bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer of unknown primary site: A population-based analysis of demographics and all-cause mortality.
Authors: Ganesh Bharath , Buragamadagu Bhanusowmya , Baralo Bohdan , Stewart Matthew , Thirumaran Rajesh
Published: June 2022

e18518

Background: Cancer of unknown primary site (CUP) is an entity that is defined by the presence of an occult primary site despite sufficient workup. Prior analyses have concluded that CUP has a poor overall prognosis. This study aims to examine a recent US cohort of patients with CUP, with a focus on discerning demographic characteristics and common causes of mortality. Methods: Patients with CUP were identified from the Surveillance, Epidemiology, and End Results (SEER) database, a large US population-based cancer registry (using SEER*Stat 8.3.4 software). Patients of all ages with cancers diagnosed between 2010-2014 were included in the study. Patients with CUP were identified by ICD-O-3 code C80.9 (‘Unknown Primary Site’). Data were extracted for adenocarcinomas and squamous cell carcinomas separately. Ill-defined and rarer histologies like ‘carcinoma, NOS’ and neuroendocrine tumors were excluded from this study. Results: The number of cases identified was 9,683 adenocarcinomas and 3,758 squamous cell carcinomas, totaling 13,441 cases that met eligibility. The median age at diagnosis was 71 +/- 13.0 years. Sex distribution was nearly equal, with males accounting for 50.8% of cases, and females 49.2%. Most patients were of ‘White’ race (81.6%), and the remainder comprised ‘Black’ (10.8%), ‘Other’ (American Indian, AK Native, Asian/Pacific Islander) (6.7%), and ‘Unknown’ (0.9%). Adenocarcinoma and its subtypes were the most common histological type reported (71.7%). Notable solid organ metastatic sites irrespective of tumor histology were bone (3.0%), brain (0.6%), liver (5.1%), and lung (0.9%). The median survival of the overall population was 2.0 months. 3,195 patients were alive at the end of the study period. Death from any cancer unsurprisingly accounted for the vast majority of mortality (87.0%). Most non-cancer deaths were caused by cardiovascular disease (4.6%) and infections (1.2%). Conclusions: CUP remains a disease with dismal prognosis. Our study characterizes the demographics and most common causes of death in patients with CUP. Patients who were diagnosed with CUP tended to be elderly, White individuals of either sex. Most patients with CUP died from their cancer, with a median survival duration of two months. Further research is required to evaluate newer treatment modalities such as targeted therapy and immunotherapy in order to improve patient outcomes.
Rural cancer care access in the United States: A worsening problem?
Authors: Bates James Edward , Henson Christina
Published: June 2022

e18521

Background: Rural counties have a decreased incidence of cancer relatively to non-rural counties; however, they have higher death rates from cancer. This disparity in death rates is worsening. Patients in rural areas face significant barriers to accessing oncologic care – limited access to oncologic providers and significant travel distances to treatment chief among them. We aimed to assess trends in geographic distribution of medical and radiation oncologists to ascertain trends in access to oncologic specialists in rural areas. Methods: We used the Medicare Physician & Other Practitioners database published by the Centers for Medicare & Medicaid Services from 2013 and 2019 (the earliest and latest available) to identify radiation oncologists and medical oncologists (including hematology/oncology) based on the Provider Type field. We used the Rural Urban Commuting Area Codes as defined by the US Department of Agriculture; rural was defined as non-metropolitan areas with a < 30% commuting flow to a large urban center consistent with the definition from the WWAMI Rural Health Research Center. The US Health Resources & Services Administration, using a similar definition, defines 19.7% of the US population as rural. Results: In 2013, we identified 10,440 medical oncologists and 4,292 radiation oncologists in the United States. 7.6% of medical oncologists and 8.9% of radiation oncologists practiced in rural areas. In 2019, 7.4% of medical oncologists and 8.5% of radiation oncologists practiced in rural areas (Table). There were 1,430 more medical oncologists practicing in 2019 as compared to 2013; only 83 (5.8%) practice in a rural area. There were 436 additional radiation oncologists with only 21 (4.8%) practicing in a rural area. Growth in both medical oncologists (χ2 = 8.47, p = 0.02) and radiation oncologists (χ2 = 8.47, p = 0.004) was more likely to be in urban than rural areas. Conclusions: While disparities in oncologist distribution along the rural-urban continuum are well known, we establish that these disparities are becoming more pronounced despite increasing awareness. This raises concern that disparities in cancer outcomes in rural patients will continue to worsen. Alternative strategies to increases access to cancer care in rural areas are critical.[Table: see text]
Addressing cancer health disparities (CHD) in an independent community cancer clinic: All solutions are local.
Authors: Clinton Natasha , Patel Kashyap B. , Gor Asutosh S. , Rabara Viral
Published: June 2022

