bluuebunny/crossref_metadata_2025 huggingface dataset:
The interplay of gender, motherhood, and the digital economy in China: exploring the experiences of urban mothers in WeChat businesses
Authors: Zhang Hong , Sun Xintuantuan , Ding Ziyao
Published: October 2023

In recent years, there has been tremendous growth in the e-commerce industry in China. This study focuses on the experiences of urban mothers who engage in e-commerce on the WeChat platform. Through in-depth interviews with 35 urban mothers as digital laborers on WeChat, our findings reveal that career disruptions due to childbirth and the lack of public support for domestic care work often drive urban mothers to engage in e-commerce. However, only a small number of highly educated mothers who strategically exemplify the practices of intensive motherhood ideology are able to generate sufficient income. This study sheds light on the commercialization of the online mother communities on WeChat and how these communities reinforce the intensive motherhood ideology. The separation of the public and private spheres in China after the economic reforms has resulted in urban mothers with young children engaging in precarious digital work. Meanwhile, the commercialization of the private sphere has blurred the boundaries between the public and private spheres with market logic, further perpetuating gender inequalities in contemporary China. Further research is needed to understand the impact of the digital economy on female digital labor in China, especially for mothers with young children.
A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study
Authors: Miyazaki Taiga , Fukushima Kiyoyasu , Hashiguchi Kohji , Ide Shotaro , Kobayashi Tsutomu , Sawai Toyomitsu , Yatera Kazuhiro , Kohno Yoshihisa , Fukuda Yuichi , Futsuki Yoji , Matsubara Yuichi , Koga Hironobu , Mihara Tomo , Sasaki Eisuke , Ashizawa Nobuyuki , Hirayama Tatsuro , Takazono Takahiro , Yamamoto Kazuko , Imamura Yoshifumi , Kaku Norihito , Kosai Kosuke , Morinaga Yoshitomo , Yanagihara Katsunori , Mukae Hiroshi
Published: October 2023

Background

Current microbiological tests fail to identify the causative microorganism in more than half of all pneumonia cases. We explored biomarkers that could be used for differentiating between bacterial and viral pneumonia in patients with community-acquired pneumonia (CAP).

Methods

In this prospective cohort study conducted in Japan, data obtained from adult patients with bacterial pneumonia, including bacterial and viral coinfections (bacterial pneumonia [BP] group), and purely viral pneumonia (VP group) at diagnosis were analyzed using multivariate logistic regression analysis to identify predictors of bacterial pneumonia. Furthermore, a decision tree was developed using the predictors.

Results

A total of 210 patients were analyzed. The BP and VP groups comprised 108 and 18 patients, respectively. The other 84 patients had no identified causative microorganism. The two groups shared similar characteristics, including disease severity; however, a significant difference (p < 0.05) was observed between the two groups regarding sputum type; sputum volume score; neutrophil counts; and serum levels of interleukin (IL)-8, IL-10, and α1-antitrypsin (AAT). Sputum volume score (p < 0.001), IL-10 (p < 0.001), and AAT (p = 0.008) were ultimately identified as predictors of BP. The area under the curve for these three variables on the receiver operating characteristic (ROC) curve was 0.927 (95% confidence interval [CI]: 0.881–0.974). The ROC curve for sputum volume score and an AAT/IL-10 ratio showed a diagnostic cutoff of 1 + and 65, respectively. Logistic regression analysis using dichotomized variables at the cutoff values showed that the odds ratios for the diagnosis of BP were 10.4 (95% CI: 2.2–50.2) for sputum volume score (absence vs. presence) and 19.8 (95% CI: 4.7–83.2) for AAT/IL-10 ratio (< 65 vs. ≥ 65).

Conclusions

Considering that obtaining a definitive etiologic diagnosis with the current testing methods is difficult and time consuming, a decision tree with two predictors, namely sputum volume and the AAT/IL-10 ratio, can be useful in predicting BP among patients diagnosed with CAP and facilitating the appropriate use of antibiotics.

Trial registration

UMIN000034673 registered on November 29, 2018.
A perspective on biodegradable polymer biocomposites - from processing to degradation
Authors: Laycock Bronwyn , Pratt Steven , Halley Peter
Published: October 2023

Given the greater global awareness of environmental impacts of plastics and the need to develop alternative materials from renewable natural resources, there has been an increasing drive over recent years to develop biobased and biodegradable composites, especially those produced from agro-industrial waste and byproducts. This perspective provides a brief introduction to the field as well as discussing some of the critical aspects to be considered as we accelerate the development of these novel alternative materials for a range of applications.
Reflection seismic imaging of subsurface geologic structures in the Bayan Obo mining area, China
Authors: Zheng Yikang , Wang Yibo , Zhang Jien , Xu Ya , Zhao Liang
Published: October 2023

