bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective assessment of AI-enabled cost savings, continuous support, and psychosocial enhancement (AI New Era Study).
Authors: Xu Chunwei , Hao Yue , Jian Qijie , Zhu Youcai , Wang Qian , Pang Fei , Zhang Shirong , Wang Dong , Lv Donglai , Chen Hui , Yuan Shaohua , Wang Kai
Published: May 2024

e13615

Background: Cancer patients (pts) need extensive primary care across their treatment journey, yet the world's primary health systems struggle with patient volume and resource scarcity. This study aims to assess the effectiveness of Artificial Intelligence (AI) medical service model in primary care and clinical service pre-screening, as well as their potential impact on improving the quality of medical services and reducing medical costs. Methods: A total of 17,856 medical consultation inquiries from 7,522 pts with various types of cancer have been collected and categorized. The study employed a novel AI-driven medical service model (based on large language model), amalgamating clinical guidelines with a local oncology database, to prospectively field questions from 454 cancer-afflicted pts. Clinicians evaluated the accuracy and comprehensiveness of the responses to basic medical issues, while pts assessed the intelligibility and satisfaction. Results: Treatment-related inquiries constituted 34.44% (n = 6,149) of the total, with 81.53% of pts asking such questions. Basic medical issues were addressed in 65.56% (n = 11,707) of inquiries, raised by 59.78% of pts. Specific concerns within basic medical issues included test report explanations (20.45%), adverse reaction consultations (19.82%), and medication information requests (17.66%). In light of the prevalence of basic medical issues, the study prospectively explores the potential of AI technology to revolutionize medical models, driving the advent of a new era in healthcare research. As result, the AI model exhibited high performance across several metrics: accuracy (96.87 ± 10.29), comprehensiveness (97.40 ± 9.91), intelligibility (95.72 ± 12.62), and satisfaction (96.34 ± 11.03). Notably, the model demonstrated a proficiency in identifying queries necessitating physician expertise, with a 95.60% accuracy rate upon review. A survey of 50 outpatients indicated an enhancement in service speed (7.78%) and patient satisfaction (14.29%). This increase in satisfaction was primarily ascribed to pts' heightened sense of control and safety. When benchmarked against GPT-4, the AI model's overall performance was significantly superior (95.08 ± 10.05 vs 89.70 ± 12.85, p<0.01), particularly in domestic drug knowledge and gene report analysis. Conclusions: Largely fueled by the advanced capabilities of large language model, AI has the potential to profoundly reshape the entire patient care journey. Our AI medical service model efficiently meets key healthcare needs, addressing over half of clinical issues and cutting costs. It also guides pts to the right specialists for timely care. Early surveys indicate better primary care and improved doctor-patient relations. Further research is needed to understand AI's effects on fairness, access, and outcomes across varied demographic and socioeconomic strata.
Integrating electronic health records (EHRs) to facilitate cancer biomarker testing: Real-world implementation barriers and solutions.
Authors: Huelsman Karen M. , Offit Caroline , Waugh Wendi , McNair Christopher , Kurtin Sandra E. , Enstad Crystal , Rice Courtney , Osterman Travis , Yu Peter Paul , Shepard Gregg Christian , Martin Nikki A. , Kim Joseph , Kisiel Molly , Plotkin Elana
Published: May 2024

e13649

Background: Effective integration between EHRs and cancer biomarker testing processes is an unmet need across academic and community settings. Despite the benefits of EHR-integrated workflows and the desire for streamlined test results, as supported by a recent ASCO Workforce Survey, many health systems do not currently have this capacity, especially when reference labs are external to the ordering institution. Methods: The Association of Cancer Care Centers (ACCC) convened a live summit on October 4, 2023 to understand facilitators and barriers to integrating biomarker orders and results into the EHR. To capture a comprehensive perspective, ACCC convened 37 oncologists, pathologists, nurse navigators, and administrators from diverse settings using a range of EHRs, patient advocacy groups, and EHR/testing companies. Thematic analysis of the summit transcript and a post-summit assessment was employed to identify common experiences among participants. Results: The key benefits of EHR integration include increased efficiency with test ordering/result retrieval, streamlined communication, and improved clinical decision-making. Factors associated with successful EHR integration include strong clinical champions, creation of a precision medicine oversight committee, buy-in from administrative leadership, IT support to build EHR customizations, support from EHR vendors/reference labs, and coordinated project management. Notable barriers include variations in EHR interoperability, utilization of multiple reference labs, lack of consistent nomenclature, resistance to change, allocation of time for post-integration updates/maintenance, lack of internal IT capabilities/resources, and a need to establish different clinical workflows depending on which clinician places the biomarker order. Conclusions: The rapid expansion of biomarker-driven cancer treatments requires oncologists to have timely access to guideline-concordant clinical information to inform complex clinical decision-making. While EHRs can streamline clinical workflows, these results underscore the need to address operational and human factors to facilitate successful EHR-laboratory integration. Strategies to address barriers and build successful EHR integrations across diverse clinical oncology settings are crucial for optimizing how cancer biomarker tests are ordered, reported and used in clinical practice.
AI frontiers in oncology: Bridging the gap between humanity and machine.
Authors: Sharma Rubal , Di Petro Gaetano , Rajupet Sritha , El-Sayegh Suzanne , Kwok Yue Faat Raymond , Dhar Meekoo , Bershadskiy Alexander , Gut Thomas , Castellanos Mario R.
Published: May 2024

