bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of boarding time on in-hospital mortality in patients with cancer presenting to the emergency department.
Authors: Brock Patricia A. , Langabeer Denise Manon , Page Valda D , Qdaisat Aiham
Published: June 2024

11036

Background: Longer emergency department (ED) boarding times for admitted patients is associated with increased morbidity and mortality.1 While research over the years has shown an association between boarding time to mortality in a variety of patient demographics, no specific research has been explored in a cancer population. Patients with cancer visit the emergency department frequently and have a high rate of admission compared to other patients.2 This study evaluates boarding times and mortality rates in patients presenting to an oncologic ED. Methods: A retrospective analysis was performed on 183,524 ED visits located at a comprehensive cancer center between March 2016 and December 2022. Eligibility criteria included patients 19 years and older admitted to the hospital excluding direct intensive care unit admission. Boarding time was defined from the time the physician made an order to admit to the hospital to the time of ED departure. Demographics and clinical characteristics were examined using descriptive statistics. Categorical data was analyzed using chi-square test and continuous variables employed the nonparametric Mann–Whitney U test. Boarding time was grouped into quartiles. Univariate and multivariable logistic regression analyses examined clinical factors, including boarding time and in-hospital mortality. Results: The eligible number of visits supporting the study equaled 83,629. Overall median boarding time was 2.7 hours (interquartile range: 1.5–5.1 hours) and in-hospital mortality was 5.5% (n=4607). Longer boarding time was significantly associated with in-hospital mortality. Patients with boarding time ≥5.1 hours had 1.19 (95% confidence interval [95%CI]: 1.09-1.30; P<0.001) odds of in-hospital mortality when compared to the reference group (boarding time <1.5 hours) when controlling for other risk factors including comorbidities and emergency severity index (ESI) between 1 through 5. Similar results were observed for patients with boarding times of ≥1.5- <2.7 hours and ≥2.7- <5.1 hours with odds ratio of 1.12 (95%CI: 1.02-1.22; P=0.013) and 1.11 (95%CI: 1.02-1.21; P=0.020), respectively. Higher Charlson comorbidity index and levels 1 and 2 ESI were also associated with poor survival outcome (P<0.001 for both). Conclusions: This study found an association between boarding time and in-hospital mortality in cancer patients presenting to the ED. Patients with longer boarding times were likely to experience mortality during their hospital admission. High comorbidity score and high-risk ESI were also identified as risk factors for poor survival outcome. These results emphasize the need for improved strategies to expedite the admission process and optimize care for cancer patients in the ED to reduce mortality rates. Further research and interventions targeting reduction in boarding times are warranted to improve outcomes for this vulnerable population.
Geographic distribution and accessibility of clinic trials for advanced-stage pancreatic cancer in the United States: A focus on rural and minority health disparities.
Authors: Swenson Wade T. , Westergard Emily , Swenson Abigail P , Schroeder Zachary
Published: June 2024

11048

Background: Our research delves into the geographical distribution and accessibility of clinical trials for metastatic pancreatic cancer patients in the U.S., spotlighting the challenges faced by rural communities and minority groups. Prior research indicated nearly half of these patients would have to commute over an hour to reach a trial site. [1] Our study provides a refreshed perspective on this issue, offering a more comprehensive analysis. Methods: Utilizing the ClinicalTrials.gov portal, we identified active interventional clinical trials for metastatic pancreatic cancer patients as of November 25, 2022. We obtained distinct zip codes linked to these trials and, using 2020 census data, gauged the proportion of the U.S. populace residing within specific distances from these sites. Our analysis encompassed factors like urbanity, ethnicity, and other socio-economic parameters. We also developed illustrative maps to visually represent the U.S. clinical trial accessibility landscape. Results: The majority of Americans diagnosed with metastatic pancreatic cancer have clinical trials within their reach. A significant 65.7% of the U.S. populace resides within a 30-mile radius of a relevant clinical trial site. However, a closer look reveals pronounced disparities based on urban-rural demarcations and racial lines, with American Indians facing the most pronounced accessibility challenges. Conclusions: Our data underscores the uneven geographical spread of these trials. This skewed distribution poses accessibility hurdles for specific demographics, especially those in rural areas and certain racial groups. Our findings underscore the pressing need for strategic initiatives to rectify these disparities, ensuring clinical trials are within reach for every individual, irrespective of their location or background.
The annual cost of cancer screening in the U.S.
Authors: Halpern Michael T. , Liu Benmei , Lowy Douglas R. , Gupta Samir , Croswell Jennifer M. , Doria-Rose Paul
Published: June 2024

