bluuebunny/crossref_metadata_2025 huggingface dataset:
Disparities in clinical trial participation: Survey of patients with cancer at an academic medical center.
Authors: Moreland Katie , Butsch Kovacic Melinda , Rai Shesh , Sohal Davendra
Published: May 2024

e13720

Background: This study aims to understand cancer patients' attitudes toward clinical trials and identify barriers to participation, because low participation, especially among minorities, perpetuates poor outcomes and disparities. Methods: A survey was conducted at the University of Cincinnati Cancer Center (UCCC) to assess patients' experiences and attitudes toward clinical trials, previous trial participation, and future trial interest. The pen-and-paper survey, administered by a coordinator (KM), took 5-10 minutes. Frequency tables and Chi-square tests in SAS summarized the findings. Results: From April to August 2023, a survey was offered to solid tumor patients at UCCC during their clinic visits. Participation was voluntary; 300 patients completed the survey. The cohort had 56% females and 77% Whites, with equal educational levels up to (51%) and beyond high school (49%), but with notable racial differences (Table). Index cancer diagnoses were lung (15%), head/neck (11%), breast (10%), colorectal (8%), pancreatic (8%), ovarian (6%), prostate (6%), gastroesophageal (6%), endometrial (5%), and various others (25%). Of 300 participants, only 32% had ever been asked to participate in a clinical trial; more Whites vs non-Whites; 84% chose to participate, with notable differences by race (Table). These differences were not attributable to education or sex. Of the 81 patients who chose to participate, 96% participated to gain access to new treatments, and 75% participated to contribute to research; only 11% did it for financial incentives. There were also differences by race among the 15 who declined participation (Table). Of the 203 who had never been asked to participate in a trial, 71% indicated that they would be willing to participate in the future, but with a strong sex:race interaction (Table). Nearly all (99%) indicated that they would participate to have access to new treatments; many (57%) wanted to contribute to research. Conclusions: This survey shows that many solid tumor patients are not offered clinical trials, and reveals racial disparities in patient willingness, especially among non-White men. Promisingly, there's a notable readiness among patients to join trials for treatment access and research. Efforts should focus on improving clinical trial portfolios, enhanced outreach, and target population education and trust-building. [Table: see text]
Representation of Hispanics with liver cancer in oncology genotype databases.
Authors: Monge B. M. Cecilia , Arroyo Gabriela , Greten Tim F.
Published: May 2024

e13721

Background: Hispanic Individuals, constituting the second largest subpopulation in the United States after non-Hispanic Whites (NHW), experience significant ethnic disparities in the incidence and prevalence of liver cancer. Notably, Hispanics bear the highest burden, with 15.1% of liver cancer cases occurring in this group from 2015-2019, surpassing rates in Asian (12.5%), non-Hispanic Black (NHB, 11%), and non-Hispanic White (NHW, 7.5%) individuals. According to the SEER Database, in 2020, there were 15,878 Hispanics, 12,551 NHB and 57,483 NHW individuals living with liver cancer. Methods: We conducted a comprehensive analysis of larger oncology genotype databases encompassing all cancer types to assess the representation of Hispanic individuals with liver cancer. Five databases, including Cancer LivER, NCI GDC Data Portal, cBioPortal & American Association for Cancer Research (AACR) Project GENIE, The International Cancer Genome Consortium (ICGC) Data Portal, and HCCDB: Integrative Molecular Database of Hepatocellular Carcinoma, were analyzed. Ethnicity data and the number of Hispanic individuals with liver cancer were extracted from each. Results: The databases analyzed revealed significant underrepresentation of Hispanic individuals with liver cancer. NCI GDC Data Portal reported 834 cases, with only 2.5% identified as Hispanic. cBioPortal and AACR Project GENIE's TCGA-LIHC dataset included 377 cases, with 4.8% identified as Hispanic. The ICGC Data Portal encompassed 377 patients, but ethnicity is not available. HCCDB, consisting of 24 HCC datasets, did not include ethnicity information. Cancer LivER, with 115 dataset matrices also lacked ethnicity data. Conclusions: Hispanic Individuals exhibit the highest relative incidence rates of liver cancer among major racial or ethnic groups in the US, yet they are markedly underrepresented in oncology genotype databases, comprising less than 5% of liver cancer patients in those reporting ethnicity. This discrepancy poses a critical challenge to advancing the understanding of liver cancer in the Hispanic population. Addressing the lack of ethnic characteristics and increasing the number of Hispanic cases in these databases is essential for more comprehensive insights into liver cancer within this ethnic group.
A bird's-eye view of disparity from public historic cancer mortality data in the US: Advocacy for gastrointestinal cancers and for inter-agency data harmonization.
Authors: Zhang Tingting , Hung Tony
Published: May 2024

