bluuebunny/crossref_metadata_2025 huggingface dataset:
Phytochemicals Analysis, In Vitro Antibacterial Activities of Extracts, and Molecular Docking Studies of the Isolated Compounds from Melhania zavattarii Cufod Leaves
Authors: Gonfa Teshome , Temesgen Ayalew , Erba Olyad , Mengesha Ephriem T. , Sivasubramanian Muthusaravanan
Published: June 2023

Melhania zavattarii Cufod is an endemic plant species to Ethiopia and is used to treat ailments related to kidney infection. The phytochemical composition and biological activity of M. zavattarii have been not reported yet. Therefore, the present work aimed to investigate phytochemical constituents and evaluate the antibacterial activity of different solvents’ leaf extracts and analyze the molecular binding capacity of isolated compounds from the chloroform leaf extract of M. zavattarii. Accordingly, preliminary phytochemical screening was tested by using standard procedures and the result indicated that phytosterols and terpenoids as major and others like alkaloids, saponins, flavonoids, tannins, phlobatannin, and coumarins were detected as minor in extracts. Antibacterial activity of the extracts was evaluated using the disk diffusion agar method, and the activities revealed that chloroform extract showed the highest inhibition zones, 12.08 ± 0.38, 14.00 ± 0.50, and 15.58 ± 0.63 mm against Escherichia coli at 50, 75, and 125 mg/mL concentrations, respectively, compared to that of n-hexane and methanol extracts at respective concentrations. Methanol extract showed the highest zone of inhibition 16.42 + 0.52 against Staphylococcus aureus at 125 mg/mL concentration compared to that of n-hexane and chloroform extracts. Two compounds, namely, β-amyrin palmitate (1) and lutein (2) were isolated and identified for the first time from the chloroform leaf extract of M. zavattarii, and structural elucidations of these compounds were accomplished by using spectroscopic methods (IR, UV, and NMR). For the molecular docking study, 1G2A, which is a protein of E. coli and chloramphenicol standard target, was selected. Binding energies of −9.09, −7.05, and −6.87 kcal/mol were calculated for β-amyrin palmitate, lutein, and chloramphenicol, respectively. The drug-likeness property result indicated that both β-amyrin palmitate and lutein violated two rules of Lipinski’s rule of five with molecular weight (g/mol) > 500 and LogP > 4.15. In the near future, further phytochemical investigation and biological activity evaluation should be conducted on this plant.
Supplemental Table 5 from Nitrated Polycyclic Aromatic Hydrocarbon (Nitro-PAH) Signatures and Somatic Mutations in Diesel Exhaust-Exposed Bladder Tumors
Authors: Gonzalez Nicole , Rao Nina , Dean Michael , Lee Donghyuk , Hurson Amber N. , Baris Dalsu , Schwenn Molly , Johnson Alison , Prokunina-Olsson Ludmila , Friesen Melissa C. , Zhu Bin , Rothman Nathaniel , Silverman Debra T. , Koutros Stella
Published: June 2023

REC and nitro-PAH signatures in New England
Supplementary Table 3 from Associations between MICA and MICB Genetic Variants, Protein Levels, and Colorectal Cancer: Atherosclerosis Risk in Communities (ARIC)
Authors: Wang Shuo , Onyeaghala Guillaume C. , Pankratz Nathan , Nelson Heather H. , Thyagarajan Bharat , Tang Weihong , Norby Faye L. , Ugoji Chinenye , Joshu Corinne E. , Gomez Christian R. , Couper David J. , Coresh Josef , Platz Elizabeth A. , Prizment Anna E.
Published: June 2023

Supplemental Table 3 shows the associations between pre-selected SNPs and CRC risk stratified by sex, race, or diabetes status.
Supplementary Table 5 from Somatic Mosaic Chromosomal Alterations and Death of Cardiovascular Disease Causes among Cancer Survivors
Authors: Sun Maxine , Cyr Marie-Christyne , Sandoval Johanna , Lemieux Perreault Louis-Philippe , Busque Lambert , Tardif Jean-Claude , Dubé Marie-Pierre
Published: June 2023

Supplementary Table 5: Cox regression analyses evaluating the effect of mosaic chromosomal alterations on the risk of death of cardiovascular disease causes, coronary artery disease causes, from cancer, and any cause of death stratified by smoking status groups
Data from Five-year Survival Trends for Young Adult Cancers Diagnosed from 2002 to 2014 in Taiwan and the United States
Authors: Tsai Yu-Han , Teng Yu-Tung , Kuan Tai-Chuan , Liu Jason J.
Published: June 2023

