bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of pre-treatment anemia on survival in locally advanced head neck squamous cell carcinomas treated with radiation with or without concurrent chemotherapy.
Authors: Shah Minit Jalan , Patil Vijay Maruti , Noronha Vanita , Menon Nandini Sharrel , Singh Ajaykumar Chandrabhan , Jobanputra Kunal Naishadh , Peelay Zoya Ravish , Prabhash Kumar
Published: June 2023

e18079

Background: Locally advanced head neck squamous cell carcinomas (LAHNSCCs) are treated either with surgery followed by radiation (RT) alone, surgery followed by concurrent chemoradiation (CTRT) or definitive CTRT. Patients receiving RT need to have an optimal hemoglobin (Hb) level, however there is limited data on what is an optimal pre-treatment Hb level required during RT/CTRT in these patients. Hence we performed this analysis. Methods: This data is a pooled analysis of 3 major randomized studies (RCT) performed in the field of chemoradiation over the last decade. These include, a RCT comparing weekly versus (vs) 3 weekly cisplatin in LAHNSCC‘s, weekly cisplatin vs weekly cisplatin plus nimotuzumab in the definitive setting in LAHNSCC‘s and in cisplatin ineligible patients, a comparison of radiation vs docetaxel plus radiation. The baseline demographics, Hb levels, and outcomes were collected and used for analysis. To ensure unanimity, anemia was defined as < 12g/dL in both males and females. Univariate (UVA) and multivariate analysis (MVA) evaluated the factors affecting anemia. The impact of anemia on locoregional control (LRC), disease free survival (DFS) and overall survival (OS) was studied. Kaplan meier analysis was used for estimation of time to event parameters and log rank test was used for comparison. Cox proportional hazards model was used to test the importance of anemia in presence of other important parameters like age, gender, T and N stage, concurrent chemotherapy including its pattern (weekly vs 3 weekly) and site of disease. Results: We studied 1192 patients. Anemia of any grade was seen in 417 patients (35.0%), with the median Hb levels of the entire cohort being 12.8g/dL (IQR 11.6-13.9). Grade 3 or higher anemia (Hb < / = 8g/dL) was seen in only 2 patients (0.2%). Female gender, oral cavity disease, patients with stage IV disease and those receiving adjuvant CTRT significantly impacted anaemia on UVA (p = 0.000 for all). MVA confirmed advancing age (p = 0.001), female gender (p = 0.000), patients with stage III and IV disease (p = 0.009) and those treated with adjuvant CTRT (p = 0.011) to significantly impact anemia. The LRC in patients with or without anaemia was 12.9 months (95%CI 7.8-18.0) and 23.5 months (95%CI 17.8-29.2) respectively (p = 0.000). Similarly the DFS and OS in anemic and non anemic patients were 9.6months (95%CI 6.0-13.2) vs 18.5months (95%CI 12.4-24.7, p = 0.022) and 21.5months (95%CI 16.3-26.8) vs 39.9months (95%CI 31.0-48.9, p = 0.000) respectively. Conclusions: Pre-treatment anemia in LAHNSCC‘s leads to a decrement in treatment outcomes (LRC, DFS and OS) and is an independent prognostic factor.
The smart options of induction therapy for locally advanced betel-nuts related HNSCC in Taiwan.
Authors: Chen Jo-Pai , Lu Wei-Chen , Chiang Keng-Man , Chen Hsing-wu , Huang Huai-Cheng , Chang Chen-Han , Kuo Sung-Hsin
Published: June 2023

e18080

Background: The treatment of HNSCC in Taiwan is still very challenging and might be related to betel-nuts use. Betel nut chewing might contribute to strong angiogenesis/invasion and treatment refractoriness. In western countries where HPV+ oropharyngeal cancer prevalence is high, induction TPF (TAX323/324) response rate in locally advanced HNSCC is around 70%; Erbitux and TP (Argiris in JCO2008) induction response rate is 86%. In the analysis from KGMH in Taiwan, induction chemotherapy response for locally advanced HNSCC was 55% in betel-nuts chewers compared with 75% in non-users ( p=0.038; From Su in World Journal of Surgical Oncology 2016). In further studies from Taiwan, Avastin-PF induction benefit (ORR 80%) was also prominent from NTUH (Huang in ESMO Asia2016); Erbitux-TPF induction response rate was 88% from VGH by Lu in Head & Neck2019. Neoadjuvant biochemotherapy seemed to bring more benefits in betel-nuts related HNSCC. In the era of incorporating immunotherapy to neoadjuvant setting of HNSCC, triple therapy of bio-chemoimmunotherapy deserves more attention. Methods: From 2012 to 2022, 111 unresectable stage IVA & IVB betal-nuts related HNSCC patients (OSCC 69, Hypopharynx 26, OPC 13) had ever received induction Bio-chemotherapy or triple therapy (Bio-chemoimmunotherapy) in Yun-lin Branch of National Taiwan University Hospital. We have reviewed basic characteristics, therapeutic regimens, induction response, and final outcomes of these patients. Results: See table. Conclusions: Induction TPF response in locally advanced betel-nuts related HNSCC in Taiwan was not so prominent. Flexible chemotherapy backbones, such as TP/DP-HDFL(weekly docetaxel or paclitaxel with cisplatin and 24-hr high dose 5-fluorouracil/leucovorin infusion), might produce acceptable response rates with less toxicity. Bio(EGFR or VEGFR-targeting)-chemotherapy or Bio-chemoimmunotherapy has brought encouraging induction response with favorable toxicity profiles to conversion surgery or definite CCRT. Further investigation and clinical trials will be urgently warranted. [Table: see text]
tRNA-derived fragments (tRFs) as regulators of oncogenes and tumor suppressor genes in head and neck squamous cell carcinoma.
Authors: Uzelac Matthew , John Daniel , Chakladar Jaideep , Li Wei Tse , Ongkeko Weg M.
Published: June 2023

