bluuebunny/crossref_metadata_2025 huggingface dataset:
Fostering diversity and inclusion in the preempt CRC study through strategic site selection and innovative recruitment tools.
Authors: Shaukat Aasma , Kutnik Karolina , Petersen Kristen R. , Xu Chuanbo , Lee Lilian C. , Baldo Lance , Levin Theodore R.
Published: June 2024

e23025

Background: Diversity in clinical studies is crucial in aligning the study population with the intended patient demographic. Freenome is developing a blood based test (MyTectCRC) intended to offer a convenient and accessible option for colorectal cancer (CRC) screening. Its clinical validation is supported by the PREEMPT CRC study, a prospective, multi-center observational study. PREEMPT CRC was able to achieve a diverse population representing various ethnic, racial, and geographical backgrounds that reflect the United States population. This analysis evaluates the significance of strategic site selection and use of forward-thinking study tools in achieving a diverse and inclusive study population. Methods: Starting in 2020, PREEMPT CRC enrolled participants aged 45-85 at average CRC risk. Eligible and consenting participants underwent a blood draw and a screening colonoscopy, with the blood sample analyzed by MyTectCRC. To ensure diversity, strategic site selection was employed beyond large academic institutions and hospitals to smaller sites and community hospitals. The study also incorporated a decentralized clinical trial (DCT) model to reach broader geographical areas and used electronic consenting and mobile phlebotomy (MP) services to facilitate enrollment. Results: PREEMPT CRC enrolled 48,995 participants and achieved ethnic/racial diversity comparable to 2020 U.S. Census for Blacks (11.2%, vs 13.6%), Asians (6.8%, vs 6.3%) and Hispanic or Hispanic/Latinx (11.2%, vs 19.1%), Native Hawaiian or Other Pacific Islander (0.3% vs 0.4%). The primary site types were community hospitals and regional clinics, accounting for 45.5% of all sites, followed by health systems (12.0%), research institutes (18.5%), and academic centers/teaching hospitals (16.0%). The community clinics and academic centers enrolled the highest proportion of Black participants within their sites (21.4% and 12.1%, respectively). Research institutions had the highest proportion of Asian (24.8%) and Hispanic/Latinx (18.3%) populations. There was no significant difference observed in male versus female distribution between site types. Within traditional sites, 32% used MP service. DCT enrolled 12,137 participants (24.7% of total) from every state in the U.S., including high representation from rural areas (24.5%). Conclusions: PREEMPT CRC integrated multiple methodologies and tools to enhance diversity and inclusivity. This multimodal approach ensured diversified representation through the participation of sites with harder-to-reach populations, which was reflected in ethnic and racial data, as well as the geographical diversity. PREEMPT CRC study underscores the importance of incorporating early diversity planning into study strategy and using multiple methods to broaden the representation of the patient population. Clinical trial information: NCT04369053 .
Modeling any potential change in size, cost or patient benefit, resulting from incorporation of ctDNA, or other “optimizing diagnostic,” as part of a novel “SMARTer” oncology registration trial design.
Authors: Taub Floyd , Wright Suzin Mayerson , Gao Dexiang
Published: June 2024

e23027

Background: One limitation in speeding more effective new cancer therapies to patients, and saving lives, is the time and expense of clinical trials. A second limitation is cancer is often a chronic disease, sequentially treated with multiple therapies; unlike in most registration trials, patient progress through a series of therapies. Building on previously published Sequential Multiple Assignment Randomized Trial (SMART) design, herein we model a new design to enhance registration (“SMARTer”). An “optimizing diagnostic” (often a ctDNA test) is used to determine, soon after initial use, if the new therapy is working. Those failing it are switched to the Standard of Care (SOC) for analysis they remain in the “new therapy first” arm, which is compared to the SOC arm. The aim is for all patients who benefit from the new therapy to remain on it, and, in contrast, if they are doomed to fail it, switch to SOC promptly to receive benefit from SOC early in the therapy path. Methods: To determine the value of the “new therapy first” arm we compared it to SOC by modeling assumptions of the accuracy of the optimizing test and the level of benefit of SOC after new therapy. The benefits of a new therapy first and switching, vs. SOC, was compared to a standard new therapy vs SOC “head-to-head”, without switching. Six scenarios, varying the effectiveness of the therapies, each with 16 combinations of sensitivity and specificity, were modeled. Results: Surprisingly, a good optimizing test reduces the number of patients by as much as 84% (from 710 to 114 in total) when new therapy alone had a 40% response rate and SOC a 30% rate (see table). When new therapy alone was no better than SOC, a study of 104 patients was sufficient to document that using the new therapy first added to patient benefit and could save lives, assuming independent mechanisms. Conclusions: SMARTer design thus significantly increases chances of approval, better mimics patients’ real world therapy path, and would reduce both time and cost significantly. An Optimizing Diagnostic, predicting appropriateness of a second dose/round of therapy based on the benefit of the first dose/round, thus facilitates clinical trials in a manner analogous to a Companian Diagnostic predicting the appropriateness of starting the first dose of a new therapy. [Table: see text]
Cancer care during a time of crisis: Israel’s experience during wartime.
Authors: Yakir Rottenberg , Rose Adam
Published: June 2024

