bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of social media messages on perceived risk and severity of adverse effects and regret of HPV vaccination: The moderating role of decision-making preference.
Authors: Villegas Jorge , Chen Cheng-Chia (Brian) , Lee Min Jee
Published: June 2023

10543

Background: The HPV vaccine has proven to be a highly effective and safe public health intervention for reducing the risk of various types of cancer. Despite its efficacy and safety, misinformation and negative opinions about the vaccine on social media can lead to negative emotions such as regret among those who have received it. This study investigated the impact of different content of social media messages on perceived risk and severity of adverse effects and regret of HPV vaccination. Methods: An experiment was designed to expose participants to messages posted on social media that manipulated the number of Vaccine Adverse Effects and the appeal used (narrative vs. statistics). The study measured the effect of the message on decisional regret and also assessed preferred level of involvement with medical decision-making. The online study was implemented among college students enrolled in a Midwestern or a South Texas university. We used structural equation modeling (SEM) to systematically test the relationships between the variables of interest. Results: A total of 721 participants were exposed to the experimental materials and completed the questionnaire. The results of the SEM (with overall good fitness of RMSEA = 0.015, CMIN/df = 1.172) suggest that messages that contained more numeric information (standardized regression weights [Std Reg Wght = 0.161]) and more adverse effects of the HPV vaccine (Std Reg Wght = 0.076) led to a higher perception of the risk of vaccine adverse effects. The severity of adverse effects was significantly associated with the number of side effects in the message (Std Reg Wght = 0.147). This increase in perceived risk (Std Reg Wght = 0.182) and severity of side effects of the vaccine (Std Reg Wght = 0.163) seem to increase decisional regret. However, this relationship was moderated by individuals’ preferences for making their own medical decisions. Individuals with a higher preference to make their own health decisions were less likely to experience decisional regret (Std Reg Wght = -0.238). Conclusions: Messages on social media can exacerbate negative emotions and lead to hesitation in following future medical advice. Encouraging individuals to play a more active role in their medical decision-making appears to reduce this negative emotion and increase their confidence in health decisions.
The impact of HPV vaccination in Florida compared to New York.
Authors: Neerukonda Thanuja , Makani Neeharika Srivastava , Patel Dhruv
Published: June 2023

10544

Background: HPV is responsible for cancers including anus, penis, vulvovaginal, and oropharyngeal but cervical cancer is the most common cancer caused by HPV. To study the impact of HPV vaccination, we compared age-adjusted cervical cancer incidence and death rates in New York, a state with a high HPV vaccination rate, to Florida, a state with a lower vaccination rate, prior to HPV vaccination and 10 years post HPV vaccination availability. Methods: This is an ecologic study observing the cervical cancer incidence and death rates prior to (2005) and after (2016) the introduction of the HPV vaccination using state wide healthcare cancer registries. Results: The HPV vaccine became available in the United States in 2006. Historically, Florida was found to have a low HPV vaccination rate in 2009 with less than 40% compared to New York which had a high rate of 50% in 2009. By 2016, Florida’s HPV vaccination rate improved to 55% but was still low compared to New York with a rate greater than 70%. New York had a decline of cervical cancer incidence of 9.7 per 100,000 in 2005 to 8.3 in 2016. New York had a decrease in death rate from 3.0 in 2005 to 2.7 in 2016. In Florida, the cervical cancer incidence rate from 2005 to 2016 increased from 9.7 to 9.9 and the mortality was 3.0 in 2005 and 2.9 in 2016. When comparing New York’s cervical cancer incidence rates, there was a statistically significant drop in age-adjusted incidence before HPV-vaccination compared to 10 years post vaccination availability. When analyzing cervical cancer incidence in 2016, significant increase in cases between Florida’s incidence compared to New York’s. Conclusions: Since the introduction of the HPV vaccination, age-adjusted incidence rate of cervical cancer has declined in New York but not in Florida. This may be due to lagging HPV vaccination rates in Florida in addition to other sociodemographic or healthcare factors. There has been minimal change in cervical cancer death rates between both states, likely attributed by the low death rate associated with cervical cancer. The medical community needs to work together to address the barriers to HPV vaccination and promote programs to increase vaccination rates which will reduce the incidence and mortality of cervical, anus, penis, vagina, vulva, and oropharyngeal cancer. [Table: see text]
Training oncologists (Oncs) to conduct better informed discussions with African American (AA) cancer (CA) patients (pts) about tumor genomic profiling (TGP): Results of a randomized pilot trial of gene pilot pro (GPP).
Authors: Hall Michael J. , Hoadley Ariel , Chertock Yana , Kelly Patrick J , Singley Katie J , Luck Caseem C , Bass Sarah B
Published: June 2023