e13657

Background: Artificial intelligence (AI) is rapidly transforming medical education and how healthcare services are delivered. Oncology healthcare professionals (HCPs) can significantly benefit from the advances of AI including optimized diagnostic capabilities, treatment plans, resource allocation, patient outcomes and much more. The synergy between technology and healthcare is strengthening, heralding opportunities for a revolution in medical education and the broader healthcare industry. We developed an introductory AI workshop and conducted pre- and post-surveys, aiming to inform the design of successive workshops and an AI curriculum, to access knowledge, attitudes and perceived challenges for AI integration into Medical Oncology. Methods: An interactive one-hour workshop was conducted for physicians and faculty of the Hematology and Oncology department. 18 participants, encompassing 6 physicians and 12 other HCPs completed a pre- and post-workshop survey. We evaluated participants' knowledge, opinions, and perceived limitations regarding AI in oncology research, practitioner education, and clinical applications using both open and closed-ended questions, such as multiple-choice and 1-5 Likert scale formats. Results: Survey results included 18 pre-workshop and 17 post-workshop participants, 83% had no formal computer science training: AI knowledge in medicine and awareness of clinical AI applications increased by 100%. Interestingly 24% felt the workshop influenced their view on AI's role in their medical career and better prepared for AI-related challenges. 58% believed AI would assist clinicians within 5 years. However, the belief that AI will play a significant role in their own career did not change after the intervention. Data privacy concerns increased by 25%, while concerns about physician over-reliance on AI decreased by 15%. Notably, 76% were motivated to engage with AI during their future practice after the workshop. Conclusions: The AI initiative significantly enhanced oncology healthcare professionals' understanding and readiness for AI integration, despite most lacking prior formal AI education. A marked increase in AI knowledge and motivation to use AI in practice was noted, although perceptions of AI's impact in their day-to-day work remained unchanged with one workshop, contrasting expert views and predictions. Data privacy concerns rose, but decreased fears of over-reliance on AI indicate a more balanced perspective. These findings stress the need for ongoing AI education in healthcare and underscore the importance of baseline evaluations and feedback for shaping future workshops. Since, AI's integration into society is poised to transform healthcare, an AI curriculum is essential.
Impact of digital tools in oncology: A global analysis of the adoption of ONCOassist and NCCN Chemotherapy Order Templates (NCCN Templates) in collaboration with OncoAlert.
Authors: Gandur-Quiroga Maria Natalia , Krasnapolski Martin Alejandro , Yekeduz Emre , Izzo Matt , Bambury Kevin Dan , Morgan Gilberto
Published: May 2024

e13662

Background: The integration of digital technology has significantly transformed clinical practice, especially in oncology. ONCOassist, an application that integrates content from the NCCN Templates offers professionals quick and up-to-date access to information crucial for cancer treatment. Methods: To analyze and determine whether factors such as the Human Development Index (HDI) or Gross National Income (GNI) influence the adoption of the NCCN Templates, an in-application survey was distributed to health professionals who accessed NCCN content. The survey asked two questions: (1) would respondents use a specific NCCN protocol for a current patient (2) if not, the reasons why they did not utilize it. Finally, how the acceptance of the NCCN Templates was related to HDI or GNI and specialty was analyzed. Results: The survey was responded to by 2522 health professionals from 122 countries. The NCCN Templates were widely accepted (80%) across different geographic and economic contexts, indicating their global applicability and trust. Generally, GNI is categorized by high income, upper middle income, lower middle income, and low income, while HDI includes very high, high, medium, and low income. For the lowest levels of GNI and HDI, there were few responses (1% by GNI and 8% by HDI), and for purposes of this abstract, they were combined with the next highest level, lower middle income, and medium HDI. Using GNI, the rates of using the NCCN Templates in countries with high income (72%) were lower than those with upper-middle income (83%) and lower middle/low income (86%). In a similar inverse tendency, based on HDI, the utilization rates of the NCCN Templates were 70%, 83%, and 86% in countries with very-high, high, and medium/low HDI, respectively. When stratified by specialty, the absolute numbers showed that most respondents belonged to the field of the breast (36%), followed by gastrointestinal (28%) and lung cancers (10%). However, when we analyzed percentages, we observed that the decision-making process regarding protocol adoption was consistent among specialties despite the variance in specialist population size. When we analyzed the reasons for not utilizing NCCN Templates, “Other reasons” was the primary response (51%). Among the remaining answers, using specific local protocols was the primary reason (47% of the remaining), followed by the lack of drug availability (18% of the remaining) and reimbursement issues (18% of the remaining). Conclusions: There was a general acceptance of the NCCN Templates among healthcare professionals globally. The willingness to utilize NCCN Templates content was not strongly determined by the HDI or GNI, suggesting a perception of their utility beyond economic barriers. The protocol has the potential to be used in daily clinical practice, improving decision-making.
Usability and feasibility of the open-source GeRI platform for remote assessments in older adults with prostate cancer.
Authors: Mir Nabiel Ali , Che Yan , Mendez Megan , Huisingh-Scheetz Megan , Szmulewitz Russell Zelig
Published: May 2024

