bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial and ethnic disparities in lifestyle changes during the COVID-19 pandemic: Exploring the socioeconomic and psychosocial mechanisms.
Authors: Wen Ming , Curtis David , Zhang Donglan , Chen Zhuo , Shi Lu , Chen Liwen , Su Dejun , Wei Yehua , Li Yan , Li Jian , Chen Baojiang , Li Hongmei , Han Xuesong
Published: June 2022

10558

Background: Obesity, physical inactivity, excessive alcohol consumption, and poor diet are all modifiable risk factors for cancer. These unhealthy behaviors are disproportionally concentrated in racial and ethnic minorities and these disparities may have been exacerbated during the COVID-19 pandemic. This study examined racial and ethnic disparities in weight gain and other undesirable lifestyle changes during the COVID-19 pandemic and explored mechanisms underlying these lifestyle disparities. Methods: We used data from the 2020 Health, Ethnicity and Pandemic Study, a national survey representative of US households conducted in October 2020. Racial and ethnic minorities were oversampled. Participants were asked to report lifestyle behaviors before and during the COVID-19 pandemic. We examined two outcomes in this study: weight gain and experiencing any undesirable lifestyle changes (i.e., reduced exercise time, increased alcohol drinking, or increased fast-food meal consumption). The primary exposure was race-ethnicity (non-Hispanic (NH) white, NH black, Hispanic, NH Asian, NH other race). Four sets of mediators were examined: socioeconomic status (education, household income, and undesirable job changes), family and friend social relationship change, perceived and experienced racism, and psychological distress. Weighted multivariable logistic regression models were performed. Mediation effects were examined with variance decomposition method. Results: A total of 2,709 participants were included in our sample. Compared with white respondents, black (OR = 1.71; p < 0.001) and Hispanic respondents (OR = 2.17; p < 0.001) were more likely to experience weight gain, controlling for age and sex. Among the hypothesized mediators, undesirable job changes during the pandemic, experiencing worse family relationship, and higher levels of psychological distress were all linked to higher odds of weight gain, but none of these variables played a salient role in mediating the black-white and Hispanic-white disparities in weight gain during the pandemic. As to the odds of experiencing undesirable lifestyle changes, black (OR = 1.76; p < 0.001), Hispanic (OR = 2.12; p < 0.001), and Asian respondents (OR = 1.42; p < 0.01) all exhibited disadvantages relative to white respondent. These disadvantages were largely attributable to perceived racism toward one’s own group and psychological distress for all three minority groups. Conclusions: Racial and ethnic minorities were more likely to experience unhealthy lifestyle changes relative to white individuals during the pandemic in the United States, which can be partly attributable to higher levels of perceived racism and psychological distress. The long-term effects of racial/ethnic disparities of lifestyle change during the pandemic on cancer prevention warrant further research.
Variants of unknown significance (VUS) in patients with hereditary CRC without a known pathogenic variant.
Authors: Stojovska Marija , Matevska-Geshkovska Nadica , Bozhinovikj Elizabeta Krstevska , Grozdanovska Biljana , Mitrevski Nenad , Dimovski Aleksandar
Published: June 2022

10599

Background: Nearly 5-10% of all newly diagnosed colorectal cancer (CRC) cases develop due to the presence of a highly penetrant pathogenic variant in one of the hereditary colorectal cancer (hCRC) associated genes. NGS technology raised the opportunity for fast and efficient detection of these variants, but still in ̃20-30% of patients with hCRC the genetic defect remains unknown. Recent data shows that 6-8% of these cases harbor pathogenic/VUS variant in low/moderate penetrance genes not directly associated with hCRC. Methods: A total of 109 patients with hCRC (43 with polyposis and 66 with non-polyposis syndromes) were analyzed by NGS covering coding and exon/intron sequences of 109 genes, of which 25 associated with known hCRC syndromes and 83 other cancer predisposition genes. Results: Pathogenic variants were detected in 63/109 (57.7%) of analyzed patients; 54/63 (85.7%) of these had a pathogenic variant in one of the genes associated with hCRC (APC, MMR genes, MUTYH, NTHL1, BMPR1A) and 9/63 (14.3%) had a pathogenic variant detected in genes not directly related to hCRC (CHEK2, FANCL, FANCM, ERCC2, BRIP1, FLCN, BLM). In 26/109 (23.8%) patients a rare VUS variant was detected, of which 14/26 (53.8%) in double strand repair (DRG) genes (BLM, CHEK2, PALB2, ATM, MRE11A, BRIP1, FANCM, FANCL and ERCC2), 8/26 (30.8%) in one of the known hCRC genes (APC, MSH6, PMS2 and POLE) and 4/26 (15.4%) in other cancer predisposition genes (KIT, NSD1, CDH1, EZH1 and FH). VUS variants in DRG genes were more common in patients with MSI- HNPCC (9/15, 60%), compared to patients with polyposis syndromes (6/15, 40%). The VUS variants in other cancer predisposition genes were dominantly present in patients with oligopolyposis. Most (21/26, 80.8%) VUS variants were detected as single variants, while only five patients (5/26, 19.2%) had two different variants in two different genes. In 20/109 (18.3%) patients who presented primarily with MSI- HNPCC or oligopolyposis phenotypes, no pathogenic and/or VUS variants were detected in the 109 analyzed genes. Conclusions: Genetic basis of hereditary CRC was not clearly defined in a large proportion (42.3%) of patients in our cohort. Although a VUS variant was detected in a significant portion (23.8%), a major fraction (18.3%) of patients had no known genetic variant detected. The presence of a high frequency of VUS variants in DRG genes indicates that this pathway plays an important role in CRC carcinogenesis. Although we cannot exclude the presence of deep intronic and/or regulatory region pathogenic variants in the analyzed genes, it appears that the current list of identified cancer predisposition genes responsible for the hereditary CRC is far from being complete. The influence of environmental factors in conjunction with polygenic inheritance might also play a key role in a fraction of hCRC in our population.
Genetic risk assessment in primary care settings: An evaluation of NCCN guidelines.
Authors: Milliron Kara J. , Hulswit Bailey , Cook Amanda , Fry Stacy , Schraeder Alec , Tippie Jerry , Hall Kelly , McCain Lynn A. , Keren David , Schroeder Lee , Merajver Sofia , Stoffel Elena Martinez
Published: June 2022

