bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamics of multidisciplinary teams in the Arab world.
Authors: AbdelAziz Riham H. , Abdelsalam Marwa , Bakri HebatAllah Mahmoud , Ahmed Radwa Fawzy
Published: June 2023

e18753

Background: Multidisciplinary teams (MDTs) are helpful in making clinical decisions and improving patients’ care. This study aims at describing the situation in the Arab world, probing the logistics of cancer patients' referral to MDTs, and highlighting the challenges facing them. Methods: This cross-sectional study via an online pre-tested self-administered survey targeted oncologists and non-oncologists across the Arab world. Results: The survey included 435 participants from 18 Arab countries (317 were oncologists and 118 were non-oncologists). Among the non-oncologists, 67% were involved in diagnosis and management of newly diagnosed cancer patients, 73.5% had specific patient referral criteria in their countries: upon suspected imaging (36%) or proved biopsy results (26%). However, only 36% discuss these patients regularly in MDTs, and 55 out of the 118 do not attend MDT clinics as 47% of them were not invited to MDTs and 13% have a diagnostic role only. Similarly, oncologists thought non-oncologists usually refer suspected patients to oncologists/MDTs upon: suspected imaging (52%), malignant biopsy results (48%), or both (43%). On the other hand, oncologists refer patients to non-oncologists either due to patients’ comorbidities (59%) or upon MDT decision (43%). The results indicated 57% of oncologists discuss suspected patients in MDTs. Among all MDT clinics attendants, 60% had recognized MDTs in their centers. Nevertheless, the majority do not have MDTs for all subspecialties. Moreover, 53% indicated that suspected patients are not directly referred to MDTs; and only 27% indicated they always manage cancer patients upon MDT decision. The majority agreed that surgical, radiation, medical or clinical oncology, radiology and pathology attend MDT clinics. Contrarily, only 5%, 11%, 10%, 2%, 16%, 10% and 13% indicated that psychiatry, nutrition, palliative care, physiotherapy, clinical pathology, specialized nurses and clinical pharmacy attend MDT clinics. Results showed also 94% thought patients benefit of MDTs. The participants’ main consensus upon MDTs benefit was providing accurate treatment recommendations (83%), better clinical decision (70%), and improving team competence (53%). The participants thought the challenges facing MDTs were mainly irregular attendance of physicians (55%), the large number of patients presented in MDTs (41%) and absence of some specialties in MDTs, which means referring patients directly to them (37%). Conclusions: Most institutes have MDTs, but they mainly discuss few subspecialties. Moreover, only 27% of the surveyed physicians indicated they always manage cancer patients upon MDT decision. Additionally, the majority indicated that mainly oncologists, radiologists, and pathologists attend the MDTs. However, other specialties are sorely underrepresented. These discrepancies between MDT logistics through the Arab Countries are deemed a challenge to MDT practice and patient outcomes.
Uptake of MRI in patients without a personal history of breast cancer (PHBC) classified as “high risk”.
Authors: Boccuzzi Luciarita , Paul Shirlene , McPeek Chelsea , Stempel Lisa , Alvarado Rosalinda , Levy Mia Alyce
Published: June 2023

e18754

Background: The American Cancer Society (ACS) recommends annual screening MRI in addition to mammography in patients without a personal history of breast cancer (PHBC) who are ages 25-75 with a Tyrer-Cuzick (TC) score ≥ 20%. Here, we evaluate the uptake of supplemental MRI in these high-risk patients. Methods: Data was extracted from the EMR of an academic medical center for patients (ages 25-75) with a mammogram between 07/20/2020 and 07/19/2021 and a TC ≥ 20%. We assessed uptake differences in demographics, access to healthcare, and breast density in the patient populations that opted for supplemental MRI. A chi-squared analysis was used to compare the groups: 1) No supplemental screening, 2) Patients who underwent MRI supplemental screening, and 3) Patients who did not receive MRI supplemental screening. Results: Of the 1144 patients with a TC ≥ 20%, 27% (n = 307) underwent supplemental MRI screening, while 73% (n = 837) did not. Out of 635 patients with an MRI order, those who were recommended by a high-risk breast cancer (HRBC) provider (n = 227, 36%) were more likely to undergo the MRI (88%, n = 200) compared to those without a HRBC provider (33%, n = 135) (p-value < 0.001). However, the other 509 patients that were recommended MRI never followed up for further imaging or health care visits. Of the patients who were notified that they had dense breasts (n = 842, 74%), 28% (n = 237) underwent MRI, compared to those without dense breasts (18%, n = 55) (p-value < 0.001). Conclusions: 27% (n = 307 out of 1144) of women without a PHBC who are at high-risk for breast cancer underwent MRI as a supplemental breast cancer screening. Our study shows that access to a HRBC is a contributing factor to follow through with the recommended MRI as a supplemental screening. More than 80% of the patients who underwent MRI had a HRBC. Patients may still be faced with challenges, including having access to a HRBC.
Evaluating knowledge, attitudes, and practices toward breast cancer and breast cancer screening among females in Arab countries of the Middle East: A systematic literature review.
Authors: Theeb Laith , Tarazi Alaa , Al-Kasaji Mohammad , Alduraidi Hamza
Published: June 2023

