bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective study of dietary mushroom intake and risk of mortality: results from continuous National Health and Nutrition Examination Survey (NHANES) 2003-2014 and a meta-analysis
Authors: Ba Djibril M. , Gao Xiang , Al-Shaar Laila , Muscat Joshua , Chinchilli Vernon M. , Ssentongo Paddy , Zhang Xinyuan , Liu Guodong , Beelman Robert B. , Richie John P.
Published: September 2021

Background

Whether mushroom consumption, which is a rich source of potent antioxidants ergothioneine and glutathione, vitamins, and minerals (e.g., selenium & copper), is associated with a lower mortality risk is not well understood. This study aimed to examine the association between mushroom consumption and risk of mortality in a prospective cohort study and a meta-analysis of prospective cohort studies.

Methods

We followed 30,378 participants from the continuous National Health and Nutrition Examination Survey (NHANES) extant data (2003-2014). Dietary mushroom intake was assessed using up to two 24-h recalls. Mortality was evaluated in all participants linked to the National Death Index mortality data through December 31, 2015. We used Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). We also conducted a meta-analysis, including results from our present study and 4 other cohort studies.

Results

During a mean (SD) of 6.7 (3.4) years of follow-up, a total of 2855 death cases were documented among NHANES participants. In our analysis of continuous NHANES, we found a non-significant association between mushroom consumption and all-cause mortality (adjusted hazard ratio (HR) = 0.84; 95% CI: 0.67-1.06) after adjusting for demographic, major lifestyle factors, overall diet quality, and other dietary factors, including total energy. The meta-analysis of prospective cohort studies, including 601,893 individuals, showed that mushroom consumption was associated with a lower risk of all-cause mortality (pooled risk ratio: 0.94; 95% CI: 0.91, 0.98).

Conclusion

In a meta-analysis of prospective cohort studies, mushroom consumption was associated with a lower risk of all-cause mortality.
APOC3 genetic variation, serum triglycerides, and risk of coronary artery disease in Asian Indians, Europeans, and other ethnic groups
Authors: Goyal Shiwali , Tanigawa Yosuke , Zhang Weihua , Chai Jin-Fang , Almeida Marcio , Sim Xueling , Lerner Megan , Chainakul Juliane , Ramiu Jonathan Garcia , Seraphin Chanel , Apple Blair , Vaughan April , Muniu James , Peralta Juan , Lehman Donna M. , Ralhan Sarju , Wander Gurpreet S. , Singh Jai Rup , Mehra Narinder K. , Sidorov Evgeny , Peyton Marvin D. , Blackett Piers R. , Curran Joanne E. , Tai E. Shyong , van Dam Rob , Cheng Ching-Yu , Duggirala Ravindranath , Blangero John , Chambers John C. , Sabanayagam Charumathi , Kooner Jaspal S. , Rivas Manuel A. , Aston Christopher E. , Sanghera Dharambir K.
Published: September 2021

Background

Hypertriglyceridemia has emerged as a critical coronary artery disease (CAD) risk factor. Rare loss-of-function (LoF) variants in apolipoprotein C-III have been reported to reduce triglycerides (TG) and are cardioprotective in American Indians and Europeans. However, there is a lack of data in other Europeans and non-Europeans. Also, whether genetically increased plasma TG due to ApoC-III is causally associated with increased CAD risk is still unclear and inconsistent. The objectives of this study were to verify the cardioprotective role of earlier reported six LoF variants of APOC3 in South Asians and other multi-ethnic cohorts and to evaluate the causal association of TG raising common variants for increasing CAD risk.

Methods

We performed gene-centric and Mendelian randomization analyses and evaluated the role of genetic variation encompassing APOC3 for affecting circulating TG and the risk for developing CAD.

Results

One rare LoF variant (rs138326449) with a 37% reduction in TG was associated with lowered risk for CAD in Europeans (p = 0.007), but we could not confirm this association in Asian Indians (p = 0.641). Our data could not validate the cardioprotective role of other five LoF variants analysed. A common variant rs5128 in the APOC3 was strongly associated with elevated TG levels showing a p-value 2.8 × 10− 424. Measures of plasma ApoC-III in a small subset of Sikhs revealed a 37% increase in ApoC-III concentrations among homozygous mutant carriers than the wild-type carriers of rs5128. A genetically instrumented per 1SD increment of plasma TG level of 15 mg/dL would cause a mild increase (3%) in the risk for CAD (p = 0.042).

Conclusions

Our results highlight the challenges of inclusion of rare variant information in clinical risk assessment and the generalizability of implementation of ApoC-III inhibition for treating atherosclerotic disease. More studies would be needed to confirm whether genetically raised TG and ApoC-III concentrations would increase CAD risk.
Augmented feedback for manual wheelchair propulsion technique training in a virtual reality simulator
Authors: Yan Hui , Archambault Philippe S.
Published: September 2021

Background

Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex task in a safe and realistic environment. Additionally, augmented feedback (AF) may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing AF with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion.

