bluuebunny/crossref_metadata_2025 huggingface dataset:
Radon exposure in Colombian never smoker patients with non-small cell lung cancer: A pilot study.
Authors: Mantilla William Armando , Borras Mariana , Ruano Alberto , Munevar Isabel , Viola Lucia , Zuluaga Jairo Andrés , Rojas Puentes Luis Leonardo , Cardona Zorrilla Andrés Felipe , Tellez Luis J
Published: June 2024

e22521

Background: Lung cancer (LC) is the leading cause of cancer-related death globally, with 1.8 million deaths estimated in 2022. In Colombia, up to 74% of patients with LC are diagnosed with stage IV which negatively impacts survival, with 6,000 estimated deaths in 2022. The most critical strategy for reducing LC is the reduction of tobacco exposure; however, up to 38% of LC cases are not related to tobacco. Among other risk factors different from tobacco smoke; indoor radon, a radioactive gas found naturally in closed spaces, stands out and could be the most important one. In Latin America, information on the influence of radon on the incidence of LC is scarce. This study aims to establish the prevalence of Radon exposure in Colombian never-smoker LC patients. Methods: This is a Pilot study. Adult patients with de novo NSCLC diagnosis ( < 6 mo) were included. Past smokers (≥100 cigarettes in life or ≥1 cigarette daily for 6 mo) or patients with a change in place of living in the last 10 years were excluded. Sociodemographics, clinical, and molecular information were obtained and included in an eCRF using REDCap®, Radon measurement was done using a DTPA-type detector (Alfa-track). The detector was located in the patient's home, (60-140 cm from the floor at the point of least ventilation of the space to be measured), for 90 days, Subsequently an automated count quantification was carried out using the Radosys® system at a certified lab (Universidad Santiago de Compostella Radon Lab). The Radon levels were reported in Bq/m3, using the average value observed during the measurement period (The threshold was 20 Bq/m3). Results: Between February 2022 to May 2023, 30 patients were included in the study, 86.7% were women, 73% had stage IV disease at inclusion, 53% had a driver mutation, with EGFR being the most frequent (62,5%) followed by ALK (31.3%). The mean Radon levels were 25.6 Bq/m3 (5 – 48). No patient had Radon levels ≥100 Bq/m3. Conclusions: In this pilot study, we didn´t find high radon exposure among never-smoker NSCLC patients. 2 other studies on indoor Radon concentrations have been done in Colombia, with only one demonstrating high radon levels (≥100 Bq/m3) in Bogotá. These differences could be explained by the type of house, rainfall adjustment, or underlying rock composition in our study. It´s important to increase the sample size for a definitive conclusion and to explore other risk factors in non-smoker patients as the quality of air or occupation, among others. [Table: see text]
Effects of telehealth on uptake and timeliness of genetic counseling and genetic testing among patients with endometrial cancer.
Authors: Chen Gabriela , Paiz Keiry , Lu Karen H. , Rauh-Hain Jose Alejandro , Bednar Erica M.
Published: June 2024

e22531

Background: The COVID-19 pandemic prompted genetic counseling (GC) services to shift from in-person to remote telehealth visits. Prior studies identified that telehealth allowed uninterrupted access to cancer GC during the pandemic. However, germline genetic testing (GT) completion decreased. Before the pandemic, studies found that patients with endometrial cancer (EC) had suboptimal rates of referral to GC and GT for Lynch syndrome (LS). We sought to determine how the transition to telehealth impacted EC patients’ uptake of and timeliness to, guideline-recommended GC and GT. Methods: Adults with newly diagnosed EC who completed outpatient gynecologic oncology visits were identified from a tertiary care oncology center’s tumor registry and through retrospective review of electronic medical records. Patients were assigned to the pre-pandemic and pandemic cohorts if diagnosed 9/1/2018-3/31/2020 and 4/1/2020-12/31/2020, respectively. Patients were also assigned based on whether they met guideline-based criteria for LS GT (diagnosed under the age of 50, had abnormal MSI/IHC testing, or had a synchronous LS tumor). Chi-square, two-sample t-test, and descriptive statistics were performed, with a statistically significant p-value < 0.05. In total,443 patients with EC were included; 330 and 113 in pre-pandemic and pandemic cohorts, respectively.The pandemic cohort had higher rates of GC (24% vs 19%, p = 0.22) and GT (23% and 16%, p = 0.08). Eighty-five (25.8%) of the pre-pandemic and 23 (20.4%) of the pandemic cohorts met LS criteria for GT. Of patients who met LS criteria, the pandemic cohort also had higher rates of GC (57% vs 42%, p = 0.23) and GT (48% vs 40%, p = 0.08). Results: The median time from diagnosis to GC was 138 days for the pre-pandemic and 87 days for the pandemic cohorts (p = 0.09) The median time to GT was 144 days for the pre-pandemic and 114 days for the pandemic cohorts (p = 0.19). Of patients who met GT criteria, the pre-pandemic cohort had a median of 135 days from diagnosis to GC compared to the pandemic cohort’s median of 86 days (p = 0.37). The median time to GT was 131 days for pre-pandemic and 112 days for pandemic cohorts (p = 0.27). Conclusions: Uptake of GC and GT among patients with newly diagnosed EC, including those who met GT criteria, was higher and more timely in the pandemic cohort. While differences were not statistically significant, results suggest that telehealth may have improved delivery of GC and GT for EC patients. Overall, rates of GC and GT remain low (less than 50%), and further study of sustained effects of telehealth in this population after 2020 is needed.
Effect of demographic and clinician factors on patients' likelihood of pursuing hereditary cancer genetic testing.
Authors: Arida-Moody Liliana , Hanson Erika N. , Delacroix Emerson , Austin Sarah , Rizzo Elizabeth A. , Koeppe Erika , Griggs Jennifer J. , Resnicow Ken , Stoffel Elena Martinez
Published: June 2024

