bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of delays to multidisciplinary treatment of soft tissue sarcomas at a tertiary cancer center.
Authors: Montgomery Kelsey B. , Hollenquest Britany A. , Lucy Adam T. , Banks Charles A. , Eulo Vanessa Anne , Broman Kristy Kummerow
Published: October 2023

62

Background: Management of soft tissue sarcomas often requires coordinated multidisciplinary care including radiation, medical, and surgical oncology. Delays in the multidisciplinary evaluation and treatment may lead to poorer outcomes. Coordination of care through a multidisciplinary clinic (MDC) offering access to all three specialties during the same clinic visit may reduce time from initial evaluation to treatment. Methods: Adult patients treated for soft tissue sarcoma at an NCI-designated comprehensive cancer center following the opening of a sarcoma MDC in November 2021 to May 2023 were included. Patients were either seen in the sarcoma MDC or separately by oncologic providers (usual care). The primary outcome was delay in treatment initiation, defined as greater than 21 days from initial consultation to first treatment. Reasons for delay were abstracted. Descriptive statistics and bivariate analyses were performed. Results: Among 147 patients, 20 were (13.6%) seen in MDC and 127 (86.4%) by usual care. Initial treatments were surgery (46.9%), radiation (30.6%), or systemic therapy (22.4%). Median time to treatment was 34 days (IQR 14-57 days), which differed by treatment modality (surgery 34 days, radiation 37 days, systemic 18 days). There were no significant differences in time to treatment for MDC patients (33 days, IQR 25-44) versus usual care (34 days, IQR 13-57) (p=0.93). However, a significantly higher proportion of MDC patients received multiple modalities of treatment (75.0% vs 48.8% usual care, p=0.011), with a longer average time to treatment in the multi- versus single-modality groups (41 vs 22 days, p<0.001). Among patients requiring multimodal therapy, median time to treatment was 33 days for MDC patients versus 44 days for usual care (p=0.07). MDC patients were also much more likely to receive radiation (90.0% MDC vs 45.6% usual care, p=0.001). Delays in care (n=76, 51.7% of cohort) were seen in 66.7% (12/18) of MDC patients versus 58.3% (63/108) of usual care patients. The most common reasons for delay were need for additional imaging (29.7%) or preoperative testing (18.8%). Conclusions: In this single-center study, no improvement in time to treatment was seen following the opening of a sarcoma multidisciplinary clinic, likely explained by higher proportion of MDC patients receiving multiple treatment modalities. Primary reasons for delay could be anticipated prior to initial evaluation and represent an opportunity for more active case review prior to in-person evaluation to reduce delays in sarcoma treatment.
Regional appendix cancer multidisciplinary case conference: Improving access and care of a rare disease.
Authors: Nimer Jenna , Eng Oliver S. , Polite Blase N. , Liao Chih-Yi , Lee Grace , Alpert Lindsay , Setia Namrata , Hart John , Fenton Emily , Micic Dejan , Mauk Steven , Belanski Jennifer , Savaiano Cindy , Whitridge Jeffrey , Turaga Kiran , Shergill Ardaman
Published: October 2023

63

Background: Appendiceal cancers (AC) are a group of rare tumors that lack well-established guidelines. Care for ACs need multi-disciplinary teams. Excellence in hyperthermic intraperitoneal chemotherapy (HIPEC) and complete cytoreductive surgeries (CRS) is needed. This is challenging in community settings. Here we share our experience in establishing a regional multidisciplinary case conference (MCC) to improve access and care of this rare disease. Methods: University of Chicago Medical Center's (UCMC) experts in pathology, radiology, nutrition, surgical oncology and medical oncology collaborated to form the peritoneal MCC. We consulted our legal and physician access teams to develop a compliant system through which referring providers may submit their cases including imaging, pathology and medical history. Referring providers attended the conference via a secure virtual platform. To bridge scientific collaborations we created a continuous medical education (CME)-based curriculum. With UCMC survey lab’s help, we developed and distributed an anonymous digital survey to assess the impact of this MCC. Results: The peritoneal MCC was established in May of 2020 with consistent participation of surgical oncology experts in HIPEC and peritoneal disease management, medical oncology, radiology, pathology, and gastroenterology with expertise in nutrition. Cases were referred internally and from our regional network. Between May 2020 and June 2022, 614 unique clinical cases were discussed. Our team invited 37 referring providers to join this conference. From February 1st 2021 to June 2022, more than 40 different educational lectures were presented. There were 30 respondents to the survey where the majority were from UCMC. Of those who were non-UCMC (n=8), 62.5% practiced in urban setting and 7.5% in suburban, rural or small-town setting. 62.5% of non-UCMC respondents were community-based providers, and 37.5% worked at academic centers. 45.8% of providers attending had more than 5 years of experience. 100% of the respondents reported improved confidence in treating their patients as a result of participation in this conference. 94.1% reported at least moderate improvement in the quality of their care. 93.3% of the respondents noted that the care plan of their patients changed as a result of participation in this MCC. Conclusions: Virtual MCC was feasible and reported to be beneficial in management of a rare disease like AC. Such conferences can lead to improvement in the quality of care by improving access to centers with expertise. Participating providers gain knowledge and feel more confident in taking care of their patients. In future, we aim to include more centers. Consideration on how to include patients may also prove beneficial.
Trend in breakdown of total cost of care for medical oncology over time: Learnings from the Oncology Care Model and implications for future oncology value-based care.
Authors: Owens Leah , Bilbrey Larry Edward , Dickson Natalie R. , Blakely L. Johnetta , Yue Andrew , Chaudhry Basit Iqbal , Tran Lisa , Baker Katherine , Schleicher Stephen Matthew
Published: October 2023