e23030

Background: During the last decades, there have been many crises in the world, including COVID-19, the Ukraine-Russia war and major tsunamis and earthquakes. These situations create challenges for providing appropriate care for cancer patients. It remains an important research priority to understand how to improve care delivery for cancer patients under conditions of stress or emergency. Methods: Israel has one of the highest-quality healthcare systems in the world. Strengths of the health system include advanced technology, universal health insurance, and four strong health maintenance organizations. Israel’s health system recently performed relatively well during the COVID-19 pandemic. Here, we report on system efforts to continue providing care despite the massive terrorist attack by Hamas of October 7, 2023, the ongoing rocket fire, and the mobilization of young and middle-aged adults to the army, which led to staff shortages. Our report focuses in particular on efforts to maintain continuity and quality of care for cancer patients. Results: There have been three main pillars of Israel’s efforts to maintain care for cancer patients despite the challenges. 1) We activated strategies learned from previous events, including the COVID-19 pandemic and other wars. This enabled continuing treatment of cancer patients, including those who had been evacuated from border-adjacent areas, in oncology departments that are either missile-proof or adjacent to a protected area. 2) The existence of universal health insurance, together with strong health maintenance organizations, enabled us to fill in gaps in social needs and ensure that no patient is “left behind”. This, in turn, allowed patients and their care teams to continue their cancer care without reimbursement barriers or other interruptions, despite the challenges. 3) There was a massive groundswell of volunteerism and lay-led social service initiatives. Almost half (48.6%) of the Israeli population engaged in some volunteer activity during the first two weeks of the war. This included volunteers who provided transportation for patients to and from treatments, donation of medications aimed at helping evacuees from border areas, and volunteer medical staff, such as recent retirees. These civil initiatives played a critical role in providing the initial response to the urgent needs that were left unaddressed by the government. Conclusions: We identified three main pillars that enabled continuity and high quality of care for cancer patients to continue despite a major crisis. A rapid response due to having similar, previous experiences and ready plans. A high-performance and resilient health delivery system, and lay volunteerism in times of crisis. While Israel’s challenges in the present period are unique, nevertheless lessons can be learned by health systems that wish to become more resilient and able to provide adequate care in times of crisis.
An analysis of the trends and distribution of political contributions from hematologists and oncologists in the United States.
Authors: Waris Shanawar Ali , Siva Nanda , Waris Imtisaal , Saifuddin Adnan , Dasu Sriram , Safi Salah Ud Din
Published: June 2024

e23041

Background: In today's increasingly tumultuous political landscape, understanding how healthcare providers are engaging the system to contribute to shaping the future of healthcare policy has become increasingly important. Policy can directly influence funding priorities, research agendas, and regulations for providers. This cross-sectional study aims to assess political contributions made by hematologists and oncologists across the United States from 2009-2022. Methods: Political donations to the U.S. Presidential, Senate, and House of Representatives campaigns made by hematologists and oncologists between 2009-2022 were collected from the Federal Election Commission database. Keywords used in the occupation search query were “oncologist”, “hematologist”, “oncology”, and “hematology”; the raw data was filtered to remove non-physicians. Each individual contribution was addressed to a recipient committee, which were characterized as “Democratic”, “Republican”, or “Independent”. Results: From 2009 to 2022, a total of 2889 contributions were made by hematologists and oncologists to campaigns for presidential and national legislative campaigns grossing a total of 1,324,397 with a mean donation value of $458 per contribution. Of campaign contributions, 68% ( $905,388), 31% ($405,257), and 1% ($13,751) went to democratic, republican, and independent campaigns respectively. The total number of contributions increased from 77 totaling a sum of $48,902 in 2009 to 203 totaling a sum of $107,281 in 2022. Republicans experienced an increase in total dollar amount of contributions of 9.42% from 2009 to 2022. The top five states with the highest contributions in dollar amount were California, Texas, Maryland, Florida, and Georgia, in descending order. Conclusions: The total political contribution amount made by hematologists and oncologists in the United States has increased from 2009 to 2022. Further investigation of how physician contributions influence the development and implementation of healthcare policies is imperative.
Disparities by sex in Hispanic patients with cutaneous melanoma: A national database analysis.
Authors: Mishra Anjali , Taylor Mitchell , Ituarte Bianca , Clausen Michaela , Barett Erin
Published: June 2024

