bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Practices of Cancer Outpatients at Nyeri County Referral Hospital, Kenya; A Cross Sectional Survey
Authors: Bundi Dorothy , Chege Peter , Kamuhu Regina
Published: September 2024

The global burden of non-communicable diseases remains unacceptably high and Kenya is among the countries experiencing an epidemiological transition from the communicable to non-communicable diseases. In Kenya, cancer is the second leading cause of non-communicable disease related mortalities after the cardiovascular diseases and Nyeri County is among the counties that are leading in this burden of non-communicable diseases. This study sought to assess the dietary practices of the cancer patients on chemotherapy at Nyeri County and Referral Hospital in comparison with the recommended dietary practices. Analytical cross-sectional study design was employed and the data on the dietary practices was collected using a 24-hour recall and a Food Frequency Questionnaire (FFQ). Sixty one percent of the respondents were female while 39% were male. Sixty one percent had acquired primary school education and half of the respondents survive on a monthly income of between 0-10,000. Breast cancer was the most common cancer type in the population (39%), followed by esophageal and throat cancer at 14.5% and gastric cancer at 14%. Prostate cancer was the most prevalent among the male respondents at 11%. The mean energy intake of the respondents was 1068+- 520 Kcals which was not meeting the requirements as per the ESPEN clinical guidelines on cancer. The dietary patterns identified from the research were, excessive consumption of foods from the starchy foods and the fats category (65.1%) and less than half (41.9%) were not attaining the minimum daily requirements of the fruit’s servings recommended by the World Health Organization (WHO). Nutrition education and counselling is key in improving the dietary practices among the cancer patients. However, 44.19% had not received nutrition education and counselling regarding the appropriate diet to consume in the course of their treatment. This study found out that the dietary practices of the cancer patients do not meet the recommended clinical guidelines on cancer nutrition and almost half of the population had not received nutrition education and counselling services. Social and behavior change is one of the possible strategies that could be adopted to deliver nutrition information to the population, to improve the knowledge, attitude and dietary practices of cancer patients in Kenya, which in turn will improve their nutrition outcomes.
The Impact of Social Media Use on Students’ Self-Esteem in Higher Education in Eastern Ethiopia
Authors: Sakata Moti
Published: September 2024

This study aims to assess social media use's impact on university students' self-esteem. Social media factors that affected the self-esteem of university students were investigated based on the daily time spent on social media. Data were collected using a questionnaire. Self-esteem was measured using the established Rosenberg Self-Esteem Scale. The stratified sampling technique was deployed to select 335 undergraduate university students for this study. Descriptive analysis was performed to analyze the demographic details of the response data collected, including age and social media usage. Correlation and regression analyses were executed using SPSS software to test the correlations between social media factors and self-esteem among undergraduate scholars. As a result, students’ self-esteem among the scholars was significantly affected by their time spent on social media. I recommend that further studies be conducted to investigate the main factors that affect the student’s self-esteem and regard for university scholars.
A∞-algebra Structure on Connected Multiplicative Operad
Authors: III Batkam , Tcheka Calvin
Published: September 2024

This work develops the structure of A∞-algebras on operad theory and also the preservation of this structure by a morphism of operads well defined. This structure defined here is motivated by the important role that play certain particular properties such as multiplication and connectivity on the operads. Another key ingredient used to develop this work is the brace operations; which, combined with the properties cited above allowed to better frame the study of this structure. Thus, this paper show explicitly the existence of an A∞-algebra structure on any connected multiplicative operad endowed with its brace operations and that this structure is minimal if the operad is only multiplicative. Furthermore, the paper also shows the existence of an operads morphism from an unital associative operad, Ass to any connected multiplicative operad 𝒪 preserving the structure of A∞-algebras existing on these two operads. And when the operad 𝒪 is just multiplicative then there is rather a morphism of operads from the associative operad, Asto 𝒪 preserving this time the minimal A∞-algebras structure existing on these operads.
Frontoparietal intraparenchymal hemorrhage secondary to anticoagulation
Authors: Ward Savitra , Jamal Benjamin Colaco , Ganti Latha
Published: September 2024

The authors present the case of a patient experiencing frontoparietal intraparenchymal hemorrhage. With a history of a mechanical heart valve due to rheumatic disease, the patient was on warfarin and experienced a warfarin-associated bleed. The new 2002 guidelines for the management of intracerebral hemorrhage are discussed in the context of this case.
Quantitative analysis of microplastics in Nile tilapia from a recirculating aquaculture system using pyrolysis–gas chromatography–mass spectrometry
Authors: Sefiloglu Feride Öykü , Brits Marthinus , König Kardgar Azora , van Velzen Martin J. M. , Kaldenbach Emily , Vethaak A. Dick , Doyle Darragh , Carney Almroth Bethanie , Lamoree Marja H.
Published: September 2024