e22538

Background: Hereditary cancer genetic testing (GT) is an essential tool for cancer screening and prevention. As indications for GT expand, we may consider whether patients are sufficiently informed and motivated to undergo testing. We surveyed people meeting criteria for GT to assess their likelihood to pursue GT. Methods: Individuals who met modified NCCN guidelines for GT based on self-reported personal/family cancer history were invited to participate in a clinical trial of interventions promoting uptake of GT. Participants completed a baseline survey assessing experiences and attitudes relating to GT. Respondents were asked to rate their perceived importance of GT and their readiness to receive GT (scale of 0-10). These outputs were averaged (Cronbach’s alpha = 0.841) into an index representing their likelihood of pursuing GT. Linear regression was performed to investigate the relationship between several independent variables and the likelihood of pursuing GT. Gender, age, and race were considered, as well as self-reported circumstantial factors including 1) whether the individual had previously heard of GT, 2) whether a biologic relative had previously received GT, 3) qualifying eligibility variable(s) (family vs personal history of cancer), and 4) whether the individual had received a clinical recommendation to undergo GT. Results: 312 participants completed the baseline survey. The mean age of respondents was 61.9 ± 14.47 years, 52% identified as male, and 91% were white. 53% of respondents qualified for the trial based on family history alone and 15% had a clinician recommendation for GT. Younger age was associated with higher likelihood of pursuing GT (p = 0.004) as was receiving a prior recommendation for GT from a clinician (p = 0.01). When clinician recommendation was added to the model, the R-squared value increased from 0.44 to 0.64, indicating that recommendation accounts for a large portion of variance. Gender, race, personal/family cancer history, having previously heard of GT, and a biologic relative having received GT were not statistically significant. Conclusions: Concordant with previous literature, clinician recommendation to undergo GT is a significant contributor to the likelihood of pursuing GT. Older individuals may have lower readiness for GT compared with their younger counterparts, which could have implications for clinicians’ approaches to genetic counseling. Given that indications for GT have expanded, clinicians should remain up to date with current clinical guidelines.
Public awareness of the association between the risk of breast cancer (BC) development and alcohol consumption (AC) among women aged 18–75 years.
Authors: Kaur Navneet , Brody Heather Mae
Published: June 2024

e22547

Background: Worldwide, 4·4% of all new cases of female BC are attributable to alcohol use. Alcohol is recognized as a group 1 carcinogen, as classified by the International Agency for Research on Cancer. However, public awareness of the association remains low. We aim to look at the awareness of the association between AC and the risk of BC development among female employees of a community hospital in the United States. Methods: We sent an 8-item survey to 100 randomly selected adult females working in a community hospital via an online link. The survey was voluntary, with no incentives. We captured the following measures: age, alcohol use, awareness of AC as a BC risk factor, education level, screening for BC, and personal or family history(FH) of BC. Analyses examined correlates of associations between awareness and conceptual predictors. Results: Sixty females (60% response rate) responded to the survey. The age groups were: 28%(17): 18-39 years, 25%(15): 40-49 years, and 47%(28): 50-75 years. 22%(13) had a graduate(Gr), 56%(34) had an undergraduate(UG), and 22% (13) had a high school level of education. 33% (20/60) consumed alcohol. 61% (37/60) did not consider AC as a risk factor(RF) for BC development. 54% with Gr, 62% with UG, and 71% with a high school level of education did not consider AC to be a RF for BC. 41% among 18-39, 67% among 40-49, and 72% among 50-75 year-olds did not consider AC an RF for BC. 92% (55/60) never received education about the association of BC with alcohol intake. 23% with Gr, 5% with UG, and 0% with high school received education about the association of Alcohol and BC. 86% of 40-49 years and 75% of 50-75 years had undergone screening mammograms in the last three years. Mammogram rates were 75% in women with positive FH, compared to 45% without positive FH. Conclusions: The results revealed a low level of awareness of the risk of alcohol use with BC, with just 40% of females considering it as a risk factor. Younger age and higher academic levels were the variables that had the strongest association with better awareness. A further lower level of education was reported, with more than 90% never having received education about the association. We must orchestrate awareness of this association with attention to individuals with lower educational levels.
Clinical, demographic, and contextual determinants of older breast cancer survivors' reports of discussions about exercise with healthcare providers.
Authors: Wojcik Katie M. , Wilson Oliver W.A. , Kamil Dalya , Jayasekera Jinani
Published: June 2024