e18082

Background: Roughly 50,000 individuals are diagnosed with head and neck cancers in the United States yearly. Though risk factors and common therapeutic strategies are well-established, early detection of head and neck cancers remains challenging. One strategy for early detection is high-throughput analysis of both coding and noncoding RNA transcripts, which has become increasing implicated in cancer pathogenesis. One such noncoding transcript is tRNA-derived fragments (tRFs), which are the products of enzymatic cleavage of precursor tRNAs. Though tRFs have been suggested to play important roles in the regulation of mRNA translation (similar to other noncoding RNAs), their utility as cancer biomarkers is not well-known. Methods: In this study, we investigate tRFs for correlation to cancer prevalence with specific consideration of translational regulation of oncogenes (OG) and tumor suppressor genes (TSG). tRF read counts were obtained for 499 head and neck squamous cell carcinoma tumor tissue samples and 44 adjacent normal samples. Results: The read counts between both groups were compared to identify tRFs dysregulated in tumor samples, which may be pertinent biomarkers for diagnosis. Ten tRFs were found to be significantly dysregulated in cancer samples. These tRFs were further assessed for correlation to expression of OGs and TSGs using the COSMIC database. Due to the mRNA-degrading nature of tRFs, we analyzed tRF abundance for inverse correlation to gene expression. Four tRFs upregulated in tumor samples showed significant anticorrelation to select TSG expression (ATP2B3, CSMD3, LZTR1, NTHL1, PTPRC), and three tRFs downregulated in tumor samples showed anticorrelation to OG expression (A1CF, MPL, SALL4, TNC). Notably, LeuCAG 5’ tRF was associate with high binding affinity for the TSGs CSMD3 and LZTR1, supporting the likelihood of tRF-mediated degradation. Interestingly, this tRF was inversely correlated with patient survival length. LeuCAG 5’ was also of significantly lesser abundance in patients who experienced complete or partial remission following chemotherapy treatment, further indicating this tRFs’ clinical relevance in HNSCC, potentially as an oncogenic-related agent. Conclusions: Investigation into these tRFs may reveal their potential for use in early diagnosis. High abundance of this tRF may be indicative of oncogenesis. In exploring tRFs’ for their potential as biomarkers of cancer, they may prove useful in allowing earlier diagnosis. Moreover, studying tRFs may provide additional considerations for patient care and treatment.
Ceruminous adenocarcinoma: A National Cancer Database study of demographic characteristics.
Authors: Hsia Beau , Keirns Darby , Silberstein Peter T. , Wu Xinxin
Published: June 2023

e18084

Background: Ceruminous adenocarcinoma (CA) is a rare form of malignancy that originates from the ceruminous glands located in the external auditory canal. Despite its rarity, 25% of CA patients succumb to the disease within two years of diagnosis. Radiation treatment improves the 10-year survival rate to 60%, up from 30% without radiation treatment. Due to the rarity of CA, the diagnostic trend of the disease could offer valuable insight into its epidemiology. The National Cancer Database (NCDB) database was analyzed to determine the demographic factors in patients diagnosed with CA. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included patients with a histologically-confirmed diagnosis of CA (N = 37). Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles/Deyo score) were analyzed by descriptive statistics and incidence trends were interpreted in regression analysis. Results: A total of 37 patients were identified in the database with a confirmed diagnosis of CA between 2004 – 2020 with a steady incidence of patients diagnosed per year (R2 = 0.0). The average age of diagnosis was 59.7 years (SD = 16.5, range = 14 – 90 years). The top primary site was the external ear (89.2%), although primary sites on other areas of the skin did occur. Most individuals (89.2%) had Charlson/Deyo comorbidity scores of 0. The majority of the patients were Non-Hispanic White (89.1%). More patients were in the top quartile of income earners (35.5.%) compared to those in the second, third, or fourth quartiles. A higher percentage of patients were privately insured (51.4%) than those who were uninsured or insured by Medicare/Medicaid. More patients lived in metropolitan counties with a population greater than 1 million (43.2%) than in other metropolitan counties (35.1%). Fewer patients were treated in an academic/research program (40.5%) than in a non-academic program (46.0%). Patients lived an average of 43.3 miles (SD = 74.7, range = 1.8 – 370) from the treatment facility. No patients received palliative care. Conclusions: This is the first NCDB analysis on CA to the best of our knowledge and thus addresses a significant knowledge gap on the topic. The majority of CA patients tend to be non-Hispanic and White with a primary site diagnosis presenting at the external ear, similar to earlier descriptions in case reports. This is the first time the socioeconomic factors of CA patients have been described in the literature: CA patients are more likely to be in the top income quartile, live in densely-populated metropolitan areas, and be treated in a non-academic program. Further research is needed to better understand the impact of demographic and socioeconomic factors on the diagnosis of, treatments utilized against, and overall survival of patients with CA.
Genomic characterization of papillary thyroid carcinoma in Chinese Shandong population.
Authors: Li Xungeng , Du Licheng , Li Jiyu , Zheng Luming , Zhang Jun , Sun Yongjie , Qi Ming , Shang Xingchen , Yang Shunchao , Xing Jialiang , Wang Meng , Han Ke , Liu Chuang , Li Ling
Published: June 2023

