bluuebunny/crossref_metadata_2025 huggingface dataset:
Breaking down the divide: An analysis of male breast cancer demographics and survival by race.
Authors: Yadukumar Lekha , Gogtay Maya , Singh Amninder , Sharma Namita
Published: June 2023

e18593

Background: Male breast cancer (MBC) is rare and comprises < 1% of breast cancers. The incidence of MBC has increased by 40% from 1975 to 2015. It is projected that 2800 new cases of invasive MBCs will be discovered in the US in 2023, and 530 men will die from it. We examined the demographics of MBC and assessed the racial differences influencing survival. Methods: We performed a retrospective cohort study of the Surveillance, Epidemiology, and End Results database for patients diagnosed with primary MBC between 2000 and 2019. Patient demographics, tumor characteristics, and treatments were analyzed by descriptive statistics. Cox proportional hazards regression analysis was performed to identify the factors influencing survival, followed by subgroup analysis by Caucasian (WH) and African American (AA) race. Results: A total of 8373 patients had MBC. AA had 1111 (13.26%) and WH had 6817 (81.41%) MBC cases. AA had a median age of diagnoses of 69 vs WH of 63 years. AA (22.4%) men with MBC had a higher mortality rate (HR 1.44) than WH (16.8%). Older patients were found to be at increased risk of mortality in AA (HR 1.07) and WH (HR 1.17). Tumor size < 20 mm halved the risk of death in WH (HR 0.56), it did not have any significance in AA. Regional lymph node involvement increased the risk of death in AA and WH (HR 4.79 vs 4.05). Poorly differentiated tumors had worse outcomes in WH than AA (HR 2.11 vs. 1.8). ER/PR + status was protective for both races. Mortality was higher in AA men residing in rural areas (HR 1.47) and lower for AA men in urban cities. Marriage improved outcomes for both AA (HR 0.63) and WH (HR 0.61). Surgery alone had better outcomes, AA (HR 0.21) and WH (HR 0.14) than chemotherapy or radiation. Median income was of no significance on survival in either race. Conclusions: Overall, there is a significant difference in incidence and factors influencing survival for male breast cancer between Caucasians and African Americans. Despite the markedly lower incidence of MBC in the AA population, they have poorer outcomes overall. Further studies are required to determine the specific reasons for disparity in their survival. [Table: see text]
Is access to adjuvant treatments prioritized over therapies for metastatic cancer? The Israeli experience.
Authors: Siegelmann-Danieli Nava , Azran Carmil , Topol Yael , Landsberger Daniel , Liebermann Nicky , Hammerman Ariel
Published: June 2023

e18599

Background: The Israeli National Insurance Law determines a uniform benefits package ('the Health Basket') for all residents. A public committee advises each year on which new medications should be added to the Health Basket, subject to the fixed annum budget allocated by the government for this purpose. The clinical benefit of the proposed health technologies is the committee's prime consideration; however, the committee also considers the professional medical societies' prioritizations, the expected budget impact, and other social and ethical aspects. Towards the annual discussions for 2023, 63 new indications for 41 cancer drugs were proposed for the annual update. Of those, 8 were for novel neo-adjuvant/ adjuvant indications, all given high priority ranks by the Israeli Oncologists Society based on the significant disease-free survival (DFS) figures from the phase III clinical trials. Varying the adjuvant treatment practice patterns based solely on DFS figures without available overall survival (OS) data has been in much debate recently between global key opinion leaders. We, therefore, aimed to evaluate whether the Israeli decision-makers have de-facto accepted the attitude of prioritizing budgets for adjuvant/neo-adjuvant therapies as the Israeli Oncologists Society recommended. Methods: We collected data on all cancer therapies proposed for inclusion in the 2023 Health Basket update; drug name, indication, treatment setting (curative intent vs. metastatic disease therapy), ESMO-MCBS grade, and whether or not accepted for reimbursement. All data were extracted from the official Israeli Ministry of Health website publications and press releases. Results: 20% of the allocated budget for updating the National Health basket for 2023 was provided to treat solid tumor cancers. 7 out of the 8 candidate therapies in the neo-adjuvant/adjuvant settings received reimbursement approval (88%) vs. 11 out of 55 therapies for advanced/ metastatic stages of disease (20%). 13 of the 16 candidate metastatic disease therapies that had a high ESMO-MCBS score (4 or 5) were not approved for reimbursement in the 2023 annual committee discussions. Conclusions: Our retrospective evaluation of the Israeli reimbursement prioritization process reveals that decision-makers have accepted the approach of prioritizing potentially curative adjuvant therapies over treatments for patients with incurable cancer. In an era of prosperity of adjuvant therapies in a range of tumor types, concerns might arise regarding restrictions on access to novel therapies for metastatic cancer, even those with proven benefits of significantly improving patients' OS and quality of life. Future analysis should determine the impact of this trend adopted by decision-makers in Israel on disease progression and overall survival in the real-world setting.
Immediate inpatient toxicities associated with CAR T-cell therapy: Real world data from a national inpatient sample.
Authors: Singh Vinit , Al-alwan Ahmad , sirpal vishakha , Khalid Farhan , Gupta Rajshree , Eltoukhy Hussam
Published: June 2023