11051

Background: Cancer screening can decrease cancer incidence, mortality, and treatment costs. However, the annual cost of screening to the U.S. healthcare system is unknown. Methods: We used data from national healthcare surveys and standard costing sources to model the healthcare system cost of breast, cervical, colorectal, lung, and prostate cancer screening in the U.S. in 2021. Models projected the number of individuals in the U.S. eligible for each screening test based on current guidelines/recommendations; the number of eligible individuals screened by insurance status; and the costs associated with screening (in 2021 US dollars). Multiple sensitivity analyses were performed to examine the effects of changing model population parameters and costs on projected outcomes. Results: Total 2021 cancer screening costs to the U.S. healthcare system were estimated to be $57 billion; approximately 88% of the costs were attributable to private insurance, 9% to Medicare, and 3% to Medicaid, other government programs, and uninsured individuals. Most screened individuals had private insurance except for lung cancer screening, where a majority of individuals screened had Medicare coverage. Individuals with private insurance accounted for the majority of costs for each screening modality. Screening for colorectal cancer represented approximately two-thirds of the total cost; screening colonoscopy was approximately 60% of the total cost of cancer screening. Breast and cervical cancer screening represented the second and third largest screening costs, 15.4% and 14.7% (respectively) of total screening costs. Facility costs (amounts paid to facilities where testing occurred) were generally larger components of the total estimated costs of screening than were physician costs. Cost estimates were robust to a range of variations in eligible populations and screening costs. Conclusions: The $57 billion estimated annual cost for cancer screening in the U.S. in 2021 is similar to the estimated annual cost of cancer treatment in the U.S. in the first 12 months following diagnosis. Screening may have been suboptimal in 2021, with higher screening rates and costs in subsequent years. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities. The model can be used to estimate the increased costs of enhanced access to recommended cancer screening services among underscreened populations, which would provide population-wide benefits.
Opioid prescribing trends and pain scores among adult patients with cancer in a large health system.
Authors: Baum Laura Van Metre , Soulos Pamela R. , KC Madhav , Jeffery Molly , Ruddy Kathryn Jean , Lerro Catherine C. , Lee Hana , Graham David J. , Liberatore Mark , Rivera Donna , Leapman Michael , Jairam Vikram , Dinan Michaela Ann , Gross Cary Philip , Park Henry Soo-Min
Published: June 2024

11059

Background: Some opioid stewardship policies could negatively affect patients with cancer pain. However, patients with cancer are also at risk for opioid related harms, especially with persistent use. We assessed opioid prescribing trends in the context of cancer treatment and patient reported pain in a large health system in Connecticut. Methods: We conducted a retrospective cohort study of opioid-naïve adult patients with solid tumor malignancies diagnosed from 2016 through 2020 within the Yale New Haven Health System. We identified new (≥1 opioid prescription in 0-6 months following diagnosis) and additional (0-6 and 6-9 months) opioid prescriptions. The analysis evaluated all eligible patients as well as two clinical cohorts: patients treated surgically and patients with metastatic cancer. For patients with metastatic cancer and a documented pain score in the electronic health record flowsheet data, we further stratified by any (any score≥1) or no (all scores=0) pain in the 6 months since diagnosis and prior to first opioid, if given. For these patients, we noted therapeutic class of the first opioid. We used a logistic model adjusted for patient demographics to calculate predicted probability of opioid prescription and change over time. Results: A total of 10,868 patients met study criteria. Overall, we observed a decline in new opioid prescribing from 69.0% to 62.7% (p<.001) (Table). Additional opioid use also declined from 23.4% to 20.2% (p=.02). In the surgery cohort, new opioid prescribing fell from 95.7% to 88.2% (p<.001), while additional opioid use was stable over time (approximately 12%). For patients with metastatic cancer with any documented pain, new opioid prescribing was stable over time (approximately 56%). For those with documented pain scores=0, new opioid prescribing declined from 59.7% to 34.2% (p<.001). In these patients, the class listed on the first opioid prescription was analgesia in 86.6% and cough in 13.4%. Conclusions: Overall, and in patients treated with oncological surgeries, our study in a single large US health system suggests a modest, gradual decline in opioid prescribing for patients with cancer over time. On the other hand, among patients with metastatic cancer, opioid prescribing remained stable for those with documented pain and declined steeply for those without documented pain. [Table: see text]
Risk prediction model for acute care use among patients with advanced cancer on clinical trials.
Authors: Hershman Dawn L. , Till Cathee , Vaidya Riha , LeBlanc Michael Leo , Unger Joseph M.
Published: June 2024