10605

Background: Lynch syndrome (LS) and hereditary breast and ovarian cancer (HBOC) have a population prevalence of 1/2791 and 1/4002, respectively. Despite this, >80% of patients referred for cancer genetic counseling report personal or family history of breast cancer3. This disparity may be due to increased media attention for HBOC, lower levels of provider awareness of LS, and less discussion of colorectal cancer within families compared to breast cancer4. However, potential biases in National Comprehensive Cancer Network (NCCN) criteria for genetics evaluation (GE) have not been studied. This project examined the performance of NCCN guidelines for identifying individuals meeting criteria for GE ascertained through primary care (PC) settings. Methods: Individuals scheduled for routine PC appointments at three Michigan Medicine affiliated practices from 10/24/18 through 1/24/22 were emailed a link to complete an online personal and family history (P/FHx) risk assessment module (INHERET) collecting information about cancer diagnoses (age/cancer type) in 1st, 2nd, and 3rd degree relatives. The module was written at a 4th grade reading level and could be accessed on any internet-connected device. NCCN guidelines were applied to determine if patients met criteria for GE of HBOC and/or LS. Results: A total of 465 individuals completed the module; nearly one in three (30.6%, 142/465) met NCCN criteria for GE of HBOC or LS. Of those meeting criteria, 132 (92.9%) had no personal history of cancer. The most common indication for GE was HBOC (29.5%, 137/465) and 30 patients (6.5%) met HBOC referral criteria solely based on Ashkenazi Jewish ancestry. Only 17/465 (3.7%) individuals met NCCN criteria for GE of LS. Interestingly, 12/17 (70.6%) who met criteria for GE of LS also met criteria for GE of HBOC. The completion rate was not 100% and cannot be determined; it is not known how many patients were offered the option of completing the module. This limits the study, as ascertainment bias cannot be assessed. Conclusions: Nearly one-third of PC patients who completed the P/FHx module met NCCN criteria for genetic evaluation of HBOC and/or LS. Referrals for HBOC outnumber those for LS, even though LS is just as common1, 2, 3. Further evaluation of NCCN criteria is needed to evaluate whether patients may be over-referred for HBOC and/or under-referred for LS. Unfortunately, we were not able to confirm receipt of email invitations or accurately calculate completion rate of the P/FHX risk assessment module, which limited our ability to assess for ascertainment/response bias. [Table: see text]
Building a multidisciplinary consortium in Iowa to advance genetic counseling and testing in patients with cancer.
Authors: Megally Sandra , nwaneri matthew Obinna , Kim Joseph , Atembina Limaya , Lucas Lorna , Bankert Lu Anne
Published: June 2022

10609

Background: As cancer clinicians develop increasingly complex treatment plans, the results from somatic and/or germline tests are guiding personalized treatment decisions. Many patients with cancer do not get optimal genetic counseling/testing when indicated. To ensure that cancer clinicians are following the latest clinical recommendations around genetic counseling/testing, the Iowa Oncology Society (IOS), working in collaboration with the Association of Community Cancer Centers (ACCC), developed a multiphase initiative to inform quality improvement (QI) opportunities. Methods: In 2021, IOS launched a multidisciplinary consortium to advance genetic counseling and testing in oncology. Engaging a diverse group of stakeholders, IOS held a focus group to explore the current landscape, conducted three educational lunch and learn sessions, produced a podcast, and hosted a working group meeting. These meetings and activities were designed to explore ways to overcome common barriers in care delivery and identify effective practices to coordinate cancer genetic counseling and testing in clinical practice. Results: Through this initiative, IOS identified several key improvement opportunities for cancer clinicians treating patients in Iowa. Since 43 percent of Iowa’s population is rural, this initiative also identified practical strategies for oncology practices in low-resource areas. The following insights and suggestions were generated from this initiative: 1) Cancer programs may implement creative ways to collect patient history and screen patients for hereditary cancer syndromes. 2) Clinicians may use more effective education materials when referring patients for genetic counseling. 3) Clinicians may clarify language/communication to reduce confusion about somatic vs. germline test results. 4) Cancer programs may form partnerships with local genetic counselors and/or organizations that offer telehealth services. IOS summarized these ideas and disseminated education and resources to guide cancer clinicians in assessing and improving their own practices. Conclusions: This multiphase initiative represents a framework for a state oncology society to engage other stakeholders and lead interdisciplinary efforts to improve care for patients with cancer. As the landscape of genetic counseling evolves, IOS supports legislative efforts aimed at having Medicare recognize certified genetic counselors (CGCs) as healthcare providers. IOS plans to build on this initial work to advance cancer genetic counseling and testing throughout the state by developing additional programming in 2022.
A novel analysis of data from the PALOMA-3 trial confirms the efficacy of palbociclib and provides an option for efficacy assessments that could accelerate drug approvals.
Authors: Yeh Celine , Zhou Mengxi , Bapodra Neil , Rivero Maria , Espinal Dominguez Edward Jose , Moran Marina , Hershman Dawn L. , Fojo Antonio Tito , Bates Susan Elaine
Published: June 2022

