bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping strategies of school-going adolescents during the COVID-19 pandemic in the climate vulnerable Manafwa watershed, Uganda
Authors: Batte Charles , Nuwasiima Shivan , Semulimi Andrew Weil , Apio Pamela Okwir , Mutebi Ronald Kasoma , Mwesigwa Martin Menya , Twinamasiko Nelson , Siddharthan Trishul , Mukisa John , Mukunya David , Abaatyo Joan , Nalugya Joyce Sserunjogi
Published: May 2024

Background

The COVID-19 pandemic disrupted daily life, economies, and health, prompting strict government measures, including nationwide lockdowns and school closures in Uganda, resulting in significant academic setbacks for adolescents. The coping strategies employed by school-going adolescents in Uganda amidst the COVID-19 pandemic remain inadequately understood. This study aimed to assess the coping strategies adopted by school-going adolescents (early, middle and late adolescents) in the Manafwa watershed, recognized as one of Uganda’s most vulnerable regions, during the COVID-19 pandemic.

Methods

A cross sectional study design was conducted from I5th May, 2023 to 30th June, 2023 on 762 school going adolescents from government-aided secondary schools within the Manafwa watershed area. The adolescent version of the KidCope tool was used to evaluate adolescents’ coping strategies. Factor analysis identified correlations among adolescents’ coping strategies. Independent Samples t-Test and One-Way Variance of Analysis (ANOVA) was used for comparing the mean score differences of the coping strategies among the gender and adolescents’ stages respectively.

Results

Majority (n = 141, 36.2%) of the participants employed adaptive coping followed by negative-emotion coping (n = 127, 32.6%) and avoidant coping (n = 122, 31.3%). Females employed statistically higher resignation as a coping strategy compared to males, (mean of 1.2 vs. 1.0, respectively; P = 0.026). A higher proportion (n = 88, 69.3%) of middle age adolescents employed negative-emotion regulation (P-value = 0.040). However, those in early adolescence significantly utilized distraction as a coping strategy more than those in middle adolescence (mean difference = 0.36, p = 0.013).

Conclusion

During the pandemic, majority of school-going adolescents employed adaptive coping mechanisms, including positive emotional regulation and social support. However, compared to males, females employed resignation more frequently. Moreover, middle-aged adolescents had a greater propensity for negative emotion copying. Findings from this study contribute valuable information for the development of targeted interventions and support mechanisms for adolescents facing unprecedented challenges.
The impact of positive psychology counseling on sexual and marital satisfaction and anxiety among reproductive-aged women during the COVID-19 pandemic: a randomized controlled clinical trial
Authors: Bafrani Mahdie Arab , Nourizadeh Roghaiyeh , Hakimi Sevil , Mortazavi Seyed Alireza , Mehrabi Esmat
Published: May 2024

Background

Sexual and marital satisfaction is considered one of the important factors in happiness and life satisfaction of couples. COVID-19 pandemic results in psychological effects, such as increased anxiety levels which can affect sexual and marital satisfaction. This study aimed to investigate the impact of positive psychology on women’s sexual and marital satisfaction.

Methods

A randomized controlled trial was conducted on 72 married women of reproductive age in Tabriz, Iran between February 2021 and May 2022. The participants were randomly divided into the intervention and control groups. There was no significant difference between the control and intervention groups in terms of the socio-demographic characteristics (p < 0.05). The mean age of the participants in the intervention and control groups was 31.8 ± 6.92 and 30.97 ± 5.09 years, respectively. The intervention group attended seven 60–90 min counseling sessions at weekly intervals. The Spielberger anxiety, sexual satisfaction and marital satisfaction questionnaires were completed before and four weeks after the intervention.

Results

The results of this study indicated that after counseling, the average overall score of marital satisfaction [MD: 15.46, 95% CI: 7.47 to 23.41, p = 0.034] and sexual satisfaction [MD: 7.83, 95% CI: 6.25 to 9.41, p = 0.001] significantly increased in the intervention group compared to the control group. Also, the mean score of state anxiety [MD: -2.50, 95% CI: -4.19 to -0.80, p = 0.001] and trait anxiety [MD: -1.03, 95% CI: -2.46 to -0.09, p = 0.032] significantly decreased after counseling in the intervention group compared to the control group.

Conclusions

Using counseling based on a positive psychology approach can improve anxiety, sexual and marital satisfaction, and anxiety of women of reproductive age during the COVID-19 pandemic. However, further randomized clinical trials are needed before making a definitive conclusion.

Trial registration

Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N8. Date of registration: 11/28/21. Date of first registration: 11/28/21. URL: https://www.irct.ir/user/trial/58680/view; Date of recruitment start date: 12/01/21.
Using 2% PVPI topical solution for serial intravitreous injections and ocular surface findings: a case control study
Authors: Casemiro José Henrique , Oguido Ana Paula Miyagusko Taba , Casella Antonio Marcelo Barbante
Published: May 2024

Background

The use of povidone-iodine for ocular surface asepsis is widespread for intravitreal injections. They became frequent procedures, leading to serial exposure of patients’ eyes to iodinated solutions. In this study, we investigate the changes in the ocular surface in patients submitted to repeated use of povidine for intravitreal injection of anti-VEGF asepsis, analyzing Ocular Surface Disease Index, non-invasive break up time, blinking quality, lipid layer, meniscus height and osmolarity.

