bluuebunny/crossref_metadata_2025 huggingface dataset:
Food for Cancer Health Equity: The impact of a culturally tailored food voucher intervention on food insecurity among Latinx patients with cancer.
Authors: Hanna Maria , Wood Emily Hayes , Villicana Gerardo , Lopez Guzman Lesly , Escobar Kasandra , Reynaga Jajaira , Trotter Chardria , Koontz Zachary M. , Seligman Hilary K. , Patel Manali I.
Published: September 2024

182

Background:
Food insecurity disproportionately impacts immigrant, low-income, and racial and ethnic minorities with cancer. In our prior qualitative work, Latinx and multiethnic patients with food insecurity emphasized the importance of culturally-tailored food assistance interventions that could minimize stigma and maintain self-efficacy and autonomy. In collaboration with Latinx patients and community partners in Monterey County, California, we co-developed a culturally-tailored food voucher intervention. In this study, we conducted a pilot of the intervention among multiethnic and Latinx patients with cancer and tested the impact on food insecurity and health-related quality of life.
Methods:
We recruited low-income, racial and ethnic minority adults > 18 years of age who screened positive for food insecurity using the 2-item Hunger Vital Sign while receiving cancer treatment in a clinic in Monterey County, CA between July 2023 until August 2023. All participants who consented to participate received $40 monthly grocery store gift cards redeemable at a variety of local retailers for 6 months in addition to usual care provided by trained community health workers who assisted with other health-related social needs. We conducted validated surveys at baseline (time of enrollment) and 6-month follow-up (post-intervention) assessing demographics, food behaviors, food insecurity, and health-related quality of life, as well as feasibility and acceptability of the intervention. We compared pre- and post-intervention proportions with food insecurity using McNemars tests and change in health-related quality of life using paired t-tests.
Results:
Of the 30 study participants enrolled, 27 (90%) were Latinx; 24 (80%) spoke Spanish as their preferred language; 16 (53%) had advanced (stage 3 or 4) cancer; 12 (40%) were retired or unemployed; 10 (33%) were disabled; 20 (67%) reported a household income < $35,000 USD. Of the 26 (87%) participants who completed post-intervention surveys, the proportion with food insecurity decreased from 100% to 65% (95% CI 0.60-0.77; p = 0.01); 100% adhered to recommended treatment; and health-related quality of life scores increased by 8 points from 71.9 +/-16.1 to 79.5+/- 10.5 (p = 0.02) from baseline. All (100%) participants rated the program as feasible and acceptable in post-intervention surveys.
Conclusions:
This culturally-tailored food voucher intervention was associated with reductions in food insecurity and improvements in health-related quality of life among low-income Latinx patients with cancer. This intervention may represent an effective and acceptable approach to overcome food insecurity in Latinx and multiethnic patients with cancer.
Palliative care knowledge and access among people with small cell lung cancer and their family caregivers: Preliminary findings.
Authors: Law Heather
Published: September 2024

197

Background:
People with small cell lung cancer (SCLC) make up 13-15% of those diagnosed with lung cancer. Although current statistics show the 5-year survival rate of people with lung cancer has improved overall, this is not the case for those diagnosed with SCLC. The disease is rapidly growing and aggressive, making access to palliative care crucial for improving quality of life for both people with SCLC and their family members. We developed a survey to assess palliative care knowledge and access among people with small cell lung cancer and their family caregivers.
Methods:
An online cross-sectional survey was conducted by the Lung Cancer Registry from GO2 for Lung Cancer (lungcancerregistry.org) from June 2023-present and included questions regarding treatment decision making, palliative care, and access to care. The SCLC survey is promoted to current Lung Cancer Registry participants who indicated a diagnosis of SCLC or were a family caregiver of someone with SCLC. Both people with SCLC and their family caregivers are eligible to participate in the survey. We also recruited people with SCLC through additional targeted online recruitment, direct outreach to community hospitals, and healthcare providers. Descriptive statistics were used to summarize survey findings.
Results:
As of May 2024, the SCLC survey was completed by 20 participants (mean age, 62 years; White, 85.0%; female, 55.0%; diagnosed with SCLC, 95.0%). Over half of people with SCLC (n = 11, 55.0%) had a family caregiver. While most participants had heard of palliative care (n = 15, 75.0%), less than half (n = 9, 45.0%) were offered or given information about it. Half of participants (n = 10, 50.0%) received or indicated they would like to receive palliative care. When asked what was needed from palliative care amongst these individuals, medication management for pain and physical symptoms was the top response (26.9%). For those who did not receive or would not like to receive palliative care, the top reasons included that it was not offered to them (26.7%) and wanting to learn more about it first to guide their decision-making (20.0%). Lastly, when asked what type of palliative care support was needed, emotional support was the top response (27.3%) followed by information on coping with lung cancer (24.2%).
Conclusions:
Preliminary findings suggest efforts are needed by care teams to expand access and improve education regarding palliative care among people with SCLC and their family caregivers. The fast-growing, aggressive nature of SCLC makes it especially urgent that care teams reach and meet the needs of this population. Our findings thus far highlight the need for additional research with larger sample sizes to ensure generalizability for the small cell lung cancer community.
Association between genetic information provision and decisional conflict in patients with cancer.
Authors: Yair Shira , Usman Fatima , Lim Howard J , Hughesman Curtis , Alex Deepu , Bhang Eric , Bhimani Alisha , DeMarco Patricia , Gill Karamjit , Hussein Ali , Kamali-Sarvestani Marjan , KoLeong Jason , Loree Jonathan M. , Pollard Samantha , Weymann Deirdre , Regier Dean A , Chia Stephen K. L. , Yip Stephen , Ho Cheryl
Published: September 2024

