bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognosis factors for long-term eribulin response in a cohort of patients with HER2-negative metastatic breast cancer.
Authors: El Kaddissi Antoine , Curtit Elsa , Mansi Laura , Borg Christophe , Meynard Guillaume
Published: June 2023

e13120

Background: Eribulin is a drug used since 2010 in metastatic breast cancer. Some prognosis criteria for long progression-free survival are already described in small cohorts. We present an historic cohort to determine new prognosis criteria for long-term eribulin response in HER2-negative metastatic breast cancer. Methods: Our retrospective cohort include female patient with HER2-negative metastatic breast cancer treated with eribulin in Franche-Comté, France. We defined a long-term response as six months of eribulin treatment. The primary endpoint is the analysis of criteria that differ according to the progression-free survival. Secondaries outcomes concern overall survival, response rate and analysis of MDM2/p53 axis. Results: Median progression free survival (PFS) is 3.2 months. 23.6 percent of patients have a long-term response to eribulin. Four discriminant criteria appear to separate progression free survival in two arms (PFS < 3 months or > 6 months) predicting nearly 78% the probability of a prolonged response to eribulin: histological grade, presence of meningeal metastasis, response to prior chemotherapy and OMS status. We have developed a nomogram combining these 4 criteria. Median overall survival is 8.5 months. MDM2 amplification appear not being predictive of therapeutic response in metastatic breast cancer. Conclusions: Eribulin response in metastatic breast cancer can be drive by clinical and biological factors. The application of the nomogram proposed by our analysis can assist the clinician in the therapeutic strategy and prescription of eribulin. These results should be confirmed in real life. Multivariate logistic regression to predict PFS < 3 months vs > 6 months. [Table: see text]
Development and validation of a NCC-BC-A scale to assess patient-reported outcomes for advanced breast cancer patients in China.
Authors: Guan Xiuwen , Ma Fei , Yan Xiaoyan , Liu Tianmou , Shen Ning
Published: June 2023

e13125

Background: The primary therapeutic objectives for advanced breast cancer (ABC) are to extend patients’ survival time and to maintain their quality of life (QoL). Patient-reported outcomes (PROs) symptom could improve communication with physicians, and decreased utilization of unplanned healthcare. However, localized PROs scales for ABC were seldomly used in China. This study aimed to develop a specific PROs scale for ABC patients in China and optimize the management model for breast cancer. Methods: A literature search was conducted in PubMed, Embase, Wanfang, and CNKI databases, and the dimensions and items of the scale in the literature were extracted for the item pool. Delphi method was used to modify, add, subtract, and adjust the language of scale items until the experts' suggestions or opinions reached a consensus, and the first draft of the scale was formed. The first draft of the scale was further optimized by cognitive test and pre-survey. The optimized scale was used for formal survey, and the items of the scale were further analyzed and screened by coefficient of variation, correlation coefficient, internal item consistency, factor analysis, reliability, and validity. All tests were two-sided tests, and the test level was α=0.05. Results: A total of 10945 articles were analyzed, and 237 were finally included to form an item pool containing 277 PRO items. Two rounds of Delphi expert consultation were conducted, and the average authority coefficient of experts was Cr>0.7. Based on the results of cognitive test, the corresponding items were revised by language description to facilitate understanding. After adjustments according to the pre-survey of 200 ABC patients, the PROs scale NCC-BC-A was finally formulated with a total of 38 items, including 9 physiological dimension items, 4 psychological dimension items, 9 social dimension items, 11 treatment-evaluation items, 4 overall self-evaluation dimension items, and 1 other dimension. A total of 588 ABC patients participated in the national formal survey of NCC-BC-A with the average answer time of 6 minutes, and no floor or ceiling effects were observed. A series of statistical tests were conducted on the result. A principal component analysis revealed that the items in PROs scale have great consistency while preserving enough differences between different dimensions. The results were tested to be normally distributed with good variation. Also, the PROs scale survey result has an excellent Cronbach's α coefficient of 0.925 and an excellent test-retest reliability of 0.9041. Conclusions: The PROs scale NCC-BC-A has high validity and reliability, can objectively measure the QoL of ABC patients. NCC-BC-A fully considered the characteristics of treatment status for ABC patients, and the realistic situation in China, which may help clinicians to pay more attention to QoL of ABC patients and to optimize management system for ABC.
Efficacy and safety of eribulin as a front-line treatment in patients with advanced breast cancer: The first large scale prospective real-world study in China.
Authors: Zhao Jianli , Dinglin Xiao-Xiao , Yang Ya-Ping , Luo Si-Min , Cai Yang-Yang , Chai Jie , Liu Donggeng , Wang Ying , Yao He-Rui
Published: June 2023