e18085

Background: With the emergence of mutation-based diagnosis and therapies for patients with papillary thyroid carcinoma (PTC), molecular profiling has become an important component of care. Although next-generation sequencing (NGS) gene panels are accessible to clinicians, the key genetic alterations of PTC in Chinese Shandong population were rarely descripted. Methods: A total of 127 papillary thyroid carcinoma patients were enrolled in this cohort, including 49 (38.6%) males and 78 (61.4%) females from January 2020 to May 2022. The median age were all 48 years. Formalin-fixed, paraffin-embedded (FFPE) tumor tissues were all collected and analyzed from these patients. Somatic and germline mutations were identified including 38 genes associated with tumor development. Sequencing data were analyzed to call tumor specific single nucleotide variants (SNV), small insertions and deletions (InDels), copy number alterations (CNA), gene fusions and rearrangements. Results: A total of 117 out of 127 papillary thyroid carcinoma were NGS-positive (92.1%), with a high prevalence of BRAF V600E mutations (52.0%, 66/127) and MLH1 mutations (23.6%, 30/127), and a low prevalence of RAS mutations (10.2%, 13/127)， ROS1 (9.4%, 12/127). Overall, 257 somatic mutations including 249 SNVs (6 splicing, 4 stopgain, 4 frameshift，and 235 nonsynonymous), 3 fusions, 3 deletions, and 1 insertions in 38 genes were identified in the PTC samples. Gene fusions, involving the RET and NTRK1 genes, were identified in three PTCs (2.4%), including NTRK1-TPM3, NTRK1-SQSTM1 and CCDC6-RET. And the three fusions patients were all BRAF V600E-negative cases. Furthermore, in our cohort, BRAF V600E mutation carriers also owned other actionable, the most frequent one was MLH1 (34.8%), followed by RET (15.2%), ROS1 (10.6%), and ATM (10.6%). We also found that three PTC patients carried germline variants of uncertain significance, including ATM (p.L857P), MET (p.L211W) and RET (p.C515R), which are heterozygous mutations. Conclusions: We described the distinct molecular profile in the Chinese Shandong population with PTC. Most patients had at least one potentially actionable mutation, predominantly driven by BRAF V600E and MLH1 alterations. These findings may help in moving toward the more comprehensive and effective personalized treatment of papillary thyroid carcinoma in Chinese.
Mixed medullary-follicular carcinoma: A national analysis and the demographic features.
Authors: Tade Yanick , Keirns Darby , Hsia Beau , Silberstein Peter T. , Wu Xinxin
Published: June 2023

e18090

Background: Mixed medullary-follicular carcinoma (MMFC) is a rare malignant type of cancer that affects the thyroid. Unlike other thyroid cancers, MMFC is distinct by its solid-nonfollicular pattern which includes both follicular and C-cell elements. Nearly 70% of patients present with distant metastasis to the lungs, bone, brain and/or liver with a median survival time of 75 months, plus or minus 51 months. Because MMFC is a rare cancer, analyzing the trend in diagnoses can provide important information about its epidemiology. The National Cancer Database (NCDB) was analyzed to determine how patient demographic characteristics affected diagnosis of MMFC. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 153 patients were found with a histologically confirmed diagnosis of MMFC (ICD-8346-3). Gender, race, Hispanic origin, level of education, insurance coverage, type of treatment facility, and distance from facility were analyzed via descriptive statistics and trends in incidence were interpreted using regression analysis. Results: The frequency of patients diagnosed with MMFC has remained consistent since 2004 (R2 = 0.1) with over 10 diagnoses per year. Of the 153 patients found, the average age of diagnosis was 59.05 years (SD = 14.36, range = 18 – 90 years). Approximately two-thirds of patients were female (62.7%) and the remainder were male (37.3%). Most of the patients were Non-Hispanic White (86.3%) compared to 7.2% of the patients which were of Spanish-hispanic origin. More patients were in the top income quartile (37.3%) than those in the second (18.3%), third (21.6%), or fourth (11.1%) quartiles. The other 11.8% were of unknown income status. The majority of patients were privately insured (52.9%), followed by coverage under Medicare/Medicaid (43.1%). More patients lived in metropolitan counties with a population of 250,000 or more (88.2%) compared to urban or rural areas (11.8%). A large percentage of patients were treated at an academic or comprehensive community cancer program (72.6%) compared to non-academic programs (27.4%). Patients traveled an average of 33.9 miles (SD = 93.90, Range = 0.5 – 806.8) to get to the treatment facility. Conclusions: MMFC remains a rare diagnosis. This study explores a significant gap in existing knowledge on patient characteristics that might present with MMFC. The majority of patients were White, non-Hispanic, insured by private insurance, lived in metropolitan areas, and in the top quartile of income earners. This novel study of socioeconomic factors in MMFC patients suggest that patients diagnosed with this uncommon cancer might have better access to diagnosis. Previous literature on MMFC suggested a predilection for males, but our findings serve as contrary evidence for such preference. As such, additional research to comprehend the role that sex and socioeconomic status might have on MMFC would be valuable.
Comprehensive genomic analysis of salivary gland carcinomas in a Chinese population.
Authors: Lu Hao , Zhang Xi , Liu Shengwen , Xu Wanlin , Zhu Yun , Wu Yifan , Qin Xingjun , Ren Guoxin , Hao Qing , Zhang Liwen , Guo Lijie , Yang Wenjun
Published: June 2023