1069

Background: Advances in breast cancer (BC) therapy the past few decades have led to higher survival rates. Beginning with palbociclib, cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors have emerged as a treatment option for BC. We analyzed data from PALOMA 3 that could release a biomarker of OS in patients that receive palbociclib. Methods: We estimated concurrent rates of growth ( g) and regression ( d) from the 393 women with advanced BC enrolled in PALOMA-3 who had radiographic tumor measurement data including 261 treated with fulvestrant + palbociclib, and 132 with fulvestrant + placebo. We analyzed data using a model defined as SLD (t) = exp (– d x t) + exp ( g x t) – 1, where SLD = sum of longest diameters and t = time. We examined the relationship between g and overall survival (OS) and compared the median growth rates ( g) of various cohorts. Results: g values associate highly with OS (p<0.0001). Emulating results in the clinical trial, palbociclib slowed the median g values of the entire population and those with sensitivity to previous endocrine therapy but not those deemed resistant. Further cohort analyses found greater benefit with palbociclib in those with visceral metastases, and longer disease-free interval, and benefit independent of ECOG PS, menopausal status, prior lines of therapy, and age. With only the baseline and two additional scans obtained, the median g values of the palbociclib and placebo arms were statistically different: p=0.038 after 28 (19/9) patients and p=0.0043 after 40 (26/14) patients. Conclusions: Estimates of palbociclib’s impact on tumor growth rates ( g) confirm its efficacy in PALOMA 3. Our ability to discern differences in g, a value associated with OS, after only two follow up scans in as few as 28 patients merits considering g an early biomarker of OS benefit that could bring effective drugs to patients as rapidly as possible. [Table: see text]
Phase 1b/2 study of GX-I7 plus pembrolizumab in patients with refractory or recurrent (R/R) metastatic triple-negative breast cancer (mTNBC): The KEYNOTE-899 Study.
Authors: Sohn Joohyuk , Kim Gun Min , Lee Keun Seok , Kim Sung-Bae , Kim Jee Hung , Ahn Hee Kyung , LEE JIEUN , Park Kyong Hwa , Kim Jee Hyun , Lee Kyoung Eun , Shin Eui-Cheol , Park Su-Hyung , Yang Se Hwan , Heo MinKyu , Woo Jung Won , Sung Young Chul , Im Young Hyuck
Published: June 2022

1081

Background: GX-I7 (efineptakin alfa) is a hybrid Fc-fused long-acting recombinant human IL-7 which plays an essential role in the development and homeostasis of T-cells. GX-I7 can potentially enhance the anti-tumor effect of pembrolizumab via induction of T-cell activity. Here, we report results of phase 1b/2 study of GX-I7 plus pembrolizumab in patients with R/R mTNBC. Methods: Eligible patients had R/R mTNBC that failed up to 3rd lines of chemotherapy in the metastatic setting. Phase 1b patients received GX-I7 in 5 dose levels ranging from 360 µg/kg to 1,440 µg/kg every 9 (Q9W) or 12 (Q12W) weeks plus pembrolizumab 200 mg Q3W (n=51). Phase 2 is an expansion cohort where 33 patients were treated with the recommended phase 2 dose (RP2D). The primary objective was to determine the RP2D for phase 1b and to assess the objective response rate (ORR) for phase 2. Results: The study included 84 patients (phase 1b, n=51; phase 2, n=33) and 53.6% (45/84) of patients have received 2nd to 3rd lines of previous therapy. In phase 1b, one dose-limiting toxicity (DLT; grade 3 skin rash) was reported in the 1,440 µg/kg cohort and GX-I7 1,200 µg/kg Q9W was selected as RP2D. The ORRs were 15.7% [95% confidence interval (CI): 7.0 – 28.6] for phase 1b (n=51) and 21.2% [95% CI: 9.0 – 38.9] for phase 2 (n=33). Median PFS was 2.4 months (95% CI: 2.1 – 2.7) at the median follow-up of 10.4 months for all patients combined (n=84). GX-I7 induced up to 3.6-fold (range 1.2 – 8.1) increase in absolute lymphocyte counts (including CD4+ and CD8+ T cell) in all dose levels. The most common treatment-related adverse events (AEs) of any grade were injection site reaction (50.0%), ALT increased (39.3%), pyrexia (38.1%) and rash (35.7%). The additional correlative study data will be presented. Conclusions: GX-I7 in combination with pembrolizumab demonstrated a manageable safety profile with promising anti-tumor activity in patients with R/R metastatic TNBC. Clinical trial information: NCT03752723. [Table: see text]
Is cure possible for breast cancer metastatic to the liver?
Authors: Adam Rene , Badrudin David , Allard Marc Antoine , Golse Nicolas , Ulusakarya Ayhan , Cherqui Daniel , Sa Cunha Antonio , Vibert Eric , Azoulay Daniel , Ciacio Oriana , Pittau Gabriella , Lucchese Angelica , Hammel Pascal , Lewin Maite , Giacchetti Sylvie
Published: June 2022

