bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial disparities in DLBCL: Analysis of SEER data from 2010-2019.
Authors: Lee Soyon , Seeger John D.
Published: June 2023

e18552

Background: Diffuse large B-cell lymphoma (DLBCL) is among the most common subtype of non-Hodgkin’s lymphoma accounting 31% of new cases. Introduction of immunotherapy and cell-based gene therapy has transformed the treatment landscape, yet there continue to be health disparities including differences in treatments received and health outcomes according to socioeconomic status. We aimed to quantify the association between race (white, black, American Indian/Alaska Native, Asian or Pacific Islander [API]) and cancer-specific survival among DLBCL patients. Methods: A retrospective observational study was conducted using the National Cancer Institute’s 2000-2019 Surveillance, Epidemiology, and End Results (SEER) Research Plus Data, 17 registries database. The SEER registry collects data on cancer incidence, patient and disease characteristics, and survival from approximately 35% of the US population. Patients were excluded if they had non-primary DLBCL or missing data. Survival analyses were used to evaluate cancer-specific mortality among 4 racial groups (white, black, American Indian/Alaska Native, API). Cox proportional hazards regression was used to assess the difference in cancer-specific mortality across race groups adjusting for age, sex, marital status, income, rurality, and Ann Arbor Stage. Results: The analytic sample included adult US patients diagnosed with DLBCL from 2010 to 2015 (N = 25,495). Of these 25,495 patients with DLBCL, the majority were White (82.8%), followed by API (9.3%), Black (7.4%), and American Indian/Alaska Native (0.5%). Age at diagnosis, sex, marital status, income differed across race groups. The crude cancer-specific mortality for blacks at year 2 was 29%, while 25% for whites, 24% for American Indians/Alaska Natives, and 29% for API. At year 6, the cancer-specific mortality was 36% for blacks, 33% for whites, 33% for American Indians/Alaska Natives, 35% for API. However, accounting for differences in patient characteristics (adjusting for age, sex, marital status, income, rurality, and Ann Arbor stage) resulted in an increased hazard risk (HR) of cancer-specific mortality for Black and Asian compared to whites (HR 1.28; 95% CI 1.18 to 1.40; and HR 1.19; 95% 1.11 to 1.29, respectively). The HR of cancer-specific mortality comparing American Indian/Alaska Natives to whites was 1.00; 95% CI .73 to 1.38, with the wide confidence intervals indicating that sample size is limited for this comparison. Conclusions: Despite advances in new treatment options, differences in cancer-specific mortality exists between different race groups among patients with DLBCL. The study highlights various sociodemographic features at diagnosis that could reflect disparities and lead to differences in cancer-specific mortality across race groups. It may be feasible to address some of the observed differences at DLBCL diagnosis and this may translate to better outcomes among patients with DLBCL.
Key difference-making conditions distinguishing ASCO members’ institutions that collect sexual orientation and gender identity (SOGI) data from those that do not.
Authors: Pratt-Chapman Mandi L. , Mullins Megan A , Miech Edward J , Merrill Janette K. , Swierz Alex , Smith Kimberly T , Chang Shine , Quinn Gwendolyn P. , Schabath Matthew B. , Maingi Shail , Astorino Joseph , Meersman Stephen C , Kamen Charles Stewart
Published: June 2023

e18554

Background: Despite ASCO and NIH calling it a priority, sexual orientation and gender identity (SOGI) data are not routinely collected in most cancer care settings. The aim of this analysis was to identify the key difference-making conditions that distinguish ASCO members’ institutions that collect SOGI data from those that do not. Methods: In fall of 2020, an anonymous 54-item electronic survey was distributed to ASCO members in oncology practice or research, presumably from non-overlapping institutions. We used configurational analysis to identify difference-making configurations for the presence and absence of institutional SOGI data collection. This approach applies Boolean logic and set theory, and like machine learning, is both novel and agnostic. Results: Three factors consistently distinguished sites (n = 45) that reported collecting both SO and GI data (n = 25) from those that did not (n = 20). The positive model consisted of two solution pathways: (1) replying “always” or “most of the time” to the question “Do you ask your patients what pronouns they want you to use for them?” or (2) replying “strongly agree” or “agree” to the statement “Institutional leadership supports collecting sexual orientation and gender identity (SOGI) data from patients” and replying “yes, the health record has a specific page/tab/section for SOGI data” to the question “Does the electronic health record at your institution have a specific section to collect information about patients' SOGI?” (consistency = .87, coverage = .80). The negative model consisted of three solution pathways: (3) replying “strongly disagree” or “disagree” that leadership supports collecting SOGI data OR (4) replying “no, the health record does not allow for collection of SOGI data” or “not sure” to whether the EHR supports SOGI data collection OR (5) replying “no, the health record does not have a specific section, but it can be recorded as unstructured data in notes” to whether their EHR supports SOGI data collection AND replying “sometimes” or “occasionally” to how often they ask patients about pronoun preferences (consistency = .94, coverage = .80). Conclusions: Leadership support, electronic health record structure, and clinicians asking patients about pronouns consistently distinguished institutions that collected SOGI data from those that did not in this sample. Additional data should be collected to confirm the results, given the small sample size in this study.
Sociodemographic factors affecting survival in stage IIIA NSCLC treated with surgery-based treatment or definitive chemoradiation with immunotherapy consolidation: An NCDB analysis.
Authors: Sekkath Veedu Janeesh , Hao Zhonglin , Chen Quan , Huang Bin , Talari Mridula Preetham
Published: June 2023

