bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in salivary gland tumors.
Authors: Yucel Idris , Kemal Ozgur , Kemal Yasemin , Bel Ayse , Yildirim Ugur , Atmaca Sinan , Koyuncu Mehmet , Unal Recep
Published: September 2018

e17592

Background: Salivary gland tumors are rare, comprising only 6 to 8 percent of head and neck neoplasms. Most of them are benign and commonly occur in the parotid gland. In the last decade elevated hematological inflammatory parameters like neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were identified as predictive and prognostic factors in various malignancies. The aim of this study was to evaluate the differences of preoperative of NLR and PLR levels in benign and malignant causes of salivary gland tumors. Methods: This retrospective study was made of a total of 133 patients with salivary gland tumors (age range: 17-89 years; 68 male and 65 female) who were treated between January 2006 and May 2016. Preoperative counts and levels of hematological parameters were obtained from the recorded computerized database in benign and malignant tumors. Results: NLR and PLR levels were significantly higher in the malignant salivary gland tumor group than the benign group( NLR: 0.66±1.3 vs 0.59±0.31 p=0.001, PLR: 160.3±85.7 vs 124.6±44.1 p=0.014). Conclusions: The results of the current study revealed the potential predicitve role of NLR and PLR in patients with salivary gland tumors. These cheap and easily available blood count parameters could be useful biomarkers in the future; but further investigations are needed to confirm our findings. [Table: see text]
Tissue sampling for genomic testing in a community-based center.
Authors: Farhangfar Carol J. , Farhangfar Farhang , Schneider Meghan , Mileham Kathryn Finch , Livasy Chad , Ahrens Will , Kim Edward S.
Published: September 2018

e18000

Background: Genomic testing requires greater quality than routine clinical diagnostic tests. As genomic testing proliferates and becomes more widespread, adjustments in processes may be needed by community-based pathology, radiology, and surgery groups. Both tissue quality and quantity parameters are essential for successful completion of next-generation sequencing (NGS) panels. Methods: A NGS genomic platform ( > 600 genes) was implemented in a hybrid academic community-based cancer institute, with success/failure rates recorded.. Data were collected from the electronic medical records and biorepository data system. Descriptive statistics assessed success or failure rates by tissue quality or quantity with subgroup analyses by disease sites (primary/metastases), collection procedure, and specimen age. Results: From 6/2015-2/2017, 809 NGS tests yielded 143 (17%) failures [specimen quality (34%) and specimen quantity (66%)]. Of the failed tests, specimens were collected from 26 primary disease sites [lung (21%)] and 18 metastatic sites [liver (29%), lymph node (19%), and lung, omentum, brain, and peritoneal specimens (all < 10%)]. Of the failed tests, all bronchoscopy, EBUS, and peritoneal fluid specimens and the majority of FNAs (78%) were due to insufficient tissue quantity, whereas surgical resection or excision had more issues with quality of the specimen (60%). Of note, surgical specimens ranged from 2005-2016; NGS quality initiatives were implemented system-wide in 2015, leading to substantially fewer failed tests. Cores biopsies had fewer quantity (24%) or quality (18%) issues. The number of tests failing due to insufficient quantity also declined due to education and communication processes implemented. Conclusions: The majority of NGS tests provided valuable information. Implementation of systematic tissue collection (core biopsies) and processing, for primary lung and lung and liver metastases using core biopsies consistently provided the fewest failures and implementing NGS-specific processes improved NGS success rates.
Effect of a new cancer diagnosis on labor force participation (LFP): Has there been a change over time?
Authors: Davidoff Amy J. , Cantley Linda F. , Galusha Deron H.
Published: September 2018

e18004

Background: Health shocks, such as a new cancer diagnosis, have been shown to reduce LFP in working adults. Over the past decade, there have economic swings, retirement age has increased, while newer cancer treatments may be less toxic or disabling. We update prior estimates of LFP responses, and assess whether patterns changed over time. Methods: Adults from the 1998-2014 waves of the Health and Retirement Study (HRS) who were aged 51+ yrs and working in 1998 or at HRS cohort entry in 2004 or 2010, were followed until their LFP decreased. Decreased LFP was defined as a switch from fulltime work, or a 10 hour or 25% decrease in hours worked. We created time varying indicators for health conditions (cancer, heart condition, lung disease, stroke) newly reported or worsened since the prior wave, condition history, demographics, net worth, and insurance coverage. We estimated discrete Cox proportional hazard survival models for the full sample, and with person-wave observations stratified pre/post 2008. Results: Among 13,918 working adults, mean age was 56 years, 45% women; health history included 5.3% cancer, 9.5% heart condition, 4.1% lung disease, 1.5% stroke; new health conditions included 2.9% cancer, 4.7% heart, 2.3% lung, and 1.3% stroke. Newly reported or worsened cancer, heart and lung disease were associated with similar risk of LFP decrease (see table). Prior history of lung disease, diabetes, arthritis and psychiatric disorders were associated with LFP decreases, but cancer was not. There was no difference in the effect of a new condition on LFP pre/post 2008. Conclusions: Many working adults reported preexisting health conditions. New diagnoses or worsening of cancer and other serious health conditions were associated with LFP reductions, although a longer term history of cancer was not associated with LFP changes. [Table: see text]
Size and influence of the decision support networks of women newly diagnosed with breast cancer.
Authors: Wallner Lauren P. , Li Yun , McLeod Chandler , Hamilton Ann S , Ward Kevin C. , Veenstra Christine Marie , An Lawrence C. , Janz Nancy K. , Katz Steven J. , Hawley Sarah T.
Published: September 2018