69

Background: Tennessee Oncology (TO) is a large, outpatient community oncology practice with over 200 providers and 35 clinical sites of care across Tennessee and northern Georgia. As an Oncology Care Model (OCM) participant, TO received claims data from Medicare during its OCM participation from 2016-2021. TO adopted continuous quality improvement initiatives to succeed in the program. Here we highlight our adoption of biosimilars and implementation of an independent clinical pathway program. Methods: OCM claims data received from Medicare were analyzed to determine total cost of care (TCOC) per the OCM methodology. TCOC subgroup analysis was conducted by percentage of spend over time on therapeutic and supportive care drugs, emergency room utilization, and hospitalizations. Biosimilar adoption and pathway utilization rates were tracked internally. Results: 27,927 OCM episodes were attributed to TO during the study period 2016-2021. During this time frame and as a percentage of TCOC, total drug spending increased from 58% to 71%. Conversely, spending on hospital and emergency room utilization as a percentage of TCOC decreased from 11.6% to 7.9% and 1.4% to 1.0%, respectively. Within drug spending, the ratio of supportive to therapeutic drug costs decreased from 29.5% to 7.5%. Despite increased spend on therapeutic drugs towards the end of the model, pathway adherence was over 90%, and trastuzumab and bevacizumab biosimilar adoption rates were over 86% and 97%, respectively. Conclusions: Relative contributions to TCOC changed over time during OCM. The percentage of costs associated with pharmaceuticals increased, while costs associated with hospitalizations and emergency room utilization decreased. Within costs for pharmaceuticals, there was a significant increase in the percentage of costs for therapeutics versus supportive care drugs. High rates of biosimilar conversion and pathway adherence suggest increased drug spend reflects a change in oncology practice, not an effect of inappropriate utilization. These trends have implications for future developments of oncology value-based care programs.
The impact of Medicaid expansion on the receipt of multimodal treatment for early-stage pancreatic cancer: Kentucky Cancer Registry Analysis.
Authors: Dhahri Amina , Huang Bin , Shaikh Bilal , Torres Yee Jennifer , Moss Jessica Jane , Nutalapati Snigdha , Hao Zhonglin , Patel Reema Anil
Published: October 2023

71

Background: Health equity is one main goal of the Affordable Care Act. In early stages of pancreatic ductal adenocarcinoma (PDAC), multimodal treatment (MT)—surgical resection and chemotherapy—is the only potentially curative option that improves overall survival (OS). The goal of this study is to use the Kentucky Cancer Registry (KCR) to identify the impact of Medicaid expansion on the treatment and outcomes on PDAC. Methods: We identified patients between the age of 20 and 65 years old who were diagnosed with stage I and II PDAC between 2010 to 2021 using the KCR. Years 2010-2013 were considered pre-expansion and 2014-2021 post-expansion. Descriptive statistics and multivariable logistic regression is utilized to evaluate factors associated with receipt of MT. Results: We identified a total of 659 patients with PDAC: 242 in the pre-expansion and 417 post expansion groups. Medicaid expansion in Kentucky has led to a significant increase in receipt of MT among patient with stage II PADC and Medicaid coverage 10.7% vs 22.3%. The post-expansion number of uninsured PDAC patients decreased from 10.3% to 3.1%. Post expansion PDAC patients had higher odds of MT receipt, but this was not significant (OR, 1.374; 95% CI 0.97-1.94). No change in OS was noted between the two periods (HR 0.939, 95% CI 0.78-1.122). Conclusions: Medicaid expansion was associated with increased insurance coverage for patients with early-stage pancreatic cancer and higher odds of receipt of MT, though this was not statistically significant. Additional research is needed to identify the breadth of the impact of Medicaid expansion and additional drivers of PDAC disparities. [Table: see text]
Utilization of high-cost prostate cancer therapies by oncologists in the merit-based incentive payment system (MIPS).
Authors: Hussaini S. M. Qasim , Patel Vishal R. , Mullangi Samyukta , Parikh Ravi Bharat , Sedhom Ramy , Gupta Arjun , Ballreich Jeromie M.
Published: October 2023

