bluuebunny/crossref_metadata_2025 huggingface dataset:
A retrospective study of Merkel cell carcinoma treated at The Ohio State University (OSU) in the last 20 years.
Authors: Li Chunjie , Kendra Kari Lynn , Contreras Carlo M. , Blakaj Dukagjin , Wu Richard Cheng Han , Verschraegen Claire F.
Published: June 2023

e21586

Background: Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine cutaneous malignancy. The analysis of interventions and benefits of treatments remain limited. In this retrospective study, we analyzed the clinical features and outcomes of MCC patients treated at the OSU Comprehensive Cancer Center (OSUCCC). Methods: Electronic medical records of MCC patients who were treated from 2000 to 2021 at OSUCCC were reviewed. 179 patients were enrolled. 153 patients were analyzed for overall survival (OS) after excluding 26 patients due to loss of follow-up or insufficient data. Clinical features were collected. The first patient was treated with immunotherapy (IO) on 2/24/2015. The period after this date was defined as the IO era (87 patients). Results: Among 179 patients (median age 73, male 64.8%), 41.9% died, 13.4% were lost to follow-up and 44.7% were alive by 12/31/2022. Primary tumor locations were head (50.8%), upper & lower extremities (21.2% & 10.6%), unknown primary (6.1%), trunk (5%) and neck (4.5%). Patients with stage I, II, III and IV were 41.9%, 12.8%, 36.9% and 8.4%, respectively. Sentinel lymph node biopsy (SLNB) was performed in 73.8% of patients; tumor involvement in SNL was confirmed in 38.5% and SLNB attempts failed in 15.1%. Patients who received surgery, local radiation, IO, chemotherapy and targeted medication were 92.7%, 66.5%, 27.4%, 10.1% and 2.8%, respectively. All 75 stage I patients had wide excision, and 50.7% received local radiation. 12% of stage I patients developed tumor recurrence, with IO administered in 55.6% of those patients. Most patients with stage II (52.2%) and stage III (34.8%) received surgery followed by radiation. 20% of patients with stage IV received surgery followed by radiation and IO. The median OS was 95 months (95% CI 67-123), the 3-year survival rate was 70%, and the 5-year survival rate was 61% for the 153 assessable patients. The median OS in stage I, II, III and IV was 149, not reached, 65 and 20 months, respectively ( P< 0.05). Survival in tumors on the head/neck was similar to the upper and lower extremities (median OS 102 vs. 71 vs. 99 months, P> 0.05) but slightly superior to the trunk disease (median OS 102 vs. 15 months, P= 0.072). The outcome of never-smokers was superior to former smokers (median OS 156 vs. 71 months, P< 0.01). The median OS of stage IV patients with IO was superior to those without IO (95 vs. 10 months, P< 0.05). Among dead patients in the IO era, the median OS of patients with IO was longer than those without IO (22 vs. 6 months, P< 0.01). Conclusions: Most MCC occur in the elderly, local or regional disease, and commonly on the head with a good outcome after multidisciplinary therapies. Former smokers and stage IV disease relate to a poorer prognosis. IO shows benefits with prolonged survival, especially in metastatic disease.
Immuno-embolization plus PD1 antibody in metastatic uveal melanoma.
Authors: Javed Asad , Davis Chad , Amarneh Mohammad , Freesmeier Michele T , Loeffler Bradley T. , Milhem Mohammed M.
Published: June 2023

e21592

Background: More than 90% of patients with metastatic uveal melanoma (MUM) have metastatic disease in the liver. MUM has a poor prognosis following development of liver metastasis. Control of disease progression in the liver correlates with improved survival in MUM. We present a single-institution experience of treating MUM patients with immuno-embolization (IE) of liver metastasis using GM-CSF in combination with an anti-PD1 antibody (Pembrolizumab). Methods: This retrospective study includes MUM patients who received liver-directed therapy (IE) in combination with IV Pembrolizumab at the University of Iowa. Patients selected for IE treatment had liver-predominant metastatic disease involving less than 50% of the total liver parenchyma, total bilirubin < 2, serum albumin > 3, and patient ECOG PS of 0-1. Alternating lobar IE was administered every 4 weeks using a combination of GM-CSF (2000 mcg) and Lipiodol. Pembrolizumab was administered IV at 200 mg every 3 weeks. Results: 11 MUM patients received a total of 58 IE treatments concurrently with IV Pembrolizumab. 4 patients achieved stable disease, and 2 patients achieved partial response as their best radiographic response during treatment. 6 patients received additional lines of therapy; of these, 4 were enrolled into clinical trials. 5 patients were alive at the time of analysis, and 2 patients were actively receiving IE plus Pembrolizumab therapy. The median overall survival (OS) from diagnosis was 25.6 months, and the median OS from the first IE treatment was 21.3 months. Complications related to IE treatments included bleeding (n = 1), severe post-procedural pain (n = 2), infection (n = 1), and anaphylactic reaction (n = 1). No unexpected immune-related side effects occurred with Pembrolizumab. Specifically, no immune-related hepatic toxicity was reported in any patient. Conclusions: Immuno-embolization of liver metastasis using GM-CSF in combination with systemic check-point inhibitor therapy is promising in the treatment of MUM patients, and had no reported immunologic hepatic toxicity in a single-institution patient cohort. The treatment combination is currently being evaluated in a prospective clinical trial (NCT03472586).
Demographic and socioeconomic risk factors in treatment of malignant eccrine spiradenoma.
Authors: Shin Won , Wong Jessica , Hsia Beau , Keirns Darby , Silberstein Peter T. , Wu Xinxin
Published: June 2023