e18522

Background: The COVID-19–associated global pandemic has brought many public and population health issues to light. A glaring issue is the disparities among and differences in susceptibility of diverse ethnicities. Viral infection is not the only area of healthcare facing this issue: disparities in prevalence, biology, prognosis, and outcomes of cancer exist, often based on socioeconomics and social determinants of health (SDoH). CHD have been debated and discussed at several levels, from local counties to the congress to the Centers for Medicare and Medicaid Services. Amid the debates and recommendations, it has been difficult to carve out a clear path forward. The complex factors involved include access to care because of financial challenges, biological and genetic factors, impact of SDoH, and access to screening, NGS testing, and clinical trials. CHD may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion. Addressing CHD could result in an indirect savings of as much as $1 trillion over 3 years (AACR, CDR, 2020). A comprehensive approach is needed to generate a groundswell of resources. This should include support for public policies aimed at improving understanding of the issue by all parts of the ecosystem (pharma, researchers, government agencies, physicians), adequate funding for federal and local initiatives, considerations of health in community planning and development, and collection of real-world data and evidence. At Carolina Blood and Cancer Care (CBCCA), the team decided to study this issue and initiate solutions one step at a time. Methods: CBCCA prioritized solutions in 5 categories. The top priority was to address issues impacting patients: access to care, NGS testing, cancer screening, SDoH, and clinical trial access. To address access to care issue (financial constraints), 2.5 FTEs (full-time equivalents) were allocated to carry out needs assessments and identify resources, including Medicaid eligibility, dual eligibility, other foundations, and sources for free drugs. A not-for-profit entity, No One Left Alone, was started to address CHD. Results: During 2021 CBCCA physicians saw 1787 unique cancer patients (both established and new). Of these, 319 needed IV anticancer treatment and an additional 104 needed oral oncolytics. Fifty-three could not pay for their cancer treatment. Another 101 patients needed assistance for out-of-pocket costs. Financial counselors procured free drugs worth $1,633,588 and an additional $135,931 in cash assistance for high out-of-pocket costs. The pharmacy team raised $253,218 for 64 patients (374 transactions) for out-of-pocket costs. As a result, not a single patient was left without treatment. Conclusions: Financial toxicity was addressed by allocating 0.5 FTE per oncologist to ensure access to care. In the next phase, CBCCA will address access to NGS testing.
Health and healthcare equity in the cancer care sector in Canada: Results of a rapid scoping review.
Authors: Lambert Leah , Horrill Tara C , McKenzie Michael R. , Browne Annette , Stajduhar Kelli , Kaur Jagbir , Cheng Shannon , Bourgeois Amber , Howard Fuchsia , Beck Scott , Thorne Sally
Published: June 2022

e18536

Background: Despite advances in research and treatment, and a publicly funded healthcare system in Canada, alarming inequities exist across the cancer continuum. Although attention to these inequities is increasing, it is unclear how organizations are acting upon calls to address health equity. Our objective was to identify how health and healthcare equity are being discussed as a goal or aim within the Canadian cancer care sector. Methods: A rapid scoping review was conducted for published and unpublished literature on health equity in the Canadian cancer care sector. As this review was part of a larger initiative aimed at informing policy recommendations and research priorities with specific time constraints, we also drew on the WHO’s guidance for conduct of rapid reviews to strengthen health policy and systems. Five biomedical databases, 30 public health and multidisciplinary websites and databases, and Google were searched. Documents available in English, published between 2008 and 2021, and that discussed health or healthcare equity in the Canadian cancer context were included. Results: Of 3,678 documents screened, 83 were included for full text analysis. The focus on health equity within the Canadian cancer care sector increased 3-fold between 2015-2021 when compared with the period 2008-2014. Only 25% of documents included a definition of health equity. Concepts such as inequity, inequality, and disparity were frequently used interchangeably or in a tokenistic way, resulting in conceptual muddling. Less than half of documents included an explicit health equity goal. Stated health equity goals ranged from broad to specific, with examples from across the cancer continuum. A range of actions were described to address equity goals, including health system improvements and policy and planning considerations. Most actions were framed as recommendations rather than actions taken or underway, and few documents described measurement of progress toward health equity goals. Conclusions: Health equity is a growing priority in the cancer care sector, however conceptual clarity is needed to guide the development of robust equity goals, specific objectives, and meaningful action. Moreover, evaluation mechanisms to understand the impacts of actions on equity goals are urgently needed. If we are to advance health equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.
The association of COVID-19 testing with cancer care disruption.
Authors: Panzone John , Welch Christopher , Wu Maximillian S , Jacob Joseph M , Shapiro Oleg , Basnet Alina , Bratslavsky Gennady , Goldberg Hanan
Published: June 2022

e18558

Background: Research has shown that the COVID-19 pandemic has reduced access to cancer treatment and care for patients, especially for COVID-19 patients. Methods: We investigated the impact of COVID-19 testing on access to cancer care. A US based cross sectional study was conducted on 2,393 cancer patients using data from the 2020 National Health Interview Survey. Multivariable logistic regression was used to assess associations between COVID-19 testing and likelihood of receiving cancer treatment or other cancer care during the pandemic. Results: Patients who reported ever being tested for COVID were on average younger (66.9 vs 69.3, p<0.001). Patients with professional school education reported higher rates of being tested than lower education levels (40.0%, p=0.032). Tested patients reported higher rates of not receiving medical care due to COVID-19 (23.3% vs. 19.1%, p=0.026). On multivariable analysis, patients who reported ever being tested for COVID-19 were less likely to receive cancer treatment (OR 0.639, 95% CI 0.489-0.834, p=0.001) or receive any other cancer medical care (OR 0.657, 95% CI 0.523-0.825, p<0.001) (Table). Conclusions: These data suggest COVID testing itself is associated with increased likelihood of cancer care disruption. As the pandemic persists, awareness of cancer care disruption, even by testing alone, should be raised.[Table: see text]
Assessment of COVID vaccine knowledge and hesitancy in an ethnic minority oncology patient population.
Authors: Lee Matthew , Miao Emily , Viswanathan Shankar , Rapkin Bruce D. , Halmos Balazs , Goel Sanjay
Published: June 2022