227

Background:
The decisional conflict scale (DCS) measures personal perception of uncertainty when facing a decision. In patients with cancer, decision conflict is likely when considering uncertainty in oncologic systemic treatment outcomes. Cancer genomic information can introduce more uncertainty and complexity in care. This study aims to evaluate patients’ DCS score pre or post discussing next generation sequencing (NGS) results with a medical oncologist, and assess factors that correlate with high decision conflict.
Methods:
Patients diagnosed with incurable/metastatic cancer who underwent molecular characterization with tissue+/- liquid NGS testing were enrolled. Survey instruments included the validated DCS (five subscales: informed, values clarity, support, uncertainty, effective decision), and EQ-5D-5L. DCS was administered pre or post medical oncology consultation that included review of tissue +/- liquid NGS results and treatment options. Higher DCS score correlates with higher perception of uncertainty. Descriptive statistics were used to assess clinical and demographic risk factors. Multivariable logistic regression analysis estimated the correlation between high DCS and clinical factors.
Results:
335 DCS surveys were completed by 227 patients: 188 before and 147 after discussing tissue+/- liquid NGS results with a medical oncologist. Baseline characteristics: 56% female, median age 65, ECOG 0-1 58%, median EQ5D VAS score 68, GI/lung/gyne/breast/other 42/32/10/5/11%, white/Asian/other/unknown 66/12/5/17%. Tier 1 variants were identified in 35% of patients. Patients reported decreased decision conflict after consultation. Multivariable logistic regression analysis including sex, age, race and tumor group did not predict for high DCS pre-consultation. MVA post NGS results that also included Tier 1 variants (present / absent) did not predict for high DSC post consultation.
Conclusions:
Communication regarding genomic-based tumor assessment can positively support patients in decision conflict, and improve their confidence in their treatment choice, regardless of the findings of the report. Low DCS after consultation supports the goal of shared decision making for cancer treatment.

Clinical trial information:
NCT05057234

.

DCS subscale
Pre-consultation
Post-consultation
p value

Informed
49.3
37.5
<0.001

Values clarity
45.3
35.5
<0.001

Support
34.4
28.2
0.005

Uncertainty
46.8
36.1
<0.001

Effective decision
40.0
31.4
<0.001

TOTAL
42.9
33.6
<0.001
Patient-friendliness of ChatGPT responses: NSCLC targeted therapy.
Authors: Walker Elijah , Aseem Noor , Naffakh  , Nguyen Ryan Huu-Tuan
Published: September 2024

231

Background:
Non-small cell lung cancer (NSCLC) targeted therapies are complex, often requiring extensive patient education beyond what can be conveyed in a single provider visit. Given the average US reading level is at the 8th grade, and many patients seek additional information online, it is vital to evaluate the readability of online resources. This study aims to determine the patient friendliness of information provided by AI chatbots like ChatGPT in explaining NSCLC targeted therapies compared to other commonly accessed sources.
Methods:
This analysis included targeted therapies approved by the FDA for EGFR-mutated NSCLC: Afatinib, Erlotinib, Osimertinib, Dacomitinib, and Gefitinib. Information sources included ChatGPT 4, ChatGPT 3.5, the Patient Information section of the FDA label, and the Google featured snippet. Each version of ChatGPT was queried 10 times for each individual therapy – “My doctor is suggesting starting therapy with (Drug Name). What can I expect with this medication?”. All responses, labels, and snippets were examined by Microsoft Word for word count (WC) and Flesch Reading Ease Score (FRES), which considers average sentence length and number of syllables per word to assess readability. Data analysis was performed using ANOVA in SAS.
Results:
Across all therapies, Mean FRES for ChatGPT 4 was 31.21, ChatGPT 3.5 26.69, FDA labels 50.78, and Google snippets 33.1. Mean WC for ChatGPT 4 was 312.54, ChatGPT 3.5 355.78, FDA labels 1220, and Google snippets 42. Significant differences in FRES were found among sources for Afatinib (p-value <0.0001), Erlotinib (p-value 0.0206), Osimertinib (p-value <0.0001), Dacomitinib (p-value 0.0125), and Gefitinib (p-value <0.0001). Significant differences in WC were also found among sources for Afatinib (p-value <0.0001), Erlotinib (p-value <0.0001), Osimertinib (p-value <0.0001), and Gefitinib (p-value 0.0045). No significant difference in WC was found for Dacomitinib (p-value 0.2807).
Conclusions:
While the FDA label provided the most readable information, none of the sources aligned with the average 8th-grade reading level in the US, indicating a gap in accessible patient education for NSCLC targeted therapies. Notably, readability varies significantly between ChatGPT versions, affecting accessibility for users of the free version, ChatGPT 3.5. Although ChatGPT responses are more succinct compared to the verbose FDA labels, their higher education-level readability presents a barrier to comprehension. This study highlights the need for further research into optimizing AI-generated patient education materials to be both accurate and comprehensible at appropriate reading levels, thereby improving health communication strategies.
Process improvements related to new patient scheduling.
Authors: Yelich Annie , Meredith Stacey , Jensen Terry Lynn , Mikan Sabrina Q. , Escudier Susan Marie
Published: September 2024

