bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting a climate of belonging: Justice, equity, diversity, and inclusion (B-JEDI) at the Sidney Kimmel Cancer Center (NCI-designated).
Authors: Lopez Ana Maria , El Khoury Christiane , Chapman Andrew E.
Published: June 2023

e18626

Background: Diversity fuels discovery and is, thus, essential to the well-being of a cancer center and its members. To implement our efforts, the Sidney Kimmel Cancer Center (SKCC) appointed an Associate Director for Diversity, Equity, and Inclusion (DEI) who welcomed interested faculty, staff, and trainees to gather to consider principles, coordination, aims, and priorities to achieve Center priorities for diversity, equity, and inclusion. Methods: After an initial town-hall type gathering, an analysis of approaches at peer institutions, and subsequent subgroup incubator meetings that engaged the Associate Directors for Cancer Research Training and Education Coordination and Community Outreach and Engagement and the SKCC Scientific Programs, additional members became involved, missing potential strategic partners were identified and invited to participate, and a workplan was developed. Results: Through our inclusive process, the SKCC community affirmed equity as a cornerstone value, identified a climate that supports belonging and pathways to success as strategic priorities, and committed to disseminating a survey to guide progress towards the priorities. Our group, initially known as the DEI Committee selected as its name, Belonging-Justice, Equity, Diversity, and Inclusion (B-JEDI), and invited everyone to “B-JEDI”, acknowledging that to succeed, we must all be working towards our ideals. The B-JEDI strategic planning subgroup drafted, tested, and disseminated the survey to yield a strategic plan; and another subgroup developed a DEI mission statement for SKCC. Incubator subgroups composed of faculty, staff, trainees interested in the topic (Investigation, Awareness and Education, Health Care Delivery, Community Outreach Partnership & Engagement (COPE), and Advocacy) are actively working with institutional partners to advance strategic goals and priorities. Conclusions: B-JEDI (Belonging-Justice, Equity, Diversity, and Inclusion) provides guidance and fuel to SKCC in its mission to improve lives through discovery. Composed of interested members of the SKCC community, B-JEDI is welcoming to all, has strategically engaged institutional leadership partners, and is developing processes to engage our catchment community at large. [Table: see text]
Participation in phase I oncology trials by minorities: Survival and compliance data.
Authors: Bastos Bruno R. , Roy Mukesh , Rabinowits Guilherme , Rubens Muni B.
Published: June 2023

e18628

Background: Since 1993, the National Institutes of Health requires all clinical trials to include women and minority participation in clinical research. Despite this initiative, Minority (M) participation in Phase I Oncology clinical trials is subpar; historical data indicate a participation of 79% Caucasian (C) versus 21% (M) in Phase I clinical trials. The purpose of this study is to compare demographics, survival, and compliance data between (C) versus (M) patients participating in Phase I Oncology clinical trials in our Cancer Institute. Methods: We performed a retrospective analysis in all patients enrolled in phase I clinical trials in our institution from April 2019 until October 2022. This information was obtained via OnCore. Data was abstracted manually and entered in a spreadsheet (Excel). Data variables include race, gender, withdrawal of consent, and lost follow-up. Statistical plan was determined by our statistical team with data analysis to be performed with statistical software to generate Kaplan Meyer (KM) Survival Curve. Results: A total of 99 patients were identified. 61.5% were (C) and 38.4 % were (M). (M) consisted of Hispanic (81%), African American (18%) and Asian (1%). Female Gender on (C) were 57.4% and 55.3% on (M). Lost follow-up was 2.8% on (C) and 5.9% on (M). Withdrawal of consent was 5.6% on (C) and 0% on M. The (KM) curve revealed non statistically significant difference in survival p = 0.7316. Conclusions: In our analysis, we found statistically similar (KM) survival curves for (C) and (M) participating in Phase I clinical trials (p = 0.7316). We found a significant higher participation of (M) patients in our institute than historical data. There was no significant difference in withdrawal of consent between (C) and (M) and no difference on lost follow-up. We plan to identify patterns of success in enrolling minorities in our site and validate a questionnaire to screen patients for Phase I clinical trials with the goal to minimize perception bias and barriers for enrollment of (M) in Phase I studies.
Patient access to precision medicine: Correlation of immune checkpoint inhibitor (ICI) usage in non-small cell lung cancer (NSCLC) with patient household income levels across multiple Asian markets.
Authors: De Richter Pieter , Koo Mei Yee
Published: June 2023

