bluuebunny/crossref_metadata_2025 huggingface dataset:
Adopting combination machine learning models could reduce hospital length of stay for oncology patients.
Authors: Achuthan Srisairam , Salamatullah Shaikh , Scott Jeffrey A. , Sheth Karna , Lantrip Logan , Lilienthal Drew , Ricca Joseph , Pepper Scott C. , Chatterjee Rishov
Published: June 2024

11084

Background: Integra Connect previously created in-patient (IP) admission prediction model based on OCM data. One of the challenges for practices in a value-based care (VBC) program is to provide continuous care-coordination during and after an IP admission. Our objective is to show how adopting combination machine learning (ML) models can predict IP length of stay (LOS). Potential benefits include an overall reduction in LOS which could minimize the risk of hospital acquired conditions. Methods: ML models were trained on 5 major cancer types (Lung Cancer, Multiple Myeloma, Lymphoma, Small Intestine / Colorectal Cancer, High-risk Breast Cancer') from 7 OCM practices of PP4-PP9 data, excluding surgery IP admission. The top 5 cancer types accounted for ~50% of total in-patient admissions and ~50% of total LOS in days. The IP admissions were divided into 4 major cohorts in terms of LOS in days (1-3: class 1, 4-8: class 2, 9-15: class 3, and more than 15: class 4). To reduce the overall LOS, we adopted two ML models: 1) To classify LOS, a multi-classification model (Model1, an eXtreme Gradient Boosted Trees Classifier) and 2) To predict the LOS for classes 1-3, a regression-based model (Model2, an eXtreme Gradient Boosted Trees Regressor with Early Stopping). Class 4 cohort had a wide range (16- 90+ days) for LOS and therefore was excluded from Model2. The other three cohorts belonged to Q1, IQR, and Q4, respectively. Model1 was trained on 4,280 randomly selected sample IP admissions to balance each class and Model2 was trained on 19,636 IP admissions, both with 102 features. Results: The models were tested on PP10-PP11 claims excluding 0 days LOS. Model1 predicted 296 (3,945) IP admissions in class 4 of which 88 were true positives. Assuming at least a 10% reduction in associated total LOS translated to lower LOS of 1-3% for 5 (7) practices. The remaining 3,649 IP admissions were used to predict LOS by Model2. The difference between actual LOS and Predicted LOS was found as 18%-24%. To address model prediction errors, we defined the target LOS to be predicted LOS with an upper bound of at least 10%. This led to reductions of 6% -16% across practices. Finally, combining the results of both ML models we determined that the potential to lower LOS was at least 6% and at most 19%. Conclusions: Our ML models identified opportunities to reduce LOS across multiple OCM cancer practices for 5 major cancer types. We also identified a cohort of patients with critical condition (class 4) that is vital for practice transformation initiatives. These identified reduction in LOS for oncology patients provides cost reduction and quality improvement opportunities in VBC programs. In the future, more opportunities to lower LOS will be explored with a re-admission prediction model.
Implementation of standardized electronic documentation of goals of care discussions to improve cancer care.
Authors: Vasiljevic Katarina , Kane Shelly , Tuyn Brooks , Schoenecke Jennifer , Edmonds Kyle P , Gold Kathryn A.
Published: June 2024

11127

Background: Early documentation of physician-led goals of care (GOC) discussions is important to providing comprehensive and individualized quality care to cancer patients as it can provide all members of the patient care team with a context for the type of care each patient wishes to receive prior to and at end of life. The electronic medical record (EMR) should provide easy access to these conversations to seamlessly integrate outpatient, emergency room and inpatient care of cancer patients. Methods: The institution-wide initiative was introduced via presentations and emails between 8/2021 and 11/2021 to all Moores Cancer Center faculty at UC San Diego Health. A SmartPhrase was created in our EMR Epic as the intervention, including critical components of a GOC discussion: people present during discussion, goal of cancer-directed treatment, anticipated cancer trajectory shared with the patient, and patient’s health care agent. The SmartPhrase was radiolabeled to be easily searchable for any clinician accessing the patient’s chart. Physician documentation was tracked for the purposes of achieving a group goal with a target of greater than 50% documentation of GOC discussions within 30 days of the first day of the first cycle of chemotherapy. Prior to physician education, 4% of patients had a GOC note using a searchable SmartPhrase. In 12/2021, we began sending individual emails to physicians to remind them of eligible patients. Results: By 1/2022, after education, 50% of physicians ordering chemotherapy had used the GOC SmartPhrase and 29% of patients initiating chemotherapy had a GOC note using the SmartPhrase. After initiation of monthly reminder emails, documentation increased to 51% by 10/2022. An increased use of Advanced Care Planning billing codes was also noted. Conclusions: Implementation of an initiative to standardize electronic documentation of GOC conversations improved early documentation of these vital conversations. Radiolabeling of the SmartPhrase made it easily accessible to all members of a patient’s care team.
Racial/ethnic differences in incidence of squamous cell carcinoma in California.
Authors: Behl Deepti , Parise Carol
Published: June 2024

