bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnic disparities in adverse events of radiotherapy for breast cancer: A scoping review.
Authors: Hegde Siddhi , Carlos Ruth C
Published: June 2022

e18502

Background: Ethnic disparities have been well-documented in the US as a contributor to poor outcomes following radiotherapy in ethnic minorities. The objective was to examine the intra-group and inter-group ethnic differences in adverse effects experienced by Asian breast cancer patients undergoing radiotherapy. Methods: A scoping review involving the Pubmed database was conducted. The search strategy included a combination of keywords and index terms related to Asians, breast cancer, CTCAE and treatment. Title, abstract and then full-text screening was performed by two reviewers. Primary research studies and systematic review articles involving female adults in peer-reviewed articles or grey literature records, of any design or date and published in English, were included. Descriptive statistics and charting was used to summarize the results. Results: Of 1765 abstracts retrieved and screened, 37 articles were ultimately included for analysis. The majority of the studies involved Japanese patients (40.5%) followed by Chinese patients (24.3%) with an average of 468 patients being studied per study (ranging from 1-4,869 patients). Only a single study was conducted in the US. 35.1% of studies reported ethnicity and 64.8% of studies reported Asian ethnic subgroups. Most patients underwent whole-breast irradiation (62.1%). 37.5% of studies involved patients with TNM stages I-III breast cancer. Most patients were postoperatively enrolled after BCS (59.4%).ER/PR status was reported in most studies (54.1%) with an average of 553 patients being positive for either hormone receptor and averages of 210 and 905 patients each in studies where numbers were reported individually. HER-2 status was reported in 48.7% of studies with an average of 28 positive HER-2 patients in each study. Most studies reported skin toxicity following radiotherapy (81.1%), commonly grade 1 or 2 (40.5% each) affecting an average of 46% of patients in each study. These dermatological adverse events were radiation dermatitis, hyperpigmentation, fibrosis, hypertrophic scarring or erythema. Conclusions: Ethnicity was under-reported in the studied literature involving breast cancer treatment. Strategies to improve reporting of ethnic subgroups in literature and to reduce psychosocial barriers to access and treatment with a specific focus on mitigating dermatological adverse events of radiotherapy in Asian breast cancer patients may improve overall outcomes in this group.
Examining disparities in cancer pain-specific clinical trials.
Authors: Sueyoshi Mark , Salvi-Jackson Tiarrah , Shukla Utkarsh , Archer Damian , Huber Kathryn
Published: June 2022

e18513

Background: Clinical trials overall have been found to lack proportional representation of minority patient populations. This limits their generalizability as well as progress towards equitable care. This work examines the racial representation of cancer pain related clinical trials in the United States. Methods: All trials with posted results that had started between 1999 to 2019 on ClinicalTrials.gov were examined, excluding trials that included sites that were not within the United States and trials without demographic results posted on ClinicalTrials.gov. We calculated enrollment fractions (EFs) for each group as defined by the Surveillance, Epidemiology, and End Results (SEER) database cancer prevalence by race. Results: As of February 10, 2022 there were 340 trials on ClinicalTrials.gov which were categorized as “Cancer Pain” related. 84 of these studies had posted results. An additional 19 were excluded due to having non-US sites and 31 were excluded due to absence of demographic data, leaving at total of 34 studies for this evaluation (n = 2,767 patients). Examination of clinical trial enrollment was separated by decade (1999-2009 and 2010-2019), utilizing available SEER cancer prevalence by race data for 2009 (as a comparator for 1999-2009) and most recent available 2018 data (as a comparator for 2010-2019). Total enrolled patients in cancer-specific trials between 1999-2009 was 817; 85.1% white, 7.6% black/African American, 1.8% Asian/Pacific Islander. When compared to the SEER 2009 prevalence for all cancer, the EF was 97.5%, 91.6%, and 83% for white, black and Asian groups respectively. Between 2010-2019 there were 1950 enrolled patients, 85.6% white, 9.9% black/African American, 2.1% Asian/Pacific Islander. When compared to the SEER 2018 prevalence for all cancer, the EF was 101.2%, 102.1%, and 61.8% for white, black and Asian groups respectively. Conclusions: In the examination of racial representation within cancer pain-specific trials relative to all cancer prevalence between 1999-2009 and 2010-2019, there appears to be a slight increase in relative representation of white participants (+3.7%), and an even greater increase in representation of black/African American participants (+10.5%). Asian/Pacific Islanders had a notable drop in relative representation (-21.2%). This data is suggestive that minority representation in cancer-pain specific trials has become more representative with regards to black/African Americans. However, there is a large relative decrease in Asian/Pacific Islander representation in cancer pain-specific trials. Given the importance of cancer pain management, it is vital that we move toward equitable accrual to these clinical trials such that they that accurately reflect racial groups in the United States population.
A mixed-methods study of minority patients treated on a cancer clinical trial at a tertiary referral center.
Authors: O'Shea Mary , Kim Yonghun , Asiedu Gladys , Warsame Rahma M. , Price Katharine Andress Rowe
Published: June 2022