e23045

Background: Melanoma is the fifth most common form of malignancy in the United States.1 Studies have established that Hispanic patients have worse melanoma-specific survival compared to non-Hispanic White individuals.2 However, there is a paucity of literature investigating sex differences in patient characteristics and outcomes within Hispanic melanoma patients. Thus, the aim of this study is to further examine sex differences in melanoma characteristics and disease-specific survival within Hispanic patients. Methods: Individuals of Hispanic descent diagnosed with microscopically confirmed cases of cutaneous melanoma (ICD-O-3 codes 8720/3-8780/3; Primary Site codes C44.0-C44.9) between 2000 and 2020 were identified through the Surveillance, Epidemiology, and End Results (SEER) database. Statistical analyses involved Chi-squared tests, Kaplan-Meier and log-rank methods, and multivariate Cox regression, with significance set at a p-value < 0.05. Results: In a cohort of 12,328 Hispanic melanoma patients (43.3% male, 56.7% female), a significant association between sex and age was found (p < 0.001). The greatest proportion of males were in the 60-79 age group (39.7%), while females were predominantly in the 40-59 age group (39.0%). Greater number of males had truncal melanomas (31.4%) compared to females having lower extremity melanomas (35.2%) (p < 0.001). Females exhibited higher rates of localized disease (80.3% vs 70.2%) while males were more frequently diagnosed with regional (18.5% vs 13.8%) and distant disease (11.3% vs 5.9%) (p < 0.001). Males demonstrated greater mean Breslow thickness (1.80 vs 1.44; p < 0.001), elevated rates of lymph node positivity (37.2% vs 27.2%; p < 0.001), and metastatic disease (2.8% vs 1.6%; p < 0.001). On univariate Kaplan-Meier analysis, males demonstrated significantly reduced disease-specific survival (182.9 months) compared to females (214.2 months) (p < 0.001). After adjusting for age, disease stage, annual income, rural vs urban residence, and primary tumor site, male sex independently increased disease-specific mortality compared to females (HR = 1.31; 95% CI 1.16-1.48; p < 0.001). Conclusions: Our investigation reveals that Hispanic males tend to receive melanoma diagnoses at older ages, advanced-stage disease, and primarily on the trunk.3 Furthermore, our study is the first to highlight a significantly reduced disease-specific survival in males compared to females. The observed sex differences may arise from a complex interplay of behavioral factors and immunological, hormonal, or genetic influences.4 Men exhibit a lower likelihood of engaging in skin self-examinations and seeking medical assistance. Limitations to this study include use of data reported through a national database. Nonetheless, this study underscores the significance of sex-specific variations in presentation and disease-specific survival among Hispanic patients.
Thromboembolic incidents in prostate cancer patients: A nationwide propensity-matched study.
Authors: Devarkonda Vishal , Ali Shafaqat , Kumar Manoj , Farooq Faryal , Byreddi Laxman Yashwant , Sultan Muhammad , Afzal Muhammad Sohaib , Nasir Bilal , Atluri Sundeep
Published: June 2024

e23082

Background: Venous thromboembolic events (VTE) are a major cause of morbidity and mortality in cancer patients. We aim to investigate the outcome and incidence of acute DVT and PE in prostate cancer compared to all other malignancies. Methods: The National Readmission Database (2016-2020) was utilized to identify all-cause admissions for patients with a history of prostate cancer. A Propensity Score Matching (PSM) model, matched such patients with subjects having any type of other malignancies. Pearson’s x2 test was applied to the PSM-2 matched cohorts to compare outcomes. Results: Among 3.2 million all-cause hospitalizations of prostate cancer patients, about 3.3% suffered a VTE. The majority had acute DVT (1.6%), followed by PE (1.1%) & DVT with PE (0.6%). On a propensity-matched & multivariate analysis, patients with prostate cancer have a lower incidence of acute PE (1.1% vs 1.9%, aOR: 0.57), DVT (1.9% vs 2.8%, aOR: 0.65) & combined DVT with PE (0.6% vs 1%, aOR: 0.62) [p < 0.001] as compared to other malignancies. Among different VTEs, the mortality was highest for Acute PE (aOR: 2.69), followed by DVT with PE (aOR: 1.68) & DVT (aOR: 1.55) [p < 0.001] in prostate cancer. Resource utilization is also higher in prostate cancer hospitalizations complicated by VTE, with patients suffering a DVT having the highest LOS (9 vs 3 days) & total cost of hospitalization ($20,425 vs $14,452) [p < 0.001] followed by DVT with PE and only PE [p < 0.05]. Interestingly, patients with DVT have higher readmission rates as compared to PE at 30 days (16.6% vs 13.5%, p < 0.001) and subsequently at 90-day intervals. Conclusions: The odds of venous thromboembolism were lower in prostate cancer when compared to all other patients with active cancer. The mortality was highest for PE in this cohort, while healthcare-related burden and readmission rates were higher for DVT. [Table: see text]
Employing machine learning (ML) and explainable artificial intelligence (XAI) to predict and explain suicidal ideation among patients with prostate cancer.
Authors: Poolakkad Sankaran Satheesh Kumar , Mohan Minu , Epstein Joel Brian , Pili Roberto
Published: June 2024