Microplastic (MP) ingestion through fish consumption is a concern for human exposure. While the presence of plastic particles in fish tissues has been documented worldwide, information on microplastic concentrations in edible tissues, especially those smaller than 10 µm, remains scarce. Spectrometric techniques provide a complementary analytical tool to measure MP mass for human exposure studies without intrinsic size limitations; however, their application to fish analysis is limited. In this study, we utilized pyrolysis gas chromatography–mass spectrometry (Py-GC–MS) for the identification and quantification of MPs in fish muscle tissues. Two sample preparation methods, pressurized liquid extraction, and chemical digestion, were tested for compatibility with Py-GC–MS analysis. An analytical method using chemical digestion was validated for analyzing particles ≥ 0.7 µm for 4 polymer types: polypropylene, polyethylene, polystyrene, and polymethyl methacrylate. The developed method was applied to 24 adult Nile tilapia (Oreochromis niloticus) samples from a recirculating aquaculture system. MPs were detected in 42% of the samples, with an average concentration of 0.14 ± 0.32 µg/g, while high variations within subsamples were observed. Our findings reveal trace amounts of MPs in edible fish tissues from aquaculture, highlighting the potential risk of microplastic ingestion through fish consumption. This underscores the need for further risk assessments to evaluate the impact on human health and to develop appropriate mitigation measures.

Graphical Abstract
A large structural variant collection in Holstein cattle and associated database for variant discovery, characterization, and application
Authors: Grant Jason R. , Herman Emily K. , Barlow Lael D. , Miglior Filippo , Schenkel Flavio S. , Baes Christine F. , Stothard Paul
Published: September 2024

Background

Structural variants (SVs) such as deletions, duplications, and insertions are known to contribute to phenotypic variation but remain challenging to identify and genotype. A more complete, accessible, and assessable collection of SVs will assist efforts to study SV function in cattle and to incorporate SV genotyping into animal evaluation.

Results

In this work we produced a large and deeply characterized collection of SVs in Holstein cattle using two popular SV callers (Manta and Smoove) and publicly available Illumina whole-genome sequence (WGS) read sets from 310 samples (290 male, 20 female, mean 20X coverage). Manta and Smoove identified 31 K and 68 K SVs, respectively. In total the SVs cover 5% (Manta) and 6% (Smoove) of the reference genome, in contrast to the 1% impacted by SNPs and indels. SV genotypes from each caller were confirmed to accurately recapitulate animal relationships estimated using WGS SNP genotypes from the same dataset, with Manta genotypes outperforming Smoove, and deletions outperforming duplications. To support efforts to link the SVs to phenotypic variation, overlapping and tag SNPs were identified for each SV, using genotype sets extracted from the WGS results corresponding to two bovine SNP chips (BovineSNP50 and BovineHD). 9% (Manta) and 11% (Smoove) of the SVs were found to have overlapping BovineHD panel SNPs, while 21% (Manta) and 9% (Smoove) have BovineHD panel tag SNPs. A custom interactive database (https://svdb-dc.pslab.ca) containing the identified sequence variants with extensive annotations, gene feature information, and BAM file content for all SVs was created to enable the evaluation and prioritization of SVs for further study. Illustrative examples involving the genes POPDC3, ORM1, G2E3, FANCI, TFB1M, FOXC2, N4BP2, GSTA3, and COPA show how this resource can be used to find well-supported genic SVs, determine SV breakpoints, design genotyping approaches, and identify processed pseudogenes masquerading as deletions.

Conclusions

The resources developed through this study can be used to explore sequence variation in Holstein cattle and to develop strategies for studying SVs of interest. The lack of overlapping and tag SNPs from commonly used SNP chips for most of the SVs suggests that other genotyping approaches will be needed (for example direct genotyping) to understand their potential contributions to phenotype. The included SV genotype assessments point to challenges in characterizing SVs, especially duplications, using short-read data and support ongoing efforts to better characterize cattle genomes through long-read sequencing. Lastly, the identification of previously known functional SVs and additional CDS-overlapping SVs supports the phenotypic relevance of this dataset.
The influence of occupational noise exposure on blood pressure and hearing loss among female workers of childbearing age
Authors: Zhang Danhua , Wu Di , Wang Sihua , Jiao Jie , Yang Yan , Zhou Wenhui , Zeng Dong , Li Leike
Published: September 2024

Objectives

Women exposed to occupational noise experience adverse pregnancy outcomes. Therefore, we initiated a large, population-based, cross-sectional study to further investigate the effects of occupational noise on hearing and blood pressure among female workers of childbearing age.

Study design and setting

A total of 6981 childbearing-aged female workers were selected for this cross-sectional study. Basic characteristics of participants were analyzed by comparing the exposed and control groups. Logistic regression models were employed to calculate the odds ratios (ORs) and 95% confidences intervals (CIs) for the associations of occupational noise with levels of hearing loss and blood pressure. The associations were further explored through stratification by age and duration of noise exposure.

Results

Compared with participants not exposed to occupational noise, increasing years of occupational noise exposure were independently associated with an elevated risk of hypertension after adjustment of age, industry classification, enterprise size and economic type. Compared to participants not exposed to occupational noise, only the prevalence of bilateral hearing loss was significantly higher after adjustments for age, industry classification, enterprise size and economic type. Compared with those with normal hearing, the ORs and 95% CIs were 1.97 (0.95–4.07), 2.22 (1.05–4.68) and 1.29 (1.06–1.57) for bilateral, unilateral and any ear hearing loss, respectively.

