bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the literature on artificial intelligence use in oncology.
Authors: Phillips Ruth Anne , Jani Janvi , Bradley Sarah K.
Published: May 2024

e13642

Background: Artificial Intelligence (AI) allows machines to analyze data in a way that mimics human intelligence. AI has been used in oncology diagnostics such as radiology and pathology. However, the specific processes and tasks that AI can support, especially in oncology, have not been fully explored. Methods: The electronic databases PubMed and MEDLINE were searched from September 1, 2018, to September 1, 2023, for publications related to the use of AI in oncology. Inclusion criteria consisted of English language, article type “study” and keywords Artificial Intelligence, Healthcare, Predictive/Prediction, Fever, Cytokine Release Syndrome, Nursing, Patient Care, Oncology, and Neutropenic Fever applied in a progressive manner to narrow the search. Results: The term Artificial Intelligence yielded over 124,385 studies. This number was reduced to 466 when adding “healthcare, predictive/prediction, and oncology.” Adding “patient care” further reduced the number to 102. Out of the 102, seven studies identified included the term “nursing” and focused on clinician decision support, readmissions, palliative care, and scheduling. One identified study discussed the potential benefits of AI-generated algorithms for risk stratification related to cytokine release syndrome. The keywords “neutropenic fever” did not generate any results. Six studies were identified by adding in the term “fever,” which focused on AI use in specialties outside of oncology. The literature reviewed shows that AI has had limited use in oncology outside of radiology and pathology. Only one study suggested the use of AI would be beneficial in predicting symptoms related to treatment. Small studies were identified showing the value of AI in increasing adherence to schedules, reducing readmissions, and providing precision medicine. Conclusions: AI is a promising tool for the future of oncology. The current availability of AI within oncology practices has been limited. Further studies should be undertaken to identify how AI can reduce provider burnout, care costs, and early identification of symptoms to prevent adverse events.
Detection of contralateral breast cancer in patients with primary breast cancer through AI-assisted mammography.
Authors: Jung Ji-Jung , Kang Eunhye , Byeon Jinyoung , Kim Hong-Kyu , Lee Han-Byoel , Moon Hyeong-Gon , Han Wonshik
Published: May 2024

e13645

Background: Survivors of breast cancer are at an elevated risk for developing contralateral breast cancer (CBC), a risk that surpasses the incidence of initial primary breast cancer within the general population. Consequently, annual mammography screenings are advocated to monitor for ipsilateral recurrence and the emergence of CBC. However, the sensitivity of surveillance mammography exhibits considerable variation, ranging between 45% and 90%, with notably lower detection rates in younger individuals and those with dense breast tissue. This study explores the efficacy of an artificial intelligence (AI) detection algorithm in mammography for the early identification of CBC prior to the official diagnosis. Methods: A retrospective analysis was conducted on patients treated for primary breast cancer from 2000 to 2021 at Seoul National University Hospital. This involved reviewing serial mammograms post-surgery and adjuvant therapy from 460 patients who subsequently developed CBC (CBC group) and 469 patients who did not (control group). These mammograms were evaluated using the Lunit INSIGHT mammogram AI system, which provides a pixel-level abnormality score between 0 and 100, with higher scores indicating increased abnormality. Scores exceeding 10 were considered indicative of CBC, reflecting a 90% sensitivity based on the AI software's tuning dataset. The diagnostic accuracy of AI-assisted mammography was then juxtaposed with that of specialist radiologists' evaluations. Results: At the point of CBC diagnosis, the median AI abnormality score was markedly higher in the CBC group (22.9 [IQR, 2.1-81.1]) compared to the control group's final follow-up mammogram (0.4 [IQR, 0.1-1.5], p<0.001). The AI system's sensitivity for CBC detection paralleled that of radiologist assessments (59.6% for AI vs. 56.5% for radiologists out of 460 detected cancers), with the AI method achieving an AUROC of 0.836 and a specificity of 91.0%. Notably, AI detected 84 cases (30.7%) at least six months and 59 cases (21.5%) more than a year before the official CBC diagnosis. Conclusions: The application of AI in mammography screening has demonstrated significant potential for the early detection of CBC, identifying cases up to a year before formal diagnosis. This underscores the value of integrating AI tools in mammography to enhance early detection rates of CBC among primary breast cancer patients.
Treatment (Tx) inequities in patients (pts) with metastatic non-small cell lung cancer (mNSCLC) harboring actionable driver oncogenes (ADO) in the first-line (1L) setting.
Authors: Vidal Gregory A. , Stricker Thomas , Ma Esprit , Yu Elaine , Xia Zhiyu , Sheinson Daniel , Sincan Murat , Huang Richard S. P. , Lin Victor T. G. , Zuniga Richard Michael , Jain Neha M. , Martin Richard Lewis , Daniel Davey B.
Published: May 2024

