bluuebunny/crossref_metadata_2025 huggingface dataset:
Frailty screening in head and neck cancer care: Implementation outcomes and clinician perspectives.
Authors: Brauer Eden , Lazaro Stephanie , Erman Andrew , Rapkin David , Jeong Jennifer , Surampudi Vijaya , Abemayor Elliot , Wong Deborah J.L. , St. John Maie
Published: October 2023

453

Background: Frailty is a complex medical syndrome characterized by an increased vulnerability to stressors, distinct from age or comorbidity. Among patients with head and neck cancers, frailty is a significant predictor of post-operative complications, reduced quality of life, and increased rates of morbidity and mortality. Despite these known risks, frailty status is rarely assessed in routine oncology care or considered systematically in treatment planning. In this study, we evaluated the implementation of a frailty screening protocol as a new standard of care for patients with head and neck cancers at a large academic medical center. Methods: Frailty screening was embedded into an existing telephone-based intake workflow for newly referred patients, using the patient-reported Risk Analysis Index (RAI). RAI data was scored, documented in the health record, and presented at weekly case conferences. To evaluate the implementation, medical record data, including frailty status and sociodemographic and clinical information, between August 2020 and November 2022 was abstracted, and feedback from clinicians was collected using a brief survey on perceived clinical value. For the chart review and clinician survey, quantitative data was analyzed using descriptive statistics; thematic analysis was used to identify key findings in the qualitative data. Results: During the evaluation period, 488 of 585 eligible patients completed the frailty screening questionnaire, resulting in a compliance rate of 83.4%. Of those screened, the mean age was 63.1 years (SD: 16.2), 64% were male, and 20.5% had > 3 comorbid conditions. For the total sample, the mean RAI score was 38.4 (SD: 6.52), with 43% deemed not frail, 52.7% frail, and 4.3% very frail. For the survey, the majority of respondents (11/14) believed that frailty screening added clinical value. Key qualitative themes emphasized how frailty screening facilitated a “whole patient” approach and a “valuable heads-up regarding a patient’s vulnerability.” Potential enhancements focused on making RAI data more clinically actionable. Conclusions: Overall, findings suggest that frailty is common in patients with head and neck cancer, and that frailty screening is achievable in routine care and provides clinical value to multidisciplinary oncology teams at the time of treatment planning. Future work may extend these findings to inform targeted pre-habilitation interventions for frail HNC patients and examine their impact on clinical outcomes.
Changes in primary care engagement and communication from breast cancer treatment to longer-term survivorship.
Authors: Mullins Megan A , Furgal Allison Kate Cullen , Hamilton Ann S. , Ward Kevin C , Radhakrishnan Archana , Wallner Lauren P.
Published: October 2023

475

Background: Primary care physicians (PCPs) have varying roles in a patient’s care across the cancer continuum. However, little is known about how PCP engagement and communication change over time in the transition from breast cancer treatment to longer-term survivorship. Methods: The iCanCare study is a longitudinal study of women diagnosed with breast cancer in 2014-15 identified in the Los Angeles and Georgia Surveillance, Epidemiology and End Results registries. Women were surveyed during initial treatment and again 6 years later during survivorship (2021-22) (Expected final N=1430, 60% current response rate). At both time points, respondents were asked to rate on a 5-point Likert scale, how often they talked with their PCP about their breast cancer follow up (communication), and how informed their PCP was about their breast cancer (engagement). Scores ³3 during initial treatment were considered strong. We then evaluated change in PCP engagement and communication over time from initial treatment to survivorship, with decreases reflecting worse engagement and communication. We evaluated factors associated with worse engagement and communication using multi-variable logistic regression modeling, adjusted for clinical and sociodemographic characteristics, PCP relationship, baseline communication/engagement, and COVID-19 impact. Results: In this sample of 807 women, most women reported strong PCP engagement (62.7%) and strong PCP communication (58.6%) during treatment. Over time, 40.4% reported worse PCP communication and 38.5% reported worse PCP engagement in survivorship compared to treatment(p<0.0001). Women who had comorbidities and women who changed their PCP between treatment and survivorship more commonly reported worse communication and engagement (p<0.05). Fewer women who had chemotherapy reported worse engagement and more Black and Asian women reported worse communication (p<0.05). Women who changed their PCP were more likely to report worse communication than women with the same PCP (adjusted Odds Ratio (aOR) 2.52, 95%CI: 1.52, 4.19). Women who had chemotherapy (vs. not) were less likely to report worse communication over time (aOR 0.59 CI 0.37, 0.95). Women who changed their PCP had higher odds of worse engagement over time compared to those with the same PCP (aOR 1.69, 95%CI: 1.05, 2.72). Women who had chemotherapy (vs. not) were less likely to have worse PCP engagement over time (aOR 0.59, 95%CI: 0.37, 0.92). Conclusions: In this population-based sample of breast cancer survivors, many women experienced worse communication and engagement with their PCP over time in survivorship, despite reporting high engagement and communication during initial treatment. Effective engagement and communication are key to delivery of high-quality survivorship care, thus future work focused on maintaining survivor-PCP relationships over time is needed.
Effects of treatment delays on lung cancer survival.
Authors: Guzman Percy , Segura Sharon , Halpern Michael T.
Published: October 2023