e18570

Background: Complicating the pandemic are the healthcare disparities experienced by ethnic minorities, including Black and Hispanic Americans. This is further exacerbated in those ethnic subgroups, especially if they have comorbidities, including cancer. With the introduction of COVID-19 vaccines, the shift is now focused on promoting vaccination. However, vaccine hesitancy and motives of why ethnic minority cancer patients receive or do not receive vaccines have not been explored and are the focus of this study. Methods: A cross-sectional survey was administered among cancer patients to understand the knowledge and attitude towards COVID-19 vaccines at a single institution in a predominantly ethnic minority population between February 1-June 30, 2021. The participant's inclusion criteria were >18 years old and diagnosed with solid or hematologic malignancy. Descriptive statistics were used to summarize the patient characteristics, COVID-19 vaccine knowledge, and uptake motives. A composite score of COVID-19 and vaccine knowledge was derived and its role on vaccination status was assessed using a multivariable logistic regression model. Results: Of 52 patients surveyed, COVID-19 vaccination prevalence during the survey was 40.4% (95% CI: 27, 54.9). Participants' average (sd) age was 63.5 (13.6) years; 42% were male, 36% were Black, and 30% Hispanic; 65% were receiving active treatment for their cancer. Seventy-nine percent believed COVID-19 infection to be dangerous or harmful to them, 61% were concerned about the side effects of the COVID-19 vaccine, yet 65% considered vaccines safe. Those refusing the vaccine (n=7) cited side effects (71%) or believed that the vaccine was not needed (57%). Of those who were unvaccinated (n=31), 48.4% (n=15) got vaccinated post-survey. The odds of vaccination was 3.79 (1.63, 8.82) times higher with a 1 unit increase in COVID-19 knowledge score but was not significant in the multivariable model. The final model suggested that the odds of vaccination increased 2.9 times more for a 1 unit increase in vaccine knowledge score; Blacks were two times more likely to get vaccinated and those with more than high school education had a five-fold increase in vaccination. The model results are presented in Table. Conclusions: This exploratory study has demonstrated that there are multiple reasons why an ethnic minority cancer patient would be vaccinated and possible reasons why they would not. This information will become important in improving vaccine campaigns targeting these populations and ensuring their safety and protection against COVID-19.[Table: see text]
An update to a retrospective comparison of results between the National Breast and Cervical Cancer Early Detection Program and NCI cancer center based early detection program with evidenced based patient navigation and social work support.
Authors: Vaughan-Briggs Celeste , Mitchell Edith P. , Pepe Vincent
Published: June 2022

e18572

Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) through the CDC has provided uninsured women access to breast and cervical cancer screening/diagnostic services. The uninsured face obstacles which include fear, lack of access and trust in the system, financial and logistical barriers to accessing health care services (Natale-Pereira, et.al, 2011) Disparities in access to screening and diagnostic testing, cancer treatment and survivorship is well documented for medically vulnerable populations that impact stage of diagnosis and mortality (Guadagnolo, Dohan & Raich 2011). The Jefferson's program participates in the NBCCEDP program and uses other private resources which incorporate Social Work core competencies that provide assistance to address barriers. The program navigates along the continuum of cancer care (e.g, prevention, screening, treatment and survival). We have found in a comparative analysis that TJUH’s program has higher rates of diverse racial and ethnic participation of key medically underserved demographics than the National Program. Methods: TJUH's program employs a clinical model, Clinical Patient Navigation with a Licensed Clinical Social Worker operating from a strengths based framework to direct care with administrative support. The program utilizes best practices for working with the at risk population: translation services for the Limited English Proficient, appointment confirmation, transportation assistance and psychosocial support from initial point of contact through final diagnosis. Program staff coordinate internal and external referrals from multiple providers. Results: The study population includes 3144 participants who received breast and cervical cancer screening services through the program from 2012 through 2020. 13.9% were white, 41.7% were African-American, 24.5% were Asian and 19.1% Latinx participated in the program, Table. The age of the participants was slightly younger than the National program as well with 15% under 40, 46% between the ages of 40-49. Conclusions: TJUH’s program provides comprehensive psychosocial support to address barriers along the continuum of screening and diagnostic services leading with increased participation among at risk populations. This further reduces no show rates and participants being lost to follow up. TJUH’s program screens a larger proportion of African American and Asian and younger women compared to the NBCCED program. Additionally, we serviced a slightly younger population than the national program. TJUH’s program addresses health disparities and inequity in access to cancer screening services as shown by the data of the diversity of the participants.
Impact of an internal specialty pharmacy medication assistance program on the adherence rates of oral oncolytics.
Authors: Jeon Chaeok , Leiva Maya
Published: June 2022