e21595

Background: Malignant Eccrine Spiradenoma (MES) is a rare malignancy that affects the eccrine sweat glands. Although a rare malignancy, MES commonly metastasizes to various regions of the body. Tumor resection with tumor-free margins has a recurrence-free survival of only 23%. There is a lack of analysis on the demographic and socioeconomic factors of MES patients in the literature. Therefore, the National Cancer Database (NCDB) database was utilized in order to address the insufficient epidemiological and demographic information in MES patients. Methods: The National Cancer Database (NCDB) retrospective cohort analysis from 2004 - 2020 included patients with histologically-confirmed diagnosis of MES (N = 188). Regression analysis was used to interpret demographic factors (race, Hispanic origin, facility type, urbanization, income, and Charleson-Deyo score). Results: A total of 188 confirmed cases of MES were identified in the database between 2004 – 2020 with a gradual increase of diagnosed patients per year (R2 = 0.2). The average age of diagnosis was 64.7 years (SD = 15.1, range = 19-90 years). The most common primary site of MES was the skin of the trunk (30.9%), however, primary sites on the skin of upper limb and shoulder (19.1%) and lower limbs and hip (16.5%) were also prevalent. A majority of patients (78.7%) had a Charlson-Deyo comorbidity score of 0. Out of the 188 cases, 83.5% were classified as White. Patients skewed more towards the top quartile in income (30.3%) followed by the second highest quartile (24.5%). The primary source of insurance for patients was Medicare (45.7%) followed by private insurance (41.5%). Most of the patients resided near a metropolitan area (93.6%). The majority of patients were treated in a non-academic facility (59%), rather than an academic facility (41.0%). On average, patients lived 42.3 miles (SD = 184.4, range = 0.6 – 2,319.5) away from their treatment facility. Conclusions: This is the first NCDB analysis on MES, addressing a discrepancy in knowledge on demographic factors contributing to MES. Most MES patients are non-Hispanic and White with their primary site diagnosis being found at the trunk, as seen in case reports. MES patients are more likely to live near a metropolitan area, be treated in a non-academic facility, and have Medicare insurance. More research is imperative to establish an effective treatment protocol for patients with metastatic involvement and to better comprehend the influence of socioeconomic factors on diagnosis and overall survival of patients.
Outcomes among children with hearing loss admitted with acute lymphocytic leukemia.
Authors: Ramphul Kamleshun , Sharma Shivani , Chennapragada Suma Sri , Dandwani Mehndi , Verma Renuka , Pagidipally Alekhya , Sombans Shaheen , Sanikommu Sailaja , Ramphul Yogeshwaree , Dhillon Balkiranjit Kaur , Lohana Petras , Kumar Vijay , Arti Fnu
Published: June 2023

e22000

Background: Hearing loss among children can influence their growth and development. It can also influence how they seek help for any significant health-related complications. While some studies have highlighted such issues in the adult population, there needs to be more data on pediatric hospitalizations. We, therefore, attempted to conduct a retrospective analysis among Acute lymphocytic leukemia (ALL) cases in children with a diagnosis of hearing loss. Methods: Children below 18 were recruited from the 2016-2020 National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project. The diagnoses of ALL and hearing loss (of any form) were found using the International Classification of Disease 10th Revision (ICD-10) codes. We evaluated the presence of hearing loss in various patient groups and compared different potential complications of ALL between children with hearing loss (vs. those without). Results: We found 123430 weighted cases of ALL among children of ages 0-17 (inclusive) in the United States. Nine hundred fifty-five children (0.8%) also reported a diagnosis of hearing loss. Such diagnosis was more likely in patients who were Hispanics (vs. White, aOR1.458, 95% CI 1.247-1.703, p < 0.01) or of ages 11-17( vs. ages 0-10, aOR 1.920, 95% CI 1.679-2.196, p < 0.01). Meanwhile, children with ALL and hearing loss are less likely to be covered by Private Insurance (vs. Medicaid, aOR 0.811, 95% CI 0.699-0.941, p < 0.01), and less likely to be females (aOR 0.469, 95% CI 0.402-0.547, p < 0.01). Moreover, the presence of a diagnosis of hearing loss among ALL patients was also associated with a higher odd of septicemia (aOR 2.211, 95% CI 1.797-2.721, p < 0.01), use of palliative care (aOR 3.111, 95% CI 2.252-4.299, p < 0.01), and mortality (aOR 2.604, 95% CI 1.659-4.087, p < 0.01). Conclusions: Our analysis provides a novel perspective on the characteristics of hearing loss patients with ALL. Racial and socio-economic differences were confirmed. Furthermore, as they have higher odds of being under palliative care, they may also be sicker, which explains the higher odds of complications such as septicemia and mortality during hospitalization. Further studies must be done to understand the disparities seen in our study in a more clinical setting and address them appropriately.
Clinical features and outcomes of pediatric nasopharyngeal carcinoma: A SEER database study.
Authors: Nirmal Garima , Ali Adnan , Gupta Neha , Pendharkar Dinesh
Published: June 2023