e18543

Background: Representation of minority patients (pts) in cancer clinical trials (CCTs) is low and contributes to health disparities. Our study sought to understand the beliefs and motivations of minority patients and to identify barriers and facilitators of CCT enrollment. Methods: 270 minority pts treated on CCT were identified from the medical record from 2018-2021. Of the 138 of pts alive, 13 (9.4%) consented. Semi-structured qualitative interviews were conducted exploring motivations, barriers, and facilitators to CCT participation. Surveys collected demographics and explored beliefs towards cancer and factors that influenced participation. Results: Of the 13 participants, 9 were female (69%), 4 Hispanic (30%), 3 Black (23%), 3 multiple races (23%), 2 Asian (15%), 2 Native American (15%), and 1 Native Hawaiian (8%). Two pts had a high school education (15%), 7 ≥ 4-year college (54%), 4 ≥ 2-year college (30%). Eight pts were married, 3 divorced, 1 widowed, and 1 single. Employment status was: employed (4 pts, 30%), unemployed (1 pt, 8%), disabled (5 pts, 38%), retired (3 pts, 23%). All pts were insured. Median household was 3 people (range 1 to > 5); 3 pts had dependents. 9 pts had their own vehicle; 4 used public or subsidized transport. 2 pts had trouble finding transportation. Income was: 3 pts < 25K, 4 pts 25-35K, 1 pts 35-50 K, 1 pts 50-75K, and 4 pts > 75K. 4 pts received emotional support from religion. All pts had heard of CCTs and 6 (46%) had known other CT participants. Direct communication from healthcare provider was the most common way of hearing about CCT. 9 pts (69%) had trust or strong trust in experimental therapy/CCT; 4 pts (30%) were neutral. 8 pts (61%) believed standard therapy was needed to cure cancer. 5 pts (38%) believed God would decide if they die from cancer. 7 pts (54%) believed that worry makes cancer worse. Key themes about patients’ motivation to participate: chance for cure, staying positive, giving back to others, having representation in research, and advancing science. Key themes about facilitators to participation: supportive family, cost coverage for treatment, and limited treatment options. Key themes on participation: minimizing logistical barriers, decentralizing CCTs, increasing awareness via patient narratives, diversifying research staff, minimizing cost, and being clear on purpose and benefit of CCT. Factors from survey that influenced participation are summarized in Table. Conclusions: Understanding minority pts experience through in-depth interviews is valuable and may help with recruitment.[Table: see text]
Perceptions of cancer care coordination among rural patients in Hawaii.
Authors: Okado Izumi , Liu-Duerr Michelle , Hewitt Tracey , Elhajj Carry , Nishiyama Skyler , Holcombe Randall F.
Published: June 2022

e18553

Background: Rural residents experience disproportionate burdens of cancer including higher incidence and mortality than urban residents. Disparities in rural cancer health outcomes are partially attributed to limited access to specialty care and care coordination challenges in rural areas. To date, little is known about rural cancer patients’ perceptions of care coordination (CC). In this study, we examined rural patients’ perceptions of cancer CC and compared rural and urban patients’ perceptions of cancer CC using the Care Coordination Instrument (CCI), a validated patient-report measure of CC. Methods: 80 rural patients receiving active treatment for any cancer residing in rural areas of Hawaii (Hawaii Island, Kauai) completed the CCI from Sept. 2020 to Dec. 2021. These rural areas are on separate islands from Oahu (urban) where tertiary care hospitals in Hawaii are located. Data for the urban cohorts ( n = 220) were derived from our archival data. The CCI assesses overall patients’ perceptions of CC (Total) and includes subscales that evaluate CC across three domains (Communication, Navigation, Operational). We used descriptive statistics to describe rural patients’ CC details and linear regression models to compare CCI scores between rural and urban patients. Results: Among 300 patients, demographic and clinical characteristics were similar between the rural and urban cohorts (mean age = 63.6, 56% female, most common cancer type: 28% breast and 25% GI). Patients were racially diverse, with 25% White/Caucasian, 24% Japanese, 16% Native Hawaiian, and 24% two or more race. Among rural patients, 43% indicated having traveled by air to another island (Oahu; urban) for cancer treatment (50% surgery). Of these patients, 38% indicated having paid out-of-pocket for cancer care-related travel costs. 65% of these patients reported travel costs as a burden, with 6% of patients having canceled or delayed treatment due to costs. Overall, there were no differences on the Total CCI scores between rural and urban patients ( p = 0.73). However, significant differences were found for Communication and Navigation ( p = 0.02 and p = 0.04, respectively), with rural patients reporting lower scores on these domains. No differences were found for the Operational domain scores. Conclusions: Our results demonstrate that that while rural patients’ overall perceptions of CC were similar to their urban cohorts, rural patients perceived greater CC challenges related to the communication and navigation aspects of CC. Off-island cancer care-related travel costs were reported as a significant burden for rural patients who must travel to another island for their cancer treatment. These findings highlight the need for interventions to address financial, communication and navigation challenges for rural patients in order to improve the quality of cancer care delivery in rural areas.
Not just biology: Comparing social determinants of health in patients diagnosed with late-stage lung, breast, and colon cancer.
Authors: Rhinehart Dena , Lozier Jessica , Silvestri Gerard A.
Published: June 2022