A dense 2D seismic reflection survey was conducted at the Bayan Obo rare-earth-elements-Nb-Fe deposit in China to explore its geologic features and mineral endowment. A composite processing workflow was established for prestack depth imaging of this data set, which involved static correction to compensate for shifts caused by lateral inhomogeneities in near-surface layers and rugged topography. Standard methods were used to attenuate different types of noise and improve the signal-to-noise ratio of the data. A velocity model in the depth domain was obtained from refraction tomography and velocity analysis, and then used in migration. The preliminary interpretation of the final image revealed the mapping of mineralization at its true position in depth, indicating a relatively deep extension (approximately1.5 km). The results demonstrate the potential of seismic imaging as a complementary exploration tool to gravity and electromagnetic methods for mineral exploration purposes in the Bayan Obo mining area, providing a high-resolution seismic image and allowing for depth characterization of the mineral deposits. In addition, the images provide important information for guiding the selection of drilling borehole locations for deep exploration.
Association of health insurance coverage disruptions and breast, colorectal, and cervical cancer screening.
Authors: Shi Kewei Sylvia , Star Jessica , Zhao Jingxuan , Han Xuesong , Yabroff Robin
Published: October 2023

116

Background: Health insurance coverage is critical for ensuring access to recommended health care in the United States. This study investigates the effects of insurance coverage disruptions on receipt of breast, colorectal, and cervical cancer screenings. Methods: We identified adults <65 years eligible for breast, cervical and/or colorectal cancer screening from the 2015, 2019, and 2021 National Health Interview Survey (years cancer control supplements fielded). Adults were categorized into 5 groups based on insurance type at survey and prior coverage disruptions (lack of insurance during prior 12 months): private, with and without disruption; public, with and without disruption; and uninsured. Screening outcomes included: 1) past-year screening and 2) guideline-concordant screening, defined from the US Preventive Services Task Force guidelines available at the time of each survey. Separate multivariate logistic regression models were used to evaluate the associations of insurance coverage disruptions and cancer screening. Results: We identified 12,121 women aged 50-64 years eligible for breast cancer screening, 23,490 people aged 50-64 years eligible for colorectal cancer screening, and 33,391 women aged 21-64 years eligible for cervical cancer screening. Compared to people with continuous private or public coverage, people with coverage disruptions were less likely to receive past-year or guideline-concordant cancer screening (Table). People without health insurance coverage had the lowest level of screening. Among people with private coverage, disruptions were associated with lower guideline-concordant screening across all three cancer types in adjusted analyses (breast: AOR: 0.45, 95% confidence interval (CI): (0.32, 0.63); colorectal: 0.49 (0.39, 0.62); cervical: 0.70 (0.58,0.84)); among people with public coverage, disruptions were associated with lower guideline-concordant breast cancer screening (AOR: 0.39 (0.23, 0.65)). Conclusions: Health insurance coverage disruptions were associated with lower past-year and guideline-concordant breast, colorectal, and cervical cancer screening. Findings underscore the importance of stable health insurance coverage as part of a comprehensive approach to improve cancer screening rates and early detection of cancers when treatment is most effective.[Table: see text]
Comprehensive review of patients with hematologic malignancies in a cancer urgent care center: A single center experience.
Authors: Shahid Muhammad Ali , Albusoul Linda , Ramanan Sruthi , Gutta Radhika , Springer Kylie , Rose Courtney M , Kuriakose Philip
Published: October 2023

144

Background: Patients with hematological malignancies are subjected to unique disease and therapy related complications that can lead to a substantial burden for them and their site of care. The emergency department has been the main gateway to acute care delivery for cancer patients, however, more recently cancer urgent care centers have been established to meet their specific care needs. This study describes the demographics and disease related characteristics of patients presenting to cancer urgent care centers and whether the visit prevented utilization of the emergency department. Methods: We performed a retrospective chart review of patients diagnosed with hematological malignancies seen in the cancer urgent care center at Henry Ford Cancer Institute between January 1, 2021, to December 31, 2022. We evaluated their demographics by race and gender, and then characterized them based on whether they were on active treatment during their visit, receiving standard of care or a clinical trial, and if they were early or late in their treatment course. Early treatment course was defined as within the first 2 cycles of therapy. We also evaluated the reason for their visit, and if an emergency department visit was prevented or not. Results: A total of 270 patients diagnosed with a hematological malignancy presented to the cancer urgent care center. 139 (51.5%) patients were male, and 141 (48.5%) were female. In terms of race, 145 (53.7%) were African American, followed by 72 (26.7%) Caucasian, with 53 (19.6%) of other races. The most common presenting reasons were gastrointestinal symptoms (63 patients [23.3%]), infectious symptoms (52 patients [19.3%]), and hematological symptoms (47 patients [17.4%]). 184 (68.1%) patients were on active treatment during their visit. Of these, 89 (33%) presented early in their treatment course. 227 patients (84%) were on standard of care treatment for their respective malignancy during the time of visit. 194 (71.9%) patient visits to the cancer urgent care prevented an emergency department visit. Conclusions: Our data demonstrates the major role of a cancer urgent care within a cancer care network. It showcases the large volume of patients with hematological malignancies that were seen in our cancer urgent care, and nearly 72% of these patients had an emergency department visit that was prevented. We will be further studying the seeming disparity in the racial proportion of such patients when compared to the race mix within the population as a whole.
Racial disparities in treatment initiation between Black and White older adults with multiple myeloma: A SEER-Medicare analysis.
Authors: LeBlanc Matthew Roger , Zhou Xi , Jensen Christopher Edward , Lund Jennifer Leigh , Baggett Christopher D. , Jackson Bradford E. , Wheeler Stephanie B. , Rubinstein Sam , Hirschey Rachel , Tuchman Sascha Alexander , LeBlanc Thomas William , Reeder-Hayes Katherine Elizabeth
Published: October 2023