e18555

Background: Stage IIIA non-small cell lung cancer (NSCLC) is a heterogeneous disease treated by surgery-based approach or definitive chemoradiation (CRT) and immunotherapy (ICI) consolidation. Studies have shown that black patients in general are diagnosed at advanced stages, are less likely to receive ICI, and have lower overall survival (OS) compared to whites. Importantly, ICI was shown to impart similar or even better OS among advanced-stage black NSCLC patients, compared to whites. Geographical location and socioeconomic status have also been shown to affect outcomes. There are no studies on sociodemographic factors affecting survival in stage IIIA NSCLC in the ICI era. Methods: We used National Cancer Database (NCDB) to identify 23,110 patients with clinical stage IIIA NSCLC treated with either surgery-based approach or definitive CRT followed by ICI during 2017-2019, and surgery-based treatment or CRT during 2014-2016. We analyzed age, race, sex, insurance type, income, geographic location, Charlson Comorbidity Index (CCI) and education. Kaplan-Meier (KM) plots were used to examine survival curves and descriptive analysis was performed to examine the characteristics of sociodemographic variables by the two treatment modalities. Cox regression analysis was used to identify factors associated with OS. Results: ICI maintenance improved the OS of all stage IIIA NSCLC patients after CRT during 2017-2019 compared to CRT only in 2014-2016. On multivariate analysis of surgical and CRT-ICI cohorts, blacks had slightly better OS compared to whites (HR, 95%CI, p-value) (0.89, 0.84-0.95, < 0.001) but lower than other races including Asians (0.77, 0.69-0.87, < 0.001). While there was no OS difference in the surgical arm (0.94, 0.83-1.07, p = 0.356) between black and white patients, better survival was seen in blacks in the CRT-ICI arm (0.88, 0.82-0.94, < 0.001). No significant interaction between race and CRT-ICI was identified which indicates the benefit of CRT-ICI is independent of the race effect. Other factors associated with lower OS were older age with age > 75 HR 1.00, ages 19-39 (0.47, 0.35-0.64) ages 40-64 (0.71, 0.67-0.75), ages 65-74 (0.79, 0.76-0.83), median quartile income < $40,227 (1.07, 1.01-1.14), non-metro location (1.12, 1.07-1.17), non-academic facility (1.09, 1.05-1.14), and male sex (1.24, 1.20-1.29). Insurance status had no effect on OS. Conclusions: Our study indicates that there is no survival difference between white and black patients treated with surgery, but blacks had better survival when treated with CRT-ICI. Racial disparity in NSCLC survival depends on stage and access to care. Treatment modality, income, metro location, and access to an academic center are more significant predictors of survival than race. Interestingly, health insurance had no impact on OS.
Defining the patient population with HER2-low breast cancer in Hawaii.
Authors: Beaman Amanda Yachiyo , Hayama Sara , Pagano Ian , Killeen Jeffrey , Fukui Jami Aya
Published: June 2023

e18560

Background: About half of HER2-negative tumors (immunohistochemistry (IHC) 0, IHC 1+, or IHC 2+ without in-situ hybridization (ISH) amplification) are HER2-low (IHC 1+ or IHC2+ without ISH amplification). These tumors have gained attention due to their responsiveness to HER2-directed antibody-drug conjugates. Most studies have found a positive association between HER2-low and hormone receptor (HR) expression. Few studies report the demographics of patients that develop HER2-low tumors, and those that do were performed in ethnically homogeneous populations. Our study aims to characterize patients with HER2-low tumors in Hawaii, the US state with the highest diversity index, to better understand the patient population affected by HER2-low tumors. Methods: A retrospective chart review at a major health system in Hawaii evaluated all breast cancer specimens with HER2 testing performed between January 2021 and June 2022. Patient demographics at the time of diagnosis were collected, including age, menopausal status, body mass index (BMI), race/ethnicity. Tumor characteristics were identified by searching pathology reports and included: HER2 status-IHC score and ISH amplification, HR status, histologic type and grade, clinical stage, and 21-gene recurrence score. Results: Clinical and pathologic data was available for 332 cases of HER2-low breast cancers out of 1,478 cases. Of these, 309 (93.1%) were HR+, and 23 (6.9%) were HR-. In the HER2-low, HR+ group 53 (17.2%) were age < 50 and 256 (82.8%) were age 50+, compared to the HER2-low, HR- group with 2 (8.7%) patients and 21 (91.3%) patients respectively. Of all patients with HER2-low tumors, 99 (29.8%) were Japanese, 64 (19.3%) were White, 60 (18.1%) were Filipino, and 47 (14.2%) were Native Hawaiian. This distribution remained constant irrespective of HR status. Those with a BMI of < 25 kg/m2 made up 39.7% of HER2-low patients, and those with a BMI > 25 kg/m2 made up 54%. Of 159 HR+ cases that had a 21-gene recurrence score, 133 (83.7%) of these had a low score (£25). Most HER-2 low tumors were < 2cm, grade 1 or 2, and stage 1A. Conclusions: Our data confirmed the strong relationship between HER2-low and HR+ expression. As expected, most patients were age 50+, although there were more patients younger than 50 in the HER2-low, HR+ group compared to the HR- group. The ethnic distribution of HER2-low tumors is consistent with that of the general population of Hawaii, there does not appear to be any group more at risk than another. [Table: see text]
Clinical outcomes of patients with cancer before the SARS COV2 pandemic vs during the pandemic: A nationwide analysis.
Authors: Swarna Siri Chandana , Deenadayalan Vaishali , Baloch Ali Shahbaz Shehbaz , Kim Junglee , Gupta Shweta
Published: June 2023