Methods

Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency AF group received AF in the form of knowledge of performance throughout all propulsion training; the faded AF group received this AF in a faded schedule (high relative frequency of AF early in practice, with relative frequency of AF provision diminishing throughout practice); and the control group underwent training with no AF. Propulsion assessments were performed at baseline and 48 h after practice in both virtual and real environments to measure retention and transfer, respectively.

Results

Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant between-group differences were also found between the high-frequency and faded feedback groups.

Conclusion

Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes AF regarding propulsion biomechanics.
Activin-A impedes the establishment of CD4+ T cell exhaustion and enhances anti-tumor immunity in the lung
Authors: Morianos Ioannis , Tsitsopoulou Aikaterini , Potaris Konstantinos , Valakos Dimitrios , Fari Ourania , Vatsellas Giannis , Bostantzoglou Clementine , Photiades Andreas , Gaga Mina , Xanthou Georgina , Semitekolou Maria
Published: September 2021

Background

Although tumor-infiltrating T cells represent a favorable prognostic marker for cancer patients, the majority of these cells are rendered with an exhausted phenotype. Hence, there is an unmet need to identify factors which can reverse this dysfunctional profile and restore their anti-tumorigenic potential. Activin-A is a pleiotropic cytokine, exerting a broad range of pro- or anti-inflammatory functions in different disease contexts, including allergic and autoimmune disorders and cancer. Given that activin-A exhibits a profound effect on CD4+ T cells in the airways and is elevated in lung cancer patients, we hypothesized that activin-A can effectively regulate anti-tumor immunity in lung cancer.

Methods

To evaluate the effects of activin-A in the context of lung cancer, we utilized the OVA-expressing Lewis Lung Carcinoma mouse model as well as the B16F10 melanoma model of pulmonary metastases. The therapeutic potential of activin-A-treated lung tumor-infiltrating CD4+ T cells was evaluated in adoptive transfer experiments, using CD4−/−-tumor bearing mice as recipients. In a reverse approach, we disrupted activin-A signaling on CD4+ T cells using an inducible model of CD4+ T cell-specific knockout of activin-A type I receptor. RNA-Sequencing analysis was performed to assess the transcriptional signature of these cells and the molecular mechanisms which mediate activin-A’s function. In a translational approach, we validated activin-A’s anti-tumorigenic properties using primary human tumor-infiltrating CD4+ T cells from lung cancer patients.

Results

Administration of activin-A in lung tumor-bearing mice attenuated disease progression, an effect associated with heightened ratio of infiltrating effector to regulatory CD4+ T cells. Therapeutic transfer of lung tumor-infiltrating activin-A-treated CD4+ T cells, delayed tumor progression in CD4−/− recipients and enhanced T cell-mediated immunity. CD4+ T cells genetically unresponsive to activin-A, failed to elicit effective anti-tumor properties and displayed an exhausted molecular signature governed by the transcription factors Tox and Tox2. Of translational importance, treatment of activin-A on tumor-infiltrating CD4+ T cells from lung cancer patients augmented their immunostimulatory capacity towards autologous CD4+ and CD8+ T cells.

Conclusions

In this study, we introduce activin-A as a novel immunomodulatory factor in the lung tumor microenvironment, which bestows exhausted CD4+ T cells with effector properties.
Network security situation prediction based on feature separation and dual attention mechanism
Authors: Li Zhijian , Zhao Dongmei , Li Xinghua , Zhang Hongbin
Published: September 2021

With the development of smart cities, network security has become more and more important. In order to improve the safety of smart cities, a situation prediction method based on feature separation and dual attention mechanism is presented in this paper. Firstly, according to the fact that the intrusion activity is a time series event, recurrent neural network (RNN) or RNN variant is used to stack the model. Then, we propose a feature separation method, which can alleviate the overfitting problem and reduce cost of model training by keeping the dimension unchanged. Finally, limited attention is proposed according to global attention. We sum the outputs of the two attention modules to form a dual attention mechanism, which can improve feature representation. Experiments have proved that compared with other existing prediction algorithms, the method has higher accuracy in network security situation prediction. In other words, the technology can help smart cities predict network attacks more accurately.
Supplementation of non-fermented and fermented goji berry (Lycium barbarum) improves hepatic function and corresponding lipid metabolism via their anti-inflammatory and antioxidant properties in high fat-fed rats
Authors: Lee Sunhye , Jeong Soyeon , Park Yeongju , Seo Hyunji , You Cheongbin , Hwang Unsik , Park Hoon , Suh Hee-jae
Published: September 2021