e18576

Background: High-cost medications pose a barrier to adherence which results in poor therapeutic outcomes and an increase in overall healthcare spending. Medication adherence is critical, especially in cancer patients, in order to achieve optimal, progression-free and disease-free survival. The projected cost of cancer continues to rise, putting patients at a greater risk for delayed treatment and nonadherence. This study evaluates the impact financial assistance has on medication adherence by comparing the oncolytic adherence rates found in published literature with the rates found in patients receiving financial assistance through an internal specialty pharmacy. Methods: This was a single-center, retrospective chart review evaluating patients over 18 years of age who received Hisaoka Cancer Fund and filled their oral oncolytic medications with the internal health system specialty pharmacy. The outpatient pharmacy software and electronic health records were utilized to run reports based on the eligibility criteria between January 1, 2020 and June 30, 2020. Patient demographics included age, gender, race, and cancer diagnosis. Patients younger than 18 years of age, who filled injectable oncolytics or supportive medications, have incomplete data, or were on off-label prescription drugs were excluded. The medication possession ratio (MPR) and time-to-treatment (TTT) in patients receiving the fund were compared to adherence rates found in the literature. Results: A total of 167 patients with a total of 297 prescription fills were evaluated. The MPRs had an average of 82.8% with a median of 92.8% (range 53.8% – 100%). The average TTT was 1.1 days, with a median of 0 day (range 0 – 12 days). In contrast, MPRs found in the two published studies were 75% and 61%, respectively and TTTs were found to be 10.9 and 27 days in those who filled medications through an external specialty pharmacy. A total of $12,793.43 was covered by the fund, with an average of $1,599.18 per patient during the six-month period. Conclusions: Adherence rates in patients who received the medication assistance program through internal health system specialty pharmacy exceeded the rates found in patients who filled medications from external pharmacies. The Hisaoka Fund reduced the financial burden by covering the cost of medications. Due to limited number of patients, further studies are needed to evaluate the impact of the medication assistance program on adherence rates across institutions.[Table: see text]
Efficacy of an educational comic book for HPV vaccination information in Nigeria.
Authors: Roy Mohana , Saleem Atif , Said Ayah , Inoyo Itoro E. , Garrity Philip , Bashorun Yetunde , Anjorin Tunji , Ibeka Paulette , Remen Danna , Huang Franklin W. , Bhatt Ami Siddharth
Published: June 2022

e18577

Background: In Nigeria, cervical cancer is the second most common cancer in part due to disparities in education, access to screening, and access to treatment. In Nigeria, the HPV vaccine is planned for introduction into the public sector but will not be mandated. Given the preventable nature of the disease and need for public awareness, we developed an easy-to-understand teaching tool, the Global Oncology (GO) Comic Book focused on both general cancer education and about cervical cancer and HPV vaccination. Methods: The GO Comic Book is set in modern-day Lagos, Nigeria and aims to dispel myths and misconceptions associated with cancer in general and cervical cancer in particular. After developing the comic book, we developed a teaching guide and a plan for a pilot distribution of the comic book to students in Nigeria. In late 2019, GO and programmatic partners including the Clinton Health Access Initiative (CHAI), Cancer Education and Advocacy Foundation of Nigeria (CEAFON) and Panaramic Comics (based in Lagos, Nigeria) successfully conducted a pilot distribution of the GO Comic Book to nearly 5,000 students representing 18 junior secondary schools in Lagos and Rivers states. The comic books were distributed as part of 12 school assemblies which featured interactive, live-readings of the comic book by students and Nigerian physician volunteers. Pre-/post-tests with 9 questions were administered to a subset of the students (N = 202) to assess change in knowledge before and after the educational assemblies and data was analyzed using descriptive statistics. Results: The response rate of the 202 administered surveys was 98% (N = 198) with 193 female (97.5%) and 5 male (2.5%) respondents. Participants were an average of 11.2 years of age. All multiple-choice-type assessment items showed shifts to better-informed responses following the educational intervention. The item with the highest positive-percent change as assessed in the post survey queried: “what types of virus can cause cervical cancer?” (pre-test = 25.2%, post-test = 68.2%). The table below shows the cervical cancer related questions that were asked and the proportion of correct answers. Conclusions: The GO comic book in conjunction with school assemblies, improved the knowledge regarding cervical cancer causes and risk factors in Nigerian school children. Findings highlight the lack of knowledge regarding cervical cancer among the young population eligible for HPV vaccination, and describe an effective educational strategy in this setting.[Table: see text]
Two years of the Australian Rare Cancer Portal: a national referral service for rare cancer information and research.
Authors: Georgiou Chloe L. , Kee Damien , Papadopoulos Lia , Caldwell Reece , Bourne Allison , Haurat Javier , Turner Maureen , Goldstein David , Scott Clare L.
Published: June 2022