e13673

Background: Targeted treatments (TT) have been approved for pts with mNSCLC harboring ADO in the 1L setting in recent years. This study aimed to understand if subpopulations of mNSCLC pts harboring ADO do not receive equitable access to guideline recommended 1L TT in US clinical settings. Methods: This retrospective study used the Flatiron Health electronic health record-derived, US nationwide, de-identified database. Pts with de novo mNSCLC (stage IVA or IVB) diagnosed between 4/1/2018-6/30/2023 were included if they were ≥18 y, had ≥2 visits after advanced diagnosis (aDx) and ≥90 days follow-up, received any biomarker testing prior to 1L Tx initiation, and harbored ADO (ALK, BRAF, EGFR, MET, NTRK, RET and/or ROS1). Results: Overall 2165 pts met study criteria: mean age was 67 y, 65% female, 11% Medicare insured, 58% commercial insured, 76% treated in the community setting with 11% Medicare and 64% commercial insured (vs 12% and 41% treated in the academic setting with Medicare and commercial insurance), and 45% had smoking history; of non-missing data, 12% had lowest socioeconomic status (SES), 26% with highest SES, 95% had non-squamous NSCLC, and 83% had ECOG performance status ≤1. The median time from aDx to testing result among the 53% non-Latinx (nL) white, 8% nL Black, 7% Latinx, 13% nL Asian, 7% nL other and 13% missing race/ethnicity was 21, 23, 24, 21, 23 and 20 days, respectively; median time from aDx to TT initiation was 38, 38, 43, 36, 47 and 37 days, respectively. Pts significantly more likely to receive 1L TT were (Table): pts of color vs white pts; Medicare vs commercial insurance at community sites; without vs with smoking history. Pts less likely to receive 1L TT were (Table): community vs academic sites; Medicare vs commercial insurance at academic sites. Consistent findings were seen in the 1817 pts with established 1L ADO (ie. ALK, EGFR or ROS1) (Table). Conclusions: When pts with mNSCLC harboring ADO had biomarker testing before Tx initiation, contrary to prior observed racial inequity in NGS testing, there was no racial inequity in receiving 1L TT. However, inequity in receiving 1L TT was observed by insurance type, smoking history and site of care. Interventions are warranted to address these contributors to 1L TT inequities. [Table: see text]
Black patient representation in anti-cancer drug development.
Authors: Karol Alexander B. , Paredes Rodrigo , Fujiwara Yu , Argulian Anna , Joshi Himanshu , Galsky Matt D.
Published: May 2024

e13680

Background: Black patient enrollment in cancer clinical trials is critical to improving the generalizability of trial results and advancing an understanding of potential differences in drug efficacy and safety in underrepresented populations. Prior research indicated that in 2018, Black patients comprised ~2.5% of accruals to phase III trials in oncology (1). Here, we probed whether the representation of Black patients has increased in contemporary trials. Methods: We systematically searched the clinicaltrials.gov database to review racial demographics for phase III clinical trials. These trials evaluated systemic anti-cancer therapies in adult patients between October 28th 2013, and October 28th 2023. Studies were excluded if they did not include racial demographic information. The demographics of the trials and cancer subtypes were recorded. 19-year domestic cancer specific prevalence data was obtained from United States Cancer Statistics as a reference to evaluate the representation of Black patients in the included clinical trials. P-values were calculated with a chi-squared test. Results: 436 trials met criteria for review and 238 trials, enrolling 115,969 patients, met our inclusion criteria. Among these patients, 72,471 (62.5%) were White, 1,895 (1.6%) were Black, 31,996 (35.9%) were from another race. Systemic therapies explored included: immunotherapy (99 trials, 41.6%), targeted therapy (110 trials, 47.9%), chemotherapy (17 trials, 7.6%), and other therapies (7 trials, 2.9%). Black patients were underrepresented in phase 3 trials across the vast majority of tumor types (Table). Sub-group analysis revealed significantly increased Black clinical trial representation in trials beginning enrollment in 2019-2022 versus 2013-2018 (2.3% vs 1.8%, p=0.02). Conclusions: Adult Black patients are significantly under-represented (<2%) in modern oncology trials. However, there has been a significant increase in Black enrollment since 2019. Ongoing efforts are needed to ensure optimal representation of Black patients in oncology trials. 1. Tharakan, Cancer, 2021. [Table: see text]
Integrating social drivers of health screening into ambulatory cancer care.
Authors: Jones Tessa , Snow Alison , Aryeh Brittany , Liu Mark , Smith Cardinale B. , Mazor Melissa
Published: May 2024