e18761

Background: Among all types of cancer, breast cancer (BC) is the most diagnosed cancer in women and is the leading cause of cancer-related deaths in females globally. Developing countries possess approximately 60% to 70% of all worldwide breast cancer deaths. Despite the increasing efforts to expand awareness and encourage screening, breast cancer is still the most frequently diagnosed form of the disease in Arab countries. In this study, we aim to systematically review the knowledge, attitudes, and practices of middle-eastern Arab women toward the recognition of early breast cancer symptoms, risk factors, and screening. Methods: A literature search was conducted on PubMed and Scopus to identify relevant literature. Search terms included “Knowledge” OR “attitude” OR “practice” AND “breast cancer” AND “Arab region” OR “middle east region”, and other relevant and equivalent terms. All English language studies which achieved the inclusion criteria were included. Each article was independently screened by two researchers in two levels (title/abstract and full-text screening). Data extracted included, but was not limited to, country, study design, study population, sample size, level of knowledge, attitudes, practices, conclusions, and limitations for each study. Results: Out of the 1182 publications identified, 14 cross-sectional studies were included with respondents aged 15 and above. Study populations varied from females attending healthcare centers, to country residents and students. Five studies reported the level of overall BC knowledge, where respondents with low levels of knowledge ranged from 19.7% to 67%. The most chosen risk factors for BC were personal or family history (n = 5), and prior radiation (n = 2). A breast lump or mass was the most chosen warning sign (n = 5), followed by an armpit lump (n = 2). Regarding screening, women who had ever performed breast self-examination (BSE) ranged from 30.3% in Yemen to 57.5% in Oman, while those who consistently performed BSE ranged from 17.4% to 27.9%. Women who had ever undergone mammography ranged from 1.6% to 40%. Barriers to screening included system-related barriers (n = 2), feeling healthy (n = 2), fear of the results (n = 2), and others. Better screening practices were mostly associated with a higher level of education (n = 5), and personal or family history (n = 4). Conclusions: The majority of Arab women in the middle east had heard about breast cancer, but had a low level of knowledge, attitudes, and practices toward breast cancer and its screening methods, which was also variable among different counties. Multiple barriers to screening were found. Such findings can raise the need for programs that elevate knowledge, and provide accessible screening programs that solve for the barriers to screening in the Arab region.
Advancing TNBC care in the community oncology practice: Insights from a quality improvement initiative.
Authors: Force Jeremy Meyer , Rugo Hope S. , Sullivan Shelby , Dewald Ilona , Carter Jeffrey D. , Heggen Cherilyn , McKinnon Kelly E.
Published: June 2023

e18762

Background: New and emerging treatments for metastatic triple negative breast cancer (mTNBC) are improving outcomes for patients. However, given the fast pace of innovation, staying informed about the latest clinical trial data, guideline recommendations, and adverse event management, is challenging, particularly in community-based settings. To improve the care of mTNBC patients, we conducted a quality improvement (QI) initiative across 10 community-based oncology practices. Methods: Between 9/7/2021 and 2/11/2022, we surveyed multidisciplinary oncology team members (N = 121) at 10 community oncology clinics to assess current practices, challenges/barriers, and areas for improvement in mTNBC care. Providers then participated in audit/feedback (AF) educational sessions (N = 150) where they (a) assessed system-specific practice gaps identified via the provider surveys, (b) prioritized areas for improvement, and (c) developed action plans for addressing root causes of the identified gaps. Results: Providers reported the top challenge in caring for patients with mTNBC as sequencing treatment options across multiple lines of therapy (33%). Providers participating in the AF sessions identified impact on overall survival (55%), molecular test results (49%), and impact on patient quality of life (44%) as their primary considerations when differentiating among new and emerging targeted therapies for mTNBC. Additionally, clinicians reported having the most difficulty managing gastrointestinal distress (31%), cardiotoxicity (31%), and endocrinopathies (31%) associated with novel therapies. Providers believed improved collaboration across interprofessional teams (32%) and increased patient education for aspects of supportive care (28%) would improve care for mTNBC patients. To address the identified gaps at each location, teams developed action plans to improve coordinated mTNBC care, provide patient-centered supportive care, increase testing for targeted therapies, improve symptom and adverse event management, and create standardized order sets. Conclusions: Through this QI initiative, clinical teams identified gaps/barriers in their own practices, and developed and implemented action plans for improvement. These data and actionable insights support safe, effective, and evidence-based integration of novel therapies into mTNBC care to optimize patient outcomes. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from Gilead Sciences, Inc., who had no role in the study design, execution, analysis, or reporting.
Unmasking the MASCC score: A retrospective study.
Authors: Arun Kumar Sumukh , Janamejey Fnu , Prabhu Sushmita , Arun Kumar Pramukh , Ramasamy Chidambaram , Abraham George M. , Seetharaman Kala
Published: June 2023