e23086

Background: It is anticipated that implementing machine learning (ML) strategies will impact the clinical decision-making process in the future. This study aimed to compare the accuracy of various machine learning algorithms in predicting suicidal ideation in patients who were receiving treatment for prostate cancer (PC). Further, to predict suicidal ideation and explain the burden of illness (BOI) by utilizing ML algorithms and XAI-based interpretability. Methods: We analyzed the United States 2017 National Inpatient Sample database for patients hospitalized for PC using linear and non-linear ML methods. Using techniques such as forward selection (FS) and backward elimination (BE), Random Forest (RF), decision trees, Multivariate Adaptive Regression Splines, and Gradient Boosting Machine (GBM), we determined subsets and features. We used linear and non-linear MLs-- Lasso, Ridge, RF, and Neural Networks (NN). A 70% and 30% partitioning was performed on the training and test datasets. The performance of the model was tested using discrimination (C-statistics), the Receiver-Operating Characteristics (ROC) curve, and the Hosmer-Lemeshow tests on both the training data and the test data. Several XAI approaches, including permutation significance, global surrogate marker, feature interpretation, interactivity, and local interpretability, were also utilized to examine the BOI (Length of stay (LOS)) among PC cancer cohort with suicide ideation. Results: We identified 680 patients with suicidal ideation among 208,730 PC patients. The most important variable derived through FS and BE were depression, drug abuse, psychiatric disorder, alcohol dependence, race, Medicaid beneficiaries, cardiac arrhythmias, metastasis, weight loss, congestive heart failure, and un-complicated hypertension, further confirmed through the GBM and other methods. There was successful documentation of demographic, socioeconomic, and clinical characteristics through feature selection approaches. Linear models, Lasso, and Ridge demonstrated an excellent area under the ROC for all cohorts ( > 0.9 in train and test datasets). On the other hand, tree-based models, such as RF, performed poorly (AUC 0.72 for train and 0.66 for test). The findings of the XAI methodologies showed that among PC suicide ideation, higher BOI was associated with patients staying in low-income neighborhoods, Whites, Medicaid beneficiaries, and those with weight loss. Conclusions: We showcase the increasing capability of predictive analytics, particularly XAI, in predicting suicidal ideation. The combination of the vast amount of data generated by the digitalization of healthcare systems with the advanced processing power of modern servers enables the development of machine learning-based care pathways, which has the potential to revolutionize clinical decision-making in cancer.
Investigations of the quality of fertility preservation education provided to patients with cancer at a large community hospital.
Authors: Zhao Chelsey ShengQi , Fenech Melissa , Miklas Maegan , Ntienjem-Sherwood Isidora , Hamm Caroline M.
Published: June 2024

e23087

Background: Infertility is a challenge many young cancer patients face as a consequence of aggressive treatments. Moreover, many eligible patients do not receive discussion about their fertility, and even fewer obtain referrals to fertility specialists. The goal of the investigation was to examine the frequency and quality of fertility preservation education provided to eligible patients at the Windsor Regional Cancer Program (WRCP). Methods: The first part of the investigation involved a retrospective chart review which identified 203 patients that presented to the WRCP between January 15, 2018 to January 15, 2020 under the age of 40. Amongst these patients, we identified 54 patients that were eligible for fertility preservation. These 54 patients were contacted to participate in the survey and we received 11 responses. The survey data collected include demographics and experience with fertility preservation. The data were analyzed using University of Windsor RedCap. Windsor Regional Hospital REB approval number: 22-426. Results: The retrospective chart review revealed that 34% of the 54 eligible patients did not receive documented fertility preservation counseling. Amongst the survey respondents that had fertility preservation discussions, 86% (6 patients) cited that it was initiated by a healthcare provider. In addition, we found that only 27% (3 patients) of survey respondents were interested in pursuing fertility preservation. The reasoning cited most often included not wanting children, already had children, and barriers such as finances, time and effort to pursue fertility preservation and fear of delaying fertility preservation. Moreover, the 3 survey respondents successfully pursued fertility preservation in the form of sperm collection (2 patients) and freezing eggs/embryos (1 patient). Conclusions: We identified the need to improve standardization of fertility preservation education in eligible patients. Moreover, we found that few patients desired fertility preservation. Although this is a small number of patients, providing appropriate fertility education is essential in cancer survivorship. Our next steps include piloting and implementing an improved fertility education program.
Access to and equity in cancer clinical trials in Oregon.
Authors: Oyogoa Emmanuella , Crespo Michael , Marsh Trisha , Castro David , Mayer Kathleen , Turk Eliana , Shannon Jackilen , Nemecek Eneida R.
Published: June 2024