1099

Background: Metastatic breast cancer (MBC) is a lethal disease and is generally only amenable to systemic treatment. Although increasingly recommended on selected patients, local treatments, and particularly surgery, are seldom used in the therapeutic armamentarium for MBC and their long-term survival benefit is unknown. We hypothesized that combining surgery to systemic treatment for selected patients with breast cancer liver metastases could lead to long-term survival or even an option of cure. Methods: A retrospective study of prospectively gathered data from a surgical series of liver resections for MBC was conducted. Patients with no or limited and stable extra-hepatic disease were offered surgery after multidisciplinary discussion, if the liver metastases were responding to systemic treatment and were amenable to complete macroscopic resection. Five- and ten-year actual survivors were identified and their characteristics were explored. Results: From 1984 to 2020, 207 female patients underwent liver resections for MBC in our institution. There was no postoperative mortality. Postoperative complication rate was 23.3% and liver-specific complication rate was 19.0%. There was a total of 48 repeat hepatectomies. Median disease-free interval between initial breast cancer and liver metastasis was 36 ± 90.1 months. There was a median of 2 ± 1.8 liver metastases at diagnosis with a median size of 33.0 ± 18.3 mm and 73.1% of patients had radiological response before resection. Five- and ten-year overall survivals (OS) as well as 5- and 10-year disease-free survivals (DFS) were 39.6% and 12.7% as well as 14.2% and 6.4%, respectively. Median OS was 44.0 ± 47.2 months in the whole series. Focusing on the 5- and 10-year survivors, median OS were 89.5 ± 44.7 months and 144.0 ±42.6 months, respectively. In the 10-year survivors’ group, median DFS was 98 ±62.3 months. Observed survivals in this study underestimate true actual survivals owing to censoring of patients lost to follow-up. Conclusions: Long-term survival (≥ 5 years) as well as a curative perspective (≥ 10 years survival) are achievable for selected patients with breast cancer liver metastases by combining surgery to systemic treatment. Considering the recent improvements in the results of systemic treatments, introducing surgical resection in the treatment sequences of MBC could play an even more beneficial role.
Alleviating the click fatigue on clinicians to improve referrals for colorectal cancer screening.
Authors: Amin Robby , Odhiambo Lorriane Achieng , Ali Sayeda , Islam KM , Yates Joycelyn W , Hotz James , Desai Koosh , George Cynthia , Mitchell Katreena , Durham Lynn M. , Gabram Sheryl G. A. , Cortes Jorge
Published: June 2022

11021

Background: The impact of clinician burnout on patient care is pervasive across medical delivery systems. The effects are also felt in preventive care where cancer screening efforts rely on clinician referrals through the electronic medical records (EMRs). Though designed to support healthcare, EMRs are a significant source of clinician burnout given the number of clicks or navigation time needed to refer a patient. This is a barrier to Patient Navigation (PN) when ordered tests do not materialize into screenings or when clinicians order labs/imaging and the pending orders are not created. This causes frustration for all clinical staff involved, delays the workflow processes, and leads to missed opportunities for PN. We implemented an ‘order set’ intervention to reduce the click burden linked to colorectal cancer (CRC) screening referral among clinicians in South Georgia. Methods: The ‘order set’ intervention was developed to facilitate PN for a Colorectal Cancer Control Program (CRCCP) aimed at implementing Evidence-Based Interventions to increase CRC screening rates in Georgia. The ‘order set’ was designed to address workflow issues by consolidating steps associated with CRC screening. This reduced typing input and the need to click between multiple windows within the EMR while making a referral to PN. The intervention was piloted in the Albany Area Primary Health Care (AAPHC) system after modifications were made to the EMR and clinician workflows. The monthly CRC screening rates continue to be generated and tracked post-implementation. Results: The use of the ‘order set’ reduced the click burden from 78 to 7 inputs and clinician EMR interaction time from 110 seconds to 29 seconds. Providers from 4/7 clinics have adopted the ‘order sets’ when making referrals for CRC screening. Two clinics provided post-implementation screening data. The pre-implementation screening rates for one clinic were comparable (August = 59.3%, September = 57.6%) to post-implementation (October = 56.3%, November = 56.6%, December = 57.2%), while the second clinic showed some increase (August = 58.6%, September = 60%) vs. (October = 61%, November = 62.1%, December = 62.8%). Conclusions: The ‘order sets’ intervention reduced the time clinicians spent creating referrals for CRC screening, including fecal immunochemical tests (FIT) and colonoscopies. Additional follow-up and rollout to clinics participating in the program is underway to evaluate further the impact of the order sets on CRC screening outcome and process measures, including qualitative interviews with clinicians. There is significant potential in the application of order sets to various workflow processes to aid in preventative health efforts. Challenges linked to the COVID-19 pandemic and staff turnover affected acquisition of patient referral data.
Applying cognitive integration to oncology: A novel asynchronous foundational science curriculum for medical students during clerkships.
Authors: Brondfield Sam , Hyland Katherine , Cornett Patricia A. , Kirsch Heidi
Published: June 2022