e22549

Background: Exercise offers various benefits to older breast cancer survivors, but studies report that healthcare providers do not frequently engage in discussions about exercise in clinical practice. The purpose of this study was to evaluate the clinical, demographic, and contextual determinants of receiving exercise advice from healthcare providers among older breast cancer survivors in the U.S. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registries linked to the Medicare Health Outcomes Survey (MHOS). Participants included women diagnosed with histologically confirmed invasive breast cancer from 2008-2015 who were 65+ years of age and had completed a MHOS survey at least two years after diagnosis. Descriptive statistics were calculated. We conducted a multivariable logistic regression analysis to identify clinical, demographic, and contextual variables associated with the likelihood of receiving exercise advice from a healthcare provider. Results: The sample of breast cancer survivors (n = 1,836) included 960 who received exercise advice and 876 who did not. The median age of the women in the sample was 76.2 years (range: 67.0-100.6). Survivors who were American Indian/Alaska Native/Asian or Pacific Islander (Odds Ratio (OR): 1.54; 95% Confidence Interval (CI): 1.09-2.18) or who had overweight (OR: 1.50; 95% CI: 1.17-1.91) or obesity (OR: 1.71; 95% CI: 1.31-2.23) were significantly more likely to receive exercise advice. In contrast, survivors who were never married (OR: 0.60; 95% CI: 0.37-0.96), had a high school degree (OR: 0.73; 95% CI: 0.58-0.92) or less (OR: 0.55; 95% CI: 0.42-0.73), were underweight (OR: 0.59; 95% CI: 0.36-0.95), or who were older (OR: 0.98; 95% CI: 0.96-0.99) had lower odds of receiving advice about exercise. The associations varied by type of comorbidity. Conclusions: Individual clinical and contextual characteristics of breast cancer survivors were associated with the likelihood of receiving exercise advice in a clinical setting. The consideration of the patients’ full range of circumstances when discussing and advising about exercise could potentially improve the overall quality of survivorship care. A personalized clinical decision tool could support individualized discussions about exercise in clinical settings.
Cost effectiveness of colorectal cancer screening in the Dominican Republic.
Authors: Pumpalova Yoanna S. , Wagner Sophie , Agyekum Alice , Aziz Zainab , Reyes Andria , Mejia De la Cruz Dolores Magdalena , Cedeño María Fernanda , Rivas Julio , Ebrahim Omar , Pineda Karla Marie Disla , Sanchez De Rodriguez Ann Stephany , Hur Chin
Published: June 2024

e23033

Background: Colorectal cancer (CRC) incidence in the Dominican Republic (DR) is increasing, and CRC now ranks as the third-most prevalent cancer in the DR. There are no national CRC screening guidelines in the DR, and CRC screening is not routinely performed. We evaluated the impact of nationwide CRC screening by comparing the cost-effectiveness of four CRC screening strategies to the current practice of no screening. Methods: We developed a Markov model comparing four CRC screening strategies to the current practice of no screening, or natural history (NH): colonoscopy every ten years (Colo); sigmoidoscopy every five years (Sig); fecal immunochemical test biennially (FIT); and fecal occult blood test biennially (FOBT). Model inputs for screening arms were derived from international randomized controlled trials whenever possible. Data from The Rosa Emilia Sánchez Pérez de Tavares National Cancer Institute in the DR was used to estimate baseline CRC incidence, stage distribution and mortality. Screening was implemented from age 45 to 75. We assumed a 60.6% adherence rate for each screening arm. The model was cross validated by comparing the estimated lifetime impact of each screening arm on CRC incidence and mortality to estimates derived from the MIcrosimulation SCreening Analysis (MISCAN) Colorectal Cancer Model in the US. The primary outcome was the incremental cost-effectiveness ratio (ICER) of each screening strategy. Secondary outcomes included life expectancy, total cost, CRC incidence and CRC-related mortality. The willingness to pay threshold (WTP) was set to the 2022 DR gross domestic product per person ($10,111.20/life year gained). Results: In the NH strategy, 2.3% of the population developed CRC, and 1.2% died from CRC, with a lifetime cost of 203.47 per person. Compared to NH, FIT prevented 27% of CRCs and 37% of CRC deaths, with a lifetime cost of 244.76 per person. Colo was more effective than FIT, preventing 33% and 43% of CRC cases and deaths, respectively, compared to NH. However, the ICER for Colo exceeded the WTP threshold. One-way sensitivity analyses showed that the model is most sensitive to test performance characteristics and test costs. Conclusions: Among the evaluated CRC screening strategies, FIT is the cost-effective option, averting a significant number of CRC cases and deaths, at an incremental cost that is well within the WTP threshold for the DR. Inclusion of local data on the effectiveness and acceptability of the tested CRC screening modalities would improve this model, and strengthen the credibility of our findings. [Table: see text]
Discrepancies in therapeutic indications for the same oncology drugs among FDA, EMA, and Brazilian agency.
Authors: Marchi Blatt Camila , Furlanetto Miranda Mario Henrique , Barreto Rafael Balsini , Uliana Bárbara Andressa , Bodnar Denize
Published: June 2024