26

Background:
With over 530 physicians across 280 locations, the new patient time to first appointment varied across the state, with results ranging from 1 to 33 average days to schedule. Beginning in January 2021, a new patient scheduling model was developed to improve access to care and the patient experience. A new patient scheduling model was developed. The program was structured to support both on site and remote scheduling.
Methods:
Provider scheduling cards detailing physician preferences for scheduling, required records and prioritization for the type of diseases seen was implemented. Physicians were required to designate new patient time slots in their clinics tied to new patient volume trends. New patient scheduling workflows and required record guidelines were standardized and revised. Reporting and tracking metrics were created – average days to schedule, average days to appointment, referral fulfillment rate, referral to appointment ratio, true cancellation rate. Physicians were eligible to participate in a yearly bonus if time to first appointment goals were met. Utilized Virtual and in-person APPs provided benign hematology consults to address capacity constraints.
Results:
New patient true cancellation rates decreased from 9.84% to 5.22% resulting in capture of over 800 patients a month. There was a 56% increase in patient retention with a 138% increase in referral volume. The Practice realized a 69% reduction in average days to schedule from 9 to 3 days. The average time to first appointments improved from 23 to 14 days; a 38% decrease.
Conclusions:
With increasing numbers of new cancer patients, increasing numbers of cancer survivors and shortages of medical oncologists, it is essential to maintain access to timely cancer care. New models helped improve patient experience and practice retention of new cancer patients, by focusing on administrative staff to implement these programs. APP benign hematology clinics freed up physician time for new cancer patient consults. Physician support was obtained with education, frequent outreach, and financial incentives.

2021 Q1
2021 Q2
2021 Q3
2021 Q4
2022 Q1
2022 Q2
2022 Q3
2022 Q4
2023 Q1
2023 Q2
2023 Q3
2023 Q4
2024 Q1

Referral Volume
44,305
54,379
57,282
57,475
67,890
75,111
79,281
75,843
85,419
91,811
94,286
88,396
100,115

Avg. Days to Scheduled
9.1
6.9
5.4
6.2
5.8
4.9
3.9
4.0
3.7
4.0
3.8
3.6
3.3

Avg. Days to Appointment
22.4
24.3
23.3
22.9
20.9
21.8
20.0
19.2
17.0
17.5
17.1
16.7
14.9
Optimizing workflow for OncotypeDx result turnaround time from surgery to report at safety net hospital.
Authors: Hung Christie , Sin Hye Gyeong , Wu Jennifer
Published: September 2024

317

Background:
OncotypeDx test has been widely used for breast cancers patients with early-stage (I-IIIa), hormone-receptor positive, HER2-negative disease. It predicts the benefit of adjuvant chemotherapy in addition to hormone therapy. Delivering OncotypeDx results in a timely manner is important to inform treatment decisions. As a quality improvement project, we implemented a strategy to reduce the Turn Around Time (TAT) from breast surgery to OncotypeDx report at Bellevue Cancer Center, the tertiary referral center of the NYC Health and Hospitals System.
Methods:
The primary measure was TAT from surgery to receiving OncotoypeDx result in electronic medical record (EMR). We compared TAT before and after implementation of the strategy. The historical control was from 5/2021 through 3/2022, while the group after strategy implementation was from 6/2023 to 1/2024. The strategy revolved around streamlining the identification of eligible patients by collaborating with the breast surgery team, creating and utilizing a smart phrase in the EMR. It also involved ordering OncotypeDx by closely communicating with the pathology department, obtaining insurance approval by working with the OncotypeDx vendor, and tracking OncotypeDx results. The above process was done by a breast surgery provider that offered real time updates in the EMR.
Results:
The patient groups were similar both before and after implementing the strategy, including patient number (26 and 27 respectively) and patient mean age (61 and 59). The majority of both groups were minority patients (77% and 81%). We found that a higher percentage of patients were from Medically Underserved Areas and Populations (MUA/P) in the group after strategy implementation (35% and 56%). Our strategy reduced the average TAT from 56 days to 30 days.
Conclusions:
We developed a strategy to optimize the OncotypeDx workflow in a large safety net health system despite an increase in patients from MUA/P. Initiating ordering of OncotypeDx by breast surgery along with communication with pathology and the vendor significantly reduced TAT. EMR integration with OncotypeDx vendor would be the next step to further improve the process.

Before Strategy Implementation (n=26)
After Strategy Implementation (n=27)

Patient Mean Age
61
59

Race (%)

White

27
18.5

Hispanic

39
44.4

Black

7
25.9

Asian

23
11.1

Other

4
0

Ethnicity (%)

Hispanic

39
44.4

Non-Hispanic

61
55.6

Underserved Area and Population (%)
35
56

Health Professional Shortage Area (%)
50
59

Non-English Speaking (%)
50
40.7
Income, wealth, and debt among families with a history of cancer.
Authors: Zheng Zhiyuan , Hu Xin , Zhao Jingxuan , Yabroff Robin
Published: September 2024