e18763

Background: Febrile neutropenia (FN) is a common oncological emergency in patients receiving anticancer treatments. The Multinational Association for Supportive Care in Cancer (MASCC) and the Clinical Index of the Stable Febrile Neutropenia (CISNE) are validated risk assessment tools widely used to guide the need for hospital admission. There is sparse research regarding the utility of these scores in predicting in-hospital outcomes. Methods: We conducted a retrospective chart review of patients admitted with FN from 2012 to 2022 in our community-based teaching hospital and compared the performances of MASCC and CISNE scores on in-hospital outcomes such as length of hospital stay, duration of intravenous (IV) antibiotics, intensive care unit (ICU) admission, pressor use, length of ICU stay, in-hospital mortality and cost of hospital stay. Logistic regression was applied to calculate the unadjusted odds ratio for qualitative outcomes and linear regression to calculate the association for quantitative outcomes. Results: Among 139 patients screened, 100 met the inclusion criteria. Sixty eight percent of patients were 65 years or older, 53% were females, the most common presenting complaint was fever/chills (46%) and 67% had underlying hematologic malignancies. Patients with high-risk MASCC scores (HM) were noted to have higher odds of ICU admission (OR 20.3), pressor use (OR 5.09), and in-hospital mortality (OR 4.11) compared to those with low-risk MASCC scores (LM). Patients with HM had 3.3 days longer hospital stay and 2.3 days longer ICU stay compared to patients with LM with the mean duration being 6.5 days and 1.59 days, respectively. Patients with HM required 3.1 additional days of IV antibiotics compared to those with LM, with the mean duration of 5.23 days. The mean cost of stay was 52,890 USD, with an additional cost of 42,086.95 USD for patients with HM than for patients with LM. Comparisons of CISNE scores showed no statistical significance for any of the above-mentioned hospital outcomes and cost of the stay. Conclusions: FN patients with HM were found to have worse in-hospital outcomes and more expensive hospital stay than patients with LM. Our study highlighted the utility of MASCC score as a potential screening tool at the time of admission to predict severity of illness and guide resource utilization. [Table: see text]
Understanding the motives to seek additional care at non-governmental organizations.
Authors: Villarreal-Garza Cynthia , Ramirez Arantxa , Gonzalez-Sanchez David G , Vazquez Juarez Daniela , Platas Alejandra , Platas Ana Laura , Rivera Samuel , Zapata-Tarres Marta , Cuellar Mendoza Miguel Enrique
Published: June 2023

e18766

Background: Providing patient-centered comprehensive breast cancer (BC) management remains a global health challenge. In Mexico, public health institutions (PHIs) are the largest providers of BC care. They seek to offer quality BC treatment for their constituents while facing financial and operational challenges accentuated by the increasing prevalence of BC. This system leaves patients with unmet needs, especially limited access to supportive care services. Some non-governmental organizations (NGOs) have been created to fulfill these gaps. This study aims to understand the unmet needs perceived by BC patients at PHIs and their motives to contact NGOs for complementary services. Methods: An online survey was created and distributed to BC patients that received care at PHIs and had contacted Médicos Investigadores en la Lucha Contra el Cáncer, a BC NGO, from June 2022 to July 2022. The questionnaire consists of multiple-choice questions and a comments section. Results: We received 93 responses. The median age (range) was 51 years old (31-68). Most participants were residents of Mexico City and the State of Mexico, 97%. The most frequently reported clinical stages were stage 2 and stage 3, 31% and 40% respectively. Medication availability and diagnostic services were considered above average, 76% and 71% respectively. Patients referred that 78% of nursing services, 69% of primary and 82% of secondary/tertiary level care physician services were above average. The majority of participants, 91%, reported having unmet needs during their treatment. Table 1 describes the participant’s perceived needs including adequate information and referral to other integral health services within the institution like pain management, physical therapy, mental health services, and nutrition. A recurring comment reported by patients was that not enough time was dedicated to answering their concerns. Conclusions: This study shows that PHIs struggle to adequately provide comprehensive BC management. There is a high perception of unmet needs and a low referral rate to pain management, physical therapy, nutrition, and psychology services. However, patients consider the services provided by doctors and nurses as above average and are satisfied with the diagnostic services and medications provided by the institution. Future studies need to be conducted to understand the barriers to adequate referral to comprehensive care services and how NGOs address these unmet needs. [Table: see text]
A contemporary national population-based analysis of demographics and outcomes of Hispanics with adult T-cell leukemia/lymphoma in the US.
Authors: Velez-Mejia Carolina , Mines Ian Michael , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique
Published: June 2023

e18771

Background: Adult T-cell Leukemia/Lymphoma (ATL) is a malignancy caused by the human T-cell leukemia virus type I with heterogenous clinical course (Blood Adv PMID29545256 J Clin Exp Hematop PMID34937829). There are endemic regions, but emigration has increased its incidence in the United States (US) (Hematol Oncol Clin North AmPMID2834087). There is a need to recognize trends and ethnic patterns to better understand this malignancy (J Oncol Pract PMID28796966 Blood Adv PMID29545256). This is the first national population-based analysis evaluating ethnic differences for HI diagnosed with ATL in the US. Methods: Data were analyzed on ATL patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2018. Demographic, clinical and survival patterns were analyzed. Kaplan-Meier and Cox regression analyses were used when appropriate. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: 598 patients (HI=65, NH=533) were diagnosed with ATL. Male sex predominated in in both. HI were diagnosed at a younger median age, 52 years (y) vs 63y for NH [p<0.001]. Most of HI presented in the age bracket of 40-60y, while NH were identified between 60-80y [p <0.001]. Regarding race, most of HI and NH were whites 82% vs 52% respectively, however, for NH Blacks and Asian/Pacific Islander were noted to be representative in the sample [p <0.001]. The majority of HI were diagnosed between 2010-2014, however for NH, same incidence was reported from 2005-2009 and 2010-2014 [p = 0.107]. For both group the presence of B symptoms was predominantly unknown. The median survival for HI was 1.5y vs 0.8y for NH. The survival probability at 2, 5 and 10y for HI corresponded to 0.474, 0.341 and 0.238, while for NH it was 0.347, 0.244 and 0.153, respectively. The OS probability at 10y had no statistically significant difference but a tendency favoring HI [p = 0.053]. On multivariate analysis, when adjusted for age, those patients who were older than 80y and between 60-80 y, had worse OS compared to those younger than 60y, with Hazard Ratio of 3.9 (95% CI: 2.7 – 5.6) and 1.7 (95% CI: 1.2 – 2.2), respectively. Conclusions: This national population-based study identified similar OS in HI diagnosed with ATL in the US. The median survival time was noted to be higher for HI and the OS had a tendency favoring this group; however, findings are not yet significant. This association should be further analyzed as there may be unique oncologic response in this ethnic minority. HI may have remarkable immunologic reaction to infection due to oncogenic viruses plus the creation of a distinct tumor microenvironment. Recognizing clinical trends and identifying genetic predictors may assist in constructing more accurate prognostic indices to deliver targeted therapy.
Agranulocytosis secondary to cancer chemotherapy and association with higher in-hospital mortality in patients with central line insertion during hospital stay.
Authors: Mohamed Jiffry Mohamed Zakee , Carmona-Pires Felipe , Okam Nkechi , Vargas Jonathan , Ahmed-Khan Mohammed Aimal , Moin Kayvon , Josephs Meagan
Published: June 2023