e23035

Background: Divergent marketing approvals for oncology drugs among prominent agencies can prompt questions, especially when they are grounded in the same evidence. The aim of this study was to evaluate and compare the assessment and approval processes for novel products and indications by the FDA, EMA, and the Brazilian Health Regulatory Agency (ANVISA). Methods: Therapeutic indications for FDA-approved anticancer drugs from January 2019 to December 2023 were identified. Data, including approval dates, details on authorization procedures and evidence presented, were extracted from the databases of the FDA, EMA, and ANVISA. Only approvals for non-hematologic solid tumors were considered. All data were publicly available, and ethical approval was not required. No patient involvement occurred in this study. Results: Between 2019 and 2023, the FDA granted approval for 154 therapeutic indications for marketing authorization, resulting from 148 pivotal trials. The predominant cancer types during this period were non-small cell lung cancer (31 approvals [20.1%]). Most trials were in phase III (66.8%) and randomized (68.1%). Additionally, 41 (26.6%) received accelerated approvals, with 6 subsequently obtaining regular approvals. Among the therapies, 66 trials (42.8%) involved active comparators, while 53 (34.4%) and 35 (22.7%) were single-arm and placebo-controlled trials, respectively. Approximately half (74 [48%]) of the therapies were approved for metastatic first-line treatment, 54 (35%) for second-line treatment, and the rest for neoadjuvant and/or adjuvant treatment. Regarding endpoint characteristics supporting approval, the most prevalent was a combination of objective response rate (ORR) + duration of response (DoR) (38 [24.6%]), followed by progression-free survival (PFS) + overall survival (OS) (31 [20.1%]). When comparing the 154 FDA-approved indications, 50 (32.4%) were not approved by EMA, and 60 (38.9%) were not approved by ANVISA. Furthermore, in 33 cases (21.4%), there were disparities in clinical indications between the FDA and EMA, primarily related to the target population specification, with 10 cases (6.4%) attributed to programmed death ligand-1 (PD-L1) expression. Notably, in these instances, the FDA approved the drug regardless of PD-L1 expression, while the EMA required a percentage of cells with PD-L1 expression. In all these cases, ANVISA aligned with the FDA's assessment. Conclusions: Significant clinical disparities were identified in the outcomes of the approval process for oncology products among the FDA, EMA, and ANVISA. Additional efforts are needed to standardize decision-making across regulatory systems.
Latin America and cancer clinical trials: Underrepresented region with significant growth potential.
Authors: Nunes Filho Paulo Ricardo Santos , Brandalise Patrícia , Kannan Geoffrey Sumithran , Gandia Daniel , Berraondo Maria I. Ignacia , Vidal Boixader Laura , Berardocco Renata , Bartlett Giulietta , Morrison Kenneth Stephen , Chico Isagani , Saini Kamal S.
Published: June 2024

e23038

Background: Latin America (LATAM) represents 8.4% of the world's population and has a growing cancer incidence compared with other regions. However, most clinical trials are conducted in high-income countries. The clinical research regulatory regimen in LATAM has been evolving consistently in the last decade and now is stable and mature, and data quality is comparable to other geographies. Enhanced LATAM involvement in global clinical trials would help these studies to meet recruitment goals, increase diversity, and reduce costs and perhaps timelines associated with clinical research. This abstract shows the current landscape of clinical research in LATAM trough data and experience of a global clinic research organization (CRO) (Fortrea). Methods: We obtained the 2020 cancer incidence in Brazil, Mexico, Argentina, Chile, Peru, Colombia, LATAM, and worldwide, from the World Health Organization’s GLOBOCAN database, as well as the information about ongoing, terminated, or completed clinical trials in these regions using Citeline’s database, from 2018 to 2023. We gathered LATAM countries' regulatory approval timelines from Fortrea’s database. Results: Overall, 7.7% of all cancer cases in 2020 were diagnosed in LATAM; however, only 3.64% of oncology trials were conducted there. The major disparities are in prostate cancer (15.2% vs 3.9% of cases and trials, respectively), followed by thyroid (10.8% vs 3.7%), cervix uteri (9.8% vs 4.6%), leukemia (8.1% vs 3.6%), and colorectal (7% vs 2.51%). Brazil had 3.1% of all cases but 1.9% of trials, while Mexico had 1% vs 1.3%, Argentina had 0.7% and 1.3%, Chile had 0.3% vs 0.7%, Peru had 0.4% vs 0.6%, and Colombia had 0.6% and 0.45% respectively. Regarding trial phases, 0.7% of Phase I trials were run in LATAM, 2.2% of Phase II, 15.6% of Phase III, and 2.8% of Phase IV. In the Table below, we present the proportion of clinical trials in LATAM in the past 5 years, based on the actual enrollment first date. Regulatory approval timelines in LATAM vary among countries, being 4.5 months in Argentina, 4 to 7 months in Brazil, 4.6 months in Chile, 7 months in Colombia, 2.8 months in Mexico, and 9 months in Peru. Conclusions: As a region, LATAM has been underrepresented in the clinical research scenario in the past five years, including in much-needed areas like prostate, colorectal, and cervical cancer. It is better represented in phase III studies but has almost negligible participation in other trial phases. There are differences among individual countries, with Brazil being underrepresented as opposed to Argentina and Mexico. Start-up timelines are variable among countries but overall comparable to other regions. We notice a significant potential to increase the number of clinical trials in LATAM. [Table: see text]
Influence of sociodemographic factors on time to diagnosis and treatment among members of a large national payor diagnosed with lung cancer.
Authors: Reddy Shirisha , Byrd Brooke , Craig Kelly , Zaleski Amanda , Rutter Cliff , McKeever Shannon , Bhandari Meghana , Dalton Karla , Altieri-Alger Leah , Verbrugge Dorothea J. , Avalos-Reyes Elisea , Johnson Kjel Andrew , Brito Rogelio
Published: June 2024