145

Background: We have previously identified racial disparities in multiple myeloma (MM) treatment initiation within 12 months of diagnosis. Black MM patients (60.6%) were significantly less likely to initiate treatment than White MM patients (69.5%). This current study aimed to explore the extent to which Black/White (B/W) disparities in MM treatment initiation were explained by differences in the distribution of demographic and health characteristics. Methods: We identified Black and White adults (66+) diagnosed with MM 2007 to 2017 in linked SEER-Medicare data. Patients were required to have 12 months of continuous Medicare Parts A and B pre- and post-diagnosis and Medicare Part D for 12 months post-diagnosis or until death. Our outcome was MM treatment initiation within 12 months of diagnosis and our independent variable was race (Black or White) as identified in SEER. Covariates thought to confound the relationship between race and MM treatment initiation were added to successive binomial regression models to estimate risk differences and 95% confidence limits (CL). Model 1 included only race. Model 2 added age and sex. Model 3 added Medicare low-income subsidy status and census tract poverty. Model 4 added rurality and SEER region. Model 5 added comorbidity and predicted frailty. Results: Our cohort (n=10,666) consisted of 1,649 Black and 9,017 White older adults with MM. Distributions of all individual, area-level and health characteristics differed significantly by race. In bivariate analysis all characteristics, except for sex and rurality, were significantly associated with treatment initiation. B/W risk differences remained significant across models and ranged from 3.7% (CL=0.9, 6.5) to 10.7% (CL=8.2, 13.2). Covariates explained some, but not all, of the B/W disparities in MM treatment initiation (Table 1). Conclusions: After accounting for differences in demographic and health characteristics, Black MM patients remained significantly less likely to initiate treatment within 12 months. Our study identified several factors that if addressed could attenuate B/W treatment initiation disparities. Further investigation is needed to understand how these factors contribute to treatment disparities, in order to develop health equity interventions to address them. Our results also suggest that there are additional unidentified factors contributing to disparity in MM treatment initiation. These factors must be identified and explored as we work to eliminate B/W disparities in MM treatment.[Table: see text]
Impact of the COVID-19 pandemic on administration of systemic therapy in the Medicare population.
Authors: Kardel Peter , Kolodziej Michael A. , Jacques Louis , Samuels Marc , Varghese Irene , Sheetz Caitlin
Published: October 2023

158

Background: The treatment of cancer was profoundly disrupted by COVID-19. Although there were well-documented impacts on cancer screening and surgery, the precise effect on treatment patterns with systemic therapy in the Medicare population has not been described. Methods: This study analyzed the 100% Medicare Research Identifiable Files (2017-2022) for patients with breast cancer, colorectal cancer, lung cancer, prostate cancer, and lymphoma who received antineoplastic therapy under either the Part B or Part D benefit setting. We examined patient demographics, patient diagnoses, treatment regimens, and Total Cost of Care (TCOC) (per month on treatment). Patients were selected for analysis if they had 12 months of continuous enrollment in Medicare Parts A, B, and D within the calendar year, and at least 2 claims of the same therapy within 60 days. Demographic information was attributed from the Master Beneficiary Summary File (MBSF). Results: Prior to the pandemic, 14% of breast cancer patients, 16% of colorectal cancer patients, 34% of lung cancer patients, 25% of lymphoma patients and 12% of prostate cancer patients received systemic therapy. During the pandemic, the number of Medicare beneficiaries with a cancer diagnosis decreased in all diagnosis groups. In addition, during the peak year of the COVID pandemic (2020), the proportion of beneficiaries receiving therapy decreased as well, ranging from -3% (lymphoma) to -9% (colorectal). This decrease was uniform across race and socio-economic indicators (LIS beneficiary or dually enrolled in Medicare/Medicaid). For four of the cancer types (breast, colorectal, lung, and prostate), the average number of months on therapy in 2020 slightly increased for chemotherapy. Across all cancer types and treatment types, the average per month TCOC increased during in 2020. Conclusions: Treatment of cancer was disrupted by COVID-19. A smaller number of Medicare beneficiaries were diagnosed with cancer and of these, a smaller percent received systemic treatment. Of those treated, time on treatment was slightly longer and TCOC was slightly higher. These effects were seen to the same extent in all examined sociodemographic groups. The pandemic certainly impacted the systemic treatment of cancer but to a modest degree.
Impact of interventions to reduce racial disparities in receipt of breast cancer guideline-concordant treatment: A statewide simulation analysis.
Authors: Wheeler Stephanie B. , Yanguela Juan , Jackson Bradford E. , Roberson Mya , Rocque Gabrielle Betty , LeBlanc Matthew Roger , Baggett Christopher D. , Green Laura , Laurie Erin , Reeder-Hayes Katherine Elizabeth
Published: October 2023