e18629

Background: 1st line (1L) advanced/metastatic NSCLC patients wild-type (WT) for EGFR, ALK and ROS1 have been shown to benefit from treatment with ICIs, and these drugs have been incorporated into most treatment guidelines for this cancer. However, some patients cannot afford these costly treatment options, especially in countries where reimbursement coverage is partial/absent. This study uses real-world data to explore the correlation between monthly household income levels (MHHI) and ICI shares in Thailand, Indonesia, Vietnam, Taiwan and mainland China. Methods: Ipsos’ Oncology Monitor is a physician-reported syndicated patient record database. 532 cancer-treating physicians (Thailand = 37, Indonesia = 30, Vietnam = 80, Taiwan = 40, China = 345) were screened for specialty, role and caseload and submitted data on 1,134 1L WT stage IIIB/IV NSCLC patients (aggregate) with known MHHI. Data were collected (online + pen & paper) from July ’21 – June ’22. Results: In all 5 countries, a correlation was observed between MHHI and the percentage of WT patients in each cohort receiving an ICI as part of their current 1L therapy. In Thailand and Vietnam, share of ICIs was ≤10% for patients in the study earning < 39,999 THB and < 12,000,001 VND, respectively. This compared to an ICI share of 79% among the most affluent Thai patients ( > 1,000,000 THB) and 35% among the highest-income Vietnamese patients ( > 12,000,000 VND). In Indonesia, all 8 patients prescribed an ICI were in the highest income bracket ( > 10,000,000 IDR). In Taiwan, the correlation was less pronounced, but those earning < 40,000 NTD per household were still least likely to receive an ICI. In China, patients with a MHHI above 10,000 CNY were most likely to be given an ICI. Conclusions: Results from this study suggest that, among this cohort, there is a clear link between patient household income and likelihood to be prescribed an ICI across 5 different Asian markets. While all patients should have access to the most optimal treatment based on their diagnosis and molecular profile, this does not appear to be a reality in the clinical setting, based on data from this real-world evidence study in Asia. More must be done to ensure equal access to all, regardless of country of residence or income. [Table: see text]
Barriers to and facilitators of prostate cancer screening among men in Uganda prisons: Findings from a survey of 2565 prisoners.
Authors: Orem Jackson , Atuhe Innocent , Atuyambe Lyn , Jatho Alfred , Nalwadda Babra , Ejiri Annabella Habinka
Published: June 2023

e18637

Background: Studies have shown that prostate cancer (PCa) is increasing at a rate of 5.2% per annum and as few as 5% of men have ever screened for PCa in Uganda. The situation may be worse among male prisoners given their vulnerability status. The study aimed to examine the perceptions, attitudes and beliefs of men in Uganda Prisons regarding barriers to and facilitators of PCa screening. This would enable the identification of potential interventional strategies to promote PCa screening among men in Uganda prisons. Methods: In May 2022, we conducted 20 focus group discussions and 17 key informant interviews. Results: The belief that all cancers have no cure was one barrier that inhibited most participants not to consider screening as of any value, coupled with fear of being told that one is positive and the stress that comes with it. Participants revealed that they would rather live without getting to know the unknown. In addition, lack of knowledge on prostate cancer and lack of Pca screening services in prisons were perceived as barriers to PCa screening in prison settings. Overall, qualitatively, the interventional strategies that men in Uganda prisons believed could help health care providers promote and increase PCa screening were; using the prison peer educators, working with the UPS to train & equip Prison HCs to screen for PCa, conducting outreach from the cancer hospital, Ministry of Health to work with the UPS authority to establish system for prostate cancer screening in prisons, using health workers within prisons, using the regional prisons health centers to establish prostate cancer screening in prisons, using IEC materials such as posters, and conducting group health education sessions. Conclusions: Culturally-relevant interventions are needed to address the barriers to prostate cancer screening among men in the Ugandan prisons focusing at the entire prison health system.
Advancing digital innovation to improve equity and reduce financial toxicity in cancer treatment.
Authors: Sheehan Sarah M , Patel Smit , Leach Corinne R , Goldsack Jennifer C , Robinson Edmondo J
Published: June 2023

e18644

Background: The global burden of cancer is set to increase by more than 60% (to 29.4 million cases) by 2040 . Certain subgroups of patients experience avoidable disparities in access to specialized cancer treatment and discrepancies in clinical outcomes following treatment. The risk of financial toxicity following a cancer diagnosis is also not equally distributed . These disparities in cancer disease burden, treatment, and the risk of financial toxicity have the potential to be disintermediated by digital innovation. Methods: The Digital Medicine Society and Moffitt Cancer Center are co-hosting a pre-competitive collaboration to define the value of digital innovation in cancer treatment, address methodological and implementation gaps, and develop best practices for equitable adoption of digital health technologies at scale in precision oncology. We undertook a landscape review to identify and prioritize causes of disparities and financial toxicity and to benchmark the clinical, engineering, and implementation science dimensions relevant to enhanced digital innovation in cancer treatment. We convened and synthesized information from an expert roundtable which focused on challenges preventing the effective implementation of digital solutions as well as the infrastructure, payment, policy, and regulatory changes needed to promote equity and address financial toxicity with digital health tools. Results: We outline the value of digital innovation in cancer treatment and present consensus-based recommendations from workgroup convening about how digital health tools can be implemented to: Reduce costs associated with advanced cancer treatment and ameliorate disparities in cancer burden by equitably supporting early detection and cancer prevention   Advance precision oncology, minimize the costs of delays in accessing the right care and ensure that the best outcomes are available to all cancer patients  Reduce disparities in access by extending the best specialist expertise and clinical trial opportunities to all cancer patients . Conclusions: Innovative digital approaches have yet to be applied at scale to minimize the burden of financial toxicity to patients with cancer and to reduce healthcare access and outcomes disparities. The delivery of high-quality precision cancer care for all patients depends on our collective ability to increase access to specialized care, harness flows of existing patient data and the power of decentralized clinical trials, and reduce the impact of social determinants of health on patient outcomes. There is substantial opportunity to leverage the results of this landscape review and convening to 1) build impact models that articulate the value of implementing fit-for-purpose digital solutions to promote equity and reduce financial toxicity, and 2) develop implementation toolkits for the equitable and effective deployment of those solutions.
Using key stakeholder interviews to inform implementation of a cancer center collaborative intervention to improve clinical trial accruals.
Authors: Goel Pakhi , Lin Sylvia , Bickell Nina A. , Smith Cardinale B. , Hillyer Grace C. , Goodman Karyn A. , Edmonds Megan C.
Published: June 2023