e13664

Background: The Geriatric Remote Initiative (GeRI) is an open-source tool to collect patient-generated health data for older adults with cancer. It comprises a WiFi-enabled Raspberry Pi tablet, a Bangle.js 2 wrist accelerometer, and Mi Body Composition Scale 2 for data collection. Following the initial phase where feedback from older cancer survivors and caregivers refined a demonstration GeRI platform, this study deployed a live version of GeRI in advanced prostate cancer patients to evaluate its feasibility and usability. Methods: In this single-arm pilot feasibility and usability study, we evaluated GeRI among ten advanced prostate cancer patients aged ≥65 years undergoing androgen deprivation (ADT) across varied frailty risk categories. Participants interacted with GeRI for ≥12 weeks. Data collection comprised demographics, clinical information, and vulnerability assessment (Cancer and Aging Research Group [CARG] score) from in-clinic surveys. Biometric (wearable/scale) and electronic patient-reported outcomes data from the tablet were securely transmitted to the institution’s HIPAA-compliant cloud. Usability was evaluated using the System Usability Scale (SUS), aiming for an average score of 68 or higher. Feasibility was achieved if ≥6 participants completed at least 50% of all prompted interactions with the system components (surveys, wearable, and weight/bioimpedance) throughout a 12-week study period. Results: Ten men with metastatic hormone-sensitive prostate cancer [median age: 73 years; 40% minority; median of 3 months of ADT exposure (IQR: 2-4.5); 80% had intensified ADT with 60% getting concurrent prostate-directed radiation] engaged with GeRI for a median of 104 days (IQR: 93-131). 40% were vulnerable with a CARG>5. System usability, evaluated by SUS, yielded a mean score of 84 (SD: 12.5). All participants met the feasibility criterion. Deficiencies in obtaining complete 48-hour accelerometry data from 7 participants were noted with only 1 being due to persistent non-wear of the wearable and the remainder due to transmission failure. Conclusions: The GeRI platform exhibited exceptional usability and met all feasibility benchmarks in a geriatric oncology setting, highlighting its potential despite technical hurdles in accelerometry data collection. Further deployment of GeRI is underway [or planned] through an expanded program focusing on other cancer types, including head and neck, and more robust biometric data collection.
Enhancing oncology research through data sharing and re-use: A five-year review of Vivli's global data platform.
Authors: Li Rebecca , Sudlow Rebecca Mary Caroline , OCallaghan Jennifer
Published: May 2024

e13670

Background: The last decade has seen a paradigm shift in clinical research with the accessibility of trial data, facilitating secondary analyses and the development of novel predictive models. Vivli a non-profit entity established in 2018, epitomizes this movement with its global platform (vivli.org) dedicated to the facilitating access to and re-use of individual participant data from completed clinical trials for use by researchers worldwide. Methods: Commencing with approximately 2,500 trials from 15 members, Vivli has expanded over five years to encompass more than 7,000 trials involving 3.6 million participants across 50 members who contribute trial data from various sectors (industry, academic, government and non-profit foundation). Results: Oncology trials constitute 11% of the Vivli data pool of 7,000 trials, constituting 36% of Vivli’s research proposals due to the therapeutic area's high-impact potential. Researchers accessing data in the Vivli platform have produced a significant body of scientific work, with 74 oncology-focused publications emerging from their analyses. Notably, Roche's data has been a key resource, denoted by the 28% of all Vivli proposals requesting access to Roche data. Fifty-eight publications have resulted from secondary analysis of Roche oncology data. The motivation for secondary analyses in oncology have been predominantly for new research into treatment effectiveness or safety (39%). Other reasons include confirmation of existing research (15%), individual participant data (IPD) meta-analysis (14%), statistical method (10%), clinical trial design (5%), and summary-level meta-analysis (4%), training/testing (7%), other (5%). Conclusions: The Vivli platform has proven to be a key resource in recent years for the oncology community enabling the integration and publication of new insights. The sharing of IPD is in part motivated to ensure reproducibility of findings; our experience demonstrates that a minority of researchers are interested in reproducibility analysis but the majority of research is focused on new insight generation. The platform's success in facilitating the findability, accessibility and reuse of patient level data is signified by ever increasing numbers of scientific publications emerging from analyses on the Vivli platform and this underscores its role in advancing scientific discovery and development within the field of oncology.
Efficacy of a culturally tailored screening campaign to tackle cervical cancer disparities among Hispanic patients.
Authors: Po Justine , Bookstein Arthur , Barahona Rosa , Baezconde-Garbanati Lourdes
Published: May 2024