e18777

Background: Agranulocytosis secondary to cancer chemotherapy (ASCC) remains a leading cause of morbidity and mortality. Central line associated bloodstream infections (CLABSI) are also particularly prevalent in these populations and may portend a poorer outcome. Our study serves to investigate the relationship between patients with agranulocytosis secondary to cancer chemotherapy and insertion of a central venous catheter (CVC) with respect to in-hospital mortality. Methods: We utilized the National Inpatient Survey 2019 database. We utilized ICD-10 CM codes to identify ASCC and other medical comorbidities. We utilized ICD-10 PCS codes to identify CVC insertions. Multivariate logistic regression was utilized to study the effect of CVC insertion on in-hospital mortality. Results: In patients with ASCC, CVC insertion was associated with a higher in-hospital mortality (unadjusted: 11.9% vs 1%, p < 0.001, adjusted OR 19.27, 95% CI 5.84 – 65.6, p < 0.001) adjusted for baseline characteristics and other comorbidities. Patients in the study cohort who were older than 70 years of age also had a higher in-hospital mortality relative to younger age groups (adjusted OR 2.31, 95% CI 1.04-5.13, p < 0.039). Conclusions: In patients with ASCC, CVC insertion during the hospitalization is associated with a higher in-hospital mortality.
COVID-19 vaccination, infection, and symptoms among cancer survivors in the United States during 2021.
Authors: Yang Nova , Han Xuesong , Yabroff Robin , Zhao Jingxuan , Zheng Zhiyuan
Published: June 2023

e18786

Background: The effects of the COVID-19 pandemic on cancer survivorship during 2021, the second year in the US when vaccination became widely available, is largely undocumented. This study reports COVID-19 vaccination, infection, and symptoms among cancer survivors using nationally representative data. Methods: We used the 2021 National Health Interview Survey to identify adults with and without cancer history. Age-adjusted percentages for COVID-19 vaccinations, infection history and symptom severity were calculated among adults with and without a cancer history. We further calculated the percentage of COVID-related outcomes stratifying by sex, age, race/ethnicity, education level, and health insurance coverage among cancer survivors. Results: Compared to adults without a cancer history (n = 26,023), cancer survivors (n = 3,428) were more likely to have two or more COVID-19 vaccines (66.6% v 62.3%, P= 0.003) and as likely to have COVID-19 infection history (14.1% vs 14.2%, P= 0.93), but once infected, face higher likelihood of developing moderate/severe symptoms (62.5% v 54.2%, P= 0.02). Among cancer survivors, older age, higher educational attainment, and having health insurance coverage were significantly associated with higher vaccination rate (all P< 0.001). Age was significantly associated with COVID-19 infection history, with the highest percentage of COVID-19 infection history (17.3%) among cancer survivors aged 45-54 years. Among cancer survivors infected with COVID-19, being female and younger age were associated with higher likelihood of developing moderate to severe symptoms (both P< 0.05). Moreover, loss of taste or smell were most frequently seen among COVID-19 infected cancer survivors who were female (68.7%), 45-54 years of age (71.1%), Hispanic (73.2%), and survivors younger than 65 years without private insurance (75.1% for publicly insured and 73.1% for uninsured). Conclusions: In 2021, cancer survivors had better COVID-19 vaccine completion than adults without a cancer history. If infected, cancer survivors were more likely to develop moderate/severe symptoms; survivors who were female, younger age, Hispanic or uninsured had worse experiences with COVID-19 infection, suggesting ongoing tailored efforts to prevent infection are warranted as the pandemic evolves.
The utilization of cryopreserved sperm in males with cancer.
Authors: Reynolds Anna Claire , Ghidei Luwam , Kassab Jordan , Campbell Kevin , Sullivan John , Lipshultz Larry , Mckenzie Laurie
Published: June 2023