Methods

This case-control study included 34 individuals (68 eyes), 14 males, 20 females aged 48 to 94. Inclusion criteria were individuals who received application of 2% povidone-iodine eyedrops for intravitreal injections treatment with the non-treated contralateral eye used as control. Ocular surface examinations were performed at a single occasion. A pre-intravitreal injection asepsis protocol with povidone-iodine was applied. All statistical analysis was performed using the STATA® 18.0 Software and a p-value = 0.05 was considered as the statistical significance value in all tests.

Results

The median number of IVIs in treated eyes was 12 (range 6–20). The results in treated eyes compared with untreated eyes were respectively : median OSDI 16 (IQR 6–39) and 12.5 (IQR 8–39) (p = 0.380); mean NIBUT 10.30 (SD ± 2.62) and 10.78 (SD ± 2.92) ( s, p = 0.476); median blinking quality 100 (IQR 100) and 100 (IQR 100 ) (%, p = 0.188); median lipid layer 87 (IQR 77–90) and 86 (IQR 74–100) (nm, p = 0.451); median meniscus height 0.22 (IQR 0.19-0,31) and 0.24 (IQR 0.20–0.27) (mm, p = 0.862), median Meibomian gland atrophy 33 (IQR 24–45) and 31.5 (IQR 25–39) (%, p = 0.524); and mean osmolarity 306.6 (SD ± 21.13) and 313.8 (SD ± 29) (mOsm, p = 0.297). There was no statistically significant relationship between the repetitive use of 2% iodinated solution and signs or symptoms compatible with dry eye syndrome in this group of patients.

Conclusions

The findings suggest that 2% povidone iodine is a safe and efficacious agent for ocular surface antisepsis during intravitreal injections, not leading to substantial ocular surface modifications. This conclusion supports the continued use of povidone iodine in routine ophthalmic procedures without increased risk of inducing dry eye syndrome.
Automatic grid topology detection method based on Lasso algorithm and t-SNE algorithm
Authors: Huang Sheng , Que Huakun , Zhang Yingnan , Xie Tenglong , Peng Jie
Published: May 2024

For a long time, the low-voltage distribution network has the problems of untimely management and complex and frequently changing lines, which makes the problem of missing grid topology information increasingly serious. This study proposes an automatic grid topology detection model based on lasso algorithm and t-distributed random neighbor embedding algorithm. The model identifies the household-variable relationship through the lasso algorithm, and then identifies the grid topology of the station area through the t-distributed random neighbor embedding algorithm model. The experimental results indicated that the lasso algorithm, the constant least squares algorithm and the ridge regression algorithm had accuracies of 0.88, 0.80, and 0.71 and loss function values of 0.14, 0.20, and 0.25 for dataset sizes up to 500. Comparing the time spent on identifying household changes in different regions, in Region 1, the training time for the Lasso algorithm, the Constant Least Squares algorithm, and the Ridge Regression algorithm is 2.8 s, 3.0 s, and 3.1 s, respectively. The training time in region 2 is 2.4s, 3.6s, and 3.4s, respectively. The training time in region 3 is 7.7 s, 1.9 s, and 2.8 s, respectively. The training time in region 4 is 3.1 s, 3.6 s, and 3.3 s, respectively. The findings demonstrate that the suggested algorithmic model performs better than the other and can identify the structure of LV distribution networks.
Extraction and Imputation of Eastern Cooperative Oncology Group Performance Status From Unstructured Oncology Notes Using Language Models
Authors: Xu Wenxin , Gu Bowen , Lotter William E. , Kehl Kenneth L.
Published: May 2024

PURPOSE

Eastern Cooperative Oncology Group (ECOG) performance status (PS) is a key clinical variable for cancer treatment and research, but it is usually only recorded in unstructured form in the electronic health record. We investigated whether natural language processing (NLP) models can impute ECOG PS using unstructured note text.

MATERIALS AND METHODS

Medical oncology notes were identified from all patients with cancer at our center from 1997 to 2023 and divided at the patient level into training (approximately 80%), tuning/validation (approximately 10%), and test (approximately 10%) sets. Regular expressions were used to extract explicitly documented PS. Extracted PS labels were used to train NLP models to impute ECOG PS (0-1 v 2-4) from the remainder of the notes (with regular expression–extracted PS documentation removed). We assessed associations between imputed PS and overall survival (OS).

RESULTS

ECOG PS was extracted using regular expressions from 495,862 notes, corresponding to 79,698 patients. A Transformer-based Longformer model imputed PS with high discrimination (test set area under the receiver operating characteristic curve 0.95, area under the precision-recall curve 0.73). Imputed poor PS was associated with worse OS, including among notes with no explicit documentation of PS detected (OS hazard ratio, 11.9; 95% CI, 11.1 to 12.8).

CONCLUSION

NLP models can be used to impute performance status from unstructured oncologist notes at scale. This may aid the annotation of oncology data sets for clinical outcomes research and cancer care delivery.
Telisotuzumab vedotin monotherapy in patients with previously treated c-Met–overexpressing non-squamous EGFR wildtype advanced NSCLC: Primary analysis of the LUMINOSITY trial.
Authors: Camidge David Ross , Bar Jair , Horinouchi Hidehito , Goldman Jonathan W. , Moiseenko Fedor Vladimirovich , Filippova Elena , Cicin Irfan , Ciuleanu Tudor Eliade , Daaboul Nathalie , Liu Chunling , Bradbury Penelope Ann , Moskovitz Mor , Katgi Nuran , Tomasini Pascale , Zer Alona , Looman Jim , Ratajczak Christine , Li Martha , Xia Summer , Lu Shun
Published: May 2024