e18094

Background: Salivary gland carcinomas (SGCs) represent a heterogeneous group of poorly characterized head and neck tumors, which are rare and challenging to treat. A strategy based on molecular screening and targeted therapy seems to be the best approach for treating patients with SGCs in the future, whereas the genomic mechanisms of SGCs are largely unclear. Methods: A total of 49 patients with histologically confirmed SGCs, including mucoepidermoid carcinoma (MEC, n = 10), adenoid cystic carcinoma (ACC, n = 20), carcinoma ex pleomorphic adenoma (cxPA, n = 10) and other pathological types (n = 9) were enrolled in our study. Tumor tissue specimens were collected and targeted next-generation sequencing for 450 cancer-related genes was performed in OrigiMed (Shanghai, China), a College of American Pathologists (CAP) accredited and Clinical Laboratory Improvement Amendments (CLIA) certified laboratory. Results: In all samples, the most frequently mutated genes were MYB (26.53%), TP53 (26.53%), ERBB2 (12.24%), KMT2D (12.24%), and TERT (12.24%). Actionable genes included ERBB2 (12.2%), PIK3CA (8.2%), ATM (4.1%), CDKN2A/B (4.1%), and EGFR (4.1%). Among these patients, female patients accounted for a higher proportion in ACC compared to that in MEC and cxPA (ACC: 65%, MEC: 30%, cxPA: 30%). Gene fusions/rearrangements were identified in 13 tumors, and 10 (76.9%) had evidence of MYB-NFIB fusion, which may represent an important new therapeutic target for ACC. Higher frequency of MYB (p < 0.0001) and EP300 (p = 0.0445) mutations was also identified in ACC compared with that in other types. Mutational frequencies of TP53 (p = 0.0096) and ERBB2 (p = 0.0228) were obviously higher in cxPA, whereas the frequency of CCNE1 (p = 0.0433) mutations were significantly higher in MEC compared with those in other types. The gene mutations of Chinese SGCs were mainly enriched in RTK/RAS (56.7%), TP53 (40.8%), Notch (34.5%), and PI3K (30.5%) signaling pathways. Conclusions: This report revealed the molecular characteristics of Chinese SGC patients diagnosed with different pathological types, which would be helpful for the investigation of the underlying genomic mechanisms of SGC. Our result highlights the potential role of gene alterations, many of which could conceivably be actionable with targeted therapies.
Retrospective analysis of NUT carcinoma: The Northwestern experience.
Authors: Serritella Anthony V. , Obeidin Farres , Boumber Yanis , Patel Jyoti D. , Li Haimin , Yi Rui , Lorch Jochen H.
Published: June 2023

e18096

Background: NUT carcinoma (NC) is a rare, highly aggressive carcinoma that originates from a wide variety of organs, typically presenting as poorly differentiated squamous cell carcinoma. Cases typically are aggressive, with a median overall survival (OS) of only 6.5 months. Given only 40-50 cases are diagnosed in the United States annually, NC is an orphan disease with no standard treatment options and the outlook is generally poor. A previously published case of thyroid NUT carcinoma demonstrated a prolonged response to pembrolizumab for > 3 years. Methods: Patients (pts) harboring NUTM1 rearrangements were retrospectively identified at our institution. We reviewed characteristics related to tumor immune microenvironments by tumor immunohistochemistry and next generation sequencing as well as clinical outcomes. Results: 10 NMC pts were identified (5 female, 5 male): lung (6), thyroid (2), primary mediastinal (1), maxillary sinus (1). The median age at diagnosis was 49 years (range of 27-75). The thyroid cases were diagnosed at ages 51 and 75. 8/10 had metastatic or unresectable disease at diagnosis, 3 of which with central nervous system metastases. In 8 evaluable patients, NUTM1 rearrangements included BRD2 (1), BRD3 (1), BRD4 (2), NSD3 (3), SCL12A6 (1). Median OS was 10.8 months (range 1.1-75.8m); 3/10 patients were deceased. 3 patients received IO (2 ipilimumab/nivolumab, 1 pembrolizumab) after either surgery, RT, or chemotherapy combined with RT. Patients who received IO had a median survival of 18 months (range 10.9-76.0 months) compared with 8.5 months in the 8 patients not receiving IO (p = 0.07). All patients with tissue available in this cohort all had PD-L1 staining < 5%, were microsatellite stable (MSS) and had a low median tumor mutation burden (TMB) of 3.1 mut/Mb. Conclusions: In our series, NC originating from the thyroid gland accounted for more cases than expected, thyroid NC patients were older than NC cases arising in other locations and with the more typical squamous histology. Despite relatively low PD-L1 staining, TMB, and MS status, our data suggests NMC tumors may be amenable to treatment with immune checkpoint inhibitors, warranting further investigation.
Overall survival trends of papillary thyroid cancer: A Surveillance, Epidemiology, and End Results (SEER) population-based data (2002-2016).
Authors: Balozian Patil , Al Armashi Abdul Rahman , Boustany Antoine , Palaparty Poornanand
Published: June 2023