e13723

Background: We searched into public datasets released by CDC to answer a question raised during an NCI Health Disparity Workshop: "Can we have a bird’s-eye view of health disparity in cancer care in the US?" By looking into the historic data reported, we hope to identify not only health disparity reflected by the different cancer mortality rates for major cancer types, but also what might be missing from the data-reporting. Methods: We analyzed 2016-2020 US Cancer Statistics (USCS) cancer burden data to assess cancer disparity as reflected by rates of death in different races or ethnicities. We then looked into the recently available “Single Race 15” grouping for the underlying cause-of-death data in WONDER@CDC to count cancer deaths 2018-2021 in California comparing cancer mortality among 7 Asian minority groups, including Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asians. We then matched census data for these Asian minority groups published by Census 2020. Results: We identified gastrointestinal (GI) cancers as an area of cancer health disparity. 5 GI cancers (colon and rectum, pancreas, liver and bile duct, stomach, and esophagus) contributed to a quarter of cancer deaths, and cancers in the pancreas, liver and bile duct, and esophagus still have very poor outcomes. Based on USCS data, Black non-Hispanic Americans are more likely to die from cancers of colon/rectum or pancreas. All minority races or ethnicities are more likely to die from cancers in liver and bile duct, or stomach than white non-Hispanic Americans. Cancers in colon and rectum, liver and bile duct, or stomach also cause high numbers of death in the under-50 US population. Since the 2022 AACR report on cancer in Asian Americans raised concerns on liver and stomach cancers, we counted cancer deaths in recent 4 years for different Asian groups in California that numbered about 7 million (alone or in combination) in 2020 Census. This includes 1.8 million Chinese, 1.7 million Filipino, 900k Asian Indian, 800k Vietnamese, 560k Korean, 470k Japanese, and other Asian ethnicities. Chinese has the highest numbers of deaths (2.8k) in 4 years from these 5 GI cancers followed by Filipino (2k), Vietnamese (1.2k), Korean (1.1k), Japanese (800), other Asians (1.1k), and Asian Indian (< 400). The lower cancer deaths in Asian Indians may be associated with their younger median age based on Census. With anecdotal stories suggesting immigrants may seek end-of-life care in their birth country to access more culture-concordant services, we looked into how cancer deaths abroad were reported. The data appeared missing. Conclusions: We identified gastrointestinal cancers as focuses for cancer health disparity advocacy. Harmonized consulate report of death abroad to include detailed race/ethnicity information will complete view of cancer mortality data in the US.
Supporting patient access to pharmaceutical-sponsored assistance programs: Implications for health equity and care delivery at safety-net systems.
Authors: Chintapenta Monica , Fatabhoy Irfan , Berge Carrie , Dickerson Umber , Sadeghi Navid
Published: May 2024

e13724

Background: The ever-rising cost of cancer care, driven in large by oncology drugs, has a significant impact on access to care and contributes to disparities. Pharmaceutical-sponsored patient assistance programs (PAPs) are intended to improve access to care; however, vulnerable populations may experience delays, denials, and treatment interruptions due to complexity of the application process and variable qualifying requirements. We present the impact of a pharmacy-run process to facilitate access to PAPs at a safety-net institution. Methods: Parkland Health (PH) is the safety-net system for Dallas County, which has one of the highest uninsured rates in the US. PH provides free health care to uninsured patients below 250% of the federal poverty income level. Hematology-Oncology patients who are prescribed medications with an existing PAP are identified in a work queue within the EHR. A team of licensed pharmacy technicians - Medication Access Technicians (MATs) - screen patients and if eligible, assist in filling and submitting the application, and follow up with PAP sponsors to ensure timely review and approvals. MATs also monitor refills and assist in PAP renewals to prevent interruptions in care. In this study, we used the average wholesale price to quantify the value of the medications provided through PAPs. Data for 10/01/22 through 09/30/23 are presented here. Results: During the study period, MATs enrolled 548 uninsured patients (90% Hispanic/Black) in PAPs for 38 unique clinic-administered drugs, with an estimated value of $45.2 million (M), averaging $78,853 per patient. The highest value and most common clinic-administered PAP drugs were pembrolizumab (96 patients, $8 M) and rituximab (159 patients, $5 M), respectively. For oral agents, MATs enrolled 77 uninsured patients (84% Hispanic/Black) in PAPs for 20 unique medications with an estimated value of $8.8 M, averaging $114,711 per patient. Dasatinib was both the most common and highest value PAP oral drug, with 24 patients and an estimated value of $3.6 M. Of the 38 PAPs for clinic-administered drugs, 25 did not include replacement for dispensed medications. Legal US residence was required by 7 PAPs. The institutional investment by PH (MAT salaries) is estimated at $620,000 annually. Conclusions: A dedicated team of MATs at PH facilitated access to care through PAP enrollments, reduced treatment interruptions by renewing applications, and reduced institutional drug expenditure, allowing investment in other care delivery initiatives. PAPs are philanthropic by nature and requirements such as legal residence and no-replacement for dispensed medications may negatively impact specific segments of our communities, or result in treatment delays. Advocacy by professional organization and patient groups is warranted to expand access to these potentially life-saving programs.
Understanding the relationship between palliative care consultation and mental health services in patients with pancreatic cancer: A US cross-sectional analysis.
Authors: Subramaniam Divya S. , Zhang Zidong , Timmer Zachary , DeMarco Elisabeth C , Hinyard Leslie J.
Published: May 2024