11139

Background: Squamous cell lung carcinoma is strongly associated with a history of smoking. Typically, no actionable mutations are found, and treatment options are more limited. It is not known if race has any impact on the incidence of squamous cell cancers, especially for Asian ethnicities since most studies combine multiple Asian populations in an Asian/Pacific Islander (API) category. The purpose of this study was to compare the odds of squamous cell carcinoma versus adenocarcinoma in Hispanic, American Indian, Middle Eastern, and 7 Asian ethnicities when compared with both Black and White men and women. Methods: We accessed 211,987 cases of invasive lung cancer with either squamous cell or adenocarcinoma from the California Cancer Registry 2000-2020. Race was categorized as White, African American/Black, Hispanic, American Indian/Alaskan Native, Middle Eastern, Chinese, Japanese, Korean, Filipino, Southeast Asian (SEA), Pacific Islander, or Asian Indian. Separate logistic regression analyses were used to assess the odds of squamous cell versus adenocarcinoma for each race/ethnicity using White and Black as the reference categories. Analyses were conducted separately for males and females and adjusted for age, smoking status, socioeconomic status, marital status, and Charlson Comorbidity Score. Odds Ratios (OR) and 95% confidence intervals (CI) were computed. Results: When compared with White men, American Indian men had increased odds (OR: 1.39; 95% CI: 1.03, 1.88) and Black, Hispanic, Chinese, Filipino, SEA men had decreased odds of squamous cell carcinoma. Japanese women had increased odds (OR: 1.54; 95% CI: 1.15, 2.07) while Black, Hispanic, Middle Eastern, Filipino, and SEA women had decreased odds of squamous cell carcinoma when compared with White women. When compared with Black men, White men, (OR: 1.11; 95% CI: 1.01, 1.24) American Indian, (OR: 1.56; 95% CI: 1.13, 2.13) and Korean (OR: 1.35; 95% CI: 1.05, 1.73) men had increased odds and Chinese, Filipino, and SEA men had decreased odds of squamous cell carcinoma. White, (OR: 1.13; 95% CI: 1.01, 1.28) Japanese, (OR: 1.75; 95% CI: 1.28, 2.39) and Korean (OR: 1.63; 95% CI: 1.09, 2.42) women had increased odds and Southeast Asians had decreased odds when compared with Black women. Conclusions: Some Asian ethnicities have a higher risk for squamous cell lung cancer than both Black and White men and women even after adjusting for smoking. This is not apparent when the Asian ethnicities are classified as API. Examining individual Asian ethnicities is important since they have little to no shared genetic or cultural variables and are grouped together for convenience rather than any scientifically plausible reason.
End of life (EOL) care in head and neck squamous cell carcinoma (HNSCC) compared to other solid tumors (OST) in Washington (WA) State.
Authors: Shih Lauren , Sun Qin , Fedorenko Catherine R. , Futran Neal D. , Barber Brittany , Marchiano Emily , Parvathaneni Upendra , Liao Jay Justin , Rodriguez Cristina P. , Ramsey Scott David , Shankaran Veena
Published: June 2024

11147

Background: Real world data describing EOL care in HNSCC is limited. We performed a retrospective study evaluating EOL in HNSCC vs OST in a population-based sample of patients in WA. Methods: We used a database linking WA state cancer registry records with claims records from Medicare, Medicaid, and two large commercial insurers. Patients with HNSCC (oral cavity, oropharynx, hypopharynx, or larynx) were compared to OST (any solid tumor diagnosis). Adults with AJCC stage II-IV or SEER stage Regional/Distant who died in 2011-2021 with continuous insurance enrollment 6 months before death were included. We compared proportions of patients with >1 ED visits in the last 30 days of life, ICU admission in the last 30 days of life, chemotherapy in the last 14 days of life, and hospice enrollment at least 3 days prior to death. We performed multivariate regression analysis to determine factors associated with hospice enrollment. Results: 1,389 patients with HNSCC and 41,412 patients with OST were identified. Demographics for HNSCC vs OST included median age 68 vs 73, white race 91.5% vs 90.1%, stage IV 57.5% vs 45.3%. Insurance types for HNSCC vs OST were commercial 8.4% vs 9.8%, Medicaid 16.6% vs 8.8%, Medicare 59.1% vs 65.5%, multiple 15.8% vs 15.9% (p<0.0001). HNSCC patients had lower rates of >1 ED visits compared to OST (14.1% vs 16.4%, p=0.02); there was no significant difference in ICU admission (25.1% vs 24.0%, p=0.3) or chemotherapy receipt (6.3% vs 5.1%, p=0.056). Hospice enrollment was significantly lower in HNSCC patients (49.0% vs 56.4%, p<0.0001). A stratified analysis limited to stage IV patients yielded consistent findings in all categories. HNSCC patients died more at home and less in hospice (20.2% vs 12.7% and 41.5% vs 52.0%, p<0.0001). In a multivariate regression analysis (Table) HNSCC, black race, living with a partner, or living in neighborhoods with higher area deprivation index (ADI) was associated with lower hospice enrollment. Patients with Medicare or multiple insurance types were more likely to enroll in hospice; AJCC stage was not significant. Conclusions: In this population-based sample, compared to OST, a greater proportion of HNSCC patients were insured by Medicaid at EOL and were less likely to enroll in hospice prior to death. The reasons driving these observed disparities in hospice enrollment warrant further study to optimize EOL care among patients with HNSCC. [Table: see text]
Understanding trends of US breast cancer hospitalization, mortality and costs using the National Inpatient Sample database.
Authors: Kumar Arun , Solangi Zeeshan , Agudile Emeka , Elmanaseer Oday , Shah Ghulam , Devi Amirta , Whitaker Kristen Danielle
Published: June 2024