e13127

Background: Eribulin is a non-taxane microtubule inhibitor, which was approved for third-line treatment of advanced breast cancer (ABC) in China in 2019. However, efficacy and safety data for eribulin in Chinese patients with ABC are lacking, regardless of the therapy line. This study evaluated the efficacy, safety, and treatment pattern of eribulin in first- to third-line settings in Chinese patients with ABC. Methods: Patients with histologically confirmed ABC who had received ≤2 lines of prior treatment for metastatic disease were enrolled. Patients with HR+/HER2- ABC received eribulin monotherapy; those with HER2+ ABC received eribulin plus anti-HER2 targeted therapy, and those with metastatic triple-negative breast cancer (mTNBC) received eribulin plus immunotherapy/chemotherapy. The primary outcome was progression-free survival (PFS). Secondary outcomes included disease control rate (DCR) and safety. This study was approved by the SYSMH and SYSUCC Ethics Committee (approval No. 2020-KY-064). Results: In total, 160 patients were enrolled from 1 January 2021 to 31 December 2022 and 142 received study treatment. Eribulin was administered as first-line therapy in 41 (28.9%) patients, second-line therapy in 50 (35.2%), and third-line therapy in 51 (35.9%). The DCR was 71.6%; 55 patients (45.8%) had stable disease and 31 patients (25.8%) had complete or partial remission. The 6-month PFS rates (95% confidence interval [CI]) were: overall, 68.4% (58.0%, 76.8%); first-line eribulin, 75.4% (54.9%, 87.6%); HR+/HER2- ABC, 67.4% (53.8%, 77.7%); HER2+ ABC, 70.1% (38.5%, 87.6%); mTNBC, 69.5% (46.3%, 84.2%). PFS data were immature; the median (range) PFS was not reached with first-line eribulin and was 11.8 (3.3, 11.8) months with second-line eribulin. Subgroup analyses are shown in the Table; the 6-month PFS rate was 64.3% versus 74.0% in patients with versus without visceral metastases (p=0.25364). Common treatment-related adverse events (AEs) were hematological toxicities including leukopenia (9.5%), neutropenia (5.3%), and hypochromia (7.3%). There were no grade ≥3 AEs or AE-related treatment discontinuations. Conclusions: There was no significant difference in the efficacy analysis between the subgroup with visceral metastases and the subgroup without visceral metastases. Eribulin as first- or second-line chemotherapy is effective and has manageable toxicity in patients with ABC. Clinical trial information: NCT04683445 . [Table: see text]
A novel pan-RAS inhibitor for luminal B breast cancer.
Authors: Arshad Tariq , Donninger Howard , Burlison Joe , Sabo Mike , Trent John , Clark Geoffrey J.
Published: June 2023

e13132

Background: Luminal B breast cancer makes up between 10-20% of cases and is among the most lethal forms of breast cancer. Prognosis is little better than that of the notorious Triple Negative disease. There is currently no effective treatment for Luminal B breast cancer. Recently it has been found that, although mutations in the RAS oncogene are rare in Luminal B, hyper activation of the wild type RAS protein is common due to inactivation of key negative regulators of RAS such as DAB2IP and RASAL. Therefore, targeting RAS is a logical novel approach to developing enhanced therapy for this disease. There are three main isoforms of RAS and there are no currently approved pan-RAS inhibitors. We have developed a small molecule pan-RAS inhibitor which binds directly to all forms of RAS. It acts to block the ability of RAS and to bind and signal through its effectors by disrupting the RAS effector domain. It is active in vitro and in vivo against models of Luminal B breast cancer. Methods: In silico screening of a virtual compound library was performed to identify an initial candidate inhibitor. Iterative rounds of Medicinal Chemistry informed by structural modeling and bioassay in 3D vs 2D growth assays were performed to identify an enhanced activity derivative. Target binding was confirmed by Microscale Thermophoresis and NMR. RAS/RAF complex status was measured by co-immunoprecipitation of the endogenous proteins. Ras signaling was assayed by Western analysis of Phospho-ERK and RAL-GTP pull down assays. In vitro activity was measured using 3D soft agar assays. In vivo activity was measured by ip or po administration against a Luminal B breast cancer cell line. Results: The current lead, designated RAS-F binds all three main isoforms of RAS at low uM kd and modulates the RAS effector domain in NMR studies. It suppresses RAS signaling pathways in transient assays and suppresses Luminal B tumor cell tumor cell growth in soft agar and in vivo. Conclusions: We have developed a pre-clinical pan-RAS inhibitor that is active in vitro and in vivo against Luminal B breast cancer models. The agent also has potential uses against other tumor types partially driven by deregulated wild type RAS such as triple negative breast cancer.
Evaluating the impact of a molecular tumor board in a community oncology center: Results from the Avera Cancer Institute's experience.
Authors: Elsey Rachel , Meissner Tobias , Sun Yuliang , Hattum Crystal , McKean Heidi Ann , Solomon Benjamin Maurice , Starks David , Rojas-Espaillat Luis Alexander , Spanos William Charles , Lee John H. , Williams Casey B.
Published: June 2023