e18582

Background: Lung, colorectal, and breast cancer account for the majority of cancer deaths in the U.S. Patients with late stage lung cancer have the shortest survival of the three, and lung cancer patients are more likely to be diagnosed at later stages. We undertook this study to compare social determinants of health in patients diagnosed with late stages of lung, breast, and colon cancer to assess the impact they have on health and mortality. Methods: Data from the National Cancer Database was used for this study. We compared factors including insurance, income, and residency among late stage cancer patients (Stage III and IV). We also compared baseline health status measured by comorbidity index. Descriptive statistics were used to compare patient characteristics. Statistical significance was determined on the basis of a two-sided p value < 0.05. All statistical analysis was performed using SAS, version 9.4. Results: Between 2004 - 2016, 3,005,513 patients were diagnosed with lung (1,004,999), breast (1,309,796), and colon (690,718) cancer. The racial make-up of the groups was similar. 72.5% of lung cancer patients were diagnosed at late stage compared to 48.8% of colon and 13.8% of breast cancer patients. Patients with late stage lung cancer were more likely to have income < $38,000, reside in rural locations, and less likely to have private insurance. Late stage lung cancer patients were 2 and 4 times more likely to have at least 2 comorbidities than patients with colon and breast cancer respectively. Conclusions: Patients with lung cancer are disproportionately affected by several negative social determinants of health. The association between smoking and lung cancer may help explain this because the highest smoking rates in the U.S. occur in populations with lower income, low education status, less insurance coverage, and significantly more comorbidities (e.g. COPD, Heart Disease). These patients are dealing with the complex interplay of negative social determinants of health and worse baseline health status causing delays in diagnosis and treatment when compared to other cancers. Recognizing this may allow systems to better support this disadvantaged population and improve access to screening, clinical trial inclusion, and personalized treatment options while working longitudinally to reverse the systemic factors affecting disproportionate tobacco use and lack of healthcare access in for this underserved population.
Raising the level of cancer care: Feasibility and reported benefit of a virtual tumor board.
Authors: Chiec Lauren , Dempsey Naomi , Agarwal Mohit Shiv , Ogden John R , Broughman James R. , Mayo Zachary , Shonkwiler Erin , Chaby Michael , Socinski Mark A. , Pegram Mark D. , Bilen Mehmet Asim , Lieu Christopher Hanyoung , Butler Reni , Thirman Michael J. , Gradishar William John , Nooka Ajay K. , Levy Benjamin Philip , Drakaki Alexandra , Slovin Susan F. , Jahanzeb Mohammad
Published: June 2022

e18595

Background: Multidisciplinary tumor boards (TBs) are a key component of high-quality oncology care. Access is variable, particularly outside the academic setting, and limited access likely disproportionately impacts underserved patient populations and may contribute to healthcare disparities. Virtual tumor boards (VTBs) may provide a solution. Methods: Objectives of this endeavor are to test the feasibility of conducting VTBs and assess their perceived benefit and educational value. Expert US faculty formed VTB panels via an online platform to discuss complex cases submitted by clinicians. Each panel included a moderator and a radiologist, as well as a medical, radiation and surgical oncologist. After the panel discussion, written recommendations and video recordings (de-identified) were shared with submitters. Recordings were available online to viewers with embedded questions to assess learning. Submitters were surveyed as to their perceived benefit of the discussion. Viewers were surveyed to assess the educational value. Results: From 07/2020-12/2021, 323 cases (97 breast, 109 thoracic, 49 gastrointestinal, 37 genitourinary, 31 hematologic) were submitted by 48 clinicians to 38 VTBs. Submitters were surveyed with a 73% response rate; 100% reported they were likely to submit a future case for discussion and that they believe the VTB will improve care for patients. Viewers (n = 39) were surveyed with a 72% response rate and included trainees and APPs working in medical, radiation, and surgical oncology as well as radiology. All viewers endorsed that the videos were a good educational resource, and that they would use them in the future. Both embedded questions were answered 74% of the time (315/425); answers post-viewing changed 43% of the time (137/315). Conclusions: VTBs are feasible and lead to a high degree of satisfaction among case submitters. In this cohort, users reported that their patient management changed based on the discussion. Of those who discussed the case at their own TB, most felt that the VTB expanded upon prior recommendations. A large proportion of users stated that their case was not discussed at an internal TB, suggesting the VTB may address an unmet need. Those who watched the videos found them to be a good resource and would use them in the future. Data from larger cohorts will be key in understanding the full impact of this endeavor, particularly in helping to address healthcare disparities.[Table: see text]
Disparities in biomarker testing in ovarian cancer.
Authors: Smith Anna Jo Bodurtha , Alvarez Rafael , Heintz Jonathan , Haggerty Ashley Ford , Ko Emily Meichun
Published: June 2022