e18791

Background: Ten percent of individuals diagnosed with cancer in the United States are under age 45. Fortunately, improvements in cancer therapy have enabled younger individuals to survive with cancer related deaths decreasing steadily over the past 20 years. The American Society for Clinical Oncology (ASCO) recognizes the importance of future family building for cancer survivors and states healthcare providers should discuss fertility preservation options prior to cancer treatment initiation. Despite these recommendations, the data regarding survivor utilization of cryopreservation sperm is limited. The aim of this study is to assess factors that impact the post treatment utilization of cryopreserved sperm. Methods: 721 patients who underwent sperm cryopreservation for cancer indication from 1/1/2010 – 10/1/2020 at a single institution were included in the retrospective chart analysis. Cancer diagnosis, patient age at time of sperm banking, sample storage duration, and sample disposition were collected. Sample disposition included utilization for pregnancy effort(s), request to discard and/or donate to research, and lost to follow up. Descriptive statistics were employed via Excel. Results: Fifty-two of 721 (7.21%, 95% CI 5.4-9.4%) patients utilized their sperm samples for fertility treatment, and 104 patients (14.42%) subsequently requested their samples be discarded. When stratified by age at time of sperm banking, men who banked between the ages of 36 and 40 years had the highest rate of sample utilization for pursuing fertility treatment (12/68, 17.65%, 95% CI 9.5-28.8%). Importantly, those that cryopreserved sperm and subsequently discarded the samples ranged from 8.97% (21 to 25 years) to 28.13% (41 to 45 years). When analyzed by diagnosis, patients who utilized their samples for fertility treatment had varying cancer diagnoses with percent utilization ranging from 4.11% (skin/connective tissue/musculoskeletal cancers) and 20.0% (lung cancer). Overall, 75.59% of the samples collected are unutilized (545/721, 95% CI of 72.3-78.7%). Only 3% were lost to follow up, defined as inability to contact patient after three attempts. Conclusions: Cryopreserved sperm is widely underutilized with only 7.21% of patients utilizing the samples for future conception. Men between ages 36 to 40 years at time of banking are most likely to utilize their samples and utilization varied by cancer diagnosis. This large cohort (with less than 5% lost to follow up) highlights the importance in identifying additional predictors of cryopreserved sperm utilization in cancer survivors. [Table: see text]
Real-world utilization pattern of pexidartinib in patients with tenosynovial giant cell tumor (TGCT).
Authors: Lin Feng , Tse Jenny , Shaikh Nazneen Fatima , Wang Elizabeth J , Near Aimee , Kwong Jackie , Tap William D.
Published: June 2023

e18792

Background: In August 2019, pexidartinib became the first and only systemic therapy approved in the US for the treatment of symptomatic TGCT associated with severe morbidity or functional limitations and not amenable to improvement with surgery. As TGCT is a rare condition, real-world pexidartinib utilization data are limited and greatly needed to inform clinical use. Methods: Adults (≥18 years) with ≥1 pexidartinib claim from 8/2/2019 - 1/1/2022 identified in the IQVIA Longitudinal Prescription Claims (LRx) linked with Medical Claims (Dx) databases were analyzed. Patient characteristics 6 months before first (index) pexidartinib claim were summarized. Pexidartinib dosing, interruption, and treatment duration were assessed post-index. Discontinuation was defined as treatment gap of ≥90 days. Results: Of 167 patients treated with pexidartinib (median age, 45 years; 59.9% female), the most common comorbidities were osteoarthritis (10.8%), hypertension (8.4%), and obesity (7.8%); 3 patients (1.8%) had mild liver disease and none had moderate-to-severe liver disease pre-index. Median starting dose was 800 mg/day (Table). Over median follow-up of 17.9 months, median (IQR) dose was 622 (442-750) mg/day. Dose reduction was observed in 57 (34.1%) patients and dose increase in 14 (8.4%) patients. Probability of discontinuation was 24.0%, 38.3% and 53.7% at 3-, 6- and 12-month follow-up, respectively. Median (95% confidence interval [CI]) time to pexidartinib discontinuation was 10.1 (7.1, 13.0) months. Fourteen (8.4%) patients restarted pexidartinib after discontinuation. Overall, median (95% CI) time on treatment was 14.2 (10.1, 18.4) months when treatment duration after restart of therapy was considered. Rate of joint surgery after pexidartinib treatment was low (7.2%, n = 12) with median (IQR) time from index to surgery of 5.4 (4.2-12.5) months and median time from last pexidartinib claim to surgery of 2.7 (1.0-8.2) months. Three patients restarted pexidartinib after surgery. Conclusions: Compared to patients in ENLIVEN, real-world pexidartinib patients had similar demographic characteristics. Real-world average daily dose was lower than the full dose recommended in the prescribing information. Compared to ENLIVEN, rate of discontinuation was higher in first 6 months but similar at 12 months. Findings could inform treatment strategy in clinical practice and future research in TGCT. [Table: see text]
Durvalumab outcomes for patients with PD-L1 positive and negative stage III unresectable non-small cell lung cancer treated at veterans health administration facilities.
Authors: Burton Elizabeth M. , Moore Amanda , Nooruddin Zohra , Cotarla Ion , Simmons Daniel , Davis Laura , Reveles Kelly R , Datta Paromita , Roman Souza Gabriel , Irabor Omoruyi Credit , Franklin Kathleen , Jones Xavier , Frei Christopher R
Published: June 2023