10552

Background: Molecular characterization of tumors to guide therapy choices using next-generation sequencing-based TGP has become standard practice for pts w/multiple CA types. AAs are more likely to have negative attitudes towards genetics, rooted in concerns about privacy, cost and discrimination, and higher mistrust of medical institutions. Oncs are poorly prepared for informed discussions w/CA pts about secondary hereditary risks of TGP and often fail to have these conversations despite 2015 ASCO guidelines benchmarking this standard, and further are poorly informed of the potential challenges of discussing TGP and germline risk w/their AA CA pts. Methods: Formative work included 1-on-1 interviews (n = 10) to assess oncs’ perceptions of TGP use and discussions w/AA CA pts, and a national survey (n = 50) to assess TGP practice patterns, communication of hereditary risk, and challenges encountered in AAs. Interviews/survey data and advisory board input informed development of GPP, a 12 min online training video to improve Oncs’ awareness of ASCO guidelines, confidence and preparation to have TGP discussions w/pts, and improve awareness of barriers to TGP unique to AA CA pts. The control consisted of 10 slides with information about TGP drawn from industry/academic websites and the 2015 ASCO guidelines. Participants (n = 63) completed baseline (100%), post-intervention (100%), and 1-month (95%) follow-up surveys. The study was approved by the Fox Chase Cancer Center IRB 18-8006. Results: Oncs were recruited by email and randomized to view GPP or control material. The majority were age 40-49 (38%), 71% male, 44% White, w/mean 15 yrs in practice; 85% reported none or only informal training to communicate TGP risks/results to pts. GPP produced a durable increase in recognition of 4 core ASCO guideline elements (20% baseline, 67% post, 63% 1 month). At 1-month follow-up, GPP significantly improved recognition of barriers specific to AA CA pts related to TGP and hereditary risk (p = 0.001) and promoted greater preparedness to support TGP discussions w/AA pts including preparedness to identify (p < 0.01) and understand (p < 0.01) issues that matter most to their AA pts. 1-month confidence to conduct difficult discussions related to genetic mistrust (p = 0.004) and TGP cost (p = 0.003) was better preserved after viewing GPP compared to control. Among Oncs viewing GPP, 90% agreed/strongly agreed that GPP helped them “better understand how to address concerns my AA pts may have about TGP” and 97% definitely/probably would recommend GPP to other Oncs. Conclusions: GPP significantly improved Oncs’ awareness of barriers related to TGP communication in AA CA pts, improved preparedness to facilitate informed decision-making, and supported sustained confidence to lead difficult discussions.
Comparative overall survival of patients in trials of CKD4/6 inhibitors in combination with endocrine therapy in advanced breast cancer.
Authors: Kappel Coralea , Elliott Mitchell , Kumar Vikaash , Nadler Michelle B. , Desnoyers Alexandra , Amir Eitan
Published: June 2023

1056

Background: CDK4/6i and endocrine therapy (ET) are an international gold standard therapy in estrogen receptor (ER) positive and HER2-negative advanced breast cancer (aBC). Individual trials of abemaciclib, palbociclib and ribociclib show similar impact on progression-free survival yet differing statistical significance for OS. A robust comparative evaluation of the efficacy, safety, and tolerability of the three drugs is warranted. Methods: We searched PubMed, ASCO, ESMO and SABCS proceedings to identify phase 3 randomized clinical trials reporting OS of CDK4/6i in combination with ET in ER-positive aBC in first or second line. A network meta-analysis using WinBUGS was performed to evaluate comparative efficacy, based on the ET partner, in the absence of direct comparisons. Trial level data on common and serious adverse events (AE) were extracted for each drug. The odds ratio (OR) for each AE was calculated comparing each CDK4/6i to the respective endocrine therapy backbone (aromatase inhibitor (AI) or fulvestrant) alone. Results: Seven studies comprising 4087 patients met the inclusion criteria. Median follow up was 70.2 months. Four studies paired a CDK4/6i with an AI or tamoxifen, 3 studies were paired with fulvestrant. There were no statistically significant differences in OS between any of the CDK4/6i with any ET backbone. Compared to palbociclib, ribociclib and abemaciclib showed significantly lower grade 1-2 fatigue/asthenia (ribociclib OR 0.69 [95% CI 0.58, 0.83]; abemaciclib OR 0.6 [95% CI 0.49, 0.74]) and abemaciclib showed significantly lower grade 1-2 alopecia (abemaciclib 0.76 [95% CI 0.6, 0.97]). Compared to palbociclib, ribociclib and abemaciclib showed significantly higher GI toxicity (ribociclib any grade vomiting OR 1.71 [95% CI 1.36, 2.15]; abemaciclib any grade vomiting OR 2.1 [95% CI 1.61, 2.62], any grade diarrhea 13.2 [95% CI 10.31, 16.78]). Treatment discontinuation was highest with abemaciclib. Conclusions: In this network meta-analysis, there was no statistically significant difference in OS between CDK4/6i despite differences in individual trials. Real-world data analyses may help to identify if a there is a meaningful inter-drug difference in efficacy. Significant differences between CDK4/6i are observed for safety and tolerability outcomes. [Table: see text]
Assessing disparities in lung cancer screening eligibility among high-risk individuals.
Authors: Gudina Abdi , Kamen Charles Stewart , Gilmore Nikesha , Kehoe Lee , Cupertino Ana Paula
Published: June 2023