73

Background: TheMerit-Based Incentive Payment System (MIPS) is currently the only federally mandated value-based payment model for oncologists. MIPS uses cost and quality metrics to assign oncologists an overall MIPS score, where higher scores correspond to greater payments for practices. The extent to which MIPS delineates between oncologists administering high-cost anti-cancer therapeutics with unproven benefit is unknown. In this study, we investigated administration of low-value prostate cancer therapies by differently scored oncologists. Methods: We identified MIPS scores for oncologists using publicly available data for the year 2019. We cross referenced these scores with the 20% restricted sample of Medicare fee-for-service claims for 2019 using provider National Provider Identifications (NPIs). We then identified patients who were treated by these oncologists for prostate cancer using ICD-10 diagnosis codes for prostate cancer. Use of Sipuleucel-T (Provenge) and Radium Ra 223 dichloride (Xofigo), two low-value treatments with unproven benefit in prostate cancer, was identified using HCPCS codes in the claims file. The top 25 and bottom 25 percentile of oncologists based on their MIPS scores were identified using summary statistics. Odds ratios (OR) and corresponding confidence intervals (CI) were generated for Sipuleucel-T and Radium Ra 223 dichloride use by top 25 and bottom 25 percentile MIPS scores. Results: We identified 533,966 claims for prostate cancer treated by oncologists with a MIPS score in 2019. Of these claims, there were 100 instances of Sipuleucel-T use and 308 instances of Radium Ra 223 dichloride use (500 instances of Sipuleucel-T and 1540 instances of Radium Ra 223 dichloride if scaled to national use). Oncologists in the lowest 25% of MIPS scores less likely administered Sipuleucel-T (OR 0.25, 95% CI 0.12, 0.54) while those in the highest 25% did not show a significant trend (OR 1.36, 95% CI 0.90, 2.07). Oncologists in the lowest 25% of MIPS scores more likely administered Radium Ra 223 dichloride (OR 1.53, 95% CI 1.21, 1.95) while those in the highest 25% less likely administered the drug (OR 0.66, 95% CI 0.49, 0.88). Conclusions: Low MIPS scoring oncologists were less likely to utilize Sipuleucel-T and more likely to use Radium Ra 223 dichloride to treat prostate cancer. Our findings suggest that the MIPS program may be ineffective at measuring and incentivizing high value care among oncologists. Specialty-specific recalibration of cost and quality measures is needed to ensure that policy efforts to promote value-based care do not compromise healthcare quality and outcomes. [Table: see text]
Assessing drug cost avoidance in clinical trials: An observational study in a Spanish tertiary hospital.
Authors: Gomez-Randulfe Rodriguez Martin Igor , Rabuñal Alvarez Maria Teresa , Alonso de Castro Beatriz , Silva Diaz Sofia , Parajó Vázquez Iria , Sánchez Carballo Pablo , Domínguez Guerra María , Calleja Teresa , Busto Fernandez Fernando , Campelo Rosario Garcia , Martín Herránz Isabel
Published: October 2023

8

Background: Clinical trials (CTs) are pivotal to progress in cancer treatments, but their benefits reach further. Economically, they contribute to the sustainability of the healthcare system through drug cost avoidance (DCA). Despite its importance, the literature quantifying this economic advantage remains sparse. The aim of this study was to assess the DCA in a tertiary-level hospital in the northwest of Spain. Methods: We conducted a retrospective observational study of CTs in a tertiary-level hospital between January 2020 and December 2022. The study included CTs carried out by the Oncology Department involving patients undergoing active treatment, with a comparator provided by the sponsor, and with an impact on the avoided cost in the hospital budget. The therapeutic alternative was agreed upon by a multidisciplinary team of oncologists and pharmacists. The estimation of the DCA considered the theoretical administrations of the therapeutic alternative that the patient would have received if not included in the CT. The selling price of the considered alternatives (RP+VAT-discounts) was extracted from the Pharmacy Department's economic management program. Results: In the 2020-2022 period, 89 CTs met the criteria. Most were phase III (56/89 trials) and industry sponsored. A total of 281 patients were treated on a CT, averaging 2 patients/trial (range 1 - 24). The total DCA during the study period was €6,372,718, yielding an average DCA per trial of €71,604 (€40 - €949,892). Yearly breakdown of DCA is as follows: 2020 - €1,866,345; 2021 - €2,255,404; and 2022 - €2,250,969. Conclusions: DCA, resulting from participation in CTs, effectively curbs drug-related costs, contributing to the economic robustness of the healthcare system. Moreover, these trials play a pivotal role in advancing scientific knowledge in oncology. As such, promoting the development and active participation in CTs is a strategy of crucial importance for long-term healthcare stability. [Table: see text]
The utilization and perceptions of chaplaincy among patients of Dharmic religions in a cancer hospital: A mixed methods study.
Authors: Patel Rushil Virendra , Bowden Jill M , Boselli Danielle , Strahley Ashley Elizabeth , Gibbs Sydney-Evelyn L. , Kotecha Ritesh R , Murali Komal P , Patel Viraj R , Nelson Judith Eve
Published: October 2023