e18605

Background: Chimeric antigen receptor T-cell therapies (CAR-T) have shown overall survival benefits in multiple hematological malignancies. Since Tisageneleleucel's first approval in 2017 for ALL in pediatric and young adults, FDA has approved 5 CAR-T cell product for adult hematological malignancies all in refractory/relapsed setting. Cellular therapies are associated with severe immune related adverse events (IRAE) like Cytokine release syndrome (CRS), Immune effector-cell associated neurotoxicity (ICANS), and Hemophagocytic Lymphohistiocytosis (HLH). Limited real world data available for CAR T-cell associated immediate toxicity. CMS approved recent updates in ICD coding leading to better identification of IRAE in discharge data. We used NIS 2020 database with updated ICD codes to quantify immediate inpatient toxicity related to CAR T-Cell therapy. Methods: We identified patients with CAR T-cell from discharge data by utilizing ICD-10 procedure codes of CAR T-cell therapy for 5 approved products. Codes for acute lymphoblastic leukemia (ALL), DLBCL (diffuse large B-cell lymphoma), multiple myeloma (MM,) Follicular lymphoma (FH), Mantle Cell Lymphoma (MCL) were used to identify the indication. Patients without these indications were categorized as "Others". Appropriate weights were applied to the analyses to obtain national estimates. We analyzed in-hospital outcomes i.e Length of stay(days), and mortality. CAR T-cell related specific toxicity i.e CRS, ICANS, and HLH were identified and reported along with other complications. Cost to charge ratio adjusted hospitalization cost were estimated. Results: 2240 patients were identified on review of the NIS 2020 with 61.1% males, 74.11% NHW, mean age 57.54 years (95%CI 55.31-59.78), while 42.19% of the patients were age ≥65 years. 47.1% patients had private insurance while 39.06 % had Medicare. CAR-T cell was used for DLBCL in 60.94%, FH 2.23%, MCL 7.37%, MM 8.93% and ALL 9.38% patients respectively. The use of CAR-T was approximately equally distributed among four geographical regions of the United States. The mean length of stay was 19.4 days (17.05-21.75) and in patient mortality was observed in 3.79% of the patient population. The IRAE noted were CRS (17.19%), ICANS (12.5%) and HLH (2.46%). Other significant complications among patients were sepsis (9.15%), acute kidney injury (15.85%), Seizures (1.79%) and intubation (4.46%). Overall cost associated with the CAR-T therapy was found to be 270,446.9 (235670.5 - 305223.3). Conclusions: CAR-T therapy has appeared as a breakthrough in cancer management. Demographic variation is still an important issue and majority of the patients treated are white and have private insurance. DLBCL remains the most common target for CAR-T. Neurological syndromes remain significant adverse effects of the therapy and should be closely monitored.
Ethnic disparity in hospitalization among veterans with COVID-19 and cancer.
Authors: Gogtay Maya , Kaushik Ruchi , Martinez Nicolina , Mader Michael , Sanchez-Reilly Sandra , Restrepo Marcos I.
Published: June 2023

e18613

Background: COVID19 results in severe disease and resource utilization, particularly among patients with cancer. Hospitalization rates among COVID19 outpatient US veterans with cancer vary according to race (white vs non-Hispanic black). Less is known about ethnic (Hispanic vs non-Hispanic) disparities in hospitalization rates. We aimed to identify ethnic disparities in all-cause hospitalization rates among COVID19 outpatient US veterans with cancer. Methods: We conducted a retrospective cohort study of veterans with cancer and an index diagnosis of COVID19 (ICD10 U07) between 1/1/2020 and 3/31/2022 managed at the South Texas Veterans Health Care System. We included patients for whom ethnicity data (Hispanic or non-Hispanic white) were available. Our primary outcome was all-cause hospitalization rates at 30 days and 60 days following an index diagnosis of COVID19 among Hispanic and non-Hispanic white patients with cancer. We analyzed continuous variables using unpaired t test and categorical variables using Chi-square analysis for statistical significance (p < 0.05). Results: Of 968 outpatient veterans with a history of cancer and a COVID19 diagnosis between 1/1/2020 and 3/31/2022, 762 met our inclusion criteria. Of these, 300 (39.4%) identified as Hispanic (94% male, p < 0.05) and 462 (60.6%) identified as non-Hispanic white (90% male). At baseline Hispanic patients were younger and were more likely to have underlying comorbidities (T2DM, mild liver disease, AIDS; p < 0.05). Hispanic patients with cancer demonstrated hospitalization rates after the index COVID19 diagnosis comparable to those of non-Hispanic white patients at 30d (34% vs 28.8%) and 60d (35.7% vs 32%). Conclusions: Although Hispanic patients with cancer demonstrated a trend of higher hospitalization rates at 30d and 60d following a COVID19 diagnosis, this difference was not statistically significant. Further studies with a larger sample size and generalizability to assess ethnic disparities in other clinical settings are warranted.
Distribution of non-Hodgkin lymphomas across US: Are Hispanics any different from non-Hispanics?
Authors: Urueta Portillo Daniela , Michalek Joel , Liu Qianqian , Diaz Duque Adolfo Enrique
Published: June 2023