Conclusions

Occupational noise exposure is positively associated with both hypertension and bilateral hearing loss among female workers of childbearing age. Those exposed to occupational noise show an increased risk of hypertension after adjusting for potential confounders.
Gastrointestinal adverse events of metformin treatment in patients with type 2 diabetes mellitus: a systematic review and meta-analysis with meta-regression of observational studies
Authors: Nabrdalik Katarzyna , Hendel Mirela , Irlik Krzysztof , Kwiendacz Hanna , Łoniewski Igor , Bucci Tommaso , Alam Uazman , Lip Gregory Y. H. , Gumprecht Janusz , Skonieczna-Żydecka Karolina
Published: September 2024

Introduction

Metformin is the most prescribed medication for type 2 diabetes mellitus (T2DM); there is a well-established link with the elevated incidence of gastrointestinal (GI) adverse events (AE) limiting its administration or intensification.

Objectives

The objective of this systematic review and meta-analysis of observational studies was to evaluate the pooled incidence of GI AE related to metformin use in patients with T2DM.

Materials and methods

PUB MED/CINAHL/Web of Science/Scopus were searched from database inception until 29.07.2024 for observational studies in English describing the frequency of GI AE in patients with T2DM treated with metformin. Random-effects meta-analyses were used to derive effect sizes: event rates.

Results

From 7019 publications, we identified 211 potentially eligible full-text articles. Ultimately, 21 observational studies were included in the meta-analysis. The prevalence of GI AE was as follows: diarrhea 6.9% (95% CI: 0.038–0.123), bloating 6,2% (95% CI: 0.020–0.177), abdominal pain 5,3% (95% CI: 0.003–0.529), vomiting 2.4% (95%: CI 0.007–0.075), constipation 1.1% (95%: CI 0.001–0.100). The incidence of bloating (coefficient -4.46; p < 0.001), diarrhea (coefficient -1.17; p = 0.0951) abdominal pain (coefficient -2.80; p = 0.001), constipation (coefficient -5.78; p = 0.0014) and vomiting (coefficient -2.47; p < 0.001) were lower for extended release (XR) metformin than metformin immediate release (IR) formulation.

Conclusions

This study highlights the prevalence of GI AE in patients receiving metformin, with a diarrhea predominance, followed by bloating, diarrhea, abdominal pain, constipation, and vomiting. The incidence is lower in patients administered with XR metformin.

Trial registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289975, identifier CRD42021289975.
Keratinocyte derived extracellular vesicles mediated crosstalk between epidermis and dermis in UVB-induced skin inflammation
Authors: Li Yubin , Baniel Avital , Diaz DeAnna , Ogawa-Momohara Mariko , Ricco Cristina , Eldaboush Ahmed , Bashir Muhammad , Sharma Meena , Liu Ming-Lin , Werth Victoria P.
Published: September 2024

Background and rationale

Ultraviolet-B (UVB) light induces dermal inflammation, although it is mostly absorbed in the epidermis. Recent reports suggest extracellular vesicles (EVs) act as a mediator of photodamage signaling. Melatonin is reported to be a protective factor against UV-induced damage. We hypothesized that EVs derived from UVB-irradiated keratinocytes might trigger proinflammatory responses in dermal cells and tested whether melatonin can ameliorate UVB-induced inflammation.

Methods

We used UVB-irradiated HaCaT cells, primary keratinocytes and STING knock-out mice to model production of EVs under photodamaging conditions and performed immunoblotting and ELISA to measure their effect on dermal macrophages.

Results

UVB-irradiated keratinocytes produce an increased number of EVs that contain higher concentrations of DNA and protein compared with controls. KC-derived EVs (KEVs) induced a STING- and inflammasome-mediated proinflammatory response in macrophages in vitro, and a pronounced inflammatory infiltrate in mouse dermis in vivo. Melatonin ameliorated KEVs inflammatory effect both in vitro and in vivo.

Conclusions

This data suggests EVs are mediators in a crosstalk that takes place between keratinocytes and their neighboring cells as a result of photodamage. Further studies exploring EVs induced by damaging doses of UVB, and their impact on other cells will provide insight into photodamage and may help develop targeted therapeutic approaches.
Intravitreal faricimab for treatment naïve patients with neovascular age-related macular degeneration: a real-world prospective study
Authors: Grimaldi Gabriela , Cancian Giuseppe , Paris Arianna , Clerici Michele , Volpe Giulio , Menghini Moreno
Published: September 2024

Background

Intravitreal faricimab, a bispecific antibody targeting both angiopoietin-2 (Ang-2) and vascular endothelial growth factor-A (VEGF-A), was recently introduced for the treatment of neovascular age-related macular degeneration (nAMD), diabetic macular oedema and cystoid macular oedema secondary to retinal vein occlusion. The aim of our study was to assess the efficacy, safety and durability of intravitreal faricimab in a real-world cohort of treatment-naïve patients with nAMD.