e13729

Background: Anxiety and depression can worsen symptom burden, quality of life, and end-of-life care for pancreatic cancer patients. Palliative care consultation has been used in other areas to improve holistic care and has been successful. This study aims to investigate the effects palliative care consultation on mental health (MH) service utilization, including pharmacotherapy, among pancreatic cancer patients. Methods: The sample consisted of pancreatic cancer patients within Optum’s de-Identified Integrated Claims-Clinical dataset diagnosed with new-onset anxiety or depression. Palliative care consultation (PC) within 12 months of cancer diagnosis was the exposure variable, while utilization of MH services or pharmacotherapy after depression or anxiety was diagnosed were the outcomes of interest. Covariates included patient demographics and the Charlson Comorbidity Index (CCI). The association of MH services and pharmacotherapy with PC were quantified using multiple logistic regression. Results: Within the database, 4029 patients were identified as having newly diagnosed pancreatic cancer. Of these 4029 patients, only 1022 patients received a palliative care consultation (25.36%). Of the patients that received PC, there was a higher percentage of African Americans, patients received a higher score on the CCI, and there was a higher prevalence of anxiety and depression, compared to those without PC. Notably, patients that were diagnosed with only anxiety or only depression were less likely to document treatment of each modality compared to patients diagnosed with both anxiety and depression (aOR - 0.551 for anxiety; aOR - 0.376 for depression). The specific mental health diagnosis was not the only variable that influenced mental health treatment, age, region of care, and CCI all had significant effects. Regarding palliative care, no statistically significant difference was observed between the documentation of mental health treatment between patients that received palliative care and those that did not. Conclusions: Palliative care remains underutilized among pancreatic cancer patients. This study identifies variables that influence the mental health treatment provided for patients with pancreatic cancer, and even identifies specific cohorts that are more vulnerable based on age and region of care. The findings of this study highlight information that providers can use while making clinical decisions and provide a foundation for further research determining the effects of palliative on mental health for patients with advanced, complex diseases.
Breast cancer disparities among Hispanics in the US: Insights into healthcare access.
Authors: Roldan Estefania , James Ted A. , Schlam Ilana
Published: May 2024

e13734

Background: Breast cancer (BC) is the most prevalent cancer and the second leading cause of cancer-related death in women in the US. Hispanics account for 19.1% of the US population, ranking as the second-largest racial/ethnic group, following the Non-Hispanics White (NHW) population. We aimed to assess the current BC characteristics and treatment patterns among Hispanics in the US. Methods: We conducted a retrospective cohort analysis utilizing the Surveillance, Epidemiology, and End Results Registry (SEER). Women newly diagnosed with breast cancer stages 1-3 between 2018 and 2020 were included. Bivariable analyses were conducted using two-sample Wilcoxon rank-sum and Chi2 square to evaluate delay in treatment, defined as a lapse of 3+ months between diagnosis and the initiation of treatment. Treatment encompassed neoadjuvant chemotherapy, radiation, or upfront surgery. Results: The study included 135,690 participants, among whom 16.5% (22,346) were Hispanic. Hispanic women were notably younger than their NHW counterparts (58 vs 65 years old). Most Hispanic and NHW patients resided in metropolitan areas and counties with an MHI exceeding $75,000. While both groups were predominantly diagnosed with Stage 1 IDC, it is noteworthy that a higher proportion of Hispanics tended to be diagnosed at more advanced stages (25.3% vs 17.9%). Additionally, Hispanic and NHW women were mostly diagnosed with HR+/HER2- BC (70.1% vs. 77.7%). Moreover, Hispanics had a higher percentage of HER2+ (15.2% vs. 11.5%) and TNBC (11.4% vs. 8.5%). Hispanics and NHW patients received mostly upfront surgery (74.3% vs. 83.1%), although a larger percentage of Hispanics were treated with NACT (20.8% vs 12.4%). Hispanic patients had a median time to treatment of 1.5 ± 1.34 months, while NHW patients had a shorter time of 1.22 ± 1.07 months, p-value <0.001. After adjusting for all variables, Hispanic women had 2.47 times the odds of experiencing a treatment delay compared to NHW women. Conclusions: This study reveals healthcare access disparities for Hispanic BC patients, emphasizing the need for targeted interventions. Personalized strategies in clinical practice and health policy are crucial for ensuring equitable outcomes for all. [Table: see text]
A comprehensive analysis of patient demographics and disparities in contemporary oncology clinical trials (2022-2023).
Authors: Reddy Neha K. , Williams Rikki , Khosla Atulya Aman , Menta Arjun , Subbiah Ishwaria M. , Gouda Mohamed Alaa , Subbiah Vivek
Published: May 2024

e13748

Background: Overcoming disparities in cancer research is a major challenge that needs to be prioritized in clinical trials in oncology. In this study, we aimed to assess the current representation of patient demographics in phase 2 and 3 clinical trials in oncology to illuminate healthcare inequities during clinical trial recruitment. Methods: We identified published phase 2 and phase 3 oncology studies in five medical journals (New England Journal of Medicine, Journal of Clinical Oncology, Lancet, Lancet Oncology, and JAMA Oncology). We extracted data on patient demographics including sex, age, race, and ethnicity. We also extracted information on trial sponsorship (industry vs investigator initiated). Results: We included 381 articles published between 2022 and 2023 (108 investigator-initiated; 273 industry-sponsored). Details on age groups (<65 vs >65) were available in 149 studies (n=78,523 patients) including 47,192 (60.1%) < 65; and 31,331 (39.9%) >65. Data on gender were available in 373 studies (n=159,836 patients) including 73,308 (45.9%) males and 86,526 (54.1%) females (2 patients were listed as other). Race was reported in 214 studies (n=92,562) including 65,876 Caucasian (71.2%), 3,428 (3.7%) Black, 18,235 (19.7%) Asian, and 5,023 (5.4%) other/missing. Ethnicity data were available in 52 studies including 2,570 Hispanics (12.4%) and 18,234 non-Hispanics or unknown (87.6%). Conclusions: While there are efforts being made to diversify the recruitment of clinical trials, inequities in trial recruitment remains a major issue. Caucasian and younger patients represented the majority of patients, which may not be reflective of real-world practice. There is an important need to focus on increasing enrollment of underrepresented populations and understanding barriers to enrollment.
The physician oncology referral process and its effect on tumor board outcomes.
Authors: Oureilidis-DeVivo Barbara
Published: May 2024