11074

Background: Reducing acute care use is an important strategy for improving value. Patients with advanced cancer are at high risk for unplanned Emergency Room visits (ER_visit) and hospital stays (HS). Identifying patients at highest risk could inform personalized risk-based intervention strategies and resource allocation. Methods: The data were from the SWOG Cancer Research Network. We linked data from trials in advanced cancer to Medicare claims data. The primary endpoint was the occurrence of any HS or ER_visit within 1 year after enrollment. Patients were required to have had continuous Medicare parts A and B claims from registration to 12 months after registration or death to detect all utilization outcomes. We examined sociodemographic (age, sex, race, ethnicity, insurance status), geographic (rural or urban, area-level deprivation), clinical (prognostic risk, performance status), treatment characteristics (line of therapy, therapy type), and individual comorbidity factors to establish a predictive risk model. Twenty-six factors were evaluated. A training/test approach was used. First, a 60% random sample training set of patients was generated. Best subset selection was used to identify candidate variables that minimized mean squared error using 5-fold cross validation repeated 10 times. Candidate variables were examined in multivariable logistic regression, with factors with p<.05 retained. A risk model was built by summing adverse factors and creating high vs low- risk groups by splitting at the median and into quartiles. The derived model is reported. Results: Among N=1397 total patients from 6 trials (lung, 3; prostate, 2; pancreas, 1), 839 (60%) comprised the training set. In these, 32.9% were 75+ years, 21.3% were female, and 7.7% were Black. The overall proportion of patients with >1 hospitalization/ER visit was 67.5%. In the training set, adverse risk factors were first line treatment (vs. subsequent), high (vs. low) prognostic risk, coronary artery disease (yes vs. no), hypertension (yes vs. no), and liver disease (yes vs. no). Patients with >2 factors (high risk; n=487, 58.0%) vs. 0/1 risk factor (low risk; n=352, 42.0%), were more likely to experience hospitalization/ER visit (80.3% vs. 49.7%, p<.001), corresponding to a >4-fold increase in risk (OR=4.12, 95% CI, 3.03-5.59, p<.001). Quartile-level proportions were 38.8%, 55.4%, 76.8%, and 84.0%, respectively, with an eightfold increased risk for those in the highest vs. lowest quartiles (Q4 vs. Q1, OR=8.25, 95% CI, 4.98-13.65, p<.001). Validation of the derived risk model in an independent set of 558 patients (40%) is planned. Conclusions: A limited set of 5 comorbid conditions, clinical and treatment variables predicted a 4-fold increased risk of HS and ER_visits in cancer patients with advanced disease. Personalized targeted interventions aimed at preventing acute care use could decrease the cost and improve the quality of cancer care.
Associations of symptom burden with patient-reported outcomes (PROs) and clinical outcomes among early-phase cancer clinical trial (EP-CT) participants.
Authors: Lam Anh B. , Lundquist Debra , Pelletier Andrea , Durbin Sienna , Petrillo Laura A , Jimenez Rachel , Turbini Victoria , Bame Viola , Lynch Kaitlyn , Yalala Vaishnavi Reddy , Ollila Nicholas , Malowitz Benjamin , McIntyre Casandra , Juric Dejan , Nipp Ryan David
Published: June 2024

11101

Background: Individuals with cancer often endure a substantial physical and psychological symptom burden. However, little is known about the baseline symptom burden of patients with cancer participating in EP-CTs or the associations of this symptom burden with other PROs and clinical outcomes. Methods: We prospectively enrolled adults with cancer participating in EP-CTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed baseline surveys prior to EP-CT initiation that assessed symptoms (Edmonton Symptom Assessment System [ESAS]), quality of life (QOL; Functional Assessment of Cancer Therapy-General), hope (Herth Hope Index), depression/anxiety symptoms (Patient Health Questionnaire-4 [PHQ-4]), and financial wellbeing (COST tool, higher scores indicate greater financial wellbeing). We used regression models to explore associations of baseline symptom burden with other PROs (QOL, hope, depression/anxiety, financial wellbeing) and clinical outcomes (time on trial, hospitalizations, overall survival). Results: Among 205 participants (median age=63.3 [range: 31.8-88.6], 57.1% female), the most common cancer types were gastrointestinal (34.6%), breast (20.0%), and head and neck (10.2%). Based on the ESAS, approximately half of participants reported moderate/severe fatigue (50.2%) and poor wellbeing (49.5%). Under half reported moderate/severe drowsiness (35.7%), pain (25.9%), lack of appetite (25.4%), shortness of breath (20.0%), anxiety (18.0%), depression (15.4%), and nausea (9.2%). Higher baseline ESAS total, physical, and psychological scores were associated with worse QOL, lower hope, greater PHQ-4 depression/anxiety symptoms, and worse financial wellbeing (see Table). Higher baseline ESAS scores were associated with decreased time on trial and worse overall survival. Conclusions: In this study of EP-CT participants, we found associations of baseline symptom burden with other important PROs and clinical outcomes. Specifically, higher baseline symptom burden was associated with decreased QOL, lower hope, increased depression/anxiety symptoms, and diminished financial wellbeing as well as greater risk for shorter time on trial and worse survival. Interventions seeking to enhance care delivery and outcomes for EP-CT participants should strive to address the symptom burden of this population. [Table: see text]
Estimating adult cancer cachexia prevalence and impact on survival in the US: Real-world data analysis.
Authors: Roeland Eric , Crawford Jeffrey , Dunne Richard Francis , Jacobs Ira Allen , Groarke John , Rossulek Michelle I , Cater Nilo B. , Bonomi Philip D.
Published: June 2024

