bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and implementation of a digital remote symptom monitoring program (RESPONSe) to support patients undergoing IV chemotherapy at a community ambulatory cancer clinic in Richmond, BC, Canada.
Authors: Ho Jeremy J. , Morgana Tamsin , Daliran Shahrzad , Enno Ann , NgAKein June , Lui Adele
Published: September 2024

406

Background:
We identified delays in accessing symptom management during treatment as an existing care gap at the Richmond Cancer Clinic. Patient-reported outcome measures (PROMs) have been demonstrated to communication, quality of life, and reduce symptom burden and acute care utilization. The RESPONSe program was initiated to address this gap by implementing a digital remote symptom monitoring (RSM) system paired with a supporting Symptom Management Nurse (SMN).
Methods:
We designed a digital RSM system to collect PROMs at specific timepoints during the first 6 months of IV chemotherapy initiation, with automated triaging logic to flag symptoms of concern that would result in a phone call from the SMN. Routine surveys include baseline, health-checks on days 3 and 10 post-chemotherapy, and pre-doctor’s-appointment; with optional health checks available anytime. Through competitive procurement, SeamlessMD was selected as the technology partner. From Aug 2023 to Jan 2024, multiple design cycles with dry run testing were held to incorporate branching logic, COSTARS oncology symptom specific questionnaires, automatic triaging flags, immediate self—management tips and links to educational resources. Concurrent development of SMN clinical workflows included in-person patient enrolment, digital dashboard monitoring and integration with the clinical chart.
Results:
From Jan 22-Apr 30, 2024, 32 patients have been enrolled with 42% over the age of 70. 90% of patients completed the baseline survey, 79% of patients completed at least 1 post-treatment health check and 45% completed at least 1 pre-doctors’-appointment survey. An average of 22 library resources were accessed per patient. Through the system, 19 severe and 34 moderate symptoms were identified. The dashboard prompted 63 telephone calls from the SMN, with a further 28 follow-up calls required. Early 3-month patient experience surveys (n=8) indicate high satisfaction, with 100% of patients saying they would recommend the program to others undergoing treatment. 87.5% of patients felt the system was very helpful in communicating their issues to the clinical team, with 100% reporting very high/extreme satisfaction with the support provided by the SMN. Additionally, 67% of patients felt very satisfied with the RESPONSe program overall.
Conclusions:
The RESPONSe program demonstrates the potential of digital RSM systems in improving patient-centered care and assisting with symptom reporting and management. Initial results suggest high engagement and patient satisfaction, showing this is a feasible approach in community oncology settings. We will be reviewing acute care utilization to assess the impact of the RESPONSe program on emergency room visits and hospitalization.
Associations of Medicaid expansion with stage at diagnosis, timely initiation and receipt of guideline-concordant treatment, and survival among individuals newly diagnosed with non-small cell lung cancer.
Authors: Zhao Jingxuan , Graetz Ilana , Howard David H. , Han Xuesong , Zhang Lu , Yabroff Robin , Lipscomb Joseph
Published: September 2024

47

Background:
Medicaid expansion under the Patient Protection and Affordable Care Act improved health insurance coverage among patients with cancer. Individuals with non-small cell lung cancer (NSCLC) may benefit from Medicaid expansion throughout the cancer control continuum. This study examined the associations of Medicaid expansion with stage at disease diagnosis, timely initiation and receipt of guideline-concordant treatment, and five-year overall survival among individuals with NSCLC.
Methods:
We identified individuals newly diagnosed at age 18-64 with stages I-IV first primary NSCLC between January 1, 2008 and December 31, 2019 in 50 states and Washington, D.C. from the National Cancer Database (n=332,368). We examined the associations of Medicaid expansion with (1) diagnosis stage, which was categorized into early (I&II) and late (III&IV); (2) timely initiation of guideline-concordant treatment within 30 days after cancer diagnosis (yes/no); (3) receipt of guideline-concordant treatment (yes/no) derived from the National Comprehensive Cancer Network cancer treatment guidelines; and (4) five-year overall survival. We applied a difference-in-differences (DD) approach to examine the changes in study outcomes associated with Medicaid expansion, controlling for key sociodemographic and clinical factors.
Results:
The percentage of early-stage diagnoses increased from 23.1% pre-expansion to 31.9% post-expansion in expansion states and from 22.3% to 29.5% in non-expansion states, translating to greater increase of 1.7 (95% confidence interval (CI): 0.3-3.1) percentage points (ppt) in expansion states after adjustment (Table). Medicaid expansion was also associated with greater increases in timely initiation of guideline-concordant care (DD: 1.6 (95% CI: 0.1-3.1) ppt) and five-year overall survival (DD: 1.3 (95% CI: 0.7-1.9) ppt).
Conclusions:
Medicaid expansion may improve access to NSCLC care and outcomes across the cancer control continuum, from early-stage diagnosis, treatment initiation, and overall survival.

Association of Medicaid expansion and study outcomes among NSCLC patients.