e13692

Background: Despite the known impact of social drivers of health (SDOH) on cancer related outcomes, the integration of SDOH screens into routine oncology clinical practice is scarce and suboptimal. Recent findings indicate feasibility of integrating these tools, yet data is limited in how to develop and implement the screens to address unmet SDOH related needs. This study aims to provide an overview of the development and integration of a SDOH screener and referral system into clinical workflow and describe the patients who completed and didn’t complete the survey. Methods: The 17-item Quality of Life and Support (QOLS) survey was based on evidence-based SDOH questionnaires, co-created with our community board, and built into the Mount Sinai Tisch Cancer Center EHR, Epic. The survey is sent out via the patient portal 7 days prior to patients’ second oncology appointment, with repeat measures every 90 days. Surveys are available in English and Spanish and evaluate SDOH needs such as transportation, food insecurity, employment, social support, financial strain, stress, and depression. If survey answers indicate need for additional support the case is ‘escalated’ to social work, chaplaincy, or family care coordinator depending on the area of need. We used descriptive statistics to describe patients who completed versus didn’t complete the survey. Of those completed, we also describe the SDOH trigger and frequency of ‘escalation’. Results: Between June 2022 - December 2023, 10,655 patients were assigned 25,353 surveys across 5 sites. 37% of the assigned surveys were completed.A total of 6,179 individuals completed at least one survey. The average number of surveys completed was 2. Of the completed surveys, 43% were completed before the appointment date. Of completed surveys, 21% were escalated to social work, 8.5% to chaplaincy, and 1.3% to family care with the most frequent reasons for escalation being distress, financial strain, and transportation. A significant relationship was found between Race (Pearson chi2 = 107.9 p < .000) and Ethnicity (Pearson chi2 = 58.8, p<.000) and survey completion with differences due primarily to White and non-Hispanic White completion vs non-completion. Notably, Black and Hispanic individuals are completing the survey in the same proportion as those receiving it. Conclusions: This study shows successful integration of a SDOH screen into ambulatory cancer care which allows for systematic referrals to SDOH resources. [Table: see text]
Ethnic disparities in breast cancer: A comprehensive analysis of socio-demographic and clinical characteristics among African American, Hispanic, and Caucasian women.
Authors: Proskuriakova Ekaterina , Aryal Barun Babu , Shrestha Dhan , Adams Megan , Valencia Stephanie , Varsani Akshay , Sakhuja Anuradha , Jasaraj Ranjit Babu , Kovalenko Iuliia , Verda Larissa , Khosla Paramjeet Grewal
Published: May 2024

e13698

Background: Despite advancements in breast cancer therapy leading to a decline in mortality rates within certain ethnic populations, there exists a concerning trend of increasing cancer incidence among African American (AA) and Hispanic women. This persistent rise highlights the urgent need to explore and comprehend the socio-demographic and breast cancer characteristics specific to these populations. Methods: We assembled a 10-year database of women diagnosed with breast cancer in the community hospital in Chicago. After excluding minority ethnic groups, specifically AA, Hispanic, and Caucasian cohorts were included in this study, comprising 786 patient records analyzed. Results: The distribution revealed a predominance of AA patients at 49.7%, Hispanics at 42.1%, and Caucasians at 8.14%. Noteworthy differences across the three ethnic groups were observed in age categories at cancer diagnosis, BMI categories, family history of first-degree relatives with breast cancer, marital status, smoking habits, menopausal status, and alcohol use at the time of diagnosis (p < 0.05). Within the molecular subtypes, 14.5% were identified as triple-negative breast cancer (TNBC), with a higher prevalence of 18.7% among the AA subgroups. 19.6% of patients had advanced disease, proportion was higher in AA ethnic group (22.8%; p = 0.83) compared to other ethnicities. Breast conservative procedures were prevalent in almost half of the patient population on average (52.1 %), with a slightly higher frequency of mastectomies noted in the Hispanic patient group (44.1%, p < 0.05). In logistic regression analysis, compared to the reference AA ethnicity, Hispanics exhibited higher odds of having HER-2 positive breast cancer (OR 1.74; CI 1.04 – 2.94; p < 0.05), as did Caucasians (OR 2.35; CI 1.05 – 5.04; p < 0.05). Conclusions: In summary, our study underscores substantial socio-demographic and breast cancer characteristic differences among AA and Hispanic populations compared to Caucasians, revealing notable ethnic disparities in breast cancer. Despite these variations, our findings highlight promising healthcare equity, with comparable access to surgical and chemotherapy interventions across ethnicities. TNBC demonstrates molecular heterogeneity and a higher prevalence among AA women, contributing to significant racial disparities.
Utilization of circulating tumor DNA (ctDNA) testing by race and ethnicity in more than 135,000 patients.
Authors: Davis Andrew A. , Bucheit Leslie A , Zhang Nicole , Pretz Christopher , Strickler John H , Chachoua Abraham , Wise David R , Wong Kwok-Kin , Aviki Emeline Mariam , Zhang Tian , Qin Qian , Clemens Keelia M.
Published: May 2024

e13702

Background: Studies have shown low rates of tumor genomic profiling in the metastatic population and disparities in cancer care have been observed across races, ethnicities, and ages. We aimed to better understand how ctDNA is being utilized across race, ethnicity, and age in common cancer types using a real-world (RWE) clinicogenomic database. Methods: GuardantINFORM is an RWE database that aggregates de-identified records from ctDNA testing (Guardant360), and aggregated payer claims from which race, ethnicity, age, cancer type and setting (academic/community) were extracted from 2021-2023 using the patients’ first test. Common cancers with biomarker/targeted therapy opportunities were included. Rates of ctDNA testing by race were assessed for non-Hispanic (NH) White, Black, and Asian/pacific islander (PI) and separately for Hispanic ethnicity. ctDNA testing rates were compared to recent CDC Wonder incidence using previously published methods (PMID: 36658153) and to tissue-based testing rates (PMID: 33106634) using t-test and Fisher’s Exact Test (significance: p < 0.05). Results: There were no significant differences in sex, setting (academic/community), or age ( > 65, 50-65 years) for each group compared to the overall cohort (p > 0.2). ctDNA testing occurred most frequently in NH White (71.5%) followed by NH Black (12.1%), Hispanic (9.1%), and NH Asian/PI (4.7%); rates were comparable to published tissue-based rates (White: 76%, Black: 7%, Asian: 6%, N/A for Hispanic; p = 0.97). Controlling for incidence, ctDNA testing rates were significantly less-than-expected for 75% (6/8) of cancers in NH White, 37.5% (3/8) of cancers in both NH Black and Asian/PI, and 100% (8/8) of cancers in the Hispanic cohort (Table 1). Conclusions: In this large clinicogenomic database, Black and Asian patients had higher than expected rates of ctDNA testing, while Hispanic patients had lower rates. While the representation of Black patients is encouraging, ongoing efforts are needed to improve availability and frequency of testing, particularly for Hispanic patients. [Table: see text]
Overcoming racial and ethnic disparities in clinical trial enrollment real world evidence from an NCI-Designated Cancer Center in a minority majority county.
Authors: Lee Frank , Valerin Jennifer Brooke , Dayyani Farshid
Published: May 2024