e18650

Background: Cancer clinical trial (CT) participation rates in the US are low, especially among BIPOC populations. Patient enrollment to CTs is influenced by structural characteristics of the care delivery system, and the nature of individual needs and available resources. We are developing a multi-level intervention across 3 cancer centers in New York City by creating a collaborative pool of, and a referral system for breast, prostate, and liver cancer CTs to increase overall participation, particularly among BIPOC populations. To inform implementation of this intervention, we explored key stakeholder perceptions and attitudes around CT enrollment process across 3 hospitals within one such cancer center. Methods: We conducted semi-structured interviews with 23 key stakeholders to determine the attitudinal and structural factors affecting CT accrual at 1 cancer center and its 2 community hospital affiliates. Stakeholders included oncologists, nurses, informaticists, oncology leadership and research staff, identified using a targeted and snowball sampling approach. Guided by the Behavioral Model of Health Service Use, we identified themes related to enabling, predisposing, and need factors, and coded transcripts until theme saturation in Dedoose. Results: Key approaches to improve CT participation focused on these structural enabling themes: increased availability of CTs, personnel to screen and enroll patients, well-timed and technology-assisted clinician notification of a potential CT match (within or outside home institution), along with an institutional culture encouraging stakeholder engagement, provider outreach, and care coordination. Important predisposing and enabling themes related to stakeholders’ beliefs about patients included: financial access, knowledge and perceptions about CTs, language barriers, motivation, and medical mistrust. Knowledge about open trials, and skepticism or enthusiasm about CTs were important predisposing themes related to clinicians. Need theme affecting implementation was clinician judgment about their patients’ eligibility for CT evaluated based on functional status, comorbidities, age, advanced cancer stage, progression of disease, change in therapy, and drug targets. Conclusions: We identified actionable enabling, predisposing, and need factors that serve as barriers to CT accrual and to successful implementation of our intervention. Major findings were structural and attitudinal, including lack of staffing resources for clinicians, and financial assistance and access for patients. Updated information about open CTs, implementation of e-screening tools for patient enrollment, addressing clinician skepticism for enrollment by increased recognition for their research efforts, as well as delivery of culturally sensitive patient education around CTs may improve CT enrollment.
Medical terminology and interpretation of results in plain language summaries published by oncology journals.
Authors: Wissing Michel D. , Tanikella Sai A. , Kaur Preetinder , Tomlin Holly R. , Cornfield Linda J. , Porter Amy C. , D'Cruz Shereen C. , Alcala Alissa M. , Capasso-Harris Holly , Tabas Linda
Published: June 2023

e18653

Background: Plain language summaries (PLS) are increasingly added to published scientific manuscripts in oncology, either as an abstract or standalone manuscript, to increase transparency in medical research. We evaluated PLS published in oncology journals by publication type and institution for criteria deemed essential to adequately inform laypeople. Methods: PLS published in oncology journals in 2021 or 2022 were identified in PubMed using prespecified search terms. Two medical writers independently reviewed and scored PLS based on use of medical terminology, language level, and adequate interpretation of data (i.e., a lay reader would be able to put the data adequately in context). Scoring discrepancies were resolved by a third reviewer. Established Flesch readability statistics were compared to the reviewers’ scoring. Scoring results were evaluated between institutions (academia or pharmaceutical companies) using Fisher's exact tests in R. Results: 63 PLS were analyzed in 9 oncology journals; scoring results are displayed in the table. All PLS manuscripts were written by pharmaceutical companies; PLS abstracts were provided by both pharmaceutical companies and academia. Only 5% of all PLS were graded as understandable at the pre-university level. Flesch readability statistics provided similar results, and reviewers’ scores correlated with Flesch readability statistics (n = 38, W = 0.599, r = 66.5, P= .002). Medical terminology was avoided or explained in all PLS manuscripts and in 23% of PLS abstracts. Similarly, data were adequately interpreted in all PLS manuscripts and 17% of PLS abstracts. PLS provided by pharmaceutical companies avoided or explained medical terminology ( P< 0.001 ) and adequately interpreted all data more often than PLS written in academia ( P< 0.001). Importantly, 6 PLS (10%) were found to overstate results. Conclusions: PLS published in oncology journals, particularly as abstracts, frequently had inadequate data interpretation and often used language only accessible for people with advanced scientific or medical training, both when written by academic investigators or within pharmaceutical companies, limiting their intended purpose. We recommend scientists in academia and pharma to adapt easily interpretable language in PLS, which would allow PLS to be used to advance equal access to healthcare research. [Table: see text]
Evaluating access to brentuximab in elderly patients with Hodgkin lymphoma.
Authors: Mobley Erin Michele , Li Yujia , Guo Yi , Braithwaite Dejana , Wingard John R. , Mailhot Vega Raymond
Published: June 2023

