bluuebunny/crossref_metadata_2025 huggingface dataset:
Resource and reimbursement barriers to comprehensive cancer care (CCC) delivery: An association of community cancer centers (ACCC) survey research analysis.
Authors: Benson Al Bowen , Boehmer Leigh , Shivakumar Latha , Trosman Julia Rachel , Weldon Christine B. , Hahn Elizabeth A. , Kircher Sheetal Mehta
Published: October 2020

31

Background: CCC delivery is recommended in guidelines, required by accreditation bodies, and essential for high-quality cancer management. Barriers, such as insufficient reimbursement and lack of specialist staff, prevent consistent access to and delivery of CCC, particularly supportive oncology services. Challenges especially persist in community programs, where access to philanthropy and similar funding is limited. ACCC conducted a representative survey of its member programs to elucidate capacity and barriers to CCC delivery in the community/academic setting in order to inform policy and value-based payment reform. Methods: Survey development methodology included item generation with expert review, iterative piloting and cognitive interviews to achieve content and internal validity. An online survey was piloted at the ACCC 2018 Annual Meeting and sent to member programs via email link. The final survey included 22 questions on availability and funding for supportive services. Twenty-seven supportive oncology services were assessed for availability, reasons not offered, reimbursement/funding and patient payment. Analyses were conducted with SAS. Results: 172 of 704 ACCC member programs responded and completed the majority of survey as of 10/7/19. Despite a high proportion of programs offering supportive oncology services, gaps between cost and reimbursement were present for all (Table). Deficits in reimbursement are compensated by patient out-of-pocket payments, grants and donations. Most centers report needing more staffing in psychology (61%), social work (60%), navigation (59%), nutrition (57%), palliative care (56%), genetic counseling (52%), and financial counseling (53%). Gaps were observed regardless of region or practice type. Conclusions: There is a lack of sufficient reimbursement, staffing, and budget to provide CCC across the U.S., regardless of region or practice type. Oncology care models and reimbursement policies must include CCC services to optimize delivery of care.
A comparison of two models of multidisciplinary lung cancer care within a community-based healthcare system.
Authors: Meadows Meghan , Ray Meredith , Smeltzer Matthew , Faris Nicholas , Fehnel Carrie , Akinbobola Olawale , Jackson Bianca , Foust Courtney , McHugh Laura , Signore Raymond S. , Wright Jeffrey , Robbins Edward T. , Osarogiagbon Raymond U.
Published: October 2020

36

Background: The Multidisciplinary Thoracic Oncology Conference (MTOC) model is easier to implement than the Multidisciplinary Clinic (MDC) model, but does not directly involve patients in decision-making. We compared the processes and outcomes of lung cancer care between patients discussed in a weekly MTOC versus those seen in a MDC. Methods: Prospective observational study of thoroughness of staging, stage confirmation (defined as biopsy of the stage-defining lesion), National Comprehensive Cancer Network guideline-concordant treatment, overall (OS) and event-free (EFS) survival of lung cancer patients in a community healthcare system’s MDC and MTOC from 2014-2019. We used the chi-square test and multivariable logistic regression to evaluate guideline-concordant treatment and stage confirmation; Kaplan-Meier curves and multivariable Cox regression were used to evaluate OS and EFS. We adjusted models for age, sex, race, insurance, smoking status, and histology. Results: 614 patients received care in MDC; 571 in MTOC. MDC patients were older (median age: 69 vs. 67); less likely to be active smokers (44% vs. 47%; p=0.03); more likely to have bimodal (98% v 95%, p=0.02) and trimodal staging (60% v 46%, p<0.0001). The stage-confirmation rate (OR: 1.55; 95% CI: 1.22-1.96) and mediastinal stage confirmation rate (OR: 1.55; 95% CI: 1.23-1.95) were both significantly higher in MDC, even after adjustment (aOR: 1.60; 95% CI: 1.25-2.03); (aOR: 1.58, 95% CI: 1.25-2.00). A higher proportion of patients received guideline-concordant treatment in MDC than in MTOC (82% vs. 73%; OR: 1.63; 95% CI: 1.21-2.20) even after adjustment (aOR: 1.64; 95% CI: 1.20-2.24). However, MTOC patients had significantly better OS (p=0.03) and EFS (p=0.001) than MDC patients and a lower hazard of death (HR: 0.81; 95% CI: 0.67-0.98), even after adjusting for confounding variables (aHR: 0.79 95%CI: 0.66-0.95). Conclusions: Although the processes of lung cancer care delivery were better in MDC than in MTOC, survival was better in MTOC. Patient selection may have played a role in these survival differences. The MTOC model, as implemented, seems competitive with the MDC model and is worthy of further exploration as a more feasible model of multidisciplinary care. [Table: see text]
The optimal living and survivorship program: Piloting a novel survivorship care model.
Authors: Corcoran Stacie , Russell John , Clayton Jill , Kelly Bridget , Smith Andrea , Keenan Kate , Robson Mark E. , Iyengar Neil M.
Published: October 2020