478

Background: Previous studies have established a link between treatment initiation delays and reduced overall survival in individuals diagnosed with lung cancer. These delays are often influenced by diagnostic complexities, logistical hurdles, and patient-related factors. However, the association between treatment delays and survival outcomes has yet to be extensively investigated using data from a large national cohort. This study aims to fill this research gap and provide unique insights into the relationship between treatment delays and lung cancer survival by utilizing data from a substantial national cohort. Methods: The study population consisted of 3,723 lung cancer patients participating in the NCI PLCO Cancer Screening Trial. Cox Proportional Hazards (PH) Regression analyses examined the time between cancer diagnosis and treatment initiation using several measures including intervals from tumor doubling/stage progression time models by Spratt et al. (1964) and Detterbeck et al. (2008). Analyses controlled for patient and clinical characteristics including age, sex, race/ethnicity, smoking status, histopathologic type, cancer stage, and treatment modality. Data analysis was conducted using Microsoft Excel, STATA, and IBM SPSS software. Results: PH Regression analyses demonstrated a clear association between longer time intervals from diagnosis to treatment initiation and increased risk of mortality. Patients with time intervals exceeding 20 days exhibited a hazard ratio (HR) for mortality of 1.21 (p < 0.001, 95% confidence interval [CI] 1.1158-1.3176).The Spratt tumor progression model, considering intervals exceeding 88 days, revealed a HR of 1.22 (p = 0.03, 95% CI 1.0146-1.4885). On the other hand, the Detterbeck model, which considered intervals exceeding 118 days, did not show a statistically significant association with increased mortality risk. Furthermore, PH analysis identified cigarette smoking status, marital status, and tumor grade as significant predictors of mortality risk. Conclusions: Data from a large national cohort study indicate that delays in lung cancer treatment initiation have detrimental impacts on survival. Treatment initiation shortly after diagnosis had the most significant differential impact on mortality risk. Timely initiation of treatment is of utmost importance and should be prioritized in lung cancer care. By addressing factors contributing to treatment delays, it is likely possible to improve the survival rates of patients with lung cancer.
Impact of survivorship care plans on mortality in a contemporary cohort of childhood cancer survivors.
Authors: Castellino Sharon M. , Ji Xu , Williamson Lewis Rebecca , Effinger Karen Elizabeth , Mertens Ann C.
Published: October 2023

481

Background: Childhood cancer and its treatment predispose survivors to the risk of late effects, resulting in debilitating and life-threatening diseases. The heterogeneous construction and dissemination of survivorship care plans (SCPs) have raised the question of their ability to improve the quality of cancer survivorship care. This study aims to determine what populations of eligible patients were seen in a pediatric cancer survivor program and received a personalized SCP; and to investigate the association between receiving a SCP and overall mortality. Methods: This retrospective cohort study included patients treated for a newly diagnosed cancer at Children’s Healthcare of Atlanta (CHOA) in 2002-2016 who were ≥2 years post-treatment and in remission (i.e., eligibility to be seen in the Aflac Cancer Survivor Clinic of CHOA). Descriptive analyses were conducted to examine SCP receipt between 01/01/2005 and 12/31/2020 and mortality through 12/31/2020 based on linkage to the National Death Index. A multivariable cox proportional hazard model was used to estimate the association between SCP receipt and mortality, controlling for sex, race/ethnicity, and treatment with chemotherapy and/or radiation therapy. Results: Among 3,394 eligible pediatric cancer survivors, 1,894 (55.8%) received a SCP at a median of 0.7 years (Q1-Q3: 0.3-1.7 years) from eligibility for survivorship clinic. Recipients of a SCP were younger at original diagnosis (mean ± SD age: 7.7 ± 5.6 vs. 9.1 ± 6.0 years), more likely to be diagnosed with leukemia (82.9%) or lymphoma (70.7%) vs. CNS tumor (29.4%) or other solid tumor (35.1%) (p<0.01), and more likely to have received chemotherapy (73.7% vs. 9.0%, p<0.01) or radiation therapy (69.4% vs. 52.0%, p<0.01). Overall, 3.4% of patients were deceased at the end of follow-up (median follow-up from eligibility: 7.0 [Q1-Q3: 4.0-10.8 years]). Receipt of a SCP was associated with an improvement in survival in multivariable model (adjusted hazard ratio: 0.31 [95% CI: 0.31, 0.46]). Conclusions: Overall survival was superior in survivors who received a SCP compared to those who did not. Longitudinal follow-up of this cohort enables us to examine patterns of death and healthcare utilization to delineate the effectiveness of survivorship care, and to further define lifetime risk after contemporary treatment.
Is YouTube a reliable source of information on chimeric antigen receptor T-cell therapy? An analysis.
Authors: Chahal Rutvi , Garg Tulika , Karass Susan Hosny , Khosla Atulya Aman , Singh Rohit , Sukaina Mahnoor , Mishra Rahul , Kutheala Nikhil , Singh Navpreet , Kaur Suhana Preet , Jain Rajat , Ahmed Shahid Sattar , Jatwani Karan
Published: October 2023