e23100

Background: Approximately 20,000 people per year are diagnosed with cancer in Oregon. The OHSU Knight Cancer Institute is the only academic cancer center in the state, with the nearest center located almost 200 miles away. Clinical trials (CT) are essential for cancer care but only a small proportion of eligible people participate due to multiple factors. In this retrospective study, we identified the association between sociodemographic factors and cancer CT participation at OHSU. Methods: Adult patients referred to OHSU for evaluation and treatment of a new cancer 2019-2022 were included. Data collected included age, gender, race/ethnicity, zipcode, insurance, type of cancer and CT participation. Zip-codes were used to estimate poverty level as defined by the American Community Survey, rural vs. urban location and distance to the cancer center. Multivariate analysis was conducted to identify factors associated with CT participation. Results: A total of 14,261 patients with median age 65 (18-101) years were treated at OHSU from 2019-2022 (86% for solid tumors, 14% hematologic malignancies). Of these, 53% were > 65yrs, 51% male and 8.5% self-identified as non-White (including Hispanic). These numbers are similar to those reported in the statewide cancer registry. About 61% of those < 65 yrs were privately insured, 84% of those > 65 yrs had Medicare, and 31% were from areas at or below the national poverty level. About 40% lived > 30 miles from OHSU (29% > 60 miles, 14% > 120 miles) and 31.5% lived in rural areas. A total of 2134 patients (15%) participated in cancer CT (8% interventional, 6% interventional therapeutic and 10% noninterventional). Factors independently associated with decreased CT participation on multivariate analysis included age > 65yrs regardless of type of insurance, < 65yrs with public insurance, female, racial/ethnic minority, solid tumor diagnosis and cancer care at a community-based clinic (Table 1). Conclusions: Patient with cancer treated at OHSU are representative of the population in our catchment area and region. However, there is room to improve access and CT participation for older adults and persons from racial/ethnic minorities and disadvantaged backgrounds. Our study highlights the importance of understanding the catchment area and accounting for social determinants of health when implementing community outreach strategies for CT participation. [Table: see text]
Disparities in gynecologic oncology clinical trial availability in the United States: A state-level analysis.
Authors: Ko Emily Meichun , Tubridy Elizabeth , Spataro Solorzano Sebastian , Simpkins Fiona , Smith Anna Jo Bodurtha , Boland Mary
Published: June 2024

e23128

Background: Disparities in minority participation in gynecologic cancer clinical trials is well documented. FDA guidance stipulates geographic informed analyses to reduce barriers to trial participation. We performed a geographical analyses of gynecologic cancer clinical trials in the United States relative to racial distribution and social vulnerability indices to identify areas of increased need. Methods: We performed a cross-sectional analysis of NIH ClinicalTrials.gov by retrieving all trials first posted 1/1/2013 through to 1/10/2024. We searched for ovarian, uterine, cervical, endometrial, vaginal/vulvar and gynecological cancer. We reviewed enrollment criteria to exclude non-gynecological cancers (1643 trials) or non-invasive gynecological conditions (224 trials). We aggregated census data, state-level total population size, percent Non-Hispanic White (NHW), and the FEMA Expected Annual Loss per state as a measure of social vulnerability. Using R statistical software (v 4.3.1), we measured the association between these variables and the number of gynecological trials per 100,000 persons using Pearson’s correlation. Results: We identified 3,428 trials, filtered down to 1,561 invasive cancer trials. The most common trials were ovarian (911, 58.3%) and cervical (438, 28.0%), followed by endometrial (385, 24.6%), uterine (158, 10.1%), vulva-vaginal (78, 4.99%), and 7.62% genetic-based. Texas had the highest number of trials (501) followed by California (454) and New York (427). The state with the highest population-adjusted number of trials was South Dakota (8.57 trials per 100,000 persons), followed by Rhode Island at 8.38 per 100,000 persons. California, Mississippi, and Puerto Rico had the lowest number of trials per 100,000 persons with 1.148, 0.979, 0.466 respectively. States/territories with greater than 4 trials per 100,000 were comprised of populations that were > 50% NHW. The correlation between the state-level percentage of NHW in 2020 and the number of trials per 100,000 persons was p = 0.057 indicating that there was a correlation between Whiteness at the state-level and trial availability. We found that states with higher FEMA expected annual loss had lower numbers of gynecological trials per 100,000 persons (p < 0.001). Conclusions: We found a disparity in the geographical distribution of trials available for gynecological cancers that was correlated with racial disparities and social vulnerability. Efforts to increase decentralization of trials and improve access and availability of gynecologic cancer clinical trials are necessary to increase equity for minority representation in clinical trials at the national level.
Evaluation of clinical adherence measures for oral oncolytics: A systematic review.
Authors: Lee Eugene , Klos Laura , Zhong Rui , Carlson Rebecca , Dark Erin , Muluneh Benyam
Published: June 2024

e23130

Background: Despite the critical importance of adherence monitoring for oral oncolytics, there are no standard measures for clinical practice. Methods: We conducted a systematic review using 4 databases aiming to characterize validated adherence monitoring tools utilized in either pre-implementation or evaluation of clinical programs. Various Medical Subject Headings (MeSH) and other search terms related to cancer, oral oncolytics, adherence, metrics, and outcomes were included. Measures used only for research (outside of clinical use) were excluded. Two independent reviewers screened articles with a third reviewer resolving discrepancies. Data extraction and quality assessments concluded the review. Results: Out of 751 screened articles, 73 proceeded to full-text review, with 6 selected for data extraction and quality assessment (Table 1). Two studies focused on the Morisky Medication Adherence Scale-8 (MMAS-8) tool, while others examined Michigan Oncology Quality Consortium Patient Reported Outcome Measure (MOQC PROM), 6-Item Girerd Scale, Medication Adherence Self-Efficacy Scale (MASES), and EXPeriencia con y ADherencia a AntiNEoplasicos Orales (EXPAD-ANEO). Among the five tools, MASES featured the most questions (24). All tools were implemented by healthcare professionals. Girerd and MASES were used specifically in hematologic and solid tumor populations respectively, whereas the remaining tools were applied in both cancer types. MMAS-8 and MASES were employed to evaluate current clinical programs, while MOQC PROM, Girerd, and EXPAD-ANEO were used during pre-implementation for future programs. Common biases from studies included limited generalizability, patient self-reported adherence credibility, and variability in patient baseline characteristics. Conclusions: Our findings highlight the paucity of validated adherence monitoring tools in clinical practice. The five tools discussed above exhibit potential in measuring adherence in a clinical setting; however, small sample size and short duration limit generalizability. Further investigation of new and existing tools in broader settings is needed. [Table: see text]
Evaluating the impact of depression on self-reported quality of life measurements for patients with a history of cancer: A 2022 behavioral risk factor surveillance system questionnaire study.
Authors: Ward Erin Patricia , Sood Divya
Published: June 2024