103

Background: Approximately 25% of patients (pts) with non-squamous (NSQ) EGFR wildtype (WT) NSCLC have c-Met protein overexpression (Ansell et al. 2022 CRUK), which is associated with a poor prognosis (Liang, Wang. Onco Targets Ther. 2020). Telisotuzumab vedotin (Teliso-V) is a c-Met–directed antibody-drug conjugate comprising the mAb telisotuzumab and the microtubule polymerization inhibitor monomethyl auristatin E. The phase 2 LUMINOSITY trial (NCT03539536) aimed to identify the c-Met–overexpressing (OE) NSCLC population best suited to Teliso-V and expand selected group(s) for further evaluation of efficacy. We report on the primary analysis for pts with c-Met OE NSQ EGFRWT NSCLC. Methods: This phase 2, non-randomized, multicenter study enrolled pts with locally advanced/metastatic c-Met OE NSCLC, ≤2 prior lines of therapy (chemotherapy [CTx] + immunotherapy [IO] or sequential CTx + IO), and ≤1 line of chemotherapy. c-Met OE (Ventana MET [SP44] clinical trial assay [CTA]) was defined as ≥25% tumor cells with 3+ staining (high: ≥50% 3+; intermediate [int]: 25 to <50% 3+). Teliso-V was dosed at 1.9 mg/kg IV Q2W. Primary endpoint was overall response rate (ORR) by independent central review per RECIST v1.1. Results: 172 pts with NSQ EGFR WT NSCLC received ≥1 dose of Teliso-V and comprised the safety population; 161 (c-Met high, 78; c-Met int, 83) were included in baseline and efficacy analyses. Median age was 64 yrs (range 33–83), 69% were male, and 70% had ECOG PS 1. 97.5% had prior platinum and 82.0% had prior immune checkpoint inhibitor. Efficacy data are presented in Table below. ORR was 34.6% (c-Met high), 22.9% (c-Met int), 28.6% (overall). Median DOR was 9.0 mo (c-Met high), 7.2 mo (c-Met int), 8.3 mo (overall). Most common any-grade treatment-related AEs (TRAEs) were peripheral sensory neuropathy (30%), peripheral edema (16%), and fatigue (14%). Grade 5 TRAEs occurred in 2 pts (interstitial lung disease, respiratory failure). Conclusions: Teliso-V has shown compelling and durable responses in pts with c-Met OE NSQ EGFR WT NSCLC, especially in pts with c-Met high. Teliso-V had an acceptable safety profile that was clinically manageable, which is consistent with previous data. Clinical trial information: NCT03539536 . [Table: see text]
CCNE1 amplification as marker of poor prognosis and novel therapeutic target in advanced breast cancer.
Authors: Marra Antonio , Selenica Pier , Zhu Yingjie , Safonov Anton , Razavi Pedram , Roulston Anne , Koehler Maria , Curigliano Giuseppe , Ross Dara S. , Weigelt Britta , Reis-Filho Jorge , Schram Alison M. , Chandarlapaty Sarat , Rosen Ezra
Published: May 2024

1040

Background: Cyclin E1 (CCNE1) overexpression or gene amplification is linked to dismal outcomes in various tumors, including breast cancer (BC). Recent studies suggest that CCNE1 amplification is a potential target for new synthetic lethality-based treatments, including CDK2-selective and PKMYT1 inhibition. This study explores the clinical and genomic characteristics of CCNE1-amplified BCs. Methods: We analyzed genomic and clinical data from consecutive BCs that underwent clinical tumor-normal targeted panel sequencing (MSK-IMPACT) between April 2014 and December 2021. Allele-specific copy number, including CCNE1 amplification, and fraction genome altered (FGA) were calculated by FACETS. Mutual exclusivity and co-occurrence analyses were performed using CoMEt. Benjamini–Hochberg method for multiple testing correction (q) was applied. Real-world progression-free survival (rwPFS) was assessed by the Kaplan Meier method and Cox models, focusing on patients with available pre-treatment samples. Results: Out of 3,753 BCs, 125 (3.3%) had CCNE1 amplification. A higher occurrence of CCNE1 amplification was noted in post-treatment (n=2,368) compared to treatment-naïve tumors (n=1,385; 4% vs 2.4%, p=0.007). CCNE1 amplification was less common in hormone receptor (HR)+/HER2- BCs (2%) compared to HER2+ (7.6%) and triple-negative (7.2%) tumors (p<0.001). BCs with CCNE1 amplification showed higher median FGA, indicating increased genomic instability. In primary BC, TP53 alterations were more frequent in CCNE1-amplified tumors (q<0.001), while CDH1 alterations were mutually exclusive (q<0.001) suggesting that lobular BCs rarely harbor CCNE1 amplification. Similar trends were seen in post-treatment samples. CCNE1 amplification detected at baseline was linked to shorter median rwPFS in HR+/HER2- metastatic BCs treated with CDK4/6 inhibitors plus endocrine therapy (8.8 vs 15.2 months in CCNE1-amplified [n=9] vs CCNE1-non amplified [n=402]; hazard ratio [HR] 2.82, 95% CI 1.38-5.75), and in HER2+ metastatic BCs treated with first-line THP regimen (7.3 vs 20.8 months in CCNE1-amplified [n=5] vs CCNE1-non amplified [n=106]; HR 3.1, 95% CI 1.24-7.87). In a CCNE1-amplified triple-negative cell model (HCC1569), treatment with the PKMYT1 inhibitor RP-6306 significantly reduced tumor growth. Conclusions: CCNE1 amplification in BCs is associated with greater genomic instability and characterizes a group of metastatic BCs with poor response to standard of care therapies. Novel therapies targeting CCNE1-amplified tumors are under evaluation in preclinical and clinical studies.
Deciphering the global landscape of breast cancer in 38 OECD countries from 1990-2019: A benchmarking global analysis.
Authors: Vemparala Priyatha , Sonani Shivani B , Bathvar Pinank , Kochhar Gunjan , Koyani Himanshu Bharatkumar , Vavaliya Nihar Prafullchandra , Vashi Mandeepsinh , Patel Dhruval Pinalkumar , Vanodia Mihir Paresh , Lakkimsetti Mohit , Patel Juhi , Gadhiya Dhruvkumar , Amin Vishrant , Desai Hardik Dineshbhai
Published: May 2024