e18569

Background: The novel SARS COV2 pandemic has disrupted cancer treatment, both preventive as well as treatment services. We aimed to study the clinical outcomes of cancer patients who were hospitalised before and during the pandemic. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016-2020 was queried to identify adult patients (Age > 18 years) with a diagnosis of cancer using the ICD-10 (International Classification of Diseases) codes. Study population was stratified based on the year of admission- 2016 to 2019 vs 2020 (the pandemic year). Primary outcomes included mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included prevalence of pulmonary embolism (PE), ICU admission, acute respiratory failure (ARF), blood transfusion, and sepsis. Statistics were performed using multivariate linear and logistic regression using STATA v17. Results: There were 18 million admissions in adults with cancer from 2016-2020. Among them 14.6 million (81.1%) were hospitalised during 2016-2019 (pre pandemic) whereas 3.4 million (18.9%) were hospitalized in 2020 (pandemic). There was no significant difference in the mean age of both groups, pandemic group had higher charlson comorbidity burden (66.4 vs 63.7%, p < 0.01). Pandemic group had higher rates of DM (26 vs 24%), CHF (15 vs 13.8%), CKD (18 vs 16.5%), dyslipidemia (36.4 vs 33%), PEM (15 vs 13%), anemia (44 vs 42) all p < 0.01. A total of 835,065 cancer patients died during the study period, the mortality rate in the pre-pandemic and pandemic years was 4.5% and 5% respectively (p < 0.05). After adjusting for confounders, the all-cause mortality was increased in the pandemic group (aOR 1.10, 95% CI 1.05-1.12, p < 0.01). The adjusted LOS was decreased by 0.1 days (95% CI: 0.06- 0.20, p < 0.01)). The adjusted total hospitalization charges was increased by $12,891 (95% CI: 9745-16,035, p < 0.01). Pandemic group had higher odds of sepsis (7.8 vs 6.5%), mechanical ventilation (4 vs 3%), pressor requirements (1.5 vs 1%), acute kidney injury (10 vs 7%) and acute respiratory failure (10 vs 7%), all p < 0.01. Conclusions: During the COVID-19 pandemic, cancer patients with a high prevalence of medical comorbidities were more likely to be admitted to the hospital with COVID infection. The higher mortality in these patients was likely the result of higher secondary complications, also likely leading to earlier death explaining the lower LOS and higher hospitalization charges. Cancer patients with medical comorbidities should take higher preventive measures from COVID including encouraging continued primary vaccinations and regular boosters.
Identification of healthcare vulnerabilities associated with unplanned hospital care in Black patients with pancreas cancer.
Authors: John Kristen M , Louis Tanya C. , Saluja Deepak , King Daniel
Published: June 2023

e18572

Background: Black patients with pancreatic cancer are underrepresented in clinical trials and have worse outcomes than other patients. A retrospective analysis we conducted of 658 patients with pancreatic cancer identified that Black patients are 2.8x more likely to have recurrent ED visits than non-Black patients. This finding motivated this study of Black patients with pancreas cancer who had ED visits over a two-month period to better understand the causal factors that predispose this population to higher rates of unplanned hospital care. Methods: A quality improvement pilot study of Black patients with pancreas cancer who had ED visits between 12/06/22-02/06/23 was conducted. Computational identification of this cohort was performed using a novel Power BI dashboard that tracks health system encounters by patients with pancreas cancer using ICD10 C25 as a cohort identifier in daily updates. Each ED visit then prompted a phone call to the patient from an African American oncology nurse practitioner who served as a cultural translator to evaluate their healthcare vulnerabilities. Demographic and clinical features were recorded from the EMR. Median household income was extrapolated by zip code using data from the US Census Bureau. Results: During this two-month period, 14 Black patients had at least 1 ED visit. Of these, 50% had ≥2 ED visits during this timeframe. Through retrospective review, we found that patients in this cohort had an average of 4.4 ED visits in the past year. The cohort was 50% male with a mean age of 65.5 years and median household income of $67,032. 21% have commercial insurance, 36% have Medicaid, and 43% have Medicare. 86% established care with a primary care physician and 71% established care with a medical oncologist. 79% of patients did not have a social work assessment in their charts. We were unable to reach 50% of patients in this cohort at their preferred phone numbers. Of the patients we connected with: 71% note their highest level of education as high school, 29% do not feel safe in their communities, 14% lack a reliable support system, and 57% experience financial insecurity. Conclusions: We observed a substantial burden of ED visits among Black patients. Remarkably, half of the patients already required a second ED visit during the two-month span of this project. Given these intriguing results, we intend to pursue a prospective study using a validated questionnaire to better understand and address the factors that lead to these ED visits.
Impact of pandemic on accrual of minority participants to interventional cancer clinical trials.
Authors: Wingard Jaia , Sallee Vicki , Gabriel Peter Edward , Doucette Abigail , Wormley Wallace P , Grosso Colleen M. , Schnoll Robert A. , Washington Armenta L. , Pryma Daniel A , Nathanson Katherine , Guerra Carmen , Vonderheide Robert H.
Published: June 2023

