bluuebunny/crossref_metadata_2025 huggingface dataset:
Older adults (OA) in clinical trials: Where are they? Representation of OA in clinical trials conducted at the national cancer institute (NCI) clinical center.
Authors: Iannantuono Giovanni Maria , Choradia Nirmal , Gulley James L. , Karzai Fatima , Floudas Charalampos S.
Published: June 2023

e18517

Background: Clinical trials are a significant source of evidence for diagnostic and management strategies in cancer patients. Diversity, equity, and inclusion are necessary to provide access to clinical trials and improve care. Despite the increase of OA in the United States (US), OA are still under-represented in clinical trials, with a lack of information on clinical outcomes and safety. The NCI provides oncologic care on research studies conducted at the Clinical Center (CC), the research hospital of the National Institutes of Health (NIH) where third-party payers are neither notified nor invoiced for treatments received. Participants come from all over the US and are primarily referred by their primary oncologists. We sought to evaluate the participation of OA in clinical trials at the NCI-CC. Methods: In this retrospective analysis, OA were defined as participants aged ≥65 years. The demographic data of OA enrolled from 2005 to 2019 were retrieved from the Biomedical Translational Research Information System (BTRIS), the NIH clinical research data repository. Data on the incidence of new cancer diagnoses in the US population for the same period (2005-2019) were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. We compared the proportions of OA enrolled in NCI-CC clinical trials with the corresponding data from SEER program. We further stratified the OA into four age subcategories: from 65 to 69, from 70 to 74, from 75 to 79, and older than 80 years of age. No inferential statistical analyses were performed. Results: A total of 37,326 participants were enrolled from 2005 to 2019 on NCI-CC clinical trials. The number of OA = 7,934 (21.3%). According to the SEER program, 11,017,070 people were diagnosed with cancer from 2005 to 2019, and 5,971,607 (54.2%) were OA. Notably, the proportions of OA enrolled in NCI-CC was lower than the SEER data in all the subcategories. Patients ≥75 years accounted for the most under-represented (Table). Conclusions: OA are under-represented in clinical trials conducted at the NCI-CC from 2005 to 2019, emphasizing the need to “geriatricize” clinical trials. Adaptations of trial design such as expansion of eligibility criteria, utilization of geriatric assessment tools, and inclusion of OA-specific enrollment targets may reduce barriers to enrollment. Outreach initiatives to the oncology community to reinforce the need for increased referral of OA along with incorporation of telehealth for trial screening and assessments could also be considered to expand enrollment and increase the evidence base to guide treatment of OA with cancer. [Table: see text]
Demographic comparison of survival outcomes after bone marrow transplantation in adolescent and young adult patients: A single institution cohort study.
Authors: Seymour Kimberly Helen , Flanagan Hayley Brianne , Mariano John , Baran Andrea M. , Andolina Jeffrey Robert
Published: June 2023

e18522

Background: Bone marrow transplant (BMT) has become an increasingly common treatment modality for both malignant and non-malignant conditions. However, BMT requires significant healthcare and financial resources, which can result in allocation disparities across socioeconomic, demographic, and racial/ethnic groups. The data exploring how demographic disparities impact survival after BMT is limited, particularly within the adolescent and young adult (AYA) population, defined as patients between the ages of 15 and 39 years. The goal of this study was to assess overall survival of AYA patients undergoing transplant at our institution and to gain insight into if demographic factors impact the likelihood of mortality after transplantation. Methods: Patients aged 15-39 who underwent transplant at the Wilmot Cancer Institute in Rochester, NY between 2012-2020 were identified. Information regarding demographic characteristics, indication for transplant, and mortality was collected. The primary endpoint was overall survival (OS), defined as the time from transplant to the date of death from any cause or the date of last in-person contact. Survival criteria were estimated using the Kaplan-Meier method and compared using mortality odds ratios. These analyses were stratified by indication for transplant, recorded race/ethnicity, gender, and by age. Results: 169 patients met inclusion criteria, and median OS for the entire cohort was not reached. Of 108 allogenic transplant recipients, median OS was 7.85 years (95% CI [3.3, not estimated]). Median OS for patients receiving transplant for solid tumor pathology was 3 years (95% CI [0.4 years, not estimated]), compared to other indications for transplant where survival exceeded the median. For allogenic transplant patients, median OS for Black patients was 4.8 years (95% CI [0.7 years, not estimated]), 7.8 years for Caucasian patients (95% CI [3.3 years, not estimated]), median OS was not reached for Hispanic patients, and 1.1 years for all other minorities (95% CI [0.4 years, not estimated]) (p = 0.28). There was no significant difference in mortality based on insurance type or gender for either type of transplant. There was a significant difference in mortality for allogenic transplant patients based on average median household income when compared at an average income of $60,000/ year (OR 2.6, 95% CI [1.164, 5.6] p = 0.0097). Conclusions: Overall survival for AYA patients who had a transplant for any indication at our institution was better than expected. There were no significant differences for either transplant type based on gender, racial/ethnic background, gender, age, or indication for transplant. There was a significant difference based on median household income. Larger multi-institutional studies are likely needed to accurately identify further demographic disparities.
Breast cancer brain metastases: The graded prognostic assessment index (GPA) in a real-world low- and middle-income (LMIC) population.
Authors: Carvalho Giselle de Souza , de Lucena Giullia Bortolini , Small Isabele Avila , Bines Jose
Published: June 2023