Expansion States
Non-expansion States

Pre-ME
Post-ME
Difference
Pre-ME
Post-ME
Difference
DD
Adjusted DD

Early-stage diagnosis
23.1
31.9
8.7 (7.4 to 10.1)
22.3
29.5
7.2 (6.2 to 10.1)
1.5 (-0.1 to 3.2)
1.7 (0.3 to 3.1)

Timely initiation of guideline-concordant care
31.3
27.5
-3.9 (-5.3 to -2.4)
33.4
27.8
-5.6 (-6.24 to -2.4)
1.7 (0.1 to 3.3)
1.6 (0.1 to 3.1)

Receipt of guideline-concordant care
65.2
68.2
2.9 (1.8 to 4.0)
62.9
66.4
3.5 (2.7 to 4.0)
-0.6 (-2.0 to 0.8)
-0.2 (-1.7 to 1.3)

Five-year survival
21.3
34.8
13.5 (13.1 to 13.9)
18.6
30.2
11.6 (11.1 to 12.2)
1.9 (1.2 to 2.5)
1.3 (0.7 to 1.9)

Abbreviation: ME, Medicaid expansion.
Moderating effects of organizational minority representation on racial and ethnic differences in early palliative care receipt among patients diagnosed with advanced cancers in 2010-2019 in the US.
Authors: Hu Xin , Jiang Changchuan , Kwon Youngmin , Fan Qinjin , Shi Kewei Sylvia , Zhao Jingxuan , Warren Joan , Yabroff Robin , Han Xuesong
Published: September 2024

52

Background:
Early palliative care (PC) is recommended for advanced cancers, but differential use has been documented by race and ethnicity. We examined whether racial and ethnic differences in early PC use were moderated by organization-level proportions of minority patients served.
Methods:
We identified patients aged ≥65.5 years diagnosed with advanced-stage breast, colorectal, non-small cell lung (NSCL), small cell lung (SCL), pancreas, and prostate cancers in 2010-2019 with ≥6 months survival and continuous fee-for-service coverage from the SEER-Medicare data. Early PC was identified by PC encounter diagnosis codes or hospice and palliative medicine (HPM) specialty codes within 90 days post-diagnosis or up to first hospice admission date. Treating physicians and organizations were assigned based on the plurality of visits within 180 days surrounding diagnosis. Using patient race and ethnicity information, organizations were classified based on the percent of racial and ethnic minorities patients (Low<10%, Medium 10-19%, and High Minority-Serving ≥20%). Multivariable logistic models assessed interacting effects of organizations’ minority representation and individual race and ethnicity on early PC receipt, adjusting for patient characteristics.
Results:
Among 102,060 patients treated at 8,039 organizations, the percent receiving early PC increased from 1.44% in 2010 to 10.30% in 2019. High Minority-Serving organizations were larger size and more likely to employ a HPM specialist and to treat a higher proportion of patients in metropolitan but lower socioeconomic areas, and were dually Medicare-Medicaid eligible. After adjusting for patient characteristics, Hispanic patients were 1.6 percentage points (ppts, 95%CI=-3.1, -0.1) less likely to receive early PC than Non-Hispanic (NH) White patients in Low Minority-Serving organizations. In High Minority-Serving organizations, Hispanic and NH Black patients were 0.8 ppts (95%CI=0.1, 1.6) and 1.6 ppts (95%CI=1.0, 2.3) more likely to receive early PC than NH White patients. (Table).
Conclusions:
Racial and ethnic minorities were more likely to receive early PC than NH White at High Minority-Serving organizations but not Medium/Low Minority-Serving organizations. System-level factors may be modified to narrow racial and ethnic differences in early PC use.

Adjusted difference in early palliative care by race and ethnicity.

Organization Minority Representation
Individual
Adjusted Probability Difference (95% CI)

Low

NH White

Ref

Hispanic
-1.6 (-3.1, -0.1)

NH Black
0.01 (-1.7, 1.7)

Other/Unknown
1.1 (-1.2, 3.4)

Medium

NH White

Ref

Hispanic
-0.6 (-1.7, 0.5)

NH Black
-0.8 (-1.7, 0.2)

Other/Unknown
0.4 (-0.9, 1.7)

High

Non-Hispanic White

Ref

Hispanic
0.8 (0.1, 1.6)

NH Black
1.6 (1.0, 2.3)

Other/Unknown
-0.3 (-1.1, 0.4)
Improving advance care planning outcomes through social work and provider collaboration.
Authors: Marcouiller Nicole , Dey Debbie , Mills Lydia
Published: September 2024

55

Background:
For many patients living with a life-limiting illness, the ability to have authority in their end-of-life (EOL) decision making is a foundational aspect in achieving a peaceful passing. Literature shows, however, that a low percentage of adults in the United States have completed advance directive documents or had discussions indicating their wishes for EOL care. With their unique communication and advocacy skills, licensed masters-prepared social workers (MSWs) are primed to play an active and effective role in Advance Care Planning (ACP) discussions with patients. The purpose of this study aimed to explore the extent to which MSWs in an oncology setting are harnessing these skills.
Methods:
An online survey was dispersed to social workers working in outpatient oncology clinics in The US Oncology Network. The survey reviewed the level of education, licensure status, involvement and comfort with ACP discussions, and factors that would aid increased engagement of these conversations.
Results:
41 out of 75 social workers completed the survey. 95% of respondents were masters prepared (MSW) and licensed at the masters (27%) or clinical (73%) level. Of these MSWs, 95% are having ACP conversations with their patients and loved ones, and 87% are initiating these discussions independently. Although 64% report that they are getting referrals from physicians in their practice, almost half (49%) indicated they would like more support from physicians around ACP conversations with patients. Per respondent comments, a need was expressed for providers to help initiate and normalize ACP discussions. It was also indicated that MSWs do not believe providers fully understand MSWs ability to engage in these discussions. Interestingly, only 10% of MSWs are billing for ACP discussions, yet 46% indicated they would be interested in doing so.
Conclusions:
Our results indicate there is a gap between the work MSWs are doing in the ACP space and how providers are utilizing the MSW’s clinical expertise in this area. The use of MSWs in a cancer care setting can enhance patient self-determination and documentation of wishes for EOL, as well as support multidisciplinary care of the patient. Additional benefits could include improvement of ACP quality measures, increased revenue, and provider satisfaction in knowing these sensitive conversations are being addressed by a trusted member of the healthcare team.
Adherence to guideline-recommended cardiac screening in Medicaid-enrolled survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).
Authors: Hu Xin , Castellino Sharon M. , Srivastava DeoKumar , Nathan Paul C. , Armstrong Gregory T. , Mertens Ann C. , Kirchhoff Anne C. , Ji Xu
Published: September 2024