40

Background: Multiple agencies define cancer survivorship as beginning at the time of diagnosis. However, traditional care models deliver “survivorship care” months or years after diagnosis, which can cause care disruption and “transition anxiety”. We hypothesized that an approach centered around wellbeing could be applied across the cancer continuum (starting at diagnosis) and serve as a novel survivorship care model. Methods: We developed the Optimal Living and Survivorship Program with 3 key components: 1) a centralized model that provides multidisciplinary care; 2) an individualized Wellness Plan (WP); and 3) enrollment at the time of diagnosis to mitigate post-treatment transition. Participants complete a digital wellness questionnaire (WQ) prior to the 1st medical oncology consult, receive a validated algorithm-based WP, and meet with a Wellness Advanced Practice Provider (WAPP). The WP consists of individualized education and referrals (e.g., nutrition, exercise, financial counseling). The WAPP will assume post-treatment (“survivorship”) care. We piloted this approach in patients diagnosed with breast cancer beginning in 11/19. The primary outcome is feasibility defined by completion of the WQ. Secondary outcomes include participation in the WAPP visits, attendance at appointments, and quality of life (QOL). Results: Due to COVID-19, the pilot was paused in 2/20. Data collected from 11/19 through 2/20 reveal a total of 67 eligible patients with newly diagnosed breast cancer were approached, with 65 enrolled. All participants completed the WQ and all received a WP with supportive referrals and educational resources. All participants engaged with WP recommendations. Participants were screened at high risk for an average of 3.8 unmet needs, and 98% were at high risk for 2 or more needs at time of diagnosis. Exercise was the highest unmet need (83%). There was 76% adherence with referral to the program’s Exercise Physiologist. Other areas of needs were nutrition (59%) and sleep quality (51%). WAPP tele-visits began in 6/20; visit completion rates will be presented. Qualitative data regarding patient experience and QOL will be obtained via interviews and feedback will be categorized in thematic domains. Conclusions: Most patients enrolled in the program, completed a WQ and engaged with the WP. Our findings suggest that this early intro to survivorship is feasible. Earlier engagement and incorporation of wellness and supportive services from time of diagnosis may improve our ability to address multifactorial needs during and after cancer therapy.
Inadequacies in genetic testing referrals and counseling in prostate cancer.
Authors: Suri Yash , Nandagopal Lakshminarayanan , Basu Arnab
Published: October 2020

43

Background: Recent studies have recognized the high prevalence of germline mutations in genes affecting DNA repair in patients with prostate cancer. In recognition of their growing clinical significance, the NCCN guidelines recommend genetic counselling in prostate cancer pts with certain risk factors. The application of these guidelines in clinical practice were evaluated. Methods: All new clinic visits of prostate cancer pts at UAB from January 2019 – June 2019 were identified and analyzed. We constructed a flow diagram of the UAB two-step referral model, and performed a chart review and analyzed the new clinic visits. We then sent a 10-item questionnaire to providers at UAB to collect information on germline genetic testing patterns, general approach to testing, and the barriers of GC, and actions to overcome barriers. Results: From January to June 2019, 57 new prostate cancer patients were seen, of which 23 had metastatic disease, 20 had high or intermediate risk localized disease and remaining had biochemical recurrence. In total, 38 had an indication for GC. The most common indication was metastatic disease in 23 pts (40%) and localized high risk in 15 pts (26%). Significantly 33% of 24 patients with early onset prostate cancer < 60 yrs did not meet NCCN defined criteria for testing. Only 39% of the 38 eligible patients were referred, with testing completed in 11% of those with indications. The response rate to the survey was 91%. 30% of respondents reported that they would be comfortable completing genetic counseling themselves, and the most commonly reported barrier to providing the testing themselves was time, and lack of expertise/experience. 70% percent of providers cited that lack of genetics workforce was a barrier to genetic testing, and 60% cited lack of knowledge of genetic testing and genetics and the inadequate coordination of referrals were barriers. Conclusions: While a majority of prostate cancer patients seen in the oncology clinic meet criteria for GC, referrals are inconsistent, and only a handful of eligible patients complete testing. From the survey results, the areas that need to be improved from the provider’s side are education and comfort with genetic testing. From a systems perspective, the need for more genetics workforce, and better process workflows are required to improve the uptake of Genetic Testing Referral and Testing. The interventions of practice transformation and education need to be implemented, and tested at UAB to improve adherence to the NCCN guidelines for genetic testing of prostate cancer.
Managing the delivery of quality cancer care during the COVID-19 pandemic in a small community cancer clinic.
Authors: Patel Kashyap B. , Clinton Natasha
Published: October 2020