e18581

Background: Underrepresentation of Black (BL) and Hispanic (HIS) participants in cancer clinical trials remains a major challenge. Community- and patient-facing initiatives facilitate minority participant accrual (Guerra et al, ASCO, 2021); however, limitations due to COVID-19 pandemic and loss of in-person activities in the community have threatened efforts. In response, the Abramson Cancer Center (ACC) at Penn launched community and patient outreach initiatives that were virtual or socially distanced, including drive-through cancer screening ‘mini-clinics’ in community parking lots, mobile mammography, virtual patient education, and community clinical trial ambassadors. Here, we report accrual of BL and HIS participants to interventional cancer clinical trials at the ACC from 2019 through 2021. Methods: Two geographic areas were examined (i) the ACC 12-county catchment area, where 81% of tumor registry patients reside, and (ii) Philadelphia County, ACC’s physical location and where 22% of ACC patients reside. The primary metrics evaluated per geographic area for BL and HIS individuals were: % of residents in the population, % of cancer cases overall, % of adult cancer patients seen and cared for at the ACC, and % of adult participants enrolled on treatment (T) or non-therapeutic interventional (NTI) trials. Data sources were: US Census 2010 and 2020; state cancer registry data for 2015-2019 (most recent); and ACC data for 2019-2021. Pragmatic clinical trials were excluded. Results: The total new patients seen at ACC decreased by 13% in 2020 compared to 2019 rebounding in 2021. Compared to 2019, total T accruals decreased 40% in 2020 and 45% in 2021. NTI accruals decreased 58% in 2020 but recovered by 2021. Primary metrics are shown in the Table. From 2019 through 2021, the % of BL and HIS patients seen at the ACC was constant. For BL patients from the entire catchment or from Philadelphia County, the % enrolled on T trials matched or exceeded the % of BL patients at ACC. For NTI accruals, there was a modest decrease in 2021 in the % of BL participants for the 12 counties but an increase in Philadelphia. For HIS individuals, the % of patients seen at ACC and enrolled on T or NTI trials was stable. Conclusions: With community- and patient-facing efforts adjusted for pandemic limitations, relative accrual of BL and HIS participants to interventional clinical trials was sustained at our cancer center in the first two years of the COVID-19 pandemic. [Table: see text]
Disparities in molecular tumor board recommendations and treatment implementation.
Authors: Hensien Jack McNamara , Pierattini Chiara , Karovic Sanja , Dvergsten Erik , Randall Jamie , Cannon Timothy Lewis , Winer Arthur , Wadlow Raymond Couric
Published: June 2023

e18582

Background: The Inova Schar Cancer Institute Molecular Tumor Board (ISCI MTB) is a multi-disciplinary group that meets biweekly to discuss molecular test results for patients with advanced cancer to inform potential targeted therapy and clinical trial options. Previous work analyzing the racial distribution of patients in the ISCI MTB compared to the institutional cancer registry (CR) demonstrated that self-identified Black/African American patients were under-represented in the MTB. We next sought to evaluate the association between race and the implementation of MTB-recommended therapy. Methods: We evaluated ISCI MTB records from 1/1/16 to 12/31/21 and identified patients with at least one treatment recommendation informed by molecular biomarker results, including clinical trials, targeted medications, immunotherapy, and chemotherapy. Patient data were extracted from the EMR using the Epic Slicer/Dicer Tool and integrated with the MTB REDCap database. Manual chart review was used to fill missing data and identify patients for whom at least one MTB recommendation was implemented. Recommendation implementation was defined as treatment with or prescription of a recommended therapy or evaluation for a clinical trial. Results: 244 of 530 patients (46%) had one or more MTB recommendations implemented. There was no clear distinction in age at MTB presentation (64 vs 65) or sex (45% of males and 47% of females vs 55% of males and 53% of females) between patients who had recommendations implemented and those who did not. 45% of White/Caucasian, 41% of Asian, 56% of Black/African American, and 58% of Hispanic/Latino patients had MTB recommendations implemented. No statistically significant differences in implementation of recommendations were observed for age, sex, or race. Conclusions: Fewer than half of patients with advanced cancer receive biomarker-directed or investigational therapies recommended by an institutional MTB. White and Asian patients are less likely than Black/African American and Hispanic/Latino patients to be treated with MTB-recommended therapy, although these differences did not reach statistical significance. Further investigation of confounding variables including payor status and care fragmentation is necessary to clarify potential disparities and barriers to accessing innovative cancer care.
Assessing changes in cancer-related financial support needs across three waves of the COVID-19 pandemic.
Authors: Thom Bridgette , Incudine Andrea , Arora Neha , Stivers Thomas , Winder Katharine , Chino Fumiko
Published: June 2023