e23048

Background: Diagnostic and treatment delays may be associated with later stage lung cancer diagnosis. This study explores the time from lung cancer screening to biopsy and biopsy to treatment in members of a national health plan diagnosed with lung cancer. Methods: De-identified administrative records of Medicare, Medicaid and Commercial fully-insured (C-FI) members with a claim for lung cancer between January 2020 and December 2022 were retrospectively analyzed. Poisson regression modeling determined duration (days) from screening to biopsy and biopsy to treatment initiation by insurance type group controlling for covariates. Between-group differences in duration was estimated by exponentiating the model estimate and converting to a percentage change, which was then applied to the mean days to event. Time-to-event modelling was conducted with Cox Proportional and Aelen’s Additive Hazard models. P< 0.05 was considered significant. Results: 8,221 members (C-FI: 402; Medicare: 7,103; Medicaid: 716) with a diagnosis of lung cancer were evaluated. Mean duration between screening and biopsy was 34.3 days (95% confidence interval [CI]: 32.8-35.8). Compared to C-FI members, Medicaid and Medicare members experienced shorter duration between screening to biopsy by -14.0 days (95% CI: 13.1-14.9) and -18.9 days (95% CI: 18.2-19.5), respectively (both P< 0.0001). Gender, language, age, and race were associated with time to biopsy (all P< 0.001). Mean duration between biopsy and treatment was 37.9 days (95% CI: 36.8-39.0). Compared to C-FI members, Medicare and Medicaid members experienced a longer duration between biopsy to treatment by +14.6 days (95% CI: 12.1-17.3) and +22.5 days (95% CI: 19.4-25.8), respectively (both P< 0.0001). Compared to C-FI members, Medicaid members had a higher risk of not receiving treatment (Hazard ratio [HR] = 0.831; 95% CI: 0.735-0.939; P= 0.003). Among the total sample, males were more likely to receive treatment at any time compared to females (HR = 1.067; 95% CI: 1.021-1.114; P= 0.0035). Conclusions: This real-world evaluation suggests that insurance type is associated with the timeline of screening to biopsy and biopsy to treatment initiation. Medicaid and Medicare members had a shorter time from screening to biopsy compared to C-FI; however, a longer duration from biopsy to treatment initiation was experienced. Future studies will explore if these differences translate to variations in health outcomes and identify potential interventions that aim to improve time from biopsy to treatment initiation.
The predictive value of the MASCC score in patients with febrile neutropenia.
Authors: Anderson Zackary , Plowman Keegan , Ahsan Mohammed , Rasnake Mark , Kubiak Michal J. , Grossman Joel Scott
Published: June 2024

e23059

Background: Febrile neutropenia (FN) is a life-threatening complication in patients receiving cytotoxic chemotherapy. Guidelines classify FN as a one-time oral temperature of greater than 38.3°C or sustained temperature greater than 38°C for ≥ 1 hour with an absolute neutrophil count (ANC) of less than 500 cells/μL or an ANC expected to decrease to less than 500 cells/μL within a 48-hour period. This condition has a high rate of hospitalization and mortality. Currently, the Multinational Association of Supportive Care in Cancer (MASCC) risk score is used to classify patients as high or low risk. The current study outlines the predictive role of MASCC scoring in risk stratifying patients with FN at our institution. Methods: This is a single-center, retrospective observational study. IRB approval was obtained for this study. Electronic medical record data was reviewed to record mortality, length of stay (LOS), and antimicrobial use as primary outcomes with age at time of admission, sex, race, type of malignancy, any confirmed infection diagnosis, MASCC risk score, and subspecialist consultation as predictors of outcomes. Results: 220 records of possible FN episodes were screened, 160 were excluded leaving a total of 60 patients for review. The median age was 72.5 with 28 males and 32 females. Overall mortality rate was 10%.33 patients (55%) did not have an identifiable source of infection. Among the 27 patients with confirmed infection, 7 were associated with COVID-19, 12 had gram negative rod (GNR) sepsis and 8 were other bacterial infections. Patients with GNR sepsis had the highest mortality risk in which 4 of the 12 (33%) died. LOS was also significantly longer in patients with GNR sepsis. Lower MASCC scores were associated with identification of GNR sepsis. Of the patients with MASCC score of < 24, significantly more patients 7/20 (35%) developed GNR sepsis compared to 5/40 (12.5%) of those with MASCC score of 24 or greater (p = .004). Patients with GNR sepsis received a mean 5.7 days of broad spectrum antibiotics compared to 3 days in those without, (p < 0.001). Those with no identified infection had significantly lower LOS (4.5 days) compared to the groups with GNR sepsis (11.1 days) or other bacterial infections (10.1 days). Conclusions: Febrile neutropenia is a complication of cytotoxic chemotherapy that warrants special attention due to high mortality rates. We found lower MASCC scores were associated with GNR sepsis and that in the setting of FN these patients had higher mortality rates and longer LOS. This highlights the importance of risk stratification with MASCC index scoring as early recognition and treatment of high risk patients could lead to improved patient outcomes.
Origin associated with heterogeneity amongst Hispanic patients with breast cancer in the United States.
Authors: McIntyre Anahi , Bilani Nadeem , Tiersten Amy
Published: June 2024