486

Background: YouTube is an open-access source of information with more than 2.5 billion users. It plays an important role in disseminating information especially related to health, including cancer. Chimeric antigen receptor-T (CAR-T) cell therapy has significantly improved outcomes for hematologic malignancies over recent years. We aim to assess the quality and engagement parameters of the 100 most viewed videos on YouTube on CAR-T cell therapy. Methods: A systematic search was conducted on YouTube using the search terms (“CAR-T Cell therapy” AND “Cancer”). One hundred most viewed videos in English were selected. We utilized the already validated tools PEMAT and DISCERN to assess the quality of these videos on CAR-T. Additionally, we looked at the number of views, comments, and likes. Descriptive statistics and Pearson correlation tests were performed using R studio v2022.12.0-353. Results: The videos in our study had up to 3.4 million views (median number of views:19901), and the overall quality of information was fair (50%) by the DISCERN score. These videos were categorized into different sources academic (60%), media (22%), and industry (18%). The mean DISCERN score (44.27± 10.8), mean PEMAT actionability (47% ± 38%), mean PEMAT understandability (75.6% ± 15.5%). While benefits were mentioned by 67%, only 29% discussed the risks of CAR-T Cell therapy; 37% of videos promoted shared decision-making, and only 10% summarized the information at the end. There was no significant correlation between DISCERN and PEMAT scores with video engagement parameters, including likes, views, and comments. Interestingly, only 30% of videos discussed other treatment options except for CAR-T. While 88% of videos used everyday language, medical terminologies were defined by 73% of videos; 32 % of videos were broken into short sections with informative headers. Conclusions: This is the first study to our knowledge evaluating the quality of information on CAR-T therapy on YouTube. Compared to historical studies on YouTube 1, this study shows the quality of the information provided in these videos is valid and reliable. They also prove to be actionable and understandable; these videos focus on the benefits of CAR-T cell therapy and are less likely to discuss risks or shared decision-making. Contrary to previous studies2, we believe YouTube videos on CAR-T Cell therapy may serve as a supplementary source of providing information to patients wishing to learn more on this topic. References: 1. Di Bello et al. Immunotherapy for Urological Tumors on YouTube: An Information-Quality Analysis, Vaccines 2023. 2. Steinberg et al. YouTube as Source of Prostate Cancer Information, Urology 2010.
Endocrine therapy initiation among women diagnosed with ductal carcinoma in situ breast cancer from 2001-2016.
Authors: Bowles Erin Aiello , Ramin Cody , Feigelson Heather S. , Gander Jennifer C , Veiga Lene H. S. , Bodelon Clara , Curtis Rochelle E. , Brandt Carolyn , Vo Jacqueline B , Berrington de González Amy , Gierach Gretchen
Published: October 2023

487

Background: Endocrine therapy (ET) initiation in people within 1 year of diagnosis of estrogen-receptor-positive (ER+) ductal carcinoma in situ (DCIS) has ranged from 21-45% in prior studies; however, these studies did not evaluate initiation post-2011 and may not reflect current patterns of use. ET use following ER+ DCIS diagnosis can reduce the relative risks of recurrence and contralateral breast cancer by 30-50%. We evaluated ET initiation over time and by demographic, tumor, and treatment characteristics in the Kaiser Permanente Breast Cancer Survivors Study between 2001-2016. Methods: We included people aged 20+ years diagnosed with unilateral DCIS with at least 1 year of cancer-free follow-up from three U.S. integrated health systems. We excluded people with ER-negative disease, no surgery, and those who received chemotherapy or unknown radiation therapy. ET dispensings (tamoxifen and aromatase inhibitors) were extracted from electronic pharmacy records within 1 year of a person’s initial DCIS breast cancer diagnosis. Using generalized linear models with a log link and Poisson distribution, we estimated relative rates (RRs) of ET use (vs none) over time and by demographic, tumor, and other treatment characteristics. Results: Among 1,782 pre- and postmenopausal people, 577 (32%) initiated ET within 1 year of diagnosis. From 2001-2016, ET use did not change over time (34% vs 36%), tamoxifen use declined slightly (34% vs 29%), and aromatase inhibitor use increased slightly (0% vs 7%). People were less likely to initiate ET if they were ≥65 years, Black, had borderline or unknown ER status, were not tested for ER, had breast conserving surgery (BCS) without radiation, or had a unilateral mastectomy. Conclusions: Only one-third of people with DCIS diagnosed in a community healthcare setting and potentially eligible for ET, initiated treatment within 1 year of their diagnosis. Previous studies have shown long-term benefits of ET use in people with DCIS; however, we saw no increase in use over time. Concerns about side-effects, overdiagnosis and overtreatment of DCIS, and confusion about treatment guidelines may explain relatively low ET initiation.[Table: see text]
Large language models encode medical oncology knowledge: Performance on the ASCO and ESMO examination questions.
Authors: Longwell Jack Bennett , Grant Robert C , Hirsch Ian , Binder Fernando , Jang Raymond Woo-Jun , Krishnan Rahul G.
Published: October 2023