11028

Background: Cognitive integration (CI) connects foundational science (FS) to medical practice and improves clinical reasoning. While evidence supports CI in medical training, the clinical relevance of FS is often obscure to medical students, particularly in oncology, and few learning materials exist to support CI during clerkships. Providing effective and engaging tools to promote CI may enhance understanding of FS relevance to clinical medicine. We therefore aimed to create an online module to integrate FS into clerkships. Methods: Previous student feedback at our institution advocated for clinically relevant FS content. Applying Cognitive Theory of Multimedia Learning principles, we (an oncologist, a biochemist, and an instructional designer) created a cancer module grounded in the hallmarks of cancer (HoC), a key FS principle. To emphasize clinical relevance, we recorded patient interviews incorporating FS. The module, composed in Qualtrics, includes an introduction and four cases, each starting with a brief patient interview, followed by clinical text, images, questions, and explanations. Content co-created by the oncologist and biochemist combined clinical and FS perspectives and referenced the HoC throughout. We piloted a draft with a focus group of four students. The evaluation plan includes written learner feedback, a case-based pre/post-test, and review of clerkship assessments for evidence of CI. Results: We produced an FS oncology module with an estimated engagement time of two hours, which students may complete over multiple sittings. The development team met monthly over the course of one year. Filming and editing cost $100/hour. Overall, the project required approximately 60 faculty person-hours and 12 instructional designer person-hours. The patients interviewed for the module expressed gratitude for sharing their stories with students. The student focus group yielded unanimously positive feedback about the content, the multimedia format, the level of FS covered, and the use of authentic patient videos to enhance clinical relevance. Students strongly preferred this module compared to prior online learning activities. Conclusions: This novel interactive module can serve as a model for development of clerkship curricula promoting CI. Module creation based on real patients resulted in authentic story-telling and enhanced FS relevance. Content development involving a clinician and a basic scientist aligned with CI goals. Limitations include the need for funding and instructional design assistance. A randomized controlled trial comparing a series of novel FS modules to older recorded lectures may demonstrate improved outcomes. Involving learners in curriculum development may decrease faculty burden and increase student interest in FS.
Transdisciplinary research in energetics and cancer (TREC) training program for early career investigators.
Authors: Irwin Melinda L. , Lowry Diana , Neuhouser Marian L. , Henry Curtis , Sears Dorothy , Schmitz Kathryn , Nebeling Linda , Ligibel Jennifer A.
Published: June 2022

11031

Background: Given the rising prevalence of obesity, poor diet and physical inactivity, known in combination as “energy balance” or “energetics”, as well as their associations with cancer incidence and mortality, innovative research, clinical care and training of scientists are needed to lower the prevalence of these risk factors and in turn, lower cancer incidence and mortality rates. Methods: With NCI support (R25CA203650) from 2016-2021, we developed and offered an annual one-week, in-residence Transdisciplinary Research in Energetics and Cancer (TREC) Training workshop, followed by a yearlong mentoring program, that focused on energy balance and cancer research across the cancer control continuum. Results: We recruited, educated, trained and mentored 123 early career investigators (TREC Fellows) from 64 different institutions and from diverse academic backgrounds (i.e., 20% basic, 33% clinical and 47% population sciences) in transdisciplinary research in energetics and cancer. Fellows accepted to the TREC Training Program worked with more than 20 expert international TREC Faculty on developing grant applications and original research toward key gaps in energy balance and cancer research. TREC Fellows have published over 270 manuscripts in peer-reviewed journals, with at least 62 published manuscripts including the TREC Fellow as first or senior author and including a TREC Faculty and/or Fellow as co-author. Since completing the Program, TREC Fellows have received at least 31 extramural grants, as principal investigator. Building upon the strengths of the previous five years, we were awarded a competitive renewal to continue the TREC Training Program through 2026. TREC Training program goals are: (1) to continue to offer a TREC Training Program for ̃100 academically diverse early career investigators including a 5-day in-residence workshop focused on the Fellows research, networking, mentoring and professional development; (2) to evaluate the TREC Training Program and track TREC Fellows career development; and (3) to disseminate the TREC Training sessions, webinars and newsletter to the broader community of investigators. Conclusions: To our knowledge, no other in-residence training program exists that focuses on energetics and cancer research. Our vision is to continue the TREC mission of training scientists and clinicians to develop a cadre of well-trained, diverse researchers. The overall impact of this transdisciplinary training course will be defined by the degree to which TREC Fellows produce innovative research approaches and discoveries, thereby accelerating the dissemination and implementation of evidence-based approaches into everyday practice and patient care and improving the health of the population at risk for cancer as well as cancer survivors.
Are YouTube videos a reliable information source for young women with metastatic breast cancer?
Authors: Morena Nina , Ahisar Yitzchok , Wang Xena , Nguyen Diana , Rentschler Carrie A. , Meguerditchian Ari N.
Published: June 2022