e13697

Background: Cultural barriers have been identified as drivers of cervical cancer disparities. Hispanic patients specifically experience a higher incidence of cervical cancer and are more likely to be diagnosed at advanced stages than non-Hispanic White patients, mediated by multiple factors including cultural perceptions. To tackle cultural barriers in cervical cancer screening, this study assessed the efficacy of a community-based media campaign to increase Pap tests within a predominantly Hispanic community in east Los Angeles (LA). Methods: The campaign was implemented through a collaboration of local community members, design and communication experts, and cancer researchers. Prior to campaign design, focus groups were conducted with at-risk Hispanic women aged 18-45. Learnings from these focus groups and additional study of the visual culture of east LA led to selection of the jacaranda tree, which blooms for a short time in LA each spring, as a visual cue to pursue screening. This imagery was accompanied by a scheduling phone number and messaging (“It’s time.” and “You can prevent cervical cancer.”) in Spanish and English. Campaign materials were displayed on bus benches, billboards, and light post banners throughout east LA. To analyze campaign efficacy, intercept surveys were conducted from 2015-2018 by trained interviewers at locations throughout the community. In their preferred language, female participants (n=770) were asked standardized questions assessing campaign recall, message interpretation, and likelihood of scheduling a Pap test after viewing the campaign. Results: Among participants, mean age was 47.4 years, 88.7% primarily spoke Spanish at home, 25.2% were uninsured, 80.6% had not been vaccinated against HPV, and 12.5% had not had a Pap test in the last 3 years. 25.7% of participants recalled having seen campaign materials prior to survey, with 71.7% interpreting the message as a call to prevent and/or get screened for cervical cancer. 89.3% of participants stated that they were Likely or Extremely Likely to schedule a Pap test after viewing the campaign, including 87.2% of those who had not had a Pap test in the last 3 years. Conclusions: These findings support the efficacy of a community-based strategy to increase cervical cancer screening. This campaign showed high screening intent in a sample of participants who were disproportionately uninsured (25.2% v. 8.5% overall in the US in 2018), with similar efficacy among those who were overdue for recommended screenings. These results emphasize the benefit of culturally tailored messaging to improve screening uptake within underserved populations.
Rural-urban disparities in colorectal cancer-related mortality changes in the United States.
Authors: Byreddi Laxman Yashwant , Atluri Sundeep , Gaddam Shiva Jashwanth , Pothuraju Annapurna , Javvadi Sri Lakshmi Pratyusha , Devarkonda Vishal , Grewal Udhayvir Singh
Published: May 2024

e13714

Background: Colorectal cancer is the second leading cause of cancer-related death in the world. The incidence of colorectal cancer rates is higher in rural areas compared to urban populations which is attributed to obesity, and lower adherence to screening. It is hence vital to identify large population-based data on rural and urban disparities in colorectal cancer-related mortality. We, therefore, sought to analyze the outcome variances between urban and rural populations. Methods: We retrieved the mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database (years:1999-2020) for patients aged 15 years and above, with malignant neoplasm of colorectum (ICD-10: C18.9, C19, C20) listed as underlying cause of death. We analyzed age-adjusted mortality rates (AAMRs) per 100,000 population and assessed temporal trends in the average percent change (APC) of AAMRs by applying the simplest model with a maximum of 3 joinpoints (using the Joinpoint regression program 5.0.2). We conducted nonparallel pairwise comparisons to assess differences in trends between large metropolitan, small/medium metropolitan, and rural areas (per National Center for Health Statistics Urban- Rural Classification Scheme, 2016) using average annual percentage change difference (AAPCD). Results: A total of 810,577 colorectal cancer-related deaths were retrieved, amongst which 418,744 (51.6%), were in the large metropolitan, 249,933 (30.8%) were in the small/medium metropolitan, and 141,900 (17.5%) were in the rural regions. We noted a decline in the AAMR overall and across large metropolitan, small/medium metropolitan, and rural areas. However, the decline in AAMR was significantly higher among large metropolitan areas as compared to rural areas (AAPCD: -1.0043, 95% CI -1.64, -0.35, p=0.0022). There was no statistically significant difference in decline in AAMR when large metropolitan areas were compared to small/medium metropolitan (AAPCD: -0.4517, 95% CI -0.90, -0.002, p=0.051) and when small/medium metropolitan were compared to rural areas (AAPCD: -0.5526, 95% CI -1.16, -0.05, p=0.07). Conclusions: We identified discrepancies in the decline in colorectal cancer AAMR between urban and rural areas. A substantially lower decline in AAMR is eminent in the rural regions, as compared to the large metropolitan counterparts. This raises the concern for poor access to cancer care in this population group. Our results emphasize the imperative of prioritizing and designing strategies to ensure healthcare equity in rural areas. [Table: see text]
Racial differences in degrees of side effects to taxane based chemotherapy in patients with breast cancer.
Authors: Yuan Helen , Sheen Melanie Anne , Biggs Erin , Mishra Meena , Peeples James , Saxena Raina , Haupt Carl
Published: May 2024

e13726

Background: Taxane-based chemotherapy is well-established as a backbone of treatment for patients with breast cancer. While highly effective, all taxanes are known to cause peripheral neuropathy, with a high prevalence in obese patients. Other risk factors to developing peripheral neuropathy include older age, smoking, and hyperglycemia. Prior studies have shown that obesity is more prevalent in Black women compared with other racial group in the United States. Obese women have higher body surface areas and thus, tend to receive higher doses of chemotherapy. The higher total doses of taxanes received by obese women puts them at higher risks for developing peripheral neuropathy. We sought to evaluate the racial and BMI differences in rates of neuropathy in patients with breast cancer receiving taxanes. Methods: We created a 2-year database (2021-2022) of women diagnosed with breast cancer who received a taxane across a single health system. Data collected included age at diagnosis, self-identified race, breast cancer subtype, BMI, type of taxane, neuropathy, smoking and diabetes. Stratification analysis was performed using SAS Software 9.4. Results: The rate of neuropathy was 65.2% in White patients and 71.01% in Black patients (p=0.4649). The risk ratio between Black patients with neuropathy to White patients with was 1.26, 95% Cl (0.73-2.17), p=0.6525. In the total cohort of patients, regardless of neuropathy, 60.6% of Black patients had a BMI >30 compared with only 39.5% of White patients. Of those who had neuropathy, obesity was present in 64% of White patients and 65% of Black patients. Conclusions: The data presented here suggest that in a population of breast cancer patients treated with taxanes, there was a trend towards increased neuropathy in Black patients, but no increase in neuropathy based on BMI. Black women were more obese, which suggests that they are at increased risk for developing neuropathy. Factors such as universal effects of chemotherapy across races, comorbid conditions and insufficient sample size could have masked potential significant differences. Further research is needed to understand the complex elements influencing treatment responses in a diverse population. [Table: see text]
Healthcare disparities are associated with eligibility and enrollment in clinical trials in Louisiana.
Authors: Hartupee Conner D , Danos Denise , Mederos Eileen T , Ochoa Augusto , Nfonsam Valentine N , Moaven Omeed
Published: May 2024

