-year OS was 67% (95% CI, 62% to 72%) and 66% (95% CI, 61% to 71%) in the TamRT and Tam groups, respectively. Conclusion: With long-term follow-up, the previously observed small improvement in locoregional recurrence with the addition of radiation therapy remains. However, this does not translate into an advantage in OS, distant disease-free survival, or breast preservation. Depending on the value placed on local recurrence, Tam remains a reasonable option for women age 70 years with ER-positive early-stage breast cancer.Publication Reply to A.S. Sie et al, K. Hemminki et al, and J. Larsen Haidle(American Society of Clinical Oncology (ASCO), 2014-10-10) Wood, Marie E.; Lu, Karen; Wollins, Dana; Hughes, KevinWe agree with Hemminki et al1 that family history information can be used to identify individuals at both hereditary and familial cancer risk. We also agree that, in general, the percentage of any cancer type attributed to a familial form of cancer will be greater than the percentage that is likely hereditary. Hemminki et al point out that genetic testing is not yet available for those at familial risk.Publication Resection of the Liver for Colorectal Carcinoma Metastases A Multi-institutional Study of Long-term Survivors(1988) Hughes, Kevin; Rosenstein, Rebecca; Songhorabodi, Sate; Adson, Martin; Ilstrup, Duane; Fortner, Joseph; Maclean, Barbara; Foster, James; Daly, John; Fitzherbert, Diane; Sugarbaker, Paul; Iwatsuki, Shunzaboro; Starzl, Thomas; Ramming, Kenneth; Longmire, William; O'Toole, Kathy; Petrelli, Nicholas; Herrera, Lemuel; Cady, Blake; McDermott, William; Nims, Thomas; Enker, Warren; Coppa, Gene; Blumgart, Leslie; Bradpiece, Howard; Urist, Marshall; Aldrete, Joaquin; Schlag, Peter; Hohenberger, Peter; Steele, Glenn; Hodgson, W. John; Hardy, Thomas; Harbora, Denise; McPherson, T. Alexander; Lim, Christopher; Dillon, Daniel; Happo, Richard; Ripepi, Phillip; Villella, Edward; Smith, William; Rossi, Ricardo; Remine, Stephen; Oster, Mary; Connolly, David; Abrams, Jerome; Al-Jurf, Adel; Hobbs, K.E.F.; Li, Michael K. W.; Howard, Ted; Lee, EmonuelIn this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to l-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primary carcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized.Publication Resection of the liver for colorectal carcinoma metastases: A multi-institutional study of indications for resection(Elsevier, 1988) Hughes, KevinIn an investigation of the indications for hepatic resection in the treatment of colorectal carcinoma metastases, the records of 859 patients who had undergone this procedure were reviewed. This patient group, from 24 institutions, was found to have a 5-year actuarial survival of 33% and a 5-year actuarial disease-free survival of 21%. The only factors that might by themselves be considered contraindications to hepatic resection are the presence of positive hepatic nodes, the presence of resectable extrahepatic metastases, or the presence of four or more metastases. Other factors that had a negative effect on long-term survival were margins of resection on the liver metastases less than or equal to 1 cm (S [5-year actuarial survival = 23%), the presence of positive mesenteric nodes in the primary tumor specimen (S = 23%), and a disease-free interval of less than 1 year (S = 24%). The effect of any one of these factors was not great enough to contraindicate resection. However, combinations of prognostic factors must be considered before resection is recommended. The overall 5-year survival rate for this large series has been very satisfying. Decision making in the future must take into account such factors as number of metastases, extrahepatic involvement, and stage of the primary tumor.Publication The feasibility of using natural language processing to extract clinical information from breast pathology reports(Medknow, 2012) Hughes, Kevin; Buckley, Julliette M; Coopey, Suzanne; Sharko, John; Polubriaginof, Fernanda; Drohan, Brian; Belli, Ahmet K; Kim, Elizabeth M. H.; Garber, Judy; Smith, Barbara; Gadd, Michele; Specht, Michelle; Roche, Constance A; Gudewicz, Thomas MichaelObjective: The opportunity to integrate clinical decision support systems into clinical practice is limited due to the lack of structured, machine readable data in the current format of the electronic health record. Natural language processing has been designed to convert free text into machine readable data. The aim of the current study was to ascertain the feasibility of using natural language processing to extract clinical information from >76,000 breast pathology reports. Approach and Procedure: Breast pathology reports from three institutions were analyzed using natural language processing software (Clearforest, Waltham, MA) to extract information on a variety of pathologic diagnoses of interest. Data tables were created from the extracted information according to date of surgery, side of surgery, and medical record number. The variety of ways in which each diagnosis could be represented was recorded, as a means of demonstrating the complexity of machine interpretation of free text. Results: There was widespread variation in how pathologists reported common pathologic diagnoses. We report, for example, 124 ways of saying invasive ductal carcinoma and 95 ways of saying invasive lobular carcinoma. There were >4000 ways of saying invasive ductal carcinoma was not present. Natural language processor sensitivity and specificity were 99.1% and 96.5% when compared to expert human coders. Conclusion: We have demonstrated how a large body of free text medical information such as seen in breast pathology reports, can be converted to a machine readable format using natural language processing, and described the inherent complexities of the task.