e18012

Background: Little is known about the size and characteristics of informal decision support networks of women diagnosed with breast cancer and whether involvement of informal decision supporters (DSP) influences breast cancer treatment decisions. Methods: A population-based sample of newly diagnosed breast cancer patients reported to the Georgia and Los Angeles SEER registries in 2014-15 were surveyed approximately 6 months after diagnosis (N = 2,502, 68% response rate). Network size was estimated by asking women to list up to 3 of the most important DSPs who helped them with locoregional therapy decisions. For each individual DSP listed, respondents reported how important each DSP’s opinion was in treatment decision making, and how satisfied they were with their involvement (5 pt. scales, “not at all” to “very”). Decision deliberation was measured using 5-items assessing degree patients thought through the decision, with higher scores reflecting more deliberative treatment decisions. We compared network size (0-3 or more) across patient-level characteristics and estimated the association between network size and deliberation using multivariable linear regression. Results: Of the 2,502 women in this analysis, 51% reported having 3 or more DSPs, 20% reported 2, 18% reported 1, and 11% reported not having any DSPs. Married/partnered women, those younger than 45 years old, and black women were all more likely to report larger networks (all p < 0.001). Partnered women most often reported their partner as their main DSP (37.9%), whereas not partnered/unmarried women most often reported children (38.4%). The majority of women were highly satisfied with their DSP being involved in their decisions (76.5%) and 68.6% felt their DSP was very important in their decision making. Larger support networks were associated with more deliberative surgical treatment decision-making (p < 0.001). Conclusions: Most women engaged multiple DSPs in their treatment decision making, including spouses, children, and friends. Involving more DSPs was associated with more deliberative treatment decisions. Future initiatives to improve breast cancer treatment decision making should acknowledge and engage informal DSPs.
Prescription trends of everolimus in non-elderly cancer patients with private insurance in the United States.
Authors: Xing Yan , Xu Ying , Meric-Bernstam Funda , Chang Jenny Chee Ning , Shih Ya-Chen T.
Published: September 2018

e18016

Background: The use of targeted oral cancer medications has increased significantly since 2001. Everolimus, an mTOR inhibitor was first approved for cancer treatment by FDA as second line for patients with advanced renal cancer. Subsequently it has been approved for advanced pancreatic neuroendocrine tumor (NET) in 2011 and breast cancer in 2012 respectively. Off-label use is common in oncology practice. The objective of this study is to assess prescription trends, especially off-label use of everolimus, among non-elderly cancer patients with private insurance in the United States from 2009 to 2014. Methods: Data from the MarketScan database were analyzed. Between 2009 to 2014, 4,728 cancer patients with at least one everolimus prescription were included in the analyses. The diagnosis which incurred the most recently to the initial everolimus use in each calendar year was recorded. Off-label use was defined as using everolimus by all of the cancer types except of renal cancer in 2009-2014, NET in 2011-2014 and breast cancer in 2012-2014. Results: The number of patients received everolimus has increased significantly from 243 in 2009 to 1,194 in 2014. The most common diagnoses associated with everolimus use were breast cancer (42%), followed by renal cancer (24%), and NET (7%). Off-label use of everolimus increased from 29% in 2009 to 47% in 2011 then decreased to 23% in 2014. The 3 most common diagnoses associated with off-label use of everolimus were secondary malignancies (30.7%), breast cancer (10.4%) and liver cancer (5%) in 2009-2011, compared to secondary malignancies (47.3%), brain cancer (4.2%) and lung cancer (3.9%) in 2012-2014. The off-label use in female has decreased significantly from 32% in 2009 to 19% in 2014 (p = 0.03). There was no statistical difference in off-label use of everolimus by geographic region. Conclusions: Analyses of MarketScan data suggest off-label use of everolimus is common among US cancer patients, especially in lung, liver and brain cancer and secondary malignancies after the approved indication was expanded to breast cancer in 2012. Further research of the factors associated with off-label use of everolimus and its economic implication is needed.
Attendance at National Cancer Institute Cancer Centers (NCI-CC) by older adults with myeloma.
Authors: Wildes Tanya Marya , Fiala Mark A
Published: September 2018