e13728

Background: Clinical trials offer an opportunity to evaluate novel therapeutic strategies and modalities of care. Overall enrollment is low for clinical trials, but previous literature has highlighted lower rates of enrollment among underrepresented populations. A disproportionately low accrual of minority or other populations will result in reducing the ability of such clinical trials to prove general benefit to the overall population. This study aims to evaluate the population of those able or unable to qualify for and enroll in the Gulf South Clinical Trials network, a minority/underserved NCORP community site. Methods: Patient data was collected through interviews using a screening tool developed by the National Cancer Institute’s Community Oncology and Prevention Trials Research Group and active enrollment of ongoing clinical trials. Patients were interviewed regarding demographic data and tumor staging. Reason for ineligibility or non-enrollment was documented by the clinical staff. Clinical trials were categorized between Cancer-Control and Cancer Care Delivery Research (CC-CCDR) Trials and Cancer Treatment Trials from 2017 and 2023. Rates of eligibility and enrollment were compared via Fisher’s Exact tests. Results: CC-CCDR Trials had 363 participants while Cancer Treatment had 550 participants. CC-CCDR Trials resulted in 19% (n=69) of patients being ineligible with 81% (n=294) being eligible with a higher proportion of Whites (p<.001), non-rural (p = .021), low income (p=.007), private insurance (p=<.001), stage 1 tumors (p<.001), and having a genetic predisposition (p<.001) being ineligible. From the patients that were eligible, 13% (n= 39) of patients were not enrolled with 87% (n=255) of patients enrolled. Cancer Treatment Trials resulted in 23% (n=129) of ineligible patients and 76.5% (n=421) of eligible patients, with a higher proportion of low income (p=.002), private insurance (p=.035), and those not having genetic predispositions (p=.022) being ineligible. From the participants that were eligible, 20% (n=85) of patients were not enrolled with 80% (n=336) of patients enrolled, with a higher proportion of female (p= .002) patients not enrolled. Conclusions: Disparities in socioeconomic factors and female gender are associated with lower rates of eligibility and enrollment in clinical trials in community oncology settings. Future research identifying modifiable underlying factors can assist in developing strategies to improve enrollment in underserved populations.
Social determinants of health and treatment outcomes among a retrospective cohort of patients receiving immunotherapy for cancer.
Authors: Elko Catherine A. , Dragnev Nathalie C. , Evans Joni , Hunting John , Faucheux Andrew Thomas , Olson Eric , Ruiz Jimmy , Lycan Thomas William
Published: May 2024

e13744

Background: Disparities due to socioeconomic status persist in the treatment of cancer. Newer therapies, such as immune checkpoint inhibitors (ICIs), offer easier administration, lower risk of toxicity, and may improve accessibility compared to cytotoxic chemotherapy. Prior studies on ICI outcomes have shown mixed results at the county level, and there is a need to investigate social determinants of health at a more granular level. Our study aims to compare long-term ICI outcomes between socioeconomic groups at the census tract level among patients with cancer. Methods: The investigators compiled data from 2/1/2011 to 4/7/2022 on patients who received at least one dose of an ICI at a comprehensive cancer center and its outreach clinics to create a retrospective patient registry. Investigators used a secure, cloud-based REDCap registry, validated it with data quality rules, and resolved discrepancies. Clinical research specialists at Vasta Global captured most of the data. Investigators correlated patients’ ZIP codes with 2010 US Department of Agriculture Rural-Urban Commuting Area (RUCA) classifications and census tracts with 2020 Center for Disease Control Social Vulnerability Index (SVI) data. The univariate analyses used the ANOVA or Kruskal-Wallis tests, chi-square tests, and Kaplan-Meier methods. The multivariate analyses used Cox and logistic regressions, adjusting for age, race, ethnicity, type of cancer, smoking status, age-adjusted Charlson Comorbidity Index, and other comorbidities. Results: Our cohort consisted of 1,807 patients who were an average of 66 years old, predominantly male (60.8%), white (84%), non-Hispanic (98%), and had lung cancer (45.1%) as the most common tumor type. Univariate analyses found no associations between either RUCA or SVI and overall survival (OS), progression-free survival (PFS), immune-related adverse events (irAE), or time to irAE. For RUCA, multivariate analysis found that rural location of residence was associated with shorter PFS (all covariates, p 0.0386). For SVI, multivariate analysis showed no significant association with OS, PFS, number of irAEs, or time until irAE (including high-grade irAEs). Conclusions: Rural residence by ZIP code was associated with shorter PFS, indicating that there may be decreased access to ICI for these patients. However, the overall findings suggest similar ICI treatment outcomes across patients with widely variable social determinants of health by census tract. Further research is needed to understand how newer therapies can be best positioned to overcome disparities in cancer care.
Why cancer survivors who are parents are not getting support for their children.
Authors: Kabir Alicia
Published: May 2024