511

Background: Chatbots based on large language models (LLM) recently developed an unprecedented ability to answer questions across a broad range of applications. Whether LLMs encode sufficient knowledge to answer questions about medical oncology, a highly specialized domain requiring rapid integration of new evidence, is unknown. Methods: We presented ChatGPT (GPT-3.5 and GPT-4) with the American Society of Oncology (ASCO) Self Assessment Program and the European Society of Medical Oncology (ESMO) Examination Trial questions, excluding those that included images or required knowledge unavailable before the algorithm’s training cutoff date. The proportion of correct answers was compared against random chance. ChatGPT was prompted again for a different answer if the previous was incorrect. The reasoning provided by ChatGPT was qualitatively evaluated by two medical oncologists. Results: ChatGPT (GPT-4) correctly answered 84.4% (38/45, 95% confidence interval [CI] 70.5-93.5%, P<0.0001 versus random answering) of ASCO and 86.7% (65/75, 95% CI 76.8-93.4%, P<0.0001) of the ESMO examination questions. GPT-4 outperformed GPT-3.5 (57.8% [26/45, 95% CI 42.2%-72.3%, P=0.001] for ASCO and 65.3% [49/75, 95% CI 53.5%-76.0%, P=0.004] for ESMO). Including second attempts, GPT-4 correctly answered 93.3% (42/45, 95% CI 81.7-98.6%) of ASCO and 93.3% (70/75, 95% CI 85.1-97.8%) of the ESMO examination questions. Incorrect responses for ASCO questions were more common in questions whose answers referenced papers published after 2018 (22.2% [4/18] versus 11.1%, [3/27], P=0.03). Oncologists rated the reasoning behind correct answers by GPT-3.5 as complete for 93.3% of questions (70/75, CI 85.1-97.8%). Conclusions: LLMs can answer examination questions designed for medical oncology fellows with impressive and improving accuracy, alongside correct reasoning. These results imply broad potential applications of LLMs during cancer care to improve the patient and provider experience.
Telemedicine electronic consenting preference among clinical trial participants.
Authors: Buckley Michael T. , Chimonas Susan , Shah Suken , Redelman-Sidi Yael , White Charlie , Seier Kenneth , Baser Raymond E , Kuperman Gilad , Panchal Renata , Lengfellner Joseph M. , Terzulli Stephanie Lucia , Sabbatini Paul
Published: October 2023

516

Background: Telemedicine (TM) disparities in the US during the pandemic are well-reported; however, its use by diverse participants providing electronic informed consent (eIC) for clinical trials in oncology remains unexplored. Our previous research found eIC comparable to in-person paper-based visits across participants: stress, technology burden, comprehension, and agency for complex clinical genetic and Phase I-II clinical trial discussions. Based on this work, we hypothesized that our implementation of eIC via TM would be well received, and we evaluated participant characteristics associated with their consent method preferences. Methods: Research participants with in-person clinic and TM eIC visits from Aug 2021- Jan 2023 received anonymous, uncompensated surveys electronically. We assessed age, sex, primary language, ethnicity, race, and 3 groups of survey questions generated from factor analysis: 1) TM usability, 2) TM satisfaction and 3) eIC process comfort (comfort using TM for eIC) (Table). A multivariable multinomial regression model evaluated associations between factors and eIC preference, a survey item assessing overall preference for eIC via TM or in-person or no preference. Results: Among 1,154 respondents (28% response rate), 52% preferred TM for eIC, 29% had no preference, and 19% preferred in-person. Respondent median age was 65; 51% were male; 97% English speaking; 6% were Hispanic; 84% White, 7.7% Asian-Far East/Indian Subcontinent, 5.3% Black, 2.6% other. Non-native English speakers (odds ratio (OR) 0.31; 95% confidence interval (CI) (0.1, 0.93), p=0.037) and Black participants (OR 0.37; 95% CI (0.16, 0.83), p=0.016) had decreased odds of preferring TM to in-person for eIC. Similarly, increased age (OR 0.98; 95% CI (0.96, 0.99), p=0.008) was associated with a decrease in no preference compared to in-person preference for eIC. Conclusions: Most participants preferred TM for eIC or had no preference. However, adjusting for eIC process comfort, TM satisfaction, and other demographics, participants who were Black, older, or non-native English speakers were more likely to prefer in-person for eIC. Our future research will target these areas to help support equitable consenting standards and care.[Table: see text]
Associations of comorbidities with telehealth use in cancer survivors amidst the COVID-19 pandemic: Findings from the HINTS 6 (2022).
Authors: Cho Youmin , Zhou Weijiao
Published: October 2023

522

Background: Cancer survivors with comorbidities often need specialized care. Telehealth, using remote technologies such as phone calls or video conferences, addresses their specific needs, particularly during the COVID-19 pandemic, offering time and cost savings. However, understanding of telehealth use among cancer survivors with comorbidities is limited. This study examines the associations between comorbidities and telehealth use in cancer survivors during the pandemic. Methods: We analyzed the Health Information National Trends Survey (HINTS) 6, a nationally representative survey conducted in 2022. This study included 4,756 adults aged ≥18 (representing 195 million), including 730 cancer survivors (representing 20 million) in the U.S. The outcome variable was telehealth use in the past 12 months, including video or phone call with healthcare providers. Comorbidities included diabetes, hypertension, heart conditions, lung diseases, and depression. Design-based F-test was used for bivariate analyses. Logistic regression was used to determine associations of comorbidities and telehealth use, controlling for sociodemographic and cancer-related clinical factors. All data analyses accounted for the complex survey design and sample weights using jackknife replication method. Results: Cancer survivors’ telehealth use was slightly higher than adults without cancer (50.37% vs. 43.62%). Among cancer survivors, bivariate analysis revealed associations between telehealth use and younger age and higher number of comorbidities (P<.001). These associations remained significant in the logistic regression model (OR=0.25 and 0.12, 95% CI 0.11-0.57 and 0.05-0.29 for ages 61-75 and >75, respectively; OR=1.65, 95% CI 1.32-2.07 for number of comorbidities; all P<.001). When examining specific comorbidities, the logistic regression model indicated that cancer survivors with heart conditions (OR=6.03, 95% CI 2.34-15.54, P<.001), lung diseases (OR=5.53, 95% CI 1.89-16.17, P=.002), and depression (OR=4.46, 95% CI 2.35-8.46, P<.001) were more likely to utilize telehealth compared to those without comorbidities. Additionally, higher education levels were associated with increased telehealth use, even after adjusting for other factors (OR=2.41, 95% CI 1.04-5.59, P=.04). Conclusions: This national survey analysis detected the higher rate of telehealth use in cancer survivors with comorbidities during the pandemic. Further research is needed to explore the experiences of cancer survivors with heart conditions, lung diseases, and depression regarding telehealth. Additional support is necessary to encourage older individuals and those with lower education levels to embrace telehealth for the delivery of optimal and high-quality care.
Patient adherence and early biochemical outcomes following relugolix with stereotactic body radiation therapy (SBRT) for unfavorable prostate cancer.
Authors: Gallagher Lindsey , Xiao Jerry , Hsueh Jessica , Shah Sarthak , Danner Malika , Zwart Alan , Ayoob Marilyn , Yung Thomas M. , Simpson Tiffany , Fallick Mark , Kumar Deepak , Leger Paul Denis , Dawson Nancy Ann , Suy Simeng , Collins Sean P.
Published: October 2023