e18584

Background: Cancer-related financial hardship is well-documented and associated with treatment/medication nonadherence and poor outcomes. Family Reach is a national nonprofit that aims to remove financial barriers to cancer treatment through education, resource navigation, financial coaching, and direct financial assistance. We sought to evaluate variation in patient financial support needs throughout three waves of the COVID-19 pandemic: March-December 2020 (Wave 1), January-December 2021 (Wave 2), and January-June 2022 (Wave 3). Methods: Applications for Family Reach services were evaluated. Descriptive statistics and univariate tests characterized responses, and multivariable analysis, considering age, race/ethnicity, insurance, gender, insurance, % of federal poverty level (FPL), and children < 18 in the home, assessed associations between pandemic wave and self-reported financial and essential needs concerns. Results: From 3/2020-6/2022, 10679 applications were processed: 39% in 2020, 38% in 2021, and 24% in 2022. When relationship to the patient was specified (62%, n = 6647), most applications were submitted by a parent (53%) or the patient (28%). Common diagnoses included leukemia (26%), breast cancer (16%), sarcoma (8%), and lymphoma (7%). Patients were a median age of 30 years (IQR: 11-46); racial/ethnic identity included 41% Non-Hispanic White, 24% Non-Hispanic Black, 21% Hispanic patients; 53% had a child < 18 years at home. Median %FPL was 123.2 (IQR: 68.3-207.6): 54% reported losing income because of the pandemic, with a greater than expected proportion experiencing income loss in the Wave 2 (Wave 1: 49%, Wave 2: 59%, Wave 3: 54%; χ2= 67.0, df = 2, p < .001). Financial concerns across the entire sample included medical expenses (50%), nonmedical expenses (61%), childcare costs (17%), and food insecurity (42%). One-third (33%) were at risk of utility shut off within the past 90 days. In multivariable analyses, concerns about medical expenses were higher in Wave 2 (OR = 1.8, 95% CI: 1.5-2.1, p < .001) and Wave 3 (OR = 3.2, 95% CI: 2.7-3.9, p < .001), when compared to Wave 1. Past 90-day-risk of utility shut off (Wald = 26.0, p < .001), food insecurity (Wald = 46.7, p < .001), and childcare concerns (Wald = 26.0, p < .001) were higher in Wave 1 when compared to Waves 2 and 3. General nonmedical needs were consistent across all three waves of the pandemic (Wald = 1.28, p = .53). Conclusions: Although the early months of the COVID-19 pandemic led to high rates of immediate essential needs in patients with cancer, nonmedical financial concerns remained consistent, and medical financial concerns rose over time. Given ongoing financial gaps in care delivery for the most vulnerable, financial assistance and other services through programs like Family Reach will continue to be a key resource for patients and families, but structural and policy-focused interventions are needed for sustainable change.
Disparities in African American oncology care in the US: A socioeconomic and geographic outlook.
Authors: Jasaraj Ranjit , Gaire Suman , Proskuriakova Ekaterina , Kassem Mohammed Azher , Khosla Paramjeet Grewal , Verda Larissa , Karki Nabin R
Published: June 2023

e18590

Background: Mortality from cancer has been decreasing for all races and ethnicities. However, African Americans (AA) continue to have the highest mortality. Healthcare disparity contributes to poor outcomes. Here, we evaluate the differences in access to health care and socioeconomic status between different races and ethnicities in the US. Methods: We extracted data on demographic and healthcare coverage variables of patients diagnosed with cancer from the 2021 Behavioural Risk Factor Surveillance System (BRFSS), a national health-related telephone survey. We analyzed the effect of racial disparities in relation to socioeconomic factors and Census Bureau regions. R version 2.2.2 was used for all data extraction and analysis. Results: Out of 4,31,639 responders of BRFSS from the mainland US territory, 41,933 (9.71%) had been diagnosed with cancer other than skin cancer. Of these, 9,746 (9.74%) were from North East, 8,827 (9.11%) were from West, 10,806 (9.98%) were from South, and 12,554 (9.92%) were from Mid-West. In our sample, 35,137 (83.8%) were White, 2,356 (5.6%) were AA, 1,383 (3.3%) were Hispanic, and 3,047 (7.3%) were from others (Asian, American Indian/Alaskan Native, other race). More than 95% of oncology patients had health care coverage. However, the proportion of AA without healthcare coverage was higher than the White population (2.1% vs 1.2%, p < 0.005). 5.3% of cancer patients did not see physicians due to cost. This percentage was significantly higher among AA compared to White (8.2% vs 4.3%, p < 0.001). The rates of health care coverage and being unable to see a physician due to cost between AA and White were also statistically significant in each census region (not shown in table). Compared to White, AA patients with cancer were found to have statistically significantly lower education and income levels. This difference was present in all census regions of the US (not shown in table). Conclusions: Among cancer patients, AA are more likely not to have health care coverage, unable to see a physician due to cost, and have lower education and income level than White. These disparities impacting care of cancer patients exists in all major US regions, which likely promotes poor health outcomes. In addition, AA patients are underrepresented in this survey. [Table: see text]
Clinical trial deserts: US urban vs rural patient enrollment among patients with advanced cancer in phase 1 clinical trials at a major cancer center.
Authors: Davidson Tara Marie , Le Hung , Campbell Erick , Ozenne Cherri A. , Dumbrava Ecaterina Elena , Fu Siqing , Hong David S. , Karp Daniel D. , Naing Aung , Piha-Paul Sarina A. , Rodon Ahnert Jordi , Tsimberidou Apostolia Maria , Yap Timothy A. , Meric-Bernstam Funda , Subbiah Vivek
Published: June 2023