AbstractBackground:
Young adult cancer incidence has been increasing in Taiwan, but no studies have examined their survival trends.
Methods:
We analyzed data from the Taiwan National Health Insurance Research Database and the U.S. Surveillance, Epidemiology, and End Results Program. We obtained the five-year survival estimates and trends for primary invasive cancers diagnosed at 20–39 years of age from 2002 to 2014. When analyzing specific cancers, we focused on the common young adult cancers in Taiwan. For the trend analysis, the average annual percent change (AAPC) was calculated using joinpoint Regression Program. We also obtained estimates stratified by sex or age at cancer diagnosis.
Results:
The five-year age-standardized relative survival for all young adult cancers combined significantly increased in Taiwan [AAPC = 1.4%; 95% confidence interval (CI), 1.3%–1.5%] and the United States (AAPC = 0.4%; 95% CI, 0.3%–0.6%). Cancers occurring in both sexes had similar trend directions for both sexes. Lung and bronchus cancer, liver cancer, and leukemia had the most survival improvement in both regions. However, the five-year relative survival for cervical cancer declined in Taiwan (AAPC = −0.6%; 95% CI, -1.0% to −0.1%) and did not improve in the United States (AAPC = −0.1%; 95% CI, −0.4%–0.2%).
Conclusions:
Survival has improved for most but not all of the common young adult cancer types in Taiwan. Additional studies can understand why survival has not improved for certain cancer types, and examine subtype-specific survival trends.
Impact:
This is the first study of five-year survival trends for young adult cancers in Taiwan and the United States stratified by sex or age at diagnosis.
Data from Trend in Cervical Cancer Incidence and Mortality Rates in China, 2006–2030: A Bayesian Age-Period-Cohort Modeling Study
Authors: Yuan Meiwen , Zhao Xuelian , Wang Honghao , Hu Shangying , Zhao Fanghui
Published: June 2023

AbstractBackground:
There are no studies extrapolating the incidence and mortality of cervical cancer in China by comparing incidence and deaths pattern between geographic and age groups.
Methods:
We applied age-period-cohort models to assess region-level trends in incidence and mortality from 2006 to 2016, with piecewise linear regression in a Bayesian framework to predict these trends to 2030.
Results:
Between 2006 and 2016, age-standardized incidence rates (ASIR) for females aged 15 to 84 years increased by 3.7% (95% confidence interval, 3.1%–4.3%) annually from 11.01 to 16.41 per 100,000 females in China. In the 25 to 39 age groups, the incidence rates decreased in urban regions and inversely increased in rural regions. The age-standardized mortality rates (ASMR) increased from 3.18 to 4.83, with annual increases of about 3.6% (1.5%–5.8%). From 2017 to 2030, the ASIR is expected to increase from 17.13 (15.91–18.46) to 23.22 (20.02–27.01) by 2.5% per year (P < 0.05). Meanwhile, the average age at diagnosis is predicted to grow from 53.1 to 60.5 years. In the 15 to 54 age groups, the incidence rates decreased in urban regions but increased in rural regions. The ASMR is expected to increase consistently from 4.82 (4.38–5.31) to 9.13 (7.35–11.39) by 5.0% per year (P < 0.05).
Conclusions:
Cervical cancer incidence and mortality rates are projected to increase in China. In addition, the urban–rural incidence gap is estimated to widen further among young women.
Impact:
Cervical cancer prevention should consider the trend and diversity in incidence patterns between urban and rural regions.
Data from COVID-19 Outcomes by Cancer Status, Site, Treatment, and Vaccination
Authors: Salvatore Maxwell , Hu Miriam M. , Beesley Lauren J. , Mondul Alison M. , Pearce Celeste Leigh , Friese Christopher R. , Fritsche Lars G. , Mukherjee Bhramar
Published: June 2023

AbstractBackground:
Studies have shown an increased risk of severe SARS-CoV-2–related (COVID-19) disease outcome and mortality for patients with cancer, but it is not well understood whether associations vary by cancer site, cancer treatment, and vaccination status.
Methods:
Using electronic health record data from an academic medical center, we identified a retrospective cohort of 260,757 individuals tested for or diagnosed with COVID-19 from March 10, 2020, to August 1, 2022. Of these, 52,019 tested positive for COVID-19 of whom 13,752 had a cancer diagnosis. We conducted Firth-corrected logistic regression to assess the association between cancer status, site, treatment, vaccination, and four COVID-19 outcomes: hospitalization, intensive care unit admission, mortality, and a composite “severe COVID” outcome.
Results:
Cancer diagnosis was significantly associated with higher rates of severe COVID, hospitalization, and mortality. These associations were driven by patients whose most recent initial cancer diagnosis was within the past 3 years. Chemotherapy receipt, colorectal cancer, hematologic malignancies, kidney cancer, and lung cancer were significantly associated with higher rates of worse COVID-19 outcomes. Vaccinations were significantly associated with lower rates of worse COVID-19 outcomes regardless of cancer status.
Conclusions:
Patients with colorectal cancer, hematologic malignancies, kidney cancer, or lung cancer or who receive chemotherapy for treatment should be cautious because of their increased risk of worse COVID-19 outcomes, even after vaccination.
Impact:
Additional COVID-19 precautions are warranted for people with certain cancer types and treatments. Significant benefit from vaccination is noted for both cancer and cancer-free patients.
Short-term Endpoints for Cancer Screening Trials: Does Tumor Subtype Matter?
Authors: Owens Lukas , Gogebakan Kemal Caglar , Menon Usha , Gulati Roman , Weiss Noel S. , Etzioni Ruth
Published: June 2023