526

Background: Prostate SBRT offers an abbreviated treatment course with comparable efficacy to conventional radiotherapy. Injectable GnRH receptor agonists have been shown to improve cancer control when combined with radiotherapy. Relugolix is a new oral GnRH receptor antagonist which achieves rapid, sustained testosterone suppression. This prospective study sought to evaluate early testosterone suppression and PSA response following Relugolix and SBRT for unfavorable prostate cancer. Methods: This prospective study sought to evaluate early testosterone suppression and PSA response following Relugolix and SBRT for unfavorable prostate cancer. Relugolix was initiated at least 2 months prior to SBRT. PSA and total testosterone levels were obtained prior to and 1-4 months post SBRT. Profound castration was defined as serum testosterone < 20 ng/dL. Poor drug adherence was delineated as failure to reach profound castration. PSA nadir was defined as the lowest PSA value within 4 months of completion of SBRT. Per prior trials, we examined the percentage of patients who achieved PSA level of ≤ 0.5 ng/mL and < 0.2 ng/mL during the first 4 months post SBRT. Results: Between July 2021 and January 2023, 52 men were treated at Georgetown with Relugolix (4-6 months) and SBRT (36.25-40 Gy in 5 fractions) per an institutional protocol (IRB 12-1775). Median age was 71 years. 26.9% of patients were black and 28.8% were obese (BMI ≥30 kg/m2). The median pretreatment PSA was 9.1 ng/ml. 67% of patients were > Grade Group 3. 44 patients were intermediate- and 8 were high-risk. The disease volume was high (mean 43.6% of total cores involved). Patients initiated Relugolix at a median of 3.6 months prior to SBRT with a median of 6.2 total months. 92.3%of patients achieved profound castration during Relugolix treatment. Poor drug adherence was observed in 2 patients. A third patient chose to discontinue Relugolix due to side effects. By post-SBRT month 4, 87.2% and 74.4% of patients achieved PSA levels ≤ 0.5 ng/ml and ≤ 0.2 ng/ml, respectively. Conclusions: Relugolix combined with SBRT allows for high rates of profound castration with low early PSA nadirs. Given the potential benefits of Relugolix over injectable GnRH receptor agonists, its usage may be preferred, especially in specific patient populations (fear of needles, prior cardiovascular events). We observed a 96% compliance rate without the utilization of scheduled cues/reminders. This finding supports the notion that patients can consistently and successfully follow an oral ADT protocol in a real-world setting. Future studies should focus on barriers to medication access.
Uptake and efficacy of immuno-oncology combinations in metastatic renal cell carcinoma in the United States: Evidence from the ASCO CancerLinQ Discovery database.
Authors: Vento Joseph , Haake Scott Mattox , Beckermann Katy , Rini Brian I. , Chen Yu-Wei
Published: October 2023

532

Background: Immuno-Oncology (IO) combinations, either an IO/IO (ipilimumab/nivolumab) or an IO/TKI combination (pembrolizumab/axitinib, avelumab/axitinib, nivolumab/cabozantinib, and pembrolizumab/lenvatinib), have emerged as the standard of care for frontline treatment of metastatic clear cell renal cell carcinoma (mccRCC) since 2018. Here we present uptake trends and efficacy of IO combinations in the United States from 2018 to 2022 using American Society of Clinical Oncology’s (ASCO) CancerLinQ Discovery database (CLQD). Methods: Patients diagnosed with mccRCC treated with frontline IO-based combinations from 2018-2022 were identified in the CLQD kidney dataset. The Kaplan-Meier survival method was used to present time to treatment discontinuation (TTD) and overall survival (OS) stratified by International mRCC Database Consortium (IMDC) risk. Results: There were 515 mccRCC patients who received frontline IO agents in 2018-2022: 228 (44.3%) patients received ipilimumab/nivolumab, 153 (29.7%) patients received IO/TKI (139 out of 153 received pembrolizumab/axitinib), and 122 (23.7%) patients received IO monotherapy (nivolumab or pembrolizumab). 385 (75%) were IMDC intermediate/poor risk and 97 (19%) were favorable risk patients. The median age was 69 (interquartile range: 61-79) and 59% were male. There was an increasing trend of use of IO/TKI from 2019 to 2021 [30.8%, 42.8%, 44.3%, respectively; analysis for 2022 was limited by sample size (n = 8)]. The median follow-up for ipilimumab/nivolumab and pembrolizumab/axitinib was 13.1 and 11.8 months (mos), respectively. The mTTD for ipilimumab/nivolumab and pembrolizumab/axitinib was 8.5 vs 11.0 mos, respectively. The median OS (mOS) was not reached (NR) in either regimen. The TTD and OS stratified by IMDC risk are presented in Table 1. Conclusions: Uptake of frontline IO combinations therapy in mccRCC and in particular IO/TKI combinations increased in the United States since 2018. Compared to progression-free survival (PFS) from the landmark trials, this analysis demonstrated shorter TTD, indicating either underestimation of the true PFS or worse outcomes in a non-clinical trial setting. Integration of radiologic response into this dataset could help clarify outcomes.[Table: see text]
Crowdfunding campaigns and cancer survivorship: A comprehensive overview of GoFundMe in the US in the last decade.
Authors: Yu Shaojun , Zhao Jingxuan , Zhang Jing , Yabroff Robin , Zheng Zhiyuan
Published: October 2023