e18531

Background: Up to 15% of breast cancer patients develop brain metastases during the course of their disease. Graded Prognostic Assessment (GPA) estimates survival for patients with brain metastases. This retrospective analysis assesses the applicability of the GPA and highlights the outcomes for patients from a Low- and Middle-income Country (LMIC). We compared the GPA-predicted survival for each patient with the actual overall survival. Methods: A single-center retrospective analysis of patients identified from the neurosurgery, radiation therapy and palliative care databases of the Instituto Nacional de Câncer (INCA), Brazil, from October 2018 to June 2020. Survival analyzes were performed using the Kaplan-Meier method and the curves were compared by the Log-rank test. Results: We identified 110 patients with breast cancer brain metastasis and 84 patients were followed through December 2021. 10 patients were still alive at the end of follow-up. Median age at breast cancer diagnosis was 48 years, and median time from breast cancer diagnosis to brain metastases diagnosis was 30.6 months. 62% were premenopausal and ECOG-PS was 0 - 1 in 44%, and 2 in 25% of patients. 94% of tumors were of ductal histology, 43% hormone receptor (HR) +/HER2 - disease, 30% triple-negative, and 27% HER2 + (17% HR+ and 10% HR-). 22% stage IV disease at diagnosis. The median time from breast cancer diagnosis to brain metastases was 30.6 months (range, 0.3 to 232 months). 95% of patients were symptomatic at the time of the brain imaging, mainly headache and focal neurological deficit. 64% of patients had less than three brain metastases. Patients underwent neurosurgery (71%), stereotactic radiosurgery (13%) and WBRT (38%), and the median time from brain metastases diagnosis to local treatment was 18, 20 and 10 days, respectively. Median time from brain metastases to death was 5.5 months, being 4.0 months for HR+HER2-, 4.5 months for triple-negative, and 12.0 months for HER2+ disease (p = 0.18). The median time calculated according to the GPA for the whole patient population was 13 months. Conclusions: Breast cancer patients with brain metastases had a shorter median survival time than the one estimated by the GPA. We hypothesize that a delay between CNS symptoms and brain imaging may explain this worse outcome. The prognostic score is an important tool to assist in choosing therapeutic options. It can also highlight health disparities and consequently stimulate the search for potential strategies to improve patients outcomes.
Palliative medicine referral trends by demographics for patients with stage IV cancer at an urban safety net hospital.
Authors: Sharma Sandhya , Reinert Catherine , Ferraro Kelly
Published: June 2023

e18541

Background: Multiple randomized trials have shown that early referral to palliative clinic improves quality of life and has survival advantages when combined concurrently with standard oncology care in patients with advanced cancer. We reviewed data referral trend data for stage 4 cancer patients at an urban safety net hospital with the goal of characterizing demographic factors that may be associated with the amount of time both to referral and to the patient establishing care with palliative medicine in order to identify possible barriers to care. Methods: We identified patients with stage IV cancer seen in our oncology clinic from 2017-2020 using tumor registry cancer staging. We conducted a retrospective chart review of these patients. Demographic data were collected through chart review using a standardized data collection tool. We calculated data using relative frequency. Results: A total of 249 patients with Stage IV cancer were identified during this timeframe. Of these, 137 patients (55%) were referred to palliative clinic. This included 77 male and 60 female patients. The average time between the patient’s first oncology visit and a referral made to the palliative clinic was 187 days, with much higher referral time for female patients (279 days). The referral relative frequency was high among African American and Asian population of 1.46 and 1.20, respectively; with highest rate of 2.14 for African American women. Patients identifying as African and Hispanic had the lowest relative referral frequency, with 0.29 and 0.77, respectively. The average number of days between referral made and first palliative appointment was 41 days, with longer delay in female patients (54 days). The time to first appointment relative frequency was high among Asian population (4.04) and low among African (0.36) and Hispanics (0.63). Patients with Medicaid and those who were uninsured were referred to palliative clinic sooner with average of 121 days and 109 days respectively, as opposed to patients with private insurance (387 days). The appointment relative frequency was also earlier for uninsured and Medicare patients of 0.60 and 0.92, respectively. Conclusions: Our study shows that there is delay in getting palliative care referrals and appointments among African American and Asian population, and female patients. This can be due to cultural and systemic barriers: palliative care is a newer field, with a broader community understanding of its purpose and benefits still growing in many patient populations. We can improve the gap with patient-oriented targeting the identified subgroups who demonstrated more opportunity. The study also highlights more expeditious care for patients with Medicare and uninsured patients, as opposed to private insurance. These early referrals may be due to higher psychosocial needs and clinical requests for help from the palliative interdisciplinary team.
Dedicated overseas consultation for patients evacuated from the south Pacific: Report of experience after six months of existence.
Authors: Epaillard Nicolas , Geraud Arthur , Garcia Gabriel , Flippot Ronan , Cherot Laury , Besse Benjamin , Blanc-Durand Felix , Ouali Kaissa , Mahjoubi Linda , Routier Emilie , Drovetti Gianmaria , Gustin Pierre , Matias Margarida , Moulin Jean François , Azan Simon , Herve Robert , Pistilli Barbara , Colomba Emeline , Ducreux Michel Pierre , Honoré Charles
Published: June 2023