Methods

Single-centre, prospective cohort study of 21 eyes from 19 treatment-naïve nAMD patients who were treated with intravitreal faricimab from October 2022 to April 2024. Patients underwent a loading dose (LD) of 4 monthly faricimab injections followed by a treat-and-extend regimen. Primary outcomes included best-corrected visual acuity (BCVA) and structural parameters from spectral-domain optical coherence tomography (SD-OCT). Secondary outcomes included the proportion of eyes achieving a dry macula, maximal fluid-free interval and intended interval at last follow-up.

Results

The study included 21 eyes of 19 patients (mean age 83.1 years). After LD, 93.3% of eyes achieved a dry macular SD-OCT scan within a median time of 8 weeks. At the first extension, 53% of eyes remained dry, while 47% showed fluid recurrence. Long-term analysis (n = 14) revealed significant reductions in macular volume (MV), central subfield thickness (CST), and pigment epithelial detachment (PED) height over a median follow-up of 64.9 weeks, with sustained visual and anatomical improvements. Median BCVA, CST, and MV at the final follow-up were significantly improved from baseline (p < 0.01). The intended interval between injections was ≥ 12 weeks in 42.86% of eyes. No cases of intraocular inflammation were observed, although 10% experienced retinal pigment epithelial tears.

Conclusions

Intravitreal faricimab demonstrated favourable efficacy, safety, and durability outcomes in a real-world cohort of treatment-naïve nAMD patients.
Evaluation of GARP immunohistochemical expression in papillary thyroid carcinoma
Authors: Atia Esraa Adel Mahmoud Mohamed , Sammour Sanaa Abd Elmaged , Ibrahim Eman Abdel-Salam , Abou Gabal Hoda Hassan , Elgohary Shimaa Abdelraouf
Published: September 2024

Background

Glycoprotein A repetitions predominant (GARP) is a novel transmembrane protein highly expressed on the surface of regulatory T cells (Tregs), which are a subset of immunosuppressive T lymphocytes that play a major role in inhibiting the antitumor immune response. Many studies documented increased GARP expression in various tumors, which is related to a poorer prognosis, and only one single paper investigated its expression in thyroid tumors.

Aim

To evaluate the immunohistochemical expression of GARP in differentiated thyroid carcinomas and their tumor-infiltrating lymphocytes (TILs) in comparison to its expression in other benign and low-risk lesions.

Methods

Sixty-nine cases of different thyroid lesions were subgrouped into 37 cases of malignant thyroid neoplasms, 25 cases of benign thyroid lesions, and 7 cases of low-risk neoplasms collected from the Pathology Department Laboratories of Ain Shams University Hospitals during the period from January 2017 to December 2021 and stained immunohistochemically for GARP. Immunohistochemical (IHC) results were evaluated in thyroid epithelial cells and TILs. The expression of GARP was correlated with the different clinicopathological parameters.

Results

GARP expression discloses a significant statistical difference between the three studied groups (P < 0.001). High GARP expression was detected in 89.19% of the malignant cases and in 28.57% of low-risk neoplasms, while all benign lesions exhibited low GARP expression. High GARP expression of TILs was detected in 60% of the malignant cases. Synchronous high GARP expression in tumor tissue and in the surrounding TILs was detected in 63.16% of the malignant cases, yet these results did not reach statistical significance.

Conclusion

GARP is a marker of Tregs, whose high expression is increased in malignant over benign and low-risk lesions. It might be a potential novel target for anticancer immunotherapy.
Genomic Landscape in Prostate Cancer in a Latin American Population
Authors: Angel Martín , Freile Berenice , Rodriguez Andres , Cayol Federico , Manneh Kopp Ray , Rioja Patricia , Soule Tomas , Losco Federico , Bernal Vaca Laura , Penaloza Jose Mauricio , Zapata Muñoz Maycos Leandro , Neciosup Silvia Patricia , Sanchez Roger Rodrigo , Passarella Carolina , Guerreño Elvio , Farelluk Diego , Maturana Leiva Ernesto , Zarba Martin , Bourlon Maria Teresa , Mora Pineda Mauricio , Sade Juan Pablo
Published: September 2024

PURPOSE

This study aims to describe genomic characteristics of patients with metastatic prostate cancer (mPC).

PATIENTS AND METHODS

This study is a retrospective, multicenter cohort study of patients with mPC and reports on genomic testing. Patients were included from 12 academic centers in five countries.

RESULTS

A total of 349 patients with PC were included in this study. Most patients (209, 59.9%) were de novo metastatic. Genomic analysis was performed in 233 (66.6%) patients in the metastatic castration-resistant prostate cancer (mCRPC) setting, and only 115 (32.8%) patients had a tumor evaluation in the metastatic hormone sensitive prostate cancer scenario. The evaluation of somatic and/or germline mutations was performed through multigene panel analyses in 290 (83.09%) patients, and next-generation sequencing of
BRCA1
and
BRCA2
genes was performed in 59 (16.91%) patients. Analyzing the mCRPC subgroup, with a median follow-up of 15.6 months (IQR, 14-19.06), the median progression-free survival (PFS) was not reached (NR) and the PFS at 16 months was 58.7% (95% CI, 50.8 to 67.8). When comparing patients with
BRCA
mutations with those who are not
BRCA
-mutated in the mCRPC scenario, the median PFS was NR (95% CI, 14 to NR) and 26.3 months (95% CI, 16.7 to 36.5;
P
= .2), respectively. Two of six patients with
BRCA
mutations were treated with targeted therapies (poly-ADP-ribose polymerase inhibitors).