Development of obesity is associated with excessive fat accumulation and oxidative stress along with chronic inflammation. Goji berries (Lycium barbarum) are high in polyphenolic compounds and have anti-inflammatory, anti-oxidant, and hypolipidemic properties that may alleviate the pathogenesis of obesity and related metabolic complications. Thus, the aim of this study was to investigate potential metabolic benefits of GB supplementation against high fat (HF) diet-induced obesity and its comorbidities in HF diet-fed rats (male Sprague–Dawley, n  =  8/group, 6 weeks old). We also sought to examine the potential metabolic benefits of fermented GB (FGB) with L. plantarum CB3 and possible distinctions in the degree and/or mechanism of action compared to GB. GB and FGB supplementation suppressed the gene expression of inflammation indices at the local (adipose tissues) and systemic (liver) levels. In addition, GB and FGB supplementation upregulated the gene expression of antioxidant enzymes compared to the HF and/or even low fat (LF) group with more remarkable antioxidant effects by GB supplementation. Also, GB and FGB supplementation protected from HF-induced damages of the liver and dyslipidemia. In conclusion, we demonstrated that GB and FGB supplementation protected from HF-induced metabolic complications primarily by improving hepatic function and corresponding lipid metabolism via their anti-inflammatory and antioxidant properties. To our knowledge, this is the first in vivo study confirming metabolic benefits of GB in a fermented form. Thus, these findings support the potential application of both GB and FGB to ameliorate obesity-associated metabolic abnormalities.
Perceptions from pharmaceutical stakeholders on how the pharmaceutical budget is allocated in South Africa
Authors: Moodley Lirosha , Suleman Fatima , Perumal-Pillay Velisha Ann
Published: September 2021

Background

South Africa faces a heavy burden of disease, which impacts resource allocation. The needs of South Africa require efficient translation into pharmaceutical expenditure for medicine provision, to ensure availability of medicines. Given that South Africa faces various challenges with medicine provision accompanied by rising pharmaceutical expenditure, this study aimed to report on the considerations and methods used to determine the healthcare budget for South Africa, and how it is translated into pharmaceutical expenditure for medicines provision on the Standard Treatment Guidelines and Essential Medicines List and non-essential medicines in the public sector.

Method

Qualitative, semi-structured interviews guided by a discussion guide were conducted with seven pharmaceutical officials involved in the budget and resource allocation process, between October 2019 and March 2020. Interviews were recorded and transcribed verbatim. Once the interviews were coded by the first author they were verified by the other authors. Data were thematically analysed.

Results

This study depicted the knowledge and participation of pharmaceutical services in the budget process. The National and Provincial Department of Health have improved pharmaceutical budgeting by making strides towards a collaborative, informed, and more evidence-based approach. Pharmaceutical services have roles in advising on requirements; commenting where necessary, constantly monitor and taking accountability for their budget. The main considerations that determined the budget included population size and growth, historical expenditure, the extra heavy burden of disease and incidence rate, demand data and forecasting. The local and provincial pharmacy and therapeutics committee play a vital role in monitoring the budget and expenditure; ensuring adherence to guidelines; controlling the extent to which non-Essential Medicine List items are used and advising accordingly.

Conclusion

This was the first study to report on the decision and thought processes of the healthcare budget and its translation into pharmaceutical expenditure for medicine provision in South Africa. Many factors were considered to inform the budget, with the Standard Treatment Guideline and Essential Medicines List being the principal guide for medicine provision. This process was well-controlled and monitored by the pharmaceutical therapeutics committee. Documenting the South African experience can assist other countries in their budget decisions for medicines.
Short-term follow-up HRCT Chest of COVID-19 survivors and association with persistent dyspnea
Authors: Kumar Ishan , Prakash Adity , Ranjan Manoj , Chakrabarti Sankha Shubhra , Shukla Ram C. , Verma Ashish
Published: September 2021

Background

There is an increasing concern that a proportion of the survivors of COVID 19 might develop fibrotic and/or other non-reversible lung changes. The aim of this retrospective study was to review the imaging findings of HRCT of lungs in a cohort of COVID 19 survivors, coming for short-term clinical follow-up and to assess the relation of the observed HRCT changes with the presence of dyspnea.

Results

In total, 40 patients with residual CT findings were included in this study with a mean age of 44.3 years and male: female ratio of 3:2. The presence of residual ground-glass opacities (85%) and reticular opacities (80%) was the most common findings. 25% of the cases had cystic changes in their lung. The presence of dyspnea was significantly associated with male sex and a history of smoking. On HRCT, the presence of cystic changes, involvement of > 10 lung segments, and an HRCT severity score > 7 were significantly associated with dyspnea.

Conclusion

Survivors of COVID 19 demonstrate persistent changes in the lung on HRCT. We recommend that a follow-up HRCT should be performed in these patients to identify those with post-COVID sequelae.
Suicides from 2016 to 2020 in Finland and the effect of the COVID-19 pandemic
Authors: Partonen Timo , Kiviruusu Olli , Grainger Marjut , Suvisaari Jaana , Eklin Aki , Virtanen Antti , Kauppila Riitta
Published: September 2021