e18542

Background: The management of rare and/or complex cancers between patients living in metropolitan France and those living overseas remains unequal. Herein, medical transfer to metropolitan France is required in about 20% of overseas-living patients and is often experienced as an additional source of distress, which requires multidisciplinary support (social, psychological, medical, and cultural). Therefore, we developed a dedicated “Overseas” consultation (OC) to provide personalized cancer care in this specific population. We aim to present the evaluation of the first 6 months experience. Methods: The OC was dedicated to patients from the South Pacific (French Polynesia or New Caledonia) requiring “highly specialized” cancer treatments in Gustave Roussy, including surgery, chemotherapy, or diagnostic procedures, which were considered non-achievable in the local hospital after multidisciplinary discussion by videoconference. Multiple interventions including medical, administrative and psychological support were provided. Results: Between July 15, 2022, and January 15, 2023, 25 patients with rare and/or complex cancer diagnosis / treatments benefited from an OC. Median age was 57 years (30-81), 19 patients (76%) were women, 18 (72%) came from French Polynesia and 7 (28%) from New Caledonia. Median number of OC for each patient was 1 (range 1-3), and median length of stay in metropolitan France was 23 days (range 4-95 days). At the time of analysis, 7 patients had not yet returned back home. The most common cancer locations were breast (52%), lung (16%) and gastrointestinal (16%). Patient presented localized disease in 52% of cases. At the first OC, 92% patients were ECOG Performance Status 0-1. The main reasons for metropolitan France medical transfer were an imaging procedure (64%) or a complex surgical or interventional radiology biopsy (24%). Seven patients (28%) had complex management (defined as two or more procedures) during their stay. Eleven patients (44%) benefited from molecular profiling, 7 (27%) from an oncogenetic consultation and 1 (4%) from inclusion in a clinical research trial. Conclusions: OC, set up 6 months ago in our institution, has optimized diagnostic workflow and disease management of these complex patients living overseas and has demonstrated its feasibility. However, it requires the involvement of multiple health-care professionals, multidisciplinary concertation, paramedical interventions such as social and psychological support and the overarching support from institutions.
Health disparities among patients with Ewing sarcoma in Florida.
Authors: Pham Dan Kim , Rahul Rachna , Kronenfeld Rachel , Koru-Sengul Tulay , Pinheiro Paulo S. , Dhir Aditi
Published: June 2023

e18549

Background: Ewing sarcoma (ES) is the second most common malignant bone tumor in children and young adults. Although usually localized, subclinical metastatic disease is often present. Treatment includes multi-agent chemotherapy with surgery or radiation for local control. Though overall survival (OS) has improved to 70% for localized disease, mortality from recurrent or metastatic disease remains high. Although, ES is most common among Non-Hispanic White adolescent males, prior population-based ES studies utilizing Surveillance, Epidemiology, and End Results (SEER) have shown increased mortality among White Hispanics, Blacks, and those of low socioeconomic status (SES). Florida is not part of SEER but is home to a unique population with high proportions of immigrants and Hispanics of distinct backgrounds including Cubans, Puerto Ricans, and South Americans that contrasts to the Mexican Hispanic majority in other US states. As there are no prior population-based studies examining ES in Florida, the role of racial/ethnic disparities on outcomes among this diverse patient population remains unknown. By utilizing the Florida Cancer Data System (FCDS) for ES patients, this study will assess overall racial/ethnic disparities, evaluate the impact of racial/ethnic disparities on OS, and compare ES incidence rates in Florida with national SEER-21 rates to assess risk. Methods: This retrospective secondary analysis examined all patients diagnosed with ES (2005-2018) in Florida (n = 411) and SEER-21 (n = 1,513). Age-adjusted incidence (AAI) with 95% confidence interval (95%CI) was analyzed for the entire group and OS was estimated using Kaplan-Meier survival analysis. Univariable and multivariable analyses using Cox regression models were performed for variables of interest—race/ethnicity, age, sex, year of diagnosis, site of disease, staging, SES, and insurance type. Adjusted hazard ratio (aHR) with 95%CI were calculated. Results: Per the FCDS, there was a higher incidence of ES in Hispanic males (AAI 2.6; 95%CI: 2.0-3.2 per 1,000,000; n = 84) as compared to the SEER (1.2; 1.1-1.4; n = 250). Among non-metastatic ES, Hispanics had an increased risk for cancer-related mortality compared to Non-Hispanic Whites (aHR 2.9; 95%CI: 1.46-5.74; p =0.002), after adjusting for all other variables. In the full model (all cases regardless of stage at diagnosis), older age and distant metastasis were statistically significant factors for poor OS while SES and insurance status were not. Conclusions: Hispanics in Florida are of interest for ES with a higher-than-expected incidence compared to the US and remarkably worse survival for non-metastatic disease compared to Non-Hispanic Whites. Further in-depth studies are needed to examine why this disparity exists, but it is potentially multifactorial. This is the first known study for ES health disparities in Florida and provides updated national data for comparison.
Representativeness in cancer treatment trials in community and academic settings.
Authors: Altomare Ivy , Wang Xiaoliang , Falk Sam , Kaur Maneet , Guadamuz Jenny , Xiao Forrest , Meropol Neal J. , Zhao Yihua
Published: June 2023