45

Background: The global pandemic resulting from COVID-19 has resulted in over 400,000 deaths and nearly 7 million active cases at the time of writing this abstract (World Health Organization, 2020). This Public Health Emergency (PHE) represents an unprecedented challenge for oncologists and cancer patients alike. They are met with the challenge of providing uninterrupted care to cancer patients, a predicament that includes a balance between the use of immunosuppressive chemotherapy, it’s potential impact on contracting COVID-19 and the risk of cancer progression. Liang et al reported that cancer patients were not only at very high risk of contracting COVID -19, but also at a much higher risk of complications and death. Our medium sized oncology practice rapidly adapted to meet the challenge to continue to provide care. Methods: Employee and patient safety: Implement CDC recommendations in waiting room, infusion suites and supply of PPE. Categorize patients into priorities based on severity and need of treatment. Implement telehealth. Implement care in accordance to Cancer Patients Assessment and Treatment Priority Determination (top, intermediate and low priority)–Table. As a part of our initial strategy, we discussed the risk and balance of postponing chemotherapy or elective surgery for stable cancer patients during the first phase of closures. We also focused on more intensive surveillance in the older patient population or those with multiple high-risk comorbidities. For patients in complete remission on maintenance therapy, we balanced risk and benefit of stopping chemotherapy. In other patients, we considered the option of switching their chemotherapy regimen from IV to oral therapies, where clinically appropriate, to decrease the frequency of clinic visits and potential exposure. In cases where the option of non-immunosuppressive oral therapy is existed, we implemented the same. Results: Our clinic continues to provide uninterrupted care since the declaration of PHE. We saw a drop of 25% patient volume in March and 35% in April. However, with instant adaptation and implementation of CDC recommendations patient volume reached back to pre COVID 19 related emergency. None of our employees, their dependents nor any of our patients have contracted COVID-19 to date (according to DHEC feedback) at the time of writing. We had a total of 5082 patients visits (1261 chemo visits). Conclusions: By implementing the right steps and precautions, it is possible to provide continued care for and protect staff, physicians and patients. [Table: see text]
Reducing medical oncology infusion no-show rate by improving patient and intra-clinic communication.
Authors: Kainthla Radhika , Anderson Bryana , Culver Sarah , Jones Amy Little
Published: October 2020

47

Background: Parkland Health and Hospital System (PHHS) is the safety-net health system for Dallas County. In a resource-limited health care system, no-shows create waste and delay care. We sought to decrease the no-show rate (NSR) for patients scheduled for infusions, transfusions, and injections in the PHHS medical oncology infusion center by 33% in a 4-month period. Methods: A multidisciplinary team reviewed the NSR from January 2020 to May 2020. The reasons for missed appointments were investigated via chart review to better develop an intervention for meaningful change. A telephone follow-up protocol by the infusion nurses with standardized documentation and communication with the clinic and scheduling teams (intra-clinic communication) was implemented for each missed infusion appointment starting in February 2020. Results: The infusion center had a 16.4% NSR in January 2020. Of the 306 missed appointments, there was no documented reason for 44% (159). 19% (70) were related to change in plan-of-care; 19% (67) were in patients who had been admitted. Patient-related issues (transportation, illness, work/family obligations, etc.) were 13% of no-shows. Only 40 (11%) of the no-shows had a follow-up call. After implementation of follow-up telephone calls, the NSR was 11.2% by May 2020, a 32% decrease. 57.8% (204/1822) of patients who no-showed received a follow-up call to document reason for the missed appointment. Conclusions: We decreased the NSR in the PHHS medical oncology infusion center by 32% over a 4-month period, nearly reaching our goal, by implementing standardized post-no-show follow-up calls. Through our process, we discovered that communication, with the patient and intra-clinic, accounted for the most missed appointments rather than patient-related or other factors. Perhaps confounding our results were changes brought about by the COVID-19 pandemic, including mandatory telephone screening of patients prior to infusion appointments. Next steps include integrating pre-appointment calls into the workflow, standardizing change-in-plan communication, and cost analysis of interventions in our resource-limited setting.
Care coordination challenges between a high-volume center and rural physicians treating patients with pancreatic cancer.
Authors: DePuccio Matthew , Kurien Natasha , Sarna Angela , McAlearney Ann Scheck , Ejaz Aslam
Published: October 2020

58

Background: Pancreatic cancer (PC) patients treated at high-volume centers (HVCs) benefit from specialty services that may not be accessible to rural patients: complex treatment planning, advanced surgical and chemo-radiation options, and multidisciplinary team-based care. As a result, rural PC patients often seek treatment at multiple locations for different episodes of care (i.e., chemotherapy and surgery). The facilitators and barriers to coordinating care between rural physicians and HVCs for rural PC patients treated by both types of providers are not well-understood. Methods: We conducted semi-structured interviews with PC specialists (medical, surgical, and radiation oncologists, n = 9) at a HVC (The Ohio State University) actively treating and co-managing rural PC patients with rural physicians. Using rigorous qualitative methods, two co-authors independently coded the interview transcripts to develop a thematic account of HVC-rural physician care coordination barriers and facilitators. Results: Initial interactions between PC specialists and rural PC patients often require duplication of diagnostic testing (i.e., imaging) due to inadequate transfer of medical records at the time of consultation. This is partly due to inefficient phone communication between HVCs and rural physicians. Such inefficiencies often discourage two-way communication between HVCs and rural physicians, and this can hinder development of a shared understanding of patients’ treatment plans. Specialists suggested a dual-approach may help to improve care coordination in this context: (a) developing better personal relationships with rural physicians to facilitate information-sharing and “closing-the-loop” on patients’ treatment plans; and (b) implementing data systems that permit physicians to share patients’ records across organizations. Several specialists acknowledged the benefit of having a dedicated care coordinator who could help patients connect with specialists, navigate the different healthcare systems, and relay information between providers. Conclusions: Given the challenges that can complicate the PC treatment process for rural patients, it is important to consider opportunities to address these issues. Taking steps to improve efficiency in communication may help facilitate the development of cohesive treatment plans and promote team-based care. Further studies are needed to examine the effects of care coordination interventions, like the use of care coordinators, on improving care for rural PC patients.
Systematic review and meta-analysis of incremental cost-effectiveness ratio (ICER) for new cancer drugs.
Authors: Oliveira Fernanda Alves , Oliveira Eduardo Alves , Lopes Gilberto , Lima Joao Paulo SN
Published: October 2020