e18596

Background: Biomarker-based treatments have revolutionized treatment in ovarian cancer. Our objective was to examine the association of biomarker testing in ovarian cancer with patient and health system factors. Methods: We conducted a retrospective cohort study of ovarian cancer patients diagnosed from 2011-2021using the nationwide de-identified, electronic health record-derived Flatiron Health database. We used multi-level regression modeling to analyze the association of patient, sociodemographic, health system, and cancer factors with receipt of biomarker testing. We analyzed results overall and by biomarker: BRCA, homologous recombination deficiency (HRD) or genomic instability score (GIS). Results: Of 8,519 patients with ovarian cancer, 55.4% (95%CI 54.3-56.4) had undergone any biomarker testing. 55.3% (95%CI 54.3-56.5) had undergone BRCA testing and 6.1% HRD/GIS (95%CI 5.6-6.6). Medicare insurance, older age, ECOG of 2+, and living in Puerto Rico was associated with lower likelihood of biomarker testing, while recurrence or a later year of diagnosis was associated with greater likelihood of biomarker testing. Findings were similar for BRCA and HRD/GIS. Conclusions: Only 55% of patients underwent biomarker testing. Insurance type, ECOG status, region, and recurrence were predictors of ever undergoing biomarker testing. Interventions to improve Medicare coverage and care of medically complex patients may improve biomarker testing and use of directed therapies in ovarian cancer.[Table: see text]
Using customized PRO profiles to evaluate expected patient quality-of-life outcomes.
Authors: Iaconangelo Charles , McManus Shauna , Serrano Daniel
Published: June 2022

e18607

Background: Patient Reported Outcomes (PROs) are routinely employed in patient-focused drug development programs. However, PRO data are often under-utilized. Better approaches could employ trial data to describe expected patient outcomes. The objective of this work was to present a method for leveraging PRO-based patient profiles to project and thereby anticipate expected patient outcomes. Methods: A model-based approach to analyzing PRO scores allows for a more tailored approach to evaluating outcomes of interest. To demonstrate this approach, we analyzed PRO data from a Phase 3 trial of patients with prostate cancer randomized to either Hypofractionated 3D-CRT/MRT (experimental arm) or Conventionally Fractionated 3D-CRT/MRT (comparator arm). The outcome of interest was the difference between treatment arms on the Expanded Prostate cancer Index Composite (EPIC) urinary domain scores, defined on the sum of responses to 12 items. A longitudinal regression model was fit to EPIC scores at 6, 12, 24, and 60 months post-baseline. Patient profile variables (baseline EPIC urinary scores, treatment arm, age, race, clinical T-stage, and Gleason score) were included as predictors. For a particular patient profile of interest, expected EPIC urinary score at 6 months was estimated, as well as associated 95% confidence intervals, which allowed for an understanding of the range of likely outcomes for that particular patient profile. Results: n = 550 patients in the experimental arm and n = 542 patients in the comparator were analyzed. The difference in EPIC urinary scores between treatment arms at 6 and 12 months were computed, with higher scores reflecting greater symptom severity. The model estimated a difference of 2.12 points (p = 0.009) at 6 months and 2.16 points (p = 0.013) at 12 months, favoring the experimental arm. To illustrate how customized patient profiles can be used to better understand patient outcomes, a single profile is presented. At baseline, a patient receiving the experimental treatment, EPIC urinary score 98.0, age 57, white, clinical T-stage T2, Gleason score 6, could be expected to report an EPIC urinary score of 94.3 (92.06, 96.00) at 6 months based on the statistical model. In the observed trial data, one patient with this profile reported an EPIC urinary score of 93.8 at 6 months. The expected EPIC urinary score overestimated the observed score by only 0.53%, indicating the accuracy of the expected EPIC urinary scores. This corresponds to approximately one category decrease on two of the 12 domain items (i.e., a decrease in symptom severity). Conclusions: Well-established statistical methods can lead to improved clinician understanding of expected outcomes specific to a given patient profile. This would facilitate communication between clinician and patient regarding anticipated oncology treatment outcomes. Recommendations to support the use of these methods should be considered.
Beyond biomarker testing: Aligning the needs of oncologist and diagnostic companies to improve biomarker results reports for accurate clinical treatment selection.
Authors: Lovly Christine M. , Martin Nikki A. , Basu Roy Upal Kunal
Published: June 2022

e18611

Background: The benefits of precision medicine, including targeted therapies and immunotherapy, for lung cancer patients are well-documented. National clinical guidelines recommend broad multiplex molecular panels for advanced stage NSCLC. Increased understanding of the molecular heterogeneity of lung cancer has led to novel biomarkers being discovered, increasing the potential to match patients to new treatments. Pairing a patient to the correct biomarker-defined therapy is dependent on both biomarker test being ordered and accurate interpretation of test results. However, the increasing complexity of biomarker reports could contribute to inaccurate diagnoses and suboptimal therapeutic selections. Our objective was to understand the extent of the problem of report interpretation and identify opportunities for harmonizing key elements of the reports, in order to improve report interpretability and patient care. Methods: A multi-stakeholder group comprised of 40 leaders from thoracic medical oncology, professional societies, government agencies, and diagnostic companies was convened by LUNGevity Foundation. Participants responded to pre-and-post meeting surveys to capture insights on the main challenges of results report generation (diagnostic companies) and accurate interpretation for patient care (oncologists) as well as recommended solutions and areas to jointly address. Recommendations were informed by an audit of 12 biomarker reports from commercial/ governmental labs for similarities and differences regarding report structure, terminology, and content. Results: Pre-meeting survey results and discussion from diagnostic companies (N = 12) and academic and community cancer center oncologists (N = 8) revealed multiple challenges with report generation as well as interpretation. Diagnostic companies highlighted the need for superior, time-intensive attention to detail for accurate evidence curation and report generation. Oncologists highlighted challenges reviewing and interpreting results such as inconsistencies in nomenclature for genomic variants, alignment of genomic alterations with approved therapies, and lack of clarification of the level of evidence for therapeutic selection. In post-meeting surveys, participants proposed solutions to harmonize specific aspects of biomarker testing reports to improve patient care. Top areas for alignment included establishing consensus on harmonization of clinical nomenclature, refining report structure, and shortening report length. Conclusions: It is not enough to only promote biomarker testing for lung cancer patients. Attention is also needed to systematically unify and streamline clinical biomarker reports to best serve the oncology community. These efforts may also serve as a model for application in other cancers beyond lung cancer.
International approaches to head and neck cancer multidisciplinary tumor board.
Authors: Yao Christopher MKL , Beatty Sydney , Giri Anshu , Liu Jeffrey Chang-Jen , Bauman Jessica R , Sturgis Erich M. , Galloway Thomas James , Ridge John A.
Published: June 2022