e23131

Background: Patients with cancer are known to have higher rates of depression than the general population. Depression is known to impact cancer-specific outcomes. We aimed to understand if a history of depression for patients with a history of cancer impacts self-reported quality of life measurements. Methods: We identified patients with a history of cancer and patients with a history of depression using the 2022 phone based Behavioral Risk Factor Surveillance System Questionnaire. The demographics and reported outcomes for several quality-of-life questions, including perceived emotional support, social isolation, cancer-related pain, memory, and ability to complete daily activities independently, were compared using a Chi-Square analysis. Results: Of the 441,339 patients over the age of 18 who completed the 2022 survey, 72,765 (16%) reported a history of cancer, and 90,489 (21%) reported a history of depression. Of those patients who reported a history of cancer 72,443 (99.6%) answered if they had ever been diagnosed with depression, and of these 14,987 (21%) reported a history of depression. Compared to patients with cancer alone, patients with a history of cancer and depression were younger (10% vs. 4% under the age of 45, p < 0.001), less often married (45% vs.59%, p < 0.001), more likely to be in the lowest income bracket (8% vs. 3%, p < 0.001), more likely to be obese (36% vs. 26%, p < 0.001), and more often active smokers (16% vs. 7%, p < 0.001). Several quality-of-life questions were asked of the participants, although not everyone answered each question. Overall, among patients with cancer, patients with a history of depression were more likely to report > 14 poor mental health or physical health days (35% vs. 6% and 34% vs. 14%, respectively, p < 0.001) and more likely to report their general health as fair or poor (41% vs. 21%, p < 0.001). Cancer patients with depression were less likely to report always having the social or emotional support that they need (33% vs. 55%, p < 0.001) and more likely to report always or usually feeling socially isolated (17% vs. 5%, p < 0.001). Cancer patients with depression were more likely to report pain associated with their cancer (16% vs. 7%, p < 0.001) and five times as likely to report issues with making decisions and memory (31% vs. 6%, p < 0.001). Finally, patients with depression were also more likely to report an inability to run errands alone (21% vs. 7%) and report difficulty getting dressed or bathing (12% vs. 4%, p < 0.001). Conclusions: Among people with a history of cancer, those with a history of depression are more likely to report worse physical and mental health, report worse social and emotional support and report less independence in activities of daily living. Further work is needed to understand the complex interactions between depression and quality-of-life measures for cancer patients.
Evaluation of online patient education materials for acute myeloid leukemia.
Authors: Weiss Jessica M. , Mahayni Yasmeen , Steinberg Amir S.
Published: June 2024

e23135

Background: Acute myeloid leukemia (AML) is the most common adult leukemia, accounting for approximately 80% of all cases. In the modern healthcare landscape, a substantial number of patients turn to online platforms such as Google for information pertaining to their diagnoses and treatment options. This study sought to assess 14 online AML websites for their understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT). Methods: Fourteen patient-facing U.S. online AML websites were searched in Google, selected and analyzed using the PEMAT criteria. The PEMAT rating tool is a freely accessible online resource evaluating print and audiovisual information. The ‘understandability’ section is scored out of 17 possible points and the ‘actionability’ section is scored out of 6 possible points. The websites were rated by two independent reviewers and any discrepancies were discussed. The websites were categorized by Government, Public/Private companies, Patient Advocacy Groups, Professional Societies, and Cancer Centers. Results: The study analyzed 14 websites on AML education material. The mean ‘understandability’ score was 85% ( Range: 79%–92%); Government scored the highest, followed by Professional Societies, Patient Advocacy Groups, Cancer Centers, and Private/Public Companies. PEMAT metric 11 ‘the material provides a summary’ scored poorest across all ‘understandability’ criteria. The mean ‘actionability’ score was 66% ( Range: 56%–90%); Patient Advocacy Groups scored the highest, followed by Professional Societies, Government, Private/Public Companies, and Cancer Centers. PEMAT metric 26 ‘the material uses visual aids whenever they could make it easier to act on the instructions’ scored poorest across all ‘actionability’ criteria. Conclusions: Most of the AML websites analyzed were easy to understand but lacked material that prompts patients to take action. As patients turn to online website sources for information, it is crucial that these education materials provide clear information that patients can appropriately act on. This study highlights an opportunity to enhance online patient education material by adding action-oriented features, such as content summaries, tangible tools, and visual aids. [Table: see text]
Disparities in cancer care utilization in patients with brain tumors: A nationwide analysis.
Authors: Ahmad Shahzaib , Javaid Saad , Aziz Nouman , Khan Hadin Darain , Yousaf Mirza Rehan , Rehman Haseeb Ur , Chaudhary Muhammad Ahsan Hanif , Ganiyani Mohammad Arfat , Khokhar Muhammad Abbas , Ahluwalia Manmeet Singh
Published: June 2024