66

Background: This systematic review and meta-analysis compared incremental cost-effectiveness ratios (ICERs) of cancer drugs and their relationship with society’s willingness to pay (WTP) across different countries, scenarios and indications. Methods: We sought for cost-effectiveness studies in PubMed, Embase, Cochrane and LILACS published from December 2012 to December 2017. CAR-T cell therapies were excluded given short follow-up. We converted ICERs value and respective annualized 1time the Gross Domestic Product per capita (GDP) - used as a proxy for WTP threshold - into purchase-parity-power dollars (PPP) for better economic reality comparisons. Economics data came from the International Monetary Fund website. Characteristics studied in the distribution of ICERs values were compared using the Mann-Whitney or Kruskal-Wallis U-test with multiple comparison correction and simple linear regression. The chance of ICER being below the 1x GDP threshold was expressed as odds ratio and 95% confidence interval, calculated by logistic regression. Results: We retrieved 354 drug-versus-drug different assessments. PPPconversion increased median ICER of middle-income countries ($32k to $68k;P < 0.001). Median ICER was highest in USA ($154k), followed by other high-income countries ($76k; P < 0.001). In multiple regression, anti-VEGF (P < 0.001) and US-led (P = 0.03) studies had highest ICERs, while curative therapies (p = 0.02) had the lowest ones. 22% of studies were below the WTP bar, none of anti-VEGF, sipuleucel, anti-CD-30, castration-resistant, hepatocarcinoma, and renal cell ones. Immune checkpoint inhibition (OR 8.70; P = 0.045) and middle-income (OR 7.40; P < 0.001) studies were more likely above WTP, whereas curative therapies were more likely below WTP. Conclusions: Cancer therapies’ cost exceeding the WTPs is a worldwide pattern, with some factors related to ICER variation. These findings may foster better understanding and aid stakeholders deal with the global issue of high oncology care costs.
Is less more? The association between hospital volume and low-value breast cancer surgeries.
Authors: Minami Christina Ahn , Jin Ginger , King Tari A. , Mittendorf Elizabeth A.
Published: October 2020

68

Background: Hospital volume is often equated with surgical quality. In breast surgical oncology, higher hospital volume has been associated with higher overall survival rates, but whether it is a proxy for quality with respect to low-value care remains unexplored. We thus examined the association between hospital volume and the use of three breast surgeries identified as low-value by the Choosing Wisely campaign. Methods: Patients with stage 0-III unilateral breast cancer diagnosed from 2013-2016 were identified in the National Cancer Database. The outcomes of interest were: 1) contralateral prophylactic mastectomy (CPM), 2) axillary lymph node dissection (ALND) for breast conserving therapy (BCT) patients with cT1-2N0 disease and <2 positive nodes, and 3) sentinel lymph node biopsy (SLNB) in women >70 years old with cT1N0 hormone receptor-positive (HR+) cancer. Multivariable regression models with restricted cubic splines were used to examine the association between annual hospital volume and outcomes of interest, after adjusting for patient-, disease-, and hospital-level risk factors. Results: Overall, 13.6% of 841,610 women with unilateral Stage I-III breast cancer underwent CPM, 9.2% of 832,205 BCT patients with clinical T1-T2N0 disease underwent ALND, and 85.7% of women >70 years of age with cT1N0 HR+ cancer underwent SLNB over the study period. In adjusted analyses that defined hospital volume by decile, patients treated in the first and tenth decile hospitals had lower odds of undergoing CPM as compared to those treated in the middle deciles (Table). BCT patients with cT1-2N0 disease treated in hospitals in the first and second decile had higher odds of undergoing an ALND than patients treated at higher volume hospitals. Hospital volume did not have an overall significant association with SLNB use in women >70 years old with cT1N0 HR+ disease. Conclusions: The relationship between hospital volume and performance of low-value breast surgeries differed for each Choosing Wisely recommendation, indicating that hospital volume is not a reliable proxy for quality with respect to low-value practices. Additional studies to identify practice-specific deimplementation strategies are needed. [Table: see text]
Employment concerns experienced by ovarian cancer patients and caregivers.
Authors: Liang Margaret Irene , Simons Janice Leahgrace , Herbey Ivan I. , Wall Jaclyn , Rucker Lindsay , Huh Warner King , Ivankova Nataliya V. , Pisu Maria
Published: October 2020

69

Background: Our aim was to obtain patient input on the impact of cancer treatment on employment. Methods: We recruited patients with ovarian cancer receiving systemic therapy who screened positive for financial distress using Comprehensive Score for Financial Toxicity <26. Participants completed a 45-minute interview with 2 interviewers on their costs of care, including employment concerns. Interviews were recorded, transcribed, and coded by 3 analysts using inductive thematic analysis. Results: Of 22 participants, 86% were <65 years old and 28% were on curative intent treatment. There were 18 with currently evaluable interviews. Themes are shown in the table. Conclusions: Cancer care has a negative impact on patient and caregiver work productivity, income, and employer benefits. Incorporating resources to navigate workplace factors, such as Family Medical Leave Act benefits and negotiating accommodations with an employer, could improve care delivery. [Table: see text]
Cost-effectiveness of filgrastim-sndz as primary prophylaxis (PP) versus secondary prophylaxis (SP) to prevent chemotherapy-induced febrile neutropenia (FN) in breast cancer patients at intermediate risk.
Authors: Li Edward C. , Mezzio Dylan , Campbell Kimberley J. , Spargo Andrew , Lyman Gary H.
Published: October 2020