CONCLUSION

Our study, to the best of our knowledge, represents one of the larger data sets for somatic testing in patients with PC in Latin America (LATAM). It adds valuable information to the growing body of knowledge about the genomic landscape of advanced PC in real-world daily practice scenarios in LATAM countries, which are not always well-represented in large-scale randomized clinical trials.
Circulating Tumor DNA Sequencing for Biologic Classification and Individualized Risk Stratification in Patients With Hodgkin Lymphoma
Authors: Heger Jan-Michel , Mammadova Laman , Mattlener Julia , Sobesky Sophia , Cirillo Melita , Altmüller Janine , Kirst Elisabeth , Reinke Sarah , Klapper Wolfram , Bröckelmann Paul J. , Ferdinandus Justin , Kaul Helen , Schneider Gundolf , Schneider Jessica , Schleifenbaum Julia Katharina , Ullrich Roland T. , Freihammer Max , Awerkiew Sabine , Lohmann Mia , Klein Florian , Nürnberg Peter , Hallek Michael , Rossi Davide , Mauz-Körholz Christine , Gattenlöhner Stefan , Bräuninger Andreas , Borchmann Peter , von Tresckow Bastian , Borchmann Sven
Published: September 2024

PURPOSE

Current clinical challenges in Hodgkin lymphoma (HL) include difficult-to-treat relapsed/refractory disease and considerable long-term toxicities of treatment. Since clinical risk factors lack discriminatory power, intensity of therapy is mainly based on tumor burden. Exploring HL genetics and tumor microenvironment (TME) might provide valuable insights for improved risk stratification.

MATERIALS AND METHODS

In this study, we applied circulating tumor DNA sequencing to 243 patients obtained from pivotal German Hodgkin Study Group trials to identify subtypes of HL. Independent validation of the subtypes was performed in 96 patients treated in the EuroNet-PHL-C2 study. Outcome differences of subtypes were assessed in an event-enriched clinical validation cohort comprising 72 patients from the HD21 trial, using a refined, validated, and clinically feasible assay.

RESULTS

We propose a biologic classification of HL consisting of three distinct subtypes: inflammatory immune escape HL is characterized by frequent copy-number variations including immune escape variants such as high-level amplifications of the
PD-L1
locus and an inflammatory TME. Virally-driven HL is associated with Epstein-Barr virus and/or human herpesvirus 6 and an inflammatory TME with neutrophils and macrophages, while the tumor mutational burden (TMB) is low. Oncogene-driven HL is defined by a high TMB, recurrent mutations in oncogenic drivers such as
TNFAIP3
,
ITPKB
, and
SOCS1
, and a cold TME. A refined and validated assay version aiming at clinically feasible risk stratification showed significant progression-free survival differences between subtypes. In addition, assessment of minimal residual disease (MRD) allowed for the detection of patients at very high risk of relapse within the subtypes.

CONCLUSION

We propose a clinically feasible, noninvasive method for individualized risk stratification and MRD monitoring in patients with HL on the basis of circulating tumor DNA sequencing.
The impact of neighborhood socioeconomic deprivation on treatment and survival for patients with metastatic gastric cancer: An incidence-based retrospective cohort study.
Authors: Raghu Apurva , Shah Shreya , Permuth Jennifer B. , Chen Dung-Tsa , Park Margaret , Knott Cheryl , Powers Benjamin Daniel
Published: September 2024

110

Background:
Studies have shown that socioeconomic deprivation (SED) is associated with reduced treatment and overall survival (OS) for gastric cancer. However, these studies have typically used large geographic areas for assessment of SED and aggregated all stages. Using a statewide cancer registry, the Area Deprivation Index, a granular measure of SED, was used to assess receipt of treatment and OS for metastatic gastric cancer patients.
Methods:
Using the incidence-based Florida Cancer Data System, gastric adenocarcinoma patients diagnosed from 2007-2015were identified (n=8,304). The Area Deprivation Index (ADI) is a composite measure of SED and validated dataset that ranks neighborhoods (census block groups) from 1-100 (higher scores=higher deprivation). Demographic, tumor, and treatment variables were assessed using descriptive statistics, regression, and survival analysis.
Results:
Overall, 3,050 stage IV patients met inclusion criteria; 53.9% were male and the median age was 67. When assessed by SED quartile, there were significant differences by race, ethnicity, insurance, and receipt of chemotherapy (p<0.05). For the cohort, 55.3% of patients received chemotherapy. However, 61.3% of the lowest deprivation cohort received chemotherapy compared to 50.4% in the highest deprivation cohort (p<0.001). After adjustment for potential confounders, the lowest deprivation quartile had increased odds of chemotherapy compared to the highest deprivation quintile (OR 1.52; 95% CI,1.20-1.92). Of patients who received chemotherapy, the median time in months to initiation was 1.1 (interquartile range 0.6-1.7). Median OS was 5.8 months. The median OS for the lowest and highest SED quartiles was 7.5 and 5.1 months, respectively (p<0.001). For patients who received and did not receive chemotherapy, median OS was 10.0 and 1.9 months, respectively. The median OS of the lowest and highest SED quartiles for those who received chemotherapy was 11.3 and 8.8 months, respectively (p<0.001).
Conclusions:
In an incidence-based, statewide cancer registry examining metastatic gastric cancer, just over half of patients received chemotherapy and median OS was poor. Additionally, higher SED was associated with lower odds of chemotherapy and worse OS. These data suggest that SED impacts metastatic gastric cancer outcomes and future studies are needed to understand the multilevel factors driving disparities.