11162

Background: Studies have shown a rising breast cancer incidence in the US. However, its impact on healthcare utilization is unclear. Our study delves into the previously unexplored territory of hospitalization and cost trends among breast cancer patients, aiming to shed light on resource allocation and potential areas for improvement. Methods: To investigate trends in breast cancer admissions and costs, we queried the National Inpatient Sample database. Patients admitted between January 2011 and December 2019 with following criteria were included in the analysis: female gender, age ≥ 18, and ICD diagnosis code corresponding to unspecified malignant neoplasm of the breast as their primary reason for admission. Our primary outcome was defined as the temporal trends in the number of admissions, discharge rates, length of stay, and cost of hospitalization and mortality rates. Analyses were performed using Stata version 15.1 College station TX: StataCorp LP 2017. Appropriate discharge weights were applied to the dataset during the analyses to account for critical elements of sampling design. A p-value of <0.05 was considered statistically significant. Results: Between 2011 and 2019, hospital admissions for breast cancer as the primary diagnosis declined significantly, from 32,126 to 12,742 (P < 0.001). However, while average length of stay increased slightly from 4.3 to 4.9 days (P < 0.01), hospital charges for breast cancer rose dramatically. Adjusted for inflation, mean charges per patient rose 38.8%, from $50,663.86 in 2011 to $70,334.11 in 2019 (P < 0.001). Despite this surge, the total aggregate cost ("national burden") of hospitalizations with breast cancer as main discharge diagnosis decreased, falling from $1.63 billion in 2011 to $896 million in 2019 (inflation adjusted) (P < 0.001). Discharges for breast cancer peaked in women between 45 and 64, followed by the 65-84 demographic. Compared to the overall decrease in hospitalization rates, the declines in the above age groups were notably steeper with declines of 62% for 45-64 and 48% for 65-84 (p<0.001). Although absolute number of breast cancer deaths decreased from 2011 to 2019, the mortality rate paradoxically increased from 4.3% to 5.8% over the same period (P < 0.001). This seemingly contradictory trend warrants further investigation to better understand contributing factors. Conclusions: While breast cancer diagnoses are on the rise in women, our study reveals a fascinating paradox: significant declines in hospitalization, associated costs, and overall mortality. This encouraging trend likely stems from widespread surveillance mammography with increases in early stage, curable disease diagnosis, and the flourishing landscape of outpatient therapies, including targeted treatments, with more tolerable toxicity profiles allowing for majority of breast cancer care to be completed in the outpatient setting.
Geographic and sociodemographic variations in disease burden, epidemiological trends, and risk factors of early-onset lung cancer: A global analysis.
Authors: Li Wang-Zhong , Gui Xianhua , Liang Hengrui , Wang Wei , Liang Wenhua , He Jianxing
Published: June 2024

11169

Background: Exploring the emerging trend of early-onset lung cancer (EOLC) burden is pivotal for guiding the implementation of preventive strategies among young adults. We aimed to provide a comprehensive examination of the geographic and sociodemographic variations in the disease burden, along with epidemiological trends and risk factors associated with EOLC over the past three decades. Methods: EOLC refers to lung cancer diagnosed in individuals aged 20-49 years. Utilizing the GBD 2019 data, we estimated the age-standardised incidence, mortality, and disability-adjusted life years (DALYs) rates for EOLC by sex, socio-demographic index (SDI) quintiles, and geographical location for the period from 1990 to 2019. We investigated the relationships between concomitant risk factors and EOLC incidence at national level, and calculated the DALYs attributable to risk factors. The relative contribution of population growth, population ageing, and epidemiological changes to the variations in burden of EOLC over study period was measured using the decomposition analysis. Incidence was forecast to 2040 using the Bayesian age-period-cohort model. Results: A total of 135,704 EOLC cases, equating to a age-standardised incidence rate of 4.0 (95% UI 3.6 to 4.3) per 100,000, were estimated in 2019 worldwide and was the second leading cause of cancer death among young adults, with higher disease burden occurred in males and those from middle and high-middle SDI regions. An overall decreasing trend in burden of EOLC was observed globally; such trends were more pronounced among males and followed a gradient across SDI levels, with the greater decrease observed in high and high-middle SDI regions. Sex, tobacco smoking prevalence, per capita cigarette-equivalent estimates, average age of smoking initiation, ambient ozone pollution, and GDP per capita were independently and significantly associated with EOLC incidence at the population level. Smoking remained the top contributor to burden of EOLC, with the exception of Andean Latin America, North Africa, and the low SDI regions, where ambient particulate matter pollution and household air pollution from solid fuels ranked as the foremost attributable risk factors. Population growth was the primary driver behind the global increase in EOLC cases in low and low-middle SDI regions, while epidemiological changes accounted for the most substantial reduction in EOLC cases across most regions. The global incidental cases of EOLC was projected to increase by 31.1% in 2040, with a more pronounced increase in females and those from high-middle and middle SDI locations. Conclusions: Our findings underscore significant geographic and sociodemographic disparities in the epidemiological burden of EOLC, emphasizing the necessity for policymakers to devise and apply region-specific, evidence-driven preventive strategies.
Treatment trends for metastatic urothelial carcinoma across eight Mexican centers: A global oncology perspective.
Authors: Beas-Lozano Evelyn Lilian , Remolina Bonilla Yuly Andrea , Caballero Rosa , Sobrevilla-Moreno Nora , Perez Perez Perla , Díaz-Alvarado Maria Guadalupe , Zayas-Villanueva Omar Alejandro Alejandro , Martinez Erika , Campos Gomez Saul , Cardoso Aparicio Luis Arturo , Mendoza Oliva Dolores , Bourlon Maria T.
Published: June 2024