The COVID-19 pandemic has had negative mental health outcomes in populations, but the suicide numbers in Finland have remained unchanged compared with expected levels based on the pre-pandemic period. We included all deaths from suicide verified by the official cause-of-death investigations, including forensic autopsy with analysis of forensic toxicology samples, between 1 January 2016 and 31 December 2020 in Finland. There was a decline in suicide incidence from 2016 to 2020 in men, and a declining tendency in suicide rates for every consecutive month during the COVID-19 pandemic period. The COVID-19 governmental policy responses do not seem to have led to an increase in suicide numbers.
Impact of smoking behavior on cognitive functioning in persons at risk for psychosis and healthy controls: A longitudinal study
Authors: van der Heijden Heleen S. , Schirmbeck Frederike , Kempton Matthew J. , van der Gaag Mark , Allott Kelly , Nelson Barnaby , Ruhrmann Stephan , de Haan Lieuwe , Vermeulen Jentien M ,   Eu-Gei High Risk Study
Published: September 2021

Background

The high prevalence of smoking in individuals who are at ultra-high risk (UHR) for psychosis is well known and moderate cognitive deficits have also been found in UHR. However, the association between smoking and cognition in UHR is unknown and longitudinal studies are lacking.

Method

A cohort study with 330 UHR individuals and 66 controls was conducted, as part of the European network of national schizophrenia networks studying gene–environment interactions (EU-GEI). At baseline and after 6, 12, and 24 months, smoking behavior was assessed with the Composite International Diagnostic Interview and cognitive functioning with a comprehensive test battery. Linear mixed-effects analyses were used to examine the multicross-sectional and prospective associations between (change in) smoking behavior and cognitive functioning, accounting for confounding variables.

Results

At baseline, 53% of UHR and 27% of controls smoked tobacco. Smoking UHR and controls did not significantly differ from nonsmoking counterparts on the tested cognitive domains (speed of processing, attention/vigilance, working memory, verbal learning, or reasoning/problem solving) across different assessment times. Neither smoking cessation nor initiation was associated with a significant change in cognitive functioning in UHR.

Conclusions

No associations were found between smoking and cognitive impairment in UHR nor in controls. However, the fact that one in every two UHR individuals report daily use of tobacco is alarming. Our data suggest that UHR have fewer cognitive impairments and higher smoking cessation rates compared to patients with first-episode psychosis found in literature. Implications to promote smoking cessation in the UHR stage need further investigation.
Epstein-Barr Virus Latent Membrane Protein-1 Expression in Nasopharyngeal Carcinoma
Authors: Salano Valerie E. , Mwakigonja Amos R. , Abdulshakoor Ashfaq , Kahinga Aveline A. , Richard Enica M.
Published: September 2021

PURPOSE

Nasopharyngeal carcinoma (NPC), a malignant neoplasm of the epithelium covering the nasopharynx, is a rare disease in most parts of the world. Epstein-Barr virus (EBV), the most potent oncogenic virus, coupled with environmental and genetic factors has been identified to play a role in the development of NPC. An array of methods for detecting the virus do exist, from serologic detection of antibodies to DNA amplification. There is paucity of local data on the status of EBV infection in relation to NPC within the region, and this study attempts to shed more light on the subject.

METHODS

This was a retrospective cross-sectional laboratory-based study on histologically confirmed, archived tissues from July 2015 to June 2019. Immunohistochemistry expression of latent membrane protein-1 (LMP-1) was used to detect EBV infection in the tissues.

RESULTS

A total of 71 cases were enrolled in this study. The mean age was 47.87 years ± 16.84 years with a male-to-female ratio of 1.5:1. There was a unimodal distribution of EBV detection, with the peak (26.8%) at 36-45 years. About 45.1% of the 71 samples tested positive for LMP-1, all of which were nonkeratinizing carcinoma. Nonkeratinizing carcinoma was the most common histopathologic subtype (n = 67; 94.4%), with the majority (38 of 67; 56.7%) being undifferentiated and 29 of 67 (43.3%) differentiated. Keratinizing and basaloid subtypes had two cases each, representing 2.8%.

CONCLUSION

A significant proportion of NPC, particularly nonkeratinizing histologic subtype, seems to show LMP-1 positivity by immunohistochemistry, which may be adopted in resource-constrained settings to detect EBV infection in these tissue biopsies.
Using blood wisely in oncology patients: An institutional analysis of the Choosing Wisely Canada restrictive transfusion strategy guidelines.
Authors: Tesch Megan Elizabeth , Alghawas Mae , Gerrie Alina S.
Published: September 2021