10563

Background: Low-dose computerized tomography (LDCT) scanning confers a 20% reduction in lung cancer mortality by diagnosing the disease at earlier, more treatable stages. Racial/ethnic minorities have historically been less likely to be eligible for lung cancer screening. In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its 2013 guideline for lung cancer screening eligibility by reducing the minimum age (55 to 50) and decreasing the cumulative number of cigarette pack-years smoked (30 to 20). The purpose of this study was to assess if the updated guideline will mitigate disparities in lung cancer screening eligibility among high-risk individuals. Methods: Data were obtained from the Behavioral Risk Factor Surveillance System (2017-2019), a population-based survey administered annually by the Centers for Disease Control and Prevention. Only subjects with complete information on the variables used to determine eligibility (age, smoking status, age at first start smoking, age at last smoked, average number of cigarettes smoked each day) (n = 793,537) were included in the final analysis. Logistic regression was used to model the association between predictors and 2021 vs. 2013 lung cancer screening eligibility. Results: Based on the 2013 guideline, Non-Hispanic Blacks (OR: 0.34; 95%CI: 0.31 - 0.38), Hispanics (OR: 0.12; 95%CI: 0.10 – 0.14), and other racial/ethnic minorities (OR: 0.59; 95%CI: 0.54 – 0.64) were less likely to be eligible for lung cancer screening than Non-Hispanic Whites. Using the 2021 guideline, Non-Hispanic Blacks (OR: 0.45; 95%CI: 0.42 - 0.49), Hispanics (OR: 0.15; 95%CI: 0.13 – 0.16), and other racial/ethnic minorities (OR: 0.63; 95%CI: 0.58 – 0.67) remain less likely to be eligible for lung cancer screening than Non-Hispanic Whites. Conclusions: The 2021 guideline slightly reduces racial/ethnic disparities in lung cancer screening eligibility. Further efforts should be made to develop a guideline that better addresses disparities in lung cancer screening eligibility to reduce lung cancer deaths in racial minorities.
Colorectal cancer and digital/live screening navigation: Promoting prevention through personalized recommendations and access.
Authors: Newcomer Kim , Goodman Andrea , Klein Marcie , Guevara Alex , Anderson Montel , Kufuor Nana
Published: June 2023

10566

Background: This project evaluates the effectiveness of an advocacy organization-led digital and live navigation framework aimed at colorectal cancer (CRC) screening completion. The Colorectal Cancer Alliance’s screening quiz guides patients to a clinically valid, personalized CRC screening recommendation with a handoff to live navigation for those at risk. The framework utilizes digital innovation, targeted awareness, and financial support to support populations experiencing the greatest disparities and increase screening intention, behavior, and further health equity in colorectal cancer. This simple intervention is critical due to existing research consistently indicating on-time screening for CRC leads to favorable outcomes. Methods: In July 2022, the Alliance launched an enhanced quiz to improve the CRC screening navigation experience and increase engagement. The new survey instrument was restructured to streamline time to completion while preserving clinically accurate risk stratification. The follow-up navigation protocol was reordered from digital-first to live-first to leverage high-touch strategies earlier in the screening journey and dynamic content was added to the recommendation page to create a more personalized resource. The Alliance also deployed social media and influencer campaigns to increase outreach to at-risk communities. Results: The enhanced quiz delivered over 8,300 CRC screening recommendations and improved the average monthly completion rate (33%) and contact capture rate (14.4%) compared to the previous quiz in 2022 (24%; 8%). The median age of respondents was 55, and 37.2% of the respondents were between the ages of 45 and 64. Of the respondents, 26.7% were male and 73.3% were female. The majority were White (77.1%), 7.3% identified as Black/African American, 5.5% were Hispanic or Latino, and 3% were Asian. Most respondents were symptomatic (67.8%) but 8.1% were asymptomatic high-risk. Respondents (1,078) were triaged to live Alliance patient navigation. Conclusions: This digital and live navigation framework may serve as a strong solution in driving colorectal cancer screening and supporting shared-decision making conversations compared to other available interventions. The framework provides users with robust access to live navigation, educational resources, and support services for CRC screening and diagnosis. The Alliance is uniquely positioned to utilize its communications channels, social media and influencer campaigns to reach at-risk communities with credibility. Data attributed to specific campaigns are still being analyzed, and the Alliance will continue to optimize its navigation protocol and awareness efforts as quality improvement processes allow for a deeper understanding of more inclusive and impactful navigation experiences to close screening gaps among at-risk populations.
Navigation program for LDCT lung cancer screening implementation: A quality initiative.
Authors: Shrestha Jasmine , Reddy Aswanth , Nwankwo Nkolika
Published: June 2023

10568

Background: Lung cancer remains the leading cause of cancer-related death worldwide. Despite recommendations from experts, the lung cancer screening has not been well adopted in practice. Methods: We started a pilot program in our cancer center in collaboration with Pulmonary medicine in November 2021 as we identified that the rates of Low Dose CT scan (LDCT) are meager in our community. Two areas that needed attention were identified. The first was the need for shared decision-making by the primary care physician (PCP) before ordering LDCT. The second was the follow-up for patients with positive lung nodules. A lung nodule patient navigator was assigned exclusively for this initiative. Reports were obtained from EPIC every month to identify patients who fit the criteria. PCPs of the respective patients were then reminded to discuss LDCT in the upcoming visit. The lung nodule navigator then followed the ordering and test results of LDCT. A dedicated lung nodule conference discussed all patients with positive lung nodules. Follow-up interventions included referrals to pulmonology, interventional radiology, or further imaging with PET scan. Per guidelines, patients who did not need acute intervention were kept on track for their follow-up CT as recommended. Results: We reviewed our baseline performance in LDCT from January to June 2021.The total screening included 271(32%) patients compared to 836 eligible patients who fit the criteria. From January 2022 to June 2022, out of 749 eligible patients who were expected to meet their PCP, 574(76%) patients received LDCT. Of the patients screened, 436(75%) had their baseline CT chest, with the remaining patients having follow-up CT. Fifteen patients had findings needing immediate intervention. Conclusions: The USPSTF has updated its annual lung cancer screening guidelines with LDCT for adults aged 50 to 80 years who have a 20-pack-year smoking history and current smoker or have quit within the past 15 years. With our approach, the screening rates have more than doubled compared to previous year. LDCT does carry certain risks, including false positive results and unnecessary biopsies; hence shared decision-making is needed before ordering the test. We identified the shared decision process as the rate limiting step across our institution. Our contact with PCP was a significant intervention that improved the screening. The second obstacle was the follow-up for positive LDCT, and we alleviated it with the multidisciplinary lung nodule conference. This process is undoubtedly difficult to achieve without a lung nodule navigator. Each hospital system is unique and has various difficulties implementing screening guidelines. We show that, with the help of a lung nodule navigator, the rates of lung cancer screening can be significantly increased.
The probability of lung cancer in patients with incidentally detected pulmonary nodules detected via low-dose computed tomography screening in China.
Authors: Lan-Wei Guo , Lyu Zhangyan , Zhang Shaokai
Published: June 2023