e18550

Background: Patients with cancer who participate in clinical trials may not be representative of the broader patient population, which can impact the generalizability of results. However, it is unknown whether practice setting influences representativeness of trial participants. Here we evaluated (1) whether demographic characteristics of patients enrolled in cancer treatment trials at academic sites differ from those in the community and (2) the degree to which trial patient characteristics are representative of the overall patient population seen in each practice setting. Methods: This retrospective study used the nationwide Flatiron Health electronic health record-derived de-identified database, originating from ~280 US cancer clinics (~800 sites of care). We included patients with a cancer diagnosis and clinical visits between 11/1/17 - 11/1/22. Clinical study drug administration was used as a proxy for trial participation. We applied multivariate logistic regression to assess the association of age, sex, race/ethnicity, insurance status and neighborhood socioeconomic status [SES] quintile with practice setting among trial participants, and Pearson 𝛘2 test for independence to assess the association between distribution of patient characteristics in trial participants versus trial non-participants. Results: Of 28,235 trial participants, 13,297 (47%) were treated at academic and 14,938 (53%) at community sites. Among patients who participated in clinical trials, the odds of enrollment at a community versus academic site were significantly higher among patients who were older (75+ odds ratio [OR] 1.91, 95% confidence interval [CI] 1.73-2.11), Female (OR 1.22, CI 1.14-1.31), Black (OR 1.32, CI 1.16-1.50), had Medicaid (OR 1.22, CI 1.07-1.39 ) or were uninsured/unknown (OR 2.05, CI 1.82-2.31) and had the lowest quintile SES (OR 1.78, CI 1.58-2.00), and were significantly lower among patients who were Latinx (OR 0.56, CI 0.48-0.65) or higher ECOG Performance Status (2+ OR 0.75, CI 0.65-0.87). Significant differences in each patient characteristic category existed between trial participants and trial non-participants at both academic and community sites (p < 0.001). Trial participants and trial non-participants were more similar (𝛘2 values less discordant) in sex and race/ethnicity at academic sites, and more similar in insurance and SES categories in the community. Conclusions: When compared to academic centers, community sites had proportionately greater enrollment of older, Black, Medicaid/uninsured and low SES patients. Significant differences existed between trial participants and trial non-participants in both settings for each demographic category. These findings highlight how community site involvement may improve trial representativeness, and underscores the need for targeted solutions to optimize trial representativeness in both academic and community practices.
Disparities in minority patients with breast cancer under 40 years of age: A single center experience.
Authors: Patel Rajvi , Ellison Kimberly , Parsons Dawn , Anusim Nwabundo Ifeyinwa
Published: June 2023