1046

Background: Breast Cancer (BC) stands as the primary contributor to disability and the second leading cause of death among countries belonging to the Organization for Economic Cooperation and Development (OECD). A comprehensive cross-country analysis of BC is crucial to monitor the growing burden. Methods: Employing the global burden of disease framework, we have calculated the incidence, prevalence, mortality, disability-adjusted life years (DALYs), and years of life lost (YLL) attributed to BC, categorized by age, gender, year, and geographical location across the 38 OECD member countries. Results: The total number of BC cases has witnessed a notable increase, rising from 5.5 million (95%UI: 5.1-6) in 1990 to 9 million (8.2-9.8) in 2019. BC-related deaths have also risen from 172,148 (164,284-176,147) in 1990 to 214,458 (195,692-226,347) in 2019, while DALYs have increased from 4.6 (4.5-4.8) in 1990 to 5.1 (4.8-5.5) in 2019. The annual percentage change (APC) in incidence has surged by 59% (44-75%) from 1990 to 2019. The highest APC in age-standardized incidence rates was observed in South Korea at 150% (99-205), while the most substantial decrease was recorded in Switzerland at 3%. Regarding death rates, Japan saw an 11% increase, Costa Rica 10%, Mexico 9%, South Korea 8%, and Turkey 4%, whereas the remaining countries witnessed a decrease from 1990 to 2019. In terms of DALY rates, Mexico and Japan experienced a 10% increase, South Korea 5%, Turkey 3%, with the rest showing a decrease from 1990 to 2019. Males bore a higher burden compared to females, with an APC in total incidence of 109% versus 58%, deaths at 73% versus 24%, and DALYs at 57% versus 10% from 1990 to 2019. The highest overall burden was observed in the 70+ age group, while the <70 and <20 age groups exhibited a decreasing trend. The total number of deaths is projected to continue increasing. Conclusions: In 2019, BC accounted for 6.64% of all cancer-related deaths and 7.9% of DALYs among women. Based on these findings, low-resource countries should consider reallocating funding to combat this burden, and public health policymakers need to prioritize surveillance and early screening efforts.
Lessons learned from a genetic counseling randomized clinical trial: Implications for recruiting individuals identifying as Asians in research.
Authors: Wu Constance , Tsoh Janice Y. , Pasick Rena , Guerra Claudia , Kerlikowske Karla , Dixit Niharika
Published: May 2024

1576

Background: Despite the clinical importance of genetic testing and counseling for cancer risk reduction and treatment, minority populations are less likely to receive genetic testing and counseling or participate in genetics research, contributing to health disparities. In a randomized study of three modes of genetic counseling (GC3) conducted in three safety net hospitals, we noted a lower accrual of participants identifying as Chinese despite the availability of language-concordant study documents and bilingual staff. To understand barriers to recruitment, we conducted a mixed methods study using responses to the San Francisco Mammography Registry (SFMR) Breast Health History questionnaire (used for recruitment for GC3) and qualitative interviews with seven participants of the genetic counseling study. Methods: We extracted data from the SFMR from 2014-2018 for patients self-identifying as Asian and a control group of patients self-identifying as White. The primary outcome was the proportion of patients who agreed to be contacted for future breast health research. Survey data included information for personal history of breast cancer, history of biopsy, first-degree relative with cancer, age, and level of education. Z-tests were conducted for comparisons between groups. For qualitative analysis, seven Chinese-identifying participants were interviewed to understand why they chose to participate in the genetic counseling study and identify potential barriers and facilitators. Results: We included 121,415 patients (n=38,483 Asian). Asian patients had significantly lower rates of accepting future contact for breast health research studies (25.4% for Asians vs. 48.3% for White, p<0.0001). Lower rates were observed across Chinese (23.3%), Filipina (30.2%), Japanese (27.8%), and Vietnamese (23.3%) subgroups (p<0.0001 for all). A history of breast cancer (personal or family) or biopsy was associated with higher rates of acceptance within both Asian and White groups (p<0.001 for all comparisons). Education did not change participation rates as much in Asian patients as in White patients. The qualitative study found barriers across three domains: awareness, opportunity, and acceptance, with a referral from the participant’s medical team identified as a facilitator. Conclusions: Individuals identifying as Asian in the SFMR were less likely to agree to be contacted for future breast health research. We identified multilevel barriers through qualitative interviews. This has important implications for designing recruitment strategies for Asian populations.
Demographics of cancer screening in Providence’s homeless population.
Authors: Martinez Boris , Jennings Pamela , Strick Matthew , Simon Kevin , Wolfe Kerri , Patel Sharmi , Safran Howard
Published: May 2024