e18615

Background: Multidisciplinary tumor boards are widely accepted as vehicles for improving patient outcomes in Head and Neck Cancer (HNC). Little work describes their structure and practices. The purpose of this study is to better understand the international practice patterns of multidisciplinary HNC tumor boards. Methods: A cross-sectional survey on head and neck cancer multidisciplinary tumor board practice patterns was developed by a panel of six experts and distributed internationally to HNC providers. The survey interrogated the attendance, participation, operation, and perceptions of multidisciplinary tumor conferences, through a mix of Likert-based, tick box and open-ended questions. Results: One hundred and twenty-three responses (55%) were received from 88 surgical oncologists, 17 radiation oncologists, and 18 medical oncologists from nine different countries. Overall, most HNC tumor boards are led by a surgeon (77%), and most commonly 5-10 minutes (61%) was spent on each case. In 60% of responses, all HNC patients were discussed at their tumor boards, while select cases were presented in 40% of responses. Pathology was routinely reviewed in 75% of sites and imaging reviewed in 95% of sites. In 75% of responses, sufficient time was felt to be spent on each case. Majority (75%) of tumor boards documented their recommendation, with 92% reporting that inability to reach a consensus recommendation was rare. When this occurred, the most common recourse was involving patient decision making (53%), followed by offline discussion until an agreement is reached (38%). Most respondents felt that tumor boards rarely altered the treatment plan (68%), while 37% felt the treatment plan was sometimes altered. Involvement of radiation and medical oncology prior to surgery varied, with 53% sending patients routinely, 32% sometimes, and 15% deferring referral. Logistics was cited as a primary barrier. Surgeons and radiation oncologists agree that the top three reasons tumor boards assist in cancer care are: receiving additional opinion and perspective, coordinating care, and communication. Medical oncologist also found tumor boards enhance clinical trial enrollment. Conclusions: While there are variations in the structure and process of multidisciplinary tumor boards, the majority of management is agreed upon by the treatment team. Areas of improvement include verification of cancer stage, identifying logistics that prevent timely and documentation of recommendations. Identifying the variations from most-common practice should provide a mechanism for improvement.
Quality of cancer care in a low-resource setting: A single-center observational study.
Authors: Tolani Musliu Adetola , Gundu Isaac , Nwabuoku Emeka Stanley , Umar Shehu Salihu , Dansani Amina Ibrahim , Dauda Bashir Abubakar
Published: June 2022

e18622

Background: There are challenges in access to healthcare in developing countries. The quality of care is however an important consideration in achieving sustainable positive outcomes during patient management. This study, therefore, aimed to assess this measure of cancer care in our setting. Methods: A cross-sectional study of sixty-three patients with malignancy, who had or were planned for cancer treatment, was performed. Information on their demographic and clinical characteristics were obtained. Quality of cancer care was measured using the Consumer Assessment of Healthcare Providers and Systems instrument. SPSS was used for data analysis and p-value < 0.05 was considered significant. Results: Their average age was 60.0 (43.8 – 69.3) years. Twenty (31.7%) had gastrointestinal malignancy while 17 (27.0%), 15 (23.8%) and 11 (17.5%) had prostate, breast and cervical cancer respectively. The median duration since cancer diagnosis was 4.0 (2.0 – 14.0) months. Regarding support provided by the care team to manage the cancer and the effects of its treatment; majority of the respondents, 30 (54.5%), answered in a negative tone. Similarly, the majority of the respondents did not select the maximum score on the scale in the aspects of receiving timely appointments, care, and information; communication between the cancer care team and patients; information use for care co-ordination; and the availability to give information when required (Table). Despite this, patient rating of their cancer care team and their overall experience was 8.0 ± 1.8 and 7.8 ± 2.0 respectively. There was however a significant difference in the latter between those who had cancer recurrence in comparison to those who did not experience this event (6.8 ± 2.2 versus 8.2 ± 1.7, p = 0.048). Conclusions: Even though the general rating of the experience of these patients was high; the gaps highlighted in the areas of patient support, communication and navigation and their sub-optimal experience during cancer recurrence could be further improved to enhance the delivery of cancer care in this limited resource setting.[Table: see text]
Breast cancer characteristics and time to chemotherapy initiation in Belize.
Authors: Wong Wayne , Dickerson James , Sood Rupali , Yacab Ramon Argenes , Valtis Yannis , Lattin John , Garrity Philip , Bhatt Ami Siddharth , Huang Franklin W.
Published: June 2022