e18553

Background: Current guidelines recommend screening for breast cancer (BC) starting at age 40. However, BC in women under 40 years is increasing in incidence. Pathogenic germline mutations are found to be the driving force in nearly 17% of those diagnosed under 45 years and 50% of those under 30 years. Limited data is available on the prevalence of pathogenic mutations in minority patients. We conducted a retrospective analysis of young breast cancer patients from low socioeconomic backgrounds between 2010-2022 at a single center in Central Texas. Methods: Patients were selected based on a diagnosis of BC under 40 years old and living at or below 200% of federal poverty level as noted through their insurance status of Medicaid and Medical Assistance Program of Travis County. Data regarding age of diagnosis, demographics, clinical presentation, staging, germline mutations and outcomes were extracted from the medical record. Descriptive statistics were used to analyze the dataset. Results: A total of 125 patients were identified for the study. Median age of the cohort was 35 years old (range: 19-39 years). Demographics included 61 Hispanic patients (48.8%), 40 White patients (32.0%), 16 Black patients (12.8%) and < 2% for each other group. Analysis of germline mutations was available for 86 patients. High risk mutations were identified in 28 patients, including 13 Caucasian women, 10 Hispanic women, and three Black women. BRCA mutations were the most common mutation (75%). Other mutations included CHEK2 (7.2%), MUTYH (7.2%), ATM (3.6%), PIK3CA (3.6%), PTEN (3.6%), RAD51C (3.6%) and RAD51D (3.6%). Variants of unknown significance were found in 18 patients, including 11 Hispanic women, four Black women and two White women. Forty patients had BC independent of mutations. Staging on initial diagnosis was available for 113 patients, 40.7% of which were locally advanced (28.3% in Stage III disease and 12.4% with metastatic disease). Advanced disease was higher in Hispanic patients (22/61) and Black patients (10/16) compared to White patients (10/40). Breast cancer subtypes included 22.8% with triple negative BC, 8.1% with HER2-enriched BC, 27.9% with hormone receptor (HR) positive and HER2 negative BC and 14.0% with both HR and HER2 positive BC. At the time of data review, only 30 patients were documented to have died, of which 22 died within five years of diagnosis. Five year death rate was 26.2% for Hispanic patients, 18.8% for Black patients and 7.5% for White patients in the study cohort. Conclusions: This study shows disparities among young Hispanic and Black patients with BC, particularly in the initial staging of BC and 5-year death rate. A large number of VUS were seen in minorities, suggesting little is known about the pathogenic nature of these mutations. Future prospective studies should consider investigating interplay between race and outcomes of those diagnosed with BC under 40 years old.
Disparities in screening, diagnosis, treatment, and survivorship care among urban and rural patients with colorectal cancer in the United States: A systematic review and meta-analysis.
Authors: Sepassi Aryana , Li Meng , Zell Jason A. , Chan Alexandre , Saunders Ila M , Mukamel Dana B
Published: June 2023

e18558

Background: Older rural patients suffer from disproportionately higher rates of colorectal cancer (CRC) and mortality due to CRC compared to older urban patients. These disparities may be multifactorial including geographic barriers to care, lack of health insurance coverage, or lack of preventive health behaviors, among others. To further understand this burden of rural-urban CRC disparities along the cancer care continuum, we sought to evaluate and synthesize literature on screening, diagnosis, treatment, and survivorship care differences between urban and rural CRC patients. Methods: We performed a systematic literature review using PubMed and EMBASE in August 2022 using keywords related to screening, diagnosis, treatment, and survivorship care for CRC urban-rural patients for studies published in 2000 to 2022. A meta-analysis was performed for results related to screening using a random-effects model. Results: Of 836 studies collected, 46 met criteria for review, and 12 for a meta-analysis evaluating the effect of rurality on any reported CRC screening. The majority of studies evaluated disparities in screening (46%), followed by diagnosis (30%), treatment (20%), and survivorship care (4%). In general, studies indicated urban CRC patients as more likely to report age-appropriate screening, to receive early-stage diagnosis, and to receive timely and appropriate treatment compared to rural CRC patients. Only one study was found evaluating a difference in receipt of surveillance colonoscopy in urban/rural CRC survivors, with rural survivors as 2.28 times more likely to report nonadherence to surveillance screening (OR = 2.28, 95%CI:1.07-4.85). Meta-analysis results indicate that rural patients had 22% lower odds of reporting screening compared to urban patients prior to any diagnosis (pooled OR = 0.78, 95%CI:0.66-0.92, I2= 42.9%). Conclusions: Despite widespread support and effort to implement policy aimed toward reducing disparities of care, screening, diagnosis, and treatment gaps are still present between urban and rural CRC patients. Further research must be performed to evaluate the effects of these disparities on clinical outcomes in the rural CRC patient population.
Clinical outcomes and national information of patients with multiple myeloma (MM) covered under the largest national health insurance in a low-middle-income country.
Authors: Lombana Quinonez Milton Alberto , Sabogal Jorge Enrique , Gonzalez Guido , Torres Ana Milena
Published: June 2023

e18561

Background: In Colombia, national health insurance is private in all the country, with coverage greater than 95% of population. However, there is few health outcomes published in specific neoplastic diseases. We analyze relevant clinical outcomes and the information known by the largest health insurer Nueva EPS (NEPS) in a major region of Colombia, in patients with MM, which could allow decision-making in public health. Methods: Pts treated under the Valle del Cauca regional NEPS insurance with a diagnosis of MM between 1996 and 2018 and who received care at comprehensive cancer centers, were retrospectively identified. We collect relevant variables from the institutional electronic medical records and the information available from the insurer. Our primary objective was to determine the overall survival (OS) in general and specific populations and what was the important clinical information that could be extracted directly by the insurer to analyze and support decisions. We performed Kaplan Meier, and cox regression analysis with relevant variables. Results: 233 pts treated in 3 comprehensive cancer care centers in the city of Cali were included. Median overall survival was 68 months, with 25% alive at 15 years. Age > 75 years [HR 2.4, 95%CI 1.5-4, P = 0.0001], ISS category [HR 1.7, 95%CI 1.0-2.9, P = 0.003], and chronic kidney disease [HR 3.6, 95%CI 1.9- 6.7, P = 0.0004] were associated with a higher risk of death. Receiving an autologous transplant [HR 0.2, 95% CI 0.1-0.6, P = 0.0006] and the use of proteasome inhibitors and or immunomodulators were associated with better survival (OS 54 vs 15 months, p = 0.05). This contrasts with the scarce data available at the insurer, with information about heavy chain involved in only 63% of pts, light chain 44%, Durie-Salmon stage 54%, ISS stage 31%, FISH studies in 16%, type of 1st line of treatment in 65%, objective response 26% and overall survival in 72%. Conclusions: The survival of patients with MM treated under the largest health insurer in Colombia was good and similar to international series in highly experienced centers, however the relevant clinical information known by the insurer was poor. This supports the need to develop and have a single national electronic medical record that allows a better access to health data for decision-making in public health.
Rural cancer care delivery during the COVID-19 pandemic for patients with early-stage cancer.
Authors: Okado Izumi , Liu Michelle , Elhajj Carry , Wilkens Lynne , Holcombe Randall F.
Published: June 2023