Lowest Deprivation
Low Deprivation
High Deprivation
Highest Deprivation
p-value

N=752

N=780

N=747

N=718

Chemotherapy

0.003

No
262 (34.8%)
315 (40.4%)
306 (41.0%)
314 (43.7%)

Yes
461 (61.3%)
424 (54.4%)
410 (54.9%)
362 (50.4%)

Unknown
29 (3.9%)
41 (5.3%)
31 (4.1%)
42 (5.8%)
Accelerating access: The power of gold carding in reducing treatment delays.
Authors: Sharma Gunjan , Indurlal Puneeth , Gress Jean A. , Markley Lora , Albaugh John , Francis Alice , Malisetti Rajini Katipamula
Published: September 2024

114

Background:
Delays in time to treatment initiation (TTI) for cancer patients have been shown to impact survival/mortality/outcomes, and cause patient distress. The process of obtaining prior authorizations (PA) often leads to significant treatment delays, affecting patient outcomes and posing administrative challenges for healthcare providers. PAs have become a ubiquitous part of modern healthcare, aimed at ensuring appropriate utilization of medical treatments and reducing costs. In recent years, the concept of gold carding (GC), a practice where payers waive PA on services and prescription drugs ordered by providers with a proven track record of PA approvals based on guideline concordance or pathway adherence, has gained attention as a potential solution to provide administrative relief to all stakeholders affected by the PA process. This abstract seeks to explore the impact of GC on TTI for a large multi-site community-based oncology practice in The US Oncology Network having a GC contract with a regional payer.
Methods:
Using administrative claims data from 2021 to 2023, we derived a population of cancer patients who initiated chemotherapy as their first treatment, calculated the TTI (time from the date of first consultation to the date of treatment initiation), and compared TTI between GC and non-GC patients.
Results:
The average TTI for 4,836 patients that met the inclusion criteria was 26.3 days. Patients initiating therapy under a GC eligible payer coverage started therapy 4.5 days earlier (22.13 days vs 26.68 days, p<0.00001, Kruskal–Wallis test). 80% of GC eligible patients started their treatment within 30 days of their initial consultation.
Conclusions:
The findings indicate that gold carding has the potential to expedite the time to treatment initiation for cancer patients. Further research is needed to quantify the cost savings, patient and provider satisfaction, and other intangible benefits from GC. Gold carding offers a viable approach to balance guideline concordant care with lowering administrative burden. We enthusiastically support legislative reforms that encourage gold carding and selectively implement prior authorization requirements based on stratification of health care providers’ performance and adherence to evidence-based medicine.

Patient Count
Average TTI (days)

GC

401

22.13

Commercial
217
21.13

Managed Medicare
184
23.32

Non-GC

4435

26.68

Commercial
1610
25.41

Managed Medicare
1405
27.37

Medicare
959
26.48

Managed Medicaid
254
29.06

Medicaid
112
29.54

All Other
95
30.15
Higher levels of neighborhood deprivation and risk for incident colorectal cancer and mortality outcomes: A systematic review and meta-analysis.
Authors: LoConte Noelle K. , Lawler Thomas , Giurini Lauren , Barbosa Carroll Cibele , Weiss Jennifer , Warren-Andersen Shaneda
Published: September 2024