e18020

Background: Older adults with myeloma (MM) have poorer survival than younger patients. NCI-CC attendance is associated with superior outcomes in many cancers. Studies show that older adults are reluctant to be treated in university settings and are more likely to be treated in the community setting. We aimed to define the factors associated with NCI-CC attendance in older adults with mm from a nationally representative sample and its association with survival. Methods: We identified all mm cases in the SEER-Medicare linked database from 2000-2011. Included cases were enrolled in Medicare Part A and B > 1 year prior to diagnosis; we excluded those enrolled at age < 65. Any center designated a NCI-clinical or -comprehensive center in 2002, 2005, or 2010 was considered an NCI-CC; attendance was defined as ≥2 separate claims from an NCI-CC in the 1-year after mm diagnosis. CM were calculated using the Charlson Comorbidity (CM) Index (CCI). Poor performance status indicators (PSi) were coded as present or absent. Logistic regression was performed to determine if age was associated with NCI-CC attendance. Cox regression was determined the association of NCI-CC attendance with survival. Results: 21,843 cases were included; median age was 77 years. Overall 10.6% of the cohort attended an NCI-CC. Increasing age was associated with decreasing NCI-CC attendance rates: 18.6% (age 65-69), 13.9% (age 70-74), 9.0% (age 75-79) and 6.0% (age ≥80). After controlling for race, gender, socioeconomic status, and urban/rural regions, increasing age, poor PSi and CCI were each associated with lower odds of NCI-CC attendance [Age: OR 0.925/year (95% CI 0.92-0.93); Poor PSi: OR 0.87 (CI 0.76-1.00); CM: 0.94/CCI point (CI 0.90-0.97)]. After controlling for sociodemographics, PS and CCI, NCI-CC attendance was associated with lower mortality [HR 0.74 (95% CI 0.70-0.78)]. Conclusions: With increasing age, poor PS indicators and CM, pts are less likely to attend an NCI-CC. After controlling for other prognostic factors, attendance at an NCI-CC was associated with lower mortality. Data from trials in older mm pts from NCI-CC or other tertiary care centers must be viewed with caveat that pts tend to have better PS and fewer CM.
Value of innovation in oncology: The position of European cancer patients on access to innovative treatments.
Authors: Florindi Francesco , De Lorenzo Francesco , Apostolidis Kathi , Pelouchova Jana , Winterbottom Andrew , Chrostowski Szymon , Cimpoeru Dan , Bolanos Natacha , Rek Anna , Manneh-Vangramberen Isabelle , Bolhuis Jiska , Makaroff Lydia
Published: September 2018

e18021

Background: The paper presents the position of the European Cancer Patient Coalition (ECPC), in partnership with Interel, on the value of innovation in oncology today, focusing on issues that would benefit most from the direct involvement of patients.The objective of the paper is to present key factors affecting access to innovation in oncology in Europe and to propose key recommendations on how to improve equity in access and to actively involve patients in decision-making. Methods: The document was produced under the supervision of the ECPC Board of Directors, and the contribution of the ECPC General Assembly, which was consulted in June 2016 during the Annual General Meeting.The paper is based also on a systemic literature review. Results: The paper analyses the main systems barriers to access to innovation, which affect all European cancer patients: low level fo health expenditure on cancer; high cost of innovative treatments; complex regulatory and reimbursement pathways; lack of enabling environments; limited patient involvement in decision making. The paper goes on identifying 40 key policy recommendations in 10 pivotal areas (see Table). Conclusions: Innovative healthcare technologies, strategies, and services offer the potential to improve the lives of many people living with cancer. Ensuring that effective innovations are accessible and affordable to all patients is a challenge facing all cancer stakeholders. The successful development and implementation of new cancer care modalities stems from putting the needs of patients at the centre of the innovation process. Patients are the ultimate beneficiaries and users of cancer diagnosis, treatment, and care. They have unique knowledge, perspectives, and experiences that improves and encourages innovation in oncology. Optimal innovation can only be obtained by understand the diverse needs and preferences of cancer patients, and integrating patient-centred approaches into the regulatory and healthcare system. [Table: see text]
Are patients with high-risk polycythemia vera (PV) receiving cytoreductive medications? A retrospective analysis of real-world data.
Authors: Paranagama Dilan , Yu Jingbo , Colucci Philomena , Evans Kristin , Bonafede Machaon , Parasuraman Shreekant
Published: September 2018

e18031

Background: Risk-adapted therapy in PV is aimed at preventing thrombotic events (TE). Under current treatment recommendations (including European LeukemiaNet), high-risk patients (age ≥ 60 y and/or history of TE) should be managed with cytoreductive medications in addition to phlebotomy and low-dose aspirin. The objective of this study was to describe cytoreductive medication usage in patients with high-risk PV. Methods: Retrospective claims from the Truven Health MarketScan Database were analyzed. Inclusion criteria were ≥ 2 non-diagnostic claims for PV >30 days apart, age ≥ 18 y, continuous enrollment during pre-index (1/1/2012–12/31/2012), and continuous enrollment through or death during the study period (1/1/2013–12/31/2014). Patients with claims for myelodysplastic syndrome, myelofibrosis, acute myelogenous leukemia, or secondary polycythemia were excluded. Descriptive statistics were used. Results: The study included 2856 patients. Mean (SD) age was 62.5 (13.5) y, 65.9% of patients were male, and 63.8% were high-risk. Comorbid conditions of interest were reported more frequently in high-risk patients than low-risk patients: hypertension (65.0% vs 43.1%), diabetes (21.7% vs 10.1%), and congestive heart failure (6.6% vs 0.6%). In low- and high-risk patients, the most commonly used cytoreductive medications were hydroxyurea (93.6%), anagrelide (7.6%), and interferon (2.4%). Low-risk patients received cytoreductive medications less often than high-risk patients (Table). However, only 42% of the high-risk patients received treatment with a cytoreductive medication by the end of the study. Conclusions: Despite higher cardiovascular risk and treatment recommendations, less than half of the high-risk PV patients received cytoreductive medications. Furthermore, less than a third of younger patients with a prior TE received cytoreductive medications. [Table: see text]
Understanding of important chemotherapy terminology by underserved populations.
Authors: Pentz Rebecca D. , Jacson Candice A , Gillespy Kristen , Lohani Minisha , Dixon Margie D
Published: September 2018