e18566

Background: Cancer mortality rates remain substantially higher among rural populations. Rural-urban disparities in cancer outcomes are partly associated with care delivery challenges in rural areas, and the COVID-19 pandemic may have exacerbated these disparities. Care coordination (CC) is a critical component of patient-centered care; yet, rural patients experience significant CC-related challenges. In this study, we examined patient-reports of CC and time to treatment initiation (TTI) among rural patients with early-stage cancer. Methods: We conducted a cross-sectional survey with 51 patients with early-stage (I-III) cancer receiving active treatment at rural oncology practices between May 2021 and June 2022. Rural was defined using RUCA. Enrolled patients completed the background questionnaire and the Care Coordination Instrument (CCI). A validated instrument, the 29-item CCI assesses overall patient perceptions of CC and three domains of CC (Communication, Navigation, Operational). Items are rated on a 4-point Likert-scale. Data for the urban cohort were derived from historical data. General linear models (GLMs) were used to compare CCI scores between rural and urban patients. Results: The mean age of rural patients was 58.5 (range 24.0-84.0), and 64.7% were female. GI (39.2%) and breast (33.3%) were the most common cancer types. Median time from diagnosis to treatment initiation for rural patients was 61.0 days (IQR: 30.0-65.8), significantly longer compared to the pre-pandemic state registry data. 21.6% of rural patients reported delays in active treatment. Overall, there were no rural-urban differences on the overall perception of CC ( p > .05). However, rural patients reported significantly lower Communication scores ( p = .027). After adjusting for the effects of covariates, rural-urban differences on Communication remained significant ( p = .016). Item-level analyses revealed significant rural-urban differences in specific aspects of CC (e.g., physician-patient communication). CCI scores were not associated with TTI. Conclusions: Our findings indicate that rural patients with early-stage cancer experienced significant delays in treatment initiation during the pandemic, and there were notable differences in Communication aspects of CC between rural and urban patients. Interventions to improve TTI among rural patients are urgently needed to prevent potentially further exacerbating cancer health disparities.
Quality dashboards: Uncovering potential health disparities.
Authors: Zhang Kevin Juan , Sato-DiLorenzo Aya , Celmen Melis , Chude-Sokei Rosemary , Dechen Tenzin , O’Donoghue Ashley L. , Zerillo Jessica Ann
Published: June 2023

e18567

Background: A number of demographic characteristics and social determinants of health have been demonstrated to impact cancer outcomes. It is essential to assess quality metrics stratified by these characteristics so that potential disparities may be identified and addressed amongst marginalized populations. Methods: We examined our Cancer Center’s quality dashboard’s quality metrics and identified which could be stratified by race, ethnicity, language preference, sexual identity, and gender. Databases included Vizient, Press Ganey, Tumor Registry, and our institution’s performance reports. Where data was available, we conducted cross-group comparisons to assess for differences in outcomes. ANOVA and Fisher’s exact tests were performed to compare groups. A P-value of < 0.05 was considered statistically significant. Results: Of the 13 metrics, six (46%) could be stratified by demographic characteristics (likelihood to recommend the practice, mortality index, length of stay index, 30-day readmission, return to the operating room, adequate lymph node sampling). Six (46%) could not be stratified due to a lack of demographic information (new patient access, medication harm events, distress screening, preventable admissions, preventable emergency department visits, survivorship care plan). One metric was not at the patient-level, and thus did not apply to our investigation (non-template chemotherapy orders). More White patients (86.1%) were very likely to recommend the practice compared to Black (72.1%) or Asian patients (60.1%) (P < 0.001). Additionally, significantly more English speakers were likely to recommend the practice than non-English speakers (84% vs. 65%; P < 0.001). A significant difference was found in the 30-day readmission rate when stratified by race (White [8.2%] vs. Black [8.8%] vs. Asian [10.6%] vs. other [14.5%] vs. unknown [1.0%]; P = 0.02). No significant group differences were found in mortality index, length of stay, the proportion of adequate lymph node sampling, or returning to the operating room. Notably, the proportion of patients with “unknown” race and ethnicity ranging from 3.9%-17.5% for five metrics, represented the second largest group behind White race and non-Hispanic ethnicity. Conclusions: Less than half of the quality dashboard’s core metrics could be stratified by demographic characteristics. Even when data was available, the high frequency of missing data identifies a need for improved data collection accuracy so that more meaningful assessments can be made. Existing data suggests a disparity exists for patients of limited English proficiency having a lower satisfaction with the practice. This warrants further exploration in order to close gaps in cancer quality outcomes.
Factors associated with readmission to the same hospital within 30 days of discharge in patients who received surgical treatment for head and neck cancer: An NCDB analysis.
Authors: Verplancke Kiana , Silberstein Peter T. , Keirns Darby
Published: June 2023