e18581

Background: Rare cancers (RC) occur at incidence < 6/100,000 and accessing treatment and evidence-based care can be challenging. Australia’s geographical distance adds complexity when referring to RC sub-specialists, clinical trials or research. The Australian Rare Cancer (ARC) Portal aims to address this unmet need. Methods: The ARC Portal is a free online academic referral hub designed to facilitate rare cancer clinical care and research. Registered cancer specialists can request RC guidelines, expert advice and molecular testing/interpretation. Patient consent allows researchers access to de-identified clinical data, with optional consent for biospecimen access, for dedicated rare cancer research projects (Melbourne Health HREC/15/MH/396). Portal case reports are collated by research fellows with reference to published evidence and expert opinion to inform treating clinician decision making. Surveys are sent at 3 time points following case completion to assess the ARC Portal impact on patient management. The ARC Portal is funded by Omico, with support from BioGrid Australia, Rare Cancers Australia and the Stafford Fox Rare Cancer Program. Results: Over two years, 924 patients have been enrolled into the ARC Portal. Demographics include 73% females, 27% males, at different disease stages from initial diagnosis (23%), on relapse/ progression (48%) or with stable disease/in remission (29%). The spread of incidence of individual cancers varied from 6/100,000 to < 0.1/100,000. Primary tumour types include gynaecological (44.4%), gastrointestinal (19%), thoracic (6%), ocular (5.2%), soft tissue (3.8%), breast (3.6%), skin (3.0%), and CNS tumors (2.5%). Endocrine, head and neck, urological, and cancers of unknown primary comprised the remaining 12.5% of cases. Longer term follow up of 100 cases demonstrated ARC Portal reports impacted clinician decision making in at least 42%. This included subsequent lines of treatment, molecular testing access or clinical trial enrolment. Conclusions: The ARC Portal uses an online centralized streamlined approach to overcome challenges and inequities inherent in rare cancer care, by optimizing clinician access to RC expertise and clinical trials; and to facilitate future RC discoveries by enabling research through collection of clinical data and accessible annotated biospecimens.
Trends in cancer diagnosis during the SARS-CoV-2 pandemic.
Authors: Aqui Tamara Lynne Bautista , Hwang Andrew , Ayutyanont Napatkamon , Junqueira Erica
Published: June 2022

e18584

Background: In a national survey 40.9% of 4,975 adults reported delaying or avoiding care due to concerns over COVID-19. Avoidance of medical care with lockdown and a decrease in access to services carries the possibility of increased morbidity and mortality from metastatic disease due to delays in diagnosis. We examine the trends in cancer diagnosis in admitted adult patients, comparing the incidences of diagnoses before lockdowns, after lockdowns, and as restrictions were lifted. Increase in diagnoses linked with metastatic disease in the late pandemic compared to early when lockdowns occurred would show delays in care due to decreased access from the pandemic, and likely increase in morbidity and mortality. Methods: Data was retrospectively analyzed patients admitted to HCA hospitals March 2020 to December 2021, separated to three periods: pre (Mar 2019-Feb 2020), early (Mar 2020-November 2020) and late pandemic (Dec 2020-December 2021). 66,022 patients with ICD-10 codes matching malignancies of lung, small intestine, colorectal, pancreas, breast, or cervix were included and patients that additionally had ICD-10 codes for metastatic disease were identified. Patients with unlinked metastatic disease codes were removed. Population demographics including sex, race, ethnicity, insurance were also included. Results: There was a decrease in lung cancer diagnoses in the pre-pandemic period from 6,546 to early at 3,248, and an increase in the late period to 4,763. Diagnoses of metastatic disease with lung cancer decreased from 4,143 in pre-pandemic to 3,357 in late pandemic. Colorectal cancer (CRC) patients without metastatic disease pre-pandemic numbered at 5,836; 3,717 early pandemic; and 5,672, late pandemic. Diagnoses with metastatic disease decreased from 2,980 to 2,511 in the late period. Pancreatic cancer diagnoses decreased from 1,623 pre-pandemic to 1,508 late pandemic. Associated metastatic disease decreased from 1,181 pre-pandemic to 1,061 late pandemic. Breast cancer diagnoses decreased from 2,241 pre-pandemic to 1,915 late pandemic, and diagnoses with metastatic disease decreased from 2,334 to 1,711. Cervical cancer diagnoses increased from 385 pre-pandemic to 444 late pandemic and diagnoses with metastatic disease decreased from 252 to 187 in the late pandemic. Conclusions: Delays in access to care due to the pandemic are reflected in decreases of diagnoses seen. There was a decrease in lung, colorectal, pancreatic, breast, and cervical cancer diagnoses in the early pandemic period likely due to lockdown and diversion of medical effort. In the late pandemic period, diagnoses of these cancers rose, reflecting loosened restrictions. Our study is not able to determine the impact of delayed diagnosis, but likely results in increased morbidity and mortality. These effects could be mitigated in the future with uninterrupted access to telehealth and cancer screening.
Factors associated with DCIS treatment patterns in a large cancer center network.
Authors: Kim Hayeon , Wang Hong , Diego Emilia , Clump David Anthony , Smith Kenneth , Rosenzweig Margaret Q.
Published: June 2022