Multicancer early detection tests are precipitating a reexamination of potential short-term endpoints for cancer screening trials. A reduction in advanced stage incidence is a prime candidate, and stage-shift models that substitute early-stage for late-stage survival have been used to predict mortality reduction due to screening. However, standard stage-shift models often ignore prognostic subtypes, effectively implying that cancers detected early also have an associated subtype shift. To illustrate the differences between mortality predictions from stage-shift models that ignore versus preserve prognostic subtype, we use ovarian cancer partitioned by histologic subtype and prostate cancer partitioned by grade. We infer general conditions under which stage-shift models that preserve prognostic subtype are likely to predict mortality reductions that differ from those that ignore subtype and examine the implications for short-term endpoints based on stage in cancer screening trials.
Supplementary Figure S1 from Collagen-Anchored Interleukin-2 and Interleukin-12 Safely Reprogram the Tumor Microenvironment in Canine Soft-Tissue Sarcomas
Authors: Stinson Jordan A. , Sheen Allison , Momin Noor , Hampel Jordan , Bernstein Rebecca , Kamerer Rebecca , Fadl-Alla Bahaa , Samuelson Jonathan , Fink Elizabeth , Fan Timothy M. , Wittrup K. Dane
Published: June 2023

Patient tumor images and cohorts
Supplementary Table S2 from Type 2 Diabetes Mellitus and Efficacy Outcomes from Immune Checkpoint Blockade in Patients with Cancer
Authors: Cortellini Alessio , D'Alessio Antonio , Cleary Siobhan , Buti Sebastiano , Bersanelli Melissa , Bordi Paola , Tonini Giuseppe , Vincenzi Bruno , Tucci Marco , Russo Alessandro , Pantano Francesco , Russano Marco , Stucci Luigia Stefania , Sergi Maria Chiara , Falconi Martina , Zarzana Maria Antonietta , Santini Daniele , Spagnolo Francesco , Tanda Enrica T. , Rastelli Francesca , Giorgi Francesca Chiara , Pergolesi Federica , Giusti Raffaele , Filetti Marco , Lo Bianco Francesca , Marchetti Paolo , Botticelli Andrea , Gelibter Alain , Siringo Marco , Ferrari Marco , Marconcini Riccardo , Vitale Maria Giuseppa , Nicolardi Linda , Chiari Rita , Ghidini Michele , Nigro Olga , Grossi Francesco , De Tursi Michele , Di Marino Pietro , Queirolo Paola , Bracarda Sergio , Macrini Serena , Inno Alessandro , Zoratto Federica , Veltri Enzo , Spoto Chiara , Vitale Maria Grazia , Cannita Katia , Gennari Alessandra , Morganstein Daniel L. , Mallardo Domenico , Nibid Lorenzo , Sabarese Giovanna , Brunetti Leonardo , Perrone Giuseppe , Ascierto Paolo A. , Ficorella Corrado , Pinato David J.
Published: June 2023

Details of diabetes medications.
Data from Characterization of Cell-Free DNA Size Distribution in Osteosarcoma Patients
Authors: Udomruk Sasimol , Phanphaisarn Areerak , Kanthawang Thanat , Sangphukieo Apiwat , Sutthitthasakul Songphon , Tongjai Siripong , Teeyakasem Pimpisa , Thongkumkoon Patcharawadee , Orrapin Santhasiri , Moonmuang Sutpirat , Klangjorhor Jeerawan , Pasena Arnat , Suksakit Pathacha , Dissook Sivamoke , Puranachot Pitithat , Settakorn Jongkolnee , Pusadee Tonapha , Pruksakorn Dumnoensun , Chaiyawat Parunya
Published: June 2023

AbstractPurpose:
Cell-free DNA (cfDNA) analysis is a powerful tool for noninvasively predicting patient outcomes. We analyzed the size distribution of cfDNA and assessed its prognostic and diagnostic values in an osteosarcoma cohort.
Experimental Design:
The fragment size distribution and level of cfDNA were analyzed in 15 healthy donors and 50 patients with osteosarcoma using automated capillary electrophoresis. The prognostic performance of cfDNA size analysis was assessed using univariate and multivariable analyses. By performing whole-genome sequencing of matched cfDNA and osteosarcoma tissue samples, we investigated the correlation between the size and mutation profiles of cfDNA and the mutation concordance between cfDNA and paired tissue tumors.
Results:
The size of cfDNA fragments in patients with osteosarcoma was significantly shorter than in healthy donors, with the integrative analysis of size distribution and level of cfDNA achieving a high specificity and sensitivity of 100%. The short cfDNA fragment (150-bp cut-off) was an independent prognostic predictor in this osteosarcoma cohort [HR, 9.03; 95% confidence interval (CI), 1.13–72.20; P = 0.038]. Shortened cfDNA fragments were found to be a major source of mutations. Enrichment of cfDNA fragments with less than or equal to 150 bp by in silico size selection remarkedly improved the detection of copy-number variation signals up to 2.3-fold when compared with total cfDNA, with a higher concordance rate with matched osteosarcoma tissue.
Conclusions:
This finding demonstrated the potential of cfDNA size profiling in the stratification of poor prognostic patients with osteosarcoma. The short fragments of cfDNA are a promising source for boosting the detection of significant mutations in osteosarcoma.