e13500

Background: The use of molecular tumor boards (MTB) has been widely documented at large academic medical centers, but there is limited experience and data available in smaller settings like community oncology centers. The Avera Cancer Institute has had a molecular tumor board in place since 2014, but the composition and methodology have changed over time. Our 10 years of hands-on experience and involvement in studies like I-PREDICT showed that in addition to molecular matching, considering factors like tumor type, previous treatment responses, comorbidities, medication coverage, and treatment availability provide crucial insights for determining optimal therapy for patients. Methods: We analyzed next-generation sequencing (NGS) testing results from August 2019 to December 2022. At the time of NGS testing result, providers were offered to have the case reviewed and presented at MTB. Our multidisciplinary team consists of members with backgrounds in bioinformatics, medical oncology, pathology, translational science, trial coordination, and pharmacy. Recommendations from the MTB discussions were provided in three categories: standard of care, clinical trials, and off-label options. Results: From August 2019 to December 2022, 1,514 qualified or resulted NGS reports were returned and considered for analysis. 733 (48%) were presented at the molecular tumor board and from this group, 629 patients were evaluable. Oncologists chose a recommended therapy 66% of the time. Of the remaining 34%, the most common reason for not utilizing recommendations was that patients were unable to receive further lines of systemic therapy. A subset analysis of 202 cases (June 2021 – August 2022) who either received a recommended therapy (n = 88, 43.6%, group 1) or not (n = 114, 56.4%, group 2) showed a survival benefit. Median overall survival was not reached in group 1, as compared with 14 months in group 2 (HR = 0.58; 95% CI, 0.37 – 0.92; p< 0.02). The median PFS was 8.2 months in group 1 versus 5 months in group 2 (HR, 0.67; 95% CI, 0.48 - 0.92; p< 0.017). Conclusions: The results of our study demonstrate the positive impact of a molecular tumor board review in helping oncologists determine the best treatment options for their patients. Our findings show that recommendations made by the board are well received and frequently adopted by providers. While providers generally prefer standard of care options or clinical trials, they are open to considering all available options to make informed therapy decisions.
Network-enabled rapid growth of a US-based remote asynchronous oncology subspecialist case review service.
Authors: West Howard Jack , Wong Debra A. , Nathwani Nitya , Wright Carol , Liang Crystal , Sachs Todd M. , Barzi Afsaneh
Published: June 2023

e13507

Background: AccessHope (AH) is a company that provides remote subspecialist insight on cancer care for patients via an asynchronous model of review of medical records followed by a detailed assessment of current and potential future management options sent to the patient’s local oncologist. This summary characterizes the rapid and ongoing scaling and growth as demand for this service has expanded and as AccessHope has transitioned from a single site to a geographically diverse US-based network of National Cancer Institute-designated comprehensive cancer centers (NCI-CCCs) as foundational partners. Methods: Cases were identified based on a trigger list of high complexity cancers or by request for case review by participating patients with cancer. Using descriptive statistics, we assessed measures of eligible patient, completed case volumes, and number of unique expert reviewers over time; the distribution of cancer types; the extent of concordance between care outlined by the local care team and that recommended by the reviewing expert; and potential cost savings from recommended changes. Results: From 1/2019-9/2022, the number of sponsor organizations and eligible “covered lives” increased by 1462% and 393% respectively; case volume increased from 42 to 525 cases/quarter over this interval. The most common cancer diagnoses were gastrointestinal (30%), hematologic/lymphoid (18%), lung (14%), and breast (12%). While reviewers recommended an alternative treatment in 29% of cases and agreed overall with current management in 71%, only 4% agreed and had no proposed refinements associated with anticipated evidence-based improvements. Recommendations leading to cost savings if adopted were identified in 16.1% of cases, translating to projected cost savings of $13,008/patient. Conclusions: After initially demonstrating the feasibility of completing a rapid turnaround of cases of lung cancer either patient-initiated for review or prospectively triggered by diagnosis and stage, this program of asynchronous second opinions has grown from a single institution to a network of five NCI-CCCs around the US. Demand for this service has rapidly escalated, so that AH has been able to provide input and support to local oncologists for many-fold more physicians and patients over the past few years.
Improving compliance with post-hospitalization follow-up visits: A single community cancer center experience.
Authors: Venigalla Tejaswi , Anipindi Manasa , Patel Dhaval , Morginstin Mark S.
Published: June 2023

e13508

Background: Hospital discharge follow-up visits are crucial for the continuity of care and for reducing rehospitalizations. They prevent medication disruptions, missing opportunities for making a post-discharge treatment plan, and identifying complications. Our aim is: 1. To review the compliance of post-hospitalization follow-ups for a medical specialty. 2. To study the timeline from the discharge to the time they were seen in the hematology-oncology clinic. 3. To identify why patients seen in the hospital were lost to follow-up. 4. To improve compliance with post-discharge follow-up visits. Methods: This is a retrospective chart review of patients seen by our Hematology-oncologists at Einstein Medical Center Montgomery between January 2021 to December 2021. Data collected included: Specialty consulted- Hematology versus Oncology; if follow-up is indicated; if they have a Hematology Oncology provider elsewhere; if they were seen in the clinic and how long did it take for the patient to be seen after discharge; if they did not follow-up, the reason for failure to follow-up was reviewed. We defined “No contact from our office” when there was no documentation that our office staff tried to contact the patient to make a follow-up appointment. Results: Out of the total 526 inpatient consultations, 338 were for hematology, 169 were for oncology and 19 were for both hematology and oncology. Follow-up upon discharge was recommended for 429 patients (82%). Out of those 429 patients, 168 patients (39%) were seen in the clinic and 176 patients (41%) were not seen after discharge from the hospital. 85 patients (20%) had a Hematology Oncology provider in a different institution. 118 patients (68%) in this group of 168 patients were seen in less than 30 days. 41% of the patients that were not seen after discharge from the hospital had various reasons, which included 18% of patients who expired, and 10% of patients who chose to be on comfort care. 41% of the patients were lost to follow-up (unable to track after the discharge – data was limited due to this being a retrospective study), 2% of the patients were incarcerated, 23% of the patients had no contact from our office to make a follow-up appointment, 1% of the patients were subsequently hospitalized, and finally, 5% of the patients followed up in a different institution. Conclusions: Hematology was consulted more often than Oncology for the subspecialty in-hospital consultations. 41% of the patients were lost to follow-up due to reasons unknown who should have been seen in the Hematology/Oncology Clinic. Interventions that we recommend in improving this compliance are 1. Formulate a rapid discharge clinic – run by Hematology-Oncology fellows with attending oversight. 2. Involve the Oncology Nurse Navigator to help coordinate patient follow-up. 3. Provide better education for hospital staff about the importance of reviewing discharge instructions with the patients.
Carboplatin beyond 4 cycles during therapy with carboplatin, pemetrexed, and pembrolizumab for advanced non-small cell lung cancer (NSCLC).
Authors: Ahmad Yaser , Chen Dung-Tsa , Gray Jhanelle Elaine , Tanvetyanon Tawee
Published: June 2023