1585

Background: Adults experiencing homelessness have a higher incidence and mortality from cancer. It is estimated that almost 60% of homeless people in the US are from racial and ethnic minorities. Therefore, cancer mortality among the homeless may be an important disparity. In recent years homelessness has increased in Providence RI due to high rents and end of covid subsidies. The objective of this project was to learn about the demographics of the homeless population in Providence, focusing on risk factors for cancer and barriers to screening, to acquire the necessary information to develop interventions to improve cancer screening in the unhoused population. Methods: We conducted a cross-sectional survey of homeless individuals in Providence, RI. Survey data was obtained at homeless shelters, on the street, at soup kitchens and at other community events supporting the homeless. The largest single source of participants was those attending the Matthewson Street Church Friendship Breakfast on Sunday mornings. Results: Data was obtained from 278 homeless individuals from September 2023 to December 2023. 70% were male, 30% female. Age ranges included 28 (10%) < 40 years, 78 (28%) 40-49 years, 88 (32%) 50-59 years, 74 (27%) 60-69 years and 10 (4%) > 70 years. Race/ethnicity included 56% White, 18% Black, 13% Hispanic/Latino, 2% Native American, 9% multiracial and 2% other. 51% were sleeping in a shelter, 29% were unsheltered (including outside, car or tent), 12% “couch surfing”, and 7% were recently housed. Most participants (92%) had health insurance, the majority being state Medicaid, and had PCP visits (59%), mostly to community health centers, within the last 12 months. 72% of individuals were current cigarette smokers and 45% currently used alcohol. Among women, only 32% were on schedule for mammogram and 61% were on schedule for cervical cancer screening. Colon cancer screening rate for individuals > 45 years was 32%. Only 32% of males over 50 had prostate cancer screening. Barriers identified included needing to have other needs met such as food and housing, lack of transportation to healthcare facilities, and lack of awareness about the need to undergo screening. Conclusions: The most common age range of homelessness in Providence, ages 50-59, is when cancer screening should be ongoing. There is a higher incidence of homelessness among minorities. The homeless population have high risk factors for cancer but screening rates for breast, cervical, lung, prostate and colon cancer are well below national guidelines. This represents a health disparity. Given the proportion of participants with a PCP and health insurance, interventions to improve cancer screening in this population may be feasible. We plan to develop educational partnerships with community health centers during the next phase of this initiative to increase awareness and uptake of screening recommendations.
Racial disparities in presentation and survival for lobular breast cancer.
Authors: Sandhu Simran , Lim David Wai , Giannakeas Vasily
Published: May 2024

1596

Background: We characterized differences in presentation and survival, and identified predictors of survival, among women of varying race with lobular breast cancer. We also assessed if these trends were unique to ILC by comparing with invasive ductal carcinoma (IDC) and mixed invasive ductal-lobular carcinoma (IDLC). Methods: Using the SEER database, we performed a population-based retrospective cohort study of women diagnosed with ILC, IDC, and IDLC between 1998 and 2019. We collected race, age, marital status, and income. Clinical data included grade, size, laterality, clinical stage, receptor status, surgery type, chemotherapy, radiation, and breast-cancer-specific survival (BCSS). Differences between racial groups were assessed using Chi-square tests or one-way ANOVA. To identify predictors of survival, Cox-proportional hazard models were constructed. Statistical analyses were performed using SAS and P values < 0.05 were considered significant. Results: 38,769 women with ILC were identified, including 32,857 White, 2398 Black, 2352 Asian, and 1162 women of other race. Black women presented with higher-grade, advanced clinical stage, ER+ disease, N2-3 stage, and lower rates of unilateral/bilateral mastectomy than White women. Black women were more likely to not undergo surgery (7.13%), compared with White (4.25%) and Asian (4.04%) women ( P = .0001). Asian women were younger, had more ER-/PR- ILC, and received more chemotherapy. The five-year BCSS rates in Black, White, Asian, and women of other race were 91.5%, 94.2%, 93.7%, and 95.7%, respectively ( P< .0001). Predictors of worse survival include Black race (HR 1.32, P < .0001), ER-/PR- (HR 2.18, P< .0001), ER+/PR- (HR 1.52, P< .0001), and no surgery (HR 4.19, P < .0001). Radiotherapy was associated with improved survival (HR 0.82, P < .0001), while chemotherapy did not affect survival (HR 1.1, P= 0.0504). In comparing across breast cancer subtypes, Black women similarly present with higher grade tumors, advanced clinical stage, ER+ disease, and had higher rates of surgery omission in IDC and IDLC. However, ER-/PR- subtype was notably higher in ILC among Asian women compared with IDC, whereas Black women have higher rates of ER+/PR+ and ER-/PR- ILC. Black women had the lowest five-year BCSS rates across all breast cancer subtypes. Predictors of worse survival in IDC and IDLC include Black race and negative hormone receptor status, while radiation therapy was associated with improved survival. Conclusions: There are differences in clinical presentation of invasive lobular breast cancer according to race.Black women had more advanced disease, while Asian women were younger. Across all subtypes, overall survival for Black women at 5 years was worse compared to other racial groups. Our data provides insight into the complex interactions of race, clinical characteristics, and survival outcomes in lobular breast cancer, with implications for screening considerations.
Racial/ethnic inequities in care for patients with advanced endometrial cancer: What’s structural racism and social determinants of health got to do with it?
Authors: Ryals Cleo A. , Ho Gene G. , Patel Khilna , Pierre Amy , Ascha Mustafa S. , Miller Taavy A. , Mbah Olive M
Published: May 2024