e18108

Background: In the United States, the 5-year survival rate for patients with thyroid cancer is 98%. However, survival rates are mainly influenced by the type of thyroid cancer and the stage of the disease. The tremendous research in the area and the need to assess outcomes of recently implemented treatments necessitate the evaluation of the epidemiology and overall survival rates of the most common type of this malignancy, papillary thyroid cancer (PTC). Although the cause-specific survival (CSS) of Papillary Thyroid Cancer (PTC) patients has been extensively investigated, the overall survival (OS) of these patients is unclear. In this study, we aim to conduct an evaluation of survival trends after PTC diagnosis by stage of disease for the years 2002 through 2016 in the United States. Methods: We used the SEER 9 database to study PTC cases during 2002-2016. The patient survival data for the three disease stages (local, regional, and distal) were compared for the two time periods of interest, (2002-2008) and (2009-2016). The data for each cohort were split into six groups, (those whose deaths were in each of the five one-year intervals and those surviving the five-year follow-up period). These categorical counts were compared by the chi-square test of contingency table data. Statistical significance was taken as a p-value less than 0.05. Results: We reviewed 73,333 PTC cases in the United States from 2002 through 2016. There was an overall survival improvement with the exception of the distal stage, which did not demonstrate any statistical difference in the 2-time frames of interest. For local sites, there was a highly significant difference between the survival distributions of patients in the two time periods of interest (p = 0.0095; chi-square test statistic = 15.20 with 5 degrees of freedom). For regional sites, there was a highly significant difference between the survival distributions of patients in the two time periods of interest (p = 0.0077; chi-square test statistic = 15.72 with 5 degrees of freedom). For the distant stage, there was no significant difference between the survival distributions of patients in the two time periods of interest (p = 0.28; chi-square test statistic = 6.25 with 5 degrees of freedom). Conclusions: PTC’s survival rates have shown an improvement over the years 2002 through 2016, mostly noted in the local and regional stages. Although most patients with PTC have a favorable prognosis when conventional treatments are implemented, local recurrence and distant metastasis of advanced PTCs still hamper the survival and clinical management in certain patients.
A comparison of thyroid cancer survival managed with different surgical subtypes: A SEER database analysis.
Authors: Cogua Laura , Silberstein Peter T. , Tupper Connor
Published: June 2023

e18110

Background: Thyroid cancer is a common endocrine malignancy that has been shown to be treatable with surgical intervention. Multiple surgical approaches can be used to treat thyroid cancer ranging from minimally-invasive local destruction or partial lobectomy to total thyroidectomy. There are limited studies comparing the survival between different surgical subtypes used to treat thyroid cancer at a national registry level; we herein investigate the differences between surgical subtypes in the management of thyroid cancer. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) Database for patients with thyroid cancer (primary site code C739) diagnosed between 2000-2019. All histologic subtypes were included. Patients with multiple primary tumors and patients without surgical intervention were excluded. Variables selected for review included age at diagnosis, race, sex, stage, and surgery subtype. Surgical subtypes of interest included codes 20-50 which corresponds to the removal of less than a lobe NOS, local surgical excision, partial lobectomy, lobectomy only, isthmectomy only, lobectomy with isthmectomy, removal of a lobe and partial removal of the contralateral lobe, subtotal or near-total thyroidectomy, and total thyroidectomy. Descriptive statistics, Kaplan-Meier (KM), and Cox regression analyses were performed using SPSS version 28. Results: A total of 167932 patients were included. Of these, 1564 patients received local/partial lobectomy. On KM, partial lobectomy showed significantly improved survival compared to both local excision and removal of less than a lobe, NOS (p’s < 0.05). For lobectomies and isthmectomies, a total of 24904 patients were included. On KM, both lobectomy alone and lobectomy with isthmectomy showed survived significantly improved than isthmectomy alone (p’s < 0.001). A total of 141464 patients received either subtotal thyroidectomies or total thyroidectomies, 95% of which were total thyroidectomies. On KM, patients managed with total thyroidectomy survived significantly better than subtotal thyroidectomy (p < 0.001). After controlling for age, sex, race, and stage, Cox regression analysis showed complete lobectomy (Hazard ratio [HR] = 0.352), subtotal thyroidectomy (HR = 0.416), and total thyroidectomy (HR = 0.162) all had significantly improved survival relative to local excision or destruction (p’s < 0.001). Conclusions: Our results show that more complete removal of the thyroid, including complete lobectomy, subtotal thyroidectomy, and total thyroidectomy, is associated with improved survival in patients with thyroid cancers. The improved outcomes with more invasive procedures suggest wider margins may reduce the risk of spread or recurrence after initial resection.
Association between social determinants of health and outcomes among young patients with prostate cancer.
Authors: Akinyemi Oluwasegun , Weldeslase Terhas , Abodunrin Faith , Adeoye Oluwatayo , Silberstein Peter T. , Metwalli Adam
Published: June 2023