e13509

Background: Since the publication of KEYNOTE-189 study , carboplatin/pemetrexed/pembrolizumab (carbo/pem/pembro) has become a common frontline regimen for advanced non-small cell lung cancer (NSCLC). In KEYNOTE-189, carboplatin was administered for a maximum of 4 cycles. To date, the number of carboplatin cycles administered in the real-world setting remains unclear. We analyzed factors predicting the receipt of carboplatin beyond 4 cycles (CB4). Methods: We interrogated a population-based, real-world database by Flatiron for NSCLC patients with no actionable EGFR/ALK who received carbo/pem/pembro from March to July 2019 (pre-pandemic period) and from March to July 2020 (pandemic period). Patients were included if they completed the regimen as shown by transitioning to maintenance pem, pembro, or pem/pembro. Primary endpoint was CB4. Secondary endpoint was overall survival. Multivariable logistic regression analyses were performed to identify independent predictors of receiving CB4. Results: Among 2090 patients treated during the study period, 966 patients (46%) started on carbo/pem/pembro and subsequently proceeded to maintenance therapy. Among them, 134 patients (14%) received CB4. Multivariable analysis revealed the following statistically significant predictors of receiving CB4, along with respective odds ratios (95% CI) and p-values: Non-white race 1.67 (1.09-2.57) (p=0.017), ECOG ≥1 1.66 (1.07-2.59) (p= 0.024), pandemic year 2020 1.68 (1.11- 2.52) (p=0.013), and ever-smoking status 0.51 (0.30-0.87) (p=0.013). Survival analysis is ongoing. Conclusions: A significant number of patients received CB4. Since this practice is not considered a standard practice, the benefits and risks of CB4 is unknown. Predictors of receiving CB4 included year of treatment, race, ECOG, and smoking status. Further investigation is needed to understand patient-physician decision making process with regards to the length of carboplatin administration. [Table: see text]
Evaluating the impact of nurse navigation on high-risk breast clinic appointment uptake in a cancer risk assessment program.
Authors: Levin Samantha , Paul Shirlene , McPeek Chelsea , Alvarado Rosalinda , Levy Mia Alyce , Stempel Lisa
Published: June 2023

e13510

Background: Patients in the breast imaging center are offered comprehensive cancer risk assessment (CRA) using validated risk assessment models (Tyrer-Cuzick 8, GAIL, and NCCN guidelines for genetic testing) at the time of screening mammography. All patients who receive a high-risk breast cancer score are recommended to follow-up at the high-risk breast clinic (HRBC) to determine a personalized management plan including MRI screening, genetic testing, and treatment options. Insufficient communication and patient education regarding breast cancer screening contributes to low HRBC appointment uptake. Nurse navigation (NN) was used to increase the HRBC appointment completion rate. This project aims to assess the effect of NN on HRBC appointment uptake in patients with a high-risk of breast cancer. Methods: Data regarding NN and HRBC appointment uptake for all women at a breast imaging center with a high-risk breast cancer score between July 2021 and January 2022 was extracted from the EMR and grouped into cohorts to assess the impact of NN on HRBC appointment completion. Family history of breast cancer, breast cancer risk model type, and insurance status were also extracted to analyze their relationships with HRBC appointment uptake. A chi-squared analysis was performed to assess the significance of the results. Results: NN contact and HRBC appointment completion of 4090 patients were analyzed. Of the 4090 patients, 1787 (43.7%) were successfully contacted by a nurse navigator. Patients with a family history of breast cancer were more likely to have contact with the nurse navigator (p = 0.022) and complete HRBC appointment (p = 0.017). The distribution of breast cancer risk model and distribution of insurance type were different for patients who completed HRBC appointments and those who did not, (p = 0.0012) and (p = 0.0027), respectively. Of the 4090 total patients, 122 (3.0%) attended the HRBC. Of the 1787 patients contacted by a nurse navigator, 80 (4.5%) completed HRBC appointments (p < 0.0001). Conclusions: Coupling NN with a CRA program at the breast imaging center increased the number of qualified patients who completed HRBC appointments who would not have been identified prior to this program. Patients with a family history of breast cancer, certain types of breast cancer risk model, and certain types of insurance were found to have increased uptake of HRBC appointments. As a result, more patients will receive recommended supplemental screenings and management from a multidisciplinary care team.[Table: see text]
Changes in time to treatment initiation for patients diagnosed with breast, lung, colon, or rectal cancer during the 2020 COVID-19 pandemic in the US.
Authors: Fan Qinjin , Dong Weichuan , Schafer Elizabeth , Wagle Nikita Sandeep , Zhao Jingxuan , Shi Kewei Sylvia , Han Xuesong , Yabroff Robin , Nogueira Leticia M.
Published: June 2023