10569

Background: Low dose computed tomography (LDCT) screening has been proven to be effective in reducing lung cancer mortality, but the ensuing high false-positive and overdiagnosis rates shackle the effectiveness of lung cancer screening (LCS) in China. Nodule malignancy prediction models may be an applicable solution. Methods: We developed and internally validated the model using data from the ongoing Henan province Cancer Screening Program in Urban China (CanSPUC). From 2013 to 2021, 23031 heavy smokers underwent baseline screening with LDCT; 2553 participants were diagnosed with pulmonary nodules. Detailed questionnaire, physical assessment and follow-up were completed for all participants. We then externally validated the model using the National Lung Screening Trial (NLST) dataset consisting of 10485 lung nodules in 4660 participants. Multivariable Cox proportional risk regression models were used. Data analysis was performed from July 1, 2022, through December 31, 2022. Results: A total of 111 and 1089 lung cancer cases with a median follow-up duration of 3.7 years occurred in the Henan CanSPUC and NLST study, respectively. Age, gender, physical activity, consumption of pickled food, history of silicosis or pneumoconiosis, nodule type, size, calcification, and pleural retraction sign were included into the model. The AUC (95% CI) of the model for 5-year lung cancer risk was 0.857 (0.801, 0.914) and 0.847 (0.829, 0.881) in the training set and validation set, respectively. Compared with Mayo model, VA model, PKU model, and Brock model, the Henan CanSPUC model yield statistically better discriminatory performance (all P values < 0.05). The model calibrated well across the deciles of predicted risk in both the overall population and all subgroups. Conclusions: The model developed and validated in this study may be used to estimate the probability of lung cancer in nodules detected at baseline LDCT, allowing more efficient risk-adapted follow-up in population-based LCS programs.
Assessing the risk of gastrointestinal cancers among cannabis users compared to nicotine users.
Authors: Waris Shanawar Ali , Raiker Rahul , Siva Nanda , Boustany Osama , Pakhchanian Haig , Khalid Ahmed A.
Published: June 2023

10571

Background: Exposure to nicotine is a well-studied preventable cause of numerous malignancies, while the association of cannabis use with the development of cancer is not clear. Cannabis contains both carcinogens as well as compounds with antitumor activity, which inhibit chronic inflammation. The aim of this study is to assess the risk of gastrointestinal malignancy in cannabis users compared to nicotine users. Methods: A retrospective cohort study was conducted using TriNetX, a federated database of ~100 million patient records. Adult patients (≥18 years) were queried by ICD-10 coding to find variables of interest. Two groups were created: one group with a history of only cannabis use and the other with a history of only nicotine use. Then lifetime risk of nine different gastrointestinal cancers were assessed and compared between the two groups. 1:1 propensity score matching was conducted, adjusting for comorbidities and demographics, to calculate adjusted risk ratios (aRR) with 95% Confidence Interval for the comparative analysis. Results: A matched cohort of 413,628 patients revealed that cannabis only patients had a significantly lower lifetime risk of developing esophageal cancer (aRR[95%CI]): (0.456[0.364,0.572]), gastric cancer (0.492[0.41, 0.60]), pancreatic cancer (0.547[0.47,0.64]), liver & intrahepatic bile ducts cancer: (0.728[0.70,0.75]), colon cancer (0.351[0.32,0.38]), rectosigmoid cancer (0.699[0.59,0.83]), and rectal cancer (0.563[0.46,0.68]). No significant differences were seen for small intestinal cancer (1.21[0.88,1.6]) and anal cancer (0.87[0.67,1.14]). Conclusions: The results of this study suggest that the lifetime risk of developing numerous gastrointestinal malignancies is lower in cannabis users when compared to nicotine users. It is not clear if this relative risk reduction is due to the beneficial effects of cannabis or a lack of nicotine consumption and its associated effect on carcinogenesis. Long-term studies following cannabis users may provide a better understanding of the association of cannabis use with the risk of developing various malignancies. Additionally, the quantity of exposure to cannabis and its association with the risk of cancer should be further investigated. [Table: see text]
Rates of routine cancer screening compared with pre-pandemic levels.
Authors: Oakes Allison H , Boyce Kelly , Patton Catherine , Jain Sanjula , Revol Cindy
Published: June 2023