e18589

Background: There remains variability in management of DCIS, particularly with radiation therapy (RT) and hormone therapy (HT). Little is known about DCIS treatment patterns according to patient characteristics. We examined associations between patient characteristics, treating center location and DCIS therapy received. Methods: We performed a retrospective registry review of all patients diagnosed and treated with DCIS from 2018-2019, collected from the UPMC network, an NCI designated cancer center, serving western and central Pennsylvania. Demographics and administered treatments were compiled from cancer registry records. Descriptive statistics and logistic regression were used for analysis. Treatment centers throughout the network were dichotomized to academic (academic practice) or community (non-academic) sites, race was divided into two groups, Black and White/Other. Neighborhood deprivation index (NDI) was dichotomized to median level at > = 59% vs. < 59% and extremes > = 75% vs. < 75%. Results: A total of 941 patients treated for DCIS;29 patients were not eligible for surgery because of trial enrollment randomizing away from surgery. Of the remaining 912 patients, 506 patients were from academic sites and 406 patients from community sites. Median patient age was 63 years old (range: 24-90 years). There were no treatment differences noted for age, race, or NDI. For treatment, 80 patients refused recommended HT; 46 patients refused recommended RT. The likelihood of receiving RT was similar between academic and community sites (64.3% vs. 67.2%; p= 0.47). Of those having surgery, 25% had mastectomy (231 of 912), more likely at academic sites (29% vs. 21%; p= 0.0045). Among patients with lumpectomy, community patents had greater HT utilization than academic patients (82% vs. 68%; p < 0.001), while ER status was not different. Conclusions: Within the UPMC network, variability in the management of DCIS did not differ based on age, race, or NDI. However, academic practice locations had higher levels of mastectomy, while greater HT utilization was observed in community sites. Further qualitative information is under examination from patients and clinicians to better understand how treatment decisions are framed and completed in the context of patient centered care for DCIS.
Differences in mammographic screening among women 40-49 years old by race/ethnicity, socioeconomic status, and region in the United States.
Authors: Lloyd Maxwell Roger , O’Loughlin Lauren , Mukamal Kenneth J.
Published: June 2022

e18593

Background: The recommended age to initiate screening mammograms in non-high-risk women varies amongst governing bodies in the United States (US) and now ranges from 40 to 50 years old. As a result, mammography among women aged 40-49 represents an area of uncertainty and discretion for patients and providers. Whether mammography in this age group is equitably targeted is uncertain. We aimed to identify factors associated with breast cancer screening among women aged 40-49 in the US. Methods: We used the Behavioral Risk Factor Surveillance System (BRFSS), an annual nationally representative telephone survey of American adults. We included women aged 40-49 (and, for comparison, 50-59) who reported no personal history of breast cancer. In total, 154,860 women (aged 40-49, n = 62,158; aged 50-59, n = 92,702) were included from 2016 and 2018; mammography was not routinely queried in 2017 or 2019, and COVID-19 interrupted screening in 2020. Women who reported having a mammogram in the past one to two years were considered to have a recent mammogram. Using STATA 15, we used logistic regression to estimate weighted adjusted odds ratios (OR) and 95% confidence intervals (CI) of recent mammography associated with age, race, geographic region, and cost as a barrier to healthcare. Results: A total of 62% (95% CI = 61-63%) of surveyed women aged 40-49 reported a recent mammogram. This population had expectedly lower odds of being screened compared to women aged 50-59 (OR = 0.51, 95% CI = 0.48-0.53, p < 0.001). Compared to White women 40-49 years old, Black (OR = 1.37, 95% CI = 1.22-1.50, p < 0.001) and Hispanic (OR = 1.17, 95% CI = 1.04-1.32, p = 0.01) women had higher odds of reporting a recent mammogram. Women living in the South (OR = 0.85, 95% CI = 0.76-0.94, p = 0.004) or West (OR = 0.67, 95% CI = 0.60-0.76, p < 0.001) were less likely to have a recent mammogram compared to the Northeast. Women reporting cost as a barrier to accessing medical care were less likely to report a recent mammogram (OR = 0.52, 95% CI = 0.48-0.58, p < 0.001). Conclusions: In this nationally representative analysis of women aged 40-49, Black and Hispanic women were more likely to report breast cancer screening than White women. This evidence contrasts prior work showing that Black and Hispanic women historically had lower rates of mammography. The results of this study encouragingly suggest that women of color may be initiating screening at younger ages. Poverty is a poor prognostic factor for breast cancer, and cost appeared to serve as a major barrier to mammography. The substantial degree of geographic heterogeneity underscores established variation in how medical resources are distributed and used in the US. Our results provide a benchmark for future studies of interventions at the patient, provider, and systems levels to ensure equitable, cost-effective and broad-based use of mammography nationwide.
Delayed head and neck cancer detection and treatment by patient-insurance and community-level socioeconomic status.
Authors: Semprini Jason
Published: June 2022