83

Background: Spiritual care administered through chaplaincy services (CS), is an integral component of cancer care in the US; however, chaplaincy utilization (CU) among patients who identify with a Dharmic religion (DR; Hinduism, Buddhism, Sikhism, Jainism) is unknown. This study measures CU and explores perceptions of CS among hospitalized DR patients with cancer. Methods: A retrospective chart review identified patients hospitalized in a specialty cancer center in New York City between 2015 and 2019. The primary objective was to measure proportions of DR and non-DR (NDR) patients with CU (≥1 CS visit); secondary objectives included identifying factors associated with CU. Demographics, length of stay (LOS), total number of CS visits, and disposition were collected. Bivariate and multivariate logistic regression analyses examined associations between religion, age, race, language, LOS and advanced illness (AI; ICU admission, inpatient death, hospice discharge) with CU. Semi-structured interviews were conducted to explore CS perceptions and preferences among DR patients with cancer in 2020. Data was coded and analyzed independently and iteratively by two investigators and themes were identified. Results: Of 54,828 patients, 59% identified as Christian, 14% identified as Jewish, and 2% identified with a DR (n=1163; 58% Hindu, 33% Buddhist, 4.8% Sikh, 3.4% multiple faiths, 0.2% Jain). Compared to NDR patients, DR patients were younger (median age 59 vs. 63, p<0.001), more likely East or South Asian (79% vs. 5.6%, p<0.001), had more AI (23% vs 15%, p<0.001), but lower CU (37% vs 32%, P<0.001). In multivariable analysis, LOS, NDR, and AI were associated with CU (Table); with Non-Hispanic, White as the reference group, race was not associated with CU. Twenty-two patients (91% Hindu, 9% Sikh) were interviewed. Few reported being approached about CS during their admission, and most expressed unfamiliarity with CS. Some felt CS and spiritual care was tailored to Jewish and Christian faiths but not DR. Suggestions for the hospital included having DR-specific chaplains, religious materials, and worship space. Conclusions: Despite more AI, CU was lower among DR patients. DR patients identified unfamiliarity and/or NDR perceptions as barriers to CS and recommended greater access to faith-specific resources. More work is needed to deliver faith-concordant spiritual care for DR patients.[Table: see text]
Team-based versus technology-based supportive cancer care (SCC): Implementation across 24 clinical settings.
Authors: Moufarrej Sacha , Wood Emily Hayes , Medrano Hector S. , Perez Cynthia , Agrawal Madhuri , Patel Manali I.
Published: October 2023

86

Background: Advanced care planning and symptom management, otherwise known as Supportive Cancer Care (SCC), are fundamental services that patients should receive after a cancer diagnosis. Yet, barriers prevent such care delivery. In response, we launched a 24-clinic site cluster randomized trial in July 2022 comparing two SCC delivery approaches: a team-based intervention in which patients engage with a SCC-trained health educator via phone versus a technology-based intervention in which patients receive internet-based SCC education. The preliminary aim of this study is to evaluate clinic characteristics that may impact SCC implementation and effectiveness. Methods: Study staff at all 24 sites, including community oncology clinics, Kaiser Permanente clinics, Veterans Affairs facilities, safety-net hospitals, and academic centers, participated in a survey and semi-structured interview. We used Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, and Implementation (RE-AIM) frameworks to assess organizational culture, facilitators, and barriers. Surveys were analyzed using descriptive statistics; interviews were qualitatively coded and thematically analyzed. Results: Among 31 interview participants, of which 24 completed surveys, 9 (29%) were principal investigators, 10 (32.3%) were research staff, and 12 (38.7%) were implementation staff. Survey respondents implementing team-based SCC were more confident that their approach accounted for patient care preferences (93.8%) and had strong evidence (87.5%) than respondents implementing technology-based SCC (62.5% and 25.0% respectively). More team-based SCC respondents expressed confidence in organization leadership (100%) and adequate resources for SCC (87.5%) than technology-based SCC respondents (87.5% and 75.0% respectively). Interviews revealed that team-based SCC was more likely to be effective, as it could 1) adapt delivery to patient needs, 2) improve patient support and outcomes, and 3) decrease clinician time burden, rather than tech-based SCC which could 1) worsen sociodemographic disparities in SCC delivery due to digital delivery and 2) result in EHR messaging overload for patients and clinicians. Participants were concerned about sustainability of both SCC approaches due to 1) competing organization priorities that limit staffing and funding, 2) barriers to technology access for patients, 3) information overload at time of diagnosis, and 4) patients’ hesitancy to engage in end-of-life care discussions. Conclusions: Supportive cancer care requires resources, organizational leadership, and assessment of patient needs. While the comparative effectiveness of team-based and technology-based approaches remains yet to be determined, many believe that team-based approaches may be more effective but remain concerned about sustainability.
A global assessment of access to pediatric palliative care for children with cancer in resource-constrained settings.
Authors: Houston Logan Cole , McNeil Michael , Le Mai An , Forrest Heather , Gonzalez-Guzman Miriam , Friedrich Paola
Published: October 2023