11171

Background: Urothelial carcinoma represents 3% of new cancer cases globally. Metastatic urothelial carcinoma (mUC) poses a notable challenge to healthcare systems, given its treatment complexity and high mortality. These challenges are magnified in resource-constrained settings. We aim to describe treatment trends for mUC across public and private Mexican centers. Methods: Retrospective study across 8 referral centers. Adults with mUC from 01/2001-12/2021 were included. We assessed clinical records, demographics and comorbidities. We recorded subject eligibility for first line platinum therapy, treatment lines received, and access to novel drugs. Descriptive statistics were used for demographics, treatment details and outcomes. Survival analysis was performed, including Kaplan Meier curves and Cox proportional hazards model. Results: We found 342 cases of mUC, 76% were male, with a median age of 67 years. Median follow-up was 8.4 months. Among those that received a first line (n=223, 65%), regimens used were cisplatin-based chemotherapy (n=100, 45%), carboplatin-based chemotherapy (n=87, 39%), gemcitabine (n=5, 2.2%), immunotherapy (n=4, 1.8%) or unspecified (n=27, 12%). Most causes of cisplatin ineligibility were ECOG ≥2 (41%) and glomerular filtration rate <60 ml/min (33%). Of those who received upfront platinum therapy (n=187), 65% received >3 cycles (n=121), 20% received 2 or 3 cycles (n=38) and 15% received 1 cycle (n=28). Progression as best response was found in 47% (n=88). Avelumab maintenance was only used in 14/99 eligible patients (14.1%). The proportion of individuals receiving a second, third or more lines was 24.6%, 8.8% and 3.5%, respectively. The most common second line treatment was chemotherapy (64.4%) followed by immunotherapy (28.6%). Median overall survival (mOS) was 11.8 months. Treatment notably impacted mOS, favoring those who received a first line(16.7 vs. 4.6 months, p<0.0001). Stratified analysis showed worse mOS for those with visceral disease (17.1 vs 10.3 months, p=0.0065) and ECOG ≥2 (17.6 vs 5.8 months, p<0.001).These features correlated with higher mortality, while first line treatment was associated with lower mortality. Conclusions: These data represent the first effort to delineate treatment trends of mUC in Mexico. First line treatment rates were higher than those described worldwide (35-60%1). Further, cisplatin-eligibility was higher compared to reports of high-income countries. Considerable rates of progression to platinum therapy were found, likely due to aggressive disease. This study highlights the limited access to novel treatments, showed by the infrequent use of avelumab maintenance, immunotherapy or targeted agents. [Table: see text]
Outcomes of liver transplant recipients with pretransplant malignancies: Insights from a single institution’s experience.
Authors: Vobugari Nikitha , Heyne Kirk , Connor Ashton , Ajmal Zainub , Adroja Shubham , Gao Yuan , Mathur Sunil , Kodali Sudha , Saharia Ashish , Mobley Constance M , Elaileh Ahmed M , Patel Khush , Ghobrial Rafik Mark
Published: June 2024

11173

Background: Increasing liver transplantation (LT) utilization has resulted in more and more patients with a history of a non-hepatobiliary malignancy. Rather than deny such patients a lifesaving therapy the benefits must be weighed against risk of tumor recurrence and de novo malignancies (DNM) post-LT, especially with the immunosuppression required. While data has been presented on outcomes of pre transplant malignancies (PTM) in kidney and heart transplants, LT data is lacking. Our aim is to characterize rates of recurrence, DNM, and overall survival (OS) post-LT at a single, high volume American center. Methods: This retrospective study at Houston Methodist Hospital included patients who underwent LT with known history of PTM. Data was extracted from electronic health records, and descriptive statistics performed. Institutional IRB approval is obtained. Results: Between 01/1999- 12/2022, 1617 LTs were performed at our institute. We identified 261 LT recipients with 297 PTM, including 91 non- and 206 hepatobiliary cancers (See Table). Follow-up period ranged from 1 to 23 years. Post-LT malignancies were observed in 66 patients, 25% of the study population. Tumor recurrences accounted for 44 (17%) cases, and DNM were seen in 22 (8%). The DNMs included skin non-melanoma (n=8 cases), head & neck (3), PTLD (2), prostate (2), renal (1), lung (1), CRC (1), pancreatic (1), gynecologic (2), and poorly differentiated (1). The OS rate at 1-, 5-years (excluding those less than 5 years follow-up and unknown), and at time of last follow-up were 86.6%, 60-65% and 70%, respectively. Patients with post-LT malignancies had lower OS compared to those without (46% vs. 77.7%). Conclusions: To our knowledge, this study is the first to assess post-LT outcomes in patients with PTM. This study of LT recipients with PTM demonstrates post-LT malignancy rates of 25%, including 17% with recurrences and 8% with DNM. The latter is within the previously reported range of 3-14% DNM in the general post-LT population and dominated by skin cancers. Post-LT OS is excellent in these recipients and comparable to all LT patients. However, OS is lower in those with post-LT malignancies, implying a possible role for increased cancer surveillance. Limitations include retrospective design and potential chart bias. Future work in this cohort will focus on immunosuppression effects for this high-risk population. [Table: see text]
Long-term cardiovascular outcomes in survivors of 20 adult solid tumors: Large population-based matched cohort study.
Authors: Krishnan Arunkumar , Kadakia Kunal C. , Walsh Declan , Alqahtani Saleh A
Published: June 2024