e13752

Background: Oncology settings are known for their hierarchical structure, with distinct status demarcations among professional occupational specialties. The physician oncology referral process, a critical aspect of cancer management, reflects this hierarchical nature. This process, initiated upon suspicion of cancer, entails sequential clinical evaluation and treatment by physicians in the following order: surgeons, medical oncologists, specialty physicians, and referral physicians like interventional radiologists and radiation oncologists. Those at the top of the hierarchy wield considerable influence over the oncology referral process, directing subsequent patient care. While several studies have criticized the effectiveness of cancer management teams, little attention has been given to the potential role of the referral process in reinforcing hierarchical structures within tumor boards, possibly undermining their intended goals. Methods: This qualitative, ethnographic study investigated the interplay between the physician oncology referral process and tumor board outcomes in oncology settings. Data spanning three years were collected from seven research hospitals in the United States and the United Kingdom, encompassing observations from 44 tumor boards and eighteen semi- and unstructured interviews. The principal investigator conducted an analysis and synthesis of the gathered data. Results: The ethnographic study revealed that the hierarchies observed in tumor boards align with and are influenced by the traditional oncology referral process. Group interactions and treatment deliberation outcomes were significantly affected by the social dynamics of hierarchy mirrored in the referral process, ultimately compromising the intended objectives of tumor boards. Surgeons and medical oncologists, who traditionally lead the referral process, tended to dominate tumor board meetings. In contrast, sub-specialties like interventional radiologists and radiation oncologists, positioned at the end of the referral process, were less engaged in deliberations and often overlooked for treatment referrals. The higher the position in the hierarchy and referral process, the more pronounced the tacit authority and ability to direct patient treatment. Conclusions: This study highlights the alignment of traditional oncology referral processes with tumor board dynamics, showcasing similar social and clinical impacts. Despite potential resentment cultivated by reinforced hierarchy in the referral process, tumor board members tend to acquiesce, accepting decisions even when they may not align with optimal patient care.
Investigation of racial disparities in hepatocellular carcinoma and rates of liver transplant: A SEER 2000-2020 study.
Authors: Nelson Nick , Hu Robert , Peace David
Published: May 2024

e13754

Background: Hepatocellular carcinoma (HCC) most commonly occurs in patients with pre-established liver disease and is occurring with increasing incidence and mortality across the United States while disproportionately affecting all US racial/ethnic minority populations. Surgical resection or liver transplant is the preferred treatment for HCC if patient is a surgical candidate and offers the best chance to cure HCC. Previous literature analysis of HCC racial disparities using the Surveillance, Epidemiology, and End Results (SEER) database between the years 1998 and 2012 has been reported, however recent data has not yet been investigated to compare trends. Methods: The SEER database was used to identify 134,212 patients diagnosed with HCC between 2000 and 2020 in the US. Patients with HCC were identified using the ICD-0-3 primary site code C220 and histologic type codes 8170, 8172, 8173, 8174, and 8175. Patient race was categorized as White, Black, American Indian/Alaska Native, Asian or Pacific Islander, and Unknown based on SEER coding scheme. Racial disparities were then determined using chi-squared testing. Results: Patients with reported Unknown race or American Indian/Alaska Native had the greatest increase in proportion of new HCC diagnoses when comparing the years 2016-2020 to 2000-2005. Across all races, the average age at diagnosis was between 60-69 and males were more likely than females to be diagnosed with HCC. Those with Unknown race were more likely to present with Tumor grade I. American Indian/Alaskan Native patients were more likely to be reported as unstaged for HCC and also more likely to have surgery recommended, but not performed for an unknown reason. American Indian/Alaskan Native patients were less likely to receive liver transplant. Patients with Unknown race were more likely to be alive or dead of other cause and less likely to be dead from HCC diagnosis. When comparing this data to previously reported data from 1998-2012, there is an increase in proportion of patients having unstaged HCC especially in the American Indian/Alaskan Native cohort. Conclusions: Native American Indian/Alaskan Native patients continue to have significantly decreased rate of liver transplant (p<0.001) compared to White patients (24.24% vs 30.31%). Previous rates reported 4.4% vs 5.5%.
Barriers to receipt of oncological care at the community level.
Authors: Ramesh Nithya , Rajeshkumar Chitra Shanjeev Kumar , Durugu Satya , Thirumaran Rajesh
Published: May 2024