e18046

Background: Terminology used to describe chemotherapy can be difficult to understand, hindering shared decision making. Using a word bank of 42 misunderstood words we created previously (2016 ASCO abstract 164532), we identified the most misunderstood words and created 6 videos to describe six of them. Methods: An expert panel - three oncologists, two health literacy experts, an education specialist and a social worker - chose 20 words from the word bank to test. The number 20 was chosen to avoid participant fatigue. The 20 words were the 17 most frequently chosen by patients as hard to understand and 3 deemed crucial to understand by providers (curative, palliative, risk of infection) (Table). These words were tested for understanding with 50 underserved oncology patients, who were asked to provide definitions. Frequency of misunderstanding was calculated. Wrong definitions were tabulated to guide the expert panel in writing the script for the videos. Videos were created using VideoScribe software. Results: Eleven words were misunderstood by more than half of the participants (Table). After studying the wrong definitions, the expert panel provided definitions for six words (cancer, chemotherapy, curative, palliative, risk of infection, blood count) to create videos for a pilot study of the effectiveness of the videos. The video for ‘cancer’ can be found here https://www.youtube.com/watch?v=losI4fvESuU . Conclusions: Key words used to describe chemotherapy are not understood by patients. A simple intervention like a short video may aid in understanding. [Table: see text]
Last year of life of adolescent young adult (AYA) oncology patients: Inpatient utilization.
Authors: Johnston Emily E. , Alvarez Elysia Marie , Saynina Olga , Sanders Lee , Bhatia Smita , Chamberlain Lisa J
Published: September 2018

e18047

Background: Studies of AYA oncology patients’ end-of-life care utilization are critical as cancer is the leading cause of non-accidental AYA death and end-of-life care contributes significantly to healthcare expenditures. We sought to determine the quantity of and disparities in inpatient utilization in the last year of life of AYAs with cancer. Methods: Using the California Office of Statewide Health Planning and Development administrative database linked to death certificates, we performed a retrospective population-based analysis of cancer patients aged 15-39 who died between 2000 and 2011. We determined the number of hospital days and inpatient costs for each patient in their last year of life. We determined clinical and socio-demographic factors associated with high inpatient utilization. We also evaluated admission patterns (frequency and location) as death approached. Results: The 12,883 patients were admitted an average of 40 days in their last year of life, resulting in $149,307 per patient in inpatient costs [non last year of life AYA oncology: 11.6 days (p < 0.01) and $43,423 (p < 0.01)]. As death approached, admission rates and the percent of admissions at non-specialty centers increased. Five percent of patients used 20% of bed-days in the last year (high-utilizers). Sociodemographic and clinical factors associated with high utilization included younger age (15-21y: OR = 2.85; 95% CI, 2.3-3.6, 22-30y: OR = 1.81; 95% CI, 1.5-2.2, reference: 31-39y), Hispanic ethnicity (OR = 1.51; 95% CI, 1.2-1.9, reference: Non-Hispanic White), non-HMO insurance (private: OR = 1.48; 95% CI, 1.1-2.0, public/self pay: OR = 1.84; 95% CI 1.3-2.5), and hematologic malignancies (OR = 3.11; 95% CI 2.6-3.8, reference: solid tumors). Conclusions: AYA oncology decedents spent 40 days in the hospital in their last year of life, with average costs approaching $150,000 per patient. Subgroup with high utilization had distinct sociodemographic and clinical characteristics and non-specialty center admissions increased as death approached. This demonstrates the need for availability of palliative care at non-specialty centers. Whether these disparities and admission patterns represent goal-concurrent care needs to be examined.
A multidimensional view of racial differences in access to prostate cancer care.
Authors: Pollack Craig Evan , Armstrong Katrina , Mitra Nandita , Chen Xinwei , Ward Katelyn R , Radhakrishnan Archana , Ross Michelle Elana , Bekelman Justin E. , Branas Charles C , Rhodes Karin , Grande David
Published: September 2018

e18048

Background: Racial differences in prostate cancer treatment and outcomes are widespread and poorly understood. We sought to determine whether access to care, measured across multiple dimensions, contribute to racial differences in prostate cancer. Methods: The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer from 2012 to 2014. Patient survey data was used to determine experiences of accessing prostate cancer care (response rate 51.1%). An audit survey using simulated patient calls was used to determine appointment availability and wait times at 151 urology practices. Patient and practice addresses were geocoded to construct distance measures. We used multivariable logistic regression models to determine the association between five different domains of access—availability, accessibility, accommodation, affordability, and acceptability—and receipt of definitive treatment with radical prostatectomy or radiation, satisfaction with care, and doctor-patient communication. Results: There were 1907 non-Hispanic white and 394 black men in our cohort, the majority (71%) with stage 1 disease. Overall, 85% of men received definitive treatment with no differences by race. None of the access domains were significantly associated with definitive treatment overall or with radical prostatectomy in adjusted models. Black men were less likely to report good doctor-patient communication (60% vs 71%, p < 0.001) and high satisfaction with their care (69% vs 81%, p < 0.001). Communication ratings remained significantly lower among black men compared to white men in adjusted models (odds ratio = 1.49, 95% Confidence Interval 1.03, 2.16). Each domain of access was significantly associated with lower satisfaction with care and worse communication; however, differences in access did not mediate racial disparities for these measures. Conclusions: This study presents the first comprehensive assessment of access to prostate cancer care, showing that while access was related to overall satisfaction and better doctor-patient communication, it did not appear to explain racial differences in these measures of cancer care.
A closer look at some National Clinical Trials Network sites and their recruitment ability.
Authors: Makosiej Frank , Lizaso Montessa
Published: September 2018