10

Background: Numerous studies support the safety of single-unit red red blood cell (RBC) transfusions and restrictive pre-transfusion hemoglobin (Hg) thresholds (≤ 70-80 g/L) among diverse populations of hospitalized patients, including those with malignancies on myelosuppressive systemic therapy. Using Blood Wisely is a national Choosing Wisely Canada (CWC) initiative that challenges hospitals to benchmark themselves on evidence-informed restrictive transfusion strategies, with the aim to decrease inappropriate RBC transfusions in Canada. We assessed transfusion practices among oncology inpatients at BC Cancer Vancouver Centre as part of this initiative and performed an exploratory analysis among outpatients. Methods: BC Cancer Vancouver RBC transfusion records were obtained for the period of October 2019-September 2020. The percentage of single-unit transfusions and transfusions for Hg ≤ 80 g/L were measured, to assess adherence to CWC targets of ≥ 65% and ≥ 80%, respectively, for these metrics. Univariate analyses were used to compare treatment variables and transfusion outcomes. Results: During the 1-year audit period, 120 inpatient and 586 outpatient RBC transfusions occurred. For inpatient transfusions, 40.8% (n = 49) were single-unit and 79.2% (n = 95) were for Hg ≤ 80 g/L. For outpatient transfusions, 11.8% (n = 69) were single-unit and 65.7% (n = 304) were for Hg ≤ 80 g/L. Outpatients and patients with solid malignancies were more likely to receive multiple-unit transfusions, compared to inpatients (p < 0.001) and patients with hematological malignancies (p < 0.001), respectively. Patients with solid malignancies and those on active treatment were more likely to be transfused when Hg was > 80 g/L, compared to patients with hematological malignancies (p = 0.004) and those off treatment (p = 0.003), respectively. Multiple RBC units were more likely to transfused when the interval from pre-transfusion bloodwork to receipt of transfusion was > 3 days (p = 0.029). Conclusions: A high rate of inappropriate RBC transfusions are being ordered for oncology patients at our institution, in discordance with CWC restrictive transfusion strategy guidelines. Quality improvement interventions are planned to adopt best practices in transfusion medicine in this high-use population.[Table: see text]
Implementing a patient navigation program to improve adherence with cancer treatment for community health center patients newly diagnosed with cancer.
Authors: Percac-Lima Sanja , Irwin Kelly , Whited Emma , Benjamin Carmen , Pichardo Ausubel , Oravcova-Mejia Mira , Thompson Solomon , Morrill James , Ford Colleen , Wheeler Amy , Moy Beverly
Published: September 2021

103

Background: Community health centers’ (CHCs) patients newly diagnosed with cancer often experience barriers to accessing timely treatment. Patient navigation decreases barriers to cancer screening and diagnostic care, but the exact impact on cancer treatment is unclear. We implemented patient navigation to provide underserved patients with support to access and adhere to cancer treatment. The goal of our study is to determine the effect of patient navigation on missed appointment rates, treatment adherence, and health outcomes among an underserved patient population. Here, we present preliminary data about program implementation. Methods: Utilizing a population health registry, TopCare, and referrals from CHCs physician champions, newly diagnosed cancer patients from Massachusetts General Hospital CHCs were referred to the Cancer Center, identified and verbally consented to participate in the study’s intervention. Patients are randomized either to receive in-person patient navigation or enhanced usual care, which consists of two reminder phone calls prior to each oncology appointment. Adherence to treatment, healthcare utilization, patient satisfaction with cancer care and patient navigation, patient engagement, financial burden, symptom burden, health-related quality of life, and psychosocial care are longitudinally assessed. Our primary outcome is missed appointment rate to oncology appointments. Results: The trial started in November 2017 and as of April 2021, we have identified 349 eligible patients and enrolled 261 (82% consent rate for reached patients). Of 261 enrolled patients, 50% were women, 38% identified as non-White, 25% identified as Hispanic or Latino, and 28% did not speak English. The most frequent cancer types enrolled include genitourinary (n=67), thoracic (n=47), gastrointestinal (n=47), and breast (n=46). Patients had 6257 visits and 195 were missed (3.1%). Navigators performed 4553 interventions. There were 152 emergency department visits and 127 unplanned hospital admissions. Of 120 referrals to supportive care, 54 were to social work, 38 to palliative care and 28 to Psychiatric Oncology or behavioral health. Conclusions: Patient navigation is feasible for underserved CHC patients newly diagnosed with cancer. Our current missed appointment rate is 3.1%, including the time period of the COVID-19 pandemic. After trial completion in July 2021, we will compare the outcomes in patients who received in-person patient navigation to patients who were randomized to enhanced usual care. Clinical trial information: NCT03226405.
Biomarker testing in patients (pts) with metastatic colorectal cancer (mCRC): Survey of U.S. oncologists (ONC) in rural areas and urban clusters.
Authors: Lewis Mark Andrew , Stansfield Lindsay , Kelton John M. , Edwards Michelle L. , Lieu Christopher Hanyoung
Published: September 2021