e18619

Background: Non-Hodgkin lymphoma (NHL) encompasses various subtypes that differ in incidence, etiology, clinical features, and survival. NHL subtypes can be divided into B-cell and T-cell lymphomas, when classifying them based on cell of origin. The distribution of NHL subtypes has been known to variate between geographic locations, and always results are reported without classifying them among ethnicities. Hispanics are by now, the largest ethnic minority in US, according to the latest 2020 US Census, and it is of utmost importance to understand variations related to ethnicity. This is to our knowledge, the largest retrospective study comparing NHL frequency of subtypes in Hispanics vs Non-Hispanics. Methods: Data were analyzed on NHL patients in the US and reported to the Surveillance, Epidemiology, and End Results (SEER) 18 database between 2000 and 2018. SEER 18 contains the most comprehensive population-based cancer information in the US, covering approximately 27% of the US population and up to 36% of HI alone. Racial groups analyzed included NH whites and HI whites. Results: There were 366516 patients diagnosed with NHL over the 8-year study period included in our study. Most of these patients belong to the B-cell NHL type, comprising 91% of the group. The distribution of the major subtypes of NHL is shown in the pie charts. We noted differences in the distribution of major NHL subtypes among NH and H. Among the B-Cell NHL subtypes, Hispanics had higher proportions of DLBCL (42% vs. 31%), FL (19% vs. 17%), and Burkitt lymphoma (4% vs. 2%) than NH. On the contrary, a significant difference was found, with a higher presence of CLL/SLL in NH, which was seen in 31% vs. 15% in H. Within the T-Cell NHL subtypes, compared with non-Hispanics, Hispanics had higher proportions of NK/T cell lymphoma (11% vs. 3%) and anaplastic large cell lymphoma (15 vs. 12%) but a lower proportion of mycosis (26% vs. 30) in NH and cutaneous T-cell lymphoma (9% vs. 13%). The rest of the subtypes showed to have similar proportion rates. Conclusions: In conclusion, our study shows evidence of a significant difference in subtype distribution between NH and H patients. The involvement of a complex process in developing NHL and the etiologic heterogeneity among subtypes has been previously described. These differences in subtype distribution across races may be due to geographic location, genetic variants, occupational exposures, infectious conditions, family history, and socioeconomic status. Analyzing and comparing multiple cancer subtypes can provide critical clues for future epidemiological investigations to improve care among our minorities. Due to the growing Hispanic population in the US, it is significantly vital to represent the differences in subtype presentation graphically.
Rates of surgical site infections and length of stay following major gynecologic oncology surgery for patients on federally funded insurance: A 6-month retrospective cohort.
Authors: Malone Allyson , Aliabadi Arya , Johnson Caitlin Ruth , Salani Ritu , Cohen Joshua Garrett , Kapp Daniel Stuart , Chan John K.
Published: June 2023

e18627

Background: An estimated 94,000 women have newly diagnosed gynecologic cancer annually–with rates increasing over the last 20 years. The incidence of gynecologic cancers is known to vary by insurance status; more specifically, uninsured or federally insured women are more likely to have advanced-stage disease at the time of diagnosis and worse overall survival compared to privately insured women. Surgical site infections (SSIs) complicate up to 4% of hysterectomies in the United States. Other post-operative sequelae, such as wound dehiscence and 30-day readmission, further complicate the post-surgical course. We sought to determine differences in postoperative outcomes for patients with private and federally-funded insurance plans, such as SSI, length of hospital stay, and 30-day wound dehiscence, and 30 all-cause readmission following gynecologic oncologic surgery. Methods: We conducted a retrospective cohort study from a large metropolitan academic health system between January 1st, 2022, to June 30th, 2022. The study population included adult women who received gynecologic oncologic surgery–surgical staging or interval cytoreduction. Postoperative complications were compared to national rates from the National Surgical Quality Improvement Project (NSQIP) database. Trends were analyzed using chi-squared analysis and a two-sample t-test. Results: Over our 6-month study period, 233 patients underwent gynecologic oncologic surgery. Robotic-assisted hysterectomies were the most common (27.89%, n = 65), followed by total abdominal hysterectomies (21%, n = 49), laparoscopic hysterectomies (7.72%, n = 18), and supracervical hysterectomies (3%, n = 7). More patients required bilateral salpingo-oophorectomy (63.51%, n = 148) compared to unilateral procedures (9.87%, n = 23). Although most patients had private insurance (73.39%, n = 171), 26.1% had federally-funded health plans (n = 62)–Medicaid and Medicare. Rates of wound dehiscence were higher than the NSQIP rate of 1% among our cohort (3%, n = 7). Although there was a high rate of 30-day readmission (9.44%, n = 22) compared to NSQIP rate of 6.1%, the incidence of SSI was fewer than the NSQIP rate of 4% (3.86%, n = 9). Upon intersectional analysis, patients with federal insurance plans had higher rates of SSI (n = 5, p < 0.05). Specifically, Medicare patients had a longer average length of stay at 2.64 days (p < 0.05) compared to a study average of 1.76 days. Conclusions: Patients with federal insurance had longer hospital stays and higher rates of SSI compared to those with private plans. There was no difference in 30-day wound dehiscence or 30-day all-cause readmission between study populations. More studies are needed to risk-stratify patients by insurance type before gynecologic oncology surgery to improve postoperative outcomes further.
Impact of COVID-19 pandemic on lung cancer diagnosis in a community hospital.
Authors: Arun Kumar Sumukh , Sekar Abinesh , Singh Abhishek , Ravichandran Sharmitha , Mishra Rahul , Siddiqui Ahmad Daniyal
Published: June 2023