e18600

Background: Health insurance helps Head and Neck Cancer (HNC) patients overcome delays for accessing treatment. To overcome gaps in access, policymakers have expanded insurance coverage. If, however, access to timely treatment still varies by insurance status, disparities may persist. Methods: I analyzed data from the Surveillance Epidemiology and End Results program’s “Specialized HNC-HPV” datafile (2010-2016), which categorizes each HNC case into a socioeconomic status (SES) quintile based on the patient’s census-tract of residence. Patients were grouped by having private insurance, Medicare, Medicaid, or being uninsured. Two binary outcome variables were analyzed for differences by insurance status across SES quintiles: a distant stage diagnosis and initiating treatment at least two months after diagnosis. To account for the dynamic nature of HNC, the sample was stratified by Human Papilloma Virus (HPV)-association. Using a linear probability regression model, I tested for differences between insurance categories within each SES quintile. Results: Across all SES quintiles, HPV-negative cancer patients insured by Medicaid had higher rates of distant stage diagnoses and delayed treatment than privately insured patients. Uninsured patients also had higher rates of delayed detection and treatment initiation than privately insured patients. There were no significant differences in the rate of distant-stage diagnoses between privately insured and Medicare patients. However, for all SES quintiles, patients insured by Medicare had higher rates of delayed treatment than privately insured patients. Results were consistent for HPV-positive HNCs, but differences were not significant across all SES quintiles. Conclusions: Even after conditioning on community-level SES, a HNC patient’s insurance type may be associated with delayed detection and treatment. While expanding insurance remains a priority, policymakers must also improve the quality of public health insurance programs to ensure equitable access to timely HNC care.[Table: see text]
Association between area deprivation index and quality of life and psychosocial well-being following breast cancer surgery.
Authors: Hassan Abbas , Nguyen Huan T , Corkum Joseph P , Liu Jun , Kapur Sahil K , Chu Carrie K. , Butler Charles E. , Offodile Anaeze Chidiebele
Published: June 2022

e18612

Background: Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has been conducted to examine the relationship between area-level deprivation (ADI) and post-mastectomy outcomes. Methods: We conducted a cross-sectional survey of all adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019. Patient-specific demographics, clinical history and ADI information were abstracted and correlated with post-operative global- (SF-12) and condition-specific (Breast-Q) quality-of-life performance via multivariable regression. Patients were classified into three groups based on their ADI scores: 0–39 (prosperous/comfortable), 40–59 (mid-tier), and 60–100 (at risk/distressed). Results: A total of 564 consecutive patients were identified; mostly white (75%) with a mean age of 60.2±12.4, mean body mass index (BMI) of 28.8±7.1, mean Charlson Comorbidity Index of 3.5±2.0, and mean ADI of 42.3±25.7. Minority patients and those with high BMI were more likely to reside in highly-deprived neighborhoods (p = 0.003 and p < 0.001). In adjusted models, Patients at risk/distressed had significantly lower mean SF-12 physical (44.9 [95%CI, 43.8-46.0] vs. 44.9 [95%CI, 43.7-46.1] vs. 46.3 [95%CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95%CI, 59.32-67.8] vs. 69.3 [95%CI, 65.1-73.6] vs. 69.7 [95%CI, 66.4-73.1], p = 0.01) than the mid-tier and prosperous/comfortable groups. Conclusions: Patients residing in deprived neighborhoods were more likely to have worse psychological well-being and quality of life. ADI should be incorporated in the shared-decision making process and perioperative counselling to engender value-based and personalized care, especially for vulnerable populations.
The use of patient experience in improving the care pathway for patients with head and neck cancer undergoing radio-chemotherapy.
Authors: Billard Camelia , De Jesus Anne , Dumitrescu Gabriela , Cremadez Michel , Escudier Bernard , Deutsch Eric
Published: June 2022

e18625

Background: Patient satisfaction with the care received or the judgment that patients make of the quality of their care, is now recognized as essential in assessing the quality of health care. Patients and the caregivers have additional experiential knowledge that hospitals must consider in order to improve theirs performance. Methods: The objectives of our study was to determine the key points to be improved in the complex multidisciplinary course of the patient with advanced head and neck cancer undergoing curative treatment by radio-chemotherapy at Gustave Roussy oncological centre in France. To do this, we considered that the collection of the experience of patients, who had recently finished or were still in the process, was essential to design a patient course that takes into account their legitimate expectations. We realised a qualitative research in the form of an interview survey. Seven patients who completed their treatments at different times from October 2020 to September 2021 and four patients still undergoing radio chemotherapy between October to December 2021 gave their consent and participated in the study. We conducted eight face-to-face interviews, one by telephone and two by teleconference between September 2021 and January 2022. All interviews were conducted with two interviewers. Having opted for non-directive interviews, we have limited our interventions as much as possible, depending on the rhythm and content of each patient's story. Our questions focused on points the patient had not addressed by himself. Results: Patients consider the circuits of care to be fluid and the staff to be very attentive. They feel confident, respected and receive personalized care before and during the radio-chemotherapy. Nevertheless, most of the patients mentioned the lack of coordination between the carers of different specialties (medical oncology, radiotherapy, head and neck surgery) and between the institute and the home carers with difficulties in managing toxicities, especially post-treatment. Another breaking point has been the lack of information offered by medical staff about supportive care and cancer patient associations. Conclusions: Several areas for improvement emerged with regard to the coordination of care during treatment and the monitoring of post-treatment side effects. Therapeutic education, prevention and management of toxicities by specialized nurses may respond to this problem as well as digital applications in oncology. A complementary solution can be the implementation of peer patients for this complex head and neck cancer patients course. Our work will continue with a quality research on the impact of nurse-peer patient partnership.
Preliminary outcomes for non-metastatic breast cancer before and during the coronavirus disease 2019 pandemic at community cancer centers.
Authors: Yuan Fangzheng , Abdelhakeem Ahmed , Blevins Samantha , Peters Chelsey , Whalen Susan E. , Hymel Ernest Clayton
Published: June 2022