11177

Background: The past few decades have seen notable advancements in how cancer is diagnosed and treated, with improvements in cancer survival. Cardiovascular diseases (CVDs) are the major life-limiting comorbidity among cancer survivors. Evidence is scarce on the risks of specific CVDs in survivors of a wide range of solid tumors, hindering informed strategies for prevention and management. Thus, we evaluated a large population-based U.S. electronic health records database. Methods: This large retrospective cohort study was conducted by using the TriNetX dataset between January 2008 and December 2022. All adult patients (>18 years) with a diagnosis of 20 most common solid tumors alive 12 months after diagnosis were matched with controls without a cancer history in a 1:1 ratio with these a priori identified potential confounders: demographics, BMI, nicotine dependence, comorbidities, labs, and medications. The primary outcome was the first incidence of CVD like heart failure (HF), major adverse cardiovascular events (MACE; unstable angina, myocardial infarction, or coronary artery intervention), or venous thromboembolism (VT), and cerebrovascular events (CVE; stroke, transient ischemic attack, cerebral infarction, carotid intervention). Hazard ratios (HR) were calculated to assess the outcomes. Results: 890126 individuals with a solid tumor of interest followed up at least 1 year later were identified and matched to 1787244 controls. The VT risk was higher among survivors of 18 out of 20 specific solid cancer types than controls. HRs ranged from HR 3.68( 95% CI 3.48-3.89) for kidney cancer and HR 1.27 (95% CI 1.21–1.35) in patients after pancreatic cancer. HRs for VT were more prominent without prior CVDs. Higher risks of CVDs were the most common immuno -and chemotherapy. Higher risk of HF was observed in lung (HR 1.46, 95% CI 1.32–1.89), liver (HR 1.22, 95% CI 1.18–1.26), and ovarian (HR 2.01, 95% CI 1.64–2.45) cancers and in patients younger than 55 years. Pericarditis and arrhythmia were common in lung, bile duct, and stomach cancers. A greater risk of arrhythmia was also observed in lung, kidney, and thyroid cancers, whereas CVE was observed in CNS cancers. Conclusions: Survivors of site-specific solid tumors are at a higher medium to long-term risk of one or more CVDs than the general population. Notably, substantial variations in risk were observed across different cancer primary sites. The outcomes underscore the importance of heightened monitoring for CVDs after a cancer diagnosis.
Intra-read analysis of radiologists in the setting of blinded independent central review of oncology studies.
Authors: Elbahnasawi Amir
Published: June 2024

11179

Background: This study explored the outcome of an analysis completed on the Intra-reader variability of radiologists when assessing the imaging endpoint surrogates of Date of Progression (DOP) and Best Overall Response (BOR) within the context of Blinded Independent Central Review (BICR) in Oncology clinical trials. The analysis encompassed 55,000 test cases derived from 217 clinical trials involving 138 readers. Methods: Data collection and parsing were executed through a Python script, enabling a manual analysis of the results. The analysis posited that Intra-read variability serves as a valuable tool when seeking to exclusively observe the consistency of readers in a specific re-read setting. Results: The data analysis yielded significant insights, revealing that 89.81% of readers demonstrated substantial and above agreement in DOP determinations, while 72.38% achieved the same in BOR determinations. This suggests a higher level of consistency in DOP compared to BOR determination. Notably, 11 DOP and 20 BOR inconsistencies were observed. This prompted further investigation which led to 5 of the 138 readers being flagged based on discrepancies against their own prior or subsequent reads. The kappa values for these 5 readers ranged from 0.33 to 0.59, consistently indicating fair and moderate agreement. Conclusions: This analysis underscored the role of Intra-read variability in identifying inconsistent readers within the landscape of BICR in Oncology clinical trials. The re-read inconsistency is not a universal requirement, and its application is recommended primarily for complex oncology clinical trials or those with indications known to have elevated adjudication metrics. The study emphasized the potential for targeted retraining strategies based on Intra-read analysis outcomes, contributing to the ongoing refinement of reader proficiency. Future directions may involve further exploration of specific retraining strategies or assessing the effectiveness of exclusively using Intra-read variability as a metric for reader performance.
Impact of social determinants of health on health-related quality of life in cancer survivors.
Authors: Peitz Josephine , Adebamowo Sally Nneoma
Published: June 2024