e13516

Background: The COVID-19 pandemic resulted in substantial disruptions in health care and declines in cancer diagnoses in the US. We used nationwide data to examine changes in time to first treatment for patients newly diagnosed with cancer during 2020, the first year of the pandemic. Methods: Adults aged ≥18 years newly diagnosed with breast, non-small cell lung cancer (NSCLC), colon, or rectal cancer between January 2019 and November 2020 were identified from the National Cancer Database. Logistic regression was used to calculate crude and adjusted (by age and sex and diagnosis quarter) odds ratios (AOR) of initiating any treatment within 30 days of the diagnosis comparing 2020 vs. 2019 overall and by quarter. Results: A total of 668,229 adults newly diagnosed with cancer were identified, including 358,255 in 2019 and 309,974 in 2020. Individuals diagnosed in 2020 were more likely to initiate treatment ≤ 30 days of breast (AOR = 1.12, 95% confidence interval [95% CI] =1.11-1.14), NSCLC (AOR = 1.09, 95% CI =1.07-1.11), colon (AOR = 1.13, 95% CI =1.09-1.16) or rectal (AOR = 1.08, 95% CI =1.04-1.12) cancer diagnosis, compared to those diagnosed in 2019. Increases in treatment initiation ≤ 30 days were greatest in the second quarter of 2020 for all four cancers. Findings changed little after adjustment for quarter of diagnosis and AORs remained statistically significant. Conclusions: During 2020, there was an increase in treatment initiation within 30 days from diagnosis, especially in the second quarter. The lower volume of diagnoses and efforts by providers to prioritize cancer care may partly explain the observed improvements. Ongoing evaluation of these changes and cancer outcomes is warranted.[Table: see text]
Disparate impact of healthcare access restrictions due to COVID-19 pandemic on breast cancer diagnosis and treatment.
Authors: Nair Devi , Layeequr Rahman Rakhshanda , Daniele Karla , Jensen Brooke , Dhanasekara Chathurika S.
Published: June 2023

e13518

Background: The COVID-19 pandemic altered healthcare access avenues for patients. In May 2020, 79% of cancer patients in the US in active treatment experienced some delay in their healthcare due to COVID-19 related restrictions. Hispanic patients are known to be disproportionately affected by their social determinants of health, and therefore are at higher risk of being affected by the pandemic. Our institution, designated as a “Hispanic Serving Institute (HSI)”, is ideally suited to study the impact of the pandemic on this population. Methods: In this retrospective study, the institutional breast cancer database was queried for patients managed between January 1, 2018 and April 18, 2022. Socio-demographic variables, screening, and treatment initiation dates were analyzed to determine the impact of COVID-19 related restrictions. Patients were stratified into groups based on date of diagnosis: Group 1 (pre-pandemic), Group 2 (pandemic), and Group 3 (post pandemic). Statistical analyses were conducted using R statistical software (R version 4.1.3). ANOVA or Kruskal Wallis tests with multiple pairwise comparisons using independent samples t-test or Wilcoxon rank sum test and χ2 tests with multiple pairwise comparisons using Fisher’s exact test were used to compare the groups. Interaction models were created to evaluate the association between 1) Ethnicity and 2) Distance from the treatment center on the time lapses between 1) mammogram and biopsy and 2) biopsy and first treatment separately. Results: Of the 488 patients during study period, 163 (33%) patients were Hispanic. Median (IQR) number of days between biopsy and first treatment was similar across all groups [Group 1=39.5 (102.5) days; Group 2= 50 (121) days; Group 3=57 (54) days - p=0.338]. Patients who lived > 50 miles away from the treatment facility experienced longer time lapses between biopsy date and first treatment compared to those living ≤ 50 miles away (β= 40.60, SE (standard error) =20.87, p = 0.052). Compared to Non-Hispanics, Hispanics in Group 2 experienced a shorter time lapse between mammogram and biopsy (β= -17.34, SE=5.46, p = 0.002). However, these patients experienced a longer time lapse between biopsy and initiation of treatment (β= 43.57, SE=18.25, p = 0.017). There was a significantly higher proportion of non-insured patients in the Hispanic group compared to the non-Hispanic group [Hispanic group=12 (7.4%) patients; Non-Hispanic group=8 (2.5%) patients - p=0.020]. Conclusions: Pandemic related delays in breast cancer treatment were observed mainly in Hispanics and patients living more than 50 miles from the treatment center.
Influence of personal and socioeconomic factors on patient’s perception and experience of clinical trial participation at rural NCI designated comprehensive cancer center.
Authors: Afzal Muhammad Zubair , Wankel Bret , Palmer John P. , Kale Soham , Pirruccello Jonathan P. , Cao Yuanzhen , Corea-Dilbert Flanklin E. , Sharma Aditya , Lu Ziyao , Dhawan Natasha , Ibrahim Samer , Sarwar Tayyaba , Shirai Keisuke
Published: June 2023