e13747

Background: Previous research indicates there are approximately two million cancer survivors in the United States who have children under the age of 18, impacting between three and five million youth. These children are often caregivers and face mental health issues, including fear and depression. Kesem is the largest nonprofit dedicated to supporting children impacted by a parent’s cancer, and we completed research to understand why so few cancer patients seek and receive support for their children. Methods: Kesem’s methods included three weeks of ethnographic research in mostly underrepresented communities in rural Mississippi, the Pacific Northwest, and southern Nevada. We completed 124 interviews in 18 cities. We also surveyed 147 survivors and reviewed over 30 databases. Results: There are two primary reasons why cancer survivors do not seek support for their children. First, many families lack awareness of support options. Second, even if support was presented, there are many barriers keeping a family from participating. There is a lack of awareness about parental cancer. The majority of the research participants had not heard of Kesem or any other program offering support for their children. Focus group data indicated that most survivors were given only information for themselves and for an adult caregiver. Most had never been asked whether they had children. Even if support were presented, survey data (n=147) showed that many families would not participate. Notably, survivors had low trust in the healthcare system. Only 63% of the patients surveyed (n=147) would have approached their oncologist’s or physician’s office for advice on how to support their children, had they known to ask. Per above, 49% assumed they could not trust the service provider offering support for their children, without even seeing information on the provider or the program. Conclusions: There are at least three million children in the United States alone navigating a parent’s cancer journey without the mental health support they need. During a cancer diagnosis, continued focus on the social determinants of health, including a review of the core family structure, is critical. We must be asking if youth are in need of support. In order to have higher participation in programming, we must build trust in underrepresented communities, which can be partially addressed by providing services at no cost to families and by being flexible to address scheduling concerns. [Table: see text]
Access to germline testing and prevalence of somatic mutations in patients with breast cancer from disadvantaged areas: A single-center study.
Authors: Alharbi Malak , Roy Arya Mariam , Krishnan Jayasree , Patel Archit , Patel Riya Jayesh , Kapoor Ankita , Attwood Kristopher , Catalfamo Kayla , Omilian Angela , Gage-Bouchard Elizabeth R. , Yao Song , O'Connor Tracey L. , Levine Ellis Glenn , Gandhi Shipra
Published: May 2024

e13750

Background: Socioeconomic disparities affect clinical outcomes in several malignancies including breast cancer (BC). The Area Deprivation Index (ADI) is a tool used to classify regions based on socioeconomic factors, including employment, education, housing, and poverty. Here, we investigate ADI among patients (pts) with BC seen at Roswell Park Comprehensive Cancer Center and its association with recurrence free survival (RFS), time to next treatment (TNT), overall survival (OS), and access to somatic mutation via next-generation sequencing (NGS) and germline testing of BC pts. Methods: We conducted a retrospective analysis of 409 pts diagnosed with stages 1-3 and de-novo stage 4 BC from 2014 to 2018. ADI scores were derived from patients' home addresses using www.neighborhoodatlas.medicine.wisc.edu and categorized into four quartiles: Q1 (80-100%), Q2 (60-79%), Q3 (40-59%), and Q4 (0-39%) with Q1 representing areas with highest deprivation. Demographic and clinicopathological characteristics were summarized by ADI. Kruskal-Wallis and Chi-square was used for comparing continuous and categorical variables respectively. Results: Among 409 pts, 92% were female, 77% White, and 10% Black. 30% (n=123/409) lived in the most disadvantaged area Q1, 26% (106/409) Q2, 26% (104/409) Q3, and 12% (51/409) Q4, and 6% (25/409) unknown. 72% pts were hormone receptor positive, 14% HER2+, and 14% triple negative BC. No significant differences were noted in the racial distribution, employment, comorbidities, smoking, screening mammogram, type of insurance, BC stage and subtype, and adherence to therapy by ADI. Access to germline testing was significantly lower among pts from Q1 and Q2: (68/232 or 28%) vs. (65/156 or 42%) from Q3 and Q4, p= 0.03. There was no difference in RFS and OS by ADI. There was a trend towards decreased TNT (9 vs. 11 months, p=0.4) among BC pts living in areas with higher vs. lower ADI (>60% vs <60%). Notably, among stage 4 pts, in disadvantaged areas with ADI >60%, there was higher prevalence of Estrogen Receptor1(ESR1) 72% (8/11) vs. 27% (3/11) and TP53 75% (9/12) vs. 25% (3/12) somatic mutations compared to less disadvantaged areas with ADI <60%, p= 0.08 and 0.04, respectively. Conclusions: Our study shows disparities in access to germline testing, with lower rates among pts from more deprived areas. Moreover, somatic testing results show distinct mutational profiles across different ADI groups, suggesting potential impact of ADI on somatic characteristics. Larger studies are needed to investigate the association of ADI with somatic mutation burden of BC.
Phase III study to evaluate the efficacy and safety of GLSI-100 (GP2 + GM-CSF) in patients with breast cancer with residual disease or high-risk PCR after both neo-adjuvant and postoperative adjuvant anti-HER2 therapy: Flamingo-01.
Authors: Patel Snehal , Thompson Jaye , Patel Mira , Daugherty F. Joseph , Rimawi Mothaffar F.
Published: May 2024