e13708

Background: Significant racial and ethnic disparities continue to persist in clinical trial enrollment. Specifically, Asian and Hispanic individuals are severely underrepresented compared to their census estimates and make up as little as 1% and 6% respectively of all clinical trial enrollments [PMID: 35875251]. This limits the generalizability of clinical trials and consequently the application of novel therapeutics for diverse populations. This observational study looks at enrollment demographics at the University of California, Irvine (UCI) with an emphasis on minority participation in clinical trials. We hypothesized that minorities would be underrepresented in our enrollment population. Methods: The UCI Chao Family Comprehensive Cancer Center (CFCCC) is located in Orange County (OC), CA, a minority-majority county. Enrollment data from clinical trials was collected from 2015-2023 through the CFCCC clinical research database. Demographics were compared to data provided by the NIH SEER reports in both OC and United States. Results: Between 2015-2023, 2315 individuals across 3 UCI Health facilities were enrolled. Demographics were as follows: White, Asian, Black, American Indian/Alaska Native, mixed/unknown race (66.4%/20.1%/2.4%/0.7%/0.7%/ 9.3%). Non-Hispanic vs Hispanic ethnicity (77.8%/20.6%). Female vs Male sex (47.6%/52.3%). Age <70 vs >70 years (78.6%/21.4%). Low Income/Health Professional Shortage Areas (HPSA) vs non-Low Income/HPSA (44.9%/55.0%). Study Phase: Phase I/II (39.2%), Phase II (28.0%), Phase III (29.3%), Phase II/III (3.0%), and Phase IV (0.3%). Study sponsor: Industry (61.2%), Investigator initiated (23.5), Cooperative group (14.9%), other (0.3%). Most notably, the Asian enrollment (20.1%) and Hispanic enrollment (20.6%) exceeded demographic representation of Asians (15.6%) and Hispanics (17.3%) in OC. Conclusions: Our results demonstrate that accrual of minorities is feasible across all types of clinical trials. These findings suggest that minorities are not inherently less likely to enroll in clinical trials. A clinical trial portfolio mirroring the catchment area might improve accrual of minorities. Enrollment based on race/ethnicity and trial phase/sponsor will be presented at the meeting.
Influence of patient awareness and health disparities on early identification of neutropenic sepsis risk.
Authors: Kolyvas Emily , O'Farrell Aislinn , Sanderson Hannah , Wilson Anna , Melesi Gini , Crispin Ortuzar Mireia , Ahmad Saif
Published: May 2024

e13711

Background: Neutropenic sepsis (NS) is a life-threatening condition predominantly affecting immunosuppressed cancer patients undergoing cytotoxic chemotherapy. Recognition of the associated symptoms and swift action in response is critical. Timely administration of antibiotics within the first hour of symptom onset is the gold standard of care, with each hour of delay associated with an 8% rise in mortality. Health disparities further compound this challenge by affecting patient access to healthcare. This study aimed to understand the intricacies of NS awareness amongst patients receiving chemotherapy and their caretakers, and to identify demographic and socioeconomic factors shaping this understanding. Methods: Inclusion criteria included current/prior chemotherapy patient/caregiver, any cancer type, age > 18. Structured interviews were conducted by 52 North (n=15) to obtain qualitative information around NS understanding. In collaboration with the Macmillan Cancer Support, a focused online survey utilizing a 5-point Likert scale was used with 252 respondents in the United Kingdom to date. Participant consent was obtained. Results: Findings from the interviews underscored the relationship between non-adherence to NS guidelines and factors including income, socioeconomic status, and other features impacting behavior. Survey participants included: male:female – 29:219, ages 20-80+ (63.2% 51-70), patient:caregiver – 218:34. Only 160/248 (64.5%) of individuals agreed or strongly agreed that they understood NS while 65/248 (26.2%) disagreed or strongly disagreed and 23/248 (9.2%) were neutral. NS symptoms such as fever were reported by 213/252 (84.5%) of respondents, however only 87/213 (40.8%) sought medical advice in less than 1 hour, 71/213 (33.3%) waited over 1 hour, and 28/213 (13.1%) did not seek advice. Individuals reporting greater NS understanding were more than twice as likely to seek help in less than 1 hour (47.9% vs 19.6%; 68/142 vs 10/51). Individuals with salaries >£40K vs <£40K (~$50K) were more likely to seek help less than 1 hour after symptoms (42.5% vs 36%; 34/80 vs 33/91). Conclusions: This study reveals a compelling association between comprehension of NS and likelihood to seek treatment within the recommended 1-hour timeframe. Furthermore, higher income emerges as a factor influencing the promptness of seeking treatment. These insights highlight the critical issue of delayed care due to a lack of understanding, exacerbated by socioeconomic disparities. This study emphasizes the urgent need for enhanced education targeting at-risk groups. By addressing knowledge gaps and socioeconomic barriers, there exists a tangible opportunity to mitigate NS-related mortality in patients undergoing chemotherapy. Subsequent studies will extend these data to include the United States, to compare analysis of barriers to care in different geographic locations.
Racial disparities in the intervention trials in colon cancer.
Authors: Vyas Abhinav , Kaur Dania , Savani Saloni , Shahzad Moazzam , Singh Rohit , Yadav Udit , Mushtaq Muhammad Umair , Batra Akshee
Published: May 2024