350

Background:
Cancer survivors and their families often experience financial hardship due to high out-of-pocket medical costs and lost income from time away from work during treatment for patients and informal family caregivers. Little is known about detailed income, wealth, and debt among families with a history of cancer.
Methods:
The 2021 Panel Study of Income Dynamics was used to identify families with a cancer history. Family characteristics included survey response person’s age, sex, marital status, and race and ethnicity, number of dependent children living in the family, and time since cancer diagnosis. For families with multiple cancer diagnoses, time since cancer diagnosis was calculated according to the most recent cancer diagnosis. Family income was assessed by total income in tax year 2020, which consisted of combined taxable and transfer income of the response person, spouse/partner, and other family members. Wealth with and without equity (i.e., value of home minus mortgage) were assessed by sum of values of different types of assets (e.g. savings, checking, bonds, retirement accounts) net of debts (e.g., credit card debt, student loans, and medical bills).
Results:
A total of 701 families were identified with a cancer history. Within families, half of cancer survivors were 18-64 years and the other half were >65 years at the survey. About two thirds were married or living with partners, three fourths of response persons were male, one fifth had dependent children living in the same family, two thirds were non-Hispanic white, and two thirds of cancer survivors were diagnosed > 6 years prior to the survey. The median family income was $67,498 (inter-quartile range: $33,480 to $121,200), and the median wealth with and without equity were $188,000 and $5,5000, respectively. Moreover, 29.9% of families had credit debt (median: $4,500; inter-quartile range [IQR]: $1800-$14,000); 11.3% of families carried student loans (median: $4,500; IQR: $15,000-$60,000); and 10.7% of families had outstanding medical bills (median: $4,000; IQR: $2,000-$9,000).
Conclusions:
Families with a history of cancer have multiple types of debts, including medical debt, even years after diagnosis. Efforts to identify changes in wealth and income before and after cancer diagnosis are warranted.

Income, wealth, and debt among families with a history of cancer.

Family income
Wealth without equity
Wealth with equity

Mean (Std)
Median (IQR)
Mean (Std)
Median (IQR)
Mean (Std)
Median (IQR)

$94,776(123,870)
$67,498(33,480, 121,200)
$459,956(1,142,647)
$5,5000(4,000, 391,364)
$649,912(1,307,959)
$188,000(30,400, 645,000)

Credit card debt (n=693)

Student loans (n=698)

Medical bills (n=627)

n (%)

Mean (Std)

Median (IQR)

n (%)

Mean (Std)

Median (IQR)

n (%)

Mean (Std)

Median (IQR)

207(29.9%)
$8,832 (10,300)
$4,500(1800, 14,000)
79(11.3%)
$55,948(75,256)
$35,000(15,000, 60,000)
67(10.7%)
$13,309(32,525)
$4000(2,000, 9,000)
A multi-modal EHR-based approach to screen patients for oncology clinical trials.
Authors: Afghahi Anosheh , Frahm Filip , Kaur Maneet , Lu Yichen , Cipolla Catharine Kline , Leybovich Barry , Altomare Ivy , Meropol Neal J.
Published: September 2024

411

Background:
Inefficiencies in patient (pt) screening may impair enrollment in oncology trials and could potentially be mitigated by a centralized trial matching infrastructure. The objective of this study was to implement a novel clinical trial screening service using electronic health record (EHR)-based structured variables, machine learning (ML) and human abstraction.
Methods:
To construct the model, we defined a set of inclusion and exclusion (IE) criteria unique to each trial and routinely documented in EHRs. Patients that met IE criteria via structured and ML-extracted clinical data were selected for review by trained specialists via a technology-enabled abstraction platform. Real-time notifications for eligible pts were issued via EHR alerts to research teams at participating study sites.
Results:
Between January and May 2024, over 80,000 pts were screened prior to a clinic visit for two trials at three sites. Using structured IE criteria alone, 98.7% and 99.6% of pts were excluded. An additional 31.9% of pts were excluded when employing ML modeling. A total of 15 (3.0%) and 5 (4.0%) pts were deemed eligible when using structured, ML, and abstraction-based criteria (Table). Seventeen percent of surfaced pts were consented within 10 days of implementation. Median time for abstractor confirmation of pt eligibility was 13.3 hours (interquartile range: 2.8, 27.4) with abstraction of highest priority pts taking a median of 3.0 and 9.9 hours, respectively.
Conclusions:
Our results support the implementation of a centralized, technology-enabled pt screening service for effective trial eligibility assessments across large patient populations. The value of using structured, ML- and abstraction-based data models, improved accuracy by more than 95% compared to structured data alone. The impact of multi-modal centralized screening is being evaluated across additional clinical trials in a nationwide community oncology research network.

Pts, No. (% pts excluded).

Trial 1

Trial 2

1. Pts with upcoming visit
37,865
44,973

2. Pts meeting structured criteria
(including: age, stage, prior IV therapy)

497 (98.7)
182 (99.6)

3. Pts meeting ML model-based criteria
(including: prior oral therapy)

-
124 (31.9)

4. Pts meeting steps 1-3 and abstraction criteria
(including: cancer diagnosis, biomarker status, prior malignancies)

15 (97.0)
5 (96.0)
Effect of streamlining prior authorization processes for systemic cancer treatments on efficiency and financial losses.
Authors: Bhardwaj Aarti Sonia , Liu Mark , Williams Chanda , Liggins Jennifer , Soto Haydee , Favre Daniel , Smith Cardinale B.
Published: September 2024