108

Background: In the US, rural areas have higher cancer mortality rates than urban areas. Clinical practice guidelines recommend testing for BRAF and RAS mutations, and deficient mismatch repair (dMMR)/microsatellite instability (MSI) in pts with mCRC. However, data on biomarker testing rates in rural communities are limited. We surveyed ONC in the US who practice in rural areas and urban clusters to identify biomarker testing patterns and barriers. Methods: A web-based survey was administered to board-certified ONC who spend ≥ 40% of their time providing direct care to pts in rural areas or urban clusters (US Census Bureau definition) and who treated ≥ 2 pts with stage IV mCRC in the month prior to the survey. ONC in Maine, Vermont, and West Virginia were excluded (state legislature), as were those employed by the US government, Veterans Affairs, or Kaiser Permanente. Respondents were compensated. Data were analyzed descriptively. Results: From Feb 12 to Mar 18, 2021, 99 ONC (40% medical ONC, 60% hematologists/ONC) completed the survey. Respondents spent 56% and 18% of their time (mean) practicing in urban clusters and rural areas, respectively; 33% were in the South, followed by 26%, 22%, and 18% in the Northeast, Midwest, and West, respectively. 97% of ONC had ordered biomarker tests for pts; 35% referred pts for independent genomic testing. ONC tested biomarkers most commonly for stage IV disease: 72%, 65%, 63%, 59%, and 66% for KRAS, NRAS, BRAF, PD-L1, and dMMR/MSI, respectively (Table). 41% of ONC reported performing reflex testing at their primary practice, most commonly for PD-L1 (62%), KRAS (60%), and dMMR/MSI (52%). DNA-based next-generation sequencing (NGS) was the most common testing method reported. ONC indicated they would test for an actionable biomarker if it were known to occur in ≥ 28% of pts with mCRC. The most commonly cited barriers to testing were insufficient tissue samples and lack of insurance coverage. Although > 50% of ONC agreed telehealth can improve testing rates, 81% noted barriers, including pts lacking technology equipment (56%) and pts being disengaged or unwilling to use telehealth (37%). Further data on testing-related decision making and barriers will be presented. Conclusions: Biomarker testing in rural areas and urban clusters falls short of current guideline recommendations. Further exploration of rural biomarker testing practices and strategies to improve testing are needed.[Table: see text]
When oncology care goes digital: A closer look at disparities.
Authors: Habouch Jad , Mane Adit
Published: September 2021

119

Background: Oncology providers are increasingly integrating digital solutions, such as patient relationship management (PRM), to improve patient care. PRM enables patients to communicate with their clinic, view health records, receive educational materials and submit patient-reported outcomes (ePROs). However, disparities in PRM adoption and engagement in oncology care are unclear. Methods: Patients with cancer aged ≥18 years at first appointment between Oct 2017-Sep 2020 with ≥6 months’ follow-up, regardless of tumor type, line of therapy or diagnosis date, were selected from 77 US oncology clinics. Patients’ demographics, login history and digital activity data were sourced from the clinics’ PRM (Navigating Cancer). Chi-square analyses identified statistically significant differences by race/ethnicity. Results: 202,345 patients were identified as White (78%), Black (11%), Hispanic (8%), Asian/Pacific Islander (PI)/Native Hawaiian (NH; 2%) and American Indian (AI)/Alaska Native (AN; 1%) (Table). Of these, 85,020 (42%) had digital access (≥2 valid PRM logins) ranging from 46% (White) to 21% (Hispanic). Similar proportions of White, Asian/PI/NH and Hispanic patients were digitally active for 6 months (8%-13%), while Black patients lagged behind at 5% ( P<0.0001). Digital education completion, which required a patient to read all assigned materials, ranged from 26% (AI/AN) to 14% (Asian/PI/NH). Surpassing other patient groups, 32% of AI/AN patients reported symptoms via phone, followed by 16% of White patients. ePROs submission rates were 5 times higher than rates of symptom reporting via phone for all groups except AI/AN. Conclusions: This study demonstrated that White patients have higher digital access rates compared with other racial/ethnic patient groups, especially Hispanic and Black patients. Further evaluation of digital health components depicted disparities in digital, phone and ePROs engagement for all groups, except AI/AN patients, who invariably had higher engagement. No differences were observed in ePROs access. Further, disparities observed in symptoms reporting via phone were larger than the disparities seen in ePROs submissions. More studies are needed to assess other determinants of digital health disparities.[Table: see text]
Adherence to screening mammogram guidelines in the transgender/non-binary population.
Authors: Luehmann Natalie , Ascha Mona , Chwa Emily , Stockslager Caitlin , Hackenberger Paige , Termanini Kareem , Beach Lauren , Benning Christopher , Gupta Dipti , Sama Danny , Kulkarni Swati , Jordan Sumanas
Published: September 2021

120

Background: Data is limited regarding rates of breast cancer and mammography screening within the transgender/non-binary (TGNB) population. Screening recommendations vary and there is no global consensus. TGNB patients face unique challenges that may preclude screening and risk assessment, such as barriers to accessing healthcare, lack of provider education, and limited data regarding hormonal impacts on risk. This study aims to address adherence to current screening mammogram recommendations within the TGNB population at a single hospital system. Methods: A retrospective chart review was performed using ICD codes, sexual orientation and gender identity data, and key words to identify TGNB patients that had contact with the Northwestern Hospital system between March 2019 and February 2021. Patients designated female at birth (DFAB) and age ≥ 40 with breasts at time of screening eligibility were included as well as patients designated male at birth (DMAB) and age ≥ 50 with ≥ 5 years of hormone therapy (HT). Rates of screening mammogram were evaluated along with analysis of demographic factors that may predict for or against adherence to recommendations. ASBrS and USPSTF guidelines, screening mammograms starting at age 40 and 50, respectively, were applied to patients DFAB. UCSF Center for Transgender Health and Fenway Health guidelines (screening mammogram at age 50 and ≥ 5 years of HT) were applied to patients DMAB. Results: The table illustrates screening adherence rates according to guidelines with two definitions of adherence. We evaluated patients who had screening mammogram “on-time” which was defined at age 40 or 50 with a two year grace period. We also defined adherence as having had a screening mammogram within the two year study period regardless of age. Univariate analysis and multivariate analysis evaluating for insurance status, employment status, level of education, and hormone use did not identify any factors associated with likelihood of adhering to screening guidelines in either the DFAB or DMAB population. Conclusions: Adherence to screening mammogram recommendations among the TGNB population at Northwestern Hospital system is low across all sub-groups. In contrast, the ACO rate of adherence to screening mammogram (within the last two years) at our institution for all-comers (age ≥ 50-74) in 2019 was 77.33%. Demographic data failed to elucidate any association with likeliness to undergo appropriate breast cancer screening. This disparity demands the development of initiatives aimed at increasing breast cancer screening rates for the Northwestern TGNB population.[Table: see text]
Association of pretreatment financial toxicity with time to treatment for patients with head and neck carcinoma and lung carcinoma.
Authors: Lam Sharon , Schlecht Nicolas , Rosenblatt Gregory , Mehta Vikas
Published: September 2021