10573

Background: The COVID-19 pandemic caused significant disruptions to healthcare delivery in the US due to mandatory stay-at-home orders and patient fears about visiting healthcare facilities. A logical consequence, many forms of healthcare use, including cancer screenings, sharply decreased in early 2020. Early studies suggest that cancer screening rebounded through the summer of 2020; however, > 2 years removed from the start of the pandemic, the long-term impact of missed screenings is unknown. The objective of this study was to examine trends in breast, cervical, and colorectal cancer screening from 2017-2022. Methods: This cross-sectional study used the Trilliant Health national all-payer claims database to analyze calendar year quarterly medical claims from Q1 2017- Q2 2022. We limited the study sample to those aged 21-85, the guideline-concordant target populations for the screening procedures. For breast and cervical cancer, we limited our sample to women. Using Current Procedural Terminology (CPT) codes, we calculated the quarterly number of individuals, per 100,000 eligible beneficiaries, who received screening for breast cancer, cervical cancer, and colorectal cancer. Percentage change in screening tests was compared. Results: In total, the analysis included > 300M unique individuals. For breast cancer, the median quarterly rate of pre-pandemic screening mammography was 8013 per 100k beneficiaries, which declined to 4,884 in Q2 of 2020—a 39% decrease. Screening mammography rebounded to pre-pandemic levels by Q3 and Q4 of 2020 but declined to a median rate of 7,314 per 100,000 beneficiaries in Q2 2022, with quarterly deficits ranging from 4-16%. For cervical cancer, the median quarterly rate of pre-pandemic screening was 5,469 per 100k beneficiaries. The rate of cervical cancer screening fell to 3,550 in Q2 of 2020—a 35% decline. By Q3 2020, cervical cancer screening rebounded toward the pre-pandemic median, then progressively declined to 4,557 per 100k beneficiaries by Q2 2022. Over the same time period, colorectal cancer screening decreased from a pre-pandemic median of 3,111 per 100k beneficiaries to 1,731 in Q2 of 2020—a 44% difference. From Q3 2020 to Q1 2022, the quarterly colorectal cancer screening rate remained 10-17% below pre-pandemic levels, but returned to 3,047 per 100k in Q2 2022, only 2% below the pre-pandemic median. Conclusions: Across the three studied cancer types, population-based screening remains below pre-pandemic levels. In agreement with other research, we find that screening quickly rebounded following the initial stages of the pandemic; however, the longer follow-up time reveals that gaps in preventive cancer screening returned and worsened. Underutilization of recommended cancer screenings will likely result in an increase in later-stage initial diagnoses and excess mortality from cancer in the future.
Enhancing lung cancer screening through ‘Saved by the Scan’: Lessons from a multipronged public service advertising program.
Authors: Bellur Shreyas S , Ozair Ahmad , Khosla Atulya Aman , Ordonez Kristen , Mileti Papsy , Aguiar Debbie Ferrera , Hernandez Bianca , Pagan Stacy , Cohen Chrissy , Batlle Juan , Dylewski Mark , Ahluwalia Manmeet Singh
Published: June 2023

10575

Background: Lung cancer screening rates remain low across the US in populations recommended for screening by low-dose CT (LDCT). Screening rates further declined during the COVID-19 pandemic, particularly in high-risk populations including racial and ethnic minorities. The American Lung Association (ALA) launched a nationwide public service advertising (PSA) program called ‘Saved by the Scan’ to enhance lung cancer screening rates, for which Baptist Health South Florida (BHSF) became the first healthcare system partner. The following work describes this major PSA effort in South Florida to enhance lung cancer screening, and the lessons learned thereof. Methods: A multipronged, institutionally-driven public awareness program, in collaboration with ALA, was initiated in 2021 by BHSF, the largest healthcare organization in the region, and was targeted towards South Florida residents. This innovative multimedia effort used traditional communication modalities, including newspapers, billboards, etc., along with digital modalities, including email and social media, to increase lung cancer screening awareness in both English and Spanish in a locally-adapted manner. Key performance indicators (KPIs), reach, and impact of the program were tracked. The most successful components, as per KPIs, were identified. Deidentified data of screening LDCT done at BHSF was reviewed to determine all individuals screened during 2019-2021 and descriptive statistics were calculated. Results: 4619 individuals from South Florida were screened at BHSF from 2019-2021, 1498 were in 2019, 1193 in 2020, and 1928 in 2021. Screening fell by 20.3% in 2020, likely due to the pandemic, and rose by 61.6% in 2021, helped by the program. Overall, a 21.9% increase from pre-COVID screening rates was seen. In 2022, the total reach of traditional media was estimated to be 4,607,273 individuals. Out of 133,554 emails sent, 36,877 (27.2%) were opened, with a click-through rate of 6.4%. Out of 1,768,438 digital impressions, 16,791 (0.9%) had links clicked. The total number of conversions from digital media was estimated to be 337 individuals with 232 (68.9%) from emails and 105 (31.1%) from social media. Conclusions: Lung cancer screening can be successfully boosted through large organizational efforts, particularly those targeted to needs of the local population. Digital media approaches for improving public health have seemingly low conversion rates but their large outreach provides a high impact. Efforts are warranted to enroll more healthcare systems and scale the program nationwide.
Long-term clinical and psychosocial outcomes of surveillance in Li Fraumeni syndrome.
Authors: Zaheed Milita , Napier Christine E , Cops Elisa J , Ferris Nick , Moodie Kate , Milner Brad , Moses Daniel , Poplawski Nicola , Dow Eryn Gaye , Harris Marion , Tucker Kathy , Trainer Alison , James Paul , Thomas David Morgan , Ballinger Mandy L.
Published: June 2023