e13718

Background: Colorectal cancer (CRC) is the third-leading cancer worldwide and racial minorities bear a disproportionate burden of this disease. Methods: We searched the clinicaltrials.gov database for all the completed clinical trials conducted on adult patients until 2023 in the United States. In intervention trials, we manually abstracted data on the racial distribution of enrollees, phases, tumor histology, intervention type, and year of completion. We divided interventions into chemotherapy, radiotherapy, surgery, immunotherapy, behavioral, diagnostic tests, and others. To quantify the racial disparity, we calculated the enrolment ratio (ER) as the observed ratios of racial participation in the study compared to the prevalence in colorectal cancer per the 2009-2019 Surveillance, Epidemiology and End Results (SEER) database. We also conducted subgroup racial enrollment based on clinical trial and type of intervention. Results: We identified 394 studies, of which 252 studies (64%) had racial distribution published, including 138814 participants. Most studies were phase 2 trials (168), followed by phase 1/2 trials (49) and phase 3 studies (43). The racial breakdown included 88677 White participants (63.9%), 23230 were African Americans (16.7%), 9963 were Asians (7.1%), 4398 were of other races (3.2%), and 12546 were of unknown race (9.0%). The frequency of including racial data was 100% in Phase 1 studies, 56.5% in Phase 2, 58.1% in Phase 3, and only 16% in Phase 4. A total of 185 were immunotherapy trials, out of which 63 studied chemotherapies, radiotherapy and/ or surgery along with immunotherapy. Racial enrolment data was reported in 68.6 %, 58% and 59.3% in immunotherapy, chemotherapy, and radiotherapy interventions respectively. The ERs of whites, blacks, and Asians were 0.8, 1.3, and 0.9, respectively (Table). However, ER in subgroups with specific interventions, such as chemotherapy, immunotherapy, and radiotherapy, were 0.5, 0.4, and 0.6, respectively. Conclusions: African Americans are underrepresented in CRC intervention trials. Equal access and tailored strategies for cultural and linguistic differences are needed for fair participation. [Table: see text]
Expansion of outreach to native Hawaii and Pacific Islander communities to increase breast cancer screening and clinical trial awareness in underserved and rural Oahu.
Authors: Chun Kirsten , Tran-Dang Mai-Phi , Cornett Patricia , Braun-Inglis Christa M , Fukui Jami Aya
Published: May 2024

e13725

Background: Multiple barriers exist in the enrollment of racial and ethnic minority groups into breast cancer screening and clinical trials. Such barriers include the lack of knowledge, mistrust, and access. To increase participation of rural-dwelling Native Hawaiian/Pacific Islanders (NHPI) and other underserved minority groups in breast cancer screening and clinical trials, a pilot project was developed to augment community engagement, provide education, and gain insights into the cancer screening/clinical trial process. Our objective was to engage rural Oahu's underserved communities in breast cancer screening and facilitate enrollment into the Digital Tomosynthesis Mammography and Digital Mammography in Screening Patients of Breast Cancer Trial (TMIST) utilizing a team comprising of a cultural congruent and gender concordant Community Health Educator (CHE) and medical oncology health care provider. Methods: We reviewed the community activities over the course of a year. The CHE facilitated outreach by speaking at numerous church events and other community gatherings. Results: Participants did not respond favorably to surveys on social determinants of health. Common reasons for their reluctance included lack of perceived importance and medical mistrust. When discussing verbiage that was intimidating or confusing such as clinical trial protocol consent language, TMIST study participants conveyed a strong sense of dehumanization. Conclusions: A total of 93 women were screened for the TMIST clinical trial. Of those, 13 were enrolled in TMIST and 31 participants received mammograms. Participant insight highlighted the importance of education using culturally sensitive language and community engagement to combat the lack of knowledge and mistrust. Continued development of education materials centered around community involvement will improve the accrual of NHPI participation in breast cancer screening/clinical trials. We hope this project established a basis for equity in communities with low breast cancer screening and clinical trial participation rates. We intend to build upon the community partnerships forged during this pilot project.
Navigating the intersection: Exploring racial disparities in major cardiovascular and cerebrovascular events among patients with hepatocellular carcinoma.
Authors: Uttam Chandani Kanishka , Agrawal Siddharth Pravin , Raval Maharshi , Siddiq Sajid , Nadeem Ahmed , Chintakuntlawar Ashish V.
Published: May 2024