1602

Background: Structural racism and social determinants of health (SDOH) have been linked to inequities in cancer care and outcomes. However, little is known about the contribution of such factors to care inequities among patients with endometrial cancer, where Black women experience a nearly two-fold increased risk of death relative to their White counterparts. We examined the role of structural racism and SDOH in explaining racial/ethnic inequities in care for patients with advanced endometrial cancer (aEC). Methods: This retrospective study used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database, focusing on patients diagnosed with aEC from January 2013 to September 2023 (follow-up through December 2023). Outcomes included time-to-treatment initiation, use of immunotherapy or targeted therapy, biomarker testing, and clinical trial participation. We estimated a series of multivariable Cox proportional hazards models assessing racial/ethnic inequities in outcomes, sequentially adjusting for clinical factors (e.g., age, stage at diagnosis) followed by structural racism (residential segregation) and SDOH factors (e.g., insurance, practice setting, area-level vehicle ownership). Results: The cohort included 5,496 patients (2.2% Asian, 14.8% Black, 5.2% Latinx, 61.4% White, and 16.0% Other/Unknown). Although diagnosed with more aggressive disease (37% vs. 21% serous carcinoma), Black patients were less likely than White patients to initiate treatment during follow-up (hazard ratio [HR]=0.91 [95% CI: 0.83-0.99]), participate in a clinical trial (HR=0.56 [95% CI: 0.38-0.84]), and receive biomarker testing (HR=0.88 [95% CI: 0.81-0.97]). Compared with their White counterparts, Latinx patients were less likely to participate in a clinical trial (HR=0.41 [95% CI: 0.19-0.87]). Black-White (HR=0.80 [95% CI: 0.47-1.38]) and Latinx-White (HR=0.71 [95% CI: 0.31-1.60]) inequities in clinical trial participation were partly explained by structural racism and SDOH factors, while Black-White inequities in treatment and biomarker testing remained largely unchanged following structural and social determinants adjustment. We saw no racial/ethnic differences in use of immunotherapy or targeted therapy. Conclusions: We observed racial/ethnic inequities in treatment initiation, biomarker testing, and clinical trial participation among patients with aEC, with structural racism and SDOH substantially accounting for inequities in trial participation. Thus, findings from this study suggest that efforts aimed at improving diversity in endometrial cancer trials, and overall equity in endometrial cancer outcomes, should prioritize mitigating the structural and social barriers to clinical trial participation.
Exploring health disparities in prostate cancer through circulating tumor DNA analysis.
Authors: Maleknia Samaneh , Rezaei Benam Sanam , Hassoun Rebecca , Adra Nabil , Shahbazi Reza
Published: May 2024

1603

Background: African American men (AAM) suffer from the highest rates of prostate cancer in the world. In addition, AAM experience the highest rates of aggressive prostate cancer and prostate cancer-specific mortality of any ethnic group in the United States [1, 2]. The reasons behind the increased burden of prostate cancer poor outcomes in AAM remain unresolved. A large proportion of variation in prostate cancer mortality remains unexplained solely by epidemiologic risk factors. We investigated genomic differences between AAM and Caucasian men with metastatic castration resistant prostate cancer (mCRPC) utilizing circulating tumor DNA (ctDNA) analysis. Methods: AAM and Caucasian men with mCRPC were enrolled in this study. We collected and analyzed 88 plasma samples, including 66 from Caucasian and 22 from African American patients, with no significant age difference between the groups. The targeted sequencing libraries were prepared following the Agilent SureSelect XT HS2 target enrichment workflow coupled with the SureSelect custom prostate cancer panel (Agilent, Inc.). The final libraries were sequenced on an Illumina NextSeq 2000 to generate 150 bp paired-end reads. Results: A total of 88 men with mCRPC were enrolled. About 60% of African American patients exhibited organ metastasis at the time of diagnosis, while this proportion was 36% for Caucasian patients and they primarily reported metastasis during relapse. Analyzing 1824 variants in 138 genes meeting inclusion criteria, 281 significant mutations across 88 genes revealed racial differences. Notably, 29% of these variants were somatic. Approximately 60 cancer-related pathways, tissues, and diseases were identified from these datasets, encompassing 59 of our significant genes. Among these associated genes, the prevalence of significant variants, higher in AAM, exceeds that in Caucasians in 76% of cases. The top genes that have more contribution in considering pathways are shown (Table). Conclusions: Genomic variations were observed in ctDNA analysis between African American and Caucasian patients diagnosed with metastatic castration-resistant prostate cancer. Our findings highlight the potential inclusion of ctDNA analysis in the clinical assessment of these patients, offering valuable insights for informed therapeutic decision-making. The top genes with the most contribution to prostate-related pathways. [Table: see text]
Exploring disparities in palliative care utilization among hospitalized patients with hepatocellular carcinoma: A retrospective cohort study.
Authors: Olusoji Rahman Adesoji , Abbey Enoch , Ahluwalia Meena
Published: May 2024