11183

Background: Social determinants of health (SDoH) encompass the various environmental conditions that influence health, well-being, outcomes, and potential risks. Adverse SDoH can exacerbate health disparities and result in a reduced health-related quality of life (HRQoL). We conducted an investigation into the impact of SDoH on the HRQoL of cancer survivors. Methods: The study population was a nationally representative cohort of individuals aged 20-80 years who took part in the United States National Health and Nutrition Examination Survey (NHANES) 2001 to 2018 cycles. We evaluated HRQoL by measuring the number of physically unhealthy days, mentally unhealthy days, inactive days, as well as assessing social support and emotional well-being. We used logistic regression models to investigate the impact of each SDoH on the HRQoL of cancer survivors. Results: We included 4,780 participants in our analyses, comprising 2,533 women and 2,247 men. The participants mean age was 66 (±14) years at the time of enrollment, and 55 (±17) years at the time of cancer diagnosis. Among the total study population, non-melanoma skin cancer (16%) was the most prevalent cancer type. After adjusting for age, age at cancer diagnosis and gender, people who had the lowest self-reported health were more likely to have completed fewer years of education (OR 0.380 [95% CI: 0.32 - 0.45], p < 0.0001), be unemployed (OR 2.30 [1.91 - 2.77], p < 0.0001), have lower family income (OR 0.36 [0.28 - 0.45], p < 0.0001), be food insecure (OR 3.90 [2.80 - 5.44], p < 0.0001), not have private health insurance (OR 1.68 [1.37 - 2.07], p < 0.0001), and have been hospitalized overnight in the last year (OR 5.23 [3.49 - 7.83], p < 0.001) compared to those with the highest self-reported health. SDoH including employment status, family income, food security status, health insurance type, and overnight hospital patient status, were significantly associated with physical and mental health, and physically active days. Level of education and food security were significantly associated with social support and emotional well-being. Conclusions: Adverse SDoH were associated with the reduced HRQoL of cancer survivors in the United States. These findings underscore the importance of addressing and mitigating these social determinants in order to alleviate health disparities and improve the overall well-being and quality of life for cancer survivors.
Late mortality and chronic health conditions in long-term survivors of nasopharyngeal cancers: The 20-year follow-up of territory-wide Hong Kong Nasopharyngeal Cancer Survivor Study (HKNPCSS).
Authors: Chiang Chi Leung , Cheung Ching Lung , Chan Sik-Kwan , Au Philip Chun Ming , Fong Ka Shun , Sing Chor Wing , Wong Charlene Hoi Lam , Chow James Chung Hang , Cheung Ken Ka Man , Tin Winnie Wing Yan , Wong Edwin Chun Yin , Lau Tracy Tsz Shan , Wong Kenneth Chun Wai , Chan Ann Sum Yin , Lee Victor Ho-Fun , Lee Anne Wing Mui , Ng Wai Tong , Wong Ian Chi Kei
Published: June 2024

12045

Background: The survival rate of patients with nasopharyngeal cancer (NPC) has significantly improved in the last decade. However, there are only a few studies that have quantified the long-term morbidity and mortality that follow NPC treatment. This study aims to analyze the chronic health conditions, all-cause mortality, and cause-specific mortality among NPC survivors. Methods: The Hong Kong NPC Survivor Study (HKNPCSS) is a retrospective cohort study conducted across all six oncology centers in Hong Kong. It included longitudinal follow-up of 5-year survivors diagnosed with NPC between 1997 to 2015. We compared the standardized mortality ratio (SMRs) of 7893 survivors to a matched population in terms of age, sex, and calendar year. We also calculated the frequencies of chronic conditions of 7893 survivors and 23679 healthy individuals with matched age, sex, and date of cohort entry. Chronic health conditions were classified using the Common Terminology Criteria for Adverse Events. Cox proportional hazard models were used to estimate hazard ratios (HRs) for chronic health conditions. Results: The mean age of NPC survivors was 49.1 years, while healthy individuals had a mean age of 50.5 years. Among the 7893 NPC survivors, the 20-year cumulative all-cause mortality was 34.0% (95% CI, 29.1%-38.9%), with 1668 (59.9%) of 2785 deaths attributed to health-related causes. The SMR for NPC survivors compared to the general population was 3.81 (95% CI, 3.67-3.95), with the highest SMRs observed for pulmonary (SMR: 6.18, 95% CI, 5.73-6.64) and cardiovascular (SMR: 2.12, 95% CI, 1.90-2.36) causes. Among the survivors, 59.2% (n=4674) had severe, life-threatening, or fatal (grade 3-5) health conditions, with a 20-year cumulative incidence of 59.0% (95% CI, 56.4%-61.5%). The adjusted hazard ratio (HR) of grade 3-5 chronic condition in NPC survivors, compared to healthy cohorts, was 7.02 (95% CI, 6.64-7.42). Gastrointestinal (HR: 20.7), hearing, visual, and nasal (HR: 15.4), and neurological (HR: 8.39) conditions had the highest risks. Intensity modulated radiotherapy (IMRT), compared to non-IMRT, was associated with reduced risks of all-cause mortality (HR: 0.83, 95% CI, 0.74-0.91) and a trend towards reduced grade 3-5 chronic health conditions (HR: 0.89, 95% CI, 0.75-1.05). Conclusions: Even 20 years after diagnosis, NPC survivors still face increased risks of late mortality and morbidity. The findings emphasize the need for a comprehensive survivorship program to improve outcomes for NPC survivors.
Efficacy of treatment with traditional Chinese patent medicine (Fufang E'jiao Syrup) for cancer-related fatigue in patients with advanced cancer: A randomized, double-blinded, placebo-controlled, multicenter trial.
Authors: Gu Shan Shan , Xu Yun , Mao Jun J. , Sun Lingyun , Cui Ning , Wang Feiye , Dong Jing , Guo Xingyu , Fu Li , Wang Jinghui , Shi Jiyan , Zeng Yumei , Hu Yidan , Zhang Zipei
Published: June 2024