87

Background: Pediatric palliative care reduces suffering, improves communication, and enhances quality of life for children with complex disease, especially children with cancer. Despite a disproportionate burden of pediatric cancer in resource-constrained settings) the provision of pediatric palliative care services is limited. We aim to describe the global landscape of palliative care services for pediatric hematology/oncology patients using data from the Abbreviated PrOFILE (Pediatric Oncology Facility Integrated Local Evaluation), a 360-degree evaluation tool assessing care capacity and guiding the development of an improvement strategy in institutions caring for children with cancer. Methods: One hundred and twelve institutions across 23 countries completed the Abbreviated PrOFILE from 2019-2021. We extracted data from questions regarding pediatric palliative care personnel and training, medications for symptom management, and patient outcomes. Results were stratified by World Bank income level. Results: The analyzed hospitals were from low (LIC) (6), lower-middle (LMIC) (34), upper-middle (UMIC) (55), and high (HIC) (17) income levels. They self-identified as primarily cancer hospitals (19%), children’s hospitals (22%), general hospitals (45%), and pediatric oncology institutions (12%). Access to specialists varied by income level with 71% of HICs, 41% of UMICs, 32% of LMICs, and 17% of LICs reporting almost always having access to palliative care specialists. These specialists were more likely to have formal education in childhood cancer in HIC (59%) compared to low- and middle-income countries. Oral morphine was reported available in 100% of HICs, 76% of UMICs, 27% of LMICs, and 33% of LICs. Injectable morphine had similar results with 100% of HICs, 96% of UMICs, 41% of LMICs, and 33% of LICs reporting almost always having availability. Ibuprofen, acetaminophen, dexamethasone, ondansetron, metoclopramide, omeprazole, diazepam, phenobarbital, and phenytoin were reported as almost always or frequently available in at least 50% of institutions in each income level. End-of-life and bereavement services were less available in LICs (17%), LMICs (18%), and UMIC (36%) than HICs (53%). Following completion of the Abbreviated PrOFILE tool, 50% of the regional cohorts set a priority to improve supportive, palliative, or end-of-life care. Conclusions: Access to pediatric palliative care services varies by income level. Despite increased need for palliative services in LMICs, there is less access to trained providers and essential medications, especially in those with decreased resources. These results will inform the implementation of improvement interventions among institutions providing care for children with cancer.
Characterizing home care services use among US survivors of cancer.
Authors: Premnath Naveen , Pandey Urvashi , Vasudev Ishita , Sedhom Ramy , Hussaini S. M. Qasim , Gupta Arjun
Published: October 2023

90

Background: Cancer survivors often require home care services, but accessibility barriers prevent many patients and care partners from harnessing their full benefit. We sought to characterize home care services use among cancer survivors in the United States. Methods: We identified patients with and without history of cancer from 2016 to 2019 in the nationally representative Medical Expenditure Panel Survey (MEPS). We extracted sociodemographics and clinical characteristics. We constructed a composite measure of patients being eligible for home care if they reported any one of three criteria: completely unable to do any activity, limitations doing housework, or dependent on activities of daily living. We identified home care use and associated details, including type of home care provided—by licensed professionals (e.g., home health nurse, physical therapy etc.) associated with agencies, hospitals, or nursing homes, by non-agency (self-employed persons), and by unpaid informal care providers not living with the patient, and the number of days such services were provided in a calendar year. We used multivariable logistic regression to identify factors associated with eligibility for and non-receipt of home care services. Results: We identified 9,585 cancer survivors (median age, 67 years, 53% female, 76% non-Hispanic White, 15% breast cancer) and 83,393 persons without cancer history. Cancer survivors were more often eligible for (22% vs 9%) and more often used home care (10% vs 3%), compared to those without cancer. Cancer survivors receiving home care annually remained stable from 2016-2019 (10%, 8%, 11%, 12%; p = 0.25). Among cancer survivors who received home care, the annual median/mean days of services were 28/87 days. Of these, the median/mean days of service were: agency (16/66), non-agency (0/4), and unpaid informal caregivers (0/17). In multivariable analysis, higher age (per year, aOR 1.02), female sex (aOR 1.29), income below poverty (aOR 1.82), unmarried status (aOR 1.65), public insurance (aOR 2.15), and number of comorbidities (per 1 comorbidity, aOR 1.70), had increased odds for being eligible for home care (p <0.05 for all). In multivariable analysis, higher age (per year, aOR 1.01), unmarried status (aOR 1.55), and number of comorbidities (per 1 comorbidity, aOR 1.58) had higher odds, while Hispanic ethnicity was associated with lower odds of receiving home care (p <0.05 for all). Conclusions: In this nationally representative study, we found that only 10% of US cancer survivors received home care services, with notable sociodemographic variability. Our data highlight an urgent need to understand underlying market factors, and whether these data reflect a capacity, incentive, or implementation problem. Policy level efforts from the recent American Rescue Plan Act and upcoming Cancer Moonshot initiatives should aim to fund home-based care programs.
Comprehensive pediatric cancer care in the community oncology setting: 2022 Landscape survey results.
Authors: Beauchemin Melissa P , Ji Lingyun , Gilleland Marchak Jordan , Santacroce Sheila Judge , Nightingale Chandylen L , Williams AnnaLynn , Dressler Emily Van Meter , Parsons Susan K.
Published: October 2023