412

Background:
Prior authorizations (PAs) for systemic cancer treatments are a barrier to timely quality cancer care delivery. The high administrative burden to complete peer to peer’s (P2P) and appeals leads to care delays and revenue losses. At our tertiary academic cancer center, in partnership with our cancer registry and Epic teams, we shifted the clerical work required for PAs from clinicians to certified tumor registrars (CTRs) to increase authorization efficiency and decrease financial losses from denials.
Methods:
Clinicians place the treatment plan order which goes to the CTR work queue. We leveraged the Epic staging smart form to consolidate and auto-populate common elements needed for PA. The CTRs then complete and validate the form prior to the authorization specialists obtaining the PA. We compared the pre (1/2022-9/2022) and post-implementation (11/2022-4/2024) periods on our primary outcomes: average monthly number of PAs pending review (including P2P, appeals and authorizations requiring clarifying clinical documentation), average monthly denial rate and average time spent on PAs by the authorization specialists. We compared the financial losses from denied PAs from calendar year 2022 to 2023. Analyses were conducted using descriptive statistics.
Results:
There was a 1.4% reduction in the average monthly number of PA’s pending review (350 vs 345). The average monthly authorized rate was steady from the beginning of the intervention (94%) to present time (95%). The average monthly denial rate was 2.9% at the beginning of the intervention and 0.9% at present time. There was a consistent decrease in the average time a PA was spent in pending review status: 118 hours in 2022, 102 hours in 2023 and 79 hours in quarter 1 of 2024. Despite the overall increase in volume of authorizations submitted, there was an overall cost savings of $27,392,894 from 2022 ($49,964,703) to 2023 ($22,571,809) from the decrease in denials. In 2022, 6.2% of total approved charges were denied and this decreased to 2.7% in 2023.
Conclusions:
By leveraging the EHR and optimizing existing non-clinical staff workflows, we maintained sustained average authorized and denial rates despite overall volume going up due to improved authorization efficiency and reduced financial losses due to denials. Additionally, there were overall cost savings for the institution due to the decreased percent of denials of total approved charges. Future work will include further refinement of treatment and disease specific optimizations.
Associations of individual and partner incarceration history and receipt of cancer screening in the US.
Authors: Zhao Jingxuan , Han Xuesong , Nogueira Leticia M. , Zheng Zhiyuan , Shih Ya-Chen Tina , Bradley Cathy J. , Yabroff Robin
Published: September 2024

50

Background:
Incarceration history is linked to limited access to care, including cancer screenings. Adverse consequences may also extend to their partners due to financial burdens and social stigma. This study examined associations of individual and partner incarceration history and receipt of cancer screenings in the United States.
Methods:
We identified individuals aged ≥ 50 years currently living with a partner who responded to the 2014-2020 Health and Retirement Study. Incarceration history was defined from responses to the question ‘Have you ever been an inmate in a jail, prison, juvenile detention center, or other correctional facility?’ People were categorized into 3 groups: 1) without individual or partner incarceration history, 2) with individual incarceration history only, and 3) with partner incarceration history only. People with both individual and partner incarceration history were excluded due to small sample size. We used multivariate logistic regression models to generate prevalence ratios (PRs) comparing receipt of any breast, cervical, and colorectal cancer screenings ≤2 years among screening-eligible people (defined by the US Preventive Services Taskforce guideline) with individual or partner incarceration history to people without incarceration history, stratifying by sex and controlling for age group, race and ethnicity, educational attainment, and comorbidity.
Results:
Of the sample, 0.9% and 11.8% of females and males reported individual incarceration history, respectively; 11.1% and 1.0% reported partner incarceration history, respectively. Compared to females without individual or partner incarceration history, women with partner incarceration history were less likely to receive breast cancer screening (PR:0.7, 95CI: 0.5-0.9); women with individual incarceration history were less likely to receive colorectal cancer screening in the past 2 years (PR: 0.7, 95% CI: 0.5-0.9). Compared to males without individual or partner incarceration history, men with partner incarceration history were less likely to receive colorectal cancer screening (PR: 0.5, 95% CI: 0.4-0.7).
Conclusions:
Individual or partner incarceration history was associated with lower prevalence of cancer screening. Programs to improve access to care and cancer screening among both people with incarcerations history and their partners are warranted.

Adjusted association of individual and partner incarceration history and receipt of cancer screening.

Female
Male

No Individual or Partner History
With Individual History
With Partner History
No Individual or Partner History
With Individual History
With Partner History

Cancer screening

Breast (n=2556)
Ref.
2.0 (0.5 - 8.3)
0.7 (0.5 - 0.9)
--

Cervical (n=817)
1.4 (0.4 - 5.6)
0.9 (0.6 - 1.4)

Colorectal (n=2682 for female, n=2207 for male)
0.7 (0.5 - 0.9)
0.9 (0.7 - 1.0)
Ref.
1.0 (0.9 - 1.2)
0.5 (0.4 - 0.7)

Ref: referent group.
Racial disparities in end-of-life care among patients with neuroendocrine tumors.
Authors: Baskar Suriya , Grewal Udhayvir Singh
Published: September 2024