160

Background: Inequities in the receipt of guideline-concordant treatment contribute to worse survival in Black breast cancer (BCa) patients. Inequity reduction interventions (e.g., navigation, bias training, and real-time treatment tracking) may close such treatment gaps. However, evidence to date has been derived from small-scale interventional studies, and the potential impact of these interventions on population-level disparities is unclear. The aim of this study was to simulate the effect of implementing inequity reduction interventions on observed racial inequities in treatment and downstream outcomes after BC diagnosis. Methods: We used data from the North Carolina (NC) Cancer Information and Population Health Resource - which links multi-payer claims to state cancer registry data, for women diagnosed with BCa in 2004-2017 - to calculate Black/non-Black inequities in the receipt of chemotherapy (CTx) within 4 months for women ages <70 with hormone receptor-negative stage Ib-III BCa (n=2,223) and endocrine therapy (ET) within 12 months for stage I-III hormone receptor-positive BCa (n=16,220) in NC. Using effect estimates from trials of inequity-reducing interventions, we simulated the potential increase in the proportion of patients receiving CTx or ET if such interventions were implemented statewide. We estimated the effect of this potential increase in CTx and ET receipt on 10-year BCa mortality by building cohort-, race-, and treatment receipt-stratified simulation Markov models. We report confidence bounds representing 95% of simulation results. Results: Only 70.7% and 72.9% of Black patients in our cohorts received guideline-recommend ET and CTx, respectively, in 2004-2017 (versus 74.3 and 79.4% of non-Black patients, respectively; p<.005). Statewide implementation of inequity reduction interventions could increase ET and CTx receipt among Black patients to 84.3% (79.1-89.3%) and 86.8% (81.5-91.9%), respectively. This would be expected to reduce 10-year BCa mortality among Black patients from 14.2% to 13.6% (13.3-13.9%) in the ET cohort and from 29.4% to 28.7% (28.3-29.1%) in the CTx group. As a result, the racial mortality gap would decrease from 5.7 to 5.2 (4.9-5.5) from 7.0 to 6.6 (6.2-6.9) in the CTx cohorts, respectively. Conclusions: Implementation of interventions designed to reduce treatment inequities are likely to improve cancer care equity. However, increases intreatment receipt alone will not close the BCa mortality gap. Inequities at other points on the cancer continuum, such as in pre-diagnostic risk factors, screening, diagnostic work-up, and post-treatment factors, may explain residual gaps which will require more comprehensive interventions to achieve full equity in breast cancer outcomes.
Lymphoepithelial carcinoma of nasal cavity and sinuses: An analysis of survival stratified by demographic features.
Authors: Hu Trevor T. , Silberstein Peter T. , Hsia Beau
Published: October 2023

169

Background: Lymphoepithelial carcinoma is a rare type of cancer that can often impact the nasal cavity and sinuses. It is characterized by poor differentiation of epithelial cells and an abundance of lymphocytes. Clinically, it is hard to distinguish from other cancers, and surgical management is considered the standard of care. Using patient information found in the Surveillance, Epidemiology, and End Results (SEER), this study identifies associations between survival rates and demographic factors. Previous research has not examined these relationships, so this study seeks to fill this gap in knowledge and better understand survival outcomes. Methods: We identified 4,114 patients with lymphoepithelial carcinoma in the nasal cavity and maxillary sinus. 3,234 patients were later used in the survival analysis, which excludes patients who are alive with no survival time and cases labeled as “All Death Certificate Only and Autopsy Only”. Demographic factors examined include: age, race, gender, median income, and treatment. We then used survival, frequency, and rate tables to measure survival outcomes. Survival tables determined 1, 2, 3, 4, and 5-year survival rates. The nasal cavity and maxillary sinus were selected as sites to focus on since they were consistent with the ICD 8082 classification. The SeerStat software was used in the analysis. Results: The study had more male (60.7%) than female (39.3%) patients, and patients were mainly White (76%), compared to Black (12.6%), Asian (10.3%), American Indian (.632%), and Unknown (.486%). Most individuals (73.6%) were over the age of 55 when the diagnosis was made. For surgical treatment, no discrepancies were identified among racial groups. However, differences were noted in other areas. Survival tables still revealed differences in 5-year survival rate by race (Table 1). The Unknown group had the highest survival rate (67.3%, z= 1.898), followed by Asian (48.8%, z= 1.854), White (42.5%, z= -0.165), Black (38.9%, z= -1.303), and American Indian (28.7%, z= -2.087). Meanwhile, 5-year survival for males and females were 41.1% and 44.1% respectively. Conclusions: This is the first SEER study focusing on correlations between demographic characteristics and survival outcomes for patients with this type of cancer. Given the variance in 5-year survival rates, future research should investigate for differences in the long-term management of lymphoepithelial carcinoma of the nasal cavity and maxillary sinus.[Table: see text]
Neighborhood deprivation and race as predictors for cancer-related mortality in breast cancer.
Authors: Roy Arya Mariam , George Anthony , Patel Archit , Attwood Kristopher , Gandhi Shipra
Published: October 2023