541

Background: Cancer is a life-threatening disease and often associated high out-of-pocket (OOP) costs. Cancer patients may forgo or delay medical care because of costs and struggle to afford other basic needs in the US. Crowdfunding can help people cover OOP costs and daily living expenses, such as food, housing, and transportation. GoFundMe is one of the most utilized crowdfunding platforms for personal medical reasons in the last decade. However, little is known about the money raised on GoFundMe and the relative portion of cancer-related campaigns. Methods: The 2012-2022 crowdfunding campaigns were collected from the GoFundMe website using a distributed web scraper. The downloaded data was parsed to extract campaign details such as category, organizer information, fundraiser story, fundraising goal, amount of money raised, and donation records. Preprocessing steps were applied to remove duplicate records or invalid entries. Offline donations were excluded from analyses due to the inability to verify transactions. Additionally, campaigns with over 1000 donations were removed from analyses because GoFundMe website only provides a maximum of 1000 donations per campaign, which accounts for a small proportion (<0.01%) of total number of campaigns. Results: About 2.3 million crowdfunding campaigns were retrieved, of which 490,008 (21.3%) fund-raising events were due to personal medical reasons. In sum, there were 33 million donation records and 3.4 billion dollars were raised for personal medical reasons, and the average amount was $6,893 per campaign. The annual amount of money raised increased over time, from about $655k in 2012 to $68.4 million in 2022. About 15.6% campaigns reached their fundraising goals. California, Texas, and New York – three of the most populous states - were the top three states in terms of the total amount of money raised. Cancer-related fundraising events accounted for 41.1% of all medical campaigns (n=201,474) with a total amount of $1.6 billion raised, and the average amount of money raised was $7,994 (Table). All monetary values were nominal dollars without inflation adjustment. Conclusions: A growing number of individuals resort to GoFundMe for personal medical reasons, and cancer-related campaigns are the most common, underscoring the financial vulnerability of patients with cancer and their families in the US. The annual amount of money raised increased substantially in the last decade. However, only a small percentage of campaigns reach their financial goals. Future research analyzing fundraiser stories to understand the contents and severity of financial hardship caused by cancer in this population are warranted.[Table: see text]
Better Together: A team-based approach to improve prior authorization efficiencies and wellness in physicians and advanced care providers.
Authors: Pintova Sofya , Royer Jessica , Sheng Tianxiang , Liu Mark , Noble-Kirk Alana , Smith Cardinale B. , Bhardwaj Aarti Sonia
Published: October 2023

55

Background: The burden of prior authorizations (PAs) required for costly oncologic treatments is high. Upon PA denials, peer-to-peer requests are performed. These requests consume time and effort of physicians and advanced care providers (APPs) contributing to burnout and may have a negative impact on patient care. We aimed to assess the degree to which the PA process contributed to burnout among oncology clinicians prior to implementation of a new streamlined workflow aimed at improving clinician wellness. Methods: A baseline wellness survey was sent to all hematology-oncology faculty and APPs at the largest clinical site of our academic cancer center. Burn out, our primary outcome, was measured using the work-related Copenhagen Burnout Inventory. We included selected questions from the American Medical Association (AMA) surveys regarding physician perceived impact of PAs on clinical workload and care delivery. We asked physicians and APPs to rate the impact of PAs on burnout on a scale of 0-100. Analysis was conducted using descriptive statistics. This study was sponsored by our Office of Well-Being and Resilience. Results: The wellness survey was completed by 35 physicians and 21 APPs with a response rate of 53% in both (Table). The median Copenhagen burnout score for physicians was 46.43 (35.71-60.71) with higher burn out scores among those identifying as females, in practice less than 15 years and with more than 60% time in direct patient care. The median burn out score for APPs was 64.28 (50-83.03). Similar to physicians, APPs with less clinical experience had higher burn out scores. When asked about the impact of PAs on burnout, physicians reported a lower median of 13.5 (5.5-40.25), compared to APPs who reported a median of 53.5 (24-68.25). Conclusions: Physicians and APPs report high baseline rates of burnout and dedicate a significant portion of the week to completing PAs. Importantly, APPs perceived the PAs to have a high impact on their burn out compared to physicians. We will use these data to determine the efficacy of a new process that utilizes a single EMR platform for finance and cancer registry teams to abstract and document all of the required elements to streamline the PA process for intravenous/injection cancer treatments with the goal to reduce the number of PAs and improve wellness. [Table: see text]
Opportunities for expanded nurse and nurse navigator involvement in design, implementation and management of remote patient monitoring programs.
Authors: King-Kallimanis Bellinda , Offit Caroline , Chihuri Tendai , Mangir Christina , Dicker Adam P. , Smith Cardinale B. , Penberthy David , Rainey Anne Marie , Dean Martin Amanda G. , Patel Smit , Pierce Erin , Sedhom Ramy , Tacka Karen , Plotkin Elana , Boehmer Leigh
Published: October 2023