e23142

Background: Brain tumors are highly aggressive and are associated with poor prognosis. Minority populations still experience inequities in the delivery of cancer care, despite concerted efforts to reduce such disparities. We studied disparities in receipt of cancer care for patients with primary brain tumor. Methods: National Inpatient Sample 2017-2020 was queried to identify the patients admitted with brain tumor. Results of the study were reported in accordance with the STROBE guidelines. We divided the cases into two groups i.e., the patients undergoing curative cancer care (CC) and palliative care (PC). We performed descriptive analysis and analyzed predictors of getting PC or CC using logistic regression analysis. Results: Among 144,355 patients hospitalized for primary brain tumor, 33,645 (23.3%) received PC. Mean age of PC group was 60±20.1 years, while the CC group had mean age of 52.9±21.3 years ( P < 0.01). Compared to patients < 45 years, the patients with age 46-64 years and ≥65 years were more likely to receive PC (OR = 1.9, 95% CI 1.6-2.4 and OR = 2.23, 95% CI 1.8-2.8, P < 0.01, respectively). The proportion of Black patients in the PC group was more compared to the CC group (10.4% vs 7.6%). However, the proportion of White patients in the PC group was lower than the CC group (74.8% vs 77.9%), P < 0.001. Black patients were more likely to receive PC (OR = 1.5, 95% CI 1.3-1.7, p < 0.01), while no difference was observed in other ethnic or racial groups. Compared to CC group, PC group had a higher percentage of patients with Medicare (50.9% vs 35.9%), Medicaid (14.4% vs 13.8%) and a lower percentage of patients with private insurance (31.9% vs 47.0%) p < 0.01. Patients with private insurance were less likely to receive PC (OR = 0.7, 95% CI 0.6-0.8, p < 0.01). PC group had a higher percentage of low-income group patients compared to the CC group ($1-$49,999: 22.5% vs 20.6% and $50,000-$64,999: 25.3% vs 24.2%, P < 0.01). Patients in teaching hospitals had decreased odds of PC (OR 0.8, 95% CI 0.7-0.9, P = 0.01) compared to non-teaching hospitals. Patients with major depressive disorder (OR 1.3, 95% CI 1.1-1.4, P < 0.01), electrolyte disorders (OR 1.6, 95% CI 1.5-1.8, P < 0.01), and atrial fibrillation (OR 1.3, 95% CI 1.1-1.5, P = 0.01) had increased odds of receiving PC. Conclusions: The patients who underwent PC were older, more likely to be Black, and of low-income groups. Patients in teaching hospital had a decreased likelihood of undergoing PC. The health care disparities should be addressed to achieve a better quality of care across all groups. [Table: see text]
A real-world assessment of the treatment-related symptoms and associated burden among patients with lung cancer receiving chemotherapy.
Authors: Galaznik Aaron , Rusli Emelly , Holt Tracy , Kramer Mordecai , Trask Peter
Published: June 2024

e23159

Background: For patients (pts) with metastatic non-small cell lung cancer (NSCLC), treatment with chemotherapy has shown improved survival, symptom control, and increased quality of life. In clinical trials, the adverse event profile associated with these treatments has been identified. Less explored is the real-world experience of treatment-related symptoms and treatment burden. The objective of this study is to evaluate treatment-related symptoms and treatment burden among chemotherapy-treated NSCLC pts through an electronic remote symptom monitoring system. Methods: Pts diagnosed with NSCLC who received chemotherapy at U.S. academic cancer centers were enrolled in the Carevive’s Patient Reported Outcomes Mobile Platform (Carevive PROmpt®) from September 2020 - June 2023. 174 pts were enrolled. Weekly PRO-CTCAE-derived surveys assessed severity, frequency, and interference for 16 symptoms: anxiety, constipation, cough, decreased appetite, diarrhea, fatigue, general pain, insomnia, mouth/throat sores, muscle pain, nausea, numbness and tingling, rash, sadness, shortness of breath, and vomiting. The GP5 assessed weekly overall side effect treatment bother. Results: The mean age of NSCLC pts was 67.3 (SD = 9.2) years, with 51% female, and 12% African American. The majority of pts, 126 (72%), were enrolled at or within 1 month of the start of treatment. Ninety-one (52%) received chemotherapy and 83 (48%) received chemotherapy in combination. At enrollment, cough, fatigue, and shortness of breath was reported by > 40% of pts receiving chemotherapy, with constipation, decreased appetite, general pain, and numbness/tingling occurring in > 20% of pts. Over 40% of pts reported being at least “somewhat” bothered by the side effects of treatment. Pts with decreased appetite, nausea, and numbness/tingling were more likely to rate symptoms as “somewhat” or “very much” bothersome. No differences were noted for those with combination regimens. Conclusions: For real-world chemotherapy pts, the most frequent symptoms at enrollment were cough, fatigue, shortness of breath, decreased appetite, general pain, and numbness/tingling. Patients with decreased appetite and numbness/tingling were more likely to note higher treatment bother. Results show the feasibility of assessing symptom burden and corresponding patient bother in a real-world NSCLC population, which will have increasing importance increasing use of new treatment modalities with and without cytotoxic chemotherapy. [Table: see text]
An application (ePRO) -based patient reported outcomes of quality of life from an innovative cancer care delivery model.
Authors: Pendharkar Dinesh , Tripathi Chandramauli , Parmar Ajay , Ather Mohammad Imam , Nagar Ashok Kumar , Raj Abhishek , Hari Vishnu
Published: June 2024