e23077

Background: There are over 50 million self-identifying Hispanics in the United States. This, however, represents a heterogenous population variably affected by an array of determinants of health, including race and insurance status. We used a national registry to investigate for significant differences in outcomes of Hispanic patients with breast cancer in the United States by country of origin. Methods: We identified a cohort of Hispanic patients in the United States with breast cancer for which origin was documented using the 2004-2019 National Cancer Database (NCDB) dataset. The NCDB delineates the following specific origins: Puerto Rico, Mexico, Cuba, South or Central America (excluding Brazil), or the Dominican Republic. We performed multivariate logistic regression modeling to identify whether origin was a significant predictor of advanced cancer staging at diagnosis (AJCC stage III or IV), adjusting for age, race, receptor subtype, histology, grade, insurance status, and facility type. Consequently, we used Cox Regression survival modeling to investigate whether overall survival (OS) differed by Hispanic origin after adjusting for stage at diagnosis and other confounders of survival: age, race, stage at diagnosis, receptor subtype, and systemic therapy received. Results: Of the identified n = 60,438 Hispanic patients with breast cancer in the United States: n = 26,800 (44.3%) had Mexican, n = 9,792 (16.2%) had Puerto Rican, n = 5,283 (8.8%) had Cuban, n = 14,381 (23.8%) had South/Central American, and n = 4,172 (6.9%) had Dominican Republic origins. After adjusting for the aforementioned covariates, we found that origin was a significant predictor of staging at diagnosis (p < 0.001). Patients originally from Mexico were more likely to be diagnosed at advanced stages compared to patients from Puerto Rico (OR 1.31; 95% CI, 1.18-1.46; p < 0.001). We also identified that origin was a significant predictor of overall survival in this cohort even when controlling for various confounders, including stage at diagnosis. Compared to patients from Puerto Rico, patients from Central/South America (HR 0.78, 95% CI 0.70-0.88, p < 0.001) and patients from the Dominican Republic (HR 0.77, 95% CI 0.65-0.92, p = 0.003) exhibited significantly improved overall survival. There was no statistically-significant survival difference between patients from Mexico and patients from Puerto Rico. Conclusions: This real-world analysis showed that, for Hispanic individuals living in the US with breast cancer, origin is significantly associated with outcomes even after accounting for other known determinants of health. We suggest that region of origin should be studied further as a potential determinant of outcomes in patients with cancer.
Impact of cancer treatment in patients with inflammatory bowel disease: A systematic review and meta analysis.
Authors: Mukhtiar Vaibhavi , Menon Mythili , Juthani Ronit , Seetharaman Kala
Published: June 2024

e23084

Background: The association between cancer treatments and impact of inflammatory bowel diseases (IBD) remains uncertain. Given the growing prevalence of IBD globally, it is crucial to understand the impact of various cancer treatments in this patient population to make informed decisions and optimize outcomes. Thus, the objective of our systematic review is to assess how cancer treatments impact the activity of underlying IBD. Methods: We performed a systematic review of the literature on cancer therapy in patients with pre-existing IBD. Various databases like PubMed, Cochrane, Embase and Google Scholar were searched for studies reporting effects of cancer treatment in patients with IBD, till February 1, 2024. Studies without relevant data were excluded. The outcomes studied were the flares of IBD following cancer treatment and initiation of systemic steroids or biologics for management of IBD flares. Results: In total, 36 studies were included which comprised 1,443 patients with IBD who received cancer treatment. The overall occurrence of IBD flares in patients with IBD receiving cancer treatment was 28% (CI 22.9%-33.8%, I2= 68%) out of which 35.9% (CI 27.5% - 45.3%, I2= 40) had received immune checkpoint inhibitor therapy. The flares resulted in the utilization of systemic steroids and biologics in 27% and 10% respectively. Conclusions: While the data suggests a high proportion of patients with IBD experience flares during cancer treatment, all of the reported episodes were manageable with steroids and/or biologics. However, the population studied only included 1443 patients, and larger population studies are required to optimize individual outcomes, and to explore methods to minimize severity and frequency of flares, when possible.
Integration of patient navigation into clinical operations of an outpatient cancer center.
Authors: Green Emma , Pohl Sarah , Svoboda Ludmila , Contreras Magnolia , Lathan Christopher S.
Published: June 2024

e23091

Background: Recognizing the critical importance of expanding access to high-quality, integrated cancer care, Dana-Farber Cancer Institute’s (DFCI) Cancer Care Equity Program developed a multi-year plan to integrate a centralized, systems-based patient navigation (PN) program focused on supporting adult medical oncology patients from historically marginalized groups. The goal was to proactively address patients’ socio-economic, emotional, and structural barriers to attending medical appointments and adhering to cancer treatment plans through care coordination, physical accompaniment, and resource provision. Methods: Inclusion of the new program in DFCI’s operating goals supported prioritization of the work across the cancer center. A multidisciplinary workgroup developed standard operating procedures grounded in evidence-based approaches while leveraging existing clinical operations. The Freeman Navigation Model informed PN scope of work with a focus on historically marginalized communities. DFCI’s Community Health Needs Assessment guided the decision to prioritize patients from zip codes with significant disparities related to social determinants of health. Utilization of electronic health records for PN documentation ensured effective communication with care teams and enabled accurate and consistent data collection and reporting. Alignment of the program’s measurement strategy with national PN metrics and development of a data dashboard allowed for ongoing monitoring and evaluation. Results: The program was implemented sequentially in five cancer treatment centers: gastrointestinal, breast, thoracic, and gynecologic oncology as well as hematologic malignancies. 517 patients were contacted and 1,736 barriers to cancer care were addressed at time of analysis. Preliminary findings from the first cancer treatment center suggest a decreased no show rate in the second year of the program. Conclusions: The multidisciplinary approach to integrating an evidence-based PN program into clinical operations supported general adoption among care teams and timely replication across cancer types. The infrastructure developed for the program could potentially support implementation of Centers for Medicare and Medicaid Services reimbursement for PN services. Next steps include confirming preliminary findings in a larger sample, conducting a cost-benefit analysis, and expanding the program across the clinical enterprise. [Table: see text]
Assessing patient eligibility at breast imaging for receipt of additional health screenings.
Authors: Atluri Shalini , Paul Shirlene , McPeek Chelsea , Levy Mia Alyce , Alvarado Rosalinda , Stempel Lisa , Gupta Dipti
Published: June 2024