131

Background:
Significant geographic and racial disparities exist for colorectal cancer (CRC) incidence and mortality in the United States (US), which may be caused by neighborhood-level deprivation and limited access to preventative cancer screening. We completed the first systematic review and meta-analysis of neighborhood-level deprivation in relation to CRC incidence, mortality, and screening among individuals from the US.
Methods:
A systematic literature review was completed to identify original research articles from PubMed, Scopus, and Web of Science. Eligible studies reported associations between deprivation at the census block or tract level using a validated deprivation index (e.g. the Area Deprivation Index or Yost Index) and CRC incidence, mortality, or screening outcomes in a US-based sample. A fixed-effects meta-analysis was completed using inverse-variance weighting to estimated hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for CRC incidence, mortality, and screening outcomes, comparing the highest vs. lowest quantiles of neighborhood-level deprivation. All analyses were completed using the
meta
package in R.
Results:
In total, 19 studies were included in the meta-analysis. Living in a neighborhood in the highest quantile of deprivation was associated with significantly higher risk for incident CRC (HR 1.37, 95% CI 1.34-1.41, seven studies). In stratified analysis, positive associations with incident CRC were observed for White (HR 1.43, 95% CI 1.39-1.47, three studies), Black (HR 1.18, 95% CI 0.96-1.44, three studies), and Asian/Pacific Islander individuals (HR 1.18, 95% CI 1.08-1.28, two studies). For individuals diagnosed with CRC, higher deprivation was associated with elevated risk for overall mortality (HR 1.11, 95% CI 1.10-1.13, four studies) and CRC-specific mortality (HR 1.17, 95% CI 1.15-1.19, seven studies). Higher deprivation was associated with lower completion of recommended screening for CRC, including colonoscopy, sigmoidoscopy, or fecal occult blood testing (OR 0.76, 95% CI 0.74-0.79, four studies).
Conclusions:
Individuals who reside in neighborhoods with high levels of deprivation have significantly elevated risk for CRC incidence and mortality compared to individuals from low deprivation neighborhoods. Targeting healthcare resources to highly deprived neighborhoods to increase uptake of preventative screening may help to address racial and geographic disparities for CRC.
The impact of gender and underrepresented minority demographics on nationwide academic radiation oncology faculty promotion.
Authors: Cotterell Yvonne , Westley Monique , Huang Christina C. , Sun Yilun , Jagsi Reshma , McClelland Shearwood
Published: September 2024

162

Background:
The US is a diverse country with 13.6% of the population identifying as African-American, 19.1% as Hispanic or Latino, and 50.4% female according to the most recent US Census. Per demographic data from the American Society for Radiation Oncology (ASTRO) (the largest US organization of radiation oncologists), 28% of radiation oncologist members identify as female, 4% as African-American race, and 4% as Hispanic/Latino ethnicity; additional data has indicated the rate of URM radiation oncologists in US comprehensive cancer cents to be 5%. This data objectively indicates that females and URMs are underrepresented in the field of radiation oncology compared with the gender and racial/ethnic diversity of the US population. There is minimal data regarding promotion rates in academic radiation oncology, with virtually no data focusing on promotion rates among females and URMs. The primary objective of this study was to assess the relationships between gender and URM status in academic promotion of radiation oncology faculty.
Methods:
A database consisting of radiation oncologists from 51 National Cancer Institute-designated Comprehensive Cancer Centers from 2019 was accessed in September 2023 to assess academic promotion in a four-year timespan. Data regarding the gender, graduation year, institution, URM identification, and professional rank of radiation oncologists ranked as junior faculty was collected. URM was defined as African-American race and/or Hispanic ethnicity and was collected via self-described internet depictions, interviews, and facial recognition as previously described (PMID 30996695). Junior faculty status was defined as instructor/assistant professor. An online search was then conducted to identify the 2023 academic rank of previously identified faculty, focusing on promotion status from junior to senior faculty or from associate professor to full professor. Regression analysis was performed using a generalized linear mixed model to assess the impact of gender and URM status on promotion, with statistical significance defined as
p
< 0.05.
Results:
In an analysis of 554 radiation oncologists comprised of 203 women (36.7%) and 21 URMs (3.8%), 338 (61%) received promotions. Analysis revealed that neither female gender (odds ratio 1.02, 95% confidence interval, 0.68 – 1.52;
p
-value 0.94) nor URM status (odds ratio 0.57, 95% confidence interval 0.19 – 1.71;
p
-value 0.32) was significantly associated with promotion.
Conclusions:
These findings indicate that radiation oncologist gender and URM status may not be associated with academic promotion. However, given the small URM sample size and odds ratio of 0.57, it is possible that this study may be underpowered to adequately assess URM status on promotion. Further studies involving longer time intervals will provide much needed additional data regarding academic promotion.
Improving language access in pharmacy at a comprehensive cancer center.
Authors: Ferzoco Maria , Eng Kelly , Donohue Caitlin C
Published: September 2024

176

Background:
Dana-Farber Cancer Institute (DFCI) conducted quantitative analyses of patient satisfaction survey data, stratified by patient demographics, to understand where gaps in experience exist. Results demonstrated differences among certain demographic groups, directing us to explore patient experiences qualitatively. DFCI conducted focus groups with diverse patient groups to identify improvement opportunities. Twelve virtual focus groups were conducted with adult cancer patients with Limited English Proficiency (LEP) and/or from historically marginalized populations (n=34). One additional focus group was conducted with DFCI patient-facing staff (n=15). Focus group participants identified the need for providing timely and informative ways to telephonically communicate with pharmacy staff in their preferred language. Patients with LEP indicated they felt less valued/heard due to the language barrier and were subject to longer call wait times because they needed an interpreter to speak with pharmacy staff.
Methods:
A multidisciplinary team was assembled to assess the current state of telephonic pharmacy language access and to redesign the workflows of the pharmacy phone lines. By June 2024, DFCI aims to increase the number of languages in which patients can engage with pharmacy services from 1 to 5 by expanding telephone workflows to include multi-lingual prompts and automatic connection to an interpreter. Process metrics include rate of patients communicating telephonically with DFCI pharmacies in their preferred language and average time for a non-English speaking patient to connect with an interpreter. To assess patient experience, DFCI is administering a satisfaction survey (both pre- and post-go-live of the phone line redesign) to patients with LEP who have used the pharmacy phone lines. This will assess whether the change has resulted in improvement.
Results:
Post go-live (June 2024) results will include the process and patient experience metrics described above.
Conclusions:
DFCI is among the first in the country to analyze its patient satisfaction data by demographic characteristics; to convene focus groups (informed by patient satisfaction demographic analysis) with historically marginalized and/or LEP populations; and to carry out an improvement effort (leveraging quantitative and qualitative data) to redesign pharmacy phone lines to be more inclusive. The pharmacy phone line redesign is critical to providing an equitable and satisfying experience for our patients with LEP.
Closing the referral loop on health-related social needs.
Authors: Osborne Evan , Staggs Stuart George , Mills Lydia , Wilfong Lalan S. , Neeb Jessica louise , Weber Dana
Published: September 2024