e18643

Background: Breast cancer is the most common cancer in low and middle-income countries. Belize, a middle-income country in the Caribbean with significant inequality, lacks a national screening program and has limited treatment capacity. There are no studies describing breast cancer characteristics in Belize in the available literature. We collected data from the sole public oncology clinic in the country, established in 2018 at Karl Heusner Memorial Hospital (KHMH), to describe the characteristics of breast cancer patients and establish baseline measurements of time to chemotherapy initiation for the curative intent treatment population; the aim being to identify potential areas for quality improvement. Methods: We performed a retrospective chart review of available patient data from December 2020 to December 2021. We examined the time from a patient’s initial visit at KHMH until chemotherapy initiation (TCI) in the neoadjuvant setting with patients stratified by stage. Significant outliers (predominantly patients with misclassified data or those with private access to physicians and therapeutics) were excluded. Results: The clinic provided care for 80 patients with biopsy-proven breast cancer between December 2020 to December 2021. Patients were 97% female with a median age of 55 (Range: 34-81). For stageable patients (n=75), 33% presented with clinically localized disease, 49% with locally advanced, and 17% with recurrent or metastatic disease. Of the 51 patients on chemotherapy, 57% were receiving preoperative treatment, 31% were on adjuvant therapy, and 12% on palliative therapy. Patients not on therapy (n=29) at KHMH were either in surveillance, referred to a private cancer center, or deceased. Neoadjuvant TCI was calculated for 21 patients after the removal of outliers (n=5). The majority of these patients arrived at their initial clinic visit with a biopsy-proven diagnosis. Mean TCI for early stage disease was 49 days (n=7, 95% CI [9, 89]) and locally advanced disease was 36 days (n=14, 95% CI [12, 61]). Aggregate mean TCI was 40 days (n=21, 95% CI [19, 62]). Conclusions: In Belize, breast cancer affects younger women and patients present with later stages of disease than in high-income countries; however, time to chemotherapy initiation in a small sample of neoadjuvant patients at the Belizean clinic was comparable. Given the inherent limitations of small samples of data, additional investigation is needed to support these findings, as well as to delineate patient barriers to access and potential for improvements in clinic follow-up. Nevertheless, indications of a robust TCI call for further characterization of this newly established cancer clinic and its practices.
The impact of patient-reported outcomes in cancer patients in Croatia.
Authors: Trivanovic Dragan , Kopic Boris , Budisavljevic Anuska , Hrstic Irena
Published: June 2022

e18659

Background: Perception of symptoms is essential for optimal cancer care and improving the quality of life but an inappropriate interpretation may lead to treatment outcomes failure or may leave the patients undertreated. This variation in the perception of adverse events (AEs) can lead to wrong assumptions and potentially unnecessary hospitalizations (H) or emergency room visits (ERV). Methods: Patients considered for inclusion were 18 years of age or older receiving systemic therapy and were able to read and understand questionnaire via tablet computers. All patients had a verified diagnosis of malignant disease of breast (31%), lung (17%), colorectal (16%), hematological (8%) or other site cancers (28%). Patients were asked on the same day as physician assessment, to complete 10 PRO-CTCAE symptoms (including fatigue, pain, nausea, vomiting, diarrhea, dysgeusia, appetite, sleep disturbance, fever, and alopecia). Participants remained on study until discontinuation of cancer treatment, withdrawal, or death. Informed consent was obtained from all patients and the study was approved by the institutional review board of the General Hospital Pula, Croatia. Concordance of symptoms reporting between patients and health care providers at the individual level was compared, and intraclass correlation coefficients were computed by a two way mixed effect model and an absolute agreement definition. Univariate and multivariate COX proportional hazard models adjusted for covariates including age, gender, cancer type and performance status were constructed for unplanned H and ERV. Results: The median age of 308 included patients in this trial was 62 years. Cohen's coefficient of agreement that corrects for chance for AEs gr. 1-5 and AEs gr. 3-4 was 0.115 (95%, CI, 0.15 to 0.02), indicating only slight agreement and 0.320 (95%, CI, 0.428 to 0.448) indicating fair agreement, respectively. Physicians underestimated symptoms at the group level (p < 0.013) for all symptoms. The highest level of agreement was found for pain but fatigue and alopecia were most underestimated. The median times of follow-up were 13 months, and 8,1 % of patients had H or ERV. Female patients had worse PRO scores, with higher levels of pain, fatigue, and alopecia across disease groups. In multivariate analysis, patient symptoms was not predictive, but we noticed trend for higher patient reports of pain (p = 0.05) for unnecessary H or ERV. Conclusions: The failure of the physician to identify a substantial number and severity of symptoms identified by the PRO instrument is not surprising considering the published experience in clinical trials. To our knowledge, this is the first such analysis aimed specifically at examining the reliability of physician identification of AEs in a real world practice in Croatia. The incorporation of PRO measures into routine practice might help to avoid unnecessary hospitalizations and emergency room visits. Clinical trial information: 2019-000855-15.
Development of a risk stratification model to predict oncology patient emergency room and/or hospital utilization.
Authors: Laird Courtney C , McLarty Sarah , Reddy Shirisha , Thompson Edward , Cullum Robert , Cavers William , Friend Kayla E , Johnson Kathryn D , Johlie Melissa , Sawicki Christine , Johnson Kjel Andrew
Published: June 2022