e18500

Background: Influence of Social Determinants of Health (SDHs) on Outcomes among Young Patients with Prostate Cancer. SDHs significantly influence prostate cancer patients' incidence, presentation, and outcomes. However, how these factors affect outcomes in younger patients with prostate cancer has been understudied in the literature. Prostate cancer is the commonest cancer among men in the US, and studying these factors will further enhance efforts to develop appropriate public health strategies to combat the disease. Aim: To determine the influence of patients' race and SDHs on outcomes among young patients with prostate cancer. Methods: Utilizing data from the National Cancer Database (NCDB), we conducted a retrospective analysis of all patients with a primary diagnosis of prostate cancer from January 2004 to December 2018. The outcome measures were diagnosis to definitive treatment time (days), length of hospitalization (days), and overall survival. We determined the influence of patients’ race/ethnicity, insurance type, residence annual median income (median household income for each patient's area of residence), and residence education level (defined as the proportion of adults ≥25 years who did not complete high school in the patients' zip code) on the overall survival among young patients with prostate cancer. Results: There were 843,511 cases of prostate malignancy reported in the National Cancer Database between 2004 and 2018. About 6.3% of these patients were younger than 50 years (N=52,890). Among the younger patients, 74.0% were whites, and 21.3% were Blacks. These compare to the control of adults older than 50 years, with 84.3% whites and only 11.3% Blacks. On multivariate analysis, Black patients have a longer diagnosis to definitive treatment time and overall longer hospital stay but no racial disparity in overall survival. Significant predictors of overall survival among the young prostate cancer survivors were patients with private insurance and higher income quintiles (see table). Conclusions: Insurance and income rather than race/ethnicity or education level appear to constitute a significant predictor of survival among young prostate cancer patients in the United States.[Table: see text]
Navigator utilization rates in breast cancer patients by race in a comprehensive cancer center.
Authors: Onyewadume Louisa , Burnette Ursula , Cheatham Chesley , McClelland Shearwood
Published: June 2023

e18501

Background: African-Americans have the highest overall cancer death rate and shortest survival time of any racial or ethnic group in the United States. Elucidation of disparities in cancer care access is important since previous work has indicated that when equal access to Radiation Therapy (RT) in prospective randomized trials is granted, race does not independently affect outcomes. The most common cancer studied in African-American radiation therapy (RT) access disparities research is breast cancer. Furthermore, prospective analyses have demonstrated that African-Americans receive hypofractionation following breast-conserving surgery less frequently than Caucasians. As such, the goal of this study is to eventually evaluate the impact of patient navigation on short-course RT access for African-American breast cancer patients. Methods: Our study is a prospective survey-based evaluation of the impact of patient navigation on access to hypo-fractionated RT and financial toxicity in African-American breast cancer patients. As the first step to investigating the impact of patient navigation on RT access in this population, medical records of women with breast cancer in our center (University Hospitals Cleveland Medical Center, Seidman Cancer Center) were identified from support groups. The baseline navigation rate for this population was determined from the initial data collected during tumor board sessions from June 2022 through October 2022. Results: We identified female patients who were diagnosed with breast cancer and thus were eligible for navigation. From June 1st through October 31st, 30 female patients were identified. Nine (30%) were Caucasian and 21 (70%) were African-American. Of the 21 African-American female patients, only four (19%) were connected with patient navigation services. Of the 9 Caucasian female patients, only four (44.4%) were connected with patient navigation services; this difference between African-American and Caucasian patients did not reach statistical significance. The total baseline navigation rate at our center during this period was 26.67% (8 out of 30 patients). Conclusions: Over a recent five-month period, it was determined that the baseline navigation rate for Caucasian female breast cancer patients is numerically more than 2x that of African-American female patients at our comprehensive cancer center. This information is an important precursor to the first investigation of the impact of patient navigation on reducing RT access disparities facing African-American breast cancer patients. We anticipate that after collating and analyzing survey results for patients pre-RT versus post-RT as well as for those with versus without patient navigation, navigation will serve to overcome barriers in compliance to therapy and increase adherence to optimal care.
Racioethnic differences in missing data in the national cancer database: A window into inequities in cancer care.
Authors: Raman Vignesh , Migaly John , Greenup Rachel Adams , Tong Betty Caroline , Fayanju Oluwadamilola Motunrayo
Published: June 2023

e18502

Background: While the National Cancer Database (NCDB) is frequently used for observational studies about cancer care including disparities, study populations are often overwhelmingly White. The aim of this study was to assess racioethnic inequities in the NCDB by characterizing the completeness of data in the registry. We hypothesized that Black and Hispanic patients are more likely, compared to White patients, to have missing data about staging, treatment, and survival. Methods: We used the 2004-2016 NCDB files for breast, colon, and lung cancer focusing on non-Hispanic White, Black, and Hispanic patients. The primary outcome was the comparative missingness in data between the three racioethnic groups, measured using multivariable logistic regression models. A stepwise study progression from diagnosis of cancer, histology, clinical staging, treatment documentation, survival, and guideline-concordant care was used. Results: Compared to the U.S. Census data from 2010, Black and especially Hispanic patients were much less likely to be registered in the NCDB compared to Whites. Black and Hispanic patients were also more likely to have missing or non-usable histology data, incomplete or missing clinical staging, and treatment documentation (Table). Survival and follow-up documentation was similar between the three groups. Black and Hispanic patients were less likely to receive surgery for stage I-III disease compared to White patients. Conclusions: Our study suggests that the NCDB may be a limited resource for study of cancer in Black and Hispanic patients, and that inequities in missing data in its own structure may reflect racioethnic inequities in cancer care in the United States. Summary of fraction of missing treatment status, by malignancy, stratified by race/ethnicity in the NCDB. Data are represented as count (percent) unless otherwise noted. The p values are obtained by the Pearson’s chi squared test. Results from a multivariable logistic regression examining the odds of missing treatment status are provided for each malignancy as well. [Table: see text]
Association of socioeconomic status (SES) with use of specialist palliative care (SPC) among people who died with cancer before and during the COVID-19 pandemic.
Authors: Iqbal Javaid , Moineddin Rahim , Fowler Robert , Krzyzanowska Monika K. , Booth Christopher M. , Downar James , Lau Jenny , Le Lisa W , Rodin Gary , Seow Hsien , Tanuseputro Peter , Earle Craig , Quinn Kieran , Hannon Breffni , Zimmermann Camilla
Published: June 2023