131

Background: Financial toxicity (FT) describes objective and subjective burden of costs associated with medical care. Patients with head and neck cancer (HNC) and lung carcinoma are acutely impacted by FT, as these cancers disproportionately occur in populations that are poor, unemployed, and/or of minority backgrounds compared to patients with other cancers. Our group recently published results showing delay in time to treatment initiation (TTI) was associated with poorer survival in HNC patients. Another study reported that FT was associated with worse progression-free survival in non-small cell lung cancer patients. In this study, we sought to investigate the association between FT, TTI and clinical outcomes among HNC and lung carcinoma patients, as well as predictors of FT. Methods: A retrospective analysis of 140 patients diagnosed with either HNC or lung carcinoma between January 2007 and March 2018 with quality-of-life data collected prospectively at the time of radiation oncology treatment was conducted. Participants responded to a question about their experience on ‘financial difficulties’ with a 4-point Likert Scale within the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) quality of life assessment. FT was low when patients indicated ‘1’ (not at all) or ‘2’ (a little), and high if patients indicated ‘3’ (quite a bit), and ‘4’ (very much). Chi-square test and Student’s t-test were used to compare characteristics of patients with and without FT. The association between FT and TTI and survival outcomes were analyzed using the Kaplan-Meier methods and Cox proportional-hazards regression models. Results: The study sample included 70 patients with HNC (mean [SD] age, 64.3 [12.0]; 62.7% male) and 70 patients with lung carcinoma (mean [SD] age, 69.1 [10.2]; 38.0% male). Over half (N = 80, 55.2%) reported experiencing financial toxicity (64% HNC vs. 45.7% lung carcinoma). Younger age (< 60 years), having Medicaid, and having small-cell lung carcinoma were associated with greater FT (p = 0.049, p = 0.042, p = 0.034, respectively). Patients who reported having poorer health and quality of life also experienced greater FT (p = 0.030, p = 0.016, respectively). HNC patients who experienced greater FT were less likely to experience treatment delay (p = 0.035). After adjusting for age, sex, ethnicity, tumor site, and tumor stage, FT was associated with worse survival outcomes in all patients (HR = 1.52, 95% CI 1.06-2.19). Conclusions: Greater FT was associated with younger age, having Medicaid, and having small-cell lung carcinoma. HNC patients who experienced greater FT were less likely to experience treatment delay, which suggests that delay may not be a causative factor for the worsened survival seen with patients who report FT.
Identifying opportunities to improve equity in breast cancer care for uninsured Hispanic patients in underserved communities.
Authors: Botrus Gehan , Ertz -Archambault Natalie , Kosiorek Heidi E. , Nafissi Nellie , Gonzales Miguel , Ernst Brenda , Northfelt Donald W.
Published: September 2021