73

Background: According to clinical practice guidelines, the threshold for routine myeloid growth factor (MGF) PP is a high risk (>20%) of developing FN. However, in response to the COVID-19 pandemic, a recent recommendation expands this threshold for using MGF PP to include patients at intermediate risk (10-20%) of developing FN, with the goal of reducing emergency room and hospital visits. Patients with breast cancer receiving potentially curative chemotherapy consisting of docetaxel or paclitaxel (every 21 days) are at an intermediate risk (10-20%) of developing FN. This study evaluates the cost-effectiveness of PP vs. SP using a biosimilar MGF, filgrastim-sndz, in early-stage breast cancer patients at intermediate risk of FN. Methods: A Markov model with a lifetime horizon was constructed to evaluate the total costs and clinical outcomes when using filgrastim-sndz as PP vs. SP in 56 year old early-stage breast cancer patients receiving adjuvant docetaxel (following doxorubicin/cyclophosphamide) every 3 weeks for 4 cycles. Patients had ≥1 FN risk factor (i.e., recent surgery) without the receipt of anti-HER2 therapy, representing a 16% baseline FN risk. Average Sales Price (ASP) calculated from the Centers for Medicare & Medicaid Services July 2020 ASP Drug Pricing File was used as the filgrastim-sndz cost. Incremental cost-effectiveness ratios (ICERs) were calculated for cost per FN event avoided, life-year saved (LYS), and quality-adjusted life-year (QALY) gained from a United States payer perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. Results: Filgrastim-sndz as PP vs. SP provided an additional 0.102 FN events avoided, 0.065 LYS, and 0.056 QALYs at an incremental cost of $2,106. The ICERs were $20,656, $32,624 and $37,333 for cost per FN event avoided, cost per LYS, and cost per QALY gained, respectively. In the PSA, the likelihood of cost-effectiveness at a willingness-to-pay (WTP) threshold of $50,000 per QALY gained was 71.3%. Conclusions: For early-stage breast cancer patients at intermediate risk of FN receiving adjuvant docetaxel with 1 or more risk factors, PP with filgrastim-sndz compared to SP is cost-effective based on a WTP threshold of $50,000/QALY. [Table: see text]
Financial burdens of insured adolescent and young adult cancer patients: A need for crowdfunding platforms, fundraisers, financial grants, and cost conversations with their cancer care team.
Authors: Mann Karely , Waters Austin R. , Vaca Lopez Perla L. , Ray Nicole , Tsukamoto Tomoko , Kaddas Heydon K. , Warner Echo L. , Fair Douglas Beaty , Lewis Mark Andrew , Perez Giselle K. , Park Elyse R. , Kirchhoff Anne C.
Published: October 2020

83

Background: Cancer patients in the United States often experience distress surrounding out of pocket costs from treatment. Adolescents and young adults (AYA) are more likely to be underinsured, skip care due to cost, go into debt, and file for bankruptcy after a cancer diagnosis than patients diagnosed at older ages. We conducted semi-structured interviews with AYA cancer patients and survivors to evaluate their experiences with health insurance, cancer costs and use of crowdfunding. Methods: Eligible participants were ages 18-39, diagnosed with cancer, and currently insured. Recruitment occurred largely through patient navigators at two large cancer centers from October 2019 to March 2020. Data was collected via individual semi-structured telephone interviews, which were analyzed for content. Questions were asked pertaining to crowdfunding platforms, fundraisers, satisfaction with current health insurance policy, and cost conversations with their cancer care team. Interviews were analyzed applying two rounds of thematic content analysis. Summary statistics were calculated for demographics. Results: Twenty-four interviews were completed, with more than half of participants being female (58%), most participants being Non-Hispanic White (79%), mean age at 26.5, and currently receiving cancer treatment (79%). Three themes emerged about AYAs’ experience with treatment costs and health insurance: 1) Even with insurance, cancer care was unexpectedly expensive and burdensome on financial wellbeing; 2) Conversations about cost with cancer care teams were brief and rare and 3) Crowdfunding platforms, fundraisers or financial grants were often used as financial safety nets, and did not cover all out of pocket costs. More than half of participants expressed interest in having cost conversations with their oncologist, nurse or social worker. All participants expressed a need for education on managing cancer costs and a particular interest in educational information on appeals and out of pocket costs. Conclusions: AYAs with cancer report unexpected costs and are interested in discussing this with their cancer care team. AYAs often receive money from fundraisers, financial grants or crowdfunding platforms to assist with the expenses of treatment. Discussions between cancer care teams and AYA patients about health insurance policies and cost saving mechanisms may help reduce out of pocket costs and reliance on external financial mechanisms.
Associations of rural residence and low socioeconomic status on the risk of new onset cardiovascular disease (CVD) in cancer patients.
Authors: Batra Atul , Kong Shiying , Rigo Rodrigo , Cheung Winson Y.
Published: October 2020