e18504

Background: Access to high-quality care, including SPC, is known to vary according to SES. The effect of SES on access to SPC during the COVID-19 pandemic remains unknown. We measured the association of SES with SPC use in different care settings among people who died with cancer before and during the COVID-19 pandemic. Methods: This retrospective, population-based cohort study included 173,915 adult patients who died with cancer from 16/3/2015 to 15/3/2020 (pre-pandemic), and from 16/3/2020 to 15/3/2021 (pandemic period), in Ontario, Canada; March 16, 2020 coincided with the start of pandemic-related hospital entrance screening. The primary outcome was access to SPC in the last 30 days of life, measured as the percentage of people with at least one SPC visit and the rate of visits/patient/30 days across home, hospital inpatient, and outpatient care settings. We used an interrupted time series analysis with segmented linear regression accounting for serial correlation to examine the immediate and gradual changes due to the pandemic. Analyses were stratified by SES, defined using area-level material deprivation quintiles (Q1, least to Q5, most deprived). Results: In total, 100,462 (57.8%) people received SPC in the last 30 days of life. The access to SPC increased steadily by 0.13% per 30 days over the pre-pandemic period ( P<0.001), with a drop of 5.34% at the start of pandemic ( P<0.001) and a trend increase of 0.19% during the pandemic period ( P = 0.10). The table shows study outcomes by care setting and SES. At baseline, patients in Q5 (vs Q1) had lower rates of SPC home visits, while rates of inpatient visits and outpatient visits were similar. Pre-pandemic for Q1 and Q5, inpatient visits were decreasing, outpatient visits were increasing, and home visits were stable. For both Q1 and Q5, there was an immediate decrease in home visits and increase in outpatient visits at pandemic onset, followed by a recovery in home visits; trends for inpatient and outpatient visits were unchanged. Conclusions: The COVID-19 pandemic led to an immediate decrease in access to SPC among people who died with cancer, particularly for home visits. SES was significantly associated with access to home visits, both before and during the pandemic. [Table: see text]
Disparities in accessing open notes at a comprehensive cancer center.
Authors: Cutting Elena R. , Lee Euyhyun , Zhang Ge , Gold Kathryn A.
Published: June 2023

e18507

Background: Patient use of open access medical notes can promote understanding of and engagement in disease management, in turn improving patient satisfaction, trust, medication adherence and clinical outcomes. Previous studies have shown that racial minorities were less likely to utilize personal health records online, as were patients with lower incomes compared to those with higher incomes. The CURES Act, enacted as of April 5 2021, is a national policy that requires healthcare providers to give patients access to the information and notes available on their own electronic medical registry. Given the recency of this legislation, little is known about who is accessing this information or how we can help it to be more widely accessible. Methods: We extracted demographic data available for all patients with an outpatient oncology encounter at UCSD between 1/1/21-12/31/21. Data available included age, gender, ethnicity, preferred language, and type of insurance. Mann-Whitney U test and Fisher’s exact test were used to compare continuous and categorical variables between the two groups, respectively. This analysis was approved by the UCSD ACQUIRE committee and met criteria for IRB excusal. Results: There were 22,419 patients who met inclusion criteria, 21,892 (97.3%) of whom were registered on MyChart and 4,114 (18.4%) of whom had accessed an oncology note. There was no significant difference in age or gender between those who did or did not access notes. Patient race, ethnicity, preferred language, and insurance type were all significantly different between groups (p<0.001), with those who were non-White, Hispanic, Spanish speaking, or on Medicaid less likely to access their notes through OpenNotes. Conclusions: There are significant differences in the demographics of patients who do and do not access notes. Targeted outreach efforts (e.g., translation efforts) may help in making access to open notes more equitable. [Table: see text]
Real-world associations among patient-physician sex concordance, treatment practices, and cancer outcomes.
Authors: Ding Philip Q. , O'Sullivan Dylan E. , Shamsi Rubab , Wada Aisha , Farrer Christie , Cuthbert Colleen Ann , Brenner Darren R , Cheung Winson Y.
Published: June 2023