92

Background: A first step in providing guideline-endorsed, cancer-related psychosocial resources for children with cancer treated in community oncology settings is screening for need. We describe the current landscape of screening for distress and social determinants of health (SDoH) for children treated in NCI-Community Oncology Research Program (NCORP) practices. Methods: NCORP practice groups completed the Landscape Survey in 2022 to describe infrastructure, resources, and research capacity. Practice groups were assessed for capacity to provide oncology care for pediatric patients, presence of a Pediatric Oncology Program (POP), and the annual pediatric cancer cases seen. Among practice groups with a POP, we describe the proportion with routine screening for distress (psychosocial and financial) and SDoH. Results: Of 271 responding NCORP practice groups, 54 (20%) reported providing oncology care for children; 47 (87%) of these had a dedicated POP. Of these 47 practice groups, 33 reported the number of new pediatric cases seen per year (range 7-126). Of the seven practices that reported providing oncology care for children, but did not have a dedicated POP, the practice either did not report the number of pediatric cases (n=3) or fewer than 2% of annual cancer cases were children aged 0-14 years. Among the 47 practices with a dedicated POP, 12 were affiliated with a Minority- Underserved NCORP. Geographically, most of these NCORPs (n=18, 38%) were located within the South, followed by the Midwest (n=11, 23%), the Northeast and the West (both, n=9, 19%). Within the 47 NCORP practices with a POP, but not specifically within the POP, 41 (87%) conducted routine psychosocial distress screening, 39 (83%) routine financial screening (other than insurance/billing purposes), and 41 (87%) screened for SDoH with a variety of tools. Most of the practices (n=33, 70%) screened for all three indicators of need for cancer-related resources. Conclusions: This analysis describes the settings where children with cancer are treated in the community and the infrastructure across NCORP practices with a POP. These data are indicative of potential research capacity and will be used to develop future Cancer Care Delivery Research (CCDR) studies through the NCORP. Future research will seek to identify multi-level barriers and facilitators to linking families with identified needs to available resources and to resource uptake.
The financial cost of cancer clinical trial participation.
Authors: Deng Luqin , Caston Nicole E. , Pisu Maria , Rocque Gabrielle Betty , Arend Rebecca Christian , Azuero Andres , Gallagher Kathleen D. , Angove Rebekah SM , Williams Courtney
Published: October 2023

96

Background: Though financial hardship is a well-documented adverse effect of standard-of-care cancer treatment, little is known about out-of-pocket costs and their impact on patients participating in cancer clinical trials. This study explored financial effects of clinical trial participation. Methods: This cross-sectional analysis used survey data collected December 2022 and May 2023 from individuals with cancer previously served by Patient Advocate Foundation, a non-profit organization providing social needs navigation and financial assistance to individuals with a chronic illness. Surveys included questions on cancer clinical trial participation, trial-related financial hardship, and sociodemographic data. Descriptive and bivariate analysis were conducted using Cramer’s V to estimate in-sample magnitude of association. Multivariable analysis and inference on associations between financial hardship and sociodemographics was conducted using adjusted relative risks (aRR) and corresponding 95% confidence intervals (CI) from modified Poisson regression models with robust standard errors. Results: Of 650 survey respondents, 18% (N=118) reported ever participating in a clinical trial. Of those, 47% (n=55) reported financial hardship as a result of their trial participation. Respondents reporting trial-related financial hardship were more often unemployed or disabled (58% vs. 43%; V=.15), Medicare enrolled (53% vs. 40%; V=.15), and traveled >1 hour to their cancer provider (45% vs. 17%; V=.33) compared to respondents reporting no hardship. Respondents who experienced trial-related financial hardship most often reported expenses from travel (reported by 71% of respondents), medical bills (58%), dining out (40%), or housing needs (40%). Modeling results indicated that respondents traveling >1 hour vs. ≤30 minutes to their cancer provider had 2.2 times higher risk of financial hardship, even after adjusting for respondent race, income, employment, and insurance status (aRR=2.2, 95% CI 1.3-3.8). Most respondents (53%) reported needing $200-$1,000 per month to compensate for trial-related expenses. Over half (51%) of respondents reported less willingness to participate in future clinical trials due to incurred financial hardship. Notably, of patients who did not participate in a clinical trial (n=532), 13% declined participation due to cost. Conclusions: Cancer clinical trial-related financial hardship, most often stemming from travel expenses, affects almost half of trial-enrolled patients. Interventions are needed to reduce adverse financial participation effects and potentially improve cancer clinical trial participation. These would likely include increased compensation, broader reimbursement for expenses, or changes to trial design that minimize travel and other financial burdens.
The Internet Shutdown and Revolutionary Politics: Defining the Infrastructural Power of the Internet
Authors: Truscello Michael
Published: October 2023