11042

Background: Young women with metastatic breast cancer (MBC) are an underserved population, rendering them susceptible to media sources that lack in credibility and reliability. YouTube (YT) is the most commonly used search engine following Google. This study aims to assess the quality of MBC YT videos and to identify common themes in MBC experiences. Methods: A systematic review of YT videos with search terms “metastatic breast cancer young” was conducted in 08/2021. Title, date uploaded, length, poster identity, number of likes, dislikes, and comments were collected. Understandability, actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT) for audiovisual (A/V) materials; information reliability/quality was assessed with DISCERN. Scoring was done by 3 reviewers. Themes, presence of sponsorships, healthcare professionals’ and patients’ narratives were also reported. Results: 101 videos were identified. Of these, 78.2% were sponsored. Average video length was 14.9 minutes (SD 22.5). Majority were posted by nonprofit groups and breast cancer advocacy organizations. Mean PEMAT A/V score was 78.8% (SD 15.3) and 43.1% (SD 45.2) for understandability and actionability, respectively. Overall, videos had moderate reliability and quality levels; mean DISCERN score was 2.44/5 (SD 0.7). Patient narratives were shared in 63.3% and healthcare professionals in 57.4%. Identified themes include treatment (66.3%), family relationship (45.5%), motherhood (37.6%), terminal status (31.6%), the path to diagnosis (28.7%), and spousal relationship (24.7%). Conclusions: YouTube videos about MBC are highly understandable but demonstrate low to moderate rates of actionability, with low reliability and quality scores. Many have a potential commercial bias. More research is needed to evaluate their impact on patient decisions and possible interventions provided by healthcare institutions. [Table: see text]
#SurgOnc: Global discussions about surgical cancer care on Twitter during COVID-19.
Authors: Gereta Sofia , Patel Vishal R. , Mackert Michael , Haynes Alex Bernard
Published: June 2022

11045

Background: Social media platforms such as Twitter are highly utilized to communicate about cancer care. Although surgery is the primary treatment for solid malignancies, little is known about public perceptions or communication behaviors regarding this treatment modality. Further, prolonged lockdowns and widespread delays of planned operations during the COVID-19 pandemic have magnified the importance of virtual communication about surgical cancer care. Methods: Tweets referencing cancer surgery were collected from January 2018 to January 2022 using Twitter’s Application Programming Interface. Account metadata was used to predict user demographic information and to compare tweeting metrics across users. Natural language processing models were applied to tweet content to resolve common topics of conversation and to classify tweets by cancer type. Results: There were 442,840 original tweets about cancer surgery by 262,168 users. Individuals accounted for most users (65%) while influencers accounted for the least (1.4%). Influencers made the most median impressions (19,139). Of 240,713 tweets discussing surgery for specific cancers, breast (20%) and neurologic (17%) cancers were most mentioned. When adjusting for national rates of procedures performed, tweets about surgery for neurologic cancers were the most common (231 tweets per 1000 procedures) whereas those for urologic cancers were the least common (15 tweets per 1000 procedures). Discussions about cancer surgery research made up 31% of tweets before the pandemic but only 11% of tweets during the pandemic. During the pandemic, concern regarding COVID-19 related delays was the most tweeted topic (23%). Cancer surgery research was most cited by oncologists, as well as in tweets about hepatopancreatobiliary and colorectal cancers. The cost of surgery was commonly mentioned in tweets about breast and gynecologic cancers and contained the most negative sentiment score (-0.7). Conclusions: Twitter was highly utilized to discuss surgical cancer care during the COVID-19 pandemic. During the pandemic, conversations shifted focus from research to survivorship and reflected real-time events such as COVID-19-related surgical delays. We identified the financial burden of cancer care as a commonly held concern among patients discussing cancer surgery on social media. Future public health outreach about cancer surgery may be optimized by coordinating with influencers and by targeting topics of concern like cost of surgery and undermentioned content like urologic cancers. Twitter’s role as a platform for research dissemination was disrupted by the COVID-19 pandemic, and further tracking is needed regarding online research discussions after the pandemic.
Evaluation of trends in breast cancer–related content on TikTok.
Authors: Siva Nanda , Koirala Monika , Raiker Rahul , Waris Shanawar , Pakhchanian Haig , Puckett Yana
Published: June 2022

11046

Background: Social media plays an important role in disseminating information to patients. It is important to investigate the healthcare content on popular platforms to understand the material consumed by patients that may influence their medical decision making. TikTok has over 1 billion monthly active subscribers and has become common ground to communicate healthcare information, including that of breast cancer. This study aims to provide an analysis of breast-cancer related information on TikTok. Methods: The most popular TikTok hashtag related to breast cancer was identified, and the top videos were gathered on January 23, 2022. Data was collected to reach a target of 100 videos. Exclusion criteria were non-English videos, repeated videos, or upload of movie/tv clip without educational info. The video source was characterized based on healthcare role, gender, and race. Healthcare provider was defined as an individual with a professional medical degree (MD, PA, RN, other). The videos were categorized into patient experience, educational, advertisement, and other. Specific content components, including chemotherapy, surgical intervention, mammogram, and self-breast exam, were tracked. Results: The hashtag “#breastcancer” was identified as the most popular, with 773.8 million views. The videos had a combined 258,886,300 views, 31,573,400 likes, 413,604 shares, and 567,520 comments. Of the 100 videos analyzed, 91 were uploaded by a layperson, 2 by a healthcare professional, and 7 by a company. The healthcare professionals consisted of one OB/GYN and one general surgeon. The racial designations of the main subjects in the videos were 87.2% White, 3.2% Black, 2.1% Hispanic, 4.3% Asian, and 3.2% undetermined. Content categorization revealed 81% patient experience, 22% educational, 6% advertisement, and 8% other. The major topics presented in the videos related to surgical treatment (39%), chemotherapy (37%), and radiation treatment (2%). Conclusions: An overwhelming majority of breast cancer related information on TikTok was not presented by qualified healthcare professionals and exhibited a lack of cultural diversity and inclusivity.[Table: see text]
Value of adjuvant radiotherapy in patients with localized Ewing sarcoma at the extremities: Report from the Ewing 2008 trial.
Authors: Heesen Philip , Ranft Andreas , Bhadri Vivek , Brichard Bénédicte , Collaud Stephane , Cyprova Sona , Eich Hans-Theodor , Ek Torben , Gelderblom Hans , Havemann Lianne , Hauser Peter , Juergens Heribert , Kanerva Jukka , Kuehne Thomas , Raciborska Anna , Rascon Jelena , Streitbuerger Arne , Timmermann Beate , Uhlenbruch Yasmine , Dirksen Uta
Published: June 2022