e13756

Background: Though the field of Oncology is advancing at a rapid pace, there exist several barriers to the receipt of care in cancer patients that are known to affect outcomes. This study aims to describe the social, logistical, and financial barriers to healthcare faced by a diverse group of cancer patients in the community setting. Methods: A total of 40 patients receiving various kinds of oncological care (chemotherapy infusions, radiation therapy, immunotherapy, outpatient follow-up appointments) at a community hospital from 12/2023 to 01/2024 were anonymously surveyed using a standardized questionnaire. Responses were compiled and analyzed. Patients were divided into 2 groups that missed appointments (Group 1) and did not miss appointments (Group 2) during the study period. Results: While there was no difference between ethnic groups, women were less likely to miss their appointments. Patients who were not married, who lived in single-income households with annual income less than $32,048, had less reliable access to transportation and were more likely to miss appointments. Distance from the hospital and having a social worker assigned did not seem to affect compliance with scheduled appointments. Conclusions: Socioeconomic disparities and lack of family support remain significant barriers in the delivery of quality cancer care. These are seen to affect patient compliance and hence treatment outcomes. Hence adequate resources should be allocated to address the holistic needs of our patients and alleviate the above-mentioned barriers. [Table: see text]
Predicting fitness for chemotherapy in older adults with metastatic bladder cancer.
Authors: Russell Brian , Fein Daniel E.C. , Berg Stephanie A. , Gupta Shilpa , Rosenberg Jonathan E. , CHOUEIRI Toni K. , Bellmunt Joaquim
Published: May 2024

e13761

Background: Guidelines advocate using comprehensive geriatric assessments (CGA) in older and frailer adults to optimize treatment recommendations, but it is unclear if genitourinary (GU) oncologists employ them. Through a national survey, this study aimed to evaluate techniques that providers use to predict fitness for chemotherapy in older adults with metastatic bladder cancer. Methods: This cross-sectional study surveyed US-based GU medical oncologists. Providers were included if they were identified as specializing in bladder cancer, had an accessible email address and worked at a National Cancer Institute-designated cancer center or an institution with an ACGME accredited hematology-oncology fellowship. Surveys were sent via email and collected in REDCap. The eleven-item survey consisted of multiple-choice questions and Likert scales evaluating use of geriatric assessments and other tools to predict chemotherapy tolerance. Results: There were 300 GU oncologists contacted, and 37.3% (n=112) completed the survey. Of respondents, 41 (36.6%) practiced in the Northeast with the remainder spread throughout the country. 51.8% (n=58) had practiced for ≥ 10 years, and 81.3% (n=91) had a panel composed primarily of patients ≥ 65-years-old. When making specific chemotherapeutic treatment recommendations, all providers consider a patients’ frailty. The majority (77.7%, n=87) do not use a specific age cut off, but rather, evaluate frailty on a case-by-case basis. Still, in predicting fitness for chemotherapy, 90.2% (n=101) almost never or never utilize a comprehensive geriatric assessment. Primary barriers centered on logistics including time constraints (71.4%, n=80), inadequate staffing (65.2%, n=73) and insufficient resources (33.9%, n=38). Beyond medical comorbidities, factors within a CGA that at least 50% of respondents consider important in predicting treatment tolerance include mobility (87.5%, n=98), social support (81.3%, n=91), cognitive function (73.2%, n=82) and nutritional status (71.4%, n=80) (Table). Conclusions: All surveyed providers believe frailty is important in predicting chemotherapy fitness, but the majority infrequently utilize CGAs in their evaluations. Highlighted barriers include time and resource constraints. While the CGA remains part of the standard of care in evaluating older adults for treatment, if a CGA cannot be performed, GU oncologists could consider focusing pre-treatment evaluation on the most important domains identified in this study: mobility, social support, cognitive function and nutritional status. [Table: see text]
Geriatric enrollment patterns in clinical trials at a National Cancer Institute.
Authors: Khazak Andre , Parsa Kian , Elias Evelyn , Liaw Bobby Chi-Hung
Published: May 2024

e13762

Background: Despite the majority of new cancer diagnoses occurring within the geriatric population, there is a disproportionate rate of clinical trial enrollment within this population. Previous data has estimated enrollment rate to be 18.9% in treatment trials among all adult cancer patients at designated National Cancer Institute Cancer Centers. The objective of this study is to assess geriatric cancer patient clinical trial enrollment rates in a single National Cancer Institute and highlight inequities within cancer care delivery. Methods: We performed a retrospective review of the electronic health record and included patients with cancer ≥ 65 years of age who died at our institution between January 2020 and July 2022. We examined the relationship between cancer type, patient race/ethnic identity, and age and analyzed enrollment in clinical trials. Analyses were conducted using descriptive statistics. Results: Of 117 decedent records analyzed, 11 (9%) were enrolled in treatment clinical trials of which 5 (4.3%) identified as White, 4 (3.4%) Other, and 2 (1.7%) Hispanic. Among the 117 geriatric patient records reviewed, there were 21 Black patients (17.9%) of which 0 (0%) Black patients were enrolled in clinical trials. In comparing enrollment by malignancy type, 5 patients had a hematologic malignancy (leukemia, lymphoma, or multiple myeloma), 3 patients had a genitourinary malignancy, 1 patient had a pancreatic malignancy, 1 patient had an endometrial malignancy, and 1 patient had a breast malignancy. Among all patients analyzed, 37 patients (31.6%) had a hematologic malignancy and 80 patients (68.4%) had a solid tumor malignancy. The average age of enrolled patients was 73, consistent with the average age of all patients analyzed (73.78). Conclusions: Geriatric patients with cancer are disproportionately underrepresented in treatment clinical trials. The inequity is exacerbated when analyzing enrollment among minoritized patients. There was a greater proportion of clinical trial enrollment in patients with hematologic malignancies than solid tumor malignancies, however analysis in larger population samples is necessary. Additional research to identify barriers to clinical trials and methods of increasing geriatric enrollment, including the use of geriatric specific performance scales, is necessary to ensure equitable access and representation in clinical trials. While these results may be skewed in the setting of the COVID-19 pandemic and selection of a decedent population, further research into geriatric accessibility in clinical trials is paramount.
Fractionated external-beam radiation therapy in elderly patients.
Authors: Rao Sonia , Chava Samhitha , Chang-Halpenny Christine , Batth Sukhjeet Singh , Monson Jedidiah Mercer
Published: May 2024