e18055

Background: Targeted therapies have prompted clinical trials centers to screen large numbers of patients of a particular tumor type and to test further to identify those with molecular targets that meet the criteria of the study protocol. In March of 2014, the NCI converted Cooperative Groups into National Cancer Trials Network (NCTN) to better address the scientific needs and challenges these more innovative treatments introduce. The Alliance for Clinical Trials in Oncology is one of the five US Oncology Network groups, and Lead Academic Participating Sites (LAPS) are academic institutions recognized to be able to enroll high numbers of patients onto NCTN trials. Some LAPS sites were recognized to overlap into the Alliance Network as well. An analysis of their recruitment rates and comparison to non-LAPS or non-Alliance sites were reviewed. Methods: Between the years of 2011 to 2016, Covance Xcellerate captured over 2,688 unique Investigators participating in cancer trials in the United States. Seven hundred, seventy-four, cancer trials were involved. Nine hundred, forty-eight unique sites were identified. Results: On a site view, those institutions that were part of the Alliance Network enrolled patients at a median rate of 0.24 pts/site/mo, while LAPS sites recruited at a faster median enrollment rate of 0.33 pts/site/mo. Sites that overlapped within both networks enrolled at a rate of 0.30 pts/site/mo, and sites that were not members of either the Alliance or LAPS network enrolled at a rate of 0.23 pts/site/mo. When analysis of recruitment rate was narrowed further to look at individual investigators that were members of these networks or not, investigators representing from both Alliance and LAPS, their median enrollment rate was slightly higher at 0.33 pts/site/mo when compared to those investigators that were only members of LAPS network. Also, those sites that part of Alliance and LAPS recruited the most patients into studies. Conclusions: Sites that are members of networks such as the Alliance or LAPS, can recruit more patients into a clinical trial at a faster rate than sites that were not participants of the Alliance or LAPS.
Evaluation of online search (OS) by patients with cancer in a private (Pr) and a public (Pu) institution.
Authors: Espinoza Diego , Pastrana Victor , Menocal Florencia , Correa Zeballos Gustavo , Arroyo Elisa , Segovia Rodrigo , Arcuri Jorge Raul , Zarba Juan Jose
Published: September 2018

e18059

Background: Information technologies, such as Internet, have an impact on the field of medicine. Cancer diagnosis leads patients (pts) to inform about their illness. Objectives: To determine the percentage and motivation of pts who browse online about their illness. The most frequent cause to avoid OS according to the institution. Whether OS had an influence on the therapeutic decision. Whether the educational level (EL) and Age Cohort (AC) are related to the frequency of OS. Methods: Descriptive, cross-sectional study. The data was collected from anonymous surveys to pts who made a consult from March to April, 2015 in Pu; and from February to April, 2016 in Pr Results: 360 surveys were made. 180 in Pr, and 180 in Pu. Gender: 55% female. AC: 4% 18-31 y; 13% 32-45 y; 38% 46-59 y; and 45% of 60 y or older. EL: Elementary 43%; High school 42%; College/University 15%. OS: Pu: 17%. Pr: 32%. Reasons to avoid OS: The info provided by the doctor is enough Pr: 24% Pu: 16%; Pr 18.69%, Pu 1.35% avoid further info; Pr 40%, PuI 35% ignore how to use the Internet; Pr 17%, Pu 47% lack Internet access. Reasons for OS: the doctor does not provide enough info Pr 39% Pu 14%; to add further info: Pr 61% Pu 86%. Considers trustworthy info: Always Pr 13% PuI 31%; Sometimes Pr 81% PuI 66% Never Pr 6% PuI 6%.Useful information to make decisions about their treatment: Pr 83% Pu 81% EL/OS:p = 0.001. AT/OS: p = 0.001. Institution/OS:p = 0.001. Conclusions: More than 75% of pts did not consult online mainly due to lack of internet access. 20% considers that the information is always trustworthy, in 80% was useful for the decision making of their treatment. A significant relation among EL, AC and the institution was found, thus showing that the younger the age –and the higher the academic training-, the more OS is made by oncology pts. That is the reason why we consider that raising awareness about these factors in order to properly guide pts into an adequate and trustworthy OS could improve the process of decision making.
The impact of race and insurance status on survival of patients with non-small cell lung cancer.
Authors: Minocha Vinay Nikhil , Smotherman Carmen , Hew Jason Desmond , Pham Dat C.
Published: September 2018