e18634

Background: Coronavirus disease 2019 (COVID 19) pandemic saw its first case in the United States in 2020. Although lung imaging for COVID-19 patients theoretically increased chances of detecting cancerous lung nodules, strict quarantine measures disrupting routine cancer screening was a concern. Real-world data on lung cancer diagnosis during the pandemic at community level is less known. Methods: We conducted a retrospective chart review on patients newly diagnosed of lung cancer from 2018- 2022 in our community hospital. Demographic details, year of diagnosis, type and stage of cancer, inpatient or outpatient diagnosis and mode of diagnosis (surveillance, incidental or symptomatic) was noted. Descriptive analysis of the above parameters was conducted across three eras- 2018 and 2019 as pre-COVID era (PreCo), 2020 and 2021 as COVID era (Cov) and 2022 as post-COVID era (PosCo) irrespective of COVID-19 diagnosis. Results: Out of 287 patients included, 40% (116) were diagnosed during PreCo, 27.5% (79) during Cov and 32% (92) during PosCo. In the PreCo, 16% (19) were incidentally detected, 21% (24) were ISym, 48% (56) on surveillance, and 15% (17) were OSym. In Cov, 13.9% (11) were incidentally detected, 53.3% (42) were ISym 13.9% (11) on surveillance, and 18.9% (15) were OSym. In PosCo, 11.3% (11) were incidentally detected, 19% (18) were ISym, 44% (41) on surveillance, and 24% (22) were OSym. Stage IV cancers among new lung cancer diagnoses were noted to be highest in PosCo (43.4%) followed by PreCo (31.9%) and Cov (26.6%). Conclusions: Cov saw a decrease in the annual rate of new lung cancer diagnosis compared to PreCo likely secondary to reduced routine screening. A staggering increase in new and stage IV cancers were noted in PosCo which could stem from missed screening as well as rapid progression of undiagnosed cancers during the pandemic. In Cov, there was a dramatic increase in symptomatic inpatient lung cancer cases (53.3%) as symptoms of COVID-19 and lung cancer overlap. Comparable rates of cancer diagnosis via surveillance in PosCo (44%) and PreCo (48%) hints at possible restoration of access to outpatient cancer care. [Table: see text]
How to close the care gap: Factors hindering the use of BRCA mutation profiling of patients with breast cancer and ovarian cancer in a real world setting.
Authors: A. Muneer V. , Harindran Vallathol Dilip V. , Sankar Uma V. , Warrier Narayanankutty Edavalath , P. S. Sreedharan , K. V. Sajeevan , Parameswaran Prasanth V. , P Gopika V
Published: June 2023

e18636

Background: The majority of hereditary breast and ovarian cancers are linked to BRCA1/2 mutations. However, in patients with a suggestive personal or family history, a specific predisposing gene is identified in < 30% of cases. Mutation testing is recommended for individual genes in the appropriate clinical setting with a high suspicion index for a specific mutated gene. The risk of contralateral breast cancer increases with the time since the first breast cancer, reaching 20%–30% at ten years of follow-up and 40%–50% at 20 years, depending on the gene involved. Methods: The study assessed the prevalence of BRCA testing among young breast cancer women (age less than 50 years) and explored the factors hindering the performance of the BRCA mutation test. Among the 3400 breast cancers reported from 2017 to 2022, 46.17% (n = 1570) of young breast cancer women were advised for BRCA testing. We administered the questionnaire on factors influencing the BRCA mutation profiling performance to all the young breast cancer women (n = 1532). The data was collected from the electronic medical records and the department of molecular oncology. We performed regression analysis to predict the act of BRCA mutation profile testing. Results: Among them (n = 1570), only 17.70% (n = 278) performed BRCA1/2 genetic testing. In 278 patients who had undergone BRCA testing, pathogenic or likely pathogenic BRCA1/2/HRR mutations were detected in 52 patients (18.7%). 38 (13.7%) with BRCA 1, 14(5%) with BRCA2. Somatic with HRR testing was done in 13(4.6%), Somatic testing in 37(13.3%) and germline testing was done in 228 (82%). BRCA mutation was detected in 18 (34.6%) patients with breast cancer, 32(61.5%) patients with ovarian cancer. The factors influencing not performing the BRCA testing were the higher Cost of the test (83.4%), delay in getting the result (32.4%), unawareness of the importance of the test (52.6%), and not being advised by the physician as a mandatory test to perform (47.6%) and male spouse as a decision maker (31.8%). Conclusions: BRCA mutation profile test is mandatory to know their recurrence risk and treatment decisions for opting for PARP inhibitor. But the Cost of the test is the main barrier to performing this in a low-middle-income country setting. Female gender and related decision-making conflict could be the other reasons not to perform the test.
Impact of primary language on health inequities in multiple myeloma.
Authors: Conic Julijana Zoran , Alavi Navid , Hora Mehar , Bell Britney , Ruiz Lopez Jorge , Edwards Camille Vanessa
Published: June 2023