See related commentary by Weiser et al., p. 2017
Data from G-CSF Is a Novel Mediator of T-Cell Suppression and an Immunotherapeutic Target for Women with Colon Cancer
Authors: Ray Anita L. , Saunders Apryl S. , Nofchissey Robert A. , Reidy Megan A. , Kamal Maria , Lerner Megan R. , Fung Kar-Ming , Lang Mark L. , Hanson Joshua A. , Guo Shaoxuan , Urdaneta-Perez Maria G. , Lewis Samara E. , Cloyde Michael , Morris Katherine T.
Published: June 2023

AbstractPurpose:
G-CSF enhances colon cancer development. This study defines the prevalence and effects of increased G-CSF signaling in human colon cancers and investigates G-CSF inhibition as an immunotherapeutic strategy against metastatic colon cancer.
Experimental Design:
Patient samples were used to evaluate G-CSF and G-CSF receptor (G-CSFR) levels by IHC with sera used to measure G-CSF levels. Peripheral blood mononuclear cells were used to assess the rate of G-CSFR+ T cells and IFNγ responses to chronic ex vivo G-CSF. An immunocompetent mouse model of peritoneal metastasis (MC38 cells in C57Bl/6J) was used to determine the effects of G-CSF inhibition (αG-CSF) on survival and the tumor microenvironment (TME) with flow and mass cytometry.
Results:
In human colon cancer samples, the levels of G-CSF and G-CSFR are higher compared to normal colon tissues from the same patient. High patient serum G-CSF is associated with increases in markers of poor prognosis, (e.g., VEGF, IL6). Circulating T cells from patients express G-CSFR at double the rate of T cells from controls. Prolonged G-CSF exposure decreases T cell IFNγ production. Treatment with αG-CSF shifts both the adaptive and innate compartments of the TME and increases survival (HR, 0.46; P = 0.0237) and tumor T-cell infiltration, activity, and IFNγ response with greater effects in female mice. There is a negative correlation between serum G-CSF levels and tumor-infiltrating T cells in patient samples from women.
Conclusions:
These findings support G-CSF as an immunotherapeutic target against colon cancer with greater potential benefit in women.
Data from Myosin Light-Chain Kinase Inhibition Potentiates the Antitumor Effects of Avapritinib in PDGFRA D842V-Mutant Gastrointestinal Stromal Tumor
Authors: Rossi Ferdinand , Liu Mengyuan , Tieniber Andrew , Etherington Mark S. , Hanna Andrew , Vitiello Gerardo A. , Param Nesteene J. , Do Kevin , Wang Laura , Antonescu Cristina R. , Zeng Shan , Zhang Jennifer Q. , DeMatteo Ronald P.
Published: June 2023

AbstractPurpose:
To create an in vivo model of PDGFRA D842V-mutant gastrointestinal stromal tumor (GIST) and identify the mechanism of tumor persistence following avapritinib therapy.
Experimental Design:
We created a patient-derived xenograft (PDX) of PDGFRA D842V-mutant GIST and tested the effects of imatinib, avapritinib, and ML-7, an inhibitor of myosin light-chain kinase (MYLK). Bulk tumor RNA sequencing and oncogenic signaling were evaluated. Apoptosis, survival, and actin cytoskeleton were evaluated in GIST T1 cells and isolated PDX cells in vitro. Human GIST specimens were analyzed for MYLK expression.
Results:
The PDX was minimally responsive to imatinib but sensitive to avapritinib. Avapritinib therapy increased tumor expression of genes related to the actin cytoskeleton, including MYLK. ML-7 induced apoptosis and disrupted actin filaments in short-term cultures of PDX cells and decreased survival in GIST T1 cells in combination with imatinib or avapritinib. Combined therapy with ML-7 improved the antitumor effects of low-dose avapritinib in vivo. Furthermore, MYLK was expressed in human GIST specimens.
Conclusions:
MYLK upregulation is a novel mechanism of tumor persistence after tyrosine kinase inhibition. Concomitant MYLK inhibition may enable the use of a lower dose of avapritinib, which is associated with dose-dependent cognitive side effects.
Data from Collagen-Anchored Interleukin-2 and Interleukin-12 Safely Reprogram the Tumor Microenvironment in Canine Soft-Tissue Sarcomas
Authors: Stinson Jordan A. , Sheen Allison , Momin Noor , Hampel Jordan , Bernstein Rebecca , Kamerer Rebecca , Fadl-Alla Bahaa , Samuelson Jonathan , Fink Elizabeth , Fan Timothy M. , Wittrup K. Dane
Published: June 2023

AbstractPurpose:
Cytokine therapies such as IL2 and IL12 suffer from impractically small therapeutic windows driven by their on-target, off-tumor activity, limiting their clinical potential despite potent antitumor effects. We previously engineered cytokines that bind and anchor to tumor collagen following intratumoral injection, and sought to test their safety and biomarker activity in spontaneous canine soft-tissue sarcomas (STS).
Experimental Design:
Collagen-binding cytokines were canine-ized to minimize immunogenicity and were used in a rapid dose-escalation study in healthy beagles to identify a maximum tolerated dose. Ten client-owned pet dogs with STS were then enrolled into trial, receiving cytokines at different intervals prior to surgical tumor excision. Tumor tissue was analyzed through IHC and NanoString RNA profiling for dynamic changes within treated tumors. Archived, untreated STS samples were analyzed in parallel as controls.
Results:
Intratumorally administered collagen-binding IL2 and IL12 were well tolerated by STS-bearing dogs, with only Grade 1/2 adverse events observed (mild fever, thrombocytopenia, neutropenia). IHC revealed enhanced T-cell infiltrates, corroborated by an enhancement in gene expression associated with cytotoxic immune function. We found concordant increases in expression of counter-regulatory genes that we hypothesize would contribute to a transient antitumor effect, and confirmed in mouse models that combination therapy to inhibit this counter-regulation can improve responses to cytokine therapy.
Conclusions:
These results support the safety and activity of intratumorally delivered, collagen-anchoring cytokines for inflammatory polarization of the canine STS tumor microenvironment. We are further evaluating the efficacy of this approach in additional canine cancers, including oral malignant melanoma.
Data from Additional Oncogenic Alterations in RAS-Driven Differentiated Thyroid Cancers Associate with Worse Clinicopathologic Outcomes
Authors: Bikas Athanasios , Ahmadi Sara , Pappa Theodora , Marqusee Ellen , Wong Kristine , Nehs Matthew A. , Cho Nancy L. , Haase Jacob , Doherty Gerard M. , Sehgal Kartik , Barletta Justine A. , Alexander Erik K. , Landa Iñigo
Published: June 2023