e18064

Background: Previous studies have demonstrated disparities in survival outcomes between black and white patients with lung cancer. Black patients are more likely than white patients to have no health insurance or insufficient coverage which may limit their access to treatment. The purpose of this study was to determine the impact of race and insurance status of patients with non-small cell lung cancer on survival outcomes at our institution. Methods: Our study included patients diagnosed and treated for non-small cell lung cancer from 2005 through 2015 at University of Florida hospital in Jacksonville. Cox proportional hazard models were used to study the effect of race (black vs white), insurance, age, tobacco use, family history of cancer and stage on hazard rates for mortality. Time to treatment was compared between blacks and whites using the non-parametric Wilcoxon rank sum test. Results: Of the 1301 patients in our study, 445 (34%) were black. More black patients had Medicaid (24% vs 18%, p = 0.01), and were diagnosed at stage III or IV (81% vs 75%, p = 0.01) compared to white patients. Black patients had higher death rates compared to white patients (80% vs. 71%, p < .0004). Adjusting for stage and insurance, black patients had higher hazard rates for mortality than white patients (HR = 1.18, 95%CI 1.03, 1.35, p = 0.02). Patients with Medicaid and Medicare without supplement had higher hazard rates for mortality compared to other insurance categories (Table). There was no significant difference in time to treatment amongst patients of different races (p = 0.38) and insurance types (p = 0.54). Conclusions: Our study reveals worse survival outcomes in black patients compared to white patients with non-small cell lung cancer, controlling for insurance status and stage at presentation. Future research is needed to determine whether other factors may explain these racial disparities. [Table: see text]
Analysis of potential disparities by race, ethnicity, and age in adult accruals to NCI National Clinical Trials Network (NCTN) breast, lung, prostate, and colorectal trials.
Authors: Mishkin Grace , Temkin Sarah Madhu , Denicoff Andrea , Kohn Elise C. , Massett Holly A. , Mooney Margaret M. , Abrams Jeffrey S. , Minasian Lori M.
Published: September 2018

e18072

Background: Previous studies have raised concerns about disparities in patient accrual to NCI cancer trials and how this could impact the generalizability of trial results. This study compared the demographics of patients enrolled in NCTN cancer trials to the incident US population. Methods: We analyzed US adult accruals aged 40 or older to NCTN breast, lung, prostate, and colorectal cancer treatment trials between the launch of the NCTN on 3/1/14 and 12/31/16. Accruals were compared to the proportion of patients with these cancers by race, ethnicity, and age in the US population estimated using census-adjusted SEER incidence data for 2010-2013. Results: There were 14,247 accruals across 56 NCTN group treatment trials in breast (39.7% of accruals), prostate (25.9%), lung (23.9%), and colorectal cancers (10.5%). Hispanic and black patients were underrepresented in prostate, lung, and colorectal trials, but overrepresented in breast trials (see table). American Indian/Alaska Native populations were slightly overrepresented in 3 of 4 disease areas, and Asian populations in 2 of 4. Elderly patients were underrepresented in breast, lung, and colorectal cancers, with the greatest disparities in colorectal cancer patients over age 70 (19% of accruals versus 48% of incident patients). However, prostate cancer patients aged 65 to 84 were overrepresented (46% versus 36%). Conclusions: Disparities in race and ethnicity between patients accrued to NCTN studies and the incident population were smaller than seen in previous studies. However, challenges remain in certain diseases, and particularly in enrollment of elderly patients. Improvement efforts should focus on key disparities. [Table: see text]
Racial/ethnic differences in comprehension of biospecimen sharing/banking: University of Rochester Cancer Center NCI Community Oncology Research Program (URCC-NCORP) nationwide study in 710 cancer and healthy subjects.
Authors: Asare Matthew , Kamen Charles Stewart , Morrow Gary R. , Heckler Charles E. , Peppone Luke Joseph , Long Joan , Cole Sharon , Onitilo Adedayo A. , Feige Michelle M , Minasian Lori M. , Windler Dave , Weil Carol J. , Janelsins Michelle Christine
Published: September 2018

e18077

Background: Informed consent documents containing language about biospecimen storage/sharing (BSS) may be a barrier to minority participation in cancer research. We explored this issue in a nationwide URCC-NCORP observational study by assessing whether breast cancer patients and healthy control subjects, who provided consent to a cognitive function study, differed in their understanding of the ways their BSS could be used by researchers. Methods: We analyzed cross-sectional data from female breast cancer patients scheduled to receive chemotherapy at NCORPs and healthy controls. After reading a consent form related to BSS and consenting to participate in a study about cognitive function, participants’ understanding of BSS was evaluated using four items for biospecimen sharing (score 0-4); three items for relevance to care (score 0-3); nine items for biospecimen use (score 0-9); and six for research purpose (score 0-6); a higher score indicates better understanding. Linear models were used to compare the mean scores between white and non-white subjects, adjusting for education and baseline reading comprehension (WRAT). Results: 461Breast cancer patients and 249 healthy controls completed the survey. The adjusted linear models showed that white subjects scored higher than non-whites (mean scores 14.43 vs. 13.43) on the survey questions overall (p < 0.05), after accounting for education and WRAT. White subjects were more likely than non-whites to correctly answer all the questions for the biospecimen use (42.1% vs. 34.4%, p < 0.22), biospecimen sharing (31.3% vs. 28.1%, p < 0.74), relevance to care (35.1% vs. 17.2%, p < 0.01), and research purpose (4.1% vs. 1.4%, p < 0.97). Conclusions: Our research suggests that informed consent comprehension related to BSS is low overall across all racial/ethnic backgrounds, but non-white subjects’ scores remained lower than whites even after adjusting for education and WRAT. Efforts should be made by researchers to make it easier for all study subjects, especially non-white subjects, to understand informed consent form and BSS.
Are NCI-designated cancer centers websites linguistically accessible?
Authors: Rodriguez Jorge Alberto , Davis Roger B , Nipp Ryan David , Moy Beverly , Percac-Lima Sanja
Published: September 2018