174

Background: The socioeconomic status (SES) of individuals and their neighborhoods significantly influences their access to healthcare and the outcomes of their diseases. Inequities in opportunities, education, income, and infrastructure can contribute to worse prognosis and unfavorable outcomes for certain malignancies in areas with lower SES. We studied the association of race and neighborhood deprivation with the survival of breast cancer (BC). Methods: We linked the neighborhood deprivation index (NDI) data by the National Cancer Institute with the BC cohort from the SEER database diagnosed from 2010 to 2016. NDI score of each county is created using factor analysis to identify variables from 13 SES attributes from the dimensions: wealth/income, education, occupation, housing conditions. NDI was classified into quintiles (qn) (Q1 least deprived - Q5 most deprived). The association between NDI, race/ethnicity and overall survival (OS) and disease-specific survival (DSS) was analyzed using Cox multivariate regression model. All analyses were adjusted for age, race, grade, insurance, and treatments. Results: Most of the early-stage (ES) (N= 88, 572) and advanced-stage (AS) BC (N= 12336) patients (pts) were in the Q5 (ES- 27.4%, AS- 30%) qn. There was a predominance of racial minorities in Q5 and Q4 compared to Q1 qn (ES: Blacks 13-15% vs 8%, Hispanics 15% vs 6%; AS: Blacks 19-23% vs 14%, Hispanics 13% vs 7%, p<0.001). Uninsured ES pts were higher in Q5 compared to Q1 qn (2.2% vs 1.7%, p<0.001). Triple-negative BC was higher in Q5 compared to Q1 qn (ES: 14.5% vs 11.7%; AS: 16.5% vs 8.8%, p<0.001). ES BC pts who live in Q5 qn have inferior OS and DSS compared to Q1 qn, but this trend was not observed in advanced BC (Table 1). The interaction between NDI and race for OS and DSS was significant (p-interaction 0.0030 and 0.02 respectively) for the ES BC, but not for advanced BC (p-interaction 0.67 and 0.72 respectively). In ES BC, Whites residing in Q5 qn had higher overall (OS: HR= 1.23, 95% CI= 1.14-1.34, p<0.001) and disease-specific mortality (DSS: HR= 1.29, 95% CI= 1.15-1.45, p<0.001) compared to Whites from Q1 qn. However, this disparity in mortality based on the NDI was not observed for Blacks with ES BC (OS: HR= 1.2, 95% CI= 0.98-1.46, p=0.06, DSS: HR= 1.2, 95% CI= 0.94-1.55, p= 0.12). Conclusions: Early-stage BC pts from areas with worse NDI have poor OS and DSS. Blacks with early-stage BC have poor OS and DSS regardless of the SES of the neighborhoods. To improve their clinical outcomes, personalized treatments are needed for Black pts with early-stage BC. Targeted investments and policies should prioritize improving the SES of neighborhoods with high deprivation to reduce healthcare disparities and enhance BC outcomes.[Table: see text]
Evaluating socioeconomic status, racial, and US geographic regional differences in biomarker testing and treatment in advanced ovarian cancer.
Authors: Chapman-Davis Eloise , Pack Simon , Luo Linlin , Pyrih Nick , Segunmaru Zulikhat
Published: October 2023

175

Background: Disparities in access and use of biomarker testing have been reported in patients (pts) with advanced ovarian cancer (AOC) that may result in worse outcomes. This study aimed to characterize socioeconomic status (SES), racial, and US regional differences in the use of biomarker testing and first-line maintenance (1LM) therapy among pts with AOC. Methods: We retrospectively included pts ≥18 years old who were diagnosed with AOC from Jan 2019–Mar 2022 from the nationwide electronic health record-derived Flatiron Health database. Use of biomarker testing (BRCA mutation [BRCAm] only and homologous recombination deficiency [HRD] not including BRCAm tests) and 1LM therapy (PARP inhibitor ± bevacizumab, bevacizumab monotherapy, or other 1LM) were evaluated by SES (scored 1 [low]–5 [high]), race, and US region, using descriptive statistics and chi-squared testing. Results: Of 907 pts included, 91% were from community clinics; median age was 68 years. Overall, 87% (n=787/907) of all pts were BRCAm tested (test type: 31% [n=247/787] germline, 52% [n=411/787] somatic, and 16% [n= 129/787] unknown testing type); 28% (n=255/907) were HRD tested. Of pts who were germline BRCAwt, 22% (n=45/201) underwent additional HRD testing. Of all non-BRCAm pts (defined as germline or somatic BRCAwt or BRCAunknown pts), 28% (218/772) underwent HRD testing; they were more likely to have had surgery (91% vs 71%) vs those who were not HRD tested. Pts with SES score 1 and Black pts had numerically lower testing rates vs the overall population and the relationship between BRCAm testing rates and SES was significant ( P <0.05) (Table). Of all biomarker-tested pts, 49% (n=387/788) received 1LM therapy (71% [n=96/135] of BRCAm, 68% [n=54/80] of BRCAwt/HRD-positive, and 47% [n=55/118] of HRD-negative pts). Among non-biomarker-tested pts, 82% (n=98/119) did not receive 1LM therapy. 1LM therapy use was comparable across SES, race, and US region. Conclusions: While most pts with AOC underwent BRCAm testing, some differences in biomarker-testing rates by SES and race were observed in our study. Further exploration of these differences is required to better understand potential disparities in testing, treatment, and outcomes.[Table: see text]
From quality measures to disparity signatures: Elucidating cancer within-hospital hospice racial disparities using clinically informed machine learning.
Authors: Khayal Inas S , Brooks Gabriel A. , O'Malley A. James , Barnato Amber E
Published: October 2023