e18663

Background: Despite the high survival associated with Hodgkin lymphoma (HL), established disparities exist both in survival for Black and Hispanic patients and their access to consolidative treatments like radiotherapy as demonstrated using large, population-based databases. Elderly patients with HL face inferior survival compared to younger patients. Brentuximab is an approved second line therapy for those patients with refractory/relapsed HL. We examined whether there were inequities in receipt of treatment among those diagnosed with HL in a contemporary cohort receiving frontline doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), allowing for evaluation of targeted therapy. Methods: Data from Surveillance Epidemiology and End-Results (SEER) linked to Medicare claims were used to identify individuals diagnosed with HL from 2008 to 2017 who received frontline treatment with ABVD using applicable Healthcare Common Procedure Coding System codes. We examined differences in associations with receipt of brentuximab following ABVD within two years of diagnosis. Descriptive statistics were used to characterize the sample. We ran univariable and multivariable logistic regression models (producing adjusted odds ratios, aOR and 95% confidence intervals, CI) predicting treatment with brentuximab. Multivariable models were adjusted for age at diagnosis, sex, race/ethnicity, stage, insurance at diagnosis, and geographic location. Results: A total of 2,651 people diagnosed with HL were identified, 2,007 (76%) of which survived two years and 1,475 (56%) were still alive at last follow-up in 2019. Mean age at diagnosis was 69 years (SD: 12.4), most were men (N = 1,457, 55%), non-Hispanic White (N = 2,050, 77%), Hispanic (N = 291, 11%), or non-Hispanic Black (N = 220, 8%), diagnosed with stage I or II disease (N = 1,591, 60%), and received radiotherapy (N = 663, 23%) or brentuximab (N = 181, 7%) within two years of diagnosis. On univariable analysis, race and ethnicity did not have a statistically significant association with receipt of brentuximab as adjuvant treatment within two years of diagnosis. On multivariable analysis, individuals without insurance at diagnosis (aOR 1.54; 95% CI 1.02, 2.30) or those diagnosed with stage III or IV disease (aOR 2.04; 95% CI 1.04, 2.98) were more likely to receive brentuximab as adjuvant treatment within two years of diagnosis, after adjusting for the variables described above. Conclusions: Although we cannot definitively say that receipt of brentuximab within two years of diagnosis following ABVD is due to relapse, we posit that this can be used as a proxy for relapse. Our analysis did not demonstrate that race and ethnicity rose to traditional levels of statistical significance regarding associations with decreased odds of receiving brentuximab. In multivariable analysis, patients without insurance or diagnosed with stage III or IV disease were more likely to receive brentuximab.
Evaluating root causes contributing to real-world disparities in ovarian cancer care: Insights from an implementation science initiative utilizing tethered patient-provider surveys and chart reviews.
Authors: McKinnon Kelly E. , Moore Kathleen N. , Carter Jeffrey D. , Heggen Cherilyn
Published: June 2023

e18665

Background: Quality ovarian cancer care is significantly impeded by racial disparities in treatment and survival outcomes for black women with ovarian cancer. In this implementation science (IS) initiative, we evaluated root causes for disparities in care among patients with ovarian cancer at 3 diverse health systems and implemented focused action plans to facilitate improved care quality and promote health equity. Methods: Between 11/2020 and 3/2021, we surveyed oncology team members (n = 53) and ovarian cancer patients (N = 41), and performed randomized and retrospective baseline chart audits (N = 100) at 3 health systems to assess current practices, challenges/barriers, and areas for improvement in equitable care of ovarian cancer patients. Providers then participated in audit/feedback (AF) educational sessions and developed and implemented action plans to address identified gaps. Follow-up chart audits measured practice change following the educational initiative. Results: Significant differences were found between Black and non-Black patients in chart documentation patterns and self-reported survey responses. For example, Black patients were significantly less likely to have chart-documented practices of biomarker testing (BRCA testing 47% of Black patients, and 70% on non-Black patients), assessments for treatment-related adverse events and supportive care (40% vs 70%), fertility counseling (4% vs 17%) and shared decision-making (57% vs. 81%). Patient survey and data suggest racial/cultural differences in the emphasis placed on different treatment decision-making factors, as well as differences in the time/extent to which treatment risks and benefits are discussed with patients. Oncology team members participating in AF sessions developed action plans to improve equitable ovarian cancer care, including increasing education and patient counseling, increasing use of patient navigators, and improving documentation. After implementing action plans, follow-up chart audits showed improvement in the provision of patient education, shared decision-making, biomarker testing, and supportive care for both Black and non-Black patients with ovarian cancer. Conclusions: These findings reveal important factors contributing to racial disparities in ovarian cancer outcomes. The identified gaps may inform future IS initiatives and represent key opportunities for improvement in equitable ovarian cancer patient care. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from AstraZeneca, GlaxoSmithKline, and Merck & Co. Inc., who had no role in the study design, execution, analysis, or reporting.
Role of social disparity in 30-day readmissions and healthcare utilization in patients with history of sickle cell crisis in United States: Cross-sectional analysis from US national database.
Authors: Nagadia Urja , Basida Sanket , Radhakrishnan Swathi , Chelapareddy Lakshmi Ramya , Naha Kushal
Published: June 2023