60

Background:
Due to the rising incidence of neuroendocrine tumors (NETs), the prevalence of NETs now surpasses many other malignancies. Due to a slower course of disease and lack of awareness among care teams, end-of-life (EOL) care is typically underutilized in patients with NETs. Owing to a heavy symptom burden (related to disease burden and/or functionality), patients with NETs often struggle due to lack of palliative care and eventually EOL care support. Prior studies have revealed that Black patients with advanced cancer are more likely to receive aggressive care and suffer a significant decline in quality of life at EOL. However, similar data investigating racial differences in EOL among patients with NETs are lacking.
Methods:
The National Inpatient Sample (NIS) was queried between years 2016-2020 to identify all hospitalizations (regardless of site of origin) with NETs utilizing the appropriate ICD-10 codes (neuroendocrine carcinomas were excluded). Hospitalizations of White and Black patients with documented inpatient mortality events were then extracted. Demographic and clinical data were analyzed using independent sample t-test, Chi-square test, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). NIS discharge weights were applied to calculate national estimates. Statistical analyses were performed with SPSS 28.0. A p-value of <0.05 was considered statistically significant.
Results:
A total of 6,265 hospitalizations with NETs were included, of which 5,125 (81.8%) and 1,140 (18.2%) had White and Black patients respectively. Black patients were younger, more likely to be females, and less likely to have a do not resuscitate (DNR) code status. There was no significant difference in CCI between the groups. Palliative care consultation was less likely to be performed among Black patients (adjusted OR=0.70, p<.001). Black patients also had longer mean length of stay in the hospital (10.25 vs 8.42 days, p<.001). Black patients were also more likely to receive aggressive care in the form of mechanical ventilation at EOL (Table).
Conclusions:
This is the largest analysis demonstrating significant racial disparities in EOL care among patients with NETs. Black patients had longer inpatient stay, were less likely to receive inpatient palliative care consultation, have a DNR order and more likely to receive aggressive care at EOL. These findings may have implications for informing healthcare decision making for EOL care among Black patients with NETs.

WhiteN=5125
BlackN=1140
aOR (95% CI)
p-value

Age (years)
67.67 ± 11.89
65.14 ± 11.29
-

<.001

Females
46.1%
50.9%
-

.004

CCI
11.0 ± 3.22
10.9 ± 3.42
-
.538

Mean length of stay
8.42 ± 10.03
10.25 ± 15.75
-

<.001

Palliative
62.6%
54.5%
0.70 (.61-.80)

<.001

DNR
64.9%
60.1%
0.80 (.70-.92)

.002

Blood transfusion
13.2%
15.4%
1.18 (.98-1.41)
.052

Mechanical ventilation
28.8%
38.6%
1.55 (1.35-1.77)

<.001

Vasopressor
9%
9.6%
1.07 (.86-1.33)
.47
Housing-related disparities in receipt of breast cancer screening among Medicaid beneficiaries.
Authors: Kwon Youngmin , Roberts Eric T. , Sabik Lindsay M. , Degenholtz Howard B. , Jacobs Bruce L. , Cole Evan S.
Published: September 2024

76

Background:
People experiencing or at risk of homelessness (PEH) are often diagnosed with advanced breast cancer, suggesting barriers to preventive care and screening. However, there is limited data that examine screening among PEH, undermining efforts to characterize and address potential disparities in screening. To address this gap, we investigated housing-related disparities in receipt of breast cancer screening in Medicaid, which disproportionately serves low-income PEH.
Methods:
We used a novel linkage of Pennsylvania Medicaid data with encounter-level data on housing-related services (Housing Management Information System; HMIS) from 2011 to 2017. We compared rates of biennial mammography between a cohort of Medicaid women receiving housing-related services in HMIS (i.e., a proxy for experience/risk of homelessness) and randomly sampled comparison beneficiaries without any housing services use. We estimated both unadjusted and adjusted disparities in receipt of biennial mammography (controlled for county and year fixed effects, demographic and Medicaid eligibility characteristics, and baseline healthcare utilization and comorbidities). We also examined heterogeneity in disparities by beneficiaries in the following HMIS subgroups: 1) receiving supportive housing, 2) experiencing chronic homelessness (i.e., 12+ months of homelessness), and 3) unstably housed (housed but receiving homelessness prevention services).
Results:
We identified 1,792 Medicaid beneficiaries with an HMIS encounter and 71,664 comparison beneficiaries. Those in the HMIS cohort were more likely to be younger, non-Hispanic Black, eligible for Medicaid due to disability, and have a higher number of inpatient visits and comorbidities. The unadjusted proportion receiving mammogram was 44.8% and 50.1% in the HMIS vs. comparison cohort, with an overall disparity of 5.3 percentage-points (pp,
P
<.001). This disparity estimate remained was robust to adjusting for covariates (-4.3 pp;
P
< .001). We found the largest adjusted disparity when comparing beneficiaries experiencing chronic homelessness (-8.5 pp;
P
= .038) relative to the comparison cohort. In contrast, the disparity was smaller among women receiving supportive housing (-3.7 pp;
P
= .098) and unstably housed women (-3.3 pp;
P
= .071).
Conclusions:
There was a significant disparity in the utilization of mammography among women PEH, especially those who experience chronic homelessness, in Pennsylvania Medicaid. Our finding illuminates the health consequences of housing insecurity and underscore a need for programs providing adequate housing, such as supportive housing, to address disparities in screening. In the meantime, greater efforts should be dedicated to improving the uptake of screening among at-risk populations at the point of contact with the healthcare system (e.g. when PEH engage with care).
Evidenced-Based Prior for Estimating the Treatment Effect of Phase III Randomized Trials in Oncology
Authors: Sherry Alexander D. , Msaouel Pavlos , Kupferman Gabrielle S. , Lin Timothy A. , Abi Jaoude Joseph , Kouzy Ramez , McCaw Zachary R. , Ludmir Ethan B. , van Zwet Erik
Published: September 2024

PURPOSE

The primary results of phase III oncology trials may be challenging to interpret, given that results are generally based on
P
value thresholds. The probability of whether a treatment is beneficial, although more intuitive, is not usually provided. Here, we developed and released a user-friendly tool that calculates the probability of treatment benefit using trial summary statistics.