e18793

Background: Clinical trials and real-world studies have documented the benefit of durvalumab consolidation therapy in patients with stage III unresectable non-small cell lung cancer (UR-NSCLC) following chemoradiotherapy (CRT). Methods: Patients with stage III UR-NSCLC on durvalumab following CRT, at any Veterans Health Administration (VHA) facility from 1/1/17 to 6/30/20, were included. Patients were followed from their durvalumab initiation date through the earliest of their last VHA visit, loss to follow up, death, or end of study. Electronic health record and chart review data were retrospectively collected to determine baseline characteristics, number of durvalumab doses, length of follow-up, and overall survival (OS). Chi-square and Wilcoxon rank sum tests were used to compare baseline characteristics for patients with PD-L1 negative (<1%) and positive (1% or greater) tumors. Kaplan-Meier curves were constructed for OS. Cox proportional hazards regression, with controls for divergent baseline characteristics, were used to compare OS between the two groups. Results: Of 935 available patients, 340 had PD-L1 results: 221 had PD-L1 positive (65%) and 119 had PD-L1 negative (35%) tumors. The two groups of patients were largely similar with respect to baseline characteristics, including age, sex at birth, White race, smoking status, marital status, Charlson Comorbidity Index, ECOG status, histology, stage, EGFR, and RAS mutations (Table). Patients with PD-L1 positive and negative tumors had a similar median (interquartile range [IQR]) number of durvalumab doses (15 [6-24] vs 12 [5-23], p=0.38) and length of follow-up (31.5 [12.1-43.5] vs 28.7 [12.2-40.6] months, p=0.43). Kaplan-Meier survival curves were similar for patients with PD-L1 positive and negative tumors: estimated 12-month OS rates (95% CI) of 84% (78%-88%) vs 89% (81%-93%) and 24-month OS rates of 72% (65%-78%) vs 76% (67%-84%); median OS was not reached in patients with PD-L1 positive tumors and was 47.0 months for the PD-L1 negative group. Cox Proportional Hazards regression analysis also demonstrated similar OS for both groups (p=0.64). Conclusions: In this real-world study of a subpopulation of VHA patients with stage III UR-NSCLC and known PD-L1 levels, survival benefits with durvalumab were consistent with those reported in the PACIFIC trial, despite having worse baseline prognostic factors. Patients with PD-L1 positive and negative tumors experienced similar overall survival, including 12- and 24-month OS rates.[Table: see text]
Did COVID-19 impact national trends of hospitalization and outcomes for neutropenic fever in adults with cancer?
Authors: Bhardwaj Prarthna V , Yadukumar Lekha , Patel Ishani , Pasupula Deepak , Loke Chandravathi , Mehta Kathan , Siddappa Malleshappa Sudeep Kumar
Published: June 2023

e18799

Background: Neutropenic fever (FN) is an oncologic emergency associated with significant morbidity and mortality. Patients on chemotherapy are at a higher risk of COVID-19-related complications. During the initial phase of the pandemic, healthcare systems were overwhelmed, resulting in shortage of resources and rationing of care. We aimed to assess the impact of the COVID-19 on trends of hospitalization and outcomes in adult emergency department (ED) visits for cancer-related FN in the US between 2019 and 2020. Methods: In this retrospective observational study using the National Emergency Department Sample of adults presenting to ED for cancer-related FN as primary diagnosis (using ICD-10-CM codes), we compared the outcomes between patients presenting in 2019 (pre-pandemic) and 2020. The primary outcome was mortality. Secondary outcomes were incidence of shock, discharge disposition, and length of stay (LOS). A propensity score matching was performed to estimate the effect of COVID-19 on outcomes. Results: There were a total of 95,163 visits to the ED for FN in 2019 and 2020. Both groups had similar demographics, with mainly White (68.1% vs 69.3%) patients presenting to large metropolitan areas (57.6% vs 58.6%) and mostly metropolitan teaching hospitals (74.5% vs 77.2%). More patients presenting in 2020 had a higher Elixhauser comorbidity index (66.6% vs 70.2% for comorbidity of ≥3; p = 0.0002). Although the number of patients who got admitted or died in the ED was similar in 2019 and 2020 (88.4% vs 87.8% for admission and 0.1% for death, p = 0.83), higher number died during their hospitalization (3.4% vs 4.4%, p = 0.002), and were likely to develop shock (6.0 vs 7.1%, p = 0.005) in 2020. More patients were discharged home with services (21.9% vs 17.1%, p < 0.001), while fewer patients went to nursing homes (7.9% vs 8.5%, p < 0.001) in 2020. There were no significant differences in LOS or cost of hospitalization. A propensity score matching was performed to estimate the effect of COVID-19 on outcomes showing higher mortality during hospitalization (13.7% vs 4.6%, p = 0.006) and increased LOS (6 days vs 5 days, p = 0.02) for patients with concurrent COVID-19. Conclusions: Overall, mortality related to FN was higher during the pandemic and more so among patients with concurrent COVID-19. While patients developing shock was higher in 2020, this was not attributable to COVID. Fewer patients were discharged to nursing homes, and more patients went home with services during the pandemic highlighting the constraints imposed on resources during the pandemic. [Table: see text]
Association of COVID-19 pandemic with indolent lymphoma care delivery and outcomes in Ontario, Canada: A population-based analysis.
Authors: Crump Michael , Gong Inna Y. , Ante Zharmaine , Calzavara Andrew , Cheung Matthew , Prica Anca A.
Published: June 2023