e18666

Background: Factors like age, mental status, spirituality, financial security, and clinic attendance affect hospital admissions/readmissions in sickle cell disease patients. To further understand the predisposing factors associated with increased readmissions in sickle cell disease patients, this study examined the relationship between readmission rates and socioeconomic status of Sickle cell patients in the US. Methods: All adult hospitalized patients in the Nationwide Readmission Database (NRD) for the year 2019 were captured. The sample population included all patients with primary diagnosis of Sickle cell crisis, identified using ICD-10 codes (International Classification of Diseases, tenth edition). We used the Wilcoxon rank sum test to compare continuous variables and chi square test for categorical variables. Predictors of readmission were analyzed using multivariate logistic regression models. We used StataCorp LLC MP4 17 version to perform statistical analysis. Results: The sample size included 48,715 patients admitted with sickle cell crisis, of which 55.12% were females and 44.88% were males. The mean age of presentation was 32.84 years. The rate of all cause 30-day readmission in patients admitted with Sickle cell crisis was 27.19%. The total hospital charges for these readmitted patients during the year 2019 was 507 million dollars and total length of stay was 69,418 days (about 190 years). The most common causes of readmissions were Sickle cell crisis including Acute chest syndrome and splenic sequestration crisis, followed by sepsis due to MRSA and femoral fractures. After adjusting for confounders on multivariate analysis, compared to patients belonging to income category 1 ( < $46,000), patients in category 2 ($46,000-$58,999) had 11% lower risk (p-value 0.018) and category 3 had 16% lower risk (p-value 0.008) of 30-day readmission. However, there was no increased risk of death based on socioeconomic status (OR 1.03, p-value 0.875). Conclusions: Our study concludes that socioeconomically deprived Sickle cell crisis patients are at higher risk of readmissions. Factors like poor living situation, lack of means for transportation, potential lower level of education leading to decreased medication compliance and clinic follow ups could be attributed to these findings. Interventions targeting this population can help reduce healthcare burden and patient morbidity significantly. [Table: see text]
Disparities in medical oncology visit adherence among African American (AA) men with prostate cancer (pCa).
Authors: Nelson Ariel Ann , Ladwig Christina , Riemersma Kristin , Bylow Kathryn A. , Kilari Deepak
Published: June 2023

e18671

Background: AA patients (pts) with pCa tend to have worse outcomes when compared to Caucasians. Disparities in access to healthcare among AA pts with pCa is a significant barrier to improvement in outcomes. Medical oncology visit attendance among this population has not been thoroughly investigated. Methods: Pts with a diagnosis (dx) of pCa scheduled to see a provider (MD or advanced practice provider) at a single academic institution medical oncology clinic between January 2022 and December 2022 were retrospectively identified. Pts were categorized by self-identified race. The total number of scheduled clinic visits was recorded, and each visit was categorized by visit status; completed, cancelled, no-show, or left clinic. The reason for visit cancellation was assessed and cancelled visits for non-pt driven reasons (ie. scheduling error) were removed. The data were summarized using descriptive statistics. Z-test and Chi-square analysis were utilized to compare proportions of visits between AA and Caucasian pts and the association of race with visit status. Results: A total of 992 pts were selected, 80% (n = 792) were Caucasian and 16% (n = 162) were AA, representing 4231 clinic visits during the study period. AA pts accounted 18% (n = 763) of the total scheduled visits. 94% of visits (n = 3962) were follow up and 6% (n = 269) were new pt visits. 86% of all scheduled visits were completed and 10 % (n = 436) were cancelled for pt driven reasons. Roughly 3% (n = 135) of visits were no-show. AA pts had fewer completed visits compared to Caucasian pts, 78% vs 88% (p < 0.001) and a higher no-show rate of 10% vs 1.5% (p < 0.001). The cancellation rate was similar between AA and Caucasian pts, 11% vs 10% (p = 0.33). The combined no-show and cancellation rate for AA pts was 22% vs 12% for Caucasian pts (p < 0.001). There was a significant association between AA race and no-show visit status (p < 0.001). Conclusions: AA men with pCa have much poorer visit adherence to scheduled medical oncology visits compared to their Caucasian counterparts. Identifying reasons for no-show and visit cancellations and targeted interventions to improve access to care are needed to improve outcomes. [Table: see text]
Factors associated with health information technology use in adults recently diagnosed with cancer: NHIS 2012-2017.
Authors: Monestime Shanada , Liu Jialiang , Brown Natasha , Rodriguez Estelamari
Published: June 2023