e13740

Background: Hepatocellular carcinoma (HCC) ranks as the 6th most common cancer and as the 3rd leading cause of cancer-related mortality. With immunotherapy improving survival rates, the relevance of major adverse cardiovascular and cerebrovascular events (MACCE) is increasing. We aim to explore the racial disparities in MACCE among patients with HCC, thus leading to a better understanding of the interplay of these conditions with social determinants of health. Methods: Using ICD-10 codes, patients with HCC were identified from National Inpatient Sample 2019 database. We included all-cause in-hospital mortality (ACIHM), acute myocardial infarction (AMI), atrial fibrillation (AF), cerebrovascular accident (CVA), and sudden cardiac death (SCD) as MACCE for the outcomes. Baseline characteristics including demographics, comorbidities; and MACCE outcomes were compared using chi-square for categorical or ANOVA for continuous data (statistical significance determined as p-value <0.05) and results were stratified based on patient’s races. Results: Out of the total sample size of 89,615 patients admitted with a diagnosis of HCC, 60.14% (53,895) were White, 13.67% (12250) were Black, 15.64% (14015) were Hispanic, 6.48% (5805) were Asian/Pacific Islander, 0.8% (720) were Native American, while 3.27% (2930) belonged to other ethnicities. There were significant racial differences in comorbidities with hypertension being most prevalent in Black patients (42.53%), diabetes mellitus in Native American patients (45.14%) and dyslipidemia in Asian/Pacific Islander patients (32.39%). When compared to White patients, ACIHM was the significantly higher in Black patients with adjusted odds ratio (aOR) of 1.305 (95% CI 1.123-1.517, p=0.001), Asian/Pacific Islander patients with aOR 1.271 (95% CI 1.024-1.578, p=0.03) and Other races patients with aOR 1.578 (95% CI 1.2-2.076, p=0.001). AF was significantly lower in all races when compared to White patients. CVA was significantly higher in Black patients with aOR 1.654 (95% CI 1.329-2.059, p<0.001) compared to White patients. SCD was significantly higher in Asian/Pacific Islander patients with aOR 2.22 (95% CI 1.364-3.612, p=0.001) when compared to White patients. https://docs.google.com/document/d/1wM_b0jmNjChKEfpyj5SL6HmSKEhDo0N3X5H76jC-w0I/edit?usp=sharing Conclusions: In patients with HCC, Asian/Pacific Islander patients had higher ACIHM and SCD while Black patients had higher ACIHM and CVA as compared to White patients. This study highlights the importance for development of healthcare strategies stratified by race which may aid to mitigate the higher risk of MACCE in certain races. Further research involving possible genetic influences and social determinants of health contributing to poorer outcomes in people of color becomes imperative.
Identifying factors underlying increased emergency care needs of Black patients with pancreas cancer.
Authors: John Kristen M , Louis Tanya C. , Saluja Deepak , King Daniel
Published: May 2024

e13749

Background: In a retrospective study, we observed that African American/Black patients are 2.8x more likely to have recurrent ED visits than non-Black patients. These findings motivated this prospective study using a standardized questionnaire to better understand the factors leading to ED visits among Black patients. Methods: A study of Black patients with pancreas cancer who had at least 1 ED visit in a 5 month period in 2022-2023 was conducted. Computational identification of health system encounters by patients with pancreas cancer was performed using ICD10 C25* as a cohort identifier. The cohort was filtered by encounter type for ED and self-reported race for Black. Weekly, an African American oncology nurse practitioner called these patients to administer a questionnaire regarding social determinants of health and discuss reasons underlying the ED visit. Three attempts were made to contact each patient. Demographic and clinical features were obtained from the electronic health record. Results: During this 5-month period, 31 patients meeting criteria were identified; among these 31 who had at least 1 ED visit, 45% had ≥2 ED visits and 13% had ≥5 ED visits. The cohort was 68% female with mean age of 70.3 and median household income of $92,608. 74% had non-metastatic disease and 35% were on chemotherapy at the time of visit. 52% of patients had Medicare, 35% had commercial insurance, 10% had Medicaid, and 3% were uninsured. We reached 55% patients, of whom 71% agreed to participate. Notably, 83% endorsed high school as their highest level of education, 25% were immigrants to the United States, and 17% experienced financial barriers to care (Table). 33% had been seen at our institution’s pancreas cancer multidisciplinary clinic. Two recurrent themes noted during discussions with these patients were that that those with multiple ED visits were nearing end-of-life and/or had caretakers or family members in the medical field. Conclusions: We identified female gender, education level, immigrant status, and financial barriers to care as themes associated with ED visit burden in Black patients with pancreas cancer. Having caretakers in the medical field, who may have witnessed the consequences of healthcare disparities, may also contribute to higher rates of ED use. We hope to use these data to inform interventions to address these disparities. [Table: see text]
Investigating perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.
Authors: Sorensen Luke , Lam Anh B. , Moore Vanessa Ann , Bouvette Max Joseph , Diaz Adolfo , Wismann Andrea , Nipp Ryan David
Published: May 2024