e18640

Background: Limited English proficiency (LEP) has been shown to exacerbate health inequities in the US due to difficulties navigating a complex health system and assimilating complicated information regarding diagnosis, and treatment. Advances in multiple myeloma (MM) care have improved clinical outcomes but added complexity to diagnosis and treatment. However, there is limited data on whether LEP impacts health inequities in MM care. We sought to assess the impact of primary language on MM care and outcomes at our safety net hospital, serving a culturally and linguistically diverse population where patients have equal access to novel agents and autologous stem cell transplant (SCT). Methods: We retrospectively studied 213 patients with newly diagnosed MM between January 1st, 2000, and December 31st, 2021. Data were extracted from electronic medical records. Patients were classified as LEP or EP based on self-reported language at the time of diagnosis. Patients were subsequently propensity matched based on age, sex, type of insurance, Charlson comorbidity index, creatinine, LDH, year of MM diagnosis, ISS stage, presence of high-risk cytogenetics, and receipt of SCT. Type of insurance was used as a surrogate for socioeconomic status. Kaplan Meier estimate and log rank tests were used to assess overall (OS) and progression free survival (PFS). Results: Of 213 patients, 75 (35.2%) had LEP, 135 (63.4%) were black, 49 (23.0%) were white, 22 (10.3%) patients were of another race, and 7 (3.3%) did not self-identify. Mean age was 63.6 (SD ± 11.4), and 114 (53.5%) patients were male. Median follow-up of the entire cohort was 56.9 months. At baseline, there were no statistically significant differences in the covariates above between LEP and EP patients except for increased incidence of diabetes mellitus in EP patients (84.0% vs. 89.1%, p 0.02). More LEP patients were inpatients at the time of diagnosis compared to EP patients (36.0% [27/ 75] versus 23.9% [33/138]). Median number of hospitalizations and ED visits in the first 6 months of diagnosis were 4 and 3 versus 1 and 2 in LEP versus EP patients, respectively. There were no differences in adjusted PFS or OS between propensity matched LEP and EP patients. Conclusions: In our cohort, there were no significant differences in demographics, clinical parameters, socioeconomic status, or transplant utilization between LEP and EP patients, which allowed us to assess the association of primary language with any observed health inequities. In a setting where all patients have access to novel treatments, SCT, patient navigators, interpreters, and social workers, there were no differences in PFS or OS. However, language barriers may explain health inequities related to later diagnosis and increased healthcare utilization. LEP patients with MM may benefit from additional language-concordant resources to improve disparities.
Access to National Cancer Institute (NCI)–designated cancer centers among Native American patients with cancer.
Authors: Li Haoran , Sahu Kamal Kant , Gebrael Georges , Mathew Thomas Vinay , Tripathi Nishita , Sayegh Nicolas , Maughan Benjamin L. , Agarwal Neeraj , Swami Umang
Published: June 2023

e18646

Background: Native Americans (NA) have some of the highest mortality rates from cancer in the US. Despite that, they face significant geographic barriers to access to cancer care. However, little study addresses disparities in accessibility in NA population. This study aims to estimate the travel distance to National Cancer Institute (NCI)-designated cancer center for NA patients in Utah and the continental US. Methods: We first retrospectively collected geographic information of patients with genitourinary cancer (NA vs. white) from Feb 1, 2013, to Jan 31, 2023. The travel distance from patients’ home zip code to Huntsman Cancer Institute (HCI) at the University of Utah was calculated using GeoData ZIP Code Distance Calculations Matrix Template. Then, the shapefile was downloaded from the NCI website. Area Deprivation Index (ADI) state decile was used to match between NA reservations and the control block groups within the same state. The travel time was calculated using Google map. Locations were mapped in ArcGIS 10.7 using coordinates and a 5-digit zip code tabulation area (ZCTA). Results: During the ten-year period of time, a total of 468 NA patients were seen in our cancer clinic. The median travel distance for NA patients vs. white patients to HCI is 190.6 mi (range: 1.1-596.4 mi) vs. 21.6 mi (range: 1.1-269 mi, p< 0.0001). In the continental US, the median travel distance from NA reservations vs. ADI-matched block groups to the nearest NCI-designated cancer centers is 186.5 mi (range 77.8-629 mi) vs. 159 miles (range 1.9-671.3 mi, p< 0.01) (Table). Map data and travel time will be presented at the meeting. Conclusions: The travel distance to HCI for NA cancer patients in Utah was almost nine times longer than that of white cancer patients. It is also significantly longer from most NA reservations to the nearest NCI-designated cancer centers compared to ADI-matched block groups. This study highlights the significant disparity in cancer care accessibility faced by Native American communities and the urgent need for action to address this issue. [Table: see text]
Opportunities and challenges to implementing a coordinated social care network for patients with cancer: Perspectives of local community based organizations.
Authors: Hassan Sirad , Girgis Abigail , Abramsohn Emily , Pinkerton El , Gross Cary Philip
Published: June 2023

e18647

Background: Interest is growing in identifying and addressing health related social needs for patients with cancer. One proposed approach is the creation of coordinated social care networks (CSCNs) to facilitate access to community-based resources and communication between community-based organizations (CBOs) serving patients with cancer. However, little is known about the perspectives of CBO leaders’ perspectives of addressing address health-related social needs or participating in CSCNs to serve patients with cancer. Methods: We conducted qualitative interviews of CBO leaders in New Haven, CT to assess perceived barriers to and facilitators for joining a CSCN. We also assessed leaders' awareness of how their services align with cancer care guidelines to address social and material needs of patients with cancer. CBOs were identified through a resource inventory of all New Haven-based CBOs. We employed qualitative content analysis and applied the Consolidated Framework for Implementation Research (CFIR) to classify emergent themes. Results: Respondents (N = 15) representing food pantries (n = 3), transportation agencies (n = 2), financial assistance organizations (n = 2), cancer-specific advocacy groups (n = 2), homeless shelters (n = 1), and general service organizations (n = 5) participated. We identified four themes: COVID-19 impact, referral challenges to other CBOs, challenges addressing client needs, and barriers and facilitators to joining a CSCN. The strongest theme was challenges addressing client needs which aligns with the CFIR domains of inner setting and individual characteristics. For instance, CBO leaders identified significant challenges with providing resources for patients with cancer due to lack of knowledge of client’s diagnosis. The theme of referral challenges to other CBOs, which aligns with the intervention CFIR domain, was exemplified by sentiments of limited funding and resources, lack of availability of information, and desire for client privacy. The impact of the COVID-19 pandemic was a theme relevant to both the individual and inner setting CFIR domains, particularly given its lasting effect on both the general community and patients with cancer utilizing CBOs at a higher rate, contributing to longer waitlists. Lastly, barriers to and facilitators of joining a CSCN largely align with the process CFIR domain. Respondents noted that lack of funding and resistance to adapting new technologies were barriers to implementing a CSCN in the New Haven area. Conclusions: While CSCNs may be a helpful mechanism to increase coordination between CBOs to help patients with cancer, critical barriers such as capacity, funding, and technology resistance may hinder implementation.
Area deprivation index and breast cancer subtypes in young patients.
Authors: Chung Victoria , Sheen Melanie Anne , Henry Marcia , Olet Susan , Taylor Caitlin , Alberti Matthew , Peeples James , Yuan Helen , Saxena Raina , Cattie Rabia
Published: June 2023