56

Background:
Childhood cancer survivors face increased risks of heart failure and myocardial dysfunction associated with cancer treatment exposure. Children’s Oncology Group (COG) guidelines recommend periodic cardiac screening for survivors exposed to anthracycline or radiation. However, the extent of adherence to cardiac screening among Medicaid-enrolled survivors—a group typically characterized by socioeconomic disadvantages—remains unclear. Additionally, as Medicaid expansion under the Affordable Care Act has occurred in most, but not all states, cardiac screening adherence may vary based on survivors' state of residence.
Methods:
Data from the CCSS were linked to administrative Medicaid insurance claims from 2015 to 2019. We included at-risk survivors (i.e., received radiation to chest or heart, total body irradiation, and/or anthracyclines), aged 18-64 years, continuously covered by Medicaid during 2015-2019, and without a history of grade 3-4 cardiovascular conditions by 2019 to ensure the identified cardiac tests were for screening purposes. Our primary outcome assessed adherence to COG guidelines (V4.0) based on age- and therapy dose-specific frequency of cardiac testing (i.e., echocardiogram, multigated acquisition scan, or magnetic resonance imaging) during the study period. Multivariable logistic models assessed sociodemographic, clinical, and policy-related factors associated with adherence, with adjusted probability differences (i.e., marginal effects [MEs]) reported.
Results:
We identified 1,062 survivors at risk of cardiovascular conditions, with 57.0% female, 52.8% young adults (ages 18-39 years), and 72.8% non-Hispanic White. During 2015-2019, 285 (26.8%) survivors received any cardiac test, and 102 (9.6%) adhered to COG guideline-based frequency of cardiac testing. In multivariable models, survivors residing in states that expanded Medicaid in 2014 and later has 4.3 percentage points (ppts, 95% CI=0.58.1,
p
=0.025) and 6.1 ppts (95% CI=0.611.6,
p
=0.031) increased likelihood of adhering to guideline-based frequency of cardiac testing respectively compared to states that did not. Compared to leukemia survivors, the likelihood of adhering to guideline-based frequency of cardiac testing was higher in survivors of central nervous system tumors (ME=7.6 ppt, 95% CI=2.712.6,
p
=0.002), Hodgkin lymphoma (ME=10.7 ppt, 95% CI=1.320.1,
p
=0.026), and non-Hodgkin lymphoma (ME=9.4, 95% CI=1.017.8,
p
=0.028).
Conclusions:
Adherence to risk-based cardiac testing is low among Medicaid-enrolled survivors of childhood cancer, and associated with residence in a Medicaid expansion state and cancer type. Policy reforms toward improving affordable, continuous health insurance coverage are important means to increase adherence to guideline-based cardiac tests among survivors.
Assessing and enhancing legal literacy in cancer care: A nationwide analysis of a training intervention for healthcare workers.
Authors: Chen Krista , Blackford Amanda L. , Bryant Monica Fawzy , Morales Joanna , Rocque Gabrielle Betty , Hussaini S. M. Qasim
Published: September 2024

6

Background:
We previously showed the significant extent to which legal barriers requiring appropriate navigation are encountered by patients with cancer and their caregivers. Despite this, structured training on legal topics is not offered for healthcare workers (HCW). We performed a nationwide analysis to ascertain baseline legal knowledge in HCWs, and investigate the impact of a training program aimed at improving knowledge gaps in legal, financial, and social services navigation.
Methods:
This is a retrospective analysis of HCWs participating in legal and financial training sessions from 2021-2023 led by attorneys from Triage Cancer, a nonprofit organization providing free education on legal issues that impact individuals with cancer. Pre-training surveys assessed baseline knowledge, comfort, and frequency with which HCWs counseled patients with cancer, on legal barriers. Impact of training was evaluated via surveys at 1 week and 6 months post-training. Survey scores were descriptively analyzed to summarize changes in knowledge compared to baseline. Paired t-tests evaluated self-rated competence before and after legal training.
Results:
The pre-intervention survey was completed by 2141 HCWs who were primarily White (63.9%), female (89.8%), and social workers (39.3%) during the most recent survey year. HCWs served patients of ≥20 cancer types including breast (33.4%), hematologic (12.7%), and lung (6.9%), and reported assisting patients with health insurance options (82.6%), financial navigation (53.3%), and disability insurance claims (46.5%). Only few HCWs reported feeling “comfortable” or “very comfortable” assisting patients with health insurance (22.1%), finances (17.2%), or disability insurance (9.5%). The 1-week and 6-month post-intervention surveys were completed by 852 and 211 individuals, respectively, and standardized questionnaire scores demonstrated improvement in tested knowledge from baseline (26% questions correct) to 1-week (67.5%) and 6-month (35%) follow-up. Self-rated improvement in HCW competence following intervention at 1-week (surveyed using 10-point scale, mean improvement 3.14, 95% CI [3.05, 3.25]) and 6-months (corrected mean improvement 2.52 [2.29, 2.75]) were significant (p < 0.001 for both). At 6-month follow-up, 90.5% of surveyed HCWs reported changing behavior or practice based on the training, noting the education facilitated patient care through navigation of health and disability insurance and appeals; reducing financial burden, stress, and anxiety; and improving quality of life (Likert scales ranged 3.17-3.41 with 3 for Agree and 4 for Strongly Agree).
Conclusions:
This study showcases the necessity, success, and practicality of implementing a legal training for HCWs who note high frequency of legal concerns from their patients, but lack the comfort or expertise in appropriately navigating these.
Impact on ambulatory palliative appointment lead times by standardizing scheduling protocols based on cognitive computing models.
Authors: Sidle Erin , Georges Juanita , Rodriguez Elizabeth , Viveros Stefany , Mendoza Giselle , Hood Jennifer , Morrow Jason , Poland Jared , Martinez Nicolina , LaCoss Jennifer , Cervantez Sherri Rauenzahn
Published: September 2024