e18570

Background: Readmission rates within 30-days of discharge is an important quality metric when caring for hospitalized patients. Higher rates of readmission are a predictor of all-cause mortality and associated with negative financial implications for hospitals. Patients undergoing surgery for the treatment of head and neck cancer have readmission rates ranging from 7.3% to 26.5%. The benefits to the patient and the hospital highlight the importance of determining if certain patient features impact the likelihood of readmission. This study sought to determine if certain socioeconomic and demographic factors are associated with higher 30-day readmission rates following surgically treated head and neck cancers. Methods: Using the National Cancer Database, 221,822 patients were identified as having surgically treated head and neck cancer between 2004 and 2020. Using SPSS statistics 28, 30-day readmission rates for these patients were compared to each other based on certain characteristics including sex, race, ethnicity, insurance status, income, and facility type. Results were analyzed using descriptive statistics, a multivariate binary logistic regression, and chi-square analyses using a significance level of p < 0.05. Results: Higher 30-day readmission rates in patients with certain demographic and socioeconomic factors were identified. Black and Asian patients had higher readmission rates in comparison to white patients (p < .001, 95% CI = 1.24-1.41 and 1.08-1.30, respectively). Patients of Hispanic backgrounds were 25% more likely to be readmitted than non-Hispanic patients (p < .001, 95% CI = 1.15-1.34). Males had a 13% higher readmission rate than females (p < .001, 95% CI = 1.09-1.17). Uninsured patients were more likely to be readmitted than those with some form of insurance (p < .001). Those with a median annual income less than $46,277 were 11% more likely to be readmitted than those who had a median annual income higher than $46,277 (p < .001). In comparison to those treated at a community cancer program, patients who received treatment at academic/research programs or integrated network cancer programs were 32% and 21% more likely to be readmitted, respectively (p < .001, 95% CI = 1.20-1.45 and 1.10-1.34, respectively). Conclusions: Patients who are more likely to be readmitted to the same hospital within 30-days of being surgically treated for head and neck cancers include black patients, Asians, those of Hispanic descent, males, the uninsured, those with a lower median annual income, and those who received surgical treatment at academic/research programs or integrated network cancer programs. Identification of factors contributing to readmission allows for development of targeted interventions to prevent this occurrence.
Transnational utilization of diagnostic studies across the US-Mexico border.
Authors: Diaz Fernando Cristobal , LaPelusa Michael Brian , Verduzco-Aguirre Haydee Cristina , Aldaco Fernando , Soto Pérez de Celis Enrique
Published: June 2023

e18574

Background: Transnational healthcare utilization between US and Mexico border states is well described for specific medical conditions; however, little is known regarding the trans-border use of diagnostic imaging and invasive studies in cancer care in this region. We aimed at identifying patterns of diagnostic testing use among US- and Mexico-based patients. Methods: A cross-sectional online survey was sent to oncologists practicing in Mexican border states (Baja California, Chihuahua, Coahuila, Nuevo León, Sonora, and Tamaulipas), identified from the Mexican Society of Oncology’s member directory. The survey was administered through REDCap between October and November 2022. Responses were analyzed using descriptive statistics. The study was approved by the IRB of Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Results: Sixty-six respondents completed the survey. Respondents were mostly medical oncologists (n = 24) or surgical oncologists (n = 24). Most reported primarily practicing for < 5 years (46.9%) in both public and private practice settings. Approximately 70% (n = 46) of respondents reported interacting with US-based patients traveling to Mexico to undergo diagnostic imaging studies, the most common of which included CT-scan (82.6%). Fifty-six percent (n = 37) of respondents interacted with patients traveling to Mexico for the purpose of undergoing invasive testing, requiring access via percutaneous puncture or incision, where the most frequently sought test included a biopsy (91.9%, n = 34). Forty percent (n = 26) of respondents interacted with patients from Mexico who travelled to the US for diagnostic imaging, who most frequently sought nuclear imaging studies (80.0%). Approximately 33% of respondents (n = 22) interacted with patients who travelled for diagnostic testing, with next generation sequencing (NGS) the most common study requested (90.9%). See Table. Conclusions: Diagnostic studies play an essential role in the management of cancer. A significant proportion of patients travelling to Mexico for diagnostic tests pursued CT imaging scans and biopsies, which may be due to the lower costs of those procedures in Mexico, even for patients who might have insurance. In contrast, most Mexican patients who traveled to the US for testing pursued nuclear imaging and NGS, perhaps reflecting lack of access and availability. Strategies aimed at improving access to evidence-based diagnostic testing are needed to reduce inequities both in high- and middle-income countries. [Table: see text]
Pursuing cancer treatment across the US-Mexico border: Motivations and barriers.
Authors: LaPelusa Michael Brian , Verduzco-Aguirre Haydee Cristina , Diaz Fernando Cristobal , Aldaco Fernando , Soto Pérez de Celis Enrique
Published: June 2023