90

Background: Cancer patients are predisposed to CVD due to cancer treatments and shared risk factors (smoking/physical inactivity). We aimed to assess if rural residence and low socioeconomic status (SES) modify the risk of developing CVD. Methods: Patients diagnosed with non-metastatic solid organ cancers without baseline CVD in a large Canadian province from 2004 to 2017 were identified using the population-based registry. Postal codes were linked with Census data to determine rural residence as well as neighborhood-level income and educational attainment. Low income was defined as <46000 CAD/annum; low education was defined as a neighborhood in which <80% attended high school. Myocardial infarction, congestive heart failure, arrythmias and cerebrovascular accident constituted as CVD.We performed logistic regression analyses to examine the associations of rural residence and low SES with the development of CVD, adjusting for measured confounding variables. Results: We identified 81,275 patients diagnosed with cancer without pre-existing CVD. The median age was 62 years and 54.2% were women. The most prevalent cancer types included breast (28.6%), prostate (23.1%), and colorectal (14.9%). At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD was 29 months. Rural patients (32.3 vs 28.4%,P < .001) and those with low income (30.4% vs 25.9%,P < .001) or low educational attainment (30.7% vs 27.6%,P < .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio[OR], 1.07; 95% confidence interval[CI], 1.04-1.11;P < .001), low income (OR,1.17;95%CI,1.12-1.21;P < .001) and low education (OR,1.08;95%CI,1.04-1.11;P < .001) continued to associate with higher odds of CVD. Further, patients with colorectal cancer were more likely to develop CVD compared with other tumors (OR,1.12;95% CI,1.04-1.16;P = .001). A multivariate Cox regression model showed that patients with low SES were more likely to die, but patients residing rurally were not. Conclusions: Approximately one-third of cancer survivors develop CVD on follow-up. Despite universal healthcare, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs. [Table: see text]
Do eligibility criteria restrict access to clinical trials?
Authors: Stefaniak Nessa , Walker Jennifer , Murphy Monica L. , McKinney Mishellene , Liu Lu , Edge Stephen B.
Published: October 2020

94

Background: Stringent eligibility criteria may be a barrier to oncology clinical trial enrollment. We examined patients meeting basic trial eligibility criteria defined in a clinical pathway where the trial was not selected, and then performed a thorough review of full trial eligibility. Methods: Locally available trials are embedded into a pathways tool used at the point of care by medical oncologists at a tertiary cancer center. The physician can choose to have the patient fully screened for the recommended trial or bypass it. Patients where the physician bypassed the trial for eleven Phase 2 and 3 solid tumor trials from April 2018 to December 2019 were reviewed for trial eligibility. Basket trials and adoptive cellular therapy trials were excluded. Trials selected for the audit were presented for more than 20 patients and were bypassed in 80% or more cases. For each trial a random set of 20% of cases or a minimum of 15 cases minimum were reviewed. Results: Among the 184 cases reviewed, 149 (81%) were trial ineligible based upon one or more criteria. The most common reasons for patients' ineligibility were the wrong biomarker profile, prior drug treatment, and health conditions including co-morbidities, autoimmune diseases, other cancers and poor performance status. Conclusions: The majority of patients meeting basic eligibility in a clinical pathways system did not meet strict eligibility criteria. This suggests the trials may not be reflective of the needs of the cancer population being treated and may limit the applicability of trial results to the general cancer population. Use of the pathway program to define eligibility is limited by the numerous and nuanced eligibility criteria that cannot be programmed into the pathways system. Clinical trials eligibility criteria and pathway tools need to adapt to the patient population to help advance cancer research. [Table: see text]
UPLC-MS/MS-based Lipidomic Profiles Revealed Aberrant Lipids Associated with Invasiveness of Silent Corticotroph Adenoma
Authors: Wang Zihao , Guo Xiaopeng , Wang Wenze , Gao Lu , Bao Xinjie , Feng Ming , Lian Wei , Zhu Huijuan , Xing Bing
Published: October 2020

Context

The accumulation of aberrant lipids and abnormal lipid metabolism in silent corticotroph adenomas (SCAs) could contribute to changes in clinical phenotypes, especially sphenoid sinus invasion.

Objective

To systematically investigate lipidomic and transcriptomic alterations associated with invasiveness and their potential molecular mechanisms in SCAs and to provide candidate biomarkers for predicting invasiveness and novel treatment options for invasive SCAs by targeting lipids.

Methods

Fifty-four SCAs (34 invasive/20 noninvasive) were subjected to lipidomic analysis based on ultraperformance liquid chromatography mass spectrometry, and 42 clinically nonfunctioning pituitary adenomas (23 invasive/19 noninvasive) were subjected to transcriptomic analysis. Differential analysis was performed to determine differential lipids and genes between invasive and noninvasive tumors. A functionally connected network was constructed with the molecular pathways as cores. Multiple machine learning methods were applied to identify the most critical lipids, which were further used to construct a lipidomic signature to predict invasive SCAs by multivariate logistic regression, and its performance was evaluated by receiver operating characteristic analysis.