179

Background: Racial disparities in hospice care are well documented for patients with cancer, but the existence, direction, and extent of disparity findings are contradictory across the literature. Current methods to identify racial disparities aggregate data to produce single-value quality measures that exclude important patient quality elements, such as timing of initiation and length of stay, and, consequently, lack information to identify actionable equity improvement insights. Our goal was to develop an explainable machine learning approach that elucidates healthcare disparities and provides more actionable quality improvement information. Methods: We infused clinical information with an engineering systems modeling approach, and data science to develop a time-by-utilization profile per patient group at each hospital. We applied this approach to US Medicare hospice utilization data for a patient cohort of beneficiaries with poor-prognosis advanced cancer that died April-December 2016. We calculated the difference between group profiles for people of color and white people to identify racial disparity signatures. Using machine learning, we clustered racial disparity signatures across hospitals and compared these clusters to classic quality measures and hospital characteristics. Results: With 45,125 patients across 362 hospitals, we identified 7 clusters; 4 clusters (n=190 hospitals) showed more hospice utilization by people of color than White people, but at varying times, 2 clusters (n=106) showed more white patient hospice utilization than people of color, and 1 cluster (n=66) showed no difference. We found no evidence that quality measures or hospital characteristics explain the shape of disparity signatures. Our approach of explicitly incorporating time ``informs" machine learning to explicitly design for an understanding of racial disparities. Our findings suggest unique and heterogeneous within-hospital racial disparity behaviors that cannot be predicted from quality measures or exogenous hospital characteristics and show how the true shape of disparities can be distorted through the lens of quality measures. Conclusions: The developed informatics approach is first to elucidate the shape of hospice racial disparities within hospitals algorithmically from administrative claims data. Racial disparity signatures that may help explain mixed literature findings and highlight the importance of developing bespoke equity solutions.
Prescription savings across oncology: A cost comparison of Mark Cuban Cost Plus Drugs pharmacy against 2021 Medicare Part B and Part D claims.
Authors: Bouvette Max Joseph , Lam Anh , Bouvette Christopher Adam , Ayanambakkam Adanma , Nipp Ryan David
Published: October 2023

18

Background: The Mark Cuban Cost Plus Drug Company (MCCPDC) was established in 2022 to provide more affordable and transparent access to prescription medications. While prior work has demonstrated the cost-efficacy of MCCPDC, there remains a need to increase awareness of this public-benefit corporation, especially among healthcare professionals and patients using oncologic drugs covered by Medicare Part D and B. Methods: We identified 9 cancer-directed drugs available for purchase on the MCCPDC pharmacy. Potential savings were estimated by substituting the unit price for Medicare claims with the pricing models offered by MCCPDC. We evaluated oncologic claims utilizing 2021 Medicare Part B and D Spending by Drug data. We extracted the total dosage units, beneficiaries, and average spending per dosage unit for each respective drug. The unit price was determined from Medicare claims and then compared against cost projection using MCCPDC 30-count (30c) and 90-count (90c) supplies. When MCCPDC offered multiple dosages, the most expensive dose was chosen to provide a conservative estimate. We used the National Average Drug Acquisition Cost (NADAC) database to adjust for raw ingredient and manufacturing cost changes between 2021-2023. Results: Across the 9 selected oncological drugs, estimated Medicare Part D and B spending totaled $1.21 billion. When filled at the 30c and 90c MCCPDC unit price point, projected costs were $203 million and $147 million respectively (% savings; 83%, 88%). All drugs claimed on Medicare Part D demonstrated an advantaged 90c price point when filled through MCCPDC (% savings range: 40-98%). At the 30c price point, only anastrozole was unfavorable (% loss; 7%). Out of the three drugs claimed on Medicare Part B, capecitabine and temozolomide demonstrated savings at both 30c and 90c unit price points (% savings range; 28-80%). Methotrexate remained unfavorable at either MCCPDC price point when compared to Medicare B coverage (% loss; 18%, 129%). In total and across Medicare Part D and B claims, estimated savings when filled at the MCCPDC 90c unit price point are $1.06 billion. Conclusions: We demonstrate a potential annual savings of $1.06 billion with MCCPDC compared to Medicare D and B coverage. An awareness of current drugs offered by MCCPDC and particularly those with a highly favorable price point may allow healthcare professionals to more effectively navigate the socioeconomic barriers to care often faced by patients. [Table: see text]
Limited health literacy in Hispanic caregivers of children with cancer and childhood cancer survivors.
Authors: Aristizabal Paula , Bird Victoria , Robles Joanna , Nodora Jesse , Martinez Elena
Published: October 2023