1616

Background: Hepatocellular carcinoma is one of the common gastrointestinal cancers, and its advanced stage requires palliative care due to its inferior prognosis and mortality. Palliative care significantly improves the burden of HCC on patients and the healthcare system. Despite the evidence of its use, reported utilization could have been better. This study aims to investigate the disparities in utilization of palliative care in hospitalized patients with HCC and examine related factors. Methods: This retrospective cohort study used data from the 2018-2020 National Inpatient Sample (NIS) database. Patients aged 18 or above with hepatocellular carcinoma were studied to determine how their utilization of palliative care varied based on their race and other identifiable risk factors. Palliative care utilization encompasses palliative care/ comfort care or under the care of a palliative care physician or referral. We examined these patients' demographics, All Patient Refined Diagnosis Related Group (APR-DRG) risk of mortality, and their relationship with palliative care utilization. Results: This study identified 128,140 patients with hepatocellular carcinoma (HCC), of whom 26,730 (20.9%) had utilized palliative care. The majority of study participants were White and male. The palliative care utilization (PCU) group comprised mainly White patients, with 50% of the group having extreme APR-DRG risk of mortality. Compared to Whites, Blacks had increased odds of palliative care utilization in both unadjusted (OR=1.08; 95% CI: 0.99-1.18) and adjusted models (aOR=1.11; 95% CI: 1.01-1.22). Hispanics had reduced odds in both unadjusted (OR=0.83; 95% CI: 0.75-0.91) and adjusted models (aOR=0.84; 95% CI: 0.76-0.93). Moreover, over 50% of study participants were in large, bed-sized hospitals and on Medicare insurance. Conclusions: Our study showed significant disparities in palliative care utilization among hospitalized patients with hepatocellular carcinoma. While the majority of patients were White and male, Black patients had increased odds of palliative care utilization, and Hispanics had reduced odds. Additionally, patients in large, bed-sized hospitals and on Medicare insurance comprised over 50% of the study population. The racial disparities in utilization might stem from differences in socio-cultural beliefs and practices alongside other factors. Efforts are needed to address these disparities and ensure equitable care for all patients, particularly vulnerable populations. Further research and quality improvement initiatives are essential to explore and address these disparities and contributing factors, enhancing outcomes for patients with HCC.
Association of single nucleotide polymorphisms (SNPs) in inflammatory pathways with breast cancer (BC) risk: A multi-ethnic scoping review.
Authors: Quinn Erina , Carlos Ruth C.
Published: May 2024

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Background: Breast cancer is the most prevalent cancer affecting women of every ethnic group in the United States. This is a scoping review assessing SNPs in inflammatory pathways posited to modify BC risk by ethnicity. Methods: We followed PRISMA guidelines for scoping reviews. PubMed, Medline, and OVID databases were interrogated for publications between 1/2000-12/2023 using search terms “breast cancer” AND [BMI OR “body mass index” OR elevated BMI OR obesity] AND [SNP OR “single nucleotide polymorphism” OR polymorphism OR mutation] AND [inflammation OR cytokines OR IL-1 OR IL-2 OR IL-4 OR IL-6 OR IL-8 OR IL-10 OR IL-12 OR TNF-A or TGFB OR CRP] AND [Asian, Black or Hispanic]. A single reviewer assessed 72 unique publications and determined that 42 met inclusion criteria. Two reviewers extracted the following data: demographics, SNP, number of cases and controls by ethnicity. Disagreements were resolved by consensus with a third reviewer. Results: Data were extractable from 42 studies, all case controls. In analyses stratified by ethnicity, we detected effects of SNPs on BC risk (Table). IL-1β rs1143634 and IL-10 (1082 A/G) had a significantly increased BC risk in Asian populations but insignificant in white populations. There were minimal publications for Black and Hispanic populations. Conclusions: The association of inflammatory SNPs and BC risk is complex and can be both protective and predisposing to BC, with ethnicity modifying SNP risk. Future research can be directed at assessment of SNPs and BC risk in diverse populations. [Table: see text]
A nationwide analysis of demographic and treatment patterns in admissions for malignant pleural effusions from 2016-2020.
Authors: George Lina James , Turk Ekrem , Oh Youjin , Vallejo Alejandro , Caputi Angelo , Gupta Shweta
Published: May 2024

1618

Background: Malignant pleural effusions are an indicator of metastatic malignancy, with poor survival and need for palliative procedures to alleviate symptoms. Our study aims to identify the disparities in the utilization of these procedures and their effects on hospitalization outcomes. Methods: The Nationwide Inpatient Sample (NIS) was used to identify all adult hospitalizations with malignant pleural effusion (MPL) between the years 2016-2020. We studied patient demographics and treatment modalities during admission. The study's primary outcome measure was to identify the difference in the total length of stay (LOS) and total healthcare cost (THC)incurred during admission. The secondary outcome was mortality rates among patients undergoing these procedures. Statistical analysis was done using multivariate linear and logistic regression models. Results: A total of 439,245 admissions for MPL were identified, constituting 0.2% of all U.S. admissions. Among these, 59.6% were females and mean age was 67.3 years. There were 68% Whites, 15% Blacks, 8% Hispanics, 4% Asians or Pacific Islanders, 0.4% Native Americans, and 2.9% others. About 61% had Medicare, 11.2% Medicaid, 25.7% Private insurance, and 1.9% Self-pay. Most admissions occurred in teaching hospitals (76.3%), urban settings (94.5%), and hospitals with larger bed strength (56.1%). The most common primary admission diagnosis was sepsis (8.3%). The most common primary malignancies were Lung (39.9%), breast (27.9%), gastrointestinal (9%), and hematopoietic malignancies (7.1%). We studied rates of thoracocentesis, Pleurodesis, Decortication, and intrapleural chemotherapy. The mean LOS and THC increased in admissions where procedures were performed, highest for decortication (12.1 days, p<0.01). However, the odds of death in hospitals significantly reduced. When compared to primary lung cancer causing malignant effusions, primary G.I., renal, urinary, and upper aerodigestive malignancies with MPL had significantly higher mortality rates (p<0.05). Disparities were observed in procedures performed, with women having 29% lower odds of undergoing decortication (p<0.001). African Americans had lower odds of undergoing any procedures for MPL when adjusted for age, sex insurance status, compared to whites. Teaching hospitals had 10.9 times higher odds of performing thoracocentesis but lower odds of performing pleurodesis and decortication (p<0.05). Conclusions: This investigation provides insights into the favorable impact of invasive procedures on in-hospital mortality for malignant pleural effusions, suggesting a possibility that patients with better performance status underwent such interventions. We also noted racial and sex-based disparities in the performance of these procedures. Further studies are essential to identify the reasons for this disparity to help promote equitable care.
Facilitating adaptive coping with fear of recurrence among breast cancer survivors: Feasibility and acceptability outcomes from a three-arm randomized controlled trial.
Authors: Johns Shelley A. , Li Yang , Hays Matthew E. , Bricker Jonathan B. , Miller Kathy
Published: May 2024