e18594

Background: Ethically and scientifically clinical trials must be equally accessible. Unfortunately, racial and ethnic minorities, socioeconomically disadvantaged, elderly and rural populations continue to be underrepresented in all phases of cancer clinical trials due to multiple interrelated economic, cultural, social and medical barriers. Per U.S. 2010 census data about 57 million people (18-19% of the population) and 84% of the U.S. land mass qualify as rural. Examining the affect of geographic distance from trial sites and rural residency on patient enrollment in early phase cancer trials will aid in prioritizing how to address these barriers. Methods: We reviewed EMR data from 8/1/2016 to 8/1/2022 on all initial visits of consults and new patients with advanced cancer ( > 18 years of age) to a single institution phase 1 clinical trials unit. International patients and those without provided addresses were excluded. Bing geocode data for patient’s home zip codes was used in conjunction with the haversine distance formula to determine geographic distance to the cancer center. Rural-Urban Commuting Area codes, which classify U.S. 2010 census tracts based on zip codes using measures of population density, urbanization and daily commuting, were used to determine rural vs urban areas based on the Rural Health Research Center Categorization A and the Federal Office of Rural Health Policy definitions. Results: Among the 10,630 patients with diverse cancers referred to the phase 1 unit, 9182 patients (86.4%) were urban vs. 1448 (13.6%) rural. Patients from urban areas were more likely female 53.8% (4939) vs rural areas 49.2% (712). In terms of race, full data is provided in Table 1 with significantly less diversity in rural enrollment. Travel distance for study inclusion in urban vs rural patients was: 32.8% (3012) vs. 11.1% (161) < 100 miles, 37.0% (3396) vs. 53.9% (781) 100-499 miles, 19.7% (1813) vs. 26.2% (379) 500-1000 miles and 10.5% (961) vs. 8.8% (127) > 1000 miles. Overall, 75.6% (6944) patients from urban and 77.1% (1117) patients from rural areas consented to ≤ 1 study. Of those that consented 62.5% (4337) of urban patients and 64.0% (715) of rural patients enrolled in study. Conclusions: The largest Phase 1 cancer trial cohort of patients with advanced cancer with provided demographics and distance traveled for trial participation reveals disparities among U.S. rural vs. urban enrollment. Clearer understanding of these populations will allow for improved trial design and broad accrual. [Table: see text]
Association of inability to secure timely medical appointment and medication non-adherence among cancer survivors in the US.
Authors: Chido-Amajuoyi Onyema , Osaghae Ikponmwosa , Nzeako Tochukwu , Chandra Joya , Shete Sanjay
Published: June 2023

e18595

Background: Access to health care is defined as the “timely use of personal health services to achieve the best possible health outcomes.” Cancer survivors have higher health care utilization than individuals without a history of cancer, yet studies examining health care access and its impact on medication adherence in this population are lacking. Methods: Study data were derived from the National Health Interview Survey. The prevalence of reports of inability to secure timely medical appointment among cancer survivors was estimated by respondent characteristics. Weighted multivariable logistic regressions were used to assess the relationship between inability to secure timely medical appointment and medication non-adherence among Cancer Survivors in the US. Results: Respondents were a total of 2,590 cancer survivors, of which 8.9% (n = 225) reported inability to secure timely medical appointment. The prevalence of reports of inability to secure timely medical appointment were higher among those without insurance coverage (17.3%), earning income < $34,999 (12.3%), those aged 18-45 years (15.9%), American Indian natives (32.2%), and females (10.4%). The odds of skipping medication to save money was almost four-fold higher for cancer survivors who were unable to secure timely medical appointment (adjusted odds ratio (aOR) 3.84; 95% CI: 2.19-6.74), compared to those who did not experience delays securing medical appointment. Similarly, the odds of taking less medication to save money was almost five-fold higher for cancer survivors who were unable to secure timely medical appointment (aOR 4.99; 95% CI: 2.83-8.77), compared to those who did not experience delays securing medical appointment. The association remained significant even after adjusting for potential confounding factors. Conclusions: This study found a significant association between inability to secure timely medical appointment and medication non-adherence among cancer survivors in the United States. These findings highlight the importance of timely medical care for cancer survivors and the potential consequences of delay in getting medical appointments, such as medication non-adherence. Interventions aimed at reducing delay in accessing medical care and improving medication adherence may improve outcomes among cancer survivors.
Evaluating differences in cancer survivorship care plans experienced by cancer survivors with disabilities.
Authors: Poghosyan Hermine , Sarkar Sayantani
Published: June 2023