e18800

Background: Due to concern for infection risk, the coronavirus disease 2019 (COVID-19) pandemic presented a unique challenge for optimal management of indolent non-Hodgkin lymphoma (iNHL). We examined treatment (trt) selection, healthcare utilization, and COVID-19 outcomes of pts with iNHL receiving first-line (1L) systemic treatment during pre-pandemic vs. pandemic period. Methods: We performed a retrospective cohort study using administrative databases in Ontario, Canada, comparing outcomes in pts with iNHL who initiated trt from, with end of follow-up Mar 31 2022. The primary outcome was trt pattern (eg, 1L regimen, rituximab [R] maintenance use); secondary outcomes were death, toxicities, healthcare utilization (emergency department visit [ED], hospitalization), SARS-CoV-2 outcomes (infection, ED visit, hospitalization/death). Adjusted hazard ratios (aHR) from cause-specific proportional hazards models were used to estimate associations between factors and outcomes. Results: We identified 4,143 pts (1,079 pandemic, 3,064 pre-pandemic), median age 69 yrs, 44% female. In both pre- and pandemic periods, bendamustine (B)+R was the most frequent prescribed regimen, with no difference in number of cycles or dose delays (Table). During the pandemic, fewer pts received R maintenance and completed the full course (aHR 0.81, 95% confidence interval [CI] 0.71-0.92, p = 0.0010) (Table). Pts treated during the pandemic had less healthcare utilization (ED visit aHR 0.77, 95% CI 0.68, 0.88, p < 0.0001; hospitalization aHR 0.81, 95% CI 0.70-0.94, p = 0.0067) and trt-related complications (infection aHR 0.69, 95% CI 0.57-0.82, p < 0.0001; febrile neutropenia aHR 0.66, 95% CI 0.47-0.94, p = 0.020), with no difference in death (aHR 0.79, 95% CI 0.58-1.08, p = 0.14). R use (first dose to 1 yr post last dose) was associated with higher risk of SARS-CoV-2 infection (aHR 1.56, 95% CI 1.09-2.24, p = 0.015) and COVID-19 complications (ED visit aHR 4.28, 95% CI 1.79-10.26, p = 0.0011; hospitalization/death 1.81, 95% CI 1.11-2.93, p = 0.016). Conclusions: During the pandemic, BR remained the preferred regimen for iNHL trt, while R maintenance use was less. Despite the similar 1L regimen, healthcare utilization and infectious complications were less in the pandemic cohort. R use was associated with nearly 2-fold risk of COVID-19 hospitalization/death. [Table: see text]
Survival in patients with cancer of unknown primary site (CUP): Mayo Clinic experience.
Authors: Suleiman Riham , Duran Mayra , Algarin Perneth Sandra , Loor Torres Ricardo , Soto Jacome Cristian , Gile Jennifer , Graham Rondell P. , Villasboas Jose Caetano , Leon-Ferre Roberto Antonio , Thome Stephan , Halfdanarson Thorvardur Ragnar , Fuentes Bayne Harry E
Published: June 2023

e18802

Background: CUP is a rare cancer with an incidence of 7–12 cases per 100,000/year. CUP is defined as metastatic cancer with no identifiable primary tumor despite comprehensive evaluation. Despite its heterogeneous clinicopathological presentation, the treatment of CUP has primarily been with platinum-based combination chemotherapies but results are poor and survival is short. Here, we describe survival outcomes in real-world dataset of patients with CUP seen at a tertiary referral center. Methods: Retrospective study of patients treated at Mayo Clinic, Rochester MN, from 2010 to 2021. Survival probabilities were estimated with the Kaplan-Meier method. We used Cox proportional hazard regression with forward modeling to explore the association between each variable and death. Overall survival (OS) analysis was conducted in the entire cohort, and it was stratified by histological subtype. For the hypothesis test, we considered p < 0.05 to be statistically significant; all tests were two-sided. All data were analyzed by the SPSS version 22.0 software (SPSS, Chicago, IL, United States). Results: From a total of 214 patients, 198 patients were included in the survival analysis. The patients were predominantly white (87%), female (50.2%), with a mean age of 63 (SD: 13) without history of smoking (51%). The predominant histology was adenocarcinoma (30%), followed by neuroendocrine neoplasms (NEN) (27%), carcinoma NOS (25%), squamous cell carcinoma (SCC) (10%) and non-classifiable tumors (7%). The median follow-up time was 23 months, and medial OS was 23 months in the entire cohort. OS by histology was as follows: 51 months for NEN, 34 months for SCC, 18 months for carcinomas NOS and 11 months for adenocarcinomas (p < 0.001) (fig.1). Similar OS trends were observed when we restricted the analysis to poorly differentiated tumors. The 3- and 5-year cumulative survival by histology were as follows: 7% and 0% for adenocarcinoma, 25% and 8% for carcinoma NOS, 39% and 17% for SCC, and 56% and 22% for NEN. In Cox regression models we did not identify any prognostic factors among patients with adenocarcinoma. Conclusions: Patients with adenocarcinoma of unknown primary possess a considerable challenge and the OS is short. CUP of other histologies have higher OS. This study highlights the need of accurate tumor identification and better treatment, perhaps as a multiomics therapeutic approach.
Genomic landscape of cancer of unknown primary site (CUP): Mayo Clinic experience.
Authors: Duran Mayra , Suleiman Riham , Algarin Perneth Sandra , Loor Torres Ricardo , Soto Jacome Cristian , Gile Jennifer , Graham Rondell P. , Thome Stephan , Villasboas Jose Caetano , Leon-Ferre Roberto Antonio , Halfdanarson Thorvardur Ragnar , Fuentes Bayne Harry E
Published: June 2023