e18664

Background: Patients diagnosed with cancer require comprehensive care management during the complex cancer care journey to improve outcomes and control healthcare costs. A care team can use risk stratification to provide patient-specific interventions to improve outcomes and reduce unplanned admissions. The purpose of this study is to evaluate specific factors that may predict a cancer patient’s likelihood of requiring unplanned emergency room (ER) visits and/or hospitalizations, which can then ultimately be used to classify patients into risk categories and match cancer patients to the appropriate level of care management. Methods: Medical claims data from oncology patients included age, gender, cancer type and co-morbidities. Stepwise multiple regression was then used to determine the correlation between predictors and patient ER and/or hospital admissions during the study period, January 1, 2021, to December 31, 2021. Akaike’s Information Criterion (AIC) was used to limit the total number of variables included in the final model to those predictive of outcomes. A logistic regression model was to determine which predictors significantly correlated with unplanned outcomes; p < 0.05 was considered statistically significant. Results: 779 Medicare patients were evaluated. A total of 13 common comorbidities, patient age, gender and cancer type were explored. The final model included age, cancer type, and 6 comorbidities. Increasing age (p < 0.07) and certain cancer types (cervical, pancreatic and ovarian) increased the risk of emergency room and/or hospital utilization. Metastatic cancer (p < 0.007), sepsis (p < 0.0003), renal failure (p < 0.01), heart disease (p < 0.0002), hypertension (p < 0.002) and back pain (p < 0.003) were also significant predictors of an ER visit and/or hospitalization. In receiver operating characteristic (ROC) analysis, our model demonstrated strong discriminative power, with an area under the ROC (AuROC) of 0.762 and p < 0.05. Conclusions: This study developed and tested an algorithm to predict cancer patients for whom an ER visit and/or hospitalization outcome is more likely. The results can be used to prioritize and personalize care management resulting in improved outcomes, better allocation of care management resources, and improved overall value of care.
Clinical assessment of the Omicron outbreak in Europe and trends in morbidity and mortality from COVID-19 and cancer.
Authors: Cortellini Alessio , Aguilar-Company Juan , Sharkey Rachel , Sureda Balari Anna , Bertuzzi Alexia Francesca , Brunet Joan , Rizzo Gianpiero , Perachino Marta , Lee Alvin Jun Xing , Chowdhury Amani , Ruiz-Camps Isabel , Plaja Andrea , Hanbury Georgina Helen , Van Hemelrijck Mieke , Diamantis Nikolaos , Gaidano Gianluca , Grosso Federica , Gennari Alessandra , Tabernero Josep , Pinato David J. James
Published: June 2022

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Background: Whilst patients (pts) with cancer are at increased risk of adverse outcome from Coronavirus disease 2019 (COVID-19), no evidence exists as to the natural history of the SARS-CoV-2 B.1.1.529 (Omicron) variant in this population. Methods: Capitalizing on OnCovid study data (NCT04393974), a European registry that collects data on consecutive patients with cancer and COVID-19, we analysed COVID-19 morbidity and case fatality rates at 14 days (CFR14) across 3 phases defined following the evolution of the pandemic in Europe, according to date of COVID-19 diagnosis: “Pre-vaccination” phase (27/02/2020-30/11/2020), “Alpha-Delta variant” phase (01/12/2020-14/12/2021), “Omicron variant” phase (15/12/2020-31/01/2022). Results: By the data lock of 04/02/2022, 3820 consecutive pts were enrolled, 3473 of whom were eligible for this analysis. Among them, 2033 (58.6%), 1075 (30.9%) and 365 (10.5%) were diagnosed during the Pre-vaccination, Alpha-Delta and Omicron phases. Pts diagnosed in the Omicron phase were more likely aged < 65 years (48.6% vs 42.5%, 39.4% p = 0.01), had < 2 comorbidities (61.9% vs 55.6%, 52.1% p = 0.01). They had more advanced-stage tumours (62.1% vs 53.3%, 49.0%, p < 0.01) and were more likely receiving systemic anticancer therapy (SACT) at COVID-19 diagnosis (54.9% vs 43.9%, 39.6%, p < 0.01). Proportions of fully vaccinated/boosted pts were higher in the Omicron phase (33.9%-48.1%) compared to the Alpha-Delta phase (16.6%-2.3%, p < 0.01). Pts diagnosed in the Omicron phase had improved CFR14 (9.0% vs 13.9%, 23.1%, p < 0.01) lower hospitalization rates due to COVID-19 (24.4% vs 41.4%, 56.6%, p < 0.01), lower complications rates (15.3% vs 33.6%, 39.4%, p < 0.01) and reduced need for COVID-19 specific therapy (22.4% vs 43.0%, 65.7% p < 0.01) compared to the Alpha-Delta and pre-vaccinal phase. After adjusting for country of origin, sex, age, comorbidities, tumour stage, status and receipt of SACT at COVID-19, patients diagnosed in the Omicron phase displayed the lowest risk of death at 14 days compared to earlier phases. Similarly, rates of hospitalization and complicated COVID-19 were lowest for Omicron phase. Conclusions: This is the first study to portray the evolution of the SARS-CoV-2 Omicron outbreak in Europe, documenting an improvement in all COVID-19 outcomes compared to earlier phases of the pandemic. Enhanced healthcare capacity, improved disease management, immunization campaigns alongside differential virulence of viral strains are likely contributing to improved outcomes across phases.[Table: see text]
Clinical characteristics and outcomes of COVID-19 disease in patients with cancer.
Authors: Ozer Muhammet , Goksu Suleyman Yasin , Mahdi Mohammed , Gandhi Neel Jitendra
Published: June 2022