e13764

Background: To review the outcome of elderly patients treated with fractionated external-beam radiation therapy (RT) at a privately-owned, multi-disciplinary cancer center. Methods: From January 7, 2019, to August 22, 2023, 63 elderly patients were treated with fractionated RT at California Cancer Associates for Research and Excellence (“cCARE”), a privately-owned, multi-disciplinary cancer center in Fresno, California. The median age at the time of RT was 90 y/o (range, 85-98 y/o). Twenty-three patients were female and 40 were male. Forty-six patients identified as white and 17 as non-white. Treatment sites/histologies included primary lung 10, non-melanomatous skin 6, bone metastases 6, breast 5, esophagus 5, H&N 5, prostate 4, primary CNS 3, brain metastases 3, rectum 3, bladder 2, Merkel tumor 2, sarcoma 2, anus 1, liver 1, melanoma 1, multiple myeloma 1, NHL 1, pancreas 1 and stomach 1. Results: Thirty-two of the patients (51%) were treated with curative intent. The remaining 31 patients were treated for palliation. All patients were treated with fractionated RT. However, 4 patients also received a separate course of single-fraction RT. Twenty-seven patients received more than one course of RT. The median RT course was 10 fractions (range, 1-35 fractions). Most patients had previously been treated with systemic therapy. Nearly one third (31%) received systemic therapy concurrent with their RT. The majority of the patients (73%) completed their prescribed course(s) of RT. Many patients (61%) required one or more treatment breaks. The median duration of a treatment break was 1 day (range, 1-29 days). There were no grade 3 or higher RT toxicities recorded. The median follow-up since RT was 5 months (range, 1-59 months). Twenty-four patients have expired. The mediation duration from RT to death was 5 months (range, 1-32 months ). Of the remaining 39 patients, 92% were scored as clinically stable at the time of their last f/u visit. Conclusions: In our experience at cCARE, fractionated RT was administered to elderly patients and the majority completed their prescribed treatment courses. None of the patients in our review experienced clinically significant side effects (Grade 3 or higher) during their RT even in the cohort (31%) who were treated with concurrent systemic therapy. Clearly, careful patient selection and state-of-the-art RT administration is paramount. It is also highly advantageous for patients to be treated in a multi-disciplinary setting such as cCARE where seamless coordination of cancer care among radiation oncologists, medical oncologists and surgeons excels. A companion study is in process comparing the outcome of similarly matched elderly patients from our center who were treated with systemic therapy alone. We anxiously await the outcome of this vital comparison review.
Incidence of mortality in vulnerable and non-vulnerable older patients with cancer.
Authors: Rodriguez Calvillo Héctor Alejandro Alejandro , Hernandez Barajas David , Zayas Villanueva Omar Alejandro , Abundis Márquez Estefania Elizabeth , Urdiales Hidalgo Elias Román
Published: May 2024

e13775

Background: Cancer most often affects older adults; 56% of all newly diagnosed cancer patients and 71% of deaths belong to this age group. Frail patients are at increased risk of unfavorable outcomes after Treatment. Methods: This cross-sectional study included adults older than ≥ 65 years who attended the Oncology department were included, with a diagnosis of a solid malignant neoplasm during March 2022-May 2023. Sociodemographic characteristics and characteristics of the disease were evaluated, and the G8 test was applied, a tool that identifies patients at risk of frailty (nutritional status, mobility, age, general health status, neuropsychological status, drugs used); a score ≤14 indicates that they are vulnerable. They were classified into two groups: group 1 (vulnerable) and group 2 (non-vulnerable). Telephone follow-up was performed at 12 and 24 weeks. We evaluated the incidence of mortality in both groups after oncological medical management. Results: Eighty-eight older adults were recruited, the majority were men (77.3%), and the mean age was 74.2 ± 6.71. Forty-seven patients (53.4%) were vulnerable (group 1), and 41 patients (46.6%) were non-vulnerable (group 2). Mortality at 12 weeks was evaluated: vulnerable (29.8%) vs. non-vulnerable (0%), and mortality at 24 weeks: vulnerable (46%) vs. non-vulnerable (4.9%). In both follow-ups, statistically significant results were obtained (<0.001). Conclusions: Vulnerable patients have a higher risk of unfavorable outcomes; their detection is essential to perform a comprehensive geriatric assessment and provide multidisciplinary treatment, improving the prognosis of their disease. [Table: see text]
Genetic Testing Utilization: Discrepancies Between Somatic and Germline Results in Patients With Cancer Reviewed at the UW Health Precision Medicine Molecular Tumor Board
Authors: Horn Isaac P. , Zakas Anna L. , Smith-Simmer Kelcy J. , Birkeland Laura E. , Sundstrom Rachel , Burkard Mark E. , Weiss Jennifer M.
Published: May 2024

PURPOSE

Somatic and germline testing are increasingly used to estimate risks for patients with cancer. Although both germline testing and somatic testing can identify genetic variants that could change a patient's care and eligible treatments, the aims of these tests and their technologies are fundamentally different and cannot be used interchangeably. This study examines the timing and results of somatic and germline genetic testing for patients with cancer at UW Health.