11141

Background: Cancer cachexia is defined by weight loss that nutritional support cannot fully reverse, leading to worse pt outcomes. Cachexia prevalence across cancer types relies on outdated studies. This study assesses the frequency of cachexia diagnosis using ICD9/10 codes or observed weight loss consistent with real-world cachexia diagnosis and its impact on survival. Methods: Retrospective, observational, real-world analysis using deidentified adult pt data from Clinformatics Data Mart database (Aug 1, 2016-Jul 31, 2021). Pts with at least 1 of 23 cancer types were identified using diagnostic and procedure codes and classified in 1 of 3 cachexia categories: (1) diagnosed (diagnostic code identified); (2) observed (BMI decrease: >10% within 12 mo, >5% within 6 mo, or >2% with a BMI <20 kg/m2), (3) none (with no cachexia diagnostic code/observed). For observed, pts required ≥10 BMI records. Summary statistics presented as mean, median, or n (%). Survival rates compared using Cox proportional hazards model. Results: 672,665 pts were identified; 278,923 met inclusion criteria. Diagnosed + observed (subgroup) cachexia rates are shown for the 5 most prevalent cancer types (Table). Over 5 y, diagnosed cachexia rates ranged from 0.9-6.3%; observed from 60-83% (in subgroup with ≥10 BMI records). After cancer diagnosis, observed cachexia was identified on average 0-11 mo, while formal diagnosis occurred on average 11-24 mo. At least 16% of diagnosed and 31% observed pts received diagnosis or met observed criteria at or before cancer diagnosis. Average percent BMI decrease over 5 y was 22.0% ± 12.1, 17.8% ± 9.5, and 6.8% ± 5.5 for diagnosed, observed, and none, respectively. Compared with no cachexia, diagnosed and observed showed worse survival (HR 10.72 [95% CI 10.56-10.88]; HR 2.35 [95% CI 2.32-2.38]), respectively. Conclusions: Across all cancer subtypes, prevalence of observed cachexia cases documented by weight loss far exceeded cachexia prevalence based on diagnostic coding. After cancer diagnosis, pts met diagnostic criteria of cachexia within 1 y, but formal diagnosis took up to 2 y. The presence of cancer cachexia (diagnosed or observed), with or without metastatic disease, was associated with lower survival.[Table: see text]
Impact of protein energy malnutrition on hospitalized patients with lung cancer: A United States population-based cohort study.
Authors: Arya Yajur , Syal Arshi , Wattanachayakul Phuuwadith , Obomanu Elvis , Lara Joao Manoel da Silveira , Casipit Bruce Adrian , Leighton John Charles , Dourado Claudia M.
Published: June 2024

11160

Background: Lung cancer is the leading cause of cancer related deaths in the United States. Patients with advanced lung cancer tend to have varying degrees of protein energy malnutrition (PEM), due to multiple reasons including cancer related cachexia, sarcopenia, and adverse effect of chemotherapy. However, the impact of PEM on clinical outcomes in this subgroup needs further exploration. Methods: We utilized the 2020 National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified patients with lung cancer and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with lung cancer based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of <0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charge among hospitalized patients with lung cancer. Results: We identified a total of 92425 hospitalized patients with lung cancer, of which 10.53% (9739/92425) had comorbid PEM. The overall in-hospital mortality among patients with lung cancer was 5.79% (5360/92425). Among those with concomitant PEM, the mortality rate was significantly higher at 13.13% (1279/9739, p<0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 2.11; 95% (confidence interval [CI] 1.77-2.51; p<0.001), longer LOS (coefficient 3.02; CI 2.62-3.42; p<0.001), and higher total hospitalization charge (coefficient $22105; CI $13423- $30786; p<0.001). Conclusions: Our analysis demonstrated that PEM was widely prevalent in hospitalized patients with lung cancer and associated with worse outcomes. Efforts should be made to promote nutritional assessment and screening mechanisms with the aim to initiate early nutritional support as indicated. Further prospective studies are warranted to better understand these associations and guide management.
Time to treatment initiation: An assessment of trends in delays in patients with lung cancer across Missouri.
Authors: Chelapareddy Lakshmi Ramya , Beheshti Mohammad , Naha Kushal , Zachary Iris
Published: June 2024

11186

Background: Lung cancer is a major health challenge globally. Missouri's incidence rate of 68.1% exceeds the national rate of 54.0% indicating a significant disease burden. It is the 2nd most common malignancy in men and women in the state. Timely treatment can significantly improve while delays can worsen outcomes. The Institute of Medicine strongly recommends efforts promoting timely care in lung cancer. The RAND Cooperation suggests treatment should begin within 6 weeks after diagnosis. These priorities align with the Healthy People 2030 Initiative which aims to reduce lung cancer incidence and mortality through enhanced screening and early treatment. The U.S. National Committee on Health Care identified a goal of 60% of lung cancer patients receiving treatment within 30-days of diagnosis. Our primary objective was to assess delays in treatment initiation post-diagnosis and to investigate Missouri’s adherence to treatment delay guidelines in lung cancer patients. Methods: Study population included adults (age>18) with a diagnosis of Lung Cancer, identified using ICD-10 codes C50.0-C50.9. Records were retrieved from the Missouri Cancer Registry and Research Center database for the years 2012-2022. Data for 2022 had a completion rate of 90%, all others had at least 95% completeness. We used the RAND guidelines 42-day treatment delay rule and the Missouri Cancer Action Plan's (MCAP) 30 day treatment delay metric as our benchmarks. Treatment delay was determined by subtracting the Date of Initial Diagnosis from the Date of First Course Treatment. Records with missing or incomplete dates were excluded. Data processing and analyses were performed using Python 3.11. Results: Of the 68,293 adult lung cancer patients in the database, 7,882 were excluded due to missing or incomplete data. Among the eligible 60,411 patients, 89.5% were Caucasian, median age was 69 (range 18-105), gender distribution was nearly equal with males accounting for 51.3% of the total. Average time from diagnosis to treatment was 36.8 days, with a median of 27 days. About 31.2% of patients had a gap over 42 days from diagnosis to first treatment. This delay has risen from 26.3% in 2012 to 42.6% in 2022, marking a 16.3% increase. In terms of adherence to the MCAP’s 30 day treatment delay metric, 45.6% of patients experienced more than a 30-day gap between diagnosis and treatment. The trend shows an increase in delays, from 40.4% in 2012 to 58.1% in 2022, reflecting a 17.7% rise. Conclusions: Despite the declining incidence rate of lung cancer in Missouri over the years, our analysis revealed a surprising increase in treatment initiation delays over the years. The average time from diagnosis to treatment and the percentage of patients experiencing delays exceed the RAND guideline and the MCAP's treatment delay metric and with a rising trend from 2012 to 2022. Further analysis into factors causing delay in treatment initiation is needed and being planned.
The utility of procalcitonin in febrile neutropenia.
Authors: Nilles Jonathan , Shonka Nicole A.
Published: June 2024