62

Background:
Although palliative care is available across the United States, access continues to remain variable. In Texas, only 52% of hospital systems have palliative services. As a result, optimizing existing systems is critical to providing timely services to this vulnerable population. The Supportive Care Services Clinic at University Health in San Antonio, TX provides ambulatory palliative services to patients including physical and psychosocial symptom management and care coordination. For the period April 1, 2023 to June 30, 2023 average lead times for new palliative patient visits (NPPV) and hospital consult discharge visits (HCDV) was 53 days and 39 days respectively. The aim of this project was to decrease the lead times for NPPV and HCDV through standardization of scheduling criteria. We hypothesized that by applying a scheduling protocol utilizing cognitive computing models (CCM) calculating readmission risk scores to prioritize referrals, we could reduce appointment lead times.
Methods:
During the implementation phase, we developed referral triage criteria to prioritize patients on a scheduling wait list, including patients who were at higher risk of hospitalization or rapid decline based on CCM readmission risk scores calculated within the electronic medical record. Patients were assigned to next available in template. If a cancelation occurred, patients were pulled forward and vacancy was filled based on priority score.
Results:
For the initial post-implementation period between September 1, 2023 and November 30, 2023 NPPV average lead time was 47 days which was a reduction of 11% from baseline. The average lead time for HCDV was 33 days which was a reduction of 15% from baseline. In a second follow-up period from February 1, 2024 to April 30, 2024, the average lead time of NPPV was 22 days, a 58% decrease from baseline. The average lead time for HCSV was 24 days which was a significant reduction (p-value = 0.011) of 38% from the pre-implementation baseline.
Conclusions:
Utilization of CCM risk scores to triage NPPV and HCDV significantly reduced the lead times and resulted in more timely services for critical patients. We also noted increased template utilization. Future projects aim to study the effects of scheduling protocols on template utilization, cancellation rates, no-show rates, readmission rates and other health care utilization.

Palliative appointment lead times.

April-June 2023
Sept-Nov 2023
Feb-Apr 2024

Total Pt Seen
292
364
534

Avg Lead Time (d)
41
38
29

New Patient

New Patient

New Patient

Completed
66
82
74

Avg Lead Time (d)
53
47
22

Hospital Discharge

Hospital Discharge

Hospital Discharge

Completed
27
28
25

Avg Lead Time (d)
39
33
24
Blue-button: A tool for institution-agnostic, EHR-integrated regional clinical trial matching.
Authors: Shriver Sharon , Semy Salim , Lister Zach , Arafat Waddah , Fleury Mark
Published: September 2024

65

Background:
Research indicates that most people with cancer are willing to enroll in clinical trials when offered the chance, but only 7% actually participate in cancer treatment trials. Barriers to screening and enrollment include time and effort for providers to screen patients for trials, and lack of awareness of available regional trials. Stakeholders recommended creation of free, automated screening tools and processes integrated into provider workflows, directly interfacing with site electronic health records (EHRs), that would search for regional trial eligibility. The need for such tools was independently identified in a large national survey of oncology providers.
Methods:
The Blue-button tool was developed to automatically identify relevant, regional clinical trials. A collaboration between ACS CAN and MITRE, a not-for-profit organization working in the public interest, created the tool’s functionality. Clinical workflow and research protocol were developed in collaboration with University of Texas Southwestern Simmons Comprehensive Cancer Center. This SMART-on-FHIR application works within existing EHR systems by automatically extracting and sending limited, deidentified patient data elements to third-party trial matching services via the FHIR mCODE standard, a core set of non-proprietary, open-source structured data elements that establishes minimum standards for the structure and content of oncology data in health records. Potential trial matches within a specified radius of the practice are returned in a standard format using the FHIR Research Study resource.
Results:
Blue-button extracts limited patient data from EHR and provides it in an interface allowing users to update data before sending to trial matching services. Only non-identifiable information is sent to the external clinical trial matching services, which then return prescreen trial matches for manual review to confirm patient eligibility. Thus, with a few clicks in a medical record, the tool quickly identifies comprehensive trial availability within a specified distance of the patient’s location. When used by providers, Blue-button reduces the manual burden that often prevents consideration of clinical trials and identifies regional opportunities beyond the treating institution.
Conclusions:
Successful feasibility testing demonstrated the effectiveness of automated regional trial screening as a model. We have launched a clinical trial at two sites to assess the effectiveness of the Blue-button tool with patients in healthcare settings. We expect patient enrollment to continue through part or all of 2025. This trial of the Blue-button tool will provide additional information on provider accessibility and uptake and will demonstrate whether EHR-integrated regional trial screening leads to increased opportunities and enrollment in cancer clinical trials.