e18597

Background: Survivorship Care Plans (SCPs) are crucial elements for short- and long-term follow-up care among cancer survivors and have been endorsed by leading oncologic organizations. Yet, limited research exists about the receipt of SCPs among survivors with disabilities who may face additional barriers to access the health care services. Our study examines the association between the disability status and receipt of SCPs after completion of cancer treatment among US adult cancer survivors. Methods: This secondary analysis included cross-sectional, nationally representative, population-based data from the 2021 Behavioral Risk Factor Surveillance System. We included 2110 respondents (aged ≥ 18 years) who self-reported cancer history (other than skin cancer). Outcomes were self-reported receipt of cancer treatment summaries and follow-up care instructions after completion of the cancer treatment. The independent variable was disability status, comprised of six specific disability types (having serious difficulty with hearing, vision, cognition, mobility, self-care, and independent living). We combined disability status into four groups—as having 1) no disability; 2) one disability; 3) two disabilities; and 4) three or more disabilities. We applied recommended sample weights and conducted weighted descriptive statistics and multivariable logistic regression adjusting for self-reported individual-level factors (age, sex, race, marital status, education, health insurance, provider type who provided majority of the care). Results: Overall, 4.2% self-reported as Black, 19.5% Hispanic, 70.0% White, 59.5% women, and 54.5% aged 65+ years. A total of 20.8% of participants reported having one disability, 11.1% two disabilities, and 11.7% reported three or more disabilities. Mobility disability was the most prevalent disability type (27.0%), followed by cognition (14.8%), independent living (14.5%), hearing (12.7%), vision (9.2%), and self-care (6.5%). About 18.0% did not receive follow-up care instructions, and 41.7% did not receive treatment summaries. Overall, 52.8% of survivors reported receiving both follow-up care instructions and treatment summaries. Survivors with three or more disabilities were 0.40 (95% CI 0.27-0.88, p = 0.019) times significantly less likely to report receiving follow-up care instructions than survivors without disabilities. Survivors’ disability status was not significantly associated with reporting the receipt of cancer treatment summaries. Conclusions: Nearly half of the survivors did not receive SCP upon treatment completion, which may lead to poor treatment adherence and deterioration of health. Our findings suggest disparities in follow-up instructions based on disability status, especially for people with multiple disabilities. Effective strategies are necessary to build more equitable cancer survivorship care.
Ethnically diverse communities and their priorities for cancer research.
Authors: Winter Helen , Ahmed Fatima , Matthews Claire , Hajinur Huda , Mohamed Asha , Dawson Shoba
Published: June 2023

e18602

Background: Ethnic minorities in the UK tend to have poorer access to healthcare, outcomes and experiences than the majority population. They are often underrepresented in health research. Experiencing disparities compounded by the lack of involvement in research widens the inequalities gap. Methods: Targeted community engagement was implemented in the highest areas of deprivation in the South West. The project team designed a series of questions and data was collected during outreach health checks and community events by members of the team based in the community. Information was collected from individuals and from groups. Results: Forty people, from culturally and linguistically diverse communities participated. We sought help from interpreters to ensure inclusivity and information was gathered in a cultural sensitive way. This was especially important due to the sensitivity in this topic area. Demographic information was collected from those that participated. The majority were women (n = 33), men (n = 7). In terms of ethnicity the majority described themselves as Black African/Caribbean (n = 31), Arab (n = 9) and Asian (n = 3). The age range was 25 - 64 years. Twelve people identified that their actual age was different to their recorded age on the NHS system. Fourteen people had been in the UK for less than 5 years and included those identifying themselves as refugees and asylum seekers. We conducted content analysis to identify and categorise the cancer research needs identified. Key themes identified included: Easier access to screening programmes; earlier diagnosis and how to initiate onward referral; research into cancer prevention and a more holistic approach to cancer care. Only one patient had clinical trials discussed. Conclusions: Community engagement offers the opportunity to identify cancer research priorities and discuss access to cancer prevention, cancer screening programmes, therapies and clinical trials. Through actively listening to our communities and the voices seldom heard about their experience of health and cancer care, we raise awareness and provide ongoing education to health care teams, on the delivery of care that is culturally sensitive, inclusive and more tailored to an individual. Increasing the diversity of the workforce may increase representation and greater advocacy of the communities. Engaging patients more in their own cancer care and decision-making may empower them to be more involved in their health. Our findings suggest that community engagement with people from diverse communities identify areas for improvement in their cancer care and experience. This includes how we might better engage with people from diverse backgrounds on clinical trials. Addressing the priorities identified from these communities is a first step in addressing the existing inequalities. Organisations need to actively engage, listen to and empower the communities that we serve.
Care cascade of anal dysplasia screening among MSM living with HIV from a single-center outpatient clinic.
Authors: Thirugnanasambandam Ram Prakash
Published: June 2023

e18607

Background: Anal cancer is the fourth most common cancer among people living with HIV with an incidence estimated to be 89 per 100,000 among men living with HIV who have sex with men (MSM). In comparison, the incidence of anal cancer in the general population is 1.6 per 100,000. The ANCHOR study which was a randomized control trial found that treating anal high-grade squamous intraepithelial lesions (HSIL) reduces the incidence of anal cancer by more than half. These findings provide a rationale for screening for anal dysplasia in people with HIV and could have an impact on recommendations for screening and treatment. The study also highlights the need for effective strategies to improve the screening and treatment of anal HSIL and providers trained in high-resolution anoscopy (HRA). Our goal was to determine the rate of screening for anal dysplasia among men who have sex with men (MSM) living with HIV attending our clinic and subsequent referral for HRA and completion of HRA in case of abnormal results. Methods: We assessed the rate of screening for anal dysplasia among the patients identifying as MSM (n = 305) at a large HIV clinic in Brooklyn, New York. An anal dysplasia care cascade was completed. The number of patients screened for anal dysplasia and the results of the screening were obtained from the EMR. All patients with results of Atypical Squamous cell of undetermined significance (ASCUS), Low-grade intra-epithelial neoplasia (LSIL), or High-grade intra-epithelial neoplasia (HSIL) on anal cytology were evaluated for evidence of referral for HRA and the number who completed the HRA was included in the descriptive analysis. Results: 60% of the total eligible patients included in the study were screened by anal cytology, 72% of those with abnormal cytology were referred for HRA and 37% completed the anoscopy (table 1). The patients in the age group 20-40 years were more likely to be screened. The number of patients with HSIL was low. Conclusions: The engagement of MSM clients in anal dysplasia screening and management was low based on our care cascade. Considering the results of our study, we aim to identify the barriers to screening as well as to referral and completion of HRA among MSM living with HIV in our patient population. [Table: see text]
The impact of neighborhood socioeconomic deprivation on clinical trial enrollment at an NCI-designated cancer center.
Authors: Dhahri Amina , Ginn Madison , Powers Benjamin Daniel , Chauhan Aman , Villano John L. , Anthony Lowell Brian , Zinner Ralph , Patel Reema Anil , Hao Zhonglin , Williams Lovoria , Monge B. M. Cecilia , Arnold Susanne M.
Published: June 2023