AbstractPurpose:
RAS mutations occur across the spectrum of thyroid neoplasms, and more tools are needed for better prognostication. The objective of this study was to evaluate how additional genetic events affecting key genes modify prognosis in patients with RAS-mutant thyroid cancers, and specifically differentiated thyroid cancers (DTC).
Experimental Design:
We performed a clinical–genomic analysis of consecutive patients with DTC, poorly differentiated (PDTC), or anaplastic thyroid cancer (ATC) between January 2014 and December 2021, in whom a custom-targeted next-generation sequencing assay was performed. Patients harboring RAS mutations were included, and we compared their clinical features and outcomes based upon the presence of additional oncogenic alterations.
Results:
Seventy-eight patients were identified, with 22% (17/78) harboring a driver RAS mutation plus an additional oncogenic alteration. All six (100%) ATCs had an additional mutation. Compared with DTCs harboring a solitary RAS mutation, patients with DTC with RAS and additional mutation(s) were more likely to be classified as American Thyroid Association high-risk of recurrence (77% vs. 12%; P < 0.001) and to have larger primary tumors (4.7 vs. 2.5 cm; P = 0.002) and advanced stage (III or IV) at presentation (67% vs. 3%; P < 0.001). Importantly, over an average 65-month follow-up, DTC-specific-mortality was more than 10-fold higher (20% vs. 1.8%; P = 0.011) when additional mutations were identified.
Conclusions:
Identification of key additional mutations in patients with RAS-mutant thyroid cancers confers a more aggressive phenotype, increases mortality risk in DTC, and can explain the diversity of RAS-mutated thyroid neoplasia. These data support genomic profiling of DTCs to inform prognosis and clinical decision-making.
Abstract 10: Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana
Authors: Price Matthew , Rositch Anne , Dedey Florence , Tounkara Mamadou , Brownson Kirstyn , Price Raymond , Sutherland Edward Kofi
Published: June 2023

Purpose: Breast Cancer in Ghana is the leading type of cancer and second most common cause of cancer related death. Five-year survival in Ghana has been cited at 40-48% with most cases being stage 3 or 4 at diagnosis. Robust access to early detection and diagnostic services can lead to earlier stages of diagnosis and improved survival. The purpose of this study was to evaluate the early detection and diagnostic services available at hospital facilities nationwide in Ghana and to characterize geographic access.

Methods: Trained research assistants administered a cross-sectional survey to all hospitals in Ghana from November 2020 to October 2021. Early detection and diagnostic services were characterized as having Basic, Core, or Enhanced services as per in the National Comprehensive Cancer Network (NCCN) framework for resource stratification. Availability of services were defined as available greater than 80% of the time, available less than 80%, or not at all. Results were analyzed for descriptive statistics in STATA.

Results: 328 of 346 hospitals completed the survey. Of the 328 hospitals, 2 (1%) met NCCN Basic criteria alone, 11 (3%) of the hospitals met NCCN Core criteria, and none met NCCN Enhanced criteria. When including hospitals who offer services less than 80% of the year for varying circumstances, 3 (1%) met NCCN Basic criteria, 20 (6%) met NCCN Core criteria, and none met NCCN Enhanced criteria. Mammography was offered at 21 (6%) of the hospitals, 17 (5%) of which were available more than 80% of the year. Mapping and population data to estimate the percentage of population within various distances to hospital-based breast cancer early detection and diagnostic services will be done using Ghana 2021 census data in ArcGIS.

Conclusion: Hospital based services for breast cancer early detection and diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care outlined by the NCCN framework, but there are only a limited number of hospitals who offer the full spectrum of services. Understanding of current availability, and geographical distribution of services, provides a framework for potential targeted expansion or identification of alternative healthcare delivery models.

Citation Format: Matthew Price, Anne Rositch, Florence Dedey, Mamadou Tounkara, Kirstyn Brownson, Raymond Price, Edward Kofi Sutherland. Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 10.
Abstract 13: Barriers to Diagnostic Follow-Up for Women With a Suspicious Clinical Breast Examination at the Primary Health Center in Uttar Pradesh State in India: A Qualitative Study
Authors: Liebermann Erica , Usmanova Gulnoza , Akhtar Nadeem , Agrawal Shivani , Patwardhan Vaibhav , Bhamare Parag , Kumar Somesh
Published: June 2023

Purpose: The purpose of this study was to understand key barriers to diagnostic follow-up for women with a suspicious clinical breast examination (CBE) at the primary care level in Uttar Pradesh (UP) state in India. We also explored acceptability of the use of mHealth strategies to address barriers to CBE follow up for women.