12040

Background: The utility of procalcitonin (PCT) in febrile neutropenia (FN) in oncology patients on active therapy has not been well validated. FN constitutes a critical oncologic emergency, often characterized by subtle manifestations of infection, and timely diagnosis and treatment is vital. Although a potential harbinger of dangerous infection, FN can also occur without an identifiable infection, in which case hospitalization and antibiotics may be unnecessary. PCT, an amino acid, is elevated specifically during bacterial infections in the non-cancer population and correlates with infection severity. Clinicians employ PCT levels as a diagnostic adjunct, discerning bacterial from viral infections and analyzing PCT changes to guide treatment decisions. We examined oncology patients presenting with FN to correlate PCT levels and trends with confirmed infections. Methods: We identified patients with neutropenic fever, cancer, and a PCT result seen at our institution from 12/1/2017-12/1/2022. Patients were determined to have a confirmed infection if they had a positive bacterial blood culture. Demographics and clinical characteristics were compared between infection status and induction chemotherapy or transplant status using a Wilcoxon Rank Sum test for continuous variables and a Chi-Square or Fisher’s Exact test for categorical variables. Baseline (at time of initial FN) and highest PCT levels were compared by patient and disease characteristics and proven infection using Wilcoxon Rank Sum test. Logistic regression was used to determine the association of log-transformed PCT (baseline and highest) with proven infection (yes/no) while adjusting for covariates. All tests were two-tailed with p< 0.05 considered statistically significant. Results: Of 365 patients, 61 (16.7%) had an identified infection. Median baseline and peak PCT of 1.26 and 1.51 ng/mL, respectively, were significantly greater for these patients as compared to those with negative cultures at 0.54 and 0.65 ng/mL, respectively (P= 0.01 and <0.01). For every unit increase in the log transformed baseline PCT, the odds of having a proven infection increased by 23%. There were no significant differences in patient or clinical characteristics between those with and without infection. Of those admitted for induction chemotherapy and transplant who developed FN, PCT at time of initial fever was higher at 0.97 vs 0.56 ng/mL (p=0.02). Interestingly, median baseline and median peak PCT differed between gender with females 0.51 and males 0.72 ng/mL (p=0.02) at baseline, and 0.63 vs 0.83 ng/mL (p=0.04), respectively, at peak. Conclusions: PCT levels in cancer patients with FN are significantly associated with culture positive infection. This data can help guide treatment and de-escalation of antibiotics in cancer patients admitted with FN. Further evaluation should be taken to determine how to best use PCT to determine the need for admission and antibiotic prescription.
Patients with a history of more than one cancer diagnosis: An opportunity to expand eligibility criteria?
Authors: Campos Luis T. , Peguero Julio Antonio , Koontz Michael Zach , Trotter Chardria , Svedman Christer , Paulson Joseph , Chung Wei-Yi , Tucker Valerie , McAneny Barbara L. , Campbell Fontaine Annette
Published: June 2024

e23019

Background: Patients with a history of more than one cancer diagnosis are increasingly common due to improved cure rates in early-stage cancers, and a demographic shift towards an increasing proportion of elderly patients with cancer due to longer life expectancy. Having a prior cancer diagnosis is a common exclusion criteria in clinical trials but represents a large untapped pool of patients that could increase enrollment in trials. We assessed if there are differences in the clinical characteristics, NGS testing rates and the rate of actionable genomic alterations in patients with NSCLC with a history of at least one other cancer diagnosis. Methods: We analyzed patients with a NSCLC diagnosis and an appointment scheduled between Oct 23, 2023 and Jan 14, 2024 at three US community oncology sites. All patients were enrolled in the Kaleido Registry and descriptive statistical analyses were performed on curated data. Results: 221 patients were identified (110 male/111 female). Median age was 72 (range 37-95). 157 (72%) patients had NSCLC as their only cancer diagnosis and 67 (28%) had a history of other malignancy with a median time interval since the last cancer diagnosis of 78 months (interquartile range 28-141 months ). 49 patients had a history of 1 other cancer diagnosis and 18 patients had a history of 2 or more. The most common diagnoses were breast (n = 16, 7%), colon (n = 7, 3.2%), prostate (n = 7, 3.2%) and bladder (n = 4, 1.8%) cancers. There were no differences in median age (73 yrs, range 57-91 vs (72 yrs, range 37-95), or sex distribution (30/34 vs 80/77) between patients with multiple diagnoses vs those with only NSCLC. There was not enough power to detect a difference in the rates of NGS testing rates or actionable genomic alterations (EGFR/ALK/ROS1/KRAS/RET/MET/NTRK/BRAF/HER2) in the cohorts (51% vs 64%, respectively). Conclusions: One in four NSCLC patients had a history of other cancer diagnosis. There were no significant differences in baseline characteristics or actionable genomic alterations. The median interval since the last cancer diagnosis was more than 6 years and less than a third had less than 3 years. These findings indicate that a significant number of patients with prior cancer diagnoses may be suitable candidates for clinical trials as their risk of recurrence of prior disease is likely low given long follow-up in this cohort.
Is essential thrombocytosis associated with worse outcomes in patients with stroke? Results from 2016-2020 National Inpatient Sample study.
Authors: Kharel Himal , Bhandari Samikchhya Keshary , Kharel Zeni , Sanjeevi Aditya , Rao Aniket , Shah Purva , Orakzai Abdullah Ahmad , Eltaher Basant , Pokhrel Nishan Babu , Jamshed Saad
Published: June 2024