11531

Background: In patients with Ewing Sarcoma (EWS), adjuvant radiotherapy is often performed after surgery that could not obtain wide margins or after poor histological response to surgery. However, the benefit of adjuvant radiotherapy needs further investigation. Therefore, we compared event-free survival (EFS) between surgery (SX) alone and SX combined with radiation therapy (RT), performed a subgroup analysis and identified independent prognostic factors. Methods: The data from localized EWS patients with tumors at the extremities that were treated in the Ewing 2008 trial from 2009-2018 were included in this analysis. Patients received induction chemotherapy according to the protocol and then underwent local therapy. Patients receiving SX or adjuvant RT (combined SX/RT) were included in this analysis. Hazard ratios (HRs) (95% Confidence Intervals (CIs)) were calculated using Cox regression. Results: 360 out of 863 patients (41.7%) presented with an EWS at the extremities with 81 tumors at the upper extremity, and 279 tumors at the lower extremity. Most patients were treated with surgery only (223, 61.94%), while 125 patients (34.72%) were treated with SX plus RT. Adjuvant radiotherapy was conducted after a median time of 69 days (1st quartile, 3rd quartile; 54, 109). Median EFS at 5-years for all patients was 0.74 (0.69, 0.80), 0.76 (0.70, 0.83) for patients after surgery only, and 0.73 (0.64, 0.83) after combined RT/SX. After adjusting for sex, age, tumor volume, histological response and surgical margins, the HR for combined RT/SX vs SX alone was 0.69 (0.37, 1.26), p = 0.22. In patients with poor histological response to surgery (≥10% vital tumor cells) and with high tumor volume (≥ 200mL), additional radiotherapy did not decrease the hazards of any event, HR 0.72 (0.25, 2.06), p = 0.54. We identified high tumor volume, poor histological response to surgery as well as intralesional resection of the tumor as independent prognostic factors after adjusting for other known prognostic factors with HRs of 1.73 (1.04, 2.90), p = 0.03; 2.79 (1.69, 4.62), p < 0.0001 and 215.9 (13.17, 3538.61), p = 0.0002, respectively. Surgical complication was not a prognostic factor after adjusting for above mentioned variables, HR 0.85 (0.31, 2.34), p = 0.75. Conclusions: In our cohort, adjuvant radiotherapy was not superior compared to surgery alone in all patients with localized EWS at the extremities and neither in a subgroup of patients with high-risk factors. Poor histological response, intralesional tumor resection as well as high tumor volume were identified as independent negative prognostic factors. Clinical trial information: NCT00987636.
Prognostic value of EZH2 expression for immunotherapy-based schemes in advanced soft-tissue sarcoma: A translational research from Spanish Group of Research on Sarcoma (GEIS).
Authors: Moura David Silva , Zamora Jorge , Hindi Nadia , Lopez-Alvarez Maria , Lacerenza Serena , Grignani Giovanni , Martinez-Trufero Javier , Redondo Andres , Valverde Morales Claudia Maria , Stacchiotti Silvia , Lopez-Pousa Antonio , Gutierrez Antonio , Lopez-Martin Jose A. , Martin Broto Javier
Published: June 2022

11549

Background: Immunotherapy-based treatments had shown to be active in several solid tumors, including in selected subtypes of sarcomas. IMMUNOSARC (NCT03277924) is a phase Ib/II trial [from Spanish (GEIS) and Italian (ISG) sarcoma groups], that tested the combination of nivolumab (anti-PD-1 inhibitor) plus sunitinib (anti-angiogenic agent) in advanced sarcomas. Among the 65 soft-tissue sarcoma (STS) patients (pts) enrolled, 48% were free of progression at 6 months, meeting the trial’s primary endpoint. EZH2 is the catalytic subunit of the Polycomb Repressive Complex 2 and it has been described to play an important role in the transcriptional repression of genes involved in T-cell migration and T-cell-mediated anti-tumor activity. The aim of this study was to explore the value of EZH2 gene expression as potential prognostic biomarker of the activity of immunotherapy-based schemes. Methods: The expression of EZH2 was evaluated in 64 paraffin tumor blocks, by direct transcriptomics, using HTG EdgeSeq Oncology Biomarkers Panel (HTG Molecular Diagnostics, Inc.; Tucson, AZ, USA). Data was normalized with DESeq2 and the cut-off of EZH2 expression was calculated with MAXSTAT R package. Gene expression was correlated with progression-free survival (PFS) by RECIST, overall survival (OS) and clinical benefit (patients with response or stable disease vs patients with progressive disease as best response). Results: Among the 64 pts analyzed, 52 (81%) showed overexpression of EZH2, considering a cut-off of 570.15 read counts. Undifferentiated pleomorphic sarcoma (UPS) and epithelioid sarcoma were the subtypes with higher expression of EZH2 with a median of read counts of 1888.04 (n = 10) and 1261.79 (n = 7), respectively. The lowest expressions were observed in extraskeletal myxoid chondrosarcoma (ECM) and alveolar soft-part sarcoma (ASPS) with a median of read counts of 461.42 (n = 4) and 680.84 (n = 7), respectively. Low expression of EZH2 was associated with better PFS (16.8 months vs. 3.9 months; p = 0.001) and better OS (NR vs. 20.0 months; p = 0.006). Moreover, low expression of EZH2 was also significantly associated with a clinical benefit of the patients treated with nivolumab plus sunitinib [relative risk (RR): 13; 95% CI: 3.0-56.9; p = < 0.001). Conclusions: Low expression of EZH2 was associated with better outcome in advanced STS patients treated with immunotherapy-based schemes. These results might support the rationale for the combination of EZH2 inhibitors with immune-modulating agents for future studies.
Bereavement practices of gynecologic oncologists: Physician and care team practices compared to caregiver needs.
Authors: Harrison Lauren , Morosky Christopher M. , Whitcomb Bradford
Published: June 2022