e22011

Background: Nasopharyngeal carcinoma (NPC) is a rare malignant tumor. Little is known about the clinical, histological and survival characteristics of this disease in pediatric patients. Methods: We searched 17 registries of the surveillance, epidemiology, and end results (SEER) database for pediatric patients (£20 years old) with NPC who were diagnosed between 2000 to 2019. Data obtained included the demographics, histological subtype, stage, median household income, place of residence, cause specific survival (CSS) and overall survival (OS). We describe the clinical features and survival outcomes by race of pediatric patients. Results: A total of 373 primary pediatric NPC patients were reported between 2000-2019. Median age of diagnosis was 16 years (inter-quartile range 11.5 – 19 years). Of these, 68% were males, 59% were white and 27% were black. Undifferentiated non-keratinizing carcinoma group (WHO type III) was the most frequent (70%) histological sub-type. WHO type I and II disease was found to be present in 12% and 18% cases respectively. Nearly, 4 in 5 patients (83%) had stage III – IV NPC at presentation. Stage I and II disease at presentation was found to be present in 5% and 12% of NPC patients respectively. The median follow-up was 10.1 years. The 5 and 10 year survival estimates were 83% (95% CI 78.8% to 86.9%) and 79% (95% CI 73.9% to 83.1%) respectively. On multivariate Cox regression analysis, gender (Male vs Female: HR: 1.00, 95% CI 0.39-2.57; p = 0.998) and race (White vs Black: HR: 0.81 95% CI 0.311-2.10; p = 0.663) were not found to be significant predictors of survival. Conclusions: Pediatric patients at presentation with NPC were more commonly male, had undifferentiated non-keratinizing carcinoma (WHO type III) and stage III-IV disease. Gender and race were not found to be associated with an increased risk for mortality in pediatric patients presenting with NPC.
The spectrum of RAF1 fusion positive solid tumors in children and young adults.
Authors: Chen Jiani , Wu Jinhua , Schubert Jeff , Lin Fumin , Denenberg Elizabeth H. , Muir Alison , Romasko Edward J. , Fanning Elizabeth A. , Bhatti Tricia R. , Cole Kristina Ann , Kreiger Portia A. , Mattei Peter , Luo Minjie , Zhong Yiming , Resnick Adam C , Storm Phillip B , Santi Mariarita , Surrey Lea F. , Li Marilyn M.
Published: June 2023

e22013

Background: The RAF1 gene encodes a kinase protein in the MAPK signaling pathway. Fusions involving RAF1 have been reported in solid tumors with a higher prevalence in melanoma, breast cancer, non-small cell lung cancer, and brain tumors. The fusions typically replace the N-terminal autoinhibitory domain with the 5’ partner genes leading to autonomous activation of RAF1 kinase. The efficacy of MEK inhibitors as a potential treatment for RAF1 fusion positive tumors is under investigation. Here we present a cohort of 8 RAF1 fusions involved in a spectrum of tumors in children and young adults. Methods: A retrospective search for tumors harboring RAF1 fusion was performed using our clinical database from 2016 to date. The RNA fusion analysis targets >700 exons of 117 genes for known and novel fusions. Additional genomic alterations, tumor type, and patient demographics were also collected. Results: A total of 8 cases positive for RAF1 fusion were identified from 2526 solid tumors including 6 brain tumors, 1 sarcoma, and 1 hepatoblastoma. Histologic diagnoses of the brain tumors were mostly low grade gliomas with no other driver mutations. Two pilocytic astrocytomas harbored RAF1 fusions without the pathognomonic KIAA1549: BRAF fusions. Although RAF1 fusions have been reported in rhabdomyosarcomas, it is the first time that a RAF1 fusion is associated with hepatoblastoma. 4 of the 8 RAF1 fusions identified are novel (noted with * in the table). The break points in RAF1 were at exon 7, 8, or 10, demonstrating the retention of the kinase domain. Conclusions: We report 8 RAF1 fusion positive solid tumors in children and young adults, mainly in low-grade gliomas. Although rare, the presence of a RAF1 fusion not only facilitates the tumor diagnosis but also provides genomic evidence for potential targeted therapies. References: 1. The AACR Project GENIE Consortium. AACR Project GENIE: powering precision medicine through an international consortium. Cancer Discovery. 2017;7(8):818-831. 2. McEvoy CR et al. Profound MEK inhibitor response in a cutaneous melanoma harboring a GOLGA4-RAF1 fusion. J Clin Invest. 2019; 129:1940-1945. [Table: see text]
The impact of minority health social vulnerability on population-based cancer incidence.
Authors: Onitilo Adedayo A. , Shour Abdul R. , Anguzu Ronald
Published: June 2023