Clinical trial information:
NCT05885880

.
Talk to Me: A social media campaign about clinical trials tailored to the needs of young adults with cancer.
Authors: Fedorko Victoria , Khurana Rhea , Walker Desiree , Rosen Allison , Fraser Maria , Basch Corey H. , Kahn Justine , Eisenberger Meital , Beauchemin Melissa P. , Hillyer Grace
Published: September 2024

67

Background:
Among adolescents and young adults (AYAs; 15-39 years) with cancer, clinical trial enrollment (CTE) rates range from 3% to 14%. Patient-directed interventions to improve CTE are rare. Internet-based interventions, while feasible and acceptable to AYAs with cancer, often lack patient input and engagement that are critical to success. AYAs are digital natives and report that the internet and social media are the two most important sources of health-related information. We leveraged AYA engagement with social media and designed a mixed methods research study, "Talk to Me," to create targeted social media messages to increase awareness about CTE for AYAs with cancer.
Methods:
Our interdisciplinary study team includes clinicians, researchers, health educators, and AYA patient advocates. We conducted 5 focus groups among a demographically, clinically, and geographically diverse group of AYAs with cancer (n=35) to identify priority topics to 1) inform the development of social media message libraries to address informational gaps and dispel myths surrounding CTE and 2) guide implementation strategies of these messages. Design mock-ups and color palettes were co-designed and co-developed with focus group participants and patient advocates through iterative feedback.
Results:
Guided by qualitative findings, social media posts were categorized into "introduction", "knowledge dissemination", and "addressing social, cultural, emotional, and financial issues" related to CTE. Instagram was selected to host our messages as the demographics of users most closely matched that of our target audience. Hashtags were carefully chosen based on existing posts of related material on Instagram. Links to trusted sources for additional information were embedded in the post descriptions and housed in a
linktr.ee
bio-landing page. The campaign was officially launched on Instagram in April 2024. We posted 3 times a week in both English and Spanish and monitored metrics biweekly to assess engagement and reach. Over nearly 2 months, 42 messages were posted, 116 users followed the account, 656 accounts were reached, 108 accounts were engaged, and 432 visited our profile page. Engagement peaked in Week 2 with 238 accounts reached and in Week 6 with 119. Overall, there were 173 likes (English=128, Spanish=43).
Conclusions:
An interdisciplinary, patient-informed, iterative approach to developing a social media knowledge intervention demonstrates a robust, methodologic approach to developing acceptable information and messages for AYAs who may consider participating in clinical trials.
Barriers to participation by minorities in oncology clinical trials.
Authors: Menendez Alvaro G. , Agrawal Vedika , O'Sullivan David M
Published: September 2024

68

Background:
Clinical trial (CT) diversity remains low despite numerous countermeasures. We investigated barriers to CT participation in our racially/ethnically diverse cancer population while considering loco-regional differences.
Methods:
An IRB-approved 32-item survey was administered to eligible patients in English or Spanish depending on patient preference. Comparisons were made between groups with ANOVA for age and chi square tests for categorical variables using an alpha of 0.05.
Results:
276 responses were analyzed. Spanish-speaking (“Spanish”) respondents were younger, with 29.5% between 31–49 yrs. [vs. 13.3% of English-speaking (“English”) respondents] and 15.8% were >70 yrs. (vs. 28.2%; p=0.004). 41.1% and 27.4% of Spanish respondents were single and married, respectively, compared to 19.9% and 49.7% of English respondents (p<0.001). 32.7% of Spanish respondents had attended and/or graduated college vs. 72.1% of English respondents. 79.6% of English respondents were born in one of the 50 US states (vs. 8.4% of Spanish respondents), while 58.9% of Spanish respondents were born in Puerto Rico. 4.2% of Spanish respondents preferentially spoke English at home. There was no association between CT awareness/invitation to participate and previous diagnosis of cancer, nor between CT awareness and place of birth. However, differences between English and Spanish respondents were observed (Table). Additionally, insurance coverage showed a significant difference among all respondents, with respondents on private insurance more likely to have heard about CT than those with public or no insurance (51.3% vs. 16.4%, resp.; p<0.001). Invitation to participate in CT was higher in the English group (p=0.002), although there was no difference among Hispanics who spoke English at home (p=0.420). Place of birth remained statistically significant for CT participation; 87.5% of those offered were US born (p=0.020).
Conclusions:
CT awareness continues to be higher in English-speaking cancer patients, and those with private insurance. Inequalities appear to be minimizing in Hispanics with certain acculturation degree. However, CT offering continues to exclude Hispanics, even those who have adopted English as primary language, regardless of place of birth. These findings support efforts to increase CT education in minority populations, and demonstrate certain healthcare bias for CT offering which will need to be addressed to guarantee CT diversity and health equity.

Clinical trial (CT) awareness.