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Background: Enhancing equitable oncologic care is an increasingly emphasized priority. Our study aims to identify aspects of breast cancer (BC) care in which differences exist based on insurance coverage. Methods: We performed a retrospective, case control study, (from 2014-2020); 39 Hispanic ethnicity uninsured patients (UP) from underserved communities with newly diagnosed BC and 119 insured patients (IP) diagnosed at Mayo Clinic Arizona (MCA). Patients were matched 3:1 for age, stage, year of diagnosis, estrogen receptors and HER-2 status. Demographic information, clinical variables, and zip code level specific socioeconomic information were compared. Continuous variables were compared by Wilcoxon rank-sum test and categorical variables by chi-square test. All patients were treated at MCA. Results: Similar treatment patterns with radiotherapy, chemotherapy and surgery were observed between groups. Primary language was Spanish for 94% of UP and English for 97.5% of IP. The majority of UP were of Hispanic ethnicity (97.4%); IP were 83.2% non-Hispanic White, 9.2% Hispanic, 3.4% African American. Zip code level information reflected more unemployment with a median of 10.6% versus 6.9% p < 0.001, percent of high school or lower (53.0 % v 23.2 %, p < 0.001), and lower income for UP (33733.5 v 64728.0 p values < 0.001).BMI was significantly higher for UP (30.6 V 24.7, p = 0.005), with presence of more co-morbidities; diabetes (28.2% v 5.0%, p < 0.001), hypertension (35.9 % v 20.2%, p = 0.046), dyslipidemia (28.2% v 12.6%, p = 0.023), metabolic syndrome (p 23.7% v 8.5, p = 0.013), and tobacco use (17.9% v 2.5%, p < 0.001). Genetics consultation was performed for 62.2% IP versus 35.9% UP (p = 0.004), lower acceptance of nutrition consultation for UP (29.4% vs 7.4%, p = 0.024). Median time from mammogram to biopsy (25.5 days vs. 14 days, p = 0.056), and interval from diagnosis to treatment (62 days vs. 39 days) (p = 0.001) were less favorable for UP compared to IP. Conclusions: In comparing the status of UP and IP with newly diagnosed BC, we identified greater prevalence of co-morbidities and adverse social determinants of health in the former group. We identified access to genetic counseling, nutrition consultation, and timeliness of diagnostic biopsy and initiation of treatment as disparate features in the care pathway. These observations allowed development of tailored interventions to achieve greater equity in delivery of BC care at Mayo Clinic.
Racial diversity and reporting in FDA registration trials for thoracic malignancies from 2006 to 2020.
Authors: Chiang Ryan S. , Glover Michael , Hui Gavin , Desai Aakash , Wakelee Heather A. , Lythgoe Mark , Khaki Ali Raza
Published: September 2021

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Background: Black patients have a disproportionately high incidence and mortality from lung cancer. Despite the importance of clinical trials, there continue to be significant racial disparities in recruitment for pivotal registration studies. In 2016, the FDA recommended reporting racial enrollment with a minimum of 5 categories (White, Black, Asian, American Indian or Alaskan Native [AIAN] and Native Hawaiian or Pacific Islander [NHPI]). The International Committee of Medical Journal Editors also recommend reporting race and ethnicity. We evaluated race reporting and representation in registration trials for thoracic cancers. Methods: We reviewed the FDA website and identified all new drug licensing indications in thoracic malignancies (small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC) and mesothelioma) from 2006 to 2020. NSCLC was further classified as EGFR+, ALK+, other mutation and NOS (no driver mutation). Clinical trials cited on the licensing label for market authorization were recorded and the corresponding registration trial publication was identified. If race was unreported or underreported (defined as ≤3 groups) in the licensing study, then additional information was obtained from clinicaltrials.gov. We calculated the proportion of registration trials meeting FDA criteria and the proportion of each racial group in trials. Results: From 2006-2020, we identified 55 new licensing indications, involving 26 unique drugs; 5 approvals in SCLC, 49 approvals in NSCLC and 1 in mesothelioma. Prior to the FDA race reporting guidelines, 33% (6/18) of registration studies did not meet FDA requirements. This improved to 27% (10/37) after the guideline introduction. Overall 29,545 patients participated in thoracic registration trials; 66% White, 22% Asian, 2% Black, <1% AIAN, <1% NHPI, 1% other or multiple races and 9% unknown. Table shows race distribution by cancer subtype. Conclusions: Although improving, a substantial number of registrational clinical trials in thoracic oncology still do not report race per FDA guidance. In addition, Black individuals are disproportionately under-represented in registration trials. Greater efforts are needed for the inclusion of Black patients and other minorities in clinical trials.[Table: see text]
Inpatient chemotherapy for patients with advanced solid tumors: A single-center observational study.
Authors: Soumerai Tara , Lei Matthew , Mulvey Therese Marie
Published: September 2021

158

Background: We sought to identify a population of patients with advanced-stage solid tumor diagnoses for whom inpatient chemotherapy is appropriate. In so doing, we endeavor to define standards of practice in addressing prognostic awareness and goals of therapy prior to treatment. Methods: We identified 124 patients with Stage IV solid tumors who were given at least one dose of inpatient chemotherapy in 2019. We performed manual chart review to collect information on patient demographics, details of cancer diagnosis and chemotherapy regimen, and dates of admission, chemotherapy administration, discharge, readmission, and death. Results: Ninety-four percent of patients studied were admitted for cancer-related reasons. The 30-day mortality for patients with Stage IV cancer given inpatient chemotherapy was 20.2%, including 12 patients (9.7%) who died during the same admission. The 30-day readmission rate was 40.2%. Median overall survival and readmission-free survival were both 15 days (range, 3-510 and 3-642, respectively). Among patients who died within 30 days, 18.2% (4/22) had a serious illness conversation documented prior to chemotherapy administration. Conclusions: This study demonstrates that there is a high mortality and readmission rate among patients with advanced solid tumor malignancies who receive inpatient chemotherapy. Standardizing the expectation of informed consent and/or goals of care discussion prior to treatment is necessary. This may prevent administration of futile chemotherapy to patients requiring hospitalization for advanced cancer.