Methods: We conducted 28 in-depth individual interviews with key stakeholders involved in the Breast Health Initiative in Lucknow district, UP. Primary health facilities in rural and urban settings were purposively selected based on the number of CBE screening exams conducted in the last year and the number of women with a suspicious CBE identified. We interviewed six women with a suspicious CBE at the primary health facility who did not have diagnostic follow-up, six community health workers (ASHAs), six healthcare providers from primary health facilities and four district or state-level health decisionmakers. Interviews were audio-recorded and transcribed verbatim. Coding and thematic analysis will proceed once translation of the full dataset of transcripts is complete.

Results: Preliminary analyses of qualitative interviews found that cancer stigma and fear are significant barriers to both breast screening and follow-up of an abnormal CBE. Male providers and long waits at the district hospital are barriers to completing confirmatory diagnostic exams. Providers maintain that, despite community education and outreach efforts by ASHAs, lack of awareness of breast cancer and the importance of follow-up for abnormal CBE remains a barrier to early detection.

Conclusion: Knowledge barriers, cultural barriers, and health system barriers challenge women’s ability to follow recommendations for diagnostic follow-up of an abnormal CBE in Uttar Pradesh, India. Multi-level strategies are needed to address these barriers. Our findings will help inform the content and approach of an mHealth patient navigation strategy that could include patient education, reminders, patient tracking, and care coordination.

Citation Format: Erica Liebermann, Gulnoza Usmanova, Nadeem Akhtar, Shivani Agrawal, Vaibhav Patwardhan, Parag Bhamare, Somesh Kumar. Barriers to Diagnostic Follow-Up for Women With a Suspicious Clinical Breast Examination at the Primary Health Center in Uttar Pradesh State in India: A Qualitative Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 13.
Abstract 14: Barriers to Effective Safe Handling of Chemotherapeutic Drugs Among Healthcare Workers in Vietnam: Needs Assessment by Electronic Survey
Authors: Nguyen Cham , Abramovitz Linda , Nguyen Kim Lien , Truong Bao , Hermiston Michelle
Published: June 2023

Purpose: To identify barriers and facilitators of effective safe handling of chemotherapeutic drugs among healthcare workers in hospitals across Vietnam.

Methods: We used Qualtrics to design a 45-question structured questionnaire in English and Vietnamese survey to assess the safe handling of chemotherapeutic drugs. This questionnaire was distributed as an anonymous online survey through the e-mail listserv of the Vietnam Pediatric Oncology Association in August 2022. Survey instruments included years of practice, types of prior training, knowledge, personal practice, and organizational factors. Respondents were asked whether they used specific personal protective equipment (PPE) in the steps of preparation, administration, and disposal of chemotherapeutic drugs.

Results: The survey was distributed to 310 healthcare workers at 14 children’s hospitals. Sixty-two healthcare workers from 13 hospitals completed the survey (response rate 20%). Among those who completed the survey, diverse occupations were represented (39 nurses, 21 physicians, and 2 pharmacists). Forty-six had received prior training in the safe handling of chemotherapeutic drugs, and 25 had longer than ten years of practice. Forty-two workers reported involvement in the administration of chemotherapy, and 17 reported wearing chemotherapy gloves (compliant group) while 25 wore other types of gloves or no gloves at all (non-compliant group). Thirty-six workers (86%) reported the availability of chemotherapy gloves, and 38 (90%) were aware that not all gloves provide the same level of protection. In the compliant group, 71% (n = 12) were aware of institutional policies at their workplaces, while only 36% of the non-compliant group (n = 9) reported awareness of the institutional policies. When stratified according to the availability of institutional policy, long years of practice were more common in the compliant group.

Conclusion: Overall, respondents reported having supplies of gloves and knowledge of glove use. Those who used chemotherapy gloves were generally aware of institutional policies and had longer years of practice. The next step will involve reviewing institutional policy at each institution and studying how long years of practice influence the practice of safe handling.

Citation Format: Cham Nguyen, Linda Abramovitz, Kim Lien Nguyen, Bao Truong, Michelle Hermiston. Barriers to Effective Safe Handling of Chemotherapeutic Drugs Among Healthcare Workers in Vietnam: Needs Assessment by Electronic Survey [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 14.
Abstract 33: Epidemiology, Diagnosis, and Outcomes of Pediatric Burkitt Lymphoma Patients Treated at Bugando Medical Centre in Mwanza, Tanzania
Authors: Chapman Hutton , Ntemi Paul S. , Kamanga Jacqueline , Paschal Judith , Kashaigili Heronima J. , Schroeder Kristin
Published: June 2023

Purpose: Despite the significant improvement in outcomes over the last few decades for the treatment of pediatric Burkitt lymphoma, outcomes in sub-Saharan Africa remain poor, with an approximately 50% survival rate. This disparity is likely multifactorial and significant work remains to improve these outcomes in low resource settings. As a first step in attempting to improve these disparate outcomes at our hospital, Bugando Medical Centre (BMC), in Mwanza, Tanzania, we aim to improve the understanding of the presentation, diagnosis, and outcomes with the current standard of care therapy at our site. We propose that a better understanding of the current nature of care for these patients at our site will allow for more informed future interventions aimed at improving outcomes.

Methods: Historical patient data were abstracted for pediatric patients with a diagnosis of Burkitt lymphoma treated at BMC from 2016-2022. Patients’ initial presentations (e.g. site of disease), means of diagnosis, treatment completion rate, and outcomes (if available) were analyzed.