e22501

Background: Area-level social determinants of health impact cancer outcomes. However, less is known about how the Minority Health Social Vulnerability Index (MHSVI) affects cancer incidents at the county level. Methods: County-level data from the Agency for Health Care Research and Quality from 2019 for 3,232 counties were analyzed. MHSVI themes: socioeconomic, household composition, minority status/language, housing/transportation, healthcare infrastructure/access, and medical vulnerability were the exposures (continuous). Overall MHSVI were categorized into low (.01/.25), moderate (.26/.74), and high (.75/1) percentiles. The outcome was the total number of cancer incidents (continuous). Covariates include rural-urban regions. Using STATA/MPv.17, unadjusted and adjusted negative binomial regressions with population weighting were performed. P-values of ≤0.05 were considered statistically significant. Results: There were 201,547 total cancer incidents. Adjusted analyses reveal that cancer increased as vulnerability increased especially for household composition (IRR. 1.19, 95% CI: 1.15 – 1.23), healthcare infrastructure/access (IRR. 0.89, 95% CI: 0.87 – 0.91), and housing/transportation (IRR. 0.88, 95% CI: 0.85 – 0.90) themes. Cancer increased in moderate MHSVI areas (IRR. 0.94, 95% CI: 0.92 – 0.96) and high (IRR. 0.86, 95% CI: 0.84 – 0.88) areas compared to low. Conclusions: This study discovered social disparities in cancer incidence. Quantifying the influence of MHSVI on cancer incidents could provide insight into the design/focus of future initiatives aimed at reducing cancer disparities. [Table: see text]
Patient perception and adherence to lung cancer screening in those who meet eligibility criteria.
Authors: Menakuru Sasmith R. , Dhillon Vijaypal S. , Beirat Amir F. , Hanna Nasser H.
Published: June 2023

e22503

Background: The US Preventive Services Task Force reported 14.2 million Americans qualify for lung cancer screening. As per the Lung Cancer Screening Trial, using low dose computed tomography (LDCT) for screening demonstrated a 20% reduction in lung cancer-related deaths. Despite that, the 2022 State of Lung Cancer Report from the American Lung Association indicates that only 5.8% of eligible patients in the U.S. undergo lung cancer screening. Indiana, where this study was conducted, is ranked 46/50 and 44/50 in the number of smokers and incidence of lung cancer, respectively. A statewide lung cancer screening effort is greatly needed. Methods: The study population was recruited between 10/2022 and 1/2023 from 2 hospitals within the Indiana University Health network. Patients were surveyed during their primary care clinic visits. Eligibility criteria included a 20-pack-year or more history of smoking, an age between 50 and 80, and were either current smokers or quit within the last 15 years. A survey was designed with open-ended questions and was standardized to all participants. The questions covered the cohort's familiarity with lung cancer screening, the associated risk with smoking, and the potential hindrances to getting screened. After discussing the benefits and risks of the screening, the patients were then asked if they would consider getting an initial LDCT. Patients' compliance with their scheduled LDCT date was recorded. Results: 175 persons met eligibility criteria, and all reported understanding the link between smoking and lung cancer; however, 147 (84%) were unfamiliar with the need for screening. The barriers to screening, as described by the cohort, included fear of cancer diagnosis (33.7%), lack of symptoms (22.2%), the stigma associated with being a smoker (12.6%), doubting the usefulness of screening (12.0%), not wanting to quit smoking (6.9%), cost of LDCT in those under 65 (4.6%), fear of exposure to radiation (4.0%), believing that cancer treatment would be worse than continuing to smoke (2.3%), and mistrust of the medical system (1.7%). When the patients were educated on LDCT’s benefits and risks, 118 patients (67.4%) perceived it as beneficial and elected to get it scheduled. Of the 118 patients, 64 (54.2%) attended their scheduled initial LDCT. Conclusions: The patient’s perceptions of screening varied, and from our data, it appears that most smokers were unaware of the need for a LDCT and had multiple concerns. Once the patients were educated about the benefits and risks of lung cancer screening, most scheduled an initial LDCT and perceived it to be beneficial.
Inclusive healthcare for persons with disabilities (PWDs) in advocacy and partnership in breast and cervical cancer screening through the EMPOWER Program.
Authors: Nyongo Dorothy Ogada , Wambua Jacqueline , Kanari Catherine , Muchai Eugene
Published: June 2023

e22510

Background: With the growing burden of Women cancers in Kenya, integrating cancer screening and prevention to optimize horizontal care delivery models is a paramount approach to strengthening women-centered and cost-effective primary healthcare. EMPOWER is a unique public-private-partnership with the County governments of Kenya, County referral hospitals, County First Ladies Association, International Cancer Institute, Patient organizations (Women4Cancer & Africa cancer Foundation), AMREF and Roche Kenya to demonstrate and deliver integrated cancer prevention, treatment and capacity building including Persons living with Disability (PWDs). Objectives: 1. Generate buy in from county leadership and key stakeholders for PWDs inclusivity in human resources for health. 2. Tangibly demonstrate women PWDs can contribute to community health systems community health volunteers and Promote the Integrated approach screening. 3. Improve access to breast and cervical cancer screening for and through PWDs. Methods: The Project is a multi-faceted advocacy approach, including political leadership engagement and stakeholder alignment. The political leadership engaged with local government officials to raise awareness of the issue and secure support for the initiative. The stakeholder alignment involved working with healthcare providers, community organizations, and PWDs to ensure that the initiative was inclusive and accessible. Qualitative and quantitative methods were used to evaluate the impact of the advocacy efforts. Results: The project was successful in health management teams co-creating selecting and training 50 Women PWDs as community health volunteers, the first in Africa. The advocacy efforts led to an increase in screening rates for PWDs, with 30% more PWDs accessing screening services compared to the previous year. The PWDs involved in the initiative reported high levels of satisfaction with the program and appreciated the opportunity to play an active role in their own healthcare. Conclusions: The project demonstrated that it is possible to effectively implement inclusive healthcare for persons with disabilities (PWDs) through advocacy and partnerships. The successful adoption of advocacy to address disparities in breast and cervical cancer screening among PWDs highlights the potential for scaling up this work to reach a larger population. The alignment of political leadership and stakeholders, highlights the crucial role of creating a supportive environment to ensure the rights of PWDs to the highest attainable standard of health are upheld. Future efforts to address health disparities among PWDs should build on this approach, leveraging advocacy, partnerships, and cocreation of implementation to drive change at the community level.
Lung cancer screening status and acceptability of a personalized approach in Texas.
Authors: Resong Paul , Niu Jiangong , Duhon Gabrielle , Foxhall Lewis E. , Shete Sanjay , Volk Robert Joseph , Toumazis Iakovos
Published: June 2023