e18078

Background: The digital divide has shifted from disparities in internet access to disparities in content and design. Technology overlooks limited English proficient (LEP) patients, resulting in a lack of translated online content, possibly increasing disparities in cancer prevention, treatment and clinical trial participation. We sought to determine the language accessibility for the websites of the NCI-Designated CC. Methods: In January 2017, we performed a cross-sectional review of the language accessibility of NCI-Designated CC homepages using manual review and informatics methods (i.e., web scraping). Web scraping automates data extraction from online content. The primary outcomes were presence of translated content, number of languages available and method of translation defined as no translation, Google Translate (GT) or manual translation. Manual translation was categorized as limited (few phrases), moderate (1 webpage) or full ( > 1 webpage or entire site). We used logistic regression to assess the relationship between translated website content and CC county demographics: percent LEP, median income and percent of households with an internet subscription. We performed Spearman Rank Correlation by ranking translation effort: no translation, GT, limited, moderate and full translation. Results: Of 69 NCI-Designated CC websites, 54 (78.3%) were without translation, 12 (17.4%) were manually translated and 3 (4.3%) used GT. Of 12 manually translated websites, 6 had fully, 4 had moderate and 2 had limited translations. Of 16 languages offered, Spanish was the most common (100%), followed by Chinese (50%) and Arabic (33%). We found no significant increase in the odds of having a translated website as related to LEP population, median income or percent of households with internet subscription by CC county. There was no correlation between the translation effort and LEP population, internet subscription or median income by CC county. Conclusions: We found that most NCI-Designated CC offered no translations of their website content. Despite cancer health disparities and the increasing role of health technology, the NCI-Designated CC websites currently remain inaccessible to LEP patients.
Delivering global cancer care: An international study of medical oncology workload.
Authors: Fundytus Adam Michael , Sullivan Richard , Vanderpuye Verna D. , Seruga Bostjan , Lopes Gilberto , Hammad Nazik , Sengar Manju , Hopman Wilma M , Brundage Michael Donald , Booth Christopher M.
Published: September 2018

e18080

Background: With a disproportionate global burden of cancer, access to care in low-middle income countries (LMICs) is a pressing issue. To our knowledge there is no literature that has described medical oncology (MO) workload in the global context. Here, we report the first results of an international study of global MO training, infrastructure and workload. Methods: A multinational panel of oncologists from diverse practice settings designed a 51 item online survey. The survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 50 countries. Countries were classified into low or low-middle (LMIC), upper-middle (UMIC) and high-income countries (HIC) based on World Bank criteria. Due to small numbers, African nations were reported as a region. The primary objective of this study was to describe the annual number of new cancer patient consults seen per oncologist. Results: 708 physicians completed the survey; 14% (96/708) from LMICs, 21% (152/708) UMICs, and 65% (460/708) HICs. 85% (604/708) of respondents were MOs, 9% (65/708) clinical oncologists, 6% (39/708) other. Respondents worked a median 5 days/week and had 4 weeks of annual paid vacation. The median number of annual consults per oncologist was 175 (IQR 125-375); 16% (114/708) of respondents saw 500+ new patients in a year. Annual case volume in LMICs (median consults 425, 46% respondents seeing > 500 consults) was substantially higher than UMICs (175, 15% > 500) and HICs (175, 10% > 500) (p < 0.001). Among LMICs, UMICs, and HICs, median days worked per week were 6, 5, 5 respectively (p < 0.001); annual weeks of paid vacation were 3, 3, 5 respectively (p < 0.001). Among countries/regions with 10+ responses, the highest annual case volumes per oncologist were Pakistan (median consults 950, 73% > 500 consults), India (475, 47% > 500), Turkey (475, 25% > 500), Africa (400, 42% > 500) and China (325, 31% > 500). Conclusions: There is substantial global variation in oncology case volumes and clinical workload; this is most striking among LMICs. Further work is needed to quantify activity-based global MO practice and workload to inform training needs and the design of new pathways and models of care.
In-hospital outcomes of acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic stem cell transplant (HCT).
Authors: Durani Urshila , Hogan William J. , Litzow Mark Robert , Alkhateeb Hassan , Kansagra Ankit J. , Go Ronald S.
Published: September 2018