190

Background: Health literacy (HL) is the individual’s ability to find and use information and services to make health decisions. Limited HL is associated with poorer outcomes. HL is vastly understudied in childhood cancer. Thus, we investigated HL and associations with Social Determinants of Health in caregivers of children with newly diagnosed cancer and of childhood cancer survivors. Methods: We conducted a prospective cross-sectional study in caregivers of children with newly diagnosed cancer and caregivers of childhood cancer survivors at Rady Children’s Hospital (2016-2019). Caregivers completed questionnaires in-person to assess sociodemographics, acculturation and HL with the Test of Functional Health Literacy (S- TOFHLA) and the Newest Vital Sign (NVS). Results: 459 caregivers were enrolled (199 caregivers of children with newly diagnosed cancer and 260 caregivers of childhood cancer survivors). 56% (n=256) were Hispanic and of those, 38% were Spanish-speaking, and 53% had low acculturation. Hispanics, compared to non-Hispanic Whites, had lower S-TOFHLA and NVS scores (p<0.001). Moreover, Hispanics had lower income (p<0.001) and lower education attainment (p<0.001), and were more likely to have public insurance (p<0.001), and unmarried marital status (p<0.001). Adjusted multivariable regression showed a higher odds ratio (OR) of limited HL in caregivers with education level of high school or less (OR=3.040, 95%CI:1.308,7.087), unmarried marital status (OR=2.573, 95%CI:1.065, 6.424), and Spanish as preferred language (OR=5.072, 95%CI:1.960,14.018). Conclusions: We found that Hispanic and Spanish-speaking caregivers of children with newly diagnosed cancer and caregivers of childhood cancer survivors were at higher risk for limited HL. Hispanics were also more likely to have public insurance, unmarried marital status, and lower education level. In underserved groups such as these, HL is an especially critical component of navigating cancer care and making informed health decisions. It is, therefore, essential to direct future research efforts towards developing interventions to improve HL in underserved populations to improve cancer clinical outcomes.
Multidisciplinary education and action to foster equitable cancer care.
Authors: Augustyniak Monica , Eldridge Karen , Gurtler Jayne S. , Muluneh Benyam , DePue Amy , Rodriguez-O'Donnell Julia , Atkinson Stacy , Peloquin Sophie , Murphy Ann , Lazure Patrice
Published: October 2023

193

Background: Disparities in cancer care occur when patients are offered inequitable quality of care due to socioeconomic characteristics, affecting patient outcomes (e.g., survival rates). A five-part education (three articles, a webinar, and an infographic) was designed for multidisciplinary oncology care team members to build an enhanced awareness of cancer care disparities and inspire action to foster equitable cancer care. This study evaluated the impact of the education on the learning outcomes of participants. Methods: The evaluation combined quantitative and qualitative methods assessing learners’ knowledge, confidence, change in practice and barriers to change. Collected data included 1) matched pre- and post-activity questions, 2) a post-activity survey evaluation, 3) a post-activity 30-minute interview. Where relevant, categorical data were recoded into binomial values (e.g., 0=incorrect, 1=correct) and knowledge-based responses computed into scores (0-100%). Quantitative data was subject to descriptive and pre-post analysis (McNemar statistical tests for binomial values, paired t-tests for continuous values). Qualitative data (Interview transcripts, open-field responses) were subject to inductive thematic analysis. Results: Of 2,850 completers, 1,151 were graduated healthcare professionals (58% nurses, 23% advanced practice providers, 11% physicians, 8% other), involved in cancer care in the United States. Across all activities, knowledge scores for cancer care disparities and strategies to foster equitable care were significantly higher post-activity (79-91%, depending on activity) than pre-activity (23-62%, p<.001). Similarly, the percentage of learners that were confident in their ability to a) address the personal factors impacting a patient’s willingness to pursue screening or treatment and b) identify practices that can foster equitable care to all cancer patients were significantly higher post-activity (51-75%) than pre-activity (27-38%, p<.001). Thematic analysis of qualitative responses showed that learners identified the following strategies to ensure equitable cancer care: a) multidisciplinary collaboration, b) open lines of communication with patients, c) frequent follow-ups, and d) community outreach. Barriers to change included a lack of organizational capacity and shortage of staff. Conclusions: This intervention encouraged multiple professions in oncology care to learn and reflect on factors driving disparities in cancer care. The intervention was shown to be impactful on the educational outcomes of healthcare professionals in terms of identifying strategies that can tangibly enhance cancer care equity and resulting patient outcomes. A sensitisation and problem-solving approach during the five activities underscored the importance of a multidisciplinary collaboration as a key strategy to addressing cancer disparities.
Establishing an oncology stewardship committee during the era of drug shortages.
Authors: Cook Rachel J. , Jiing Susie , McCord Keren , Kardosh Adel , Diaz Amber , Lindemulder Susan , Hayes-Lattin Brandon M.
Published: October 2023

212

Background: Chemotherapy shortages are common, causing rationing when demand exceeds supply. Hospital systems and pharmacies are responsible for chemotherapy ordering - there is no national distribution system. There is risk for inequitable and/or unethical allocation of scarce resources. Prescribing providers are at risk when making individual allocation decisions and leave themselves exposed to medicolegal risk. Given the frequency of supply shortages of antineoplastic, biologic or cellular therapies, we identified a need to create a framework for management of limited supplies and prioritization of allocation decisions. Methods: To ensure a consistent and transparent approach, the Oncology Stewardship Committee (OSC) was established, compromised of multidisciplinary representatives (adult/pediatric physicians, pharmacists, social workers, nurses, and ethicists). The committee based its work on a framework of ethical values and guiding principles, including maximizing benefits (urgency of need, likelihood of benefit, availability of alternatives) and fairness (not upon patient demographics, ability to pay, or financial impact to the health system). A tiered plan for each therapy in shortage was created (table), starting with monitoring and escalating to mitigation through conservation, allocation through a vetted pathway with an appeal process, and up to randomization if all other options were exhausted. Results: The OSC was assembled, agreed upon principles and processes, and launched in 2022. An example for which management escalated to “Tier 3” was fludarabine. During active management of fludarabine, 238 eligible patients were considered, 158 met restriction criteria and 80 were assigned an alternative therapy. Conclusions: The formation of an institutional OSC allowed for improved transparency and equitable allocation of scarce resources. In future, this framework will be used for ongoing drug shortages in addition to management of non-formulary requests.[Table: see text]
Recruitment of informal caregivers into research studies in community oncology practices: Results from the 2022 NCI Community Oncology Research Program (NCORP) Landscape Committee Assessment.
Authors: Wang Ying , Nightingale Chandylen L , Braun-Inglis Christa M , Sterba Katherine R. , Weaver Kathryn E. , Wood Eden , Kadambi Sindhuja G , Gada Umang , Montes Alexander , Magnuson Allison , Yilmaz Sule , Culakova Eva , Strause Sarah , Kamen Charles Stewart , Mustian Karen Michelle , Morrow Gary R. , Mohile Supriya Gupta , Loh Kah Poh
Published: October 2023