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Background: Fear of cancer recurrence (FCR) is one of the most prevalent and disruptive problems for breast cancer survivors (BCS). Acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) have shown promising effects for FCR in a recent meta-analysis, yet head-to-head comparisons of these interventions are rare. We present feasibility and acceptability outcomes from a randomized controlled trial comparing ACT to CBT and enhanced usual care (EUC) for BCS with clinically significant FCR. Methods: Eligible women were ≥18 years old, diagnosed with stage I-IIIA breast cancer, within 5 years of completing cancer treatment (ongoing endocrine therapy was allowed), and reported clinical FCR at enrollment. Participants were randomly assigned to group-based ACT, CBT, or EUC, all delivered via videoconference. ACT and CBT consisted of 6 weekly 1.5-hour sessions; EUC was a single 1.5-hour survivorship coaching session. Outcomes included accrual, session attendance and engagement, intervention helpfulness, and retention. Variables were summarized by mean (SD) if numerical or relative frequency if categorical. At significance level α = 0.05, the Kruskal-Wallis test was used to compare overall differences between the three groups, and two-sample T-tests with unequal variances were used for pairwise comparisons between the groups with Bonferroni multiple-comparison adjustment. Results: Of 446 BCS who screened eligible, 390 (87.4%) enrolled. Most participants were white (81.8%), not Hispanic (98.4%), partnered (68.4%), and college-educated (71.3%). Most were within 2 years of completing cancer treatment (55.7%), and mean age was 55.8 (SD = 12.0) years. Among those assigned to a 6-session intervention, participants attended a mean of 5.0 (ACT) and 5.2 (CBT) sessions; 96.1% of EUC participants attended the single session. Mean session engagement (rated per participant per session by interventionists on a 0-10 scale) was significantly different across the three groups (p < .0001), with mean (SD) of 9.3 (0.8) for ACT, 9.5 (1.0) for CBT, and 7.9 (1.3) for EUC. Pairwise comparisons showed higher engagement ratings in ACT (p < .0001) and CBT (p < .0001) over EUC, with no significant difference between ACT and CBT (p = .14). At post-intervention, participants rated mean (SD) helpfulness on a 0-10 scale as 7.2 (2.6) for ACT, 7.9 (2.0) for CBT, and 5.5 (2.7) for EUC. Overall, mean helpfulness was significantly different across the groups (p < .0001) and favored CBT over ACT (p = .0109) and EUC (p < .001) and favored ACT over EUC (p < 0.001). Outcome data retention was 93.8% through the 6-month follow-up. Conclusions: High accrual and attendance rates suggest that BCS are receptive to FCR interventions and may find ACT or CBT more engaging and helpful than a single session of survivorship coaching. Clinical trial information: NCT05364450 .
Quality of telehealth-provided cancer care in VA.
Authors: Zullig Leah L. , Jeffreys Amy , Raska Whitney , McWhirter Gina , Kelley Michael J.
Published: May 2024

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Background: As the largest integrated health care system in the United States, the Veterans Health Administration (VA) has extensive experience in utilizing telehealth-(TH) to deliver care to the 10 million enrolled Veterans, including the~50,000 patients newly diagnosed with cancer annually and ~500,000 cancer survivors. The VA National TeleOncology (NTO) service was established in 2020 to provide specialized treatment regardless of geographical location. We sought to compare quality in TH-delivered care compared to traditional (TR) in-person VA care. Methods: Using the VA EHR, we identified patients who had an ICD-10 diagnostic code for an incident malignancy from Dec 2016 to March 2021 at three medical centers providing both TR and TH care. We used EHR review to classify patients as TH users, if they received TH services at least once for their cancer care, or TR care if no telehealth was used. Using both structured EHR data and manual review by two trained abstractors, we gathered demographic, clinical, and treatment characteristics to calculate 25 Quality Oncology Practice Initiative (QOPI) measures in the domains of symptoms and toxicity management (2), end of life and palliative care (10), and core measures (13). We report QOPI measures descriptively; and used chi-squared tests with alpha = 0.05 to compare TH and TR. Results: We identified 972 patients with lymphoma, prostate, lung or colorectal cancer. 427 (44%) were TH users and 545 (56%) were TR, and they were predominately white (n=819, 84.3%) men (n=930, 95.7%). TH users had better (n=13), worse (n=9), same (n=2) and unevaluable (n=1) descriptive performance on measures. For example, TH and TR were similar in administration of appropriate antiemetic therapy for high and moderate-risk antineoplastic agents (44.8% vs 42.4%). TH performed better than TR for chemotherapy summary being completed within three months of chemotherapy ending (83.4% vs 75.6%) and for emotional well-being being assessed by the second office visit (92.3% vs 89.9%). Appropriate tobacco use cessation administration within the previous year was statistically higher in TH (85.3% vs 76.2% p=0.0021). No differences were statistically significant for any other QOPI measures. Conclusions: VA is a leader in TH cancer care because of both its volume and quality. VA-provided TH cancer care quality is similar to or better than that of TR in-person care. NTO specifically, and VA teleoncology broadly, provides another option to Veterans for cancer care.