Variable/characteristic
English-speaking
Spanish-speaking
P value*

Sample size
181 (65.6%)
95 (34.4%)

---

CT awareness
153/161 (95.0%)
33/85 (38.8%)

<0.001

CT awareness among Hispanics
11/14 (78.6%)
30/80 (37.5%)

0.007

*bold denotes statistically significant at p<0.05.
Getting a colonoscopy at The Valley Hospital.
Authors: Santana-Joseph Sobeida , Lamo Antoneta
Published: September 2024

71

Background:
Colorectal cancer (CRC) is the 3rd most common cancer in the U.S., yet it is preventable with evidence-based strategies such as early screening. The Valley Hospital (TVH) located in Bergen County NJ, is recognized for its high insured payer mix and median household income. According to the 2016 TVH Community Health Needs Assessment, only 71.4% of patients in TVH service area have had a CRC screening. The American Cancer Society National Colorectal Cancer Roundtable (NCCRT) campaigned to reach CRC screening rates of 80% and higher in communities across the nation. The Fast Track Screening Colonoscopy Program (FTSCP) at TVH was created to streamline the process of obtaining a screening colonoscopy and reach the NCCRT’s goal. Through the FTSCP, patients can omit the initial consultation with a gastroenterologist or colorectal surgeon. Patients are instead screened via a telephone call by a Physician Assistant (PA) or Advanced Practice Nurse (APN). The FTSCP is cost effective for patients as it potentially eliminates the initial consultation copayment and/or coinsurance.
Methods:
The purpose of the FTSCP is to achieve the NCCRT’s 80% goal of CRC screenings in TVH service area. An interdisciplinary team of gastroenterologists, colorectal surgeons, oncologists, anesthesiologists, and administration collaborated to create the FTSCP. A screening questionnaire was developed using the Lincoln Hospital in NYC’s existing criteria for patients who are eligible for a direct endoscopy referral. The questionnaire criteria ensures patients are safe to eliminate the initial consultation. A PA or APN determines the patients’ eligibility for the FTSCP over a screening telephone call. To qualify, patients cannot have significant medical comorbidities or exhibit signs or symptoms of CRC. If deemed eligible, the PA or APN sends a bowel preparation prescription to the patient’s pharmacy, reviews the instructions with them, and meets with them on the day of the procedure at TVH to perform a pre-procedural physical exam. To promote awareness and education of the FTSCP, multiple ongoing outreach events are held in the community. Patients also learn about the FTSCP through primary and specialty care referrals.
Results:
Since the inception of FTSCP in 2018, over 1300 patients have been screened for CRC. Additionally, adenocarcinomas, carcinoid tumors and tubular adenomas with high grade dysplasia have been detected. 394 tubular adenomas (30%) were identified and removed. In 2018, 59 patients were screened. The number of patients increased by 500% to 296 in 2023. The 2022 TVH Community Health Needs Assessment showed an increase to 79.6% of patients in TVH service area who have undergone CRC screening.
Conclusions:
The FTSCP at TVH is maximizing patient’s access to the prevention and timely screening for CRC. Additionally, TVH’s relocation from Ridgewood, NJ to Paramus, NJ offers further opportunities to educate a new community on CRC prevention.
Leveraging a geographic information system (GIS) to identify lung cancer care disparities and opportunities in rural Appalachia.
Authors: Lile Ashley , Gieske Michael , Phillips Serena , Harvey Allison , Crabtree-Ide Christina R. , Bittner-Fagan Heather , Bell Ronny A. , Reid Mary E. , McCauley-Hixenbaugh Lauren , Futrell Michelle , Kisiel Molly , Plotkin Elana
Published: September 2024

78

Background:
The Rural Appalachian Lung Cancer Screening Initiative is led by the Association of Cancer Care Centers (ACCC) and patient advocacy partners. Recognized by the White House Cancer Moonshot, this initiative seeks to improve lung cancer screening rates by partnering with health systems in rural Appalachia to develop and implement interventions. An 11-county region bordering West Virginia, Virginia, and Kentucky has significantly higher mortality and lung cancer incidence rates than the national rates of 35.0 and 54.0 per 100,000 people, respectively (Table 1). This region was identified as the focus area for the initiative with participation from health systems in Pike County, KY, and Buchanan County, VA.
Methods:
To understand availability of local resources, ACCC developed an interactive GIS tool that identifies screening and referral locations as well as essential services in the region. Lung cancer screening sites, oncology services, mammography locations, critical access hospitals, NCI-designated cancer centers, federally qualified health centers (FQHCs) and look-alikes, rural health clinics, and primary care/general health services were identified from publicly available data and data requested from state departments of health. Facilities were contacted to verify services when unclear. STATA 18 was used to combine and clean data for upload to Google MyMaps, creating an interactive map.
Results:
Of the 11 counties, all contain at least 1 FQHC or primary care site. However, 5 of the counties do not have lung cancer screening sites and 7 of the counties do not have oncology service sites (Table). The closest NCI-designated cancer centers to the participating sites are over 140 miles away.
Conclusions:
While there is a notable presence of primary care, access to lung cancer screening and oncology care is limited. Sites can utilize this map to inform development of interventions by considering potential geographical challenges, identifying referral sites, outreach opportunities, and partners to facilitate lung cancer screening and education. Further, these methods are replicable, and can be used to inform current access to care and improve equitable delivery of lung cancer screening in regions across the U.S.

Distribution of lung cancer mortality, incidence, and infrastructure within initiative focus region.

Region
Mortality*(per 100,000)
Incidence*(per 100,000)
# Lung Cancer Screening Sites
# Oncology Services Sites

KY (1 county)
70
109.3
2
2

VA (6 counties)
45.0 – 61.4
42.9 – 68.6
4
3

WV (4 counties)
57.6 – 74.8
100.4 – 111.5
1
0

*Lung & Bronchus, 2016-2020 age-adjusted death rates (KY, VA, WV) and incidence rates (KY, WV). Lung & Bronchus, 2015-2019 age-adjusted incidence rate (VA). Source: statecancerprofiles.cancer.gov.
Enhancing referral practices: A bariatric department's education initiative to reduce unnecessary referrals to hematology oncology.
Authors: Synnamon Jenna , O'Neil Abbegail , Buczek Alexandra , Brennan Patricia , Harris Eleanor Elizabeth
Published: September 2024