12053

Background: There is ongoing interest in finding effective drugs for cancer-related fatigue (CRF) in advanced cancer patients, although studies have had mixed results. Fufang E'jiao Syrup (FFEJS), a traditional Chinese patent medicine, has shown promise in alleviating CRF. This trial aims to investigate whether FFEJS could reduce fatigue and improve quality of life in advanced cancer patients. Methods: This prospective, multicenter, double-blinded, placebo-controlled trial was implemented at 29 hospitals in China, enrolling 611 advanced non-small cell lung cancer, colorectal cancer, and gastric cancer patients with Visual Analogue Scale for Fatigue ≥ 4 points. The study was conducted between September 23, 2019 and April 7, 2022, with a final follow-up on May 25, 2022. Participants were randomized to receive FFEJS (20 ml, 3 times per day) or a matching placebo orally for six weeks. The safety assessments were extended until the fourth week after the trial ended. The primary outcome was the change in total mean score (range: 0 [no fatigue] to 10 [extreme fatigue] points) on the Revised Piper Fatigue Scale-Chinese Version (RPFS-CV) from baseline to week 6. Secondary outcomes include quality of life (Functional Assessment of Chronic Illness Therapy-Fatigue, FACIT-F) and adverse events. FFEJS were compared with the placebo group using a linear mixed model. Results: Among 611 patients randomized (FFEJS: 303 and placebo: 308; 210 non-small cell lung cancer [34.4%], 201 colorectal cancer [32.9%], 200 gastric cancer [32.7%]; mean [SD] age, 62.8 [9.3] years; 413 [68.3%] man; mean [SD] baseline RPFS-CV total mean score, 4.86 [1.30] points), 503 (82.3%) completed the primary end point. By the end of week 6, the FFEJS group achieved normal fatigue levels (RPFS-CV < 4) compared to the placebo group (FFEJS: 3.78 vs Placebo: 4.39, adjusted mean difference 0.59 points [95% CI, 0.45 to 0.76 points]; P < .001). The adjusted mean difference for a favorable shift to a higher FACIT-F total score at week 6 comparing FFEJS with placebo was 2.77 points (97.36 vs 94.23 points; [95% CI, 0.56-4.96 points]; P = .02). There was no difference in adverse events occurrence between FFEJS and the placebo groups (110 [20%] vs 122 [18%], P = .38). Conclusions: In this randomized clinical trial among advanced cancer patients with CRF, FFEJS reducedfatigue severity and improved quality of life compared to placebo. Research is needed to assess the mechanism, clinical effect, and long-term safety of FFEJS for CRF in advanced cancer patients. Clinical trial information: NCT04147312 .
Attitudes and beliefs regarding sexual dysfunction among patients with advanced cancer receiving palliative care.
Authors: Bramati Patricia , Admane Sonal , Chen Minxing , Rozman de moraes Aline , Padilla Guadalupe , Erck McKenna , Delgado-Guay Marvin Omar , Bruera Eduardo
Published: June 2024

12054

Background: Sexual dysfunction (SD) is highly prevalent among patients with advanced cancer, but it is not regularly assessed by palliative care (PC) specialists. This study aims to investigate the frequency of SD, and its impact in PC patients with cancer, as well as the barriers they face to have an open communication with PC providers. Methods: AdultPC patients with cancer seen at the outpatient Supportive Care Clinic were invited to participate in a 25-item questionnaire about SD. The survey was voluntary and anonymous. Results: A total of 100 patients (54 women and 46 men) completed the survey. The mean age was 55 (range 24-78), 90% were Caucasians, 16% Hispanics and 77% were married or lived with a partner. In the month and within six months before the survey, the patients received treatment with chemotherapy (44 and 37%), radiation (14 and 13%), or surgery (4 and 20%), respectively. Only 29 patients (29%) would like to discuss their SD with a provider -this was consistent across gender ( p= 0.827) and age groups ( p= 0.194)-, even though 81% had experienced SD in the previous year and merely 45% were satisfied with their sexual function. Only 20 (20%) reported that their clinician had ever asked them about SD. Most of the patients (79%) responded that it was appropriate for the clinician to inquire about SD but only 32% thought that clinicians should always ask. Patients "strongly agreed or agreed" that the SD worsened their depression (39%), anxiety (28%), pain (14%), fatigue (13%), and wellbeing (39%). Factors that worsened the current sexual desire included medications in 33/59 participants, treatments (chemotherapy, radiation or surgery) in 61/80, miscommunication with the partner in 31/66, urinary incontinence in 17/24, weigh loss in 18/36, body image in 45/64, tube/lines (nephrostomy, colostomy, urinary catheter, etc) in 12/18, and oxygen in 4/12. When asked why they did not discuss SD, 64% said that discussing other symptoms was more important, 35% said that they wanted to keep it private, 29% because a family member was present, and 17% because of lack of time. Conclusions: SD is very common among PC patients with cancer and it worsens their emotional and physical symptoms as well as their overall wellbeing. About only a third of the respondents said they would want to discuss it with their provider, and almost two-thirds said that talking about other symptoms was more important. Our findings do not support the notion that PC specialists should always initiate a discussion about SD with their PC patients with cancer. Future studies should try to better identify which PC patients are open to talk about SD and exploring its therapies.
Trichology to predict efficacy of scalp cooling: New pathologic insights besides encouraging clinical results.
Authors: Schaffrin-Nabe Dorthe , Josten-Nabe Anke , Tannapfel Andrea , Heinze Adrian , Schaffrin Merle , Voigtmann Rudolf
Published: June 2024