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Background: The Coronavirus Disease 2019 (COVID- 19) has been nominated as a pandemic by the World Health Organization short after has spreaded globally. Unfortunately, even after several effective vaccines approved by FDA, COVID-19 cases are still surging. Compared to the general population, patients with cancer are more susceptible to COVID-19 for many aspects. Therefore, better understanding of the clinical characteristics of cancer patients with COVID-19 is urgently needed to spare these vulnerable patients from severe disease course. Methods: This retrospective study was completed in Capital Health Regional Medical Center, New jersey, USA. Adult patients with COVID-19 diagnosed between March 2020 and May 2021 were included in this study. All selected COVID-19 patients were stratified as two groups: Patients with cancer and patients without cancer. Other variables were included as age at diagnosis, gender, race/ethnicity, insurance status, obesity, comorbidity score, treatment of COVID-19, oxygen requirement and vital status. The Charlson Comorbidity Index was used to calculate the comorbidity score. Results: A total of 562 COVID-19 patients were included in this study; 67 (12%) patients diagnosed with cancer. Patients with cancer were more likely to be older (73 vs. 62 years, p < 0.001), overweight (BMI 25-29.9) (39% vs 28%, p = 0.02), and have higher comorbidity score > 3 (58% vs 15%, p < 0.001) than patients without cancer. Patients with cancer more frequently received steroid therapies (52% vs. 34%, p = 0.003), remdesivir (21% vs. 4%, p < 0.001), and convalescent plasma (21% vs. 10%, p = 0.009). The rate of high flow oxygen therapy was higher in patients with cancer than patients without cancer (30% vs. 16%, p = 0.02). The days of mechanic ventilation, hospital stay, ICU admission were similar between two groups. Patients without cancer had better survival rate compared to patients with cancer (77% vs. 64%, p = 0.02). Patients with cancer had increased D-dimer level (2.4 vs. 1.6 mg/L, p = 0.08) compared to patients without cancer but it was not significantly different. Other laboratory findings were also similar between two groups, including WBC, neutrophils, lymphocytes, lactate, lactate dehydrogenase, creatine kinase, d-dimer, C-reactive protein, procalcitonin, fibrinogen, BNP, troponin, sodium, AST, ALT, and ferritin. Multivariable logistic regression analysis showed that patients with cancer were associated with increased odds of higher than 3 comorbidity score (OR 7.09 [3.85-13.05], p < 0.001) and oxygen therapy with nasal cannula up to 6 liters (OR 3.7 [1.04-13.5], p = 0.04). Conclusions: This present analysis showed that patients had increased risk of mortality compared to counterpart. Our results emphasize that cancer patients as a group are at higher risk due to advanced age and preexisting conditions.
Trend analysis of effect of COVID-19 pandemic on breast cancer staging.
Authors: Zhao Li , Singh Vinit , Khalid Farhan , Eng Margaret , Meghal Trishala
Published: June 2022

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Background: COVID-19 Pandemic has impacted the diagnosis and treatment of breast cancer and has been shown to increase the late stage cancer at presentation. Most of studies has made year-wise comparison with 2019 for this conclusion. Same studies have also concluded that there was no difference in treatment duration after the diagnosis. Methods: We conducted an IRB-approved retrospective chart review of 505 (255 in 2018 and 250 in 2019) patients diagnosed with Breast Cancer from January 2018 to December 2019 for pre-COVID era and 206 patients diagnosed from March to December 2020 i.e. COVID era. We compared the race, histology, and stage at presentation. Patients from COVID era were compared with newly diagnosed breast cancer in 2018, 2019 patients individually and together. All the above characteristics. were compared between COVID and Pre-COVID era. Continuous variable was compared by T-test and Categorical variable were compared with details were recorded. Descriptive statistics were used in the analysis. Results: Median age of diagnosis for 2018, 2019, and COVID era was 62 (38-83), 59 (37-80) and 64(39-97) respectively. The proportion of white Race during pre-COVID era was 87.52% compared to 89.32% during the COVID era without any significant difference between all 3 years. For Histology, there was significant difference between proportion of histology between 2019 and 2020 (p-value 0.003) whereas no difference between 2018 and 2020 (p-value – 0.21) or combined pre-COVID and COVID era. Incase of staging, significantly more late stage cancer was seen in the COVID era compared to 2019 but there was no significant difference (p-value – 0.225). Same finding was seen between combined pre-COVID and COVID era (p-value - 0.94). Conclusions: Findings from our study suggest that a longer-term trend analysis is required for to find out the accurate impact of COVID-19 pandemic on breast cancer and cancer in general. A population-based study incorporating data from multicenter and multiple year should be done to assess the real effect of COVDI pandemic.[Table: see text]