e23060

Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm. Thrombosis is a major cause of morbidity and mortality in ET. It is unknown whether the morbidity and mortality of ischemic stroke in ET is different from that in non-ET patients. Similarly, the quantitative data regarding the use of platelet pheresis in this population is also unknown. This National Inpatient Sample (NIS) database study aims to answer these questions. Methods: A retrospective analysis of the NIS database from 2016 to 2020 was conducted using ICD-10 codes to identify hospitalizations with ischemic stroke. STATA version SE18.0 was used for statistical analysis. We used multivariate regression analysis to calculate the effects of ET on mortality and length of stay along with various other variables including age, gender, primary payer, household income, Charlson Comorbidity index, hospital bed size, hospital region, diabetes mellitus, heart failure, hypertension, coronary artery disease, smoking, hyperlipidemia, carotid artery stenosis, and atrial fibrillation. Results: There were 2,635,595 hospitalizations with primary diagnosis of ischemic stroke. Among these, 9604 patients had secondary diagnosis of ET. The mean age of ET patients with stroke was 67 years. 60.5% of patients were females. 40 (0.41%), 335 (3.48%) and 720 (7.49%) patients underwent plateletpheresis, thrombectomy, and thrombolysis respectively. Multivariate logistic regression showed that ET was not associated with increased mortality, but was associated with significantly increased length of stay with odds ratio (OR) of 0.95 [95% confidence interval (CI) = 0.73 to 1.23, p-value = 0.7) and 2.58 (95% CI = 2.12 to 3.04, p-value = 0.00) respectively. The effect of other pertinent variables are summarized in Table 1. Conclusions: Our analysis shows that stoke in ET was not associated with increased mortality. ET was associated with increased length of stay in patients with stroke. 0.41% of ET patients with stroke received platelet pheresis. Limitations of this study include failure of the multivariate model to account for all the variables, coding errors, and increased risk of bias due to retrospective nature of the data. [Table: see text]
Daily diary engagement among caregivers of patients undergoing hematopoietic stem cell transplant.
Authors: Poudel Ranjita , Yang Min-Jeong , Gore L. Robert , Washington Sierra , Jones Sarah , Brown Brad A. , Vinci Christine
Published: June 2024

e23064

Background: Caregivers of allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients bear significant responsibilities involving commitment to be available 24/7 up to at least 100 days post-transplant to provide emotional and physical support to their patients. Caregiving for such an extended duration is associated with reduced quality of life, compromised psychological well-being, and dysregulated metabolic and immunological functioning. Ecological momentary assessment (EMA) may allow a better understanding of the dynamic day-to-day experiences of this unique population. However, no prior research on EMA exists in this population. This study reports on the feasibility of delivering EMAs in the form of a daily diary (DD) and how completion of the DD relates to the patient’s course of treatment and caregiver’s demographics among the caregivers of allo-HSCT caregivers. Results are part of an ongoing 3-arm randomized controlled trial (71% enrolled to date) of those individuals randomized to the usual care condition. Methods: Caregivers (n = 46) received DD prompts for 6 weeks during their patient’s active treatment phase: before transplant (week 1), transplant through discharge (weeks 2 and 3), after discharge (weeks 3 through 6). The DD included six affect items from the Positive and Negative Affect Schedule (stressed, overwhelmed, frustrated, drained, guilty, and hopeful), three state mindfulness items (attention, non-judgement, and decentering), and one item related to caregiver’s self-efficacy in patient care. Results: Among 46 caregivers (mean age = 55.8 [SD = 15.7], 74% female, 32% retired), the overall completion rate (CR = total number of prompts completed/total number of prompts received) was 65.5%, with 72% of participants completing > 50% and 22% of participants completing > 85% of the prompts. For the duration before transplant, the overall CR was 63.2%, with 66.7% of participants completing > 50%, and 33.3% completing > 85% of the prompts. For the duration between transplant through discharge, the overall CR was 65.57%, with 76% of participants completing > 50%, and 26% completing > 85% of the prompts. Similarly, for the duration after discharge, the overall CR was 65.14%, with 66.7% completing > 50%, and 28.9% completing > 85% of the prompts. DD completion was not related to the caregiver’s age, sex, or employment status ( ps > 0.1). Conclusions: The completion rate for the DD was very similar across the patient’s course of treatment, suggesting EMA completion is not excessively burdensome for caregivers potentially experiencing dynamic distress. Furthermore, EMA completion was not associated with age, sex, or employment status, indicating that all caregivers, regardless of demographics, were amenable to completing EMAs. Our findings suggest that delivering EMAs is feasible in this population. Clinical trial information: NCT05078229 .
Epidemiological analysis and overall survival of adrenal malignancies in a developing Middle Eastern country over 18 years.
Authors: Abdulelah Ahmed A , Abdulelah Zaid A. , Alhajahjeh Abdulrahman Ahmad , Saadeh Aseel , Al-Dqour Mohammad , Abdel-Razeq Hikmat
Published: June 2024