10578

Background: Li Fraumeni Syndrome (LFS) is a high penetrance multi-organ cancer predisposition syndrome, associated with a significant lifetime risk of developing cancer. The Surveillance study in Multi-Organ Cancer prone syndromes (SMOC+) is investigating the utility of annual surveillance, with inclusion of whole-body magnetic resonance imaging (WBMRI), for hereditary cancer syndromes without well-established risk management strategies. Here we report the long-term clinical and psychosocial outcome of surveillance in participants with LFS. Methods: Multimodality surveillance in this multi-centre, prospective, longitudinal, observational study for adult participants with LFS included annual clinic review and examination, WBMRI, breast MRI (MRIB), full blood count, prostate specific antigen; 2-5 yearly gastro-intestinal endoscopy and faecal occult blood test in intervening years. Quantitative psychometric evaluations were requested at regular intervals each year using Hospital Anxiety and Depression Scale (HADS), the Impact of Events scale anchored to cancer (IES-C), and the Impact of Events scale MRI (IES-MRI). Results: From July 2013 to December 2021, 132 (67% female) participants were enrolled at a median age of 36 (range 18-69 )years. There were 116 prior diagnoses of neoplasms among 68 (52%) participants, including 27 (20%) with multiple primaries. At a median follow up of 4 years, 46 new primary malignancies were diagnosed in 30 (23%) individuals, with median age at diagnosis of 43 (range 24-71 years). Four (3%) individuals developed recurrence of a prior malignancy. The malignancies were detected as a result of WBMRI (27), MRIB (7), gastroscopy (1), colonoscopy (1) and clinical review and examination (17). The most frequent new primaries were leiomyosarcoma and breast cancer (Table). Overall, 22 (17%) are not currently participating due to cancer related death (10), active cancer (6) or other life events (6). At 4 years after enrollment, 94, 80 and 50 participants completed at least one HADS (463 unique observations), IES-C (362 unique observations), and IES-MRI (268 unique observations) questionnaire, respectively. Controlling for demographic and cancer history variables, there was no evidence of changes in overall anxiety or depression (p=0.2), nor in degrees of distress associated with cancer (p=0.06) or WBMRI (p=0.6) over time. Conclusions: In LFS, annual surveillance with WBMRI is feasible and well tolerated, with no difference in distress experienced in the longer term. Over 80% of participants continue to engage with surveillance. The majority of cancer-affected individuals were able to resume surveillance after management of early disease. [Table: see text]
Does adherence to cancer prevention guidelines before diagnosis associate with improved cancer survival?
Authors: Davis Evan W. , Nair Nisha M. , Hulme Karen , Barone Nancy , Ambrosone Christine B. , Cannioto Rikki A.
Published: June 2023

10582

Background: The American Institute for Cancer Research and American Cancer Society regularly publish cancer prevention recommendations for decreasing cancer risk. Which lifestyles, or whether they work together to impact cancer survival is not well established. We examined associations of adherence to cancer prevention recommendations with mortality in 5,766 patients enrolled in the Data Bank and BioRepository at Roswell Park. Methods: Patients were newly diagnosed between 2003 and 2016 with a variety of pathologically confirmed invasive malignancies. Detailed epidemiological data including lifestyles one year prior to diagnosis were linked with Tumor Registry data. The primary analytic exposure was a composite Lifestyle Index Score (LIS) created in accordance with previously published standardization guidance; the primary analytic outcome was all-cause mortality. The LIS comprised seven lifestyles including: physical activity (PA); body mass index (BMI); fruit and vegetable (FV) intake; red and processed meat (RPM) intake; sugar sweetened beverage (SSB) consumption; alcohol consumption; and smoking status. Kaplan Meier analyses were used to compare survival experience according to LIS tertiles. Multivariable Cox proportional hazard models adjusted for age, tumor type, stage, and sex were used to estimate the associations of the LIS and each lifestyle factor with mortality in the overall study population and according to tumor stage. Results: During follow-up through April 2022, we observed 2,316 deaths (median follow-up 6.9 years). Patients reporting strongest adherence to prevention recommendations (highest LIS tertile) had significantly improved survival compared to patients with the lowest LIS (93.0 vs. 75.0 months, respectively; log-rank p < 0.0001). In multivariable analyses, the highest versus lowest LIS tertile was associated with a 17% reduction in mortality in the overall study population (HR = 0.83, 95% CI: 0.74-0.93). Significant mortality reductions were observed in patients diagnosed with both early- and late-stage disease (HR = 0.73, 95% CI: 0.59-0.90 and HR = 0.85, 95% CI: 0.73-0.99, respectively). Being a never smoker (HR = 0.54, 95% CI: 0.47-0.62), meeting the PA Guidelines (HR = 0.74, 95% CI: 0.66-0.83), and highest FV intake (HR = 0.82, 95% CI: 0.73-0.91) were the only independent factors associated with significant reductions in mortality. Conclusions: Strongest adherence to the cancer prevention recommendations before diagnosis was associated with significant reductions in mortality. These findings provide additional evidence that modifiable lifestyle factors can impact cancer survival, even among patients diagnosed with advanced-stage disease. Confirmatory studies examining post-diagnosis lifestyles are needed so that lifestyle assessment tools, education, and intervention can be clinically leveraged to improve patient outcomes.
Implementation of universal pan-cancer germline genetic testing in an Arab population: The jordanian exploratory cancer fenetics (Jo-ECAG) study.
Authors: Abdel-Razeq Hikmat , Nielsen Sarah M. , Tbakhi Abdelghani , Bani Hani Hira , Sharaf Baha' , Abu Hijlih Ramiz , Alkyam Mais , Al-Azzam Khansa , Elemian Shatha , Al-Atary Areej , Horani Malek , Zeidan Zeidan , Alzibdeh Abdulla , Russell Emily M. , Heald Brandie , Nussbaum Robert Luke , Esplin Edward D.
Published: June 2023