e18673

Background: Electronic health information technology (HIT) usage among U.S. adults nearly doubled between 2007 and 2014. HIT utilization has been associated with improvement in health literacy, care coordination, provider access, and quality of care. Despite the positive influence of HIT, disparities regarding its usage exist. Individuals more likely to seek cancer prevention information online are younger, Non-Hispanic White, and highly educated. While individuals diagnosed with cancer are likely to research health information online, limited attention has focused on factors associated with HIT use among adults with cancer. The purpose of this study was to identify sociodemographic, behavioral, and health factors associated with HIT use among adults recently diagnosed with cancer. Methods: A cross-sectional analysis using the National Health Interview Survey (NHIS) 2012-2017 was conducted. Adults diagnosed with cancer within 12 months of taking the survey and reported a response to all five HIT variables (using the internet for health information, scheduling an appointment, using chat rooms for health information, filling a prescription online, and emailing a medical provider) were included (N = 3136). Survey-weighted proportions and 95% confidence intervals (CIs) were estimated for all categorical variables, and survey-weighted means and 95% CIs were estimated for continuous variables. Multiple logistic regression models were used to estimate factors associated with overall and individual HIT use. Results: Among U.S. adults with cancer utilizing HIT (51%), the highest usage was looking up health information online (53.37%) and the lowest usage was seen in using online chat groups to learn about health topics (3.04%). There was a higher prevalence in Non-Hispanic Whites looking up health information on the internet and scheduling an appointment; Asians filling a prescription online; and Non-Hispanic Blacks using online chat groups. For a one-unit increase in the number of non-cancer chronic conditions, the odds of using any HIT decreased by a factor of 0.15; p-value=< 0.0001. After adjusting for covariates, significant factors related to any HIT use were identified in patients that were younger; female; Asian and Non-Hispanic White; and had health insurance, higher education, and higher income. Conclusions: Adults recently diagnosed with cancer are increasingly utilizing the internet to find health information but use varies across subgroups. These data could be utilized to direct future research investigating the influence of certain types of HIT interventions on access to health care.
The human connection: Oncologist characteristics that facilitate therapeutic bonding among Latino patients with advanced cancer.
Authors: Tergas Ana Isabel , Prigerson Holly Gwen , Penedo Frank J. , Maciejewski Paul K.
Published: June 2023

e18676

Background: Therapeutic alliances (TA) are bonds between patients and their oncologists characterized by mutual caring, trust, understanding, and respect. They lay the foundation for the provision of high-quality cancer care. We here relate oncologist characteristics to TA in Latino vs. non-Latino advanced cancer patients. Results will inform the development of an intervention to train oncologists in how to develop a strong TA with their Latino patients. Methods: The study population included non-Latino oncologists (n = 41) and their Latino (n = 67) and non-Latino white (n = 90) patients with advanced cancers who participated in Coping with Cancer III, a multi-site prospective cohort study designed to examine Latino/non-Latino disparities in advance care planning and end-of-life cancer care, conducted at U.S. medical centers from 2015-2019. Oncologist characteristics included age, sex, race, institution type, Spanish language proficiency and practice style behaviors (e.g., “familismo”— embracing dedication, commitment, and loyalty to family), addressing patients by their first name, and personal disclosure (e.g., “personalismo”), among others. The average score of 6 items from The Human Connection scale was used to assess the patients’ TA with their oncologists. Hierarchical linear modeling (HLM) was used to evaluate the effects of oncologist characteristics on TA in the full patient sample and stratified by patient ethnicity. Results: Of the 157 patients, 67 (42.7%) were Latino; most were female (n = 92, 58.6%) and < 65 years old (n = 95, 60.5%). Most oncologists were male (n = 24, 58.5%), non-Latino? white (n = 25, 61%), and ≥ 40 years (n = 25, 61%). There were no significant associations between patient age, sex, Medicaid recipient status, education level, marital status, and geographic region with TA. An adjusted HLM in the full sample showed that Latino ethnicity was associated with significantly lower TA (b = −0.16, p = 0.037). In an adjusted HLM for TA stratified by ethnicity, oncologist preference to address patients by their first names (b = 0.34, p = 0.001) and a “familismo” practice style (b = 0.46, p = 0.001) were positively associated with TA among Latino patients. In contrast, “familismo” had no impact on TA for the non-Latino white patients. Conclusions: In this study, Latino patients with advanced cancer had a worse therapeutic alliance with their oncologists compared to non-Latino patients. Cultural differences between Latino and non-Latino white patients may be leveraged in an intervention designed to improve the therapeutic bonding and patient-clinician relationship between oncologists and their Latino patients with advanced cancer, thus potentially mitigating cancer care disparities in this important, often underserved, patient population.
Cancer deaths in the state of Sao Paulo, Brazil: Is there a solution for disparities among private and public services?
Authors: Preto Daniel D Almeida , Santos André Luiz Pinto , Neif Joao , Carcano Flavio Mavignier , Serrano Sergio Vicente , Lopes Gilberto , Teich Nelson
Published: June 2023