METHODS

Eight hundred and seventy-seven participants underwent somatic genetic testing, which was reviewed by the Precision Medicine Molecular Tumor Board (PMMTB). Patients were diagnosed with cancers, including breast, colorectal, endometrial, pancreatic, or ovarian cancer, and met National Comprehensive Cancer Network criteria for germline genetic testing. Germline testing details were collected by medical record review.

RESULTS

The results of this study found that only 310 patients (35%) had germline evaluation before PMMTB review. The percent of germline pathogenic/likely pathogenic variants identified in actionable genes was 28%. Most germline variants were identified in the BRCA1 (26%) and BRCA2 (28%) genes. In total, 65% (54/83) of germline variants were detected with both germline testing and somatic testing; however, 35% (29/83) of germline variants were not identified on somatic results. These results demonstrate the importance of combination germline and somatic testing.

CONCLUSION

This study highlights the differences in genetic testing types and demonstrates that conducting germline testing at earlier stages of diagnoses is necessary to identify potentially actionable and treatment-specific variants in patients with cancer.
Discovery and Validation of a 15-Gene Prognostic Signature for Clear Cell Renal Cell Carcinoma
Authors: Mehra Rohit , Nallandhighal Srinivas , Cotta Brittney , Knuth Zayne , Su Fengyun , Kasputis Amy , Zhang Yuping , Wang Rui , Cao Xuhong , Udager Aaron M. , Dhanasekaran Saravana M. , Cieslik Marcin P. , Morgan Todd M. , Salami Simpa S.
Published: May 2024

PURPOSE

Develop and validate gene expression–based biomarker associated with recurrent disease to facilitate risk stratification of clear cell renal cell carcinoma (ccRCC).

MATERIALS AND METHODS

We retrospectively identified 110 patients who underwent radical nephrectomy for ccRCC ( discovery cohort). Patients who recurred were matched on the basis of grade/stage to patients without recurrence. Capture whole-transcriptome sequencing was performed on RNA isolated from archival tissue using the Illumina platform. We developed a gene-expression signature to predict recurrence-free survival/disease-free survival (DFS) using a 15-fold lasso and elastic-net regularized linear Cox model. We derived the 31-gene cell cycle progression (mxCCP) score using RNA-seq data for each patient. Kaplan-Meier (KM) curves and multivariable Cox proportional hazard testing were used to validate the independent prognostic impact of the gene-expression signature on DFS, disease-specific survival (DSS), and overall survival (OS) in two validation data sets (combined n = 761).

RESULTS

After quality control, the discovery cohort comprised 50 patients with recurrence and 41 patients without, with a median follow-up of 26 and 36 months, respectively. We developed a 15-gene (15G) signature, which was independently associated with worse DFS and DSS (DFS: hazard ratio [HR], 11.08 [95% CI, 4.9 to 25.1]; DSS: HR, 9.67 [95% CI, 3.4 to 27.7]) in a multivariable model adjusting for clinicopathologic parameters (including stage, size, grade, and necrosis [SSIGN] score and Memorial Sloan Kettering Cancer Center nomogram) and mxCCP score. The 15G signature was also independently associated with worse DFS and DSS in both validation data sets (Validation A [n = 382], DFS: HR, 2.6 [95% CI, 1.6 to 4.3]; DSS: HR, 3 [95% CI, 1.4 to 6.1] and Validation B (n = 379), DFS: HR, 2.1 [95% CI, 1.2 to 3.6]; OS: HR, 3 [95% CI, 1.6 to 5.7]) adjusting for clinicopathologic variables and mxCCP score.

CONCLUSION

We developed and validated a novel 15G prognostic signature to improve risk stratification of patients with ccRCC. Pending further validation, this signature has the potential to facilitate optimal treatment allocation.
Telling late-time tails for a massive scalar field in the background of brane-localized black holes
Authors: Dubinsky Alexey
Published: May 2024

We examine perturbations of a massive scalar field around spherically symmetric, brane-localized black holes. Although the ringdown and asymptotic tails of various brane-world black holes have been extensively studied, there has been no analysis of the massive late-time tails for the simplest Schwarzschild-like, brane-localized black hole to date. We demonstrate that after the ringdown phase, two stages of oscillatory tails emerge —intermediate and asymptotic. The asymptotic decay law is distinct from those associated with Schwarzschild or Reissner-Nordström solutions. Specifically, during intermediate times, the signal decays as

, while the asymptotic decay law is

.
Novel Detection and Progression Markers for Diabetes Based on Continuous Glucose Monitoring Data Dynamics
Authors: Montaser Eslam , Farhy Leon S , Kovatchev Boris P
Published: May 2024

Context

Static measures of continuous glucose monitoring (CGM) data, such as time spent in specific glucose ranges (70-180 mg/dL or 70-140 mg/dL), do not fully capture the dynamic nature of blood glucose, particularly the subtle gradual deterioration of glycemic control over time in individuals with early-stage type 1 diabetes.