Results: Data were available on 109 patients with a diagnosis of Burkitt lymphoma between 2016-2022. Patients were on average 7.7 years old at presentation. We observed a 2:1 male to female ratio. We observed a significant proportion of abdominal disease with 58.7% presenting with abdominal disease (either alone or in combination) at initial diagnosis. There were 91% of patients who were deemed INCTR ‘high risk’ at diagnosis. There was a notable improvement in the percent of patients diagnosed with a biopsy with 46% in 2016 and 100% in 2022. Outcomes were poor but were difficult to assess with clarity due to a high rate of abandonment. Within those limitations, we observed a 1-year overall survival, of patients through 2021 with known outcomes, of 50.2% and a 1-year event free survival of 34.1% (including abandoment as an event).

Conclusion: Overall, in our patients we note epidemiology consistent with known data for endemic Burkitt lymphoma. Our patient population includes a significant proportion of abdominal and/or high-risk disease. We demonstrate overall poor outcomes with a high degree of treatment abandonment. These data suggest that improvement in treatment efficacy and treatment adherence may improve outcomes.

Citation Format: Hutton Chapman, Paul S. Ntemi, Jacqueline Kamanga, Judith Paschal, Heronima J. Kashaigili, Kristin Schroeder. Epidemiology, Diagnosis, and Outcomes of Pediatric Burkitt Lymphoma Patients Treated at Bugando Medical Centre in Mwanza, Tanzania [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 33.
Abstract 45: How Did States Adapt Their Cancer Control Plan During the COVID-19 Pandemic?
Authors: Semprini Jason
Published: June 2023

Purpose: The COVID-19 pandemic upended the delivery of cancer services across the care continuum. In the United States, the federalist system of governance led to health policy changes by federal, state, and local jurisdictions. At the intersection of these levels of government are state cancer control plans. Funded by the federal government, state cancer control plans are developed by state health departments in collaboration with healthcare providers, public health agencies, and community organizations. By outlining specific strategies for addressing cancer in the state, these plans serve a critical role during a public health emergency. This policy analysis aims to understand how states updated their cancer control plan as a response to COVID-19.

Methods: This qualitative policy analysis began by reviewing the cancer control plans of all 50 states and the District of Columbia. The inclusion criteria required that each plan be updated after March 2020 and included language related to “COVID”. These plans were then analyzed for COVID-19 related adaptations along three themes: 1) cancer care continuum, 2) service delivery, 2) population health and equity.

Results: Among the 51 cancer plans analyzed, seven plans met the inclusion criteria (IL, IA, ME, NV, NC, UT, VT). Three states (IL, IA, ME) adapted their plans to increase cancer screenings, two plans to increase clinical trials (IA, ME), and one plan each targeted increased treatment (NC) and prevention activities (NV). Three states identified telehealth as a priority for service delivery (IL, NV, UT), but only two (IL, UT) identified telehealth equity as a barrier. Two states (IA, NC) prioritized addressing workforce shortage and disruptions caused by the pandemic. Health insurance loss and public health investments were also identified as service delivery concerns. Two states (IL, IA) acknowledged the role of social determinants of health exacerbating COVID-19 and cancer inequalities. Food insecurity (NV, UT) and job loss (ME, NV, UT) were also components of equity within these plans. Utah explicitly acknowledged the role of racism and gender as related to the disparate impact of COVID-19 on cancer care.

Conclusion: This analysis highlighted how states adapted their cancer control plans in response to COVID-19 and may inform ongoing policy debate. Continued policy surveillance and evaluation could ensure that cancer patients receive timely, appropriate care during public health emergencies.

Citation Format: Jason Semprini. How Did States Adapt Their Cancer Control Plan During the COVID-19 Pandemic? [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 45.
Abstract 50: Impact of the COVID-19 Pandemic on Breast Cancer Treatments in the Brazilian Public System
Authors: da Silva Laura Tibola Marques , Barreto Pedro Antonio Paludo Menna , Beltramo Luiza Seixas de Sá , Lech Gabriele Eckerdt , Azambuja Fernando , de Andrade Rafaela , Alberti Arthur Minas , Silveira Pedro Arthur Zimmer , Kieling Lucas
Published: June 2023

Purpose: To evaluate the impact of the COVID-19 pandemic on breast cancer treatments performed in Brazil, by the Unified Health System (SUS).

Methods: Data were obtained from the DATASUS database, provided by the Ministry of Health, from 2017 to 2021. The codes C50 (Malignant breast neoplasm) and D05 (Carcinoma in situ of the breast) were used. The therapeutic modality included surgery, chemotherapy, radiotherapy and/or both as a form of treatment. Statistical analysis was performed using linear regression with a 95% confidence interval.

Results: The number of treatments for breast cancer performed in the years 2017, 2018 and 2019 was 26,335, 39,339 and 43,271, respectively. The analysis between year and number of treatments performed showed progressive growth. In 2020, impacted by the pandemic, the number of treatments was 40,934, a value 22.63% below the forecast (52,911.09) and 14.14% below the lower confidence limit (47,677.58) estimated for the year by regression. In 2021, 43,265 treatments were performed.

Conclusion: The number of treatments performed for breast cancer by the SUS, which had shown relative growth until 2019, declined in the year affected by the COVID-19 pandemic. One of the possible associated factors was the greater focus of hospital services on the prevention and treatment of the disease triggered by the virus. In addition, the immunosuppression of patients with breast cancer in treatments such as chemotherapy and radiotherapy, associated with the higher age group epidemiologically associated with the pathology, may have corroborated a higher mortality due to COVID-19. The underdiagnosis of cancer as a result of the pandemic should also be a relevant factor for future studies, since, in 2021, the number of treatments performed returned to the pre-pandemic value observed, which may characterize the resumption of cancer diagnosis and treatment services.