e13765

Background: Older adults with cancer have unique needs, particularly in perioperative settings, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. We conducted a systematic review to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials that enrolled adults >60 years old with cancer, excluding studies on pharmacologic or procedural interventions. Results: We identified 1,036 studies and 922 abstracts through our initial search. Title and abstract review resulted in 20 manuscripts. After full-text review, 9 were removed as their study design, patient population, or intervention did not align with inclusion criteria. Our final review included 11 studies (90.9% [10/11] were conducted outside of the US and 45.6% [5/11] were published within the past 2 years). Patients’ age ranged from 60-95 and median number of patients per study was 147 (range: 44-690). Studies were primarily on patients with colorectal cancer (81.8% [9/11]), with all involving non-emergent elective surgeries. Most studies (63.6% [7/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (18.2% [2/11]), nutrition optimization (9.1% [1/11]), or patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications (36.4% [4/11]), feasibility of exercise programs (27.3% [3/11]), quality of life (18.2% [2/11]), delirium incidence (9.1% [1/11]), or hospital length of stay (9.1% [1/11]). All studies had postoperative complications as a primary or secondary outcome. Overall, 54.5% (6/11) found a positive primary outcome including: postoperative complications (18.2% [2/11]), implementation of exercise program (18.2% [2/11]), quality of life (9.1% [1/11]), or nutrition (9.1% [1/11]). Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating further work is required to address the unique perioperative needs of the geriatric oncology population.
Effect of age on delivering chemotherapy to older adults with advanced pancreatic adenocarcinoma.
Authors: Tannous Toufic , Panjrolia Ekta , Resendes Natasha M. , Islam Raiyan , Hammel Iriana M.
Published: May 2024

e13767

Background: Age is one of the most important risk factors for developing pancreatic adenocarcinoma (PDAC), 65% of the newly diagnosed cancer cases occur in individuals above 65 years of age (yo). The only potential cure for PDAC includes surgical resection, however, the majority of patients (70%) present with locally advanced/unresectable or metastatic PDAC (APDAC). Many oncologists remain hesitant to administer treatment to older adults for fear of perceived increased chemotoxicity risk and the thought of treatment intolerability. Methods: This retrospective cohort study included patients who were diagnosed and treated for APDAC within the Veterans Integrated Services Network (VISN) 8 which includes Veterans Affairs medical facilities in Florida, southern Georgia, Puerto Rico, and the U.S. Virgin Islands. Demographic data such as age, sex, race, ethnicity and treatment data such as chemotherapy and palliative care use were pulled from the VA Cancer Registry, available from Corporate Data Warehouse Data. We conducted a detailed chart review in the VA electronic health record to confirm stage and the eastern cooperative oncology group (ECOG) status at the time of diagnosis. Statistical analyses were conducted using GraphPad Prism 10.1.2 software. Analyses consisted of t-test for normally distributed continuous variables, chi-squared test for categorical variables and the Mann Whitney U test for the ECOG score of both groups. Results: Ninety-nine patients with APDAC above the of age 65 were identified from the period of June 1, 2017 till July 31, 2021. 46 received chemotherapy (C group) and 53 patients did not receive chemotherapy (NC group), characteristics (Table). The mean age for those in the C group were 72 years old (yo) vs 76 yo from the NC group with a P value of 0.0017 which was statistically significant. Looking at the age subgroups, the majority of the patients that received C, were of the 65-74 age subgroup (71%). The median ECOG for the NC group was 2 and that for C was 1 group. 39% of the C group received palliative care as opposed to 32% of the NC group with a P value of 0.532. Conclusions: Despite an acceptable ECOG range between 1 and 2, Age played an important factor in determining who received chemotherapy in APDAC. Studies other than ECOG are needed to help oncologists determine the fitness of APDAC patients and minimize hesitancy to deliver treatment. The involvement of palliative care in patients with APDAC was suboptimal and a push for more involvement of palliative care is needed. [Table: see text]
Implementing a mutidisciplinary approach for older adults with cancer: Challenges and achievements in a geriatric oncology program in Sao Paulo, Brazil.
Authors: Pontes Luciola De Barros , da Silva Jennifer Kamila , Santos Juliana duarte , Proença Regiane , Buesa Nadia Haidar , Dutra Adriana Fatima , Borges Fabiola Alves de Santana , Gomes Maria Livia Leite de Abreu , Neto Raquel de Sousa , da Conceição Bianca Vasconcellos , Porro Carolina Ferraioli , França Jadna Helena dos Santos , Ferreira Nivalda Gonçalves , de Oliveira Carla Jussaria , Criminazzo Thassio Pastre , Mendes Leonardo Daniel , Freire Jakline Maria , da Silva Amanda Costa Rosa , Nascimento Evelyn Aparecida
Published: May 2024