Objective

Develop a diabetes diagnostic tool based on 2 markers of CGM dynamics: CGM entropy rate (ER) and Poincaré plot (PP) ellipse area (S).

Methods

A total of 5754 daily CGM profiles from 843 individuals with type 1, type 2 diabetes, or healthy individuals with or without islet autoantibody status were used to compute 2 individual dynamic markers: ER (in bits per transition; BPT) of daily probability matrices describing CGM transitions between 8 glycemic states, and the area S (mg2/dL2) of individual CGM PP ellipses using standard PP descriptors. The Youden index was used to determine “optimal” cut-points for ER and S for health vs diabetes (case 1); type 1 vs type 2 (case 2); and low vs high type 1 immunological risk (case 3). The markers’ discriminative power was assessed through the area under the receiver operating characteristics curves (AUC).

Results

Optimal cutoff points were determined for ER and S for each of the 3 cases. ER and S discriminated case 1 with AUC = 0.98 (95% CI, 0.97-0.99) and AUC = 0.99 (95% CI, 0.99-1.00), respectively (cutoffs ERcase1 = 0.76 BPT, Scase1 = 1993.91 mg2/dL2), case 2 with AUC = 0.81 (95% CI, 0.77-0.84) and AUC = 0.76 (95% CI, 0.72-0.81), respectively (ERcase2 = 1.00 BPT, Scase2 = 5112.98 mg2/dL2), and case 3 with AUC = 0.72 (95% CI, 0.58-0.86), and AUC = 0.66 (95% CI, 0.47-0.86), respectively (ERcase3 = 0.52 BPT, Scase3 = 923.65 mg2/dL2).

Conclusion

CGM dynamics markers can be an alternative to fasting plasma glucose or glucose tolerance testing to identify individuals at higher immunological risk of progressing to type 1 diabetes.
The Burning of Bédoin
Authors: Clarke Joseph
Published: May 2024

On May 28, 1794, a criminal investigation that had begun almost a month before concluded with the execution of sixty-three men and women, the imprisonment of fifteen more, and a few days later the destruction of an entire village. This article examines the burning of Bédoin, the crime that provoked it, and the judicial process that accompanied it, to explore the relationship between criminal cause and punitive effect during the Terror of year II. As a case study in revolutionary justice, this episode appears extreme, but this article argues that it allows us to interrogate the meanings that ordinary revolutionaries attached to terms like crime and complicity when the survival of the state seemed at stake. In looking beyond the Terror to the controversies that enveloped this village's destruction, this article also examines the aftermath of atrocity to consider how a society comes to terms with crime when both the definition of criminality and the identity of the criminal are in flux.
The Algerian Enemy Within
Authors: Beaujon Danielle
Published: May 2024

During World War II police officers in Marseille and Algiers relentlessly hunted Algerian black market operatives. Hundreds of reports from these two cities detail the actions taken to prevent individuals from selling contraband goods, exceeding fixed market prices, or ignoring rationing protocols. Long-standing colonial stereotypes had labeled Algerians as prone to theft and violence, but the economic restrictions of war created a new category of the imagined Algerian criminal: the black market trafficker. In police reports the figure of the Algerian profiteer is omnipresent, but internal communications acknowledged that Europeans profited from the black market, too. Why, then, the fixation on Algerians? This article argues that police developed a narrative of Algerians as “internal enemies” of France. Their underlying suspicion of Algerians endured throughout World War II even as governments rose and fell in France and loyalties of the entire nation shifted. In treating Algerians as threats to national security, the police justified a system of control that homogenized the Algerian community along racial lines. The racialized policing of “anti-French” Algerian traffickers built not just on visual codes of race but also on how police practice mapped ideas of race onto the space of the city.
Anthony Trollope's Formal Experiment: Repetition and the Anti-romantic Marriage Plot
Authors: Lewis Christian
Published: May 2024

In Miss Mackenzie, Anthony Trollope attempted to write a marriage plot without love or romance but admitted that he was unable to do so. This essay argues that Trollope's formal experiment developing the “anti-romantic” marriage plot did not end with Miss Mackenzie but continued across eighteen novels written from 1864 to 1876. The essay performs a midrange reading of this set of novels to argue that across this experiment Trollope iterates his anti-romantic marriage plot, replicating his central conflict and establishing three stock characters (moral maidens, hesitating heroines, and husband hunters). Trollope's experiment clashed against his own gender and class politics, forcing him to confront and reevaluate his own ideas and gradually empathize with women who choose to marry not for romance but for financial security. While Trollope's novels have, since their publication, been criticized as repetitious, the essay argues that his use of repetition is not a weakness but a strength, a formal tactic with unique affordances. This reframing offers a way to reconsider Trollope's literary technique and prodigious output as well as appreciate the impact that his experiment had on the trajectory of the Victorian realist novel. While the 1860s and 1870s are often considered the peak of Victorian high realism, Trollope's novels (and the influence they have on other major novelists) reveal how during these decades the marriage plot and realism itself was in crisis.