e18651

Background: Breast cancer (BC) diagnosed under age 40 accounts for approximately 7-9% of all BC diagnoses. Patients diagnosed with BC < age 40 have more aggressive cancers, present at later stages, and poorer outcomes. Socioeconomic status (SES), income, and education have been studied in relation to cancer incidence and prognosis. According to data reviewed from 2008 SEER database, there was no major difference in incidence of female BC among patients of varying poverty levels or annual household income and women with college education had a higher incidence of breast cancer diagnosis compared to those without college education. A composite index of these variables is categorized as Area Deprivation Index (ADI). ADI ranks census bureau neighborhoods by SES and disadvantaged metrics including income, education, employment, and housing. Louisiana and Mississippi have large areas of deprivation in rural and urban areas. Methods: We performed a retrospective chart review and collected data on 746 women diagnosed with BC < age 40 from 2012 to 2022 in single medical system (Ochsner Health System) throughout Louisiana and Mississippi. Data was collected including age at diagnosis, BMI, race, BC subtype, and zip code (to determine ADI). Data was censored for patients without zip codes. We reviewed patients’ BC subtype by ADI to determine if there is a relationship between these young patients’ BC diagnoses and ADI. Cochran-Armitage test was used to determine significance. Results: ADI State Rankings by Quintiles. Conclusions: Young women in regions of lower SES are more likely to be diagnosed with TNBC. As TNBC is an aggressive subtype in a patient population that is predisposed to aggressive BC, this data serves as rationale to increased BC outreach to women in neighborhoods of higher ADI to promote knowledge, risk reduction and early detection. [Table: see text] [Table: see text] [Table: see text]
Awareness of symptoms, risk factors, and barriers to seeking help related to breast cancer among university students in Mexico City.
Authors: Cruz Ramos Marlid , Alcalá Mariana , Fajardo Espinoza Fernanda Sarahi , Patiño Alberto , Galvez C. Lizette , Romero Jorge
Published: June 2023

e18652

Background: In Mexico, about 15% of young women (age ≤ 40 years) have breast cancer (BC). However, only 40% of women in this age group know that they should practice self-examination, and only 30% know the proper technique. Additionally, studies carried out in this group show reasons for delaying diagnosis like emotional barriers when a sign is identified, and lack of knowledge of risk factors. The purpose of the present study is to identify knowledge about self-examination techniques, lifestyle, and risk factors that influence the development of BC in university students. Methods: In this exploratory study, we used a 10-section and 55-question questionnaire based on validated international tools such as the Cancer Awareness Measure (CAM) questionnaire (CAM), the National Survey of Trends in Health Information, and the Mediterranean Diet Score (MDS), as a healthy eating pattern. Results: A sample of 53 health sciences school students was analyzed, 93% were women, and the average age was 21 years old. 83% of the students did not feel capable of recognizing signs of BC. Regarding risk factors knowledge, 78.9% recognized using hormone replacement for more than 5 years, 32.7% early menarche age, 98.1% having a closer relative with BC, 63.4% drinking more than 1 unit of alcohol by day, 65.4% being overweight; as risk factors for BC. Interestingly, 32.7% consider being sedentary as a risk factor, however, 43.8% disagree or strongly disagree. The same happens with being overweight, the 34.6% did not recognize this condition as a BC risk. Higher meat consumption was present in 54.9% of the participants. Related to barriers to receiving medical attention if they had symptoms, 21.2% feel embarrassed and 30.8% are scared to see a doctor, 30.8% are too busy, 44.3% are worried about other things, 46.2% are worried about medical findings. Conclusions: Although there was a high recognition of non-modifiable risk, the students dismiss the lifestyle as a risk factor for BC and are not capable to recognize BC signs. It is important to develop interventions to increase knowledge of these risk factors and promote healthy lifestyles from a young age to improve BC prevention. The present study gave us information to design educational strategies, based on the identified needs, that can be implemented as a cancer prevention strategy in this age group. It is also necessary to implement BC cancer prevention education strategies in health sciences school students to improve their knowledge.
Oncologist perceptions of health inequity.
Authors: Balanean Alexandrina , Jeune-Smith Yolaine , Brown-Bickerstaff Cherrishe , Feinberg Bruce A.
Published: June 2023