184

Background:
Additional clinical challenges arise by way of health-related social needs (HRSNs) presenting barriers outside of clinic walls. Taking a person-centered approach by assessing and addressing HRSNs to overcome barriers can be practiced through resource referrals to community-based organizations offering specialized social services. Using closed-loop referral (CLR) technology, HRSNs can be addressed resulting in higher treatment completion rates and on-time visits contributing to positive health outcomes, quality of life, and improved business outcomes. HRSNs are categorized in major groups such as transit, food, housing, money, health (i.e. mental health, dental care, nutrition counseling, etc.), and care (i.e. daycare, end-of-life care, physical safety, etc.). In this study, we seek to substantiate CLR technology to address common HRSNs impacting cancer patients through real-time data sharing and resource facilitation showing reportable evidence that the HRSNs have been addressed.
Methods:
On June 5
th
, 2023, The US Oncology Network (The Network) launched Findhelp’s CLR platform onboarding users in over 600 clinical service sites nationwide. Implementation and change management began with a pilot group and deployment to remaining clinical sites in a sequence of three waves. Methods used to measure engagement came through onboarding analytics and click rates tracked through the Findhelp CLR platform. For training and support job aides, new user workflows, promo materials and weekly office hours were held to catalyze engagement.
Results:
Within an eleven-month measurement period, 75% of practices in The Network showed navigation activities within the referral platform. The top five resource searches by need included health (21.7%), transit (20.8%), food (19.9%), housing (18.9%), and care (6.5%). Over 2,000 referrals were made with 1,306 being CLRs for nearly 500 patients receiving help to meet identified HRSNs through the CLR technology.
Conclusions:
In this study, over 50% of patients referred to social care services were captured as successfully receiving help meeting identified HRSNs. This study opens doors to further research on what HRSNs were not met, and to identify distressed demographics by location and geographical resource deserts with unmet HRSNs.
Immunotherapy at the end of life.
Authors: Kaur Gagandeep , Weir Catherine , Sun Terrence , Rosen Havi , Puglisi Leah , Xavier Marin Feldman , Maslov Diana Vesselinovitch
Published: September 2024

188

Background:
It is well established in the literature that cancer treatment administered at the end of life (EOL) does not improve either quality of life or survival rates. Patients undergoing systemic cancer treatments at near the EOL often have reduced access to hospice services and an increased likelihood of acute medical interventions, including emergency department visits, intensive care unit admissions, and in-hospital deaths. The development of immune checkpoint inhibitors (ICIs) has revolutionized cancer care over the past decade, demonstrating the ability to extend progression-free survival and overall survival in patients with various cancers. Furthermore, ICIs may represent a promising therapeutic option for adults with impaired performance status (PS) due to their relatively favorable side-effect profile when compared to conventional chemotherapy. While numerous studies have examined chemotherapy at the end of life, research specifically focusing on the administration of immunotherapy during this period is scarce.
Methods:
We conducted a retrospective chart review using the electronic medical record database at Scripps clinic focusing on cancer patients undergoing immunotherapy who passed away between June 1, 2017, and August 30, 2023, comprising a cohort of 641 individuals. Our investigation was designed to provide a retrospective overview of patient characteristics and outcomes, with a specific emphasis on factors at EOL.
Results:
The most prevalent tumor types were lung (34%), GI (21%), skin (13%), GU (12.6%) and others (19.4%). On average, no patients received immunotherapy in the last 30 days of their lives. Among the different cancer types, breast cancer patients had the longest interval between last treatment and death, averaging 259 days. This was followed by patients with head and neck cancer (207 days), skin cancer (199 days), genitourinary (GU) cancers (177 days), lung cancer (140 days), gynecological (GYN) cancers (135 days), and gastrointestinal (GI) cancers (134 days). 19 patients died from immune-related adverse events (IrAEs). These patients had the shortest interval between their last treatment and death, with a mean of 34 days. This was followed by those who died due to cancer progression, with an average interval of 148 days.
Conclusions:
The decision to administer anticancer therapies near the EOL is increasingly complex. Oncologists must carefully discuss immunotherapy with patients, monitor for IrAEs, and consider discontinuing treatment if there is disease progression, worsening PS or after two years of treatment.