12021

Background: Gynecologic cancers account for over 34,000 deaths in the United States annually. Family-centered care is beneficial to the family unit and patient throughout the illness course. Research is lacking regarding how physicians should approach family members or other caregivers after a patient dies. We aimed to assess how gynecologic oncologists are currently practicing and compare that to family members’ needs during the bereavement period. Methods: We devised a set of paired surveys that were distributed to the Society for Gynecologic Oncology and to patient families. Families were recruited using social media, publicizing in local organizations, and advertising in University of Connecticut campus-wide emails. Likert-scale style questions with responses ranging from “1” to “10” were used to assess opinions on aspects of bereavement care and reported as means. Differences in means were assessed using ANOVA and T-tests and considered to be statistically significant if the P-value was < 0.05. Results: We received completed surveys from 129 physicians and 17 caregivers from different families. 48% of physicians reported contacting patient families, and, similarly, 47% of family members reported receiving contact from physicians. Physicians had a mean 6.21/10 confidence level (where 10 is maximum confidence) in providing bereavement care, while families reported 5.76/10 confidence in their physician’s ability to provide bereavement support ( P = 0.493). Factors that influenced physicians confidence in providing bereavement support were undergoing formal training in bereavement (6.84/10 vs 5.14/10 for physicians who had not been trained, P < 0.001) and being in practice for more than 11 years (5.65/10 for ≤10 years in practice, 7.05 for ≥11 years, P = 0.001). Physicians who contacted patients personally had a higher confidence level (6.98/10) in providing bereavement support compared with those who did not contact families (5.51/10, P < 0.001). Family members were nearly unanimous in reporting a desire for physicians to contact them personally (16/17), and stated that a phone call (56%) or a sympathy card (38%) were their preferred methods of contact. Conclusions: Our study suggests that although families appreciate contact from physicians after their loss, physicians do not have a high level of confidence in providing this support. Physicians who undergo bereavement training and who reached out after patients had died have higher confidence levels in interacting with family members. Based on these results, formal bereavement training should be incorporated into gynecologic oncology fellowships in order to increase the comfort levels and likelihood of gynecologic oncologists reaching out to families after a patient has died.
Impact of circuit, interval-based exercise on insulin resistance and adiponectin among minority cancer survivors.
Authors: Christopher Cameron , Kang Dong-Woo , Normann Amber , Norris Mary , Dieli-Conwright Christina Marie
Published: June 2022

12059

Background: Hispanic and Black adults have a heightened risk of metabolic syndrome compared to non-Hispanic white adults, increasing the risk of cardiovascular disease, diabetes, and co-morbid outcomes. Further, Hispanic and Black adults are more likely to be sedentary and obese than non-Hispanic white adults, leading to an increased risk of insulin resistance and poor metabolic health. Exercise improves cardiometabolic health, including insulin sensitivity and adiponectin, however few studies have focused on minority cancer survivors. The aim of our (NCT03284346) was to determine whether a 4-month circuit-based aerobic and resistance exercise intervention can improve insulin resistance and adiponectin levels in breast, prostate, and colorectal Hispanic and Black cancer survivors. Methods: Overweight or obese (BMI > 25.0 kg/m2), sedentary breast, prostate or colorectal cancer survivors who self-identified as Hispanic or Black were randomized to exercise (n = 30) or usual care (n = 10). Survivors in the 4-month supervised exercise intervention participated in a thrice weekly, circuit, interval-based moderate-vigorous aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum). Insulin resistance, assessed by Homeostasis Model of Assessment (HOMA-IR), and adiponectin levels were collected at baseline and post-intervention from fasting blood sample collection. Repeated-measures analysis of variance and t-tests were performed to assess within- and between-group differences. Results: The study sample was 66 ± 10.4 years old, Hispanic (55%), Black (45%), overweight (78%), and female (60%). Adherence to the intervention was 90% and post-intervention outcome measures were available on 100% of participants. Post-intervention, insulin resistance (within group mean difference: -3.2, p < 0.01; between group mean difference: -4.5, p < 0.01) and adiponectin levels (6.1 ug/mg, p < 0.01; 8.6 ug/mg, p < 0.01) significantly improved in the exercise group when compared to baseline and to usual care, respectively. Conclusions: A circuit, interval-based aerobic and resistance exercise intervention improved insulin resistance and adiponectin levels in breast, prostate, and colorectal minority cancer survivors. Accessible exercise interventions for minority cancer survivors may be effective to mitigate metabolic dysregulation and co-morbid conditions in survivorship and support cardiometabolic health. Clinical trial information: NCT03284346.