e18656

Background: The Institute of Medicine has reported on policies and practices based on assumptions and misinformation as pervading the educational, clinical, and payer sectors of health care. In these settings, unconscious bias toward marginalized populations can negatively impact patients, providers, health systems, and research. As national focus on diversity, equity, and inclusion expands, we sought to measure oncologists’ perceptions of issues surrounding health inequity in the context of patient care. Methods: In 2022, we surveyed oncologists’ perceptions of patient diversity, health inequity and disparities, unconscious bias, and their impact. Recruitment was conducted within the Cardinal Health Oncology Provider Extended Network (800 US practices). Participation was voluntary and compensated at fair market value. Results: In total, 192 oncologists responded. Of those surveyed: 48% estimated 10%–25% of their patients were in disadvantaged neighborhoods; 40% estimated 10%–25% were Hispanic or non-White; 69% estimated 10%–50% had low health literacy; and 92% estimated < 10% were of sexual/gender minority. 96% felt prepared to talk with underrepresented patients, 80% agreed that health inequities exist, and 49% agreed they are especially prevalent in oncology. The majority also agreed that health inequities cause differences in care, outcomes, and access to care (80%, 82%, and 70%, respectively). 43% thought unconscious bias adversely affects Hispanic/non-White patients, and 74% perceived health care disparities among these patients. Additionally, 73% thought they would benefit from more research/education, and 50% had educated their coworkers on these issues and provided patient resources. Conclusions: Most oncologists are aware of health inequities and their adverse impact on clinical outcomes; they desire more education and want to help underrepresented patients. Health inequity and disparity may be driven subliminally by lower-quality patient-provider communication (eg, decreased conversationality and less participatory decision-making). Efforts at filling this need in oncology should be prioritized. [Table: see text]
Demographic factors impacting time to diagnosis of diffuse large B-cell lymphoma.
Authors: McAlarney Drury , Davitt Meghan , Hosgood H. Dean , Shastri Aditi
Published: June 2023

e18660

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin’s lymphoma. Symptoms often include a palpable mass or fever; however, patients can be asymptomatic until the presentation of an oncological emergency, such as end organ complications or tumor lysis syndrome. Delayed diagnosis is related to spinal cord compression and an increased rate of complications from chemotherapy. We investigated factors impacting time until diagnosis. Methods: We performed a retrospective cohort study of DLBCL patients from the Montefiore Health System to determine how demographic factors impacted the time from initial symptom onset until diagnosis. Logistic regression models estimated the associations between race, socioeconomic status, and primary language spoken at home and increased time to diagnosis, stratified by insurance status. Odds ratios for increased time to diagnosis based on language were calculated, based on the number of participants with a time to diagnosis above the median value. Results: In a cohort of 1,076 patients that was 24.7% non-Hispanic White, 26.5% non-Hispanic Black, 7.25% Hispanic, and 41.5% “Other” as per information from Epic, the average time from symptom onset until DLBCL diagnosis was 115.76 days. Average time until diagnosis differed by race: Non-Hispanic White participants had the highest, while Hispanic participants had the lowest (188.4 vs 85.8, p = 0.03). Average age at diagnosis also differed by race: Non-Hispanic Black patients had the lowest age, whereas non-Hispanic White patients had the highest (57.3 vs. 67.4, p < 0.0001). Relative to patients with a preferred language of English, patients who had a preferred language that was Spanish (adjusted OR = 1.99, 95% CI = 0.97-4.06, p = 0.059), or “other” had an increased odds ratio of increased time to diagnosis (adjusted OR = 3.15, 95% CI = 1.01-9.75, p = 0.047). Conclusions: Non-English speaking patients experienced increased time to diagnosis, with non-Spanish speaking patients experiencing an even higher increase in time to diagnosis of DLBCL. Differences by racial or ethnic group supported the finding that primary Spanish speakers experience increased times until diagnosis – Hispanic participants had a lower average time to diagnosis than other racial or ethnic groups, suggesting that the effect of language alone may be greater than this analysis suggested when race and ethnicity is controlled for. Interventions targeted at increasing resources for non-English speaking patients in our diverse patient population, such as increasing the availability of interpretation services, patient literature on preventative screenings in non-English languages, and increasing the number of healthcare workers with competency in common foreign languages, may potentially reduce DLBCL morbidity.
The effect of formal education on ovarian cancer, clinical trial access, and clinical trial awareness among Black and Latino US women.
Authors: Equils Ozlem , Bakaj Amonda , Lekaj Klaudi , Nwokeleme Treasure , Onigbinge Victoria , Gonzalez Indiara , Muyah Cynthia , Muyah Fanesse , Rocheburn Brianna , Ureta Elsie
Published: June 2023