Results

Twenty-eight differential lipids were identified, and a functionally connected network was constructed with 2 lipids, 17 genes, and 4 molecular pathways. Connectivity Map (CMap) analysis further revealed 32 potential drugs targeting 4 genes and related pathways. The 4 most critical lipids were identified as risk factors contributing to the invasive phenotype. A lipidomic signature was constructed and showed excellent performance in discriminating invasive and noninvasive SCAs.

Conclusions

The lipidomic signature could serve as a promising predictor for the invasive SCA phenotype and provide potential therapeutic targets for SCAs.
Lifting the Veil
Authors: Dolar Mladen
Published: October 2020

This article traces a brief genealogy of the concept of ideology, focusing on the way that this is a modern concept which presents a break with the traditional philosophical concerns with unmasking delusions and displaying the reality behind them. Ideology pertains to the very reality behind the illusions by virtue of a structural necessity, thus producing a redoubled or reflected illusion. Such was the focus of the classical ideology critique, but recent developments produced a new turn whereby the ideological construction does its own unmasking, preempting the critique. The obscene underside now comes to the fore, lifting the veil by which it was concealed, but this process doesn’t mean that we can now see the plain truth. Lifting the veil is an advanced form of obfuscation whereby the repression itself gets repressed.
The Sovereignty of Critique
Authors: Simpson Audra
Published: October 2020

This article offers a brief history of “sovereignty,” unmooring it from Western governance and the right to kill, in order to trace the life of the term within the field of Native (Indigenous) politics and Studies. Within this field, the practice of “critique” is central, examining conditions of dispossession and exploitation within other disciplines that refuse or devalue knowledge about Indigenous peoples. Historically, “critique” has been vital to Native and Indigenous Studies, which emerged from the liberatory and resistant politics of the late sixties and seventies across North America, as well as from decolonization movements and the specificities (and sovereignties) of Indian country. A developing field at that moment, Native and Indigenous Studies saw that the needs of Indigenous communities were tied directly to forms of resistance and redress but as well to the terrains of knowledge within contemporary academic institutions. As such, disciplinary formation and the critique, if not dismantling of dispossessing disciplines, became key sites for liberation, along with lands and waters.
Extinct Critique
Authors: Kornbluh Anna
Published: October 2020

What is the connection between the discourse of postcritique and the material conditions in which it has taken hold? How do privatization, the destruction of the university, and ecocide bend the trajectory of theory and critique in the present? In posing and exploring these questions, this essay endeavors to perform the traditional function of critique: inquiry into the relations around ideas, embedding ideas in their environments, in order to project alternative relations and environments more conducive to flourishing. I argue that theoretical habits of horizontalism and hypercomplexity have undermined the critical force of mapping environments and building the world up, and that critical theory abides at present in environmental activism rather than in ecocriticism.
Modulating the endoplasmic reticulum stress response attenuates neurodegeneration in a Caenorhabditis elegans model of spinal muscular atrophy
Authors: Doyle James J. , Vrancx Celine , Maios Claudia , Labarre Audrey , Patten Shunmoogum A. , Parker J. Alex
Published: October 2020

Spinal muscular atrophy (SMA) is a devastating autosomal recessive neuromuscular disease resulting in muscle atrophy and neurodegeneration, and is the leading genetic cause of infant death. SMA arises when there are homozygous deletion mutations in the human SMN1 gene, leading to a decrease in corresponding SMN1 protein. Although SMN1 is expressed across multiple tissue types, much of the previous research into SMA focused on the neuronal aspect of the disease, overlooking many of the potential non-neuronal aspects of the disease. Therefore, we sought to address this gap in knowledge by modeling SMA in the nematode Caenorhabditis elegans. We mutated a previously uncharacterized allele, which resulted in the onset of mild SMA-like phenotypes, allowing us to monitor the onset of phenotypes at different stages. We observed that these mutant animals recapitulated many key features of the human disease, and most importantly, we observed that muscle dysfunction preceded neurodegeneration. Furthermore, we tested the therapeutic efficacy of targeting endoplasmic reticulum (ER) stress in non-neuronal cells and found it to be more effective than targeting ER stress in neuronal cells. We also found that the most potent therapeutic potential came from a combination of ER- and neuromuscular junction-targeted drugs. Together, our results suggest an important non-neuronal component of SMA pathology and highlight new considerations for therapeutic intervention.
Myh6-driven Cre recombinase activates the DNA damage response and the cell cycle in the myocardium in the absence of loxP sites
Authors: Wang Xinrui , Lauth Amelia , Wan Tina C. , Lough John W. , Auchampach John A.
Published: October 2020