12093

Background: Chemotherapy continues to be an essential element of tumour-specific systemic therapy. The associated hair loss impacts patients ‘quality of life in addition. Sensor-controlled scalp cooling has proven itself as a method of preventing alopecia. This study evaluates the grade of hair preservation as well as predictive factors, including (ultra)structural changes of the hair follicle during treatment, offering potential for enhanced therapeutic strategies. Methods: Scalp cooling, was evaluated in 81 patients (79 women, 2 men, median age 56 years) undergoing breast carcinoma treatment (4x EC 90/600 mg/m² BSA followed by 12x PAC w). Key outcomes included hair preservation (Hair Mass Index = HMI), avoidance of visible hair loss (HMI ≥ 50), and prevention of severe hair loss (all measured by Cross Section Trichometer). Parameters such as hair density (HMI), trichologic parameters like hair shaft and bulb diameter, anagen rate, shaft surface damage and melanosomes changes were measured through (ultrastructural) microscopy. Results: Over the half (53%) of patients avoided successfully noticeable hair loss (HMI post ≥ 50). Most important predictors of successful hair preservation in different analyses included lower post-therapeutic shaft surface damage (via scanning electron microscopy) (β = -.30, p = .034), larger pre-treatment shaft diameter (via light microscopy) (OR = 1.11, p = .011), and stable melanosome density (via transmission electron microscopy) (β = .35, p = .013). Higher anagen ratio (β = .30, p = 0.009) and larger hair shaft diameter (β = .29, p=0,023) plays a crucial role in hair prevention, considering only light-microspcopic parameters. Comorbidity (OR = 0.12, p = .024) and alopecia causing medication (e.g. antihypertensiva) (β = -.31, p = .017) led to increased hair loss. Patients with fewer hair loss over the course reported higher quality of life (r = .25, p = .042) and lower psychological burden (r = -.42, p < .001). Data indicate that optimal pre-therapeutic hair density (HMI =/> 69), coupled with the absence of comorbidities and alopecia-inducing medications, substantially enhances the efficacy of scalp cooling, elevating the probability of preventing severe hair loss (HMI ≥ 50) by nearly sevenfold (OR = 6.98, CI95% [1.01;48.33]. Conclusions: Scalp cooling proves effective in preventing visible hair loss in 53% of patients, with mini-organ (hair follicle) characteristics influencing outcomes. It does not only prevent hair loss but also enhances quality of life, underscoring the need for personalized approaches in managing chemotherapy-induced alopecia. The study confirms the method's safety and effectiveness without increasing scalp metastasis risk.
Cognitive symptoms in patients with cancer receiving PD-1/PD-L1 checkpoint inhibitors: Insights from a cross-sectional pilot study.
Authors: Yang GeeSu , Hegde Upendra P.
Published: June 2024

12094

Background: Cancer-related cognitive impairment is common with traditional therapeutic modalities, affecting memory, psychomotor speed, attention, and executive function of up to 75% of adults with cancer. Over the past decade, immune checkpoint inhibitors (ICIs) have emerged as novel and efficacious treatments due to their ability to penetrate the blood-brain barrier and improve survival rates. However, they come with significant short- and long-term complications, including neurological toxicities. Despite their benefits, the impact of ICIs on cognitive function is not well understood. This study aims to examine the frequency and severity of cognitive impairment and the factors correlated among adults with cancer receiving ICIs. Methods: We collected questionnaire data on cognitive function using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and other concurrent symptoms, as well as saliva samples of a subset of inflammatory cytokines from patients treated with PD-1/PD-L1 checkpoint inhibitors between 2022 and 2023. Sample characteristics were described using mean, frequency, and percentage. To analyze the relationship among symptoms and demographics, we used Pearson’s correlation and the Mann-Whitney U test. Saliva cytokines were analyzed using ELISA assays. This study is IRB approved. Results: Twenty-three patients (male: n=11, female: n=12) have received ICIs for an average of eight months, with a mean age of 70.87±11.63 years. 78.3% had melanoma/skin cancer, 8.7% had head and neck cancer, and 13% had other malignancies. Pembrolizumab was administered to 47.8%, and Nivolumab to 26.1%. The mean scores of FACT-Cog for perceived cognitive impairment (PCI) and perceived cognitive abilities (PCA) were 60.87±13.06 (maximum: 72) and 22.30±6.70 (maximum: 28), respectively. 26.1% of participants (n=6) reported lower scores than the cut-off in both PCI (cut-off: ≤55.1) and PCA (cut-off: ≤19.5). Lower FACT-Cog PCI scores were significantly correlated with older age ( r=-.511, p<.05), greater fatigue ( r=-.483, p<.05) and pain ( r=-.558, p<.01). Participants with PCA and PCI scores below the cut-off showed higher mean concentrations of IL-1β (mean±SE: 188.22±133.72 vs. 80.99±14.73pg/mL), CRP (6659.47±3027.58 vs. 3910.71±1022.41pg/mL), and IL-6 (109.24±56.07 vs. 30.22±6.26pg/mL) compared to those with scores above the cut-off, although the results were not significant. This suggests that increased inflammatory cytokines may be associated with cognitive impairment. Conclusions: This preliminary study suggests that some patients may experience cognitive impairment during ICI treatment. As cancer patients are more at risk for cognitive impairment before treatment, a longitudinal study is warranted to confirm cognitive function both pre- and post-immunotherapy, along with objective measures of cognitive performance.