e13520

Background: Due to limited access to healthcare providers, lengthy travel times to clinics, and disadvantageous socioeconomic dynamics, patients in rural locations face significant challenges causing a low recruitment in clinical trials. However, there may be preconceived assumptions of a patient’s desire to participate in a trial leading to bias from healthcare organizations and thereby, decreased efforts in enrollment. Dartmouth Cancer Center is the smallest NCI designated comprehensive cancer center, serving rural New Hampshire and Vermont. In this study, we surveyed patients with cancer to assess their level of understanding of clinical trials, factors influencing patients’ willingness to enroll, and the difficulties faced after accrual in the trials. Methods: A 23 items anonymous questionnaire was distributed to the oncology patients at the outpatient clinic. The questions included demographics, socioeconomic status, time to travel, challenges faced in participating in the trials. Cox proportional regression analysis was done to identify factors influencing decision to participate in trials. Results: Among 93 respondents, 74% are within the age of 61 – 80 years, 64.45% are male and 74% are married, 51% are retired and 59.7% have household income of ≤$100,000. 32.2% of our respondents travelled over 1 hour to receive care. 73.3% of the respondents understood what it means to participate in a clinical trial. 91.8% are willing, yet only 40% were given an option to participate in a trial. Only 10.5% ever declined to participate. Additional cost, frequent travel, and possibility of receiving a placebo are the biggest factors in declining a participation. Up to 95% of the participants enrolled in a trial had positive experience and have the ultraistic motives. None of the socioeconomic or personal factors had any significant bearing on willingness to participate. Conclusions: Socioeconomic and regional factors have little bearing on a person's inclination to participate in clinical trials. There is a strong interest in understanding and enrolling in clinical studies. Cancer centers need to reduce the gap between patient interest in trials and actual trial participation.[Table: see text]
International molecular tumour board: A transatlantic precision oncology collaboration.
Authors: Gallagher David , O'Donovan Emily , Che Othman Elly , Sugrue Helen , Black Lora Jane , Hove Jenna , Powell Steven Francis
Published: June 2023

e13525

Background: Genomic testing (GT) is increasingly used to guide treatment in cancer care. There is considerable international variation in provider expertise and access to molecular tumor board (MTB) and therapeutics. In Ireland high quality GT is not broadly available; only 3% of patients receive treatment on a clinical trial. Our hypothesis is that increased GT would lead to enhanced treatment options and increase access to trials. Through institutional partnership between community cancer programs in Ireland and the United States (US), we offered GT and collaborative MTB review to patients with advanced cancer and observed the effect on treatment patterns. Methods: Eligible patients with metastatic solid tumors attending a single Irish community cancer unit between 2018 and 2022 were offered GT and collaborative MTB review on the COMPASS study. Testing was completed using a Foundation Medicine test reimbursed by multiple payors. Testing was performed on tumor tissue, or if not available, on circulating tumor DNA (ctDNA). Cases were presented virtually at MTB. Treatment decisions were based on MTB discussion of actionable alterations (AAs) with at least preclinical evidence of benefit, clinical trial availability, and local drug access. The primary outcome was impact of GT on treatment decision. Secondary outcomes included rate of AAs, and potential germline mutations. An exploratory objective evaluated potential matches to US-based NCI MATCH and ASCO TAPUR trials. Results: In total, 157 patients were screened and 120 enrolled on the COMPASS study. 46 (38.3%) male and 74 (61.7%) female with 25 different primary cancers. Tissue testing was performed for 79 (65.8%) patients and 35 (29.1%) had ctDNA testing. 105 (87.5%) patients had at least one AA by MTB criteria, 49 (46.7%) patients had more. Treatment decisions are outlined. 7 patients derived clinical benefit from treatment. 26 (21.7%) patients had a potential match for MATCH or TAPUR arms. MTB suggested 35 (29.1%) patients consider germline testing. 22 previously had genetic testing and 8 more had germline testing following GTB; 1 pathogenic germline mutation was identified. Conclusions: We successfully completely a transatlantic collaboration to introduce US MTB-directed care for Irish patients. The majority of patients had novel treatment options identified but drug access and clinical trial enrolment was limited by regional availability. International collaboration on precision oncology treatment trials should be prioritized.[Table: see text]
Cancer co-rounds: A novel inpatient multidisciplinary oncology rounding model.
Authors: Ni Lisa , Viner Jennifer , Phuong Christina , Liu Siyuan John , Yee Emily , Petrofsky Mary , Kwon Daniel H. , Daras Mariza , Boreta Lauren , Brondfield Sam
Published: June 2023