e18677

Background: There is a notable discrepancy between resources available for the private and public health care services that care for Brazilian people living with cancer. Barretos Cancer Hospital (Barretos) is a Sao Paulo countryside public hospital that stands out in Brazil for its approach of supplementing government receipts with philanthropy and fundraising, allowing it to incorporate state-of-the-art technology in the prevention, screening, and treatment of cancer. However, the availability of systemic therapies in Barretos is still restricted to the list contemplated in the public health system procedures. Lack of access to innovative systemic therapies may hinder survival. As such we aimed to evaluate the outcomes of patients treated in Barretos compared to other public and private institutions in Sao Paulo, Brazil. Methods: We performed a retrospective analysis of the public database of the Fundação Oncocentro de São Paulo, including new patients diagnosed with cancer in the period from 2013 to 2017, assessing tumor type, clinical staging, cancer survival, and treatment site (private/public/Barretos). We used Cox proportional-hazards regression for survival data with R Statistical Software, taking Barretos as reference compared to private and public services (excluding Barretos). Results: We analyzed data from 133,868 patients with the most prevalent cancers in the state: breast (n = 45,402), prostate (n = 36,046), colorectal (n = 23,951), cervical (n = 13,801) and lung (n = 14,668). More than two thirds of patients (69.88%) received treatment in public services, 16.71% in private centers and 13.41% in Barretos. There were no significant differences in OS between private centers and Barretos for patients with cancer stages 0 and I (HR 1.1; p = .48; CI 95%). For patients with stage II breast, cervical and lung cancers, and for patients with stage III cervical and prostate tumors, there were no significant differences in OS between Barretos and private services. For all patients in stages 0-I, II and III, Barretos had better survival than other public centers (HR 2.8; 1.3; 1.3, respectively p < .001; CI 95%). In stage IV cancers, Barretos had worse survival than private institutions (HR 0.6; p < .001; CI 95%) and only patients with stage IV prostate and cervical cancers had better outcomes in Barretos than in other public services. Conclusions: Strategies for earlier incorporation of health technologies have the potential to decrease disparities between public and private services in Brazil. The lack of access to novel systemic therapies likely led to poorer outcomes for patients with metastatic disease in Barretos and other public services. These data indicate that greater government investment in early diagnosis and treatment programs are needed to improve outcomes in resource-limited settings.
Comparison of lung cancer clinical trials treatment options and standard practice in Brazilian national health system over the last decade.
Authors: Melo Marina , Lazar Neto Felippe , Cunha Mateus Trinconi , Castro Gilberto
Published: June 2023

e18678

Background: New cancer drugs for metastatic non-small cell (NSCLC) and small cell lung cancer (SCLC) have been approved worldwide in the past decade, but expensive pricing has led to unequal access. Despite being categorized as an upper-middle income country, Brazil's public health system is underfunded and has faced difficulties in incorporating new cancer treatments, which is concerning as two-thirds of the population depend on the public health system for their cancer-related medical needs. We hypothesized that the disparity between the standard of care (SOC) provided in developed nations and the prevailing practices in Brazil's public healthcare system is widening. Methods: We conducted a search of the ClinicalTrials.gov database from January 1st, 2012 to December 31th, 2021, for all phase III clinical trials on metastatic lung cancer that had at least one clinical site located in Brazil. We collected data on the experimental arm therapies, planned outcomes, and control arm therapies (used as a proxy for the standard of care worldwide). We then compared the control-arm drug therapy at the trial's start date with the standard practice for lung cancer in the Brazilian Unified Health System (SUS) at that time, using available governmental protocols on lung cancer (PCDT) and recent approvals from the technology health assessment committee (CONITEC). Additionally, we assessed the potential eligibility of patients treating in SUS for second-line therapy trials based on prior required treatments to trial enrollment. We analyzed two time periods: 2012-2016 and 2017-2021. Results: Out of 86 screened trials, 64 were included. 86% of them were on NSCLC, and 67% on first-line settings. Almost half had a biomarker inclusion criterion for enrollment. Immunotherapy was studied most frequently (52%), followed by targeted therapies (36%) and antibody-conjugate drugs (ADC) (9.4%). PD(L)1 was the target of 33% of drug therapies. Compared to 2012-2017, in the 2018-2021 period we observed an increase in available clinical trials (24 vs 40) with similar rates of NSCLC (83% vs. 88%, p = 0.7) and first-line therapies (68 vs 67%, p > 0.9). The proportion of trials with control group therapies better than the standard practice available at the time increased from 8.3% to 38% in the recent time-period (p = 0.011). Among second-line therapy trials, the proportion of trials with mandatory previous therapy unavailable in SUS rose numerically from 12% to 54% (p = 0.085). Conclusions: While the number of trials increased over time, there was a rising proportion of control group therapies better than available standard practice in Brazil. The widening difference between drug therapies in clinical trials and standard cancer treatments creates difficult ethical quandaries for oncologists enrolling patients, and also impacts patient eligibility in advanced settings.
Presenting symptoms, screening and diagnosis in asian and white patients with stage IV lung cancer.
Authors: Hu Xiao , Melson John W. , Pan Stacey , Salei Yana , Cao Yu
Published: June 2023