e18634

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has changed the delivery of cancer care and may have impacted the treatment outcomes. This study described the preliminary outcomes in non-metastatic breast cancer (BC) patients before and during the COVID-19 pandemic. Methods: This retrospective study included adult patients newly diagnosed with non-metastatic BC at two community cancer centers in southeast Texas. Patients diagnosed from 1/2018-10/2018 were included in the control group. Patients diagnosed from 4/2020-1/2021 were included in the COVID-19 group. The key outcomes were progression free survival (PFS), overall survival (OS), breast conserving surgery (BCS) rate, pathological complete response (PCR) rate, and time to treatment initiation (TTI). Results: The study included 74 patients (Table). The proportion of patients with self-detected BC was numerically higher in the COVID-19 group (55%) compared to the control group (36%), although this was not statistically significant (P = 0.09). The median follow-up periods were 38 (IQR: 36-43) months in the control group and 15 (IQR: 13-17) months in the COVID-19 group. No significant difference was observed in PFS (P = 0.74), with 1-year PFS of 93% (95%CI: 80%-98%) in the control group and 100% in the COVID-19 group. No significant difference was observed in OS (p = 0.22), with 1-year OS of 98% (95%CI 85%-100%) in the control group and 100% in the COVID-19 group. No significant difference was observed in TTI between control (51 days) and COVID-19 groups (52 days) (95%CI: -14 to 13; P = 0.91). Among patients who received neoadjuvant systemic therapy and surgery, BCS rates were 29% (5/17) in the control group and 50% (5/10) in the COVID-19 group (P = 0.42). Among patients who had triple negative or HER2 positive BC and received neoadjuvant systemic therapy and surgery, PCR rates were 57% (4/7) in the control group and 33% (1/3) in the COVID-19 group. Conclusions: Although total patient volume decreased during the COVID-19 pandemic, no significant difference was observed in clinical outcomes when comparing patients diagnosed with non-metastatic BC during and prior to the pandemic. Ongoing monitoring with a larger study population and longer follow-up period will help to elucidate the long-term impact of COVID-19 on BC treatment.[Table: see text]
The importance of the long Covid-19 in the evolution of patients with neoplasms.
Authors: Popov Viola , Andreescu Mihaela , Pirvu Catalina , Grigorie Andra , Constantin Oana , Calen Andreea , Badoiu Niculae Mihaela Dana , Badea Adriana , Rus Ana , Iliescu Lelia
Published: June 2022

e18647

Background: Patients with comorbidities especially those with oncological diseases could have severe COVID-19 outcomes. OBJECTIVE: The aim of this study was to evaluate the role of prolonged positivity of SARS-Cov2 in evolution of patients with various neoplasia. Methods: We analysed clinical and laboratory (hematological parameters and inflammatory markers: interleukin-6 and ferritin) data of COVID-19 patients admitted in intensive care unit (ICU) Department of our hospital, during 2020-2021 and presented in medical history solid tumors or haematological neoplasia . The cohort of patients included 78 patients with severe and critical form of COVID-19, 31 patients with solid tumors and 47 patients with hematologic malignancies. We consider long COVID-19 all cases with SARS Cov2 positivity more than 14 days. Results: The frequency of long COVID-19 was quite equal between patients groups with solid tumors and hematologic malignancies, incidence rate 1:2, the incidence rate differences was 1:18, p = 0.75. Long COVID-19 was observed in 60% cases with favourable evolution, Chi-squared 5.35%, p = 0.02, these patients had moderate form and was admitted in hospital in 1 or more days after the onset, median value 3 (min 1, max 55) compared with patients with normal duration of positivity of SARS-Cov2 test- median value 2 (min 1, max 8), p = 0.01. The Kaplan Meyer survival analyses indicated long COVID-19 as predictive factor for unfavourable evolution, Chi-squared 17.97, p < 0.0001. Although we have not obtain significant differences, we observed more severe lymphopenia in patient without long COVID-19, probably because a part of these patients group died in the first 14 days of COVID-19 (0.765 (min 0.04, max 297.64) vs. 1.01 (min 0.09, max 254.35), p = 0.09). The rest of hematological and biochemistry parameters was not significant different between groups. Infectious and thrombotic complication was most frequent in patients with long COVID-19, Chi squared 8.6, p = 0.003. Conclusions: Long Covid-19 is predictable for unfavourable evolution and is associated with sepsis and thrombotic complication. This diagnosis is frequent in patients who was admitted in hospital after the onset of COVID-19 symptoms, early treatment of COVID-19 in oncological patients being very important for favourable evolution.