e23067

Background: Adrenal cancer imposes a significant socioeconomic and health burden due to the resulting morbidity and mortality. Accordingly, assessment of the epidemiological characteristics of adrenal malignancies in the Middle East, where the epidemiology of adrenal malignancies is poorly evaluated, is of paramount importance in management tailoring and planning as it enables appropriate risk stratification, especially in limited resource countries. Methods: Extensive and thorough data on adrenal cancer for all individuals, both males and females, of various nationalities residing in Jordan who were diagnosed from 2000-2018 was retrieved from the Jordan Cancer Registry, the formal reporting institution for cancer epidemiology in Jordan with a total of 296 patients being included. Furthermore, comprehensive epidemiological analysis was performed with Kaplan-Meier analysis being performed to assess overall survival rates. Results: 296 patients with a mean age of 18.7 ± 22.6 years old and a male predominance of 55.4% were included in the analysis. The vast majority of the included patients were non-smokers (72.3%). Adrenal malignancy was found to be most commonly located in the left adrenal gland (41.6%), while only 7 patients (2.36%) had bilateral adrenal malignancies. 19.6% of the tumors were arising from the adrenal cortex while 70.9% of the patients had adrenal gland tumors with the origin being unknown at the time of reporting. A concerning 17.20% of the enrolled patients had poorly differentiated tumors, and 8 patients (2.70%) had undifferentiated malignancies. At the time of diagnosis, a staggering 51.0% of the patients had distant and systemic metastasis, while only 11.8% of the patients had localized malignancy. The overall 5-year survival rate was determined to be 66.8%. A statistically significant increase in the crude incidence of adrenal cancer in Jordan over 18 years was evident with a crude incidence estimated effect of 0.014 (p-value = 0.003). Conclusions: Despite that the 5-year survival is 66.8%, there is an alarmingly significant uptrend in the crude incidence of adrenal cancer in Jordan with the overwhelming majority presenting at an advanced stage, and thus the introduction of early interventions and advanced management is mandated to achieve better outcomes.
Site research infrastructure and institutional performance: A report from the Voting Body of the Children’s Oncology Group (COG).
Authors: McNall-Knapp Rene Y. , Kadan-Lottick Nina S. , Chang Eugenia , Maloney Kelly W. , Malogolowkin Marcio H. , Alonzo Todd Allen , Mascarenhas Leo
Published: June 2024

e23113

Background: National Cancer Institute (NCI) sponsored cooperative group clinical research has led to significant improvements in outcomes for childhood cancer in the United States. COG is the world’s largest cooperative group, comprised of 218 institutions in good standing. There are no benchmark data of the necessary research infrastructure for successful participation in COG research. Objectives: 1) To ascertain the research personnel (RP) devoted to COG research at each member institution. 2) To compare available resources with institutional performance. Design. Methods: A REDCap® survey was designed and sent to all 218 COG institutional principal investigators (PI) with a 4-week window to complete the survey with scheduled reminders. Questions included number of and types of RP [clinical research associates (CRA), nurses, and regulatory]. To measure performance, we used the 2022 Institutional Report Card from COG that reports open trials and enrollments at each site. Sites were categorized into 4 groups based on self-reported new oncology patients diagnosed per year. We compared the number of RP to the a) number of studies open, b) enrollment on therapeutic and non-therapeutic studies. We ranked performance into quartiles by institution size. Results: 134 PIs (61%) answered some or all questions on the survey. All institutional sizes were well-represented. Total number of RP varied dramatically, even among institutions of similar size, with median number 3 RP, range 0.9-28.5. Comparing the number of open studies to regulatory personnel at site, those institutions in the top quartile for each group (except very smallest) had a minimum of 91 studies open and had at least 1 FTE for regulatory, while those in the lowest quartiles (10-67 studies open) had < 1 FTE. Total number of RP were similarly correlated with the number of enrollments, with mean of 12.5 and median 15 enrollments for each RP. Conclusions: Sites successful at opening COG studies and enrolling patients had more research personnel. We show to perform in the top quartiles, there should be at least 1 FTE dedicated to regulatory issues and another 1 FTE for every 12-15 enrolled subjects. [Table: see text]
PRO-WAVE1: Monitoring patient reported outcomes (PROs) in prostate cancer through Wave Health, a novel ePRO health platform.
Authors: Basterretxea Laura , Hernandez Amaia , Gurruchaga Ibon , Gomez Mediavilla Borja , Linares Espinos Estefania , Esteban Brigida , Cacho Diego , Congregado Belen , Rivero Belenchon Ines , Sancho Gemma , Lainez Nuria , Buchser David , Sanguedolce Francesco , Lashey Matthew , Duran Ignacio
Published: June 2024