10591

Background: Germline genetic testing (GGT) has a significant impact on cancer care. While universal testing has been selectively implemented in the U.S., less is known about adoption of this approach in other ethnic groups. This study reports on GGT results among newly diagnosed cancer patients (pts) in Jordan. Methods: Jo-ECAG was a prospective study of newly diagnosed cancer pts between April 2021 and September 2022 who underwent 84 gene GGT. Patients were classified based on the 2020 National Comprehensive Cancer Network (NCCN) GGT criteria as meeting (in criteria, IC) or not meeting criteria (out of criteria, OOC). Demographics and clinical history were clinician-provided. Pts who were carriers for autosomal recessive conditions were excluded from pathogenic germline variant (PGV) count. Differences in proportions were determined using two-tailed Fisher’s exact test and the significance was set at p≤ 0.05. Results: The cohort consisted of 3,313 Arabic cancer pts, predominantly female (69.8%), with a median age of 54 at testing. Breast was the most commonly diagnosed cancer (50.4%), followed by colorectal (14.9%) and prostate (14.3%). 52% of pts tested were guidelines-based (IC). 460 PGVs were identified in 426 (12.9%) pts. PGVs were most commonly identified in APC (predominantly I1307K variant, 144 pts, 4.4%), BRCA2 (72, 2.2%), BRCA1 (36, 1.1%), CHEK2 (26, 0.8%) and ATM (25, 0.8%). While IC pts were more likely than OOC pts to have a PGV (15.7% vs 9.8%, p<0.0001), 156 (36.6%) pts with PGVs were OOC. 232 (54.5%) pts had PGVs in DNA damage response and repair/homologous recombination repair (DDR/HRR) genes, including 61 (26.3%) OOC pts. 3,602 variants of uncertain significance (VUS) were identified in 2,199 (66.4%) pts with 1,868 of these pts having only VUS results (56.4%), but the frequency in the latter group was not different between IC and OOC pts (p=0.42). Conclusions: Universal GGT of all new cancer pts was successfully implemented and led to actionable findings that would have been missed with guidelines-based testing. With the exception of an overrepresentation of APC I1307K variants, PGV rates were similar to Western ethnic groups. Over half of pts had PGVs in DDR/HRR genes that confer potential eligibility for targeted therapies and/or clinical trials. While VUS rates were high, they were similar between IC and OOC pts. Additional efforts to sequence underrepresented populations and develop variant interpretation methods agnostic to ancestry may help to mitigate these disparities.
Cost-effectiveness analyses of population-based multi-gene testing for the prevention of breast and ovarian cancer in the United States.
Authors: Guo Fangjian , Adekanmbi Victor , Shih Ya-Chen Tina , Berenson Abbey , Kuo Yong-Fang
Published: June 2023

10596

Background: The current method of testing for BRCA gene mutations, which is based on family history, often fails to identify many carriers. With the advancement of next-generation sequencing technologies, which have significantly lowered the cost of genetic testing and sequencing, population-based testing has been proposed. We evaluated the cost-effectiveness of population-based multi-gene testing as a means of preventing breast and ovarian cancer. Methods: We developed a microsimulation model to assess the cost-effectiveness of multi-gene testing (BRCA1/BRCA2/PALB2) for all women aged 30-35 years compared to the current standard of care that is family history-based. We selected these genes for analyses as they are most prevalent high penetrance genes. We assumed a test uptake rate of 70%. Carriers of pathogenic variants who were not affected by cancer were offered interventions, such as MRI/mammography, chemoprevention, or risk-reducing mastectomy and risk-reducing salpingo-ophorectomy (RRSO), to reduce the risk of breast and ovarian cancer. We incorporated excess coronary heart disease (CHD) deaths from premenopausal RRSO. Our main outcome measure was the incremental cost-effectiveness ratio (ICER)(i.e., cost per-quality-adjusted life year (QALY) gained), with the commonly used societal willingness to pay of $100,000/QALY in the US as the C-E threshold. We ran 500 simulations on 1,000,000 women, employing a lifetime time horizon and payer perspective, and adjusted the cost to 2022 US dollar. We also used probabilistic sensitivity analyses to evaluate model uncertainty. Results: In the base case, population-based multi-gene testing is more cost-effective compared to family-history based testing, with an ICER of $41,306/QALY (95%CI $35,630-$48,441/QALY). This new testing method is able to prevent an additional 1,369 cases of breast cancer and 807 cases of ovarian cancer, but it will also result in 8 excess heart-disease deaths per million women. The probabilistic sensitivity analyses show that the probability that population-based multi-gene testing is cost-effective is 100% for all the simulations. When the cost of the test exceeds $1,100 population-based multi-gene testing becomes economically inefficient (ICER $10,0886/QALY). Conclusions: Population-based multi-gene testing is a more cost-effective option for the prevention of breast cancer and ovarian cancer when compared to current family-history-based testing methods.
Technology-enhanced acceleration of germline evaluation for therapy (TARGET): Results of a randomized controlled trial of a pretest patient-driven webtool vs. genetic counseling for prostate cancer germline testing.
Authors: Giri Veda N. , Keith Scott W. , Cheng Heather H. , Leader Amy , Gross Laura , Sanchez Nolasco Tatiana , Byrne Nataliya , Hartman Rebecca , Brown Lauren , Pieczonka Christopher Michael , Gomella Leonard G. , Kelly William Kevin , Lallas Costas D. , Handley Nathan , Mille Patrick Johnston , Mark James Ryan , Brown Gordon Andrew , Chopra Sameer , McClellan Alexandra , Loeb Stacy
Published: June 2023