The solution to the accumulation of authoritarian power enhanced by the Internet will not emerge from within the Internet itself; rather, the only radical and enduring response to the kind of networked authoritarianism that is becoming pervasive globally must regard attacking the extractivist foundation of Internet materiality as the primary and most effective antifascist tactic. Far from being a recent emergence of authoritarian infrastructure, however, the Internet was developed by the US military-industrial complex and has always carried the imprint of authoritarian utility. The Internet is now a pervasive infrastructural feature of global capitalism and its state accomplices, and the deliberate temporary stoppage of Internet functioning by state actors, a so-called Internet “shutdown” or “kill switch,” illustrates the primary purpose of this infrastructure is to defend state power and capitalist commerce. Liberal attempts to reform the Internet are misguided, and anti-authoritarians should adopt an abolitionist position regarding the Internet as infrastructure. The primary strategy for such a form of abolitionism should focus its efforts on shutting down the extractive industries that provide the material substrate of the Internet.
Narrative Power in an Era of Crisis and Convergence
Authors: Kanuga Malav , Funke Peter , Wolfson Todd
Published: October 2023

Recognizing the current conjuncture, this article explores the changing role of media and communications in the cohering of social struggles by antisystemic social movements. Transforming structural relations of media and their tactical uses, the authors argue, are key components to shifting the terrain upon which such movements build. In response to a deepening organic crisis, the authors argue for the importance of organizing against and beyond the existing political economy of platform media by building new narrative blocs as bases of power that can serve as one of several determining factors for the direction of popular movements and the generalization of new notions and political programs around which a counterhegemonic consensus may emerge for society. Transformative resistance and collective power will depend on the ability to develop movement-based media infrastructures to deepen international communication processes with and relationships to an ongoing global mass movement against the rise of antidemocratic politics, popular authoritarianism, and other morbid symptoms of a declining order.
Organizing at the Digital Water Cooler: Social Media, Platform Organizing, and the Fight against Surveillance Capitalism
Authors: Dolber Brian
Published: October 2023

This article explores how Rideshare Drivers United (RDU), a fledgling union of app-based drivers in California, works in dialectical relationship to processes of surveillance capitalism. First, the article gives a brief history of RDU's organizing strategy in the lead-up to two strikes in the spring of 2019. RDU capitalized on social media's advertising platforms, as well as on a purpose-built app called Solidarity, to bring together a disparate workforce. Next, drawing on Vincent Mosco's framework for the political economy of communication, the article describes how this strategy emerged in response to, and intervened in, the processes of commodification, spatialization, and structuration that constitute surveillance capitalism. Interviews with Los Angeles– and San Diego–area driver-organizers suggest that this use of digital tools has become a mundane feature of the contemporary labor and social life. The refusal to fetishize platforms opens space for app-based workers to challenge surveillance capitalism's logics through platform organizing.
Sharon Lockhart's Philosophy of the Casual: Toward an Eco-Cinema of Sociability
Authors: Sheehan Rebecca A.
Published: October 2023

This article considers the cinematic works of the contemporary American artist Sharon Lockhart in the context of what it identifies as philosophies and practices of “the casual,” from the impact of Emersonian aesthetics on post – World War II American avant-garde cinema to Lockhart's unique version of “hanging out,” which resonates considerably with how Leo Bersani defines sociability. Viewing Lockhart's aesthetic signatures (her use of extreme long takes, static long shots, the natural settings of the majority of her films, and the anonymous identity and relations of her subjects, many of whom are children) first as manifestations of Emerson's and Heidegger's efforts to avoid the violence of Western thinking that they call “clutching” and “grasping” at the world, and then as instantiations of Bersani's notion of sociability as “a form of relationality uncontaminated by desire,” the article argues that her films manifest an eco-cinema that proposes living less invasively in the world. It goes on to show that, for Lockhart, this environmental ethos emerges from her use of the casual to delicately craft a cinema of social care that allows its subjects the freedom of not having their relations or identities defined by or within the cinematic frame. Lockhart's cinema is thus unique for deploying an aesthetics that can be described as casual, oblique, and nonchalant, toward ethical ends that have both sociological and environmental implications, what Bersani terms “queer ecology.”
Toward a Feminist Fourth Cinema: Waru (2017)
Authors: Vonderheide Leah
Published: October 2023

This essay offers an analysis of Waru, an omnibus film written and directed by a sisterhood of nine Māori women, which illuminates a philosophy of Māori women's filmmaking and indicates new possibilities for a global Indigenous cinema. In the two decades since Māori filmmaker Barry Barclay declared the existence of a “fourth cinema,” the cinema of Indigenous peoples, the number of dramatic feature films by Indigenous directors around the globe has grown significantly, with particular attention garnered by the success of Māori filmmaker Taika Waititi. Yet, while it would be tempting to declare that Barclay's onetime ideal of a flourishing Indigenous cinema “outside the national orthodoxy” has been achieved, Māori women continue to be marginalized in the film industry. As many critics have noted, Merata Mita's Mauri (1988) remained the only dramatic feature film to be written and directed by a Māori woman for almost thirty years. That finally changed in 2017 with Waru. Drawing from the growing body of scholarship on mana wahine, often referred to as Māori feminism, by Ngahuia Te Awekotuku, Linda Tuhiwai Smith, Aroha Yates-Smith, Naomi Simmonds, and Leonie Pihama, this essay argues that Waru's filmmakers recenter mana wahine to devise a new cinematic framework that is simultaneously Indigenous and feminist to enable Māori women to contribute not only to the fourth cinema envisioned by Barclay but also to a feminist fourth cinema grounded in values specific to Māori women.
Nonmaterial Overelaboration: Gender, Casting, and Camouflaged Labor in Pat Rocco's Promotional Travelogue
Authors: Freibert Finley
Published: October 2023