e18511

Background: Prior research has linked patient-physician sex discordance with inferior surgical and cardiac outcomes. The impact of such sex inequities may be magnified in medical oncology, where patients often face a life-limiting illness and physicians assume the role of primary healthcare provider. This study examined cancer treatment practices and survival outcomes in sex-concordant vs. discordant patient-physician dyads. Methods: This was a population-based, retrospective cohort study of adults diagnosed with stage II-IV colon or lung cancer in 2013-2020 in Alberta, Canada and referred to a medical oncologist. Study data included physician- and patient-level demographics and cancer disease characteristics. Patient-physician dyads were classified as sex-concordant (female-female, male-male) or discordant (female-male, male-female). Time-to-event data were analysed using Kaplan-Meier methods and associations were assessed with Cox and logistic regression. Results: A total of 11,131 patients and 188 medical oncologists were included. Among patients, 49% were female and 50% were in sex-concordant patient-physician dyads. The median age was 68 years, 7615 (68%) had lung cancer, and 6016 (54%) had stage IV disease. In sex-concordant and discordant dyads, respectively, median overall survival (OS) was 17.1 and 18.7 months ( p = 0.047) while median cancer-specific survival (CSS) was 20.2 and 22.4 months ( p = 0.21). In multivariable analysis, sex-concordance was not significantly associated with OS or CSS in the overall cohort and in female patients. However, among male patients, sex-discordance was significantly associated with lower OS (hazard ratio [HR], 1.11; 95% CI, 1.04-1.19) and CSS (HR, 1.12; 95% CI 1.04 -1.21), largely driven by differences in survival outcomes in stage IV disease. Older age, higher comorbidity burden, lung cancer, and advanced stage correlated with worse outcomes in all multivariable models. Sex concordance was not significantly associated with adjuvant systemic anti-cancer therapy (SACT) use in stage II-III disease or with SACT use in stage IV disease. Treatment practices are summarized in the table. Conclusions: Sex concordance between patients and medical oncologists did not generally correlate with differential SACT use and survival. However, male patients treated by female physicians had worse outcomes compared to those treated by male physicians. Cancer outcomes may be prone to the effects of sex bias in specific patient-physician relationships. [Table: see text]
UK cancer healthcare professionals collaborating with colleagues in low- and middle-income counties: Mapping the extent and nature of partnerships.
Authors: Diprose Kim , Lewis Philippa , Young Annie , Sirohi Bhawna , Ranasinghe Neil , Mutebi Miriam Claire , Gyawali Bishal , Lodge Mark , Sullivan Richard , Cowan Richard , Stanway Susannah Jane
Published: June 2023

e18512

Background: Most cancer deaths occur in low- & middle-income countries (LMICs). In 2020, the UK Global Cancer Network (UKGCN) formed to unite those interested in Global Oncology & to strengthen collaborative work with colleagues in LMICs to reduce morbidity & mortality from cancer. For the first time in the UK, the UKGCN undertook a mapping exercise, to document the number & type of collaborations between the UK & LMIC partners. Methods: A semi-structured survey was developed & performed over 10 weeks from February 2021, to identify UK individuals & institutions engaged in clinical practice, research &/or education with LMIC partners, where the aim was to improve the care of people with/at risk of cancer. The survey was emailed to individuals in NHS hospitals, charities, universities, other organisations, UKGCN members & to contacts identified by a literature search. Results: A total of 639 invitations were sent & 88 responses received. Results demonstrate a range of collaborative efforts spanning many areas of cancer control:health promotion & prevention, diagnosis & treatment to survivorship & palliative care. A wide range of countries were represented: Sub-Saharan Africa, South America, MENA region, China & South-East Asia. Projects included education & training (146), clinical practice (144) & research (226; Table). Funding sources for projects included academic institutions, private sector, United Nations agencies, UK government, arms-length bodies & international government. Conclusions: This mapping exercise has demonstrated considerable UK collaboration with colleagues in LMICs across the continuum, involving all 3 domains of education, practice, & research. This mapping exercise will serve as a baseline on which to build a more accurate database to measure future work. It will enable the UK community to guide domestic strategy, increase efficiency, enable innovation & accelerate collaborations. Information from the survey has been used as a catalyst to create new partnerships between colleagues working in similar geographical settings, encouraging bidirectional learning leading to mutual benefit. Next steps include using this data to support calls for increased funding in global cancer care, & for institutional recognition of, & investment in, Global Oncology as a discipline. The survey will be repeated using more comprehensive methods to increase accuracy with a view to maintaining an up-to-date database.[Table: see text]
Lack of organization to access cancer treatment in southeast Brazil: Urgent need to change.
Authors: Aleixo Sabina B. , Pulido Jose Zago , Parmanhane Narelle , Fassarela Darcy , Fonseca Ana Paula
Published: June 2023

e18516

Background: Healthcare access is a fundamental component in achieving universal health coverage, the central commitment of the Brazilian Unified Health System (SUS). In Brazil, primary healthcare centers from the cities refer suspected or confirmed cases of cancer to accredited oncology services in their regions. Methods: This is a qualitative exploratory study aiming to knowing the functioning of the cancer care network in 26 cities of the Southern Region of the State of Espírito Santo/Brazil (686,450 inhabitants) that refer patients to an SUS-accredited oncology center.The information was collected during the year 2022 through semi-structured interviews with cities health departments. Results: Regarding the extent of the Primary Health Care Service (PHCS), the results showed that only 14 cities (54%) have 100% of their territory covered, while the others have coverage ranging from 75% to 98%. With regard to medical work in PHCS units, it was found adequate in 17 (65% )cities and not adequate in the other 9 (35% ); however, their was only 2 licensed physicians in Family Medicine working the cities. The number of patients being treated is known in just 5 (19%) cities and as far as transport to the treatment center, 16 (62%) cities report that meet the demand and 10 (32%) that do not. Finally, no city had a support service to help patients navigate the public health system. Conclusions: The results indicate that Access to basic health services is insufficient in the Southern region of the State of Espirito Santo, and that the organization of the cancer care network needs to be improved with more resources and trained medical professionals.