TPS617

Background: GP2 is a biologic nine amino acid peptide of the HER2/ neu protein delivered in combination with Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) that stimulates an immune response targeting HER2/neu expressing cancers, the combination known as GLSI-100. Of the 146 patients that have been treated with GLSI-100 over 4 clinical trials, GLSI-100 was well-tolerated and no serious adverse events observed were considered related to the immunotherapy. Methods: This Phase III trial is a prospective, randomized, double-blinded, multi-center study. After 1 year of trastuzumab-based therapy, 6 intradermal injections of GLSI-100 or placebo will be administered over the first 6 months and 5 subsequent boosters will be administered over the next 2.5 years for a total of 11 injections over 3 years. The participant duration of the trial will be 3 years treatment plus 1 additional year follow-up for a total of 4 years following the first year of treatment with trastuzumab-based therapy. Patients will be stratified based on residual disease status at surgery, hormone receptor status and region. Study size, interim analysis: Approximately 498 patients will be enrolled. To detect a hazard ratio of 0.3 in invasive breast cancer free survival (IBCFS), 28 events will be required. An interim analysis for superiority and futility will be conducted when at least 14 events have occurred. This sample size provides 80% power if the annual rate of events in placebo patients is 2.4% or greater. Up to 100 non-HLA-A*02 subjects will be enrolled in an open-label arm. The patient population is defined by these key eligibility criteria: HER2/neu positive and HLA-A*02; residual disease or high risk pCR (Stage III at presentation) post neo-adjuvant therapy; exclude Stage IV; completed at least 90% of planned trastuzumab-based therapy. Trial objectives: To determine if GP2 therapy increases IBCFS; to assess the safety profile of GP2; and to monitor immunologic responses to treatment and assess relationship to efficacy and safety. Study status: The study has been initiated at a number of sites in the US. The study is also expected to be opened in Spain, France, Germany, Italy, and Poland. Clinical trial information: NCT05232916 .
Mercy at War
Authors: Verreycken Quentin
Published: May 2024

This article examines the construction of military criminality and the granting of pardons to soldiers in late medieval France. By the beginning of the fifteenth century, the offenses perpetrated by men of war were a recurrent problem of public order for royal government. Criminal records as well as narrative sources used a rich terminology to qualify the military abuses suffered by the population, which distinguished criminal soldiers from ordinary offenders. Although these abuses were repeatedly denounced by political literature and were supposed to be severely punished according to legislation, the king of France frequently granted pardon letters to soldiers, allowing them to escape criminal prosecution in exchange for the continuation of their services. Far from being simply the result of a lax attitude of the king, these pardons reflected the fragile balance of royal power in the fifteenth century, which required the king to conciliate the exercise of justice and the conduct of warfare. Exploring the politics of royal pardon toward criminal soldiers and the reactions they provoked, the article demonstrates how the French crown dealt with military offenders at the end of the Hundred Years’ War and during its aftermath.
“Brutal by Temperament and Taste”
Authors: Eldridge Claire
Published: May 2024

Central to the historiography of the First World War, scholarship on violence has focused on abstract and impersonal forms of violence between opposing forces or on more personal forms of violence between civilians and enemy combatants. In contrast, this article uses military justice archives to explore instances of serious interpersonal violence and sustained brutality between soldiers in the same combat unit. It provides a new vantage point to explore the complex entanglement of violence and camaraderie and how that played out in the specific context of France's multiethnic Armée d'Afrique. Unpacking the accusations, explanations, and justifications that emerge from multivocal military justice sources illustrates what it meant to commit and be criminalized for certain acts of violence in a context saturated with violence; how and where the line was drawn between acceptable and unacceptable conduct; and, most important, what violence reveals about individual combat experiences and relationships between comrades. Granting access to the perspectives and internal worlds of this diverse group of soldiers, many from racially and otherwise marginalized communities, military justice evidences a complicated and rich set of situational responses and social relationships that enhances our ability to reflect on the conflict's impact on the men caught up in it.
Long-Term Survival Outcomes After Minimally Invasive Surgery for Ileal Neuroendocrine Tumors
Authors: Yogo Akitada , Paciorek Alan , Kasai Yosuke , Moon Farhana , Hirose Kenzo , Corvera Carlos U. , Bergsland Emily K. , Nakakura Eric K.
Published: May 2024

Background

Ileal neuroendocrine tumors (i-NETs) are characterized by their multifocality and bulky mesenteric mass. Having shown that minimally invasive surgery (MIS) utilizing a hand-access port device has favorable short-term outcomes and achieves the goals of surgery for i-NETs, we sought to analyze long-term survival outcomes of MIS.

Methods

One hundred and sixty-eight patients who underwent resection of primary i-NETs at a single institution between January 2007 and February 2023 were retrospectively studied. Patients were categorized into the MIS or open surgery cohorts on an intention-to-treat basis. Open surgery was selected mainly based on the need for hepatectomy or bulky mesenteric mass resection. Overall survival was analyzed using log-rank tests with propensity score matching (PSM) and Cox proportional hazards regression. PSM was performed to reduce standardized mean differences of the variables to <0.2.