e23190

Background: It is well established that the monitoring and evaluation of PROs in cancer patients has a positive impact in both quality of life and overall survival [Basch E., JAMA 2017]. In parallel, the widespread use of electronic devices such as smart phones in the general population have increased significantly over recent years [Statista, 2023], representing a unique opportunity to operationalize ePROs. However, there is uncertainty about the feasibility and applicability of these technologies in certain patient population such as prostate cancer (PC) patients. PRO-WAVE1 aims to determine the acceptability and engagement of the Wave Health patient app and healthcare provider portal, enhanced for PC patients. Specific endpoints include measuring longitudinal use of varying ePROs to impact care management, patient health literacy, and ability to identify and manage emerging risks. Methods: Patients across eight sites in Spain engaged with the Wave Health App over a 13-week period. Each week, patients completed a validated weekly symptom review (WSR) assessing 16 Prostate cancer-specific symptoms, including severity and/or frequency of each; as well as a health-related QoL (FACT-P) and health literacy survey (CHLT-30-Dkspa). A report summary of the patients’ WSR was generated for care team view in the Wave Health Connect platform – specifically to conduct weekly check ins on patients, including verifying patient completion; evaluating report content; indicating plans for follow up per patient; and rating their perceived value of the platform. Results: 98 patients were enrolled in the study – of which 82 actively participated in the study (84% acceptance). The compliance rate for the ePRO questionnaires was 93.3%, while during their participation, patients used the app for an average of 12.2 weeks, and approximately two-thirds (67.4%) used the app for all 13 weeks. Patient satisfaction with the platform was 93%, with 100% of respondents feeling the information provided in the app was relevant to their personal experience. Correspondingly, almost all HCPs (98%) rated the platform as useful – with the majority willing to recommend it to their peers and future patients; 90% of HCPs positively perceived the platform’s impact on the quality of communication with patients. Conclusions: Study results exceeded expectations for patient acceptability and engagement with the app; as well as perceived usefulness of the portal among HCPs – suggesting the platform as an impactful tool for patients working with HCPs to manage treatment journeys. A larger study using a comparator arm will help further evaluate the impact on costs and clinical outcomes.
Impact of multidisciplinary tumor boards on clinical decision making in a genitourinary oncology clinic in Mexico city.
Authors: Seidman Sorsby Alec , Caballero Rosa , Rivera Fernanda Estefanía , Remolina Bonilla Yuly Andrea , Vazquez-Narváez Karina G. , Vazquez-Manjarrez Sara E. , Flores Balcázar Christian Haydeé , Castillejos-Molina Ricardo A. , Rodriguez-Covarrubias Francisco , Bourlon Maria T.
Published: June 2024

e23217

Background: Effective management of genitourinary neoplasms demands a comprehensive approach due to the diverse treatment options and the need for multiple specialists. Multidisciplinary tumor board (MDTB) meetings are a platform for experts to collectively assess and discuss the latest evidence and provide their expertise to tailor treatment plans for patients. Methods: Cases discussed during uro-oncology MDTB meetings at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City over a five-year period (01/2018 to 12/2022) were included. We analyzed the type of neoplasm, reason for case discussion, specialties involved and whether the final decision led to a modification of the original plan. Descriptive statistics were used for analysis. Chi-squared test was used to determinate differences and p value < 0.05 was considered statistically significant. A logistic regression analysis was performed for multivariate analysis. Results: Over the study period, 500 discussions involving 399 patients were included. 87% were men. Prostate, kidney, testicular, upper tract urothelial and bladder carcinoma, represented: 223 (44.6%), 117 (23.4%), 84 (16.8%), 37 (7.4%), 32 (6.4%) of cases, respectively. The majority were presented by urology (319 cases; 63.6%). The primary reason for presentation was surgical decisions in 54.6%. Regarding final conclusions, 55.8% underwent modifications in the treatment plan, 33.2% had no changes and 11% remained inconclusive, requiring further assessment. Individuals with metastatic disease had a higher likelihood of treatment plan changes in 61.6% vs 52.3% (OR 1.46 95%CI 1.01-2.12; p = 0.042). The 163 cases (32.6%) presented during the COVID-19 pandemic were more prone to have treatment modifications 62.6% vs 52.5% (OR 1.51 95%CI 1.03-2.22; p = 0.034); cases presented for surgical reasons during this period were more likely to have a change in treatment modality 74% vs 52.3% (OR 2.6 95%CI 1.34-5.04; p = 0.004). Implementation of results was successful in most cases (72%), with a median time of 3.6 weeks. Reasons for not implementing the plan included: patient decision, treating physician decision, comorbidities, death, and lack of resources. Factors associated with implementation in the multivariate analysis included: male gender (OR 2.81), cases presented during pandemic (OR 2.0), and by urology service (OR 1.92). Conclusions: Among patients presented in our uro-oncology MDTB meetings, more than half will have a change in the original treatment plan, and this agreed strategy is successfully implemented in most individuals. These sessions remained key for patient management during the COVID-19 pandemic.