564

Background: The use of remote patient monitoring (RPM) in oncology for timely reporting of adverse events to improve patient outcomes is well-documented; however, less is known about real-world implementation of RPM and its impact on workforce needs. To assess use and perceptions about RPM, including its role in patient reported outcomes (PROs), the Association of Community Cancer Centers (ACCC) surveyed U.S. cancer program staff. Methods: Developed by expert advisors and patient advocacy partners, a survey of cancer program staff was distributed between December 2022 and January 2023. The survey included 25 closed and open-ended questions. Results: 128 multidisciplinary cancer program staff completed the survey, of which 45% are actively planning/implementing RPM programs. 34 U.S. states were represented. The three largest roles represented were medical oncologists (n=54; 42%), cancer program administrators (n=18; 14%) and nurses/nurse navigators (n=14; 11%). Of all respondents, 82% viewed nursing teams as the most appropriate to review and triage RPM data. Nurses indicated less involvement with the design/development of RPM programs (0%) compared to administrators (33%) and oncologists (48%). Similarly, 3% of nurses reported involvement in monitoring or taking actions on RPM data, compared to 12% of administrators and 56% of oncologists. Notably, no nurses compared to 6% of administrators and 18% of oncologists strongly agreed that they had access to educational resources and training needed to support a RPM program. In qualitative responses, nurses indicated provider education as the greatest need for RPM to become standard of care in cancer programs. Conclusions: Despite a high perceived need for nursing involvement in all aspects of RPM programs, real-world data indicates that nurses, who are expected to monitor/triage RPM data by most of their peers, are less frequently involved in the design and implementation of RPM programs. Future research is needed to understand these workforce barriers, and to explore novel approaches to tailored provider education and engagement to ensure that RPM programs benefit from diverse workforce and patient involvement.
Understanding testing for and treatment of homologous recombination repair (HRR)-mutated metastatic castrate-resistant prostate cancer (mCRPC): A quality initiative by Integra Connect PrecisionQ.
Authors: Thomas Roby Antony , Blanc Simon , Gart Mike , Choksi Rushir J.
Published: October 2023

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Background: In May of 2020, the approval of two Poly (ADP-ribose) polymerase inhibitors (PARPi) changed the landscape for treatment among patients (pts) with HRR mutations (HRRm) in mCRPC. The University of Pittsburgh Medical Center (UPMC) conducted a Quality Initiative (QI) with Integra Connect PrecisionQ to assess the rates of HRR testing, HRR positivity, and PARPi use in HRRm patients with mCRPC. This QI included clinical interventions to optimize testing and treatment in these patients. We aim to show the improvement in HRR testing and rates of treatment with PARPi after implementation of the QI in patients with HRRm mCRPC at UPMC. Methods: Using the de-identified Integra Connect PrecisionQ database, 223 UPMC pts with mCRPC were selected by medical chart curation as the baseline group. Patients in this group had received treatment between 5/1/2020 to 9/30/2021 and were confirmed as mCRPC. The baseline data was reviewed with UPMC clinical leadership, discussed at a physician roundtable, and shared among providers. Post-baseline, we evaluated 152 mCRPC pts who started a new line of therapy between 1/1/2022 to 12/31/2022 to assess HRR testing rates and use of PARPi in eligible mCRPC pts. The presence of one or more HRR genes was used to determine testing rates. Descriptive analyses were performed and a two-proportion z-test was used for comparisons of HRR testing in patients with mCRPC and treatment with a PARPi in HRRm mCRPC pts. Results: The average age at diagnosis was 67 years, 47% of patients had a Gleason score of > = 8, and 62% were stage IV. The rate of HRR testing at baseline was 52% (116 of 223). The results post-baseline and intervention showed an increase in HRR testing to 69% (105 of 152) of mCRPC patients who started a new line of therapy in 2022 (p < 0.01). At baseline, 60% (21 of 35) of HRRm pts were treated with a PARPi after prior NHA treatment, compared to 68% (19 of 28) post-baseline and intervention (p > 0.05). Among all HRR mCRPC tested pts, there was a 30.9% (84/272) positivity rate, of which 11.4% were BRCA1/2 positive (30/262) and 10.5% were ATM positive (26/247). Not all patients tested for HRR were tested for all genes. Conclusions: This Quality Initiative to improve testing and identification of HRR mutations in patients with mCRPC led to a 33% relative increase in HRR testing, demonstrating how QI programs can transform care and move the field toward individualized, precision medicine.
Racial and ethnic diversity of National Comprehensive Cancer Network (NCCN) committee members.
Authors: Anglade Evanie , Wu Victoria , Anglade Tahra Cassidy , Baez Alexandra , Morgan Austin , Odei Bismarck , Chino Fumiko
Published: October 2023