METHODS

We curated 415 phase III randomized trials enrolling 338,600 patients published between 2004 and 2020. A phase III prior probability distribution for the treatment effect was developed on the basis of a three-component zero-mean mixture distribution of the observed z-scores. Using this prior, we computed the probability of clinically meaningful benefit (hazard ratio [HR] <0.8). The distribution of signal-to-noise ratios and power of phase III oncology trials were compared with that of 23,551 randomized trials from the Cochrane Database.

RESULTS

The signal-to-noise ratios of phase III oncology trials tended to be much larger than randomized trials from the Cochrane Database. Still, the median power of phase III oncology trials was only 49% (IQR, 14%-95%), and the power was <80% in 65% of trials. Using the phase III oncology-specific prior, only 53% of trials claiming superiority (114 of 216) had a ≥90% probability of clinically meaningful benefits. Conversely, the probability that the experimental arm was superior to the control arm (HR <1) exceeded 90% in 17% of trials interpreted as having no benefit (34 of 199).

CONCLUSION

By enabling computation of contextual probabilities for the treatment effect from summary statistics, our robust, highly practical tool, now posted on a user-friendly webpage, can aid the wider oncology community in the interpretation of phase III trials.
Evolution of cooperation on dynamical asymmetrical networks with costs
Authors: Chen Wei , Wang Sheng , Tao Boyu , Geng Lin
Published: September 2024

Social networks denote the structure of interactions among individuals. Adjusting social relationships is a typical reaction among humans attempting to interact with altruistic partners. Theoretical investigations proved that dynamical network structures promote the evolution of cooperation. However, individuals react differently to diverse social partners and interactions. Furthermore, a large variety of potential costs of partner switching occur in real-world interactions. Establishing and maintaining different interactions cost differently. Based on these motivations, this investigation studies the interplay between the dynamics on networks and the dynamics of networks, which entangles the evolution of strategies and topology of adaptive multilayer networks whose structure is divided into a gaming layer for reaping payoff and a learning layer for spreading strategy. Individuals react differently to overlapped and un-overlapped partners whose gaming interactions and learning interactions are identical or not. And the effects of overlap levels and rewiring costs on the evolution of cooperation are explored. Simulation results demonstrate that increasing the ratio of rewiring as well as the overlap levels can enhance the evolution of cooperation significantly. However, both too frequent rewiring and too high overlap levels can result in the increment of isolated nodes, and thus provide a sanctuary for defectors to survive and make cooperators hardly to occupy the whole population. Moreover, it is found that rewiring costs have dramatically different impacts on the evolution of cooperation for different overlap levels. For a low overlap level, increasing costs suppress the evolution of cooperation. Yet a high overlap level makes increasing costs favor the cooperator to spread. Our results reveal the condition for the domination of cooperation with asymmetrical interactions, which may provide a potential way to understand the evolutionary cooperation in human society.
Robot-Assisted Pancreaticoduodenectomy Using the Anterior Superior Mesenteric Artery-First Approach for Pancreatic Cancer
Authors: Takagi Kosei , Fuji Tomokazu , Yasui Kazuya , Yamada Motohiko , Nishiyama Takeyoshi , Nagai Yasuo , Kanehira Noriyuki , Fujiwara Toshiyoshi
Published: September 2024

Background

The superior mesenteric artery (SMA)-first approach for pancreatic cancer (PC) is common surgical technique in pancreaticoduodenectomy. To date, few studies have reported SMA-first approach in robot-assisted pancreaticoduodenectomy (RPD). Herein, we present the anterior SMA-first approach for PC during RPD.

Patient and Method

A 75-year-old man with resectable PC underwent RPD after neoadjuvant chemotherapy. As pancreatic head tumor contacted with the superior mesenteric vein (SMV), the anterior SMA approach was applied. After the mesenteric Kocher maneuver, the jejunum was divided and the left side of the SMA was dissected. Subsequently, the anterior plane of the SMA was dissected. Following the division of branches from the mesenteric vessels, the SMA was taped, and the circumferential dissection around the SMA was performed to detach the pancreatic neck from the SMA completely. Finally, the dissection between the SMV and the tumor was performed under vascular control to remove the specimen.

Conclusions

The anterior SMA-first approach can be optional in patients with PC undergoing RPD. This unique approach allows for the circumferential dissection around the SMA during RPD.
Labor Market Effects of Workweek Restrictions: Evidence from the Great Depression
Authors: Fishback Price , Vickers Chris , Ziebarth Nicolas L.
Published: September 2024

We study the effects of restrictions on the length of the workweek under the President’s Reemployment Agreement (PRA) of July 1933 and the National Industrial Recovery Act. We construct a model in which the equilibrium without such a workweek restriction has an inefficiently low level of employment. We find that employment rose by about 24 percent in the month following the imposition of the workweek restriction. Industries with longer workweeks pre-PRA experienced 9.4 percent faster growth in hourly earnings post-PRA, but this increase was not sufficient to prevent a relative fall in weekly earnings in these industries. (JEL E24, E32, J22, J31, N12, N31)
Idiosyncratic Income Risk and Aggregate Fluctuations
Authors: Debortoli Davide , Galí Jordi
Published: September 2024

We study how the presence of idiosyncratic income risk affects aggregate fluctuations in the absence of binding borrowing constraints and/or cyclical income risk. Its impact is shown to be captured by the response of a consumption-weighted average of individual consumption risk to aggregate shocks. We analyze two example economies—an endowment economy and a New Keynesian economy—and show that, under plausible calibrations, the impact of idiosyncratic income risk on aggregate fluctuations is quantitatively small since most of the changes in consumption risk are concentrated among poorer (low-consumption) households. (JEL E12, E21, E24, E32)
Sociedade do consumo, tributação e decolonialidade
Authors: Oliveira Daniela Olímpio de
Published: September 2024