e13769

Background: Treating an older adult with cancer is complex and requires multidisciplinary effort. Multiple studies demonstrate the benefits of timely integration of Geriatric Oncology (GO) with routine oncologic care. Despite this growing body of evidence, there are very few cancer centers around the world that have a dedicated GO program, notably in low- and middle- income countries (LMIC). The objective of this abstract is to describe the first year of the GO program in a private oncology center in São Paulo, Brazil. Methods: As an effort of oncologists, geriatricians and nurses, the team built a consultative model with a nurse performing the G8 triage score to every cancer patient aged ≥ 70 years. For those with a G8 less than 14 points, a comprehensive geriatric assessment (CGA) was performed. The results of the CGA were than provided as a report to the treating physician and all the members of the multidisciplinary team, so that a geriatric assessment (GA) driven intervention could be planned. The patients were then followed for 3, 6, and 12 months to detect falls, emergency rooms visits, hospitalizations, and death. Results: From January 2023 to January 2024, 110 patients with a median age of 79 were evaluated, with 57% having a G8 less than 14. 70 patients we submitted to a CGA. The majority of the tumors were gastrointestinal (30%), lung (20%) and genito-urinary (17%). Regarding the GA domains: 70% of the patients had a possible or probable cognitive impairment by the 10-point cognitive screener; 53% mild psychological distress by PHQ-4 Screening Tool; 47% showed important reduction in hand grip strength scale calling the attention to sarcopenia; 48% were found to be at nutritional risk and 42% were classified as malnourished at the mini-nutritional assessment; polypharmacy was detected in 67% of the patients. Despite these findings, 78% of the patients we classified as ECOG 0 or 1. After GA driven interventions, at 3 and 6 months follow up, 88% of the patients remained with no falls, with a mild rate of hospitalizations (40%) and a low rate of treatment discontinuation (15%). By the end of 6 month follow up, 24% of the patients have died. Conclusions: Geriatric conditions such as functional impairment are common and frequently unrecognized or inadequately addressed in older adults with cancer. Identifying geriatric conditions by performing a GA can help the health team to manage these conditions and provide better oncology care.
A phase II trial comparing dalpiciclib in combination with letrozole versus standard chemotherapy as neoadjuvant therapy in patients with high-risk HR- positive HER-2 negative breast cancer: DARLING-02.
Authors: Zhang Lina , Geng Cuizhi , Liu Yueping , Han Jianjun , Han Meng , Huang Ruixue , Li Xianqiao , Luo Ruizhen , Li Yuntao , Ma Jie , Qi Huaihua , Wang Zunyi , Wang Xiaochun , Yang Chao , Yang Jingqiang , Yang Lixian , Yu Jingjing , Zhang Yingzhou , Zhang Zhisheng , Zhou Xinping
Published: May 2024

TPS626

Background: Dalpiciclib is a CDK4/6 inhibitor that has shown promising efficacy and safety when in combination with endocrine in the treatment of advanced HR+ HER2- breast cancer. Building on preliminary findings from our previous study (Geng, 2023SABCS PO2-02-05), we aim to evaluate the efficacy and safety of dalpiciclib combined with letrozole versus standard chemotherapy as neoadjuvant treatment in patients with high-risk early breast cancer (EBC). Methods: This is a prospective, multicenter, randomized phase II non-inferiority trial. Main eligibility criteria include: female patients ≥18 years, ECOG performance status of 0-1, histologically confirmed invasive breast cancer, clinical stage T1c-T2, cN1–2 or T3-4, cN0-2, ER≥50%, HER2-negative, and Ki67 ≤ 20%. Participants are randomized 1:1 to receive either 24-week experimental intervention (oral dalpiciclib 150mg once daily for 3 weeks on, 1 week off and oral letrozole 2.5 mg/day) or 24-week standard intervention (intravenous epirubicin 100 mg/m² and intravenous cyclophosphamide 500 mg/m² on day 1 for three 3-week cycles, followed by intravenous docetaxel 100 mg/m2 on day 1 for three 3-week cycles). The primary endpoint is the objective response rate (ORR) assessed by RECIST v1.1. Secondary endpoints include patient-reported outcomes (EORTC QLQ-C30, EORTC QLQ-BR23), residual cancer burden 0–I rate, preoperative endocrine prognostic index score 0 rate, pathological complete response rate , 2-year invasive disease-free survival rate, and safety. Exploratory endpoints include biomarker analysis. The hypothesis is that the experimental group will not be inferior to control group. Assuming an ORR of 70% for both groups, a sample size of 65 patients per group is required to achieve 80% power to detect a non-inferiority margin of up to 20% at a two-sided significance level of 5%. A total of 130 patients are needed (65 per group). Considering a dropout rate of 10% per group, the total sample size is approximately 144 patients. The trial was registered at ClinicalTrials.gov (NCT06107673) and is actively recruiting. Clinical trial information: NCT06107673 .
Reading (in) Graham Greene's The Ministry of Fear (1943)
Authors: Ludtke Laura Elizabeth
Published: May 2024

This essay offers a transgeneric reading of Graham Greene's 1943 novel The Ministry of Fear, first tracing the emergence of spy fiction from invasion fiction at the end of the nineteenth century and then establishing William Le Queux's influence on the culture of espionage in Britain as well as in British spy fiction. Following on from this genealogy of genre, it interrogates the novel's protagonist's claim that “[t]he world has been remade by William Le Queux” in the context of the dual histories of espionage in Britain and the spy in British fiction, while attending to the novel's own reception of those histories. Focusing on the significance of the novel's intertextual and paratextual evidence in an interpretation of the novel's unconventional narrative strategies, the essay examines hybrid modes of reading the novel, as well as reading in the novel as a way of parsing its entangled narrative modes, levels, and discourses. Greene encourages transgeneric reading as a possible resolution to the epistemological uncertainty readers experience at the novel's close due to its troubling of genre expectations, its allusiveness, and, ultimately, its eschewal of narrative closure. At the same time, the essay proposes that, in attending in spy fiction to what is read and how it is read, we might better appreciate the challenges presented by the rehabilitation of a genre that also requires disentangling the many hierarchies of modernist cultural production.