82

Background:
Bariatric surgery patients face an elevated risk of iron deficiency anemia. Referrals from the Bariatric department to Hematology Oncology for work up of these anemias strain clinic resources and delay timely care for cancer patients. We initiated a targeted education program to reduce unnecessary referrals from the Bariatric department to Hematology Oncology by raising awareness among staff about appropriate referral criteria.
Methods:
We developed a curriculum highlighting the differences between symptoms of bariatric surgery complications and hematologic malignancies. Interactive training sessions were held with Bariatric department staff, supplemented by informational materials. Case studies and real-world examples reinforced understanding and decision-making. Staff were also educated on managing iron deficiency anemia internally. Referral rates were tracked before and after the intervention.
Results:
Baseline data were collected from July 2023 to November 2023, showing an average of 17 referrals per month (85 total over 5 months). The educational initiative included three sessions in December 2023 on anemia management and referral criteria. These sessions highlighted the distinction between symptoms of bariatric complications and hematologic malignancies, as well as education to the bariatric surgery providers on management of hematologic diagnoses resulting from bariatric surgery. Post-intervention data from January 2024 to May 2024 showed a substantial reduction in referrals for bariatric-related iron deficiency anemias to an average of 4.4 referrals per month (22 total over 5 months), indicating a 74% reduction. Improved internal management of iron deficiency anemia contributed to this outcome. The percentage of cancer patients receiving a consult within 7 days of referral contemporaneously improved from 85.7% to 88.1%, indicating improved access to oncology care.
Conclusions:
The educational intervention significantly reduced unnecessary referrals from the Bariatric department to Hematology Oncology, improving access for cancer patients. Empowering staff with the knowledge to make informed referral decisions and manage common hematologic issues internally improved patient care and clinic efficiency, reducing healthcare costs and patient burden in both departments.
Is federal housing assistance associated with earlier-stage cancer diagnosis? Evidence from the new SEER-Medicare and US Department of Housing and Urban Development data linkage.
Authors: Yabroff Robin , Blackford Amanda L. , Fan Qinjin , Hussaini S. M. Qasim , Chen Katherine L. , Polsky Daniel , Katana Ogongo Margaret , Warren Joan , Gross Cary Philip , Pollack Craig Evan
Published: September 2024

85

Background:
Despite growing awareness that stable and affordable housing is a key social determinant of health, little research has examined the role of federal housing assistance in cancer outcomes. This study uses a novel data linkage to examine the association of federal housing assistance (i.e. various rent subsidy programs) on stage at diagnosis for the 4 most common cancers in the US.
Methods:
Individuals aged 66-95 years newly diagnosed with breast, colorectal, non-small cell lung (NSCLC) or prostate cancer in 2006-2019 with fee-for-service coverage were selected from SEER-Medicare Housing and Urban Development (HUD) administrative data. After identifying individuals with housing assistance at diagnosis, controls without housing assistance at diagnosis were propensity score matched in a 3:1 ratio by cancer site, age, sex, race/ethnicity, marital status, registry, year of diagnosis, area-level Yost socioeconomic status index, dual Medicaid eligibility, rural/urban residence, reason for Medicare entitlement, and pre-diagnosis comorbidity. Associations of housing assistance and diagnosis stage (SEER summary stage: localized vs. regional/distant) were examined with separate logistic regression models by cancer type.
Results:
A total of 7335 individuals with breast, 5660 with colorectal, 7399 with NSCL and 4309 with prostate cancer received housing assistance at diagnosis (Table). Compared to matched controls, a smaller percentage of individuals with housing assistance were diagnosed with regional/distant breast (36% vs. 33%), colorectal (59% vs. 57%), and NSCL (71% vs. 69%) cancers. Individuals receiving housing assistance were less likely to be diagnosed with later-stage breast (OR: 0.87; 95% CI: 0.83, 0.92) and NSCL (OR: 0.93; 95% CI: 0.88, 0.99) cancers. Housing assistance was not significantly associated with stage for individuals with colorectal or prostate cancers.
Conclusions:
Federal housing assistance is associated with earlier-stage breast and NSCL cancer diagnosis, highlighting its potential role in mitigating the adverse effects of housing insecurity on cancer outcomes.

Housing assistance and cancer diagnosis stage.

No Housing Assistance at Dx,N (%)
Housing Assistance at Dx,N (%)
OR [95% CI], P

Breast
Localized
14291 (64)
4890 (67)
1.0 (ref)

Regional/Distant
8179 (36)
2445 (33)
0.87 [0.83, 0.92] P<0.001

Colorectal
Localized
7046 (42)
2422 (43)
1.0 (ref)

Regional/Distant
9934 (59)
3238 (57)
0.95 [0.89, 1.01] P=0.09

NSCLC
Localized
6572 (30)
2298 (31)
1.0 (ref)

Regional/Distant
15625 (71)
5101 (69)
0.93 [0.88, 0.99] P=0.02

Prostate
Localized
10293 (80)
3401 (79)
1.0 (ref)

Regional/Distant
2634 (20)
908 (21)
1.04 [0.96, 1.14] P=0.33

Dx=Diagnosis; OR=Odds Ratio; CI=Confidence Interval.
Relationship between self-reported challenges with social determinants of health and delayed time-to-treatment initiation for gynecologic malignancies.
Authors: Nienaltow Tess , Davis Timothy , Mehta Vikas , Viswanathan Shankar , Zhang Chenxin , Cowan Matthew
Published: September 2024