e23099

Background: Cancer screenings reduce morbidity and mortality. Breast cancer screenings are a well-known and utilized tool by many women. However, a suboptimal percentage of women are receiving additional eligible health screenings. A lack of health literacy and knowledge surrounding the importance of timely screenings contributes to low uptake. In this study, we aim to investigate the uptake of osteoporosis screening in women who presented for breast cancer screening. Methods: Data from all breast imaging patients of an urban, academic breast imaging center from January 2020-July 2023 was extracted from the EMR. Eligibility for osteoporosis screening was determined through clinical data query and the National Osteoporosis Foundation. Data variables such as race, primary language, and whether eligible patients underwent an osteoporosis screening were analyzed. A chi-square analysis was performed to determine the significance of these results. Results: A total of 56,945 patients presented to the breast imaging center between July 2020-July 2023. Of those patients, 22,443 (42.6%) were aged 65 and older indicating eligibility for a DEXA scan. 61% of these patients who were eligible for a DEXA scan received at least one scan, while 38.9% of them who met criteria did not receive a scan. Within racial groups, the Hispanic population had the highest uptake with 2318 (68.8%), followed by African American 5624 (62.5%), Asian 508 (60.3%), White 6151 (58%), and Other 322 (51.5%). Within the identified primary language, 187 (70.57%) of the Bilingual, 1101 (66.7%) Spanish, Other (66.03%), English (59.9%) received a DEXA scan. Statistically significant results (p < 0.0001) indicated that bilingual patients were more likely to have a DEXA scan than English as primary language patients. The differences between demographics and receiving a DEXA scan were statistically significant for all analyses (p < .0001). Conclusions: The main variables that influence the decision of breast imaging patients to complete a DEXA scan are a non-White race and non-English primary language, possibly due to the presence of adequate interpretation services, culturally competent care, and available education material. Nearly 40% of patients who presented for breast cancer screening were eligible for a DEXA scan but did not receive one. This suggests the need for interventions to increase uptake. Pairing breast cancer screening services with osteoporosis screening can provide a potential opportunity to capture missed patients. Additionally, further studies are needed to assess the differences in disparities.
Time-to-first treatment for new cancer diagnoses before and during the COVID-19 pandemic in Manitoba, Canada.
Authors: Lambert Pascal , Feely Allison , Galloway Katie , Bucher Oliver , Czaykowski Piotr , Hebbard Pamela , Kim Julian Oliver , Pitz Marshall W. , Singh Harminder , Thiessen Maclean , Decker Kathleen
Published: June 2024

e23103

Background: Disruptions to health care during the COVID-19 pandemic raises the possibility of delays in treatment for individuals diagnosed with cancer. It is critical that we evaluate the association between the COVID-19 pandemic and time-to-first treatment (TTFT) to address public and patient anxiety, inform recovery efforts, and identify strategies to reduce the cancer system’s vulnerability to future disruptions. Objective: To examine the association between the COVID-19 pandemic and time from cancer diagnosis to first treatment in Manitoba, Canada. Methods: A retrospective, population-based, quasi-experimental study that included individuals diagnosed with breast, colon, rectal, hematologic, lung, or prostate cancer between January 2015 and December 2021 was performed. Interrupted time series analyses with competing risk models were used to compare TTFT for those diagnosed before and after the start of the pandemic. Time-to-first treatment was calculated from diagnosis date to first treatment date (i.e., chemotherapy, hormone therapy, immunotherapy, radiotherapy, or surgery). Death without treatment was included as a competing risk. Follow-up time was censored at three months post-diagnosis. Sub-hazard ratios (SHR) and 95% confidence intervals (CI) were reported. Higher SHR indicates earlier treatment. The delta restricted mean time-to-treatment (D_RMTT) at three months was calculated to complement SHR values, where negative times indicate earlier treatment. Since observation is standard of care for low-risk prostate cancer and androgen deprivation therapy was widely used to temporize intermediate and high-risk prostate cancer patients, analyses were restricted to stage IV prostate cancer. Results: Time-to-first treatment was shorter for individuals diagnosed with breast cancer during the COVID-19 pandemic period (SHR: 1.40; 95% CI 1.24-1.57; D_RMTT: -6.6 days). Time-to-first treatment was also shorter for individuals diagnosed with colon cancer from April 2020 to June 2021 (SHR: 1.25; 95% CI 1.09-1.42; D_RMTT: -6.5 days) but not from July 2021 to December 2021 (SHR: 0.96; 95% CI 0.81-1.15; D_RMTT: 1.2 days). All other analyses did not demonstrate a statistically significant change in TTFT: rectal cancer (SHR: 1.00; 95% CI: 0.83-1.21; D_RMTT: 0.0 days), hematological cancers (SHR: 0.87; 95% CI: 0.74-1.01; D_RMTT:3.9 days); lung cancer (SHR: 1.09; 95% CI: 0.97-1.23; D_RMTT: -2.3 days); and stage IV prostate cancer (SHR: 1.15; 95% CI: 0.89-1.49; D_RMTT: -4.1 days). Conclusions: The COVID-19 pandemic has not increased the time from diagnosis date to first treatment date for individuals diagnosed with breast, colon, rectal, hematologic, lung, or stage IV prostate cancer in Manitoba, Canada.
Utilization of TAS-102 (TAS) or regorefenib (Rego) among commercially insured refractory metastatic colorectal cancer (R-mCRC) patients.
Authors: Zheng Hanke , Yu Tianzhou , Romley John , Barzi Afsaneh
Published: June 2024