Citation Format: Laura Tibola Marques da Silva, Pedro Antonio Paludo Menna Barreto, Luiza Seixas de Sá Beltramo, Gabriele Eckerdt Lech, Fernando Azambuja, Rafaela de Andrade, Arthur Minas Alberti, Pedro Arthur Zimmer Silveira, Lucas Kieling. Impact of the COVID-19 Pandemic on Breast Cancer Treatments in the Brazilian Public System [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 50.
Abstract 53: Implementing Equitable Cancer Support Program: Lessons From Cervical Cancer Chemotherapy Access Program (C3AP)
Authors: Lawal Qudus , Adoke Kasimu Umar , Tuko Jummai Jimeta , Garba Aminu Magashi , Lawal Ishak K.
Published: June 2023

Purpose: There is an inverse relationship between diagnosis to initiation of treatment interval and outcome of cancer treatment. A significant number of diagnosed cervical cancer patients don’t receive timely treatment in low resource settings. The Cervical Cancer Chemotherapy Access Program (C3AP) is one of End Cervical Cancer Nigeria Initiative’s interventions to IMProve Access to Cervical Cancer Treatment (IMPACT) in low resource settings. This report provides documentary evidence of the evolution of the implementation of the C3AP and highlights best practices that can be scaled up.

Methods: The C3AP was conceptualized to increase the proportion of diagnosed cervical cancer patients that receive timely treatment by exploring adjuvant and neoadjuvant role of chemotherapy in the management of cervical cancer patients in settings where access to radiotherapy services can not be guaranteed.

We instituted Plan Do Study and Act (PDSA) quality improvement cycle for the C3AP and used RE-AIM framework to study the implementation processes to be acted upon as part of the PDSA quality improvement process towards improving reach of the program.

Results: The C3AP supported treatment of only 4 patients over the reporting period of 5months. Poor referral to the program is a major hurdle the program is battling. Only 2(17%) of the 12 confirmed cases of cervical cancer diagnosed in the facility within the 5month study period were able to access chemoradiation, suggesting a missed opportunity for 6/10(60%) that couldn’t afford chemoradiation. The program evolved over a PDSA cycle to eliminate social eligibility in the criteria to access the support thereby able to shorten application -support interval to same day with potential positive impact on prognosis.

Conclusion: Providing equitable support for indigent cancer patients should be beyond the emotion to help humanity. We recommend the use of structured quality improvement for all programs providing support to indigent cancer patients to ensure implementation fidelity.

Citation Format: Qudus Lawal, Kasimu Umar Adoke, Jummai Jimeta Tuko, Aminu Magashi Garba, Ishak K. Lawal. Implementing Equitable Cancer Support Program: Lessons From Cervical Cancer Chemotherapy Access Program (C3AP) [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 53.
Abstract 58: Leaving Cancer Patients Behind for Greener Pastures: The Clinical Oncology Workforce in Nigeria
Authors: Chidebe Runcie C.W. , Orjikor Tochukwu C. , Balogun Onyinye , Joseph Adedayo , Toland Samantha , Simons Alison
Published: June 2023

Purpose: For a population of over 201 million, Nigeria has only 4 doctors per 10,000 patients and 16.1 nurses, midwives per 10,000 patients, and less than 100 clinical oncologists for over 100,000 cancer patients. While Nigeria has one of the worst disease burdens in the world and a workforce shortage; 9 in 10 Nigerian physicians are seeking opportunities to leave for the USA, UK, and Canada. To improve oncology care in Nigeria, it may be important to understand the push and pull factors contributing to the migration of the clinical oncology (CO) workforce. Mathew (2018), Vanderpuye, et al., (2019), Balogun, et al., (2017), and Adebayo, (2016) have done research on CO; however, their studies were vastly focused on the African continent and not country-specific nor focused on the CO workforce in Nigeria.The aim of this study is to explore the push and pull factors to stay or leave the clinical oncology workforce in Nigeria.

Methods: Using a mixed-method research approach, 80 participants completed the questionnaire and 9 participants responded to semi-structured interviews. Multiple linear regression and Grounded theory were used for the data analysis.

Results: The results show that CO workload and satisfaction were significantly related to turnover intention. The qualitative results showed that CO as a new area of specialization, mentorship, career growth, and attractiveness of radiation science are the pull factors. While, high CO workload, poor healthcare system, poor remuneration, corruption in the public sector, and a few other themes are push factors. Empathy for patients, patriotism and a sense of fulfillment unexpectedly emerged as retention factors in the study.

Conclusion: Nigeria can improve patient treatment outcomes by the reduction of CO workload through the employment of more CO. More CO can be available for employment when they are attracted, and their training is optimized. Those employed can be retained by improving working conditions and introducing work benefits. Our recommendations are that health leaders should create more CO training and awareness of CO in Nigeria.

Citation Format: Runcie C.W. Chidebe, Tochukwu C. Orjikor, Onyinye Balogun, Adedayo Joseph, Samantha Toland, Alison Simons. Leaving Cancer Patients Behind for Greener Pastures: The Clinical Oncology Workforce in Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 58.