e18614

Background: Previous studies showed that SES is a barrier to cancer clinical trial enrollment. But, few studies have investigated the impact of socioeconomic deprivation (SED) on trial participation using a granular geocoded measure. To overcome this gap, we assessed trial enrollment at the only NCI-designated cancer center in Kentucky. Methods: We conducted a retrospective study of patients enrolled in GI and lung cancer trials from 2012 to 2021 using the Area Deprivation Index (ADI), a validated dataset that ranks census block groups based on SED and includes 17 variables. Patients with an identifiable state and national rank ADI were included and stratified in quintiles. Chi-square and Kruskal-Wallis tests were used for analysis. Results: We included 1130 patients who enrolled in a trial; 10 patient refused enrollment 0.9%. Trial participation by gender was similar: 50.5% female and 49.5% male. Race included White 93.5%, African American 5.7% and Asian 0.71% patients. Hispanics made 0.5% of the cohort. When assessed by national ADI, 45% of clinical trial participants were in the highest ADI quintile. When assessed by ADI state ranking, there was similar distribution in trial enrollment. Enrollment at the national and state levels were significant for age (p < 0.001, for both) and race (p = 0.003 and 0.023, respectively). Conclusions: Prior studies have shown that low SES is a barrier trial enrollment; however, this study demonstrates that using a granular measure of SED at the state level, GI and lung cancer clinical trial enrollment has similar distribution by ADI quintiles. But, when assessed at the national level, 45% of trial participants were in the highest SED quintile. This highlight the importance of state and national-level comparisons for SED and suggest that future research is needed to identify barriers and facilitators of cancer clinical trial enrollment. [Table: see text]
Does community size impact survival with breast cancer? Data from a large population-based cohort in British Columbia.
Authors: Jackson Emily Beatrice , Gondara Lovedeep , Speers Caroline H. , Diocee Rekha M. , Nichol Alan , Lohrisch Caroline A. , Chia Stephen
Published: June 2023

e18618

Background: Patients with breast cancer residing in rural settings have a unique set of challenges in accessing cancer care. How rural residence impacts disease-related outcomes is not fully understood. This study is a descriptive and quantitative analysis of geographically determined differences in patient presentations, treatment choices and outcomes for individuals diagnosed with breast cancer in rural and urban communities in British Columbia. Methods: Using BC Cancer’s Breast Cancer Outcomes Unit database, we identified all patients referred with newly diagnosed invasive breast cancer at any stage between 2005-2018. Using postal code, we then categorized patients as residing in either an urban (population ≥ 100,000) or rural setting ( < 100,000), using the Statistics Canada classification of community size. We analyzed baseline clinical-pathological features, patterns of initial treatment, and outcomes differences between urban and rural settings. We performed a univariable analysis examining differences in locoregional relapse, distant relapse and breast cancer-specific survival (BCSS) between urban and rural cohorts. We then performed a multivariable analysis accounting for age, grade, lymphovascular invasion (LVI), subtype, stage, initial treatment with chemotherapy, endocrine therapy (ET), radiotherapy (RT) and type of definitive surgery. Results: The median follow up was 9.7 years for 35,255 patients. 9244 patients in rural and 26011 in an urban setting. There were no clinically meaningful differences in age, LVI, grade, subtype and stage at diagnosis between the urban and rural cohorts. Patients residing in a rural setting were significantly more likely to be treated with mastectomy (43.4% vs. 39.1%), less likely to receive RT (61.4% vs. 67.7%) and less likely to receive ET (67.2% vs. 71.7%). However, there was no difference in use of chemotherapy or anti-HER2 therapies between cohorts. On univariable analysis, urban residency was associated with improved BCSS (86.5% [86.0-86.9%] vs. 85.3% [95% CI: 84.5-86.1%], p < 0.001), and lower risk of distant relapse (12.1% [11.7-12.6%] vs. 13.4% [12.6-14.1%], p < 0.001). There was no influence on locoregional relapse. On multivariable analysis, urban residency was associated with improved BCSS, with a hazard ratio (HR) of 0.92 [0.86-0.99, p = 0.03], and lower risk of distant relapse (HR = 0.91 [0.85-0.98, p = 0.01]), but no influence on locoregional relapse. Conclusions: Rural residency is a significant and independent risk factor for both distant relapse and mortality from breast cancer. It is also associated with less use of ET and RT. Understanding the factors that contribute to these disparities is necessary to close the gap between rural and urban breast cancer outcomes.