e13526

Background: Although tumor boards are well-established for coordinating care of patients (pts) with cancer in the outpatient setting, few studies have evaluated interventions for improving consultative care coordination for hospitalized pts, where coordination can be particularly complex. This study evaluated the hypothesis that implementation of an inpatient co-rounding model of care including medical-, neuro-, and radiation-oncology consult teams would improve the alignment of recommendations from these oncologic services, as perceived by primary teams. Methods: A co-rounding model was implemented in September 2021 for hospitalized pts with cancer at a tertiary medical center. The oncologic consulting services met virtually twice weekly to discuss pt care. Providers from the most common primary services for pts with cancer, internal medicine (IM) and neurosurgery (NSGY), were surveyed via institutional email listservs. The survey included Likert-type questions about the alignment of recommendations across the oncologic services and open-ended questions asking for feedback on collaboration among these services. Pre-intervention surveys were distributed, and post-intervention surveys were distributed 9 months later. Thematic analysis was performed on the pre-intervention free-text responses; post-intervention free-text responses were not analyzed due to limited number. Wilcoxon rank-sum tests were used to compare responses pre- and post-intervention. Results: At each session, a median of 6 providers attended (range, 4-8 providers), and a median of 6 pts were discussed (range, 4-8 pts). Of the 331 providers surveyed, there were 119 (36%) respondents pre-intervention and 34 (10%) respondents post-intervention. The 132 unique respondents comprised 68 (52%) IM attending physicians, 48 (36%) IM resident physicians, 6 (5%) NSGY advanced practice providers, 6 (5%) NSGY attendings, and 4 (3%) NSGY residents. There were 35 total free-text responses (29 pre-intervention and 6 post-intervention). Prior to implementation, common suggested areas for improvement included: coordination between inpatient and outpatient oncologic providers (N=7), communication among inpatient oncologic services (N=6), timeliness of response to consults (N=5), and documentation of recommendations (N=4). Post-intervention, respondents were significantly more likely to perceive alignment in oncologic consultant recommendations (67% strongly agree) compared to pre-intervention (23% strongly agree, p<0.01). Conclusions: A novel inpatient co-rounding model was successfully implemented between medical-, neuro-, and radiation-oncology. Primary teams perceived greater alignment in recommendations among these consulting services after implementation. Future directions include continued improvement upon the co-rounding model, and evaluation of the impact of this model on patient outcomes.
Time to treatment in inflammatory breast cancer: Experience from a single institution.
Authors: Lopez-Aguiar Alexandra , Stephens Julie , Clark Akia , Lee Sandy , Park Ko Un
Published: June 2023

e13530

Background: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer that accounts for nearly 10% of breast cancer caused mortality. With an annual rate between 1-4% per year and 3-year overall survival (OS) of about 65%, timely completion of trimodal treatment including systemic therapy, surgery, and radiation therapy is essential. Prior studies have demonstrated impact of time to treatment on OS of non-IBC patients. The aim of this study was to examine the relationship between the time from diagnosis to treatment and outcomes for patients with IBC. Methods: Categorically matched patients who underwent treatment of inflammatory and non-inflammatory locally advanced breast cancer at an NCI-Designated Comprehensive Cancer Center from 2006-2016 were analyzed. Clinicopathologic factors were compared using Chi-square and Wilcoxon Rank Sum tests. Overall survival was assessed using Kaplan-Meier methods and log-rank tests. Results: Of 217 patients who underwent excision for breast cancer, 99 had an IBC diagnosis. All patients were female, 85% (n=84) white, and 98% (n=97) had single-sided breast disease. Thirty-one percent (n=31) of patients had clinically node positive (N1) disease, the majority were ER negative (53%), and 38% were HER2 positive. There was no difference in time from first abnormal mammogram to diagnosis between IBC vs non-IBC patients. Ninety-one percent (n=90) of IBC patients underwent neoadjuvant chemotherapy compared to 52% (n=61) of non-IBC patients (p<0.001). Only 27% (n=27) of IBC had a pathological complete response. IBC patients tended to present earlier with symptoms (p=0.054), begin chemotherapy sooner after diagnosis (median days: 10.5 vs 17.0, respectively; p=0.002), and were more likely to receive radiation earlier after surgery (p<0.001). However, IBC patients were also more likely to undergo surgery later (191 vs 153 days; p<0.001) and have a worse OS (p=0.006). While not statistically significant, there was a trend toward worse OS for IBC patients with delayed chemotherapy initiation (p=0.459). Conclusions: IBC is an aggressive form of breast cancer associated with poor OS. Patients with this diagnosis are more likely to receive trimodal therapy sooner, but this may not significantly improve their OS. Further studies are necessary to evaluate effect of time from presentation of initial symptoms to treatment initiation on outcomes.
A comparison study of solid tumor, malignant hematology, and general medicine inpatient services.
Authors: Faieta Antonio Giuseppe , Mortazavi Amir , Verschraegen Claire F. , Husain Marium
Published: June 2023

e13532

Background: One of the most important cancer centers in Ohio experienced an explosive growth in the number of inpatient admissions, with numerous inpatient services created between 2010 and 2022. In this abstract, we present how some financial and quality measures performed during this rapid expansion. Methods: Slicer-Dicer aggregate data was used to compare financial performance and quality measures of oncologic and general medicine inpatient (IP) services over time. General medicine services do not include the cancer and the heart disease populations, but there might be a small overlap. The cancer population is served by 9 IP oncology services. The following SlicerDicer Filters were used. Population: IP admissions. Slices: populations include these study groups, 10 inpatient medical oncology (solid tumors) (MO), 6 inpatient malignant hematology (MH) (including 1 bone marrow transplant) services were compared to 10 general medicine (GM) services. Gynecologic and central nervous system tumors are served by other services and were excluded. Measures: number of admissions, median and total payments (actual payment received), median and total expected reimbursement (reimbursement expected for DRG), mortality, readmission rates, average length of stay (LOS), percentage of patients with Medicaid, percentage of patients with Medicare. Dates: from 2011 to 2022 data. For some measures, quarterly data is presented rather than yearly data for graph simplicity. Results: The number of inpatient admissions grew by 90.77%, 130.55%, and 105.58% for GM, MO, and MH, respectively. The total expected reimbursement increased by 6.22%, 13.56% and decreased by 17.14% for GM, MO and MH, respectively. The total payment received grew by 314.29%, 283.69%, 86.80%, for MO, MH, and GM, respectively. MO, GM, and HM had a median payment increase of 76.51%, 51.96%, 20.74%, respectively. Mortality dropped for MO by 32.11%, from 76.9% to 52.2%, for MH by 49.46%, from 55.6% to 28.1% and in GM by 73.80% from 35.5 % to 9.3%. The average length of stay was 1 to 2 days longer in the MH and GM (respectively) compared to MO, with an increase from 2011 to 2022 for GM and MO, but a decrease for MH. Readmission rates decreased from 17.4% to 15.1% for MO, 12.7% to 10.3% for MH, and 14.9 to 12.5% for GM. In 2014, the percentage of Medicaid population increased in GM, and decreased in the oncology services (MO and MH) reaching 35% and 14% of the admitted patient population in 2022, respectively. Percentage of Medicare patients increased from 36.9% to 52.9%, 39.6% to 44.9%, and remained stable for MO, HM, and GM, respectively. Hospice discharge fluctuated between 1.2-1.6%, 2.5-5%, 8-12.9% of the discharged patients in GM, MH, and MO, respectively. Conclusions: In this abstract, we present a decade-trend data of important measures of inpatient oncology units.
Delivery of precision oncology in advanced lung cancer: Gaps, barriers, and potential solutions.
Authors: Stein Jacob Newton , Grewe Mary E. , Johnson-Jennings Alayah , Canter Courtney , Charlot Marjory
Published: June 2023