e22516

Background: Current lung cancer screening (LCS) guidelines rely on age and smoking history. Despite its proven benefit, only 5-15% of eligible patients receive LCS, with Texas having one of the lowest rates among states in the US. Personalized screening strategies select people for LCS based on their personal lung cancer risk and may increase LCS’s effectiveness and efficiency. We assess current LCS practices and the acceptability of personalized LCS among primary care providers (PCP) in Texas. Methods: We surveyed 32,983 Texas-based PCPs including primary care physicians, physician assistants, and nurse practitioners on an existing network (Protocol 2019-1257; PI: Dr. Shete), and 400 attendees of the 2022 Texas Academy of Family Physicians (TAFP) conference. Deidentified demographics, current LCS practices, and acceptability of personalized LCS were obtained. We analyzed the responses by subgroups of interest using comparative statistics. Using nonparametric bootstrap, we derived an enriched dataset and utilized it to develop logistic regression models to further understand respondent tendencies related to current LCS practices and acceptability of personalized LCS. Results: Response rates were 0.3% (n=91) and 15% (n=60) for the 2019-1257 and TAFP surveys, respectively. Respondent demographics are provided in the table. Most (84%) respondents regularly assess LCS in their practice, with those in the following categories more likely to assess for LCS eligibility: 40-49 years old, female, non-Black, physicians, with <10 years in practice, seeing >50 patients per week, and work at a non-residency training site (all p-values < 0.05). Half of the respondents were interested in adopting personalized LCS while an additional 40% wanted to learn more information. Respondents in the following categories were associated with increased interest in personalized LCS: younger than 60 years, non-White, non-physicians, seeing 100 or more patients per week, at a non-residency training site, and at a decentralized practice (all p values < 0.05). Majority (66%) of respondents expressed concerns regarding time availability with the personalized LCS. Conclusions: There is a great need to enhance the awareness and engagement of Texas-based PCPs about LCS. Most of the respondents expressed interest in personalized LCS. Time availability was the main concern related to personalized LCS. Findings from this project highlight the need for better education of Texas-based PCPs on the benefits of LCS, and the development of efficient decision tools to facilitate shared decision-making sessions to ensure successful implementation of personalized LCS. [Table: see text]
The impact of food insecurity on county-level colorectal cancer screening rates.
Authors: Jafri Mohammad Ali Syed , Ashraf Alina , Moazzam Zorays , Ashraf Sara
Published: June 2023

e22519

Background: Colorectal cancer screening has been associated with a marked reduction in cancer- related mortality, and the achievement of screening targets has been identified as a national objective by the Healthy People 2030 initiative. Although various social determinants of health (SDoH) have been demonstrated to impact healthcare access, the association between food insecurity (FI) and colorectal screening rates (CSR) remains unexplored. As such, we sought to assess the impact of FI on county-level colorectal screening rates (CSR). Methods: Data on county-level colorectal cancer screening and food insecurity rates in 2018 were extracted from the Centers for Disease Control (CDC) PLACES and County Health Rankings & Roadmaps databases, respectively. Notably, FI and CSR were categorized as low (lowest quartile), intermediate (middle two quartiles) and high (highest quartile). Multivariable logistic regression analyses were used to evaluate the association between FI and CSR. Results: Among 3,106 counties, the median CSR was 62.1% (IQR 58.9%–65.2%) and ranged from 39.8% (Kusilvak, Alaska) to 74.4% (Newport, Rhode Island). A majority of counties were urban (Metropolitan: n = 790, 25.4% vs. Urban: n = 1,671, 53.8% vs. Rural: n = 645, 20.8%). Overall, a fourth of counties had high screening rates (Low CSR : n = 788, 25.4% vs. Intermediate CSR : n = 1,545, 49.7% vs. High CSR : n = 773, 24.9%). Similarly, 25.0% of counties demonstrated high FI (Low FI : n = 777, 25.0% vs. Intermediate FI : n = 1,552, 50.0% vs. High FI: n = 777, 25.0%). Notably, counties with increasing FI were markedly less likely to have High CSR (Low FI : n = 353, 45.4% vs. Intermediate FI: n = 370, 23.8% vs. High FI: n = 50, 6.4%)(p<0.001). After adjusting for county-level rurality, population-to-primary care physician ratio, household income, unemployment, race/ethnicity, education and uninsurance, intermediate and high FI was associated with an incrementally lower likelihood of having High CSR compared with low FI counties (ref: Low FI ; Intermediate FI : OR 0.61, 95%CI 0.47–0.80; High FI : OR 0.31, 95%CI 0.20–0.50). Conclusions: Increasing county-level FI was independently associated with markedly lower colorectal cancer screening rates, indicating that FI may play a key role in driving disparities in access to cancer care. As such, policies targeted at vulnerable communities characterized by high food insecurity and social deprivation are critically needed to ensure equitable access to preventive cancer care measures such as colorectal cancer screening.
An epidemiological profile of colorectal cancer patients diagnosed at a single cancer center in Costa Rica from 2018 to 2022.
Authors: Garita Esteban , Wiernik Andres , Ulloa Catalina , Brenes Fernando , Flores Luis Diego , Alfaro Eduardo
Published: June 2023