e23121

Background: R-mCRC is the time period after use of fluoropyrimidine, oxaliplatin, and irinotecan and usually in conjunction with biological therapies. Several agents are efficacious during R-mCRC with high level evidence for survival improvement. We describe access and utilization of therapeutics in this state using claims data. Methods: This is a retrospective cohort study using the Optum’s de-identified Clinformatics® Data Mart Database (2013-2020). We identified patients (pts) with mCRC after 2014; the metastasis date was set as the index date. Pts were required to have a continuous enrollment for 6 months pre- and 18 months post-index to ensure they were potentially in the refractory setting. Eligible pts were required to have utilization of standard therapies after diagnosis of metastatic disease. Those who switched from FOLFOX to FOLFIRI or vice versa were classified as refractory. The use of either TAS or Rego was identified during the entire follow-up period. Baseline characteristics were compared between patients who received TAS or Rego and those who did not using Chi-Squared test/T-test. We conducted multivariate logistic regressions to evaluate the factors associated with patients’ access to TAS or Rego. Results: 6,233 pts with mCRC identified, 53.7% male, and 70.4% white. FOLFOX was the dominant treatment in the 1L setting (60.1%). 9.7% received either TAS or Rego, with 4.8% taking Rego first and 4.9% receiving TAS first. Recipients of TAS or Rego were younger (mean age of 62.8 vs. 66.5, p < 0.001) and had fewer comorbidities (e.g. myocardial infarction was associated with reduced probability of receiving either TAS or Rego (p < 0.05)). More were enrolled in preferred provider organization in pts using these agents (45% vs. 37.5%, p < 0.001). In the multivariate analysis, Asian pts had a higher likelihood of using late-line therapies (OR = 1.53, p < 0.05). Among 707 pts who switched from FOLFOX to FOLFIRI or vice versa (R-mCRC), 29.8% received late-line therapy (15.7% TAS followed by Rego). The trends were similar among these patients. The TAS or Rego recipients were younger than the non-recipients (mean age of 60.6 vs. 63.8, p < 0.001), had fewer comorbidities, and enrolled in preferred provider organization (47.5% vs. 38.5%, p < 0.05). Conclusions: While front line therapy for mCRC is relatively homogenous, there is significant heterogeneity in transitioning and receiving later lines of therapy. This claims level analysis highlights the disparities in access to later lines of therapy. Further analyses for characterization of the patterns of care and disparities are underway.
Predictors of time to diagnosis and treatment: A retrospective cohort study of patients with clinically localized prostate cancer in Nigeria.
Authors: Tolani Musliu Adetola , Agbo Christian Agbo , Ojewola Rufus Wale , Umar Shehu Salihu , Mohammed Faruk , Paciorek Alan , Kaninjing Ernest , Ahmed Muhammed , DeBoer Rebecca Jane
Published: June 2024

e23123

Background: Equitable access to the management of early-stage prostate cancer is important for optimal outcome in the diagnostic and curative treatment pathway of patients. This study aimed to identify the predictors of time to treatment and time to diagnosis in these patients. Methods: This was a cohort study of 110 patients with clinically localized prostate cancer (T1-T3a, N0, M0) in three government-funded tertiary hospitals in Nigeria. Retrospective data on sociodemographic status, co-morbid conditions, clinical, pathological and radiological quality metrics, date of first presentation for cancer-related complaint in the tertiary hospital, date of diagnosis of prostate cancer, and the date of commencement of first cancer-directed treatment were collected. Primary endpoint was the time from diagnosis to treatment and the secondary endpoint was the time from presentation to diagnosis. Predictors were determined by Cox proportional hazards using Stata software, version 18.0 with a p-value of less than 0.05 considered significant. Results: Twelve percent (n = 13) of the patients had a family history of prostate cancer. Fifty-four percent (n = 59) had other co-morbid conditions. Nearly one-third, 29% (n = 32) had retired from their primary occupation and 10% (n = 11) were covered by health insurance. The overall median time to diagnosis was 30 (interquartile range (IQR) 10 - 48) days. The median time to treatment commencement was 32 (IQR 19 - 82) days for ADT; 57 (IQR 50 - 63) days for active surveillance; 45 (IQR 21 - 78) days for radical radiotherapy; and 100 (IQR 0 - 127) days for radical prostatectomy. Diagnostic PSA documentation independently predicted delayed time to diagnosis (adjusted HR = 0.22 with 95% CI [0.05,0.97]) while those with guideline concordant imaging investigations independently predicted longer time to treatment (adjusted HR = 0.63 with 95% CI [0.40,0.99]). Conclusions: The documentation of PSA level and use of guideline concordant imaging investigations were significantly associated with delayed time to care. Studies on interventions to reduce barriers associated with these factors is warranted to strengthen equitable access to care in this setting.