e13533

Background: Non-small cell lung cancer is the leading cause of cancer death. Significant survival gains have been achieved due to precision oncology, which involves testing for molecular markers that indicate sensitivity to targeted therapies. Precision oncology is essential to high-quality lung cancer care, but shortfalls in biomarker testing and targeted therapies limit improvements in lung cancer outcomes. We sought to characterize barriers and facilitators to precision oncology in academic and community practice settings. Methods: We conducted a mixed methods study on the delivery of precision medicine for patients with advanced lung cancer, including use of next generation sequencing (NGS), liquid biopsy, and targeted therapies, and the barriers and facilitators to effective delivery. Surveys and semi-structured interviews were conducted with a purposive sample of patient navigators, pathologists, and clinicians. Participants were recruited from community and academic settings in North Carolina (NC), using the NC Oncology Navigation Association and existing research networks. Results: Thirty-two participants completed the survey—9 navigators, 10 pathologists and 13 clinicians—with representation from community and academic sites. Five participants completed interviews—2 navigators, 2 pathologists and 1 clinician. Knowledge gaps about precision medicine were observed, with clinicians answering “not at all” or “a little bit” knowledgeable about NGS (23%), liquid biopsy (38%) and targeted therapies (23%). Navigators indicated feeling “somewhat” or “very” uncomfortable discussing these topics (55% for NGS, 44% for targeted therapies), and indicated having limited confidence in resolving barriers related to precision medicine. In interviews, potential solutions were highlighted, including use of financial aid from pharmaceutical companies, dedicated molecular pathology support, and partnership with social work and financial navigation to resolve barriers. Conclusions: Clinicians and navigators report gaps in knowledge and confidence in discussing precision oncology in advanced lung cancer. Qualitative data highlight several potential strategies for improving access, including addressing financial barriers. These findings suggest a need for education and financial assistance to support delivery of precision oncology in advanced lung cancer.[Table: see text]
Implementation of the novel use of an objective scoring rubric to reduce utilization of inpatient non-formulary chemotherapy.
Authors: Bhardwaj Aarti Sonia , Jain Priya , Thomas Robert , Smith Cardinale B.
Published: June 2023

e13535

Background: The cost of cancer care is an enormous healthcare burden. Most inpatient chemotherapy (IC) is not reimbursed because of diagnosis-related group codes. We implemented the use of a novel objective scoring rubric to guide and automate IC stewardship at an academic cancer center to decrease the inappropriate use of costly inpatient therapies in patients especially at the end of life. Methods: We created a scoring rubric based on treatment and regimen specific criteria. IC that is on formulary and standard of care is automatically approved. IC that is non-formulary requires evaluation using the developed criteria. Treatment factors include: type and phase of trial, and FDA and NCCN approvals. Patient factors include: performance status, line and goal of therapy. Clinicians must complete the criteria via a form in RedCap which then automatically calculates a score which is then reviewed by 2 disease specific physicians and a clinical pharmacist for accuracy. If the threshold score is met, IC is approved and if it is not met, IC is not approved for administration. Our primary outcome is cost savings and clinical outcomes. Results: Pre-implementation the cost of IV NF chemotherapy from 3/2021-10/2021 was $744,105 and post –implementation from 3/2022-10/2022 was $549,363 which is a 26% ($194,741) reduction in cost. 98 cases were reviewed over this time period. 82 (84%) cases were approved and 16 (16%) were disproved. The total cost of approved cases was $482,694 and the cost savings of disproved cases was $68,121 (14%). 51 were Solid Tumor (ST) requests and 47 were for Heme Malignancy (HM) requests. Clinical outcomes of the approved cases are illustrated. 16% of cases were submissions for immunotherapy (nivolumab, pembrolizumab) and 81% of those patients died. Conclusions: 84% of the time our cancer physicians chose the administration of IC that aligned with objective criteria which is reassuring and serves to validate the use of this tool. Alternatively, this tool prevented inappropriate administration of chemotherapy 16% of the time. Our pilot indicates that there is a role for an objective tool for automated IC stewardship.[Table: see text]