e22523

Background: According to the International Agency for Research on Cancer, in 2020 there were 1,257 patients diagnosed with colorectal cancer (CRC) in Costa Rica. Despite Costa Rica having universal health coverage, approximately 20% of patients seek care outside of the public system. This growing population may be overlooked when creating registries or research. The aim of this study is to present a five-year epidemiological profile of patients with CRC diagnosed by the only private cancer center in Costa Rica: Centro de Cáncer y Hematología del Hospital Metropolitano. Methods: A retrospective review of all the patients with biopsy proven CRC diagnosis from January 2018 until November 2022 at the center was completed. Data was extracted from pathology database that included both endoscopic and surgical samples. Variables of interest included year of diagnosis, gender, age, pathological staging, and tumor site. Variables were analyzed by descriptive statistics. Results: A total of 253 patients (n = 253) were identified. When stratified by year, there were 16 patients (6.3%) diagnosed in 2018, 59 (23.3%) in 2020, and 67 (26.5%) in 2022. There were 129 female patients (51.0%) and 124 male patients (49.0%). Age was normally distributed with a mean of 65 ± 14 years and a range of 29-92. 33 patients (13.0%) were younger than 50 years old, from which 19 (7.5%) were male and 14 (5.5%) female. According to staging, 46 patients (18.2%) had localized disease, 34 (13.4%) had regional disease, and 12 (4.7%) had distant. 161 patients (63.6%) were categorized as unknown since the staging was not available. As per tumor location, 68 samples (26.9%) were right sided tumors, which included cecum and ascending colon; 13 samples (5.1%) were transverse; 89 samples (35.2%) were left colon, including descending and sigmoid colon; and 65 samples (25.7%) were from rectum. 18 samples (7.1%) were categorized as unknown. Conclusions: This study complements existing literature regarding CRC epidemiology and contributes to the emerging research being done by developing countries in Central America. The results match international trends and they suggest a yearly growth of patients being diagnosed outside of the national public system. Additionally, real-world data like this is necessary when considering screening guidelines for CRC by national authorities. Future directions are to follow the cohort for an eventual five-year mortality study, include molecular tests to build a genetic profile, and pursue a collaboration with Costa Rican public centers to determine the disease’s behavior in a national scope.
Prevalence of cancer-related risk factors and associated cancer burden: A targeted literature review.
Authors: Jazieh Abdul-Rahman , Kim Ashley , Cong Ze , Jones Whitney
Published: June 2023

e22525

Background: Cancer risk is impacted by a variety of factors besides age, which may lead to an elevated risk of cancer compared to the general population and have disparate impact on individuals. A targeted literature review was conducted to estimate the prevalence of, and the magnitude of risk of any cancer among, individuals with key risk factors, including chronic inflammation, immunodeficiency, genetics, recurrence, or behavioral. Methods: Data were abstracted using a structured search (2000-2022) in Embase, MEDLINE, and gray literature. The most recent/high quality publications involving adults with the specified risk factors were included (Table). For each risk factor, the prevalence and the standardized incidence ratio (SIR), which measures the heightened risk of cancer relative to the general population/individuals without the condition, were abstracted. Results: Overall, 35 studies were reviewed. Risk factors with the highest SIR of cancer included genetic predisposition (SIR=5.30-9.48 for Lynch syndrome or BRCA mutation), HIV (SIR=3.62), cirrhosis (SIR=2.00), and immunodeficiency disorders (SIR=1.99), with prevalence estimates of <3.0% in the general population (Table). The most prevalent risk factors were tobacco use (42.8%; SIR=1.24), family history of cancer (35.6%; SIR=1.23), and obesity (34.8%; SIR=1.09). The prevalence tended to be higher for individuals aged 65+ (Table). Almost all studies reported an elevated risk of more than one type of cancer. Conclusions: Among individuals with known risk factors, an elevated risk of cancer was observed. Risk factors that confer the highest risk of cancer are mostly genetic and immune-related with low prevalence, while other risk factors with a moderately elevated risk of cancer are more prevalent. These estimates could be useful when determining which individuals need to be screened earlier and/or with comprehensive cancer screening options. [Table: see text]
Independent prognostic value of method of detection in lung cancer: Analysis of the PLCO lung screening trial.
Authors: Long James Patrick , Shen Yu
Published: June 2023