219

Background: Understanding experiences of community oncology practices in recruiting informal (unpaid/family) caregivers into research studies can inform resources and strategies to improve their enrollment. In this study, we aimed to describe the recruitment of informal caregivers for research studies in community oncology practices. Methods: The 2022 cross-sectional Landscape Assessment of National Cancer Institute Community Oncology Research Program (NCORP) assessed research capacity among network oncology practices. The University of Rochester Cancer Center (URCC) NCORP Research Base used these data to examine factors associated with the recruitment of informal caregivers into research studies in community oncology practices, adjusting for region of the country, practice ownership type, and total number of oncologists in logistic regression analyses. Results: Information was available from 517 discrete practices representing 271 practice groups. After excluding those serving pediatric patients exclusively (n=12) and missing information on recruitment of informal caregivers (n=1), 258 practice groups were included in final analyses. The practice groups had on average 20 oncologists [standard deviation (SD) 28.8]. Over 70% of practice groups (190/258) had advanced practice providers (APPs) involved in clinical research activities. Less than one third of practice groups (30%, 78/258) had experience recruiting informal caregivers of oncology patients for research studies. Informal caregivers were recruited in the following settings: medical oncology (97%, 76/78), radiation oncology (24%, 19/78), survivorship clinic (14%, 11/78), and surgical oncology (10%, 8/78). On multivariable analysis, having a greater number of oncologists [odds ratio (OR) 2.40, 95% Confidence Interval (95% CI) 1.23 - 4.67] and having APPs involved in clinical research activities (OR 2.32, 95% CI 1.13 - 4.76) were positively associated with experience recruiting informal caregivers for research studies. Conclusions: Most community oncology practices did not have experience recruiting informal caregivers of oncology patients, which may reflect limited research in this area. Future research should explore barriers for recruiting informal caregivers into research studies, especially in practices that may have fewer resources such as small community oncology practices or those without APPs involved in research activities.
Acceptability to patients and caregivers of a prognostic tool for near-term death from advanced breast cancer.
Authors: Ray Emily Miller , Carda-Auten Jessica , Hilton Alison , Elston Lafata Jennifer Elston , Reeder-Hayes Katherine Elizabeth , Teal Randall , Stover Angela M.
Published: October 2023

233

Background: Oncologists struggle to know which patients are near the end of life to enable timely transitions to supportive care. We developed and validated a breast cancer-specific prognostic tool for near-term death using electronic health record data from CancerLinQ Discovery, a national oncology database. In our prior work, oncology clinicians described the tool as potentially beneficial in considering whether to continue cancer-directed treatment, providing prognostic information to patients who want it, planning for supportive care, and guiding patient conversations. To prepare for implementation of the tool in usual care, we sought to understand the perspectives of patients with metastatic breast cancer (MBC) and caregivers regarding discussions of prognosis and use of the tool. Methods: We identified patients with MBC and caregivers through the UNC Breast Oncology Clinic. We conducted in-depth, semi-structured interviews by phone to assess participant beliefs and experiences about discussing prognosis with their oncologist and potential benefits and harms of using the tool in usual care. Interviews were audio recorded and transcribed, and data were analyzed using a coding-based thematic analysis. Results: We conducted 19 in-depth interviews (11 patients and 8 caregivers) from July 2022 to February 2023. Patients and caregivers had varying preferences for conversations regarding prognosis, ranging from not wanting to discuss prognosis to identifying preferences for the content and timing of these conversations. Perceived benefits of a prognostic tool included helping them make decisions about more cancer treatment versus increased supportive care, signaling the need for more end-of-life resources, decreasing uncertainty, and helping plan for the future. Among patients and caregivers who perceived risks of the tool, most identified general concerns related to discussions of prognosis, including provoking anxiety, signaling for a patient to “give up,” and suggesting to a patient their clinician had given up. Others identified specific concerns about the tool, including the possibility of receiving incorrect information. Conclusions: Implementation of a prognostic tool for near-term death from advanced breast cancer into routine clinical care must consider the perspectives of patients and caregivers with different preferences for prognostic information. Objections to use of the prognostic tool centered on beliefs regarding the appropriateness of prognostic discussions overall, rather than the specific role the tool would play in the discussion. Next steps include studying how to elicit patient and caregiver preferences for prognostic information in the clinic and how to help oncologists initiate serious illness conversations and utilize this prognostic tool in a way that aligns with patient and caregiver preferences.