10598

Background: Germline genetic testing is important for prostate cancer management, clinical trial eligibility and hereditary cancer risk assessment. Despite this, genetic testing is underutilized and there is a shortage of genetic counselors. To address these gaps, we designed a webtool to provide patient-driven genetic education and conducted a randomized non-inferiority trial to compare it with traditional pre-test genetic counseling. Methods: TARGET is a multi-center randomized controlled trial comparing standard pre-test genetic counseling versus web-based genetic education (intervention) (NCT04447703). The study protocol was previously published (PMID 35710085). Briefly, patients with prostate cancer who met criteria for germline testing (based on tumor features, ancestry or family history) were randomized to pre-test genetic education through genetic counseling vs a 9-module webtool created by the study team and Prostate Cancer Foundation. The primary endpoint was non-inferiority in reducing decisional conflict between the webtool and genetic counseling by a margin of 4 (set in advance) on the validated Decision Conflict Scale. Analysis of covariance was used to compare decisional conflict between groups. All participants opting for testing received a 51-gene Invitae panel, with results delivered to the patient and their provider. Results: 346 patients with prostate cancer with a mean age of 63.7 years were randomized to genetic counseling (n=174) or web-based genetic education (n=172). Compared to baseline, there were reductions in decisional conflict in both arms following pre-test genetic education (Table). Adjusting for study site and baseline decisional conflict, the test of non-inferiority in reducing decisional conflict between arms was statistically significant (difference = -0.04, 95% CI: -∞ to 1.95, p<0.001). Overall 265 (76.6%) participants underwent genetic testing, including 146 (83.9%) in the genetic counseling and 119 (69.2%) in webtool arm, with the following results: negative (49.4%), variant of uncertain significance (35.5%) and pathogenic variant (15.1%). Conclusions: Delivery of pre-test genetic education through a webtool was non-inferior to genetic counseling in reducing decisional conflict. These results support a new standard of care for the use of patient-driven digital webtools for expanding access to pretest genetic education and informed decision-making for prostate cancer genetic testing. Clinical trial information: NCT04447703 . [Table: see text]
Using patient-reported outcomes to assess the impact of germline genetic testing on prostate cancer patients.
Authors: Nielsen Sarah M. , Shore Neal D. , Gazi Mukaram , Pieczonka Christopher Michael , Heron Sean , Cahn David J , Belkoff Laurence , Berger Aaron D. , Mazzarella Brian , Veys Joseph , Morris David , Bevan-Thomas Richard , Engelman Alexander , Dato Paul , Cornell Robert , Wise David R , Hardwick Mary Kay , Heald Brandie , Nussbaum Robert Luke , Esplin Edward D.
Published: June 2023

10607

Background: Germline genetic testing (GGT) affords prostate cancer (PCa) patients (pts) opportunities for targeted therapies, prevention and cascade testing. Patient-reported outcomes (PRO) can evaluate physician effectiveness in promoting patient test comprehension and clinical decision making, which are critical to realize the benefits of GGT. PROs from a large PCa GGT study among urologists were analyzed. Methods: A prospective study enrolled unselected PCa pts from 15 primarily community urology practices. Pts underwent 84-gene GGT, with PROs collected via electronic or paper surveys >1-month post GGT. Differences in proportions were determined using two-tailed Fisher’s exact test and significance was set at <0.05. Results: PROs were completed by 561/982 (57%) pts (85% white, 82% non-metastatic, median age at testing 70 years). 59 (11%) pts had positive results, 247 (44%) negative and 255 (46%) variants of uncertain significance (VUS). 72% accurately recalled their result (range, 50% [VUS]-93% [negative]). 66% of positive pts, 80% negative and 54% VUS correctly understood if their result was associated with cancer risk or not. 72% of positive pts had or planned to complete ≥1 physician recommendations, significantly more than negative or VUS pts (Table). Most pts reported that their test result reduced their concerns (40%) or did not impact their level of concern (52%) regarding their PCa diagnosis, treatment or followup. 19% of positive pts reported increased concern. Conclusions: GGT for PCa was deployed without causing undue concern and resulted in adherence to physician recommendations. Still, there is room for improvement in how test results (especially VUS) and recommendations are communicated to pts. [Table: see text]