Regeneration of muscle in the damaged myocardium is a major objective of cardiovascular research, for which purpose many investigators utilize mice containing transgenes encoding Cre recombinase to recombine loxP-flanked target genes. An unfortunate side effect of the Cre-loxP model is the propensity of Cre recombinase to inflict off-target DNA damage, which has been documented in various eukaryotic cell types including cardiomyocytes (CMs). In the heart, reported effects of Cre recombinase include contractile dysfunction, fibrosis, cellular infiltration and induction of the DNA damage response (DDR). During experiments on adult mice containing a widely used Myh6-merCremer transgene, the protein product of which is activated by tamoxifen, we observed large, transient, off-target effects of merCremer, some of which have not previously been reported. On Day 3 after the first of three daily tamoxifen injections, immunofluorescent microscopy of heart sections revealed that the presence of merCremer protein in myonuclei was nearly uniform, thereafter diminishing to near extinction by Day 6; during this time, cardiac function was depressed as determined by echocardiography. On Day 5, peaks of apoptosis and expression of DDR-regulatory genes were observed, highlighted by >25-fold increased expression of Brca1. Concomitantly, the expression of genes encoding cyclin-A2, cyclin-B2 and cyclin-dependent kinase 1, which regulate the G2/S cell-cycle transition, were dramatically increased (>50- to 100-fold). Importantly, immunofluorescent staining revealed that this was accompanied by peaks in Ki67, 5′-bromodeoxyuridine and phosphohistone H3 labeling in non-CMs, as well as CMs. We further document that tamoxifen-induced activation of merCremer exacerbates cardiac dysfunction following myocardial infarction. These findings, when considered in the context of previous reports, indicate that the presence of merCremer in the nucleus induces DNA damage and unscheduled cell-cycle activation. Although these effects are transient, the inclusion of appropriate controls, coupled with an awareness of the defects caused by Cre recombinase, are required to avoid misinterpreting results when using Cre-loxP models for cardiac regeneration studies.

This article has an associated First Person interview with the first author of the paper.
Periodic subcellular structures undergo long-range synchronized reorganization during C. elegans epidermal development
Authors: Wang Chunxia , Yang Yuyan , Fu Rong , Zhu Yi , Zhang Huimin
Published: October 2020

Periodic pattern formation on the cellular and tissue scale is an important process and has been extensively studied. However, periodic pattern formation at the subcellular level still remains poorly understood. The C. elegans epidermis displays a highly ordered parallel stripe pattern as part of its subcellular structure, making it an ideal model to study the formation and reorganization of periodic patterns within cells. Here, we show that the initial formation of periodic striped patterns in the C. elegans epidermis is dependent on actin and spectrin, and requires the apical membrane attachment structures for maintenance. The periodic subcellular structures do not accommodate cell growth by continuously making new stripes. Instead, they increase the number of stripes by going through one round of uniform duplication, which is independent of the increasing epidermal length or the developmental cycles. This long-range synchronized reorganization of subcellular structures is achieved by physical links established by extracellular collagens together with extension forces generated from epidermal cell growth. Our studies uncover a novel strategy employed by evenly spaced and interlinked subcellular structures to maintain their integrity and equidistribution during cell growth and tissue development.
Ultralight Bacterial Cellulose/Polypropylene-graft-Maleic Anhydride Composite Cryogel for Efficient Oil/Water Separation
Authors: Wang Qidong , Asoh Taka-Aki , Uyama Hiroshi
Published: October 2020

An ultralight bacterial cellulose/polypropylene-graft-maleic anhydride (BC/PP-g-MA) composite cryogel was fabricated using a facile temperature induced phase separation (TIPS) method followed by freeze-drying. The presence of PP-g-MA endowed BC cryogel with the vital hydrophobicity for oil adsorption from water. With low density, high porosity, and high surface area, the obtained BC/PP-g-MA composite cryogel exhibited excellent adsorption capacity (up to 136 g/g) for a diversity of oils and organic solvents, making it a promising candidate for efficient oil/water separation.
Common and Less Well-known Upper-limb Injuries in Elite Tennis Players
Authors: Shannon Nicholas , Cable Brian , Wood Timothy , Kelly John
Published: October 2020

A recent increase in epidemiology studies on injuries in elite tennis players has helped to shed light on the types of injuries these athletes sustain. This article reviews the common upper-limb injuries in elite players and includes less well known, but important, injuries. A search was conducted to identify current relevant studies involving elite tennis players. Injury frequency rates, injuries by regions, and types of injuries together with a list of commonly reported injuries in the upper limb were established. This list was then reviewed and refined by a sports medicine physician who cares for elite tennis players to include both those injuries of the upper limb that are common and those that are less well known but still important and frequently encountered. Common injuries include internal shoulder impingement, rotator cuff pathology, labral tears, elbow tendinopathies, as well as extensor carpi ulnaris tendinopathies and subluxation. Posterior shoulder instability, distal humeral bone stress, elbow medial collateral ligament, and nondominant wrist ulnar collateral ligament injuries are not commonly reported injuries, but they are of significant clinical importance.
Anatomy of the Edelman: Measuring the World’s Best Analytics Projects
Authors: Gorman Michael F. , Nittala Lakshminarayana , Alden Jeffrey M.
Published: October 2020

Each year, the INFORMS Edelman Award celebrates the best and most impactful implementations of operations research, management science, and analytics. As the Edelman Award approaches its 50-year mark, we provide a history and characterization of the award’s finalists and winners. We provide some basic descriptive analytics about the participating organizations and authors, the impact of their work, and the methods they employed. We also conduct predictive analytics on finalist submissions, gauging contributors to success in establishing winning entries. We find that predicting Edelman winners a priori is extremely difficult; however, given a set of finalists, predictive models based on monetary impact could have predicted the winner over half the time in recent years, but would have had less predictive success in the early years of the competition. We suggest that, by characterizing the finalists, we can give future entrants a better picture of what it takes to compete for the Edelman Award.