90

Background:
Delays in time to treatment initiation (TTI) for gynecologic malignancies have been associated with worse survival. Worsened outcomes and presentation with more advanced disease are more common for gynecologic cancer patients who come from socioeconomically disadvantaged populations and whose healthcare is negatively impacted by their social determinants of health (SDoH). There is a need to characterize the particular social determinants of health that are associated with delays in treatment initiation in patients with gynecologic malignancy, particularly in underserved urban populations.
Methods:
Retrospective cohort study at an urban community-based academic center. Participants were 257 patients with primary gynecologic malignancy either of the cervix, ovary, uterus, vulva/vagina or NOS diagnosed between January 2017 and August 2022, identified through the Montefiore Medical Center Cancer Registry. The primary exposure was TTI, defined as the duration between histopathological diagnosis and initial treatment. Univariate and multivariate logistic regression analyses were conducted to examine the association between delays in TTI and SDoH. Multivariate Cox proportional hazard regression was used to obtain hazard ratios and 95% confidence intervals associated with TTI.
Results:
Among 257 patients with gynecologic malignancy (median [IQR] age 63 [56-72] years), 205 patients were treated within 45 days of diagnosis, and 52 were treated at or after 45 days. Predictors of delayed TTI (defined as ≥45 days) included positive SDoH screening in univariate logistic regression (OR = 3.12, 95% CI 1.39-6.98, p = 0.0061) and in multivariate logistic regression (OR = 3.06, 95% CI 2.62-3.57, p<0.001) as well as increased age in multivariate logistic regression (OR = 1.02, 95% CI 1.02-1.03, p<0.001). Multivariate logistic regression showed that protective factors for delayed TTI were Non-Hispanic Black race/ethnicity (OR = 0.87, 95% CI 0.77-0.99, p = 0.0351), non-Hispanic white race/ethnicity (OR = 0.37, 95% CI 0.30-0.46, p<0.001), inpatient stay within 30 days of diagnosis (OR = 0.74, 95% CI 0.62-0.88, p=0.001) and AJCC clinically late stage (OR = 0.57, 95% CI 0.50-0.66, p<0.001).
Conclusions:
In patients with gynecologic malignancies, greater SDoH burden increases risk for delays in treatment ≥ 45 days from diagnosis. Non-Hispanic race/ethnicity, inpatient stay within 30 days of diagnosis and clinically late-stage diagnoses are protective factors for expedited treatment initiation. Identification of predictive and protective factors for treatment delay will help identify at-risk patients and facilitate earlier intervention in hospitals with underserved populations.
Connections between kinks with different asymptotics
Authors: Gani Vakhid A. , Marjaneh Aliakbar Moradi
Published: September 2024

In this letter, we show how to build bridges between field-theoretic models that have kink solutions with different asymptotic behavior. We study transformational properties of kinks in models with a real scalar field in two-dimensional space-time. We show how to obtain new models with solitons having different asymptotic behavior, using deformations with specific functions. In particular, starting from the well-known

model, we obtain kinks with super-exponential, super-super-exponential, power-law, and logarithmic asymptotics. We also comment on how asymptotic behavior of stability potential and zero mode can be obtained for deformed kinks.
Immunofluorescent detection of protein CoAlation in mammalian cells under oxidative stress
Authors: Malanchuk Oksana , Khoruzhenko Antonina , Kosach Viktoriia , Bdzhola Anna , Bidiuk Dariy , Brett Charlie , Gout Ivan , Filonenko Valeriy
Published: September 2024

Previously, we reported the generation and characterisation of highly specific anti-CoA monoclonal antibodies capable of recognizing CoA in various immunological assays. Utilizing these antibodies in conjunction with mass spectrometry, we identified a wide array of cellular proteins modified by CoA in bacteria and mammalian cells. Furthermore, our findings demonstrated that such modifications could be induced by oxidative or metabolic stress. This study advances the utility of anti-CoA monoclonal antibodies in analysing protein CoAlation, highlighting their effectiveness in immunofluorescent assay. Our data corroborates a significant increase in cellular protein CoAlation induced by oxidative agents. Additionally, we observed that hydrogen-peroxide induced protein CoAlation is predominantly associated with mitochondrial proteins.
Axin1 regulates tooth root development by inhibiting AKT1-mTORC1 activation and Shh translation in Hertwig's epithelial root sheath
Authors: Zheng Xiaoyu , Huang Hongcan , Zhou Zhipeng , Guo Weihua , Yang Guobin , Chen Zhi , Chen Di , Chen YiPing , Yuan Guohua
Published: September 2024

Hertwig's epithelial root sheath (HERS) interacts with dental apical mesenchyme and guides development of the tooth root, which is integral to the function of the whole tooth. However, the key genes in HERS essential for root development are understudied. Here, we show that Axin1, a scaffold protein that negatively regulates canonical Wnt signaling, is strongly expressed in the HERS. Axin1 ablation in the HERS of mice leads to defective root development, but in a manner independent of canonical Wnt signaling. Further studies reveal that Axin1 in the HERS negatively regulates the AKT1-mTORC1 pathway through binding to AKT1, leading to inhibition of ribosomal biogenesis and mRNA translation. Sonic hedgehog (Shh) protein, a morphogen essential for root development, is over-synthesized by upregulated mTORC1 activity upon Axin1 inactivation. Importantly, either haploinsufficiency of the mTORC1 subunit Rptor or pharmacological inhibition of Shh signaling can rescue the root defects in Axin1 mutant mice. Collectively, our data suggest that, independently of canonical Wnt signaling, Axin1 controls ribosomal biogenesis and selective mRNA translation programs via AKT1-mTORC1 signaling during tooth root development.