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Background: Racial and ethnic disparities are pervasive in cancer care including within the workforce and in leadership. A diverse workforce can increase patient satisfaction, treatment adherence, and improve optimal care in underserved populations. NCCN committees set the standard of care for cancer diagnosis, treatment, and survivorship, but little is known about the diversity of committee members. Methods: All NCCN organ-specific treatment guidelines from 2022 were reviewed; demographics including degree and leadership role were documented. Photographs were collected via online search and race, ethnicity, and gender were determined using a combination of facial recognition software and manual review. Academic rank and H-index were collected from professional profiles and Scopus, respectively. Multivariate analysis (MVA) assessed diversity of committees of the deadliest cancers in Black and Hispanic patients (breast, cervical, colon, gastric, gastrointestinal, hepatobiliary, multiple myeloma, non-small cell lung, pancreatic, prostate, rectal, small cell lung, and uterine cancers). Results: 1,172 unique members were found, representing 62 NCCN committees (median: 33.5 members; range: 24-40). Photographs could not be identified for 3, leaving 1,169 as the final sample. NCCN members were 74% White, 24% Asian, 2% Black, and 3% Hispanic. Members were mostly male (62%) and senior faculty (71%). Women were more likely to be junior faculty (25% vs 37% men, p<0.001) with lower median H-Index (20 vs 30 men, p<0.001). Less than half of committees (42%) had at least 1 Black member; most (76%) had at least 1 Hispanic member. The majority (82%) had at least 1 Black or Hispanic member. Of 63 Chairs, most were White (81%) and the remainder were Asian (19%). Of 59 Vice Chairs, 80% were White, 14% were Asian, and 7% were Black. There were no identified Hispanic committee Chairs or Vice Chairs. Committees for the deadliest cancers in Black and Hispanic patients were no more likely to have a respective Black (OR=1.25, 95%CI 0.58-2.71, p=NS) or Hispanic (OR=1.08, 95%CI 0.59-1.97, p=NS) committee member. On MVA, being female (OR=1.27; 95%CI: 1.01-1.58; p=0.038) and having a higher H-index (16-30: OR=1.41; 95%CI: 1.03-1.94; p=0.033; >30: OR=1.83; 95%CI: 1.32-2.55; p<0.001) were associated with increased odds of serving on a committee of a cancer deadliest in Black and Hispanic patients; neither race nor ethnicity increased the odds of serving on these committees. Conclusions: NCCN committee members in 2022 were predominantly White and Asian, with few Chair positions held by Black or Hispanic members. Less than half of committees had any Black member and committees providing guidelines for cancers with high mortality rates in Black and Hispanic patients were no more likely to have diverse members. Future efforts should focus on both diversifying the physician workforce and within leadership positions in oncology.
Geographic accessibility to palliative care physicians and early receipt of palliative care among individuals diagnosed with stage IV cancer in the US.
Authors: Fan Qinjin , Shi Kewei Sylvia , Jiang Changchuan , Hu Xin , Shao Yaxiong , Nipp Ryan David , Parikh Ravi Bharat , Kamal Arif , Yabroff Robin , Han Xuesong
Published: October 2023

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Background: Guidelines recommend early specialty palliative care for patients with advanced cancer, but receipt is low in the US, potentially reflecting inadequate access. This study examines the association of geographic accessibility to palliative care physicians and receipt of palliative care as part of initial treatment among individuals with stage IV cancer in the U.S. Methods: Adults aged ≥18 years newly diagnosed with stage IV cancer between 2018-2019 in the contiguous US were identified from the National Cancer Database (NCDB). Medicare physicians who specialize in Hospice and Palliative Care were identified from the 2018-2019 CMS Medicare Physician and Other Practitioners dataset. We calculated a geographic accessibility score using the two-step floating catchment area (2SFCA) method, based on patients’ residence zip codes and physicians’ zip codes and road network, accounting for physician supply and patient demand. Multivariable logistic regression models examined associations of the geographic accessibility score quartiles and receipt of palliative care (abstracted from patients’ medical records including pain management, surgery, radiation, systemic or other therapy administered to alleviate symptoms). Supplemental analyses were conducted among patients who died within 180 days from diagnosis. Results: We identified and geocoded 333,127 patients with stage IV cancer and 1,063 palliative care physicians. Patients living in nonmetropolitan, socioeconomically deprived areas, living in the Southern US, or being treated at community facilities had lower accessibility to palliative care physicians. In adjusted analysis, patients with higher geographic accessibility to palliative care physicians were more likely to receive palliative care compared with those with lower geographic accessibility, among all and patients died within 180 days from diagnosis (Table). Conclusions: Higher geographic accessibility to palliative care physicians was associated with a greater likelihood of palliative care receipt among patients diagnosed with advanced cancer. Findings support the need for strategies to increase number of palliative care physicians, especially in rural and socioeconomically deprived areas, to enhance the accessibility of guideline-recommended palliative care.[Table: see text]
Board Games as Social Media: Toward an Enchanted Inquiry of Digital Capitalism
Authors: Haiven Max , Kingsmith Adam (A.T.) , Komporozos-Athanasiou Aris
Published: October 2023

Can board games be part of challenging the dangerous tide of reactionary cultural politics presently washing over the United States and many other countries? The authors frame this threat to progressive social movements and democracy as entangled with a cultural politics of reenchantment. Thanks in part to the rise of ubiquitous digital media, capitalism is gamified as never before, yet most people feel trapped in an unwinnable game. Here, a gamified reactionary cultural politics easily takes hold, and the authors turn to the example of the QAnon conspiracy fantasy as a “dangerous game” of creative collective fabulation. They explore how critical scholars and activists might develop forms of “enchanted inquiry” that seek to take seriously the power of games and enchantment. And they share their experience designing Clue-Anon, a board game for three to four players that aims to let players explore why conspiracy theories are so much fun . . . and so dangerous.