e23176

Background: With the accessibility of smartphones, it has become possible to develop applications for patient-reported outcomes. Quality of life (QoL) is an important measure in oncology research. We developed a phone application that could use any standardized form to be filled in by the patient. Here, we report using the EORTC questionnaire, QLQ-C30, built into the application as a form for data collection from our ongoing district cancer care program, which offers support at government district hospitals in India using an alternate oncology work force. Methods: An application (ePRO) was created, which allows one doctor administrator to follow the patients. Once the application is downloaded, the patient opens the QoL questionnaire (QLQ-C30), built into the application, and completes it using a smartphone. The researcher downloaded the data in Excel format and analyzed it. The application was attempted at a tertiary cancer center and a public hospital district cancer unit. A cross-sectional study was conducted over six months in 2023.The data were analyzed using SPSS version 24. Results: The application was downloaded and activated on the smartphones of 441 patients. Patients completed the form available through the application. Of all the respondents, 229 (51.9%) were male and 212 (48.1%) were female. The mean QoL of the tertiary hospital was 69.29, with a standard deviation (SD) of 18.98.The QoL scores were 50.94 (SD 23.50) in district hospital 1 and 77.01 (SD 17.35) in district hospital 2. The difference between one district and the other was significant (p < 0.001). The symptom scale scores varied between district hospitals and other hospitals. Conclusions: This presentation serves two purposes: to validate a new patient-reported outcome application and to provide data on QoL from peripheral centers compared with tertiary centers. The use of technology is feasible and can help gather patient-reported outcomes easily. There appears to be a difference in the quality of life of patients from different geographical locations. [Table: see text]
Cross-cultural differences in diet and quality of life between Taiwanese and American women during breast cancer treatment.
Authors: Yung Kristin , Thomas Maya , Liu Yu-Chen , Sander Grace , Pawlow Caroline , Chen Jacqueline , Wang Judy Huei-yu , Jeong Suin , Hsiao Fei-Hsiu , Chang King Jen , Lo Chiao , Kuo Wen-Hung , Huang Chiun-Sheng
Published: June 2024

e23187

Background: Limited research has examined the role of different food types (vegetables, fruits, meat, fat, and whole grains) on quality of life (QoL) among cancer patients undergoing active treatment. This study aimed to examine what different food intakes are associated with QoL among American and Taiwanese women who are newly diagnosed with breast cancer (BC). Methods: This ongoing observational study enrolled 77 American (Black, Latina, and non-Hispanic White) adult women from MedStar Georgetown University Hospital and 79 Taiwanese women from National Taiwan University Hospital. They were diagnosed with stage 0-III primary BC within six months prior to enrollment, were undergoing surgery, chemotherapy, and radiation, with no other cancers. Patient-reported overall health and QoL were assessed using the two global health items from the EORTC-QLQ30. Three random 24-hour diet recalls (two weekdays and one weekend) were administered using the NIH-developed ASA24 program. Linear regression was conducted to examine the associations between food categories and QoL outcome, adjusting for nationality, age, cancer stage, treatment type, body mass index, physical activities, financial problems, and appetite loss. Results: American and Taiwanese patients displayed differing food intake during BC treatment. Taiwanese patients consumed less starchy vegetables and total fat (both p < .01) than American patients, on average. Multivariate results indicated that QoL was positively associated with higher total vegetable intake (excluding starchy vegetables and legumes; β = 5.38, 95% CI: 0.22, 1.20), controlling for other food types and covariates. Starchy vegetables and legumes showed non-significant negative effects on QoL. QoL was positively associated with total fat intake (β = 0.11, 95% CI: 0.02, 0.21). Total meat, fruit, and whole grain intakes were not significantly associated with QoL. Conclusions: The associations between food intakes and QoL were not affected by nationality, regardless of food type. Non-starchy vegetables and adequate total fat intakes may support BC patients undergoing treatments. More research is needed to verify the identified associations and explore how cancer treatment affects the digestion of certain food types and their potential impact on QoL. This study provides cross-cultural insights into potential nutritional influence on QoL among patients undergoing cancer treatment.