e22526

Background: Prognostic models in cancer use patient and tumor characteristics to predict survival and disease progression. Many tumors are detected as part of screening programs such as colonoscopy for colorectal cancer, mammograms for breast cancer, and pap tests for cervical cancer. Past work in breast cancer has shown that screen detected tumors exhibit better prognosis than symptom detected tumors. The prognostic significance of method of detection in other types of cancers is less well understood. Further, the importance of method of detection, relative to other prognostic variables such as sex, age, cancer stage at diagnosis, and histology, is largely unknown. Methods: The prognostic significance of method of detection in the PLCO Lung cancer screening trial was investigated. PLCO randomized patients to intervention, with four annual chest x-ray (CXR) screenings, or control, usual care. Patients were followed for a total of approximately 13 years. All patients diagnosed with non-small cell lung cancer within 4 years of randomization were considered in the analysis (N = 934). Cox proportional hazards model and Random Survival Forests were used to build prognostic models to predict overall survival. The importance of each variable in prognostic models was assessed using hazard ratios and Random Forest variable importance measures. Results: Screen detected tumors exhibit stage shift and have better prognosis than interval and control detected tumors. The improved prognosis remains significant after controlling for stage at diagnosis and other variables commonly used in prognostic models (e.g., age, histology, sex). Variable importance measures show that method of detection is a more important prognostic indicator than sex and histology. Results are robust to different methods for cohort selection. Conclusions: Method of cancer detection should be considered when developing prognostic models in lung cancer studies. Cancer registries should routinely collect method of cancer detection.
Mediation of race/ethnicity (R/E) disparities in mental health patient reported outcomes (PROS) among elderly female patients with breast cancer (BC) in the Surveillance, Epidemiology, and end results-medicare health outcomes survey (SEER-MHOS) database.
Authors: Champion Kristen E. , Krebsbach Kendra R. , Stallion Chloe L. , Dookeran Keith A.
Published: June 2023

e22527

Background: Variations in mental health PROs between Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) elderly women with BC may be attributable to differences in socioeconomic position (SEP), comorbid disease (CD), tumor biology (TB), social support (SS), and treatment factors (TF). We examine the extent to which the R/E disparity in patient reported mental health summary scores (MCS) is transmitted through these domains. Methods: Data is from SEER-MHOS and the analytic sample (n = 17,465) included 12,493 NHW, 2,503 NHB, and 2,019 Hispanic women with newly diagnosed BC between 2010-2017. MCS were calculated using the SF-36/V linear transformation of 0-100 versions of the scale that yield a population mean of 50 and standard deviation of 10 based on 1990 population means. We estimated average controlled direct associations (ACDA) using regression models with predictive margins (risk difference %) to evaluate crude and age/body mass index (BMI)-adjusted MCS by R/E and performed a series of ACDA [with comparison of rescaled coefficients (RC)] controlling for the domains of (1) SEP [household income (< 30K, 30K-80K, > 80K) and education attainment [ < High School (HS), HS, > HS)]; (2) CD [smoking status (current smoker/current non-smoker), diabetes (yes/no), and hypertension (yes/no)]; (3) TB [stages (1-3), grade (well/moderate/poor), and subtype (luminal A/ triple negative)]; (4) SS [domestic partner (yes/no); and (5) TF [systemic therapy (yes/no)]. Results: Overall, NHB and Hispanic women were younger and had higher BMI than NHW women and crude models showed MCS disparity for NHBs (-4.13%; 95% CI: -4.63, -3.63) and Hispanics (-5.91%, 95%CI: -6.49, -5.34) compared with NHWs. In baseline age/BMI adjusted models, NHBs and Hispanics had worse MCS, -3.78% (95% CI: -3.2, -4.35) and -5.7% (95% CI: -5.04, -6.36) respectively, compared with NHWs. Control for TF had minimal effect on the observed disparity [NHB (-3.85%; 95% CI: -4.56, -3.15) and Hispanics (-4.79%; 95% CI: -5.6, -3.97) compared with NHW], but control for SEP largely reduced the disparity [NHB (-1.56%; 95% CI: -0.89, -2.23) and Hispanics (-2.8%; 95% CI: -1.99, -3.6)]. Inclusion of all 5 domains also attenuated the magnitude of the disparity to a degree such that it was still considered a minimally important difference for Hispanics (-2.34%, 95% CI: -3.75, -0.94), but not for NHBs (0.12%; 95% CI: -1.08, 1.32). However, low acculturation in Hispanics appeared to modify (worsen) the disparity. Based on the method of RC, we determined that SEP accounted for the largest fraction of mediated effects. Conclusions: Our findings suggest that observed R/E differences in mental health PROs in elderly BC patients are largely mediated by differences in SEP rather than treatment.
Post pandemic reality in breast cancer in Brazil.
Authors: Aleixo Sabina B. , Pulido Jose Zago , Parmanhane Narelle
Published: June 2023