e18575

Background: Healthcare utilization is a common reason for bidirectional travel across the US-Mexico border. We surveyed Mexican oncologists to understand why patients with cancer in the US and Mexico seek care outside their home country and what barriers they face. Methods: Approval was obtained from Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán´s IRB. Oncologists living in Mexican border states (Baja California, Sonora, Chihuahua, Coahuila, Nuevo León, and Tamaulipas) were identified from the Mexican Society of Oncology’s directory. Two hundred twenty-five participants were queried via e-mail with a REDCap survey designed by the investigators. Descriptive statistics were used to analyze responses. Results: Sixty-six respondents completed the survey, most of whom were medical (n = 24) or surgical oncologists (n = 24) who had practiced for < 5 years (n = 31). Sixty (90.9%) respondents interacted with US-based patients who traveled to Mexico to receive care, most frequently due to inadequate health insurance (n = 45). Forty-eight (72.7%) respondents interacted with Mexico-based patients who traveled to the US to receive care, most frequently due to patient perception of superior care in the US (n = 38). Table 1 describes the reported reasons patients traveled across the border for cancer care. Twenty-nine (43.9%) respondents interacted with US-based patients who wanted to receive care in Mexico but could not, most frequently due to lack of financial resources (n = 17) or of a support system in Mexico (n = 10). Forty-three (65.2%) respondents interacted with Mexico-based patients who wanted to receive care in the US but could not, most frequently due of lack of financial resources (n = 43) or passport/visa issues (n = 14). Conclusions: According to Mexican oncologists, US-based patients travel to Mexico to receive cancer care primarily due to inadequate health insurance. In contrast, Mexico-based patients travel to the US primarily due to their perception that care in the US is of higher quality and because aspects of their care are unavailable in Mexico. Both US and Mexico-based patients face many barriers to receiving care outside their home country, which should be tackled to improve access to quality care in border region. [Table: see text]
Assessment of the utilization of immunotherapy in Sub-Saharan Africa.
Authors: Olatunji Elizabeth Oluwagbemisola , Patel Saloni , Graef Katy , Mallum Abba Aji , Chigbo Chinelo Adaobi , Jaffee Elizabeth M. , Ngwa Wil
Published: June 2023

e18578

Background: The Lancet Oncology Commission for sub-Saharan Africa predicts that cancer deaths will double from 520,158 per year to more than 1 million by the year 2030. These striking figures indicate a need to urgently evaluate cancer treatment infrastructure and resources in the region. Studies have found immunotherapy to be effective for the treatment of advanced-stage cancer, which almost 70% of patients in SSA present with. Despite immunotherapy’s significant curative potential, its utilization in SSA is not well documented. The purpose of this study was to evaluate the landscape of immunotherapy in SSA. Methods: A Qualtrics survey assessing the utilization and existing infrastructure and training for safe immunotherapy administration was developed and distributed online to SSA oncology networks including that of the HypoAfrica clinical trial. The target population for the survey was healthcare providers in SSA serving patients with cancer. Descriptive statistics methods were used to analyze the data. Results: 288 responses were collected from 29 countries in SSA. Clinical and medical oncologists made up 23% of respondents and nurses made up 24%. 45% of respondents were familiar with immunotherapy. 11% indicated they were adequately trained to administer it. Of these (n = 32), 53% indicated also being trained to manage immune related adverse events related to immunotherapy administration. 29% of all survey respondents indicated that their clinic has easy access to cancer immunotherapy and 45% indicated that their clinic currently practices immunotherapy. Of clinics that practiced immunotherapy (n = 129), 12% used genomic sequencing to assess tumor mutational burden, and 43% assessed patient expression of pathologic biomarker PD-L1 prior to administration. The most common types of immunotherapies used were monoclonal antibodies (44%) and checkpoint inhibitors (17%). Conclusions: Less than half of surveyed clinics currently utilize immunotherapy, and even fewer employ biologic tools to predict immunotherapy response prior to administration, which threatens the safety and efficacy of its use. Additional training for management of immunotherapy-related adverse effects is needed. Laboratory techniques to identify patients best suited for immunotherapy, and incorporation of immunotherapy training into continuous medical education may be prerequisites for wider, effective adoption of this technique in SSA.