e18667

Background: Ovarian Cancer (OC) is ranked as one of the deadliest women’s cancers in the US. Due to non-specific symptoms, it is often misdiagnosed and detected late. The mortality rate is higher and increasing among Black women. In addition, Black women have poor participation in clinical trials. We conducted a survey study among Black and Latino US women to understand the factors influencing their understanding of genetic risks of OC, clinical trial awareness and ability to access a clinical trial. Methods: MiOra health educators administered an electronic survey to 226 women in their communities in Houston, TX, Atlanta, GA, and Los Angeles, CA. The data was analyzed using two-sided Fisher’s Exact Test. Results: Out of the 226 respondents 63.4% were 30 years of age or younger and 22.9% had high school education or less (low education). Out of 109 respondents, 93 (85.3%) self-identified as Black or Latino. Age did not influence self-reported awareness of genetic risk for OC, clinical trials or how to locate a clinical trial (Table 1). Low education women were significantly less likely to report being knowledgeable about genetic risk factors of OC, clinical trials or locating clinical trials. Thirty out of 48, 62.5% responding low education women and 118 out of 173, 68.2% high education women reported to have an annual provider visit (p > 0.05). The self-reported awareness on how to locate a trial was low in both the low (3 out of 48, 6.2%) and high education groups (34 out of 171, 19.9%, p < 0.05). Only 8 out of 44 (18.1%) respondents who knew someone with OC knew how to locate clinical trials. Conclusions: These results suggest that the level of education influences Black and Latino women’s awareness of OC genetic risk factors, clinical trials and clinical trial access. However, even among college educated Black and Latino women, only a small portion reported to know how to locate a clinical trial. Both high and low education Black and Latino women reported to comply with annual provider visits. These visits may be an opportunity to close the health-literacy disparities in OC and clinical trials for Black and Latino women. [Table: see text]
The COVID-19 pandemic's impact on diagnosis of cancers detectable through screening.
Authors: Guerra Carmen , Gabriel Peter Edward , Doucette Abigail , Grosso Colleen M , Washington Armenta L. , Verderame Emily , Melendez Claudia , Wooden Christina , Lee Daniel , Nunes Linda White , Edmonds Christine E , Englander Brian S. , Brathwaite Roderick , Noji Michael , Hollander Erin E. , Wingard Jaia , Dako Farouk , Rhodes Corrine , Mehta Shivan , Vonderheide Robert H.
Published: June 2023

e18669

Background: The COVID-19 pandemic caused major disruptions in cancer screenings. The delays in screenings were expected to be more pronounced in racial minorities due to their pre-existing barriers to accessing cancer screenings and care. Starting in 2020, to mitigate those expected declines in cancer screenings among Black individuals, the Abramson Cancer Center (ACC) and Penn Medicine decentralized cancer screenings using mailed and drive-through Fecal Immunochemical Testing, mobile mammography, community PSA blood testing and lung cancer risk assessments. Methods: The ACC catchment area comprises more than 7 million individuals who reside primarily in 12 counties across the three states (PA, NJ, DE) surrounding Philadelphia. We used the ACC cancer registry to review the number of analytic cases for cancer diagnoses for which screening is available during the three years before and two years since the pandemic began. We compared the proportion of cancer cases diagnosed in Black patients seeking treatment at the ACC throughout all five years. Results: A total of 16.5% of the individuals diagnosed and treated for cancer from 2017-2021 at ACC were Black. In 2020, there was a decline in the number of analytic cases of breast, cervical, colorectal, lung and prostate cancer at the ACC, but by 2021, the number these cancer cases returned to pre-pandemic levels. Compared to pre-pandemic years, the proportion of Black patients with these cancers was unchanged in 2020 for all cancers except for cervical and colorectal cancer which increased by almost 2%. Conclusions: During the pandemic, there was a temporary decline in the number of ACC patients diagnosed with cancers for which a screening test is available, suggesting a correlation with the disruptions in cancer screenings caused by the pandemic. The declines in cancers diagnosed did not disproportionately impact Black individuals with the exception of cervical and colorectal cancer where there was a slight increase. Limitations include the small number of cervical cancer analytic cases which may prevent reliable estimates. Decentralization of cancer screenings for Black communities during the pandemic may have mitigated potential delays to accessing timely cancer screenings. [Table: see text]
Understanding barriers to LGBTQ+ cancer clinical trial participation: A qualitative inquiry.
Authors: Andac-Jones Elif , Gonzalo Maria Belen , Wilson G. Thomas , Saks Rachel , Power Nicholas James
Published: June 2023

e18675

Background: It is well documented that LGBTQ+ cancer patients face severe challenges in accessing care and resources. Barriers are persistent despite recent advancements. Cancer clinical trial (CCT) participation rates for LGBTQ+ communities reflect this disparity. Understanding the reasons behind low participation rates and evaluating how LGBTQ+ specific experiences differ from the general population can help develop resources and programs that address the disparities in CCT participation, advancing LGBTQ+ health equity. Methods: In October 2022, CSC facilitated two virtual focus groups with 12 adults diagnosed with cancer and self-identifying as LGBTQ+. Participants were recruited from CSC’s Cancer Experience Registry (CER), representing wide gender and sexual orientation spectrums, a variety of cancer diagnosis and treatment trajectories, were 26-83 years of age, and a majority were college educated. A pre-screener survey collected sociodemographics to diversify the participant profile. Focus group data included participants' background, their experiences living with cancer as members of LGBTQ+ communities, and knowledge, attitudes, and experiences with CCTs. Transcripts were analyzed using deductive codes of sociodemographic information and inductive codes based on emergent themes. Results: LGBTQ+ patients reported: 1—Perceived institutional discrimination by healthcare providers in addressing their needs resulting in trust issues among patients; and 2—Relational and informational barriers block LGBTQ+ participation in CCTs. 19/21 screening survey respondents and 11/12 focus group participants had heard of CCTs, though none had participated. Each expressed a strong desire to help others and contribute to cancer research. However, patients doubted the medical ethics and personal benefits of CCTs, and most believed there are selective biases in recruitment. Conclusions: LGBTQ+ patients feel discriminated against when advocating for their health, identity, and rights, and struggle to trust their medical providers. Experiences of mistrust and discrimination inform LGBTQ+ patients’ perspective on and participation in CCTs. Findings suggest a need for 1—well-developed informational materials addressing the needs of LGBTQ+ communities; 2—better education and engagement of CCT teams on how to address those needs.