e18091

Background: Allogeneic HCT is a potentially curative option for certain patients with AML. However, in-hospital outcomes and cost haven't been described. We use the NIS, a nationally weighted sample of hospital discharges in the US, to examine these outcomes. Methods: Years 2002-2013 of the NIS were queried for adults with a primary diagnosis of AML undergoing HCT. Mortality, length of stay, hospital charges, and complications were analyzed and predictors of increased charges and mortality were determined with multivariate regression analysis. Results: From 2002-2013 19,965 adults with AML were admitted for HCT. Donor sources included peripheral blood stem cells (PBSCTs) (79%); bone marrow (BMTs) (15%); umbilical cord blood (6%). In hospital mortality was 8%. Major complications included stomatitis (36%), total parenteral nutrition (TPN) (17%), neutropenic fever (14%), bacteremia (12%), mechanical ventilation (6%), and dialysis (3%). Median charges per hospitalization increased (p<0.01) from $161,894 (2002) to $324,765 (2013); median length of stay (27 days) remained stable over time. Multivariable regressions are depicted (Table). Umbilical cord blood transplants were associated with increased mortality (OR 2.25, p<0.01) and charges ($69,105, p<0.01) relative to PBSCTs. Conclusions: This study demonstrates increasing cost of BMT on a national level as well as increased cost and mortality with umbilical cord transplants. [Table: see text]
Modifiable risk behaviors in adolescents and young adults (AYA) with cancer.
Authors: Smith Lia J. , King Andrea C. , Lin Xiaolei , Hedeker Donald , Henderson Tara O.
Published: September 2018

e18095

Background: A cancer diagnosis in adolescents and young adults (AYA) comes at a complex developmental interval that often coincides with risky behaviors, such as substance use. Modifiable risk behaviors are an important area of research to minimize morbidity for AYA. Our goal was to examine substance use, affect, and other health indicators in a diverse AYA cancer patient sample. Methods: We identified patients between the ages of 18-39 years and 6 or more months from date of cancer diagnosis. Measures included demographic, general health and substance use variables, the Center for Epidemiologic Studies Depression Scale (CES-D), and the State-Trait Anxiety Inventory (STAI-T). Linear trend analyses were performed to examine group differences. Backward-selection ordinal regression analyses identified specific factors associated with risky health behaviors. Results: Participants (60% male; Mage = 27; 70% White; 14% Black) included 100 patients with primary diagnoses of lymphoma (N = 45); leukemia (N = 37); sarcoma (N = 10); other (N = 8). Median time from cancer diagnosis was 2 years (range 6 months - 20 years). Past year alcohol, cigarette, and marijuana use was reported in 80% ,15%, and 33% of participants, respectively. We classified three subgroups based on past year alcohol and smoking, including non-smoker/non-drinker (n = 20), non-smoker/drinker (n = 65), and smoker/drinker (n = 15). Linear trend analyses indicated that the groups did not differ on time since diagnosis, but the smoker/drinker group initiated drinking younger ( p< 0.01), were more likely to use marijuana in the past year ( p< 0.01), and had increased depressive symptoms (CES-D; p< 0.01), anxiety (STAI-T; p< 0.05), body pain ( p< 0.05), and poorer sleep quality ( p< 0.05). Backward model selection treating outcome categories as ordinal indicated that frequent marijuana use and poor sleep quality were associated with being a past year smoker/drinker. Conclusions: A sizeable portion of AYA cancer patients engage in drinking and smoking, which is associated with negative affect and poorer self-reported health. Targeted interventions should be considered to reduce risky behaviors in this population.
Febrile neutropenia in the nationwide inpatient sample: In-hospital outcomes and impact of cormobidities in 2007-2012.
Authors: Abbasi Saqib , Nazha Bassel , Moussaly Elias , Manchanda Monika , Atallah Jean Paul
Published: September 2018

e18103

Background: Febrile Neutropenia (FN) is associated with significant in-patient morbidity and mortality. The goal of this study is to describe the in-patient outcomes of febrile neutropenia as well as the impact of comorbid conditions through a large national dataset. Methods: Using the Nationwide Inpatient Sample (NIS) for years 2007-2012, FN was defined as ICD-9 codes 288.0x for a primary discharge diagnosis of neutropenia in conjunction with 780.61 and 780.6 for fever in cancer patients. Linear regression analysis assessed for annual trends in in-hospital mortality, length of stay (LOS), and cost of stay (COS). Seasonal variations in admission rates were evaluated using ANOVA. We employed univariate and multivariate logistic regression analysis to elucidate the relationship between common comorbid conditions and mortality. Results: Among 55,253 cancer patients (weighted N = 264,384) admitted with FN between 2007 and 2012, there is a mean decrease in LOS from 5.78 to 5.47 days (p < 0.0001), an increase in COS from $33,939 to $41,395 (p < 0.0001), and a 12-15% drop in hospital admissions in winter months. Mortality rate is unchanged annually (1.06-1.28%). Univariate analysis identified an increased risk of mortality associated with atrial fibrillation (OR = 4.06), coronary artery disease (OR = 2.09), congestive heart failure (OR 4.39), hypertension (1.20), COPD (OR 2.33) pancytopenia (OR 1.81), and adrenal insufficiency (OR 5.32). All remained significant on multivariate analysis, except hypertension and diabetes mellitus. Conclusions: Between 2007-2012, FN had a slight decrease in length of stay, unchanged in-patient mortality and a 22% increase in hospitalization costs. Our results are in line with recently presented analyses of the same database (Blood 2016 128:4762, Blood 2016 128:5904). Comorbid conditions are associated with higher in-patient mortality, with up to 5-fold increase for those with atrial fibrillation, congestive heart failure and adrenal insufficiency. Clinicians should consider the significant impact of such comorbidities. Additional vigilance and potentially prophylactic antibiotics following treatment should be considered in affected patients.