Results

Overall, 129 (77%) patients underwent MIS and 39 (23%) underwent open surgery. Twenty-seven MIS patients were converted to an open procedure. The median follow-up time was 49 months (interquartile range 23–87 months). In the PSM cohorts, overall survival did not differ significantly between the MIS and open surgery cohorts {median 99 months (95% confidence interval [CI] 91–not applicable [NA]) vs. 103 months (95% CI 86–NA), p = 0.77; hazard ratio 0.87 (95% CI 0.33–2.2), p = 0.77}.

Conclusions

MIS is an alternative to open surgery for i-NETs, achieving similar short- and long-term oncological outcomes. Bulky mesenteric mass and a plan for concurrent liver resection are potential criteria for open surgery.
colonialidade da educação infantil: análise crítica das práticas pedagógicas em uma instituição em contexto periférico
Authors: Ferreira da silva Otavio henrique
Published: May 2024

Busca-se neste artigo problematizar a manifestação da colonialidade nas práticas pedagógicas de uma instituição de educação infantil situada em contexto periférico a partir da percepção de professoras e famílias. A argumentação e análise teórica adotada partem dos estudos da infância e teoria decolonial/contracolonial. Serão analisadas as conversas estabelecidas com adultos participantes da pesquisa, sendo quatro entrevistas realizadas com professoras e mães de crianças de uma instituição de educação infantil de contexto periférico e negro, localizada no município de Betim – MG. A partir dos sujeitos da pesquisa são apresentadas denúncias que configuram o que chamamos de colonialidade da educação infantil. A alimentação das crianças foi destacada, pelas professoras e mães, como um dos momentos da rotina pedagógica que gerava grande incômodo devido a práticas de violência com as crianças. Esta violência compõe o que se denomina como adultocentrismo, que existe para posicionar as crianças às margens do projeto civilizatório ocidental, sendo que nestes termos o adultocentrismo pode ser também compreendido como a peste branca produzida pela matriz eurocêntrica e colonial. Atuar contra a colonialidade e contra o adultocentrismo é defender uma experiência concreta e histórica para a educação infantil e não apenas teórica. Cada vez mais é preciso avançar na formação das professoras de forma conscientizadora quanto a emergência da contracolonização da educação infantil em articulação com o projeto de sociedade emancipatória para todos e todas.
O efeito conjunto de gemelaridade e prematuridade no aleitamento materno exclusivo na alta hospitalar
Authors: Ferreira Tainá Martins Gomes , Carvalho Marília Sá , Melo Enirtes Caetano Prates , Silva Maíra Domingues Bernardes
Published: May 2024

Objetivo: estimar a prevalência de Aleitamento Materno Exclusivo (AME) entre gemelares pré-termos e investigar o efeito de nascer gemelar e pré-termo no AME na alta hospitalar. Método: coorte prospectiva de recém-nascidos em uma instituição localizada no Rio de Janeiro, no período de 13 de março de 2017 a 12 de outubro de 2018. Dados coletados em  questionário e prontuário médico. Foi utilizado DAG para construção do modelo conceitual, análise exploratória dos dados e regressão logística múltipla. Resultados: a prevalência de AME na alta hospitalar de gemelares pré-termos foi de 47,8%. Pré-termos apresentaram maior chance de não estarem em AME na alta hospitalar. Não gemelares apresentaram maior chance de não estarem em AME na alta hospitalar. Conclusão: pouco mais da metade dos gemelares pré-termo não estavam em AME na alta hospitalar. Prematuros tiveram maior chance de não estarem em AME. Não gemelares pré-termo apresentaram maior chance de não estarem em AME.
Instrumentos de avaliação multidimensional de fragilidade para uso no cuidado de idosos com doença cardiovascular
Authors: Ferretti-Rebustini Renata Eloah de Lucena , Lucchesi Paola Alves de Oliveira , Alves Winnie da Silva , Rojas-Rivera Alejandra , Silva Diego Ferreira da , Ribeiro Joathan Borges , Simões Luan Cesar Ferreira
Published: May 2024

Objetivo: identificar quais os instrumentos disponíveis para avaliação multidimensional da fragilidade em idosos com doença cardiovascular, potencialmente aplicáveis durante a realização do Processo de Enfermagem. Método: revisão sistemática conduzida em oito bases de dados/portais, para identificação de estudos que apresentassem instrumentos multidimensionais de avaliação de fragilidade em idosos com doença cardiovascular e que fossem aplicáveis ao processo de enfermagem. Resultados: foram incluídos 19 instrumentos multidimensionais. O Brief Frailty Index for Coronary Artery Disease foi desenvolvido para uso no cuidado cardiovascular de idosos. O Frailty Index for Adults e o Maastricht Frailty Screening Tool for Hospitalized Patients foram desenvolvidos para uso no Processo de Enfermagem. Conclusão: apesar de apenas um instrumento ter sido desenvolvido para o idosos com doença cardiovascular e apenas dois serem aplicáveis ao processo de enfermagem, a maioria deles tem potencial de adaptação e validação para uso nesta população durante a avaliação de enfermagem.