Pat Rocco's ONE Adventure, a promotional film for a gay men's nonprofit's tourism subsidiary, documented early 1970s US-Europe homophile coalitions but also incorporated softcore sequences for commercial appeal to a gay male market. Yet Rocco's disavowal of pornography generally — and specifically in the case of ONE Adventure — elides the precarious labor that undergirded his films’ productions. This article proposes that gay media history needs to critically confront nonmaterial overelaboration — the covering over of the material conditions of media production — in media products, their paratexts, and historiography itself. It is necessary for gay media history to take up feminist production history methods to interrogate this elision of labor enacted by cultural history approaches to Pat Rocco's filmmaking. More broadly, the article's concept of nonmaterial overelaboration provides a critical avenue for focalizing labor in other areas of media history.
Beyond energy and growth: the role of metabolism in developmental signaling, cell behavior and diapause
Authors: Tippetts Trevor S. , Sieber Matthew H. , Solmonson Ashley
Published: October 2023

Metabolism is crucial for development through supporting cell growth, energy production, establishing cell identity, developmental signaling and pattern formation. In many model systems, development occurs alongside metabolic transitions as cells differentiate and specialize in metabolism that supports new functions. Some cells exhibit metabolic flexibility to circumvent mutations or aberrant signaling, whereas other cell types require specific nutrients for developmental progress. Metabolic gradients and protein modifications enable pattern formation and cell communication. On an organism level, inadequate nutrients or stress can limit germ cell maturation, implantation and maturity through diapause, which slows metabolic activities until embryonic activation under improved environmental conditions.
Genome-wide identification of notochord enhancers comprising the regulatory landscape of the brachyury locus in mouse
Authors: Schifferl Dennis , Scholze-Wittler Manuela , Villaronga Luque Alba , Pustet Milena , Wittler Lars , Veenvliet Jesse V. , Koch Frederic , Herrmann Bernhard G.
Published: October 2023

The node and notochord are important signaling centers organizing the dorso-ventral patterning of cells arising from neuro-mesodermal progenitors forming the embryonic body anlage. Owing to the scarcity of notochord progenitors and notochord cells, a comprehensive identification of regulatory elements driving notochord-specific gene expression has been lacking. Here, we have used ATAC-seq analysis of FACS-purified notochord cells from Theiler stage 12-13 mouse embryos to identify 8921 putative notochord enhancers. In addition, we established a new model for generating notochord-like cells in culture, and found 3728 of these enhancers occupied by the essential notochord control factors brachyury (T) and/or Foxa2. We describe the regulatory landscape of the T locus, comprising ten putative enhancers occupied by these factors, and confirmed the regulatory activity of three of these elements. Moreover, we characterized seven new elements by knockout analysis in embryos and identified one new notochord enhancer, termed TNE2. TNE2 cooperates with TNE in the trunk notochord, and is essential for notochord differentiation in the tail. Our data reveal an essential role of Foxa2 in directing T-expressing cells towards the notochord lineage.
Epidemiological and clinical characteristics of esophageal carcinoma: An experience from tertiary care hospital of Karachi, Pakistan
Authors: Butt Nazish , Soomro Sabir Ali , Haider Ghulam , Zehra Aemon
Published: October 2023

Objectives: To describe current trends and characteristics of esophageal cancer (EC) over the past ten years largest tertiary care hospital of Karachi, Pakistan.

Methods: This single center retrospective study was conducted at the Department of Gastroenterology and Oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, between the period of ten years from 1st January 2010 to 31st December 2019. Patient data including epidemiological characteristics such as age, gender, education, residence, occupation, addictions, comorbidities, symptoms, location of EC, laboratory parameters and histopathological type were recorded. All patients with missing histological and radiological findings were excluded.

Results: The mean age of all patients was 49.26±14.24 years and among them majority were females 566 (56.1%). Almost, 834 (82.7%) patients had SQC and 175 (17.3%) presented with ADS. Most common presenting symptom was dysphagia in both groups 327 (32.4%) followed by vomiting (22.8%) and weight loss 196 (19.4%). The Esophagogastroduodenoscopy (EGD) findings showed the distal esophagus involvement in most of the patients (36.3%) in both groups. CT scan findings showed that the lower region was the most involved region in 367 (36.4%) patients, followed by middle and upper in 227 (22.5%) and 156 (15.5%) patients respectively. The thickening of mass on CT- scan was circumferential in most of the patients (42.7%) in both groups.

Conclusion: According to our findings, SQC is more prevalent than ADC. Female predominance especially at younger age was most common as compared to past studies. No significant association between a single risk factor has been found in our study however smoking and betel nut chewing were found as known putative risk factors.

doi: https://doi.org/10.12669/pjms.40.1.7419

How to cite this: Butt N, Soomro SA, Haider G, Zehra A. Epidemiological and clinical characteristics of esophageal carcinoma: An experience from tertiary care hospital of Karachi, Pakistan. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.7419

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.