e18687

Background: Lung cancer (LC) is a leading cancer diagnosis and cause of cancer death in Asian Americans, the fastest growing racial/ethnic group in the US. Some racial/ethnic groups are less likely to be eligible for guideline-recommended LC screening with low-dose computed tomography (LDCT). Data on presenting symptoms (PS) and initial evaluation in Asian patients (AP) with stage IV LC in the US are limited. This retrospective study examines LDCT utilization and patterns of PS for AP and White patients (WP) with stage IV LC at an urban academic medical center serving a large proportion of AP. Methods: Patients newly diagnosed with stage IV LC from 01/01/2014 to 12/31/2019 were identified from Tufts Medical Center cancer registry. Demographics, clinical characteristics, and biomarker data were compared between AP and WP by Mann–Whitney U test and Chi-square/Fisher's exact tests for continuous and categorical variables, respectively. Univariable and multivariable logistic regressions were used to assess associations between PS and race. Results: Of 89 AP and 197 WP, AP had significantly more non-small cell (NSC) histology (85 vs 73%), never-smokers (36 vs 7%) and male representation (72 vs 48%). Similar rates of brain metastasis (35 vs 39%) were observed. Among 219 patients with NSCLC, AP had more driver mutations compared to WP (53 vs 29%), particularly more EGFR alterations (68 vs 15% of observed driver mutations). Similar PD-L1 positivity (34 vs 32%) was noted at diagnosis in AP and WP with stage IV NSCLC. At diagnosis, fewer AP (N = 14) vs WP (N = 47) met USPSTF 2013 eligibility criteria for LDCT screening (16 vs 24%, p = 0.162), however 21% (N = 3) of eligible AP completed LDCT screening compared to 9% (N = 4) of eligible WP (p = 0.336). AP tended to have more primary care (PC) visits prior to diagnosis (51 vs 38%, p = 0.064), but longer median duration of symptoms prior to diagnosis (8 vs 4 weeks, p = 0.003). More AP presented with respiratory symptoms (80 vs 54%, p < 0.001), namely cough (58 vs 33%, p < 0.001), chest pain (20 vs 8%, p = 0.004) and hemoptysis (15 vs 7%, p = 0.050). Fewer AP presented with symptoms due to metastatic disease (34 vs 51%, p = 0.011). Rates of constitutional symptoms (42 vs 35%, p = 0.311) and asymptomatic diagnoses (3.4 vs 3.0%) were similar. Adjusting for age, sub-stage, histology, and smoking status, multivariable logistic regression showed significant association between AP and respiratory symptoms presentation (OR = 3.43, p < 0.001). Conclusions: USPSTF 2013 LC screening criteria did not capture most of the AP and WP diagnosed with stage IV LC in this study and missed racial nuances in LC screening. Although limited in size, this study found that AP, more of whom are nonsmoking, are diagnosed with stage IV LC after longer preceding often respiratory symptoms, despite similar PC utilization and LDCT uptake as compared to WP. Awareness of race and associated PS should inform assessment for LC screening in AP.
Analysis of sarcoma outcomes at a metropolitan area safety net hospital.
Authors: Haji Mariam , Elsayed Marwa , Raman Anshul , Asif Samia , Cheng An-Lin , Madhusudhana Sheshadri , Shrestha Anuj
Published: June 2023

e18688

Background: Sarcomas are a group of heterogenous tumors with diverse histopathological types. They account for less than 1% of adult solid tumors (1). The estimated new cases were 13,190 with 5,130 estimated deaths in 2022(2). Survival is largely determined by presence of metastasis on diagnosis, grade, site, and size of the tumor(3). Data over 19 years in our safety net hospital were analyzed including demographic data, disease characteristics and treatment modalities in association with overall survival. Methods: All patients diagnosed with sarcoma from 1998 to 2017 were included in the analysis. Patients were categorized by insurance status, stage, site, grade, pain on presentation, and treatment modalities. Survival analysis and Kaplan-Meier curves were conducted to examine the relation between patient demographics and survival. Results: Of 163 patients included in the analysis, 54% were insured and 46% were uninsured. Uninsured patients had a higher overall survival rate compared to insured patients (HR = 0.49, CI 0.38-0.90, p = 0.014). Regarding race, 55% of patients were white, 35.6% were black and 9.2% patients were identified as other races. There was no difference in overall survival between different ethnicities. Regarding gender, 61.3% were males and 38.7% were females with no statistically significant difference in survival. Compared to stage I, stage III were 2.28 times (CI 1.27-4.08, p = 0.005) and stage IV were 5.76 times (CI 3.16-10.05, p < 0.001) more likely to die. There was no statistically significant improvement in overall survival in patients who underwent chemotherapy or radiotherapy. However, surgical intervention was associated with improved survival and patients were three times more likely to survive (0.3, CI 0.18-0.5, p < 0.001). Analysis also showed no statistically significant difference in survival in patients presenting with pain. Conclusions: Insured patients have better outcomes overall than uninsured patients in sarcomas(4). Nevertheless, within safety-net-hospitals, all patients receive necessary treatment regardless of insurance status. We found that in our institution, insurance may factor in delaying treatment due to hurdles such as prior authorizations, co-pays and coverage disruptions(5). Conversely, uninsured patients can begin appropriate treatment without such delays which could explain difference in survival rates. Additional studies are needed to identify the possible effects of insurance and pinpoint its burden on survivorship. [Table: see text]