e22530

Background: After the coronavirus disease 2019 (COVID-19) pandemic, there was impact in breast cancer diagnosis all over the world but especially in low income countries. We aimed to evaluate the impact of COVID-19 pandemic on early diagnosis of breast cancer at an oncology center in southeast of Brazil. Methods: We extracted data on new breast cancer cases from Hospital Cancer Registry (RHC) of the Hospital Evangelico de Cachoeiro de Itapermirim in Espirito Santo/Brazil. Two intervals were compared: pre-COVID-19 (2019) and pos COVID-19 pandemic (2021) periods. Results: We had 224 new breast cancer cases in 2019 and 252 in 2021. There was an increase of 12,5 % new cases comparing the two years. In 2019 we had 23% of cases diagnosed in clinical stage (CS) I, 33% CS II, 15% CS III, 11% CS IV and 18% without information. In the year 2021 13% in CS I, 40% CS II, 20% CS III, 11% CS IV and 16% without CS information (table). In respect of age da median age at first diagnosis in 2019 was 61 years and in 2021 it was 56 years, demonstrating a decrease of age over the years. Conclusions: Breast cancer in Brazil was already a public health problem before the pandemic and it has aggravated. A substantial decrease in the number of patients with earlier stages of breast cancer at diagnosis was observed after COVID-19 pandemic. This studies demonstrates the need of efficient public policy to mitigate this problem. [Table: see text]
Genetic evaluations and testing rates for hereditary breast and ovarian cancer syndrome in a community oncology setting.
Authors: Bunnell Ann , Principe Kate , Patel Gayle , Nichols Trisha , Mokhtary Sara , Sandbach John F. , Torres Vanessa
Published: June 2023

e22533

Background: Several professional medical societies recommend genetic evaluations and testing for individuals with a personal and/or family cancer history. The National Comprehensive Cancer Network (NCCN) outlines germline testing criteria for breast, ovarian, and pancreatic cancer predisposition genes. This study aims to assess the genetic evaluation and testing rates in community oncology centers among patients who qualify based on their personal history of cancer. Methods: A retrospective study assessed patients diagnosed at any Texas Oncology site between 1/01/2017 and 12/31/2019. Using NCCN Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic V1.2020, individuals with the following cancer diagnoses were included: epithelial ovarian, breast < 45 years, triple negative breast < 60 years, metastatic HER2 negative breast, male breast, exocrine pancreatic, or metastatic prostate. Data was obtained from electronic medical records. The project was approved by the Texas Oncology Privacy Board. Results: Of the 10,202 patients included, 6033 (59%) underwent genetic testing. Only 3660 (36%) had a genetic evaluation, and of those, 2720 (74%) were conducted within Texas Oncology. Younger patients were significantly more likely to be tested than those diagnosed at older ages (p = 2.2e-16). Testing rates were significantly higher (p = 8.95e-07) at sites that employ a provider with genetics training; moreover, the rates of evaluation and testing trended upward, the longer those providers had been offering genetics services. Of the patients without test results, most (76%) had neither a genetics referral nor germline test order documented, suggesting an opportunity for provider education. Conclusions: Most patients who met criteria underwent genetic testing, but the rates varied by cancer type. Patients with breast cancer were most likely to have genetic testing. This study proved that having a genetics provider on staff significantly improved testing rates for patients who qualify. However, given that 100% of the cohort qualified and only 59% underwent testing, quality improvement measures are needed to increase the rate of genetic evaluations and testing for these diagnoses. [Table: see text]
Survival outcomes of BRCA1/BRCA2 mutated breast cancers: Study from a tertiary care cancer centre in India.
Authors: S G Nithin , Gogia Ajay , Pramanik Raja , Sagiraju Hari Krishna Raju , Deo S.V.S. , Sharma DN , Batra Atul , Jha Akash , Mathur Sandeep , Gupta Ritu , Prasad Chandra Prakash
Published: June 2023

e22546

Background: There exists a discrepancy amongst various studies over the years on survival outcomes of BRCA (Breast cancer susceptibility gene) mutated breast cancers. Prevalence of BRCA mutation varies from 10 to 18% among Indian population and there is a paucity of data on the survival outcomes of this population. Methods: This ambispective observational study assessed the survival outcomes of 71 BRCA mutated breast cancer patients, treated with uniform protocol at AIIMS New Delhi between January 2014 to December 2022, using survival analysis and cox regression methods. Results: Amongst the 71 patients, BRCA1 and BRCA2 mutated cases were 52 (73.2%) and 19 (26.8%) respectively. The median age was 39 years (24-63 years) in both the groups. Positive family history for malignancy (BRCA1- 69.2% vs BRCA2- 36.8%) and incidence of Triple negative histology (BRCA1-82.7% VS 36.8%) were more commonly associated with BRCA1 positivity. Eight patients (11.3%) had synchronous cancer, most common being a contralateral breast primary. 4 patients (5.6%) developed metachronous cancer. Eighty percent of patients were premenopausal at presentation. There was no difference in stage at presentation, incidence of synchronous and metachronous cancers across both the groups. Of 71 patients, 18 (25%) and 17 (24%) patients underwent risk reducing mastectomy and risk reducing oophorectomy respectively. Thirty five (49.3%) presented with stage I & II disease, while 28 (34.4%) and 7 (9.9%) presented with stage III and metastatic disease respectively. Forty seven patients (67.1%) received neoadjuvant chemotherapy with pathologic complete response rate of 42.5% which was uniform among both the groups. Over the study period, 10 (14.1%) patients had disease relapse with 7 (70%) being metastatic and 3 patients died of the disease. With a median follow up of 36.9 months, 3-year disease free survival (DFS) was 84.2% (BRCA1: 81.1% vs BRCA2: 93.1%) and overall survival (OS) was 94.7% for both groups. Median DFS and OS were not achieved. BRCA type, receptor status, age and menopausal status were not predictors of survival in our study. Conclusions: In our study population of BRCA1/BRCA2 mutated breast cancer, survival outcomes were comparable to historical cohorts of Indian breast cancer patients. Thus, BRCA mutation positivity doesn’t seem to have any prognostic significance in breast cancer outcome.