Objetivos: O objetivo deste artigo é discutir a tributação sobre o consumo, especialmente no Brasil, como sendo regressiva e indireta, historicamente excludente. A tributação vem se estabelecendo mundialmente sobre o consumo, não sendo esta uma característica só do sistema brasileiro. O consumo é a base da sociedade moderna, global e dividida entre países de centro e de periferia. A tributação, por sua vez, aparato da sociedade moderna, contribui para o deslocamento do sujeito enquanto mercadoria, tornando a renda-consumida a medida objetiva e abstrata de verificação da capacidade contributiva, acarretando a ilusória compreensão de uma isonomia das oportunidades.
Metodologia: O método utilizado pelo estudo é o dedutivo e a pesquisa de cunho bibliográfico-documental, com abordagem qualitativa.
Resultados: Observamos, como resultado, que estamos diante de um processo naturalizado de economia que atravessa o sistema tributário com referências regressivas e amplia o fosso que separa a periferia do centro. No Brasil, desde sempre, a tributação fez-se indireta sobre produção, importação e consumo. Ao lado da tributação, em uma sociedade do consumo, a inflação, ou “imposto inflacionário”, é também um fato social, por permitir que os governos lucrem com a expansão monetária e a redução do poder de compra das famílias, privilegiando determinados atores sociais em detrimento das massas, na sociedade do consumo.
Conclusões: Portanto, podemos ver que o desenvolvimento sustentável dos países periféricos não está, ou não deve estar, em franca competição por uma condição equivalente aos países do centro, sendo este o ponto de partida para uma concepção sustentável de sociedade e, por decorrência, de um sistema tributário justo.  O presente artigo visa a levantar essas hipóteses e teses.
Depression and ineffective reproduction, i.e. psychiatric aspects of infertility
Authors: Zieliński Damian , Tokarczyk Kamila , Piegza Magdalena
Published: September 2024

Zaburzenia depresyjne stanowią jeden z najczęstszych problemów psychiatrycznych w populacji ogólnej, często dotyczą także osób walczących z niepłodnością. Udowodniono, iż problem ten jest rozpowszechniony w wielu krajach na świecie i dotyczy zarówno kobiet jak i mężczyzn, jednak z większym nasileniem objawów depresyjnych u niepłodnych kobiet. Technologie wspomaganego rozrodu, takie jak zapłodnienie in vitro, są kluczową metodą w leczeniu niepłodności, ale mogą też zwiększać ryzyko depresji, związanej z nieudaną próbą zapłodnienia. Leki przeciwdepresyjne, szczególnie SSRI powszechnie stosowane w leczeniu objawów depresji, mogą mieć pod wieloma względami negatywny wpływ na płodność, jednak ryzyko niepłodności jest statystycznie mniejsze w przypadku stosowania farmakoterapii, niż w nieleczonej depresji. Wsparcie psychologiczne, w tym psychoterapia, może stanowić istotny element terapii niepłodności, zwiększając szanse na zajście w ciążę, przez łagodzenie stresu, zmniejszenie nasilenia objawów zaburzeń psychicznych, a tymsamym poprawę jakości życia. Poniższe opracowanie ma na celu dostarczenie informacji na temat wzajemnych zależności pomiędzy depresją i niepłodnością, uwypuklenie skali zjawiska współwystępowania objawów depresyjnych i niepłodności oraz przedstawienie kierunków przeciwdziałania temu problemowi.
The histopathological and molecular heterogeneity of hepatocellular
carcinoma: a narrative review
Authors: Chung Wonju , Kim Haeryoung
Published: September 2024

Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related deaths
worldwide, with poor clinical outcomes due to challenges in early detection and
limited efficacy of current treatments such as receptor tyrosine kinase
inhibitors and immunotherapy. HCC exhibits significant heterogeneity at both
histopathological and molecular levels, complicating its management but offering
potential for personalized therapeutic approaches. This review outlines the
morpho-molecular heterogeneity of HCC and summarizes various histological
subtypes, including steatohepatitic, clear cell, macrotrabecular-massive,
scirrhous, lymphocyte-rich, and fibrolamellar HCCs. Each subtype possesses
distinct clinical, histological, and molecular features; for instance,
steatohepatitic HCC is associated with metabolic dysfunction and shows
IL-6/JAK/STAT activation, while clear cell HCCs often have IDH1
mutations and favorable prognosis. The macrotrabecular-massive subtype is linked
to poor outcomes and TP53 mutations, whereas scirrhous HCCs
express stemness markers and have TSC1/TSC2 mutations.
Lymphocyte-rich HCCs are characterized by immune cell infiltration and better
prognosis. CTNNB1-mutated HCCs show specific morphological
features and may benefit from targeted therapies. Understanding these subtypes
and associated molecular alterations is crucial for developing effective
diagnostic and therapeutic strategies, including potential predictive biomarkers
and personalized treatments. Additionally, the identification of patterns like
vessels-encapsulating-tumor-clusters offers prognostic implications and may
guide therapeutic decisions. Recent molecular studies have enhanced our
comprehension of HCC heterogeneity, laying the groundwork for more personalized
approaches. Pathologists play a vital role in recognizing these subtypes, aiding
in prognosis prediction and treatment planning. Advances in digital pathology
and artificial intelligence may further facilitate biomarker research,
ultimately improving patient outcomes in HCC management.