e18807

Background: CUP represents both a diagnostic and a management challenge. Despite improvements through sophisticated imaging modalities, specific and sensitive testing using immunohistochemistry, a concrete determination of the site of origin of the primary tumor can still be a diagnostic challenge Hereby, we described the genomic landscape of patients with CUP treated at our institution. Methods: Retrospective study of patients with CUP treated at Mayo Clinic Rochester MN from 2010 to 2021. Next generation sequencing (NGS) information was abstracted, and alterations were ranked into different levels of actionability following the Onco KB framework. All data were analyzed by the SPSS version 22.0 software (SPSS, Chicago, IL, United States). Results: From a total of 214 patients, we identified 67 (32%) patients in whom NGS was performed. Among patients with available NGS the median age was 64 years (range: 35-86) and 51% were female. the most prevalent histology included adenocarcinoma (39%), carcinoma NOS (31%), and neuroendocrine tumors (12%). NGS on tumor (t-NGS) was available in 56 (84 %) patients, circulating tumor NGS (b-NGS) was available in 12 (18%) patients, and only 1 patient had both testing available. Among the 56 patients with available t-NGS, MSI-high was detected in 9 patients, whereas among the 12 patients with available b-NGS, MSI-high was detected in 8 patients; yielding an MSI-high detection rate of 16% and 67% for t-NGS and b-NGS. In this cohort, there were a total of 474 genomic alterations detected from which 103 (22 %) were able to be ranked into one therapeutic level following the OncoKB framework. Genomic alterations were most observed among patients with carcinoma (n = 50, 48.53%) adenocarcinoma (n = 33, 32.03 %), squamous cell carcinoma (n = 3, 2.91 %) and neuroendocrine tumor (n = 2, 1.94%). Following the OncoKB framework, 39-level 1 genomic alterations were detected in a total of 14 genes. The most common level 1 genomic alterations comprised the BRCA2 (20.51%), NF1 ATM (17.95%) and HER2/NEU (ERBB2) (15.38%) genes. Therapeutic level 2 included 51 genomic alterations in 13 genes of which KRAS (17.65%), BRAF (15.69%), and BRCA2 (15.69%) were the most prevalent mutated genes. Additionally, level R comprised 13 genomic alterations in the following genes: KRAS (69.23) NRAS (23.08%) and PDGFRA (7.69%). Conclusions: CUP are malignancies rich in potentially actionable alterations, and NGS of tissue and blood samples can inform systemic therapy decisions. Alteration-specific targeted therapy may be an option for a substantial proportion of patients. NGS of tumor tissue or blood should be considered for all patients with CUP.
Outcome differences by sex in oncology clinical trials.
Authors: Kammula Ashwin V. , Schaffer Alejandro A. , Rajagopal Padma Sheila , Kurzrock Razelle , Ruppin Eytan
Published: June 2023

e18808

Background: NIH guidance advises clinical trials to analyze participants by sex to improve inclusivity. We performed a systematic analysis of reported differences in outcomes between males and females in a registry of oncology clinical trials to characterize treatment response differences more broadly by sex for future trials. Methods: We analyzed Trialtrove ( https://citeline.informa.com/trials/results ), a trial repository using over 58,000 sources, to search for oncology trials that compared outcomes in male and female participants. We implemented algorithms using Python3 programs to search for all trials that contained terms regarding sex in the context of terms suggesting comparison or outcome and considered these as candidate comparison trials. Candidate trials were manually curated to record comparisons by sex across cancer type, treatment, outcome measure, “similar” or “different” by sex and evidence. Outcomes were classified as either “survival / response / other outcome” (SRO) or side effects (E). Evidence for each comparison was labeled as statistically significant (multivariate or univariate), having non-significant numerical evidence, or having no numerical evidence. We counted only those trials in which all comparisons by sex were consistent. Results: 472 of 89,221 oncology trials in Trialtrove (data freeze 12/23/22) (0.5%) performed 532 post-treatment comparisons by sex. Among 288 trials that did statistical SRO comparisons, 47 (16%) trials reported that males showed better, statistically significant treatment responses, while 122 (42%) trials reported better results for females. We observed the strongest differences by sex for two disease-treatment pairs: EGFR inhibitors (EGFRi) in non-small cell lung cancer (NSCLC) and rituximab in non-Hodgkin’s lymphoma (NHL). In 82 trials with SRO comparisons in NSCLC, 35 (43%) showed better treatment responses in females, and 13 (16%) showed better treatment responses in males. Among the 36 NSCLC trials using EGFRi, 21 (58%) showed better treatment responses in females, versus only 1 (3%) in males. In contrast, among all 46 other NSCLC trials with SRO comparisons, 14 (30%) favored females and 12 (26%) favored males. These results suggest that EGFRi may have treatment-specific benefits in females with NSCLC. Among 33 trials with SRO comparisons in NHL, 20 (61%) showed better treatment response in females, versus only 4 (12%) in males. 13 of these trials used rituximab, among which 10 (77%) favor females and only 1 (8%) favors males. Better response in females to rituximab has been reported in single trials but not characterized in aggregate. Conclusions: Our search identified two clinically important disease-treatment pairs that showed markedly improved outcomes in females versus males. Better understanding of differences in treatment response by sex across clinical trials is needed, both to improve inclusivity and as a basis for potential future combination treatments.